American Association for Physician Leadership

The State of Podiatry

James R. Christina, DPM

May 9, 2024

Healthcare Administration Leadership & Management Journal

Volume 2, Issue 3, Pages 121-122


Podiatric medicine and surgery are thriving because of the continued evolution of education and training in podiatric medicine and surgery combined with the demand for services for lower extremity care. Although the profession faces challenges, such as student recruitment, it enjoys the advocacy efforts of the American Podiatric Medical Association, an organization with a 112-year history of defending and advancing its members and their patients. Members of this small but mighty profession are outstanding volunteers and passionate about both the specialty and patient care.

Podiatric physicians and surgeons help patients who want to stay active and healthy. They treat injuries, deformities, and conditions of the foot and ankle in patients of all ages. Podiatrists treat sprains, strains, and fractures of the foot and ankle with both conservative and surgical care.


Podiatric education now mirrors that of allopathic and osteopathic physicians. After an undergraduate degree, matriculants enroll in one of 11 podiatric medical schools. The curriculum is comparable to that of allopathic and osteopathic medical schools, particularly in the first two years. At the end of a four-year course of study, graduates receive the degree of Doctor of Podiatric Medicine (DPM). The last two years of these programs provide a greater focus on lower extremity care, but students also complete rotations in medicine, radiology, etc. Postgraduate training consists of a three-year, hospital-based podiatric medicine and surgery residency. Many podiatric physicians then go on to complete fellowships after their residency training.


Podiatric physicians and surgeons enjoy many options when entering the job market. The possibilities include opening their own private practice or employment as an associate with a small group of podiatrists or a large super-group. Podiatrists enjoy privileges to perform foot and ankle procedures as members of hospital staff, and some have gained status as chief of the surgical department or even chief of medical staff. Many podiatric surgeons serve as residency directors or are part of the attending staff training podiatric residents. Podiatrists also may be employed by hospital systems, HMOs such as Kaiser Permanente, or the Veterans Health Administration. There are also opportunities with large multispecialty groups. Currently, many podiatric practices are being bought up by large groups backed by venture capital monies, as is occurring in other specialties.


With an aging population and increasing rates of diabetes and obesity, podiatric physicians and surgeons are in high demand. Foot care is essential for people with diabetes, and podiatrists are the primary physicians preventing diabetic complications in the foot and ankle. When complications do occur, data show that patients who receive care from a podiatrist have better outcomes than those who do not.


Like all physicians, podiatric physicians and surgeons face challenges in being reimbursed fairly for the services they provide. The Medicare Physician Fee Schedule is a budget-neutral calculation that sees the conversion factor that is used to calculate payment to physicians decrease from year to year despite increases in the cost of doing business for physicians. Private insurers, although they are not bound by a budget-neutral system, often adopt some percentage of the Medicare physician conversion factor to set their rates. Healthcare organizations are lobbying Congress to provide a yearly increase in Medicare rates tied to an economic factor (such as cost of living or inflation) so providers are paid in a more equitable fashion. Although, for the most part, podiatrists are paid the same as other healthcare providers when performing the same service, there are still instances in which a particular insurer may pay less. Furthermore, prior authorization from insurance companies continues to be a challenge for all physicians, and podiatrists are no exception. The cost in staff time to obtain preauthorization for medications and procedures is another burden on running a medical practice.


Podiatric medical schools recently have faced challenges in attracting an adequate number of qualified applicants. This challenge is attributed to a combination of factors, including fewer undergraduate students, competition from other healthcare professions that require less education and less student debt, lack of knowledge about the profession, and the recent pandemic. When prospective students spend time in a podiatric physician’s office and see what they do in practice, they often apply and matriculate to a podiatric medical school. (Such interactions were greatly inhibited by the COVID-19 pandemic.)

Students with an interest in healthcare can visit to learn more about podiatry and schedule a visit to a podiatrist’s office to observe them in practice. With the demand for podiatric physicians projected to grow in the next decade and a large number of current physicians approaching retirement age, it is an outstanding time to enter the profession.

Overall, the specialty continues to thrive thanks to advanced education and training, dedicated advocacy, an engaged community of physicians, and a growing demand for the quality patient care podiatric physicians and surgeons deliver.

James R. Christina, DPM

James R. Christina, DPM, Executive Director/CEO, American Podiatric Medical Association, Rockville, Maryland.

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