03/18/2026    Allen M. Jacobs, DPM

The Best of Times, The Worst of Times

Duality and contradiction summarize the opinions
expressed in PM News with regard to the future of
podiatry. Like the opening sentence of Dickens A
Tale of Two Cities, “it was the best of times, it
was the worst of times, it was the age of wisdom,
it was the age of foolishness, it was the epoch of
belief, it was the epoch of incredulity, it was
the season of light, it was the season of
darkness, it was the spring of hope, it was the
winter of despair.”

These are indeed the best of times to be a
podiatric physician. Utilizing Medicare reported
RVU’s, the average podiatrist should earn a
minimum of $269,900 annually. An eclectic array of
the full integration of podiatry exists.
Podiatrists as members of the IWGDF. Podiatrists
as committee chairpersons in the ADA. Podiatrists
as contributors to IDSA guidelines and holding
fellowship status. Podiatrists designing and
receiving royalties for joint replacements and
devices employed for bone and joint surgeries.
Podiatrists engaged in trauma care, major
reconstructive surgery, employed at major academic
institutions.

When I arrived in St. Louis in 1980, only 3
hospitals allowed podiatrists staff privileges. In
2026 every hospital has an active podiatry staff
taking ED call, and providing in-patient care,
often for complex pathology. I feel comfortable in
my assumption that an analogous evolution has
similarly occurred in other cities.

There are textbooks and journals authored by
podiatrists. Podiatrists regularly present at
medical seminars. Podiatrists complete fellowships
and 3-year residencies at some of the most
prestigious medical institutions in the United
States. The status of podiatry in the United
States is admired and envied by our colleagues in
other countries.

The worst of times? These are the worst of times
for medicine in general. The overwhelming majority
of problems confronting the Podiatric physician
are those confronting medicine not just podiatry.
Diminishing payments, an environment hostile to
private practice and favoring corporate medicine,
increased regulatory burden, stress and burnout,
poor life-work balance, the perceived “ threat “
of NPs and PA’s, are issues facing all of
medicine, not just podiatry. How frequently do we
overhear our MD and DO colleagues state they are
discouraging their children from pursuing a career
in medicine? Very frequently. The hospital doctors
lounges have become functioning complaint centers
resembling a gathering of New York Jets fans. The
very fact that podiatrists now suffer the same
ills as all those in medicine is ironically
testimony to the achieved integration and equality
of the podiatric physician.

The current decline in college applicants is
difficult to understand and likely multi-
factorial. The problem must be addressed with
wisdom not foolishness. The DPM degree should be
supported by a belief in the education and
competence it represents, not the incredulity of
its current status in the medical community. I
have too many referrals of patients from MDs/DOs
and treat as patients too many MDs and DOs to
believe my degree is subject to skepticism in
today’s medical community.

The monomaniacal attacks on our degree by some in
our own profession may portend the future, or may
be well-meaning but incorrect. I believe the
latter. This profession has overcome early doubt
and those who attempted to destroy the growth of
this profession. We have met the challenges laid
before us with a focus on advancing the education
and clinical expertise required to complete our
mission: the evaluation and treatment of foot and
ankle pathology. Podiatry is in the season of
light, no longer of darkness.

Allen M. Jacobs, DPM, St. Louis, MO

Other messages in this thread:

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03/20/2026     Allen M. Jacobs, DPM

The Best of Times, The Worst of Times (Joseph Borreggine, DPM)

Podiatric physicians serve as hospital
chairpersons of the medical staff. Podiatric
physicians as chairperson of the hospital
department of surgery. Podiatric physicians as
chairperson or members of hospital committees.

If memory is correct, I park in the same doctors
parking lot as the MD/DO. I perform surgery in the
same operating room suites. I write orders for the
treatment of my patients which orders are carried
out by any and all hospital personnel. I sit and
eat and exchange conversation in the same doctors
lounge. MD and DO physicians ask my advice and
direction for the management of foot and ankle
pathology. I am treated as an equal and my DPM
degree is respected for its representative
accomplishment to attain.

We have witnessed the growth of our exhibitor
halls from the occasional representative to
exhibit halls filled with corporations seeking our
referrals and business. Corporations wine and dine
and “educate” our residents and fellows hopeful
for their future business.

You are a DPM, not an MD or DO. The medical degree
you have earned is respected and honored by the
medical community. My prescriptions for
analgesics, antibiotics, radiographic studies,
physical therapy, for anything I request are
filled.

You are not an MD or DO. The disenfranchised
express concern about the “limited capabilities”
of the DPM degree and suggest these constraints
will result in the ultimate demise of podiatry as
a profession. My question: on what facts is this
theoretical conjecture anchored? The DPM degree
is recognized by the 50 states for the diagnosis
and treatment of foot and generally ankle and/or
lower leg pathology. The DPM has independent
decision making for all non-operative and
operative interventions for treatment. The DPM is
entrusted to determine the curriculum and clinical
requirements in the colleges of podiatric medicine
to qualify a graduate with a DPM degree. The DPM
is trusted by society to determine the
qualifications for and maintenance of board
certification.

We are living in a country with the ageing as the
most rapidly portion of our population. We are
witnessing a pandemic in diabetes. We have greater
participation in sports with associated injuries.
The demand for podiatric services will continue to
grow in these populations.

Increasingly, other countries are seeking guidance
from American podiatric physicians for the
evaluation and care of foot pathology. There is
growing interest in developing podiatric services
in other countries.
The decreased application pool to the colleges of
podiatric medicine is indeed a cause of some
concern. The reasons for this temporary respite is
unclear, and should be clarified, defined, and
appropriately addressed. However, this may ne be a
call for the proverbial "throw out the baby with
the bathwater".
It is somewhat difficult to understand the urgent
call for an alternate license. A podiatric
physician does not have the need to perform a
spinal tap. A podiatric physician does not have
the need to interpret an EKG for subtle arrythmia.
A podiatric physician does not require the need to
perform a liver biopsy. Neither does a
dermatologist, orthopedic surgeon, or allergist.
anyone who practices clinical medicine, even in an
academic setting, evaluates and treats that which
is part of their own specialty. Yes, legally a
psychiatrist may order cancer chemotherapy. But
would they? Do they? Of course not. Neither would
an orthopedic surgeon.
Mark Twain noted that It ain't what you don't know
that gets you in trouble. It's what you know for
sure that just ain't so". The competent health
care provider, MD, DO, DPM, DDS, is the provider
who knows what they don't know, has an
appreciation of the skills and knowledge of other
specialists, and makes appropriate referrals.
Retina specialists do not do cataracts. Cataract
surgeons do not to opthalmo-plastics. All are
ophthalmologists, but function within a narrow
scope of what they know and do best. General
orthopedic surgeons do not practice orthopedic
oncology or operate on complex pediatric
deformities. They also do not perform
appendectomies or administer cardiac medications.
They have a legal ability to do so but do not,
knowing others are better informed. Why then
insist on a degree change which in the end will
not alter your actual diagnosis and management of
foot and ankle pathology. Deductive reasoning
rather than inductive reasoning is being utilized
in this argument results in an unsubstantiated and
incorrect conclusion.

I have the ability to do whatever I require to
assist my patients in the diagnosis and treatment
of those disorders for which they may seek my
care. They see me for foot and ankle pathology,
from toenail fungus to Charcot's joint disease,
from web space tinea pedis to ankle fractures.
They do not consult me for seizure disorders,
acute abdominal pain, or pneumonia. No do they
consult a dermatologist or an orthopedic surgeon
for these challenges.

There is an old joke that best summarizes the
reality of medicine. Four doctors are on a hunting
trip, sleeping one evening. A family medicine PCP
wakes up, and says "I think I heard a noise". He
wakes up the interest who listens. The internist
says "yes, there is a definite noise" The
internist wakes up the surgeon and says " we hear
a noise". The surgeon takes out a rifle and
shoots". The surgeon then wakes up the
pathologist, and says "I just shot something. Go
get it and tell me what it was."

Allen Jacobs, DPM, St. Louis, MO

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03/19/2026    Joseph Borreggine, DPM,

The Best of Times, The Worst of Times (Allen M. Jacobs, DPM)

Two esteemed podiatrists, Drs. Amarantos and
Jacobs have dedicated their careers to advancing
the field of podiatry. Both recently have
addressed crucial topics that are essential to our
profession.

Dr. Amarantos has expressed his concerns about how
the podiatric profession has historically
overlooked a vital aspect of our practice,
biomechanics, and relegating it to a secondary
position.

As a graduate of Scholl College in 1988, after
transferring from CCPM during my freshman year, I
was fortunate to have access to Scholl’s renowned
in-house orthotic laboratory and the expertise of
Professor Oleg Petrov DPM, a former CCPM graduate
who joined the faculty in 1979. This collaboration
between podiatric expertise in sports medicine and
biomechanics became an integral part of the
educational curriculum.

Throughout my career as a podiatrist, I have
consistently utilized this knowledge to provide my
patients with numerous pairs of prescription
orthotics that effectively alleviated a wide range
of foot-related issues.

Interestingly, I never permitted my assistant to
take mold impressions of the feet, whether using
plaster or fiberglass socks. I assumed full
responsibility for the entire process of
prescribing orthotics. If any errors were made, it
was my fault, and the orthotic laboratory promptly
corrected them when necessary.

As a podiatrist well-versed in biomechanics and
skilled in taking mold impressions, during my
years at Scholl, I accepted the significant number
of castings that were destroyed in the hands of
Dr. Petrov due to incorrect impressions on my
part. However, I believe that this was an
essential part of the learning process.
Regrettably, many podiatrists today minimize this
training and education, delegating it to
assistants and dismissing it altogether. This
practice extends to various aspects of foot care,
but that is a topic for another day.

I recognize that Dr. Petrov is currently serving
as the President of the National Board of
Podiatric Medical Examiners. I hope that he will
continue to prioritize the inclusion of our
profession’s expertise in biomechanics in the exam
curriculum.

Dr. Jacobs presents a compelling and often
contentious perspective on the podiatric
profession, drawing upon historical context and
its current state. His quote from Charles Dickens’
“A Tale of Two Cities” resonates deeply with our
profession’s identity.

Regrettably, the future of medicine appears
uncertain. Several factors contribute to this
bleak outlook, including the ongoing decline in
insurance reimbursement, the displacement of
private practice by corporate entities in
hospitals, healthcare facilities, and supergroups,
and the escalating cost of medical school tuition,
which takes years to recoup.

The future trajectory of podiatry remains
uncertain. We may transition to a dual degree
program, establish foot and ankle surgery as our
primary focus (parallel to our current three-year
residency and fellowship training), or fully
embrace artificial intelligence and its potential.
These are indeed “the best of times and the worst
of times.”

Joseph Borreggine, DPM, Ft. Myers, FL