03/16/2026    James DiResta, DPM, MPH

What We Should Think About(Rod Tomczak, DPM, MD, EdD)

I hope that for those readers who were fortunate
enough to read Dr. Tomczak's entry on "What we
should think about” that you will come to realize
what is happening in medical and surgical training
in the U.S .and what the future may look like
going forward. There is a tremendous outlook for
future PAs and NPs. Their educational programs are
expanding and they are training more independent
and confident providers. They have established
residency/fellowship programs at many institutions
that podiatry could only dream of practicing in
not that long ago. They have programs in many
medical and surgical specialties and
subspecialties including orthopedics and they have
training programs and educational events with the
likes of AAOS. They have bills in state
legislatures to expand their scope, more
independent practice and independent billing.

I wish I had some level of confidence that the
future of podiatry looked as promising but
honestly with our heads in the sand, and our
inability to envision increased scope and practice
for podiatry going forward, that option is not
looking good for us. Perhaps that horse has
already left the barn. Presently only a small
number of PAs are entering residency and/or
fellowship but it won't be long before it will be
a necessity and perhaps a requirement as they gain
more and more independence in practice scope and
direct billing. Very little imagination required
to foresee them taking over much of what we are
presently doing with the help of AAOS and AOFAS.

Why our leadership continues to spend its time
looking backwards to try to hold our present
status and putting out fires so we can continue to
exist at our present level without any real vision
going forward to expand our capabilities in the
healthcare world is mind boggling. I guess we just
continue to wither on the vine. We all want to
blame the system but we have no one to blame but
ourselves. I hate to even say this or even infer
that this might happen BUT it doesn't take much
imagination that members of our own profession
will see the opportunity here and may actually
drive PA expansion into the podiatry realm and
eliminate our profession in the process.

James DiResta, DPM, MPH, Newburyport, MA

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