Career As a Podiatrist

CAREER AS A

PODIATRIST

Institute Research Number 310 ISBN 1-58511-310-7 DOT Code 079.101-022 O*NET SOC Code 29-1081.00

CAREER AS A PODIATRIST DOCTOR SPECIALIZING IN FOOT HEALTHCARE

THE MAJORITY OF AMERICANS – ABOUT THREE-QUARTERS OF US – EXPERIENCE

problems with our feet at some time in our lives. There are many minor problems like corns and ingrown toenails, and more serious deformities, infections or injuries involving our feet. Podiatrists specialize in the prevention and treatment of healthcare conditions of the foot and ankle from the simplest to the most complex. In fact, Americans neglect their feet for the most part, even though that neglect may lead to often-painful conditions. As baby boomers age, and more and more of us play sports or exercise regularly, the need for foot healthcare professionals is increasing. Today, over 14,000 practicing doctors of podiatric medicine care for patients throughout the United States. Often operating out of medical offices as solo practitioners (a physician who works alone, not sharing the practice with other physicians), podiatrists treat patients of 2

all ages with all types of foot and ankle conditions. Once trained and certified, they may also operate on patients for these conditions in a surgery center or hospital. Others work in group practices formed by several podiatrists or as part of a physician office with several medical specialties. In any case, the podiatrist remains largely self-employed. On the other hand, some podiatrists work for public health agencies or other health care providers as employees. Becoming a podiatrist demands time and a thorough education. Every state requires a license to practice podiatry and the accompanying medical/podiatric education. Only seven colleges of podiatric medicine operate in the United States and those interested in podiatry as a career must meet the criteria for admission. The seven accredited colleges grant the degree of Doctor of Podiatric Medicine (DPM). Once podiatry students graduate and enter the field, they become licensed in the state in which they will practice. After setting up podiatry practice, they continue to receive training. In fact, most states require continuing education to maintain podiatry licenses. The medical field offers a number of opportunities to those with the right skills and training. Economic factors – how podiatrists and other healthcare providers get paid for their services – can change, especially affected by managed care and health insurance provisions. But the need for medical care remains constant and will build in the coming decades. The American Podiatric Medical Association (APMA) reports a strong and growing role for podiatrists. The organization works with its members to promote the profession and to educate the public on foot health. In addition, the APMA works with its members and colleges to recruit the top caliber professionals to join the field. While this career requires hard work for entry, once in the profession, most podiatrists – particularly younger practitioners – report that they enjoy a more balanced lifestyle and less stressful practice than most medical providers. At the same time, they enjoy excellent salaries. As the need for better foot health continues in our country, the demand for qualified podiatrists will expand. And the stature of these healthcare professionals as essential members of the medical community should continue to improve. 3

HOW TO BEGIN FIND OUT MORE ABOUT BECOMING A PODIATRIST SO YOU CAN CHOOSE THE RIGHT

educational path as soon as possible. You’ll most likely need a bachelor’s degree to gain entrance to a podiatric school of medicine. You’ll also need to pass a medical college admission test that will gauge your overall knowledge of medical topics.

First, decide if you have the patience, skills and desire to attend school a minimum of at least eight additional years after graduating from high school before beginning your career. Assess your current likes and dislikes. Do you enjoy school, especially classes like biology and chemistry? Are you able to handle the financial side of many years of school, with the help of scholarships, savings, employment or family? You can probably complete your undergraduate education at a school of your choosing in your home area, but will you mind moving away to go to one of the accredited schools that offer degrees in podiatric medicine? Once ready to enter the field, you can work just about anywhere, depending on the number of podiatrists already in a community or the type of employment you want. Since many podiatrists are self-employed, you’ll want to make sure you’re comfortable handling the business side of the career as well. Go online to find out more about podiatry from the APMA and podiatric schools. Learn a little more about diseases of the foot from APMA’s Web site and brochures, as well as from other consumer medical Web sites. Search podiatry career listings and see what types of jobs are currently open, as well as their locations and required skills. If working with people’s feet seems different or even unpleasant to you, consider the benefits of the job and the importance foot health and comfort play for people of all ages and walks of life. You’ll work closely with other medical providers too, so be sure you can enjoy working with colleagues and can understand a wide range of medical conditions. The best way to learn about a career in podiatry is to visit with a podiatrist near you. Most of the professionals in your community will probably be happy to meet with you, show you around their offices, and even let you shadow them on the job. If you can’t find a podiatrist to talk with in your area, contact the APMA. 4

HISTORY OF PODIATRY CAREERS COMPARED TO THE LONG HISTORY OF THE MEDICAL PROFESSION AS A WHOLE, THE

discipline of podiatry is relatively young. However, people have always needed foot care and historians have traced early records of foot care to ancient civilizations of the Greeks, Assryo-Babylonians and Egyptians. Advice about foot care is recorded as early as 2500 BC in ancient Egyptian tombs. The famous Ebers Papyrus, estimated to date to about 1500 BC, promotes applying olive oil and cow fat to corns. Biblical passages also refer to ministrations of the foot.

As early as 60 BC, Hikesios of Myrna employed plaster preparations to treat corns. The writings of Hippocrates, dating from about 460 – 377 BC, refer to clubfoot and calluses. By around 615 AD, Paul of Aegina describes a surgical approach to corns and calluses. By the 14th century in northern Europe, the Guild of Barber-Surgeons was established. The guild’s members pulled teeth, did bloodletting, cut corns and made preparations for pain relief. Scholars guess that the surgeon, dentist and podiatrist all evolved from this guild. By the 1700s, medical specialization began in France. A 1714 textbook on dermatology included a chapter on diseases of the hands and feet including extensive mention of warts and corns. A French surgeon named Rousselot began to specialize in foot care, writing the first book on the subject called Memoire sur les cors des pieds (Dissertation on Corns of the Feet) in 1755. Interestingly, corn cutting was still not the practice of physicians and surgeons at that time, since they considered the procedure beneath their dignity. These foot conditions were treated mostly by corn cutters who likely combined the trade with tooth pulling. A German named Heyman Lion settled in Edinburgh, England in the latter half of the 18th century. He published a book in 1802 titled Treatise Upon Spinae Pedum (the term he used for corns). In 1826, Lewis Durlacher, who called himself a surgeon-chiropodist, demonstrated his method for treating ingrown toenails at the Hospital for Surgery in Bath, England. A full account of the technique appeared in The Lancet, a respected English medical journal, in the same year.

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Most consider Durlacher the founder of chiropody, which later became known as podiatric medicine. He wrote a book in 1845 titled A Treatise – Corns, Bunions, the Diseases of Nails and the General Management of the Feet. The book contained the first descriptions of several foot conditions, including infected ingrown nails and plantar warts. In the United States in 1840, members of the family of Nehemiah Kenison were traveling around New Hampshire treating the feet of mill employees in cotton and shoe factories. He was later elected to the New Hampshire state legislature and given the honorary title of “doctor.” In New York in 1843, John Littlefield opened an office and became the first practitioner in the United States to use the chiropodist designation. In 1879, the Journal of the Illinois State Medical Society published the first podiatric bibliography entitled The Chiropodist. In 1895, a small group of men founded the Pedic Society of New York and petitioned its legislature for a bill that led to the enactment of the first law regulating the field. By 1908, New Jersey legally regulated chiropody practice. George Erff was president of the Pedic Society of New York and in 1910, he and 166 members of the society proposed that podiatric educational facilities be established. They also proposed a code of ethics and examinations for candidates. In 1912, the National Association of Chiropodists (NAC) began. NAC was the forerunner of the American Podiatric Medical Association. The first school for podiatry was established in New York in 1911. The New York School of Chiropody was the forerunner of the New York College of Podiatric Medicine, one of only seven such colleges offering the DPM today. Shortly after that, less than a year later, the Illinois College of Chiropody and Orthopedics was established. Eventually, the school became the Scholl College of Podiatric Medicine, which also still operates today. Soon, other colleges opened around the country. The New York Board of Medical Examiners drafted successful legislation allowing for licensing of chiropodists by the New York State Board if the candidate graduated from a chiropody school headed by a medical practitioner.

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Soon, the NAC recommended that every state establish laws regulating the practice of chiropody and that chiropodists should not use the word “doctor” on their cards as it might antagonize physicians. In 1918, the NAC formed a Council on Education, the forerunner of the Council on Podiatric Medical Education, the body that accredits all United States podiatric medical schools and residency programs. In the same year, the term “podiatry” was coined, and the New York School of Podiatry raised its admission criteria to require a high school diploma. By 1934, the Council on Education required a three-year full-time curriculum plus one year of preprofessional college. The American College of Foot Surgeons was formed in 1942. A Michigan State Supreme Court ruling paved the way for podiatrists to use postoperative analgesics, allowing them to perform more surgery. For many years, podiatrists struggled for equal rank to physicians in the armed services and for permission to perform a wider range of more complex procedures. In 1958, podiatry officially became the name of the profession. The National Board of Podiatric Medical Examiners administered its first examination in 1962. And by 1964, podiatric medical schools now granted only the degree of Doctor of Podiatric Medicine (DPM). A few years later, health insurance plans began paying for certain podiatric services. In 1967, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the body that sets quality standards for hospitals and inspects them to grant accreditation, advanced the profession greatly. Their standards that year first allowed podiatrists to operate in hospitals and nursing homes without the presence of a gowned, scrubbed MD. Throughout the profession’s course of history, podiatrists have fought to gain acceptance in line with other physicians. Hospital medical staffs and physicians (MDs) have debated whether or not podiatrists should be recognized as licensed medical practitioners. Many health maintenance organizations (HMOs) have debated the issue as well. In 1977, the American Medical Association (AMA) recognized the right of qualified podiatrists to hold privileges at hospitals. In 1978, passage of the Medical College Admissions Test (MCAT) became required for acceptance to podiatric medical schools, and the schools also began requiring a minimum of three years of college for entry. 7

The evolution of the podiatry profession, especially in the past 30 years, has led to podiatrist licensing and the creation of a physician specialty with education and training focusing on one anatomic area, similar to other medical specialties. Disputes still arise within the medical profession about the equality of podiatry to MD specialties, but these concerns may arise purely from an economic or competitive standpoint.

Over the years, improved education programs and

ongoing discussions between medical and podiatric medical groups, as well as better recognition from government and those who pay for medical care have advanced podiatry services. The profession and its acceptance by patients and others will no doubt continue to progress.

WHERE PODIATRISTS WORK MANY PODIATRISTS WORK IN PRIVATE PRACTICES. THEIR OFFICES MAY BE LOCATED

near a community’s major hospital or other physician offices. Some podiatrists may practice in other locations that are convenient to a certain group of patients or at a distance from competing podiatrists. So in effect, podiatrists work in just about every town with a population large enough to support a full-time practitioner. The podiatrist leases or owns office space and opens a practice. There will be several rooms in which to see patients, a waiting and reception area and an office for the doctor. Some may also have a room where they perform various procedures on patients’ feet. These offices can be located in any community depending on the need for a podiatrist. Sometimes, a podiatrist may take over the office of a retiring professional or join one as a partner in an existing practice. While most of the podiatrist’s work takes place in the office, there may also be travel to local hospitals or nursing homes to visit patients.

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Other podiatrists join existing practices consisting of multiple physician specialties. A large multi-specialty practice or clinic might have a podiatrist as an employed or partner physician to complement the care of other specialties. For example, endocrinologists care for patients with diabetes. Many chronic diabetes patients develop problems in their feet, some so serious that they require amputation. In that case, the podiatrist works with the endocrinologist as part of a treatment team caring for the diabetic patient to prevent this serious complication. Sometimes, the practice simply wants to provide the type of care podiatrists provide within their office, much like they would have an obstetrician on board for referral of pregnant women or perhaps a cardiologist for patients with heart trouble. An increasing number of orthopedic physicians are hiring or partnering with podiatrists to work together caring for patients with various foot and ankle injuries or conditions. Sports medicine practices are especially right for this kind of coordinated approach. Most MDs today recognize how specialists can complement each others’ expertise and work together. Some podiatrists do not work in a private practice, but are employed full time by a hospital. They may spend more time performing surgeries on patients’ feet and ankles or seeing patients after their operations on the hospital floors. The hospital might be a privately owned facility with a board of directors and medical staff or it may be part of a larger nonprofit or university based hospital system. Some hospitals are operated by the government. A podiatrist might be employed by a veteran’s administration (VA) hospital or an Indian hospital. Sometimes, health maintenance organizations (HMOs) employ podiatrists to care for those patients enrolled in their health plans. The United States Public Health Service also employs physicians to care for patients enrolled in the public health system. Some podiatrists also work for the Armed Forces, serving in military hospitals in the United States and abroad.

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WHAT PODIATRISTS DO PEOPLE RELY ON THEIR FEET FOR INDEPENDENCE AT ALL AGES AND OFTEN TAKE FOR

granted how much they depend on them to get through every aspect of the day. Some people rely on their feet more heavily as they participate in work which involves standing all day or recreational activities and sports.

Podiatrists are the only medical professionals trained exclusively to provide total care of the foot. The foot is a complex anatomical structure that provides humans with both mobility and stability. We balance our bodies on our feet, and they carry us where we want to go. Those who are on their feet too much often punish them with overuse. More and more, Americans need the help of a podiatrist to prevent and treat foot problems from stress, injury and various diseases and abnormalities. A total of 26 bones make up each foot. Amazingly, the 52 bones in our two feet make up about one-fourth of all the bones in our bodies. In addition to bones, 33 joints, 112 ligaments, and a complex network of tendons, blood vessels and nerves form the foot. Podiatric physicians care for patients of all ages. The most common types of foot disorders they treat include: Bunions A bunion is an enlargement of the joint at the base of the big toe that forms when the bone or tissue at the big toe joint moves out of place. Heel pain and heel spurs Heel pain can result from gait abnormalities or a number of other causes. Heel spurs are bony growths on the underside of the heel bone that result from strain on the muscles and ligaments of the foot. Hammertoes A hammertoe is a bending of the toe at the first joint caused by an abnormal balance of the muscles in the toes. Neuromas These are painful conditions also called “pinched nerves.” A number of factors can cause them, including trauma, improper footwear and repeated stress on the foot. 10

Nail problems Ingrown toenails are the most common nail problem and can lead to irritation, pain and swelling. Fungal infections also occur in the toenails, sometimes necessitating surgery. Warts Caused by a virus, warts can be quite painful. When they develop on weight-bearing areas of the foot, they can cause a great deal of pain. Calluses and corns These are protective layers of compacted, dead skin cells that are caused by repeated friction and pressure from skin rubbing against bony areas or shoe irregularities. Complications of diabetes People with diabetes often have ulcers in their feet that can quickly become infected and lead to more serious problems. Sports injuries A podiatrist may treat fractures of the foot and ankle, although they are often cared for by an orthopedic surgeon. Podiatrists help educate patients and the general public to help people prevent injuries from the repetitive stress of sports. To diagnose various foot problems, podiatrists ask patients their medical histories, examine their feet, and sometimes order x-rays or laboratory tests. They may use computer technology to help assess problems like those associated with a patient’s gait or foot deformity. Once the podiatrist diagnoses the patient’s condition, a treatment plan is formed. The podiatrist might prescribe drugs and order physical therapy. Podiatrists also fit corrective inserts for shoes (orthotics) or custom-made shoes. They design plaster casts and strappings that are used to correct patients’ deformities. As more and more technology enters the medical field, much of the podiatrist’s measurement for devices might be computer enhanced. When the podiatrist cares for the patient’s feet, there must be a total awareness of other medical conditions and the complete picture of the patient’s health and physical conditions. The podiatrist must consider, for example, other medications the patient takes that might 11

interact with a new one prescribed for a podiatric problem. Knowing the patient’s medical or lifestyle history might also help the podiatrist diagnose a particular illness. Foot problems seen by the podiatrist might be the first indication of an illness like arthritis, diabetes or heart disease. The podiatrist might be the first healthcare practitioner to detect signs of those diseases and may refer the patient to an appropriate medical specialist (like a cardiologist for heart trouble). In clinical work, the podiatrist uses a variety of medical tools and technologies. For instance, podiatrists operate high-speed cord drills for many foot and nail problems. The office is often equipped with x-ray and sometimes ultrasound equipment. Sterilizers help keep all equipment clean and sterile. At times, the podiatrist will use high-tech tools to aid in diagnosis and treatment. If the podiatrist performs minor surgeries in the office, a supply of sterile surgical instruments will be used on a regular basis. Knives, scalpels, blades and chisels are commonly used instruments. Podiatrists may also use specialized instruments like a corn chisel or certain types of knives specific to use on the foot. Like other medical providers, the podiatrist works under a great deal of scrutiny from insurance companies, state licensing bodies and other regulatory agencies. For example, x-ray equipment in the office means the podiatrist and the technologist who performs x-rays must meet certain radiation safety requirements. The podiatrist may need to closely follow standards set by the ACPM or other bodies that define the usual practice for different conditions and situations. Every practice must maintain malpractice insurance in the event of an accusation of improper or substandard care. Podiatrists and certain members of their staffs are trained to handle medical emergencies. Part of the podiatrist’s education and training focuses on medical emergencies most likely encountered in the office. Outside the office, the podiatrist may regularly perform surgery on patients at hospitals or surgery centers. They’ll use a number of different surgical instruments and techniques. The podiatrist will work closely with and supervise surgical technicians, nurses, or other assistants. Consulting with other physicians, patients and patients’ families is part of the duties. So is participating in hospital-wide activities, like boards and committees on various issues. 12

Many podiatrists care for patients in nursing homes and they may visit those patients on a regular basis. They may also spend time away from the office visiting patients in the hospital or consulting with physicians. Podiatrists often serve as educational resources for foot care in their communities. There is a marketing value in these educational activities and regular appearances or participation in community activities. Those who specialize in sports medicine aspects of podiatry might work closely with local athletic teams at the high school, college or professional levels. They will sometimes see athletes in their offices and also treat them at team practice locations. Some podiatrists gain reputations as specialists in their field. For example, many specialize in pediatrics, dermatology, radiology, geriatrics or diabetic foot care (as each relates to podiatric medicine). A private practice podiatrist operates a medical practice much like any doctor’s office and oversees the business side of the practice, with the assistance of an employed business manager or office manager. Running a practice involves a number of responsibilities for the podiatrist. On a regular basis, a doctor will perform a variety of duties related to the business, such as hiring and supervising office staff, reviewing financial and reimbursement records, directing staff in handling patient problems and requests from patients or physicians, participating in community activities and organizations to market the practice, ordering clinical supplies, keeping business records, etc. If the podiatrist is a member of a group practice, these management duties may be shared among the members. The podiatry group will employ people to support and bill for the work the podiatrists perform. In a group situation, the podiatrist may share office hours and patients with other members of the group. They’ll also share after-hours on-call duty, although after-hour emergencies occur with much less frequency in podiatry than in other medical specialties. Some podiatrists enter the teaching field. They work at colleges of podiatric medicine, teaching new students the skills and course work of podiatry. Teaching is often combined with an active practice. Others may use their good business skills to move into management of a hospital department or other healthcare organization. 13

PODIATRISTS TELL ABOUT THEIR CAREERS I Really Didn’t Know Much About Podiatry Until My Second Year in College “I was a pre-med major and was also

running cross country and on the college track team. After a little research and some discussion with my advisor, my interest in podiatry was sparked. I think what attracted me most was the diversity. Podiatrists provide both medical and surgical care of the foot and ankle for patients of all ages. I knew I would like working with adults, kids, elderly, athletes, all types of people. Now I’ve been in practice for more than four years. Most of my day involves interacting directly with many different patients. I also communicate constantly with my office staff and with outside physicians. Doctors who refer patients to me are a very big part of my practice and I talk to them often. At least two afternoons a week, I perform surgery at the hospital or a surgery center. I had five years of undergraduate work at Kansas State University before moving to New York City to attend the New York College of Podiatric Medicine for four years. From there, I moved to Salt Lake City for a three-year surgical residency at the Veterans Hospital and the University of Utah Medical Center. Podiatric Medical School parallels other medical schools in many ways, but the curriculum focuses on the lower extremity – the foot and ankle. I would have to say that my athletics sparked my interest in the sports medicine side of the profession. When I participate in treating athletes and recreational sports enthusiasts, I help educate the public about what a podiatrist does, and I see that as one of the biggest challenges to our profession today. We continuously work to educate the public about podiatric medicine and why podiatrists serve as the medical specialist of the foot and ankle. The diversity of patients makes the job interesting, but so does the variety of foot and ankle problems I encounter. I love the challenge of treating these different problems both medically and 14

surgically. I like the flexible hours because they allow me more free time than many other healthcare providers have. I’d have to say the thing I like least about the profession is dealing with insurance companies. Their rules, regulations, and restrictions on how healthcare professionals provide care make it difficult on podiatrists and all physicians. I would suggest that anyone interested in entering this field should do the research on the profession and compare it to others, especially other medical fields. Shadowing a few different practicing podiatrists in their offices and in surgery if possible, can be of great value.”

Podiatry Offers the Perfect Chance to Be Successful in Your Career and Happy in Your Personal Life “Family is very

important to me, and I wanted to select a career that would allow me to achieve my full potential professionally, but that would also allow me to be fulfilled at home and in my community. I thought it would be a shame to work so hard for so many years to earn a degree in a career that couldn’t help, or even worse, would hinder my reaching a balance in all the areas of my life. Podiatry offers the flexibility – I can be successful, involved in my community, and still have time for my family. I decided to enter podiatry for these very reasons. While an undergraduate at the University of Wisconsin, I knew I had a strong interest in the medical field, but couldn’t decide on a particular specialty that satisfied my desire for variety. Then I realized podiatry offered the perfect blend for me – surgery, pediatrics, orthopedics, biomechanics, primary care medicine and countless other disciplines all make up the practice of podiatry. I think podiatric medicine is unique because it’s common for a patient to feel better physically as soon as he or she leaves my office. In other specialties, that is much less common. Say a podiatrist fixes a painful corn at the office – that day the patient can walk out pain free. In treatment by most other medical specialties, the patient must wait for medications or other therapies to start working – the healing requires much longer 15

time. For the most part, a podiatrist sees, feels and hears the positive effects in almost every patient encounter. That’s extremely rewarding. I completed premedical training in Wisconsin, receiving my Bachelor of Science degree in 1995. Podiatry was a natural choice from there, since the basic science courses at podiatry school mirror those at other medical colleges. I had already taken my MCAT, so when I decided on podiatry as my specialty, I didn’t have to alter my educational preparation at all. I received my Doctor of Podiatric Medicine degree from the Dr. William M. Scholl College of Podiatric Medicine in Chicago two years ago. Currently, I’m finishing my third year of residency training in podiatric medicine and foot and ankle surgery at the VA Chicago Westside Medical Center and already have a position joining a private podiatry practice in Wisconsin in a few months. To help prepare for the field, I volunteered at a teaching hospital in college. I didn’t have direct involvement with podiatrists, but I got the chance to meet and speak with physicians in various specialties during my volunteer time. Several of them spoke very candidly about the desire for more time with family, but the reality that it wasn’t an option in their field. That experience sealed my resolve to keep from sabotaging myself by selecting a career in a medical field that would exclude all else. My current day is highly variable as a resident in a teaching hospital. We have five residents in the program, so we share many of the duties. We serve inpatients in the hospital and a very busy outpatient clinic where we treat wounds, injuries and foot and ankle problems of all types. On a daily basis, we perform elective, reconstructive and emergency surgery in the hospital and in surgery centers affiliated with the hospital. These are located all over the Chicago area. We also spend time in our attending physician’s private offices to learn the nuances of a podiatry practice and office management. I’ve seen major advances in the field even since my entry to podiatry school in 1995. Today, it’s rare to find a hospital that does not have a podiatrist on staff, or an insurance plan that doesn’t include podiatrists as paid providers. Podiatrists are a 16

recognized part of the medical and surgical team. To me, being in a relatively young medical profession gives me the exciting challenge of showcasing podiatrists’ talents to other healthcare providers. Many still have much to learn about what podiatrists offer. I’d suggest that anyone looking into the field of podiatry contact a podiatrist in the community. There’s just no substitute for going straight to the source. The APMA has formed a Mentors Network to provide access to podiatrists at various stages in their careers. Spending time in a podiatrist’s office is the single best way to see what a podiatrist does. I wish I had done that myself before entering podiatry school, just to reinforce why I chose the career. In addition to learning about the daily responsibilities of the podiatrist, you’ll have something to focus on – your long-term goal of becoming a podiatrist – when completing a short-term goal, like an anatomy final exam. My decision to become a podiatrist is reinforced every day when I go to the hospital or office, or when I come home to my family. My Dad once said, ‘If you love your job, you never work a day in your life.’ That’s so right!”

I’m a Third-Year Podiatry Medical Student and I Can’t Wait to Practice “I always knew

I wanted to be a doctor, I just wasn’t sure what specialty I would prefer. But podiatry seemed perfect. I knew that because I visited a local podiatrist a few times and followed him on office visits. I also got to see him perform some surgical cases.

To me, the big plus of podiatry is the fact that it offers so many different areas of medicine in one profession. Podiatry allows you to see kids, treat athletic injuries and do surgery. I was also very impressed with the attitude of people in this profession. Like most podiatrists, I love the profession and the time it allows you to spend with your patients. I also love the time it allows to build a family.

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I spent my undergraduate time at Texas A & M as a biomedical science major. Now I’m in my third year of podiatric medical education at the Ohio College of Podiatric Medicine. After this, I’ll complete a two or three year podiatric surgical residency. I can complete my residency in any of the 50 states. Before entering podiatric medical school, I spent time shadowing physicians of all kinds. I spent time with anesthesiologists, general surgeons and podiatrists. I also made sure to become involved in any student/doctor mentoring programs available. My third year podiatric medicine schedule consists of classes from 8 am to noon in sports medicine, surgery, traumatology (trauma and emergencies), podopediatrics (podiatry on children), general medicine, podiatric medicine, and pharmacology. From noon to 5 pm, I am in clinical rotation. My rotations consist of: Podiatric medicine – diabetic nail care, dermatology, foot infections ACLS/CPR – Advanced Cardiovascular Life Support (responding to codes, or cardiac emergencies) VA (Veterans healthcare) – We see a lot of veterans with diabetic ulcers and amputations Radiology – We learn to take and read foot and ankle radiographs to help us diagnose foot problems Surgery – We learn about surgical procedures for ankle fractures, infections and bunion surgery Emergency medicine – Common emergency problems at local hospitals Biomechanics – Examining the physics of the foot and correcting any problems with the use of orthotic devices

I love the scope of practice and variety that podiatry offers. We cover everything from diabetic foot care of nails and ulcers to pediatric cases of congenital foot problems, to sports injuries, to major surgical cases of ankle fusions.

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I also enjoy the life this profession provides. It allows for a fantastic career in medicine with unbelievable opportunity for personal life. The only drawback I see when I enter private practice is the limitations put on patient care by many insurance companies. To be successful as a podiatrist, you should become involved in your community and develop a people personality. Also, visit a podiatrist and become involved in the podiatry mentoring network at this Web site – www.aacpm.org.”

PERSONAL QUALIFICATIONS THE MOST IMPORTANT TRAIT TO CONSIDER IF YOU’RE INTERESTED IN PODIATRIC

medicine is your ability to understand very complex medical information. Your coursework will consist mostly of science-related classes so you need an aptitude for science and biology.

You’ll also need good study habits and determination. Coursework will be difficult, and with only seven schools of podiatric medicine at this time, admission to the schools could get competitive. You’ll need to show a high college grade point average. Determination comes into play because after your bachelor’s degree, you’ll still have to complete your podiatric medical education and an accredited residency. You’ll need to stay focused on your long-term goal without giving up as you encounter hurdles. Most medical students struggle with one or two subjects, while others may come easier. Being a people person is an important part of podiatry. Caring for patients requires empathy, good listening skills and good communications skills. If you are patient with people, you’ll likely have more success. You’ll often face busy schedules packed with patients and have to endure lengthy explanations of a particular patient’s pain and other symptoms. Good interpersonal skills are essential to your understanding of a patient’s condition and needs and to explaining your findings to the patient and family members. Most of all, you’ll have to detail treatment and lifestyle changes in a caring manner and in terms that the patient can understand and agree to.

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You’ll also need good interpersonal skills to work with referring physicians, your own office staff, and other professionals you encounter, like hospital administrators. A sense of fairness and the ability to listen and understand will help you supervise and motivate your office staff. Good speaking skills will help you tremendously when you go out in the community to promote your practice. People skills will also help you get along with partners if you join a group of podiatrists or other specialists. Analytical ability will be necessary. If you like solving problems, you’ll do well in this career. For the most part, every patient who walks into your office will have some sort of specific problem that needs to be resolved. Your job will consist of listening to the patient, reviewing the medical history, and perhaps ordering lab or x-ray work to confirm your tentative diagnosis of the condition. You’ll pull together all of this information and assess it against your education and experience to make a final diagnosis and design a treatment plan for the patient’s problem. If you’re good at these sorts of complex puzzles, you’ll do well as a podiatrist. Manual dexterity will also be important. You’ll perform some precise, calculated procedures on patients’ feet. For simple procedures in your office – especially for surgery – the ability to perform precise, efficient and careful movements with your hands will be essential. Managing a private practice, or even working in a hospital setting, will require basic understanding of business and financial concepts. If you can supplement your education with some business coursework, you’ll probably enjoy greater success. Even if you hire qualified people to help run your practice, it’s your business and your money at stake, so the more you know about business and finances, the better.

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ATTRACTIVE FEATURES PODIATRISTS EMPHASIZE THEIR SATISFACTION WITH THE BALANCED LIFESTYLE THEIR

profession offers. A comfortable salary combines with a manageable schedule. The same can’t be said for all medical professions. Podiatrists can set their own hours to a large extent.

Office hours and the time spent seeing patients and following up on phone calls to patients and physicians, can be very flexible if planned ahead. If a podiatrist wants to plan a family vacation, it’s simply a matter of deciding on the best dates ahead of time so the staff does not schedule patients during that time. Of course, it’s not always that easy, since the podiatrist must also consider hospital surgery or call schedules. And those who work in groups will have to request time that coordinates with other physicians’ time off. In some cases, you might choose to work part time. If you share your practice with other podiatrists, you might be able to reduce your schedule to coincide with family responsibilities. In private practice, you can enjoy autonomy and control your own work schedule. You can work harder to increase your patient base and make more money, or you can choose to earn less and instead take time off to enjoy family and other interests. You’ll gain satisfaction from helping patients eliminate some pain or discomfort associated with foot disorders or injuries. Podiatrists express a great deal of satisfaction with the ability to help others and literally see a patient walk out the door of the office feeling better. Patients often thank and revere podiatrists, seeing them as healers. You can work with patients of all ages, another benefit to podiatry. You’ll also get the chance to work with a wide variety of foot problems. Most podiatrists say that the variety and diversity of their work first attracted them to the field. On the other hand, if you would like to specialize in one area, like surgery, you can pursue that preference too. Podiatrists in private practice usually enjoy good benefits and pension plans.

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UNATTRACTIVE FEATURES THE LENGTH OF TIME REQUIRED TO REACH THE DPM LEVEL AND PRACTICE

podiatry may dissuade some people. The schooling and residency can be rigorous, tough work with potentially long hours. Only those truly dedicated to the idea of becoming a podiatrist may endure the education and residency requirements. Of course, the extensive education requirements cost money too. Although you might find scholarship assistance from colleges and organizations like the APMA, you will still need to have money for living expenses while in school, or juggle work and education at the same time. You might have to take out student loans that you’ll have to pay back after beginning practice, which will impact your income for a number of years. Although you can obtain your undergraduate degree and residency in any of the 50 states, your actual podiatric medicine training is limited to only seven schools in seven states. So you might face more economic hardship by attending a college far from your current home. If you start practice on your own, you‘ll need some money saved up for start-up costs like equipment, space (or a deposit on leased space), supplies, marketing and hiring of staff. You might be able to receive financing from a bank or friends. Or you might consider taking over or partnering in an existing practice until you establish regular income. Be aware of the payment policies in your state for podiatry services. If most large insurance companies in your area don’t pay for most services, you’ll need to consider the impact on your income, especially in private practice. If you choose employment by a hospital or other organization, you may still have more flexibility in your schedule than some providers, but you will also have to follow the schedule determined by your employer. The acceptance of podiatrists within the medical community – insurance companies, hospitals and MDs – can be a problem for some podiatrists. Although the status of podiatrists is certainly improving, some become frustrated by the perception that others in healthcare have of podiatry – the level of training and services. You’ll need to balance this concern with the positive appreciation you’ll likely receive from the community at large and from your satisfied patients. You 22

might want to check out local attitudes and hospital medical staff policies before choosing a community. Setting up your own private practice offers many rewards but carries risks as well. You’ll have to research the community you plan to practice in, or the existing practice you’ll join. Competition from other providers, changing Medicare and private insurance company reimbursement laws, even new technologies, can negatively impact your income once in practice. And with the time and money you’ll invest in podiatric medicine, you’ll need to ensure that you can continue to be successful when things beyond your control change the economics of your practice.

EDUCATION AND TRAINING ONLY SEVEN COLLEGES IN THE COUNTRY CURRENTLY OFFER DEGREES IN PODIATRIC

medicine. Enrollment in the seven schools totals only about 2,000 students each year. Each individual college’s admission criteria differs. So check carefully to determine specific qualifications for admission. Candidates for podiatric school generally must have at least three years of undergraduate school or a bachelor’s degree. In addition, the podiatric school might require certain courses in undergraduate study, like biology, organic chemistry or physics. The school might also require coursework in English or language arts. You’ll have to produce an official transcript (sealed and likely sent by the school, not copies provided by you) showing your coursework and grades. All schools require successful completion of the Medical College Graduate Admission Test (MCAT) or the Graduate Record Exam (GRE) for admission. These tests must be taken within a certain number of years of admission, so old test results will not count. In many cases, letters of recommendation from your science teachers or from a podiatric physician will be required. The college may also ask for other letters from professional or personal references. Each college enrolls only a certain number of students each semester, so even if you meet the basic criteria, you face competition from other applicants for a limited number of slots. High quality undergraduate coursework and grades and excellent references help better your chances of admission. 23

The typical four-year podiatric medical program would be similar to that of Barry University: First-year students take basic science courses and introductory courses in podiatric medicine. Second-year students take courses in the basic sciences, clinical sciences and podiatric medicine. Third-year coursework includes exposure to clinical experience (with instruction). Fourth-year students focus on clinical practice and elective coursework. Colleges offer medical rotations within their own hospital/surgery centers or at nearby hospitals for “hands-on” podiatric instruction. Some teaching clinics might offer free or reduced-cost services to elderly or poor patients. The following colleges grant the degree of Doctor of Podiatric Medicine (DPM). To learn more about them, check them out on the Internet or call them for more information. You can also find links and look for additional schools or information on the Colleges of Podiatric Medicine web site (www.aacpm.org). Barry University School of Graduate Medical Sciences (Miami Shores, Florida) The school enrolls more than 7,500 students in many healthcare degree specialties, including podiatry. Four years of study lead to the DPM degree. The school offers clinical rotations in about eight local facilities. California College of Podiatric Medicine (Vallejo, California) The school was founded in 1914 and shares campus space with a college of osteopathic medicine. It also offers eight clinical rotation sites. College of Podiatric Medicine and Surgery, Des Moines University (Des Moines, Iowa) This college shares its campus with a college of osteopathic medicine and surgery and a college of health sciences. The school emphasizes primary care podiatric medicine.

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Dr. William M. Scholl College of Podiatric Medicine at Finch University of Health Sciences/Chicago Medical School (Chicago) The legendary foot care specialist Dr. William M. Scholl founded Scholl College in 1912. The school has an on-campus teaching clinic and teaching affiliations with several area medical centers. It offers a large scholarship program in podiatric medicine. New York College of Podiatric Medicine (New York City) The New York College of Podiatric Medicine was the first of its kind, established in 1911. The four-year DPM program includes clinical training at The Foot Clinics of New York, the largest foot treatment facility in the world. Ohio College of Podiatric Medicine (Cleveland) This college was founded in 1916 and runs an on-campus Foot and Ankle Clinic and Surgical Center. Medical rotations at the clinic and other local facilities support clinical training. Temple University School of Podiatric Medicine (Philadelphia) Temple is the first American college of podiatric medicine to become part of a major state supported university. The school offers a joint DPM/PhD program in biomedical engineering.

Residency Programs

After completion of the college curriculum, most graduates enter a residency program at a hospital or similar facility that requires from one to three years. Residents receive advanced training and serve clinical rotations to prepare them for careers in podiatric medicine. Rotations usually include anesthesiology, internal medicine, pathology, radiology, emergency medicine, orthopedic surgery and general surgery. After the first year, residents generally receive more extensive training in specialty areas.

Board Certification

Certifying boards for podiatric medicine certify podiatrists in specialty areas. Currently, podiatrists can obtain board certification in podiatric orthopedics, podiatric surgery and primary podiatric medicine. Usually, board certification helps those in the profession establish their qualifications to hospitals, insurance companies, practices, and potential patients. In some cases, some employment situations might require board certification. 25

Financial Aid The Fund for Podiatric Medical Education (FPME)

began in 1959 to assist with research and loan funds for students. In 1991, the fund began providing scholarships to podiatric medical students. Although the fund doesn’t award scholarships until a student’s third or fourth year of podiatric medical school, the scholarships apply to any of the accredited schools. The APMA maintains information on the scholarship fund. Other scholarships might be available from specific podiatric schools, national or local organizations. Once in practice, your education continues. States require continuing education coursework for maintenance of medical provider licenses. Plus, you’ll want to keep up with the latest techniques, technologies and standards.

EARNINGS SALARIED PODIATRISTS TEND TO EARN lESS THAN THOSE WHO ARE SELF

employed.

A recent survey showed average net income after expenses for private practice podiatrists is about $125,000. Actual salary figures are hard to come by, especially since measuring salary within a solo practice is difficult. Those practicing for less than two years earn substantially less than the average. Those with 15 to 30 years of practice experience earn about $30,000 more than the average. When a podiatrist maintains a practice, payments are received from patients, various government agencies and insurance companies. From this money, known as practice revenue, the physician must pay all expenses for running the practice. This includes the building lease or mortgage payment, clinical and office supplies, utilities, salaries of employees, marketing costs, and many more items. The podiatrist is also paid a weekly salary. If the doctor and staff can keep the office running efficiently and see a steady number of patients, there will be additional income at the end of the year. The podiatrist may choose to reinvest some revenue into the practice by improving equipment, remodeling, hiring additional staff or another podiatrist to work in an associate role. Or, take the profit out as additional personal income. The private practice podiatrist has more control over personal income, but still relies on developments and changes in healthcare markets and payment methods. 26

Podiatric care depends on both medical reimbursement and on disposable income. In other words, not all podiatry services are covered by insurance plans. That means more people have to pay for much of the routine care they receive. That can be good for a podiatrist’s income if patients pay their bills. However, some bills go unpaid. And some people neglect foot care altogether because they don’t want to pay out of their pocket or simply can’t afford to pay. The number of podiatrists in private practice versus the number in employment situations is close to equal. Salaried podiatrists earn about $85,000 to $100,000 annually. So in both cases, the salaries are excellent. Board certification, specialty certifications and specialty residencies can increase the amount of compensation a podiatrist receives. Whether employed or in private practice, you should see a steady increase in income as you gain experience. However, healthcare is a field dependent on many outside factors like legislation and insurance reform that can lead to changes in reimbursement. If a podiatrist joins a group of other podiatrists or multi-specialty physicians, he/she might eventually advance within the practice to a partnership (or ownership) role rather than employment. Partnership means the podiatrist helps lead the group and make decisions, and that he/she receives a share of the total practice profits. Podiatrists can receive excellent benefits as part of their compensation program. In private practice, a podiatrist can arrange vacation time. There is often a well-financed pension plan, which is also shared with office employees. Podiatrists employed by the government or other organizations will receive a good benefit package that includes vacation time, health insurance, disability insurance and a pension/retirement plan.

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OPPORTUNITIES EMPLOYMENT IN THE HEALTH SERVICES INDUSTRY AS A WHOLE WILL INCREASE AT

least 25 percent in the coming decade. Podiatry employment is expected to grow as fast as the other healthcare specialties.

As baby boomers age and the percentage of elderly in the population increases, more and more people will need the services of podiatrists. The elderly generally have problems resulting from wear and tear on their feet and legs. They are more prone to foot ailments and related conditions. Experts predict that increasingly active Americans will suffer more foot injuries, but the impact of this trend on the need for qualified podiatrists varies with location and community make-up. Routine care, like callus and corn removal, is not generally covered by private insurers or Medicare (the government program that helps pay for healthcare for the elderly and certain other people). Therefore, some people may hesitate to receive care for less serious problems. Medicare and private payors do reimburse for acute and surgical services related to podiatric care. A continued emphasis on controlling healthcare costs, particularly specialist services, impacts the economic outlook for podiatric services. Board certified podiatrists face better opportunities for employment. Some managed care organizations require board certification in order to join their panel of doctors. Podiatrists right out of training will find more opportunities joining group podiatry or medical practices or seeking employment at clinics, government agencies or health networks. For example, a newly trained podiatrist might be hired by a group of orthopedic surgeons. Many orthopedists have recognized the need to work with podiatrists. Those podiatrists wishing to set up private practice will have less success in areas near podiatric medical schools. These locations tend to already have a high concentration of podiatrists and resident-related services.

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GETTING STARTED SINCE PODIATRIC MEDICINE REMAINS A SMALL, CLOSELY CONNECTED GROUP, YOU

will probably meet many mentors throughout your training and hear about possible opportunities for employment or private practice as you complete podiatric medical school and residency.

Begin networking immediately. Even the podiatrist you choose to shadow while exploring the career at this early state will probably help you years later when you start practice. This can be particularly helpful if you want to return to your home town to begin work. As you progress in your training, you might decide on a particular specialty or area of the field you like best. For example, you might enjoy caring for diabetics and decide that working in a VA hospital or other facility caring for a high number of diabetic patients appeals most to you. Be sure to match your interests to the market. You’ll have to gauge the number of podiatrists in practice and the atmosphere or attitudes of other physicians in the area concerning podiatry. Use any information you can gather – especially from discussions with other practitioners – to learn all you can about the practice of podiatry and the nuances of setting up your own practice. If you are seeking employment in a hospital or with a medical group, continue to gather good references from your college and residency training. Those who are impressed by your skills in training can speak well for your abilities and fit for actual practice. Most of all, learn all you can from every experienced podiatrist and medical provider you meet. Senior podiatrists can offer a great deal of advice, and you never know when your paths will cross again. Find a few mentors and don’t be afraid to ask for their help preparing you for practice and guiding you through start-up. If you open your own private practice, get to know people in your community. Join civic groups or other organizations and help educate your community about foot care and podiatric services. If you replace an existing physician, you might walk into a situation with a good patient base and demand for podiatric services. But you’ll probably need to have or raise enough money to purchase the practice from the podiatrist. At this point, you’ll need to involve good attorneys and accountants to advise you.

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Joining a multi-specialty practice means networking outside of podiatry too. Find out about opportunities for podiatrists in existing physician practices and clinics. You might even convince a practice of the need to add podiatry if the market supports the idea in a community in which you want to live and practice. Foremost, use the information and networking opportunities available through organizations like the APMA. Podiatric journals post classified ads for practitioners and provide helpful articles on the clinical and business aspects of practice.

ASSOCIATIONS American Podiatric Medical Association (APMA) www.apma.org American Association of Colleges of Podiatric Medicine www.aacpm.org American Academy of Podiatric Sports Medicine www.aapsm.org American Association for Women Podiatrists www.aawpinc.com American Association of Hospital and Healthcare Podiatrists www.hospitalpodiatrists.org

PERIODICALS Journal of the American Podiatric Medical Association www.apma.org Podiatry Today published by HMP Communications www.podiatrytoday.com Podiatry Management Published by Kane Communications www.podiatrymgmt.com

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ACCREDITED COLLEGES OF PODIATRIC MEDICINE Barry University School of Graduate Medical Sciences www.barry.edu/gms/podiatry California College of Podiatric Medicine www.ccpm.edu Des Moines University College of Podiatric Medicine & Surgery www.dmu.edu/cpms New York College of Podiatric Medicine www.nycpm.edu Ohio College of Podiatric Medicine www.ocpm.edu Dr. William M. Scholl College of Podiatric Medicine at Finch University www.scholl.edu Temple University School of Podiatric Medicine www.temple.edu/podiatry

COPYRIGHT 2006 Institute For Career Research CHICAGO CAREERS INTERNET DATABASE www.careers-internet.org

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