|
|
|
|
|
Search
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:
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.
03/23/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY) - PART 1C
From: Gary S Smith, DPM
I think there is a big disconnect among podiatrists. I don't think, as a profession, we know who we are anymore. I think Dr. Jacobs, who is a great lecturer, lives in a bubble and does not grasp the reality of most podiatrists. I was at a Zoom CME a couple of weeks ago and the majority of the lectures were about surgical ankle trauma, Charcot repair, and MIS surgery that about 90% of podiatry doesn't do. I was at the Buffalo seminar last fall and there were no orthotic, diabetic shoe, or podiatry instruments vendors. Obviously, it is not profitable for them to be there. Are podiatrists not doing these things? Are the majority employees and have no say in the choice of vendors?
If we are representing ourselves as “just surgeons", why would anybody choose podiatry over orthopedics? It seems that when I started 35 years ago, people were proud to be podiatrists and now they seem ashamed. I just watched another TV show a week ago where a podiatrist was the butt of multiple jokes from the other characters for not being "a real doctor." This is the perception of us that young people are seeing. We can't change that if we don't unify the profession around an identity that we can all ascribe to.
Gary S Smith, DPM, Bradford, PA
03/20/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY)
From: Allen M. Jacobs, DPM
Podiatric physicians serve as hospital chairpersons of the medical staff. Podiatric physicians as chairperson of the hospital department of surgery. Podiatric physicians as chairperson or members of hospital committees.
If memory is correct, I park in the same doctors parking lot as the MD/DO. I perform surgery in the same operating room suites. I write orders for the treatment of my patients which orders are carried out by any and all hospital personnel. I sit and eat and exchange conversation in the same doctors lounge. MD and DO physicians ask my advice and direction for the management of foot and ankle pathology. I am treated as an equal and my DPM degree is respected for its representative accomplishment to...
Editor's note: Dr. Jacobs' extended-length letter can be read here.
03/19/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY)
From: Joseph Borreggine, DPM
Two esteemed podiatrists, Drs. Amarantos and Jacobs have dedicated their careers to advancing the field of podiatry. Both recently have addressed crucial topics that are essential to our profession. Dr. Amarantos has expressed his concerns about how the podiatric profession has historically overlooked a vital aspect of our practice, biomechanics, and relegating it to a secondary position.
As a graduate of Scholl College in 1988, after transferring from CCPM during my freshman year, I was fortunate to have access to Scholl’s renowned in-house orthotic laboratory and the expertise of Professor Oleg Petrov DPM, a former CCPM graduate who joined the faculty in 1979. This collaboration between podiatric expertise in sports medicine and biomechanics became an integral part of the...
Editor's note: Dr. Borreggine's extended-length letter can be read here.
03/18/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY)
RE: The Best of Times, The Worst of Times
From: Allen M. Jacobs, DPM
Duality and contradiction summarize the opinions expressed in PM News with regard to the future of podiatry. Like the opening sentence of Dickens A Tale of Two Cities, “it was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of light, it was the season of darkness, it was the spring of hope, it was the winter of despair.”
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. An eclectic array of the full integration of podiatry exists. Podiatrists as members of the IWGDF. Podiatrists as committee chairpersons in the ADA. Podiatrists as contributors to IDSA guidelines and holding fellowship status. Podiatrists designing and receiving...
Editor's note: Dr. Jacobs' extended-length letter can be read here.
03/16/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY)
From: James DiResta, DPM, MPH
I hope that for those readers who were fortunate enough to read Dr. Tomczak's entry on "What we should think about” that you will come to realize what is happening in medical and surgical training in the U.S. and what the future may look like going forward. There is a tremendous outlook for future PAs and NPs. Their educational programs are expanding and they are training more independent and confident providers. They have established residency/fellowship programs at many institutions that podiatry could only dream of practicing in not that long ago. They have programs in many medical and surgical specialties and subspecialties including orthopedics, and they have training programs and educational events with the likes of AAOS. They have bills in state legislatures to expand their scope, more independent practice, and independent billing.
I wish I had some level of confidence that the future of podiatry looked as promising but honestly with our heads in the sand, and our inability to envision increased scope and practice for podiatry going forward thkat option is not...
Editor's note: Dr. DiResta's extended-length letter can be read here.
03/13/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY)
RE: What We Should Think About
From: Rod Tomczak, DPM, MD, EdD
Don’t think for a moment the healthcare community hasn’t noticed the downtrend in the numbers of podiatry students in this country. This down trend has caused an upswing in other lower extremity care givers. Nurses now treat what chiropodists treated in the 1950s in the United States. Nurse practitioners and physician assistants have expanded their practices, especially considering the fact that these disciplines did not exist until the early 1960s when they originated and it was not until the late 1970s that they became universally licensed. Podiatry has a history of looking to the horizon while these other care givers looked beyond the horizon after we get our heads out of the sand.
Don’t think for a moment the government isn’t aware that for the first time in years, podiatric residencies have gone unfilled because there aren’t enough graduates to fill them. Actuaries predicted what podiatry would need in the future to assure adequate foot care to an increased diabetic population. They also forecast what it would really cost to...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
02/13/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY) - PART 1B
From: Andrew Carver, DPM
The directive of adding an MD to the rear of our names may not lift up our profession to a level much greater than it already is. What about improving the "product" to our present four years study, the student, in ALL eleven podiatric colleges. Developing a student "product" that can compete intellectually AMONG our MD Associates.
What about the idea of sending teaching teams of the best of our educators, nationally, to teach electronically into all schools for a large portion of the lecture yearly material? Individuals like: E. Dalton McGlamry DPM, Lowell Scott Weil Sr, DPM, John Ruch, DPM, John Schuberth, DPM, Harvey Lamont, DPM, Allen Jacobs, DPM, John Steven Steinberg, DPM, David G Armstrong, DPM, MD, Lawrence Harkless, DPM, etc. These great minds and instructors in the profession would function directly with electronic student interactive teaching for a large segment of podiatric education. This might lift the profession higher than adding two nice letters following the DPM.
Andrew Carver, DPM, Ko Olina, HI
Editor's note: This topic is temporarily closed.
02/13/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY) - PART 1A
From: Amol Saxena, DPM, MPH
I have been reading the responses to Dr. Hrywnak's recent letter. I thought about what got me to "achieve" what I have, and it makes me sad that many of our younger members, despite apparently better training, will not achieve RRA credentials (required by Operation Footprint) and be blocked from working within the governing bodies of many Olympic sports (US Track & Field says specifically they will not take podiatrists on the medical team. They will take psychologists: only one brain, and we can treat at least two feet!).
My classmate Joe Borreggine wrote a very cogent analysis of Dr. Hrywnak's concerns. Both are SCPM/ICPM grads, which is within a medical institution with no orthopedic department. Joe was in the audience when I gave the lecture at the 2023 Midwest Conference on "Podiatry, Prejudice & Possible Solutions". He concurred with my findings as did many of my classmates who are not RRA certified and/or no longer perform surgery. Drs. Tomczak and DiResta continue to point out reasons to change. PM News polls, albeit not scientific, give signs the profession wants to change.
Amol Saxena, DPM, MPH, Palo Alto, CA
02/12/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY) - PART 1B
From: Rod Tomczak, DPM, MD, EdD
Larry, let me thank you again for again sharing your impressive CV with me and the other 21,000 readers of PM News. The thing is, Larry, not many of us have a resume as long or inspiring as yours. When we graduated, many graduates did not match to a residency. Even those who matched were not assured of a surgical program and only a few attained a PSR 24+, a real rarity. Very few podiatrists eventually secured an academic appointment, a full professorship, and yet enjoyed the thrills of private practice. A limited number became residency directors, fewer podiatrists regularly published, and a smaller minority became lecturers. Yes, Larry, we were the lucky soldiers of the 1980s and ‘90s and were truly fulfilled in our profession, but we were the far and few between podiatrists. I hear from classmates who are now hanging up their Dremels and nail nippers with the catch phrase, “If I knew then what I know now, I would have done it differently and not gone into podiatry.”
Just because every current graduate gets a three-year residency does not mean they all finish training with...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
02/12/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY) - PART 1A
From: James DiResta, DPM
It is beyond frustrating in reading recent comments regarding a plenary license for podiatrists. Dr. Olaf remarks how far we have come as a profession and we should be satisfied. He states the reality is orthopedists and others never pick up a stethoscope and frankly they know, like most specialists, to stay in their lane. I would agree but as time has gone on, we in completing our single track medical education have found ourselves stuck in our own lane; but it is not a lane in the same bowling alley as other medical and surgical specialists as we are left inferior to our peers and unable to play on the same field. The big picture has left us not being a full member as we lack a full general medical education before pursuing residency.
Trying to make this deficit up during our post-graduate time to get us to play on the same field as the big boys and girls is not working as no organization or licensing board will grant us an equal plenary license. We need to fix this issue and time is of the essence and the DO route as proposed by Dr. Tomczak is the most doable I have heard to date!
James DiResta, DPM, Newbury, MA
02/11/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY) - PART 1C
From: Lawrence Oloff, DPM
Having healthy dialogues is always worthwhile, as long as it is done in a respectful manner. I appreciate the posts by Drs. Hrywnak and Tomczak about a plenary degree. I respect their comments but I do not agree with them. I used to agree with these thoughts early in my career. However, I feel such thoughts are no longer in the best interests of our profession. I am in the tail end of my professional life. I have been blessed by the many positions that fell my way. I have been on podiatry faculty at a college, Academic Dean, managed a podiatry program in a top tier medical university, member/partner in a prominent orthopedic sports medicine group, podiatry residency director, and now my last job as full-time faculty in a medical school. Equally important is that I have been a private practitioner. I feel qualified to a give an opinion on these issues.
First a few facts. Podiatry now is not what I first started in. Those days were fighting tooth and nail for...
Editor's note: Dr. Oloff's extended-length letter can be read here.
02/11/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY) - PART 1A
From: Jon Purdy, DPM
For anyone that can see the writing on the wall, Dr. Hrywnak has spelled out exactly what needs to happen to keep podiatric practices viable. Being small in number, the podiatric profession does not have the political clout to fight battles on its own. Larger medical entities such as nurse practitioners and physician assistants do, and that is the reason they are able to do more than a podiatrist with less than half the training. We cannot employ ancillary healthcare workers without MD/DO oversight. We can’t even prescribe a cream for dermatitis on an arm.
What doesn’t hold water are the statements concerning “run away” practices. Could an orthopedist perform brain surgery or an internist perform sinus surgery? Technically with full scope they could, but why don’t they? Could a podiatrist with full scope do this?
Jon Purdy, DPM, Iberia, LA
02/11/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY) - PART 1B
From: Evan Meltzer, DPM
I have been following the discussion of the possibility of granting a plenary degree for podiatrists. This has caused me to think about a number of issues. A podiatry program director might ask a third-year podiatry resident if they feel that they have enough extra time in their three years to also study internal medicine, family medicine, etc. And if not, how many more years of residency do they think it would take to become proficient in an additional medical specialty? What might the MD/DO program directors of these specialties think?
Another major issue is how each state would handle the licensing process. New York State was one of the last states to expand the current scope of practice to include ankle surgery. I can’t imagine how many years it would take New York, for example, to approve a plenary scope of practice for podiatrists.
Evan Meltzer, DPM (retired), Rio Rancho, NM
02/10/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY) - PART 1B
From: Robert Scott Steinberg, DPM
I have been in practice for nearly 50 years, and in all that time, I have never heard anyone say that if we became MDs or DOs, we would leave podiatry behind. MDs and DOs have plenary licenses, and then choose specialties. We have MDs who are now focusing on the narrow field of foot surgery. If you do not think they have a distinct advantage over us, you are very out of touch.
Dr. Udell, Dr. Hrywnak's arguments were very well presented. You did not make any specific comments about any of his arguments. You are completely ignoring the disparity we face, as DPMs by insurance companies and other healthcare professionals. Shoe store salespeople present themselves as experts, as do DCs, PTs, and NPs. I am sure you're not alone in your opinions, as they seem to be pervasive in the APMA, as well.
I want to thank Dr. Hrywnak for his clear insights into the reality we face.
Robert Scott Steinberg, DPM, Schaumburg, IL
02/10/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY) - PART 1A
From: Joseph Borreggine, DPM
Dr. Hrywnak has presented a compelling case, substantiated by incontrovertible facts. The podiatric medical profession must address its shortcomings in the educational path it has pursued for years. Podiatry has undergone significant evolution over the decades, surpassing the expectations of its practitioners. However, this advancement has not yet resulted in the parity that podiatrists rightfully deserve as physicians. The debate surrounding MD/DPM has persisted for years, yet it has remained unaddressed. The reasons for this stagnation are unclear. Is it the podiatry schools, the Council on Podiatric Medical Education (CPME), or the American Podiatric Medical Association (APMA)? Or is it a combination of all three?
Dr. Hrywnak’s unwavering dedication to advocating for full licensure in our profession over the past decade has faced significant challenges, seemingly impeded by podiatry schools and the American Podiatric Medical Association (APMA). Given the current low admission pool for all eleven podiatry schools, it is reasonable to assume that there is a disconnect between the number of college graduates interested in entering the profession and the demand for podiatrists.
Dr. Hrywnak’s assertions appear to be accurate, but the APMA’s response has been lacking regarding his opinion on the matter. The future of our profession may be uncertain due to the inability to obtain full licensure, but the contrary view that the future of podiatric practice is promising contradicts reality. The future direction of our profession will be determined by the prevailing winds, and it is crucial that we address the challenges we face to ensure its continued success.
Joseph Borreggine, DPM, Fort Myers, FL
02/09/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY) - PART 1B
From: Narmo L. Ortiz, Jr., DPM
I am compelled to again comment on this issue because, with all due respect to Dr. Hrywnak's well-versed and possibly well-intended post, to me, it falls into the category of isolationism and not of inclusive parity.
If I may quote from one of his post's paragraphs, "Future-proofing the profession: the line between specialties is blurring. By expanding licensure, podiatrists can respond to emerging needs without outsourcing to other specialists..."
In other words, a plenary license will allow a podiatrist to diagnose, manage, and treat anything and everything ailing the patient that presents to their office or hospital's ER with a diabetic foot ulcer (which is the example given in his post). So many hats to choose from, right? In reality, "blurring" would be presenting to the public that the podiatry profession's members can be primary care, internal medicine, cardiology, and foot and ankle surgeons. Respectfully, I think only a fool would engage in such a practice without engaging in a team approach when treating a metabolically complicated patient.
Narmo L. Ortiz, Jr., DPM, Davenport, FL
02/09/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY) - PART 1A
From: Elliot Udell DPM
The subject of "unlimiting" podiatrists' limited licensure has been debated ever since I opened my first office more than 35 years ago. The old argument was to give podiatrists MD and DO degrees and allow them to choose whether to treat feet or go into some other medical specialty and leave the treatment of feet behind. Dr. Hyrwnak's approach is to broaden the DPM degree, just as DOs can do everything an MD can do, Dr. Hyrwnak's approach would seem to allow a person with a DPM degree to treat the entire body. If I am reading this line of thinking correctly, theoretically, a person with an unlimited DPM degree could do a GI fellowship, orthopedic residency, psychiatry, etc.
The problem is how many doctors with expanded licensure would decide to treat people with foot problems, and doesn't "John J Public" deserve access to a doctor who will treat people with foot problems in a scenario where the majority of graduates might turn their backs on good old foot care? The only fair way for Dr. Hyrwnak's proposal to work would be to moderately but not fully expand the scope of a DPM and monitor each stage carefully before proceeding further.
Elliot Udell, DPM, Hicksville, NY
02/06/2026
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY)
From: Sev Hrywnak, DPM, MD
Podiatry has historically focused on foot and ankle pathology, but the evolving healthcare landscape demands a wholesale shift in how this profession prepares its graduates. A limited license that restricts practice to foot and ankle care constrains the potential impact podiatrists can have on population health, collaboration, and cost-effective care delivery. Here are key reasons for pursuing planetary/full licensure and broader scope:
Competitive relevance in a crowded market: Healthcare professions are expanding scope to meet comorbidity management and aging populations. Licenses that affirm competency in a wider set of musculoskeletal and systemic health issues differentiate practitioners and attract patients seeking comprehensive foot-to-knee care in a single...
Editor's comment: Dr. Hrywnak's extended-length letter can be read here.
|
| |
|
|
|
