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05/18/2023
RESPONSES/COMMENTS
RE: Unequal Treatment of Ex-Patriot DPMs by ABPM
From: Jeff Carnett, DPM
There are many of us American trained DPMs working overseas who are not eligible to be board certified by either board as we did one or two-year residencies, but not three-year programs. So, how shocking to see that ABPM will certify those with bachelor degrees in podiatry from the UK, SA, Australia, Malta, and New Zealand who did not take the MCAT, have no basic medical sciences in their courses, and no residencies. These degrees are right from high school.
Doesn't that discredit anyone with the ABPM certification in the U.S.? So, we expatriate DPMs need to take a bachelor podiatry degree so we can get certified, but we can't get certified with a CPME-approved DPM degree and residency? I’m trying to understand how that helps the profession. While overseas, our work is often highly surgical, but alas that doesn't count.
Jeff Carnett, DPM. Auckland, New Zealand
Other messages in this thread:
07/06/2026
RESPONSES/COMMENTS (STUDENT ENROLLMENT) - PART 1A
RE: The Most Radical Proposal Yet
From: Rod Tomczak, DPM, MD, EdD
To save the profession I think it’s necessary to cater to the consumer. The first consumer is the student. What keeps us from offering a completely different curriculum at each of the schools, allowing the potential student the opportunity to choose the path he or she will best benefit them? The quick and dirty answer is CPME? There may be CPME members with academic titles, but there are no dedicated educators with hands-on, contact, advanced education degrees in philosophy, methods
or curriculum.
Let’s say the New York College wants to offer the traditional four-year DPM degree to the students with a bachelor’s degree and emphasizes the current three-year residency. They fine-tune their curriculum to complete that mission and advertise their unique plan in a universal advertisement that will describe all the schools’ programs. All the schools. All the schools together in one advertisement. Unity will not only save money but...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
07/06/2026
RESPONSES/COMMENTS (STUDENT ENROLLMENT) - PART 1B
From: Jon Hultman, DPM, MBS
Dr. Solomon makes a compelling argument regarding all of the aggravating factors that make practicing medicine and surgery less enjoyable than in past years. That being said, I do not believe that this explains the podiatric recruitment crisis. Every MD and DO physician experiences the same kinds of aggravation while practicing medicine; however, MD and DO medical schools are not experiencing the same decline in the number of applicants.
There are 142 specialties and subspecialties of medicine that are recognized by the American Board of Medical Specialties (ABMS). Our specialty is the only one that trains for seven or eight years that does not receive the same plenary license that every other specialty receives. While there may likely be many lesser factors affecting applications, I strongly believe that graduates receiving the same limited license I received in 1970 is likely the major reason for the decline.
Jon Hultman, DPM, MBS, Los Angeles, CA
07/06/2026
RESPONSES/COMMENTS (MEDICAL ECONOMICS)
RE: The Economic Value of Being an Associate
From: Sev Hrywnak, DPM, MD
Here’s why spending $400,000 (undergraduate and graduate) on medical education might not make economic sense if you only end up as an employee.
1. Opportunity costs and expected return on investment (ROI)
The upfront cost of medical education is substantial: tuition, fees, living expenses, and time out of the workforce. If the career path ends with employment, the long-term financial upside may be limited by a capped salary, promotion pace, and limited ownership opportunities. Opportunity cost analysis compares the present value of potential alternative careers (or entrepreneurship) against the guaranteed but potentially modest salary path.
2. Salary growth and lifetime earnings uncertainty
Early-career salaries for medical graduates can be solid, but long-term growth depends on...
Editor's note: Dr. Hrywnak's extended length letter appears here.
07/04/2026
RESPONSES/COMMENTS (STUDENT ENROLLMENT) - PART 1B
From: Elliot Udell, DPM
Dr. Solomon makes a valid point. The practice of medicine is inundated with hassles and they come from every angle and almost every day. When I started podiatry school back in the 1970s, my uncle was nearing retirement from his practice in general medicine. He cornered me and gave me stern advice. He said, "Elliot, the only two things you have to offer a patient are your time and your knowledge."
Today, as Dr. Solomon so eloquently stated, doctors are inundated with all sorts of paper and computer work, as well as being accountable to numerous government agencies and, of course, the insurance companies that are paying us less and less every day. This is why so many MD and DO practitioners as well as new graduates are opting to work for corporations and hospital-owned practices. Unfortunately though, when working for these corporate entities, doctors find they sold themselves to "the devil". No hassles, but less time can be spent with patients.
Elliot Udell, DPM, Hicksville, NY
07/04/2026
RESPONSES/COMMENTS (STUDENT ENROLLMENT) - PART 1C
From: Bret Ribotsky, DPM
Since my letter on the podiatric enrollment crisis appeared in PM News, I have received a meaningful volume of private correspondence from colleagues across the profession — practitioners, educators, and organizational leaders. I am grateful for the engagement. The responses were thoughtful, and several came from individuals whose standing in this profession I genuinely respect. Because they were shared privately, I will not attribute them by name, but I believe the arguments they raised deserve a public answer, because they reflect exactly the kind of institutional thinking that I believe is preventing this profession from moving forward.
The responses I received shared a common architecture. Each acknowledged, to varying degrees, that the economics are real, that student recruitment is suffering, and that the profession has struggled with unclear messaging about its identity. And each, having made those acknowledgments, arrived at the same conclusion: the answer is a ...
Editor's note: Dr. Ribotsky's extended-length letter can be read here.
07/04/2026
RESPONSES/COMMENTS (STUDENT ENROLLMENT) - PART 1A
From: Pete Harvey, DPM
Dr. Solomon modestly states he never set the world on fire. I disagree. Dr. Solomon is a firebrand. We are 50-year associates. In all that time, he always showed up. Not sometimes, not every now and then, but every time. Kudos to Dr. Solomon.
Pete Harvey, DPM, Wichita Falls, TX
07/02/2026
RESPONSES/COMMENTS (PODIATRISTS IN THE NEWS)
From Ron Werter DPM
Congratulations to Dr. Garoufalis for his award from his alma mater, Heidelberg University. But is he or almost anyone else in our profession aware that the founder of the first podiatry school, M. J. Lewi, MD was a graduate of the original Heidelberg University in Germany?
At one time for a strange reason, I had a framed photo of Dr. Lewi's graduating class from Heidelberg U. in my waiting room. Dr. Garoufalis should grow a long beard so he could fit right in.
Ron Werter, DPM, NY, NY
07/02/2026
RESPONSES/COMMENTS (STUDENT ENROLLMENT) - PART 1A
From: Carl Solomon, DPM
I’m now retired. Looking back, I think the enrollment crisis goes beyond simply looking at the economics. I attribute a large portion of it to the over-the-top and worsening hassle factor associated with practice.
When I entered podiatry, I was motivated by the satisfaction of helping people, the intellectual challenge of making diagnoses and solving problems, being able to administer treatment and see positive responses, forming long-lasting relationships with my patients and those with whom I worked. I enjoyed a successful private practice, did my share of surgery, established a very good reputation in my medical community, was chief of the podiatry service at a major hospital, never really set the world on fire but made a living that I was happy with.
Then one day it happened. The door to my reception room...
Editor's note: Dr. Solomon's extended-length letter appears here.
07/02/2026
RESPONSES/COMMENTS (STUDENT ENROLLMENT) - PART 1B
From: Chuck Ross, DPM
It has taken me some time to reply to the many comments regarding our lack of students engaged in podiatry as a career. There is a great deal to think about and I do not believe there is a wrong or absolutely correct answer to our problem. I have been in practice for 53 years and during that time served in a variety of positions for the APMA, State Society in NY and MA, and several of the colleges. My last college position was Dean for Student Services in NY and was thankfully requested by our president at that time, Lou Levine, to visit as many colleges across the country in an attempt to present podiatry as a career choice.
Most institutions via their pre-med advisor, had very little to no knowledge of what we did or what the future would be like. When I was accepted in 1968 to attend 3 of our colleges, a very close friend of mine applied to medical school and enrolled in a 6-year BS/MD program at one of the Ivy League colleges. He was accepted and completed the program with extremely high grades and practiced in...
Editor's note: Dr. Ross' extended-length letter appears here.
07/01/2026
RESPONSES/COMMENTS (STUDENT ENROLLMENT) - PART 1B
From: Elliot Udell, DPM
The writer espousing that the real underlying problem why some of our podiatry schools are not filling their classes need not hide his name.
He is correct that college seniors do their economic analysis of which medical specialty pays the best. It's not just podiatry; in many communities getting a primary care physician is becoming problematic because general practitioners do not make as much as ophthalmologists, GI specialists, and plastic surgeons, and hence, MDs and DOs are not choosing to become family doctors. This is not just affecting our own profession but is affecting our nation's entire healthcare system.
Elliot Udell, DPM, Hicksville, NY
07/01/2026
RESPONSES/COMMENTS (STUDENT ENROLLMENT) - PART 1A
From: Bret Ribotsky, DPM
Two Roads, and the Cost of Walking Down Neither
For more than thirty years — from podiums across this country, in the pages of this publication, and in every room where this profession’s future was being discussed — I have argued a simple, unfashionable truth: unless you can keep the doors open to your practice, you cannot help anybody. Economics is not a peripheral concern for the practicing physician. It is the pre-condition for everything else. So when the anonymous correspondent frames our enrollment crisis as a pure economics problem, I do not disagree with the diagnosis. I have been making a version of that argument since before many of our current applicants were born.
The debt-to-income calculus is brutal. The downstream comparisons to NPs and CRNAs are damning. The profession’s identity confusion between “surgeon” and “specialist” has left a generation of graduates holding credentials that the credentialing world does not know quite what to do with. These are facts, not provocations — and they are thirty years overdue for a direct response from...
Editor's note: Dr. Ribotsky's extended-length letter appears here.
07/01/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY) - PART 1A
From: Ivar Roth, DPM, MPH
Dr. Keil is so on point with his observations. I see way too many operations being done for problems that can be eliminated or helped with good old podiatric non-surgical treatments.
Today's students and residents are being taught that surgery is the answer and not conservative care. We are losing our way and becoming like the orthopods, with every problem a surgical one. It is not too late, but the skill set of our predecessors will be lost soon if we do not teach podiatric medicine and diagnostics to our current students soon.
Ivar Roth, DPM, MPH, Newport Beach, CA
07/01/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY) - PART 1B
From: Joel A Feder, DPM, Pete Harvey, DPM
Kudos to Dr. Kiel. He has hit the nail on the head. Wake up podiatric medical colleges.
Joel A Feder, DPM, (Retired) Sarasota, FL
Kudos to Dr. Kiel. He is precisely correct. I too have performed thousands upon thousands of bone and soft tissue surgeries. However, I never forgot the practice guidelines taught to me by my father who graduated in 1929, my brother who graduated in 1954, and dozens of other hero podiatrists in Texas and around the country.
Pete Harvey, DPM, Wichita Falls, TX
06/30/2026
RESPONSES/COMMENTS (PM NEWS QUICK POLLS)
From: Rich Hofacker, DPM
I am scratching my head today, wondering why almost 50% of my colleagues who took the recent PM News poll, are opposed to an accelerated six-year undergraduate/podiatric degree. I truly believe that one and maybe two of my children would have gone into podiatry had this change been in effect ten years ago.
What discourages many potential podiatry students is not only the cost, but the number of years it takes to finish the process. So, with enrollment in podiatry schools at an all-time low, our profession continues to keep its head in the sand. Change is inevitable in every facet of life. Why are we so determined to stay on a course that is killing our future?
Rich Hofacker, DPM, Akron, OH
06/30/2026
RESPONSES/COMMENTS (PODIATRIC PRODUCTS IN THE NEWS)
RE: Treace Medical Completes First Surgery with New HyperPlate XM Implant (Vince Marino, DPM)
From: Allen M. Jacobs, DPM
With reference to the "newest and latest", be it surgical instrumentation, a pharmaceutical, whatever, the best question I have heard was from Jack Schuberth DPM. He will listen and ask, "Well Doctor, what is the problem that you are solving?" It is a basic and brilliant question that I ask every time I read about a new wound care product, fixation device, pharmaceutical, anything. Industry informs us of a "problem" they have solved.
As Dr. Marino correctly notes, many of these solutions are expensive and may not provide significant if any benefit to the patients we treat. And yes, sometimes the oldies are goodies. For example, plate fixation vs. two-screw fixation for 1st MPJ arthrodesis. Digital implants vs. simple K-wire fixation. Complex Lapidus...
Editor's note: Dr. Jacobs' extended-length letter appears here.
06/30/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY) - PART 1A
From: Brian Kiel, DPM
Dr. Tomczak’s letter was very thoughtful and a great deal of his opinions are valid, however, I think the major issue concerning our profession is that there is very little podiatry being taught or practiced any longer. The so-called leadership has decided that we are surgeons of the foot, not podiatrists. Too many find it demeaning to debride nails and lesions. Too many have no idea about how to treat patients with orthotics. Everything is surgery, surgery, and more extensive surgery.
I have practiced for over 50 years. I have done lots and lots of surgery, but patient satisfaction is also when an 8-year-old comes in with calcaneal apophysitis that no one else has helped and they come back to you in 3 weeks asymptomatic. It is when an MD allergist that you treat for an ingrown toenail says it must be so satisfying to be able to relieve pain immediately. We have lost ourselves. We need to re-institute basic podiatry and find a way for graduates to practice without a 3-year surgical residency. Don’t eliminate 3-year residencies, just keep them for the few who want and are capable of performing that type of surgery. Allow 1- and 2-year programs that teach what most of us see daily. This allows practitioners to be able to make a good living and also, by the way, reduce the pressure to cheat.
Brian Kiel, DPM, Memphis, TN
06/30/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY) - PART 1B
From: Allen M. Jacobs, DPM
In response to Dr. Tomczak, "The truth you speak doth lack some gentleness/And time to speak it in; you rub the sore/When you should bring the plaster" (Shakespeare, The Tempest)
Allen M. Jacobs, DPM, St. Louis, MO
06/30/2026
RESPONSES/COMMENTS (STUDENT ENROLLMENT)
RE: Solving the Student Enrollment Crisis
From: Name Withheld
With respect to all the commentators here, none of them have set foot near an admissions committee or a basic science curriculum in years, if ever. Everyone is writing from the residency end of the pipeline, mistaking proximity to graduate medical education for actual insight into what's happening at the undergraduate and graduate college level. They are not educators in the sense this crisis requires. They are downstream observers diagnosing a problem they've never had to recruit, admit, or retain a class for.
So let's set the record straight. The driver isn't curriculum structure. It's economics, full stop. Nurse practitioners, non-surgical, autonomous in most states, two to three years of training post-bachelor's, out-earn the median podiatrist. CRNAs clear $300K+ with a fraction of the debt-to-income ratio our graduates carry. Any college senior with a calculator and five minutes on Reddit can run...
Editor's note: Name Withheld's extended-length letter can be read here.
06/29/2026
RESPONSES/COMMENTS (PODIATRIC PRODUCTS IN THE NEWS)
From: Vince Marino, DPM
I constantly read about the latest and greatest hardware developments to assist the podiatric surgeon in performing procedures that have been done for decades. While these inventions appear to be innovative, the problem with them is that the companies developing these charge facilities an exorbitant amount of money, making it impossible for a surgeon to use these devices in a surgery center or even hospital. While the actual implant itself is sometimes reimbursed by the insurance companies, the instrumentation used to perform the procedure with these implants is separately billed by these companies and never reimbursed by the insurance companies. Therefore, surgery center administratiion and hospital administration tell us that we cannot utilize those particular devices because they actually lose money on a surgical case.
Perhaps, these companies could make it so that the instrumentation utilized to implant the devices could be recycled, and therefore they would not have to charge the facility an amount that cannot be reimbursed. Sometimes they tried and true way of doing something the way it has been done for decades is still the most economical for for the facility and works just as well.
Vince Marino, DPM ( retired), Novato, CA
06/29/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY)
RE: Podiatry: A Shakespearian Tragedy in the Making
From: Rod Tomczak, DPM, MD, EdD
In an email last week, Allen Jacobs, DPM sent me several quotes that he felt depicted today’s podiatry status. He felt the opening sentence of A Tale of Two Cities, “It was the best of times, it was the worst of time of times” by Charles Dickens depicted the “where we are today” condition of podiatry. He also sent a few quotes from Shakespeare. The most accurate and poignant from Macbeth, “….so foul and fair a day I have not seen.”
I started thinking about the elements of a tragedy and if we personify and vivify podiatry, and use a little imagination, we have the makings of a true Shakespearian tragedy happening right before our eyes. And if you remember, Hamlet, Macbeth, Othello, Romeo and Juliet, Anthony and Cleopatra, and Julius Caesar, they do not end well for the tragic hero. The three witches in Macbeth make three predictions for Banquo, a companion of...
Editor's note: Dr. Tomczak's extended-length letter appears here.
06/26/2026
RESPONSES/COMMENTS (PODIATRIC MEDICAL EDUCATION)- PART 1A
From: Rod Tomczak, DPM, MD, EdD
There is a third alternative. At Ohio State, we offer an independence study program for the first two years. Students are given assigned readings and at the end of that assignment, which is usually one of the subjects that is being taught in the classroom, students come in and take an exam on the computer. They do have to show up for anatomy and any other clinical lab required class. They can complete the first two years at whatever speed they need. They can take step one of the national boards when they feel ready.
It might be possible to get a student to graduate with an independent study in basic science and then clinical work in three years or less. No one says we have to start residency programs July 1; students can be placed in residency programs outside of the match. We can call it early match just like MDs do for urology.
Rod Tomczak, DPM, MD, EdD, Columbus, OH
06/26/2026
RESPONSES/COMMENTS (PODIATRIC MEDICAL EDUCATION) - PART 1C
From: Donald R Blum, DPM, JD
When I applied to podiatry college in 1973, the California College offered a 3- year program, 36 months; rather than a 4-year (4 nine-month school years).
Donald R Blum, DPM, JD, Dallas, TX
06/26/2026
RESPONSES/COMMENTS (PODIATRIC MEDICAL EDUCATION)- PART 1B
From: Sev Hrywnak, DPM, MD
College seniors increasingly rely on online resources to compare healthcare paths, focusing on cost, time-to-licensure, and scope of practice. When evaluating whether a profession provides a full license after education, the four common tracks are physician assistant (PA), nurse practitioner (NP), medical doctor (MD) and doctor of osteopathy (DO). NPs and PAs practice autonomously in many states and under supervision in other states.
Cost considerations are critical. MD/DO programs typically require the longest training (pre-med, four years of medical school, residency), with high tuition, but potential lifetime earnings can be substantial. PA and NP programs are shorter and less expensive upfront, often resulting in lower debt and earlier entry into..
Editor's note: Dr. Hrywnak's extended-length letter appears here.
06/25/2026
RESPONSES/COMMENTS (STUDENT RECRUITMENT) - PART 1B
From: Tim Vogler, DPM, BS-Mgmt
I did part of my training in the early nineties at the University of Missouri Kansas City School of Medicine. 75% of their medical students at that time were on a six-year track for their MD that started out of high school. They were exceptional students. When they started their internship residency, they were very well equipped, having had years of clinical experience which began in their first year.
The rising costs of undergraduate and professional education makes this pathway very attractive to young students; obviously by shaving off two years of tuition but with the added benefit of “earning” two years earlier which decreases the compound interest effect on their student loans significantly. Of course, the DPM curriculum would have to expand to include the preliminary sciences and courses to ensure communication skills, etc.
Podiatry education has been “streamlined” for decades for our specialty. Dr. Leonard Levy used to famously quote a study on the efficiency of our curriculum in preparing students for our profession (conducted outside of our profession). Podiatry should now capitalize on its background and use this to its advantage as a recruitment tool.
Tim Vogler, DPM, BS-Mgmt, Winston-Salem, NC
06/25/2026
RESPONSES/COMMENTS (STUDENT RECRUITMENT) - PART 1C
From: Jack Reingold, DPM
50 years ago this June, I started my accelerated 3-year program at CCPM in San Francisco. Yes, we were well prepared for a residency, but it was brutal! The answer has always been in understanding the uniqueness of our degree. We are 1 of 3 physician groups under federal regulations. However, we are the only specialty that you have to pick before starting your medical schooling. Our young undergrads and their pre-med advisors just don't know this. They did not 50 years ago and they do not now!
I have had more than a dozen undergrad students come through my office and every one of them became a podiatrist. Residencies for MDs or DOs are very competitive. Many who hope to become surgeons end up as primary caregivers. Nothing wrong with that, but it was not their first choice. What an opportunity podiatry is for undergraduates. Employment for life with great income. Guaranteed 3-year residency. Many sub-specialties, including surgery to pick from. We have failed for at least the past 50 years to educate pre-med advisors and students about what a great opportunity podiatry is. Better late than never to start now.
Jack Reingold, DPM, Encinitas, CA
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