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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