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05/08/2025
RESPONSES/COMMENTS (NON-CLINICAL)
From: Elliot Udell, DPM
For many years, many of us have felt that the only way to achieve parity with the medical profession is to abolish the DPM degree and give every podiatrist an MD degree. This would effectively make podiatry a subspecialty of medicine and we would consider ourselves "real doctors". Does it really matter in 2025?
When I first graduated from NYCPM in the late '70s, the ability to provide all phases of healthcare was restricted to holders of an MD degree. Gradually over the decades, things have radically changed. I still remember that the only hospital in our area that would allow us to do surgery was a local osteopathic hospital, and it was designated that way because DOs as well as DPMs were not allowed to practice in "MD-run" hospitals.
Today, things have changed. Both DOs as well as DPMs are allowed to practice in the finest hospitals. Physician associates and nurse practitioners are also getting more and more privileges. A PA at a local hospital confided in me that many of the general surgeons will allow her to perform general surgical procedures, skin-to-skin. The bottom line is that it does not matter to most patients what degree you have, so long as you give them excellent healthcare service.
Elliot Udell, DPM, Hicksville, NY
Other messages in this thread:
05/12/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2 C
From: Robert Scott Steinberg, DPM
CPME's answer is to charter more schools in the face of declining enrollment and its refusal to require proper courses in neurology, psychiatry, and pediatric medicine. The profession also needs two-year residency programs for those who do not want to be surgical podiatrists, which would require a change in most states' practice acts. The APMA was the one that drove component societies to change their practice acts to require a 3-year residency.
Robert Scott Steinberg, DPM, Schaumburg, IL
05/12/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2 B
From: Ivar E. Roth, DPM, MPH
I like the idea of being absorbed by the DO schools and doing a legitimate 1-year general internship and then a 2- or 3-year surgical residency. That seems about perfect. We truly have a recognition problem with the DPM degree. It is also a shame the Nurse practitioners and other allied professional can work on the entire body, and we have to think twice about putting an IV in the hand if we are in or out of our scope of practice. I do not think the profession will wither and be gone but we definitely need to do some serious PR.
Ivar E. Roth, DPM, MPH, Newport Beach, CA
05/12/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2 A
From: James DiResta, DPM, MPH
In response to Dr. Meltzer's question Why are there new podiatry schools being created if we are on our "last legs"? I believe the answer is two-fold, as the old adage goes "follow the money" and secondly, knowingly or not, the powers to be see it as a chance of survival.
The podiatry profession that has existed for the past 50 years cannot continue. It just can't. It is being swallowed up from the top down and bottom up. It couldn't be more obvious but we continue to do very little hoping a Band-Aid here or a Band-Aid there will plug the leaks and eventually these forces will just go away. They won't. The profession made a calculated mistake that those of us who fought the system got caught up in. We fought for increased scope of practice based solely on the anatomy of the...
Editor's note: Dr. DiResta's extended-length letter can be read here.
05/12/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: THIS NEEDS TO BE THE YEAR WE MAKE A STAND!
From: Farshid Nejad, DPM
I have heard Dr. Kesselman voice his concerns on how physicians are being manhandled by insurers, including Medicare. Medicine has been complacent about standing up for our rights to be autonomous and getting reimbursed fairly. Know that this complacency has led to the momentum to silence us completely by creating so many regulatory requirements and, more importantly, financially stifling us to weaken our monetary ability to lobby. When we cannot afford to support ourselves, let alone our national associations, we will have very few options to fight. WE HOLD ALL THE CARDS, yet we do not know how to play them.
We need to ask for a raise, we need to stop MIPS reporting penalties, we need to create reciprocal and equal rules for audits and look backs (if we get one year to bill, Medicare should only get one year to audit), we need to remove the pay difference in POS 31 vs POS 32 in SNFs. These injustices are just the tip of the iceberg of the laundry list issues that REQUIRE CHANGE. This affects all physicians, not just podiatrists. We need our associations to contact the news networks to publicize these issues (free advertisement). THIS NEEDS TO BE THE YEAR WE MAKE A STAND!
Farshid Nejad, DPM, Beverly Hills, CA
05/09/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Gary S. Smith, DPM
I think Dr. Tonczak's letter perfectly defines the conflict between academics and practical podiatrists. I was doing some training at the Pittsburgh Podiatry Hospital when I asked the most prolific surgeon why he didn't write books and articles. He answered, "because I don't have time."
Dr. Tomczak said not knowing about a screw extractor should disqualify board certification. I was the director of a surgical residency and didn't know about them. No hospital I ever worked in would have such an instrument in stock. Maybe breaking a screw during surgery and not being able to deal with it should disqualify you from certification?
Gary S Smith, DPM, Bradford, PA
05/09/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1 C
From: Evan Meltzer, DPM
If our podiatry days are numbered and our demise is approaching according to Dr. Tomczak, can someone explain to this old retired podiatrist why more podiatry schools have been recently established? When someone asks me what my profession is, I say that I’m a retired podiatrist. If the general public doesn’t know the scope of our field, who is responsible for disseminating that information?
New Mexico is seriously short of primary care MDs and DOs. As a result, nurse practitioners are often the first primary providers seen by new patients. One of my neighbors who typically accompanies his wife on our monthly hikes was absent from the last hike. When I asked Barbara where Jim was, she said, “Jim is having foot trouble and his primary care provider (a nurse) told him, there’s nothing else that can be done for your foot.” That naive statement just dismissed our entire profession! I asked Barbara a few basic questions about Jim’s complaint and then referred him to one of the several excellent podiatrists in the area whom I know personally.
Jim was fitted with custom orthotics and is doing well. I cringe every time I see TV ads from the “Good Feet Store.” After prescribing custom orthotics for over 40 years, I don’t ever recall a patient telling me that their back pain or foot pain disappeared after one day of wearing these prescription devices, let alone those (paid persons) who claim immediate relief by wearing the OTC arch supports dispensed by the Good Feet store. So, who’s responsible for educating the general public about our beloved profession? Why are there new podiatry schools being created if we are on our “last legs?”
Evan Meltzer, DPM (retired), Rio Rancho, NM
05/09/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1 A
From: Rod Tomczak, DPM, MD, EdD
Although I agree with Dr. Udell's position about being satisfied with the DPM degree we received in the 1970s, I think he is missing my point. The PM News survey of current DPMs concerning their satisfaction with a DPM degree revealed that only 14% of the over 600 responses would settle for a DPM degree and a 3-year residency today if they had the option of earning a DO degree instead of a DPM degree. With the number of applicants to podiatry school dwindling at a rapid rate, it won't be long before podiatry schools will not be able to afford keeping their doors open. At the same time, DO schools have increased to over 35 institutions and offer more options to students when it comes to residency choices. I hope that a residency program offering a 1-year general internship and a 2- or 3-year foot and ankle program will evolve to keep the spirit and efficacy of podiatry alive.
Rod Tomczak, DPM, MD, EdD, Columbus, OH
05/07/2025
RESPONSES/COMMENTS (NON-CLINICAL)
RE: Do We Really Have a Medical Degree?
From: Rod Tomczak, DPM, MD, EdD
Podiatrists, as of late, commonly deliver unreferenced advice in local newspapers on topics like the potential catastrophic health effects of community bowling shoes. Dentists are guilty of the same veiled advertisements about same day versus delayed dental implants. For the podiatrist, at least, there is usually a sentence or two devoted to the podiatrist’s education. It asserts that Dr. Jones received his or her medical degree from Kent State University or Temple University, but seldom Ohio College of Podiatric Medicine or Pennsylvania College of Podiatric Medicine. A fellowship might also be mentioned at a medical school with a reputation as being difficult to get into. Often these schools also have a reputation as a top flight destination, a combination large stadium and a larger name, image, and likeness (NIL) pocketbook.
Should we use the phrase, “…received her medical degree from Kent State” in the media? Clearly you and I know the truth. But to take the issue one step further, is a DPM degree a medical degree? Dentists can receive a DMD...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
05/01/2025
RESPONSES/COMMENTS (NON-CLINICAL)
From: Paul Kesselman, DPM
There is insufficient space and time to comment here on a comprehensive review of the current state of the cellular tssue product (CTP) policy. Sufficient it is to say that the $10B price being currently paid for CTP is not a podiatry-centric issue. Wound care is big business and DFUs are only one type of wound receiving CTP. The proposed CTP policy does not address decubitus wounds, surgical dehiscence, or any other type of wound other than DFUs, and to some degree venous leg ulcers (VLU) of the lower extremities.
In the August 2025 issue of Podiatry Management, there will be a full-length discussion of the myriad of issues all wound care providers must face. The reality is that there must be a reasonably fair policy for all 3 entities involved: patients, providers, and CTP manufacturers. This, in order to provide more affordable cost-effective care for patients with DFUs and VLUs. Use of these expensive products for other than DFUs and VLUs must also be addressed.
Paul Kesselman, DPM, Oceanside, NY
04/30/2025
RESPONSES/COMMENTS (NON-CLINICAL)
From: Steven Kravitz, DPM
Dr. Balaj's post on the cost of wound care through Medicare is interesting, but an undermining theme that's not clearly brought out is what has been described in many posts through this newsletter by large numbers of podiatrists. Aging population aside, a main factor in driving up increasing costs for wound care is the overuse advanced wound care products. William Marston, MD, well known vascular surgeon, specializing in wound care wrote an interesting paper published in 1999, which is still valid today. Looking at approximately 200 patients that had healed their venous ulcers with a simple therapy of ambulatory compression therapy with basic standard wound care, his conclusion back then is current today. Only a small number of patients require advanced products - most required nothing more than standard quality wound care.
A caution to the young practitioner is that Medicare computerized services can monitor what we do as practitioners more accurately every day. That can be used against you and your practice if you are labeled as an over-user of these products. Be cautious. As in everything else, Medicare is a business and it looks for the best return for the dollar.
Don't be foolish. Don't jump at the advanced collagen and other more costly products as first choice as a standard routine. Use these products selectively when something more than standard care is required.
Steven Kravitz, DPM, Winston Salem, North Carolina area
04/29/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 4
From: Ron Freireich, DPM
I agree with every last word that Dr. Kornfeld writes in his post. The two questions he asks that I feel are most compelling are...Why is it that this problem is not front and center of every discussion? And why is there not a complete commitment on the part of this profession to address the misery, exploitation, and abuse that most podiatrists experience? Yes, why is that? Every stakeholder in medicine should be approaching this issue as if we were fighting for our last breath and nothing else, because I think we just might be. In fact, we may be at the point of no return.
In addition to all the physician issues mentioned by Dr. Kornfeld, I looked up how various hospitals are doing financially here in Cleveland. Four major Northeast Ohio health systems ended 2024 with budget shortfalls in the millions. One major hospital reported a loss of $142 million in 2024. That came after operating losses of $256 million in 2023 and $302 million in 2022. Lately, I have been paying more attention to what I am getting reimbursed by insurance companies and I am utterly shocked. None of this is sustainable for anyone in the medical field. I really don't understand why providers of medical care are not part of the solution for this country's financial healthcare problems, while insurance companies and their investors continue to get rich. If you keep having to bail water out of a ship, the ship is going to eventually sink.
Ron Freireich, DPM, Cleveland, OH
04/29/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Paul Stepanczuk, DPM
Regarding Dr. Tomczak's recent letter looking for an honest man, PM News has apparently found 802 of them. Any prospective candidate for podiatry should be shown the results of PM News’ recent poll regarding the rendering of palliative care. In past issues, palliative care has been described as podiatry's little secret. It's really no secret to those who are in practice, and the amount a practitioner will need to do should not be kept from people who are interested in the profession.
Paul Stepanczuk, DPM, Tinley Park, IL
04/29/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: Kudos to Amerx
From: Ted Mihok, DPM
Our Coupeville Central Lion's Club had a successful trip last month to Mexicali, Mexico. We delivered medical supplies to the most vulnerable people in Mexicali. I especially want to thank the Amerx Corporation for their contribution of wound care items. Amerx has been a sponsor of our International project for years. They continue to give back, and focus on our Lion's club motto of "WE SERVE".
Ted Mihok, DPM, Alameda, CA
04/29/2025
RESPONSES/COMMENTS (NON-CLINICAL) -PART 3
From: Charles Myers, DPM
In my area, there are a fair number of providers outside of podiatry and the wound center of doctors performing wound care. Orthopedic doctors, general surgeons, and family medicine doctors over the last couple of years are wound care specialists now and billing Medicare.
Many of these applications are now being applied at home and being billed by doctors who never made home visits before. And yes, Ortho is doing wound care in my area. I can't help but feel that much of this is money driven.
Charles Myers, DPM, Conway, SC
04/28/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
RE: Wound Care Costs
From: Seymoure Balaj, DPM
When I queried AI about wound care costs, here's what came up. "Yes, recent data indicates that Medicare is now spending more on wound care, specifically on certain types of wound dressings than on ambulance rides, anesthesia, or CT scans. This shift is attributed to factors like Medicare's coverage of wound care in patients' homes and the increasing number of seniors. particularly those with diabetic sores, requiring these dressings."
Seymoure Balaj, DPM, Southfield, MI
04/28/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: Diogenes the Cynic
From: Rod Tomczak, DPM, MD, EdD
Diogenes is partially famous because he spent time carrying a lantern looking for an honest man. He is also called Diogenes the Cynic. A good 30 years ago, I shared some uninhibited conversation and a cup of coffee with Leonard Levy, DPM, the Dean of the Des Moines college. I was a couple of classes into pursuing my education doctorate and we talked about the significance of a doctorate in education as a podiatrist in academia. In a moment of astonishing frankness, Leonard said to me, “I could do so much better for myself if I only had an MPH from Columbia and not a DPM accompanying it.”
I had experienced a taste of the three-tiered medical caste system where MDs were on top, DOs made up the second class, then there were the rest of us who made up the third layer. It was impossible to “tier up” with a DPM degree. The graduation stole, as part of our academic...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
04/24/2025
RESPONSES/COMMENTS (NON-CLINICAL)
From: Judd Davis, DPM
I agree with what others have said about the abuse and overuse of these skin graft substitutes. The vast majority of wound patients do not need these to heal. I was approached by a rep from a very large and publicly-traded medical product company to start using these grafts on my patients. He told me a tale of their top performer, a DPM in New York who did a lot of nursing home and wound care work, who had used about $20 million of their product in the last year alone. When I related that seemed fraudulent to me, the rep suggested that an offshore account could be set up to hide the money so it would be untouchable in the event that any of the treatment was determined fraudulent. I advised him that I was not interested in such schemes.
A few months passed and a patient came to my office with non-healing diabetic foot ulcers. Another provider in town had applied a series of 4-5 grafts on weekly intervals, costing over $100,000! The wounds did not heal. I am amazed that CMS has not completely shut down all use of these grafts with this type of abuse occurring.
Judd Davis, DPM, Colorado Springs, CO
04/23/2025
RESPONSES/COMMENTS (NON-CLINICAL) -PART 2 A
From: Allen M. Jacobs, DPM
The increasing cost of wound care, including the employment of skin graft substitutes, is not a podiatry centric problem. Many factors, such as an aging population, the rise in disorders with which wounds are associated (e.g.: diabetes, PAD, venous disease) have continued to drive the need for wound care. The failure of insurers to provide reasonable or in fact any payment for preventive care is a factor. Socioeconomic issues such as patient access, patient education, patient financial concerns are factors.
The expense associated with dressings, skin graft substitutes, de-facto referral of patient referrals to wound care centers, contribute to the problem. With specific reference to skin graft substitutes, Dr. Geistler notes in PM News that in his experience, skin graft substitutes are not required for the management of most wounds. There are over 350 "skin graft substitutes" available world-wide. Many are extraordinarily expensive, with little...
Editor's note: Dr. Jacobs' extended-length letter can be read here.
04/23/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2 B
From: Ivar E. Roth DPM, MPH
My highest accolades for Dr. Geistler opinions on the overuse and abuse of grafts being used in podiatry. He is right on, and I am proud to call him a true professional. I agree... throw the book at our fellow practitioners who are just milking the system for the dollars and really NOT helping the patients at all.
Ivar E. Roth DPM, MPH, Newport Beach, CA
04/23/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
From: James Hatfield, DPM
The post by Louis Profeta, MD is excellent and should be required reading by all residents, students, and applicants. I'm so tired of hearing all the whining going on about our profession. We have an excellent future and waste too much time obsessing about our degree. Get a life!
James Hatfield, DPM, Encinitas, CA
04/21/2025
RESPONSES/COMMENTS (NON-CLINICAL)
RE: Acellular Grafts
From: Perry K. Geistler, DPM
I have been in practice for 33 years. I do work in my private office as well as on call at our hospital and see patients in our hospital wound care center. I went over my statistics for last year and I averaged seeing 32 ulcers a week for 48 weeks, not individual patients but ulcers. I have found it the gross exception to have to use a graft to heal anything. I certainly use grafts but when I went over my numbers, I used a graft on 4.8% of my patients last year.
Most people who have ulcers are going to heal with using the basic paradigms; such as, off-loading, establishing circulation, taking care of systemic illnesses or contributing morbidities, surgically removing...
Editor's note: Dr. Geistler's extended-length letter can be read here.
04/19/2025
RESPONSES/COMMENTS (NON-CLINICAL)
RE: Practice Dissatisfaction
From: Robert Kornfeld, DPM
Over the past 38 years, I have worked with many doctors in the field of functional medicine and regenerative medicine. And we are a very happy and satisfied group of doctors. About 2 1/2 years ago, when I became very active on LinkedIn, I became aware of the stark reality of most doctors out there. Unhappiness, malcontent, frustration, disappointment, anxiety, depression, burnout, anger and high levels of stress have caused most to be really miserable in practice. And I'm not only speaking about podiatrists. It's universal among all doctors.
And when they share why, that is universal too. It is a combination of the low fees, unpredictable payments, administrative burdens, enormously high volume of patients they have to treat, or unscrupulous and demanding employers who put them under constant stress and don't pay them fairly. Yet, for some reason, it is the pink elephant in the room. Does the next new surgical approach or instrument really matter if you are miserable? Is the next new modality really...
Editor's note: Dr. Kornfeld's extended-length letter can be read here.
04/14/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Rod Tomczak, DPM, MD, EdD
I really want to thank Dr. Secord for his German compound word idioms. It plays precisely into the completion of defining podiatry. When I was 16, I still was fluent in German, attending a boarding school near Aachen. I still dream in German once or twice a month, but nowhere like it used to be. As a lone monk chants at the burial of as pope, “Tempus fugit, memoria mortem.” Time flies, remember death.
For quite some time, we have defined ourselves as the primary care givers of feet, especially for what we identify as sick feet. Let’s be honest, most of us don’t do reconstructive surgery on feet with multiple complex deformities and use external fixation. Orthopedic foot and ankle care givers don’t have time during their one-year fellowship to learn what we learn in seven years. If you want to make it a binary distinction, we take care of sick feet that have sometimes...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
04/14/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: Podiatry’s Identity Crisis
From: Arden Smith, DPM
Background: this is my third winter since retiring and snow-birding. Both my former partner and I are both double boarded and we were lucky enough to have developed a very early niche in the medical and surgical treatment of the high-risk diabetic foot and limb salvage through having a satellite office within a large endocrine practice, beginning in the mid-1980s. This was something that we had very little training for and learned by the seat of our pants and attending diabetic foot conferences. We started out asking a friendly vascular surgeon if we could assist on referred cases and over a relatively short period of time, started asking him if he wanted to assist us; and then eventually stopped asking, other than the vascular consult. We also had a large volume general podiatry practice that was somewhat surgically oriented. We would see multiple generations in families.
Our general practice was a neighborhood practice in a middle class area, and our diabetic practice was a referral hub between two...
Editor's note: Dr. Smith's extended-length letter can be read here.
04/10/2025
RESPONSES/COMMENTS (NON-CLINICAL)
From: Bill March, DPM
Thanks to Dr. Secord for his enlightening, educational, and entertaining response to Dr. Tomczak's frequent lengthy, erudite missives. Only took an extra 10 minutes to research, educate and enlighten myself using Dr. Google. Very impressive! Had Latin and French in HS, no help. German may have. Recently retired after 40 phenomenal, fabulous, and VERY satisfying years helping people with their feet and listening to their problems. I could not have wished for a better life or profession.
I was considering discontinuing PM News, but the variety and quality of the letters will keep me reading. Much better than politics! Thanks, fellows. Keep smiling and enjoy something every day.
Bill March, DPM, Cherry Hill, NJ
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