03/27/2026 Rod Tomczak, DPM, MD, EdD
With the Stroke of a Pen
Many years ago, I was asked to evaluate the
chiropody program at the Michener Institute in
Toronto. The Michener prepares allied health
science personnel such as radiology technicians,
anesthesia assistants, cardiac stress testing
techs and the like. Chiropody is among other
ancillary healthcare support programs.
Specifically, I was asked to determine if the
chiropody program could be transitioned into a DPM
podiatry program and what would it take to
accomplish that educational feat. I spent eight
days visiting the school, off-site externships,
chiropodists in practice both private and employed
by hospitals in Toronto and in other close by
Ontario cities. I administered some old student
tests to the appropriate years. I was given a
laptop to use while there. All data and what I
wrote was to stay at the Michener. I arrived on a
Monday and left the next Tuesday.
There was no way the curriculum could be converted
to a DPM program and expect their three-year
course to prepare students for our National
Boards. The DPM podiatrists who were in Ontario
had all trained in the US and passed our national
boards. The report concluded with the admonition
that it would be easier to begin from scratch if
the Ontario government wished to have its own DPM
program. What existed at the time was a three-year
chiropody program similar to what the U..S had in
the late 50s or early 60s with the exception of
diabetic foot care and biomechanic/orthotic
knowledge. Basic science, medicine, pharmacology
and surgery, podiatric and general were seriously
deficient.
Years later, I heard that there would be no new
podiatry licenses issued in Ontario. Chiropodists
would continue to be trained at the Michener and
when the last podiatrist closed his doors, more
complicated diabetic foot salvage and bone work
would be provided by orthopedic surgeons who had
assured the government they could handle the load.
Hence there was no need to start a podiatry school
in Ontario. The diabetic foot problems among the
Indigenous Peoples in Canada which consists of the
First Nations, Inuit, and Metis people could be
taken care of. Diabetes is 3 to 5 times higher
among the First Nations in Canada than the general
population. The First Nations also have an alcohol
abuse problem that is higher than among the normal
Canadian population. Since 1993 if a podiatrist
wishes to practice in Ontario, it is as a
chiropodist. The orthopaedic surgeons have
convinced Parliament they will be able to care for
diabetics whose pathology is out of the purview of
the chiropodists.
I started my talk at Dr. Jacobs’ seminar last
weekend with the above story. I told the over 260
souls in the audience, “Let’s get something
straight from the beginning. I am not nor ever
have been for the demise of podiatry. Never have
been, never will be. No, no, and no.
I have spent the last 5 years in a LazyBoy and
wheelchair because of an infected total knee
replacement performed by partners in the
orthopedic department at Ohio State that have left
me non-ambulatory and I have been suffering
profound depression because I cannot practice
podiatry. I miss my profession intensely.
Podiatrists who have run around preaching that I
am advocating the demise of podiatry are panic
stricken and flat out wrong. The last thing I want
to see is podiatry self-destruct because students
are no longer interested in a DPM degree. If
that’s the case, what radical measures must we
take to rekindle the interest in podiatry while
preserving the philosophy that those who have gone
before us have devoted their lives building even
if it means changing the degree as long as we can
save limbs among other tasks intrinsic to our
profession while fostering the philosophy.”
We who have around awhile been not turned off by
the DPM degree nor are we repulsed by the idea of
working on putrid, infected feet. My CRNA daughter
recently administered anesthesia to a diabetic
taking Jardiance who had developed necrotizing
fasciitis of the perineum and scrotum. She
survived the experience as have ll of us worth our
salt running into mixed organism necrotizing
fasciitis and survived. I think it’s safe to say
it’s not the grossness of some of the pathology
that is keeping people away from the profession.
The money is good. Twenty-one percent of people in
solo practice bring home less than $50,000 a year,
but management groups are helping correct that.
Young practitioners must beware of the ever-
increasing RVU trap. You’re tempted to sell your
soul to keep up with next year’s demands. And,
it’s not the money that drove us to podiatry or
any medical specialty, or at least it shouldn’t
be. This profession is a vocation.
Podiatrists can now eat lunch in the hospital
doctors’ cafeteria with the adults, park in the
doctors’ lot, be on the laundry committee, on the
OR scheduling committee or coach the women’s
softball team if you want. Every hospital differs
on policy and procedures. If you want to go into
academic medicine you can call someone and beg for
a job, or at least you could during our heavy
admissions heyday. Now there’s not so many jobs.
Promotion and tenure can be tricky committee to
sit on. At Des Moines, even Len Levy tried to add
his own interpretation to the school constitution
and by-laws concerning that tricky situation.
I have never needed to use an MD degree to treat a
patient. When the patient is sick, I prefer
someone who is an expert on CKD or the new
hypoglycemics. I’m not an expert in general
medicine but administrators still think the people
starting an MD school should have an MD degree.
That way when the neuro-ophthalmologist wants more
hours in the curriculum addressing ischemic optic
neuropathy I can explain why that is best left to
the next level of training unless we are willing
to start a fifth year of medical school.
I think pre-med advisors are still telling college
kids the DPM degree is not on par with the DO and
MD degrees. These advisors have been around a
while and they aren’t going to change. In a
nutshell in order for podiatry to live on, we have
to make it as appealing as any other DO
specialist. Suddenly generation Alpha will believe
something we have believed for decades. We have to
get to DO students and introduce them to podiatry
and whet their interest, stimulating them to look
into a DO podiatry as a new but as we know, old
specialty. Anecdotal stories about one vascular
surgeon telling us anointed podiatrists how
indispensable we are, won’t fly anymore. Why is
the value judgement and opinion of one vascular
surgeon so important? Because he or she is an MD
or DO?
We do have to be sure of the residency funding
before making a move that there is no turning back
from. If residency money that is already there for
DPMs can be transferred to physicians that carry a
DO/MD degree but have the moniker of podiatrist,
we will have successfully avoided training
competition like nurses or PAs that previously
served as referrals. If NPs and PAs are trained to
perform tasks presently restricted to podiatrists,
we have merely created new rivals for ourselves
But the way I see it, there were a significant
number of unfilled podiatry residencies this year.
Someone in the NP or PA camp is certain to notice
there is money that is not being spent.
Our goal should be to create a niche for DO
podiatrists that flourishes yet retains our
philosophy of caring for a certain section of the
population like we have been doing. We have
reached that division in the road where we must
truly make an existential choice if we want to
keep podiatry flourishing.
So what do we choose, remain DPMs with dwindling
numbers or take the leap to a thriving DO podiatry
population? You and I will most likely never see
it, but that infant just discovering his feet
will.
Rod Tomczak, DPM, MD, EdD, Columbus, OH
