There are nearly 13,000 practicing doctors of podiatric medicine m 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. The neglect may stem from a curious misconception on the part of many people that their feet are supposed to hurt That’s not the case, and it is estimated that more than 75 percent of Americans will experience foot problems of varying degrees of seriousness at one time in their lives. Among the more serious systemic diseases that can manifest themselves in the feet is diabetes, doctors of podiatric medicine play especially important team and inpidual roles in the prevention of foot and lower limb amputation attributable to diabetes. The increasing demand for services of podiatrists probably stems from two factors. First, as more Americans engage m exercise and fitness programs, more of them become aware of the limits foot pain places on full participation. Second, since foot 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. Whatever the case, it’s known that there were nearly 40 million patient visits to podiatric physicians in 1983, and the 1995 figure is estimated to be more than 55 million.
The American Podiatric Medical Association (APMA) was founded in 1912 to promote levels of understanding of the profession; it continues to work to improve the quality of foot care in the United States, to attract qualified young men and women to the field, and to increase awareness of the importance of foot health among the general public and other health professionals. PMA’s headquarters are Bethesda, Maryland, just outside Washington, DC, and it has component societies in every state, the District of Columbia, Puerto Rico, and the Federal Service. APMA also has more than 20 affiliated and related organizations, which focus attention on education, research, and specialty areas of interest, such as dermatology, pediatrics, radiology, surgery, sports medicine, and others.
There are seven colleges of podiatric medicine in the United States – the Barry University School of Podiatric Medicine in Miami, the California College of Podiatric Medicine in San Francisco, the New York College of Podiatric Medicine in New York City, the Ohio College of' Podiatric Medicine in Cleveland, the Pennsylvania College of Podiatric Medicine in Philadelphia, the Dr. William M. Scholl College of Podiatric Medicine in Chicago, and the College of Podiatric Medicine and Surgery at the University of Osteopathic Medicine and Health Sciences in Des Moines. They all receive accreditation from the Council on Podiatric Medical Education of APMA, which is recognized by the US Secretary Education and the Commission on Recognition of Postsecondary Accreditation; they all 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 and have completed a minimum of 90 Semester hours at accredited undergraduate colleges or universities. Applicants for admission are required to complete the Medical College Admission Test (SCAT) as a prerequisite. Inpiduals may apply to any or all of the colleges by submitting a single application through the application service of the American Association of Colleges of Podiatric Medicine, an APMA-affiliated organization. The course of instruction leading to the DPM degree is four years in length first two years are devoted largely to classroom 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 concentrate on courses in the clinical sciences, gaining experience in the college clinics, community clinics, 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.
Postdoctoral and Continuing Education
As they near graduation, most prospective podiatric physicians seek postdoctoral residency programs. These programs, designed to strengthen and refine the practitioner’s podiatric medica1 primary care, orthopedic, surgical, and/or public health 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 four years. There are continuing podiatric medical education requirements for state license renewal, and there is heavy attendance 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 1icensed in all 50 states, the District of Columbia, and Puerto Rico to diagnose and treat the foot and its related or governing structures by medical, surgical, or other means. In addition to private practices, they 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, Department of Veterans Affairs, municipal health departments Many podiatrists today are also accepting invitations to join group medical practices.
Special Areas of Practice
In its continuing efforts to protect and improve public health and welfare, APMA. has recognized and approved two specialty boards that certify in three areas – podiatric orthopedics, pediatric surgery, and 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.
Health Insurance Coverage
Nearly all private and public health insurance plans provide coverage for the services of doctors of podiatric medicine. Most Blue Shield plans, as well as those of commercia1 health insurance carriers, make provision in their contracts for the medical and surgical care of the feet, whether such care is rendered by doctors of medicine, osteopathy, or podiatric medicine. Even though third-party coverage of podiatrists’ services generally includes medical and surgical care of the foot, details of such coverage can and do vary among plans. The same applies to federal health insurance plans, including Medicare, federal employee heath benefits, and federal employee compensation programs. Medicaid, however, is an exception to this general rule; it is prescribed in federal law as an optional rather than a mandated service.
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. In 1992, about 87 percent of practicing doctors of podiatric medicine an the United States had staff privileges at hospitals; in 1991, 84 percent of hospitals in the United States had doctors Of podiatric medicine on staff. There is a strong and growing role for podiatrists an public health. There has been a podiatric health section in the American Public Health Association (APHA) for nearly a quarter of a century, and APMA has a policy statement on 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 0mnibus 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. There are now more than 200 doctors of podiatric medicine in the VA, and the VA sponsors a number of postdoctoral residency programs in podiatric medicine and surgery. In 1978, the US Public Health Service authorized the commissioning of podiatric medical officers, and they serve in the Indian Health Service and related federal health service programs. Since the early 1950s, podiatric physicians have been commissioned to serve in the various branches of the military services. Officers are professionally assigned to the orthopedic service at most military medical installations, where they render invaluable service to military personnel and their dependents.