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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