03/27/2026    Allen M. Jacobs, DPM

Why did you decide to pursue a career as a healthcare provider?

The recent discussions centering on and focused
upon “a good income" leave me with a sense of
discomfort. The phrase “medicine is a business" is
correct. However, the assignment of medical
practice to the category of “ just another profit
first and foremost business “ is not appropriate,
is not in keeping within the spirit of medicine,
and may lead to unacceptable ethical and at times
legal behavior.

Who was your favorite Hollywood doctor? I always
liked Dr. Galen Adams on Gunsmoke. Respected by
all. Had a beer or two at Miss Kitty's saloon.
Then there was Ben Casey, passionate about care
for his patients and confronting ethical dilemmas
(although I look and feel more like his mentor Dr.
David Zorba these days). I liked him also. But as
I aged and witnessed what has now evolved and
confronts our young podiatric physicians, as a
former residency director, I relate more to Dr.
Herbert Bock in the movie The Hospital.

No, not Trapper John or Hawkeye Pierce. Maybe
Colonel Henry Blake. Maybe. Podiatry version that
is.

A podiatric physician goes to school 8 years plus
completion of a three residency and possible
fellowship. That is 11-12 years before charging a
patient for care. On completion of training, the
average podiatrist is over $225,000 in educational
debt. During the 11-12 years of required training,
others in alternate jobs and professions are
generating incomes and savings. There are
substantial costs to a career as a podiatrist such
as office overhead, malpractice, professional
dues. You must endure long hours with the stress
and responsibility of diagnosis and management.
Good reasons for a good income.

However, how much remuneration and reward is
adequate and fair? Excessive professional fees and
the use of patients as an “income stream" as a
priority inflates the cost of medical care. We
have the most expensive medical care in the world,
and doctors are part of the problem with
unnecessary procedures, high professional fees, we
can go on and on.

Concierge and direct pay models may serve the
limited number of doctors and patients able to
participate in such services. What about the
under-insured and non-insured? How does one
maintain a viable practice with the stress and
poor reimbursement and regulatory burden of
private practice in today’s world?

To quote Dr. Herbert Bock (George C. Scott) in the
movie The Hospital; “Transplants. Antibodies. We
can manufacture genes. We can produce birth
ectogenetically. We can produce clone people like
carrots, and half the kids in this ghetto haven’t
been inoculated for polio. We have established the
most enormous medical entity ever conceived, and
people are sicker than ever. We cure nothing. We
heal nothing.”

We run up a 10 billion dollar a year cost for skin
graft substitutes and change the name to cell and
tissue products. Yet we continue to lose legs to
PAD and ulceration and diabetes. One third of
money spent on diabetes is spent on lower
extremity infection and ulceration. But the
amputations continue. Limb salvage? We condemn
distal metaphyseal osteotomy for bunion
correction, become infected with Lapidus lunacy,
and now are told by industry and their bought and
sold “ thought leaders “ that MIS bunion technique
is superior to the Lapidus. Counter attack by
industry: mini/lapiplasty. More expense. More
cost. Unclear benefit.

Lapiplasty? MIS bunion surgery? Cartiva implants?
Transtibial transport for ulceration? Whither
tightrope for bunion surgery? Dorsal, plantar, or
medial plate constructs for Charcot’s joint
disease? These are but a few examples of profit
first industry setting standard of care.

The “ business of medicine “ are important
principles which should be taught and regularly
updated. However, as Sir William Osler stated over
100 years ago, medicine IS A CALLING not a
business. You have entered the medical profession
to earn a living, but as Osler noted this must
ALWAYS be a secondary consideration. You must be a
lifelong learner. You must be dedicated to patient
care first and always. You must not be misdirected
by the pseudoscience created by industry. Finally,
as Osler noted, once you allow business to
prioritize your actions, no matter what the
rationalization, you have the lost spirit of being
a doctor. As Osler noted, it is what you add to
life, not what you take from it, which is your
sole value as a doctor.

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

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