05/26/2025    Allen M. Jacobs, DPM

Do We Really Have a Medical Degree (Arden Smith, DPM)

Arden Smith reminds those of us from Philadelphia
of his appreciation of Louis Newman and "Buzz"
Forman. Both of these were also mentors of mine.
When I was working in the OR at Kensington
Hospital in Philadelphia, I was fascinated
watching Dr. Forman teach podiatry students on
clinical rounds. He went on and on questioning and
educating the students. He was not a paid faculty
member of the college. If I recall correctly, he
was one of the first ACFAS members with a very low
number on his certificate. He was devoting his
time to advancing our profession with no financial
award. I was very young working as patient
transporter from the room to OR and back. I
remember how shocked I was watching him remove 10
toenails, thinking OMG! I watched him do forefoot
surgery, always teaching. That is how you advance
a profession.

Louis Newman was a dedicated surgical educator. I
worked with him at Oxford Hospital and Rolling
Hill Hospital in Philadelphia. He would take the
students to lunch, educate us over a meal, direct
and build our skills in the OR, then spend time
with us after cases discussing surgical and
podiatric sciences. He was a passionate and
dedicated educator who, like Dr. Forman, brought
credibility and respect to the growing new field
of podiatry. Always well dressed in a 3 piece
suit, I witnessed the respect with which he was
held in the 1970s. He was intent on our learning
and advancing our profession.

Podiatry was built by hundreds and hundreds of
names most will never know, who had a passion to
build this profession and move it forward. We all
have had those educators who will never know the
impact they had on building our careers. If you
wish to ensure the future of our profession,
invest your time and effort to building that
future. As they say, put up or shut up.

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

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05/26/2025    Paul Kesselman, DPM

Do We Really Have a Medical Degree (Arden Smith, DPM)

I too, like Arden Smith, am retired from clinical
practice, but during my clinical days, my office
waiting room, like Arden's, was always full. Most
of the MD/DO in my area were not only respectful
of my degree, but they worked with me in the
hospitals, referred their private patients to me,
and many MDs/DOs became my patients.

One internist, who was locally famous, had to
sneak in at the end of the day so as to avoid him
having to sit in the waiting room with many of his
patients. After a few such visits, I suggested we
needed to figure out a way to stop these no charge
visits to him in my reception area. My office
waiting room could not be used as his POS. But
initially I said no he had to sit in my waiting
room so he could see what it was not only like to
see how it feels to be a patient, but I wanted him
to experience the full breath of what podiatrists
treat. And believe me he learned a lot in my
waiting room!

It is true that we do not have a plenary license.
To that I say so what? From the practical matter
does it make a difference on how I or you
practice?

To fear that sticking a bolus of steroid into an
arm or performing a venipuncture for blood work is
absurd. Even here in NYS where we have a very
limited scope, it still allows you to perform
procedures which are diagnostic related to the
foot. So starting an IV, giving IM injections, and
taking blood are not out of scope. Actually
failing to perform such procedures when medically
necessary and delaying them could be construed as
a departure from the standard of care.

I have never heard from one of my orthopedic
colleagues complaining about his inability to
treat skin cancers on the shoulder. At a recent
dermatologist's visit I was asked if I thought it
was wise for him to excise a deep lipoma from the
lateral malleolus. I suggested it might not be
such a good idea given the presence of the sural
nerve. The dermatologist knew there might be some
critical structure there, but he could not name
the nerve nor its exact location (what do you
expect 30+ years after he took his Level 1
boards).

He asked what podiatrist he should refer the
patient to. My cardiologist showed me his MRI and
CT of his fractured ankle and asked me who he
should see for a repair after two failed
orthopedic surgical repairs at two world-renowned
institutions failed to resolve his problem. His
DPM eventually needed to re-fracture and re-align
and now all is well. The list goes on.

Do you think your local ASU/ASC or hospital will
allow you to insert a chest tube, perform a
colonoscopy or set a fractured shoulder simply
because you now have a DO or even MD? Likewise do
you think they would allow a Gastroenterologist
(MD or DO) to perform a cardiac bypass, hallux
valgus repair or insert a chest tube?

Not likely. Even during the dark days of the
pandemic, the orthos I spoke to were supervised by
residents and attending specialists and fellows
and not permitted to perform procedures outside
their specialty. One foot/ankle ortho I know told
me felt like a rookie and basically did H/P and
passed the patients onto residents within those
specialties for the Covid cardiac/pulmonary care
they needed.

Yes, it was all hands on deck ,but there were
limits just as there were for our podiatry
residents. He told me there was no way he would
have inserted a chest tube, as he had not done so
in more than thirty years and now in his late
fifties was not the time to relearn that skill. So
what does the plenary license other than giving
you a piece of paper entitle you to do? In
practical terms, not much more than you are doing
now.

Dr. Jacobs is right on (as usual) as is my friend
Dr. Smith. Your practice and professional life
will be what you make it. Not necessarily what
APMA or your local society will make for you. They
too bear some responsibility but the main focus is
on you. Not your two three or more letters after
your name. And as Dr. Jacobs mentioned you need to
get off your duff and work and work hard!

Here in Nassau County NY our health commissioner
is a DPM. Recently Lucinda Orsini was appointed as
a director of a research facility and there are
many many more like them.

It is true that they have other advanced degrees
and I am sure working and going to grad school and
raising a family was not easy. Their MD or DO
counterparts in similar positions also have those
other graduate non MD/DO degrees otherwise they
would not be qualified to hold those positions.
Having an MD/DO alone does not qualify you as a
public health official.

I know other DPMs who have worked for fortune 500
hundred pharmaceutical companies who make a very
nice living doing research, physician outreach and
communication in areas outside the scope of
practice of podiatry. They have worked in the area
of pulmonology, allergy, orphan drugs, etc.
Let's face it, not every DPM is suited to be a
reconstructive foot/ankle surgeon, just as not
every MD or DO is suited to perform cardiac, ortho
or neuro surgery. S

ome personalities and hand skills are just more
suited for less invasive work while others are
suited for more abstract work. There are many
successful DPMs whose practice is primarily sports
medicine and biomechanics, while others are best
suited for wound care. Others love the general
practice of podiatry. And lastly, not every
MD/DO/DPM is cut out to be a clinician. I had them
pegged by the second or third year of podiatry
school.

As to the admission to MD/DO school, Dr Jacobs
again is correct. There are a finite number of
seats and the admission process, while arduous, no
doubt leaves out many qualified candidates. I dare
say that most B students who want to work their
butts off could get through MD/DO and DPM
training. Just ask those who have managed to
obtain admission to US MD or DO programs after two
or three or more tries (I know one who finally
managed admission after 5 attempts) and have then
gone onto successful careers at major tertiary
care institutions.

Some of them have also managed to become
department chairs in departments with very
competitive residency training requirements. Ask
some foreign medical graduates who have come back
home and also attained the same achievements.
And by the way, a recent Becker's story documented
that the gov't may be shutting down certain
financial loan support systems for all medical
training programs, possibly leaving students only
from families who can support their educational
costs (>$250K). This certainly threatens all of us
as less MD/DO students select internal medicine
programs. That leaves all of us vulnerable, while
at the same time threatening all medical training
programs.

Lastly, ask those DPMs who also have achieved
prestige at some of the best tertiary care
institutions without the MD/DO degree how they got
there.

Your ability to perform as a podiatrist is not
going to be enhanced one bit by having an
additional rotation in ob/gyn and I would have to
say my rotation in gyn as a podiatry student in
1981 was the worst month of my professional life.
Where we should have more rotations is in
psychiatry. Most who see enough patients and
certainly do a lot of C/C could use that training.
The DO model works because it is separate but
equal. That is what the podiatry schools should
mirror, yet still graduate w/a DPM and have the
knowledge scope to pass the MD/DO licensing exams,
but then still go onto further DPM training.
Whether that means merging with DO schools or
doing it separately, perhaps that is the end goal
of being treated equally that matters to the
current naysayers.

From the individual perspective, the bottom line
is that it is not your degree that may be keeping
you back (that may have been true 20 or 30 years
ago). Especially with all the DPMs well in place
in most tertiary care institutions as full fledged
members of the medical staff, more likely you are
keeping you back! Work hard, get all the training
you need and keep learning and treat your patients
responsibly. Don't send the MD/DO a note once a
year because you want to fit the patient with
shoes.

Be a professional and send a consultation note
every time they see you! If you act like a shoe
salesman (and there's nothing wrong with that
profession) then you will be treated like one. Act
like a physician and you will be treated like one
not just by your patients but by the system. If
you think MD/DO are not abused by the insurance
companies, just as DPMs, I don't know where you
have been .

And lastly, don't forget that you too are human!
That last statement may help you deal with your
empathize with your patients and all your medical
colleagues more than you know.

Paul Kesselman< DPM, Oceanise, NY