12/30/2025 Rod Tomczak, DPM, MD, EdD
Cherry Picking
On December 19, 2025, I received a publication
titled “The Wonderful Mind of a Med Student” by
Haroon Tariq. This particular issue literally
scared the hell out of me. Over the past year I
have been criticized and condemned by my podiatric
confreres who have interpreted my submissions as
calls for the demise of podiatry. In reality, they
have been just the opposite, but many short
sighted podiatrists have neglected the long-term
ramifications of the almost quadratic growth in
osteopathic schools where we can grow while
sustaining our heritage, belief system, and
philosophy as DO podiatrists.
My postings have been met with responses that
flaunt the economic status of some podiatrists,
the financial stability of the profession, and the
responses of debt-free, well established, familial
practices that push the seven figure mark while
neglecting the young podiatrist who can not
partake in the joys of family, home ownership,
private education for the children and a
comfortable senior living plan for parents. Those
are not sufficient reasons to preserve the status
quo.
My thoughts have never been to diminish the
lucrative nature of podiatry for the well-
established podiatrist, but I hoped to serve up a
warning for the young podiatrist who is a multiple
six figure factor in debt. I have never belittled
a podiatrist who works hard and is due what he or
she works for. My concerns are worries about the
future of the first generation DPM who suddenly is
employed by an organization that expects almost
impossible production of RVUs. Unless the new
practitioners ethics become flexible or this
twenty something man-child stumbles into an
unbelievable situation where total ankles and
multiple rearfoot fusions become the “la situation
normale.” The temptation for flexible ethics
become justified by personal and family needs. We
have all seen questionable high dollar testing
being ordered and unnecessary procedures
performed. That has become the new normal.
I thought I would research this Haroon Tariq who
emerges as a remarkable individual but there is no
indication he is a physician. He is of Pakistani
decent and has earned an A grade in 47 different
international tests offered by Cambridge
Assessment International, something equivalent to
scoring perfect scores in the PSAT, SAT, ACT,
LSAT, MCAT, and multiple GREs. I thought an
individual of such caliber would certainly be a
member of MENSA or a triple 9 society, but he is
not. But he does have insight into the wonderful
mind of a medical student. This issue is devoted
to comparing a DO to an MD and exploring any
differences.
I never signed up for this email publication but
suddenly I am on a mailing list. How? I’m not
applying to MD or DO schools but have emailed the
podiatry schools asking for information. By this
time of year most MD schools have already
conducted the majority of their interviews for the
class beginning in the summer of 2026 and sent
some acceptances for a calendar year that hasn’t
even begun yet.
Traditionally, the MD applicants who were sent
letters telling them they didn’t make the cut for
an interview are now in a scramble mode. What are
they going to do? Some have applied to dental
school. Historically, many applied to one or more
of the 11 osteopathic schools which have ballooned
to some 37 schools. Podiatry schools had their
biggest influx of applicants when it became
apparent that they were not going to be accepted
or maybe even interviewed by a DO or MD school so
it was time to scramble. Well, the scramble just
got more interesting with all the new DO seats to
fill. Arguably, the students who are at the top of
the DPM applicant pool are suddenly at the top of
the DO pool. Good advertising doesn’t let you know
you are the target of the advertisement.
When they applied to MD programs they may have had
a specialty in mind, but when that application did
not come to fruition, they could have applied to
one of the former 11 DO schools with that
specialty still in mind. If, however the big
application wheel of fortune stopped on podiatry,
the option of specialty training suddenly had very
few options. Currently there are over 30
osteopathic schools, where the options are the
same as the MD profession. It could be more than
the MD wheel if we added podiatry.
I have also received two emails from “Future
Physicians Newsletter Team.” The newsletters
espoused the joys of AI in medicine for the future
but also warning that there is a strong temptation
to lose any empathy I have already brought to the
forefront during my premed days. It offered me a
strong bibliography from places like Mayo,
Cleveland Clinic, NIH and CNBC. There were also
references to connecting to extracurricular
websites and opportunities mentioned in the
websites, but the e-mails had a subtle slant
toward the osteopathic “whole body” philosophy.
I trained in two DO hospitals during my PSR 24+. I
gave a short talk at one of the DO schools a few
years ago and when I mentioned I spent the first
year of my residency at Metropolitan Hospital in
Philadelphia I suddenly became the fair-haired
golden boy. I was questioned about the hospital
and how difficult it was as a student to deserve a
clerkship there and how highly sought after a DO
internship was at Metropolitan and a year there
wiped away the knowledge gap between them and MDs.
When I told them I spent a couple months on a
physician’s service whose name was Bill Nickey, it
was as if I had been to the top of the DO
mountain. He was legendary as far as osteopathic
educators were concerned. I spent many nights in
the hospital library or fell asleep at my desk in
my apartment preparing for tomorrow’s rounds. I
put a lot into those two months and during my
second year asked to come back from Cherry Hill
for another month at Metropolitan as an elective.
The point is, I worked harder during those months
than I expected and I really felt more challenged
than I did in podiatry school where I was often
told, “You don’t need to know that.”, when asking
a question in class or clinic. Early in the first
rotation, DO students and residents asked why I
was putting myself through all this when I didn’t
need to know it. Like hell we don’t need to know.
If we want to be equal to other “two initials
after their name” doctors in the hospital, we need
to know the basic science and medicine they all
know and prove it by passing USMLE.
I’m not talking about a watered-down medical
assistant version, but the real thing. Just
because Robbin’s Pathology was a mandatory
textbook, doesn’t mean I read or understood it. I
think we had a medicine course, and we had a
general surgery course taught by a surgeon who
gave an exam on nothing he talked about because he
said he wanted to see what we didn’t know. In
reality, he finally admitted he didn’t want to
make up a new exam. Courses should be taught by
someone who has attained the next level of
expertise above that particular level expected to
be learned. For example:
Are serum creatinine and GFR linearly related? The
MD and DO know the answer and why. A renal
physiologist teaches basic physiology, a
pathologist teaches what happens on a molecular
level in renal disease, a nephrologist clarifies
renal disease and its effects on the whole body, a
renal pharmacologist explains any medications to
treat the problems, a urologist clarifies forms of
kidney surgery, a dialysis nephrologist describes
how he keeps a patient alive until a match for
transplant can be found and how to determine if
the patient is a candidate.
Trying to explain this authoritative approach to a
student in the throes of application mayhem to
medical or podiatry schools falls on deaf ears.
It’s like debating how many angels can dance on
the head of a pin. It’s meaningless to the student
and if the faculty member is going to tell the
truth, the difference between the medical school
and the podiatry school is infinite. Don’t come up
with that time worn response that, “Podiatrists
don’t need to know that.” Yes, we do. Are you
going to send your patient for preop clearance to
his family doc when you know the serum creatinine
is 1.5 mL/min/1.73m²?
I think DOs are seeing how important it is for
podiatrists to know the answer and are increasing
the number of first year seats around the country.
The new schools are not opening to make money. If
there is any surplus, it is reinvested in more
faculty or better facilities. Tuition usually
accounts for about 50% of the cost of running the
school. Grants are an important part of the income
and usually need PhDs to perform the research.
PhDs at podiatry schools hardly have the extra
time needed to devote to finding new knowledge;
they are teaching kidney a large part of the day.
Podiatry saw a niche and filled it. Osteopathy
sees a niche and seeks to fill it, and podiatry
can come along if it chooses wisely. We know from
the 2025 survey through PM News that 86% of the
690 podiatrists who responded preferred a DO
degree.
If we want to keep the DPM philosophy, a
philosophy every one of us have worked hard to
build and make prosperous, we need to grasp
control of our own future. Wound care nurses are
carving out a section of our niche and are working
independently. I used to sit here and type that
we, podiatrists do it better. You know, I have no
evidence that’s true. I hope we do it better, but
no one has done a head-to-head comparison of their
certified wound care specialists when we can’t
declare we have podiatric wound care specialists
who are certified. The certifying board doesn’t
seem to think it’s important.
There are some pretty convincing videos on the
internet on how to perform podiatric services, and
there are podiatrists in town who send patients to
the “Good Feet” store and receive a legal
educational salary and consulting fee per year.
ColoGuard requires a licensed referral, but a PA
or NP suffice. Not so for the “Good Feet”
orthotics. Where’s our APMA? The annual revenue of
all the “Good Feet” stores is $147,000,000 and the
average yearly revenue per store is $740,000. The
start-up cost per store is less than a student’s
debt incurred to graduate from podiatry school.
Pedicurists cut nails and reduce calluses. They
charge on a sliding scale depending on how many
different oils get used and massages are
performed. A visit to a pedicurist may be cheaper
than an office visit to a podiatrist to get your
nails cut unless you’re a diabetic. The APMA does
not list the average price for nail trimming.
Wound journals are authored by non-podiatrist
nurses and PAs, JFAS is mostly authored by foreign
MDs.
The most recent issue of JAPMA contains an article
from the Arizona school that surveyed high school
and college students concerning their awareness of
podiatry and found their knowledge of podiatry is
dismal. Students are graduating with enormous debt
and the present national government administration
has put limits on medical school loans meaning
private funding must be found to pay podiatry
school tuition, eat more than Rice Krispies all
day every day, and have a place to sleep within
walking distance to school.
The solution to these problems and loss of the
podiatry profession in the near future is to cut
our losses and join forces with the DO community
but maintain our intrinsic podiatric philosophy
except with a DO degree, one-year DO internship, a
two-year podiatric residency then a fellowship
that caters to more than just surgery. This does
not mean that present DPMs will be cut out of
anything, but I think today’s DPMs fear losing
something they have worked so hard for.
I expect there will be letters which advocate
staying the course, keeping a stiff upper lip,
finding joy where we are, and listing all the
things we are achieving, but neglecting a look to
the future; yes, the things they say are true for
them, they are true for the fortunate few who have
been in practice a long time and rode the wave of
prosperity to the present. They may even quote the
song by Timbuk 3 which I propose become the
podiatric anthem, “My Future’s So Bright I Gotta
Wear Shades.”
Rod Tomczak, DPM, MD, EdD, Columbus, OH
