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06/09/2025
RESPONSES/COMMENTS (NON-CLINICAL)
RE: Physicians and Non-Physicians: What are the differences?
From: Martin Pressman, DPM
This AMA news article is the best evidence that the 3-year residency model is the correct educational curriculum for training podiatric physicians and surgeons. It appears that we are (currently) no longer on the AMA list of lesser trained, non-physician providers. Whatever issues remain with respect to our post-graduate training model, the adherence to the MD/DO training timeframe has given gravitas to our commitment to excellence and patient care.
Martin M Pressman, DPM (Retired), Milford, CT
Other messages in this thread:
06/30/2025
RESPONSES/COMMENTS (NON-CLINICAL)
From: Steven Finer, DPM
I agree with Dr. Lai. Unless your initials say MD or DO we will always be placed with that other group. Look what the DOs have accomplished since the 1970s.
Steven Finer, DPM, Philadelphia, PA
06/27/2025
RESPONSES/COMMENTS (NON-CLINICAL)
RE: Degree, Not Training: The Parity Gap Facing Podiatrists
From: Jengyu Lai, DPM
I joined the American College of Lifestyle Medicine (ACLM) ten years ago, excited to be part of a growing movement focused on evidence-based, whole-person care. When ACLM began working toward official specialty recognition, I was excited—but then surprised to learn that podiatrists would not be recognized as physicians within the specialty but instead classified as allied health providers. This decision was not based on differences in clinical training, residency, or capability, but solely on the degree—DPM rather than MD or DO.
Many ACLM members voiced support for including podiatrists as physicians, but the final determination rested with the American Medical Association. When lifestyle medicine was officially recognized as a specialty in 2019, DPMs were excluded from physician designation. I initially refused to pursue board certification. However, after meaningful discussions with a friend and ACLM board leader, I eventually completed the exam. I am now a diplomate of the American College of Lifestyle Medicine—not the American Board of Lifestyle Medicine—and classified alongside NPs, PAs, nurses, dietitians, and therapists.
This experience highlights an ongoing issue: the lack of parity for podiatrists stems not from training or expertise, but from degree classification. As healthcare continues to evolve and new specialties emerge, such as wound management, this degree-based disparity may persist—potentially sidelining podiatrists despite our central role and qualifications in those fields.
Jengyu Lai, DPM, Rochester, MN
06/26/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: James DiResta, DPM, MPH
While I don't disagree with the need for podiatry to visit more colleges to gain more exposure to potential applicants, I am more concerned about the watering down of our applicants' strength to schools of podiatric medicine. The problem as we have stated over and over is how can we possibly get enough qualified students is this diminishing pool. Schools of osteopathic medicine are growing exponentially. For example, have you ever heard of Debusk College of Osteopathic Medicine? It has two schools in Tennessee now and a third opening in Florida in 2026. Did you know MSU has three campuses now of osteopathic medical students. How about Meritus School of Osteopathic Medicine in Maryland? How about The Edward Via College of Osteopathic Medicine (VCOM) now in four campuses!
There are 43 osteopathic schools listed but in reality there are presently 69 campuses and many more coming. The mean MCAT of all their schools for 2024 is 502.43 and falling. Several of the schools are below...
Editor's note: Dr. DiResta's extended-length letter can be read here.
06/26/2025
RESPONSES/COMMENTS (NON-CLINICAL) -PART 1B
From: Ivar E. Roth, DPM, MPH
Kudos to Drs. Tomczak and now Saxena. I have written this in PM News before without any evidence, but as told to me from my son who recently graduated. He said a good number of students in his class should never have been allowed to be accepted in the first place. A fair number dropped out after the first and second year, but he felt that there were many in his class that just graduated who were barely hanging on and probably should have been weeded out.
Ivar E. Roth, DPM, MPH, Newport Beach, CA
06/24/2025
RESPONSES/COMMENTS (NON-CLINICAL) -PART 1
From: Amol Saxena, DPM, MPH
Mic drop for Dr. Tomczak! Makes me think of the Jack Nicholson line, "You can’t handle the truth." Promoting podiatry is one thing and lowering standards to fill seats is another. Kudos to him for doing the research and pointing out the current data available.
Amol Saxena, DPM, MPH, Palo Alo, CA
06/23/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: Other Non-MD, Non-DO Doctor Healthcare Providers
From: Rod Tomczak, DPM, MD, EdD
I thought it might be interesting to look at the data surrounding other non-physicians, but in a non-judgmental view, of course. Draw your own conclusions but be sure to refrain from rash judging anyone blowing their own horn about how hard they work and the good they do. A lot of the following data had large ranges, so I used the Jethro Bodine average technique. For those who aren’t familiar with Jethro, it went something like; “Cipher, carry, naught, naught, carry, cipher, etc…”
Doctors of Chiropractic
There are 18 accredited chiropractic colleges in the U.S. with 2,800 first year students right now. In 2023, approximately 2,700 students were awarded a Doctor of Chiropractic degree. Tuition per year averages about $30,000 and the average income is $89,000 per year. Average admission GPA is 3.38 and a school can suffer loss of accreditation if they admit anyone with a GPA below 3.0. Most accredited chiropractic schools offer...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
06/16/2025
RESPONSES/COMMENTS (NON-CLINICAL)
From: Thomas A. Graziano, DPM, MD
I agree with Dr. Sherman. There is nothing wrong with advanced training, and the decision to mandate a 3-year residency was well intended. However, a mandatory 3-year "surgical" residency should be reserved for those who have a desire to specialize in surgery. A number of podiatry students are better suited and more comfortable with practicing as a general podiatrist.
No matter how you slice it (no pun intended), there is something wrong when there are only 400 applicants over 11 accredited podiatric medical schools in the U.S. It's time to face the facts and come up with another answer for this profession. If not, based on the diminished number of applicants, we're headed for a downward spiral into the abyss in the very near future.
Thomas A. Graziano, DPM, MD, Clifton, NJ
06/13/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Alan Sherman, DPM
It is gratifying to see the last two messages from Drs. Pressman and Tomczak supporting the need for some kind of dual track 3-year residency training program to best meet the training needs of both predominantly surgical and medically oriented podiatrists. We are all proud of what our profession has accomplished in the development of the standardized 3-year surgical residency model. It seems to be producing excellent foot surgeons that are well respected in medical delivery systems, well employed, and well rewarded financially. But these two individuals seem to agree with me that it is time to catch our breath and assess whether these training programs are the best that we can do in training ALL the podiatrists that the U.S. population needs to provide for their foot care needs in the decades ahead.
My main concern is that a resident’s time is well spent training in the work that they will be doing after their 3 years are up. Believe me, I know that restructuring what was years in the making will be difficult. But perhaps some programs are already well suited to offer more clinic-based outpatient training for residents heading for more medically oriented office-based practice? And where does wound care, which occupies so much of podiatry practice, fall in this dual track system? I’d like to hear opinions of other PM News readers.
Alan Sherman, DPM, Boca Raton, FL
06/13/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: Compensating for Podiatric Surgeons Who are Not Trained In General Podiatry
From Elliot Udell, DPM
There has been a great deal of discussion on how to compensate for a lack of training in general podiatry at some of our 3-year residency programs. The issue is that many who complete these programs are masters in foot and ankle surgery but are not trained in how to manage patients with "corns, calluses, warts, ingrown toenails, and other "bread & butter" pathologies.
When I did my residency many years ago, we treated patients at a hospital-based general podiatry clinic several days a week, managed all foot emergencies in the ER, and assisted podiatric surgeons and orthopedic surgeons in the operating room. Many programs today, as has been well pointed out, are strong in surgical training but lacking in general podiatry training. The root of the problem may be that these programs may not have standing general podiatry clinics. If that is the case, these programs can work with general podiatrists and have residents rotate through their offices in order to master the non-surgical aspects of our profession.
Elliot Udell, DPM, Hicksville, NY
06/12/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Martin M Pressman, DPM
Thank you, Dr. Tomzack for not burying me. I do remember my trip to Ohio State to review your program. Things have indeed changed and evolution continues in spite of the inertia. In the last PM News, there was an interesting article by Jarrod Shapiro, DPM about surgical vs non-surgical podiatry. The article is apropos to the issue at hand. As I see it, the unified 3-year residency has brought podiatry to parity with medicine with respect to post-graduate training hours. Of course this is not the solution to all issues with respect to the profession's duality (medicine vs surgery). Medicine struggled with this issue when GI docs started endoscopy and cardiologists and radiologists became interventionalists.
Somehow they solved the issues between cardiac surgeons, vascular surgeons, and general surgeons and their respective medical colleagues. Disparate training algorithms, yet somehow they work together. I saw that at Yale for 25 years. I do not have a solution for this profession's problems, but I am sure that solutions exist. Perhaps the 3-year training model can have a medical model leading to an optional approved foot surgery fellowship for those PM trained DPMs who want or need to do surgery. The surgery done in the podiatric medical model plus a one year fellowship perhaps could lead to ABFAS foot surgery certification. There is an answer that could satisfy all parties involved. This probably will not stop the turf battles that seem incurable within medicine and podiatry. The answer is NOT to allow our medicine board to certify in surgery!
Martin M Pressman, DPM, Summerville, SC
06/12/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Martin M Pressman, DPM
Dr. Kesselman asks why podiatry was “not even listed” in the AMA article on scope creep of lesser trained (post graduate hours/residency) providers. The article does not mention podiatry for good reasons. Our training hours are consistent with most MD and DO post-graduate programs. I have been part of the “parity movement” for all of my 50-year professional career. I have seen the AMA/Orthopedic partnership fight every advance podiatry has made and call it the derogatory term “scope creep”. This article was based on measuring competence and patient safety on hours of post-graduate training. (Pedagogically sound?) In all comparisons, the article stresses the lack of training hours for the professions listed. The fact that podiatry was not on the list is simply because our training has reached “parity”.
Of course, the AMA article does say one must go to an MD/DO medical school to be a physician. I am also fairly certain no orthopedic input was sought by the author or we would have somehow been number one on the list. In the end, not being on this list or even mentioned in an AMA article on scope creep is, in my view, a reluctant acceptance of our training model.
Martin M Pressman, DPM, Summerville, SC
06/11/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Rod Tomczak. DPM, MD, EdD
I would like to comment on the letter by Martin Pressman, DPM. In the spirit of true transparency which I insist upon, Dr. Pressman was one of my trainers at Metropolitan Hospital in Philadelphia where I completed a two-year residency beginning in 1977. I am neither afraid to bury or praise podiatrists who have influenced my life.
When I arrived at Ohio State University from Des Moines CPM in 1995, there were two foot and ankle care givers for the 35,000 faculty and staff plus their families who were self-insured by the University’s prime care, 55,000 students and outside patients. The two foot and ankle physicians were the chair of the department, Sheldon Simon, MD and myself. I asked him if I could start a surgical residency program shortly after arriving. He told me...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
06/11/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Paul Kessleman, DPM
I hope Dr. Pressman can answer a question or two about the reference AMA article. I agree that the three-year 4/4/3 model may have helped elevate us to the point where podiatry is no longer negatively noted in this interesting article. Unless I am missing something, however, I failed to see in the reference article any mention of podiatrists at all. The physicians who were listed were MDs, DOs, even optometrists and naturopathic physicians.
I guess the good news is that nothing was noted negatively about DPMs, but where does that leave us if we are not even listed? I am sure those of us who read the AMA article would appreciate some interpretative explanation for this. Or if I missed something, please let me know.
Paul Kesselman, DPM, Oceanside, NY
06/10/2025
RESPONSES/COMMENTS (NON-CLINICAL)
From: Paul Kesselman, DPM
Regarding totally free Medicare verification websites, I cannot stress enough signing up for your local MAC and all four DME MAC portals. To reiterate, these are totally free and provide way more than just verification. They provide the old Social Security based number to the current National Medicare Beneficiary Identifier (NMBI), deductible status for the majority of patients, same or similar for many DME items, and financial information. Most also provide a way for you to submit appeals (which in the very near future will be the only way to submit them), and even in some cases claim submission.
While consolidated billing information is also found on these portals, it is not 100% reliable as it is dependent on the information received from Social Security and that is often a month or so lagging behind. Also, the patient's enrollment into Medicare Advantage plans also does show up, but again especially at the beginning of the year, or for patients who are new to the area in which you practice. They may have switched from either traditional fee-for-service to a MCR Part C plan and that may not be up to date, especially if it was very recent.
To state for the third time is not overstating it to all readers. Enroll in both your local MCR Part B carrier and all four DME MAC portals. These are free!
Paul Kesselman, DPM, Oceanside, NY
06/04/2025
RESPONSES/COMMENTS (NON-CLINICAL)
From: Allen M. Jacobs, DPM
Once again, Dr. Sherman presents an inaccurate portrayal of the current state of podiatry graduates, resorting to ad hominem attacks on me rather than a true representation of state of podiatry education today. Here is St. Louis, there are very busy practices with a great number of podiatrists doing serious wound care on complex patients. There are a number of podiatrists doing ankle fractures, reconstructive surgeries, TARs, and engaged in advanced wound care. There are practices with greater than 20 inpatients. In fact, as I wind down my practice, I am now a minor player compared to many well-trained younger podiatrists.
My practice is not the exception. I suggest Dr. Sherman actually read JFAS, or attend the lectures at ACFAS, or familiarize himself with the advanced care on complex patients now provided by many 3-year and/or fellowship-trained podiatrists.
I will not dignify the misrepresentations of Dr. Sherman by any further responses on this subject. He can have the last word. My discussion on this subject was intended to call attention to the outstanding education our three-year residents and fellows now enjoy. My most recent communication was intended to illustrate the status of patient care responsibility inherent in many podiatry practices in 2025, and how proud we as a profession should be with regard to the fact that our residents are so well trained to manage complex foot and ankle pathology.
Allen M. Jacobs, DPM, St. Louis, MO
06/03/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 2
From: Alan Sherman, DPM
Dr. Jacobs has somehow gotten the impression that someone is arguing for less than 3 years of residency training for podiatrists, so he continues to argue that we need 3 years of training. I don't know how he has gotten the impression that any of us want to reduce the length of residency training. I have not seen anyone express that opinion and I have certainly not expressed it. He is arguing, strongly, against no one. And he regales us with an, admittedly, heroic recounting of his treating a life-threatening necrotizing fasciitis and making sophisticated decisions regarding IT. Good for him. I admire him. But how many podiatrists or for that matter, MDs/DOs want that kind of practice?
Most podiatrists would gladly refer that patient to him or the other minority of DPMs or MDs/DOs who want to treat that high risk, critically ill patient. We speak in this forum about the danger of prospective students reading negative opinions and criticism about the profession. But what do you think is the impact on that student with reading that treating this type of patient is what they will be doing as a podiatrist? How does that affect their inclination to apply to podiatry school? My opinion is that we need a few heroic foot surgeons like Dr. Jacobs in each community who do these types of cases, with the rest referring those cases to them. All DPMs need not be created in his image. We need a variety of podiatrists to treat the cross-section of patients who see podiatrists, and their training should be appropriate for what they actually do treat.
Alan Sherman, DPM, Boca Raton, FL
06/03/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1
RE: Podiatry’s Greatest Generation
From: Rod Tomczak, DPM, MD, EdD
Several of us have written about the podiatrists who mentored us in podiatry, mostly guys who were unselfish with their knowledge and time. As Tom Brokaw wrote, they stopped the greatest threats to mankind and returned home without their comrades. When they spoke, we listened and many would not talk about what they had been through. My father was a medic attached to the Marines in the South Pacific hitting a number of beaches in the first wave. When he was a 19-year-old kid, he was deciding which 19-year-old kids were going to live and which ones were going to die on that beach. The only thing he told me was that on bloody battles like Guadalcanal, he took more cigarettes and morphine for the dying. He didn’t worry much about addiction on that beach. In return, the kids he didn’t know gave him letters to send home. That’s all he ever told me.
We respected and tried to emulate. They set us straight when we complained and we knew what was expected of us. I worked...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
06/02/2025
RESPONSES/COMMENTS (NON-CLINICAL)
From: Allen M. Jacobs, DPM
I am in agreement Dr. Smith, that a 3-year residency does not guarantee competency for the treatment of even uncomplicated pathology. There are variations in the podiatric residency experience just as there are such variations in medical residencies. Dr. Smith is also correct that not all podiatrists wish to practice nor desire to do so to the full scope of their DPM degree as allowed in their state. As for individual DOPs, this is also at times potentially problematic, but much less so now. At the hospitals where I practice, orthopedic surgeon or not, without a spine fellowship or some extraordinary circumstance, you will not be given spine DOPs. Orthopedic surgeons making their living doing discretionary total joints do not do pelvic fractures. As for variability in training, an orthopedic surgeon can train at the HSS in New York or our local St. Louis osteopathic hospital. The experiences are likely far from equal.
The 3-year residency is the standard in our profession. I would rather see over-educated than under-educated. Last night, I was in the OR with a life-threatening necrotizing fasciitis patient. The patient had complex medical history with multiple co-morbities. He was on...
Editor's note: Dr. Jacobs' extended-length letter can be read here.
05/30/2025
RESPONSES/COMMENTS (NON-CLINICAL)
The Value of the DPM Degree in the VA
From: Evan F. Meltzer, DPM
In the VA system, our degree is equivalent to an MD or DO degree when it comes to leadership positions. For example, the former Chief of Podiatry at the Albuquerque VA Medical Center is now the Chief of Surgery. This means that she is in charge of all the surgical specialties at this facility, including the oversight of orthopedics. Our degree also qualifies for any other leadership positions in the VA, including the Chief of Staff and the Executive Director.
As I mentioned in my recently published memoir, I believe that the VA model is an excellent example for providing universal healthcare to all Americans, if that ever happens, and our DPM degree in this scenario is enough!
Evan F. Meltzer, DPM (retired), Rio Rancho, NM
05/29/2025
RESPONSES/COMMENTS (NON-CLINICAL)
RE: Do We Really Have a Medical Degree (Allen M. Jacobs, DPM)
From: Gary S Smith, DPM
I agree with Dr. Jacobs that a 3-year residency can make a huge difference in surgical skills. The problem is that according to PM News surveys, the majority of podiatrists don't do ORIF of ankle fractures and don't want to. Many people go into podiatry to practice podiatric medicine and not orthopedic surgery. This is no longer an option to them. With the mandatory 3-year program, it's just not logical to do the same time in training of MDs and DOs with unlimited specialty options when podiatrists only have one.
The 3-year residency, once a premiere program ensuring excellence in training is now like a high school diploma. Everybody has one. I have seen 3-year graduates who could not do a hammertoe arthroplasty or even a matrixectomy with competence. I would also like to point out that because of this generic requirement, podiatrists like Dr. Jacobs cannot get privileges at many hospitals today.
Gary S Smith, DPM, Bradford, PA
05/28/2025
RESPONSES/COMMENTS (NON-CLINICAL)
From: Alan Sherman, DPM
The accusatory and often acerbic Dr. Jacobs, as a scientist and doctor, knows that when we have facts or evidence, we cite that. Otherwise, research begins with a thesis and then we look for evidence to support it. My thesis is that the issue of the poor applicant pool in podiatry is complex and nuanced, and I believe it has been negatively impacted by putting all podiatry students through a rigorous 3-year surgical training program. I do applaud the efforts of Pat DeHeer and the APMA for doing substantive work to help solve that problem within the current podiatric education framework. I believe that work will help but is not enough and I have voiced that opinion in many forms during the last few years.
If we had facts by which to KNOW why a particular college student chooses or doesn't choose podiatry, that would be valuable...
Editor's note: Dr. Sherman's extended-length letter can be read here.
Editor's note: This topic is now closed.
05/27/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Barbara Hirsch, DPM
I do not think it is necessary to make hospital rounds or work in an OR to make a conclusion, voice an opinion, or make a suggestion on residency programs. Many practitioners are "non-practicing" in some manner. Does that mean they do not understand ways to move forward in our profession?
Dr. Sherman communicates with many podiatrists and has a broad base for understanding our profession. Not every medical student wants to do surgery. Perhaps not every podiatry student does either, and that should be taken into account. I realize Dr. Sherman's letter may not have a factual basis for each point, but he has provided input and suggestions that are valid.
Barbara Hirsch, DPM, Rockville, MD
05/27/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: James Hatfield, DPM
At the end of the day, I ask myself if I enjoy what I did in my practice - Yes. Was I as busy as I needed to be? - Yes - I was booked up for 2 months ahead. Did I make a good living? - Yes - equivalent with most of the physicians in the area. Did I need to do better? – No. Did I have good privileges at the local hospital - Yes, full scope available. Did I do my own H&Ps – Yes. Did I get referrals from the local MDs? - Yes, lots. Did the MDs call me "Doctor"? – Yes. Did the patients call me "Doctor”?- Yes.
Anyone who needs more than this has an inferiority complex. Podiatry is consistently rated as one of the highest paying jobs in the U.S: #19th by U.S. News & World Report: Any student who can't be happy considering podiatry as a career is foolish.
James Hatfield, DPM, Encinitas, CA
05/26/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1C
From: Allen M. Jacobs, DPM
On what factual basis does Dr. Sherman suggest that the 3-year surgical residency model has negatively impacted on podiatric colleges application pools? He is and has been a non-practicing podiatrist for many years. When did he last make hospital rounds with students/residents or work in an OR with students/residents? Would he be so kind as to share with us the substantive FACTS for his predicate please.
While we all appreciate his philosophy as a non-practicing clinician, legitimate and reliable data, not philosophy, should form the basis upon which to conclude that the current residency model requires serious modification. For many years, the various residency models (medicine, surgery, 1, 2, or 3 years) created uncertainty and the suggestion of lack of uniform training in podiatry among our medical colleagues. In addition, multi-level changes in the evaluation and certification of residencies would be necessary.
Allen M. Jacobs, DPM, St. Louis, MO
05/26/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B
From: Paul Kesselman, 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...
Editor's note: Dr. Kesselman's extended-length letter can be read here.
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