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02/01/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Mark Hinkes, DPM, Elliot Udell, DPM
Could it be that podiatry's "Why" is that "Podiatry is a compassionate profession"?
Mark Hinkes, DPM, Nashville, TN
Evan, your line about podiatry being a compassionate profession brought tears to my eyes. That is precisely why I entered the profession. My grandfather had a very painful toe, and he had gone to primary care doctors, orthopedists, and even a dermatologist. No one was able to give him relief. I took him to a podiatrist, and the doctor was able to relieve all of his pain in one session. Right then, I decided to cut short my graduate training in biochemistry and go into podiatry.
Even today, people come into the office with pain and leave pain-free. This is why I will stay in the profession as long as I can.
Elliot Udell, DPM, Hicksville, NY
Other messages in this thread:
02/01/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2 B
From: William Clark, DPM
I believe that I have pretty good insights as a semi-recent entrant into the post-residency world. There are many reasons why applicants remain low, and why many of my cohort regret going into podiatry in the first place.
Number 1, far and away, is that pay is too low coming out of residency compared to our MD and DO counterparts, despite having to pay the same amount for school. Sure, you can make decent money at a hospital and in private practice, but these come with their own separate issues. Hospitals require being on call, rounding, 3 months notice for any vacation, and the usual bureaucratic nonsense that doesn’t involve patient care. Many of my cohort wanted to go into private practice, but major issues with this include price for barrier of entry and complete gatekeeping by our older counterparts who constantly scam us, pay us way too little for what we make for the practice, and lie about partnership/ownership potential.
Smaller issues include a complete neglect of the board process where there’s infighting and not knowing which board you’re supposed to be on for which hospital which honestly just makes podiatrists look like hacks. Patients as a whole have gotten completely out of hand with their expectations and lack of trust in the medical community, making it harder to do our jobs. At the end of the day, the biggest reason we’re at this point is due to older generations completely screwing the pooch at federal, state, and local levels, complete abandonment of opportunity for younger generations, and nonsensical gatekeeping of practices.
William Clark, DPM, San Diego, CA
02/01/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2 A
From: Allen M. Jacobs, DPM
Respondents and contributors to PM News have proposed various theories to explain the serious decline in applications to podiatry colleges. Perhaps PM News readers should look at the obvious. How many state societies have changed their names to "foot and ankle society" when they were previously a state podiatry or podiatric society? We have, of course, board certification by the American Board of Foot and Ankle Surgery. We have the American College of Foot and Ankle Surgeons. We have podiatrists essentially denying the fact that they are podiatrists walking about with the prefix Dr. on their jackets. The problem is just that simple. No one uses the term podiatry.
PM News recently published a story regarding an award given by the North Carolina Foot and Ankle Society... not by the North Carolina Podiatry Society. We have the Ohio Foot and Ankle Society conducting a meeting. Physicians and other healthcare providers know that we are podiatrists. For example, when I receive a consultation in the hospital for an infected diabetic foot, the residents and the attending in medicine will state, "infectious disease and podiatry have been consulted." Patients frequently do not understand that the "foot and ankle surgeon" they are seeing is in fact a podiatrist. This is to a large extent, in my opinion, the reason that as of the time I am preparing this for PM News, I believe there are less than 300 applicants total for all the colleges of podiatry. You reap what you sow.
Allen M. Jacobs, DPM, St. Louis, MO
01/31/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2 B
From: Rod Tomczak, DPM, MD, EdD
I agree with everyone who claims that podiatry is not well known to the public or to pre-med students. All the letter writers are correct in suggesting that podiatrists need to expose themselves! There are no state laws that forbid any podiatrist from exposing himself or herself to the public. Conway McLean, DPM posts the multiple talks he gives in PM News as do podiatrists almost every day. They should be praised. You may say these aren’t directed toward pre-med students, but I might suggest that exposure to potential patients may ultimately result in Aunt Hortense telling her nephew or niece Lindsey, “there was this nicest foot doctor who gave a talk about heel spurs to our senior citizens’ lunch group.” Trickle down exposure of the profession. Any podiatrist can make arrangements to show up for a meeting with a thumb drive and give a talk. APMA is not going to pay for one of their executives to fly out to present to 20 people, but we can all give that presentation.
APMA has canned lectures you can...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
01/31/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2 A
From: Evan Meltzer, DPM
In the various letters regarding the low applicant numbers and the educational requirements, there is one important characteristic of the podiatry profession that hasn’t been addressed. Podiatry is a compassionate profession. How many times have you seen a patient who has been complaining of pain for days, weeks, or months; and after your treatment they walk out of your office pain-free? Even if their pain is relieved only for the duration of what you injected.
How many other medical professions can provide this compassionate service? Perhaps this reality can be mentioned to pre-medical students who are considering their future direction.
Evan Meltzer, DPM (retired), Rio Rancho, NM
01/21/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2 B
From: Richard M. Maleski, DPM, RPh
I read with interest the many opinions on the relative lack of interest in podiatry school, as evidenced by the low number of applicants compared to other medical programs. I think that all the opinions expressed are valid. I'm sure there is no one reason for this lack of interest. It is true that some pre-med students don't know about podiatry, but I believe it is also true that many pre-med students DO know about podiatry, and don't want to spend a large portion of their day simply cutting toenails.
We all know that nail care is important, especially in certain patient populations. But we also know that cutting/trimming/debriding nails doesn't require an extensive, rigorous, and expensive 4-4-3 training regimen. Understanding and recognizing pathologies as manifested in nail deformities, and knowing how to treat those deformities is absolutely important and demands the well-trained...
Editor's note: Dr. Maleski's extended-length letter can be read here
03/04/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Ivar E. Roth, DPM, MPH
I have been told by a very reliable source that the new schools opening is like a Ponzi scheme. There are funds available by the feds, etc. that allow these schools to be subsidized. Thus on paper, it can be a money-making proposition; however in reality, we do not have enough students to choose from, thus low enrollment and students with lower MCATs and GPAs are being admitted. We do not have enough residencies if all the schools were filled to capacity based on the number of podiatry schools now open. We are in a tough situation.
I hope everyone reading this post gets energized and goes out and speaks at a local high school or college and promotes our wonderful profession so we can grow in a positive direction for the future. I think our component societies should contact all local high schools and colleges and offer their members as speakers.
Ivar E. Roth, DPM, MPH, Newport Beach, CA
01/31/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2 B
From: Cosimo Ricciardi, DPM
I read with curiosity Dr. Ivar Roth’s comments on “practicing ethically” and not “chasing a dollar”.
Perhaps he could expound on his previous post on his ethical conversion of a patient’s $125 cash nail care office visit to a $3,525 cash office visit.
Cosimo Ricciardi, DPM, Fort Walton Beach, FL
01/31/2024
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2 A
From: James Wilton, DPM
I read with some interest Dr. Allen Jacobs’ comments regarding "AENS surgeons operating on diabetic peripheral neuropathy with nerve decompressions". As a member of that society and director of the basic peripheral nerve surgery course, this is as far from the truth as can be stated. The surgeons that take our course for training have a much broader background in diagnosing, and conservatively and also interventionally treating peripheral nerve disorders. We do not advocate on any level the use of PSSD testing for the evaluation for peripheral nerve pathologies. We specialize in developing skills for our surgeon students in giving a complete neurologic extremity "hands-on" examination.
As the first DPM surgeon admitted to the American Society for Peripheral Nerve, it has been eye-opening seeing the difference in training between allopathic peripheral nerve surgeons and what is being taught in traditional podiatric residencies. I had excellent medical and surgical training through Dr. James Ganley, however peripheral nerve injuries and syndromes were not a part of my training. In having taught podiatric surgeons and international plastic surgeons over the past 20 years peripheral nerve surgery techniques and also diagnostic evaluation of patients, the current podiatric residency model falls way short of the allopathic model for plastic surgeons in these fields. It is through advanced training that the AENS offers, that podiatric physicians can become better diagnosticians and surgeons
James Wilton, DPM, Claremont, NH
09/18/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2 B
From: Richard J. Manolian, DPM
I thought we established last year that you did a 2-year residency as there were only 2 three-year residencies when you graduated, none of which you matriculated in, but for some reason you keep mentioning it. I also find it odd that you were proud of upselling an elderly patient who came in for nail care and wound up with a $3,000 bill for varied services.
Would you appreciate it if an elderly relative went to an optometrist for a replacement of eyewear and wound up spending $3,000 due to up-selling?
Richard J. Manolian, DPM, Boston, MA
09/18/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2 A
From: Lancing Malusky, DPM
I started my Ohio practice in 1974. From the start, all kinds of podiatric procedures were in my purview: Warts, ingrown corrections, fractures, hammertoes, etc. Naturally, routine foot care (CNC) was a major component of my practice. I used staff to set up and finish the patient. In those days, Medicare would pay a little for a whirlpool. Patients would be finished with lotion and a foot massage. As the practice matured, I became ABPS board certified and practiced more foot surgery. But, C&C was always there and profitable.
I retired in 2016. The major factor I considered, beyond the current insurance and management hassles, was/is degenerative arthritis in my dominant hand. My hand orthopod stated he never saw so much DJD in a hand. I've had episodes of Dupuytren's and digital spurs treated in that hand since retirement. If I had worked any longer, I would not have been able to enjoy retirement. In later years of practice, I still did all the C&C, and I had a medical assistant finish the mycotic nails with a Dremel drill and central vacuum. If I would have had access to an ancillary nail person, I would have readily accepted that and stayed in practice longer. I do believe that supervision and adequate training would be necessary for such a person to be in the practice and billing "ancillary" C&C.
Lancing Malusky, DPM, Dayton, OH
07/25/2023
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2 B
From: Elliot Udell, DPM
Thank you George for shining a light on this important area. Covid was akin to a tornado that wrecked all live conventions, including medical conferences. Right now, the APMA, state societies, and other sponsors of conventions are cleaning up "the debris" by once again starting some live conventions even if they have to choose smaller hotel venues. You are correct, many doctors are still not attending. Let's be open and honest about the situation. To attend a live convention, the doctor is forced to pay travel expenses, hotel room expenses and meals, in addition to paying the tuition to the sponsor of the convention. It costs the doctor over a thousand dollars to go to an out-of-town convention.
One of the things I loved when lectured at and attended live conventions was mingling with companies in the booth hall. I learned a lot about new products for my patients, and in many cases got to give them samples provided by the vendors. I assure you that most if not all of my colleagues looked forward to seeing you and talking with you and your colleagues at live conventions. The big question, however, is this: Do the benefits of attending an in-person event make up for going to a "Zoom" convention where the doctor can literally roll out of bed, flick on the computer, attend all of the lectures, and get his or her CME credits at a fraction of the price? This problem will not be resolved overnight but with innovation, maybe we can turn things around.
Elliot Udell, DPM, Hicksville, NY
11/21/2022
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Ivar E. Roth DPM, MPH
With all my patients I always include a question if they have any back problems. For those patients, I almost always recommend orthotics. Most all who get them are very satisfied and I would say 25% of the patients coming in with back pain order the orthotics. I think all podiatrists should do this. You would be surprised how many patients you can help.
Ivar E. Roth DPM, MPH, Newport Beach, CA
01/06/2022
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Brian Kiel, DPM
I don’t disagree with Dr. Ressler as to ON shoes being the hot fashion shoe but to call it or to refer to it as a running shoe is completely wrong. New Balance, Brooks, ASICS, and Saucony are running/walking shoes. These companies are using technology to determine what needs to go into their products. ON uses eyes to determine theirs.
Our job is to guide our patients, and honestly my patients seem to appreciate and follow my recommendations as to the correct brand of shoes. ON shoes are fine to wear to the movies (whenever that is) but not as a replacement for proper athletic shoes.
Brian Kiel, DPM, Memphis, TN
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