05/12/2025    James DiResta, DPM, MPH

Do We Really Have a Medical Degree? (Evan Meltzer, DPM)

In response to Dr. Meltzer's question Why are
there new podiatry schools being created if we are
on our "last legs"? I believe the answer is
twofold, as the old adage goes "follow the money"
and secondly, knowingly or not, the powers to be
see it as a chance of survival.

The podiatry profession that has existed for the
past 50 years cannot continue. It just can't. It
is being swallowed up from the top down and bottom
up. It couldn't be more obvious but we continue to
do very little hoping a Band-Aid here or a Band-
Aid there will plug the leaks and eventually these
forces will just go away. They won't. The
profession made a calculated mistake that those of
us who fought the system got caught up in. We
fought for increased scope of practice based
solely on anatomy of the lower extremity i.e.
ankle surgical privileges and we ignored treatment
of systemic illness except for the local
manifestation of those disorders.

We also wanted to be able to treat within our
limited scope independently and admit our patients
ourselves and be able to do our own admission H&Ps
which became doable because CMS at that time was
awarding this privilege to PAs and NPs. We wanted
medical staff membership and the ability to serve
as officers and on committees. We achieved a lot.
What we didn't foresee is the increase in the
number of medical schools, especially the for-
profit model that the DOs have perfected, and the
number of physician extenders and allied health
professionals and their increased scope privileges
and authority to treat and duplicate much of what
we do.

So, the question remains, Is there a path forward
for the podiatry profession? Dr Tomczak has been
asking us this for some time now. I personally
don't think you need to be a rocket scientist to
figure this one out. It's time (let me rephrase
that) it's well beyond the time we changed focus
and tried to "make a deal". Use all the resources
and capital we have both financial and political
to get the DO profession to embrace us in a plan
to make us whole. We can develop a model that
would change our undergraduate medical education
that would include the entire DO educational
curriculum except for OMT (not just years one and
two, but all four years) along with the necessary
streamlined podiatry components and that might
need a change in summer study between years OR
perhaps adding "a fifth-year pathway". Be awarded
both DPM and DO degrees.

YES, a five-year program that would then guarantee
the graduate a three-year podiatry residency
consisting of a one-year rotating internship and
two subsequent years of foot and ankle surgery.
There are some issues here for sure as our
students will have completed the COMLEX-USA tests
and could choose to enter another residency but
that's a chance we ought to embrace. They would be
able to apply to only one program i.e. the DO
program or the DO/DPM program and not be allowed
to transfer between programs. Frankly this is just
one idea of many but all plans MUST lead to a
plenary medical degree.

We can't exist as an island in today's medical
environment with our limited DPM degree and think
we can survive. Many successful podiatrists today
have their niche and they will be fine for the
foreseeable future but this is not true for the
profession as a whole without a strong
academically and technically strong podiatry
student cohort to follow us. Leaving things like
they are to chance for much longer and we are
toast.

James DiResta, DPM, MPH, Newburyport, MA

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