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The human foot is a complex structure. It contains 26 bones-plus muscles, nerves, ligaments, and blood vessels-and is designed for balance and mobility. Podiatrists, also known as doctors of podiatric medicine (DPM's), diagnose and treat disorders, diseases and injuries of the foot and lower leg to keep this part of the body working properly.
Podiatrists treat corns, calluses, ingrown toenails, bunions, heel spurs, and arch problems; ankle and foot injuries, deformities and infections; and foot complaints associated with diseases such as diabetes. To treat these problems, podiatrists prescribe drugs, order physical therapy, set fractures, and perform surgery. They also fit corrective inserts called orthotics, design plaster casts and strappings to correct deformities, and design custom-made shoes. Podiatrists may use a force plate to help design the orthotics and shoes. Patients walk across a plate connected to a computer that "reads" the patients' feet. From the computer readout, podiatrists order the correct design.
To diagnose a foot problem, podiatrists order x rays and laboratory tests. The foot may be the first area to show signs of serious conditions such as arthritis, diabetes, and heart disease. For example, diabetics are prone to foot ulcers and infections due to their poor circulation. Podiatrists consult with and refer patients to other health practitioners when they detect symptoms of these disorders.
Most podiatrists have a general practice. Some specialize in surgery, orthopedics, or public health. Besides these certified specialties, podiatrists may practice a subspecialty such as sports medicine, pediatrics, dermatology, radiology, geriatrics, or diabetic foot care. Podiatrists generally are in private practice, which means that they run a small business. They may hire employees, order supplies, and keep records.
Podiatrists usually work independently in their own offices. They may also spend time visiting patients in nursing homes or performing surgery at a hospital. Those with private practices set their own hours, but to meet the needs of their patients, they may work evenings and weekends.
Podiatrists held about 13,000 jobs in 1994. Most podiatrists are solo practitioners, although more are entering partnerships and multi-specialty group practices. Others are employed in hospitals, nursing homes, and offices and clinics of physicians, including health maintenance organizations (HMO's). Public health departments employ podiatrists, too.
Geographic imbalances are pronounced in podiatric medicine. Most podiatry graduates establish their practices in or near one of the seven States that have colleges of podiatric medicine-California, Florida, Illinois, Iowa, New York, Pennsylvania, and Ohio. Large areas of the country-particularly the South, the Southwest, and nonmetropolitan areas-have few podiatrists. In these areas, foot care is typically provided by primary care physicians and orthopedists.
All States and the District of Columbia require a license for the practice of podiatric medicine. Each defines its own licensing requirements. Generally, the applicant must be a graduate of an accredited college of podiatric medicine and pass written and oral examinations. 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. Thirty-two States also require completion of an accredited residency program. Certain States grant reciprocity to podiatrists who are licensed in another State. Thirty-eight States require continuing education for licensure renewal.
Prerequisites for admission to a college of podiatric medicine 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). All require 8 semester hours each of biology, inorganic chemistry, organic chemistry, and physics and 6 hours of English. Over 90 percent of podiatric students have 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. During the first 2 years, students receive classroom instruction in basic sciences, including anatomy, chemistry, pathology, and pharmacology. Third- and fourth-year students have clinical rotations in private practices, hospitals, and clinics. During these rotations, they learn how to take general and podiatric histories, perform routine physical examinations, interpret tests and findings, make diagnoses, and perform therapeutic procedures. Graduates receive the doctor of podiatric medicine (DPM) degree.
Most graduates complete a hospital residency program after receiving a DPM. Residency programs last from 1 to 3 years. Residents receive advanced training in podiatric medicine and surgery and serve clinical rotations in anesthesiology, internal medicine, pathology, radiology, emergency medicine, and orthopedic and general surgery. Residencies lasting more than 1 year provide more extensive training in specialty areas.
There are a number of certifying boards for podiatric specialties. Certification means that the DPM meets higher standards than those required for licensure. Each board requires advanced training, completion of written and oral examinations, and experience as a practicing podiatrist.
People planning a career in podiatry should have scientific aptitude, manual dexterity, interpersonal skills, and good business sense.
Podiatrists may advance to become professors at colleges of podiatric medicine, department chiefs of hospitals, or general health administrators. They may also enter a higher degree program.
Employment of podiatrists is expected to grow about as fast as the average for all occupations through the year 2005. More people will turn to podiatrists for foot care as the elderly population grows. The elderly have more years of wear and tear on their feet and lower legs than most younger people, so they are more prone to foot ailments.
In addition to growth, the need to replace podiatrists who leave the occupation will create employment opportunities. Relatively few opportunities from this source are expected, however, since most podiatrists continue to practice until they retire; few transfer to other occupations. Even when combined, the number of job openings resulting from both growth and replacement needs is very low because the occupation is small.
Like dental services, podiatric care is more dependent on disposable income than other medical services. Medicare and most private health insurance programs cover acute medical and surgical foot services, as well as diagnostic x rays and leg braces. However, routine foot care-including the removal of corns and calluses-is ordinarily not covered. Because disposable income is expected to rise, more people are expected to pay for podiatric care out-of-pocket.
Establishing a new podiatric practice will be most difficult in the areas surrounding the seven colleges of podiatric medicine and in the Northeast since podiatrists are concentrated in these locations. Newly trained podiatrists will be more likely to work in group medical practices, clinics, and HMO's than in a traditional solo practice.
According to a survey by Podiatry Management, median net income of podiatrists was about $95,600 in 1994. Earnings vary according to practice size and location, and years of experience.
Workers in other occupations who apply scientific knowledge to prevent, diagnose, and treat disorders and injuries are chiropractors, dentists, optometrists, physicians, and veterinarians.
For information on podiatric medicine as a career, contact:
American Podiatric Medical Association, 9312 Old Georgetown Rd., Bethesda, MD 20814-1621.
Information on colleges of podiatric medicine, entrance requirements, curriculums, and student financial aid is available from:
American Association of Colleges of Podiatric Medicine, 1350 Piccard Dr., Suite 322,Rockville, MD 20850-4307.
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