infections; and foot complaints associated with diseases such as diabetes. To treat these problems, podiatrists prescribe drugs, order physical therapy, set fractures, and perform surgery. They also fit corrective inserts called orthotics, design plaster casts and strappings to correct deformities, and design custom-made shoes. Podiatrists may use a force plate to help design the orthotics. Patients walk across a plate connected to a computer that "reads" the patients' feet. From the computer readout, podiatrists order the correct design.

To diagnose a foot problem, podiatrists order x rays and laboratory tests. The foot may be the first area to show signs of serious conditions such as arthritis, diabetes, and heart disease. For example, diabetics are prone to foot ulcers and infections due to poor circulation. Podiatrists consult with and refer patients to other health practitioners when they detect symptoms of these disorders.

Most podiatrists have a general practice. Some specialize in surgery, orthopedics, primary care, or public health. Besides these board-certified specialties, podiatrists may practice a subspecialty such as sports medicine, pediatrics, dermatology, radiology, geriatrics, or diabetic foot care. Podiatrists generally are in private practice, which means they run a small business. They may hire employees, order supplies, and keep records.

surgery at a hospital, but generally have fewer after-hours emergencies than other doctors. Those with private practices set their own hours, but to meet the needs of their patients, they may work evenings and weekends.

Employment

Podiatrists held about 11,000 jobs in 1996. Most podiatrists are solo practitioners, although more are entering partnerships and multispecialty group practices. Others are employed in hospitals, nursing homes, the U.S. Public Health Service, and the Department of Veterans Affairs.

Training, Other Qualifications, and Advancement

All States and the District of Columbia require a license for the practice of podiatric medicine. Each defines its own licensing requirements. Generally, the applicant must be a graduate of an accredited college of podiatric medicine and pass written and oral examinations. Some States permit applicants to substitute the examination of the National Board of Podiatric Examiners, given in the second and fourth years of podiatric medical college, for part or all of the written State examination. Most States also require completion of a postdoctoral residency program. Most States grant reciprocity to podiatrists who are licensed in another State. Most States require continuing education for licensure renewal.

Prerequisites for admission to a college of podiatric medicine include the completion of at least 90 semester hours of undergraduate study, an acceptable grade point average, and suitable scores on the Medical College Admission Test (MCAT). All require 8 semester hours each of biology, inorganic chemistry, organic chemistry, and physics, and 6 hours of English. The science courses should be those designed for pre-medical students. Potential podiatric medical students may also be evaluated on the basis of extracurricular and community activities, personal interviews, and letters of recommendation. Over 90 percent of podiatric students have at least a bachelor's degree.

Colleges of podiatric medicine offer a 4-year program whose core curriculum is similar to that in other schools of medicine. During the first 2 years, students receive classroom instruction in basic sciences, including anatomy, chemistry, pathology, and pharmacology. Thirdand fourth-year students have clinical rotations in private practices, hospitals, and clinics. During these rotations, they learn how to take general and podiatric histories, perform routine physical examinations, interpret tests and findings, make diagnoses, and perform therapeutic procedures. Graduates receive the doctor of podiatric medicine (DPM) degree.

Most graduates complete a hospital residency program after receiving a DPM. Residency programs last from 1 to 3 years. Residents receive advanced training in podiatric medicine and surgery and serve clinical rotations in anesthesiology, internal medicine, pathology, radiology, emergency medicine, and orthopedic and general surgery. Residencies lasting more than 1 year provide more extensive training in specialty areas.

There are a number of certifying boards for the podiatric specialties of orthopedics, primary medicine, or surgery. Certification means that the DPM meets higher standards than those required for licensure. Each board requires advanced training, completion of written and oral examinations, and experience as a practicing podiatrist. Most managed care organizations prefer board-certified podiatrists.

People planning a career in podiatry should have scientific aptitude, manual dexterity, interpersonal skills, and good business sense. Podiatrists may advance to become professors at colleges of podiatric medicine, department chiefs of hospitals, or general health administrators.

Job Outlook

Employment of podiatrists is expected to grow about as fast as the average for all occupations through the year 2006. More people will turn to podiatrists for foot care as the elderly population grows. The

elderly have more years of wear and tear on their feet and legs than most younger people, so they are more prone to foot ailments. Injuries sustained by an increasing number of men and women of all ages leading active lifestyles will also spur demand for podiatric care.

In addition to growth, the need to replace podiatrists who leave the occupation will create employment opportunities. Relatively few opportunities from this source are expected, however, because most podiatrists continue to practice until they retire; few transfer to other occupations. Even when combined, the number of job openings resulting from both growth and replacement needs is very low because the occupation is small.

Medicare and most private health insurance programs cover acute medical and surgical foot services, as well as diagnostic x rays and leg braces. Details of such coverage vary among plans. However, routine foot care-including the removal of corns and calluses-is ordinarily not covered, unless the patient has a systemic condition that has resulted in severe circulatory problems or areas of desensitization in the legs or feet. Like dental services, podiatric care is more dependent on disposable income than other medical services.

Employment of podiatrists would grow even faster were it not for continued emphasis on controlling the costs of specialty health care. Insurers will balance the cost of sending patients to podiatrists against the cost and availability of substitute practitioners, such as physicians and physical therapists. Opportunities will be better for boardcertified podiatrists, because many managed care organizations require board-certification. Opportunities for newly trained podiatrists will be better in group medical practices, clinics, and health networks than in a traditional solo practice. Establishing a practice will be most difficult in the areas surrounding colleges of podiatric medicine because podiatrists are concentrated in these locations.

Nature of the Work

Veterinarians play a major role in the health care of pets, livestock, and zoo, sporting, and laboratory animals. Veterinarians also use their skills to protect humans against diseases carried by animals, and conduct clinical research on human and animal health problems.

Most veterinarians perform clinical work in private practices. About one-half of these veterinarians predominately or exclusively treat small animals. Small animal practitioners usually care for companion animals, such as dogs and cats, but also treat birds, reptiles, rabbits, and other animals that may be kept as pets. Some veterinarians work in mixed animal practices, where they see pigs, goats, sheep, and some nondomestic animals, in addition to companion animals. Veterinarians in clinical practice diagnose animal health problems, vaccinate against diseases such as distemper and rabies, medicate animals with infections or illnesses, treat and dress wounds, set fractures, perform surgery, and advise owners about feeding, behavior, and breeding.

A smaller number of private practice veterinarians work exclusively with large animals, focusing mostly on horses or cows, but may care for all kinds of food animals. These veterinarians usually drive to farms or ranches to provide veterinary services for herds or individual animals. Much of their work involves preventive care in order to maintain the health of food animals. They test for and vaccinate against diseases, and consult with farm or ranch owners and managers on production, feeding, and housing issues. They also treat and dress wounds, set fractures, perform surgery—including cesarean sections on birthing animals—and do artificial insemination. Veterinarians also euthanize animals when necessary.

Veterinarians who treat animals use surgical instruments; medical equipment, such as stethoscopes; and diagnostic equipment, such as radiology machines.

Veterinarians contribute to human as well as animal health. A number of veterinarians work with physicians and scientists as they research better ways to prevent and treat human health problems such as cancer, AIDS, and alcohol or drug abuse. Some test the effects of drug therapies, antibiotics, or new surgical techniques on animals. Veterinarians who are livestock inspectors check animals for transmissible diseases, advise owners on treatment, and may quarantine animals. Veterinarians who are meat, poultry, or egg product inspectors examine slaughtering and processing plants, check live animals and carcasses for disease, and enforce government regulations regarding food purity and sanitation. Some veterinarians care for zoo or aquarium animals, or for laboratory animals.

Working Conditions

Veterinarians often work long hours, with nearly half spending 50 or more hours on the job. Those in group practices may take turns being on call for evening, night, or weekend work, and solo practitioners may work extended and weekend hours responding to emergencies and squeezing in unexpected appointments.

Veterinarians in large animal practice also spend time driving between office and farm or ranch. They work outdoors in all kinds of weather, and may have to treat animals or perform surgery under lessthan-sanitary conditions. When working with animals that are frightened or in pain, veterinarians risk being bitten, kicked, or scratched.

Employment

Veterinarians held about 58,000 jobs in 1996. About a third were self-employed, in solo or group practices. Most others were employees of a practice. The Federal Government employed about 2,000 civilian veterinarians, chiefly in the U.S. Department of Agriculture, and about 500 military veterinarians in the U.S. Army and U.S. Air Force. Other employers of veterinarians are State and local governments, colleges of veterinary medicine, medical schools, research laboratories, animal food companies, and pharmaceutical companies. A few veterinarians work for zoos. Most veterinarians caring for zoo animals are private practitioners who contract with zoos to provide services, usually on a part-time basis.

Self-employed veterinarians comprise about one-third of the profession and often work extended or weekend hours.

Although veterinarians are located in every State, in 1996 about 3 out of 10 establishments providing veterinary services were located in just four States: California, Florida, New York, and Texas.

Training, Other Qualifications, and Advancement Prospective veterinarians must graduate from a 4-year program at an accredited college of veterinary medicine with a Doctor of Veterinary Medicine (D.V.M. or V.M.D.) degree and obtain a license to practice. There are 27 colleges in 26 States that meet accreditation standards set by the Council on Education of the American Veterinary Medical Association. The prerequisites for admission vary by veterinary medical college. Many do not actually require a bachelor's degree for entrance, but all require a significant number of credit hours at the undergraduate level, ranging from 45 to 90 semester hours. Preveterinary courses emphasize the sciences, and veterinary medical colleges typically require classes in organic and inorganic chemistry, physics, biochemistry, general biology, animal biology, animal nutrition, genetics, vertebrate embryology, cell or microbiology, zoology, and systemic physiology. Some programs require calculus; some require only statistics, college algebra and trigonometry, or precalculus; and others require no math at all. Most veterinary medical colleges also require some core courses, including English or literature, social science, and the humanities. Although a bachelor's degree is generally not required for entry to veterinary medical school, most of the students admitted have completed an undergraduate program.

Most veterinary medical colleges will only consider applicants who have a minimum grade point average (GPA). The required GPA varies by school from a low of 2.5 to a high of 3.2, based on a maximum GPA of 4.0. However, the average GPA of candidates at most schools is higher than these minimums. Those who receive offers of admission usually have a GPA of 3.0 or better.

In addition to satisfying preveterinary course requirements, applicants must also submit test scores from the Graduate Record Examination (GRE), the Veterinary College Admission Test (VCAT), or the Medical College Admission Test (MCAT), depending on the preference of each college.

Veterinary medical colleges also weigh heavily a candidate's veterinary and animal experience in the admissions process. Formal experience, such as work with veterinarians or scientists in clinics, agribusiness, research, or in some area of health science, is particularly advantageous. Less formal experience, such as working with animals on a farm, ranch, stable, or animal shelter, is also helpful. Students must demonstrate ambition and eagerness to work with animals.

Competition for admission to veterinary school is keen. The number of accredited veterinary colleges has remained at 27 since 1983, while the number of applicants has risen. About 1 in 3 applicants was accepted in 1996. Most veterinary medical colleges are public, Statesupported institutions, and reserve the majority of their openings for inState residents. Twenty States that do not have a veterinary medical college agree to pay a fee or subsidy to help cover the cost of veterinary education for a limited number of their residents at one or more out-ofState colleges. Nonresident students who are admitted under such a contract arrangement may have to pay out-of-State tuition, or they may have to repay their State of residency all or part of the subsidy that was provided to the contracting college. Residents of the remaining four States and the District of Columbia may apply to any of the 27 veterinary medical colleges as an "at-large" applicant. The number of positions available to "at-large" applicants is very limited at most schools, making admission difficult.

While in veterinary medical college, students receive additional academic instruction and are exposed to clinical procedures such as diagnosing and treating animal diseases and performing surgery. They also do laboratory work in anatomy, biochemistry, and other scientific and medical subjects. At most veterinary medical colleges, students who plan a career in research can earn both a D.V.M degree and a Doctor of Philosophy (Ph.D.) degree at the same time.

Veterinary graduates who plan to work with specific types of animals or specialize in a clinical area, such as pathology, surgery, radiology, or laboratory animal medicine, usually complete a 1-year internship. Interns receive only a small salary, but usually find that their internship experience leads to higher starting salaries relative to other starting veterinarians. Veterinarians who seek board certification in a specialty must also complete a 2- to 3-year residency program which provides intensive training in one of the following areas: Internal medicine, oncology, radiology, surgery, dermatology, anesthesiology, neurology, cardiology, ophthalmology, or exotic small animal medicine.

All States and the District of Columbia require that veterinarians be licensed before they can practice. The only exemptions are for veterinarians working for some Federal agencies and some State governments. Licensing is controlled by the States and is not strictly uniform, although all States require successful completion of the D.V.M. degree or equivalent education-and passage of a national board examination. The Educational Commission for Foreign Veterinary Graduates (ECFVG) grants certification to individuals trained outside the U.S. who demonstrate that they meet specified English language and clinical proficiency requirements. ECFVG certification fulfills the educational requirement for licensure in all States except Nebraska.

Applicants for licensure satisfy the examination requirement by passing the National Board Examination (NBE) and the Clinical Competency Test (CCT). The NBE comprises 400 multiple choice

questions covering all aspects of veterinary medicine and takes one day to complete. The CCT is a half-day examination consisting of 14 problems covering real-life situations in which the candidate is given a set of facts and must choose the correct course of action for the patient. Many States permit candidates to take the NBE in their third year of veterinary school, but those who pass must still graduate with the D.V.M. before they can be licensed.

The majority of States also require candidates to pass a State jurisprudence examination, covering State laws and regulations. Some States also do additional testing on clinical competency. There are very few reciprocal agreements between States, making it difficult for a veterinarian to practice in a new State without first taking another State examination.

Thirty-nine States have continuing education requirements for licensed veterinarians. Requirements differ by State, and may involve attending a class or otherwise demonstrating knowledge of recent medical and veterinary advances.

Most veterinarians begin as employees or partners in established practices. Despite the substantial financial investment in equipment, office space, and staff, many veterinarians with experience set up their own practice or purchase an established one.

Newly trained veterinarians may become U.S. Government meat and poultry inspectors, disease-control workers, epidemiologists, research assistants, or commissioned officers in the U.S. Public Health Service, U.S. Army, or U.S. Air Force. A State license may be required.

Prospective veterinarians must have good manual dexterity. They should have an affinity for animals and the ability to get along with animal owners. They must also be able to make decisions in emergencies.

Job Outlook

Employment of veterinarians is expected to grow faster than the average for all occupations through the year 2006. Job openings stemming from the need to replace veterinarians who retire or otherwise leave the labor force will be almost as numerous as new jobs resulting from employment growth over the 1996-2006 period.

Most veterinarians practice in animal hospitals or clinics, many of whom care primarily for companion animals. The number of pets is expected to increase more slowly during the projection period than in the previous decade, partly because the large baby-boom generation is aging and will acquire fewer dogs and cats. Slower pet population growth may curtail the demand for veterinarians who specialize in small animals. Nevertheless, new technologies and medical advancements will permit veterinarians to offer more and better care to animals. Pet owners are becoming more aware of the availability of advanced care. They may increasingly take advantage of nontraditional veterinary services such as preventive dental care, and more willingly pay for intensive care than in the past. Veterinarians who enter small animal practice may face competition. Large numbers of new graduates continue to be attracted to small animal medicine because they prefer to deal with pets, and live and work near or in populated areas. However, an oversupply does not necessarily limit the ability of veterinarians to find employment or set up and maintain a practice. It could result in more veterinarians taking positions requiring much evening or weekend work to accommodate the extended hours of operation which more practices are offering. Others could take salaried positions in retail stores offering limited veterinary services. Self-employed veterinarians may have to work harder and longer to build a sufficient clientele.

The number of jobs for large animal veterinarians is expected to grow slowly because productivity gains in the agricultural production industry mean demand for fewer veterinarians to treat food animals. Nevertheless, job prospects may be better for veterinarians who specialize in farm animals than for small animal practitioners because fewer veterinary medical college graduates have the desire to work in rural or isolated areas.

Continued support for public health and food safety, disease control programs, and biomedical research on human health problems will contribute to the demand for veterinarians, although such posi

Veterinarians prevent, diagnose, and treat diseases, disorders, and injuries in animals. Those who do similar work for humans include chiropractors, dentists, optometrists, physicians, and podiatrists. Veterinarians also have extensive training in physical and life sciences, and some do scientific and medical research, closely paralleling occupations such as biological, medical, and animal scientists.

Animal trainers, animal breeders, and veterinary technicians work extensively with animals. Like veterinarians, they must have patience and feel comfortable with animals. However, the level of training required for these occupations is substantially less than that needed by veterinarians.

Sources of Additional Information

For more information on careers in veterinary medicine and a list of U.S. schools and colleges of veterinary medicine, send a letter-size, self-addressed, stamped envelope to:

American Veterinary Medical Association, 1931 N. Meacham Rd., Suite 100, Schaumburg, IL 60173-4360.

For information on scholarships, grants, and loans, contact the financial aid officer at the veterinary schools to which you wish to apply. For information on veterinary education, write to:

☛ Association of American Veterinary Medical Colleges, 1101 Vermont Ave. NW., Suite 710, Washington, DC 20005.

For information on the Federal agencies that employ veterinarians and a list of addresses for each agency, write to:

National Association of Federal Veterinarians, 1101 Vermont Ave. NW., Suite 710, Washington, DC 20005.

Dietitians and Nutritionists

(D.O.T. 077 except.117-010 and .124-010)

Significant points

Employment of dietitians is expected to grow about as fast as the average for all occupations through the year 2006 due to increased emphasis on the prevention of disease by improved health habits.

The basic educational requirement for dietitians and nutritionists is a bachelor's degree with a major in dietetics, foods and nutrition, food service systems management, or a related area.

Nature of the Work

Dietitians and nutritionists plan nutrition programs and supervise the preparation and serving of meals. They help prevent and treat illnesses by promoting healthy eating habits, scientifically evaluating clients' diets, and suggesting diet modifications, such as less salt for those with high blood pressure or reduced fat and sugar intake for those who are overweight.

Dietitians run food service systems for institutions such as hospitals and schools, promote sound eating habits through education, and conduct research. Major areas of practice are clinical, community, management, and consultant dietetics.

Clinical dietitians provide nutritional services for patients in institutions such as hospitals and nursing homes. They assess patients' nutritional needs, develop and implement nutrition programs, and evaluate and report the results. They also confer with doctors and other health care professionals in order to coordinate medical and nutritional needs. Some clinical dietitians specialize in the management of overweight patients, care of the critically ill, or care of renal (kidney) and diabetic patients. In addition, clinical dietitians in nursing homes or small hospitals may also manage the food service department.

Community dietitians counsel individuals and groups on nutritional practices designed to prevent disease and promote good health. Working in such places as public health clinics, home health agencies, and health maintenance organizations, they evaluate individual needs, develop nutritional care plans, and instruct individuals and their families. Dietitians working in home health agencies may provide instruction on grocery shopping and food preparation to the elderly, or patients with AIDS, cancer, or diabetes.

Popular interest in nutrition has led to opportunities in food manufacturing, advertising, and marketing, in which dietitians analyze foods, prepare literature for distribution, or report on issues such as the nutritional content of recipes, dietary fiber, or vitamin supplements.

Management dietitians oversee large-scale meal planning and preparation in such places as health care facilities, company cafeterias, prisons, and schools. They hire, train, and direct other dietitians and food service workers; budget for and purchase food, equipment, and supplies; enforce sanitary and safety regulations; and prepare records and reports.

Consultant dietitians work under contract with health care facilities or in their own private practice. They perform nutrition screening for their clients, and offer advice on diet-related concerns such as weight loss or cholesterol reduction. Some work for wellness programs, sports teams, supermarkets, and other nutrition-related businesses. They may consult with food service managers, providing expertise in sanitation, safety procedures, budgeting, and planning.

Working Conditions

Most dietitians work a regular 40-hour week, although some work weekends. Many dietitians work part time.

Dietitians and nutritionists spend much of their time in clean, well-lighted, and well-ventilated areas. However, some dietitians spend time in hot, steamy kitchens. Dietitians and nutritionists may be on their feet for most of the workday.

Employment

Dietitians and nutritionists held about 58,000 jobs in 1996. Over half were in hospitals, nursing homes, or offices and clinics of physicians.

State and local governments provided about 1 job in 6-mostly in health departments and other public health related areas. Other jobs were in restaurants, social service agencies, residential care facilities, diet workshops, physical fitness facilities, school systems, colleges and universities, and the Federal Government-mostly in the Department of Veterans Affairs. Others were employed by firms that provide food services on contract to such facilities as colleges and universities, airlines, and company cafeterias.

Some dietitians were self-employed, working as consultants to facilities such as hospitals and nursing homes, and seeing individual clients.

Training, Other Qualifications, and Advancement

The basic educational requirement for dietitians and nutritionists is a bachelor's degree with a major in dietetics, foods and nutrition, food service systems management, or a related area. Students take courses in foods, nutrition, institution management, chemistry, biology, microbiology, and physiology. Other suggested courses include business, mathematics, statistics, computer science, psychology, sociology, and economics.

Of the 40 States having laws governing dietetics, 27 require licensure, 12 require certification, and 1 requires registration. The Commission on Dietetic Registration of the American Dietetic Association (ADA)