07/30/2025    William Wayne Egelston, DPM

DPM is NOT a Dead-End Degree; It Is Just a Starting Point (James DiResta, DPM, MPH)

I too enjoy the posts in PM News. Whether one
agrees with the authors, or not, doesn't detract
from their insightfulness. I appreciate the
dialogue presented by Drs. Kesselman and DiResta
and others on this topic. Considering how things
are evolving for podiatrists with diminishing
numbers of qualified (academically prepared)
applicants, likelihood of schools (some or all)
closing and increasing number of MD/DO schools on
the horizon. It would seem, to me, a likely
scenario might be that future applicants
matriculate to MD/DO schools (domestic/foreign),
complete orthopedic residencies and foot and ankle
fellowships (or others), then train physician
extenders (LVN, RN, NP, PA, etc.) in C&C, nail
care, and primary podiatry. I see this as a more
plausible pathway than watching our decline &
obsolescence.

I see this as I, along with other DPMs at Kaiser
(California), functioned in this fashion. Most
Kaisers had their own hospitals and regulations. I
was the sole podiatrist for many years (Central
Valley/CA) without our own hospital, so I/we co-
existed with about 35 private orthopods. I was
proctored by all over 2 years before they gave in
and awarded me full privileges and no further
interference (believe me, there was some). So,
basically, everything below the knee came my way.
Even some procedures "beyond our scope" fell into
my lap and we "legalized" them by having an
orthopod or vascular surgeon scrub-in and named as
surgeon of record with me as assistant.

This is how it went for over 30 years. It wasn't
glorious, just hard work and burn-out. In that
time, I worked with five foot and ankle fellows,
all of whom lost interest. My point is that MD/DOs
own the football and the field. As has been the
case, we are players- allowed, at times, some
liberties. I and many of my fellow DPMs were
defined and compensated as "physicians" and ran
departments, committees, and even entire medical
centers. Yes, we functioned as "physicians" and
wore the hat (carried the ball), but I see our
future in joining the "club" via matriculation and
training- (they are not going to invite us in) and
employ a cadre of "extenders" to carry out
services not requiring a doctoral degree and
residency to perform well.

I see this as our evolution (having already
achieved it in many instances) be it via an MD,
DO, or with the plenary licensed DPM. From my own
experience, there aren't enough MD/DO orthopods
interested in the foot and ankle. We need a
subspecialty in ortho covering the lower
extremity. Call it podiatry, podiatric surgery or
lower extremity orthopedics-in homage to our
history, ancestors, and current evolutionary
predicament.

William Wayne Egelston, DPM, Modesto, CA

Other messages in this thread:

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07/31/2025    Paul Kesselman, DPM

DPM is NOT a Dead-End Degree; It Is Just a Starting Point (James DiResta, DPM, MPH)

Thank you, Dr. DiResta for pointing out the fact
that APMA discontinued their sponsorship of the
Dartmouth MPH program. I was totally unaware of
that, but the fact remains that when it was in
place it provided graduates who went onto non
clinical careers or it simply improved those
individual's status in whatever clinical programs
they were involved with. Now that Becker's has
published the story I wrote about where both MD
and DO programs are offering dual programs for
medicine and MPH or MBA, perhaps it is time that
APMA reassess its importance. Perhaps APMA if it
cannot afford to sponsor this program itself, it
can partner with other private enterprises which
have profited from podiatry well over the years to
offer such scholarships to individuals interested
in one of these programs.

I have been made aware for some time that APMA has
serious financial issues. Having been a member of
various committees over the years as well as work
group leader for some time, I totally agree with
Dr. DiResta's assessment that significant changes
are needed and some already have been made.
However, assessing the need for change and
offering constructive criticism, not from an
armchair, but from within while actually doing the
hard work, including the work done by Dr. DiResta
does not equal the bashing that some have posted
here.

I am tired of hearing the comments from non-
affiliated DPMs who bash the profession, yet are
making a reasonably good living, but who because
APMA or their state society did not or even more
often could not help them for whatever reason
(legal, ethical, contractual, etc.) they continue
to offer negative comments without offering
working solutions. Many times when they do come up
with a good idea and are asked to help and
volunteer, or rejoin, they are too busy or they
bring up these dusty old stories from years
before. If everyone involved in an organization
left because an organization at one time or
another did not agree with their position, or
could not offer assistance, no one would be left
in any organization. That’s just the way it is.

No one needs to be reminded that the world of
medicine has changed dramatically in the last
decade, never mind the last forty+ years since I
started my clinical (and recently retired
clinical) career. Thus changes on how we practice,
deliver services and the most important for this
column organize our profession (specialty) and
promote the business of podiatry also needs to
change. This is no different than the business of
any other medical specialty, changes are ongoing
in where those services are performed, how they
are reimbursed etc. Podiatry is no different!

Change no doubt is painful for all regardless no
matter your role. Whether you are a clinician in
private practice, work for a hospital, private
equity group or an employee of some other entity
involved in health care, your daily routines over
the last few years have changed and not always for
the better.

I do agree with Dr. Diresta that APMA did make a
mistake by dropping the ball on the MPH program
(as they have on some other issues I deal with).
Perhaps the schools or some other enterprise could
pick up the ball on this. APMA and my state
society have made some errors in the past and
present that I disagree with and I have made it no
secret to them, yet I remain involved and make
those grievances heard in a constructive manner.
ll the other issues mentioned in Dr Diresta's
letter were in the spirit of constructive
criticism, no matter how painful those suggestions
may have been for APMA and the components.

As Festivus taught us, the "airing of grievances"
is certainly a good thing and my past letter does
not suggest we not air those different opinions.
Instead, I am suggesting it be done in a
constructive manner, at times behind closed doors
and not necessarily in the public eye at the risk
of dampening the enthusiasm of potential
candidates at our schools. Where I disagree with
the Festivus comparison, is that we don't need to
"physically wrestle" to resolve our grievances,
but instead figure out a way to be politically
correct and work together.

My opinion that the DPM degree is not a dead-end
career move remains unchanged. I have too many
colleagues, close friends and myself who have done
quite well outside of clinical podiatry, because
of our degrees to suggest otherwise. It is also
clear from the Medicare public use files that most
foot related medical services are provided by
DPMs. However, I don't think it is safe to rest
our laurels on that as we may have done so in the
past. The current forces in medicine do mandate
that in order to maintain the integrity of the DPM
degree, something has to change moving forward.
That is what we must strive for.

Paul Kesselman, DPM, Oceanside, NY