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02/04/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: George Jacobson, DPM
I have a prediction or just food for thought. Podiatry will survive as a surgical orthopedic profession. There will be a new profession, chiropody. This new profession will have more applicants than podiatry schools, further reducing their application pool. It will be sad to watch. Abandoning our roots that made us a successful profession will give rise to our replacement when needs are no longer met.
George Jacobson, DPM, Hollywood, FL
Other messages in this thread:
02/11/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Gregory T. Amarantos, DPM
Being recently retired, I am volunteering alongside Dr. Roth. For the past few weeks, I have read the posts and I believe the issue is multi-faceted. Forever the cynic, I follow the money. Where to start? Too many schools with too few candidates, thus the schools admit less qualified applicants, in turn, less qualified physicians and surgeons. Hospitals want the residency programs because they are a cash cow. All the different boards want your money so you can show you are board certified and capable of doing surgery. We all know colleagues who should never hold anything but a #10 blade to do C&C. Then let’s get to the APMA which for the past decade has shoved diabetic foot care and wound care down our throats as if that is all we are capable of doing. Follow the money; the wound care companies co-sponsor meetings.
Of course, the practicing podiatrists themselves have contributed to the lack of awareness of our profession as "everyone" qualifies for Medicare coverage. Why are so many afraid to tell the patients the truth... you do not qualify for this service and the fee is...
Editor's note: Dr. Amarantos' extended-length letter can be read here.
02/11/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A
From: Lawrence Rubin, DPM
Dr. Roth speaks words of wisdom when he implies that APMA should not be chided for inaction in helping members compete for patients in our present multi-provider crowded foot healthcare marketplace. Medical associations are all limited in what they can do by antitrust policies that prevent them from engaging in potential anti-competitive practices.
But that does not mean that podiatrists cannot do what other medical associations do when they support the formation of third-party independent practice associations (IPA) that create value-based standards of care and market their members to the public and insurance payers. There are legal requirements, but, for example, optometrists, dentists, and primary care physicians have profited from supporting the creation of specialty IPAs for many years.
Lawrence Rubin, DPM, Las Vegas, NV
02/10/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2C
From: Gary S Smith, DPM
The three-year residency has killed podiatry. My son was going to become a podiatrist and I talked him out of it. I told him it is silly to do a three-year residency just to be limited to surgery of the feet and cut toenails. The three-year residency used to be held in very high esteem. Now, it's like a high school diploma. Everybody gets one and it has become meaningless. The idea was to improve parity and our reputation, and it has done neither.
I have hired many podiatrists over the last 30 years and there is a big problem with these residencies. It used to be if someone did a 2-year surgical residency, then you had somebody that really knew their stuff. A top-notch surgeon. Now, I'm seeing three-year residency graduates that can't even do a matrixectomy competently.
Prospective applicants ask me, "will you help me do surgery?" The worst part is they can get privileges I can't because of their 3-year program. Some can't do hammertoes. Some have communication skills that would not allow them a job at the drive-through. Many take three hours to do a bunion. 20 years ago, if you asked staff at most hospitals, "who is the best surgeon," they would answer a podiatrist. Now I hear from staff at some hospitals that the podiatrist is a joke. The problem is that when one of us is "a joke", we all are. People group us all together. I don't know what the answer is.
Gary S Smith, DPM, Bradford, PA
02/10/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Lawrence Oloff, DPM
Why are applications down? Everyone who has weighed in on this is correct: too many schools, lack of identity, competition, costs, etc. Everyone who has suggested solutions is also correct: profession, schools, practitioners all need to reach out more for effective recruitment. The problems and solutions are multifactorial. How do you fix this? I don’t think you can close schools, however economics will eventually solve this problem. I do not think that all the schools will survive economic downturns forever.
I was talking to a businessman recently about this. His perspective was not what I expected. He began to cite the supply and demand curve. He thought if the supply of podiatrists went down and the demand was the same or greater, then the salaries of podiatrists would likely go...
Editor's note: Dr. Oloff's extended-length letter can be read here.
02/10/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A
From: Lee C. Rogers, DPM
I have read the comments from my colleagues with interest. I would point out that this is a topic that has received much attention from the profession's leadership and deliberative bodies. It has been addressed at the APMA House of Delegates in the past several years and it is discussed at almost every BOT meeting. The APMA has been taking action to increase the number of applicants. While it is not the APMA's "job" to boost school enrollment, the APMA (and its components) fully understands the connection between reduced qualified applicants and reduced membership and the imminent threat to the profession.
The APMA has raised money to help better the brand of podiatry as a career choice through a separate foundation. Certainly, the entity primarily tasked with increasing applicants and enrollment is the AACPM. They have also taken this threat seriously and started the "Feet on the Street" campaign, funded by...
Editor's note: Dr. Roger's extended-length letter can be read here.
02/07/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Jon Purdy, DPM, Elliot Udell, DPM
Dr. Jacobs makes some poignant and comical statements as usual. In my humble opinion, he is one hundred percent correct. I have always introduced myself as a podiatrist. Being an expert does very little in the arena of managed care unless you are well known as “the” expert. Patients are more than willing to accept insurances that don’t cover their needs and are, more often than, not oblivious to the fact they are receiving sub-par medical care in the hands of alternative providers.
With all that is happening to our profession, both in our hands and the perceptions of the medical community, Dr. Jacobs has further made the point for us to obtain a medical degree with a sub-specialty in foot and ankle.
Jon Purdy, DPM, New Iberia, LA
In the midst of all our downhearted comments about why our colleges are not doing well, a young college student called my office and asked to visit because she is interested in becoming a podiatrist. I welcomed her with open arms and will also arrange for her to shadow other colleagues who are more surgically oriented. Based on my conversation with her, I am positive that she will be a student at NYCPM.
Elliot Udell, DPM, Hicksville, NY
02/06/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Allen M. Jacobs, DPM
Recruitment? It is indeed a sad day that our colleges have been compelled to develop strategies to enhance student recruitment efforts. It is depressing to hear a call for practitioners to make efforts to recruit students. PM News readers have expressed an eclectic universe of explanations proposing the etiology for the lack of interest in our profession. Many if not most of these explanations are reasonable, and perhaps the sum total of all of these propositions explains the current disinterest in podiatry among college undergraduates. Facts are what they are. There is a demonstratable lack of interest in pursuing a DPM degree. The numbers speak for themselves.
There is no issue that the services provided by a podiatrist are needed. The issue is whether a podiatrist is needed to provide those services. As other PM News contributors have noted, services provided by a podiatrist may be provided by orthopedic surgeons, general surgeons,...
Editor's note: Dr. Jacobs' extended-length letter can be read here.
02/06/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A
From: Rod Tomczak, DPM, MD, EdD
Since late 2022, I have been submitting letters to PM News and Dr. Barry Block has graciously been publishing them for the profession to read. There have been two main topics my submissions have fallen into; 1. The issue of board certification and the ramifications between the haves and have nots and; 2. The severe decrease in the number of students in the podiatry classes at the eleven schools.
An honorable source who has nothing to gain by lying has informed me that as of last week there were approximately 300 applicants to all the podiatry schools. This may not include the Texas school in El Paso which has its own application service outside of AACPM. The number 300 refers to applicants going through AACPM. Schools offer acceptance and seats. We have been trying to tell the profession that there won’t be a need to address the first topic of conversation, board certification soon. There won’t be anyone to...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
02/05/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2C
From: Alan Sherman, DPM
I have a few more thoughts on the future of podiatric residency education. As far as the dual track for residency education....It wasn't a popular option 2 years ago when I proposed it, but timing is important and maybe its time will come soon. I just hate inefficiency and waste, and I feel so much time and effort is being wasted on training residents in surgery that most will not likely use. Their cases should go to the few residents that are suited to become specialty orthopedic surgeons of the foot and ankle. I also hate pretense, but love transparency and honesty because it leads to trust and comfort. We want to be trusted as a profession. We are podiatrists and that brand has gotten better through the years. That we aren't using the brand name is, I think, just dumb and a lost opportunity. The public is beginning to understand the name podiatry and what it means. I've always felt that patients may get a second opinion from persons who calls themselves foot and ankle surgeons, but surgery is seldom why they go to any doctor to begin with. They don't see a sign that says foot and ankle surgeon and think, I want some of that. They go to a podiatrist to obtain relief from their symptoms, to feel and perform better, and surgery isn't any more their first choice than it should be the doctor's. Alan Sherman, DPM, Boca Raton, FL
02/05/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Chuck Langman, DPM
My take as someone who is closer to retirement than just starting out is a little nuanced as we can only see life through our own eyes. I did a one-year surgical residency in the 1980s. I came out being comfortable and proficient with forefoot surgery. As I did more surgery, I realized I wasn’t in love with it (and you need to be in love with it to be great at it). I kept only to the procedures I was comfortable with and never ventured out of my comfort zone. I enjoyed far more the people I was able to keep out of the OR and the athletes I treated conservatively. Fast forward to when I was about 50 years old and was lucky enough to join a very large orthopedic group that allowed me to be non-surgical and do orthopedics and sports medicine all day.
I truly love what I do! I have a team of surgical podiatrists and fellowship-trained foot and ankle surgeons to refer to for the cases that need surgery. I also note that we have a large team of...
Editor's note: Dr. Langman's extended-length letter can be read here.
02/05/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A
From: Steven Block, DPM
I agree that many in our profession refuse to refer to themselves as podiatrists. However, between 2000-2020, foot and ankle surgery reimbursement declined 49%. Since 2017, the consumer price index (CPI) increased 24%. Have reimbursement rates kept pace? Not even close. I performed a Lapidus/Akin on a 22 year-old female a few weeks ago and was paid $492. The same week, I needed an LED strip light replaced in my office. The electrician took 30 minutes and charged me $400.
Line workers at a local factory have a starting salary of $115,000. In 2023, the five largest insurance companies in the U.S. made over $465 billion. Year after year, they post record profits. The system is broken. Podiatry, and medicine in general, will continue to be devalued until we take a collective stand. The provider has become a pawn for the corporate monster. Aside from the effort, commitment, stress, liability, if DPM were listed on the NYSE, is there anyone foolish enough to invest $250,000?
Steven Block, DPM, Owensboro, KY
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
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
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
01/29/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Mark Hinkes, DPM
I just read Dr. Solomon's comments on the issue of low enrollment in podiatry schools. As I read his post, it was clearly evident that he was suggesting the what and how about podiatry as a profession. He states, "it is because pre-medical students either do not know that we are an option, or they are not confident in the ability to have a fruitful career as a podiatric physician or surgeon."
But he failed to elucidate the "Why" concerning low enrollment. If the profession/schools are to prosper, the issue of "Why" a student should enroll in podiatry schools must be developed and shared with prospective students.... What is podiatry's "Why". Perhaps because podiatrists are the best providers of foot health services and have an armamentarium to deliver that care for the patient. If the prospective student agrees with this, we will have a seat filled in one of the colleges.
Podiatry needs to deliver the "Why" to prospective students so as to be in line with the prospective students' belief as to why podiatry is the best choice for them.
Mark Hinkes, DPM, Nashville, TN
01/28/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Aaron Solomon, DPM
Do pre-medical students know that podiatric medical school is an option? This is an important question to ask when addressing the low enrollment to podiatric medical schools. There was little information given to our pre-med guidance counselors about podiatry school. I was able to get more information from the schools by contacting them directly.
We had faculty from medical and dental schools talk to our pre-medical majors. I wonder if there is any similar outreach on a national level either from APMA or ACFAS to have the opportunity to visit with pre-medical majors and speak to them about the opportunities in the podiatric profession.
I would also look at the schools of podiatric medicine to see if they are continuing to provide an education and curriculum that is commensurate to an allopathic...
Editor's note: Dr. Solomon's extended-length letter can be read here.
01/28/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2A
From: Elliot Udell, DPM
Dr. Meltzer raises an often-discussed issue when he writes, "Should a non-surgical podiatrist refer his or her surgeries to a fellowship-trained orthopedist?" This question has been asked by many of our nonsurgical colleagues for as long as I can remember.
When a dentist needs to send a patient for complicated extractions or other dental surgery, he can be assured that the oral surgeon is not going to do fillings, cleanings, or make crowns and bridges. This is not always the case when a non-surgical podiatrist refers a case to a surgical podiatric colleague. In most cases, the doctor getting the referral will assume all podiatric care of the patient, including making orthotics, nail care, etc. Would referring foot surgeries to orthopedists be economically safer for the general podiatrist? Until podiatry reaches a level where podiatric surgeons only do surgery, can Dr. Meltzer's question be honestly addressed?
Elliot Udell, DPM, Hicksville, NY
01/27/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
RE: Why Podiatry School Applicants Remain Low (Robert Kornfeld, DPM)
From: Evan Meltzer, DPM
I’ve read with interest most of the letters regarding the low number of applicants to podiatry schools and the current state of podiatric education. I graduated from PCPM in 1977 along with just over 100 of my classmates. Two others and I went into the Army. At that time, there were only 3 states that required a one-year residency for licensure. I remember only 2 other locations where additional training was available beyond the one year: Dalton McGlamry’s program in Atlanta and Earl Kaplan’s in Detroit.
I believe that podiatric training should be both medical and surgical. While I don’t intend to write this letter as a promotion for my recent memoir, I do discuss the frustration that I experienced when my surgical privileges were...
Editor's note: Dr. Meltzer's extended-length letter can be read here.
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
01/15/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Robert Scott Steinberg, DPM
Podiatrists willing to share their offices with colleagues who lost theirs and possibly their homes should contact the California Podiatric Medical Association (CPMA). Podiatrists who lost their offices should call their office phone company to forward the number to their mobile phone. Other associations might want to consider making donations to CPMA so they can, in turn, provide loans to affected practices.
Robert Scott Steinberg, DPM, Schaumburg, IL
01/14/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
RE: Federal Watchdog Agency Bans Medical Debt from Credit Reports
From: Keith Gurnick, DPM
Rohit Chopra, President Biden's Consumer Financial Protection Bureau director, has rolled out another controversial new regulation. This week, the watchdog agency finalized rules that bar unpaid medical bills from being included in consumer credit reports, thus removing another existing tool (or threat) that doctor's offices and collection agencies have used for years to get paid from patients who owe money after their claims have been processed by their insurance carriers.
"People who get sick shouldn’t have their financial future upended,” Chopra said in a statement. “The CFPB’s final rule will close a special carve-out that has allowed debt collectors to abuse the credit reporting system to coerce people into paying medical bills they may not even owe.”
Republicans have hinted they may try to undo some of Chopra’s moves using the Congressional Review Act, which allows lawmakers and the president to spike recently completed rules. What’s more, the law bans agencies from enacting new regulations that are “substantially the same” as one Congress has reversed — meaning they could, in theory, be permanently repealed.
Source Jordan Weissmann, Yahoo Finance [1/7/25]
Keith Gurnick, DPM, Los Angeles, CA
01/02/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
RE: Alternatives for Gordon Products (Elliot Udell, DPM)
From: R. Alex Dellinger, DPM
I have been happy with products from EBM Medical. They have dry skin products, antifungal products, supplements for diabetic neuropathy, and many other products. All their products are cash pay - about what a mid-level co-pay is. They allow you to "virtually stock" items. You "prescribe" them for your patient through their portal and the item is then shipped to the patient's home in about 48 hours. You make the delta between the wholesale and retail price (you can set your own retail price). They have great product support and a great web portal. Evidence-based therapies at affordable prices.
Disclosure: I have no financial interest in EBM Medical.
R. Alex Dellinger, DPM, Little Rock, AR
01/01/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2B
From: Elliot Udell, DPM
Dr. Roth, once again asks why we as podiatrists cannot be trained to do procedures such as spinal stimulators and stents to treat PVD.
There is no doubt that Dr. Roth and most DPMs are smart enough, with proper training, to do these procedures and do them well. It all boils down to legality. Dr. Roth states that he spoke with legal counsel who said, "If the law says we can do it, why not?" The obvious question is what the law in each locality will and will not allow concerning surgical procedures done way above the ankle which directly affect the treatment of pathology in our anatomic scope of practice.
In essence, our ability to perform these procedures will probably be decided by state legislatures and courts, and we should not expect state medical societies to stand by idly and watch us take these procedures from their members.
Elliot Udell, DPM, Hicksville, NY
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