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05/26/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: Allen M. Jacobs, DPM
On what factual basis does Dr. Sherman suggest that the 3-year surgical residency model has negatively impacted on podiatric colleges application pools? He is and has been a non-practicing podiatrist for many years. When did he last make hospital rounds with students/residents or work in an OR with students/residents? Would he be so kind as to share with us the substantive FACTS for his predicate please.
While we all appreciate his philosophy as a non-practicing clinician, legitimate and reliable data, not philosophy, should form the basis upon which to conclude that the current residency model requires serious modification. For many years, the various residency models (medicine, surgery, 1, 2, or 3 years) created uncertainty and the suggestion of lack of uniform training in podiatry among our medical colleagues. In addition, multi-level changes in the evaluation and certification of residencies would be necessary.
Allen M. Jacobs, DPM, St. Louis, MO
Other messages in this thread:
05/13/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
RE: Do We Really Have a Medical Degree? (Gary S. Smith, DPM)
From: Rod Tomczak, DPM, MD, EdD
I appreciate Dr. Smith's admission that he has never heard of a broken screw extractor set. As Clint Eastwood said, "A man's got to know his limitations." Directions on how to use the many different types are readily available on reputable surgical sites such as Facebook, YouTube, and others offering "how to videos." Original internal fixation screws were not always made of the best materials like they are today. So, if a patient had a a painful, broken screw, they often wanted it extracted. So, the consent form usually read, "extraction of painful internal fixation device." It would be a real disappointment to the patient if it had to be left in the foot or ankle and the patient referred to someone more familiar with the instrumentation.
Sometimes things get left in the patient and they shouldn't be. When Woody Hayes had his gall bladder removed, a sponge was left in his abdomen and had to be removed the next day. Rumor has it the surgeon came from Michigan and the first assistant from Pennsylvania. I wonder if McGlamry, Mann, and Meyerson were too busy to operate or write textbooks or articles. In order to save them time, the ICD and CPT codes are ICD-10 84.293 and CPT 20680 for a painful internal fixation device and its removal.
Rod Tomczak, DPM, MD, EdD, Columbus, OH
02/24/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: Irv Luftig, BSc, DPM
Stephen Peslar is correct that many of the chiropodist graduates have left the profession, and the actual DPM podiatrist population is dwindling because of the idiotic 1993 legislation, stopping any DPM podiatrists coming into Ontario from practicing their full scope. This was a power grab by the medical establishment and an extremely poorly thought-out attempt by the government of the day to bring in chiropody practitioners to work in nursing homes and hospital clinics on a salary. The right to establish themselves as private practitioners and make positive progress in Ontario was through a charter of rights challenge brought by the chiropodists in the late 1980s which was successful. The governing college for the profession has been fighting tooth and nail for many years to establish podiatry as a properly recognized profession and unify us and increase our scope of practice to a full scope.
I personally had a wonderful and fulfilling career as a DPM podiatrist in Ontario until my retirement. There are many excellent, hardworking chiropodists and many excellent, well trained, skilled podiatrists in Ontario who have been pioneers in surgical procedures and...
Editor's note: Dr. Luftig's extended-length letter can be read here.
02/20/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: Stephen Peslar, BSc, DCh
While Dr. Seuferling views a foot nurse issue as an opportunity not a threat, in Canada they will have a conference that will include these topics: MedFlex nail restoration, Onyfix nail correction, onychomycosis diagnostics and photodisinfection, SWIFT wart removal, proper footwear, padding and off-loading, pedorthic management, Vandenbos procedures, heel pain that could be something else, not plantar fasciitis, and "Rash: a review of dermatitis, infections, and suspicious skin lesions."
Another nurse’s foot care association in Canada states, “our members have obtained the knowledge, skill, and judgement to competently provide medical foot and lower limb care… to determine which orthotic devices will improve one’s overall health and wellness. Our members have the option to consult with laboratory technicians who are qualified HCPs who specialize in the design and build of orthotic devices.”
It appears that they want to do more than trim toenails, reduce plantar calluses, and enucleate IPKs. If they’re doing this in Canada, my guess is they’re doing the same or soon will be performing SWIFT wart treatments, performing OnyFix nail correction, performing the Vandenbois procedures, and casting (or scanning) and dispensing orthotics.
Stephen Peslar, BSc, DCh, Toronto, Ontario
02/19/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: Ross B. Feinman, DPM
I have been practicing for over 22 years; I have seen the ups and downs of the profession as well as the residency programs. I have been fortunate enough to be involved with podiatric students through the various programs at multiple hospitals, and I have worked with some very talented residents through the years as well as students! In previous years, students were hungry for knowledge, enjoyed the banter of being “pimped”; they knew it was for educational purposes, not a personal vendetta against them. They also came prepared for the case, knew the basics and seemed interested.
Unfortunately, today many students now want to be done by 5 PM, not show up, or have to take their dog to the vet. The idea of this as a lifelong profession seems to have become lost in the fog as many students today seem to be more interested in dinner time than...
Editor's note: Dr. Feinman's extended-length letter can be read here.
11/22/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: Adam M Budny, DPM
I read this post earlier today and quite honestly I was perplexed, as I am one of the "insurance podiatrists" who I believe represent the majority of the profession, as opposed to a boutique/direct pay" podiatrist (which seems to be Dr. Roth's implied practice model?). I see nothing wrong with billing a new patient visit or x-ray as a diagnostic study. How else would a practice run if you did not bill new/established visits of one sort or another?
Specifically, in my experience and clinical practice, stretching exercises are actually the mainstay of management for plantar fasciitis, and all of my patients are given literature and a home exercise program (HEP) for performing this at their initial visit. Regarding shockwave therapy, this is also a well accepted treatment option per the American College of Foot and Ankle Surgeons Clinical Consensus...
Editor's note: Dr. Budny's extended-length letter can be read here.
10/30/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: Paul Kesselman, DPM
I have to partially disagree with Dr. Tomczak. There is no question that the MD degree may get doors open that another doctorate degree may not. I also know at least 2 MDs who either decided not to pursue residency programs or who quit their surgical residency in midstream to pursue other areas of interest, such as medical IT, etc. This area is growing by the day as physicians with clinical experience and those in medical school see how difficult clinical practice is.
However I know many DPMs who, for one reason or another, pursued work outside the clinical arena in the pharmaceutical industry, orthopedic equipment or orthotics and prosthetics industries, and some even the teaching profession, at one level or another. Other DPMs are working for insurance companies as investigators, others as...
Editor's note: Dr. Kesselman's extended-length letter can be read here.
09/23/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: Kathleen Neuhoff, DPM
I have always found it interesting that when gabapentin was only available as Neurontin, insurance companies would not pay for it because it was off-label use. Then Lyrica came on with it on-label used for diabetic neuropathy, but at a high cost. So, the insurance companies would decline Lyrica until the patient had tried and failed gabapentin, which was still off-label.
We all know that cost is never considered an adequate reason for choosing a drug, so when my patients would decline Lyrica, I had them sign a consent form advising them that we were using gabapentin in an off-label manner, and that they had declined my recommendation for Lyrica.
I do the same thing when I am using something off-label for surgeries. For example, I use cryoablation for most of my neuromas with very good success, but I have the patient sign a form telling them that the instrument I’m using was not designed for neuromas. Many of my colleagues thought I was a bit paranoid, but maybe I was not!
Kathleen Neuhoff, DPM, South Bend, IN
09/18/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: Rod Tomczak, DPM, MD, EdD
Allen Jacobs' letter on why one chooses an NP for care piqued my curiosity, but in a tangential direction. I began to wonder about the APMA Seals of Acceptance/Approval. The APMA states it desires to provide information for podiatric physicians, their patients, and the general public to ensure they can make the best possible decisions regarding foot health. On their website the APMA states the Seal is not an endorsement. Shakespeare said it best, “A rose by any other name is still a rose.”
There is a committee that determines which product is fit to use the seal/logo of approval. The members of the committee are confidential according to the APMA website. I understand. God forbid an approved treatment for bromhidrosis does not work for someone. This NSA committee is protected from retribution and the need for Witness Protection, which can get very expensive. The APMA website stresses safety and utility and the need to submit various documents to the APMA proving efficacy. They do not mention if there is a fee for evaluation of a revolutionary flip-flop seeking...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
09/17/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: Pete Harvey, DPM, Stephen Doms, DPM
Kudos to Dr. Jacobs for his astute observation of NP advertising! I fervently hope some podiatry entity will pursue this.
Pete Harvey, DPM, Wichita Falls, TX
With all due respect to Dr. Jacobs, the number of nurse practitioners is about 385,000 according the American Association of Nurse Practitioners. They graduate about 39,000 each year (Fact sheet, AANP). With those numbers, they can afford to advertise. We graduate about 500 DPMs each year. They outnumber us by 20 times or more. Our profession is so small we could never compete with their kind of national television advertising.
Stephen Doms, DPM, Hopkins, MN
08/30/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: Steven J Berlin, DPM, Carl Solomon, DPM
I read that several retired podiatrists have felt slighted by not being able or being denied the opportunity to voice their opinions on current events affecting the profession. That certainly needs to change. I suggest a column of current situations affecting this great profession. We need a special column in the newsletter drafted by senior editors and/or Journal to encourage the opinions of us older podiatrists
Steven J Berlin, DPM
I acknowledge, but don't agree with the philosophy that life members are ineligible to vote because "... members eligible to vote in a referendum are those who are most likely to be affected by the outcomes of a referendum."
That makes about as much sense as not allowing voting rights to members who are employed by a hospital or other institution, because they may not be affected by certain issues that would have a greater impact on private practice docs. Some issues affect everybody and some issues do not affect everybody. We cannot permit our membership to be fragmented like that.
Carl Solomon, DPM, Life Member, APMA
Editor's note: This topic is now closed.
08/01/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: John Throckmorton, DPM
I find it interesting that the DO school which Dr. Michael’s daughter is attending won’t let him do the white coat ceremony for his daughter. I was allowed to do this for my daughter at the DO school in Michigan and also help the Dean give her diploma to her after her four years at the graduation ceremony. After being in practice 30+ years in the state, to be with our daughter, we moved to North Carolina
She was the first DO doctor to do the palliative fellowship at Vanderbilt and she was, at times, talked down to because of her DO degree. Professional degrees status varies in different states and around the world. I believe that Michigan’s DPM status is due to the fact we had the first residency in the country at Civic Hospital in the early 60s. I am hoping that the number of residencies continues to grow in the states where we lag behind in them, and through interaction with not only our colleagues, but other health professionals, i.e. MDs, DOs, and other recognized providers.
John Throckmorton, DPM, Moorseville, NC
04/09/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: Edward S. Orman, DPM
I have also used Quick Books for about 30 years. Initially, it was 3-5 years before I had to get a new version. Over the years, the price more than doubled. In 2023, I looked into QB online and ended up purchasing that. I thought I was saving money but was lied to multiple times about the cost. It ended up being more expensive. It's a completely different program, which I didn’t like, with a steep learning curve. I eventually went back to QB desktop. These companies are pigs and don’t care about their clients.
Edward S. Orman, DPM, Perry Hall, MD
04/24/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: W. David Herbert DPM, JD
When I graduated from OCPM in 1976 approximately 500 podiatrists graduated from all 5 schools that year. In 1974, there were 2,500 applicants to our 5 schools of podiatry. I understand less than 600 new podiatrists are licensed every year. I believe as a profession we are barely replacing ourselves. I believe we don't need three years of residency to provide the care that the average podiatrist provides even today. I know that some podiatrists perform total ankle procedures, and obviously a number of years of post-graduate training are necessary for that.
In Wyoming, there are about 15 podiatrists practicing and about 30 are licensed in the state. There are 550,000 people in Wyoming and most podiatrists there are quite busy. We need more emphasis on primary podiatric care and only a couple of years of post-graduate training. A young person entering MD or DO school who wants to perform sophisticated foot surgery would probably not be able to do this unless they were able to get into an orthopedic residency. We could not graduate from OCPM unless we assisted at delivering a baby. That part of my education and training I have really never used. Let's focus on podiatric medicine.
W. David Herbert DPM, JD, Billings, MT
03/30/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: David Secord, DPM
Once upon a time, there was a podiatrist of some note who originally hailed from Michigan. After being mentioned in one of Lee Iacocca’s books (when he was at Ford Motors), this podiatrist (unfortunately) moved to the Corpus Christi area. Mr. Iacocca overheard this podiatrist sitting behind him, talking to his partner about capitalizing upon the UAW provision in their contract which allowed for 6 weeks of paid convalescent care after foot surgery and how they would use this to do a digital procedure on a UAW member. When they were about to go back to work, another digit would be done, and then another, and so on.
With the extended time off, a number of these UAW members would actually have other jobs during the convalescent period and collect two pay checks. Mr. Iacocca got off the plane, met with...
Editor's note: Dr. Secord's extended-length letter can be read here.
08/17/2022
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: Ivar E Roth DPM, MPH
Concerning Allen Jacobs’ comments, I could not agree more with Dr. Jacobs. At my local hospital, you must be board certified to apply for surgical privileges. Most of the younger doctors here are using the ABPM as their board to qualify. The hospital thinks a board is a board and has been accepting ABPM as an equal board to ABFAS certification. This is because the doctors applying are saying it is an equal. In my opinion, these doctors are disingenuous. I know for a fact that one of them could not pass or qualify for the ABFAS, but yet thinks he can pull the wool over the eyes of the hospital administration and so far this has worked. Until it is firmly determined that ABPM is not officially recognized as a surgical equivalent, this charade will continue. It is my opinion that ABFAS needs to go on the record and send out letters to all the hospitals in the U.S. and clear up this matter.
Ivar E Roth DPM, MPH, Newport Beach, CA
07/22/2022
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: James J DiResta, DPM, MPH
I read today comments by two of our most esteemed podiatrists Drs. Allen Jacobs and Bryan Markinson on podiatry's scope of practice. I'm certain they are very honest in their comments but their remarks are discouraging. These are two very bright and wonderful people. When you leave their lectures you always come away proud that you share the same cherished profession as them. They are smart. Allen can impress the best of us with his medical and surgical knowledge and insight. As a student at PCPM (TUSPM) in the '70s, I listened intently one day to a lecture he prepared on metal materials for surgical fixation procedures. When I returned home that evening, I didn't feel as smart as I did that morning and frankly if I needed a little more humility that day, he provided it. In my podiatry class at that time was another bright podiatrist to be, Charlie Arena.
Later, Charlie and I would be residents at Northlake Hospital, but before that time while we were doing externships, our paths crossed at a hospital in New Jersey. Charlie was on medicine that month and I was on the orthopedic service. By chance, I was walking in a hall outside a room where the externs on the medical service were meeting and the attending was belittling some of the medical students as he would ask them questions and when they couldn't answer correctly, he would then call on Charlie to answer. Charlie...
Editor's note: Dr. DiResta's extended-length letter can be read here.
05/24/2022
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: Allen Jacobs, DPM
People seek care for, and in most circumstances may be treated for, onychomycosis. In some populations, such as patients with diabetes, PAD, chronic edema, immunosuppression, onychomycosis is associated with increased incidence of repeated cellulitis, ulceration, and other significant poor outcomes. We have known this ever since the classic study by Jeffrey Robbins, DPM.
The use of ineffective therapies denies patients who should be treated, or who desire treatment, of effective treatment.
Here is my approach to onychomycosis;
1. Read and consider following the guidelines of...
Editor's note: Dr. Jacobs' extended-length letter can be read here.
02/16/2021
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: Keith L. Gurnick, DPM
Here are some of my ideas. I believe this is a great subject, so others should feel welcome to respond.
1) Do not order one set of "compromised" custom orthotics that will work in all varieties of shoe styles for your patients. You will end up with an orthotic that still doesn't fit in some shoes and also doesn't function well enough in the shoes they do fit into. On those patients who will require different types of orthotics because they wear different shoe styles, make one set for the most important shoes and wait a bit and then make other sets at a different date when you see how your patient responds to the first ones.
2) Never, never, never make multiple sets of orthotics at the...
Editor's note: Dr. Gurnick's extended-length letter can be read here.
02/09/2021
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: Cosimo Ricciardi, DPM
When I read the parity discussion, I consider the multiple ways this term parity is understood. From a collegial equality perspective, I look back on the considerable effort it took to bring podiatry out of the antiquity of needing ortho approval to repair a hammertoe, and into a full scope and unrestricted surgical privilege within our specialty as it is today. My practice treats local doctors, their families, and their children. We receive hospital consults as a part of a limb salvage team. In short, I have never felt "less than" because I have never allowed it to be so. I feel, in this regard, parity with our colleagues is what the individual allows it to be.
Parity in pay, however, is a different story. We currently have no control over this. How, with significant focus on equality being present, are we still paid "less than"? How, technically, could a general surgeon perform and get paid more to repair a bunion than the best of us? This is completely irrational. This, I offer, is the true argument to be made about equality. The equality of the individual practitioner can be shaped by the individual. Pay inequality cannot.
Cosimo Ricciardi, DPM, Fort Walton Beach, FL
08/12/2020
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: Lawrence Oloff, DPM
This subject seems to have a cycle and I guess it's that time again. I think it is interesting that we want to be treated with respect and parity by the allopathic medical community, yet we don’t want to be held to those same standards. I am not sure what it is like in your communities, but in mine, orthopedic surgeons are required to be board certified to have surgical privileges. Hospitals realize that surgeons (podiatric and otherwise) are not going to be board certified when they complete their residencies. They grant a reasonable time period for recent graduates to obtain board certification status. Not that long ago, one of the orthopedists, at one of the hospitals I work at, was unable to pass the exam after several years. His surgical privileges were then revoked. Too strict? Maybe, but their rules.
The specifics of what privileges are granted is up to the hospital and is vetted by applicant surgeons submitting supporting documentation of their surgical experiences. I imagine we have all gone through much the same process, the same process as our allopathic colleagues. Surgical privileges in the allopathic world means...
Editor's note: Dr. Oloff's extended-length letter can be read here.
08/11/2020
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: Vadim Goshko, DPM
I would be interested in hearing opinions on a view from different angle. Maybe the DDS model is more fitting for the world of private practice podiatry? What if those who claim “hospital surgical privileges” (as oral surgeons do), would legally drop their general practice and build practices fully dependent on referral from “non-hospital privileged” podiatrists and any other strictly surgical referrals.
“General practicing” podiatrists, by the way, still could perform surgical procedures (obviously, based on their training) in the quiet of their offices’ surgical suites (if they chose to have one). I’d like to see how those surgical podiatrists would like to compete for those cases (with MDs as well) and depend on referrals from their colleagues? The fact that there are few residencies that actually provide excellent training non-withstanding, let those graduates forgo their general podiatry practices.
Vadim Goshko, DPM, Chicago, IL
08/10/2020
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: Neil H Hecht, DPM
Just a quick comment about a recent post that quoted “allopaths protect their own” when there is discrimination from MD vs. DPM in granting hospital surgical privileges. Podiatrists ARE allopathic doctors. We do practice allopathic medicine, not homeopathy. We are trained exactly like traditional physicians albeit focused as a regional specialty.
We may have a full-scope license in a limited portion of the body, but we all practice allopathy. If you don’t believe it, look up the definition of allopathy vs. homeopathy. Just my two cents after practicing allopathic podiatry for 42 years!
Neil H Hecht, DPM, Tarzana, CA
08/07/2020
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: Bryce Karulak, DPM
While I absolutely agree with Dr. Rogers’ point of view, this is simply not the case in Texas and I imagine in most states. I am dual board certified by both ABPM and ABFAS with both foot and RRA. Yet, I have been denied privileges even though I demonstrated training in residency and competence at other hospitals in the region that I DO have those privileges at. I have never had a malpractice suit to date. Yet my request was still denied. We (podiatry) are not considered the same and are held to a different standard than any other physician/specialty. Allopaths protect their own; we don’t protect our profession.
Bryce Karulak, DPM, Fredericksburg, TX
07/16/2020
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: Alan Sherman, DPM
As co-founder of PRESENT e-Learning Systems, podiatry’s largest online education provider and among its largest live CME conference providers, Dr. Sasiene rightfully questions why his state of Texas limits online education to only 40% of what is required. We have been running an extensive information campaign to raise the awareness of our colleagues as to this issue. And yes, I have skin in both games here, but it continues to seem wrong to me that any state limits online CME, as 22 states currently do, especially this year.
Dr. Ribotsky finds a lack of passion in online education compared with live CME events. We’ve been thinking about that a lot as we plan to run our first live meeting in the COVID era, Superbones Superwounds East 2020 in Teaneck, NJ, August 14-16, because besides live conferences offering us lectures by passionate speakers, they also are satisfying professional networking experiences. I find them to be a lot of fun. We are confident we can keep our attendees, who are all foot surgeons and as well trained in safe and effective infection control procedures and practices as anyone, safe. The challenge is making it fun. We will do our best. Our model for running a safe meeting will likely be studied carefully by so many entities that hope to run meetings in this period before we have an effective vaccine.
Alan Sherman, DPM, CEO, PRESENT e-Learning Systems
06/10/2020
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: Jack Ressler, DPM
I cannot give an answer as to the effects concerning catching COVID-19 by inhaling nail dust during debridement. I have included a short video we made a few years ago which shows the difference between using and not using a nail dust extraction system. This video shows the amount of nail dust that becomes airborne during debridement. As you can see, the amount of particles/dust that is produced is very concerning. The video shows the difference in the amount of nail dust produced with and without using our nail dust extraction system. I am sure eventually there will be studies showing the possibilities of contracting COVID-19 from inhaling nail dust particles during debridement. Even without that threat, we all know the significant health hazards to ourselves, staff, and patients breathing in nail dust during patient care.
Jack Ressler, DPM, Delray Beach, FL
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