I have been looking at the periodicals published
by the schools which I view as grand advertising
campaigns. Of course, we highlight the
accomplishments of recent graduates costumed in
their not green any more greens. The central part
of the picture is usually the terms “foot and
ankle surgeon” and the text emphasizes how
grateful he or she is to the school even though we
know the residency program is really the tool
responsible for later accomplishments. As of late,
there are headlines bragging about the 100%
residency placement. That may impress some 70
something year-old podiatrists who reminisce how
difficult it was to get a residency. These
septuagenarians don’t know there are currently
more residencies than graduates.
It might be more reflective of a school’s success
in resident placement if the headline read, “93%
of Best Medical College of Podiatric Medicine are
Placed in their First Choice of Podiatric
Residency,” when there are only 24 graduates. This
good press is at least remotely intended to
bolster the reputation of the school, keeping it
open and saving faculty jobs. We can erroneously
attribute this to Darwin’s “Survival of the
Fittest,” something Darwin never said. I prefer to
call it moral fictionalism. It’s not a lie but
misleads.
Supposedly we are all scientists. We hold Darwin’s
On the Origin of Species to be self-evident proof
of evolution and the creationists are ignorant
because they have never read the book. I doubt
more than 10% of the readers of this letter have
ever picked it up and read more than the first 25
pages. It is not a Tom Clancy grabber but a very
difficult read. It is available on Cliff’s Notes
if anyone is interested. What Darwin did tell us,
that we often ignore, is that as man evolved as a
human, he also evolved socially and morally.
Spinoza, the greatest Jewish philosopher and de
Chardin, the Jesuit philosopher both got in
trouble with their religions for these views. You
might recall that as you grew in wisdom, age and
understanding you also learned how to manipulate
and as we aged we chose how misleading we really
wanted to be with people.
I see two definitions of podiatry we can be
intoxicated with. There’s the legal APMA’s
definition that not all of us really liked. It is
based on economics and state laws, the
preservation of a lifestyle and salary. Then there
is the definition each of us possess as socially
and morally evolved human beings. That is the
empathetic, feeling, sometimes gut-wrenching
definition that is more visceral than
intellectual. This later definition does not have
an essence and an accidental component but is made
up of those feelings that keep us awake at night
thinking about what we could have done better for
a patient. It’s possible to be intoxicated with
either definition, and at times, both
simultaneously.
So, what do these thoughts have in common? Moral
evolution should lead us to a place of social
altruism, a correct conscience, and beneficence.
We’ve all heard the statement that so and so is
“more evolved” than someone else. Not all
podiatrists feel the same way about our profession
as exhibited is the PM News survey which asked
what path you would choose when starting podiatry
school if there was more than the single option
that is now offered, a DPM degree and a three year
residency. Baby Boomers, if they worked hard
should feel a DPM degree served them well. Gen X
and Millennials had the doors to success and
satisfaction opened wide for them and their
potential was limited only by themselves. Late
Millennials and Gen Z podiatrists have a different
view of podiatry and have discovered that our
profession does not provide them with the tools
they thought they would receive, mostly based on
the degree and laws.
Very few of the respondents are completely happy
with a DPM degree but prefer an unlimited license.
As Boomers approach retirement, they know a change
in degree won’t affect or influence them at all.
Established podiatrists are just that …
established. The only “in an established practice”
DPMs who would be disturbed and shaken by the
change would be academics in the podiatry schools.
DPM’s in practice could easily sell their
practices to the new DO foot specialist.
To begin this part of the editorial let’s dispel
any rumor that academia is a cushy job and the
walls of these institutions are inhabited by lazy
individuals who could never make a living in
private practice. Today, podiatry professors
devote their lives to all aspects of a private
practice, then more. In most instances, part of
the salary is a function of how many RVUs one
generates. Then there is a second check for
lecturing and multiple committee appointments like
curriculum, animal care, human use, graduate
placement, promotion and tenure in the university.
These committees meet during lunchtime, so kiss
the one and one half hour lunch goodbye.
Publishing in a reputable, refereed journal is
rewarded with a bonus and funded grants influence
the academic salary. Professors are expected to
volunteer time for community service outside the
school. These are the pillars of academics in
podiatry and all are mandatory. It’s not like
private practice where you do what you want and
vacation when and for as long as you want. You are
not the boss, even if you are the dean. Deans
answer to a board. Tenure, or guaranteed
employment is going the way of the bowling alley
pinsetter. Instead, five-year contracts are
renewed every three years if the school wants to
keep you around. If you’re not renewed, you have
one year to improve your output or you are
literally put out of a job. Granted, many of us
went to school when many individuals were on the
gravy train, but not today. There aren’t many
lifers.
Private practice is no walk on the beach either.
It comes with its own set of problems, headaches,
and troubles. The majority of readers of PM News
are in private practice and most of the profession
is in the same niche. When I was a dean in Saudi
Arabia, most of the students wanted to be
administrators. As far as I could see, that meant
a lot of drinking coffee and shaking hands. Not
much patient care. Now that’s a gravy train.
Our motives and moral compass are entrenched
qualities and can predict what we will feel and
say. I think most potential podiatric students are
thinking about private practice as their calling.
When potential students come to the schools, do
the interviewers question prospective students
about how they feel concerning a three year
residency and a lifetime of surgery? We have
established that had the DO option route been
available many of us would have chosen that path.
So, most importantly, do faculty interviewers tell
prospective students there are more DO seats open
for premed students than applicants? Or does the
faculty interviewer stress the great student to
faculty ratio and a three year residency and
fellowship is the same as some DOs and MDs?
My guess is that during the podiatry college
interview process the topic of more DO seats is
never brought up by the faculty. Students may not
be cognizant of that fact and if they were, they
probably think mention of another discipline might
sink their interview experience. They are probably
just as unaware of the fact the podiatry schools
are hurting for students. The quality of the
matriculated students hasn’t changed much but the
quantity is in danger because of the budget.
Faculty employment numbers are based on
matriculation numbers. Faculty clinicians generate
much of their salary from patient care. A DPM
faculty member spends time facilitating problem-
based learning sessions like most best medical
school faculties and lecturing large groups.
Faculty is expected to do this and these teaching
encounters takes away from faculty time that could
be spent in a clinic generating RVUs. PhD
interviewers know that besides grants, their
incomes are a function of the size of the
enrollment and maybe endowments. Twenty-five
students in an entire class of 2029 or 2030
podiatrists will not produce salary monies.
Merging with medical (MD or DO) schools was
supposed to defray faculty overhead but how many
podiatry colleges are following the Des Moines
model where the DPM students sit in the same
classes at the same time next to a DO student and
take the same exams? That definitely saves money
the first two years, but how about after that. So,
are DPM faculty who are intent on keeping their
jobs and their schools open at all cost be allowed
to contribute to an error in Darwin’s evolutional
theory by not mentioning the possibility of
keeping the spirit of podiatry alive as a DO?
Podiatry will transition to what the younger
generations want. It’s inevitable. Schools can
prolong the pain of change or they can listen to
what the youth have to say and inform every
applicant there are options available. That would
be embracing the pain. Just don’t tell the
applicants the only real option is what we have
now. The young are not so inebriated with podiatry
they cannot pass the intellectual agility tests.
Darwin’s moral evolution should lead us to a place
of social altruism, a correct conscience, and
beneficence, not an institution that grants a
degree today’s podiatrists are not satisfied with?
The schools continue to ask for our financial
support but remain curiously silent with the
appearance their collective heads are in the sand
concerning an inevitable DO degree. I sometimes
think the schools feel we have our heads in the
sand but, being still intoxicated, have our
pocketbooks wide open. CPME is the authoritarian
dictator and the secret police of accreditation.
The schools will not allow ABMSP to address the
students because ABMSP is not council approved.
Soon CPME will be burning books. APMA projects a
quiet, benevolent, political visage but behind the
scenes allows no deviation from the status quo,
nor tells anyone how products gain a seal of
approval.
ACFAS assumes the intellectual leadership of the
profession by publishing a journal made up of
international authors and ABFAS works hand in hand
with the triumvirate feigning the scimitar of
surgical credibility. If the four are not on board
with change, podiatry will become nothing more
than footnotes in Wikipedia. The DPM degree served
all of us well, me included, but the courageous
path is to admit the inevitable and phase out the
DPM degree. The DPM pillars should proudly team
with the DO community and ACGME, keeping the
beneficence of podiatry alive, long into the
future.
Rod Tomczak, DPM, MD, EdD, Columbus, OH
