10/23/2025    Rod Tomczak, DPM, MD, EdD

Recent COTH ACGME Survey Results (Lawrence Oloff, DPM)

Larry, I am really happy you replied to my
thoughts concerning ACGME and COTH. Larry, not
many guys have the same quality program you do. I
think we have known each other since the early
1980s and our conversations have almost always
been about podiatry, podiatric education, and the
way it should be. ACGME could walk into your
residency tomorrow for a surprise inspection and
you’d pass with flying colors. Your standards are
impeccable. If the rest of the profession ran a
program like yours, no residency director would
have the slightest qualm about letting ACGME have
a look see at what type of residents they are
preparing for practice.

That’s where I have a problem. Why can’t every
podiatric residency be of your program’s caliber?
Every director should be proud to show their goods
to an outside, overwatch agency composed of
strangers, not fellow podiatrists who are
residency directors. I still posit most DPM
schools will eventually close and people who want
to practice podiatry will have to practice as DOs.
This means that ACGME WILL be the accrediting
agency, so let’s get ready for it.

I’m not talking about whether they get enough
sleep or can eat lunch on time. If a resident told
me in the middle of a case he or she was hungry
and needed a slice, I’d calmly tell them, “Please,
get lunch, and then a cup, and if you’re tired,
get 40 winks. We will still here, scrub back in
because we probably can’t finish without you.” But
you know, I’m just that kind of guy.

What I’m talking about is the unethical things
that you and I know may happen within certain
residencies. Maybe there are some residency
directors that have podiatry residents generate
outside income for the director. I think some
directors may be sending residents to nursing
homes to see patients for them. That would take
away from the hours a resident could be sleeping.
I may be old fashioned, but having residents work
off book for the director is still wrong.

Maybe there are programs where four residents list
a case in their logs or a program where the
resident sees patients unsupervised in a
director’s office, or a program with no academic
program, or a T program, where residents are at
the hospital Tuesdays and Thursdays, Ten to Two.

If there was no chicanery or fear of being exposed
of anything out of bounds, why would anyone be
afraid to have ACGME or the Surgeon General visit
or accredit their program? As I say, I think ACGME
will eventually be the accrediting agency for a DO
podiatric residency program. Let’s get them used
to our impeccable ethics, unimpeachable residency
directors, and spotless history. God knows, I
believe in redemption.

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

Other messages in this thread:

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10/23/2025    James DiResta, DPM, MPH

Recent COTH ACGME Survey Results (Lawrence Oloff, DPM)

I want to respond to the recent discussion and
comments made by Larry Oloff and Rod Tomczak. I
think it important for PM News readers to
understand that both men have made a great
contribution towards the advancement of our
profession and although in reading their comments
one might think them very much apart, I feel if
sat down together they would be able to come to
some 90% consensus on this issue. I was 2 years
behind Larry at Temple (PCPM) and he has done our
profession proud and he is correct when he looks
and sees how far our profession has come and the
major milestones we have made.

Our present cohort of practicing podiatrists are
in a very good place at this point in time but we
can not ignore the present crisis in student
recruitment which frankly can lead to our demise
as a profession. At this same period, Rod was a
resident across the street at Metropolitan
Hospital. I can still hear him approaching the
nursing station in his wooden clogs (always knew
when he was about to appear). Again a pillar in
our profession over the course of his career. Rod
is more concerned with where our profession is
headed and I share those same concerns and fears.

Many people don't like change. In one's
professional life and career this is a
particularly difficult issue especially for those
in leadership and those who are in control.
Whenever I have initiated an objective that
involves a change in provider behaviour the
roadblocks to change are often insurmountable.
Money and power are likely to be both obstacles
and a solution as a means to change. When I see
our leadership frown on the ACGME invite I can
smell it. Sometimes what are perceived as
obstacles can be addressed in discussion and be
the catalyst for a solution. It's the reason why
those who grow discouraged in time don't despair.

My suggestion is to take yourself out of your
comfort zone and assess what is happening in the
healthcare professions in real time. All we have
right now for data is the number of podiatry
school matriculants. We need to see all the
applicant data but even if stagnant it won't be
good. We can place blame for the decreased
strength in our applicant pool via many scenarios
and we can attempt solutions by addressing certain
concerns i.e. image problems, public education as
to what and who podiatrists are, and finding a
road to parity for the DPM degree. In the end we
will still be the product of what we created as we
have brought our profession into the 4-4-3 model
of a medical education.

As Dr. Oloff has shown, we have done wonderful in
advancing this objective and obtaining real
progress and envious positions when compared to 4
decades ago. I am afraid now the status quo won't
endure. Something went wrong along the way. Was it
the crushing of our parity plan when our students
were denied access to the USMLE exam? If that was
the case we could have invested in changing our
APMLE exam to match that of the USMLE and have it
assessed to prove it meets the same degree of
proficiency. There are a number of things that
could be tried but in the end the applicant pool
will be the same and it doesn't look promising.

The reasons should be obvious to everyone. We
didn't have the competition for applicants like we
do today. College students realize the PA gig is a
sweet one and many have gone that route. The
optometry and dental professions provide a four
year track to a professional degree and a direct
pathway into clinical practice. We left that track
years ago because we wanted to be like our MD/DO
colleagues and myself I don't want to see us go
backwards and I don't see that as an option. Why
would we deny moving forward with the ACGME
invitation to at least see what is possible?

The real change as I see it and I believe is the
entire crux of our problem is the osteopathic
profession. They have disturbed the applicant pool
by increasing medical school first year openings
exponentially. In the last three decades they have
grown from having 1,900 first year seats available
to now over 10,000 seats and that number will
continue to increase with many more schools/campus
locations planned.

Our leadership appears to want to stay the present
course. Not a smart idea. Dr Tomczak has proposed
a viable alternative which would drive our
profession to parity and our applicant pool to
sustainable levels. Waiting will change the course
of the profession and not for the better. Why not
put a new task force in place with leadership that
can provide a road to success? What are we afraid
of?
--
James DiResta, DPM, MPH, Newburyport, MA