07/15/2025    Rod Tomczak, DPM, MD, EdD

Educational Fallout and Uncomfortable Truths

I’m writing this letter to ensure the crisis in
enrollment is not conveniently forgotten as a
passing fancy which some members of the profession
would like it to be. There are a few points that
need to be brought to the forefront and hopefully
burned into the collective cerebral cortex of the
profession, especially the younger members. These
facts need to be recalled repeatedly and
contemplated extensively lest they do become the
mere musings of a neo-OG. A lot of us really care
about not only the profession and the younger
members but also those yet to become members of
the profession who will suffer from the shrapnel
that will be blown far and wide when the pin is
pulled on the Foundation for Podiatric Education
(FPE) grenade.

The shrapnel will not affect just a few. The blast
radius will cover the whole profession, those in
private practice, those getting ready for boards,
no matter which boards, the students and the
political mavens who worry more about their
itinerary and portraits than you and I are
concerned about our image and ancillaries.

How do you think it looks to the rest of the
medical profession when they see we are throwing
away good money to fill seats for incoming
classes? Our schools cannot fill in coming
classes. Yet the number of colleges has ballooned
to what, 25 or 30? Who is behind the curtain at
CPME accrediting new schools faster than a
paronychia pops up? John Marcoux, DPM, is the
chair of CPME in case you are not familiar with
his name, educational publications, or educational
credentials.

I can envision the scenario in the doctors’ lounge
where and orthopedic surgeon mentions so the room
full of MDs and DOs can clearly hear, “The middle
school up the road just closed, what you say we
open a podiatry school in that building.” Would
the assembled physicians interpret this as sarcasm
or reach for their wallets to throw $20 into the
pot for the application fee? In the real world
when there is a surplus of goods the cost goes
down, but not in podiatry where the seats are
empty but tuition is at a high. Makes sense to me.

If MCATs and GPAs are real predictors of success
in medical schools, are we going to recruit
mediocre students who have never heard of podiatry
and whose academic credentials are questionable
but just high enough to borrow hundreds of
thousands of dollars? This would be above and
beyond their undergraduate loans to go the
podiatry school when the average income for
podiatry is unpredictable because data is all over
the scale. The information regarding the number of
students who graduate is available on line. If you
go to CPME Programmatic Outcomes you will see that
the graduation rates from 2022 to 2024 are only
80%. That means that 1 out of 5 matriculated
students didn’t graduate but had to bite the
bullet for loans unless mom and dad took out
another mortgage on the family home.

By the way, do you think the LCME or AAMC (The MD
equivalent of AACPM and CPME) would tolerate an
80% graduation rate for one minute? Seeing as
medical schools have been accurately predicting
graduates for years, it’s hard to believe podiatry
schools can’t extrapolate the data and offer
admission to students who will have a 98% chance
of graduating. Of course I have some thoughts on
that. One, the school will tell us that we are
giving marginal students a chance to succeed in
our profession and academically, podiatry school
is not that difficult if the student works hard.
The second reason, and perhaps more accurate,
marginal students are admitted because, God I hate
to say this, the schools need the money generated
by all students’ tuition, marginal or not.

The Step 1 NBPME pass rate for the classes of
2022-2024 was 90%. What CPME does not tell us is
how many students passed the first time or was
this data after two or three attempts? Ninety-nine
percent of NBPME Step 2 takers passed, but again
no data on how often students had to take the test
more than once to pass. Or, did the 20% fail out
of school after year 2? For some reason, Step 3 or
in training exam results do not seem to be readily
available to the public. Step 3 is the licensing
exam for the states and without a passing mark on
step 3 there is no license to practice, but then
there’s a 3 year residency to consider.

Educational leaders have decided the 3 years make
you equal in learning to an MD but not able to
practice like an MD. That’s the 11 year plan.
Economically is certainly benefits residency
directors and hospitals.

Each of these exams during the 11 years of
training measures what should have been learned
prior to the exam, the goals and objectives of the
educational experience learned before the exam is
taken. There was too much new information to study
very much for step 1, and it seems we keep
learning new material right up until steps 2 and
3. How about board certification? Ideally, board
certification should be measuring the quality of
all rotations and experiences of the residency
program that was completed year(s) prior to taking
the exam. Orthopedic surgeons have a 97% pass rate
for written and lately an 80% pass rate for oral
exams. The same can not be said for podiatry.

There is such a disparity in residencies a one
exam fits all simply does not work. Our test
makers seem to construct the certification exam to
keep people out. They are successful at that.
The information available to the public concerning
board certification for ABFAS is much more
confusing and the pass rates almost
uninterpretable. Published pass rates vary from
25% to 67%. Even the higher rate of 67% is
unacceptable. That pass rate indicates that as a
profession we cannot certify our own residents
have met the standards we have set for them in
education, training, knowledge and competency.
That should be unacceptable to the profession.
These results are not validated by an outside
agency. It seems we are trying to compensate and
make up for our own deficiencies and inadequacies
in podiatric education by restricting the surgical
certification process to a few, select
podiatrists. All we have done is create an
epistemology of ignorance.

There is a huge difference between unethically
including some students in and unethically
excluding competent students by making the process
too difficult. I think we have failed as educators
on different levels. If a student had the
intellectual ability to succeed as a podiatrist
but was lazy, I’d bring him or her into my office,
invite them to sit down, reach into my desk and
pull out an application to work as a night clerk
at 7-11. But those were students who may have
needed a somewhat humorous wake up call.

If a student or resident came to surgery
unprepared for the procedure I would tell a story
in the OR about Dick Rothman, MD the spine surgeon
who used to hand an unprepared fellow a copy of
his book, The Spine and have him or her stand in
the corner of the OR and read the procedure step
by step out loud while a resident performed what
the fellow should have been doing. Now you might
conclude this humiliates the fellow because it is
done before an audience and it’s not done much
today, but if a person in a learner position
cannot fulfill a standard request to prepare for a
case, it tells me a lot about that student and
none of it is good. You do get a second chance
with the opportunity to plead your case, but if
it’s not a valid reason, that’s cause to direct
the teaching effort toward someone who wants to
learn.

Certification is a direct reflection on the total
residency experience. Consistent failure to pass
the boards by graduates from a program should
dictate a hard look at that program, its director,
and faculty. Two things should happen. Senior
podiatry students should be made aware of this low
certification pass rate and now that there are
plenty of residencies to select from, students
will shun these inferior performing programs.
Leadership of these programs ought to be dealt
with exactly like the unprepared student coming to
the OR. If there is no improvement, let’s look for
new leadership.

College students should investigate which schools
have the highest pass rates for board
certification. There seems to be discrepancies in
these pass rates. You may think there is no
correlation, but I know residencies do not rank
students from certain schools the same way
students are ranked higher from other schools.
That’s extremely important now. Does any applicant
get rejected immediately? Is anyone rejected after
an interview? Is it possible that podiatry schools
are accepting the best and the brightest of all
applicants? Seriously, is this a possibility or
are we accepting from the 34% of the applicant
population left of the mean of all applicants? At
what point will CPME tell us what percentage of
people applying are rejected? Maybe it’s none.

Remember, it takes the same IQ to master being an
electrician or plumber that it does to become a
podiatrist. That is a hard fact I became aware of
over 50 years ago. It was only later that I
learned accountability from upriver never existed
in our educational system.

If anybody can join the DPM club because we must
keep all these schools open due to the tuition
students generate, what will happen to NBPME? Will
step 1 become a simple multiple choice fact
recognition and recall exam because too many folks
fail? Do residencies use the data from schools to
shy away from interviewing students from certain
schools, and will in-training exams become less
taxing? Then, will the board certification process
have to be made easier to allow more podiatrists
to pass or will there be even more failures?
Podiatry has always been a reactionary community
never looking to the future. Allopaths will reuse
that same mantra they used in the early days of
podiatric board certification about a weak
education and an even weaker certification
process. We will be where we were almost 50 years
ago with no effort on our part. But that’s one of
the problems.

Well, react to this this, all you who sit on your
cat bird, board certified perches. If suddenly the
pass rate for board certification greatly
increases even though we are taking less gifted
students to fill seats, do you think word gets out
to hospitals, orthopedic organizations and
accrediting agencies? Is this a non sequitur? No,
it’s very logical and the reason why is rather
simple. It is a problem because we accredit
ourselves which will soon become evident to
outside agencies. All podiatry processes are valid
and reliable because we say they are and we are
the accrediting agency for podiatry. It sounds
like an infallibility argument to me, but only if
I am part of CPME.

If board certification continues to be the
juggernaut it is now and podiatrists cannot get
certified, they do not get hospital privileges and
suffer lower reimbursements. This will certainly
sound the end of podiatry when college students
encounter disenfranchised practitioners during a
Feet on the Street visit or an FPE encounter. APMA
could come up with a list of “approved to talk to
current podiatrists ” for the Feet on the Streets
campaign. Kind of a podiatric imprimatur and nihil
obstat meaning these podiatrists will not say
anything to the college student that doesn’t
support the company line but fills the seats.
Podiatry needs an Arthurian, Knights of the Round
Table, Parsifal to lead this organization.

Parsifal was an innocent, highly principled,
intelligent knight. There is absolutely no need
for hucksters, carpetbaggers, and politicians who
take turns sitting in all the chairs and
eventually lead this organization. In fact, going
through the chairs to hone one’s political skills
should be an impediment in itself. We are led by
Machiavelli rather than Parsifal. People who
receive an income from any entity outside their
practice automatically have a conflict of self-
interest over podiatric organizational interest.

They should be disqualified. Anyone currently
receiving an income outside of the practice should
resign from leadership. It will never happen. The
gavel of leadership ought to be a broom. Humpty
Dumpty has fallen and all the king’s men can’t put
all the podiatry pieces back together. The board
certified rear foot and ankle reconstructive,
trauma surgeons might call that a fubar
comminuted, compound fracture, but it’s just
today’s run of the mill podiatry.

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

Other messages in this thread:

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07/17/2025    John S. Steinberg, DPM

Educational Fallout and Uncomfortable Truths (Rod Tomczak, DPM, MD, EdD)

Ah the beauty and the challenge of open authorship
forums such as PM News. Congratulations to Barry
Block and his now 22,465 daily subscribers…BUT
with this media comes responsibility and a duty
for honesty.

We need to STOP publishing extremist statements
and misinformation. We don’t want to hear it
anymore. The notes of alarm that use terms such as
‘shrapnel, blast radius, and grenades’ seem
determined to misrepresent the truth and create
negativity about this great profession. I suggest
that rather than seeking to frighten readers about
podiatry for some unknown cause, we should instead
put our efforts into productive communication.

My son will apply to podiatric medical school this
fall. He will be the 4th generation of Steinberg
DPMs. My grandfather graduated from NYCPM in 1931.
My brother, father and 3 cousins are all
podiatrists…and guess what…we all have made a
great living and enjoyed a rewarding profession
that helps people every day. That seems to be the
prevailing sentiment with about every podiatrist
that I speak with around the country.

Sure, not all podiatrists are rich and put in
total ankle replacements for a living. However,
this profession has never been in a better
position for success. We have advanced our
education and scope of practice…we are on staff at
major academic medical centers…graduates from my
residency and many, many others get offers of
starting salaries that begin at $250k and range up
to over $400k.

Let’s all please stop using half-truths and
misinformation to scare our profession and those
who may want to join us. Instead, I’m going to
continue to devote my attention and energy to help
further elevate the meaning and prestige of the
DPM degree. Maybe others could join and direct
your energy this same direction?

John S. Steinberg, DPM, Washington, DC

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07/16/2025    Lawrence Oloff, DPM

Educational Fallout and Uncomfortable Truths (Rod Tomczak, DPM, MD, EdD)

Rod, thank you for your continued devotion to
podiatric medicine, but I do have some concerns
about your statements. First off is your
information about the number of [podiatry]
schools. When you stated there are "25 or 30" ,
actually there are 11, and one of these schools is
a public institution. While I agree with your
premise on the number schools, I think it is
important to be accurate about what you state.
Also, my understanding is that CPME only has the
ability to decide whether or not a school meets
their criteria. I do not believe it has the
ability to tell a school to open or not. I would
like to hear from a higher authority on whether my
information is correct. If it is, then how do you
influence a private entity from opening a school
if we have no jurisdiction over that decision?

I always wondered whether all these posts are
social media or whether they are accessible online
by the public. Maybe someone can answer that. Your
information you keep posting is interesting but
its extensiveness and persistence sometimes feels
like a diatribe against podiatry. If this is all
passion, then I would rather have you take all
this energy and apply it in a more constructive
venue, maybe as a voice to CPME and AACPM? You
would be a valuable resource to them.

Your opinions feel a bit like a Yelp review. Yelp
often serves as a platform where negative stuff
prevails. I remember passing by a neighborhood
restaurant in San Francisco that had opened a year
ago. Although always busy, the restaurant
announced its closing. There was a note on the
window stating how the few negative reviews
unfortunately resulted in them closing down.
Posted on the window were a number of patrons
thanking them and pleading with them not to close.

Your latest post starts off with the crisis in
enrollment. Instead of focusing on the poor
quality of students like you did, I would like to
hear more about recruitment. More students
applications would solve these issues. I am
interested in what APMA has started concerning
this. More is needed. Podiatry remains an unknown
entity to the high schools, colleges, and health
science career advisors.

Lawrence Oloff, DPM, Burlingame, CA