02/15/2025    Joseph Borreggine, DPM

American Foot Care Nurses Association

The APMA, I would opine, is totally fine with
this? And, I assume so is the profession? We are
the first line of defense when it comes to routine
foot care? That’s nice. I would consider this to
be an insult to the legacy of our profession. We
are the primary foot care provider period end of
story! So, if we cannot get paid for “routine foot
care”, then we just do not see the patient?
Really?

So, just send them to a registered nurse? Really?
That makes no sense. I guarantee that if a
podiatrist were to truly do a foot examination on
a patient that qualifies for routine care that
other pathology would be identified with respect
to any all the bodily systems that we are so duly
trained.

We are not and have never been “toenail
technicians”. If a podiatrist opines that they are
beneath the ability to provide routine foot care,
then just go an become an MD/DO with a 1 year
internship, 4 year surgical residency, and 3 year
fellowship in orthopedics so that you can shine as
a board certified orthopedic foot and ankle
surgeon.

Be proud of being a podiatrist. There is more to
podiatry than foot/ankle surgery folks. “Routine
foot care” should be dropped from the Medicare/CPT
verbiage and replace it with the new and improved
evaluation and management CPT codes that allow us
to utilize and bill our exemplary skills as
podiatric physician to diagnose and treat the
foot/ankle conditions that most patients do not
even know they have.

Our podiatric specialist services that our
profession is known for over the last century will
always be needed, however or professional
association need to rebut organizations like this
that downgrade what we do.

Take a look at this and see what I am talking
about. https://www.afcna.org/.

Joseph Borreggine, DPM, Fort Myers, FL

Other messages in this thread:

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02/21/2025    Allen M. Jacobs, DPM

American Foot Care Nurses Association (Ivar E. Roth, DPM, MPH)

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 their
personal time. They participate in physical
fitness activities, which is helpful for stress
reduction, and overall health. They are more adept
at utilizing technology to make them more
efficient than our generation was.

In addition, studies have shown that only 9% of
medical graduates wish to enter private practice
with the remainder looking for some type of group
or institutional employment. In summary, work life
balance is a greater priority for many of today’s
graduates. The need for such work life balance was
discussed by the great medical educator, Sir
William Osler, MD over 100 years ago. This remains
true today.

Of course, remuneration for medical services
remains important given the fact that our young
graduates have several hundred thousand dollars in
debt when completing their education. However, it
is admirable that they want to be full-time people
and part-time doctors rather than full-time
doctors and part-time people. There there is
nothing wrong with this. Perhaps the major problem
is the inability of the older generation to accept
this perception of what a doctor should be.

Hopefully the young generation of new podiatrists
will not make the same poor choices with regard to
lifestyle that many in my generation have made. I
warned the residents with whom I work that life
goes quickly. In the end your family and friends
are with you. Podiatry will not be.

Allen M. Jacobs, DPM, St. Louis, MO

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02/17/2025    Allen M. Jacobs, DPM

American Foot Care Nurses Association (James DiResta, DPM, MPH)

Dr. DiResta appears to be somewhat concerned that
a podiatrist is serving as an instructor in foot
care for nurses. I wonder if orthopedic surgeons
express the same concern to their colleagues who
participate in podiatric medical and surgical
education. After all, by doing so you are aiding
and abetting the competition (enemy), are you not?
At the NYSPMA association meeting this year, there
were interactive panels with orthopedic surgeons,
and a program in which dermatologists were
instructing in the evaluation and treatment of
foot and ankle dermatologic disorders. Should they
have refused to do so over concern for decreased
patient revenue?

Some years ago, Dr. James Ganley asked me if I
would be comfortable teaching family medicine
residents how to manage ingrown toenails and
common foot problems. He told me that he regularly
instructed non-podiatrists in the evaluation and
treatment of common foot disorders. His reasoning
made sense to me. First of all, he told me that by
education of "the competition", he found that
whatever decreased patient load he might
experience was replaced by referrals for much more
complex pathology. Secondly, he found that by
educating others, they realized that many
seemingly simple problems were more complex and
required greater knowledge and experience than
they had perceived, again resulting in more
referrals. Finally, Dr. Ganley reminded me that if
alternative health care providers were going to
evaluate and treat foot pathology, we have an
obligation to instruct them in proper evaluation
and technique, serving the public well-being in
priority to our own self-interest.

I have always willingly and enthusiastically
participated in the education of MDs, DOs, DCs,
NPs, whomever. It affords me the opportunity to
highlight the podiatry profession, to show them
how we evaluate and treat foot and ankle
pathology. In my experience, non-podiatrists are
appreciative of the discussions, and consistently
rate these presentations as amongthe best at their
seminars. What I sell is not podiatry per se, but
the knowledge and experience that you have,
providing them with education and insight. What
follows is respect for the DPM degree, and not
infrequently new referral sources. The more they
learn, the more they realize that which they did
not know. And with that is an appreciation of our
profession. As Mark Twain so aptly stated; " It
ain't what you don't know that gets you into
trouble. It's what you know for sure that just
ain't so".

Allen M. Jacobs, DPM, St. Louis, MO