05/07/2025 Rod Tomczak, DPM, MD, EdD
Do We Really Have a Medical Degree?
Podiatrists, as of late, commonly deliver
unreferenced advice in local newspapers on topics
like the potential catastrophic health effects of
community bowling shoes. Dentists are guilty of
the same veiled advertisements about same day
versus delayed dental implants. For the
podiatrist, at least, there is usually a sentence
or two devoted to the podiatrist’s education. It
asserts that Dr. Jones received his or her medical
degree from Kent State University or Temple
University, but seldom Ohio College of Podiatric
Medicine or Pennsylvania College of Podiatric
Medicine. A fellowship might also be mentioned at
a medical school with a reputation as being
difficult to get into. Often these schools also
have a reputation as a top flite destination, a
combination large stadium and a larger NIL
pocketbook.
Should we use the phrase, “…received her medical
degree from Kent State” in the media? Clearly you
and I know the truth. But to take the issue one
step further, is a DPM degree a medical degree?
Dentists can receive a DMD degree. Doctor of
Medical Dentistry. I’ve never heard a dentist say
they received their medical degree from Case
Western Reserve University. For that matter, I’ve
never heard any dentist say they received a
medical degree. But they become board certified.
They historically certified through the American
Dental Association. They state that board
certification for DDSs, DMDs, MDs and DOs and
others (I assume DPMs are included in the
“others”) demonstrate through written, oral,
practical and/or simulator based testing a mastery
of the basic knowledge and skills that define an
area of dental/medical specialization.
The American Board of Dental Specialties was
approved in 2013 by a group of dental academies
because of “perceived or actual biases” concerning
dental anesthesia. The Maxillofacial/Oral (MFO)
surgeons wanted anesthesia delivered by certain
individuals but not limit the delivery so the MFO
surgeons voted down the creation of a new board
making dental anesthesiologists a separate
certification board. Every dentist should be
allowed to deliver anesthesia according to the
state dental board and the state law. At no time
did the question of expertise or proficiency have
an influence on the boards or the other academies
decision to form another board. It was obviously
political in nature. But the salient point is the
dentistry now has another board that grants
certification.
The takeaway, the take home and the lesson to be
learned is that dentistry solved the problem, and
did not contribute to it. For some people that is
a radical concept and a departure from the
historic position of the APMA. It’s time the APMA,
ACFAS, ABFAS, and any of the podiatry boards quit
preaching they can somehow ensure quality of care
by the process of certification or continued
rolling testing. There are rumors that current
residents take the periodic computer exams
administered by ABFAS. In the final analysis it
doesn’t matter what ABFAS has to say about
qualifications based on a test score. The state
medical/podiatry boards determine what a
podiatrist can do or not do. Certification may
have an effect on insurance payments. We all know
there is always a facility where the good old boys
can operate. OCPM graduates between ’75 and ’80
remember a certain faculty member who administered
epidural blocks in his home operatory. He
performed procedures well beyond his expertise
with catastrophic results. It didn’t matter
whether he was certified or not, he had no
privileges and he found a way to “prima nocere.”
First, do harm.
Why not give the members of the American Board of
Medical Specialties in Podiatry a seat at the
table? I’ve been an oral examiner for ABFAS and
wonder how some people made it to the
Saturday/Sunday sessions. I’ve reviewed case
submissions and seen how our confreres have tried
to cheat with fallacious X-rays and op-reports.
I’ve expressed my disdain at the wound care fiasco
and its providers to a close mentor who replied
simply,” I believe more than you understand.” I
used to believe ABFAS was the ethics police and
ACFAS was the man Diogenes sought. We supposedly
self-police our organizations from the
questionable top secret APMA Seal of Approval
process, continuing education courses, and gifts,
stipends, trips and tricks for those who have
pushed the envelope past the laws for biologic
dressings.
With such a pristine history, you’d think that
before we become the roller derby of medicine we
call off the blockers for those who slipped
through the cracks of the board certification
process. Knowing all that I know, which at times
is not that much, I sit here and have come to the
conclusion that allowing a window to certification
for those who have had that window closed does not
diminish my or your certification.
There are some things we might never learn as
resident or have the opportunity to teach as
residency directors. I was operating at the Iowa
College of Podiatric Medicine when the phone rang
in the operating room. The call came from a former
student who was operating in a small hospital over
a thousand miles away. He’d broken off a screw
while trying to extract it and was lost. Not only
did he not know how to use the extractor, he had
never heard of a broken screw extractor set. If
that had been a case on the board certification
orals, complete ignorance of a screw extractor set
should be a point to fail.
It's really important to know how to use one. It’s
a Res Ipsa Loquitor on the x-ray in court. Some
people don’t know what one is and are still
certified. Certification doesn’t guarantee
anything except a sigh of relief when you find out
you passed. Maybe some folks didn’t get the
numbers required to certify, maybe the window was
too tight, maybe they were ill. Maybe they aren’t
good test takers. Open the windows for those
podiatrists.
Podiatry, as we know it, will probably be around
for a short time more. Politically, podiatry has
always been a crossfire hurricane, and it doesn’t
seem like that will change as the demise
approaches. Podiatry does not want to recognize
those not certified. Once potential podiatry
students see they can matriculate at DO schools,
our podiatry days are numbered. Podiatry
organizations will fade away because there will be
no new members. Who will be the last DPM survivor
and what does he or she merit besides a 30 second
spot on network news? What if there are two final
podiatrists, one board certified, the other not?
Wouldn’t that be sardonic?
Rod Tomczak, DPM, MD, EdD, Columbus, OH
