04/28/2025    Rod Tomczak, DPM, MD, EdD

Diogenes the Cynic

Diogenes is partially famous because he spent time
carrying a lantern looking for an honest man. He
is also called Diogenes the Cynic. A good 30 years
ago I shared some uninhibited conversation and a
cup of coffee with Leonard Levy, DPM, the Dean of
the Des Moines college. I was a couple classes
into pursuing my education doctorate and we talked
about the significance of a doctorate in education
as a podiatrist in academia. In a moment of
astonishing frankness Leonard said to me, “I could
do so much better for myself if I only had an MPH
from Columbia and not a DPM accompanying it.”

I had experienced a taste of the three-tiered
medical caste system where MDs were on top, DOs
made up the second class then there were the rest
of us who made up the third layer. It was
impossible to “tier up” with a DPM degree. The
graduation stole, as part of our academic attire,
is the same color as the one worn by those in the
top two tiers. That is not to say I wasn’t happy
as a DPM, in fact I was quite satisfied but
realized there were certain class distinctions.

I was able to spend time in externships at some
great MD schools and with leaders in medical
education where I learned. But it became clear
there would be no Magna Carta abolishing the
medical feudal system. Podiatrists would no longer
be subject to corporal punishment but it would
still take time and the courts to allow us a vote
concerning hospital politics. We might become the
head of the library committee, especially when no
one else wanted the job, but that didn’t mean we
could always have block time in the OR. However,
things changed and evolved as we approached parity
except for equal remuneration by insurances across
the board.

My podiatric elders told me how they had used the
“back door” approach to getting a parking sticker
for the doctors lot, and how they volunteered to
scrub and assist the general surgeons and impress
them with their knowledge of instrument names and
OR protocol in hopes privileges to do something in
the OR might evolve. Others talked about visiting
with family doctors who staffed the ERs because
there was no specialty called emergency medicine
and tried to convince them podiatrists were
capable of adeptly handling that occasional
emergency ingrown toenail and they would be happy
to come to the emergency room to relieve the
excruciating pain and suffering associated with
that nail. Little by little they hoped to either
break down the barriers or surmount them.

And it worked. Little by little we could keep a
hospital white coat in the coatroom with the MD
doctors, sometimes we were able to snatch a locker
when a very old physician retired and put our name
on white adhesive tape and stick it on the locker
door. But there was that moment of indecisiveness
when we contemplated whether to just use our last
name or add DPM behind our name. We really
wondered if a new MD might see the DPM and
suddenly develop the locker envy that we endured
for what seemed like ages. What if they made a big
stink and I was asked to give up my locker and be
socially embarrassed. It was indeed a quandary. Or
worse, did I deserve free meals in the cafeteria
like active staff “enjoyed?” How could I tactfully
go about researching these question without making
it seem like the answers really mattered? As the
new staff member I agreed to coach the female
employees’ softball team as if I could say no.

But it did bother me when I got bumped in the OR
because some general surgeon supposedly had an
“about to burst” infected appendix he’d been
sitting on for three days while he played in a
golf tournament. It screwed up my office schedule
but the hot appendix might result in peritonitis
if it ruptured, so I swallowed stomach acid while
he operated.

But things began to change when the wife of the
Chief of Staff could suddenly wear high heels
again after another somebody didn’t fix her hallux
rigidus just right, or somebody could play golf
again after a neuroma was removed from an inner
space not described by Morton, or somebody’s
mother with DM had a partial ray resection rather
than a BKA. We understood when the guest speaker
at a staff meeting talked about that new condition
called Reye syndrome. We even delivered a lecture
to the staff concerning what we did as a
profession or on particular malady like heel spur
syndrome. That was walking in through the front
door rather than sneaking in the back door where
the laundry delivered and hazardous material
picked up. And we felt satisfied and pretty good
about the changes we made to the system that
existed before we got there and the steps toward
equality we had accomplished.

But there’s a new generation of podiatrists who
have arrived and they are making my generation
question the landscape. Do we really have parity?
The three-year residents don’t think so. And do we
sense there is really something missing. Should we
disappoint this next generation of podiatrists? We
don’t need to find a single honest man named
Diogenes to tell us what’s missing. We
accomplished as much change as we could, now it’s
time to listen to the generation still relatively
new to practice. We are no longer the fastest
scalpels at the OK corral. We have toyed around
with the answer to what’s missing to allow us to
move up a tier.

There will be a lot of pain involved with
actualizing all the potential podiatry has to
offer. Podiatry’s potential is not just wound care
or sports medicine or biomechanics but potentially
adding podiatrists to the list of physicians with
the license they have always yearned for and is
almost in reach. The last hurdle to accomplishing
this will be based on whether podiatry is made up
of honest men and women.

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

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