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04/23/2024 Allen M. Jacobs, DPM
The Future of Podiatry
A recent article published in KevinMD.com, written
by a St. Louis plastic surgeon, Dr. Samer Cabbabe,
caught my attention. I would suggest that his
discussion on the corporatization of medicine is
thought provoking. Many of his conclusions are, in
my opinion, applicable to podiatry. Dr. Cabbabe
concludes his article with certain recommendations
for the future of quality medical care. I will
paraphrase some of these with podiatry relevance
and additionally share my personal opinions.
1. Curriculum changes are needed to focus on non-
clinical aspects of medicine, including insurance,
leadership, business, and other political aspects
of medical care delivery. Medicine is a business,
and practice survival as well as decision-making
regarding employment require knowledge and good
information. The business of medicine must be taken
seriously by the colleges and residencies.
2. The author suggests that medical schools be
shortened to a 3 year curriculum, and/or an
increase in 6 year combined college and medical
school programs be considered. This would result in
decreased debt to the student. In my opinion, there
is no reason for podiatry to not consider this
pathway. The necessary regulatory mandates should
be reconsidered. I believe this may be useful in
attracting students to podiatry.
3. The benefits of podiatry as the provider of foot
and ankle services should be heavily marketed. It
has not been. Many state societies (and the APMA)
have large coffers sitting in the bank doing little
but collecting interest. Why not a campaign
advocating the benefits of podiatry care in areas
such as diabetic foot, geriatric care, wound care,
sports medicine, foot surgery? Increasingly, NPs,
PAs, PCPs, PTs, CPEDs, DCs, and of course
orthopedists are attempting to provide such care.
Absent surgery by the foot and ankle orthopedist,
these alternative providers do so at the expense of
patients, who receive inferior care by these
providers and suffer the resultant complications
and sequela. More money must be spent to lobby for
podiatry-led foot care. It should be done so in an
effective manner.
4. State societies must take the lead in marketing
and protecting and advancing podiatry interests.
Sadly, is clear that the APMA is incapable of doing
so. All politics are local as they say. Studies
which demonstrate the benefits of podiatry are
published, cited in PM news, read by a few. Then
what ? We pat OURSELVES on the back, and nothing
changes.
5. There are only so many podiatry jobs in VA's,
orthopedic groups, medical groups and health care
systems. Perhaps the declining number of applicants
to our colleges and therefore future graduates will
solve this problem with employment available for
all the decreasing number of graduates. However,
there will be increasing needs for podiatry
services (e.g.: ageing population, diabetes,
increasing sports participation, PAD) and as a
result we shall either provide the needed care or
abrogate this care to others. We will need more
primary care podiatrists, not 100% "surgeons".
I suggest rethinking of the mandatory 3 year
medical/surgical residency model. 3 years of
podiatry college, 2 years medical residency or 3
year surgical residency +/- fellowship. The medical
(primary care) residencies should be increasingly
office based, as are family medicine residencies.
We should consider the dental model.
The theoretical is not practical. The average PA or
NP in many states have an average salary higher
than the average podiatrist according to some
studies. Alternatively, we as a profession can
elect to surrender primary care foot services to
others and hold ourselves out as surgeons only. To
some extent, we are already traveling this road,
which I believe to be a mistake.
6. We must increase instruction in the ethical
practice of medicine. This must begin in the
colleges and be reinforced during residency
training and continue at our CME programs. It is
past time that the states and CPME and APA restrict
corporate influence and allow advocacy of unproved
techniques and devices and medications to be
presented to students, residents, and
practitioners. APMA officers and BOD members, as
well as any organization providing CPMA approved
CME, should not be allowed to maintain conflicting
interests in determining CME content. The overt
dominance of industry in our CME programs is at
this point not acceptable.
Allen M. Jacobs, DPM
Other messages in this thread:
07/21/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY)
RE: AI’s Take on Podiatry’s Future
From: Lawrence Rubin, DPM
I asked AI to comment on whether today's podiatry residents would be better served by fellowships in lower extremity medicine rather than advanced surgery. AI's response was thought-provoking:
"Rather than replacing advanced surgical fellowships, podiatry should consider adding accredited fellowships in Lower Extremity Medicine. As healthcare shifts toward value-based care, prevention, chronic disease management, diabetic limb preservation, peripheral neuropathy, PAD, wound care, and multidisciplinary leadership are becoming increasingly important. Complex reconstructive surgery will always be essential, but far more patients need expert medical management than advanced surgical reconstruction. Parallel fellowship pathways—one in advanced surgery and one in comprehensive lower extremity medicine—could better prepare future podiatrists for tomorrow's healthcare environment."
Lawrence Rubin, DPM, Las Vegas, NV
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
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 (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
06/29/2026
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.
05/14/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY)
From: Steven Finer, DPM
I really appreciated Dr. Tomczak's extensive article on the history of thought and teaching. In the 1970s, the curriculum started to change at PCPM. MDs were brought in to teach courses such as Internal medicine, orthopedics, neurology, radiology and many more. PhDs taught pharmacology, microbiology, and histology. For the most part, podiatrists taught podiatric subjects. The chiropractic schools are often criticized as to their own teaching of all subjects.
Steven Finer, DPM, Philadelphia, PA
05/13/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY)
RE: Podiatric Paradigms, Incommensurability, and Transformative Learning
From: Rod Tomczak, DPM, MD, EdD
In 1962, Thomas Kuhn, a professor at numerous highly acclaimed universities such as Princeton, Harvard, Berkley, and MIT published his seminal work, The Structure of Scientific Revolutions. It was extremely influential across multiple disciplines, but for us it was powerful in change theory for education and science. Kuhn introduced the concept of paradigm and paradigm shift in order to explain how we think about the structure of ideas and how those ideas change.
We know that over time, paradigms shift and we have a change in how we think about things. Over time, we evolved from a geocentric to a heliocentric universe. When the idea of change was originally set forth, it was not readily accepted and heliocentricity was the reason Copernicus was excommunicated by the infallible Catholic Church. The Church preached a geocentric universe. Such diametrically opposed ideas were incommensurable, meaning they were not able to be discussed because...
Editor's note. Dr. Tomczak's extended-length letter appears here.
04/23/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY)
From: Paul Kesselman DPM
I am not sure where Dr. Smith got his information that a family practice or hospitalist residency is one year. According to ACGME and my family physician, a 3-year residency is required before one can become board-certified in that specialty.
A hospitalist is essentially a family practice physician who has chosen their career to work in a hospital setting as a family practitioner. Bottom line is that MDs and DOs all have to do a minimum three-year residency. Some are even longer and require fellowship post-residency which can last two or more additional years.
Paul Kesselman, DPM, Oceanside, NY
04/22/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY) -PART 2
From: Gary S Smith, DPM
I can save you the expense of a survey. People don't go into podiatry because it is silly to do 4 years of medical school and 3 years of mandatory residency only to have your scope of practice limited to the feet. You could do one year of residency and go into family medicine or be a hospitalist and have a much better chance of employment and most likely get paid a lot more money. Many of us warned that this would happen with the mandatory 3 year residency.
Many students were lured by the fact they could practice with a 1 year training period, and those who excelled could go on to 3 or 4 year programs and become the premier surgeons of our profession. I like my job. I like doing what I do but I would never suggest that my children do the same. It's just not sensible to do the same training as an MD or DO and then be limited by scope and income.
Gary S Smith, DPM, Bradford, PA
04/22/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY) - PART 1
From:Rod Tomczak, DPM, MD, EdD
I attended the Ohio Foot and Ankle Association virtual seminar on Saturday April 18. Michael Brody, DPM gave a fantastic talk about how AI will fit into podiatry in the very near future and how it is 93% accurate as AI interprets what we tell it and that number will jump to 95% by the end of the year. I thought the presentation was very interesting and included some of the platforms he thought were accurate.
At the conclusion of the meeting, I checked my email and found a piece forwarded to me by Barry Block from “Anonymous.” Anonymous quoted some information from AI platforms about the future of podiatry and it did mention what part osteopathy plays in it. I thought I would follow up on the email with some AI platform investigating two questions, I would ask the AI platforms, “Is podiatry itself in a crisis mode?” and secondly, “Is the future of podiatric education in crisis?” So, I will report to loyal PM News what Perplexity and Chat GPT have to say about these two...
Editor's note: Dr. Tomczak's extended-length letter appears here.
04/22/2026 Rod Tomczak, DPM, MD, EdD
AI and the Future of Podiatry
I attended the Ohio Foot and Ankle Association
virtual seminar on Saturday April 18. Michael
Brody, DPM gave a fantastic talk about how AI will
fit into podiatry in the very near future and how
it is 93% accurate as AI interprets what we tell
it and that number will jump to 95% by the end of
the year. I thought the presentation was very
interesting and included some of the platforms he
thought were accurate.
At the conclusion of the meeting, I checked my
email and found a piece forwarded to me by Barry
Block from “Anonymous.” Anonymous quoted some information
from AI platforms about the future of podiatry and
it did mention what part osteopathy plays in it. I
thought I would follow up on the email with some
AI platform investigating two questions, I would
ask the AI platforms, “Is podiatry itself in a
crisis mode?” and secondly, “Is the future of
podiatric education in crisis?” So, I will report
to loyal PM News what Perplexity and Chat GPT
have to say about these two questions.
Perplexity says, “Yes—in many places, podiatry is
facing a real workforce and access crisis,
especially in rural areas and health systems with
heavy diabetes-related demand. Reports and
professional commentary point to recruiting
shortages, burnout, rising patient loads, and gaps
in coverage as the main pressure points.”
How serious is it?
“In the U.S., the signals are more mixed but still
concerning: private practices and clinics report
difficulty hiring, and podiatry leaders have
described a recruitment crisis and an
“existential” threat to the profession’s
sustainability.”
And the bottom line
“So the answer is yes, but unevenly: podiatry is
not universally collapsing, yet many systems are
under enough strain that “crisis” is a fair
description in workforce and access terms.”
Are podiatry schools facing an enrollment crisis?
“Yes — podiatry schools appear to be facing an
enrollment crisis, with multiple reports showing a
sustained decline in applicants and matriculated
students over the past several years. One source
describes the situation as a “serious decline” and
notes that the applicant pool fell from 1,006 in
2020 to 716 in 2022, then remained below prior
levels in later years.”
What the data shows
“The trend is not just anecdotal. A review article
in 2023 found that applications to U.S. podiatric
medical schools had been steadily declining over
the prior decade. A 2025 piece citing AACPM data
reported 839 applicants in 2024, down from 1,006
in 2020, and 399 matriculated students in 2024,
down from 564 in 2020.”
Why it matters
“Lower enrollment can create a staffing and
workforce problem later, because fewer students
today means fewer podiatrists entering practice in
a few years. Commentators also warn that schools
may face financial pressure if they cannot fill
seats, and practices may struggle to recruit
associates”.
Why applicants may be down
“The reasons appear to be multifactorial. One
review points to broader demographic and
professional factors, including a declining U.S.
birth rate, licensing concerns, inconsistent
salary information, and internal disagreement
within the profession. In other words, the issue
seems real, but it is also being driven by a mix
of market, perception, and structural factors
rather than one single cause.”
According to Chat GPT… Is podiatry in a crisis
mode?
Short answer: no, podiatry is not in a uniform
“crisis mode”—but parts of the field are clearly
under strain, and it depends heavily on what you
mean by “crisis.”
Here’s a grounded way to look at it:
1) The workforce: not collapsing, but tight and
uneven
• there are roughly 15,000+ practicing podiatrists
in the U.S.
• Total employment is relatively small ('9,700
counted in federal data), and growth is projected
at only '2% over the next decade
That combination matters:
• Growth is slow on paper
• But supply is also limited, so many markets
still feel understaffed
?? Translation: not a collapse—more like a
constrained, niche workforce
2) Demand is actually increasing
Several forces are pushing demand upward:
• Aging population
• Rising diabetes and obesity ? more foot
complications
• Expansion of wound care and limb preservation
programs
Hospitals and groups often report:
• Difficulty hiring podiatrists
• Long recruitment timelines
• High competition for trained surgical DPMs
?? So from a pure “need” standpoint, demand is
strong, not collapsing
3) Where the “crisis” perception comes from
This is the important part—because the concern
you’re hearing isn’t imaginary.
A. Geographic maldistribution
• Rural and smaller markets ? true shortages
• Major metro areas ? more competition / perceived
saturation
?? Both can exist at the same time.
B. Training bottlenecks (historically and still
relevant)
• Residency spots have not always scaled with
graduates
• Surgical training quality and case volume can
vary
?? This creates anxiety among students and early-
career podiatrists.
C. Professional identity / scope tension
• Ongoing comparison with MD/DO orthopedics
•Variability in hospital privileges and
integration
?? Not a workforce crisis—but a professional
positioning issue
D. Practice economics & burnout
Common complaints (mirroring other specialties):
• Administrative burden
• Reimbursement pressure
• Staffing issues in private practice
4)
The paradox of podiatry right now
This is the key insight:
• Demand = rising
• Supply = limited
• Growth rate = officially low
• Experience = highly variable depending on
location and practice model
So you get two very different narratives:
• “There aren’t enough podiatrists”
• “The field is saturated and struggling”
?? Both can be true depending on context.
Bottom line
Podiatry is not in systemic collapse, but it is in
a transitional, somewhat stressed state:
• ? Strong clinical demand
• ? Stable-to-good income (median '$152K)
• ? Ongoing need for foot/ankle specialists
But:
• ? Uneven job markets
• ? Training and scope debates
• ? Practice pressure similar to the rest of
medicine
Is podiatric education in a crisis mode…according
to Chat GPT
Short answer: there are real warning signs—but
calling it a full “crisis” depends on what you
mean. It’s more accurate to say podiatric
education is under structural strain, especially
on the front end (student pipeline), rather than
collapsing outright.
?? 1. The biggest issue: declining applicants
This is the clearest and most widely documented
problem.
• Applications to U.S. podiatric schools have
declined over the past decade
• In some recent cycles, applicant numbers dropped
sharply (e.g., '716 applicants for '700 seats in
2022)
• Even in 2024–25, only '839 applicants applied
nationwide, with '525 matriculants
?? Translation:
Schools are increasingly filling seats rather than
selecting from a deep pool, which raises concerns
about:
• academic competitiveness
• long-term perception of the profession
• financial viability of some schools
????? 2. Workforce paradox: shortage of podiatrists
Ironically, this isn’t because podiatry isn’t
needed.
• Demand for podiatrists is projected to grow '28–
29% by 2030
• Supply is expected to lag behind demand
significantly
?? So the issue is not demand—it’s pipeline
failure.
?? 3. Educational system stress signals
Several secondary warning signs show strain:
• Reports of unfilled seats in schools and concern
about financial sustainability
• Ongoing need for post-match residency filling
processes, indicating imbalance between applicants
and positions (though less severe than
historically)
• Persistent discussion within the field about:
o inconsistent income data
o scope-of-practice concerns
o internal fragmentation (boards, certification
politics)
?? 4. But it’s NOT a total collapse
There are stabilizing factors:
• Residency positions now generally exist for most
graduates (unlike the crisis era '2010–2015)
• Enrollment still produces '500+ new students per
year
• Demand for foot/ankle care is strong and growing
?? Bottom line
• Yes, there is a problem—mainly declining
interest and applicant volume
• No, it’s not an existential collapse—the
profession still has strong demand and
infrastructure
A fair characterization:
Podiatric education is in a “pipeline crisis,” not
a practice crisis.
If you want the blunt insider take
Many within the field worry about:
• reputation relative to MD/DO pathways
• ROI concerns (tuition vs income variability)
• messaging to pre-med students
Those—not the clinical need—are what’s driving the
current situation.
The other platforms say essentially the same
thing. What bothers me the most is the Chat GPT
assertion that schools are increasingly filling
seats rather than selecting from a deep pool,
which raises concerns about: academic
competitiveness, long-term perception of the
profession, and financial viability of some
schools. The lack of the deep pool worries me.
When we matriculated, there were applicants who
were rejected.
Rod Tomczak, DPM, MD, EdD, Columbus, OH
04/20/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY)
RE: It’s Time
From: Rod Tomczak, DPM, MD, EdD
If we’re going to keep podiatry just the way it is, perhaps we should find out why enrollment is decreasing. It should be on the upswing. There are so many schools you can walk to school from home, just like grade school. you can even walk home for lunch, and mom cooks dinner for the family. I think the best way to find the answers we are looking for is to use some of that APMA money and contract an extensive outside survey. Yes, that “S” word again, but in order to satisfy the general podiatry population, have some recognized professionals conduct the survey.
Professional does not mean the APMA, but a recognized consumer survey agent like the University of Michigan. Not Quinnipiac or Monmouth University that specialize in political polls, but a consumer-centered organization. I am not a big fan of U of M. As a matter of fact, on football Saturdays, my second favorite team is whoever is playing Michigan. In this realm, however, they would be reliable and valid. The APMA can’t meet those criteria. I fear they would ask questions like how many bullet holes are in the combat planes that return to base? I would expect the tough questions to be asked if we really want to learn anything. Ask DPM students in schools where DOs go to class with DPMs, why did you pick podiatry over osteopathy? Did you get rejected from...
Editor's note: Dr. Tomczak's extended-length letter appears here.
04/15/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY)
From: Robert Scott Steinberg, DPM
It seems to me, in my 49+ years of practice, and a million surveys that rarely effected real change, we are surveyed out! No one seems to be listening except those of us engaged on this forum. I don't enjoy reading fantasies. Students have choices: MD, DO, DVM, DDS, NP & PA. Years to completion and costs are most likely what they are thinking about.
Robert Scott Steinberg, DPM, Schaumburg, IL
04/14/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY) - PART 1B
From: Stephen Peslar, BSc, DCh
Dr. Tomczak wrote, “I think it’s safe to say podiatry has finally made it into the tightly closed circle of the MD world.” Well, a podiatrist already made it into the serial murderer character category on TV. In the series The Practice, George Vogelman was a podiatrist who was a serial killer and a cross-dresser. He might have inspired Law and Order: Special Victims Unit, to have a character Dr. Carl Rudnick, a pathologist, who was a serial killer and a cross-dresser. So it’s good to see a podiatrist doing a consult rather than being portrayed as a cross-dressing serial killer.
But when Jay Leno was hosting The Tonight Show, he was on the UCLA campus asking university students, “what is a podiatrist?” One young lady asked if it was someone who sexually abuses children. I think podiatrists still have to educate the public about what they treat.
Stephen Peslar, BSc, DCh, Toronto, Ontario
04/14/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY) - PART 1A
From: Rod Tomczak, DPM, MD, EdD
I was looking over the PM News survey conducted last year that gave a pretty good indication how the profession feels about the DPM degree and residency programs. The first option in the survey stated that the responder was happy with a DPM degree, a limited license, and the three-year residency that is in place now. Thirteen percent (13%) of the 690 responders agreed with that statement. As a raw number, that means only 29 of the 690 who chose option 1 agreed with that statement. That’s 13%. Extrapolated to the approximately 18,000 licensed podiatrists in the U.S., less than 2,300 are happy with the status quo. There are currently 219 CPME-approved residency institutions hosting residencies. That is not the total number of residents but reflects how many hospitals are CPME-approved facilities that have residents, and each one must have a residency director.
One would think that all 219 residency directors should like the idea of a DPM degree and a three-year residency since they are...
Editor's note: Dr. Tomczak's extended-length letter appears here.
04/13/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY)
RE: Podiatric Musings
From: Rod Tomczak, DPM, MD, EdD
I think it’s safe to say podiatry has finally made it into the tightly closed circle of the MD world. An obstetrician on the TV show Chicago Med asked for a podiatry consult. It seems a young pregnant woman dressed in haute couture presented with a diabetic foot that was both sickening and gangrenous. Yes, one of the stars asked for the consult by podiatry which has reached the hospital’s second floor in the Emergency Department-based medical drama.
There were no other comments about the podiatry practitioner’s non-ACGME approved residency, not passing USMLE and professional school curricula. No one called the attending aside to remind her that the podiatrist had neither an MD nor DO degree, hence, with all the accumulated evidence, not a real physician, and most of all, the consultor has no plenary license. Board certification was not part of the attendings’ conversation. No one mentioned declining admissions in spite of increased seats at 11...
Editor's note: Dr. Tomczak's extended-length letter appears here.
03/31/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY)
RE: Podiatry and the Perception Paradox
From: Allen M. Jacobs, DPM
There is often a significant difference in the manner by which we perceive ourselves and how others perceive us. It is called perception paradox. It has been said, “if we could see ourselves the way that others see us, we would be amazed.” With an aging population, the diabetes pandemic, obesity, increasing sporting activities in all age groups, the demand for foot and ankle services has been increasing. Every evaluation of the question concludes the increasing need for foot and ankle care. This will continue to increase in the future.
Why then the decreased application rates at the colleges of podiatry?
I decided to look at an AI/Google search to determine if we as a profession suffer from perception paradox. How do non-podiatric physicians view the issue of declining applications to the colleges of podiatric medicine. In my opinion, the “outsiders view” of this problem is...
Editor's note: Dr. Jacobs' extended-length letter can be read here.
03/25/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY) - PART 2C
From: Robert Kornfeld, DPM
I graduated from NYCPM in 1980 and opened my own private practice in 1982. And shockingly, there was no such thing as managed care. We functioned in an indemnity insurance model. You did your work. You sent a claim form (handwritten, there were no ICD-10 or CPT codes). You got paid 80%. The patient or secondary plans paid 20%. Bunionectomy with osteotomy back then through commercial carriers, for example, could reimburse in the $4-6,000 range.
On 20 patients per day, I ran a financially successful practice. I was happy. Until I wasn't. In the early '90s, if you weren't signed up with managed care, insurance paid much higher out-of-network fees. But little by little, they started drastically reducing those fees and made reimbursements more and more difficult to obtain. And I was losing patients to in-network podiatrists. So I signed up for...
Editor's note: Dr. Kornfeld's extended-length letter can be read here.
03/25/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY) - PART 2A
From: H. David Gottlieb, DPM
In all my years as a podiatrist, I do not recall having, but imagine that I have met Dr. Jacobs, but I have heard only good things about him. In his latest post on the future and standing/prestige of podiatry in today's medical world, he eloquently stated what I have been saying: "You are responsible for your own fate and circumstances."
For my first 20 years, I performed hammertoe, distal bunion, and toenail surgeries. Nail debridements and lots of the old C&C (corns, calluses). My patients were thankful for the relief from pain and the ability to continue their chosen path. Several tracked me down years later to express their gratitude. I could see that this was a pathway to financial reward. Despite what Dr. Jacobs states, a good living can be made performing this vital service IF...
Editor's note: Dr. Gottlieb's extended-length letter can be read here.
03/25/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY) - PART 1
RE: Immediate Need to Address Podiatry’s Future
From: Joseph T. Hogan, DPM
It was my pleasure to attend virtually the St Louis Podiatry Seminar this past Friday and Saturday. The content and presentation of the lectures were excellent. I also found the presentation by Rod Tomczak, DPM, MD, EdD to be very informative. I have been in practice for 50 years. When I began practice in Binghamton, NY, there were two DOs in town who did not have hospital privileges. There were no FNPs and PAs. That has all changed.
I am board certified by ABPM, ABFAS, ABQAURP, faculty of a medical school, faculty of a number of schools of podiatric medicine, and faculty of a family practice residency program. Today, we, as DPMs, and they as DOs, FNPs and PAs all have hospital privileges in significant numbers. The numbers of applicants to our three-year residency program are minimal and in fact threaten the continued existence of our hospital-based residency program.
I believe our profession needs to consider establishing a collaborative study group regarding our immediate future. I recommend that Dr. Tomczak be a member of that body. The future of our profession is now, not five years from now. We need to ensure the continued existence of our specialty. We, as podiatrists, can ensure the future continued existence of our specialty with an enhancement of our degree to include us as a recognized podiatric physician.
Joseph T. Hogan, DPM, Binghamton, NY
03/25/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY) - PART 2B
From: Elliot Udell, DPM
Dr. Jacobs is correct when he asserts that there are many podiatrists who do Charcot foot surgery, total ankles, and have great surgical and podiatric medical practices and make a lot of money. Let's also focus on the other example he gave. At the dinner meeting he addressed, only four of the 40+ attendees were doing anything more than cutting nails all day.
Our profession's problem is to find ways to increase enrollment in our schools and to ensure that the public will be able to avail themselves of our services not just now, but fifty years from now. Let's be true to ourselves. A pre-med student can choose the route of being an MD, DO, DDS, or a DPM. Since they are putting their lives and future finances on the line, these students will be visiting doctors' offices. How do we make sure that they visit the offices of Dr. Jacobs and his students or the 36+ podiatrists at the dinner meeting who only cut toenails and have empty offices? If we solve this problem, the problem of insufficient applicants at our schools will automatically be solved.
Elliot Udell, DPM, Hicksville, NY
03/24/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY) -
From: Allen M. Jacobs, DPM
Dr. Smith calls for a unified identity defining podiatry. He and other PM News readers have asked the same question, and bemoan the perceived low regard for, and financial remuneration for the services of, a podiatrist. To quote Cassius from Shakespeare’s Julius Caesar, “the fault dear Brutus is not in the stars, but in ourselves that we are underlings.”
A number of years ago, I was speaker at a dinner meeting on the subject of treating diabetic neuropathy. After 5 minutes or so, it was clear to me there was little interest in the room. I decided to do something I had always wanted to do. I stopped the presentation and told the 40 something podiatrists attending that I wanted to take a survey. I asked for a show of hands. I asked how many in the room treated neuropathy. 2 or 3 people raised their hand. I asked how many did significant hind foot or ankle surgery. 4 people at...
Editor's note: Dr. Jacobs' extended-length letter can be read here.
03/23/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY) - PART 1B
From: Judd Davis, DPM
Dr. Jacobs states, "These are indeed the best of times to be a podiatric physician. Utilizing Medicare reported RVUs, the average podiatrist should earn a minimum of $269,900 annually." That may be the case for gross income, but certainly not for net income take home pay. Chat GPT and Gemini AI searches both state that the average net pay is around $150K. This is the bottom of the pay scale as far as medical specialties go. Maybe Dr. Block can post the most recent annual survey results for net and gross pay to help confirm these numbers?
I have personally watched my income being eroded away by ever increasing overhead and stagnant unchanging reimbursement from Medicare and most commercial insurances, even witnessing some podiatrists being pushed right out of business for this reason. In 1987, I had B/L matrixectomies done and my parents paid $800 cash, and thought wow, I can help people and make that kind of money. Sign me up. Today, almost 40 years later, Medicare pays...
Editor's note: Dr. Davis' extended-length letter can be read here. To view Podiatry Management's latest poll on income, click here.
03/23/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY) - PART 1A
From: James DiResta, DPM, MPH
I appreciate Dr. Jacobs' recent entry and the accolades provided and I couldn't agree more. The profession of podiatry has come of age and podiatrists are in a better and more envious position today than ever. I know as I experienced these last 40 plus years and I can only look back with gratitude on what collectively we have accomplished. But we have a problem. A very big problem and it couldn't be more obvious to anyone who has been involved in graduate medical education and it should be obvious to our profession as a whole. Calling the problem transient is delusional and won't fix it. Marketing won't fix it.
Our student applicant pool is dwindling and the strength of that pool is, well, let's just say it's lacking. If you don't see it, go and look at the numbers yourself and when you can't find all the numbers (trust me nobody in authority is releasing them), ask yourself why? Call. Request them in writing. What you'll get is bits and pieces at best and you'll start to see that something is not right. This pattern of acceptances is going to catch up with us. TUSPM, one of our jewels, had matriculant MCAT scores of 500 just ten years ago and that has gone down to...
Editor's note: Dr. DiResta's extended-length letter can be read here.
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