10/22/2024    Rod Tomczak, DPM, MD, EdD

Physician or Allied Healthcare Provider?

We are convinced that we are physicians.
Unfortunately, the rest of the world has not
universally been persuaded to classify us as such.
It’s not so much what the 40,000 or so of us call
ourselves, but what does the rest of the world
call us? Why is there a reluctance to move us from
the allied health care provider column into the
big boys’ physician column? I always look at
economics as a reason for most social problems
then move to self-esteem issues before considering
what may be the truth. One horrible truth is that
there is nothing we do that other physicians or
health care providers can’t do.

I was on the admissions committees at both Des
Moines University College of Podiatry and the Ohio
State University College of Medicine. Yes, there
are vast differences. That is not to say that
students at the podiatry colleges could not
prosper in MD or DO programs. Des Moines has a
parallel DO program for the first two years and
our DPM students match the DO students in
performance. We have yet to prove that the DPM,
MD, and DO students will score similarly on the
USMLE board exams, but I think they would do well
if given the opportunity.

The difference between the MD and DPM students who
want to become doctors is what they bring to the
interview. Historically, if you belonged to the
pre-med club and spent several Friday evenings
volunteering or observing in the Emergency
Department instead of spending those evenings
involved in dissipating activities with your
college friends who had undecided majors, you had
a chance of being admitted. Now, being a member of
the pre-med club is almost a negative. Spending a
summer building houses in Haiti is always
admirable and may reflect on a student’s
commitment to service, but hardly translates to
physicians’ activities except for the use of some
power tools.

I think one of the big differences is the research
history the MD and DO students bring to the
interview. And it is experience in impactful
research that will mean something when published.
Of course, the college student is not usually the
primary investigator in a funded project, but they
are somewhere in the group and understand the
significance of what is being done. The research
also has a potentially vast impact on the general
population. It is original bench/patient outcomes
research that may affect a large portion of the
population.

And the let someone else do the research attitude
sadly carries over to the post-graduate members of
our profession. The current issue of The Journal
of Foot and Ankle Surgery contains 22 original
research articles and seven of them are authored
by podiatrists, less than one third. Of those
seven, one addresses the attitude of ACFAS
fellowship trained podiatrists towards AI-assisted
on-line reviews.

So few DPM articles is not the Journal’s fault.
They can’t publish what’s not submitted. Levels of
Evidence for all 22 research articles were a three
or four except for a level two Swedish article
focusing on multiple amputations. If you’re not
sure about the Levels of Evidence in a research
article, my point is made.

It wasn’t that many years ago that DPM colleges
were free standing. Now, all the established
schools have university affiliations which opens
the door for immense opportunities to perform
research, real bench and outcomes research which
can change lives. How about someone answering the
question what causes bunions?

Is it genetics or that tired ‘bad shoes’ response
without defining ‘bad shoes.’ I like to tell folks
genetics may load the bunion gun, but ‘bad shoes’
pull the trigger for bunions. But then, folks who
have never worn shoes still develop bunions, and
kids acquire bunions also. We seasoned
podiatrists can get a diploma saying we graduated
from a university, but it would be like getting an
honorary sheriff’s badge. Flashing it is more
likely to get you in trouble than stop a crime.
New podiatry graduates actually attend a
university with all the benefits. I have never
been to the university that supposedly graduated
me.

If these university affiliations are for real,
there is tremendous potential to produce impactful
research that can answer important questions and
change lives. Research and publication take time
and real effort. It’s often uncompensated but is
one of the criteria for tenure, that elusive
butterfly for textbook surgeons. We finally have
something within our grasp that MD schools have
always had while we were relegated to watching
from the door or reading about in the newspaper.

Our young podiatrists can get in the laboratory
and have the potential to discover new knowledge,
not depend on pseudo-dogma handed down from the MD
community about things pertaining to our
profession. Wouldn’t it be great if there was no
doubt about who the preeminent foot and ankle care
experts are? One piece to achieving this goal is
to become the primary suppliers of new knowledge
when it comes to the foot and ankle and get it out
there for others to see.

Also, published new knowledge research just might
help podiatrists move from the allied healthcare
provider column to the physician column.

Rod Tomczak, DPM, MD, EdD, Columbus, OH

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10/23/2024    David Secord, DPM

Physician or Allied Healthcare Provider? (Rod Tomczak, DPM, MD, EdD)

Although it pains me to say so, I agree with Dr.
Tomczak on the issue of research. In 2013, I
practiced in Riyadh, Saudi Arabia, at the King
Abdulaziz Medical City, Central Region hospital.
At that time, the Chief of the Section, Dr.
Abdulaziz al Gannass, was doing Charcot
reconstructions (as indicated) as ankle fusions,
either with or without talectomy. Instead of using
an intermedullary rod, he repurposed the Synthes
VA-LCP Condylar Plate (normally used to fixate
femoral fractures) to connect the tibia to the
calcaneus. The butterfly shape of the condylar
plate worked amazingly well at the calcaneus and
after removing the distal fibula, laying the plate
at the lateral aspect of the tibia to the
calcaneus made for a robust structure, as it is a
locking screw and plate system with variable angle
abilities. The majority of the patients walked on
it post-op (although informed that they were to be
non-weight-bearing) and none of these patient
failed to fuse.

In the case of a talectomy, allograft bone stock
was used to preserve limb length and integration
of graft took in every case. I wanted to start up
a research study concerning the Synthes VA-LCP
Condylar Plate as an alternative to the
intermedullary rod for fusions. With my own
background in research, I was willing to do all of
the work with the hospital’s IRB to get things
going. I needed help putting the numbers and
demographics together and tried to enlist the
other members of the team.

Dr. Gannass was obviously on board, but not a
single, solitary other soul wanted to be on board.
Just as these DPMs did no research in their
residency, so they had no thirst for expanding the
knowledge base within the profession. Without
help, I simply couldn’t do it on my own and the
project died. It was work. It didn’t increase
their salary. They didn’t care. Until this mindset
changes among the people in our profession and
those looking to join it, we are going to be held
back.

David Secord, DPM, McAllen, TX