The Voice of Podiatrists

Serving Over 9,000 Podiatrists Daily

January 18, 2007 #2,792 Editor-Barry Block, DPM, JD

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Hettie M. Stevens, 90; 3rd-Generation Podiatrist

Hettie Martin Stevens, a podiatrist who had a practice in West Philadelphia for more than 30 years, died Dec. 24. Hettie was born in Dubuque, Iowa, the fifth of the nine children of Dr. Henry Ambrose Martin Sr., also a podiatrist, and the former Mattie Ducano. She was a graduate of the Illinois College of Chiropody. She was the only woman podiatrist in a family of three generations of podiatrists.

PM News policy is to recommend that memorial donations be made top the APMA Educational Foundation Student Scholarship Endowment, 9312 Old Georgetown Rd., Bethesda, MD 20814

Source: John F. Morrison, The Philadelphia Inquirer [1/16/07

RACs to Go Nationwide By 2010

RACs are the first Medicare auditors to be paid only when they identify errors — either underpayments or overpayments. Congress directed CMS to hire these contractors in the 2003 Medicare reform law, but the program was confined to a three-state pilot: in California, New York and Florida. Because of their perceived success — a CMS status report in November said RACs identified $303.5 million in payment errors about two-thirds of the way through the pilot — Congress expanded the program.

The Tax Relief and Health Care Act of 2006, which President Bush signed into law in December, requires CMS to use RACs nationally no later than Jan. 1, 2010. "CMS hopes a national RAC program will help CMS get closer to the goal of paying the claim right the first time," an agency official says. But some providers worry that RACs could be overzealous, and they question some of their methods.

Source: Report on Medicare Compliance [1/15/07]

C-reactive Protein Fails to Predict Rheumatoid Arthritis: Study

A measurement of C-reactive protein, an indicator of acute inflammation, does not forecast who will develop rheumatoid arthritis, according to a study published last month. This inflammatory marker remains a good way to monitor the disease's progress, but not to diagnose it or determine who will develop it.

Researchers from Brigham and Women's Hospital and Harvard Medical School in Boston worked with blood samples provided by 27,939 participants in the Women's Health Study, a randomized trial exploring the impact of aspirin and vitamin E on cancer and cardiovascular disease risk. Of this group, 90 received a diagnosis of rheumatoid arthritis that fit American College of Rheumatology guidelines. But after adjusting for age, body mass index, smoking and impact of the intervention this trial was studying, the disease's occurrence did not correlate with CRP measures.

Source: Victoria Stagg Elliott, AMNews [1/22/07]

Query: CME for H & P’s

I would like to thank all of the responses that I received regarding privileges for H&P's at various hospitals. I have found out that I will be able to get H&P privileges, but I first need to get 25 hours of CME for H&P's. Does anyone know where I can get 25 hours of CME pertaining to H&P's. I have looked online, but have had no success finding any courses.

Rick Burnell, DPM, Camden SC

RE: Quinine Sulphate (Gary Lieber, DPM)
From: Paul Kesselman, DPM

I have not heard anything about the FDA discontinuing production of quinine and share your concern. I have found that tonic or quinine water 4 oz qhs offers the same therapeutic value as the quinine tablets and avoids the GI upset often seen with the tablets.

Paul Kesselman, DPM, Woodside, NY, pkesselman@pol.net

RE: H&P Precedents (Rick Burnell, DPM)
From: Multiple Respondents

I fully understand the significance of granting podiatrists H&P privileges, but have we all looked at the flip side. What are you going to do when the PCP or internist refuses to do a pre-op H&P on your class-3 patient or refuses to round or medically manage your infected diabetic patient. Don't kid yourself that this won't happen because it already does. Many family docs don't even realize that we couldn't do our own H&P's. They just figured we were being prudent and looking out for the best interest of their patient. Let's all be careful what we wish for. Also asking the PCP to do the pre-op clearance keeps them in the loop. It also provides feedback to the PCP.

Andrew Cohen, DPM, Saginaw, MI, ahcfootdoc@aol.com

If we as a profession desire to be included as a medical equal within the medical community then we need to push for equal privileges and scopes. Whether one desires to exercise their full privilege or practice within their full scope is a matter of individual comfort and competence.

It may be the lack of training or competence, but it seems to me like there are always those within our profession that feel their deficiencies of skill and confidence should speak for the entire profession. I completed an H&P course in podiatry school. In my three years of residency I spent three months in an internal medicine rotation working side-by-side with the IM residence performing H&P’s on all patient admissions. I continued performing H&P’s when rotating through other specialties. I am quite competent to perform and H&P on a relatively healthy individual undergoing elective surgery or hospital admission. Of course, I would obtain consult and management of the tougher cases but there is no reason why I shouldn’t be able to direct admit initially. All other options are open as well.

Dr. Samuel asks what the big deal is. Well, for one, it is a big deal that the patient sees us in the light of a true physician that is going to open up their foot. Second, it is also a money and timesaver for the patient since they will not be required to go to their primary for the H&P. So who is qualified to do H&P’s; a plastic surgeon, an orthopedic surgeon? Then why not podiatrists? Dr. Samuel globally states that podiatrists cannot perform H&P’s as well as internists. I would have to say that my H&P abilities in residency were much greater than that of the IM resident who presented vitals on a dead patient in morning rounds.

Jon Purdy, DPM, New Iberia, LA, podiatrist@mindspring.com

It is vitally important that DPMs be allowed to do recognized H and P's for hospital and ASC admission and of course in their offices. However there are situations where MDs and DO's decline to do their own H and P's for specific reasons:

Mostly this is due to recognition of "Patient Class." Patient Class is a method to allocate large organ system abnormalities. A Class I patient is one with a major organ abnormality, such as COPD. A Class II patient might be one with two moa, such as chronic COPD and diabetes. A Class III patient might be one with COPD, diabetes and congestive heart failure. Etc.

Co-management of such patients is the standard of care in hospitals. Thus, an orthopedist would choose to have an internist do their admission H and P, and manage their patients' heart problems before and after surgery. This does not reflect upon the knowledge or skills of either provider, but represents the kind of care you and a member of your family want and deserve.

Podiatrists who decline to do their own H and P may do so for specific, logical reasons that have nothing to do with their healthcare degree.

Michael M. Rosenblatt, DPM, San Jose, CA, ROSEY1@prodigy.net

Editor’s Note: This topic is now closed.

EQUIPMENT FOR SALE

1 Whitehall whirlpool JO 140, 1 Whitehall whirlpool P 15 M,
3 Bailey physiotherapy stools. Would prefer to sell as package, but will sell separately. Please respond to Bob Kornfeld, DPM at Holfoot153@aol.com or call 516-869-3338.

ASSOCIATE POSITION - MID-EASTERN, NORTH CAROLINA

Potential partnership - Well-established and extremely respected single location practice. Small city east of Raleigh near coast with excellent fishing, hunting, and outdoor activities. Must be personable & motivated with strong surgical and medical skills. Prefer PSR-24/36 training with active (or in process of obtaining NC license). Send CV to ncfootankle@aol.com

ASSOCIATE POSITION – MISSISSIPPI

Well established, busy, 3-doctor practice seeks PSR 12 or 24 trained podiatrist for associate position to fill vacancy of retiring member. East central location is a great area to raise a family and is a prime location for accessibility to several major cities. Competitive salary, benefits, and incentives. Partnership possible in 2 years to right individual. June - July start date. Applicant must be ethical, personable, and motivated. Please E-mail CV and letter of intent to shanegan@bellsouth.net

ASSOCIATE POSITION - LOS ANGELES/SOUTH BAY AREA

Multi-office, multi-doctor, well-established practice near the beach cities. Seeking a board eligible/certified PSR-24 or PSR-36 trained foot and ankle surgeon. Well-rounded practice requiring knowledge in biomechanics, pediatrics, sports medicine, diabetic wound care, trauma, and reconstructive foot and ankle surgery. Full-time position available immediately with generous compensation and benefits, including malpractice, and health insurance. Two-year commitment required with partnership opportunity. Send CV to akemfoot@sbcglobal.net or fax to (310) 838-0227

POSITION AVAILABLE-SOUTH FLORIDA/BROWARD COUNTY

Needs 2 or 3-year post surgical training in forefoot and rearfoot
Salary plus incentives Email responses to office email: advfoot@bellsouth.net

EQUIPMENT FOR SALE - METTLER SONICATOR 715 ULTRASOUND

Mettler Sonicator 715 Ultrasound with 5cm2 with delivery head, great in any podiatry office for multiple uses. The cheapest I am able to price this machine new, is on Esurg at $1396.77. My unit was used about 20 times, and is about 2 years old. I will let it go for $650.00 plus shipping. Like new condition. If interested, write deg1@comcast.net

EXCELLENT ASSOCIATE OPPORTUNITY – SOUTHERN CALIFORNIA

Established 25 year well-rounded biomechanical and surgical practice seeking energetic, enthusiastic, personable and proficiently-trained PSR-24 or PSR-36 foot and ankle surgeon for associate with ultimate partnership opportunity in LA area. Excellent position for an individual interested in all aspects of podiatric medicine with emphasis on reconstructive foot and ankle surgery. Only 8% Medicare with No HMO. Email CV to dr4feet@sbcglobal.net

ASSOCIATE POSITION - CINCINNATI, OHIO

One of the largest podiatry practices in the United States is again in need of a PSR 24-36 Associate. All present doctors are in their thirties with similar training. Everyone is treated equally and there is definitely no limit to your success. Please submit resume or contact Karen Roesch via email or phone. Kroesch4poh@aol.com (513) 729-4455

POSITION AVAILABLE - SOUTHEAST TENNESSEE/ NORTH GEORGIA

Immediate position available or will wait for the right individual. Unique practice opportunity in growing multi-physician/multi-office practice. Well established/cutting edge within the medical community. Close proximity to hospitals as well as opportunity to become involved with a free standing podiatric surgical center. Must be BQ/BC. Minimum PSR/24. Competitive salary, bonus structure and benefits. E-mail CV to afcjen@hotmail.com

ASSOCIATE POSITION - CENTRAL CALIFORNIA

Central California multi-location practice looking for PSR-36 associate leading to partnership. PSR-36 trained podiatrist with great opportunity for reconstructive surgical practice. Practice has Medicare-approved surgery center. Must have excellent interpersonal skills. Excellent salary and incentive. Respond to: westsidefoot@yahoo.com

ASSOCIATE WANTED FOR SOUTH MIAMI AREA

Large group, busy, multi-office, partner potential. Motivated applicants only. Mail resumes and letters of intent to 999 N. Krome Avenue, Homestead, FL 33030. July start time OK, sooner preferable. E-mail lianadpm2@aol.com. I can also be reached at 305-331-4501.

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 POSITION - NORTHERN VIRGINIA

Well-established, busy, diversified, multioffice/multidoctor practice seeking associate with opportunity for partnership. Must be highly motivated and ethical with strong interpersonal and patient skills. Excellent opportunity for PSR 24 or higher trained individual to complement a full-scope podiatric medical and surgical practice. Competitive salary and benefits package. Please send CV and references to saglag2@aol.com or fax to (703) 368-5103.

ASSOCIATE POSITION--PHOENIX SUBURB

Attractive opportunity for enthusiastic, proficient, and personable associate. Well-established modern practice with multiple newer spacious offices, technology and equipment. Solid referral base, close to hospitals, knowledgeable certified staff. 22% MCR. Practice and surgical center partnership potential opportunity. Prefer 24-36+ PSR. Send CV: AZpodassociate@aol.com

ASSOCIATE POSITION – ST. LOUIS, MISSOURI

Immediate Opening. Busy practice in prime suburban St. Louis location looking for a surgically trained associate, possible partner. Must be honest, ethical and hardworking. ABPS preferred, but not required. Please reply with CV and requirements to mdwrtw@aol.com

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