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02/05/2025 Chuck Langman, DPM
Why Podiatry School Applicants Remain Low (Aaron Solomon, 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 nonoperative sports medicine docs to do the nonoperative care that the sports medicine, joint, hand, elbow and shoulder, and spine surgeons don’t. I appreciate the comments of Dr Clark about docs who promise associates the world and create roadblocks keeping them from achieving their potential. That said, I don’t think that is the reason college students don’t apply to podiatry schools. My son’s girlfriend is a 2nd year medical student at an allopathic medical school in Philadelphia. Approaching the end of her second year and about to start rotations she still does not know what specialty she wants to pursue. How could she be expected to know that coming out of college?
My son is pre-med and finishing his junior year of college. He just returned from three weeks in Portugal shadowing docs in a hospital that included both surgical and non-surgical specialties. He’s still not sure what direction he wants to head in. The need for podiatrists that don’t perform surgery is real. Perhaps a year of internship followed by a surgical or non-surgical residency would give PGY1 docs the ability to choose a career path to their liking.
My thoughts are: PGY-1 - combination of intro surgical skills and medicine with the ability to scrub into high level surgical cases. Really no different than what first year ortho residents do. PGY 2-3 (or 4?) surgical - everything that is currently taught in residency PGY 2 (or 3?) non-surgical - medicine, ultrasound training including PRP, TENEX or Tenjet, sports medicine, etc. . Chuck Langman, DPM, King of Prussia, PA
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02/06/2025 Allen M. Jacobs, DPM
Why Podiatry School Applicants Remain Low (Aaron Solomon, 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 contributors have noted, services provided by a podiatrist may be provided by orthopedic surgeons, general surgeons, plastic surgeons, vascular surgeons, physician assistants, nurse, practitioners, general practitioners, physical therapists, pedorthists, and others.
I am not suggesting that other healthcare providers can provide services typically administered by the podiatrist with the same degree of expertise or skill. I am suggesting, however, that there is not a uniqueness to the disorders that we evaluate and treat. This is a reality that needs to be confronted.
There are for example, many more podiatrists than foot and ankle orthopedic surgeons. Yet, 70–80% of bone joint surgeries performed on the foot and ankle are performed by orthopedics and not by podiatry. Corporations know this.
We have a mandatory three year residency program, which is supposedly preparing individuals for medical and surgical management of the foot and ankle. From my observation, the majority of emphasis is clearly in the surgical arena and many of our graduates are ill prepared to provide primary care podiatry services.
Furthermore, it appears that it will be increasingly difficult to make a living, providing primary care podiatry services.
I know many many young podiatrists who are doing extremely well financially. These were generally individuals who were motivated to learn and excel at what they do. These individuals are working as hospital employees, working within an orthopedic group, or working for a general medical organization. I know many podiatrists in private practice who are similarly are doing very well financially. The potential is certainly there for individuals who are enterprising, competent, caring, and maintain an up-to-date status with reference to the services which they provide.
There is also the opportunity in podiatry to supplement patient care income by dispensing various product products which are needed for patient management. Furthermore, as has been noted by contributors to PM news, there there is the potential to make a nice living with a cash basis practice. An individual can make a reasonable living as a podiatrist in the federal system. All is not doom and gloom.
None of these observations change the fact that we are not attractive to college graduates. Perhaps they look at the frequency of services such as nail care and feel that this is not something they wish to spend their lives doing. I frankly think this is understandable. A three year residency and significant debt is not required to perform so- called “routine care“ essentially dealing with mycosis or toenail dystrophy.
I have made my particular position clear. Individuals in this world are seldom familiar with the term podiatry or podiatric . Our profession has largely dissociated itself from the term podiatrist and prefer the term foot and ankle whatever. Others can provide similar services. Orthopedics has the exclusive on broken bones and joint replacements. We do not have the exclusive on wound care. Gastroenterologists have the exclusive on alimentary track disease. We do not have the exclusive on skin disorders of the foot and ankle. Gynecologists have the exclusive on female reproductive health, and do not walk around calling themselves ovary and uterus doctors. Podiatrists do not have the exclusive on elective foot surgical procedures. We can go on and on, I’m sure you understand. We may want to sing this song “nobody does it better “but the question is whether patients or alternative medical providers actually care. We are in the world of cost containment and not quality care.
I certainly hope that the future podiatry is not exemplified by the following from Macbeth; Out, out brief candle! Life is but a walking shadow, a poor player, that struts and frets his hour upon the stage, and then is heard no more. It is a tale told by an idiot, full of sound, and fury, signifying nothing.
Allen M. Jacobs, DPM, St. Louis, MO
02/06/2025 Rod Tomczak, DPM, MD, EdD
Why Podiatry School Applicants Remain Low (Aaron Solomon, DPM)
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 certify nor will there be anyone around to do the certifying.
This is analogous to two ship stewards arguing over which one should be in charge of deck chairs and which one should be in charge of the shuffleboard tournament on the Titanic. The graph of podiatry student enrollments has shown a steady decline in recent years. It would be hard to believe at this point that all 300 applicants will matriculate giving the schools 30 students, on average, per class. In 2023, 560 students started podiatry school. In 2024, 338 students matriculated as first year students. Should this trend continue, the total number of all students in every podiatry school graduating will be less than our 1977 graduating class of OCPM or very close to it.
Podiatrists currently in the field might want to become aware of an economic reality approaching. They won’t be able to count on selling their lucrative practices. There won’t be any buyers. Even a walk down the “K Mart Blue Light Special” on aisle three memory lane will result in no takers. There won’t be enough podiatrists ready to incur more debt to buy your practice. There are more left-handed, blond, heterochromic podiatrists today than there will be podiatrists looking to start practice in ten years. It will be a buyer’s market and sellers can expect maybe three cents on the dollar.
The three podiatrists at the local meetings will sit there slack jawed with mouths open wondering how this could have happened. They will be sitting in the midst of the demise of a once proud and flourishing profession and wonder how this all happened. Some months ago, a podiatrist sent a letter to this site relating a story about an undergraduate student who visited another young practicing podiatrist. The young podiatrist told the undergrad student that if he had it to do all over, he would choose something different for a profession and advised the student to look elsewhere in search of an occupation.
Granted, with all the DO schools opening, students have more options. What we cannot allow is those uncommitted students to neglect podiatry as an option thinking for one reason or another that podiatry is a less than profession based on a set of letters behind the name of the practitioner. It is, to say the least, an evolving profession, maturing from the inside. This development can be stymied by members of the profession who continually debase and degrade what we do. Don’t kid yourself, patients become aware these podiatrists are ashamed of our profession.
We, the practitioners of the profession are the only ones who can save what we now practice. If we do nothing, the profession will die a slow and painful death because those who are happy but do nothing are outnumbered by the vocal complainers. That often-misquoted line about the only thing needed for evil to prevail is for good men to do nothing is true. The miserable and the malcontents in this profession are not going to step up and save podiatry. In 2023 one of my late 1980s students from Des Moines sent me a text agreeing that this was a great profession, and he was performing procedures we would have never dreamed of. He said everything was great and I needed a reality check. He said, “knowledge is king which equals dollars and that’s where we are…My medical knowledge is on par with other medical professional (sic) out there…and if you ever wanna (sic) know the real truth about our profession just ask me.”
He has missed seeing what the profession has in store, but he is exactly the type of person who can save it. He is exuberant about podiatry. In his text to me he said he is very sociable, and he is. It’s time for him to use his great gifts to show undergraduate students what a fantastic profession this is before it reaches a vanishing point, like the 1971 movie. We all remember Bishop Berkely’s quote about a tree falling in a forest and if no one is there to hear it, does it make any noise? There are so many people who, if they knew about this person’s practice and the joy he experiences from it, the eleven schools would be turning away students.
If every podiatrist who is not a malcontent, talks to just one undergrad or high school student about the satisfaction gleaned from helping patients with foot pain, we would be a growing profession rather than a shrinking occupation. It was one podiatrist, Jerry Cashen, DPM who convinced me this was a great profession, and I should consider it for my future. Not a hard sell, just his attitude and pride in what he did. He was a model for the profession, and I don’t know if he knew it.
Rod Tomczak, DPM, MD, EdD, Columbus, OH
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