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

There are no more messages in this thread.