05/20/2025    Rod Tomczak, DPM, MD, EdD

Podiatry and Cardiac Escape Beats

It should be no secret, but most podiatrists won’t
admit podiatry is dying. We are podiatry and many
of us see the white light. The guys out here in
the field are podiatry. If somehow all the
podiatry alphabet organizations existed with no
podiatrists seeing patients every day, there would
be no such thing as podiatry. For some reason
though, the alphabet people are trying to keep us
from seeing that ECG that reveals prominent escape
beats that often herald cardiac arrest.

APMA is at the top of the podiatry flow chart and
it doesn’t want us to see the profession is
deteriorating around us. The why they don’t want
us to see is because the alphabet organizations
think they have some miracle medication that will
fix the inevitable cardiac arrest. We wish
podiatry wasn’t crashing, but it is.

There are two important indicators that have
surfaced of late. One was the PM News survey that
revealed only 13% of the 690 respondents were
happy with their DPM degree and a three-year
residency; essentially the status quo. Eighty-six
percent of those replying would prefer a DO
degree. A DO degree for us worker bees is unlikely
for those who replied since a DO degree would mean
we would have to drop everything, go back to
school and incur additional debt.

It does apply to those individuals in college and
younger. For them a DO degree is very possible.
There will soon be 37 DO schools with seats to
fill and those seats will be very appealing to
potential podiatry students. Recently, Kevin
Smith, DPM, PhD the dean of the Des Moines College
of Podiatric Medicine wrote in his doctoral
dissertation from the University of Nebraska at
Lincoln, that today’s DPM students are clearly
capable of completing all the work necessary for a
DO degree including passing the national board
exams required to license as a DO. He did not show
a head to head comparison, but his metrics when
compared with the research of others show DPM
students have the tools required to complete a DO
degree and earn a plenary medical license. They
have seats in their colleges that will go to
qualified students.

Let me be clear. Students do not want a partial
license and a three year residency which DPM
schools are the pathway to; new DO schools have
more seats that will go to capable students;
potential DPM students can fill those seats and
not be frustrated. But in the course of that
action they will be leaving DPM seats unfilled.
Earlier this year I shared that as of March, there
were 318 total applicants to the 11 podiatry
schools. That does not mean that 318 students had
been interviewed, accepted, made a deposit to
reserve a DPM seat or indicated they would be
attending podiatry school.

Most of us who have been around long enough to
develop mycotic toenails know that about half the
number of the March total applicants would be
present our first day of podiatry school. AACPM
was very forth coming in March but as I wrote
succeeding editorials for PM News highlighting
more DO seats, AACPM has become less accessible
concerning application numbers, or by this time
acceptance numbers. I have been trying to get an
update on what should be information available to
at least, every podiatrist.

As of this week, AACPM will not answer or even
acknowledge my calls. Put in simpler terms, all
calls to AACPM from my cell phone go to voice mail
telling me no one is available and to call back.
No one answers the calls during normal business
hours. I assume AACPM is able to recognize my cell
phone number and I get shuffled to a recorded
message that no one is available. On my first call
to AACPM earlier in the week the live operator
told me the person who compiled and shared the
March application information would return my
calls but she was not in the office and that she
had to go home because of a family emergency.

Now, I don’t even get to talk to a real person at
AACPM. I speculate the applicant numbers are not
sufficient to support 11 podiatry school faculty
salaries and other overhead and AACPM fears I
would disclose this on the PM News forum. We’re
going to find out the truth sooner or later.
Based on prior information, i.e. the PM News
survey and the increasing numbers of newly
accredited DO colleges and unnecessary DPM
schools, it appears undergraduate pre med students
who would have matriculated at one of the podiatry
colleges are no longer interested in becoming
podiatrists.

I won’t speculate as to these students’ graduate
school destination or ponder whether they are even
going into a healthcare field. It does appear
osteopathy is waxing and podiatry in waning to the
point that the podiatry ECG is replete with those
escape beats.

A Code Blue is imminent and maybe a relatively
normal sinus rhythm will be restored as it always
has been. As I said earlier, we are podiatry, and
we are resilient. But why does this scenario keep
repeating? We are constantly left in the dark by
the podiatry alphabet organizations from the APMA
down. No one is to blame, but we are still left in
the dark. The APMA believes in the mushroom theory
of leadership for all us constituents who make up
podiatry. We are kept in the dark and nourished
with what I’ll call organic fertilizer.

Is there a reason I can’t be told how many
applicants there are to podiatry schools? Who
ultimately made that decision? Doesn’t it look bad
to the readers of this post that AACPM won’t tell
me information that should be public but keeps it
a close guarded national secret or simply won’t
divulges information that will be public in a
couple months? Are the top heavy alphabet
organizations afraid of criticism, especially
knowing it is our dollars that support them? It’s
like telling the cop who stops you for a DUI that
it’s your tax dollars that pay his salary.

Maybe AACPM thinks it will discover a Deus ex
Machina between now and the start of Fall classes
in 2025 and we will have 1100 total podiatry
students starting this August. That way we won’t
be able to criticize AACPM or CPME, or APMA. Well,
it's not going to happen, so please be open,
honest and transparent. Your leaders were members
of the Woodstock generation; suddenly you are
members of the Watergate generation. That is not a
compliment. We see through you and we are calling
you out. Be authentic and drop the back door
mentality of just sneaking by.

It doesn’t do any good for those of us who are
happy with the last 50 years of podiatry to write
letters and remind the younger malcontent
podiatrists that they should be happy with what
they have. That sage advice sounds like it came
from my Mother who grew up during the depression.
The truth is, nothing is going to change for
anyone with a DPM degree today. Those of us with
that DPM degree for 50 years ought to be striving
to keep the spirit of podiatry alive while
offering the next generations a path to a DO
degree, and perceived podiatric happiness in a
future I will never see.

But, we have to respect their choices. Remember
how attendings and residency directors treated us
like crap with no apparent reason? When we became
residency directors we thought it was our turn to
get even, but everything changed and residents
became equals with feelings. That’s what’s
happening now.

We must lay the groundwork and strive to create a
DO podiatrist with a plenary license; we must
strive to preserve the essence and spirit of
podiatry that we worked so damn hard to achieve.
This DO podiatrist will have to carry on what all
of us have built; being the very best individuals
when it comes to foot and ankle care, especially
with diabetics. There are going to be more
osteopaths. The question is whether some of them
will be osteopathic podiatrists or whatever name
is christened.

Here’s where the blowback and resistance will
come. The podiatry “us” is going to go away. At
some point DOs will outnumber the DPMs and that
calculus will continue until the last DPM turns
off the nail dust evacuator. You and I will never
see it happen, but there will be no APMA, no CPME,
no AACPM which will be the first podiatry alphabet
to perish and the ABFAS will cease doing business
as we know it. There will not be enough
podiatrists to support these groups. Oddly, these
things are not necessary for podiatry to exist.
Think about it. Accreditation will be by the
osteopathic organizations, ANSI and ANAB with
ACGME will accredit a hybrid DO residency that
furnishes the DOs with their full license and two
years of foot and ankle training.

In the beginning, DPMs will have to be involved in
the training of these DO foot specialists. The
survey tells us this is what the young want, not
what the old politicians think they want because
they know what’s best for the kids. Is it worth
it? It doesn’t matter what you and I think. The
future belongs to the next generations and they
may or may not choose feet, but they will choose
an unlimited medical license, regardless of what
you or I think. Our job is to see that we keep the
spirit and essence of podiatry alive, albeit with
different initials after their name.

APMA’s last act may be to award an all expense
trip to Sandals (with orthotics) to whomever comes
up with a new name for this new DO specialty. I
chose Sandals as a destination because they are
more open than AACPM.

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

Other messages in this thread:

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05/22/2025    Allen M. Jacobs, DPM

Podiatry and Cardiac Escape Beats (Rod Tomczak, DPM, MD, EdD)

Some years ago, I was serving on the credentials
committee at a large hospital in St. Louis when a
DO orthopedic surgeon applied for staff. The
discussion, led by the MD chairperson, was that
"we" (i.e.-medicine) did not recognize his DO
residency nor his DO board certification. He was
denied staff access. Prior to that, while in high
school, college, and podiatry school, I worked as
a surgical retractor holder and then as a scrub
nurse in several major Philadelphia hospitals.
Never did I see a DO in these hospitals, nor any
positive references to the DO degree.

Today, 11% of medical school graduates hold a DO
degree, and schools of osteopathic medicine are
rapidly multiplying. With no reference points
other than common sense, I suspect the majority,
not all, but the majority of students entering
osteopathic medicine colleges do so as a second
choice to obtaining an MD degree. Similarly, I
suspect those attending Gulf of America medical
colleges on some island do so as a second choice,
not a first choice.

Tom Brady, whom some consider the greatest
quarterback in NFL history, was not a first,
second, third or even fourth round draft
selection. Brock Purdy, the last draft choice in
the 2022 draft, euphemistically referred to as Mr.
Irrelevant, just signed a contract for over 200
million dollars to quarterback the San Francisco
49ers. 181 million guaranteed.

Podiatry and podiatrists have similar historical
characteristics to the osteopathic profession and
the fact that unselected does not mean incapable
or incompetent. It means there are only so many
available seats it medical colleges. Conversely,
hold an MD degree does not guarantee ethical or
competent care.

Is St. Louis a microcosm of podiatry? I do not
know. However, this is what I see. We have 15
residents in our local program, and there are days
when there are so many surgical cases that the
residents cannot cover them all. And not all local
DPMs work with the residents. The hospitals in St.
Louis are hiring DPMs to provide foot and ankle
care. If so inclined to do so, there are numerous
DPMs here doing TAR's, ankle fractures, major
reconstructive surgeries, arthroscopic ankle
surgeries on a routine basis.

There are many DPMs who are so busy that
appointments are not available to 2-3 months.
There are DPMs making a very solid income and are
respected by the medical community providing
routine office-based care for commonly encountered
foot problems. There are DPMs who are fully
integrated into orthopedic groups, practicing with
orthopedic surgeons, medical groups, and the VA.
There are podiatrists at the medical colleges.

I recently referred a patient to interventional
cardiology whom I believed had a serious PAD
requiring urgent care. The patient was also very
anemic and was scheduled for GI scopes to evaluate
the anemia. The cardiologist called me to ask MY
opinion whether or not the intervention for PAD
should take priority over the anemia work-up,
since the hemoglobin was 7.6. The priority for
care was left to me. My point? Respect for the DPM
as an equal member of the healthcare team.

The fact that many DPMs would rather have a DO or
MD degree is not a condemnation on the DPM degree.
How many osteopaths would rather have an MD degree
? Why not do a survey, would you rather drive a
Porsche rather than a Ford. Would you rather have
a $10,000,000 home than a $700,000 home.

Not everyone wants to treat feet, or rectal
abscess, or cancer. Here in St. Louis, they have
had unfilled orthopedic fellowships in foot and
ankle. I am able to do everything I need to do. I
take skin grafts from the thigh when needed. I do
ankle and calcaneal fractures. I do "at risk" foot
care. I treat neuropathy. I am able to do anything
required to manage foot and ankle pathology. I am
addressed as doctor by MD, DO, NP, all the medical
staff. It was not always like this, but it is now.
Would a DO degree change the "appeal" to be a
podiatrist. I continually see names with DPM, MD
listed who practice only podiatry, and do not and
cannot by law practice medicine. If a legitimate
MD or DO degree were obtained, on what basis do we
conclude that the number of podiatrists would
increase? This is a theoretical proposition. It is
theory only.

We are a society with increasing demand for
podiatry services. It has been estimated that 1/3
of the US population will require foot and ankle
services. Diabetes is increasing. We have an
ageing population. We have more people engaged in
sporting activities. We have an immigrant
population from countries with high rates of
diabetes. We have patients with disorders with
with which foot and ankle disorders are
associated.

To some extent, podiatry is a victim of its own
success. We have become so integrated into
medicine that many do not realize they are
receiving care from a DPM, and quality care at
that. The 3-year residency and fellowship is
desired provide the graduate to follow a career in
many specific areas of foot and ankle care. There
are former residents from the St. Louis residency
teaching orthopedic residents foot and ankle
surgery. Like osteopathy, that would never have
been the case 40 years ago.

Oddly enough, in some manner the podiatry
education model is more practical than allopathic
medicine. Explain to me why a failure to complete
an OB/GYN rotation limits me as a podiatrist. If I
know that I am going to be treating foot and ankle
pathology, my future patients would benefit from
time spend in vascular disease, rheumatology,
trauma, dermatology, infectious disease, rather
than gastroenterology, urology, and less related
subspecialties. And by the way at PCPM 1969-1973
we DID a full course in psychiatry, internal
medicine, including clinic rotations.

I left prepared to treat foot and ankle disorders,
not a pheochromcytoma or sphenoidal wing tumor. If
I need an orthopedic surgeon, I do not need him or
her to know how to deliver a baby or place a
catheter or chest tube. If I need a gynecologist,
I could care less if they know how many bones are
in a food, or the fate of Rathke's pouch.

How do we address the college admission question?
Let people know that you are a DPM. stop saying
you graduated medical school. put DPM on your
white coat, not "Dr". Let everyone know that the
competent and concerned care they are receiving is
from a DPM, so that others come to understand what
that degree represents. Show some pride for what
this profession has accomplished. get off your
self-serving ass and make efforts to move the
profession forward, something the APMA leadership
has in recent years failed to do. get involved in
your state and local societies. teach students,
residents. lecture at md and do seminars, hospital
programs, educational programs for NPs and PAs.

Allen M. Jacobs, DPM, St. Louis, MO

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05/21/2025    David Secord, DPM

Podiatry and Cardiac Escape Beats (Rod Tomczak, DPM, MD, EdD)

I started out as an electrical engineer, attending
Milwaukee School of Engineering. My roommate and I
ended up becoming best friends and it is funny how
our lives progressed. I moved to South Texas and
worked as a telecommunications engineer. Kevin
went on to build Formula I engines for A.J. Foyt
Racing. We both eventually chose a path in
medicine. Because of my experience of tearing up
my right ankle playing basketball at The
University of Dallas, I wanted to do foot and
ankle as a profession and attended the Temple
School (PCPM at the time.) Kevin attended a DO
school and is an ER doctor in Las Vegas, after
serving some time in the Navy.

When we reconnected some years back, he was
interested in my choice and I was interested in
his choice. I never considered applying to a DO
school for a good reason: what I wanted to treat.
When I moved to South Texas, I ended up entering
the seminary to study for the Diocese of Corpus
Christi. I became friends with three individuals,
all of whom left the seminary—as I did—and became
doctors. All of them wanted to be surgeons. None
of them ended up in the top 10% of their classes,
went through the “scramble” and ended up being
(respectively) a pathologist, a radiologist and a
pediatrician. None of them wanted to do this for a
living but they had bills to pay and a family to
support.

Last week, I repaired a woman’s mid-shaft fibular
fracture in non-union after her tibial fracture
was repaired via an IM rod, four years ago. The
fibular fractures in this scenario are never
addressed, the action of the IM rod leaves the
fibular fracture bayoneted and the patient with a
limb-length discrepancy. After dealing with the
prominence and the pain of the non-union, she is
delighted with the surgical result. No more
prominence. No more pain with translation of the
tibia and fibula during gait. It is this sort of
moment which keeps me getting up in the morning
and looking forward to seeing patients.

This is also the unique aspect of podiatry. You
know that if your interest is the area below the
knee, that is what you are going to do for a
living. Dr. Tomczak is exactly right in that the
missing piece to the puzzle in our profession is
plenary licensure. Holding a license which allows
treatment throughout the patient’s needs but
allows specialization upon those maladies below
the knee is the future. It is inevitable. The path
was carved out through the wilderness by our
forefathers. We now have to establish a settlement
and raise a flag entitled: DO/DPM.

David Secord, DPM, McAllen, TX

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05/21/2025    Ivar E. Roth, DPM, MPH

Podiatry and Cardiac Escape Beats (Rod Tomczak, DPM, MD, EdD)

Dr. Tomczak wrote. “As of this week, AACPM will
not answer or even acknowledge my calls.”

I want to chime in here. I have also called AACPM
several times over 3 weeks and sent e mails as
well with no response until I literally left a
rather pissed off voice mail and e mail to them
explaining that if I did not get a response, heads
would roll. I finally got a response email that
was not signed and claimed, “Due to the small size
of our staff, we always recommend people reach out
via email with any questions or issues.”

The problem with this response is I had written
several previous e mails and called and heard
nothing. Finally, after threatening heads would
roll, I got a phone call back. The person that
called could NOT explain what my concerns were
showing me that they or NO ONE ever listened to my
detailed messages that I left.

These organization are a symptom of our times and think that it is okay
to blow off requests and that no one will care or
bother to complain and so it’s business as usual.
The same problem exists at the APMA. I called many
times and emailed and the response was to say the
least, pathetic. While I am a dues-paying CPMA
member I decided NOT to pay the APMA dues this
year until I see some progress, so far, I am not
impressed. We give them our hard-earned money for
what?

Ivar E. Roth, DPM, MPH, Newport Beach, CA