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

Other messages in this thread:

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05/14/2025    Amol Saxena, DPM, MPH

RE: Do We Really Have a Medical Degree? (Jon Hultman, DPM, MBA)

Dr. Hultman writes that MD programs are shortening
school for particularly for primary care. My MPH
thesis was on this very topic and it was discussed
in Congress. About 1/3 of US MD & DO programs are
"accelerated". There are even three accelerated
programs for orthopedics including Duke & Penn
State. I even wrote an article on this for
KevinMD: https://kevinmd.com/2023/07/is-it-time-
to-shorten-medical-education-in-the-u-s.html

Dr. Hultman also writes that we just need to be
able to take the USMLE or COMLEX. However, two
years ago at the AMA convention they stated the
"case is closed" for DPMs to take the USMLE. This
could be due to other political factors such as
opening the door to other much larger medical
professions that receive a doctorate who may also
want access to the USMLE. The door is closed for
DPMs to take the USMLE.

Keep in mind the podiatry profession is in reality
too small to have any political clout. In Paul
Starr's 500+ page book, "The Social Transformation
of American Medicine", podiatry was not mentioned
once. Many other non-physician professions were
mentioned, which is another stake in the ground
the AMA has planted: limiting physician and
surgeon status to MDs and DOs.

My interview on KevinMD discusses this, and I have
given lectures at several meetings on Podiatry,
Bias and possible solutions. Many listeners have
asked me to present at the APMA. In that lecture,
I cite an article in JBJS that orthopedic leaders
see the need to shorten their training as 90% of
orthopedists in the US specialize. Sound familiar?
https://kevinmd.com/2023/08/bias-and-inequity-in-
health-care-podcast.html

It is beyond time for podiatry leadership to bring
all the stakeholders (yes, orthopedics too) to the
table and come up with sustainable solutions. Time
for a carefully thought-out pivot. Merge with DO
schools, take on the oral surgery model, award an
MD? I have been willing to help.

I am reminded of President Teddy Roosevelt's
quote: "The first thing to do is the right thing.
The next is the wrong thing. The worst is to do
nothing."

Amol Saxena, DPM, MPH, Palo Alto, CA

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05/13/2025    Paul Kesselman, DPM

Do We Really Have a Medical Degree? (Rod Tomczak, DPM, MD, EdD)

There is no doubt that with the current class
sizes we will cause our own extinction and we must
do something about that. The question is will a DO
degree accomplish that goal? Will students going
to DO school choose podiatry as a specialty, and
or are we to continue as a profession. In the mid
‘70s , there were five schools turning out a total
of about 750 new graduates a year. Now we have
more than double that number and we graduating
nowhere near 750.

In the mid ‘70s and very early ‘80s, there were an
insufficient number of residency programs. Now we
can fill them all and some are not filled. So, we
have gone places in the past fifty years or so
since I first thought of attending podiatry school
that I never thought possible. As for the
negatives, we have no one but ourselves to blame
by continuing to bash this great profession. MD
and DO have it no better dealing with insurance
companies, decreasing RVU, heightened expectations
of the public, managed care and hospitals or
investor companies who see us as nothing but Lucy
in the chocolate factory.

Every MD DO I run into these days who is still
clinical has the same gripes as our DPM colleagues
and asks how I'm enjoying retirement. My answer is
always the same, happy to be in that space but
with it comes going to too many darn colleagues.
The problem as Dr. Tomzcak noted, is that those
who should be speaking about it are too busy to do
so. Those of us who are clinically retired or all
together retired don't necessarily have the
expertise or political connections to get this
done.

There is an expected shortfall of PCP and other
specialties in the next twenty to thirty years as
most of the baby boomer generation retires from
practice. This was not accounted for in the early
80's when an AMA study came out predicting a
physician surplus, hence a kabash on more hospital
residency slots and medical undergrad classes.
Alas not much other than some more DO schools
opening has happened to change that.

I don't profess to have any of the answers but to
suggest that all of medicine is at a critical
juncture. And we all need to put our heads
together so we can persevere! We can no longer
allow those bean counters on Wall Street or in the
Insurance industry to dictate how healthcare is
provided. We know who the wolves are guarding the
hen house and this has been tolerated far too
long. On the other hand, we need responsible
healthcare policies which cannot be abused and to
some degree rationed because we simply can't
afford to spend as we have.

Most importantly, we must stop bashing our
profession and our colleagues in these public
forums. After reading all the negative press here,
it's no wonder we are in this predicament.
Certainly alternative discussion approaches are
part of a healthy dialog, but the dismissive
holier than thou attitude needs to stop and needs
to be replaced by practical solutions. Many of us
are willing to do the hard work, but we need those
with wider vision to step up to the plate and roll
up their sleeves and get to work!

Paul Kesselman, DPM, Oceanside, NY

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05/12/2025    James DiResta, DPM, MPH

Do We Really Have a Medical Degree? (Evan Meltzer, DPM)

In response to Dr. Meltzer's question Why are
there new podiatry schools being created if we are
on our "last legs"? I believe the answer is
twofold, as the old adage goes "follow the money"
and secondly, knowingly or not, the powers to be
see it as a chance of survival.

The podiatry profession that has existed for the
past 50 years cannot continue. It just can't. It
is being swallowed up from the top down and bottom
up. It couldn't be more obvious but we continue to
do very little hoping a Band-Aid here or a Band-
Aid there will plug the leaks and eventually these
forces will just go away. They won't. The
profession made a calculated mistake that those of
us who fought the system got caught up in. We
fought for increased scope of practice based
solely on anatomy of the lower extremity i.e.
ankle surgical privileges and we ignored treatment
of systemic illness except for the local
manifestation of those disorders.

We also wanted to be able to treat within our
limited scope independently and admit our patients
ourselves and be able to do our own admission H&Ps
which became doable because CMS at that time was
awarding this privilege to PAs and NPs. We wanted
medical staff membership and the ability to serve
as officers and on committees. We achieved a lot.
What we didn't foresee is the increase in the
number of medical schools, especially the for-
profit model that the DOs have perfected, and the
number of physician extenders and allied health
professionals and their increased scope privileges
and authority to treat and duplicate much of what
we do.

So, the question remains, Is there a path forward
for the podiatry profession? Dr Tomczak has been
asking us this for some time now. I personally
don't think you need to be a rocket scientist to
figure this one out. It's time (let me rephrase
that) it's well beyond the time we changed focus
and tried to "make a deal". Use all the resources
and capital we have both financial and political
to get the DO profession to embrace us in a plan
to make us whole. We can develop a model that
would change our undergraduate medical education
that would include the entire DO educational
curriculum except for OMT (not just years one and
two, but all four years) along with the necessary
streamlined podiatry components and that might
need a change in summer study between years OR
perhaps adding "a fifth-year pathway". Be awarded
both DPM and DO degrees.

YES, a five-year program that would then guarantee
the graduate a three-year podiatry residency
consisting of a one-year rotating internship and
two subsequent years of foot and ankle surgery.
There are some issues here for sure as our
students will have completed the COMLEX-USA tests
and could choose to enter another residency but
that's a chance we ought to embrace. They would be
able to apply to only one program i.e. the DO
program or the DO/DPM program and not be allowed
to transfer between programs. Frankly this is just
one idea of many but all plans MUST lead to a
plenary medical degree.

We can't exist as an island in today's medical
environment with our limited DPM degree and think
we can survive. Many successful podiatrists today
have their niche and they will be fine for the
foreseeable future but this is not true for the
profession as a whole without a strong
academically and technically strong podiatry
student cohort to follow us. Leaving things like
they are to chance for much longer and we are
toast.

James DiResta, DPM, MPH, Newburyport, MA