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11/08/2025
RESPONSES/COMMENTS (APMA NEWS)
From: Ron Freireich, DPM
I think one of the many problems that our profession is facing is that APMA considers this a "Win". Let me remind some of our younger colleagues what happened in 2013. The Medicare Sequestration happened. The Medicare Sequestration is a budget control measure that reduces Medicare payments to providers by a set percentage, currently 2% under the Budget Control Act.
Starting in 2026 (yes, the same year as our Medicare fee schedule "Win"), this reduction may increase to 6% due to an additional 4% cut under Statutory PAYGO rules, unless Congress intervenes. So now, if one does the complicated math, 4.5% ("Win") minus 6% sequestration reduction equals -1.5%. A negative number doesn't sound much like a "Win" to me. And let me remind everyone that the 2.5% payment increase for 2026 is temporary and sunsets at the end of that year, but the sequestration reduction has been ongoing for the last 12 years.
Ron Freireich, DPM Cleveland, OH
Other messages in this thread:
11/10/2025
RESPONSES/COMMENTS (APMA NEWS)
From: Gary S Smith, DPM
I think Dr. Freireich brings up a great point. I think it is important to add a little more history. In 1998 as the result of a bipartisan attack on healthcare, the Govt. cancelled the cost of living annual increase in Medicare. They also exempted commercial healthcare insurance from anti-trust laws and protected them from civil lawsuits. This allowed them to fix prices and commit previously illegal activities like denying coverage for covered benefits without cause. This allowed commercial insurances to monopolize areas and cut how much they paid doctors and hospitals for procedures by 75%. They have not raised it since. We are getting paid for procedures and surgeries 75% less than we did in 1996. The government decided farmers need help in the 1970s and all their help ended up in the small family farm becoming extinct. The same is happening to private practice healthcare providers.
Gary S Smith, DPM, Bradford, PA
04/11/2025
RESPONSES/COMMENTS (APMA NEWS)
From: Justin T. Albright, DPM
I do appreciate the actions of many, but only seeking avoidance of 2.83% cut is insulting to physicians across the board. The WRVU model enacted in 1992 was $31. With inflationary adjustments, this should reach $72.
Americans need healthcare, safety, and education as a basic fundamental approach to how we treat each other. Inflation adjusted pay cuts have only affected 5 professions: doctors, teachers, policemen, firefighters, and librarians. This is not a sustainable path for this country, regardless of political affiliations; it ignores those basic fundamentals.
During the last 35 years, doctors have also been hit with POH ban in 2010 and lack of ...
Editor's note: Dr. Albright's extended-length letter can be read here.
07/16/2024
RESPONSES/COMMENTS (APMA NEWS) - PART 1B
From: Robert Scott Steinberg, DPM, Daniel Chaskin, DPM
What is missing from this conversation is how the public and others in healthcare perceive us. At least once a month, a patient asks me, do you do surgery? Orthos are not referred to as orthopedic doctors, are they?
At Humboldt Park Health (formerly Norwegian American Hospital), our department, which used to be a section of surgery, is now called the Department of Podiatric Medicine and Surgery and has been for over 12 years. The Illinois Podiatric Medical Association has been renamed the Illinois Association of Podiatric Medicine and Surgery. I support the APMA's recommended change.
Robert Scott Steinberg, DPM, Schaumburg, IL
The APMA has finally succeeded in proposing a definition that would increase our scope of practice by including the treatment of systemic diseases as part of podiatric care. The APMA likely agrees that we are part of an honorable profession and our integrity will provide public safety. Podiatrists as well as other healthcare professionals understand even if they are licensed, a license is not a granting permission to give treatment for which a healthcare practitioner is not currently competent at performing.
This is one more reason why podiatrists should consider joining the APMA and our state societies.
Daniel Chaskin, DPM, Ridgewood, NY
07/16/2024
RESPONSES/COMMENTS (APMA NEWS) - PART 1A
From: Jon Purdy, DPM
It’s a little laughable that our own national association has difficulty in defining who and what we are. I’m a podiatrist and I’m confused by this statement. Our state medical boards restrict us in different ways. Our training limits us to certain structures of the foot above and beyond state scope of practice.
The lumbar spine at minimum is a governing and related structure. We treat global manifestations of systemic conditions such as neuropathy, allergic reactions, and bloodborne conditions, to name a few. So we treat the leg below the tibial tuberosity but specialize in the foot and ankle? So now we are an orthopedic sub-specialty that further sub-specializes?
Our profession is archaic and continually trying to define itself. No other “physician” by definition has such issues. The MD and DO specialties are well defined, not restricted by scope, and perform within their specialty, secondary to agreement between the local healthcare entities and the physician’s level of training. It seems most of our discussions, be it professional practice, medical, surgical, or political, point us in the direction of achieving parity through inclusion in MD or DO modern medical practices.
Jon Purdy, DPM, New Iberia, LA
07/15/2024
RESPONSES/COMMENTS (APMA NEWS) - PART 1B
From: James DiResta, DPM, MPH
I read with great interest the recent comments concerning the revised definition of podiatry, specifically as to the removal of the "treatment of the local manifestation of systemic disease". Elimination of this phrase is absolutely paramount for the survival of podiatry. Increasing our scope by inching our way proximal from the tibial tuberosity is not the answer.
If we have increased our level of education to that of a true single track medical school which provides us an equal foundation to our allopathic and osteopathic colleagues during our 1st and 2nd years curriculum in the anatomical sciences and body systems course of study, and we then provide a carefully planned and more focused series of clerkships and classes during our 3rd and 4th years that emphasizes the diagnosis and treatment of systemic illnesses in addition to surgery and...
Editor's note: Dr. DiResta's extended-length letter can be read here.
07/15/2024
RESPONSES/COMMENTS (APMA NEWS) - PART 1A
From: H. David Gottlieb, DPM, Joel Feder, DPM, William Egelston, DPM
Many of the responses on PM News regarding the APMA survey on the Revised Definition of Podiatry are off the mark in my opinion. The APMA's opinion on this is their opinion. It does not carry any legal weight in any state or territory. The 'role as a podiatrist' is the scope of practice granted to you by the legal entity of the state or territory which awarded you your license to practice podiatric surgery and medicine. However aspirational or inspirational the APMA's definition may be, it does not change one iota the legal scope of practice that you currently have.
If you want a broader scope, fight for it in your state. If you don't, then enjoy what you have.
H. David Gottlieb, DPM, Baltimore, MD
Why change the "broader and working" definition of our profession to a more limiting one? The newer definition is ill conceived.
Joel Feder, DPM, Sarasota, FL
I think a less cumbersome and cogent definition might be:
Podiatry is an allopathic medical specialty addressing conditions of the lower extremity.
William Egelston, DPM, Modesto, CA
07/12/2024
RESPONSES/COMMENTS (APMA NEWS) - PART 1B
From: Brian Kiel, DPM
I just received a request to vote to change the definition of podiatry. Why is the treatment of the leg added to our definition. Exactly how many states allow us to treat, much less operate on, the leg. It is my understanding that there are states that still don’t allow surgical treatment of the ankle. Whose idea was this and what is its purpose? If the purpose is to elevate our status to “MD”, adding the word leg sure is not going to do it. I vote no!!
Brian Kiel, DPM, Memphis, TN
07/12/2024
RESPONSES/COMMENTS (APMA NEWS) - PART 1A
From: Kathleen Neuhoff, DPM
I read the APMA’s new proposed referendum defining "podiatrist", with a little bit of concern. I am sure the purpose was to increase our scope of practice. However, eliminating the phrase, “local manifestations of systemic disease” actually limits our practice.
I frequently prescribe medications for gout, and diabetic neuropathy. According to the new definition, I would be operating outside of my defined role as podiatrist. I suggest a return of this phraseology to the definition.
Kathleen Neuhoff, DPM, South Bend, IN
07/08/2024
RESPONSES/COMMENTS (APMA NEWS) - PART 1 B
From: Kathleen Neuhoff, DPM
Well written Dr. Santi!
I have paid APMA dues since I was a new graduate opening a brand new practice “from scratch”. Money was tight at that time but I have always recognized the importance of supporting the only group that truly represents ALL podiatrists.
Kathleen Neuhoff, DPM, South Bend, IN
07/08/2024
RESPONSES/COMMENTS (APMA NEWS) - PART 1 A
From: Kathleen Neuhoff, DPM
I agree with Dr. Chaskin’s comments about podiatrists being gatekeepers. In addition to his comments, I suggest that if we have already ordered appropriate tests and have results, it can expedite a referral appointment. For example, if I have a neurological patient with EMG/NCV results indicating progressive axonal degeneration in only one leg, I can generally get that patient into a neurologist within a week, especially if I send him to the neurologist who interpreted the report. Without those results, it may take months to get an appointment.
Another example, I have a patient with a non-painful “lump” in his leg. My fine needle aspirate indicated a hemangiosarcoma. I was able to get him in to an oncologist within a week. Without those results, I suspect it would have taken weeks or months. Also, in our area, we have a shortage of physicians, so many patients have only a PA for their primary care provider. Although PAs are an important part of our healthcare team, they certainly do not have the depth of training which is necessary to become an MD, DO, or DPM. As podiatrists, we are in a much stronger position to serve as gatekeepers than a PA is, and we have an obligation to accept that responsibility.
Kathleen Neuhoff, DPM, South Bend, IN
07/04/2024
RESPONSES/COMMENTS (APMA NEWS) - PART 1 C
From: Robert Kornfeld, DPM
Dr. Santi, when I quit accepting insurance 24 years ago, the reimbursement fees, which I thought were terrible and getting worse, are now about 75% lower than when I went to a direct-pay model. This does not support your argument that APMA has done so much to put money back in the pockets of podiatrists. In fact, over the past 24 years, private practice has become a dying model because of the untenable expenses imposed on doctors by the sheer fact that without seeing a high volume of patients every day, no one can survive in the insurance-dependency model. Larger offices, larger staffs, more supplies, etc. eat away at the profitability of a private practice. Stress and burnout have replaced professional satisfaction.
So young podiatrists look for employment, where they are controlled by a private equity corporation and have productivity demands, lack of job security, nasty bosses, and no autonomy at all. I'm not sure that this is something to take pride in.
Robert Kornfeld, DPM, NY, NY
07/04/2024
RESPONSES/COMMENTS (APMA NEWS) - PART 1 B
From: Andrew Levy, DPM
Once again, Dr. Jacob‘s voice is a concise, cogent, and well thought out response. He is correct, we have made inroads with a continued battle that all of us have known throughout our professional careers. His important take-away is to continue to do what we do well, ethically and properly. That will stand us well individually and as a profession.
Andrew Levy, DPM, Retired, Jupiter, FL
07/04/2024
RESPONSES/COMMENTS (APMA NEWS) - PART 1 A
From: Daniel Chaskin, DPM
I have a difference of opinion than Allen Jacobs, DPM
1. Podiatric medicine mandates knowledge beyond the foot. Podiatrists who specialize in podiatric medicine act as gatekeepers similar to internists so long as physical evaluations are in conjunction with the provision of podiatric treatment. Both an internist and podiatrist can treat a foot condition, find the underlying cause of this foot condition and make a referral to the correct specialist to treat the underlying systemic cause.
2. The way medicine is practiced today is not in the best interest of patients. Podiatrists should have knowledge beyond their own...
Editor's note: Dr. Chaskin's extended-length letter can be read here.
07/03/2024
RESPONSES/COMMENTS (APMA NEWS) - PART 1C
From: Jon Purdy, DPM
This topic once again spurs the question of degree change, or should I say augmentation. Going through the rigors of years of training, dedication, and the ever rising expense of getting a DPM degree, does make one wonder why we are swimming upstream.
My father was a podiatrist. He was not as well trained as I, nor did he have the privileges today’s podiatrists enjoy. He also had a fraction of the debt we face, minimal insurance interference, and did not have to deal with EHR or the myriad of other government regulatory and overhead expenses current podiatrists deal with. He was able to treat his patients well and enjoyed an income probably far better than most of today’s podiatrists, and did so seeing less patients. In short, his return on investment was far greater than today’s podiatrist.
So while we pat ourselves on the back for having achieved more inclusion, we are not reaping the benefits of our...
Editor's note: Dr. Purdy's extended-length letter can be read here.
07/03/2024
RESPONSES/COMMENTS (APMA NEWS) - PART 1B
From: Allen Jacobs, DPM
Quite some years ago, I served as the scientific chairman, assisted by Ray Esper, DPM for the APMA scientific meeting for three years (Disney, California, Las Vegas, and Boston). At that time, the scientific meeting was held concurrently with the House of Delegates. At the Las Vegas meeting, I had invited a number of nationally respected medical school faculty members to lecture. I was rather upset at the fact that it seemed to me that the House of Delegates was receiving priority over my needs for the academic faculty. Although I did not voice my concern, I was indeed upset about this.
James Ganley was one of the individuals I had invited to speak. With his usual insight, he sensed that I was upset. He asked me to take a walk with him through the exhibit hall. He asked me, “Allen, you any good at politics?” I told Dr. Ganley absolutely not. I have an inability to negotiate if I feel someone is wrong and willfully misrepresenting facts or willfully distorting facts. Dr. Ganley looked at me and said "neither am I." He then said, “you know, neither one of us is good at politics. But we do need politicians. We need them to move the profession forward and...
Editor's note: Dr. Jacobs' extended-length letter can be read here.
07/03/2024
RESPONSES/COMMENTS (APMA NEWS) - PART 1A
From: Lawrence A. Santi, DPM
Dr. Steinberg asks what our APMA has done to put money back in members’ pockets. In addition to defending our members’ reputations from scurrilous attacks that could have a legitimate impact on their patient volume, our APMA is the leading organization protecting members from fee cuts, onerous payer policies, and more, all of which affect your bottom line.
Following advocacy by our APMA and others to change office and other outpatient E&M level selection methodology and advocacy to increase payment associated with those services, in 2022, podiatrists submitted approximately 530,000 more Level 4 and 5 office and other outpatient E/M services than in 2018, resulting in approximately $76.8 million more paid to podiatric...
Editor's note: Dr. Santi's extended-length letter can be read here.
07/02/2024
RESPONSES/COMMENTS (APMA NEWS) - PART 1C
From: Paul Kesselman, DPM
In reviewing some email today, I came across an advertisement for a rather large orthopedic summit not affiliated with AMA, AAOS, or AOFAS. Within the foot/ankle track, there were at least 3 DPMs listed as faculty members. This track was among many orthopedic sections, with dozens of national and international orthopedic surgeons. It was great to see that three DPMs were lecturing on sophisticated surgical topics.
This trend of DPMs speaking at major orthopedic conferences is not new to me and surely not to others. Additionally, several orthopedic surgeons I have either worked with or been friends with for years have all told me the same thing. They are not members of AMA, they don't read AMA materials or care what AMA thinks, and they often disagree with what their national associations think and believe they are also out of touch with the membership. Sound familiar?...
Editor's note: Dr. Kesselman's extended-length letter can be read here.
07/02/2024
RESPONSES/COMMENTS (APMA NEWS) - PART 1B
From: Allen Jacobs, DPM
There is an old joke that goes something like this: what is the difference between an internist, a surgeon, a psychiatrist, and a pathologist? The answer: an internist knows everything but does nothing, a surgeon does everything but knows nothing, a psychiatrist knows nothing and does nothing, and a pathologist knows everything and does everything, but it is too late.
It is difficult to believe that the AMA position statement, obviously driven by AOFAS, will have any significant impact on your practice. Your medical colleagues who refer to you regularly are well aware that you are not an MD. They are well aware that you did not go to medical school. By virtue of referrals of patients and trusting you with the care of their patients, by action, they respect your diagnostic and therapeutic abilities. Otherwise, they would not refer their patients to you. This suggestion that we pursue legal action in my opinion is unfounded and likely not...
Editor's note: Dr. Jacobs' extended-length letter can be read here.
07/02/2024
RESPONSES/COMMENTS (APMA NEWS) - PART 1A
From: Keith L. Gurnick, DPM
When will our national and state associations bring us real victories? I preface this post as a 42 year dues paying member of the APMA, California Podiatric Medical Association, and Los Angeles County Podiatry Association. It is always good news when our associations fight for us and win the battles to right the wrongs. Quick action to eliminate the AMA's irresponsible, inaccurate, and defamatory social media hit piece against our profession should be commended.
The CPMA recently was victorious against Blue Shield who was planning to cut allowable payment by 50% for an E/M or consultation when billed at the same encounter (same date of service) as a minor procedure. These are two recent actions successfully undertaken where we prevailed. But is not losing the same as winning? We all know...
Editor's note: Dr. Gurnick's extended-length letter can be read here.
07/01/2024
RESPONSES/COMMENTS (APMA NEWS) - PART 1C
From: Robert Kornfeld, DPM
As a follow-up to the discussion regarding the AMA's denigration of podiatry, it doesn't stop there. As most readers of PM News know, I have been practicing functional medicine for 37 years. I was among the first doctors in the country to study under Dr. Jeffrey Bland, the "father" of functional medicine in this country.
The Institute for Functional Medicine offered no certification to podiatrists for many years. They do now. But, we are offered certification as "non-medical" professionals. The medical certification is offered only for the following degrees - MD, DO, DC, ND (naturopathic doctors), NPs, and PAs. We do not qualify for a medical certification but chiropractors do? Physician assistants do? Podiatrists are offered certification under "Certified Professionals", which puts us with acupuncturists, optometrists, pharmacists, physical therapists, psychologists, social workers, nutritionists, occupational therapists, speech pathologists, dentists, and RNs.
I blame this on our national and state organizations who clearly have done nothing to improve our image and communicate to society exactly what we are trained and licensed to do. We can complete a 3-year residency, prescribe any drug or narcotic, perform all kinds of foot and ankle surgery in a hospital OR and yet, we are not "medical" professionals? Insane. As a 1980 graduate of NYCPM, I would have thought after all of these years that this would no longer be an issue for us.
Robert Kornfeld, DPM, NY, NY
07/01/2024
RESPONSES/COMMENTS (APMA NEWS) - PART 1B
From: Ivar E. Roth DPM, MPH
I agree that removing the offensive post is not enough; a retraction with appropriate language is what is needed. The damage is done without the retraction quote. Otherwise, SUE. I would ask nicely for a retraction and if they do not respond, threaten a suit. The AMA are not our friends, as shown with this physician’s issue. The AMA needs to be dealt with appropriately until they give us the correct due respect. Just like in war, use deterrence with strength; cowering to them gets us nowhere.
Ivar E. Roth DPM, MPH, Newport Beach, CA
07/01/2024
RESPONSES/COMMENTS (APMA NEWS) - PART 1A
From: Jon Purdy, DPM
The fact of the matter is, a DO does additional training above that of the MD, yet the AMA tries to minimize their degree and strong arm them out of competition. They instill this thinking into their graduates. I remember touring a potential MD school I was considering attending. We were given a tour by an MD resident. I asked if she ever considered DO school. Her reply was, “I didn’t consider it. After all this training, I want to be respected.” I tried to keep from laughing.
We are on a path of stepping stones as DPMs, with the hopeful outcome of obtaining an MD or DO degree in addition to DPM. It may not sit well with some, but the reality is, medicine continues to change. The DO degree only has to deal with disrespect. DPMs have to deal with disrespect, lack of full scope licensure, and a small political presence.
Jon Purdy, DPM, New Iberia, LA
06/28/2024
RESPONSES/COMMENTS (APMA NEWS) - PART 1C
From: Rodney Tomczak, DPM, MD, EdD
It’s great to see the AMA has removed the inaccurate and offensive comments about our education and preparation of young podiatrists. But let’s not think for one minute that the AMA and APMA presidents are out shopping for equipment to furnish the new APMA/AMA combined office. The removal of the offensive post is not a victory. It never should have existed. The removal merely brings us back to ground zero.
Let’s not start slapping ourselves on our backs for fear of dislocating a shoulder. The AMA has not changed an underlying opinion, it just withdrew the public expression of that opinion and the posting of that opinion. The AMA has not suddenly seen what we consider to be an error in their perception of what we know to be true of our education.
A real victory would consist of AAMC and LCME allowing DPM students the chance of proving through examination that our education is on par with the MD education and our students are equal to MD students. Of course, there is risk involved for us and for the MD educational community. When our students prove their muster through examination performance and stand tall with allopathic students, the reward will be immense. However, with the opportunity for tremendous reward comes the risk that our students could fall flat on their faces. I do not believe the stumble and fall scenario would occur. Passing, on the other hand, would mean a lot more than removing a silly post on social media. It would be reliable and valid proof of what we know to be true and force the MD/DO community to admit we are equal to their graduates.
Rodney Tomczak, DPM, MD, EdD, Columbus, OH
06/28/2024
RESPONSES/COMMENTS (APMA NEWS) - PART 1B
From: Robert Scott Steinberg, DPM
What I want to know is what has my many thousands of dollars paid to the APMA done to put money in my pocket. It's time to shed the milk-toast attitude and get mad.
Robert Scott Steinberg, DPM, Schumburg, IL
06/28/2024
RESPONSES/COMMENTS (APMA NEWS) - PART 1A
From: Bret Ribotsky, DPM
Is this really a victory? It seems that a real victory would be a make good by the American Medical Association to jointly produce a “product” that demonstrates the incredible value that podiatric medicine provides to society and what integral members of the healthcare team podiatrists are.
It seems that at least yearly, there’s a direct attack from organized medicine made upon the podiatric profession. And leadership in our profession seem to be content with just a retraction. I want more! Tort laws in our country allow for recovery of intentional, misleading damages placed upon a person or party. It seems like organized podiatry always threatens to sue somebody unless they remove the offensive post, video, campaign. But that’s clearly not a deterrent until there are significant ramifications for even beginning these actions.
APMA, please share with all of us what benefit has been obtained as a result of your educating AMA to take down their tortuous action; and, while you’re doing this, maybe comment on creating a cancer registry for all of us.
Bret Ribotsky, DPM, Fort Lauderdale, FL
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