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02/06/2026 Sev Hrywnak, DPM, MD
Why Podiatry Should Pursue Broader Licensure Beyond Foot and Ankle Care
Podiatry has historically focused on foot and
ankle pathology, but the evolving healthcare
landscape demands a wholesale shift in how this
profession prepares its graduates. A limited
license that restricts practice to foot and ankle
care constrains the potential impact podiatrists
can have on population health, collaboration, and
cost-effective care delivery. Here are key reasons
for pursuing planetary/full licensure and broader
scope:
Competitive relevance in a crowded market:
Healthcare professions are expanding scope to meet
comorbidity management and aging populations.
Licenses that affirm competency in a wider set of
musculoskeletal and systemic health issues
differentiate practitioners and attract patients
seeking comprehensive foot-to-knee care in a
single provider.
Integrated care and multidisciplinary teams:
Population health management relies on teams that
coordinate across specialties. A full license
enables podiatrists to participate more fully in
primary care settings, clinics, hospitals, and
accountable care organizations, improving care
coordination for diabetes, vascular disease,
neuropathy, and obesity—conditions with major
lower-extremity implications.
Cost reduction and value-based care: Managing
vascular risk, wound healing, and preventive foot
care at the primary care level can reduce
hospitalizations, amputations, and emergency
visits. A broader license allows podiatrists to
bill for preventive and chronic disease
management, aligning incentives with value-based
models.
Expanded patient access and equity: In many
regions, podiatry services are limited by scope. A
full license can increase access to timely,
comprehensive care, especially in underserved
communities where foot and ankle health signals
broader systemic issues.
Education and training alignment with population
health: Curricula that prepare graduates for full
licensure emphasize epidemiology, data analytics,
preventive strategies, and care transitions. This
equips cohorts to contribute to public health
surveillance and population-level interventions.
Professional resilience and adaptability: The
healthcare workforce is rapidly evolving with
telehealth, AI-assisted diagnostics, and chronic
disease management. A broader license positions
podiatrists to adapt to these innovations and
maintain professional relevance.
Ethical and comprehensive patient care: Patients
often present with comorbidities affecting foot
health. A full licensure model supports holistic
evaluation and treatment planning, improving
outcomes and patient satisfaction.
Global workforce considerations: As healthcare
systems reform toward universal access and
standardized quality, a broader licensure
framework helps podiatrists participate in
international collaborations, research, and
education.
Policy and reimbursement alignment: Payers
increasingly reward comprehensive, preventive, and
coordinated care. Full licensure enables
podiatrists to maximize reimbursement
opportunities for preventive services, wound care,
diabetic foot risk reduction, and vascular
assessments.
Future-proofing the profession: The line between
specialties is blurring. By expanding licensure,
podiatrists can respond to emerging needs without
outsourcing care to other specialists.
Case in point: A diabetic patient with an
ulceration sub second meta-head can be treated by
the podiatric physician with a limited license.
The same patient can be treated by an MD, DO, PA,
NP with a full license and at the same visit
adjust the patient's blood pressure medication and
insulin dosage.
Parity: Podiatry cannot claim educational or
clinical parity with Allopathic and Osteopathic
physicians without presenting factual evidence. In
a recent podiatric journal the author stated, "
For all intense purposes, the end-products of
medical, osteopathic and podiatric educational
processes- MD, DO and DPM degrees, are equivalent
and indistinguishable."
Parity implies equal standing in outcomes, scope,
reimbursement, training, and impact on population
health, which must be demonstrated with data.
Relying on status, prestige, anecdotes or a vote
of parity by the APMA House of delegates, alone
leads to assumptions, not truth. To assert parity,
you need measurable indicators: licensure breadth,
scope of practice, patient outcomes, access to
care, cost-effectiveness, pilot programs and
comparative studies. Without transparent data,
policy decisions risk misallocation of resources
and erosion of trust. Evidenced based claims
ensure credible comparisons and informed workforce
planning.
Implementation considerations:
Curriculum expansion: to cover primary care
skills, systemic risk assessment, and chronic
disease management. Clinical rotations in Ob/Gyn,
Psychiatry, Pediatrics, Internal medicine
Competency-based licensing: with clear milestones
across foot, ankle, and related musculoskeletal
and systemic health domains.
Collaborative practice agreements that define
roles within primary care and specialty teams.
Regulatory reform at state and national levels to
recognize expanded scope and reimbursement.
Most Importantly: All podiatry organizations, from
APMA, CPME, the colleges of Podiatric Medicine,
the state associations and all the boards must
align around one single objective, to secure
plenary licensure which will secure longevity.
In sum, granting podiatric physicians a broader
license supports competitive differentiation,
enhances population health impact, improves access
and value, and ensures the profession remains
resilient in a transforming healthcare system
through the coming years.
Sev Hrywnak, DPM, MD, Chicago, IL
Other messages in this thread:
02/12/2026 Rod Tomczak, DPM, MD, EdD
Why Podiatry Should Pursue Broader Licensure Beyond Foot and Ankle Care (Lawrence Oloff, DPM)
Larry, let me thank you again for again sharing
your impressive CV with me and the other 21,000
readers of PM News. The thing is, Larry, not many
of us have a resume as long or inspiring as yours.
When we graduated, many graduates did not match to
a residency. Even those who matched were not
assured of a surgical program and only a few
attained a PSR 24+, a real rarity. Very few
podiatrists eventually secured an academic
appointment, a full professorship, and yet enjoyed
the thrills of private practice. A limited number
became residency directors, fewer podiatrists
regularly published and a smaller minority became
lecturers. Yes, Larry, we were the lucky soldiers
of the 1980s and ‘90s and were truly fulfilled in
our profession, but we were the far and few
between podiatrists. I hear from classmates who
are now hanging up their Dremels and nail nippers
with the catch phrase, “If I knew then what I know
now, I would have done it differently and not gone
into podiatry.”
Just because every current graduate gets a three-
year residency does not mean they all finish
training with close to the same amount of
knowledge and skills to enter practice and become
a success. Current graduates look at the highly
visible podiatrists and say, “I want to be like
him or her.” Larry, you know in your heart and
soul that we are hoping new graduates can
eventually pay back their loans, buy a house, have
a family and have enough money left over to trade
in their Flintstones’ car for a newer model. It’s
a tough rode to hoe for most of the podiatric
graduates who start around $144,000.
Practitioners tell college students to look at
other professions if they want to be happy after 7
or 8 more years of training while telling a
patient with a puncture wound that legally they
should be sent to a nurse for a tetanus shot. Look
on social media and every podiatry student and
young graduate is a “surgical podiatrist.” It just
ain’t so. Everybody is board certified by ABPM,
but that doesn’t get them privileges. Enrollment
in the podiatry schools is down because students
have other options. These kids are savvy and don’t
want to be pigeonholed. A classmate, Frank
Ognibene, DPM told me yesterday, “At least we knew
what we were getting into when we started.” But
some residency committee somewhere was deciding
our future. A 21-year-old today wants to be free
to choose.
Other of our classmates ended up walking away from
practices and just retired. The practice they
spent 40 years building had little value. They
never gave a lecture, never published an article,
were never expert witnesses, never taught a
resident. Some were happy in that role, while
others would not do it again. Then there are those
podiatrists who tell us that we can take those CVs
we think so highly of, get them framed and lose
them somewhere. Sure, somebody is going to harp on
the tetanus shot. That’s just a symbol. Don’t tell
me how many tetanus shots you’ve given, tell the
sheriff when he comes to see you accusing you of
practicing medicine without a plenary license.
Rod Tomczak, DPM, MD, EdD, Columbus, OH
02/11/2026 Lawrence Oloff, DPM
RE: Why Podiatry Should Pursue Broader Licensure Beyond Foot and Ankle Care (Sev Hrywnak, DPM, MD)
Having healthy dialogues is always worthwhile, as
long as it is done in a respectful manner. I
appreciate the posts by Drs. Hrywnak and Tomczak
about a plenary degree. I respect their comments
but I do not agree with them. I use to agree with
these thoughts early in my career. However, I feel
such thoughts are no longer in the best interests
of our profession. I am in the tail end of my
professional life. I have been blessed by the many
positions that fell my way. I have been a podiatry
faculty at a college, Academic Dean, managed a
podiatry program in a top tier medical university,
member/partner in a prominent orthopedic sports
medicine group, podiatry residency director, and
now my last job as full-time faculty in a medical
school. Equally important is that I have been a
private practitioner. I feel qualified to a give
an opinion on these issues.
First a few facts. Podiatry now is not what I
first started in. Those days were fighting tooth
and nail for every inch. Residency training was
all over the place. Some graduates did not get
residences because there were not enough to go
around and did clerkships instead, where they
worked in podiatry offices as journeymen. The
residencies were mostly one-year programs, with a
few that were two-year. Hospital privileges were
not easily obtained and if they were privileges
were pretty basic. Podiatry was not a homogeneous
profession. Contrast all that with now. All these
changes occurred within my professional lifetime.
Pretty amazing.
The plenary license makes no sense to what I have
observed in practice. It sounds a bit like
suggesting a change that results in a “jack of
all trades master of none”. We are specialists. We
just need to be experts of the foot and ankle -
period. Knowing medicine and medical specialties
is part of our training. For example, our
residents do two months of medicine rotation in
their first year and serve in the same capacity as
the medical residents, with their own patients to
manage, under the supervision of the chief
medicine resident just like all the medical
residents. In addition, there is exposure to many
medical specialty areas of medicine I believe they
are equipped with the necessary medical knowledge.
I was in a prominent orthopedic practice for 30
years. Do you think the orthopedists managed their
patients' medical problems? Do you think they ever
took their stethoscopes out? I could go on and on
but suffice it to say that they stayed in their
lanes as orthopedic specialists. We should do the
same. To do otherwise makes no sense. Also, why
would one want to take on that additional
headaches and malpractice risks. This makes no
sense at all.
This all seems like the perennial podiatry
insecurity with their degree. I have heard this
for well over forty years. This is what I learned
and why I have changed my thoughts on this. You
want to be respected, have acceptance by the
allopathic medical world, have patients seek you
out? The answer is simple, just be good at what
you do.
Lawrence Oloff, DPM, San Francisco, CA
02/06/2026 Sev Hrywnak, DPM, MD
Why Podiatry Should Pursue Broader Licensure Beyond Foot and Ankle Care
Podiatry has historically focused on foot and
ankle pathology, but the evolving healthcare
landscape demands a wholesale shift in how this
profession prepares its graduates. A limited
license that restricts practice to foot and ankle
care constrains the potential impact podiatrists
can have on population health, collaboration, and
cost-effective care delivery. Here are key reasons
for pursuing planetary/full licensure and broader
scope:
Competitive relevance in a crowded market:
Healthcare professions are expanding scope to meet
comorbidity management and aging populations.
Licenses that affirm competency in a wider set of
musculoskeletal and systemic health issues
differentiate practitioners and attract patients
seeking comprehensive foot-to-knee care in a
single provider.
Integrated care and multidisciplinary teams:
Population health management relies on teams that
coordinate across specialties. A full license
enables podiatrists to participate more fully in
primary care settings, clinics, hospitals, and
accountable care organizations, improving care
coordination for diabetes, vascular disease,
neuropathy, and obesity—conditions with major
lower-extremity implications.
Cost reduction and value-based care: Managing
vascular risk, wound healing, and preventive foot
care at the primary care level can reduce
hospitalizations, amputations, and emergency
visits. A broader license allows podiatrists to
bill for preventive and chronic disease
management, aligning incentives with value-based
models.
Expanded patient access and equity: In many
regions, podiatry services are limited by scope. A
full license can increase access to timely,
comprehensive care, especially in underserved
communities where foot and ankle health signals
broader systemic issues.
Education and training alignment with population
health: Curricula that prepare graduates for full
licensure emphasize epidemiology, data analytics,
preventive strategies, and care transitions. This
equips cohorts to contribute to public health
surveillance and population-level interventions.
Professional resilience and adaptability: The
healthcare workforce is rapidly evolving with
telehealth, AI-assisted diagnostics, and chronic
disease management. A broader license positions
podiatrists to adapt to these innovations and
maintain professional relevance.
Ethical and comprehensive patient care: Patients
often present with comorbidities affecting foot
health. A full licensure model supports holistic
evaluation and treatment planning, improving
outcomes and patient satisfaction.
Global workforce considerations: As healthcare
systems reform toward universal access and
standardized quality, a broader licensure
framework helps podiatrists participate in
international collaborations, research, and
education.
Policy and reimbursement alignment: Payers
increasingly reward comprehensive, preventive, and
coordinated care. Full licensure enables
podiatrists to maximize reimbursement
opportunities for preventive services, wound care,
diabetic foot risk reduction, and vascular
assessments.
Future-proofing the profession: The line between
specialties is blurring. By expanding licensure,
podiatrists can respond to emerging needs without
outsourcing care to other specialists.
Case in point: A diabetic patient with an
ulceration sub second meta-head can be treated by
the podiatric physician with a limited license.
The same patient can be treated by an MD, DO, PA,
NP with a full license and at the same visit
adjust the patient's blood pressure medication and
insulin dosage.
Parity: Podiatry cannot claim educational or
clinical parity with Allopathic and Osteopathic
physicians without presenting factual evidence. In
a recent podiatric journal the author stated, "
For all intense purposes, the end-products of
medical, osteopathic and podiatric educational
processes- MD, DO and DPM degrees, are equivalent
and indistinguishable."
Parity implies equal standing in outcomes, scope,
reimbursement, training, and impact on population
health, which must be demonstrated with data.
Relying on status, prestige, anecdotes or a vote
of parity by the APMA House of delegates, alone
leads to assumptions, not truth. To assert parity,
you need measurable indicators: licensure breadth,
scope of practice, patient outcomes, access to
care, cost-effectiveness, pilot programs and
comparative studies. Without transparent data,
policy decisions risk misallocation of resources
and erosion of trust. Evidenced based claims
ensure credible comparisons and informed workforce
planning.
Implementation considerations:
Curriculum expansion: to cover primary care
skills, systemic risk assessment, and chronic
disease management. Clinical rotations in Ob/Gyn,
Psychiatry, Pediatrics, Internal medicine
Competency-based licensing: with clear milestones
across foot, ankle, and related musculoskeletal
and systemic health domains.
Collaborative practice agreements that define
roles within primary care and specialty teams.
Regulatory reform at state and national levels to
recognize expanded scope and reimbursement.
Most Importantly: All podiatry organizations, from
APMA, CPME, the colleges of Podiatric Medicine,
the state associations and all the boards must
align around one single objective, to secure
plenary licensure which will secure longevity.
In sum, granting podiatric physicians a broader
license supports competitive differentiation,
enhances population health impact, improves access
and value, and ensures the profession remains
resilient in a transforming healthcare system
through the coming years.
Sev Hrywnak, DPM, MD, Chicago, IL
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