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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:
07/10/2026
RESPONSES/COMMENTS (CATEGORIZATION OF PODIATRIC MEDICINE)
From: Allen Jacobs, DPM
And you want to know why there is a recruitment problem? Why people do not know what a DPM is? What they do?
Allopathic medicine? Of course we practice allopathic medicine. It is a Strawman argument to suggest that only an MD can practice allopathic medicine. By the way, don’t raise that Motte-and-Baily question to the DO who must complete a mandatory course in osteopathic manipulation technique. There are multiple DOs I know who practice osteopathic manipulation techniques.
Maybe, just maybe, if YOU did not engage in the self-deprecation and devaluation of your DPM degree, and concentrated instead on demonstrating a level of clinical, academic, and ethical excellence associated with the DPM degree, some of the issues debated in PM News would be resolved without the constant use of equivocation or red herrings.
When you begin a discussion by stating, "When I graduated medical school,” you assert a foundational, “I am ashamed that I graduated a podiatric medical college or college of podiatry." It is a form of deception, self-deception as well as self-deprecation. If you do not respect yourself, why do you expect others to respect you. Otherwise, sing a chorus of Masquerade from Phantom, because that is what you are doing.
Allen M. Jacobs, DPM, St. Louis, MO
07/09/2026
RESPONSES/COMMENTS (OBITUARIES)
I was also sorry to hear about the passing of Dr. Kay Hara. He was one of the early doers promoting podiatry in California when I was a student at OCPM over 60 years ago. The profession will miss him and so will I.
Steven Berlin, DPM
07/09/2026
RESPONSES/COMMENTS (EQUITY BUY-OUTS)
RE: Are Large Groups Calling Your Office Asking You to Sell?
From: Sev Hrywnak, DPM, MD
Due Diligence Checklist for Podiatric Physicians
1) Deal Structure and Valuation
* Ownership vs. management-only model: current stake and post-transaction ownership.
* Earn-out mechanics specific to podiatry metrics (e.g., procedure mix, surgery volumes, implant reimbursements).
* Valuation basis: surgical margins, implant costs, managed care mix, diabetic foot care volume.
* Exit provisions: buy-backs, partial exits, tail revenue streams (e.g., post-op follow-ups).
2) Governance and Control
* Board composition and physician seats; reserved matters (clinical protocols, implant purchases,...
Editor's note: Dr. Hrywnak's extended-length letter appears here.
07/09/2026
RESPONSES/COMMENTS (CATEGORIZATION OF PODIATRIC MEDICINE)
From: Allen M. Jacobs, DPM
Self-denigration or self-devaluation is the undervaluing of yourself, your status, your achievements. Self-devaluation or denigration is when you refer to yourself as having graduated "medical school". That is self-denigrating your own education. Self-denigrating is hiding your DPM degree. By this very action you establish that you are ashamed of your degree. You devalue your education and degree. You feel less than respected for all that you have accomplished as a healthcare provider.
I want the DPM degree respected. I wish to be respected as a DPM. I desire the colleges of podiatry and subsequent residency and fellowship training to be respected for providing society with competent individuals to evaluate foot and ankle pathology, from onychomycosis to...
Editor's note: Dr. Jacobs' extended-length letter appears here.
07/08/2026
RESPONSES/COMMENTS (STUDENT ENROLLMENT)
RE: Podiatrists Feed their Young: An Innovative Solution
From: Rod Tomczak, DPM, MD, EdD
We’ve batted around degrees, curricula, and recruitment for the last couple of years without resolve. For the most part, we’ve done a great job criticizing but all the education experts in podiatry have shied away from the most important crisis on the doorstep. Where are the students going to find the money to earn one of the gold Doctor of Podiatric Medicine diplomas?
There is a solution, but it will take a leap of faith, teamwork, including APMA, the colleges, and our uber-successful private practitioners to remedy the predicament. Granted, the mention of APMA is usually an impediment by itself, but this is a chance for our Washington friends to serve as both an arbitrator and fixer to help ensure the future podiatrists are not eaten alive; something foreign to both the APMA, the colleges, and those practitioners who keep the banks open. It’s also a chance for all the Luddites who fear any changes in podiatry to step up and put their wallets where...
Editor's note: Dr. Tomczak's extended-length letter appears here.
07/08/2026
RESPONSES/COMMENTS (CATEGORIZATION OF PODIATRIC MEDICINE)
From: Lawrence Oloff, DPM
The debate continues over a plenary degree, the end of podiatry, student recruitment, etc. There are certainly a lot of armchair generals weighing in on a solution. Many have good points to make and I do not want to make light of those. However, very rarely is a bright light comment made on chiropody in these posts. Dr. Jacobs did an excellent job highlighting the changes that many of us have observed on a prior post about podiatrists who are faculty in medical schools, leaders in wound care, the complex surgeries that residents are taught, and so on. Show your board certification credentials and the operating room is yours to practice in, just like any area of medicine.
I think of podiatry as a premier medical profession to enter that is just not marketed correctly and remains mostly unknown to potential students. Does the answer lie in making a cheaper pathway? Maybe. But I think many of the advancements of podiatry are due in part by following the structure of...
07/07/2026
RESPONSES/COMMENTS (NATIONAL PRACTITIONER DATA BANK)
RE: It's Time to End the National Practitioner Data Bank (NPDB)
From: Richard B Willner, DPM
The National Practitioner Data Bank (NPDB) is a 20-year experiment created by an act of Congress along with the Health Care Quality Improvement Act of 1986 (HCQIA). The experiment has failed. It is time to abolish this agency. The NPDB is a blacklist reminiscent of the McCarthy blacklist of the 50s. Instead of targeting the Red Menace, or Communists, the target of this blacklist of the White Menace: “Bad Doctors.”
The problem is that too many good doctors’ names are submitted to this list. And it is disturbingly easy to do. The perception is, if a doctor is included on this list, they must be a bad doctor; otherwise, why are they on the list? The consequences of a listing are dire. As a result of a listing in this “data bank”, many doctors become unemployed and unemployable. For surgeons who must use a hospital operating room, the “data bank” is as permanent as a...
Editor's note: Dr. Willner's extended-length letter can be read here.
07/07/2026
RESPONSES/COMMENTS (CATEGORIZATION OF PODIATRIC MEDICINE)
RE: Podiatric Medicine is Allopathic Medicine
From: David Secord, DPM
I'd like to comment about people in our profession referring to MD and DO medicine as allopathic and osteopathic and then putting ‘podiatric medicine’ in a separate category, as if podiatric medicine wasn’t allopathic medicine.
There are a certain finite number of medical theories out there, including allopathic, osteopathic, homeopathic, chiropractic, native American Indian pan-theistic naturopathy, witch doctors, Eastern Indian Ayurvedic medicine, and a few others. Allopathic medicine has as its basis the idea of pathology from disease state: bacteria, virus, prion, spirochete, genetic dyscrasia, etc. Unless I missed something critical in medical school, that’s the disease model we in podiatry follow as well. As such, podiatric medicine is allopathic medicine. Allopathic is not a synonym for "MD"; allopathy is a medical theory and one our profession follows.
Podiatry is often stated as wishing to compete with "allopathic" providers in the area, as if WE were not allopathic physicians. One of the myopic tendencies in our profession is to separate ourselves in like manner from allopathy, which makes no sense to me. Podiatry follows the allopathic theory of medicine. We ARE allopathic physicians and referring to ourselves as podiatric physicians with similarities to allopathic physicians (as if allopathy means "MD", which it obviously does not) shows either ignorance of what the term means or is a strange form of self-denigration I don't understand.
David Secord, DPM, McAllen, TX
07/07/2026
RESPONSES/COMMENTS (STUDENT ENROLLMENT)
From: Paul Stepanczuk, DPM
Regarding the letter from Carl Solomon, DPM and the worries about following all the rules from the multitude of ruling bodies, Medical Economics magazine about 25 years ago published with the cover (paraphrased): We looked at all the rules you now need to follow. We concluded you have already broken one or many of them, so just keep going and do your best.
Paul Stepanczuk, DPM (Retired), Tinley Park, IL
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 (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 (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 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 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 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 (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.
07/02/2026
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 (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
07/01/2026
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
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 (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.
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.
06/30/2026
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.
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