03/04/2024    Rod Tomczak, DPM, MD, EdD

A Short History of Podiatric Discontent and Frustration

A significant portion of the older podiatric
profession are the notional progeny of
chiropodists. For many of us the first exposure
to our future profession was afforded by
individuals with the letters DSC behind their
names. They reduced calluses, managed toenails,
and applied pads to the toes and feet. There was
often a preliminary foot whirlpool to soften
calluses, cleanse feet. Plus it felt good to the
patient. DSC stood for Doctor of Surgical
Chiropody, the term surgical merely decorative.
Scalpels were used parallel to the skin to remove
calluses. Pads protected friction points and
unloaded pressure sites.

Merton Root showed up on the chiropody scene after
WW II and podiatry began to evolve with the advent
of biomechanics. Biomechanical orthotics
dispersed stress points and took the place of
padding making padding somewhat obsolete.
Biomechanics evolved into podiatric orthopedics
and maybe primary care, but real biomechanics
experts discussed into the early morning hours how
much motion occurred in the subtalar joint; this
motion being the basis of much foot pathology.
Posting plastic shoe inserts with an add-on which
was substantiated by integral and differential
calculus cured knee, hip and back pain. The
chiropody Joshua tree had branched off and we were
now podiatrists and schools issued a DPM degree to
prove that fact. This was the first branch of what
was to become board certified limbs of the Joshua
tree, fertile in the desert of the neglected foot
pathology but patients still had to pay cash for
the services and those orthotics.

Soon, very coordinated and visually gifted
podiatrists learned how to turn the scalpel 90º.
Recurrent ingrown nails could be permanently
remedied. There were things to see under the
skin, many of them troublemakers like neuromas,
ruptured or shortened tendons and bumps on bones.
A new branch was formed on the Joshua tree and
with it dissension was born into the profession.
We wanted to create our identity, or essence and
we wanted the rest of the medical community to
know we were certain we had evolved from a simple
existence into a true essence of surgery.

This sparked self-esteem issues and a big identity
crisis in the profession that did not exist when
we all trimmed nails, and calluses and applied
felt pads. Podiatrists who cared for patients by
inserting orthotics into shoes felt condescended
to by surgeons. Both groups formed board
certification organizations with hurdles and hoops
because the surgeons needed that designation like
MD surgeons to get them in the front door of the
operating room as surgeons and not as a scrub
tech. The biomechanics podiatrists preached the
necessity of post op care orthotics to prevent
recurrence of the pathology.

Someone discovered that podiatrists could be
admitted to insurance panels but the board
certified individuals were rewarded at a higher
rate than the non-board certified practitioners
and this economic disparity ruffled feathers.
Early certification was a process where everybody
certified each other because there was no
independent board to grant the certificate. It was
a good ol’ boys club. Then to make things real and
authentic, the board certification process became
a mirror image of allopathic certification and
certification was difficult to attain without a
residency. It wasn’t impossible, just very
difficult with numerous hurdles and hoops.

Unbeknownst to the leaders of this evolving
profession, podiatry had managed to create the
withs and withouts, a far cry from the DSC folks
who all got along together as conferrers, not
jealous competitors. The withs got paid more to
do the same thing the withouts did because the
insurance companies thought the withs must be
inherently better. Some podiatrists without
certification were not allowed to be insurance
providers at all and those podiatrists had to
collect money directly from the patients, just
like the chiropodists had done but they resented
the fact they stood on a lower rung of the
podiatry ladder. Chiropodists who had shared ideas
and a cocktail discussing the subtalar joint were
now podiatrists who hurled venom and Molotov
cocktails at one another in the court room.

Many organ systems are treated by allopathic
surgical and non-surgical specialists. There are
neurologists and neurosurgeons, cardiologists and
cardio-thoracic surgeons, gastroenterologists and
general surgeons, even radiologists and
interventional radiologists. For the most part,
these specialists practice what they wanted to do
when they graduated medical school and hence
trained for it. Like the Fat Man said in Samuel
Shem’s The House of God he looked forward to the
day he would become a gastroenterologist and
perform the bowel run of the stars and he was
happy with that calling. He wanted no part of a
scalpel.

Podiatrists, however, became increasingly
disenchanted and disenfranchised since there
weren’t enough surgical residencies to go around.
Coincidentally fertile growing seasons where
patients became interested in their own health
flourished which led to the spawning of the Peter
Pan Syndrome and new, hardy and bountiful sub-
specialties in medicine. As if on steroids, these
sub-specialties also hypertrophied in podiatry,
The American Board of Podiatric Medical
Specialties recognized a new mother organization
giving credence to the following sub-specialties.
(ABPMS which differs from ABFAS, ABPM, ASPM). As
the name suggests, this board certifies a
podiatrist in multiple (eight) sub-specialties
including Foot and Ankle Surgery which is
different from Lower Extremity Surgery according
to ABPMS, and also different than Minimally
Invasive Foot and Ankle Surgery, Primary Care in
Podiatric Medicine, certification in Prevention
and Treatment of Diabetic Foot Wounds, Limb
Preservation and Salvage, Podiatric Sports
Medicine, and Lower Extremity Geriatric Medicine.
Contrary to what the public may think or
unfortunately led to believe, none of these sub-
specialties have any tool, pill, poultice or
privilege that a non- certified podiatrist
practicing this particular sub-specialty may
utilize.

Research does show that Capuchin monkeys become
irate if other monkeys receive more fruit for the
same effort. (Brosnan, SF, Frans, BM. Monkeys
Reject Unequal Pay. Nature, 425, 2003). I do not
mean to equate non-certified podiatrists to
monkeys, quite the contrary; but rather this is an
example of a primate version of the bottom-line
being economics. Do the podiatrists who can’t
become board certified have just cause to be
indignant? Is it ethical to make the process of
certification so difficult only a chosen few can
achieve that status? The chiropodists always
impressed me with what seemed to be a commitment
to one another, the first stage of ethical
behavior. Are preposterous claims unethical? Is
hyping the efficacy of one procedure over another
moral? Do ABFAS certificate holders knowingly or
unknowingly lead the public to believe that their
sequence of letters is better than ABPMS’s
sequence of letters? Is there scientific
recognition of that one way or another?

I think podiatry is living in a “between”
existence right now. It is between chiropody and
MDs specializing in the medical and surgical care
of the foot and ankle but not necessarily as
orthopedic surgeons. Podiatry has an existence
but we are still in the process of creating our
own, unique essence and sometimes, to an
individual, we want to tread on those podiatrists
below us to make ourselves look taller. On the
playground or hockey rink it’s called bullying or
protecting what one cherishes. Often this behavior
is driven by insecurity. The current professional
leaders need to put a stop to self-aggrandizement,
especially when the facts don’t bear out the
claims. If this continues and it becomes necessary
our leaders must step up and reprimand the
offenders.

I can unequivocally tell you that if the ushers
had not thrown me out of the theater, I would
still be in my seat Waiting for Godot. I believe
Godot will come to rescue podiatry. He must come.
The desert cannot support unfettered growth of the
Joshua tree for long or the whole tree will die
from too many nutrient sucking limbs.

Rod Tomczak, DPM, MD, EdD, Columbus, OH

Other messages in this thread:

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03/13/2024    Lawrence Oloff, DPM

A Short History of Podiatric Discontent and Frustration (Rod Tomczak, DPM, MD, EdD)

Let me start off by saying I am happy with my
chosen profession. I have read the posts over the
years about the profession and its frustrations. As
a side note, I wish such discussions did not
surface on public forums as I fear that this likely
has had a negative impact on student recruitment,
but I guess that is the way of the world in an era
of social media. Why we should be happy with our
chosen profession is a complex discussion and
probably needs two parts. Here is Part 1.

What I find interesting is that people think that
these claims of unhappiness, discord, frustration,
the haves and have nots is unique to podiatry. I
can assure you it is not. I have had many podiatry
lives: Dean of a podiatry school, practice in an
orthopedic group who managed professional sports
teams, large institutional medicine, and as the
first podiatrist in the orthopedic department at
Stanford with an academic appointment. I have
worked the majority of my practice life along side
both allopathic medical doctors and podiatrists.
This is what I have observed. Allopathic doctors
have the same gripes. Many say they would not do it
again, although they were happy with their choice.
Many complain about colleagues for having what they
have and they don’t, reimbursement, paperwork, and
many more.

The reason for haves and have nots has an
explanation. Allopathic medicine has been much the
same over the last hundred years. Podiatry has not.
Podiatry has gone through a major evolution over
the years. This evolution has contributed to a
schism, due to the type and duration of training
for podiatrists . I imagine that podiatry will
evolve to a state like allopathic medicine, where
the difference between podiatry practitioners is
not as wide. That gap gets smaller all the time.

The board certification issue is part of the haves
and have nots. This problem is reported as having
political overtones but it is actually much simpler
than that, despite all the dialogue. Podiatry works
in an allopathic medical world, not a podiatry
world. Allopathic medicine make the rules. if you
want to be part of that world you need to play by
those rules. Hospitals are part of that allopathic
medical world and their rules are pretty clear. You
need board certification to do surgery. On rare
exception you can advocate privileges based on
experience by providing operative reports. An
orthopedist at one of the hospitals I work at was
asked to leave because his privileges were
contingent on elevating his board eligible status
to board certification. He had trouble passing the
exam and was asked to leave. These rules are pretty
straight forward.

Board certification is part of that evolution. We
started with board certification for surgery,
mirroring allopathic medicine. Not every
podiatrist’s individual experience and training
allowed them to pass this exam. Different state
laws didn’t help. As a result surgery board
certification was broken down to a foot and
foot/ankle versions to accommodate the differences
in state law and training. This was a partial
solution. Further adjustment was made many years
ago to create board certification in podiatric
medicine as an alternative pathway. Now the
politics have resulted in the podiatric medicine
board evolving into an alternative way to obtain
surgical credentials via CAQ.I am not here to argue
in favor or against this approach. I will say that
it does not follow the allopathic model for
hospital privileges that podiatry wants to be part
of. I think that it will fail as a result. If the
surgery board exam is too difficult, a
cleaner/simpler way is to look at the exam itself.
Is the pass/fail rate similar to allopathic
medicine certification exams or not? If too high
then adjust accordingly. I think trying to
circumvent the surgical privilege process just
makes podiatry look bad and serves no one. We have
come so far. It is not wise to go backwards.

Time will solve these issues - evolution. In
fighting will not. We are no different then our
allopathic colleagues. I share an office with a
young orthopedist who is in the middle of his board
certification process. One board, one process. I
asked him what he thought. He said it was difficult
but that was the way it should be. One board may be
our answer, but not one that is watered down.

Some may argue that evolution is not always good. I
think it has been for podiatry. The only negative
is that as we have strived to advance as a
profession we are leaving one of the distinguishing
features that make podiatry unique behind -
biomechanics. This is not a good idea. So to be a
good surgeon, you better understand how the foot
works. To be continued……

Lawrence Oloff, DPM, Burlingame, CA

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03/13/2024    Michael A Uro, DPM

A Short History of Podiatric Discontent and Frustration ( Rod Tomczak, DPM, MD, EdD)

Thank you Dr. Tomczak for the gracious compliment.
The feeling is mutual. Once again, I agree with
your assessment of our profession. While I do not
possess your eloquence in the written word, I will
in my own humble way attempt to further express my
feelings. Your assumption as to why I would not
recommend podiatry to a college student is correct.
I do not like the direction in which the profession
is going.

Not everyone who enters medical school wants to be
a surgeon. Not all have the abilities to become a
surgeon. Does this make them any less of a
physician? Of course not. Our patients need and
deserve the experience of all the specialties and
subspecialties. It takes many spokes to make a
wheel.

Our chosen profession is no different. Not every
candidate to podiatry school is cut out to be a
surgeon. That’s not a slight but a truism. How many
of us have been in the unfortunate position of
having to take the surgical knife away from a
resident or new surgeon being proctored because of
the obvious harm that was about to ensue? Better
that these individuals are not allowed to graduate
from residency than to unleash them on society. The
same individuals may on the other hand be
outstanding diagnosticians. So be it. They are just
as much a podiatrist and credit to our profession
PERIOD.

In my first years of practice I had a patient by
the name of Angus McKinnon, MD. He was a 95 year
old retired general practitioner who had delivered
1/3 of the population of the town of Placerville at
the time. I loved my visits with him so much that I
had my staff schedule him at the end of my day just
so that I could sit and visit with him. He
experienced times when patients could not afford
his fees. He would treat them regardless. Some
would later come by with a bushel of apples or a
chicken as payment. Others would come back a year
or two later with cash when they were flush. One of
my mentors Al Pearlstein, DPM once said to me in
surgery “This profession will provide you with a
good living but don’t count on it to make you
wealthy. For that make your money work for you”.
There is wealth and there is wealth.

The bottom line is that we are healers. Our
patients come to us for relief of their discomfort.
No matter how minor i.e. a corn or callus or how
major i.e. a gangrenous foot requiring amputation.
The simplest of treatments and some would say a
treatment that is beneath them, such as debriding a
painful dystrophic nail can provide a 90 year old
with relief that enables them to continue their
daily walks in comfort. But wait there’s more!
Walking can increase their cognitive skills,
circulation, lung capacity, increase bone density
and help them to enjoy life and stay in the game.
Patients are grateful for this care as they cannot
get it elsewhere DOCTOR!

Well as I stated in my first post, it has been a
good ride! Now it’s up to the next generation to
determine the fate of our profession. It is in your
hands. Make good choices.

Michael A Uro, DPM, Sacramento, CA

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03/11/2024    Rod Tomczak, DPM, MD, EdD

A Short History of Podiatric Discontent and Frustration (Michael Uro, DPM)

I could not be more pleased than I am with the
responses from Drs. Uro and Jacobs. I have never
met Dr. Uro, but I’ll posit the two of us would get
along famously. Dr. Jacobs was one of my trainers
when I was a resident and we have been good friends
from the first day. When I taught in Des Moines he
graciously took all levels of students, inspiring
all of them to become excellent clinicians. When I
had to make podiatric relevant decisions, I always
thought WWJD, but refused to wear a bracelet
advertising such.

I applaud Dr. Uro for having the courage to say he
would not recommend podiatry to a college student
today, in spite of the fact he loved the profession
for 45 years. This begs the question why he would
not recommend something he thinks was so
remarkable. I can only postulate, and I may be
wrong, that he is not fond of the changes he has
seen and the direction we are going. There is no
debating that this new generation has not seen the
early days of chiropody evolving into podiatry and
how they locked arms to strive for the common good.

When we graduated, we were reveling in our first
fervor, finished training and excited to practice.
In 1979 I was buying a practice of a podiatrist who
had a procedure named after him, Larry Frost, DPM.
A real mensch who had my hospital privileges before
I set foot into Michigan, a license just before
that, and an office staff that had been with him
since I was in high school. He took me to the men’s
lounge at the country club that sported a Donald
Ross golf course and introduced me to the Monroe,
Michigan policy makers since Frost was a past Mayor
of the city.

And then in 1984 things changed. Ford Motor Company
decided to use preferred providers, and although I
was board certified, the area Michigan political
podiatrist who was not board certified became the
preferred provider. This all happened because
podiatrists were operating on one hammertoe at a
time, stringing out patient disability over a year.

I lost more than half my practice. Suddenly, I was
one of the have nots, a without and but with plenty
of time on my hands. I had come to realize I
wanted to teach at a podiatry school, to form new
podiatrists, the next generation which would enjoy
being podiatrists like I did. Now I got to teach
and practice and I figured we at the new school
would be endeared, commended and celebrated by the
city’s and state’s podiatrists. Instead, I learned
the school was visualized as a preferred provider
no better than the Michigan preferred providers who
took all the patients.

This was about 40 years ago and podiatrists began
to bad mouth one another over economic issues,
always the bottom line. We went out of our way in
Iowa to make amends and build bridges, sponsored
and spoke at state seminars. We tried to turn out
graduates better than we were. We were not afraid
if the next generation was better than we were.
But the students realized there were not enough
surgical residencies to go around and suddenly 22
year old students were talking about board
certification and reimbursements. They saw
advertisements for jobs that publicized board
certified or board eligible only openings. This was
a run-away freight train that somehow had grasped
the rich imaginations of students no matter how
much we tried to quell their worries. We were in
the middle of producing a new generation of
podiatrists some of whom would have a hard time
repaying loans.

Yes, we have passed the torch, and as John McRae so
eloquently stated in the poem “In Flanders Fields,”
“To you with failing hands we throw the torch, be
yours to hold it high. If you break faith with us
who die, we shall not sleep.” We wanted to be sure
the next generation held the torch high, an analogy
for preserving all we have gained as a profession.
Excuse us if you sometimes see us as helicopter
parents, because somehow the good old days and the
podiatrists who populated those days are gone and
well, we shall not sleep.

Allen Jacobs, DPM asks you and me if we are
functioning in the absurd wasteland Waiting for
Godot. Allen is not asking if you are making a
living, let alone becoming rich. He is not asking
if you are able to keep your kids and partner in
designer clothes. Absurdity is a product of an
existential belief that if we have not created real
meaning to our existence, that existence is absurd.
The evolution of chiropody to podiatry occurred
when podiatry and podiatrists learned what could be
done when a scalpel is turned 90 degrees from
parallel to the skin to perpendicular.

This movement brought with it a myriad of questions
that have been plaguing the profession since the
partial rotation of the scalpel. Although the
profession has gained the right to do this, does
every member enjoy that right to operate or is it a
privilege bestowed on a few? Obviously this is an
ethics question and quite honestly a difficult one
that podiatry has tried to avoid. Not to make a
decision about this question is to make a decision.
The status quo prevails. Immanuel Kant is the
champion of “rights-based ethics.”

Kant famously put forth his Categorical Imperative
which states we should not subscribe to any
principle of action (or ‘maxim’) unless we could
will it to be a universal law. His second
formulation of this imperative is that we should
treat other people as ends in themselves and not
merely as means to our own ends. We can postulate
this means not everyone should be operating or that
we should operate to generate a lucrative income.
It’s not the end that’s important but the path or
means to the end, our intentions and it should
apply to everyone in that particular case.

The opposite ethical position was originally put
forth by Fletcher in 1966 and titled “Situation
Ethics” and he stated that an action was neither
good nor bad but the outcome determined whether
they were moral or immoral. If the surgeon has
good results the action of operating is determined
to be good if that action of operating is based on
a purity of intention. So, whatever obtains the
most good for the most people should be considered
the optimum utilitarian choice of action. The last
podiatry lawsuit was settled employing a
utilitarian ontogeny.

What made most people pleased was that no one was
taxed any more money, but no one on either side of
the compromise was happy. Minimal incision
surgeons got board certified but with an asterisk
on their certificate. ABPS surgeons complained the
Ambulatory Surgeons called themselves board
certified but had not navigated the same hoops and
hurdles as traditional surgeons.
Will the next dispute be settled employing a
utilitarian philosophy separate from utilitarian
ethics or will the constituents sitting around the
table weigh right versus wrong in a true
existential matter?

The core idea of existentialism is that we are free
to choose. In fact, we are condemned to choose and
thereby create our essence. Everything we do
involves a choice, from getting out of bed in the
morning to going to the office and deciding who is
a surgical candidate, to getting into bed at night.
Some have argued there is no existential ethic but
rather is a moral view where anything goes. Quite
the contrary, we make our choices based on our own
moral platform.

We, and I specifically mean we as podiatrists are
more than trench coated, Gauloises smoking, coffee
drinking, foot doctors sitting on the Left Bank of
the Seine arguing who should be board certified to
no one satisfaction. Instead, since we value our
own freedom to choose, we must also value everyone
else’s freedom to choose. We may not agree, but we
respect their right to choose.

And this brings us to an unrefined suggestion on
how to possibly solve the same old question of
board certification but on the newest time around.
Podiatry could run a complex survey of the
profession concerning the board certification
questions. Not simply, “Do you believe there
should be one board for podiatry?” but, a series of
questions, the answer to one leading to the next
question in the next series, perhaps a week away.
These questions are not fabricated as of yet but
may lead the profession to evaluate how board
eligibility is decided, how many cases are needed
in a residency to become eligible, should everyone
be taking a surgical in-training exam, If one is
board eligible should office cases count toward
certification, can a young podiatrist complete a
non-surgical residency then complete a surgical
fellowship logging a required number of cases?

What do you think about a boarded surgeon observing
you operate? Frost came to the operating room with
me when I started to observe and report to the
staff. The Dean of the medical school stopped by
to see me operate on my first patient at Ohio State
University. One set of questions leading to another
set with the desired end being a suggested
resolution of this age old question that the
profession has chosen, not the hand full of trench
coated, Gauloises smokers sitting on the Right Bank
of the Chicago River making decisions for the
entire profession.

This multi-part survey would be open to any
podiatrist with an NPI number or a special ID for
residents, however, a podiatrist must answer the
first and every subsequent question to remain in
the survey. The unique NPI must be entered with
every series of questions. To not answer a question
disqualifies a podiatrist. When the survey starts,
we answer as a profession, some who identify as
haves, some as have nots.

The profession answers each question ‘Yes ‘or ‘No’
or perhaps ‘I don’t know’ hopefully with an eye on
the future of the profession. It may be scary to
think about the outcome, but the outcome will be
utilitarian and profession wide, not made by a
handful of individuals imposing their wishes on the
profession. There is no inquisition, no trial, no
lurching toward the carotid, just an authentic
gleaning of information about how 45 or 50 years of
a profession sees itself in light of today’s
healthcare arena. Just maybe the data generated
might be useful.

Rod Tomczak, DPM, MD, EdD, Columbus, OH

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03/07/2024    Allen Jacobs, DPM

A Short History of Podiatric Discontent and Frustration (Rod Tomczak, DPM, MD, EdD)

Waiting for Godot? Vladimir and Estragon waited
and waited. As you know full well Dr. Tomzack,
Godot never arrives. The play was an offering of
the theatre of the absurd. Is this the arena in
which we as a profession now function? Yes there
are “haves and have nots”. The Joshua tree you
refer to (actually a plant and not a tree) has
branches which include rather complex surgical
interventions performed by some podiatrists.
Charcot joint reconstructions, deformity
corrections with external fixation, distal leg and
ankle trauma management are a long were from the
DSC days you fondly recall.

Our first responsibility is to protect the public
and assure that those providing advanced care with
significant responsibilities process adequate
training and experience. To a large extent, DPMs
are entrusted with the authority to determine
those qualifications. We must do so in an
effective and ethical manner. I do not believe
that lowering the standards to obtain “Board
certification”, or the creation of boards which
require minimal demonstration of experience and
academic accomplishment is the answer. I know you
do not believe that either. Godot send messages to
Vladimir and Estragon. But he never arrived.

Like you, I recall the early days when today’s
thought leaders were trained by non-certified DSCs
and early DPMs. They provided credible and
effective services in the office and the operating
room. However, there is difference between a
McBride and Keller and a Lapidus. There is a
difference between treating an ingrown toenail
with paronychia and necrotizing fasciitis. And
there is a difference in residency and fellowship
training of today’s school graduates and those of
yesteryear.

I have no answer to those who feel
disenfranchised. However, we are now trusted to
evaluate and treat serous pathology. The scalpel
is now vertical, not horizontal as you note.

Allen Jacobs, DPM, St. Louis, MO

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03/06/2024    Michael A. Uro, DPM

A Short History of Podiatric Discontent and Frustration (Rod Tomczak, DPM, MD, EdD)

I just read Dr. Rod Tomczak’s response to “A Short
History of Podiatric Discontent and Frustration”.
I whole-heartedly agree with all he had to say. I
have enjoyed practicing podiatry for 45 years. I
was fortunate enough to have enjoyed the era
before managed care. A time when we were paid 2/3
more for surgery than we are today. The
reimbursements for surgery today are an insult to
the training, experience and risks that podiatric
surgeons take every time they walk into an
operating room.

When I came to Sacramento, I was welcomed by the
podiatric, MD and DO community. I am grateful to
those mentors such as Mitch Mosher, DPM, Larry
Gerelli, DPM, Randy Sarte, DPM, Oscar Mix, DPM.
There are many others, DPMs, MDs and DOs of all
specialties. Too many to list. We enjoyed dinners,
barbecue’s, wine tastings etc. in each other’s
homes. The camaraderie was incredible. We assisted
one another in surgery and helped run a
colleague’s office when he was out due to illness.
This was at no charge I might add. It’s what you
did. We had coffee and donuts in the doctor’s
lounge of the hospital where we communed with
doctors of all specialties.

It has been a good ride. Would I do it again, or
would I recommend podiatry to an aspiring college
student, sadly, I would not. Ever since I was a
podiatry student I have heard that we have the
same training as MDs and DOs. You all know that is
not true. How many of you have delivered babies,
actually managed an ICU patient, etc. We are not
MDs. We are podiatrists. If you want to be an MD,
then go to medical school.

This is not to say that our profession has not
progressed. Those podiatrists recently out of
residency or fellowship can run circles around us
old geezers! As it should be. I applaud them.
However, not all foot problems are surgical. On
the last day of my orthopedic clerkship at UC San
Francisco, the attending orthopedic surgeon was
celebrating his last day in practice. His parting
words were “If I can impart any words of wisdom to
you all today, it is that I have performed more
surgery over the years than I needed to.” Let that
sink in.

So, there is and always will be room for and need
of chiropodists, podiatrists and podiatric
surgeons. Don’t disrespect your predecessors
anymore than you would your parents or
grandparents. Be kind. Be generous and not pompous
with your new found skills and knowledge.

Michael A. Uro, DPM, Sacramento, CA