03/24/2026 Allen M. Jacobs, DPM
The Best of Times, The Worst of Times (Gary S Smith, DPM)
Dr. Smith calls for a unified identity defining
podiatry. He and other PM News readers have asked
the same question, and bemoan the perceived low
regard for, and financial remuneration for the
services of, a podiatrist. To quote Cassius from
Shakespeare’s Julius Caesar, “ the fault dear
Brutus is not in the stars, but in ourselves that
we are underlings”.
A number of years ago, I was speaker at a dinner
meeting on the subject of treating diabetic
neuropathy. After 5 minutes or so, it was clear to
me there was little interest in the room. I
decided to do something I had always wanted to do.
I stopped the presentation and told the 40
something podiatrists attending I wanted to take a
survey. I asked for a show of hands. I asked how
many in the room treated neuropathy. 2 or 3 people
raised their hand. I asked how many did
significant hind foot or ankle surgery. 4 people
at one table. I asked how many did significant
hind foot trauma cases. Same 4 people. I asked
about Charcot joint surgery. Same four. I asked
about diabetic ulcers. Maybe 6-8.
I then did what I always wanted to do? My version
of the Phil Donahue show. I took the microphone
and went from table to table and asked this
question, “what do you do all day?” Nobody would
answer. Just the 4 in the back who raised their
hands several times previously. The remainder
would not speak.
On the return to my hotel room, the rep for the
company that sponsored the dinner program told me
the following. He said, “Dr. Jacobs I call on and
have known these podiatrists for years. I’ll tell
you what they do. They cut toenails all day. Most
have an empty waiting room. That is what they do.”
Conversely, I was catching up with some former
residents at my annual St Louis podiatry seminar
this past weekend, The meeting was at the Grand
Floridian in Orlando, not an inexpensive venue.
One former resident was doing 5-6 ankle fractures
a week, routinely doing ankle replacement
surgeries, was now on the hospital medical
executive committee. He and another former
resident were the largest RVU producers in the
hospital. His concern was that they were so busy
that work life balance had become an issue. I knew
this was all true beforehand our local Stryker rep
has constantly kept me posted. It was not
braggadocio. Another former resident and I were
catching up on the past year. This particular
resident never went home as a resident. He
scrubbed ortho cases. He scrubbed vascular cases.
He scrubbed general surgery. One day our chief of
anesthesia pulled me aside snd asked, “is he OK”?
I asked why. He said he is always here working all
the time.
No I do not “live in a bubble “. The DPM degree
like an MD or DO or DDS or any degree, does not
guarantee success. As Charles Lombardi would tell
his residents, “ I can teach you how to paint. But
I cannot make you an artist.“
You are responsible for your own fate and
circumstances. You are not another example of the
I am a victim culture so pervasive in today’s
world. There are far too many academically and
financially successful podiatric physicians to
conclude the DPM degree is an albatross. The
colleges provide a more than adequate education
superior to that available previously. Today the
graduate completes a 3-year , ,residency with
optional fellowship. That is a long journey from
the days of no residency training, a one year
residency training, or a preceptorship.
Interestingly, those of the Barry Block
generation, with little available formal training
beyond podiatry school, have been, in general
successful financially. THEY brought this
profession to its current status. THEY did so with
limited integration into general medicine, limited
hospital access and limited privileges at those
hospitals. THEY overcame early exclusions from
many insurance plans. THEY overcame overt hostile
opposition to recognition of the DPM degree. I
have watched the advances in opportunity for the
DPM degree for 50 years. I listen to the Jack
Schuberths, Guido LaPortas, and so many of today’s
young capable podiatrists, the content of their
presentations, and compare that to the 3-month
course in onychopathy ( you read that correctly )
we endured as students at PCPM in 1971.
As the readers likely recall, a soothsayer warns
Caesar, “beware if the ides of March”. Indeed,
podiatric soothsayers have issued such concerns
regarding the future of podiatry which require
serious examination.
Your podiatry career will be what YOU make it to
be. If you are a cut toenails all day, give a few
injections podiatrist that is fine if that is your
comfort level, These services are needed. But do
not expect a large income.
I am so old that I had Larry DiDomenico as a
student. Not too long ago, he paid me a great
compliment. He recalled being a student with us,
and told me that I advised him of the following:
the more you know, the more you can do. And the
more that you can do, the more successful you will
be. He thanked me for the direction. And certainly
he has been the penultimate representation of
academic and financial achievement in our
profession. Knowledge is power.
I have continued limited interactions with
residents. It is clear which will be successful
and which will not be.
Sir Francis Bacon the father of the scientific
method, stated, “scientia potentia est”.
Today’s podiatrist is armed with the education for
influence, reputation, and achievement.
Will podiatry meet the fate of Julius Caesar on
March 15, 22 BC? Is the unsuccessful DPM a victim
of circumstance?
I would argue no to both propositions. problems
confronting podiatry today are generally not
unique to podiatry, but rather society and medical
care in the United States.
The colleges and residencies and current status
and recognition of our profession provides today’s
graduate with the opportunity, resources, and
guidance to be successful. It is the individual
who must determine to act and take advantages of
today’s opportunities. It is called free will. How
you choose to practice. Where you choose to
practice. What you choose to learn. We have all
heard “ you can lead a horse to water but you
cannot make him drink”. But sometimes the horse
may wish it had.
This weekend, 280 podiatrists choose to devote 2
days to increasing their knowledge base to improve
their knowledge base, clinical skills, and income
at our seminar. They did so at the behest of their
individual motivation. No one forced them to do
so. They listened to Dr. Tomczak discuss issues of
medical education. They listened to discussions in
neurology, infectious disease, wound care, ethics,
vascular disease. They did so be become a better
podiatric physician. They relegated time and money
to do so.
The fault dear podiatrist, is not in the stars. It
is in yourself if you are an underling.
Allen M. Jacobs, DPM, St. Louis, MO
