12/05/2024    Allen M. Jacobs, DPM

“I Have Built a Monument More Lasting than Bronze…” (Rod Tomczak, DPM, MD, EdD)

Hereclitus, the late 6th century BCE philosopher,
stated " you cannot step into the same river twice
". Bob Dylan famously sang " the times they-are-a
changing". Indeed, the flowing river of modern
society and medicine are rapidly changing. Dr.
Tomczak notes in his recent communication in PM
News that it is more likely than not that
yesterdays solutions and answers may not be serve
the podiatric profession, and the public that is
is intended to serve, well in the future. A change
in the board certification process should be
seriously considered.

Dr. Tomczak references the results of two PM
weekly polls. He states that the majority of the
profession favors a one-board solution to podiatry
board certification. He also notes (as did I with
apparent equal surprise) that a recent PM News
poll suggests that podiatrists view foot care
nurses as the greatest potential "threat" to
podiatry.

One cannot help but wonder if the results of such
polls might not be different if taken, for
example, of attendees at an ACFAS annual
scientific meeting. Furthermore, the polls cited
represent less than 10% of all podiatrists. Mark
Twain famously noted " Data is like garbage. You
better know what you are going to do with it
before you collect it ". Twain is further credited
as stating " There are three types of lies. There
are lies, damn lies, and statistics".

In my opinion, the initial question to be asked is
this: is podiatry a surgery first profession,
somewhat analagous to orthopedic surgery? As a
student and later faculty member at PCPM, we had
both a medicine and a surgery department. Anthony
Kidawa DPM was a passionate teacher who emphasized
the need to learn about vascular disorders. Harvey
LaMont may clear the need for a detailed
understanding of dermatologic disorders. James
Ganley, although an accomplished surgeon, inspired
us to understand biomechanics and what I will
refer to as "orthopedic medicine. Inspired
teachers such as Alan Whitney DPM taught us how to
evaluate and manage commonly encountered foot
pathologies. The major seminar of those years, the
Hershey seminar of the Pennsylvania Podiatric
Medical association, had dual tracts, medicine and
surgery.

Concurrently, at PCPM, we observed the growth of
podiatric surgery led by a young brilliant surgeon
named Guido Laporta. Podiatrists, previously
excluded from medical staffs at major hospitals,
began involvement at hospitals with increasing
surgical volumes. Dr. Tomczak states some may
remember the DSC days. I am old enough to be one
of those. I ecall the days of limited podiatric
surgical scope of practices. When we moved our
residency from Lindell Hospital to Deaconess
hospital here in St. Louis, I remember a vascular
surgeon laughing in my face. He stated that there
was no possible way a podiatrist would be awarded
surgical scope of practice at Deaconess, a major
hospital at that time.

Prior to determination of a one or two board
solution, we must first determine what our
profession is. Are we a surgical profession or a
medical profession. I have long maintained that
podiatry is more akin to dentistry, not medicine.
However, with that said look at cardiovascular
disease. Cardiologists do not perform cardiac
bypass surgeries. Electrophysiologists perform
limited procedures but do not perform heart
transplant surgery. There are subspecialties such
as CHF, pediatric cardiac surgery, and so forth.
The difference lies in the extensive addition
training (eg-fellowships) our medical colleagues
receive that podiatrists do not.

There is great diversity in podiatry residency
training. Here is St. Louis, there are many
residents who have absolutely no interest in
performance of "advanced" or major surgeries.
Nevertheless, they are compelled to participate in
such surgeries which are not performed with enough
regularity to ensure competency.

Dr. Tomsczak's opinions are, in my opinion, well
taken. There will will those potentially left
behind. Minimal competency is not equivalent to
incompetent. A legitimate, vigorous certification
is mandatory to ensure the public and the medical
profession that our profession provides safe and
effective care. However, before we establish a
one or two board certification process in the
future, we must first define what a podiatrist is.
One thing is certain: we are stepping into a
rapidly flowing river called medicine and medical
care delivery.

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

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