11/03/2025    Rod Tomczak, DPM, MD, EdD

Podiatric Obfuscation

Obfuscation is the ability to make things obscure
or unclear. A wonderful example is Mark Twain
popularized the quote, “There are lies, damned
lies, and statistics.” Simply put, it is obscuring
the facts, and maybe even talking about statistics
and probability. There are two classic ways to
look at probability. One is the frequentist view
which tells us that if we flip a coin 100 times,
when we’re done, we will end up with a 50:50 ratio
or close to it of heads and tails. The other
method is called the Bayesian or belief-based
method of looking at the facts that we know right
now or interpreting part of the facts to influence
what we are going to say. We are merely leaving
out some important details. A hot topic for
another posting might be, “Are podiatric seminars
science-based or influencer-based experiences.”
You get the idea.

An alternative way of describing Bayesian
statistics is to say, “Probability probably
wouldn’t exist if we had all the probable
information.” So, probability gives us a way to
think about things when we don’t have all the
information. When your 18-year-old comes home at
midnight and you ask him or her, “Is anything
new?” and they answer, “Some kids got detained by
the police for drinking in the park.” You’re
getting part of the information and what you’re
getting is truthful and certainly not a lie. What
you’re not getting is information that will keep
you from worrying about how you are going to pay
the check for your kid’s tab at that elite
Princeton eating club. Your kid did not lie to
you, he or she just didn’t tell you some important
facts. Like Sergeant Joe Friday used to say,
“Facts, just the facts, ma’am.”

Your kid, on the other hand is hoping that the
driver of the van forgets some of the kids who
ran in every direction when the cops pulled up to
the park with lights on and sirens blazing and
their name is on of the forgotten list that no
longer exists. Your kid might be thinking you
won’t be mad because you did the same thing when
you were 18 and ended up a successful podiatrist,
or heaven forbid, the cops get involved in a real
crime situation that night and the list of
drinkers vanishes, and the outcome is as if
nothing ever happened and your kid’s story never
makes it home to you or to Princeton, but he or
she is a local hero at high school and the Bobby
Fuller Four song “Who fought the Law?” has a
different ending and as we know, the ending is
everything. Situational ethics rule the day. The
end justifies the means.

Should APMA members ever be obfuscated by the
mother organization or any of her children? So
far, we have merely been obfuscated by rumors of
ACGME possibly ruining podiatry residencies or
inane surveys that would never have been solicited
let alone submitted to PM News which should be
praised for printing it to show all the APMA
members the work COTH is capable of.

We are at the crossroads of Crisis and Opportunity
Roads, except many private practitioners who have
done extremely well in podiatry and love our
profession have been blinded by the light of
success. The following is a text sent to me
directly by a former podiatry student of mine in
Des Moines who is a good and trusted friend, an
ethical person who sees most of the information
about podiatry but is not concerned about
enrollment in the podiatry schools or the
temperament of Gen Z graduates toward the practice
of medicine, the increase in DO seats available to
enrolling college graduates, the offer by ACGME
and what it means in the big picture, the number
of three-year residency slots available, the
difficulty in becoming board certified in surgery
as opposed to the ease of becoming certified in
podiatric medicine and fee schedules for certified
versus non-certified podiatrists. His niche is
secure, so he is not worried about non-surgery
certified podiatrists not being allowed on or
kicked of hospital staffs. He is not being told
the truth. This is his note to me, verbatim,
except where something may identify him. If he
wishes, he can disclose his identity to PM News.

“I’m not so sure from reading your articles that
you are so in touch with what’s going on in our
profession. I’m so proud of podiatrists, they have
trained and perform procedures that I would never
have dreamed of and to tell you the truth, you
would never have dreamed of and to tell you the
truth, you would never have dreamed of performing.
Rodney, this is a real profession/knowledge is
king which equals dollars and that’s where we are,
just came back from dinner always love hearing
your name, but you need a reality check, the best.

“My medical knowledge is on par with any other
medical professional out there, including you, I
wish you were here to see what procedures podiatry
are doing (sic) in hospitals, as you know, I’m
very sociable as well as a very academic student,
and if you ever wanna know the real truth about
our profession just ask me, and you had a great
part in my success/all good my friend.”

He lives in the present, and the present is good
for him. I think he feels the future will take
care of itself and the caretakers are Dr. Bisbee’s
unnamed stakeholders. The only stakeholders there
can possibly be are members of APMA and its
alphabet children. You might call him my friend,
my student and podiatric confrere. I fear he is
being obfuscated by APMA. I have often used the
term “mushroom theory” of leadership. We are being
kept in the dark and given fertilizer for
knowledge and nutrition. So, we are being
obfuscated by APMA.

Let’s be honest, the APMA has not been entrusted
with any top-secret information reserved for
certain podiatric SEALs on a covert mission to rid
the world of orthopedic foot and ankle surgeons.
Nobody is wearing a wire when dining at a
podiatric seminar, and we haven’t read about one
of our own gloriously making the ultimate
sacrifice and being awarded the Medal of Honor.
There is the APMA Distinguished Service Citation.
Dr. Barry Block, publisher of this PM News was
awarded this honor on March 16, 2025. It is no
secret that Dr. Block has been a long-time
proponent of changing the DPM degree to MD or DO.
This would not be possible until our residencies
are recognized by ACGME.

Six months to the day after Dr. Block received
this award, APMA published the following: “APMA
gathered feedback on the pros and cons of
participating in an exploratory process with ACGME
and determined that this question requires
significantly more input from the profession and
would ultimately need to be vetted by our House of
Delegates.”

APMA wants to vet the ACGME. That’s like the Boy
Scouts of America vetting the Spec Ops of the U.S.
Military. The only good thing that could come from
this useless exercise is an open account of how
individuals vote. Without approval we are looking
at the slow and painful death of podiatry because
a few people are afraid to open their underwear
drawers where their secrets are kept.

For the sake of podiatry, please tell us idiots
who cannot understand what could possibly be the
reason there even needs to be a vote to allow
ACGME to look at our residencies. Without their
approval any hope of having DO or even MD
podiatric physicians in the future is gone. What’s
in that dresser drawer you don’t want anyone to
see? If it’s so bad, why is it there? And more
importantly, what are those individuals doing as
residency directors? Perhaps they should be
vetted. They continue to obfuscate us and
completely ruin the future of podiatry. Perhaps
they have not read the enrollments and the
graduation rates.

Stop the secrets and let the world of podiatry
know what you are afraid of or, if those secrets
are that bad and irreparable, it might be time to
look for resignations. There’s time to halt
residents and fellows from working in private
practice for directors, time to beef up the
academic programs, and for programs without
advertised patient volume, time to close. There
also needs to be accounting for direct and
indirect costs so APMA members see where the money
goes. No secrets.

Let’s suppose APMA continues with CPME and COTH,
shunning ACGME. Well, students could attend a DO
school, spend the first post-graduate year in a
general internship to receive a plenary medical
license, then spend another two years in an ACGME-
approved residency outside the talons of the
polymath APMA, CPME, and podiatric COTH. APMA goes
the way of the Elevator Operators’ Union. The new
podiatrists will flip 100 heads in a row and all
the data will be made public.

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

Other messages in this thread:

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11/04/2025    David Secord, DPM

Podiatric Obfuscation (Rod Tomczak, DPM, MD, EdD)

I greatly admire the time and effort Dr. Tomczak
puts into his messages to us. I'm sure that he
will be remembered as a sage voice among us. As
such, here's my two cents, for what it's worth:

I am of course as old as dirt and don’t really
have a dog in this fight. I’m only still working
because I lost everything I owned in combination
with the Christus Spohn crucifixion and the 2008
banking-housing collapse given to us by the
Community Reinvestment Act (. Although I’ve
taken the USMLE I, II, and III practice exams and
passed with flying colors, we are at least a
decade away from our two, divergent paths.

One will be obsolescence (brought about by Topor-
induced, entrenched fiefdoms no one will
surrender); or common sense (add the classes and
residency rotations to become on par with our
other allopathic friends/competitors [once again
we are allopathic physicians and not osteopathic
physicians and should NOT be seeking a DO behind
our names], take and pass the USMLE I, II and III
and an approved residency.

I’m quite certain that the people in power will
not voluntarily relinquish their positions to
further the profession and face reality. They
would rather see the profession die than do what
is right, which would mean becoming unemployed.
That theme runs throughout the profession as a
whole. I’m willing to bet that the grand majority
of my peers who graduated more than 20 years ago
wouldn’t be able to read an EKG if their life
depended upon it. As that is one contextual
content of the USMLE, you are in a tough spot. The
new graduates are reported as knowing nothing of
general podiatry from the reports in Barry Block’s
listserve. Some have a certificate for a three-
year program and are reported to have never done a
“C” case (and should therefore be allowed nowhere
near a scalpel.) That would certainly be a concern
to the people at ACGME.

The old guys couldn’t pass the USMLE if their
lives depended upon it and will fight its
institution as a standard as they will be left in
the cold when we transform to an MD. The “haves”
and the “have nots” again. We know how this will
be addressed. We’ve seen it before. When standards
were imposed upon what it took to become board
certified, it included having done at least two
years of surgery at an approved program. The older
guys fought it with everything they had as a grand
majority did preceptorships and not hospital-based
residencies. There was an expensive lawsuit and
voilà, we had board certification via
“grandfathering.” No recertification, no testing,
no abilities.

Just how a patient could tell the difference
between two practitioners in our profession, both
of whom were ABFAS certified when one did a 3-year
residency and the other was grandfathered in was
up for grabs and only word of mouth assisted that
determination.

With the entrenched powers, I have no doubt that a
similar solution will be proposed (and rejected by
ACGME and the AMA). Of course, you shouldn’t have
an MD behind your name if you can’t legitimately
pass the USMLE I, II and III. No one on Earth
would allow a grandfathering into an MD degree. We
got away with grandfathering into surgical board
certification individuals who didn’t qualify
because it was incestual and expensive. My theory
on why any talks with ACGME are being rejected is
due to past history. Lets’ say a timeline was
established for a transition. You enter a program
which allows you to add the classwork and the
rotations and another date to take the USMLE, part
by part.

With the very first advertised dates for same, the
lawsuits fly from those who know that they will be
orphaned. The entrenched know how this will play
out and what it will cost and also know that there
will be no such thing as “grandfathering” to an
MD. A number—perhaps half—of the schools will be
closed as irrelevant and the number of residencies
needed to bring us up to par will be considered,
along with funding. As the new guard presses
forward into a new day of parity and opportunity,
armed with the plenary licensure we all desire and
need, the old guard will be cast off into
obscurity—and will fight back like hell, as they
did with the board certification question. The
ensuing schism will destroy us, as no
grandfathering solution can be offered and the
“all of us or none of us” mentality will take down
the ship.
The cruel irony of all this is that, for decades,
the orthopaedic community has been trying to kill
us off. Here in Texas, it accelerated when we
wanted the ankle and the leg above it. Florida
didn’t help the cause by going after the knee, but
there you go. I once had a spine orthopod call the
State of Texas Attorney General to demand that
charges be brought against me for doing ankle
surgeries (averaging about two a week.) I wasn’t
taking bread from his children’s mouths, he was
simply a podiatry hater, didn’t care whether I was
trained to do ankle trauma and didn’t care that it
was in my scope of practice. His comeuppance was
being kicked off staff for refusing to do “time
outs” before the beginning of a case. I was
present for that meeting with the Medical
Executive Committee and heard him vehemently deny
ever refusing to do a “time out.” That was
followed by a full half dozen surgical techs and
back table nurses as well as the DON documenting
how he refused to do “time outs” with his claim
that only the surgeon has the authority to
initiate such. The Joint Commission would
disagree. I presented him with a broad smile as he
was told that he was being dismissed from staff
and that move would end up on the NPDB report for
all to see. A different orthopod in town once had
the unmitigated temerity to state to my face: “I
don’t care how many ankle fractures you’ve done
between residency, fellowship and private
practice. NO Podiatrist is qualified to do an
ankle fracture.” As long as he opened the door, I
responded to him that a preponderance of redo
cases I inherit are from his efforts and that—in
my professional opinion—every, single foot and
ankle case he does appears to be active
malpractice and—if asked to do so—I would state
that opinion under oath. I offered to meet him
outside in my office to discuss this further if he
could borrow a pair of testicles from someone in
the room. He—being a coward with a big mouth—did
not rise from his chair, surprising no one.

When we decided to grandfather people into board
certification, I would hear some talk among the
orthopod community that our board certification
was worthless and one comment that “I could
probably get my dog board certified with their
standards.” In my milieu, the only way I finally
established a firm referral base and some respect
from the Ortho community was from results. My
being board certified, receiving a perfect 8 out
of 8 on the exam and being told that I did it in
record time (all ten questions answered in just a
couple of minutes) meant nothing. I was eventually
doing more ankle cases in my city than all of the
Orthopods combined and they were none too happy
about it.

A move was made by an Ortho group to have my
surgical privileges revoked for “violating
standard of care” because I never use a
tourniquet, use epinephrine in the block and never
admit as a short stay for indwelling drain or PCR.
My people don’t need a PCR as they don’t have pain
due to my use of “Supercaine” in the block before
I close (0.5% Marcaine with epi, mixed with 2%
Tetracaine plain) which renders an average of 36
hours of anaesthesia and because I don’t use a
tourniquet. Because of judicious use of cautery
for hemostasis, I don’t need a drain. The five
Orthopods presented their case and I presented
mine. I made the point that my final costs for the
exact, same procedure are far lower as I’m not
running up a hospital bill with the 23-hour
admission. I also demanded to have a presentation
of post-op infection rates. Theirs was 4% for
ankle procedures. Mine was none. In my career,
I’ve had one post-op infection, due to the patient
tripping over her dog and tearing open the
incision. One. Not one percent. One. At the
conclusion of all this and the dismissal of
charges against me, I then demanded that these
Orthopods face the exact, same meeting with the
Medical Executive Committee, to face the same
charge that they don’t follow the standard of
care. I threw the fact that their cost for doing
an ankle procedure was massively higher than mine
with the short-stay admission and was unnecessary.

I pointed out that a 4% post-op infection rate
when mine was 0% should be investigated by The
Joint Commission and that, until these cost and
post-op infection rates were addressed, all of
these surgeons should have their procedures
proctored and documented. There was much yelling,
screaming and accusations. After I left, I was
told by someone who remained that the head of the
Medical Executive Committee told these five
individuals that they started it, my concerns were
valid and that if you live in a glass house, you
shouldn’t throw stones. Needless to say, I never
heard a peep from this group or any other Orthopod
in town about my scope and privileges. Those were
the sort of wars I fought and with that sort of
vigor.

Oddly, in my city, I brought upon myself not only
the ire of the Orthopods, but my fellow
Podiatrists. They thought that I should simply
stop doing ankle and rearfoot procedures and “play
nice” so that the heat was off of all of us. No
one else in town had ankle or rearfoot privileges,
so they were paying no price by “giving those
areas up” to the Orthopods. My favorite procedure
is the ankle fracture and always has been. To hell
with the Orthopods who don’t like it. To make the
point, the Orthopaedic community has been trying
to kill us off for a long time, both locally and
regionally. Now, all they have to do is sit back
and watch us do the job for them. Time is not on
our side. You either adapt or go extinct. The
clock is ticking…

David Secord, DPM, McAllen, TX