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From: Charles M Lombardi, DPM


All this musing about two separate training programs is amusing to someone who has been around for some time and has been intimately involved in the progression of this profession. In 2000 or 2001, the CPME ad hoc committee to rewrite the 320 document recommended to the HOD and the community of interest three separate programs: A 2-year surgical, a 3-year surgical, and a 2-year primary podiatric care program. The APMA HOD and the community of interest REJECTED it outright, stating that ALL podiatrist must be trained the same. Some of the SAME people that were opposed to a separate primary podiatric care program are now in favor of it. The ABPS argued against a unified program, but lost the battle.


Now looking back, the unified program allowed many states to change the scope of practice laws because one of the arguments against us was a lack of unified training. Much good came from that decision. I was always in favor of two separate training tracks, but that train has left the station. To hear the SAME people who were opposed to a separate training program in 2001, but now say our profession must have two separate training programs are in psychiatric terms schizophrenic. Our profession would be considered a schizophrenic profession by lawmakers.


Charles M Lombardi, DPM, Flushing, NY

Other messages in this thread:



From: Martin Pressman, DPM


I don’t know for sure what the diagnosis is in this case. That said, High on my list is neuroma. Neuromas need to be 4mm before they are visible on MRI. Intermittent forefoot  pain that is severe with “ fullness” sounds to me like a neuroma. Diagnostic nerve block may help and test interspaces for hypoesthesia sharp/dull. Neuromas are great pretenders!


Martin Pressman, DPM, Milford, CT



From: Lorraine Loretz, DPM, MSN, NP


Knowledge of the foot and related specialties varies greatly among primary care providers, regardless of credentialing. NP classes and clinical rotations focus on internal medicine, family practice, geriatrics, and pediatrics. Exposure to Ortho and other surgical specialties is minimal during NP school, and most NPs who work in these fields receive post-grad training on the job and through continuing education. 


Working in vascular surgery as a dually-credentialed DPM/NP, I am fortunate to be involved with NP/MD post-grad education and often deliver lectures or workshops on my areas of expertise, especially on the diabetic foot. The education is very much appreciated by all providers: NPs, PAs and MDs. I think the important thing with your experience is that the NP knew to reach out to you for help, and was grateful for the information you imparted.


Lorraine Loretz, DPM, MSN, NP, Worcester, MA



From: David S. Wolf, DPM


Kudos to both podiatrists in this reality TV series, who exemplify the finest in our profession. They will educate the public of the scope of our practice and will augment what the APMA has attempted to accomplish. We have all seen the pathology of these TV patients but at least now, it will be seen by millions of viewers. What a positive PR coup for our profession. Wish I would have thought of it.


David S. Wolf, DPM, (Retired) Houston, TX 



RE: Source for Radiesse 

From: Valerie Marmolejo, DPM


The intended use indications for Radiesse are: “RADIESSE is indicated for subdermal implantation for the correction of moderate to severe facial wrinkles and folds, such as nasolabial folds and it is also intended for restoration and/or correction of the signs of facial fat loss (lipoatrophy) in people with human immunodeficiency virus.”


While physicians can use Radiesse off-label as they please, the company CANNOT promote, aka sell or market, off-label product use. As podiatrists do not treat the face, there is no reason for the company to reach out to us. 


Valerie Marmolejo, DPM, Seattle, WA



From:  Bret Ribotsky, DPM


In response to Dr. Fellner, years ago, when I was involved with DermFoot and running workshops, I had many detailed discussions with a few different CEOs of Merz over the years. The issue is that there is NO FDA-approved use for Radiesse that is within the scope of practice of a DPM. Thus, the attorneys for the company advised not to sell to DPMs directly.  


Workarounds were in place for those who received training that I provided throughout the country (a short term fix). I was involved in a few research papers that were the start of a possible attempt to get an FDA indication for the feet (like the hands). Then I got injured in May 2015, so I do not know what has happened since then. 


Bret Ribotsky, DPM, Boca Raon, FL



From: Cosimo Ricciardi, DPM, Denis LeBlang, DPM


Ditto that on Mr. Crosby. He's a hard worker and good communicator. He will be a great asset in your search.


Cosimo Ricciardi, DPM, FT Walton Beach, FL


I used Mike Crosby to negotiate the sale of my practice last year. He is professional, compassionate, and a wonderful human being. He was there to speak with me and literally held my hand and controlled my mindset throughout the process. It took a while for the situation to come to an end, but Mike was the voice of reason and controlled my stress and anxiety levels and calmly assured me that it would all work out. 


I  recommend him as the guru of podiatric practice sales. 


Denis LeBlang, DPM, Westchester County, NY



From: Steven Finer, DPM


I recently purchased Quantum Rub at a seminar. It contains polarized CBD, menthol, and various herbs and oils including vitamin E. My wife has used it after our trips to the gym. She said that it helps with generalized soreness, not strong pain. Naturally, this is anecdotal evidence. It seems all rubs contain menthol for their cooling effect. Many can contain ingredients that produce warmth and new evidence shows it may speed healing. As to the claim of polarization, it is unproven. Ingested CBDs in the form of pills and gummies may be taken off the market due to lack of standards. I personally prefer Voltaren gel on a limited basis, as there is some systemic absorption.   


Steven Finer, DPM, Philadelphia, PA



From: Robert Scott Steinberg, DPM


Yes, the train has left the station, and I hope for good. Those who think differently just don't get it. Just as we get our schools to move to a complete set of courses, matching those of medical students, the last thing we need is to divide us into tiny pieces, each of which will be ignored and lost on other physicians and patients.


More than anything else, doctors of podiatric medicine need to become a stable, cohesive profession, and anyone attempting to divide us should be shown the door.


Robert Scott Steinberg, DPM, Schaumburg, IL



From: Ira Baum, DPM 


Dr. Levy speaks from experience and knowledge, but the practical response from Dr. Purdy would be more effective and efficient. Taking into consideration the healthcare environment today with respect to student debt, years in training, and reimbursement schedules for podiatrists, it doesn’t make a lot of sense to pursue a regional specialty that other medical professionals serve based on a system specialty. There was a time for that type of specialty, but that time has passed. The train has left the station.


The obvious obstacle to transitioning DPM to MD/DO is the solid structure of the podiatric medical systems. Until those systems realize the future of the profession and see the value for those in leadership positions of our associations, educational institutions and boards to change, podiatrists' recognition will remain unchanged, and our war for parity will be never ending. Unfortunately, it is the grassroots podiatrists who will suffer for their inaction. I strongly recommend those in leadership positions to consider these points and begin to explore options and opportunities for change.


Ira Baum, DPM, Miami, FL



From:Pamela Hoffman, DPM, Ara Kelekian, DPM


I have used the vacuums from Jan L attached to my Dremel drills for over 3 decades. I have had no lung issues or dust problems. I have replaced several drills, but the vacuums have lasted. 


Pamela Hoffman, DPM, Katonah, NY


In our office, we use Surround Air units Multitech XJ3000C with replaceable filters. They have timers which make it easy to turn on and forget about it.


Ara Kelekian, DPM, Montebello, CA



From: Donald R Blum, DPM, JD


We use a service based in Frisco Texas called the Appointment Desk. Your patient will dial the local number (312-***-****) for your office and it will be answered (for example):


Appt Desk: "Good afternoon this is Dr. Hoberman's office how can we help you?"

Patient: "I would like to make an appointment."

Appt Desk would then open the schedule and make the appointment for the patient or the patient might ask about their bill and say:

Patient: "I would like to speak to the person about my bill."

Appt Desk: "We will transfer you."

The appt desk would then connect the patient to your office.


During all this conversation, the patient will presume they are talking to your office. Appointment Desk could also answer your phone on the fourth ring if you wanted. Hours for the Appointment Desk are 07:00 AM - 07:00 PM.


Donald R Blum, DPM, JD, Dallas, TX



From: Loretta Logan, DPM, MPH


As chair of the Department of Orthopedics and Pediatrics at the New York College of Podiatric Medicine (NYCPM), I feel it is necessary to respond to your recent comments regarding the current state of orthopedic training at the schools of podiatric medicine. While I agree with the consensus that the younger practitioners entering practice have placed surgery at the head of their treatment plans, the first sentence in point #1, “The undergraduate level of biomechanical training is apparently shameful as compared to when I was at ICPM 1977-1981” was particularly troubling.


I would be happy to share curriculum documents with you, which show the evolution and expansion of orthopedic training from...


Editor's note: Dr. Logan's extended-length letter can be read here.



From: Jay Berenter, DPM


In response to the question about to where to find a scribe, I have been using HelloRache, a virtual scribe service for over 2 years. They provided me with an excellent virtual scribe who is based in the Philippines and is "in" our office daily. He is efficient, on-time every day, and dedicated to his job. My staff and I consider him a vital and trusted employee (I even got an invitation to his upcoming wedding next month). This service comes at a fraction of the cost of a scribe that is based locally. I highly recommend taking a look.


Jay Berenter, DPM, San Diego, CA



From: Peter Smith, DPM


Robert Teitelbaum states that he hopes the verdict against Johnson and Johnson is the beginning of a turnaround. In my opinion, the verdict against J&J is a joke!  They make pills that help people. They do not prescribe them, dispense them, or hold people’s mouths open and force them to swallow them! Our culture of passing blame instead of assigning personal responsibility is poisoning our youth and may be the downfall of our society. Should Anheuser Busch be blamed for alcoholism? Should Smith and Wesson be blamed for murders committed with their guns? Some might say yes, but not me.


And by the way, since the post was really about the cost of medicine, the next time Johnson and Johnson raises their prices, ask them if it has anything to do with the half a billion dollar verdict against them.


Peter Smith, DPM, Stony Brook, NY



From: Simon Young, DPM


Adding healthier people to this pool might result in lower costs. But "Medicare for all" will result in a government program and when government runs out of money, they usually cut medical, school, arts and sciences, sports, and school lunches.


Listening to the debates, I think a Medicare public option will be the correct path, and let private insurances compete. Private insurances made (according to Sen. Bernie Sanders) $100 billion stealing from doctors and stealing more from DPMs. I have no pity for these middlemen. These middlemen have harmed a lot of private practitioners and, in my opinion, are intent on burying private practice for hospital-based treatment.


Simon Young, DPM, NY, NY



From: Joseph Borreggine, DPM


I have been using VoIP for the last 4 years. There is a definite difference in phone voice quality since it is digital. There are also many extra features beyond the scope of this answer that will benefit your business. The only thing that is bad about VoIP is that when the Internet goes down, you lose your phone service. I use Consolidated Communications based in many states throughout the U.S.


Joseph Borreggine, DPM, Charleston, IL



From: Charles Lombardi, DPM


ABOS requires submission of all cases done in the last two years. Then they require you to come down and defend your cases (that they pick). This process is repeated in re-certification. That is why most orthopedists don't want difficult cases in their window.


Charles Lombardi, DPM, Flushing, NY



From: Robert Scott Steinberg, DPM, Name Withheld 


What justification is there to spend that much of the healthcare dollar, when there are proven treatment protocols which not only address the presenting complaint but also address the cause?


Robert Scott Steinberg, DPM, Schaumburg, IL 


I have used the product in the past and have found maybe a 50% success rate when used for plantar fasciitis. You are correct, there is no reimbursement code for this product and hence it must be a cash service. However, you are being grossly overcharged. Our rep was selling this product for half of what you are paying. 


As you may or may not be aware, this company has had legal problems where their CEO and CFO, along with other executives, were being investigated for legal and accounting issues (Google “Mimedx Investigation”). I no longer do business with this company. I believe there are better products out there for plantar fasciitis that fails the usual conservative treatments.


Name Withheld



From: Roody Samimi, DPM, Jack Ressler, DPM


I would suggest going to  No matter what stage you're at, even if only a couple  of years from retirement, our veterans would benefit from such vast experience that you have, and there's usually a variety of opportunities... especially if you stay on the lookout!  Good luck!


Roody Samimi, DPM, Modesto, CA 


I sold my main practice but kept two entities, a satellite office and two senior facilities. I was 59 at the time. I didn’t suffer from practice burnout. My reason for selling was more of a physical disability not allowing me to continue a full time schedule. Selling your practice and being able to continue to work as an employee would definitely relieve a great amount of stress providing your financial needs are met. I will not discuss the details I used, in this post, but if anyone has any questions l would be more than happy to share my strategies. I did not hire a broker or pay a “professional” to provide a valuation of my practice. Simple advertising on this website was all I had to do. 


Jack Ressler, DPM, Delray Beach, FL



From: Robert Scott Steinberg, DPM, Michael Lawrence, DPM


I have been seeing a large number of stem cell clinic ads on Facebook. None list the physicians' names or specialty. I have copied the links to the page and to their Website and sent them to my state's department of professional regulations. 


Robert Scott Steinberg, DPM, Schaumburg, IL


Yes, we have them as well. They advertise heavily and offer "free informational dinner meetings" at nicer restaurants to attract patients. Out of curiosity, I attended one of these meetings. The canned speech and visuals were informative. Joint injections, especially in the knees, were advocated along with their injections for neuropathy and fibro. And yes, it is very expensive; payment plans were offered and the treatments are done by extenders. This concept is being pushed to chiropractors by at least one company, Advanced Integrated Medical, owned by Michael Carberry, DC. There appears to be a connection to Scientology much like Sterling or Stellar.


I am a candidate for such treatment, though cortisone in both my knees is buying me nearly a year of relief, done by my good friend orthopedist. I can say with great certainty that when the time comes for other injections, I will opt for the provider with exceptional training and skills and years of experience.   


Michael Lawrence, DPM, Chattanooga, TN



From Paul Kesselman. DPM


From a purely utilization standpoint, those who dispense bilateral AFOs on the same date of service, stand out on the right end of the bell curve. Now mind you, being on the right side of the bell curve or being an "outlier" is not necessarily a bad thing. But if you are going to be a "pioneer", be prepared for lots of potential negative push back from carriers, simply because you are not in step with your peers. And by your peers, I mean all providers of AFOs, not just podiatrists. Currently, the data simply is not in line with bilateral dispensing of AFOs.


As for the time period mentioned by Dr. Shavelson, I believe he was referring to the Same or Similar issue, which somewhat precludes a new AFO within a 5 year (not 3-5 as mentioned in his LTE) period. While the Same or Similar period can be overcome through appealing to your DMEMAC and meeting the requirements stipulated in the LCD (new diagnosis, change in anatomy, physiology, etc.), it's no slam dunk to a successful appeal. If your appeal fails, you may... 


Editor's note: Dr. Kesselman's extended-length letter can be read here.



From: Elliot Udell, DPM


At the expense of insulting friends and colleagues who have a vested interest in balance braces, allow me to give my personal experiences with them. When these products first became available, I attended many sponsored lectures on them and it was exciting. Having lost a grandparent as a result of a fall, I wanted to do anything and everything to help my patients prevent unnecessary falls, so I dispensed many pairs of balance braces to patients. My findings were that the patients who used them did well and reported back greater stability and less falls.


The problem is that the devices are bulky, often hard for an elderly patient to put them on, and most of the patients stopped using them. Some were open and honest about it. Others said they were using them but when they came into my office for some "mysterious" reasons they never had them on. Yes, I truly believe they have value but the rate of compliance in my patient population was not there. I am, however, open to revisiting the issue of balance braces if they can be rendered more comfortable so that my patients will use them.  


Elliot Udell, DPM, Hicksville, NY



From: Dieter J Fellner, DPM


As a 57-year-old podiatrist (Class 1987, UK, England) who also graduated from the American system of podiatry education in 2016, I have a little insight. I concur 100% with Dr. Markinson. Podiatric and medical education are similar: on paper. Podiatry school attempts to cram in topics in a few hours of 'teaching' that will receive three months of studious attention in medical school. This disparity, among others, is ever more evident when the hapless podiatry resident is thrown into the e.g. vascular service, in residency, charged with the duty to keep the patients safe and attempt to match the effort of the medical resident. A plea to the movers and shakers of podiatry education: wake up and smell the coffee. That's just an absurdity.


I will also agree that if podiatry were ever to follow the model of the osteopath, in the quest for 'parity', podiatry will wither away. I, for one, am quite happy with what I know, and what I can do. Had I wanted to work as an MD, I would have gone to medical school, not podiatry school.


Dieter J Fellner, DPM, NY, NY



RE: Using the DPM Degree Outside of Podiatry 

From: Bryan C. Markinson, DPM


I have stayed away from this discussion (but Alan Sherman drew me in) because I feel the hard facts as I see them regarding podiatric medical/medical/DO equivalency are also going to be hard truths.


First of all, the notion that a gynecology course and psychiatry course evens up the score is an outrageous fantasy. It does so only on paper. The milieu, structure, oversight, support, etc. in a medical school is different than...


Editor's note: Dr. Markinson's extended-length letter can be read here.



RE: Using DPM Degree Outside of Podiatry 

From: David S. Wolf, DPM, Robert Scott Steinberg, DPM


With only a 45% pass rate for the ABFAS Certification test, maybe the USMLE will be easier? Maybe that is one of the reasons that younger DPMs are looking outside of their DPM degrees for more realistic opportunities. The ABFAS needs to make their requirements to even sit for the exam more seamless as well as make the exam more relevant and less esoteric (I was board certified with ABFAS).


David S. Wolf, DPM, Retired, Houston, TX 


What should we do to the podiatry colleges that refuse to add Ob/Gyn, Peds, and Psych? Does your alma mater offer these courses? Are you a member of the alumni association? If so, would you contact them and let them know you expect them to offer a modern and complete education? 


Robert Scott Steinberg, DPM, Schaumburg, IL

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