03/31/2026    Allen M. Jacobs, DPM

Podiatry and the Perception Paradox

There is often a significant difference in the
manner by which we perceive ourselves and how
others perceive us. It is called perception
paradox. It has been said “if we could see
ourselves the way that others see us, we would be
amazed”. With an aging population, the diabetes
pandemic, obesity, increasing sporting activities
in all age groups, the demand for foot and ankle
services has been increasing. Every evaluation of
the question concludes the increasing need for
foot and ankle care. This will continue to
increase in the future.

Why then the decreased application rates at the
colleges of podiatry?

I decided to look at an AI/Google search to
determine if we as a profession suffer from perception paradox. How do non-podiatric physicians view the issue of declining applications to the colleges of podiatric medicine. In my opinion, the “outsiders view” of this problem is accurate.

I asked the question “why are applications to
podiatry colleges decreasing?”. Within seconds,
AI/Google provided me with multiple references.
Here is exactly what is stated, word for word.
“Applications to podiatry schools are decreasing
due to a combination of high tuition debt, limited
awareness of the profession among pre-med
students, and the negative public betrayals of the
career by existing practitioners. Other factors
include a lack of uniform licensure, inconsistent
income data, and competition from other medical
fields.”

AI/Google notes that “despite these declines, the
demand for foot and ankle care is growing, which
may lead to a shortage of doctors in the future.”
It is interesting to see that others outside of
podiatry have considered the issue of a declining
applicant pool. As I write this, I am sitting in
the surgeon’s lounge at the hospital (the same
lounge as the MDs and DOs, waiting to perform a
Jones suspension in the same operating room as a
cholecystectomy is being closed. When we finish, I
will have lunch with the podiatry resident in the
doctors’ lounge. Why then, does this problem
exist?

The listing by AI/Google contains self-inflicted
wounds. With regard to a negative public
perception, AI/Google, an outsider looking as us,
states “social media has allowed practicing
podiatrists to share regrets, highlighting
burnout, lack of respect, and issues with the
profession”. Burnout is an acknowledged problem
with all health care providers, as are regrets.
There may have been a lack of respect 20-30-40
years ago. But having just finished a biopsy which
will precede bilateral TMA’s in a patient with
diabetes and a complex medical history, referred
to me from an MD, I have difficulty with those who
feel a lack of respect. Tell John Steinberg that
his professorship and accomplishments at
Georgetown are a demonstration of lack of respect.
Or the two former residents from our city who are
full faculty at University of Alabama medical
school.

Tell that to David Armstrong as he travels from
country to country seeking podiatry guidance
needed in their countries. Tell that to the many
young podiatric physicians .The complaints of the
minority, of those dissatisfied, are echoed on
social media. My mother was always fond of saying
“the empty barrel makes the most noise”. This is a
correctable problem.

With regard to low awareness and prestige,
AI/Google notes “Podiatry is often overlooked by
pre-med students, often seen as less prestigious
than traditional MD/DO roles”. In my opinion, this
is a correctable issue. Podiatry has grown from
the day I graduated in 1973. Grown exponentially.
Less prestigious? We are trained to care for foot
and ankle pathology. Did you know that studies
show the disability of ankle osteoarthritis is
equivalent to that of congestive heart failure or
ESRD?

AI/Google is aware of professional in-fighting. It
specifically states “Disagreements among various
board and professional organizations create a
perception of instability within the field”. This
is again an issue not limited to podiatry. Ask
internal medicine. Or plastic surgeons upset with
ENT “facial plastic surgeons”. Nevertheless, it is
another self-inflicted wound which needs to be
immediately healed.

AI/Google noted the variable scope of practice
issue, stating “Differences in what podiatrists
are allowed to do across various states make the
career path seem less appealing”. Again, a
correctable problem which has, with the training
now available, largely self-corrected. There are
exceptions. But this is no longer a generalized
problem as it once was.

AI/Google notes high student debt and ROI
concerns. It notes “The high cost of education
often results in a poor return on investment
compared to other, more prominent medical fields”.
The RVU value for podiatry is higher than some
MD/DO specialties, such as pediatrics,
endocrinology, and neurology. Many podiatrists do
very well financially, much better than their
allopathic medical colleagues. How many MD/DO’s
make the money typically generated by certain
specialties such as interventional cardiology,
neurosurgery, or orthopedic surgery? It is the
individual doctor, not te specialty, which largely
determines income.

Finally, AI/Google notes that there are
demographic trends affecting podiatric school
applications. It notes “A general decline in the
U.S. birthrate has reduced the overall pool of
college aged individuals, affecting applications
for various educational programs”.

In summary, reduced visibility is a recognized
problem by those observing podiatric medicine from
“the outside”. Misconceptions regrading what a
podiatrist is and does is sighted as a problem by
those outside looking in at podiatry.
When all is said and done, podiatry is now an
attractive and needed profession with a growing
future need. The core podiatry care including foot
and ankle surgery, care of the diabetic foot,
performance of complex foot and ankle
reconstructive procedures, gait biomechanics, will
continue to increase in demand. The demand for
podiatry services by a DPM will remain and
increase in demand.

Podiatry, specifically the DPM degree, is not a
dying profession. As noted by Quora, the
decreasing applicant pool is a supply and
perception problem, not proof the profession is
dying. Quora summarizes the problem is this manner
as a practical takeaway: Podiatry faces genuine
threats from task-shifting, reimbursement trends,
and limited visibility. Survival and growth depend
on strengthening pipeline programs, emphasizing
surgical and limb-salvage expertise, and aligning
with evolving team-based care models.

Our educational system with outstanding college
faculty providing the appropriate knowledge base,
the three-year residency and optional fellowship
providing the opportunity to acquire exceptional
clinical experience expertise, is in place.
Perception is not reality. It is a problem which
should have been anticipated or recognized at its
inception. In my humble opinion, perception is the
problem to be corrected. Not the DPM degree.

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

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04/01/2026    Bret M. Ribotsky, DPM

Podiatry and the Perception Paradox (Allen M. Jacobs, DPM)

Dr. Jacobs has written a thoughtful and honest
analysis of the perception problem confronting
podiatric medicine. I write to add a dimension
that deserves equal weight: the economic reality
practitioners face — and that prospective students
are quietly calculating before they ever submit an
application. Put plainly, when adjusted for the
cost of living, many of us were working for 17
cents on the dollar compared to a generation ago.
That is an 83% effective decline in professional
compensation. Perception may be a problem. But
that number is not a perception.

Dr. Jacobs correctly notes that AI/Google cites
high student debt and poor return on investment
among the factors driving declining applications,
and he counters that many podiatrists do very well
financially. That is true in aggregate. But it
obscures a more granular truth every practicing
podiatrist knows: reimbursement has been in steady
decline for decades while the cost of running a
practice — and living a life — has not.

My own experience illustrates the point. The first
ankle fracture repair I performed in the early
1990s generated close to $4,000 in reimbursement.
By 2015, a comparable procedure paid approximately
$700. The surgeon in 2015 carried the same
training, the same risk, and the same
responsibility as the one in 1993 — for a fraction
of the return. Malpractice premiums, staff
salaries, equipment costs, and basic living
expenses moved in the opposite direction the
entire time.

I have been out of active practice for eleven
years. In that time, the overhead burden on
physician practices has continued to worsen —
driven by inflation, staffing costs, electronic
health record mandates, and relentless
administrative expansion. The 83% effective
compensation decline I experienced by 2015 was
painful. What that number looks like today for
colleagues still in practice, I can only imagine —
but I am confident it is worse. The math that
prospective students are doing is not
hypothetical. It is grounded in a trend that shows
no sign of reversing.

This reality points toward an uncomfortable but
necessary conclusion: survival may depend on
deliberately building practice vectors that exist
entirely outside of insurance reimbursement. Non-
covered services — aesthetic procedures, concierge
care, cash-pay wellness offerings — are no longer
a luxury add-on for the ambitious practitioner.
For many, they are becoming the financial
foundation that makes the rest of the practice
viable. I began teaching the use of aesthetic
fillers within podiatric medicine years ago, at a
time when only a handful of practitioners were
exploring that space. The interest has grown
steadily since, and for good reason. Those who
diversified early understood something the broader
profession is only now beginning to reckon with:
when the insurance-dependent side of the practice
can no longer carry the overhead, something else
must. The DPM who builds competency in non-covered
care today is not abandoning the mission of
podiatric medicine — they are protecting their
ability to continue practicing it.

The profession must be willing to make this case
loudly: every practitioner is entitled to a
reasonable and sustainable return on investment
for their time, training, risk, and opportunity
cost. This is not a mercenary argument — it is an
argument for the long-term survival of the
profession.

Dr. Jacobs is right that perception is a
correctable problem. Economic reality is
correctable as well — but only if we name it,
advocate for it, and refuse to accept the slow
erosion of professional value as simply the cost
of doing business.

Bret Ribotsky, DPM, Fort Lauderdale, FL