05/01/2026    Robert D Teitelbaum, DPM

A 40 Year Retrospective

David Secord's posting recently about "allopathic"
medicine and how DPMs are allopathic doctors was a
great lesson in the real meaning and the
corruption of common words that we use to describe
our professional status. I would also like to
bring up three words that have held us back
professionally and consistently for 40 years and I
have not seen them much talked about. Those three
words are "routine foot care".

My thesis is this:

1.There is no complaint about foot pain that is
routine. A patient who realizes that her bent 2nd
toe has a painful corn on the first joint that
hurts in all shoes is in distress. They need
someone to counsel them on the choices they may
face and the treatments that are relevant. The
patient wants our experience, knowledge and
ability to communicate. They want a plan of
action--in other words they want E/M services. But
if something is categorized as 'routine' as in
'trivial' and non-reimbursable, that patient is
now a cash patient and their Medicare insurance is
useless. The E/M services are fraudulent if
Medicare is billed. To me, that is ridiculous, and
I am sure I am not alone.

2. There is nothing "routine" about a painful corn
or callus. There never was. Something that bothers
people is real and if they are going to turn
themselves in to the medical establishment which
is difficult these days, they don't want to be
told they have a trivial and non-reimbursable
condition.

3. Is there a symptom or sign that a primary care
physician is presented with that is 'routine' in
the sense it has been used against podiatrists?
The answer is no. Everything has an equal
significance as well it should be.

4. The conditions or diseases that justify RFC are
mostly arcane and/or never seen in practice and
leave out many common conditions that if patients
have them---no one would want them to do RFC on
themselves (or have non professionals do it)
because it would be dangerous for them. After all,
Medicare patients are elderly patients with all
that implies. At the back end of life, they are
more fragile, less perfused, more neuropathic for
many reasons, and more susceptible to infection.
Conditions that should be reimbursable, maybe at a
lower rate, would be blindness or severe sudden
vision problems, spinal arthritis, CVA's (not
every jurisdiction allows RFC with anticoagulant
therapy), morbid obesity, severe respiratory
conditions and arthritis of the dominant hand.

5. Why do podiatrists have to attest every six
months to the status of a disease that hardly ever
disappears? While there are some patients who
lose the 50 pounds and attain normal blood sugar
levels it is pretty rare. And type 1 Diabetes is
not going away. PAD can be treated and improved
and not be limb threatening, but rarely approaches
normality. I think this goes back 50 years to
when these RFC rules were formulated and Medicare
put podiatry and chiropractic in the same basket.
And basically we were not to be trusted. A lot has
changed since then and the CMS needs to know this.

6. Lastly, how about fear and anxiety. There are
many patients who are pathologically afraid to
treat any pedal condition. That's an underlying
cause of patients who have not gotten care for six
or more months -- difficult cases all. An entire
pharmaceutical effort exists to treat nervous and
anxious patients, who take medications that are
often fraught with nasty side effects--the doctor
visits and drugs are covered by Part D (somewhat),
but if they go to a podiatrist with their feet,
they are on their own. When it comes to fear, feet
don't count.

Robert D Teitelbaum, DPM, Naples, FL

Other messages in this thread:

---

05/07/2026    Allen M. Jacobs, DPM

A 40 Year Retrospective (Bret Ribotsky, DPM)

It seems to me that the majority of contributors
to PM News are of the older generation such as
Kesselman, Udell, Warsaw, Secord, Ribotsky, Oloff,
Tomczak, myself, and many others. In general,
these are individuals who have devoted a portion
of their lives to efforts at the advancement of
this profession through the participation in
educational activities. I suspect the majority of
PM readers are of the same generation, as we
seldom witness commentary from younger podiatric
physicians, as can be seen, for example, on the
podiatry student network.

As a direct consequence of decreased college
enrollment, we are now witnessing a phenomena
which was unimaginable years ago: unfilled
residency positions. It is ironic than at a time
that our profession has reached the summit of
integration and acceptance in medicine, for which
our podiatric forefathers such as Earl Kaplan and
Dalton McGlamary, Tilden Sokoloff, Arthur Helfand,
Irv Kanat, Theodore Clarke fought so hard to
attain, that interest in the profession has waned.
Thes Perhaps PM News needs to replace celebratory
declarations by the colleges that all of the
graduates placed in a residency with
congratulations to those residencies which filled
all of their positions.

If you read the commentary on the podiatry student
network, the insightful and intelligent and
informed communications indicate that today's
student is well-informed on matters podiatric.
They know which programs are providing the best
education, and as a result there will be a
Darwinian-like survival for the best residencies,
while those programs less desirable will be lost
through attrition.

Graduates in podiatric medicine, like those of
medicine in general, will more likely than not
practice in an institutionalized environment,
working for health care systems, orthopedic or
medical groups, and we will in my opinion witness
declining participation in classic models of
private practice. Perhaps, as some have suggested,
the direct pay will offer continuing private
practice opportunities.

My point is that the increased training in surgery
and limb salvage and the diminished numbers of
available podiatrists will result in a decreased
interest in the provision of so called "routine
care". Podiatry has become and will increasingly
be a surgical specialty by virtue of training and
desire. I believe that routine nail and callus
care will and should be assigned to the equivalent
of a podiatry assistant, similar to dental
assistants.

The older generation was taught by Theodore Clarke
that Earl Kaplan moved this profession "from the
nail groove to the sinus tarsi". Indeed, this
profession is involved in complex limb
reconstruction, management of foot and ankle
trauma, diabetic wound care and limb salvage,
minimal incision surgical techniques, ankle joint
arthroplasty, arthroscopic surgery, Charcot's
joint salvage, orthoplastics. We owe a significant
debt of gratitude to those who moved this
profession to its current status in the medical
community. The DPM degree is respected and
trusted.

I suspect that "routine foot care' performed by
the podiatric physician will slowly disappear as a
service generally provided personally by the
podiatric physician. The older podiatrists who are
PM News readers but who are remote from the
todays graduate cannot appreciate the advanced
education of today’s graduate when compared to the
podiatry graduate in the ‘70s and ‘80s. They are a
different breed, competent and capable. Maybe it’s
just time to let toenails and calluses go.

Allen M. Jacobs, DPM, St. Louis, MO

---

05/06/2026    Bret Ribotsky, DPM

A 40 Year Retrospective (Robert D Teitelbaum, DPM)

Dr. Teitelbaum has once again put his finger on a
wound that has festered for decades. The “routine
foot care” designation is not merely a billing
inconvenience — it is an institutional insult that
has shaped how our profession sees itself, and
perhaps more importantly, how we allow others to
define our worth. But I want to add a perspective
that the reimbursement debate sometimes obscures:
the label matters far less than the performance.

Whether CMS calls it routine or not, whether we
are classified as allopathic, specialty, or
profession — none of that determines the ceiling
of what an individual practitioner can achieve.
What does determine it is the quality of care
delivered, the skill of communication with the
patient, and the ethical clarity with which a fair
value is established for that care.

The proof is in the upper tier of our profession.
The best podiatrists are not waiting for CMS to
validate them — they have earned genuine respect
within the broader medical community entirely on
merit, and without apology for their DPM degree.
Orthopedic surgeons refer to them. Vascular
specialists consult them. Primary care physicians
trust them implicitly. Not because of how a degree
is categorized, but because these practitioners
have made themselves indisputably the foremost
experts on feet in their communities. That is a
standing no insurance table can grant — and none
can take away.

The podiatrists who have transcended the
reimbursement trap share common traits. They
communicate masterfully — patients understand
their condition, their options, and their
prognosis. They charge a fair value for what they
do, and they do it without apology. And they
deliver clinical excellence that speaks louder
than any Medicare benchmark ever could.

Dr. Teitelbaum is right that no patient complaint
about foot pain is trivial. But here is the
corollary: no podiatrist who treats it with
excellence, explains it with clarity, and values
it honestly should ever measure their success by
what an insurance table allows. Those who have
built practices on that foundation have achieved
levels of professional and financial success that
no CPT code could have predicted or permitted.

The battle over terminology and reimbursement
categories is worth fighting at the legislative
and organizational level. But in the meantime, the
individual practitioner’s most powerful response
is simply to be exceptional — and to charge
accordingly.

Bret Ribotsky, DPM, Fort Lauderdale, FL

---

05/05/2026    David Secord, DPM

A 40 Year Retrospective (Robert D Teitelbaum, DPM)

I thought that the comment upon the use of the
term allopathic here was entertaining. I have
commented in this listserv about 10 times about
the meaning of the term allopathy and had a
submission to Podiatry Today published some years
back on the topic. This is an excerpt:

As long as I’m on a roll here, I thought I’d also
comment on people in our profession referring to
MD and DO medicine as allopathic and osteopathic
and then putting ‘podiatric medicine’ in a
separate category, as if podiatric medicine wasn’t
allopathic medicine. There are a certain finite
number of medical theories out there, including
allopathic, osteopathic, homeopathic,
chiropractic, native American Indian pan-theistic
naturopathy, witch doctors, Eastern Indian
Ayurvedic medicine and a few others.

Allopathic medicine has as its basis the idea of
pathology from disease state: bacteria, virus,
spirochete, prion, genetic dyscrasia, etc. Unless
I missed something critical in medical school,
that’s the disease model we in Podiatry follow as
well. As such, Podiatric Medicine IS Allopathic
medicine. If this is important at all, it is from
the aspect that we follow all the other aspects of
allopathic medicine (except we center on the care
of the foot and ankle) and should also mirror the
typical training of the allopathic physician as
well. Instead of making the 4th year of medical
school into some sort of residency (hard to do, as
you aren’t licensed yet), we should be attempting
to do 3rd and 4th year rotations in the various
aspects of allopathic medicine.

Doing OB/GYN and psych rotations would help us be
on par for the USMLE, increase our knowledge of
internal medicine, and rotating through the
different disciplines of medicine would allow us
to be even more well-rounded. I think our training
model should be that of the surgical resident: a
one-year internship in medicine, with ward
service, ICU and E.R. months and then a multi-year
surgical residency. I don’t think that basing our
education on that of the MD or DO doctors out
there dilutes the worth of our profession. I think
it shows an appreciation for the world of medicine
out there and our place in it as another medical
specialty.

David Secord, DPM, McAllen, TX

---

05/05/2026    Paul Kesselman, DPM

: A 40 Year Retrospective (Robert D Teitelbaum, DPM)

This article was written almost three years ago
and published in Nov/Dec 2023, but based on the
feedback just revived, it must have been recently
re-posted. I searched both my manuscript and the
edited published copy and don't see where I
specifically defined podiatry under allopathic.
Having said that, Dr. Teitelbaum, brings up in
interesting question. Is podiatry allopathic or
something else? I am not sure this article ever
took a position on this.

Searching the web for a uniform definition of
allopathic medicine, I used an AI tool which from
the Univ. of Kansas describes allopathy as
follows: Allopathic medicine, or "conventional
medicine," is a modern, evidence-based system
where healthcare professionals (doctors/MDs) treat
diseases and symptoms using drugs, surgery, and
radiation. It focuses on diagnosing ailments
through scientific methods, such as imaging and
lab tests, to provide targeted solutions and is
the most common form of care in Western countries.

So I am not sure what the issue is. It states
Drs/MDs. Does that mean only MD physicians or does
that include other healing professionals with
doctorate degrees who use these techniques?
Osteopathic physicians use all these forementioned
techniques. They are Drs. and they also use other
techniques.

It also states allopathy is the most common form
of care.. but it does not eliminate or diminish
others.

So, are we or not practicing some form of
allopathic medicine? If no does it not matter?
Are dentists not also practicing some limited form
of allopathic medicine? After all they are
prescribing/ordering/administering medications,
using imaging and performing surgery.
Dentistry, however, has answered the question of
being a profession, simply because no one else
does what they do. So for them it doesn't matter.

This may evoke the same age-old question
constantly debated, are we a profession or a
medical speciality?

Thanks to Dr. Block for taking this almost 3.5
year old article, blowing off the dust and
bringing it back to the spotlight. It was fun re
reading it! Dr. Teitelbaum's response is not the
only one response to this. Thanks to those who
have DM me via email or text. They too obviously
have enjoyed reading it.

It's good to see that this article still has some
play left in it. But I wish that there would be a
simple easy answer to the questions raised then
and now.

Paul Kesselman, DPM, Oceanside, NY

---

05/01/2026    Robert D Teitelbaum, DPM

A 40 Year Retrospective

Paul Kesselman's Podiatry Management article about "allopathic" medicine and how DPMs are allopathic doctors was a great lesson in the real meaning and the
corruption of common words that we use to describe
our professional status. I would also like to
bring up three words that have held us back
professionally and consistently for 40 years and I
have not seen them much talked about. Those three
words are "routine foot care".

My thesis is this:

1.There is no complaint about foot pain that is
routine. A patient who realizes that her bent 2nd
toe has a painful corn on the first joint that
hurts in all shoes is in distress. They need
someone to counsel them on the choices they may
face and the treatments that are relevant. The
patient wants our experience, knowledge and
ability to communicate. They want a plan of
action--in other words they want E/M services. But
if something is categorized as 'routine' as in
'trivial' and non-reimbursable, that patient is
now a cash patient and their Medicare insurance is
useless. The E/M services are fraudulent if
Medicare is billed. To me, that is ridiculous, and
I am sure I am not alone.

2. There is nothing "routine" about a painful corn
or callus. There never was. Something that bothers
people is real and if they are going to turn
themselves in to the medical establishment which
is difficult these days, they don't want to be
told they have a trivial and non-reimbursable
condition.

3. Is there a symptom or sign that a primary care
physician is presented with that is 'routine' in
the sense it has been used against podiatrists?
The answer is no. Everything has an equal
significance as well it should be.

4. The conditions or diseases that justify RFC are
mostly arcane and/or never seen in practice and
leave out many common conditions that if patients
have them---no one would want them to do RFC on
themselves (or have non professionals do it)
because it would be dangerous for them. After all,
Medicare patients are elderly patients with all
that implies. At the back end of life, they are
more fragile, less perfused, more neuropathic for
many reasons, and more susceptible to infection.
Conditions that should be reimbursable, maybe at a
lower rate, would be blindness or severe sudden
vision problems, spinal arthritis, CVA's (not
every jurisdiction allows RFC with anticoagulant
therapy), morbid obesity, severe respiratory
conditions and arthritis of the dominant hand.

5. Why do podiatrists have to attest every six
months to the status of a disease that hardly ever
disappears? While there are some patients who
lose the 50 pounds and attain normal blood sugar
levels it is pretty rare. And type 1 Diabetes is
not going away. PAD can be treated and improved
and not be limb threatening, but rarely approaches
normality. I think this goes back 50 years to
when these RFC rules were formulated and Medicare
put podiatry and chiropractic in the same basket.
And basically we were not to be trusted. A lot has
changed since then and the CMS needs to know this.

6. Lastly, how about fear and anxiety. There are
many patients who are pathologically afraid to
treat any pedal condition. That's an underlying
cause of patients who have not gotten care for six
or more months -- difficult cases all. An entire
pharmaceutical effort exists to treat nervous and
anxious patients, who take medications that are
often fraught with nasty side effects--the doctor
visits and drugs are covered by Part D (somewhat),
but if they go to a podiatrist with their feet,
they are on their own. When it comes to fear, feet
don't count.

Robert D Teitelbaum, DPM, Naples, FL