By Aaron Rathsam
For many individuals interested in pursuing a career in medicine, there is a major question they must answer:
“In what branch do I want to practice?”
As an undergraduate biology major with a pre-medicine track, I was constantly exposed to the MD (Doctor of Medicine) and DO (Doctor of Osteopathic Medicine) routes. I finally discovered podiatry during my junior year, and to be honest, I didn’t even realize a DPM (Doctor of Podiatric Medicine) was an option until that point. Nevertheless, I learned a DPM is a specialized doctor who treats many facets of lower extremity pathologies and plays an equally important role in treating patients as MD and DO colleagues. All three branches have similarities regarding the application process, medical education and training, and ultimately clinical practice; however, the differences in philosophy and tradition behind the branches is what makes them unique. When deciding which branch to pursue, it is important to evaluate which of the three most closely aligns with your own personal values and goals for treating your future patients.
The Journey
In many aspects, the journey to become an MD, DO, and DPM is very similar. All three require strong academic pre-requisites in the basic medical sciences, clinical experience through shadowing and volunteering, and competitive scores on the MCAT exam. They also require completion of a 4-year medical education at accredited programs where both didactic and clinical competency courses are taken such as anatomy, biochemistry, physiology, pharmacology, and pathology, along with many others. Each degree is conferred based upon the type of school at which your education takes place. For example, to obtain an MD, you must attend an allopathic school. For a DO or DPM degree, you must attend either an osteopathic or podiatric medical school, respectively. Additionally, each path requires passing or scoring competitively on several board examinations. The MD and DO students must take several steps of the USMLE or COMLEX respectively, while those following the DPM path will take several steps of the APMLE.
The differences in these exams account for the differences in professional practice and education. For example, DO students are taught how to perform osteopathic manipulative medicine, and DPM students, because of their increased specialization towards the lower limbs, are evaluated more heavily on their understanding of anatomy and clinical pathologies related to the lower extremity. All three also perform clinical rotations which expose them to many aspects of medicine, and help the student identify interests and goals moving forward in their medical career. These are performed before completing more specialized residency programs ranging anywhere from 3 to 7 years. DPMs are required to complete a 3 to 4-year surgical residency program prior to becoming board certified.
All three [DPM, MD, DO] also perform clinical rotations which expose them to many aspects of medicine, and help the student identify interests and goals moving forward in their medical career.
Medical Practice?
In terms of medical practice as an MD, DO, or DPM, all three must treat patients according to the scope of practice associated with their degrees, training, and geographic locations. All are capable of practicing medicine, prescribing medications, and performing surgery. Traditionally, when speaking about a doctor, most people assume you are speaking about an MD. These physicians are found within numerous specialties ranging from primary care to orthopedics and neurosurgery, and primarily use medications and surgery to treat disease and pathologies. DOs tend to practice more commonly in family, emergency, and internal medicine, and utilize a more holistic philosophy to treatment and practice. They employ techniques such as osteopathic manipulative treatments, which attempt to improve the body’s ability to heal itself. Both branches tend to focus on more anatomically systemic conditions unless additional specialization is achieved through residency or fellowships, leading to the practice of cardiology, gastroenterology, or dermatology, to name a few.
Podiatry is slightly different in that while it is relatively specific in anatomic scope to the lower extremity, especially the foot and ankle, there is a very broad medical scope through which these pathologies can be treated. DPMs are highly specialized from the beginning of their education separate from MD or DO rotations, allowing for an in depth understanding and treatment of surgical, biomechanical, sports medical, dermatological, endocrinological, vascular, or neurological pathologies encountered. On any given day, a podiatrist practices many realms of medicine, requiring a holistic understanding of the entire body to offer their patients the best care. There is great flexibility in the ways a podiatrist can practice as well. They can work in numerous settings ranging from solo private practices to orthopedic groups and even hospitals. Because of the surgical training podiatrists receive, they can treat severe traumas and infections or use reconstructive procedures to reduce deformities. In addition, numerous conservative treatment options exist as well such as altering shoe gear and utilizing bracing techniques, creating custom molded orthoses, prescribing medication, and administering injections. DPMs, just like their MD and DO colleagues, utilize an extensive amount of evidence-based medicine and collaboration with other specialties to treat their patients.
There is great flexibility in the ways a podiatrist can practice as well. They can work in numerous settings ranging from solo private practices to orthopedic groups and even hospitals.
Final Thoughts
While there are many similarities with MD and DO colleagues, it is important to navigate and shadow across the various fields to educate yourself about the opportunities available in each. As a current podiatric medical student who learned about podiatry later in my undergraduate studies, I hope you will also consider podiatry as you begin pursuing a career in medicine.
By Aaron Rathsam
School: Temple University School of Podiatric Medicine
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