12/21/2024    James DiResta, DPM, MPH

Definition of Podiatry (Allen M. Jacobs, DPM)

If there is one lesson to be learned from these
recent blog entries, whether overtly stated or
implied, and I might add from some of our most
esteemed colleagues is the stupidity of suggesting
that we ought to "stay in your lane". If
podiatrists of my generation stayed in our lane we
would be nowhere. We have come this far because we
were willing to buck the system and work to
improve our profession beyond the instruction we
received. I for one anticipated that those coming
along behind me would expand our scope further and
not be satisfied with the status quo.

If we fail to move this profession forward and
expand our scope to practicing more general
medicine we will be extinct in a very short time.
The walls are closing in on us. Why are we
committing ourselves to being stuck in our lane?
It is unthinkable that our 4-4-3 model of
education has limited us to treating only the
local manifestation of systemic diseases of the
foot and ankle. Can't we tune our medical
education model to provide for the treatment of
systemic disease that we feel comfortable treating
and that can improve upon the lives of our
patients?

This is imperative in today's healthcare arena
especially for our many residency graduates who
don't envision doing complex surgeries and yet
don't want to be existing financially on routine
foot care which is slipping away and frankly can't
support the lifestyle that our graduates were
promised and deserve. What's with all the
resistance?? If we need to increase our residency
programs by an additional year to provide the
clinical experience of primary care for our
graduates, let's do it. I cannot fathom any pre-
med college student choosing a 7 year plus
podiatry education over a 27 month physician
assistant educational program and being out done
by a PA.

This is nonsense. Today NPs can practice with full
authority in 26 states and PAs are gaining ground
in becoming more independent as well. It's just a
matter of time as they as a profession gain more
clinical experience. They have already changed who
they are from physician assistants to physician
associates. No DPM needs to be an all-inclusive
expert in any medical treatment just as no general
practitioner whether NP, MD or DO is expected to
be.

The key is knowing when to refer and treat
collaboratively which is something our profession
already does only too well. If we drive ourselves
any further into this bunker we are going to limit
only the few that can maneuver their way out. What
a selfish mistake that will be.

James DiResta, DPM, MPH, Newburyport MA

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12/19/2024    Robert Kornfeld, DPM

Definition of Podiatry (Allen M. Jacobs, DPM)

Dr. Jacobs’ definition of podiatry, should it be
the majority opinion, will surely lead to the
death of podiatry. If all we do is look at the
foot, focus on the foot and treat the foot
regardless of the underlying immune burdens (as if
the foot is independent of the body it is attached
to) we will surely be replaced by NPs and PAs in
the coming years. We are already a profession that
is slowly being usurped by these new professions.
Dr. Jacobs and I are from the older generation
that began the battle for parity through better
surgical skills.

But will that sustain us? I say absolutely not. I
feel that our schools need to provide more
comprehensive training in what creates an
inefficient immune system that is part and parcel
of most of the pathology we treat. Are we not
allowed to advance our skills once in practice? Or
are we only allowed to practice what we learn in
school and post-graduate training? Dr. Jacobs
admits that we do treat our patients systemically
but opines that’s only in the direct treatment of
foot pathology. And I opine that a functional
medicine podiatrist is doing just that. Treating
the pedal symptoms by managing the systemic
factors. Just by way of supporting, rather than
suppressing.

Several years ago, I wrote to every school of
podiatric medicine offering to teach what I have
been doing for decades. And sadly, I was ignored
by every single one of them. So, if you want to
sustain the limited thinking of our schools and
continue this antiquated idea of what we, as
doctors, should be able to do for our patients,
then there will be no need for podiatry. The foot
will become the domain of MDs, DOs, NPs and PAs
who are being trained in functional medicine and
will address what must be addressed in order to
actually practice health care. And that, after a
very satisfying and successful career, would
really disappoint me. In my mind, this is
professional suicide.

Robert Kornfeld, DPM, NY, NY