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05/16/2025
RESPONSES/COMMENTS (NON-CLINICAL)
From: Irv Luftig, DPM
Dr Jacobson's elegantly simple letter makes more common sense than anything I've read on this topic. We have shot ourselves in the foot. We understand the idea of elevating the profession for those podiatrists who want to be hospital-based and concentrate on surgery, but there are other podiatrists who want to do some surgery but also practice general podiatry.
Others want their practice to be pediatric or sports medicine, etc., and being in school for 4 years of undergrad, 4 years of podiatry, and then a mandatory 3-year residency plus a fellowship is not necessary for those cohorts. Podiatry enrollment woes make total sense in the context of Dr. Jacobson's letter.
Irv Luftig, DPM, Hamilton, ON, Canada
Other messages in this thread:
05/22/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Alan Sherman, DPM
I agree with my good friend Dr. Reingold that, certainly, we are regarded as doctors by our patients and the medical community but disagree with him strongly on one point that he makes. Putting all podiatry students through a 3-year surgical residency is resulting in 3 major problems for us: (1) it is directly reducing the application pool to podiatry schools, and (2) it is wasting the time of the majority of podiatrists in training who are not suited to be advanced surgeons, and (3) it is resulting in those who will be foot and ankle surgeons having less cases to train on. I am not advocating for shortening residency training for any podiatrists. We must never reduce residency training to less than 3 years.
What I am advocating for is to stratify residency training, to have a "sorting" process after the first year, when it's clear who is suited to be an advanced surgeon, and who is better suited to do wound care and general podiatry. Over time, we will get more applications to podiatry schools by the many who know that they don't wish to be surgeons, but do want to be great general practice foot doctors.
Alan Sherman, DPM, Boca Raton, FL
05/22/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Arden Smith, DPM
Maybe I am overly simplistic, or maybe I’m just old! But, if you open up a foot, move the bones around as needed, put it all back together again, that sounds like a doctor to me; and also to everyone that I know, including other medical professionals. If you heal a nasty wound that’s been around for a long time and possibly save a limb, that sounds like a doctor to me; and also to everybody that I know, Including other medical professionals.
On the flipside, if you have a busy office full of patients that love you, because you make them feel better, that sure sounds like a doctor to me; and also, to everyone I know, including other medical professionals. I can understand the fixation on the degree, but it’s time to either get over it, or to somehow try to fix it. I hope that...
Editor's note: Dr. Smith's extended-length letter can be read here.
05/21/2025
RESPONSES/COMMENTS (NON-CLINICAL)
From: Lawrence Oloff, DPM
I want to acknowledge and thank two doctors who recently contributed to PM News, Dr. Gottlieb for his cogent argument for the 4-4-3 model and Dr. Jack Reingold for his affirmation that we are doctors. Both were clear on the need for a full educational experience, and it is best to have a rich broad educational experience and done, then focus on what you want to do or not do once you are in practice. This is the standard medical education/practice model. These discussions made me feel better after reading the tirades about the death of the profession and the need to have a degree change. I would like to address both of these areas of concern.
Let me first address Dr. Tomczak’s DO degree argument. If you are unhappy with the DPM degree, do you really think that a DO degree is going to improve your status with the public? I trained in a DO hospital and they suffered the same insecurities about their degree that podiatrists did then...
Editor's note: Dr. Oloff's extended-length letter can be read here.
05/20/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Jack Reingold, DPM
After reading dozens of viewpoints on the subject, I thought I would add mine. First of all, we are doctors. I’ve never had a patient in my 40 years of practice question whether or not I was a doctor or even realize what degree I hold. I graduated in 1979 and had the privilege of being residency trained. I had the ability to change the guidelines at three hospitals and added ankle privileges to all. At the last hospital, I sat on the orthopedic committee and said that I thought we should be judged by the same standards as any surgeon and there were no complaints. I noticed that in the orthopedic guidelines, they had one check off box for ankle, so I did the same (note, the applicant had to show competency.). The guidelines were passed without discussion!
Most of our residents are very well trained in foot and ankle pathology. Whether they choose to practice in the surgical arena or not is their choice. There are many orthopedists who have completed surgical residencies but choose areas where they are not in the OR. This is true of other specialties also. I believe that our residencies should train us all to be surgeons, but there should be fellowships for those who wish to excel in one specific area.
Those of us who had less than three years of residency will disappear with time. The three-year residency will be the standard, plus fellowships for many. In summary, we should all have training in all areas of pathology, and all of our residents should have the ability to practice in the direction they wish to go.
Jack Reingold, DPM, Solana Beach, CA
05/20/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Jeffrey Trantalis, DPM
It is difficult to have a profession when you can go to your local store and get orthotics. Seeing ads for Good Feet orthotics is not going to strengthen our profession.
Jeffrey Trantalis, DPM, (Retired), Delray Beach, FL
05/19/2025
RESPONSES/COMMENTS (NON-CLINICAL)
From: H. David Gottlieb, DPM
Dr. Luftig and others raise some points to consider regarding our degree, choice and scope of individual practice, and how this all relates to current training as the 4-4-3 model is.
When I started podiatry school in 1978, I did so with the understanding that after 4 years of schooling, I would join a family practice of general practice podiatry going back to 1934. After about 20 years of some forefoot surgery, orthotics and lots of corns, calluses, and toenails, board certification by ABPM, I realized that I no longer found podiatry to be rewarding. I then retired from practice for the first time and tried to join one of the many biomedical companies in my area. After many applications over 2 years, I received one...
Editor's note: Dr. Gottlieb's extended-length letter can be read here.
05/15/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1 B
From: George Jacobson, DPM
It is really simple. The applicant pool is showing the lack if interest in spending 7 years to become orthopedic surgeons of the foot. It takes 7 years to get licensed even if you don’t want to primarily practice surgery. How many medical students want to be orthopedic surgeons? We chose podiatry so we could do it all, not just surgery. How many of us would not have chosen podiatry if it took 7 years to get licensed? That is 11 years post high school graduation.
A lot could be done in 11 years, without the expense. One could be 11 years closer to a pension, have savings, and a family. We may have ruined a simple path to success that we knew as podiatry.
George Jacobson, DPM, Hollywood, FL
05/15/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1 A
From: Rod Tomczak, DPM, MD, EdD
On October 19, 2021, The USMLE replied to the podiatry task force made up of our alphabet organizations. USMLE dealt us an unequivocal denial of our petition to take the USMLE in search of a plenary (not limited to body part) medical license. Some years ago, Len Levy, DPM persuaded Larry Jacobson, DO, the dean of Des Moines University, to allow a select group of DPM students to take COMLEX level 1 after the second year of school, around the time of the DPM boards, so our students were "studied up." Only 10% passed the COMLEX. We never told the students the results.
We do not teach the same curriculum of medical school. Because there is a 4-4-3 model does not mean everything is the same. We are not one childbirth and a bipolar patient away from and equal curriculum. The third and fourth years are miles apart as far as clinical experience goes, and there is no comparison. We do not have a month of dedicated pediatrics, ED, neurology, women's health and pregnancy, or psychiatry. Letting our students take these tests without the proper preparation would deliver a devasting blow to their self-esteem. Let's do things the right way rather than trying to sneak in the back door.
Rod Tomczak, DPM, MD, EdD, Columbus, OH
05/14/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: Intoxicated with Podiatry
From: Rod Tomczak, DPM, MD, EdD
I have been looking at the periodicals published by the schools which I view as grand advertising campaigns. Of course, we highlight the accomplishments of recent graduates costumed in their not green any more greens. The central part of the picture is usually the terms “foot and ankle surgeon” and the text emphasizes how grateful he or she is to the school even though we know the residency program is really the tool responsible for later accomplishments. As of late, there are headlines bragging about the 100% residency placement. That may impress some 70 something year-old podiatrists who reminisce how difficult it was to get a residency. These septuagenarians don’t know there are currently more residencies than graduates.
It might be more reflective of a school’s success in resident placement if the headline read, “93% of Best Medical College of Podiatric Medicine are Placed in their First Choice of Podiatric Residency,” when there are only 24 graduates. This good press is at least remotely intended to bolster the ...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
05/14/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
RE: Bringing a Podiatric Voice to the Global Sports Medicine Stage
From: Karli Richards, DPM, MHA
I’m excited to share a recent milestone in my work as a podiatric surgeon and sports medicine specialist. I recently presented findings from my pilot study, Protect Our Players (POP) at the 2025 FIFA Isokinetic Conference in Madrid. This research explores key injury risk factors in female soccer players — including cleat design, playing surface, strength and conditioning, and menstrual cycle tracking.
As a board-certified foot surgeon with a Master’s in Healthcare Administration, I’ve focused much of my career on improving injury prevention for female athletes. I currently serve as a podiatric medical content advisor for U.S. Soccer’s Recognize to Recover initiative, helping develop educational materials on biomechanics, footwear, and athlete safety. I also work with IDA Sports on female cleat and shoe design.
The POP survey is now expanding nationally to include youth clubs, collegiate programs, and professional teams. Future research will build on these findings to support cleat innovation and integrate hormonal tracking into performance and injury risk strategies. I’m passionate about bringing a podiatric perspective to the forefront of global sports medicine and contributing meaningful data to improve outcomes for female athletes.
Karli Richards, DPM, MHA, Chambersburg, PA
05/14/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 3 A
From: Amol Saxena, DPM, MPH
Dr. Hultman writes that MD programs are shortening school, particularly for primary care. My MPH thesis was on this very topic and it was discussed in Congress. About 1/3 of US MD & DO programs are "accelerated". There are even three accelerated programs for orthopedics including at Duke and Penn State. I even wrote an article on this for KevinMD:
Dr. Hultman also writes that we just need to be able to take the USMLE or COMLEX. However, two years ago at the AMA convention they stated the "case is closed" for DPMs to take the USMLE. This could be due to other political factors such as opening the door to other much larger medical professions that...
Editor's note: Dr. Saxena's extended-length letter can be read here.
05/14/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 3 B
From: H. David Gottlieb, DPM, Ivar E. Roth, DPM, MPH
Dr. Hultman hits the nail on the head. The MD degree does nothing for anyone unless they are going into pure research. What matters is one's license. That determines what one can do. Fight for the plenary license with our current education and training, not another degree.
H. David Gottlieb, DPM, Baltimore, MD
I agree with Dr. Hultman's solution that a plenary medical license could very well work for our profession, but I also know that these discussions have gone on for over a decade and from what I can see, nothing has happened here in California. I would appreciate hearing more from Dr. Hultman on what it would take and when he thinks this could really happen. The time is now and the profession needs this upgrade now, so please tell us what needs to happen.
Ivar E. Roth, DPM, MPH, Newport Beach, CA
05/13/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1 A
From: Jon Hultman, DPM, MBA
We do not need a medical degree. What we do need is a medical license – a plenary license. We are the only medical-surgical specialty that does not have a plenary license. In California, the medical and orthopedic associations are willing to support DPMs in our quest for a medical license as long as we take “their test” – either the USMLE or a modified version of the COMLEX.
A dual degree (DPM/MD or DPM/DO) would get DPMs a medical license only if they completed a three-year DO or MD residency. DPMs would also need to complete a comprehensive podiatric residency to become board certified in podiatry. We do not need extra years of education, training, and expense because we already have the same education model as medicine – four years of undergraduate education, four years of professional education, and three years of residency (the 4-4-3 model).
Some medial schools are now testing programs to truncate medical school to three years if a student declares s/he wants to go into primary care. Does declaring a specialty at the front-end of professional education sound familiar? MDs and DOs have plenary medical licenses upon completion of residency programs. DPMs have a limited license upon completion of their residencies, but they can, and should be, the next degree to qualify for a medical license. We simply need to access either the USMLE or COMLEX to make the DPM degree equal to the MD and DO degrees.
Jon Hultman, DPM, MBA, Los Angeles, CA
05/13/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
RE: Do We Really Have a Medical Degree? (Gary S. Smith, DPM)
From: Rod Tomczak, DPM, MD, EdD
I appreciate Dr. Smith's admission that he has never heard of a broken screw extractor set. As Clint Eastwood said, "A man's got to know his limitations." Directions on how to use the many different types are readily available on reputable surgical sites such as Facebook, YouTube, and others offering "how to videos." Original internal fixation screws were not always made of the best materials like they are today. So, if a patient had a a painful, broken screw, they often wanted it extracted. So, the consent form usually read, "extraction of painful internal fixation device." It would be a real disappointment to the patient if it had to be left in the foot or ankle and the patient referred to someone more familiar with the instrumentation.
Sometimes things get left in the patient and they shouldn't be. When Woody Hayes had his gall bladder removed, a sponge was left in his abdomen and had to be removed the next day. Rumor has it the surgeon came from Michigan and the first assistant from Pennsylvania. I wonder if McGlamry, Mann, and Meyerson were too busy to operate or write textbooks or articles. In order to save them time, the ICD and CPT codes are ICD-10 84.293 and CPT 20680 for a painful internal fixation device and its removal.
Rod Tomczak, DPM, MD, EdD, Columbus, OH
05/13/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1 B
From: Paul Kesselman, DPM
There is no doubt that with the current class sizes we will cause our own extinction and we must do something about that. The question is will a DO degree accomplish that goal? Will students going to DO schools choose podiatry as a specialty, and/or are we to continue as a profession. In the mid ‘70s, there were five schools turning out a total of about 750 new graduates a year. Now we have more than double that number, and we are graduating nowhere near 750.
In the mid ‘70s and very early ‘80s, there were an insufficient number of residency programs. Now we can fill them all and some are not filled. So, we have gone places in the past fifty years or so since I first thought of attending podiatry school that I never thought possible. As for the negatives, we have no one but ourselves to blame by continuing to...
Editor's note: Dr. Kesselman's extended-length letter can be read here.
05/12/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2 A
From: James DiResta, DPM, MPH
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 two-fold, 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 the anatomy of the...
Editor's note: Dr. DiResta's extended-length letter can be read here.
05/12/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: THIS NEEDS TO BE THE YEAR WE MAKE A STAND!
From: Farshid Nejad, DPM
I have heard Dr. Kesselman voice his concerns on how physicians are being manhandled by insurers, including Medicare. Medicine has been complacent about standing up for our rights to be autonomous and getting reimbursed fairly. Know that this complacency has led to the momentum to silence us completely by creating so many regulatory requirements and, more importantly, financially stifling us to weaken our monetary ability to lobby. When we cannot afford to support ourselves, let alone our national associations, we will have very few options to fight. WE HOLD ALL THE CARDS, yet we do not know how to play them.
We need to ask for a raise, we need to stop MIPS reporting penalties, we need to create reciprocal and equal rules for audits and look backs (if we get one year to bill, Medicare should only get one year to audit), we need to remove the pay difference in POS 31 vs POS 32 in SNFs. These injustices are just the tip of the iceberg of the laundry list of issues that REQUIRE CHANGE. This affects all physicians, not just podiatrists. We need our associations to contact the news networks to publicize these issues (free advertisement). THIS NEEDS TO BE THE YEAR WE MAKE A STAND!
Farshid Nejad, DPM, Beverly Hills, CA
05/12/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2 B
From: Ivar E. Roth, DPM, MPH
I like the idea of being absorbed by the DO schools and doing a legitimate 1-year general internship and then a 2- or 3-year surgical residency. That seems about perfect. We truly have a recognition problem with the DPM degree. It is also a shame the nurse practitioners and other allied professionals can work on the entire body, and we have to think twice about putting an IV in the hand if we are in or out of our scope of practice. I do not think the profession will wither and be gone but we definitely need to do some serious PR.
Ivar E. Roth, DPM, MPH, Newport Beach, CA
05/12/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2 C
From: Robert Scott Steinberg, DPM
CPME's answer is to charter more schools in the face of declining enrollment and its refusal to require proper courses in neurology, psychiatry, and pediatric medicine. The profession also needs two-year residency programs for those who do not want to be surgical podiatrists, which would require a change in most states' practice acts. The APMA was the one that drove component societies to change their practice acts to require a 3-year residency.
Robert Scott Steinberg, DPM, Schaumburg, IL
05/09/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Gary S. Smith, DPM
I think Dr. Tonczak's letter perfectly defines the conflict between academics and practical podiatrists. I was doing some training at the Pittsburgh Podiatry Hospital when I asked the most prolific surgeon why he didn't write books and articles. He answered, "because I don't have time."
Dr. Tomczak said not knowing about a screw extractor should disqualify board certification. I was the director of a surgical residency and didn't know about them. No hospital I ever worked in would have such an instrument in stock. Maybe breaking a screw during surgery and not being able to deal with it should disqualify you from certification?
Gary S Smith, DPM, Bradford, PA
05/09/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1 C
From: Evan Meltzer, DPM
If our podiatry days are numbered and our demise is approaching according to Dr. Tomczak, can someone explain to this old retired podiatrist why more podiatry schools have been recently established? When someone asks me what my profession is, I say that I’m a retired podiatrist. If the general public doesn’t know the scope of our field, who is responsible for disseminating that information?
New Mexico is seriously short of primary care MDs and DOs. As a result, nurse practitioners are often the first primary providers seen by new patients. One of my neighbors who typically accompanies his wife on our monthly hikes was absent from the last hike. When I asked Barbara where Jim was, she said, “Jim is having foot trouble and his primary care provider (a nurse) told him, there’s nothing else that can be done for your foot.” That naive statement just dismissed our entire profession! I asked Barbara a few basic questions about Jim’s complaint and then referred him to one of the several excellent podiatrists in the area whom I know personally.
Jim was fitted with custom orthotics and is doing well. I cringe every time I see TV ads from the “Good Feet Store.” After prescribing custom orthotics for over 40 years, I don’t ever recall a patient telling me that their back pain or foot pain disappeared after one day of wearing these prescription devices, let alone those (paid persons) who claim immediate relief by wearing the OTC arch supports dispensed by the Good Feet store. So, who’s responsible for educating the general public about our beloved profession? Why are there new podiatry schools being created if we are on our “last legs?”
Evan Meltzer, DPM (retired), Rio Rancho, NM
05/09/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1 A
From: Rod Tomczak, DPM, MD, EdD
Although I agree with Dr. Udell's position about being satisfied with the DPM degree we received in the 1970s, I think he is missing my point. The PM News survey of current DPMs concerning their satisfaction with a DPM degree revealed that only 14% of the over 600 responses would settle for a DPM degree and a 3-year residency today if they had the option of earning a DO degree instead of a DPM degree. With the number of applicants to podiatry school dwindling at a rapid rate, it won't be long before podiatry schools will not be able to afford keeping their doors open. At the same time, DO schools have increased to over 35 institutions and offer more options to students when it comes to residency choices. I hope that a residency program offering a 1-year general internship and a 2- or 3-year foot and ankle program will evolve to keep the spirit and efficacy of podiatry alive.
Rod Tomczak, DPM, MD, EdD, Columbus, OH
05/08/2025
RESPONSES/COMMENTS (NON-CLINICAL)
From: Elliot Udell, DPM
For many years, many of us have felt that the only way to achieve parity with the medical profession is to abolish the DPM degree and give every podiatrist an MD degree. This would effectively make podiatry a subspecialty of medicine and we would consider ourselves "real doctors". Does it really matter in 2025?
When I first graduated from NYCPM in the late '70s, the ability to provide all phases of healthcare was restricted to holders of an MD degree. Gradually over the decades, things have radically changed. I still remember that the only hospital in our area that would allow us to do surgery was a local osteopathic hospital, and it was designated that way because DOs as well as DPMs were not allowed to practice in "MD-run" hospitals.
Today, things have changed. Both DOs as well as DPMs are allowed to practice in the finest hospitals. Physician associates and nurse practitioners are also getting more and more privileges. A PA at a local hospital confided in me that many of the general surgeons will allow her to perform general surgical procedures, skin-to-skin. The bottom line is that it does not matter to most patients what degree you have, so long as you give them excellent healthcare service.
Elliot Udell, DPM, Hicksville, NY
05/07/2025
RESPONSES/COMMENTS (NON-CLINICAL)
RE: Do We Really Have a Medical Degree?
From: Rod Tomczak, DPM, MD, EdD
Podiatrists, as of late, commonly deliver unreferenced advice in local newspapers on topics like the potential catastrophic health effects of community bowling shoes. Dentists are guilty of the same veiled advertisements about same day versus delayed dental implants. For the podiatrist, at least, there is usually a sentence or two devoted to the podiatrist’s education. It asserts that Dr. Jones received his or her medical degree from Kent State University or Temple University, but seldom Ohio College of Podiatric Medicine or Pennsylvania College of Podiatric Medicine. A fellowship might also be mentioned at a medical school with a reputation as being difficult to get into. Often these schools also have a reputation as a top flight destination, a combination large stadium and a larger name, image, and likeness (NIL) pocketbook.
Should we use the phrase, “…received her medical degree from Kent State” in the media? Clearly you and I know the truth. But to take the issue one step further, is a DPM degree a medical degree? Dentists can receive a DMD...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
05/01/2025
RESPONSES/COMMENTS (NON-CLINICAL)
From: Paul Kesselman, DPM
There is insufficient space and time to comment here on a comprehensive review of the current state of the cellular tssue product (CTP) policy. Sufficient it is to say that the $10B price being currently paid for CTP is not a podiatry-centric issue. Wound care is big business and DFUs are only one type of wound receiving CTP. The proposed CTP policy does not address decubitus wounds, surgical dehiscence, or any other type of wound other than DFUs, and to some degree venous leg ulcers (VLU) of the lower extremities.
In the August 2025 issue of Podiatry Management, there will be a full-length discussion of the myriad of issues all wound care providers must face. The reality is that there must be a reasonably fair policy for all 3 entities involved: patients, providers, and CTP manufacturers. This, in order to provide more affordable cost-effective care for patients with DFUs and VLUs. Use of these expensive products for other than DFUs and VLUs must also be addressed.
Paul Kesselman, DPM, Oceanside, NY
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