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01/24/2025
RESPONSES/COMMENTS (NON-CLINICAL)
From: Joel Feder, DPM
I think it’s time for a recalibration of the professionals we are graduating. We are wrong to label ourselves as a surgical profession. We are general practitioners who can choose any or all of the medical arts disciplines as they relate to the foot.
In my 50 years of practice, I prided myself in being able to perform dermatological, medical, orthopedic, and surgical treatment to my patients... solely dependent on their need. I tried to instill that in my residents and the preceptors who observed our offices.
We need to wake up and rethink our current education. Not everything can be solved with the knife.
Joel Feder, DPM, Sarasota, FL
Other messages in this thread:
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
02/20/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Ivar E. Roth, DPM, MPH
I agree with Dr. Feinman. It does appear that today’s graduates look to lifestyle and convenience as their priorities. I remember when I was so thirsty for knowledge. The competition to get a residency, which only 50% of the class got was what caused us all to be very competitive. Now everyone is guaranteed a residency and so complacency seems to have taken hold with a good number of the graduates.
I have recently interviewed candidates for an associate position, and I can tell you most of them are just looking to work the bare minimum 40 hours a week with no intention or drive to work more hours or harder than the minimum required. Needless to say, I have been disappointed.
Ivar E. Roth, DPM, MPH, Newport Beach, CA
02/19/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: Ross B. Feinman, DPM
I have been practicing for over 22 years; I have seen the ups and downs of the profession as well as the residency programs. I have been fortunate enough to be involved with podiatric students through the various programs at multiple hospitals, and I have worked with some very talented residents through the years as well as students! In previous years, students were hungry for knowledge, enjoyed the banter of being “pimped”; they knew it was for educational purposes, not a personal vendetta against them. They also came prepared for the case, knew the basics and seemed interested.
Unfortunately, today many students now want to be done by 5 PM, not show up, or have to take their dog to the vet. The idea of this as a lifelong profession seems to have become lost in the fog as many students today seem to be more interested in dinner time than...
Editor's note: Dr. Feinman's extended-length letter can be read here.
02/19/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Glenn McClendon, DPM
We all get tired at times of trimming toenails and calluses, but don't other doctors get tired of their most routine treatments. Why don't podiatrists have a non-insurance nail segment of their business for many of the patients who don't meet qualified at-risk foot care. It could be an adjoining or simultaneous adjunct to your office. A trained nail tech could do that work and take a load off of you. And it would be all cash. Ophthalmologists employ optometrists. ENTs employ audiologists. Almost all MD/DOs have a practitioner working under them. It would be a way to produce income from others’ efforts, and provide a good referral source.
It would be great to have some income when on vacation. I'm sure there are plenty of people who would prefer to go to a nail salon affiliated with a podiatrist vs. one in a local shopping center for various reasons. How many podiatrists sell OTC products through their office for income and convenience to patients? Are there challenges in making this an extension of your medical practice? Sure. Rarely is there any easy money without some sacrifice. Maybe someone will come up with a business model along these lines that will work. I'd sure consider it.
Glenn McClendon, DPM, Conway, AR
02/19/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Elliot Udell DPM)
We need to be honest with ourselves. Comparing our profession to dermatology and orthopedics to show that there is nothing wrong with teaching nurses how to practice general podiatry is unfair. Why? Every dermatologist and orthopedic surgeon knows that the overlap between what we do and what they do in their practices is small. We do not operate on knees and hips nor treat skin disorders above our anatomic ranges of practice. On the other hand, everything a podiatrist does can be duplicated by someone in the MD and DO worlds.
I suspect that Dr. DiResta's concern is that MDs and DOs choose not to practice non-surgical general podiatry. If we train nurses to do what almost all of us do most of the time, why would they send us any of their patients for foot care? They can hire a nurse to render all general foot care and profit from it. Taking it one step further, nurses and PAs can be trained to do most of the foot surgeries we do, but we probably don't have to worry about that in a few years to come.
Elliot Udell, DPM, Hicksville, NY
02/18/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 3
RE: Why Podiatry School Applicants Remain Low
From: Jack Reingold, DPM
I have been involved in podiatry, both politically and educationally since I graduated 45 years ago. I have personally mentored about a dozen undergraduate students in my office and virtually all of them are now podiatrists. I have been involved with podiatry schools and residency programs for most of my career. I have brought up the issue of declining applicants for over 20 years. At first thought, this makes no sense! When I graduated in 1979, there were 225 million Americans and about 10,000 podiatrists. Now there are 325 million Americans and about 15,000 podiatrists. I believe the average age of a practicing podiatrist is now over 50 (like our MDs). We are an aging profession.
Please forgive me if my numbers are off, but I think the point is that it is a great time to be a podiatrist. A 3-year residency program has been the standard for many years and there are many opportunities for practice. It is not unreasonable for our new graduates to receive salaries of 225K and up, plus...
Editor's note: Dr. Reingold's extended-length letter can be read here.
02/18/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
RE: Low Student Enrollment/American Foot Care Nurses
From: Richard Rettig, DPM
I read with interest the paradox between two separate topics that are being discussed simultaneously on PM News. We are reading that there are only about 300 TOTAL applicants to all podiatry schools. Some of them are certainly not qualified for acceptance, and some will not complete the four-year course of study. The application year is not over yet, but surely the trend here is that there will not be enough graduates to replace those of us who are currently practicing. As far as encouraging more applications to podiatry schools, the Pennsylvania Podiatric Medical Association, for one, has been beating that drum at the HOD and elsewhere for over 25 years.
The other topic is that there are nurses who have started foot care practices. This has also been ongoing for at least 25 years, but when a nurse opens up in someone's practice area, that doctor suddenly becomes acutely aware of the problem and starts a new 'OMG' discussion string on PM News. So the paradox is this: if we aren't going to produce enough podiatrists in the future, who do you think is going to do the footcare?
Richard Rettig, DPM, Philadelphia PA
02/18/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A
RE: American Foot Care Nurses
From: Chris Seuferling, DPM
I cannot speak for the rest of the country (though I imagine most states have similar concerns), but I am well-versed in Portland, Oregon's podiatry and foot nurse dynamics. I am also familiar with Portland Foot Care Clinic and its CEO Amarachi, RN. In fact, we have had multiple conversations at the state level and national APMA level to address this issue… even introducing Proposition language at the 2024 HOD (see my proposed language below). It did not gain the traction I had hoped for, but I’m told it’s on APMA’s radar.
With that said, I ultimately feel it’s an “us” issue, not a “them” issue….i.e.; it is a “Podiatry Identity” crisis and not a “Foot Nurse competition” one. Many times during the course of the year, I have the following conversation with a new patient…"Mrs. Jones, I noticed podiatrist Dr. X performed your ankle fracture surgery. Why are you not seeing...
Editor's note: Dr. Seuferling 's extended-length letter can be read here.
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