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05/29/2025
RESPONSES/COMMENTS (NON-CLINICAL)
RE: Do We Really Have a Medical Degree (Allen M. Jacobs, DPM)
From: Gary S Smith, DPM
I agree with Dr. Jacobs that a 3-year residency can make a huge difference in surgical skills. The problem is that according to PM News surveys, the majority of podiatrists don't do ORIF of ankle fractures and don't want to. Many people go into podiatry to practice podiatric medicine and not orthopedic surgery. This is no longer an option to them. With the mandatory 3-year program, it's just not logical to do the same time in training of MDs and DOs with unlimited specialty options when podiatrists only have one.
The 3-year residency, once a premiere program ensuring excellence in training is now like a high school diploma. Everybody has one. I have seen 3-year graduates who could not do a hammertoe arthroplasty or even a matrixectomy with competence. I would also like to point out that because of this generic requirement, podiatrists like Dr. Jacobs cannot get privileges at many hospitals today.
Gary S Smith, DPM, Bradford, PA
Other messages in this thread:
06/26/2025
RESPONSES/COMMENTS (NON-CLINICAL) -PART 1B
From: Ivar E. Roth, DPM, MPH
Kudos to Drs. Tomczak and now Saxena. I have written this in PM News before without any evidence, but as told to me from my son who recently graduated. He said a good number of students in his class should never have been allowed to be accepted in the first place. A fair number dropped out after the first and second year, but he felt that there were many in his class that just graduated who were barely hanging on and probably should have been weeded out.
Ivar E. Roth, DPM, MPH, Newport Beach, CA
06/24/2025
RESPONSES/COMMENTS (NON-CLINICAL) -PART 1
From: Amol Saxena, DPM, MPH
Mic drop for Dr. Tomczak! Makes me think of the Jack Nicholson line, "You can’t handle the truth." Promoting podiatry is one thing and lowering standards to fill seats is another. Kudos to him for doing the research and pointing out the current data available.
Amol Saxena, DPM, MPH, Palo Alo, CA
05/27/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: James Hatfield, DPM
At the end of the day, I ask myself if I enjoy what I did in my practice - Yes. Was I as busy as I needed to be? - Yes - I was booked up for 2 months ahead. Did I make a good living? - Yes - equivalent with most of the physicians in the area. Did I need to do better? – No. Did I have good privileges at the local hospital - Yes, full scope available. Did I do my own H&Ps – Yes. Did I get referrals from the local MDs? - Yes, lots. Did the MDs call me "Doctor"? – Yes. Did the patients call me "Doctor”?- Yes.
Anyone who needs more than this has an inferiority complex. Podiatry is consistently rated as one of the highest paying jobs in the U.S: #19th by U.S. News & World Report: Any student who can't be happy considering podiatry as a career is foolish.
James Hatfield, DPM, Encinitas, CA
05/26/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Allen M. Jacobs, DPM
Arden Smith reminds those of us from Philadelphia of his appreciation of Louis Newman and "Buzz" Forman. Both of these were also mentors of mine. When I was working in the OR at Kensington Hospital in Philadelphia, I was fascinated watching Dr. Forman teach podiatry students on clinical rounds. He went on and on questioning and educating the students. He was not a paid faculty member of the college. If I recall correctly, he was one of the first ACFAS members with a very low number on his certificate. He was devoting his time to advancing our profession with no financial award. I was very young working as a patient transporter from the room to OR and back. I remember how shocked I was watching him remove 10 toenails, thinking OMG! I watched him do forefoot surgery, always teaching. That is how you advance a profession.
Louis Newman was a dedicated surgical educator. I worked with him at Oxford Hospital and Rolling Hill Hospital in Philadelphia. He would take the students to lunch, educate us over a meal, direct and build our skills in the OR, then spend time with us after cases...
Editor's note: Dr. Jacobs' extended-length letter can be read here.
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
02/19/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Elliot Udell DPM)
We need to be honest with ourselves. Comparing our profession to dermatology and orthopedics to show that there is nothing wrong with teaching nurses how to practice general podiatry is unfair. Why? Every dermatologist and orthopedic surgeon knows that the overlap between what we do and what they do in their practices is small. We do not operate on knees and hips nor treat skin disorders above our anatomic ranges of practice. On the other hand, everything a podiatrist does can be duplicated by someone in the MD and DO worlds.
I suspect that Dr. DiResta's concern is that MDs and DOs choose not to practice non-surgical general podiatry. If we train nurses to do what almost all of us do most of the time, why would they send us any of their patients for foot care? They can hire a nurse to render all general foot care and profit from it. Taking it one step further, nurses and PAs can be trained to do most of the foot surgeries we do, but we probably don't have to worry about that in a few years to come.
Elliot Udell, DPM, Hicksville, NY
02/07/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
From: Ivar E. Roth, DPM, MPH
Dr. Rubin has hit this nail on the head. All we need is a group of “thought leaders” to come up with some solutions here. I do not feel it is the APMA that we should turn to. If they have not done this to date, there is a reason. I believe we need some real “in the trenches” DPMs with experience in life, and I for one, would volunteer to help out. We have so many problems going on concerning our future.
I recently spoke with a recent residency graduate who did a three-year surgical program, and he said no one from his program ever did a case skin-to-skin in the three years of training. How is this possible? He said he is too afraid to say something as he is early on in his career and does not want to make any problems. I am just dumbfounded that no one has spoken up. If others reading this post are moved to be part of the “thought leaders” let’s hear from you and hopefully we can do something positive together.
Ivar E. Roth, DPM, MPH, Newport Beach,, CA
02/03/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1 A
From: Alan Sherman, DPM
Sometimes it is hardest to see that which is right in front of our faces, and particularly, if it has been growing there for some time. Allen Jacobs is right. While it is not the only factor, our devaluation of the name podiatry IS hurting applications to podiatry schools and general awareness as to what a podiatrist is. We should rethink this. Either we complete the process of becoming foot and ankle specialist MDs or we go back to using the term podiatrist and be the DPMs that we should be.
I continue to strongly believe that we need dual track residency education - a surgery track for the minority of residents who are deemed to be suited to be specialty foot surgeons and a medicine/general track for the majority of residents who will practice general podiatric medicine and wound care. One will refer to the other to provide complete care of the foot and leg.
Alan Sherman, DPM, Boca Raton, FL
01/17/2025
RESPONSES/COMMENTS (NON-CLINICAL)
From: Alan Sherman, DPM
The ever thoughtful and astute Rod Tomczak, DPM opines on the reasons for the declining applicants to podiatry schools. I agree that the huge numbers of spots that have opened up in DO schools and the innumerable offshore medical schools have provided a more attractive option for many that might have considered podiatry school. We should all have the patience to accept the things that we cannot change. But I am more concerned about the fact that we have come to REQUIRE that ALL PODIATRISTS be 3-year trained surgeons. I have been saying for years, and I believe that we will come to learn, that we have made a big mistake by single tracking all podiatrists into this one training program. By doing so, we have eliminated from consideration many of the candidates that have no interest in surgery or don't think they are well suited to be surgeons.
Why are we putting any future non-surgical podiatrists through 3 years of rigorous, demanding surgical training? To stress them? To test their mettle? Do we truly no longer want non-surgical podiatrists? I personally can't imagine a podiatry profession without non-surgical podiatrists. Apropos to this, see Jarrod Shapiro's Practice Perfect 945: Surgical Versus Non-surgical Podiatry: Should There Be a Separation?
Alan Sherman, DPM, Boca Raton, FL
12/16/2024
RESPONSES/COMMENTS (NON-CLINICAL)
From Jon Purdy, DPM
It goes without saying that this is a tragedy regardless. The other tragedy is the root cause of what led to this, and that started with the inception of Medicare. It is, and always was, destined to be insolvent. Medicare does not function as originally promised, and now is tinkering with the system, partnering with private plans. The not so unintended consequences are seen in everyday practice and patient care.
Can anyone name a program the government runs that is fiscally responsible and works well? If the working class were allowed to keep and invest the money the government takes from them their entire working lives, an individual would have a million plus dollars to spend as they see fit on their healthcare. This ownership inevitably necessitates responsibility. One would be able to afford their own insurance premiums and pass what is left to their own families. The government in all its wisdom has farmed out Medicare allowing for further corruption, as has been eloquently outlined numerous times by Dr. Kesselman.
Medicare effectively pulls millions of people out of the free market affecting the price and function of private plans. It is not subject to market forces such as they demand a quality and cost-effective product to stay in business.
Jon Purdy, DPM, New Iberia, LA
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.
11/22/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Charles Morelli, DPM
I'd like to echo Dr. Roth's sentiment and experience when it comes to the fact that "the medical billing rip-off is rampant in medicine and podiatry." Yes, every profession has their bad actors, but sometimes you come across with a story that makes you shake your head. I'll try to be brief.
A patient was seeing the same podiatrist every 6 weeks, for over 22 years. He was treating her for a chronically ingrown nail, was cutting the corner of her nail, charging her the $25.00 co-pay and I imagine also billing her insurance carrier. She called one day for an appointment and asked to be seen as she was in pain, and felt it was an emergency. According to the patient, no matter how hard she pleaded, she could not be seen and...
Editor's note: Dr. Morelli's extended-length letter can be read here.
11/20/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
From: Jon Purdy, DPM
I had a similar frustrating experience when I sent myself for my first routine colonoscopy. I was told an exam was necessary and received one from their PA. A little palpation here and there and an order for stool examination. To my protest, I was told the doctor will not do the procedure without it. I complied and received my first bill for a CPT 99204. I questioned the validity of that exam level with the office manager to no avail.
On the day of the procedure, the doctor asked if I was ready and said they would be taking me back. I said what about my results? He looked confused. I told him I was told he would not do the procedure without the stool path and he said “that is not true.” So I underwent my procedure irritated about the entire process thus far. In recover the doctor said, “everything looks great, but there was one spot of inflammation I needed to biopsy.” It was a “Where’s Waldo” game to discern anything in the photo, but I know that extra $350 comes in handy.
So they made some good money on me while I was stuck with unnecessary bills, frustration, and inconvenience. This just verified to me of what is out there, and what I do not do to my patients.
Jon Purdy, DPM, New Iberia, LA
10/25/2024
RESPONSES/COMMENTS (NON-CLINICAL) PART 2
From: Michael J. Schneider, DPM
I would like to add my congratulations to SuEllen and David on their retirement. I had used their products throughout my career. When I retired and began volunteering at the Denver Rescue Mission, SuEllen and David donated Gordon Labs products for my patients. Good Luck on your retirement!
Michael J. Schneider, DPM, Denver, CO
10/25/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Paul Kesselman, DPM
I stand by my partner Alan Bass, DPM, whose opinion is absolutely correct. Each patient encounter should have at a minimum an appropriate history and physical with components of lower extremity systems including but not limited to dermatology and must also include neurovascular and a MSK examination. Any changes in patient history or PE should be well documented and incorporated into the note.
But the change in history is not what will get you paid for a separate E/M nor is documenting a change in the physical examination. It is that last part, the management, what exactly did you do? If all you did was document a change in history, nope. If all you did was document a change in the PE, again, no dice. You must document all 3 issues, ...
Editor's note: Dr. Kesselman's extended-length letter can be read here.
10/25/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Lawrence Rubin, DPM
A recent post in PM News pertaining to insurance reimbursement compliance said, "Any abnormal findings on the LEAP Vitals Exam, i.e. dry and xerotic skin (L85.3) caused by sudomotor dysfunction, is a significant risk to a patient with diabetes. It therefore warrants a care plan." To prevent confusion of business names, this is not a stated opinion of the 501(c)3 not-for-profit LEAP Alliance.
Lawrence Rubin, DPM, Las Vegas, NV
09/30/2024
RESPONSES/COMMENTS (NON-CLINICAL)
From: Bret M. Ribotsky, DPM
It’s time to really look at the APMA budget and see where money can be re-allocated. Currently, $290K is spent on advertising, and $457K on pensions of employees - True Marketing/Advertising has never been more reasonable - Social Media, DPM influencers, etc. should be tried.
So here’s a few ideas for APMA to consider re-allocating money and I’d love others to make suggestions:
1) APMA - exit the seminar business, and leave it to others; this, will leave significant money available. Currently $750 thousand was spent last year.
2) Limit travel of board members to regional/state meetings and use telecommunication to allow more members to get involved. $1.2 million was spent on travel last year.
Bret M. Ribotsky, DPM, Fort Lauderdale, FL
09/23/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Ron Werter, DPM
What I don’t understand (and maybe the lawyers among us could explain) is how does the insurance company have the legal right to charge the doctor for writing a prescription. The doctor has no financial stake in the prescription; the patient and the pharmacy are the ones who have financial benefit. Is there something in an insurance company contract that says they can do that?
Ron Werter, DPM, NY, NY
09/20/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From Elliot Udell, DPM
Thank you, Dr. Kesselman for making us aware of this new way in which insurance companies may finally put an end to the practice of medicine.
On one hand, I understand where they are coming from. Drugs like Ozembic are high ticket items and if insurance companies were forced to pay out thousands of dollars for every patient who refuses to try diet and exercise and would rather take injections, they would either go belly up or would have to raise everyone's premiums through the roof.
On the other hand, if I had to pay back for every script I have written for gabapentin or cortisporin otic solution, bankruptcy would definitely be in my future.
Elliot Udell, DPM, Hicksville, NY
09/20/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: Back to the Future
From: Steven Finer, DPM
Upon reading the new issue of Podiatry Management, I counted ten ads for various creams and lotions pertaining to skin, nails, and pain relief. There were other ads for orthotics and podiatry-related machines. I have a 1962 Journal of the American Podiatry Association. It contains three ads for prescription internal medications. Also there were various ads for skin, nails, and orthotics. I know the various surgical magazines feature countless ads for surgical instruments and devices.
Must we now read internal medicine journals and use the Internet to review the latest medical news. I know everything is segregated in medicine, but this 62 year old journal was ahead of its time.
Steven Finer, DPM, Philadelphia, PA
09/03/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Jerry Peterson, DPM
No, you are not missing something. He should be able to assist ANY physician on ANY surgery. In Oregon, a podiatric physician can assist in general surgical procedures, Ortho, Neuro procedures, etc. They are not required to have the privileges to be able to assist. Good luck moving forward.
Jerry Peterson, DPM, West Lynn, OR
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.
08/28/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 3
RE: Who Decides Who is a Physician? (Rod Tomczak, DPM, MD, EdD)
From: Paul Kesselman, DPM
This is a very interesting topic considering that on this very day 47 years ago, I attended my first classes at what was then referred to as the Illinois College of Podiatric Medicine (ICPM) and which is now part of the Rosalind Franklin University (RFU). Almost fifty years later, ICPM has been incorporated into the "mainstream" medical educational system. For those who are unaware, RFU hosts the Chicago Medical School, Scholl College of Podiatric Medicine, School of Nursing, Pharmacy, and several other programs in the medical field.
During my undergraduate podiatry rotations, whether at the VA or Naval Hospitals, there was no distinction for medical (MD) vs. podiatry (DPM) vs. DO students. We all were treated in the same tough manner. Not once during those rotations did I ever hear, "Oh, you are a podiatry student; we don't expect you to ...
Editor's note: Dr. Kesselman's extended-length letter can be read here.
08/28/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
From: Eric J. Lullove, DPM
There are numerous multilayer compression systems on the market for management and treatment of venous leg ulcers. They are not “replacements” of an Unna boot. They are specific for a different diagnosis code set. Multilayer compression systems should be billed with the I87.xxx series ICD-10s. The CPT code for those systems is 29581. The code is not a substitute for making a multi-layer compression from your supplies — this code was designed specifically for the compression system kits that are manufactured by 3M, Urgo, Milliken, Hartmann, et al.
You must document the need for edema control, CEAP or VCSS clinical documentation for a VLU or venous hypertension (or hyper congestion) as well as the failure of conservative therapy of elevation and stockings. You also should as a caveat have a recent ABI dated from the initial onset of the venous event or ulcer and any other additional vascular studies (venography, for example). As always, it’s about documentation, documentation, documentation, especially with wound care services.
Eric J. Lullove, DPM, Coconut Creek, FL
07/19/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Steven Kravitz, DPM
I fail to understand why there is so much attention to podiatrists or at least some podiatrists trying to expand scope of practice beyond that of our specialty area - the foot and ankle. The concept of the serving as gatekeeper brings many questions, and I agree with Dr. Rodney Tomczak. The DPM degree has served me well and the podiatrists I know. My colleagues (many in wound care) have benefitted from their education and ability to practice medicine within the scope of DPM degree they earned. That degree points to the general public and more importantly to other medical providers that we are indeed specialists in the foot and ankle pathology. We have developed very good reputations generally; we as a group provide excellent service to patients. At the end of the day, it is the patient that matters.
Becoming gatekeepers necessitates overseeing treatment of medical conditions out of our scope of...
Editor's note: Dr. Kravitz's extended-length letter can be read here
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