10/29/2025    Rod Tomczak, DPM, MD, EdD

Podiatry and Manifest Destiny

Is the practice of podiatry exclusively our turf?
After seven, maybe eight long years should
everything about the diagnosis and treatment of
foot pathology belong to podiatrists? Orthopedic
surgeons spend a year fellowship learning about
the foot pathology, mostly trauma or maybe
deformities and lay claim to a right of first
refusal for all things foot. If the pathology is
“clean” and they have hospital administration in
their pocket, there’s a good chance patients
coming through the emergency department will never
see a podiatrist. Ulcerated, infected, malodorous
feet may see an NP in the orthopedic surgeon’s
office, but the orthopedic surgeon doesn’t want to
contaminate and infect a clean patient by seeing
the diabetic on the verge of becoming a non-
infected amputee. But podiatrists have fought for
care of the global foot here in the United States
and have slowly managed to gain entrance to the
complete spectrum of foot care. This includes
forefoot, rearfoot and ankle, walk-in or trauma,
infected or clean. After all, as Carly Simon sang,
“Nobody Does it Better.” Or don’t we?

To be fair, let’s examine what’s happened to
orthopedic surgery. Little by little the body
parts have been chopped up and the orthopedic
surgeon has had to fight for bones and joints like
never before. Neurosurgeons have laid at least
partial claim to the spine. Plastic surgeons
assert hand surgery is to delicate for the “bigger
mallet, please” orthopedic surgeons. Physiatrists
are successfully injecting hyaluronic acid into
arthritic knees and hips delaying or even
obviating joint replacement surgery.

Many orthopedic sports medicine physicians are
losing patients to a family practice physician
with a one year sports medicine fellowship. What
makes us think orthopedic surgery is just going to
cede the foot and ankle to a bunch of doctors who
didn’t sit for USMLE or have their residencies or
fellowships approved by ACGME, but rather the same
agency that accredits what some would call a
questionable undergraduate program? Even the kids
who go to class in the Caribbean wearing flip-
flops, shorts and T-shirts have to contend with
ACGME and USMLE. If podiatry tells allopathic and
osteopathic medicine they don’t need the outside
accreditation everyone else agrees to, podiatry
becomes the softest of targets in a now target
rich environment. Podiatry has become the Fokker
bi-plane being hunted by an F-35 Lightning. There
simply is no doubt who will become the winner of
that combat scenario.

What makes the allegory more literal and symbolic
is that the keepers of the accreditation key,
ACGME has offered to investigate making the fight
a fairer encounter. We think we are the one in a
million David and Goliath story. Or do we? Maybe
CPME has secret stones to use in the battle but
aren’t telling anyone and no one knows about it
except their small secret insiders. And this begs
the question, should there be any secrets between
the podiatry residencies, AACPM, CPME, podiatric
COTH, and the private practice APMA members? I
just can’t imagine anything so nefarious and
threatening to the profession that the reason for
not inviting ACGME to sit down with us is
something we are not being told for our own good.
Hopefully they might be able to suggest points
where we could improve our residencies so that
“Nobody does it better!” is true.

We aren’t a profession that can choose a body part
to concentrate on. We already have the foot. So,
we know from a questionable survey that some
individuals want to keep their “NO” votes Secret
Squirrel hush-hush. I’ve played those games in
podiatry school where suddenly we needed to pass a
never mentioned before oral exam to graduate or a
surgery teacher gives an exam on material never
covered in class so he can find out what we didn’t
know, and the Dean had a doctorate in Russian
history. The only honest guy was a fellow named
Dr. Bennie Lee Owens. We survived those scandals
which makes me believe there’s nothing all these
alphabet organizations are going to throw at me
and send me over the edge.

Let’s suppose ACGME finds some residencies sub-par
compared to other residencies. That’s probably
closer to the truth than any other lame reason,
but the reason for keeping it secret is there is
money involved and fear that if a program is
closed somebody loses some cash. Well, that may
not be the case since we aren’t asking ACGME to
suddenly take over for CPME. ACGME may be loaded
with real educators who want to make the programs
better and aren’t interested in taking away
anybody’s stipend. To me that’s greed and that
position is the type of position that endangers
the whole profession.

You know and I know there are some programs just
dangling out there and probably shouldn’t be
accredited programs. We needed those programs when
we had a lot more graduates. Schools actually
advertise 100% residency placement like it’s an
accomplishment. Let’s advertise how many graduates
of each school match to their first or second
choice.

There has to be some programs weaker than others,
just like all thirty students who graduate from a
particular podiatry college are all tied for
valedictorian. Somebody has to be at the bottom of
the class. I agree that some podiatrists are the
best at foot and ankle but not everyone that
graduates a residency program is automatically the
best. Some of our podiatry residency graduates may
be less prepared to do what we do than some MD or
DO orthopedic surgeons who finish a one year foot
and ankle fellowship. ACGME is willing to help us
change that if we let them rather than keep
secrets. To go around blowing our horn that
“Nobody Does it Better” is wrong. To not get help
for those young podiatrists is worse on the part
of COTH, CPME and the other co-conspirators.
Remember, Carly Simon also recorded, “You’re so
Vain.”

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

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