06/11/2025 Rod Tomczak. DPM, MD, EdD
Physicians and Non-Physicians: What are the differences? (: Martin Pressman, DPM)
I would like to comment on the letter by Martin
Pressman, DPM. In the spirit of true transparency
which I insist upon, Dr. Pressman was one of my
trainers at Metropolitan Hospital in Philadelphia
where I completed a two-year residency beginning
in 1977. I am neither afraid to bury or praise
podiatrists who have influenced my life.
When I arrived at Ohio State University from Des
Moines CPM in 1995 there were two foot and ankle
care givers for the 35,000 faculty and staff plus
their families who were self-insured by the
university’s prime care, 55,000 students and
outside patients. The two foot and ankle
physicians were the chair of the department,
Sheldon Simon, MD and myself. I asked him if I
could start a surgical residency program shortly
after arriving. He told me to be patient, get to
know the lay of the land and become known by the
community.
My first surgery was an endoscopic plantar
fasciotomy on a lady who had suffered for years.
Incidentally, she was the secretary for the dean
of the medical school who decided to stop by since
he had never heard of this procedure. It seemed
like half the university decided to “stop by” for
my first case and to see if the new guy was
related to a previous quarterback.
The dean was impressed, especially with how
quickly his secretary returned to work and I
became known by name recognition so the residency
start date moved up substantially. Dr. Simon and I
sat down and discussed what he thought the
residency should look like. He said to me, “If we
are going to do this, we are going to do it
right.” It should look like an orthopedic
residency but shorter. I had dreamed of a three-
year program with the first year being identical
to the first year of a PGY-1 orthopedic residency
meaning the new podiatry residents would be
spending months in endocrinology, general surgery,
orthopedic trauma surgery, emergency medicine,
psychiatry, neurology, vascular medicine,
anesthesiology, etc. The residents would attend
all the orthopedic conferences and take overnight
call. During the first year, podiatry exposure
would be on a “drive by” basis.
If the first year resident happened to be free
from other commitments and there happened to be a
podiatric clinic or surgery scheduled, the PGY 1
could attend. Naturally the first years were not
ecstatic about their schedule and could not see
the relevance behind these other rotations whining
about how they should be at the other end of the
table from the anesthesiologist.
When I approached each of the department chairs to
ask if our residents could rotate through, not as
observers but as hands-on-doers, just like any
other resident from any service, I was met with
overwhelming enthusiasm by the chairs and teaching
faculty. Those who had been familiar with podiatry
before coming to Ohio State were more accustomed
to a non-participatory resident who came and went
with no commitment to the hosting service. They
were not involved in patient care which they had
to defend, never presented at journal club, spent
a year or so with a preceptor, were never expected
to produce any publishable new knowledge, were
never asked academic questions based on assigned
readings, and never made rounds prior to rounds
with the service.
This was not podiatry’s or the preceptee’s fault,
it was just the way it was because podiatrists
weren’t expected to know about much above the
anterior talofibular ligament. I asked the
attendings from other departments why they were so
enthusiastic about having a young podiatrist on
their service. There were varied responses but
most included the idea that although they would be
taking care of the foot and ankle, they were
ministering to the whole patient. They needed to
know as much as possible and these attendings were
excited to see podiatry moving out of a little
corner box on shelf in the closet of the medical
guest bedroom. It was time for podiatry to move
into the medical mainstream.
I received a rather surprising response from one
of the orthopedic surgeons. He had spent 12
consecutive years a Northwestern University,
undergraduate, medical school and a four year
residency. He was older and, like many orthopedic
surgeons of his day did not complete a fellowship
but did enjoy taking call and operating on trauma
in the middle of the night. He was the consummate
gentleman orthopedic surgeon. Early on, he asked
me to come to his academic office where he said,
“What can you do?” Imagine that. When the
residency started he asked if it would be OK to
call a podiatry resident at home if he had an
interesting or difficult trauma to do overnight.
Of course.
With all the paperwork completed, it was time for
the residency evaluation people to inspect the
program and make sure we had not penned a work of
fiction involving an imaginary podiatry residency
within an orthopedic department at a huge
university where podiatry residents rotated
through busy teaching services like MD interns.
Dr. Pressman pulled me aside and asked me if I
knew what I had created at Ohio State. I told him
this was not just my work, but a fellowship
trained foot and ankle orthopedic surgeon had the
vision to see podiatric residency education the
way I saw it; exactly like MD orthopedic surgeon’s
residency programs.
To be honest, what we put together was based on my
program at Metropolitan Hospital/PCPM and Cherry
Hill Medical Center where I trained. Dr. Pressman
told me we had created a model for what CPME hoped
would become the podiatric residency template of
the future where podiatry graduates would train
along side MD and DO residents. It would be in
academic centers where podiatrists would get a
foothold on a residency education that was on par
with allopathic and osteopathic residency
education. As these MDs and DOs left their
training facilities and went to community
hospitals, they would carry their memories of
training side by side with DPMs and remember what
DPMs were capable of.
But, there was one glitch in the system. Not all
DPM graduates wanted to fit into these cookie
cutter residency programs. Not everyone wanted to
accept high risk and not always high reward
patients. Not everyone wanted to perform complex
reconstructive trauma surgeries. The idea of total
ankle replacements did not appeal to everyone.
ABPM certification was easier to achieve but
didn’t guarantee hospital privileges or insurance
panels.
ABFAS certification was difficult and not everyone
wanted to follow the more difficult path. Some
young podiatrists did not want to pursue a
sometimes problematic academic route but preferred
a more casual direction, even preferring a cash
practice. When podiatrists fought for Emergency
Department referrals they did not expect calls on
the sixth hole of a $20 Nassau or in the middle of
the night to come see a donor cycle accident with
a compound-comminuted ankle fracture. They didn’t
expect to miss a daughter’s championship softball
game because of a necrotizing fasciitis that
needed to be operated on now. These expectations
complicated employment contracts and the board
certification process to the extent that young
podiatrists were losing their jobs.
Maybe we didn’t see this coming. Maybe we thought
this generation was like we were; craving as much
exposure to podiatry patients; any time, any day
and any where. That’s important. There are now
rules about residents and how they’re treated, but
more importantly, they are adult human beings with
rights and entitlements. Our phrase, “When I was a
resident…or…when I was new in practice,” doesn’t
exist anymore except in our aging minds. The
cookie cutter residency model we worked so hard to
emulate making podiatry residencies like a short
orthopedic residency doesn’t work for every DPM
graduate anymore. Orthopedic residency graduates
can do just fine transitioning to physiatry or
non-operative sports medicine. Podiatry not so
much right now.
There is non-operative podiatry but is there
parttime operative podiatry? Well, sure, but how
does a young podiatrist achieve and maintain the
board certification he or she needs which allows
comfort zone hospital privileges? We need to start
thinking about how to solve this problem and
planning for a future that won’t exist if there’s
no light at the end of the troubled tunnel. Why go
to podiatry school if I have no options about my
future? Our one training model more or less pigeon
holes one hospital certification. If I want to do
some surgery it doesn’t always fit. To me, the two
most nauseating words in the English language are,
“You should….”
Sometimes I don’t even know what I should do. To
keep this profession alive and robust, we need
options for the next generation like podiatric
physiatry or part-time operative podiatry. These
are smart young men and women, but we need options
to keep podiatry alive, we need real existential
freedom and free will and a place for Gen Z to
work the way they want or podiatry will quietly
fade away. Time to go to work again, Marty!
Rod Tomczak. DPM, MD, EdD, Columbus, OH
