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01/13/2020
RESPONSES/COMMENTS (NON-CLINICAL)
From: Elliot Udell, DPM, Vladimir Gertsik, DPM
There are some less expensive programs you can buy to e-prescribe. One is Veradigm.com. It’s part of Allscripts. They have plans that range from 9 to 18 dollars a month. There are other programs as well. Check them all out.
Elliot Udell, DPM, Hicksville, NY
For those who are near retirement, you can ask your state for exemption. Go to their website and try to find it.
Vladimir Gertsik, DPM, NY, NY
Other messages in this thread:
05/15/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1 B
From: George Jacobson, DPM
It is really simple. The applicant pool is showing the lack if interest in spending 7 years to become orthopedic surgeons of the foot. It takes 7 years to get licensed even if you don’t want to primarily practice surgery. How many medical students want to be orthopedic surgeons? We chose podiatry so we could do it all, not just surgery. How many of us would not have chosen podiatry if it took 7 years to get licensed? That is 11 years post high school graduation.
A lot could be done in 11 years, without the expense. One could be 11 years closer to a pension, have savings, and a family. We may have ruined a simple path to success that we knew as podiatry.
George Jacobson, DPM, Hollywood, FL
05/15/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1 A
From: Rod Tomczak, DPM, MD, EdD
On October 19, 2021, The USMLE replied to the podiatry task force made up of our alphabet organizations. USMLE dealt us an unequivocal denial of our petition to take the USMLE in search of a plenary (not limited to body part) medical license. Some years ago, Len Levy, DPM persuaded Larry Jacobson, DO, the dean of Des Moines University, to allow a select group of DPM students to take COMLEX level 1 after the second year of school, around the time of the DPM boards, so our students were "studied up." Only 10% passed the COMLEX. We never told the students the results.
We do not teach the same curriculum of medical school. Because there is a 4-4-3 model does not mean everything is the same. We are not one childbirth and a bipolar patient away from and equal curriculum. The third and fourth years are miles apart as far as clinical experience goes, and there is no comparison. We do not have a month of dedicated pediatrics, ED, neurology, women's health and pregnancy, or psychiatry. Letting our students take these tests without the proper preparation would deliver a devasting blow to their self-esteem. Let's do things the right way rather than trying to sneak in the back door.
Rod Tomczak, DPM, MD, EdD, Columbus, OH
05/14/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 3 B
From: H. David Gottlieb, DPM, Ivar E. Roth, DPM, MPH
Dr. Hultman hits the nail on the head. The MD degree does nothing for anyone unless they are going into pure research. What matters is one's license. That determines what one can do. Fight for the plenary license with our current education and training, not another degree.
H. David Gottlieb, DPM, Baltimore, MD
I agree with Dr. Hultman's solution that a plenary medical license could very well work for our profession, but I also know that these discussions have gone on for over a decade and from what I can see, nothing has happened here in California. I would appreciate hearing more from Dr. Hultman on what it would take and when he thinks this could really happen. The time is now and the profession needs this upgrade now, so please tell us what needs to happen.
Ivar E. Roth, DPM, MPH, Newport Beach, CA
05/14/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 3 A
From: Amol Saxena, DPM, MPH
Dr. Hultman writes that MD programs are shortening school, particularly for primary care. My MPH thesis was on this very topic and it was discussed in Congress. About 1/3 of US MD & DO programs are "accelerated". There are even three accelerated programs for orthopedics including at Duke and Penn State. I even wrote an article on this for KevinMD:
Dr. Hultman also writes that we just need to be able to take the USMLE or COMLEX. However, two years ago at the AMA convention they stated the "case is closed" for DPMs to take the USMLE. This could be due to other political factors such as opening the door to other much larger medical professions that...
Editor's note: Dr. Saxena's extended-length letter can be read here.
05/14/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
RE: Bringing a Podiatric Voice to the Global Sports Medicine Stage
From: Karli Richards, DPM, MHA
I’m excited to share a recent milestone in my work as a podiatric surgeon and sports medicine specialist. I recently presented findings from my pilot study, Protect Our Players (POP) at the 2025 FIFA Isokinetic Conference in Madrid. This research explores key injury risk factors in female soccer players — including cleat design, playing surface, strength and conditioning, and menstrual cycle tracking.
As a board-certified foot surgeon with a Master’s in Healthcare Administration, I’ve focused much of my career on improving injury prevention for female athletes. I currently serve as a podiatric medical content advisor for U.S. Soccer’s Recognize to Recover initiative, helping develop educational materials on biomechanics, footwear, and athlete safety. I also work with IDA Sports on female cleat and shoe design.
The POP survey is now expanding nationally to include youth clubs, collegiate programs, and professional teams. Future research will build on these findings to support cleat innovation and integrate hormonal tracking into performance and injury risk strategies. I’m passionate about bringing a podiatric perspective to the forefront of global sports medicine and contributing meaningful data to improve outcomes for female athletes.
Karli Richards, DPM, MHA, Chambersburg, PA
05/14/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: Intoxicated with Podiatry
From: Rod Tomczak, DPM, MD, EdD
I have been looking at the periodicals published by the schools which I view as grand advertising campaigns. Of course, we highlight the accomplishments of recent graduates costumed in their not green any more greens. The central part of the picture is usually the terms “foot and ankle surgeon” and the text emphasizes how grateful he or she is to the school even though we know the residency program is really the tool responsible for later accomplishments. As of late, there are headlines bragging about the 100% residency placement. That may impress some 70 something year-old podiatrists who reminisce how difficult it was to get a residency. These septuagenarians don’t know there are currently more residencies than graduates.
It might be more reflective of a school’s success in resident placement if the headline read, “93% of Best Medical College of Podiatric Medicine are Placed in their First Choice of Podiatric Residency,” when there are only 24 graduates. This good press is at least remotely intended to bolster the ...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
05/13/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
RE: Do We Really Have a Medical Degree? (Gary S. Smith, DPM)
From: Rod Tomczak, DPM, MD, EdD
I appreciate Dr. Smith's admission that he has never heard of a broken screw extractor set. As Clint Eastwood said, "A man's got to know his limitations." Directions on how to use the many different types are readily available on reputable surgical sites such as Facebook, YouTube, and others offering "how to videos." Original internal fixation screws were not always made of the best materials like they are today. So, if a patient had a a painful, broken screw, they often wanted it extracted. So, the consent form usually read, "extraction of painful internal fixation device." It would be a real disappointment to the patient if it had to be left in the foot or ankle and the patient referred to someone more familiar with the instrumentation.
Sometimes things get left in the patient and they shouldn't be. When Woody Hayes had his gall bladder removed, a sponge was left in his abdomen and had to be removed the next day. Rumor has it the surgeon came from Michigan and the first assistant from Pennsylvania. I wonder if McGlamry, Mann, and Meyerson were too busy to operate or write textbooks or articles. In order to save them time, the ICD and CPT codes are ICD-10 84.293 and CPT 20680 for a painful internal fixation device and its removal.
Rod Tomczak, DPM, MD, EdD, Columbus, OH
05/13/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1 B
From: Paul Kesselman, DPM
There is no doubt that with the current class sizes we will cause our own extinction and we must do something about that. The question is will a DO degree accomplish that goal? Will students going to DO schools choose podiatry as a specialty, and/or are we to continue as a profession. In the mid ‘70s, there were five schools turning out a total of about 750 new graduates a year. Now we have more than double that number, and we are graduating nowhere near 750.
In the mid ‘70s and very early ‘80s, there were an insufficient number of residency programs. Now we can fill them all and some are not filled. So, we have gone places in the past fifty years or so since I first thought of attending podiatry school that I never thought possible. As for the negatives, we have no one but ourselves to blame by continuing to...
Editor's note: Dr. Kesselman's extended-length letter can be read here.
05/13/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1 A
From: Jon Hultman, DPM, MBA
We do not need a medical degree. What we do need is a medical license – a plenary license. We are the only medical-surgical specialty that does not have a plenary license. In California, the medical and orthopedic associations are willing to support DPMs in our quest for a medical license as long as we take “their test” – either the USMLE or a modified version of the COMLEX.
A dual degree (DPM/MD or DPM/DO) would get DPMs a medical license only if they completed a three-year DO or MD residency. DPMs would also need to complete a comprehensive podiatric residency to become board certified in podiatry. We do not need extra years of education, training, and expense because we already have the same education model as medicine – four years of undergraduate education, four years of professional education, and three years of residency (the 4-4-3 model).
Some medial schools are now testing programs to truncate medical school to three years if a student declares s/he wants to go into primary care. Does declaring a specialty at the front-end of professional education sound familiar? MDs and DOs have plenary medical licenses upon completion of residency programs. DPMs have a limited license upon completion of their residencies, but they can, and should be, the next degree to qualify for a medical license. We simply need to access either the USMLE or COMLEX to make the DPM degree equal to the MD and DO degrees.
Jon Hultman, DPM, MBA, Los Angeles, CA
05/12/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2 C
From: Robert Scott Steinberg, DPM
CPME's answer is to charter more schools in the face of declining enrollment and its refusal to require proper courses in neurology, psychiatry, and pediatric medicine. The profession also needs two-year residency programs for those who do not want to be surgical podiatrists, which would require a change in most states' practice acts. The APMA was the one that drove component societies to change their practice acts to require a 3-year residency.
Robert Scott Steinberg, DPM, Schaumburg, IL
05/12/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2 B
From: Ivar E. Roth, DPM, MPH
I like the idea of being absorbed by the DO schools and doing a legitimate 1-year general internship and then a 2- or 3-year surgical residency. That seems about perfect. We truly have a recognition problem with the DPM degree. It is also a shame the nurse practitioners and other allied professionals can work on the entire body, and we have to think twice about putting an IV in the hand if we are in or out of our scope of practice. I do not think the profession will wither and be gone but we definitely need to do some serious PR.
Ivar E. Roth, DPM, MPH, Newport Beach, CA
05/12/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2 A
From: James DiResta, DPM, MPH
In response to Dr. Meltzer's question, Why are there new podiatry schools being created if we are on our "last legs"? I believe the answer is two-fold, as the old adage goes "follow the money" and secondly, knowingly or not, the powers to be see it as a chance of survival.
The podiatry profession that has existed for the past 50 years cannot continue. It just can't. It is being swallowed up from the top down and bottom up. It couldn't be more obvious but we continue to do very little, hoping a Band-Aid here or a Band-Aid there will plug the leaks and eventually these forces will just go away. They won't. The profession made a calculated mistake that those of us who fought the system got caught up in. We fought for increased scope of practice based solely on the anatomy of the...
Editor's note: Dr. DiResta's extended-length letter can be read here.
05/12/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: THIS NEEDS TO BE THE YEAR WE MAKE A STAND!
From: Farshid Nejad, DPM
I have heard Dr. Kesselman voice his concerns on how physicians are being manhandled by insurers, including Medicare. Medicine has been complacent about standing up for our rights to be autonomous and getting reimbursed fairly. Know that this complacency has led to the momentum to silence us completely by creating so many regulatory requirements and, more importantly, financially stifling us to weaken our monetary ability to lobby. When we cannot afford to support ourselves, let alone our national associations, we will have very few options to fight. WE HOLD ALL THE CARDS, yet we do not know how to play them.
We need to ask for a raise, we need to stop MIPS reporting penalties, we need to create reciprocal and equal rules for audits and look backs (if we get one year to bill, Medicare should only get one year to audit), we need to remove the pay difference in POS 31 vs POS 32 in SNFs. These injustices are just the tip of the iceberg of the laundry list of issues that REQUIRE CHANGE. This affects all physicians, not just podiatrists. We need our associations to contact the news networks to publicize these issues (free advertisement). THIS NEEDS TO BE THE YEAR WE MAKE A STAND!
Farshid Nejad, DPM, Beverly Hills, CA
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
05/09/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1 C
From: Evan Meltzer, DPM
If our podiatry days are numbered and our demise is approaching according to Dr. Tomczak, can someone explain to this old retired podiatrist why more podiatry schools have been recently established? When someone asks me what my profession is, I say that I’m a retired podiatrist. If the general public doesn’t know the scope of our field, who is responsible for disseminating that information?
New Mexico is seriously short of primary care MDs and DOs. As a result, nurse practitioners are often the first primary providers seen by new patients. One of my neighbors who typically accompanies his wife on our monthly hikes was absent from the last hike. When I asked Barbara where Jim was, she said, “Jim is having foot trouble and his primary care provider (a nurse) told him, there’s nothing else that can be done for your foot.” That naive statement just dismissed our entire profession! I asked Barbara a few basic questions about Jim’s complaint and then referred him to one of the several excellent podiatrists in the area whom I know personally.
Jim was fitted with custom orthotics and is doing well. I cringe every time I see TV ads from the “Good Feet Store.” After prescribing custom orthotics for over 40 years, I don’t ever recall a patient telling me that their back pain or foot pain disappeared after one day of wearing these prescription devices, let alone those (paid persons) who claim immediate relief by wearing the OTC arch supports dispensed by the Good Feet store. So, who’s responsible for educating the general public about our beloved profession? Why are there new podiatry schools being created if we are on our “last legs?”
Evan Meltzer, DPM (retired), Rio Rancho, NM
05/09/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1 A
From: Rod Tomczak, DPM, MD, EdD
Although I agree with Dr. Udell's position about being satisfied with the DPM degree we received in the 1970s, I think he is missing my point. The PM News survey of current DPMs concerning their satisfaction with a DPM degree revealed that only 14% of the over 600 responses would settle for a DPM degree and a 3-year residency today if they had the option of earning a DO degree instead of a DPM degree. With the number of applicants to podiatry school dwindling at a rapid rate, it won't be long before podiatry schools will not be able to afford keeping their doors open. At the same time, DO schools have increased to over 35 institutions and offer more options to students when it comes to residency choices. I hope that a residency program offering a 1-year general internship and a 2- or 3-year foot and ankle program will evolve to keep the spirit and efficacy of podiatry alive.
Rod Tomczak, DPM, MD, EdD, Columbus, OH
04/29/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 4
From: Ron Freireich, DPM
I agree with every last word that Dr. Kornfeld writes in his post. The two questions he asks that I feel are most compelling are...Why is it that this problem is not front and center of every discussion? And why is there not a complete commitment on the part of this profession to address the misery, exploitation, and abuse that most podiatrists experience? Yes, why is that? Every stakeholder in medicine should be approaching this issue as if we were fighting for our last breath and nothing else, because I think we just might be. In fact, we may be at the point of no return.
In addition to all the physician issues mentioned by Dr. Kornfeld, I looked up how various hospitals are doing financially here in Cleveland. Four major Northeast Ohio health systems ended 2024 with budget shortfalls in the millions. One major hospital reported a loss of $142 million in 2024. That came after operating losses of $256 million in 2023 and $302 million in 2022. Lately, I have been paying more attention to what I am getting reimbursed by insurance companies and I am utterly shocked. None of this is sustainable for anyone in the medical field. I really don't understand why providers of medical care are not part of the solution for this country's financial healthcare problems, while insurance companies and their investors continue to get rich. If you keep having to bail water out of a ship, the ship is going to eventually sink.
Ron Freireich, DPM, Cleveland, OH
04/29/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Paul Stepanczuk, DPM
Regarding Dr. Tomczak's recent letter looking for an honest man, PM News has apparently found 802 of them. Any prospective candidate for podiatry should be shown the results of PM News’ recent poll regarding the rendering of palliative care. In past issues, palliative care has been described as podiatry's little secret. It's really no secret to those who are in practice, and the amount a practitioner will need to do should not be kept from people who are interested in the profession.
Paul Stepanczuk, DPM, Tinley Park, IL
04/29/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: Kudos to Amerx
From: Ted Mihok, DPM
Our Coupeville Central Lion's Club had a successful trip last month to Mexicali, Mexico. We delivered medical supplies to the most vulnerable people in Mexicali. I especially want to thank the Amerx Corporation for their contribution of wound care items. Amerx has been a sponsor of our International project for years. They continue to give back, and focus on our Lion's club motto of "WE SERVE".
Ted Mihok, DPM, Alameda, CA
04/29/2025
RESPONSES/COMMENTS (NON-CLINICAL) -PART 3
From: Charles Myers, DPM
In my area, there are a fair number of providers outside of podiatry and the wound center of doctors performing wound care. Orthopedic doctors, general surgeons, and family medicine doctors over the last couple of years are wound care specialists now and billing Medicare.
Many of these applications are now being applied at home and being billed by doctors who never made home visits before. And yes, Ortho is doing wound care in my area. I can't help but feel that much of this is money driven.
Charles Myers, DPM, Conway, SC
04/28/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
RE: Wound Care Costs
From: Seymoure Balaj, DPM
When I queried AI about wound care costs, here's what came up. "Yes, recent data indicates that Medicare is now spending more on wound care, specifically on certain types of wound dressings than on ambulance rides, anesthesia, or CT scans. This shift is attributed to factors like Medicare's coverage of wound care in patients' homes and the increasing number of seniors. particularly those with diabetic sores, requiring these dressings."
Seymoure Balaj, DPM, Southfield, MI
04/28/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: Diogenes the Cynic
From: Rod Tomczak, DPM, MD, EdD
Diogenes is partially famous because he spent time carrying a lantern looking for an honest man. He is also called Diogenes the Cynic. A good 30 years ago, I shared some uninhibited conversation and a cup of coffee with Leonard Levy, DPM, the Dean of the Des Moines college. I was a couple of classes into pursuing my education doctorate and we talked about the significance of a doctorate in education as a podiatrist in academia. In a moment of astonishing frankness, Leonard said to me, “I could do so much better for myself if I only had an MPH from Columbia and not a DPM accompanying it.”
I had experienced a taste of the three-tiered medical caste system where MDs were on top, DOs made up the second class, then there were the rest of us who made up the third layer. It was impossible to “tier up” with a DPM degree. The graduation stole, as part of our academic...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
04/23/2025
RESPONSES/COMMENTS (NON-CLINICAL) -PART 2 A
From: Allen M. Jacobs, DPM
The increasing cost of wound care, including the employment of skin graft substitutes, is not a podiatry centric problem. Many factors, such as an aging population, the rise in disorders with which wounds are associated (e.g.: diabetes, PAD, venous disease) have continued to drive the need for wound care. The failure of insurers to provide reasonable or in fact any payment for preventive care is a factor. Socioeconomic issues such as patient access, patient education, patient financial concerns are factors.
The expense associated with dressings, skin graft substitutes, de-facto referral of patient referrals to wound care centers, contribute to the problem. With specific reference to skin graft substitutes, Dr. Geistler notes in PM News that in his experience, skin graft substitutes are not required for the management of most wounds. There are over 350 "skin graft substitutes" available world-wide. Many are extraordinarily expensive, with little...
Editor's note: Dr. Jacobs' extended-length letter can be read here.
04/23/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2 B
From: Ivar E. Roth DPM, MPH
My highest accolades for Dr. Geistler opinions on the overuse and abuse of grafts being used in podiatry. He is right on, and I am proud to call him a true professional. I agree... throw the book at our fellow practitioners who are just milking the system for the dollars and really NOT helping the patients at all.
Ivar E. Roth DPM, MPH, Newport Beach, CA
04/23/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
From: James Hatfield, DPM
The post by Louis Profeta, MD is excellent and should be required reading by all residents, students, and applicants. I'm so tired of hearing all the whining going on about our profession. We have an excellent future and waste too much time obsessing about our degree. Get a life!
James Hatfield, DPM, Encinitas, CA
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