03/31/2026    Bret M. Ribotsky, DPM

Why did you decide to pursue a career as a healthcare provider? ( Allen M. Jacobs, DPM)

Dr. Jacobs has offered a thoughtful and
historically grounded perspective on the evolving
business of podiatric medicine, and his invocation
of Sir William Osler reminds us all why we entered
this profession. His concerns about industry
influence, unnecessary procedures, and the ethical
drift that can accompany a profit-first mentality
are legitimate and deserve serious reflection by
every podiatric physician — young and seasoned
alike.

However, while we examine our own house, we must
be equally willing to examine the patient’s role
in the very crises Dr. Jacobs so passionately
describes.

He rightly points out that one-third of all
diabetes spending is consumed by lower extremity
infection, ulceration, and amputation. That
statistic is staggering — and it is not solely the
product of industry influence, inadequate
reimbursement models, or physician ethical lapses.
It is also, in very large measure, the consequence
of a culture of preventive neglect at the patient
level. Diabetes does not ambush most of its
victims overnight. It arrives with warning signs,
with pre-diabetic markers, with lifestyle signals
that are detectable and addressable years before a
wound develops, before a toe is lost, before a
limb is condemned. The amputations continue not
only because we have failed systemically — they
continue because patients have too often failed
themselves, and we as a profession have not been
forceful enough in demanding accountability.

The Osler model of the physician as selfless
calling is noble and worth preserving. But Osler
practiced in an era before fast food, sedentary
living, and metabolic syndrome became epidemic.
The modern podiatric physician bears an additional
burden that Osler could not have fully
anticipated: the obligation to be an aggressive,
even uncomfortable, advocate for preventive
engagement. That means telling patients the truth
— that their choices have consequences, that non-
compliance is not a neutral act, that access to
the finest limb salvage technology in the world
means very little if the patient will not control
their glucose, follow a prescribed offloading
protocol, or return for a scheduled wound check.

Dr. Jacobs is correct that young podiatric
physicians must resist being misdirected by
industry and must guard the spirit of their
calling. I would add only this: they must also
keep their doors open to every patient, regardless
of insurance status or ability to pay, and they
must do so as sharp and disciplined financial
stewards of their practices. Idealism without
solvency serves no one. A physician who cannot
sustain a practice cannot serve the underinsured
patient Dr. Jacobs rightly worries about.

The calling and the business are not mutually
exclusive — but neither is compassionate care and
patient accountability. We owe our patients
excellent, ethical, evidence-based medicine. They
owe themselves the commitment to prevention.

Bret M. Ribotsky, DPM, Fort Lauderdale, FL

There are no more messages in this thread.