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12/21/2024
RESPONSES/COMMENTS (PODIATRIC EDUCATION)
From: Bret M. Ribotsky, DPM
Allen, you clearly missed my point. If the profession guaranteed financial success (like Ortho, Derm, Cardiology, etc.), then the applicant pool that is choosing to become nurse practitioners or physician associates would be giving more thought into our profession. If many DPMs are earning less than half of what other professionals are earning - this issue needs to be dealt with. While money is not the root of success, it does give a stable foundation that would lower malpractice claims (additional stacked procedures), would reduce insurance fraud, and give everybody a greater sense of well-being, respect, and success.
Bret M. Ribotsky, DPM, Fortt Lauderdale, FL
Other messages in this thread:
05/28/2025
RESPONSES/COMMENTS (PODIATRIC EDUCATION) - PART 1B
RE: We Missed the Boat
From: Steven D Epstein, DPM
Nurse Practitioners (NPs) have that vaunted “plenary” license, so if doing wound care, it's all wounds (including ostomies), not just feet. They're not independent? Some are, but most are hospital-employed, well compensated, so who cares, and no financial risk that way – just salary and benefits. So, if you don't do surgery but do wound care, you are competing with them. If you can't plane the bone or excise the exostosis responsible for the ulcer or apply the surgical graft, what can you do that they can't? Not to mention that since they are hospital-employed, they are getting tons more referrals than you – and tons more experience and expertise that comes with that.
And BTW, you all know this because you view those free wound care webinars at which they lecture provided by companies like HMP, that began during the pandemic and have continued. Oh, will they take over routine foot care? I doubt they'll do much of it themselves. Too time-consuming, not to mention mainly not insurance reimbursable, so they'll train some nail techs or LPNs to do it.
Older docs like me remember when nursing truly was a “lower” profession, but that began changing about...
Editor's note: Dr. Epstein's extended-length letter can be read here.
05/28/2025
RESPONSES/COMMENTS (PODIATRIC EDUCATION) - PART 1A
RE: Why the 4-4-3 Model Makes Sense Today
From: H. David Gottlieb, DPM
When I graduated PCPM [now Temple] in 1982, all podiatry colleges stated their mission was to prepare graduates to enter practice after graduation. They were all able to meet that goal. We all had exposure to surgical cases - some more, some less - but we were comfortable doing osteoplasties/arthroplasties and Austin bunionectomy. We all knew how to avulse a nail or do a matrixectomy and what the difference was, not to mention orthotics and “C&C”.
Today, all podiatry colleges state that their mission is to have their graduates prepared for residency, or to be the best possible resident, or some variation on that theme. The graduates' exposure to the skill sets mentioned above now varies greatly from school to school, and even within any graduating class. The reality now is that residency is REQUIRED if a graduate from podiatry school wishes to earn a living as a podiatrist or get a license. It is in residency where our graduates now learn the skills to practice. It takes 3 years to train them in these skills and the knowledge of when and where to apply them. Consider it vocational training if you will.
Graduates are intelligent and kind which makes for a good podiatrist. This isn't their fault and I don't know exactly how it is this way, and I don't care. However you want to think about the situation; this IS the reality being lived. If you won't deal with reality, well, I can't be clearer.
H. David Gottlieb, DPM, Baltimore, MD
05/22/2025
RESPONSES/COMMENTS (PODIATRIC EDUCATION)
From: Allen M. Jacobs, DPM
Some years ago, I was serving on the credentials committee at a large hospital in St. Louis when a DO orthopedic surgeon applied for staff. The discussion, led by the MD chairperson, was that "we" (i.e.-medicine) did not recognize his DO residency nor his DO board certification. He was denied staff access. Prior to that, while in high school, college, and podiatry school, I worked as a surgical retractor holder and then as a scrub nurse in several major Philadelphia hospitals. Never did I see a DO in these hospitals, nor any positive references to the DO degree.
Today, 11% of medical school graduates hold a DO degree, and schools of osteopathic medicine are rapidly multiplying. With no reference points other than common sense, I suspect the majority, not all, but the majority of students entering osteopathic medicine colleges do so as a second choice to obtaining an MD degree. Similarly, I suspect...
Editor's note: Dr. Jacobs' extended-length letter can be read here.
05/21/2025
RESPONSES/COMMENTS (PODIATRIC EDUCATION) - PART 1A
From: David Secord, DPM
I started out as an electrical engineer, attending Milwaukee School of Engineering. My roommate and I ended up becoming best friends and it is funny how our lives progressed. I moved to South Texas and worked as a telecommunications engineer. Kevin went on to build Formula I engines for A.J. Foyt Racing. We both eventually chose a path in medicine. Because of my experience of tearing up my right ankle playing basketball at The University of Dallas, I wanted to do foot and ankle as a profession and attended the Temple School (PCPM at the time.) Kevin attended a DO school and is an ER doctor in Las Vegas, after serving some time in the Navy.
When we reconnected some years back, he was interested in my choice and I was interested in his choice. I never considered applying to a DO school for a good reason: what I wanted to treat. When I moved to South Texas, I ended up entering the seminary to study for the Diocese of Corpus Christi. I became friends with three individuals, all of whom left the seminary—as I did—and became doctors. All of them wanted to be surgeons. None of them ended up in the top 10% of...
Editor's note: Dr. Secord's extended-length can be read here.
05/21/2025
RESPONSES/COMMENTS (PODIATRIC EDUCATION) - PART 1B
From: Ivar E. Roth, DPM, MPH
Dr. Tomczak wrote, “As of this week, AACPM will not answer or even acknowledge my calls.”
I want to chime in here. I have also called AACPM several times over 3 weeks and sent emails as well with no response until I literally left a rather pissed off voicemail and email to them explaining that if I did not get a response, heads would roll. I finally got a response email that was not signed and claimed, “Due to the small size of our staff, we always recommend people reach out via email with any questions or issues.”
The problem with this response is that I had written several previous emails and called and heard nothing. Finally, after threatening heads would roll, I got a phone call back. The person that called could NOT explain what...
Editor's note: Dr. Roth's extended-length can be read here.
01/27/2025
RESPONSES/COMMENTS (PODIATRIC EDUCATION)
From: James DiResta, DPM, MPH
Dr. Kass couldn't be more correct when he states, "Everyday I read how various professions are increasing their scope of practice... nurses, NPs, PAs, etc. I wonder when podiatry is going to jump on the bandwagon." I read today where pharmacists are expanding their scope from treating covid with Paxlovid, flu symptoms with (oseltamivir), Relenza, or Xofluza and in some states now prescribe antibiotics for various illnesses like a urinary tract infection. The horse and wagon left the barn years ago; when the heck will podiatry jump on? The profession needs to increase its scope in medical care.
James DiResta, DPM, MPH, Newburyport, MA
01/24/2025
RESPONSES/COMMENTS (PODIATRIC EDUCATION) - PART 1 A
From: Robert Scott Steinberg, DPM
Dr. Kass makes some excellent points about the medicine part of podiatric medicine. It's too bad that CPME, APMA, and the colleges don't bring podiatric medical education into this century. The curriculum must be expanded to include more medicine. The Illinois Association of Podiatric Physicians and Surgeons (ILAPPS) (formally IL Podiatric Medical Association) failed to convince Scholl College to switch from using candles to using light bulbs.
As someone who joined 209 out of 218 students at the Illinois College of Podiatric Medicine in the early 1970s who went on strike for two months against the college, I can tell you, as it was true back then, it is true now: Students are being cheated.
Robert Scott Steinberg, DPM, Schaumburg, IL
01/24/2025
RESPONSES/COMMENTS (PODIATRIC EDUCATION) - PART 1 B
From: Jeffrey Kass, DPM
Dr. Chaskin brings up an interesting point about the unfairness of the New York podiatry scope. I find it absurd that in order for a podiatrist in New York to treat skin above the ankle, the doctor must be board certified in forefoot and rearfoot surgery. What other medical profession has a board certification requirement by law to treat patients? This law is so absurd. I have younger colleagues who finished three-year surgical residencies and are adept at treating ankle conditions and performing ankle surgery, yet are forced to take their patients to New Jersey to treat their patients because the process in New York takes time to complete.
I agree with Dr. Chaskin that there are numerous lawsuits that can be brought to change the current status quo. Aside from what I mentioned above, there is the fact that “interstate commerce” is being affected. If a doctor is competent to perform an ankle surgery in New Jersey, then they are competent to perform it in New York. Every day I read how various professions are increasing their scope of practice....nurses, NPs, PAs, etc. I wonder when podiatry is going to jump on the bandwagon.
Jeffrey Kass, DPM, Forest Hills, NY
01/23/2025
RESPONSES/COMMENTS (PODIATRIC EDUCATION) - PART 1 B
From: Daniel Chaskin, DPM
I disagree with Dr. Spinner. Some state legislatures (for example, the NYS legislature) feel we are a specialty with only recognition of being board certified in surgery. When the NYS ankle law was discussed in 2012, there was no mention of the antitrust effects on members of the ABPM, prohibiting medical treatment of the ankle. Board certification in podiatric medicine is not recognized to “medically" treat the ankle. Yet board certification in surgery is required to medically treat the ankle, in the absence of a chronic foot ulcer.
If the written minutes or discussions of the New York State legislature had no mention of the anti-competitive effects on podiatrists who are board certified in podiatric medicine, this 2012 ankle law might be able to be rendered null and void as anticompetitive and not in compliance with federal legislation that prohibits antitrust activity. Scope might be increased to allow podiatrists board certified in podiatric medicine to medically treat the ankle.
Can state societies take political action to correct what might be classified as a possible restraint of trade against podiatrists only board certified in podiatric medicine? Do any members of ABPM have similar opinions? Did any state society ever contact the U.S. Dept of Justice and/or the Federal Trade Commission for their opinions on how to recognize the value of being board certified in podiatric medicine, and if not, why not? Problems like this might be a possible reason why there is such low enrollment in our podiatric medical colleges.
Daniel Chaskin, DPM, Ridgewood, NY
01/23/2025
RESPONSES/COMMENTS (PODIATRIC EDUCATION) - PART 1 A
From: Jeffrey Kass, DPM
Dr. Gottlieb gives a good explanation of why longer residencies are needed in terms of funding, but I thought he fell short on his last sentence. A non-surgical resident can be trained to do so more than “chipping and clipping”. Podiatrists can be trained much better in the “podiatric medicine arena”, whereby no one has to be afraid to treat podiatric conditions with broader systemic concerns. For example, many podiatrists might make a diagnosis of gout but then return the patient to the internist or rheumatologist to treat the gout. A well-rounded and trained podiatrist could/should be trained to treat this, as some currently do. Gout is just one example.
The scope of podiatry needs to be expanded and, in my mind, needs to be the same in every state. I think it is silly to force everyone into 3-year surgical programs when not everyone wants to do surgery or is not adept at doing it.
Jeffrey Kass, DPM, Forest Hills, NY
01/22/2025
RESPONSES/COMMENTS (PODIATRIC EDUCATION) - PART 2 B
From: Steven Spinner, DPM
Kudos to Dr. Neuhoff’s post. When I had the opportunity to address the APMA House of Delegates as president of ABPS, I argued against the homologation of our residency training model. We are not a surgical specialty…we are a diverse profession which has foot and ankle surgery as one of our sub-specialties. When I was done with my presentation, I was approached privately by, if I remember correctly, the executive director at that time. He confided that I presented a strong argument but the APMA had to protect the "grassroots" podiatrists, and the profession believed that all podiatrists, regardless of training, had a right to do foot surgery. I remember asking him if he had a daughter, and if he did, would he rather a doctor from my training model or his do her surgery. He leaned in closely and said, “well, yours of course, but I can’t tell anyone that.”
So there are 2 issues. The first is that, as Dr. Neuhoff said, that not all of our graduates either...
Editor's note: Dr. Spinner's extended-length letter can be read here.
01/22/2025
RESPONSES/COMMENTS (PODIATRIC EDUCATION) - PART 2 A
From: Ivar E. Roth, DPM, MPH
How sad but true. Many of the matriculating students just do not have the hands or eye coordination to be a surgeon and thus this training is to some extent a waste. This also holds true of probably the lower one quarter of the graduating students at the podiatry schools that they are either not bright enough or motivated to be decent practitioners.
I do not know the answer, but the low number of applicants seems to guarantee that less than adequate students are being pushed through the system and thus are doomed to failure or not providing the public a competent practitioner. We should try and get ALL medical school applicants to also apply to, or be made aware of, podiatry medical education. This could be done by the APMA putting up a website specifically directed to the DO and MD applicants.
Ivar E. Roth, DPM, MPH, Newport Beach, CA
01/22/2025
RESPONSES/COMMENTS (PODIATRIC EDUCATION) - PART 1
RE: Why We Need 3-Year Residencies
From H. David Gottlieb, DPM
The reason is, quite frankly, simple. Money. Money, and Medicare. In all U.S. jurisdictions (except Maryland which has a Medicare exemption), residencies receive most of their financial support through Medicare. Medicare rules state that, essentially, they will provide full funding for the MINIMUM number of residency years required for board certification. If only 2 years of residency are required for certification, then Medicare would only fully fund 2 years of residency. This creates a financial burden on all 3-year programs.
If you peruse the AACPM list of podiatry residency programs, you will see only about 10 do not have the Rearfoot/Reconstructive Ankle [RRA] suffix. If there was a single, initial certifying board, I believe that that ratio would eventually flip. Those who wish additional designation will be free to earn that. Also, the curriculum at podiatry colleges now has as their goal to prepare their students for residency, not practice. Who wants to go through residency to learn chip & clips?
H. David Gottlieb, DPM, Baltimore, MD
01/11/2025
RESPONSES/COMMENTS (PODIATRIC EDUCATION)
RE: Ethics of Belief
From: Rod Tomczak, MPM, MD, EdD
It’s always in vogue to criticize the colleges of podiatric medicine and surgery for all the problems affecting podiatry for the next fifty years following a student’s graduation. Podiatric problems exist right now and forever if you listen to the word on the street that is disseminated by graduates of podiatry schools. Educators live by something called a mission statement. Everything that happens at every podiatry school should synchronize with the mission statement. Some schools have lofty mission statements about finding and curing all foot pain, onychomycosis, bromhidrosis, sheltering the homeless, and creating new knowledge to benefit mankind. Pretty lofty plans.
Realistically, all the podiatry schools today should have an identical, singular and straightforward mission, “We will prepare students for the next level of training.” If students can pass their boards and are ready to learn at the PGY-1 level, the schools will have...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
12/17/2024
RESPONSES/COMMENTS (PODIATRIC EDUCATION) -PART 1B
From: Allen M. Jacobs, DPM
No, Dr. Ribotsky, the answer is not money. Real money is made in business, not the "business of medicine". People go into podiatry because they wish to impact lives in a positive manner. They go into podiatry because they wish to do surgery. They choose podiatry because it brings respect. They choose podiatry because they have an interest in science. They may choose podiatry as an alternative to other healthcare professions for a variety of reasons. Guaranteeing $400,000 or more annual income is not the reason to enter medicine. Many, if not most, podiatrists (according to surveys, including PM News) do not earn $400,000 a year.
The “complaints” regarding the practice of podiatry are generally no different from the “complaints” of our medical colleagues. Yes, money is important. And having money is nice. However, as Sir William Osler so well noted, that while you entered this profession to earn a living, generating money must always be a secondary concern. This may be difficult in today’s world, but ethically medicine is still a calling and not a business first profession.
Allen M. Jacobs, DPM, St. Louis, MO
12/17/2024
RESPONSES/COMMENTS (PODIATRIC EDUCATION) - PART 1A
From: Robert Scott Steinberg, DPM
Nothing will improve until the mindset of CPME changes. They are living in the past and cannot see the future. We need to demand that CPME seek a more complete medical education. The colleges don't seem to want to do that. Case in point: The Illinois Association of Podiatric Medicine and Surgery (ILAPPS) - formally the IPMA, has run into a brick wall with the Scholl College at Roseland Franklin University (RFU), which includes the Chicago Medical School. We asked them to allow the podiatry students to take additional courses with the medical students. RFU refused. It will take CPME to force the issue. This is the only way we will see a long-term modernization of podiatric medical education.
Robert Scott Steinberg, DPM, Schaumburg, IL
10/01/2018
RESPONSES/COMMENTS (PODIATRIC EDUCATION)
From: Ivar E. Roth DPM, MPH
David Herbert has a great idea about the DAT. He is thinking out of the box. Congratulations, you just solved podiatry’s problem finding qualified applicants.
Ivar E. Roth DPM, MPH, Newport Beach, CA
09/27/2018
RESPONSES/COMMENTS (PODIATRIC EDUCATION)
RE: Podiatry Schools Should Accept DAT Results
From: W. David Herbert, DPM,JD
I have met several dentists who told me that they would have probably applied to podiatry school if they had known more about the profession. I understand that almost 15,000 applicants take the dental aptitude test every year. I also understand that less than 50% of the applicants to dental school actually gain admission.
Maybe the profession could consider accepting the dental aptitude test (DAT) results for admission to podiatric medical school. Just by having podiatric medical schools as an option to send scores to would put podiatric medical schools in contact with students who could eventually become podiatric medical school students.
W. David Herbert, DPM, JD, Billings, MT
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