12/09/2024    Rod Tomczak, DPM, MD, EdD

“I Have Built a Monument More Lasting than Bronze…” ( Allen M. Jacobs, DPM)

I was extremely edified reading Dr. Jacobs’
response to my editorial titled, “I have Built a
Monument more Lasting than Bronze.” I wish more of
the silent majority would join Dr. Jacobs and
myself. It is very edifying to see that we are on
the same page when the question of board
certification is posited. While reading Dr.
Jacobs’ response I could not help thinking about
the play by Samuel Beckett, “Waiting for Godot.”
It was voted the most significant English language
play of the 20th century. It is the perfect
example of existential absurdist theater defying
interpretation but like all good literature
personal interpretation is encouraged, and as it
applies to the number of certifying boards in
podiatry, it is textbook. It is a unspoiled
version of tragic comedy, and an existential
metaphor for the present certification problem.
Should ABFAS refuse to compromise, it is like a
kid taking his football and going home. If ABPM
digs in it heels, and doesn’t compromise, we will
be at the conclusion of “Waiting for Godot.”

Two individuals named Estragon (Gogo) and Vladimir
(Didi) are found on a barren set, except for a
single leafless tree in Act I. They banter angrily
and discuss life and nothing in particular while
they wait for Godot who never arrives. A young boy
appears on set informing the two actors that Godot
will not be coming today, but surely tomorrow.
Gogo and Didi have known each other for fifty
years but still seem to have a love hate
relationship. They agree they will come back
tomorrow to wait for Godot’s arrival.

The next day, Act II finds the two actors on the
same set except for a few leaves on the tree.
Nothing else has changed. Once again after
conversing and bickering a young boy appears on
set and informs Gogo and Didi that Godot will not
be coming today either, but surely tomorrow. The
two men are angered and agree they should hang
themselves from the single tree using Gogo’s belt.
Gogo removes the belt from his pants. Gogo’s pants
fall as the two actors remain motionless. The
lights go down and the curtain closes as the play
ends.

The play is reminiscent of Camus’ “Myth of
Sisyphus.” Both are tragic comedies where one is
forced to laugh at the absurdity of the human
condition and the futility of what we are trying
to accomplish. In Camus’ essay, Sisyphus spends
all eternity rolling a large rock up a hill only
to see it roll back down as he nears the pinnacle.
The absurdity of the two literary works runs
parallel to what we are facing right now with the
two board versus the single board question. The
question has been on the back burner, but it will
soon be brought to the front and the heat turned
up. Of course, both parties think they are
correct. To have two correct answers to this
dilemma is not possible.

At the end of the play, the suicide fails, pants
are down and although the actors agree to leave
the set, they remain motionless. Does this remind
you of anything relevant to the current podiatry
condition? Peter Woodthorpe who played Gogo asked
Beckett one day while riding in a taxi what the
play was about and Beckett replied, “It’s all
symbiosis, Peter; it’s symbiosis.” Does art
imitate life here or does life imitate art? We
have two boards stuck in their own convictions and
at the end of the day are motionless, not budging.
Sisyphus is frustrated because it’s the same task
day after day while Gogo and Didi never get to
meet the solution they are waiting for; Godot.

Let’s say there are 15,000 podiatrists in the
United States. There could be that many characters
in “Waiting for Godot.” There may be 15,000
practitioners named Sisyphus rolling that rock up
the mountain in their office and everyone has the
answer as to when Godot will show up or how to
finally crest the mountain top. Why can’t we work
together as a profession to solve the
certification problem? Is everyone an independent
contractor or do we fall into just two stubborn
verklempt camps?

We keep comparing ourselves to orthopedic
surgeons. As Dr. Jacobs writes, we are more like
dentists in what we do and how we do it. This is
not to disparage our education and training; I
continue to preach we could pass USMLE at the rate
MDs and DOs pass. Our curriculum is targeted
toward podiatry and the practice of podiatry.
Isn’t that ludicrous? No, it’s the way it is for
now. But, if we were to sit for USMLE, we would
teach to USMLE, take USMLE, then rely on our three
year residency and fellowships to teach podiatry.
Novel thought. Podiatry schools would be called
medical schools, we could change the degree and
students would still have to match into podiatry
residencies otherwise, there would be no need for
podiatry schools. After all, didn’t we all learn
more podiatry in our residencies than in podiatry
school? Be honest. But those thoughts are for
tomorrow when Godot will surely be coming.

In the meantime, that’s not the way it is, and a
degree change is going to be a bit more
complicated. So, we need to make the most of what
we have and how we become certified. We must work
together, symbiotically to counter the absurdity.
Everyone’s opinion is worth as much as the next
podiatrist’s. But we don’t hear about the
communities’ solutions. My solution to the degree
granted won’t change the board certification
process. We still have all those subspecialties
under the DPM degree. That’s what we must work
with today and tomorrow when Godot will surely
come. I’m pretty sure if we don’t work together,
Godot will never show up.

Then there will be another tomorrow with no answer
from Godot and then another tomorrow until we make
what Sartre called the ultimate free choice. We
will throw a belt over the tree branch with our
pants down around the ankles we have fought so
fervently for attempting to hang ourselves. What
irony. In one version of the play Gogo and Didi
use a rope that continues to break. Their
solution? They search for a sturdier rope and will
come back tomorrow to hang themselves. Insanity.

In the late 1970s and early 1980s we told people
we were reconstructive foot surgeons. Our job was
to be instrumental in changing the profession from
medical DSCs to surgical DPMs. Maybe we were wrong
trying to roll the rock up the hill for everyone
with a DPM degree.

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

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