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01/11/2025
RESPONSES/COMMENTS (NON-CLINICAL)
RE: Why The Podiatry School Applicant Pool is So Small
From: Elliot Udell, DPM
This topic gets bandied around every year. The current survey on PM News may lead to some answers. At this moment 18% were either somewhat dissatisfied or not at all satisfied. 37% are only somewhat satisfied.
An astute pre-med student who will be facing 7 years of training and a mountain of debt may have difficulty choosing podiatry after looking at this survey. What are the main areas bothering practicing podiatrists? Once we know and acknowledge each area of deficiency, we can begin to repair the problems. Only then will this lead to far more attendance at our colleges.
Elliot Udell, DPM, Hicksville, NY
Other messages in this thread:
04/23/2025
RESPONSES/COMMENTS (NON-CLINICAL) -PART 2 A
From: Allen M. Jacobs, DPM
The increasing cost of wound care, including the employment of skin graft substitutes, is not a podiatry centric problem. Many factors, such as an aging population, the rise in disorders with which wounds are associated (e.g.: diabetes, PAD, venous disease) have continued to drive the need for wound care. The failure of insurers to provide reasonable or in fact any payment for preventive care is a factor. Socioeconomic issues such as patient access, patient education, patient financial concerns are factors.
The expense associated with dressings, skin graft substitutes, de-facto referral of patient referrals to wound care centers, contribute to the problem. With specific reference to skin graft substitutes, Dr. Geistler notes in PM News that in his experience, skin graft substitutes are not required for the management of most wounds. There are over 350 "skin graft substitutes" available world-wide. Many are extraordinarily expensive, with little...
Editor's note: Dr. Jacobs' extended-length letter can be read here.
04/23/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2 B
From: Ivar E. Roth DPM, MPH
My highest accolades for Dr. Geistler opinions on the overuse and abuse of grafts being used in podiatry. He is right on, and I am proud to call him a true professional. I agree... throw the book at our fellow practitioners who are just milking the system for the dollars and really NOT helping the patients at all.
Ivar E. Roth DPM, MPH, Newport Beach, CA
04/23/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
From: James Hatfield, DPM
The post by Louis Profeta, MD is excellent and should be required reading by all residents, students, and applicants. I'm so tired of hearing all the whining going on about our profession. We have an excellent future and waste too much time obsessing about our degree. Get a life!
James Hatfield, DPM, Encinitas, CA
04/14/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Rod Tomczak, DPM, MD, EdD
I really want to thank Dr. Secord for his German compound word idioms. It plays precisely into the completion of defining podiatry. When I was 16, I still was fluent in German, attending a boarding school near Aachen. I still dream in German once or twice a month, but nowhere like it used to be. As a lone monk chants at the burial of as pope, “Tempus fugit, memoria mortem.” Time flies, remember death.
For quite some time, we have defined ourselves as the primary care givers of feet, especially for what we identify as sick feet. Let’s be honest, most of us don’t do reconstructive surgery on feet with multiple complex deformities and use external fixation. Orthopedic foot and ankle care givers don’t have time during their one-year fellowship to learn what we learn in seven years. If you want to make it a binary distinction, we take care of sick feet that have sometimes...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
04/14/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: Podiatry’s Identity Crisis
From: Arden Smith, DPM
Background: this is my third winter since retiring and snow-birding. Both my former partner and I are both double boarded and we were lucky enough to have developed a very early niche in the medical and surgical treatment of the high-risk diabetic foot and limb salvage through having a satellite office within a large endocrine practice, beginning in the mid-1980s. This was something that we had very little training for and learned by the seat of our pants and attending diabetic foot conferences. We started out asking a friendly vascular surgeon if we could assist on referred cases and over a relatively short period of time, started asking him if he wanted to assist us; and then eventually stopped asking, other than the vascular consult. We also had a large volume general podiatry practice that was somewhat surgically oriented. We would see multiple generations in families.
Our general practice was a neighborhood practice in a middle class area, and our diabetic practice was a referral hub between two...
Editor's note: Dr. Smith's extended-length letter can be read here.
04/09/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: David Secord, DPM
Once again, Dr. Tomczak helps focus upon the pivotal point in the progression of our fate. That he does so while being able to throw in a little modus tollens Aristolean syllogistic logic is that much more entertaining. It had been a while since I’d seen the term portmanteau, so kudos!
His description of our struggles to define ourselves before we can define what we do and who we are as a profession to the lay public as a synecdoche or metonymy rings true. Dr. Tomczak does a wonderful job in his musings as a erziehungsroman of sorts. We are truly, as a profession, writing a bildungsroman as we go. Hopefully, the story will end as a victory and not a tragedy. Change is inevitable. Our indecision to initiate and continue the journey is not encouraging.
David Secord, DPM, McAllen, TX
04/09/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: Podiatry Salaries vs. Nurse Salaries from Becker's Hospital Review
From: Steven D Epstein, DPM
Certified registered nurse anesthetists (CRNAs) make more than most of us do. An RN makes this after only four years of undergraduate education. And this doesn't preclude them from going into advanced practice; in fact, experience as a "mere" RN is usually required to be accepted for advanced practice training. Failing to be accepted for that consigns one to a miserable six figure salary career.
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Nurse's Salaries (Source: Becker's Hospital Review) |
This kind of info is now freely available for high school and college students to see. Is it any wonder that smaller numbers of students are choosing podiatry as a career?
Steven D Epstein, DPM (retired), Lebanon, PA
02/28/2025
RESPONSES/COMMENTS (NON-CLINICAL)
From: Richard M. Maleski, DPM, RPh
I'm glad to see someone else is interested in seeing the DPM's role go from cutting nails to overseeing the management and treatment of nail pathology. I've opined in this forum a few times now that we should not be spending our time on the physical practice of cutting nails. About 30 years ago, I spoke with the Executive Director of our state society (PPMA), Michael Davis, about the possibility of having podiatric assistants cutting nails and still being able to bill for that. At that time, he told me that podiatrists were not legally able to supervise such activity in Pennsylvania, let alone bill insurance for it.
When I asked how difficult would it be to change that, he said that it would probably have to involve state legislative changes, which would be very difficult. I did speak with a Board member also, a DPM, and he felt that there would be very strong resistance from the podiatric community. Most DPMs were very content to ...
Editor's Note: Dr. Maleski's extended-length letter can be read here.
02/27/2025
RESPONSES/COMMENTS (NON-CLINICAL)
From: H. David Gottlieb, DPM
Change is constant in life and in podiatry. The APMA used to be the APA, and before that, NAP. The degree used to be DSC (and PodD) before DPM. Podiatry schools in the early '80s had as their mission "to prepare graduates for practice.'' Now, their mission is to "prepare graduates for residency." Many states did not require residencies for a license. Now most do, and I expect very few, if any, require only a one-year residency.
Providers on this forum complain incessantly that the APMA is not addressing the current "crisis"' facing our profession… that they need to do something to be more aggressive… that the current staff needs to "wake up''. So change is being made. First, someone with an MBA is hired to lead the organization - someone with a fresh perspective who can evaluate APMA as a business, which it is. After assessing the business of APMA and determining what "needs" need to be met in order to be successful, appropriate changes are being made to accomplish those goals. APMA is no longer doing business as usual.
So, as I see it, APMA is first being criticized for not making changes to address the current crisis but when APMA starts to make changes to meet the challenges facing this profession, TODAY they get criticized. Give me a break. Change must be made. Change IS being made.
H. David Gottlieb, DPM, Baltimore, MD
02/26/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Ivar E. Roth, DPM, MPH
Dr. Whelan is correct. Let’s take control of this situation. The writing is clearly on the wall; we as a profession have to move, and move fast to make sure we are in charge of any change. The students graduating today are not interested in routine care. It is sadly now a fact. Also, we have to lose the limited license aspect of our profession. We are so well trained, but can do less than a PA, nurse, or many other allied professionals.
The time is now. Who will lead the charge is dependent on our leaders, but the time has come.
Ivar E. Roth, DPM, MPH, Newport Beach, CA
02/26/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A
From: Thomas A. Graziano, DPM, MD
Dr. Whelan brings up some salient points when addressing the concerns over the future of podiatric medicine. Many years ago, the foot was neglected by the medical community and podiatry came into its own by filling that void. The current requirement for EVERY podiatry school graduate to complete a 3-year surgical residency has fostered the neglect of routine foot care. And now that void appears to be filled by nurses or non-podiatric ancillary staff. History may be repeating itself.
In 41 years in practice, I've seen the gradual decline in the public's perception and the insurance industry's devaluation of healthcare professionals. We are no longer perceived as doctors. We are now looked at by the insurance industry and to some degree by the public merely as "providers."
The recent survey on this forum demonstrating that if given the choice, over 43% would prefer a career path in osteopathic medicine is not at all surprising. Let's address the elephant in the room. A good friend of mine whose son just completed a DO family practice residency accepted an offer of 350K/annum as a hospitalist. And this for an 18 day/month work schedule. Perhaps the survey results and paucity of podiatry school applications might have something to do with the disparity between podiatry and osteopathic medicine.
Whether one agrees or not as to why the profession of podiatric medicine is at a crossroads right now, there's no doubt the writing is on the wall. 300 applications to all the podiatry schools sends a clear message. Dr. Whelan's comments may not only be insightful but may be a necessity in the very near future.
Thomas A. Graziano, DPM, MD, Clifton, NJ
02/26/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
From: Lawrence Rubin, DPM
Along with others posting, I was saddened to hear that APMA has fired two very qualified and seasoned health policy employees. I hope there is justification for this, since national health policies having to do with health insurance reimbursement are changing dramatically with the advancement of the Medicare led value-based care payment model. APMA health policy employees should be thinking forward and hard at work developing ways and means to help its members transition to value-based care now, as it is already moving forward and is considered the future of healthcare to be fully implemented in 2030.
Value-based care offers numerous benefits for both patients and providers. These benefits include improved patient outcomes, greater physician satisfaction, and a more sustainable financial model by focusing on quality of care rather than just volume of services delivered. It also offers financial rewards for those podiatrists who will collaborate in providing lower extremity chronic disease prevention services.
APMA members who delay the transition due to lack of information and guidance could potentially be missing opportunities for better patient care and could put their practices at a competitive disadvantage. Hopefully, this was considered when the decision to fire these employees was made.
Lawrence Rubin, DPM, Las Vegas, NV
02/25/2025
RESPONSES/COMMENTS (NON-CLINICAL) -- PART 2
RE: Source for Injectable Alcohol
From: Louis Cappa, DPM
I found a compounding pharmacy that sells injectable alcohol for neuromas...Compounded Solutions in pharmacy in Monroe, CT
Louis Cappa, DPM, New Windsor, NY
02/25/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 4
RE: Redefining Roles in Podiatric Care: Exploring the Potential for a Standardized Foot Care Assistant Model
From: James H Whelan, DPM
The landscape of foot and ankle care is evolving. With an aging population, a growing number of patients with diabetes, and shifts in podiatric training emphasizing surgical intervention, there is an increasing need to ensure continued access to high-quality foot care while reinforcing the role of podiatric physicians as the foremost experts in foot and ankle health. A topic of growing discussion within the profession is the expansion of routine foot care services provided by non-podiatric healthcare professionals. While this raises concerns about scope of practice, it also presents an opportunity to explore structured, podiatrist-led models that enhance patient care and optimize the efficiency of podiatric practices.
One potential solution is for professional organizations such as APMA and ACFAS to evaluate the feasibility of developing a standardized Foot Care Assistant (FCA) role—a structured position within podiatric practices that allows trained professionals to...
Editor's note: Dr. Whelan's extended-length letter can be read here.
02/25/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 3
From: Rod Tomczak, DPM, MD, EdD
There are now 37 osteopathic schools in the United States, meaning more seats. There are 158 MD schools in the U.S. which are not increasing in numbers or seats. LCME and AAMC limit the number of seats at each medical school and there is no increase in the foreseeable future. Acceptance to a Caribbean medical school is a given, but passing USMLE is a crap shoot. DOs take the same USMLE licensing exams as MDs and match into historically allopathic residencies.
The difficult part of the plan will be extending the DPM residency funding to include DOs with a one-year general internship that has been allocated for DPMs. If, however, there are no DPMs, or only a few pure DPMs, there will be money available. Remember, the new DO foot and ankle provider must learn everything about the foot and ankle in two years of residency training. Foot and ankle orthopedic fellows do it in one year.
It will be easier for a future non-DPM foot care specialist to get accepted into a DO school. I take umbrage with the conceptualization of DOs as intrinsically different than MDs. DOs and MDs use the same textbooks and take the same USMLE exam for licensing and match into the same residencies. Some MD schools are combined with a DO school. How many strict DO hospitals are you aware of? Historically, DOs had to serve a one-year internship in a DO hospital to gain privileges at a DO hospital. That concept went the way of the lamplighter, milkman, and DO hospital. I see these foot care specialists being certified by a single board titled something like the American Board of Foot and Ankle Medical Specialties. All the other certifications will be superfluous and obsolete. Time to come together.
Rod Tomczak, DPM, MD, EdD, Columbus, OH
02/25/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: Shocked and Saddened
From: Mark Block, DPM
On February 21st, out of the blue, I, along with the APMA membership, was informed of significant changes within the Association. It appears that APMA has decided to undergo a major restructuring.
Having been a long-standing member since my time as a student, I recognize that while other podiatric entities contribute meaningfully to our profession, APMA along with other missions serve as a unifying voice. Its ability to lobby and advance legislative initiatives is essential to the profession’s strength and future. I have come to appreciate that the Association’s long-term viability must be ensured. Should APMA cease to exist, it would leave a tremendous void with serious negative ramifications...
Editor's note: Dr. Block's extended-length letter can be read here.
02/24/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: Irv Luftig, BSc, DPM
Stephen Peslar is correct that many of the chiropodist graduates have left the profession, and the actual DPM podiatrist population is dwindling because of the idiotic 1993 legislation, stopping any DPM podiatrists coming into Ontario from practicing their full scope. This was a power grab by the medical establishment and an extremely poorly thought-out attempt by the government of the day to bring in chiropody practitioners to work in nursing homes and hospital clinics on a salary. The right to establish themselves as private practitioners and make positive progress in Ontario was through a charter of rights challenge brought by the chiropodists in the late 1980s which was successful. The governing college for the profession has been fighting tooth and nail for many years to establish podiatry as a properly recognized profession and unify us and increase our scope of practice to a full scope.
I personally had a wonderful and fulfilling career as a DPM podiatrist in Ontario until my retirement. There are many excellent, hardworking chiropodists and many excellent, well trained, skilled podiatrists in Ontario who have been pioneers in surgical procedures and...
Editor's note: Dr. Luftig's extended-length letter can be read here.
02/24/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Daniel Chaskin, DPM
There has got to be some sort of educational program so non-surgical podiatrists can increase their scope of practice to treat the ankle as well as the rest of the body. Nursing schools should offer advanced placement for DPMs who wish to medically treat the ankle and above, as well as systemic diseases in certain states. This way, a DPM could qualify to get a nursing degree as a path to obtaining a license for treating the ankle as well as systemic diseases.
Once getting a nursing degree, they could then opt to get a nurse practitioner degree. Is it possible Touro might consider offering advanced placement for DPMs to obtain a nursing degree as a path to increasing scope?
Daniel Chaskin, DPM, Ridgewood, NY
02/24/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: David Secord, DPM
Although I agree that the future of the profession is plenary licensure, I’m confused as to why there would be a push to obtain a degree as an osteopath with a podiatric sub-specialty, as opposed to obtaining a degree as an allopath with a podiatric sub-specialty? There are a certain finite number of medical theories out there, including allopathic, osteopathic, homeopathic, chiropractic, native American Indian pan-theistic naturopathy, witch doctors, Eastern Indian Ayurvedic medicine, and a few others.
Allopathic medical theory has as its basis the idea of pathology from disease state: bacteria, virus, spirochete, genetic dyscrasia, prion, etc. Unless I missed something critical in medical school, that’s the disease model we in podiatry follow as well. As such, podiatric medicine IS allopathic medicine. As we don’t follow the osteopathic theory of medicine, why would we obtain degrees as osteopaths, practice as allopaths, and so muddy the waters? I’m finding this very curious.
David Secord, DPM, McAllen, TX
02/21/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Raymond S. Murano, DPM
Regarding foot care nurses doing foot care and wound care in the hospital setting as well as the home setting....they are filling a need left by new podiatrists who do not want to cut toenails. Are you serious? At my hospital, the administration dropped podiatry consults for nail care/calluses, to be done now on an outpatient basis because the younger podiatrists don’t want to cut toenails. So what happens when a patient is scheduled to be discharged to a SNF and requests that the toenails be cut before sending them over for an admission?
No podiatrists are available. So the family hires a nurse practitioner to go in and take care of the patient’s toenails so that she can be admitted to the nursing home. The nurse practitioner or RNs that I trained in diabetic foot care as well as wound care do an excellent job. These new RN nurse practitioners are coming on board. Our hospital will be supervised under my service. So there is a low number of applications for podiatry schools?
Raymond S. Murano, DPM, Medford, MA
02/21/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Stephen Peslar, BSc, DCh
Dr. Tomczak was correct when he wrote there are about 600 chiropodists for about 15 million people in Ontario, Canada. Decades ago, Ontario Ministry of Health decided to shut down podiatry based on some unfortunate foot surgery outcomes performed by podiatrists. In 1991, the Chiropody Act was passed with the clause, “No person shall be added to the class of members called podiatrists after the 31st day of July 1993.”
Then in 2015, the Health Professions Regulatory Advisory Council completed an extensive study of over 350 pages, that included a jurisprudence review and a consultation with stakeholders. The concluding recommendation to the Minister of Health was, “no changes should be made at this time to the current legislation on the registration of podiatrists in Ontario.” Since 1983, there have been about 900 graduates from the Ontario chiropody program. Around 300 have abandoned the chiropody profession mainly due to...
Editor's note: Stephen Peslar's extended-length letter can be read here
02/21/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Rod Tomczak, DPM, MD, EdD
I ask everyone who replied to this week's survey concerning options for undergraduates interested in healthcare to read my extended letter concerning the possibility of a DO degree and a commitment to foot and ankle care without a DPM degree. The PM News of 02/15/2025 and 02/17/2025 are intrinsically attached to the survey and the current DPM population.
It is important that everyone who participates in the survey understands this could be the end of the DPM degree and podiatry since there will not be a podiatry degree but merely a new medical/surgical specialty called podiatry. Although APMA could exist just like the AAOS exists, APMA would not be the same organization.
Rod Tomczak, DPM, MD, EdD, Columbus, OH
02/21/2025
0RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A
From: Allen M. Jacobs, DPM
Dr. Roth has made the observation that some of the young residents and practitioners lack the drive and intensity to work longer hours and harder than his generation. Many of today’s younger doctors are smart and seek a much better work/life balance than did my generation. This is in my opinion a good thing not a bad thing. This generation wishes to reduce the stress and burnout that has afflicted so many healthcare providers in today’s world. The newer generation is not as motivated to generate maximum income, but rather maintain a good work balance while providing good care for their patients. They do not wish to engage in the long hours and sacrifices that our generation was taught to be part of being a doctor.
Work/life balance integration is important to many of our younger doctors. Older healthcare providers may not relate to this manner of thinking. However, younger doctors are anxious to limit commitment to being a podiatrist and set boundaries for their work hours versus...
Editor's note: Dr. Jacobs' extended-length letter can be read here.
02/20/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: Stephen Peslar, BSc, DCh
While Dr. Seuferling views a foot nurse issue as an opportunity not a threat, in Canada they will have a conference that will include these topics: MedFlex nail restoration, Onyfix nail correction, onychomycosis diagnostics and photodisinfection, SWIFT wart removal, proper footwear, padding and off-loading, pedorthic management, Vandenbos procedures, heel pain that could be something else, not plantar fasciitis, and "Rash: a review of dermatitis, infections, and suspicious skin lesions."
Another nurse’s foot care association in Canada states, “our members have obtained the knowledge, skill, and judgement to competently provide medical foot and lower limb care… to determine which orthotic devices will improve one’s overall health and wellness. Our members have the option to consult with laboratory technicians who are qualified HCPs who specialize in the design and build of orthotic devices.”
It appears that they want to do more than trim toenails, reduce plantar calluses, and enucleate IPKs. If they’re doing this in Canada, my guess is they’re doing the same or soon will be performing SWIFT wart treatments, performing OnyFix nail correction, performing the Vandenbois procedures, and casting (or scanning) and dispensing orthotics.
Stephen Peslar, BSc, DCh, Toronto, Ontario
02/20/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Chris Seuferling, DPM
Point of Clarification: I’ve received comments about “what a podiatrist SHOULD be”. The intent of my post was not that I agree with the current podiatry residency training model, but rather how we should deal with the existing gap of traditional podiatric care IF the current residency model remains as is. These are two intertwined, but different topics.
Bottom line: I would love to have podiatry satisfy all the general foot care needs (nail, callus, diabetic, etc.) of the population. I feel we have lost our identity as to what podiatry “SHOULD” be and residency program revision needs to be a topic of discussion at the table. However, if that’s not an option and it is truly a “bridge too far”, then we need to deal with the reality that IS, not the “SHOULD” be.
Chris Seuferling, DPM, Portland, OR
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