Nature of the Work:
Podiatry or podiatric medicine is a branch of medicine dedicated to the study of diagnosis, medical and surgical treatment of ailment of the feet. Podiatrists treat the major foot conditions: Corns and calluses, ingrown toenails, and bunions. Other conditions treated by podiatrists include hammertoes, ankle and foot injuries, and foot complaints associated with diseases such as diabetes. For example, diabetics are prone to ulcers and infections due to their poor circulation.
In diagnosing a foot problem, podiatrists may order X-rays and laboratory tests. If the podiatrist determines that the problem is improperly fitting shoes, he or she may use a new instrument, the force plate, to help design custom-made shoes. A patient walks across the plate that is hooked up to a computer, which reads the patient's feet From the computer readout, properly fitted shoes can be designed. Depending on the diagnosis, they also fit corrective inserts called orthotics, prescribe drugs, order physical therapy, or perform surgery. Corrective surgery, performed in hospitals, outpatient surgery centers, clinics, or podiatrists' offices, is an increasingly important part of podiatric practice.
Some practitioners specialize in surgery. Other specialties are orthopedics and public health. Besides these three recognized specialties, podiatrists may choose subspecialty areas such as elderly care, sports medicine, and diabetic foot care. One of the biggest subspecialty areas is primary podiatric medicine, which is considered the family medicine of foot care.
Going to a podiatrist for treatment of a foot problem may be the entry point into the health care system for some patients since clinical signs of diseases such as arthritis, diabetes, and heart disease may first appear in the foot. Podiatrists are trained to spot these and other systemic diseases, and refer patients to other medical specialists when appropriate.
Working Conditions:
Podiatrists usually work independently in their own offices. They work over 38 hours a week, on the average. Podiatrists with solo practices set their own hours. Podiatrists who are employed in hospitals, health maintenance organizations (HMO's), or clinics may work nights and weekends and be on call.
Employment:
The vast majority of podiatrists are in private practice. Traditionally, podiatrists have been solo practitioners and most still are. Recently, however, other practice arrangements such as partnerships and group practices have begun to emerge. Some podiatrists are employed by hospitals, nursing homes, clinics, HMO's, and podiatric medical colleges. The Veterans Administration and public health departments employ podiatrists, too.
Geographic imbalances are pronounced in podiatric medicine. This reflects the fact that most podiatry graduates establish their practices in or near one of the seven States that have colleges of podiatric medicine. This has left large areas of the country - particularly the South, the Southwest, and nonmetropolitan areas - with few podiatrists. In these areas, foot care is typically provided by primary care physicians and orthopedists.
Training, Other Qualifications, and Advancement
All States and the District of Columbia require a license for the practice of podiatric medicine. Each State and jurisdiction defines its own licensing requirements. Generally, however, the applicant must be a graduate of an accredited college of podiatric medicine and pass written and oral examinations. Many States also require applicants to have completed an accredited residency program. Some States permit applicants to substitute the examination of the National Board of Podiatric Examiners, given in the second and fourth years of podiatric medical college, for part or all of the written State examination. Certain States grant reciprocity to podiatrists who are licensed in another State.
The nine colleges of podiatric medicine are located in California, Florida, Illinois, Iowa, New York, Pennsylvania, Ohio and Chicago. Prerequisites for admission include the completion of at least 90 semester hours of undergraduate study, an acceptable grade point average, and suitable scores on the Medical College Admission Test (MCAT). Certain undergraduate courses are required: Eight semester hours each of biology, inorganic chemistry, organic chemistry, and physics and 6 hours of English. Most entrants surpass the minimum qualifications. Although not mandated, 9 of every 10 recent podiatric students possessed a bachelor's degree.
Colleges of podiatric medicine offer a 4-year program whose core curriculum is similar to that in other schools of medicine. Classroom instruction in basic sciences, including anatomy, chemistry, pathology, and pharmacology, is given during the first 2 years. Third-year and fourth-year students have clinical rotations in different practice settings, including private practice, hospitals, and clinics. During these rotations, they acquire clinical skills, learning how to take general and podiatric histories, to perform routine physical examinations, to interpret tests and findings, to make diagnoses, and to perform therapeutic procedures. Graduates are awarded the degree of doctor of podiatric medicine, DPM.
Most graduates complete a 1 to 3-year residency after receiving the DPM degree. Competition for admission to residency programs is keen. Since 13 States have licensure provisions that require completion of at least 1 year of postgraduate education, failure to secure a residency may restrict a new DPM's choice of practice location.
Residency programs are hospital based. The first-year resident receives advanced training in podiatric medicine and surgery and serves clinical rotations in anesthesiology, internal medicine, pathology, radiology, emergency medicine, and orthopedic and general surgery. Second- and third-year residencies provide more extensive training in one of the three specialty areas.
There are three recognized certifying boards for the specialty areas: The American Board of Podiatric Surgery, the American Board of Podiatric Orthopedics, and the American Board of Podiatric Public Health. Certification means that the DPM meets higher standards than those required for licensure. Each board has specific requirements, including advanced training, success-ful completion of written and oral examinations, and experience as a practicing podiatrist
Persons planning a career in podiatry should have scientific aptitude, manual dexterity, and interpersonal skills. They must be able to acquire scientific knowledge and stay abreast of new developments in the field of medicine; develop the motor functions and professional skills needed for clinical practice; and develop personal rapport and empathy with patients. A good business sense and congeniality are assets, as in any medical profession.
Most podiatrists are in private practice, which means that they are in fact running a small business. Depending upon the size of the practice, podiatrists may handle administrative and managerial duties personally, or delegate decision making in these areas to an office manager.
Job Outlook
Employment of podiatrists is expected to grow much faster than the average for all occupations as more people turn to podiatrists for foot care. The growing population of the elderly and increased enthusiasm for sports will spur demand. The elderly have accumulated more wear and tear on their feet and lower legs than most younger people, so they are prone to foot ailments. In addition, the growing popularity of jogging, tennis, racquetball, and other sports is expected to result in more podiatric injuries that require medical attention. Even less strenuous activities, like low-impact aerobics, are likely to add to the demand for podiatric care.
Because health insurance helps people pay for podiatric care, widespread access to health insurance will contribute to increased demand in the years ahead provided current benefit patterns are not altered substantially. Generally speaking, Medicare and most private health insurance programs cover acute medical and surgical foot services as well as diagnostic X-rays, fracture casts, and leg braces. Routine foot care, including the removal of corns and calluses, is not ordinarily paid for by health insurance. Health maintenance organizations and other prepaid plans may provide routine foot care, however.
In addition to opportunities created by rapid growth in employment, many openings will result from the need to replace podiatrists who retire or stop working for other reasons. Opportunities for graduates to establish new practices, as well as to enter salaried positions in group practices and special foot clinics, such as diabetic foot centers, should be excellent.
Related Occupations
Podiatrists work to prevent, diagnose, and treat diseases, disorders, and injuries. Workers in other occupations that require similar skills include chiropractors, dentists, optometrists, physicians, and veterinarians.
