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

Other messages in this thread:

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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

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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