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January 14, 2008 #3,140 Editor-Barry Block, DPM, JD

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Block and McCord Debate MD Degree at SAM Meeting

While Democrat and Republican presidential candidates are busy debating across the nations, a packed lecture hall at the Florida Podiatric Medical Association’s Scientific and Management Meeting heard a debate about podiatry’s future. Podiatry Management’s Editor Barry Block, DPM, JD and Podiatry Today columnist John McCord, DPM presented arguments for and against the adoption of an MD degree for podiatrists.

Drs. John McCord (L) and Barry Block

Block, who has been a leading advocate for the degree change for over 25 years, presented the case that the attainment of the MD or DO degree was the only way to achieve true parity and an unlimited scope of practice. He lauded APMA’s Vision 2015 as a necessary plan to achieve this goal. He asserted that such a move would save the profession millions of dollars in lobbying efforts in a never-ending battle to include podiatrists in legislation which limits the definition of physicians to MD’s and DO’s. He also pointed out that having an MD would attract more qualified applicants to our colleges.

McCord argued that if podiatrists received MD degrees, it would only confuse the public. He claimed that many potential students would use this mechanism as a backdoor to medical school, and would then abandon the profession. He read several letters from podiatry students who believed that the degree would actually decrease the already diminished applicant pool.

Editor’s note: This debate will be published in Podiatry Management and will be available on DVD in the near future.

Alexander Elected as FPMA President

Linda Alexander, DPM has been elected the 68th president of the Florida Podiatric Medical Association. Dr. Alexander graduated from CCPM in 1984 and completed her residency at the VA in Chicago. She then served as an active duty podiatrist in the Navy for four years, followed by seven years in the Navy Reserves.

Dr. Linda Alexander

Dr. Alexander is department head of orthopedics, cardiology, dermatology, podiatry, gastroenterology, and wound care at the Jacksonville VA Clinic.

Also elected were;

1st Vice President: Bradley Haves, DPM
2nd Vice President: Terence McDonald, DPM
Treasurer: Robert Iannacone, DPM
Secretary: Samir Vakil, DPM

TN Podiatrist Named for Second Term on State Board

A Paris, TN podiatrist has been named to an unexpected second term on a state regulatory board. David H. Long was named to the Board of Podiatric Medical Examiners, formerly known as the Board of Registration in Podiatry, by Gov. Phil Bredesen. Long, who practices at East Wood Clinic in Paris, said he had completed a three-year term on the board only last year. “I’ve been on the board one other time, and my term ended in June of ’07,” he said.

Dr. David H. Long

Long said the board is chiefly concerned with licensure, discipline and complaints. It also currently is involved in creating changes in requirements for licensure. He hopes the type of work he and the board have accomplished in his last term will continue during the next three years.

“During my term there, we’ve seen a change in the scope of practice for podiatric medicine,” Long said. “Who knows what’s coming in the future, but (I’d like to see us) carrying on along the same road that we started four years ago.”

Source: The Paris Post-Intelligencer (1/11/08)

Query: Study Guides For ABPS Recertification Exam

The ABPS recertification exam is coming up soon. I'd like to hear advice on study guides, etc. from anyone who has taken the test recently.

Dan Waldman, DPM, Asheville, NC

RE: MicroVas (Peter J. Bregman, DPM)
From: Multiple Respondents

I have been using the Microvas for over 6 months now and have to caution you that the Microvas like all electrical stimulation equipment is not to be billed to Medicare for diabetic pain, Neuropathy or PAD unless their is an open lesion and the other criteria of that lesion are met regarding time and improved status of that lesion. This is spelled out on their website.

To my understanding, you can bill Medicare for Musculoskeletal diagnosis as outlined by your local carrier. Our CAC representative advised us at a recent meeting that improper billing of the Microvas and other electrical stimulation modalities was the leading cause of payment review and subsequent request for monies to be refunded to Medicare. That being said I have had patients that have had no response and others that were pleased and were only concerned if the benefit would be long lasting. The question of profitability can only be determined by you patient payer mix and their individual payment policies, as they do vary from payer to payer.

Jan David Tepper, DPM, Upland CA, jdtdpm@aol.com

I Have been using microvas for about 6-7 months purely for peripheral neuropathy patients. I have been generally pleased with the results. Pre treatment and post treatment assessments are done with pssd and the results are excellent for about 70% of the patients but patients have to understand change is going to be slow. Pts require at least 12 sessions , 45 min each . The reimbursement is about $60 per patient per session so it is profitable. When combined with other therapies the results are even more impressive (such as anodyne, gait training etc.)

Gregory Mowen , DPM Ventnor NJ, gregmowen@comcast.net

I've been using MicroVas for just over three years now. There definitely is therapeutic benefits. To date I've used it for diabetic and non-diabetic neuropathy, diabetic wounds, Morton's neuroma, and plantar fasciitis with varied results. By far, the most dramatic results have been with diabetic neuropathy and wounds. Because both have a microvascular etiology, this therapy is particularly suited for these uses, since it stimulates microvascular angiogenesis. In a two year follow-up with patients treated for diabetic neuropathy, there has been no return in symptoms except where the patient's diabetes has become uncontrolled and neuropathic symptoms return. I have stopped using MicroVas for non-diabetic neuropathy as I have not seen the same benefits. As for Morton's neuroma and plantar fasciitis, I use the therapy rarely and usually at the patient's request as a last resort to avoid surgery or ESWT. Results have been mixed.

The downside of the therapy is that it is an in-office 45 minute treatment that keeps a room occupied for about an hour. If you are short on treatment rooms, you may want to consider that issue. Also, I have found that maximum benefit occurs with treatment 3 times a week, which some patients can't commit to.

The therapy is profitable. The payment can be easily covered by 1 patient per month (treated 3 times a week, which has been my standard protocol). There have just been double blind studies completed and the company hopes for a dedicated CPT code instead of the PT codes it currently uses. They think that this will increase reimbursement, but it can backfire like it did for Anodyne and lower reimbursement too. Overall, I consider MicroVas a fantastic adjunct to my wound care practice as well as much needed relief for patients with diabetic neuropathy.

Andrew Schneider, DPM, Houston, TX, AJSDPM@aol.com

RE: Windswept Toe Deformity (Tip Sullivan, DPM)
From: Rich Bouché, DPM

From the x-ray shown, I agree the 2nd metatarsal “mal-alignment” is the problem with a medial subluxed 2nd digit (basically a ‘bunion deformity’ of the 2nd ray). For definitive correction of the second ray, the digit can be addressed with a hammertoe procedure and FDL tendon transfer, if the plantar plate is torn or significantly attenuated (as elucidated by the Lachman test) a plantar plate repair can be considered and most importantly the second ray needs to be slightly shortened but more importantly medially transposed with an oblique shortening transpositional distal osteotomy in this case (if the mal-alignment is severe occasionally the correction needs to be performed at the base or even occasionally at the base and the head).

Predisposing factors may also need to be addressed as well to “shield” the 2nd ray from further deforming forces. These factors include HAV w/ bunion, first ray hypermobility w/ or wo/ bunion, ankle equinus and forefoot equinus to name a few. Just as a bunion deformity of the first ray requires metatarsal realignment and soft tissue balancing so does the 2nd ray bunion deformity- decompressing (shortening) alone will not get the job done.

Rich Bouché, DPM, Seattle, WA, spmrtb@earthlink.net

RE: OCPM’s New Facility (Hal Ornstein, DPM)
From: Simon Young, DPM

You can lead a student to great facilities but it's up to the student to utilize and benefit. I feel learning can be done under any circumstances so long as the "colleague in training" is motivated to succeed and learn.

Nevertheless, It's wonderful to see our profession getting adequate funding to create a state-of-the-art learning facility.

Simon Young, DPM, NY, NY, Simonyoung@juno.com

ASSOCIATE POSITION - MICHIGAN

Successful and expanding multi-office practice. Up to date technology, EMR, digital x-rays, ultrasound, APC SmartPReP. Great opportunity for a hard-working, personable new or established surgeon. Hospital and surgery privileges are available. ABPS eligible/certified. Full scope of foot and ankle care including wound care. Partnership opportunity. E-mail letter of introduction, photo and CV to: michfootdr@yahoo.com

PODIATRISTS NEEDED - CHICAGO --NORTHWEST INDIANA

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists. We are located in Chicago and Northwest Indiana. Full and part time positions are available. Competitive Compensation including malpractice. Contact Scott Schneider. Phone-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com -- www.homephysicians.com

ASSOCIATE POSITION - VIRGINIA

Multi-office practice, EMR, digital x-rays, sonography. Great opportunity for hard-working, personable new or established surgeon. Hospital and surgery center privileges available. ABPS eligible/certified. Full scope of foot & ankle care. Base salary, immediate percentage, and benefits. E-mail letter of introduction, CV and photo to practice administrator at: mtrevor41@yahoo.com

ASSOCIATE WANTED – NEW YORK IMMEDIATE OPENING

Busy multi-dimensional practice; 70 miles north of New York City . Currently five (5)-doctor practice. looking to expand – all phases of podiatric medicine. contact: (845) 454-8308 EXT: 106

PART-TIME PRACTICE FOR SALE - FLUSHING, NY

40 year old part time practice for sale. Priced for quick sale. Please contact me at footdoc60@gmail.com. Serious inquires only, please

ASSOCIATE POSITION- KANSAS CITY, MO

Excellent opportunity for a hard working, ethical podiatrist to join a vibrant, successful and growing podiatric medical and surgical practice. Dedicated, supportive staff with strong marketing and medical knowledge. Must be board eligible/certified. PSR/24. Partnership opportunity. Competitive salary, bonus structure, benefits. Wonderful place to raise a family. Fax CV to 816-455-8901

ASSOCIATE-TO-PARTNERSHIP OPPORTUNITY NEW HAMPSHIRE

Established practice located 1 hour north of Boston in tax-free New Hampshire is seeking a well-trained graduate of a 24-month surgical/general podiatry residency. This is a practice with a nice mix of surgery, biomechanics, injuries, diabetic and general care. No nursing homes. Very modern office with EMR, US, excellent referral base, and a well-trained staff. E-mail inquiries howardbon@aol.com

ALTERNATIVE PATHWAY TO BOARD CERTIFICATION PETITION

I am seeking to gather the names of my fellow podiatrists who are being denied the opportunity to sit for the board certification exams and would like to join my efforts to petition our leadership for a fair alternative within the system. To join this effort, please email your name and contact information podiatrydoc@gmail.com

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