08/14/2025    Rod Tomczak, DPM, MD, EdD

Podiatry at the Crossroads (Paul Kesselman, DPM)

I want to thank Dr. Kesselman for his kind
comments, insightful observations and salient
questions concerning the future of podiatric
medical education, I don’t think I’ve ever met Dr.
Kesselman, but I can unequivocally say, “He gets
it!” He is majorly prophetic in his predictions
about the future and what we need to do in order
to preserve our rich heritage while not losing our
essence. It is not unequivocally necessary to
retain only the initials DPM after our names to
maintain the mandate handed to us through the
years to be who we are and continue to be it well.
When DSC transitioned to DPM, holders of the
former degree did not have to undergo extended
periods in sweat lodges to purify themselves of
the DSC degree and become DPMs before exiting the
ritual cleansing of initials that had become
anathema. Some chiropodists preferred to retain
the DSC initials but everyone in our profession
retained the traits and identity of the
chiropodist before signing their name as DPM for
the first time. If anything the initial change
spurred us on to become better at what we did
rather than distancing us from our roots. We seem
to have survived the change quite nicely I might
add.

It seems to be time for another major step in our
evolution. The next generation to whom we will
pass the torch has asked the post nominal letters
be changed to signify an unrestricted license. It
is quite obvious from the decline in enrollment at
podiatry colleges that the younger generation is
not satisfied with a restricted license. Separate
but equal does not fly once again. Our admonitions
and counsel that the license’s privileges and
responsibilities is not what the next generation
wants to hear. Remember how angry the scolding,
“Because I say so.” made all of us feel? This
generation wants to sit for and pass the same
exams and have the same license as their peers.
Because we tell them they really don’t need it or
how we got along just fine without it has not been
received very well. They want to swim in the deep
end of the pool just like their DO and MD
counterparts. The water may be just as wet in the
shallow end, but it’s not where the next
generation wants to swim. They want to swim, not
wade.

Dr. Kesselman goes on to ask real concrete
questions, and rightfully so. You attend a DO
school like Des Moines which has an incoming class
of over 200 students and get a DO degree. After
the general internship that will allow them to
apply for an unrestricted license, how do they
become a podiatrist? This is where our profession
must come together and find an answer to both Dr.
Kesselman’s and my question. Their may be enough
students who want to be DPMs to keep a DPM school
open and enough graduates to follow the current
pathway, but where do the DOs who want to be a
podiatrists go?

How do we structure a two- or three-year program
in podiatry, who funds it, who teaches it, who
certifies it for a board certification and what
scope of practice will these graduates enjoy? At
this point we can only speculate because if we
start putting a plan into place we will have the
time needed to integrate it into an ACGME postI
want to thank Dr. Kesselman for his kind comments,
insightful observations and salient questions
concerning the future of podiatric medical
education, I don’t think I’ve ever met Dr.
Kesselman, but I can unequivocally say, “He gets
it!” He is majorly prophetic in his predictions
about the future and what we need to do in order
to preserve our rich heritage while not losing our
essence. It is not unequivocally necessary to
retain only the initials DPM after our names to
maintain the mandate handed to us through the
years to be who we are and continue to be it well.
When DSC transitioned to DPM, holders of the
former degree did not have to undergo extended
periods in sweat lodges to purify themselves of
the DSC degree and become DPMs before exiting the
ritual cleansing of initials that had become
anathema. Some chiropodists preferred to retain
the DSC initials but everyone in our profession
retained the traits and identity of the
chiropodist before signing their name as DPM for
the first time. If anything the initial change
spurred us on to become better at what we did
rather than distancing us from our roots. We seem
to have survived the change quite nicely I might
add.

It seems to be time for another major step in our
evolution. The next generation to whom we will
pass the torch has asked the post nominal letters
be changed to signify an unrestricted license. It
is quite obvious from the decline in enrollment at
podiatry colleges that the younger generation is
not satisfied with a restricted license. Separate
but equal does not fly once again. Our admonitions
and counsel that the license’s privileges and
responsibilities is not what the next generation
wants to hear. Remember how angry the scolding,
“Because I say so.” made all of us feel? This
generation wants to sit for and pass the same
exams and have the same license as their peers.
Because we tell them they really don’t need it or
how we got along just fine without it has not been
received very well. They want to swim in the deep
end of the pool just like their DO and MD
counterparts. The water may be just as wet in the
shallow end, but it’s not where the next
generation wants to swim. They want to swim, not
wade.

Dr. Kesselman goes on to ask real concrete
questions, and rightfully so. You attend a DO
school like Des Moines which has an incoming class
of over 200 students and get a DO degree. After
the general internship that will allow them to
apply for an unrestricted license, how do they
become a podiatrist? This is where our profession
must come together and find an answer to both Dr.
Kesselman’s and my question. Their may be enough
students who want to be DPMs to keep a DPM school
open and enough graduates to follow the current
pathway, but where do the DOs who want to be a
podiatrists go?

How do we structure a two- or three-year program
in podiatry, who funds it, who teaches it, who
certifies it for a board certification and what
scope of practice will these graduates enjoy? At
this point we can only speculate because if we
start putting a plan into place we will have the
time needed to integrate it into an ACGME
postgraduate residency/fellowship. CPME will be
out of the picture for these DO graduates. We are
in the deep end of the pool.

The scope of practice will be limited by
conscience and institutional rules. This DO, hope
to be a podiatrist could examine eyes for diabetic
retinopathy in his office but insurance would not
pay and he may get away with self-pay until
something goes wrong. Then he has to justify his
actions to the medical board and malpractice
insurances and a jury. Sometime ago, the chief of
dermatology at Ohio State University Medical
Center could not perform Mohs surgery since he did
not perform enough cases in his residency,
fellowship to qualify. It seems that minimal
incision vein surgery is the newest rage. Does a
weekend course suffice for adequate training?
Shortly after my residency was completed CO2
lasers were a necessity for a successful practice,
You needed to take a one-day course, operate on an
anesthetized dog’s liver (how things have changed)
then be proctored three or four times. At a
credentials meeting a gynecologist wanted to use a
laser for cervical warts. The chairman of the
committee, an orthopod denied the privileges.
After all, this new money maker could put a hole
in the OR wall if not handled properly. What could
it do to a cervix? The institution decides what
qualifies a person to employ new equipment and
grants the appropriate privileges, sometimes.

Teaching and funding are my major concerns as the
program begins. Will podiatrists be acceptable to
ACGME? Will orthopedic surgeons be willing to
create competition? Will podiatry residency
funding be extended to include this new class?
Lastly, we have to jump on board the board
certification merry go round once again and who
certifies the first classes? These can all be
worked out.

There is one final hurdle to be overcome. Let’s
hope this next generation wants to be podiatrists
with a full license and a DO degree. There are
about 1,100 orthopedic foot and ankle surgeons in
the US. Will they be willing to help give birth to
a new class of foot and ankle caregivers?

graduate residency/fellowship. CPME will be out of
the picture for these DO graduates. We are in the
deep end of the pool.

The scope of practice will be limited by
conscience and institutional rules. This DO, hope
to be a podiatrist could examine eyes for diabetic
retinopathy in his office but insurance would not
pay and he may get away with self-pay until
something goes wrong. Then he has to justify his
actions to the medical board and malpractice
insurances and a jury. Sometime ago, the chief of
dermatology at Ohio State University Medical
Center could not perform Mohs surgery since he did
not perform enough cases in his residency,
fellowship to qualify. It seems that minimal
incision vein surgery is the newest rage. Does a
weekend course suffice for adequate training?
Shortly after my residency was completed CO2
lasers were a necessity for a successful practice,
You needed to take a one-day course, operate on an
anesthetized dog’s liver (how things have changed)
then be proctored three or four times.

At a credentials meeting a gynecologist wanted to
use a laser for cervical warts. The chairman of
the committee, an orthopod denied the privileges.
After all, this new money maker could put a hole
in the OR wall if not handled properly. What could
it do to a cervix? The institution decides what
qualifies a person to employ new equipment and
grants the appropriate privileges, sometimes.

Teaching and funding are my major concerns as the
program begins. Will podiatrists be acceptable to
ACGME? Will orthopedic surgeons be willing to
create competition? Will podiatry residency
funding be extended to include this new class?
Lastly, we have to jump on board the board
certification merry go round once again and who
certifies the first classes? These can all be
worked out.

There is one final hurdle to be overcome. Let’s
hope this next generation wants to be podiatrists
with a full license and a DO degree. There are
about 1,100 orthopedic foot and ankle surgeons in
the US. Will they be willing to help give birth to
a new class of foot and ankle care givers?

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

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