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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:
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
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
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
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