03/07/2024    Allen Jacobs, DPM

A Short History of Podiatric Discontent and Frustration (Rod Tomczak, DPM, MD, EdD)

Waiting for Godot? Vladimir and Estragon waited
and waited. As you know full well Dr. Tomzack,
Godot never arrives. The play was an offering of
the theatre of the absurd. Is this the arena in
which we as a profession now function? Yes there
are “haves and have nots”. The Joshua tree you
refer to (actually a plant and not a tree) has
branches which include rather complex surgical
interventions performed by some podiatrists.
Charcot joint reconstructions, deformity
corrections with external fixation, distal leg and
ankle trauma management are a long were from the
DSC days you fondly recall.

Our first responsibility is to protect the public
and assure that those providing advanced care with
significant responsibilities process adequate
training and experience. To a large extent, DPMs
are entrusted with the authority to determine
those qualifications. We must do so in an
effective and ethical manner. I do not believe
that lowering the standards to obtain “Board
certification”, or the creation of boards which
require minimal demonstration of experience and
academic accomplishment is the answer. I know you
do not believe that either. Godot send messages to
Vladimir and Estragon. But he never arrived.

Like you, I recall the early days when today’s
thought leaders were trained by non-certified DSCs
and early DPMs. They provided credible and
effective services in the office and the operating
room. However, there is difference between a
McBride and Keller and a Lapidus. There is a
difference between treating an ingrown toenail
with paronychia and necrotizing fasciitis. And
there is a difference in residency and fellowship
training of today’s school graduates and those of
yesteryear.

I have no answer to those who feel
disenfranchised. However, we are now trusted to
evaluate and treat serous pathology. The scalpel
is now vertical, not horizontal as you note.

Allen Jacobs, DPM, St. Louis, MO

Other messages in this thread:

---

03/13/2024    Lawrence Oloff, DPM

A Short History of Podiatric Discontent and Frustration (Rod Tomczak, DPM, MD, EdD)

Let me start off by saying I am happy with my
chosen profession. I have read the posts over the
years about the profession and its frustrations. As
a side note, I wish such discussions did not
surface on public forums as I fear that this likely
has had a negative impact on student recruitment,
but I guess that is the way of the world in an era
of social media. Why we should be happy with our
chosen profession is a complex discussion and
probably needs two parts. Here is Part 1.

What I find interesting is that people think that
these claims of unhappiness, discord, frustration,
the haves and have nots is unique to podiatry. I
can assure you it is not. I have had many podiatry
lives: Dean of a podiatry school, practice in an
orthopedic group who managed professional sports
teams, large institutional medicine, and as the
first podiatrist in the orthopedic department at
Stanford with an academic appointment. I have
worked the majority of my practice life along side
both allopathic medical doctors and podiatrists.
This is what I have observed. Allopathic doctors
have the same gripes. Many say they would not do it
again, although they were happy with their choice.
Many complain about colleagues for having what they
have and they don’t, reimbursement, paperwork, and
many more.

The reason for haves and have nots has an
explanation. Allopathic medicine has been much the
same over the last hundred years. Podiatry has not.
Podiatry has gone through a major evolution over
the years. This evolution has contributed to a
schism, due to the type and duration of training
for podiatrists . I imagine that podiatry will
evolve to a state like allopathic medicine, where
the difference between podiatry practitioners is
not as wide. That gap gets smaller all the time.

The board certification issue is part of the haves
and have nots. This problem is reported as having
political overtones but it is actually much simpler
than that, despite all the dialogue. Podiatry works
in an allopathic medical world, not a podiatry
world. Allopathic medicine make the rules. if you
want to be part of that world you need to play by
those rules. Hospitals are part of that allopathic
medical world and their rules are pretty clear. You
need board certification to do surgery. On rare
exception you can advocate privileges based on
experience by providing operative reports. An
orthopedist at one of the hospitals I work at was
asked to leave because his privileges were
contingent on elevating his board eligible status
to board certification. He had trouble passing the
exam and was asked to leave. These rules are pretty
straight forward.

Board certification is part of that evolution. We
started with board certification for surgery,
mirroring allopathic medicine. Not every
podiatrist’s individual experience and training
allowed them to pass this exam. Different state
laws didn’t help. As a result surgery board
certification was broken down to a foot and
foot/ankle versions to accommodate the differences
in state law and training. This was a partial
solution. Further adjustment was made many years
ago to create board certification in podiatric
medicine as an alternative pathway. Now the
politics have resulted in the podiatric medicine
board evolving into an alternative way to obtain
surgical credentials via CAQ.I am not here to argue
in favor or against this approach. I will say that
it does not follow the allopathic model for
hospital privileges that podiatry wants to be part
of. I think that it will fail as a result. If the
surgery board exam is too difficult, a
cleaner/simpler way is to look at the exam itself.
Is the pass/fail rate similar to allopathic
medicine certification exams or not? If too high
then adjust accordingly. I think trying to
circumvent the surgical privilege process just
makes podiatry look bad and serves no one. We have
come so far. It is not wise to go backwards.

Time will solve these issues - evolution. In
fighting will not. We are no different then our
allopathic colleagues. I share an office with a
young orthopedist who is in the middle of his board
certification process. One board, one process. I
asked him what he thought. He said it was difficult
but that was the way it should be. One board may be
our answer, but not one that is watered down.

Some may argue that evolution is not always good. I
think it has been for podiatry. The only negative
is that as we have strived to advance as a
profession we are leaving one of the distinguishing
features that make podiatry unique behind -
biomechanics. This is not a good idea. So to be a
good surgeon, you better understand how the foot
works. To be continued……

Lawrence Oloff, DPM, Burlingame, CA

---

03/06/2024    Michael A. Uro, DPM

A Short History of Podiatric Discontent and Frustration (Rod Tomczak, DPM, MD, EdD)

I just read Dr. Rod Tomczak’s response to “A Short
History of Podiatric Discontent and Frustration”.
I whole-heartedly agree with all he had to say. I
have enjoyed practicing podiatry for 45 years. I
was fortunate enough to have enjoyed the era
before managed care. A time when we were paid 2/3
more for surgery than we are today. The
reimbursements for surgery today are an insult to
the training, experience and risks that podiatric
surgeons take every time they walk into an
operating room.

When I came to Sacramento, I was welcomed by the
podiatric, MD and DO community. I am grateful to
those mentors such as Mitch Mosher, DPM, Larry
Gerelli, DPM, Randy Sarte, DPM, Oscar Mix, DPM.
There are many others, DPMs, MDs and DOs of all
specialties. Too many to list. We enjoyed dinners,
barbecue’s, wine tastings etc. in each other’s
homes. The camaraderie was incredible. We assisted
one another in surgery and helped run a
colleague’s office when he was out due to illness.
This was at no charge I might add. It’s what you
did. We had coffee and donuts in the doctor’s
lounge of the hospital where we communed with
doctors of all specialties.

It has been a good ride. Would I do it again, or
would I recommend podiatry to an aspiring college
student, sadly, I would not. Ever since I was a
podiatry student I have heard that we have the
same training as MDs and DOs. You all know that is
not true. How many of you have delivered babies,
actually managed an ICU patient, etc. We are not
MDs. We are podiatrists. If you want to be an MD,
then go to medical school.

This is not to say that our profession has not
progressed. Those podiatrists recently out of
residency or fellowship can run circles around us
old geezers! As it should be. I applaud them.
However, not all foot problems are surgical. On
the last day of my orthopedic clerkship at UC San
Francisco, the attending orthopedic surgeon was
celebrating his last day in practice. His parting
words were “If I can impart any words of wisdom to
you all today, it is that I have performed more
surgery over the years than I needed to.” Let that
sink in.

So, there is and always will be room for and need
of chiropodists, podiatrists and podiatric
surgeons. Don’t disrespect your predecessors
anymore than you would your parents or
grandparents. Be kind. Be generous and not pompous
with your new found skills and knowledge.

Michael A. Uro, DPM, Sacramento, CA