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08/20/2025
RESPONSES/COMMENTS (PODIATRIC MEDICAL EDUCATION)
RE: Have We Lost our Biomechanical Expertise?
From: Bret M. Ribotsky, DPM
I recently attended a seminar where third-year residents gave case presentations that left me with some concerns about the direction of our surgical training. While I was impressed by the third-year residents’ presentations on advanced surgical techniques—showcasing sophisticated hardware applications with screws, plates, and wires, along with comprehensive revisional care protocols —I noticed a troubling gap. Not once during these presentations was patient ambulation discussed. There was no mention of appropriate footgear or post-surgical gait considerations. When I raised questions about biomechanics during the Q&A—specifically about the need for rocker sole modifications following ankle fusion to optimize patient mobility—the residents seemed unfamiliar with these fundamental concepts.
This experience has me wondering: have we become so focused on surgical hardware and technique that we’re overlooking the biomechanical principles that have traditionally set our profession apart? The ability to achieve optimal functional outcomes for our patients has always depended on understanding not just how to perform surgery, but how our interventions affect the patient’s long-term mobility and quality of life.
I’m curious whether other practitioners have observed this trend. Are we adequately preparing the next generation of surgeons to think beyond the operating room to the patient’s functional recovery? I believe our profession’s unique strength lies in combining surgical expertise with biomechanical understanding. I hope we can maintain this holistic approach in our training programs. I’d welcome thoughts from colleagues who may have similar observations or different perspectives on this issue.
Bret M. Ribotsky, DPM, Fort Lauderdale, FL
Other messages in this thread:
08/26/2025
RESPONSES/COMMENTS (PODIATRIC MEDICAL EDUCATION) - PART 1A
from: Douglas Richie, DPM
I fully agree with the observations made by Dr. Kirby regarding the demise of biomechanics in the podiatric profession. The push by leaders in our profession to have podiatric education mirror allopathic medical schools has eliminated the unique advantage that podiatrists previously had in evaluating and treating all foot and ankle pathologies. The APMA Vision 21st Century influenced all of the podiatric medical schools to substantially reduce all formal courses in biomechanics which were replaced by general medicine courses.
In 2022, the Council on Podiatric Medical Education passed CPME 320 which reduced the number of biomechanics cases in podiatric residency by thirty percent. Without adequate biomechanics training, podiatric physicians can only wish to be as good, but not better than our orthopedic colleagues.
Douglas Richie, DPM, Long Beach, CA
08/26/2025
RESPONSES/COMMENTS (PODIATRIC MEDICAL EDUCATION) - PART 1B
From: Howard Dananberg, DPM
I’ve been following the thread on how podiatry is losing its expertise in biomechanics. I understand the allure of surgery, but with the pathetic insurance reimbursements, stress, and periodic complications that a surgical practice creates, it’s surprising that designing and dispensing custom foot orthotics doesn’t have greater acceptance. It can be financially rewarding, and patients love them and the practitioners who provide them.
When combined with lower extremity manipulation techniques, many long-term issues can spontaneously resolve as well. And, thinking through biomechanical issues can be a very satisfying academic endeavor and rewarding to both patient and doctor. Think about attending the Richard O. Schuster seminar on October 24 and 26 at NYCPM in New York. Well worth it.
Howard Dananberg, DPM, Stowe, VT
08/25/2025
RESPONSES/COMMENTS (PODIATRIC MEDICAL EDUCATION) - PART 1B
From: Paul Kesselman, DPM
Having written on this subject many times here, it seems that despite some efforts by the schools industry and others, not much has changed. The question is not so much who is at fault, but who is responsible for taking charge of this situation and coming up with a remedy. Is it industry, the schools, CPME, residency directors, attendings hiring new practitioners out of residency, or APMA, ACFAS, ABPM, etc.? Or is it a combination of all of the above?
To repeat the same old story and a reflection of the issue(s):
Karen Langone, Jeffrey Ross, I, and others less than a decade ago presented a three-hour symposium on "Advanced Biomechanics for the 21st Century" at a past APMA meeting. Fewer than 50 attendees out of the thousand at the APMA meeting attended this...
Editor's note: Dr. Kesselman's extended-length letter can be read here.
08/25/2025
RESPONSES/COMMENTS (PODIATRIC MEDICAL EDUCATION) - PART 1A
From: Kevin Kirby, DPM
Dr. Ribotsky and the others who have responded to his post have noted a decrease in knowledge and technical skills in foot and lower extremity biomechanics within the podiatry profession. After 40 years of private practice and having trained numerous surgical residents in biomechanics and foot orthosis therapy over a 25-year period from the Kaiser Sacramento residency program, I have also noted that there has been a gradual lessening of biomechanical skills and knowledge in our more recently trained podiatrists. In fact, I have commented on this same fact multiple times here on PM News over the past decade or more.
What I find interesting is that during my podiatry school years from 1979 to 1983 at the California College of Podiatric Medicine, many of our professors commonly made comments tending to emphasize the belief that podiatric surgeons were better than orthopedic surgeons simply because of their biomechanical knowledge. In fact, it seemed to be commonly believed among the podiatry profession during the 1980s and 1990s that the one thing that set podiatry apart from our orthopedic surgery colleagues was that podiatrists were more educated on foot and lower extremity biomechanics and, as such, could make better surgical...
Editor's note: Dr. Kirby's extended-length letter can be read here.
08/22/2025
RESPONSES/COMMENTS (PODIATRIC MEDICAL EDUCATION) - PART 1B
From: Rod Tomczak, DPM, MD, EdD, Kathleen Neuhoff, DPM
Considering the contemporary meanings of "tweak," I sincerely hope we don't tweak anymore. But this is an example of how out of touch we can become. They have a new vocabulary and set of social norms.
Rod Tomczak, DPM, MD, EdD, Columbus, OH
Sadly, I agree with the previous authors. I used to tell patients that the reason they had better results with foot surgery than their friends who went to an orthopod was not because podiatrists were better surgeons but that podiatrists did not just discharge them after surgery. We made them orthotics, recommended appropriate footgear, and followed up until they were sure their problems were resolved.
That is no longer the case with many (most) podiatrists. Some will send them to me or another “old timer” for follow-up care, but many discharge them ASAP just like the orthopods. We might as well become MDs or DOs. We are no longer better at total foot care than they are.
Kathleen Neuhoff, DPM, South Bend, IN
08/22/2025
RESPONSES/COMMENTS (PODIATRIC MEDICAL EDUCATION) - PART 1A
From: Robert Scott Steinberg, DPM
Our expertise in biomechanics enables us to perform more effective surgeries to relieve pain and improve foot function. It is that same expertise that allows us to create orthotics to further enhance the function of the foot and ankle.
While some of you scan feet, just like chiropractors and physical therapists do, I still use plaster because they can't master the technique. And, no, my assistant does not do it!
Robert Scott Steinberg, DPM, Schaumburg, IL
08/21/2025
RESPONSES/COMMENTS (PODIATRIC MEDICAL EDUCATION)
From: Paul Stepanczuk, DPM
In response to Dr. Ribotsky's letter regarding residents with advanced knowledge of surgery and surgical equipment, I have seen this type of letter in this forum before and am always reminded of an editorial Dr. Lowell Weil wrote many years ago. If memory serves me correctly, it regarded the difference between podiatrists and orthopedic surgeons.
His point, in summary, was that we tweak. We did not just do the surgery, but followed up personally with whatever the patient needed (e.g. pads, shoe counseling, etc.). It has been a decade or more since I came to the realization that attendings, let alone residents, no longer regarded this as a viable protocol. In short, we no longer tweak.
Paul Stepanczuk, DPM, Munster, IN
08/07/2025
RESPONSES/COMMENTS (PODIATRIC MEDICAL EDUCATION)
From: Rod Tomczak, DPM, MD, EdD
Just a short note to correct Dr. Gottlieb and his erroneous conception of what Caribbean medical schools are and their standards. Caribbean schools are not driven by academic institutions that offer an MD degree once tuition is paid. There is no wink-wink, slap on the back, and transfer of cash under the table to get an MD degree. A student goes to classes for two years and then sits for step 1 USMLE boards. Even podiatry school uses that format. In order to sit for USMLE step 1, a DPM graduate would have to repeat the first two years of medical school or the school could forfeit accreditation which allows Caribbean students to sit for USMLE, all parts. I don’t know how many times it has to be repeated but just because some DPMs think our basic science curriculum is equal to an MD curriculum, doesn’t make it so. The Caribbean schools must publish statistics concerning their pass rates for students taking Step 1 who attend the first two years of classes in the Caribbean.
Caribbean students must perform well on Step 1 practice tests before they are allowed to sit for...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
08/06/2025
RESPONSES/COMMENTS (PODIATRIC MEDICAL EDUCATION)
From: Glen Robison, DPM
Thank you for the laugh, but I only laughed because it is real. I tell anyone who is interested in going into medicine that it is about a labor of love and not about money. Any medical professional wants to know who is making the money. Look at who you are writing the checks to: the marketing firm, electrical company, lease holder, mortgage company, medical supply company, lawyers, accountant, stockbroker, EMR software, handyman, HVAC, office supplies. They all make more money than we do and their overhead is a lot less.
Have you ever heard of a billionaire doctor? I’m not saying a hospital or corporation but “a” doctor who continues to practice and is a billionaire? It doesn’t exist.
Glen Robison, DPM, Mesa, AZ
08/05/2025
RESPONSES/COMMENTS (PODIATRIC MEDICAL EDUCATION) - PART 1B
From: David Secord, DPM
I have a niece, whose husband is a journeyman electrician. He is now 30 years of age, is the head of his crew of 15 and they do large, industrial wiring projects. The last time I talked to him, he let me know that he makes about $250,000 a year, after spending six months in school to obtain his certification. His crew has done projects around the world, with the accommodations picked up by the client.
I really like what I do for a living but have to admit that the preponderance of individuals spending four years in a University setting to obtain a degree in underwater basket weaving or some such other waste of time should really look at what plumbers, electricians, welders, pipe fitters and tool makers are earning. With that earnings potential, without massive school debt, and zero chance of malpractice actions, these occupations are also a threat to our professional longevity. Searching for warm bodies to occupy seats at our schools, as opposed to those with a drive and thirst to help people and serve the profession is not the way to go. Just my opinion.
David Secord, DPM, McAllen, TX
08/05/2025
RESPONSES/COMMENTS (PODIATRIC MEDICAL EDUCATION) - PART 1A
From: H. David Gottlieb, DPM
The only workable solution to the DPM v. MD degree debate that I can see is based on what many of our colleagues have done. All 11 podiatry colleges should work out an agreement with an off-shore medical college such that all graduates can receive a DPM/MD/DO degree. If a graduate wants to practice as an MD/DO, they will sit for all the appropriate exams, and if they pass, apply for a medical residency; they can then receive a license in their state of choice as an MD/DO.
If they wish to practice as both an MD/DO and a DPM, well, they will do both and go through both processes to be licensed as both an MD/DO and as a DPM. Merely having an MD/DO or DPM degree does not mean that one can practice as one. You still need the appropriate license. Of course, the MD/DO license would allow one to practice foot care as a podiatrist does based on the DPM training as well as that upper extremity and treat warts, or whatever.
I believe that this model would allow for a greater pool of applicants. It would also end the incessant perennial debate that one must scroll through here just to find some new bit of opinion or tidbit of news.
H. David Gottlieb, DPM, Baltimore, MD
08/04/2025
RESPONSES/COMMENTS (PODIATRIC MEDICAL EDUCATION) - PART 1A
RE: Health Professions Scholarship Program (Evan Meltzer, DPM)
From: Joe Agostinelli, DPM
Actually, military podiatrists are NOT members of the Medical Corps in the armed forces. USAF podiatrists are in the Biomedical Services with all the other non-physician healthcare providers except dentists (who have their own Dental Corps). The U.S. Navy and U.S. Army podiatrists are in the Medical Services Corps.
The addition of podiatrists into the Medical Corps has been an ongoing concern since the beginnings of podiatrists in the military. That is why a degree change is the only way for a DPM to be commissioned into the Medical Corps. This issue is extremely important as to the acceptance of DPMs as physicians.
Joe Agostinelli, DPM, Colonel, USAF (Retired). Daytona Beach, FL
08/04/2025
RESPONSES/COMMENTS (PODIATRIC MEDICAL EDUCATION) -PART 1B
From: Robert Boudreau, DPM
A neurosurgeon woke one morning to find around 6” of water flooding his basement. He called the local plumber and told him what was happening, and the plumber said he’d be right over. When he arrived, the neurosurgeon led him to the basement. Donning his waders, the plumber stepped into the water. Leaning over, he felt around for a few minutes, pulled the drain plug, and said, “There you go, it’s fixed”. “How much do I owe you?” The plumber said, “That’ll be $400, cash, check, or credit card”. “Wow, I’m a neurosurgeon and I don’t make that kinda money!” The plumber smiled and said, “Neither did I when I was a neurosurgeon!”
Robert Boudreau, DPM, Tyler, TX
08/01/2025
RESPONSES/COMMENTS (PODIATRIC MEDICAL EDUCATION) - PART 1
RE: Health Professions Scholarship Program
From: Evan F. Meltzer, DPM
I became aware of the significant cost of a podiatric medical education while working with residents at the Audie Murphy VAMC in San Antonio, Texas. When I graduated from PCPM/Temple in 1977, I never owed the school any money for my four years there, and I paid nothing for my textbooks or equipment. How did I do this?
I was very fortunate to be awarded an Army Health Professions Scholarship (look up HPSP on your search tool) that paid for my tuition, books, and equipment for my four years at Temple. In addition, I was also paid a monthly stipend for living expenses.
What’s the catch? I repaid my debt by serving as an...
Editor's note: Dr. Meltzer's extended-length letter can be read here.
08/01/2025
RESPONSES/COMMENTS (PODIATRIC MEDICAL EDUCATION) - PART 2
RE: Trade School vs. Medical School
From: Steven Finer, DPM
I was listening to Doctors Radio the other day. It was a segment on emergency medicine. This physician was presenting a case when he suddenly diverted to a new subject. He was having a lot of work done to his house and complained about the outrageous bills from plumbers and electricians. He suggested that parents send their kids to trade school.
Steven Finer, DPM, Philadelphia, PA
08/01/2025
RESPONSES/COMMENTS (PODIATRIC MEDICAL EDUCATION) - PART 3A
From: Jon Purdy, DPM
This is a case of swallowing the bitter pill to remedy the problem. Educational institutions can provide loans, either themselves or by partnering with private banks to secure loans. The main point of my post was to point out that a government loan is the worst type of loan one can get. These loans have become a financial burden on our population. Private institutions will gladly loan money to safe bets such as medical school. They most likely will not loan a person $200,000 for a degree in gender studies.
I have a sneaking suspicion, if one cannot obtain a loan for a dead-end degree or a degree that has a traditionally high default rate, the price of education may drop as quickly as the applicants unable to fund those high dollar party years.
Jon Purdy, DPM, New Iberia, LA
08/01/2025
RESPONSES/COMMENTS (PODIATRIC MEDICAL EDUCATION) - PART 3B
From Gary S Smith, DPM
Podiatrists have not gotten a raise from Medicare, Medicaid, or commercial insurance since 1998. Podiatry school tuition has gone up 300% over that same time period. Maybe that's the issue and not limits on loans?
Gary S Smith, DPM, Bradford, PA
07/31/2025
RESPONSES/COMMENTS (PODIATRIC MEDICAL EDUCATION)
From: Elliot Udell, DPM
Dr. Purdy may be correct in stating that one does not need to attend college to make a living, and we are all aware of famous billionaires who achieved success without graduating from college. The problem we are dealing with in PM News is not the guy who forgoes college to become a plumber or electrician. We are facing a serious shortage of applicants to podiatric medical colleges. If the government does cut loans to these applicants, the problem could become far worse.
Expecting most of our podiatric medical colleges to fund loans to applicants is a pipe dream. Our institutions do not have the kinds of endowments that the Harvards and Yales of the world have. Perhaps some of the directors of our podiatric medical colleges could enter this discussion and let us know what percentage of their student population relies on government loans in order to foot their tuition.
Elliot Udell, DPM, Hicksville, NY
07/30/2025
RESPONSES/COMMENTS (PODIATRIC MEDICAL EDUCATION)
From: Jon Purdy, DPM
I’m happy to hear government funded loans are being regulated. I frankly feel they should be discontinued. Nowhere else can someone get a loan for almost any amount with bad credit, no credit history, or for educational tracks that historically do not create enough income to repay the loan. Government loans are not low interest loans as they are touted. They are not subject to bankruptcy. If one becomes unable to pay, the interest is compounded and the repayment exponentially increases. If one has to claim bankruptcy, the loan is not discharged and continues accruing compounded interest, becoming a noose around that person’s financial neck.
Educational institutions have figured out, no matter how much of an increase they place on the cost of education, the government will finance it, hence the high cost of education. These institutions have even added degrees that lead nowhere, since the institution bears no liability in the future success of the student.
How does one receive an education without government loans? The institutions themselves can and should back the loan and have some skin in the game. There are private sector loans and scholarships available. Let’s face it, not everyone should attend college. We have a serious deficit in trade school applications, and the reason why plumbers and electricians are making more than doctors. One does not even need to attend school to have a successful business or career. Our education system is so flawed, it’s no wonder a person ends up in their late twenties yet to generate income, all the while creating debt.
Jon Purdy, DPM, New Iberia, LA
07/28/2025
RESPONSES/COMMENTS (PODIATRIC MEDICAL EDUCATION)
From: Elliot Udell, DPM
If what Dr. Tomczak says is true, that there is an annual and lifetime cap on loans to medical students, we might not have to worry. Such a ruling will affect medical, osteopathic, dental, optometry, and physical therapy doctoral programs. The old saying is "misery loves company."
This would give all the professional societies a chance to pool their funds and work together to petition for this to be overturned. Together we could hire the biggest and best lobbyists. I am sure that if this is true, all of the societies are preparing to deal with it.
Elliot Udell, DPM, Hicksville, NY
07/21/2025
RESPONSES/COMMENTS (PODIATRIC MEDICAL EDUCATION) - PART 1B
From: Bret M. Ribotsky, DPM
I wanted to take a moment to express my sincere congratulations on Dr. Block’s outstanding work with PM News these 8,000 issues. His dedication to journalistic excellence has not gone unnoticed, and I felt compelled to acknowledge the remarkable integrity he brings to our profession.
In an era where media landscapes are often polarized and one-dimensional, Dr. Block’s commitment to presenting multiple perspectives on complex issues stands as a beacon of responsible journalism. His willingness to explore various sides of the same story demonstrates a level of intellectual honesty that is both refreshing and essential for informed podiatric discourse. This balanced approach allows PM News’ audience to form their own well-rounded opinions rather than being fed a singular narrative.
Dr. Block’s moral standards and unwavering integrity shine through in every piece he...
Editor's note: Dr. Ribotsky's extended-length letter can be read here.
07/21/2025
RESPONSES/COMMENTS (PODIATRIC MEDICAL EDUCATION) - PART 1A
From: Amol Saxena, DPM, MPH
I have only met Dr. Tomczak once (I believe at a meeting in Canada in 2003) and view him as a podiatrist dedicated to helping the profession advance. As he and others have related, the truth is hard for many to accept. So what if MDs read this? He is suggesting ways to improve the profession going forward and this may be unpleasant for many to hear as well as change. I have motivated over 30 students to become DPMs but have noticed various things have decreased the interest in the profession including limited license, difficulty in achieving board certification, and paying off student loans. Is it a rewarding profession: yes. Can you make a good living now, i.e. pay off your loans (look at the Big Beautiful Bill restrictions on educational loans and would podiatry even count?), buy a house, provide for a family including their education, and retire comfortably: It depends, but it is much more difficult for the current graduates.
I continue to mentor younger DPMs and help them publish valuable research as they don't seem to get the support to do this...
Editor's note: Dr. Saxena's extended-length letter can be read here
07/18/2025
RESPONSES/COMMENTS (PODIATRIC MEDICAL EDUCATION)
RE: Educational Fallout and Uncomfortable Truths (Lawrence Oloff, DPM, John S. Steinberg, DPM)
It's good to hear from an occasional reader of my letters to PM News. I see you have recognized my hyperbole concerning the number of podiatry schools as a form of literary sarcasm. I have used the actual number 11 in all my posts thus far, but you may have missed those. One of my issues is the clandestine manner AACPM and CPME do business. At times, it appears they are a combination of the U.S. government’s NSA and CIA when it comes to my attempts at gathering data which should be available to anyone who would like the information. For all I know, the number of schools with partial accreditation or applications might well be more than 11. The accreditation fees of about $50,000 per school invites multiple applications. The entire process of accreditation for podiatry schools is detailed here.
What I would like to see is a certificate of need by a sponsoring...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
06/26/2025
RESPONSES/COMMENTS (PODIATRIC MEDICAL EDUCATION)
RE: Updating Podiatric Medical Education (Lawrence J. Kansky, DPM, JD)
From: H. David Gottlieb, DPM
There may be many things that need improvement in podiatry education and training but the residency experience, while not 100% close to uniform nor can it be, is not where to look. Over the many years I have been involved in training residents, I have noted a very large range in the knowledge and abilities of the students who rotate through the program. They are all nice and ethical, but the abilities and skills they arrive with, not only between schools but within schools, vary between minimally competent to almost fully competent. I do believe that the schools need to standardize their training especially since they are all now associated with a university.
Additionally, one should take complaints about current training with more than a grain of salt when they come from people with an axe to grind. A quick Internet search will help to identify those who may have an ulterior motive. I for one will not dignify them with a response.
H. David Gottlieb, DPM, Baltimore, MD
06/25/2025
RESPONSES/COMMENTS (PODIATRIC MEDICAL EDUCATION)
From: Steven Finer, DPM, Kenneth L Hatch, DPM
I too was at PCPM in the 1970s. I personally never heard or witnessed any improprieties. I came into contact with many clinicians of the old school. I learned many basic tools such as strapping , padding, and the Budin splinting. I also learned casting techniques. We were taught orthotic construction. I used these basic techniques for many years in my practice.
Steven Finer, DPM, Philadelphia, PA
I also graduated from PCPM in 1975. I also was NOT aware of any guidance counselor services available to us students. I find the comment that Dr. Kansky referred to as also very hard to believe.
Kenneth L Hatch, DPM, Annapolis, MD
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