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09/16/2019
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Elliot Udell, DPM
Dr. Borreggine is correct. One does not need to make an appointment to see a doctor in order to acquire a set of custom foot orthotics. This is not new. Making and dispensing foot orthotics has never been a practice which required a medical license. Orthopedic shoe stores, chiropractors, and physical therapists have been dispensing custom orthotics for years. What distinguishes a podiatrist from a "Joe Blow" working in a shoe store dispensing orthotics is our training in biomechanics. It’s the knowledge and training that enables the podiatrist to add corrections into a custom orthotic that distinguishes us from shoe store employees and others who make foot orthotics.
To this end, it would be great if the orthotics labs could roll back the clock and once again subsidize lectures on biomechanics and foot orthotics at every one of our conventions and at every one of our schools. That would once again make a real difference for our profession as well as the general public.
Elliot Udell, DPM, Hicksville, NY
Other messages in this thread:
05/09/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Gary S. Smith, DPM
I think Dr. Tonczak's letter perfectly defines the conflict between academics and practical podiatrists. I was doing some training at the Pittsburgh Podiatry Hospital when I asked the most prolific surgeon why he didn't write books and articles. He answered, "because I don't have time."
Dr. Tomczak said not knowing about a screw extractor should disqualify board certification. I was the director of a surgical residency and didn't know about them. No hospital I ever worked in would have such an instrument in stock. Maybe breaking a screw during surgery and not being able to deal with it should disqualify you from certification?
Gary S Smith, DPM, Bradford, PA
02/24/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Daniel Chaskin, DPM
There has got to be some sort of educational program so non-surgical podiatrists can increase their scope of practice to treat the ankle as well as the rest of the body. Nursing schools should offer advanced placement for DPMs who wish to medically treat the ankle and above, as well as systemic diseases in certain states. This way, a DPM could qualify to get a nursing degree as a path to obtaining a license for treating the ankle as well as systemic diseases.
Once getting a nursing degree, they could then opt to get a nurse practitioner degree. Is it possible Touro might consider offering advanced placement for DPMs to obtain a nursing degree as a path to increasing scope?
Daniel Chaskin, DPM, Ridgewood, NY
02/21/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Stephen Peslar, BSc, DCh
Dr. Tomczak was correct when he wrote there are about 600 chiropodists for about 15 million people in Ontario, Canada. Decades ago, Ontario Ministry of Health decided to shut down podiatry based on some unfortunate foot surgery outcomes performed by podiatrists. In 1991, the Chiropody Act was passed with the clause, “No person shall be added to the class of members called podiatrists after the 31st day of July 1993.”
Then in 2015, the Health Professions Regulatory Advisory Council completed an extensive study of over 350 pages, that included a jurisprudence review and a consultation with stakeholders. The concluding recommendation to the Minister of Health was, “no changes should be made at this time to the current legislation on the registration of podiatrists in Ontario.” Since 1983, there have been about 900 graduates from the Ontario chiropody program. Around 300 have abandoned the chiropody profession mainly due to...
Editor's note: Stephen Peslar's extended-length letter can be read here
02/20/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Chris Seuferling, DPM
Point of Clarification: I’ve received comments about “what a podiatrist SHOULD be”. The intent of my post was not that I agree with the current podiatry residency training model, but rather how we should deal with the existing gap of traditional podiatric care IF the current residency model remains as is. These are two intertwined, but different topics.
Bottom line: I would love to have podiatry satisfy all the general foot care needs (nail, callus, diabetic, etc.) of the population. I feel we have lost our identity as to what podiatry “SHOULD” be and residency program revision needs to be a topic of discussion at the table. However, if that’s not an option and it is truly a “bridge too far”, then we need to deal with the reality that IS, not the “SHOULD” be.
Chris Seuferling, DPM, Portland, OR
02/19/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Glenn McClendon, DPM
We all get tired at times of trimming toenails and calluses, but don't other doctors get tired of their most routine treatments. Why don't podiatrists have a non-insurance nail segment of their business for many of the patients who don't meet qualified at-risk foot care. It could be an adjoining or simultaneous adjunct to your office. A trained nail tech could do that work and take a load off of you. And it would be all cash. Ophthalmologists employ optometrists. ENTs employ audiologists. Almost all MD/DOs have a practitioner working under them. It would be a way to produce income from others’ efforts, and provide a good referral source.
It would be great to have some income when on vacation. I'm sure there are plenty of people who would prefer to go to a nail salon affiliated with a podiatrist vs. one in a local shopping center for various reasons. How many podiatrists sell OTC products through their office for income and convenience to patients? Are there challenges in making this an extension of your medical practice? Sure. Rarely is there any easy money without some sacrifice. Maybe someone will come up with a business model along these lines that will work. I'd sure consider it.
Glenn McClendon, DPM, Conway, AR
02/04/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Kathleen Neuhoff, DPM
I was so saddened to read Dr. Clark‘s letter. I wonder if some of his opinions about his inadequate pay resulted from lack of knowledge about the cost of running a practice. Quite a few years ago, I had an associate doctor. I paid her 40% of the gross that she generated and allowed her to set her own hours and determine how many patients she would see. She chose to work less than 30 hours a week and still generated an income above average for a full-time practitioner at that time. My own income was approximately 32% of my gross because I saw more than twice as many patients and was carrying her. However, I liked her. She was a good doctor and my patient liked her so it was perfectly content with that.
After about five years, she came to me and told me that she thought she should be receiving 90% of the gross that she generated because it hardly took me any extra cost to keep her on. I sent her to my accountant for a day and had them go over all the cost of the practice and the profit and...
Editor's note: Dr. Neuhoff's extended-length letter can be read here.
01/23/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Robert Kornfeld, DPM
I think Dr. Roth brings up a great point. Our profession convinced itself that surgery-only residencies would give us credibility. But it has caused a great lack in the medicine part of podiatric medicine. I enjoyed doing surgery but stopped in 2011.
Ironically, since then, I have helped more patients heal from chronic pain syndromes via functional and regenerative medicine and was able to create a more lucrative practice. Without a focus on causes of pathology, and developing a plan of action to heal our patients, this profession will be eaten alive by MDs, DOs, NPs, PAs, and anyone else who sees the void we have created.
Robert Kornfeld, DPM, NY, NY
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.
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.
10/05/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Robert Kornfeld, DPM
I think it is an absolute travesty that as the years went on, podiatrists have been paid less and less. I agree with Dr. Kass that something must be done. However, it is my opinion that a union will have only limited success because insurance companies will still retain the power of payment. After all, they collect the premium dollars. They don't want to share that money with doctors. You can go on strike, but you will be limited to the power of negotiation and the amount of money that insurance will be willing to let go of.
There is a movement (finally) in medicine back to private practice/direct-pay models. I am friendly with many MDs and DOs who are leading the charge away from...
Editor's note: Dr. Kornfeld's extended-length letter can be read here.
09/28/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Robert Kornfeld, DPM
I thoroughly enjoyed reading Dr. Tomczak's post about how exciting it is to have a new APMA administration that finally understands what is happening and is going to do something about it. Well, I am a 1980 graduate of NYCPM. If you do the math, I graduated 44 years ago. And during all 4 1/2 decades that I have been a podiatrist, APMA has been "working" on making things better for us. Sometimes, they work "hard" at making things better. Yet, in all these years, not only has it not gotten better, it has gotten so much worse.
I won't go into details about my personal issue with my own NYSPMA which I quit many years ago, but what I will say is if anyone out there wants to make things better, you need to stop counting on APMA and do it yourself. When I realized that nothing was changing for the better, I decided to do it myself. And to be honest, my efforts to improve my professional experience all paid off without dues to an organization that is always working hard for us but never seems to accomplish what they promise.
I'm sure I'll catch some backlash for this, but my career is nearly over and I don't care what they have to say about me and my opinions. Of course, what I have already heard is if I'm not a dues-paying member, then I'm part of the problem. Nah. My career was amazing in spite of, not thanks to, APMA.
Robert Kornfeld, DPM, NY, NY
09/26/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Rod Tomczak, DPM, MD, EdD
I wonder if Jon’s letter was written tongue in cheek. If accurate, Jon’s report about a recent encounter with a secret agent from APMA who assured Jon there are changes a comin’ at APMA headquarters gives cause for celebration. That’s tongue in cheek. If what Jon was told is indeed true, and why should we doubt anything out of the mouth of an unnamed secret APMA leader, then I am grateful that the spirit of Deep Throat is alive and well in Washington, DC. One difference between the original Deep Throat and the APMA Deep Throat is that the current mole is wearing old Rohadur orthotics posted to the casts to throw off younger potential trackers.
But there is a disparity between these new APMA promises and those made in the waning moments of the Nixon administration. Deep Throat’s assertions proved to be true. Both the current APMA Deep Throat and the Watergate Deep Throat were accurate when they presently advised Purdy and in...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
09/23/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Justin Sussner, DPM
But how often do all of us get a fax or email or phone call that "ABCD" antifungal cream needs pre-approval, all for what may be a $20 generic. Isn't it the insurance companies' fault for not requiring the big ticket items to be pre-authorized first? This doesn't make sense to me. Maybe they just don't trust DPMs, and let the MDs do whatever they want.
Justin Sussner, DPM, Suffern, NY
09/18/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Ivar E. Roth, DPM, MPH, Jeffrey Trantalis, DPM
Dr. Jacobs is correct. WE the profession, APMA, need to fund a campaign on TV to get the word out about our services. I had a local Dr.’s wife who was treating with an MD orthopod foot and ankle fellowship trained with the usual hands-off approach. The patient had an ulcer that was infected and very callused. When she saw me, the first thing I did was debride the callus which gave her immediate relief and now the ulcer could also drain properly, etc. Let’s make this happen. Good observation Dr. Jacobs.
Ivar E. Roth, DPM, MPH, Newport Beach, CA
Dr. Jacobs is correct in the ability to promote podiatry as a profession. However, because of my experience working for a back surgeon, we as a profession can take it a step further promoting non-surgical care for the lower extremities and lower back. People are not aware of our training and skills in the biomechanics which provides a non-surgical approach to the complete lower extremities and lower back care.
Jeffrey Trantalis, DPM, Delray Beach, FL
09/17/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Robert Scott Steinberg, DPM
I can tell you why the APMA doesn't do something similar: money and how they spend it. It is costly to put on the HOD. The budget for the 2024 HOD was $234,000. The Illinois Association of Podiatric Physicians and Surgeons has budgeted $20,000 for the 2025 HOD. Each state could use some of what they budgeted for the HOD to promote our profession. The APMA could do the same.
Nothing Earth-shattering happens at the HOD that necessitates hundreds and hundreds of delegates going to DC. The HOD recently ditched Roberts Rules of Order for Sturges for no practical purpose other than acting like they are the House of Lords. If you go to Facebook and search for plantar fasciitis, you will then be inundated with ads from PTs, DCs, and others who claim to be the experts. I rest my case.
Robert Scott Steinberg, DPM, Schaumburg, IL
09/03/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Donald R Blum, DPM, JD
Many years ago, I would have agreed with your hospital. That is the assistant should be as qualified as the primary surgeon. In the past, the assistant surgeon should have been able to give input to the surgeon and opinion during the procedure. However in today’s world a “certified medical assistant” is allowed to assist in surgery and in many cases also bill an assisting fee. Many times, this is out-of-network which greatly benefits the employing surgeon. This is possibly a good argument for allowing the DPM to assist on procedures with the privileged DPM.
Additionally, having a podiatrist assist whether trained in the particular procedure or not should decrease the OR time as the primary surgeon will be more efficient, and one could expect better outcomes as a result. Efficiency would occur as the assistant is more knowledgeable of the instrumentation and order of the procedure. Setting up power equipment, aligning a fixation wire or other hardware will be easier with a podiatrist, even one who does not do the procedure on a regular basis. The language and skill of the DPM assistant beats the knowledge of a “PRN” medical tech or a permanent OR medical assistant employed by the hospital but typically does general surgery or non-orthopedic procedures.
An item which the assisting podiatrist needs to check on is whether one's malpractice will cover them for these more involved procedures. Many times a doctor doing non-boney procedures will have a different medical liability coverage than one doing bone and tendon/ligament work.
Donald R Blum, DPM, JD, Dallas, TX
08/30/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Ken Hatch, DPM, Herb Schmirer, DPM
I did get a notice via my state association. I first joined APMA in 1976. I am now a life member. When I tried to vote, it kicked out my password and number. When I called APMA, I was told that LIFE membership did not include voting rights. WE old guys saw the best and worst of podiatric medicine over many years. I guess the current leadership does not need input from our experience.
Ken Hatch, DPM, Annapolis. MD
I join the growing list of APMA life members whose vote is not important to the APMA. If my opinion is not good enough for the APMA, my money will not be either.
Herb Schmirer, DPM (Retired), Port Washington, NY
Editor's note: This topic is now closed.
08/19/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Steven Finer, DPM
After reading Dr. Tomczak’s post, I reviewed the various boards in Pennsylvania. The Podiatry Board is the only medical one that requires two physicians, save one other. Physical therapists, require one. I have not researched the history of these board hand holdings. Somewhere in our past, podiatrists needed a lot of guidance, lest they stumble and do something idiotic. It seems that chiropractors, optometrists, and dentists do not need any help.
Steven Finer, DPM, Philadelphia, PA
08/01/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Jose Aponte, DPM
I am sorry to hear that your daughter was denied the privilege of your being able to put the white coat on her future White Coat Ceremony at her present school of osteopathy. In my opinion, this sends the wrong message to the new students. Recently, I attended my son's WCC at a medical school and was allowed to put the white coat on his shoulders without any controversy.
As I understand, the WCC was designed by The Arnold P. Gold Foundation. I would contact this foundation and let them know your situation. Maybe they have a position that you can present to the osteopathic school your daughter is attending and hopefully help change their thoughts about all this. Regardless of the outcome of this situation, your daughter should be very proud of you for being a DPM.
Jose Aponte, DPM, Caguas, PR
06/06/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Jack Ressler, DPM
Why pay someone thousands of dollars to evaluate your own practice when all they are going to do is look over your numbers without even making an in-person evaluation of your office? They will offer to come out and evaluate your practice but at an even higher price. You can save money up front and sign a contract with other companies that will charge you a percentage of your sale price but you are at their mercy and cannot control the extent at which they advertise your practice. Signing with one of these companies gives them complete control of the sale of your practice even if you find your own buyer. I doubt they will give you exclusions.
Who better to value your practice than yourself? It is you who know your patients, staff, physical office set-up, demographics, and numbers better than anyone. The valuation of your practice comes down to one simple thing and that is the number a potential buyer is willing to pay. When I sold my main practice in 2016, I advertised it in the classified section of this forum. I did all of the work myself and paid a very reasonable amount for advertising and...
Editor's note: Dr. Ressler's extended-length can be read here.
05/10/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Richard M. Maleski, DPM, RPh
The recent thread in this forum on the future of podiatry has been extremely interesting and thought-provoking, with the most recent emphasis on the pros and cons of direct pay versus the more typical insurance dominated practice model. Let's not lose our historical perspective on this. Back in the 1960s, with the advent of Medicare, everything in healthcare changed. Prior to that, virtually all practices were direct pay, and the only insurance coverage was Major Medical, sometimes referred to simply as "hospitalization." When Medicare came around, our profession clamored to be included.
There are colorful stories of the behind closed doors antics that went on inside politicians' offices to assure that podiatric services would be covered. Since then, any time there has been a change, such as the emergence of managed care, we, along with every other medical group have done everything possible to keep ourselves included. And by being included in this payment model, we have been able to expand our status within...
Editor's note: Dr. Maleski's extended-letter can be read here.
05/07/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Kathleen Neuhoff, DPM
It is unfortunate that local providers turfed their patients to Dr. Tomczak. However, in our area, this kind of turfing is rampant among those who accept insurance. Most of our local Latino population does not have insurance and many providers will not see them at all.
Ironically, when I accepted insurance, I was taken to task by the administration of our local hospital because I gave a significant discount to all religious leaders (rabbis, priests, ministers, nuns, etc.). I was advised that I was in violation of the contracts with my insurance carriers and had to “cease and desist”. Now that I have no contacts with insurance companies, I have restored these discounts. I also see large numbers of patients who have no insurance and am able to provide care for them at a cost they can afford.
Some of these patients are very sad. For example, Wednesday I saw a gentleman who had had an ingrown nail for months. He had been unable to find anyone to treat him until the local” free” clinic sent him to me. He is an uncontrolled diabetic and had osteomyelitis of the entire distal and part of the proximal phalanx. I had him admitted to the hospital which will end up eating the cost, and I will probably need to amputate at least his hallux. We have failed this patient at a huge cost to him and to our healthcare system. I do not think this is an issue of self-pay vs. insurance providers. It is a loss of the patient care mentality which should guide all of us.
Kathleen Neuhoff, DPM, South Bend, IN
04/09/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Richard Rettig, DPM, Kim Antol
Quicken is a great product, and the most expensive version is $5.50 per month first year, then about $120 per year. Since you are outsourcing payroll (good idea), you never needed Quickbooks in the first place. Unfortunately, you cannot convert your Quickbook files to Quicken.
Richard Rettig, DPM, Philadelphia, PA
If all you need is a simple program to print checks....Quicken should do the trick for under $100. Not subscribing to online versions and options will save you from annual fees.
Kim Antol, President, Sigma Digital X-Ray
03/29/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Ivar E. Roth, DPM, MPH
As I have mentioned before, I agonized for quite a while if I should charge a credit card fee. I have been doing so for the last 6 months with very little opposition.
For the few patients who complain, I usually just waive the fee to make them happy. In the end, I am saving tens of thousands of dollars per year which is a nice bonus.
Ivar E. Roth, DPM, MPH, Newport Beach, CA
03/06/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Michael Uro, DPM
I just read Dr. Rod Tomczak’s response to “A Short History of Podiatric Discontent and Frustration”. I whole-heartedly agree with all he had to say. I have enjoyed practicing podiatry for 45 years. I was fortunate enough to have enjoyed the era before managed care...a time when we were paid 2/3s more for surgery than we are today. The reimbursements for surgery today are an insult to the training, experience, and risks that podiatric surgeons take every time they walk into an operating room.
When I came to Sacramento, I was welcomed by the podiatric, MD, and DO communities. I am grateful to those mentors such as Mitch Mosher, DPM, Larry Gerelli, DPM, Randy Sarte, DPM, and...
Editor's note: Dr. Uro's extended-length letter can be read here.
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