There are approximately 14,000 practicing doctors of podiatric medicine in the United States. The skills of these physicians are in increasing demand because foot disorders are among the most widespread and neglected health problems affecting people in this country.
An estimated 75 percent of Americans will experience foot problems of varying degrees of seriousness at one time in their lives. As more Americans engage in exercise and fitness programs, more of them become aware of the limits foot and ankle pain places on full participation. Since foot and ankle problems are often the result of a lifetime of neglect, and the number of older Americans is increasing almost three times as fast as the population as a whole, they may account for a disproportionate share of the growing demand.
Education of the Podiatric Physician
There are seven colleges of Podiatric Medicine: Barry University School of Graduate Medical Sciences, California College of Podiatric Medicine, Des Moines University College of Podiatric Medicine and Surgery, Dr. William M. Scholl College of Podiatric Medicine, New York College of Podiatric Medicine, Ohio College of Podiatric Medicine, and Temple University School of Podiatric Medicine.
They all receive accreditation from the Council on Podiatric Medical Education, which is recognized by the US Secretary of Education and the Council on Higher Education: they grant the degree of doctor of podiatric medicine (DPM).
Candidates for admission to all seven colleges are expected to complete baccalaureate degrees before admission. As with institutions granting MD (medical doctor) and DO (doctor of osteopathy) degrees, the colleges will consider candidates who show unusual promise andhave completed a mininum of 90 semester hours at accredited undergraduate colleges or universities. About 95% of all first-year students enter the colleges of podiatric medicine possess baccalaureate degrees, and about 10% have advanced degrees.
Applicants for admission are required to complete the Medical College Admission Test (MCAT) as a prerequisite, although some of the college accept the Graduate Record Examination (GRE) as well.
The course of instruction leading the DPM degree is four years in length. The first two years are devoted largely to clasroom instruction and laboratory work in the basic medical sciences such as anatomy, physiology, microbiology, biochemistry, pharmacology, and pathology. During the third and fourth years, students concerntrate on the courses in the clinical sciences, gainign experience in the college clinics, community clinics, and accredited hospitals. Clinical courses include general diagnosis (history taking, physical examination, clinical laboratory procedures, and diagnostic radiology), therapeutics (pharmacology, physical medicine, orthotics, and prosthetics), surgery, anesthesia, and operative podiatric medicine.
After completing the four-year course and receiving the DPM degree, the graduate is eligible to take a state board examination to obtain a license to practice in about one-third of the states; two-thirds require an additional year of postdoctoral work before licensure.
As they near graduation, most prospective podiatric physicians seek postdoctoral residency programs. These programs, designed to strengthen and refine the practitioner's prodiatric medical primary care, orthopedic and/or surgical skills, are based in hospitals accredited by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) and the American Osteopathic Association. The programs are at least one year in duration, and may extend to three years.
Almost all states impose some continuing podiatric medical education requirements for license renewal, and there is good attendence at many educational programs and seminars developed and presented each year by the colleges and local, state, and national podiatric medical associations.
Podiatric physicians are licensed in all 50 states, the District of Columbia, and Puerto Rico to treat the foot and its related or governing structures by medical, surgical, or other means. The vast majority of states also include ankle care as part of the podiatric physician's scope of practice. In addition to private offices, podiatric physicians serve on the staffs of hospitals and long-term care facilities, on the faculties of schools of medicine and nursing, as commissioned officers in the Armed Forces and US Public Health Service, in the Department of Veterans Affairs, and in municipal health departments. Many podiatrists today are also members of group medical practices.
Special Areas of Practice
In its continuing efforts to protect and improve public health and welfare, CPME has recognized and approved two specialty boards that certify in three areas:
primary podiatric medicine
These boards confer certification on a podiatric physician who has satisfactorily passed written and oral examinations and has demonstrated knowledge and experience in his or her chosen specialty.
Those boards are the American Board of Podiatric Orthopedics and Primary Podiatric Medicine, in Chicago, and the American Board of Podiatric Surgery, in San Francisco.
There are also podiatrists who are board certified in public health, through a certifying board that ceased to exist in 1994.
Health Insurance Coverage
Nearly all private and public health insurance plans provide coverage for the services of doctors of podiatric medicine. Even though third-party coverage of podiatrists' services generally includes the medical and surgical care of foot complaints, details of such coverage can and do vary among plans. The same applies to federal health insurance plans, including Medicare, federal employee health benefits, and federal employee compensation programs. Medicaid, however, is an exception to this general rule; it is prescribed in federal law as an option rather than a mandated service and is determined on a state-by-state basis.
Community Podiatric Medicine
Consistent with the podiatrist's education and licensure, JCAHO, the American Medical Association, and other organizations recognize the right of qualified podiatric physicians to serve on the staffs of hospitals and other health care facilities. According to a 1998 surve of hospitals, an overwhelming majority of them (80.6 percent) had podiatric physicians as part of their medical staff.
There is a strong and growing role for podiatrists in public health. There has been a podiatric health section in the American Public Health Association (APHA) for nearly two decades, and APHA has a policy statement which represents minimum professional standards for public health units which have foot health programs.
The growth in numbers among podiatrists in the federal service has been most impressive since two occurrences in the 1970s. First, the Veterans Omnibus Health Care Act of 1976 launched an expanded VA podiatric medical program. By granting VA podiatrists Department of Medicine and Surgery classification and compensation benefits, the new law strengthened the VA's foot health services.