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05/06/2026
RESPONSES/COMMENTS (PM ARTICLES) - PART 1B
From: Bret Ribotsky, 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...
Editor's note: Dr. Ribotsky's extended-length letter appears here.
Other messages in this thread:
05/07/2026
RESPONSES/COMMENTS (PM ARTICLES) - PART 1B
From: Ivar Roth, DPM, MPH
I always get a chuckle out of reading Dr. Jacobs’ responses to some of my posts. Here are some of my observations after I completed a comprehensive 3-year residency in foot and ankle surgery some 40 plus years ago.
Having been blessed and trained to have excellent hand eye coordination from performing surgery, I adapted and used these skills to what I consider perfecting the medical pedicure. From my close association to routine care and what I saw daily... athletics foot, fungus nails, and IPKs... I was able to come up with cures and I do not say that lightly for athletics foot, fungus nails, and recently the resolution of IPKs... all of these conditions which have been hopeless to resolve until now. I am currently in discussions with academic centers to have FDA studies done to prove what I have discovered and bring these cures out to the public. I envision podiatrists leading the way so we can claim some glory and re-imagine what podiatry has to offer to the medical community. Again, thanks to Dr. Jacobs for his pithy comments.
Ivar Roth, DPM, MPH, Newport Beach, CA
09/10/2024
RESPONSES/COMMENTS (PM ARTICLES) - PART 1B
From: Paul Kesselman, DPM
The article cited in a recent PM News edition requires some updating. Since it was written and published, CMS has made a change with respect to the process of prior authorization of bone stimulators. Due to some technical issues with various generations of this technology, CMS last week announced that they were halting the prior authorization process on bone stimulators. When enforcement of this process takes place, CMS promises to make another announcement.
Paul Kesselman, DPM, Oceanside, NY
09/21/2022
RESPONSES/COMMENTS (PM ARTICLES) - PART 1B
From: William Beaton, DPM
Be careful what you ask for in payment for orthotics from insurance companies. Many of us remember when we were appropriately reimbursed for bunion/hallux valgus surgery $2,000. +/- as compared to the current reimbursement rate with the 90-day follow-up. That is what happens when insurance companies control free enterprise with participation contracts and make us providers for their insureds. This past week, I counted 19 advertisements on Facebook for all different kinds of orthotics to cure from plantar fasciitis to low back pain from $39.00 to $250.00. This is a sad state of affairs, creating confusion for the general public.
William Beaton, DPM, Saint Petersburg, FL
08/10/2021
RESPONSES/COMMENTS (PM ARTICLES) - PART 1B
From: Robert S. Schwartz, CPed
For most of the last 48 years, I’ve had the privilege of providing education and training to third year students at NYCPM. As I explain to them, the shortcut to biomechanics is the “Worn shoe evaluations, shoes-on, shoes off!” Our worn shoes tell our story. The Eneslow worn shoe evaluation form is used clinically. It’s a great tool to easily train staff and create and develop a biomechanical and forensic approach. The most efficient way to achieve this is to start assessment with patients still wearing their shoes while standing. Then, the shoes can come off for further study, along with an evaluation of the feet and body.
Disclosure: I am the President and CEO of Eneslow Pedorthic Enterprises.
Robert S. Schwartz, CPed, NY, NY
08/06/2021
RESPONSES/COMMENTS (PM ARTICLES) - PART 1B
From: Richard A. Simmons, DPM
Dr. Richie, with all due respect, rather than change the topic of the question, please offer your opinion. I am simply offering my opinion. I believe medical economics and billable CPT codes are driving all aspects of medicine right now. I am 65 years old, and for the last ten years, my annual physical exam with 5 different PCPs have all occurred with me fully clothed. I’m sure the reason why is that the medical group had to crunch numbers and interpret the CPT codes, then determine that reviewing my clinical lab results and reading some snippet off of WebMD was “an annual physical exam.”
I am old enough to remember reimbursements of $300 for matrixectomies; now, it is less than half and barely more than a simple nail avulsion. I performed vascular exams for more than $200 each and simply stopped doing...
Editor's note: Dr. Simmon's extended-length letter can be read here.
08/05/2021
RESPONSES/COMMENTS (PM ARTICLES) - PART 1B
From: Kevin A. Kirby, DPM
Dr. Jarrod Shapiro’s recent article, “Why Are Podiatry School Graduates Not Grasping Biomechanics?” hits the nail squarely on the head. In the 36 years that I have been in private practice and teaching foot and lower extremity biomechanics, both nationally and internationally, 28 of those years involved training podiatric surgical residents on the principles of foot and lower extremity biomechanics, foot and ankle surgical biomechanics, sports medicine, and foot orthosis therapy. As Dr. Shapiro also observed, I have noted a gradual decline in the biomechanics knowledge that these third-year podiatric surgical residents possessed when rotating through my office over the past 10-15 years. As such, I believe a few comments are in order about “biomechanics”, what it means, and what we, as a profession, should do about teaching “biomechanics” to our podiatry students, podiatric surgical residents, and podiatrists.
First of all, we must all understand that the term “biomechanics” does not simply mean evaluating, casting/scanning, prescribing and...
Editor's note: Dr. Kirby's extended-length letter can be read here.
10/28/2020
RESPONSES/COMMENTS (PM ARTICLES) - PART 1B
From: Bryan C. Markinson, DPM
Although I wish Dr. Levy did not invoke my name in his initial correct comments on this article, the response by Dr. Kalish has degenerated the conversation to a level that I hope to put to rest with this post. There are certain accepted and widely practiced surgical oncology principles that neither the youth of Dr. Levy or the "judgment call of the experienced surgeon" as Dr. Kalish stated, can ignore, dispute, or change.
Neither Drs. Levy, Kalish, or I are musculoskeletal oncologists, the specialty which is charged with the expertise and knowledge and research regarding the initial management of...
Editor's note: Dr. Markinson's extended-length post can be read here.
02/19/2020
RESPONSES/COMMENTS (PM ARTICLES) - PART 1B
From: Lawrence Oloff, DPM
I believe this dialogue about “advanced foot and ankle vs. general practice podiatrist” espoused by Dr. Sherman misses many key points. It bothers me that after all the progress that I have seen our profession make, there are still advocates that want to have our profession take two steps back. I have been involved with podiatric medical education for forty plus years and continue to do so today as a residency director. These are my observations.
Completing residency does not force its graduates to perform advanced surgery, or for that matter any surgery at all. The extent of one's practice is purely up to the discretion of each graduate of a residency program. Residency just allows its graduates to provide basic competency in the care of their patients, both as generalists and as surgeons. Finishing a residency is just the beginning of obtaining competency as a...
Editor's note: Dr. Oloff's extended-length letter can be read here
02/17/2020
RESPONSES/COMMENTS (PM ARTICLES) - PART 1B
From: Michael M. Rosenblatt, DPM
I read with interest the recent polls of newly graduated residents, in which the majority answered that they want to practice mostly surgery in their work. I understand this. Many years ago, I felt the same way. Because I owned my own Medicare Certified Surgical Center, there was (I suppose) a financial incentive for doing more surgery. But that is not how it turned out. The physical aspects of surgery require an enormous amount of energy that, as you age, you become less able and willing to exert. I was also a co-resident director and shared responsibility for teaching new podiatry residents surgery.
I had a surgical program at a VA hospital where I was exposed to a great deal of surgery, besides foot and ankle procedures. Even now, I am astonished at the...
Editor's note: Dr. Rosenblatt's extended-length letter can be read here.
12/17/2019
RESPONSES/COMMENTS (PM ARTICLES) - PART 1B
From: Dale Feinberg, DPM
I took my friend aside and we did discuss how the impressions for her custom prescription orthotics were made. It was interesting to me that she retired with a degree in mechanical engineering. She stated that the podiatrist took a pronated impression in a pink foam box while the chiropractor did a full biomechanics exam including gait evaluation before using an ipad scanner and writing a custom prescription for the devices. She said she wondered why there was such a difference in completeness of her competing exams but was only interested in which orthotics felt the best, and that she now recommends all of her tennis friends to her chiropractor.
Finally, she told me her sister had a bunionectomy with perfect results done by a local podiatrist, and her best friend had a similar procedure performed by a well renowned local orthopedic surgeon with poor results. When she asked her friend why she didn’t see her sister's podiatrist, she was told the orthopedic surgeon was a medical doctor.
Dale Feinberg, DPM, Yuma, AZ
10/17/2019
RESPONSES/COMMENTS (PM ARTICLES) - PART 1B
From: Ira Baum, DPM, Naples, FL
I don’t think a unified board would do anything to mitigate confusion regarding the services podiatrists provide to the public. I also think it would be a disservice to those podiatrists who received specialized training in surgery. Here’s the obvious dilemma: a majority of states require at least 2 years of post-graduate training in a certified residency program. So how can the profession satisfy state laws requiring the minimum residency training and differentiate non-surgical from surgical training?
Additionally, DPMs, by definition, are doctors of podiatric medicine and surgery, so the definition of our degree needs to be addressed. I’m sure there are many other hurdles that would need to be addressed before changes in board status, training, and meaning would be rational.
Ira Baum, DPM, Naples, FL
03/26/2019
RESPONSES/COMMENTS (PM ARTICLES) - PART 1B
From: Daniel Chaskin, DPM
Regarding Jarad Shapiro’s article, I respectfully disagree. Non-surgical programs lead to the path of being denied an ankle permit to medically treat the ankle in certain states. In NY, a PMSR 24 is not accepted regarding an ankle permit. Connecticut, NY, etc. only recognize a PMSR/RR regarding granting an ankle permit to give medical and surgical treatment. There is currently a shortage of PMSR/RR positions for any of the unmatched to apply to.
Daniel Chaskin, DPM, Ridgewood, NY
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