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06/10/2022
RESPONSES/COMMENTS (PM EDITORIALS) - PART 1B
From: Tilden H. Sokoloff, MD, DPM
Dr. Block asks, “Who wants to be a podiatrist?” Dr. Fellner discusses how non-professionals appear to charge more for routine foot care than podiatrists. Dr. Davis shows how logic plays into this ongoing scenario for DPMs, if we just take action toward parity at all levels including plenary licensure. Past APMA President Jeff DeSantis, DPM, communicated well the need to have our profession at the level of core competencies that could entitle equivalent licensure opportunities to entering classes to podiatric medical schools.
The osteopathic profession can’t open schools fast enough with entering classes of around 150 students in each. There are currently 38 accredited colleges of osteopathic medicine in the United States. These colleges are accredited to deliver instruction at 60...
Editor's note: Dr. Sokoloff's extended-length letter can be read here.
Other messages in this thread:
06/17/2024
RESPONSES/COMMENTS (PM EDITORIALS) - PART 1B
From: Daniel Chaskin, DPM, Jon Purdy, DPM
Board certification should be available to every podiatrist, and no podiatrist should be left behind. All licensed podiatrists should have the ability to take a board certification exam. If they pass, they pass. If they fail, they fail. If cases are required to be presented, the cases should be legally within the scope of podiatry practice for any initial board certification.
Daniel Chaskin, DPM, Ridgewood, NY
Dr. Jacobs, you make perfect sense. This day and age we should all be trained to pass one surgical and podiatric medical board. However, we still have those in the profession who were not surgically trained and some who have been eliminated from the possibility of becoming board certified due to the ambiguous “passage of time” that deemed them ineligible.
It might make sense to have a podiatric medical certification with a sunset for those in need. The other myriad of specializations could certainly have proficiency testing and be deemed something short of “certification” but something of prestige to hang on the wall for all to admire.
Jon Purdy, DPM, New Iberia, LA
06/14/2024
RESPONSES/COMMENTS (PM EDITORIALS) - PART 1B
From: Allen Jacobs, DPM
Personally, I would approach things somewhat differently, Dr. Purdy. I think we should have one board and one board only. We should be in podiatric medicine and surgery. If a person has a particular interest in some area, for example, wound care, limb, salvage, sports medicine or whatever, then if you really feel, compelled to do so offer a "certificate of added qualification”.
I personally do not feel this is needed or would benefit any individual practitioner in the long-term, I think this is a far better solution than continuing with a ridiculous number of board certifications in podiatry. If I treat an athlete with a Jones fracture, my treatment is going to be identical for that patient whether I am “board-certified in sports medicine” or ...
Editor's note: Dr. Jacobs' extended-length letter can be read here.
06/13/2024
RESPONSES/COMMENTS (PM EDITORIALS) - PART 1B
From: Allen Jacobs, DPM
I had an interesting conversation with our chief of orthopedics. We were discussing the two board issue in podiatry. Non-podiatrists find this to be confusing and find this sets us apart from the remainder of medicine. He feels this leads to a lack of credibility for our profession. He looks at orthopedic surgery as an example. Regardless of the residency completed, there is one orthopedic surgery board. If you are an orthopedic surgeon, certified or not, you cannot apply to our hospital for spine privileges unless you demonstrate adequate experience in spine surgery. We can go on from there.
You have orthopedic surgeons who complete fellowships and concentrate, for example, in upper extremity surgery, sports medicine, pediatrics, oncology, and so forth. The point is, however, that regardless of how narrow, the scope of practice an orthopedic surgeon elects to practice, the orthopedic surgeon still must satisfy the requirements for one board. There are not separate boards for feet, shoulders, knees, hips, infectious disease, and...
Editor's note: Dr. Jacobs' extended-length letter can be read here.
10/19/2022
RESPONSES/COMMENTS (PM EDITORIALS) - PART 1B
From: Steven Kravitz, DPM,
Thank you, Vince Marino, DPM for a very compelling argument in your well drafted post as well as comments from Dr. Block that preceded your post. It's time for podiatry to get back to its grass roots, decrease the "over emphasis" on surgical procedures, and increase emphasis on biomechanics and diagnosis of medical conditions, etc. In the past, I ran a general practice emphasizing wound healing and directed a surgical residency program that had as many as 35 internal medicine residents rotating through it yearly. I was fortunate enough to run a private practice while teaching at TUSPM, including at the clinic. During those years, surgery paid substantially more than it does now, with decreased costs. Even during those times when surgery was more lucrative, the biomechanics therapy of my practice was a very important and consistent aspect.
I used basic Root theory for my biomechanical examinations, (approximately $200 for 30 minutes) with a five-minute consultation at the end of the exam, explaining the results. Orthotics were charged separately, I believe $500- $600 at that time. It requires much experience to analyze the nuances of foot pathology, especially in those with complicating diagnoses. Today as I continue to be involved with wound healing, these principles are still core to my therapeutic approach.
I encourage all the young practitioners to more carefully look at the subspecialty. Embrace it, read more about it, and go to courses that can teach you more about it. You can develop a very successful practice with minimal liability, very successful therapeutic results, and happy patients who will continue to refer more patients to you.
Steven Kravitz, DPM, Winston Salem, NC
07/21/2022
RESPONSES/COMMENTS (PM EDITORIALS) - PART 1B
From: Marshall R. Feldman, DPM
In response to Dr. Neuhoff's recent post as it pertains to my CHOSEN profession, let me say that I respectfully disagree with her supposition as well as her suggestion to reinstate the one year residencies of previous years. For those of us who worked tirelessly in order to "further" our profession at both the State and National level as well as at the local level, her suggestions are completely "off base."
The hundreds of man/woman-hours performed by those before me and after me in order to elevate our profession to what it is today, is a testament to what can be achieved by demonstrating the abilities that we have garnered through intensive study and training. This includes as it pertains to the local hospital hierarchy, the local physicians, and yes, the public at large. To even suggest that individuals are choosing to obtain a PA licensure as opposed to applying to our profession, or to even enter either the fields of podiatry and dentistry because it was a "lower investment of time and money," is both erroneous and laughable.
Marshall R. Feldman, DPM (retired), Rahway, NJ
06/25/2022
RESPONSES/COMMENTS (PM EDITORIALS) - PART 1B
From: Judd Davis, DPM
Dr. Brower, you must live in a very podiatry friendly town which surprises me. As I recall, Arizona recently had a law that DPMs couldn't even amputate a toe; maybe that has changed? Bottom line is there is still plenty of discrimination against the DPM going on out there. I am doubtful that most foot and ankle orthopods stand "shoulder to shoulder" with DPMs during their schooling/residencies and so have no clue as to our training or capabilities. Nor do most of them care as we are direct competition for them. In my town, there are younger generation orthopods who actively joust and badmouth podiatrists when their patients end up there for second opinions.
I am currently on call at a hospital system that does not pay podiatrists for taking that call. If a podiatrist wants privileges there, they are forced to take call pro bono. Be assured, the orthopedists are paid for that service. For prospective students out there, I would say if you want the respect and pay grade of an orthopedist, then you should go that route. I'm sure things are better now for DPMs than 40 years ago, but let's not sugarcoat it; all is not equal.
Judd Davis, DPM, Colorado Springs, CO
06/24/2022
RESPONSES/COMMENTS (PM EDITORIALS) - PART 1B
From: Bryan Markinson, DPM
It's sometimes hard to be truthful about our problems without being accused of being anti-podiatry, and in the case of Dr. DiResta's post, partially responsible for the decreased interest in podiatry among college students. In my experience with a few thousand students and a few hundred residents, and the vast majority of my colleagues, I am quite sure that not a single one ever questioned my passion and love for podiatry.
Dr. DiResta states emphatically that he has no problem with podiatrists saying they went to medical school. Okay, but people who did go to medical school, and regulate and certify medical schools, do have a problem with it. When that problem is solved, by "filling in the gaps" as he says, who does Dr. DiResta think will be saying...
Editor's comment: Dr. Markinson's extended-length letter can be read here.
06/23/2022
RESPONSES/COMMENTS (PM EDITORIALS) - PART 1B
From: W. David Herbert DPM, JD
I grew up on a cattle ranch in California and our family veterinarian reminded me that animals were not covered by health insurance. I was a pre-vet major in college. In 1965, there were 13 veterinary schools and 10 optometry schools nationwide. Today, there are over 20 optometry schools and over 30 veterinary schools. I am sure there are a number of optometrists and veterinarians who would love to be a podiatrist if they could be given advanced standing in podiatry school. Just a thought.
W. David Herbert DPM, JD, Billings, MT
06/23/2022
RESPONSES/COMMENTS (PM EDITORIALS) - PART 1B
From: Richard M. Maleski, DPM, RPh
I've been following with great interest the different opinions as to why our applicant pool is so low compared to the MD and DO schools and I'm surprised that no one has mentioned one obvious factor: "routine" foot care. I would imagine that most mainstream podiatric practices still involve doing a fair amount of regularly scheduled RFC, and I doubt that most young people interested in a career in medicine want to spend a substantial portion of their day trimming or debriding toenails.
Is this part of practice necessary? Absolutely yes! The need is there, especially in the geriatric and at-risk population. But why should a DPM, with 4 years of undergraduate education, 4 years of podiatric medical education, and 3 years of comprehensive medical and surgical training be required to be...
Editor's note: Dr. Maleski's extended-length letter can be read here.
06/21/2022
RESPONSES/COMMENTS (PM EDITORIALS) - PART 1B
From: James DiResta, DPM, MPH
In reading some of these comments, you might wonder why any potential applicant would want to be a podiatrist. Really? Why do some of our most esteemed colleagues belittle podiatry school training and perpetuate the myth that there is no resemblance of parity with our MD/DO colleagues? Why? When podiatrists post medical treatments in this blog that some perceive as beyond their scope, they immediately call foul! Why? And knowing our residency programs today, how can they comment that somehow our residencies would never be acknowledged by ACGME? If you don't want parity, you won't ever get it.
I love being a podiatrist and I am forever advocating for our profession and for parity, especially with hospital privileges and third-party reimbursement. Knowing the large variation in educational training programs between...
Editor's note: Dr. DiResta's extended-length letter can be read here.
06/20/2022
RESPONSES/COMMENTS (PM EDITORIALS) - PART 1B
From: Robert Kornfeld, DPM
Dr. Trepal is upset that an applicant to NYCPM withdrew his or her application because of a post regarding a negative view of the current state of podiatry. Dr. DiFeo asserts that it is purely the love of helping others that should motivate one to become a podiatrist. A number of years ago, I lectured to a room with about 200 podiatrists in attendance. I asked, “Please raise your hand if you love being a podiatrist.” TWO podiatrists raised their hand.
I was taken aback but not surprised. Do we continue to ignore the elephant in the room? Why do this if you cannot make the kind of living commensurate with the amount of education and on-going training required of today’s podiatrists? Sorry Dr. DiFeo, but altruism does not pay the bills and certainly would not motivate me to become a ...
Editor's note: Dr. Kornfeld's extended-length letter can be read here.
06/17/2022
RESPONSES/COMMENTS (PM EDITORIALS) - PART 1B
From: William DeFeo, DPM
Interesting that Dr. Feinberg’s self-professed “proudest moment” was the suggestion that he supposedly had an income greater than a plastic or vascular surgeon. In my opinion, this conclusion represents exactly what is wrong in medicine in general. When financial success is the major goal, to paraphrase Sir William Osler, you have lost the true spirit for which you entered medicine. My proudest moments have been those occasions in which physicians praised my competence and have accepted me, a podiatrist, as their intellectual and academic equivalent as a healthcare provider. Respect for your care is far more rewarding than respect for your wallet.
As I look back on 45 years of podiatry practice, I feel compelled to write about the discussion of parody with medicine. When I read my classmate Dr. Larry Oloff's letter, I couldn’t agree more. Maybe because of my own ignorance, I felt after finishing my residency that I was competent...
Editor's note: Dr. DeFeo's extended-length letter can be read here.
06/16/2022
RESPONSES/COMMENTS (PM EDITORIALS) - PART 1B
From: Dale Feinberg, DPM
A recent posting by Lawrence Oloff caught my attention when he stated, “I would not claim to be smarter than anyone else in our profession and anyone else could have done the same.” Thanks Larry of the vindication of my career.
I came from a generation when only 50% of the 600 graduates in 1981 got a one-year residency. I failed to place in one of these coveted spots even though I graduated in the top 10% of my class. By the time that our fourth year rotations began, all spots were already allocated. Like a baby bird, I was kicked out of the nest and on my own. My first surgery, an arthroplasty 5th digit left, was performed in private practice. The extent of my CCPM surgical experience was throwing one simple interrupted stitch during a surgical...
Editor's note: Dr. Feinberg's extended-length letter can be read here.
06/15/2022
RESPONSES/COMMENTS (PM EDITORIALS) - PART 1B
From: Michael M. Rosenblatt, DPM
When I was in podiatry school, there was an unremitting negative chorus from some students. It was tiresome and sad. Worse, it was mostly inaccurate. When I graduated, hospital privileges were the main lack of parity. That problem ended. Lack of parity still exists in some forms. But it didn’t affect me.
Allopathic physicians don’t have everything. Not only did they themselves die taking care of Covid patients, but also were not allowed to prescribe drugs their plenary license permitted. I had never seen this before. I’m not arguing against parity, which by the way, we earned. But I am not a...
Editor's note: Dr. Rosenblatt's extended-length letter can be read here.
06/15/2022
RESPONSES/COMMENTS (PM EDITORIALS) - PART 1B
From: Elliot Udell, DPM
There is an elephant in the living room that none of us is addressing. Podiatry has changed since I entered the profession 40 years ago, but so has the business of medicine. Forty years ago, when an MD or DO finished his or her training, they would either start or buy into a private practice. Today, private practices in all facets of medicine are becoming extinct. Corporations and hospitals are taking them over, rendering physicians employees of larger entities. Most MD and DO grads today have no wish to enter private practice but apply to and are accepted at well-paying jobs either at hospitals or in outpatient settings. These same businesses are also hiring PAs and other non-MD, -DO professions at huge starting salaries.
My next door neighbor completed a two-year program in some non-doctoral pulmonary field and was offered $150,000 as a starting salary. Bottom line: Can we guarantee a graduate with a DPM, completing a residency, a high paying job as the MD, DO and ancillary medical world can? If the answer is "no, maybe, or perhaps," that explains why our applicant pool is shrinking.
Elliot Udell, DPM, Hicksville, NY
06/14/2022
RESPONSES/COMMENTS (PM EDITORIALS) - PART 1B
From: Robert G. Smith, DPM, MSc, RPh
Of course, I defer to the learned colleagues, leaders, and giants of the profession who have imparted the audience with their thoughts and opinions. I sincerely thank them for their work and insight. I have attempted to lead an effort to research and create continuing education experiences centered on state mandated courses that I felt needed a podiatric approach and data: HIV-AIDs, medical errors, medical ethics, human trafficking, and opioid prescribing and monitoring.
In the past, I felt our podiatric profession was neglected by allopathic/osteopathic professions, and nursing as state podiatry boards offered and approved programs from the above professions. My interpretation to this action is summed up in the word: “PARITY”.
Recently, I applauded all the work performed at the congressional level for Veterans Affairs parity. We as a profession travel the yellow brick road on our way to Oz and encounter travelers with views that differ from ours yet add to our collective consciousness; thus we learn and become better professionals for the betterment of our patients.
Robert G. Smith, DPM, MSc, RPh, Ormond Beach, FL
08/09/2021
RESPONSES/COMMENTS (PM EDITORIALS) - PART 1B
From: Eddie Davis, DPM
Sorry, I am a bit of a latecomer to this discussion but after reading Barry Block's editorial, “We Have Met The Enemy and It is Us” as well as Tilden Sokoloff’s response, more questions arise.
According to the Wikipedia article on the USMLE: “The USMLE assesses a physician's ability to apply knowledge, concepts, and principles, and to determine fundamental patient-centered skills that are important in health and disease and that constitute the basis of safe and effective patient care. Examination committees composed of medical educators and clinicians from across the United States and its territories create the examination materials each year. At least two committees critically appraise each test item or case, revising, or discarding any materials that are in doubt. The program intends to provide state medical boards in the United States with a common examination for all...
Editor's note: Dr. Davis' extended-length letter can be read here.
Having presented both sides of this issue for over a week, this topic is now temporarily closed.
08/06/2021
RESPONSES/COMMENTS (PM EDITORIALS) - PART 1B
From: Sabrina Minhas, DPM, James Hanna, DPM
We are writing to address the PM editorial comments offered on the topic of the APMA-endorsed White Paper and AMA Resolution submitted to the AMA House of Delegates for its consideration last June. This is a problem which needs to be examined on two levels. The first level is an examination of the “ends”; and the second level is an examination of the “means.” Dr. Block quotes philosopher George Santayana in support of the APMA actions. One level of our concern is that the actions of the APMA are also burdened by Machiavelli’s; “The ends justify the means.”
In his editorial, Dr. Block cites three examples of “opposition” to seminal developments in the profession of podiatry. The first is the professional change from the term chiropody to podiatry. This was accomplished through: “…a late-night Parliamentary maneuver in 1957 to finally get it passed.” The second example was...
Editor's note: To read the extended-length letter of Drs. Minhas and Hanna, click here.
08/05/2021
RESPONSES/COMMENTS (PM EDITORIALS) - PART 1B
From: Jon Hultman, DPM
Taking and passing the USMLE is the true path to parity. DPMs are the only healthcare practitioners whose training includes a minimum of four years of podiatric medical school and three years of residency training that do not hold a plenary medical license. Because of this, DPMs are not considered physicians, are lumped with chiropractors and optometrists as providers of optional services under Medicaid, and must constantly amend state bills to include DPMs whenever those bills use the term “physician.” Every advancement that has been made in podiatric medicine has been considered a victory because it gave DPMs a benefit or privilege that MDs and DOs already had. This process has moved us incrementally closer to MDs and DOs, but in spite all these small “victories,” this will not win our “war for parity.”
The only achievable pathways that have been available for DPMs to attain true parity with MDs and DOs were to go to an LCME accredited medical school or a COCA accredited osteopathic school to obtain am MD or DO degree, or to obtain a dual degree by taking additional years of education at an...
Editor's note: Dr. Hultman's extended-length letter can be read here.
09/24/2018
RESPONSES/COMMENTS (PM EDITORIALS) - PART 1B
From: Richard Bloch, JD
I am responding to the editorial in the September issue of Podiatry Management. (“Podiatry’s Continuing Identity Crisis”). The Maryland Podiatric Medical Association (MPMA) had a bill introduced in this year’s legislative session (January-April 2018) to change the term “podiatrist” to “podiatric physician” in the Maryland Code. Although the bill did not pass, we will continue this effort. With this in mind, there are several concerns regarding the editorial.
The survey apparently did not include the term “podiatric physician”, yet Dr. Block concludes it “would be appropriate [to change to podiatric physician] only with a...
Editor's note: Mr. Bloch's extended-length letter can be read here.
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