The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

February 03, 2011 #4,080 Publisher-Barry Block, DPM, JD

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Temple Podiatry Club Offers Students a New Way to Think About Feet

As a high school senior in 2003, Mike Sganga took a course in forensics — the art of crime solving — and discovered an interest that stayed with him as he began his studies in Temple’s School of Podiatric Medicine. But Sganga’s curiosity about solving crimes soon took a backseat to exams and clinical rotations — until the Fall 2009 semester, when he took an anatomy course taught by Arthur Washburn, an associate professor of anatomy and cell biology in Temple’s School of Medicine.

Arthur Washburn (right), assistant professor of anatomy and cell biology, and podiatry student Mike Sganga have started the country’s first forensic podiatry club. (Photo) Jeanne Lockner/Temple University

Sganga wondered why there wasn’t a formal course on forensics at any of the podiatry schools in the U.S., and with Washburn’s help, decided to remedy that by starting the first club in the country dedicated to learning how podiatrists can help process crime scenes. So far, the forensic podiatry club at Temple has had two meetings with about 60 people attending in total. At the most recent meeting, Washburn lectured on identifying bones at a crime scene.

Source: Renee Cree, Temple University

AAPPM Inspires OCPM Students to Donate $2,100 to APMA PAC

After an inspiring lecture in OCPM's practice management class led by Drs. Hal Ornstein and  John Guiliana, the first year class was given a breakdown of why the APMA PAC is important to students by APMA PAC Donations Coordinators Tom Biernacki and Scott Walrath.

Drs. John Guiliana and Hal Ornstein with OCPM's first year class.

After a motivating explanation, OCPM's first year class alone (pictured with Drs. Guiliana and Ornstein) raised over $2,100 in donations for the PAC.  

10 IPMA Podiatrists Volunteer for "Talk to a Podiatrist Day" Event

Ten podiatrists volunteered their time to answer questions from Illinois residents this week as part of Talk to a Podiatrist Day event held by the Illinois Podiatric Medical Association: Drs. Helena Reid, George Tsatsos, Steven Rembos, Richard Bennett, Marlene Reid,  David Finkelstein, Lawrence Kosova, Jeffrey Crowhurst, Rolland Tolliver, and Stephanie Ellis Spicer.  

Dr. Marlene Reid

The Talk to a Podiatrist event was established so Illinois residents could access free, reliable healthcare information about foot care issues, from calluses and bunions to sprained ankles and ingrown toenails. Volunteer podiatrists answered tweets on the IPMA Twitter account, posts on the association’s Facebook page, and phone calls.  According to IPMA president Marlene Reid, DPM, the call-in event helped provide useful and factual information from podiatric physicians.

States' Ability to Slash Medicaid Payments Rests With Top Court

A recently revived California Medicaid case may impact whether states receive more freedom to reduce payments to physicians and other health care professionals. The U.S. Supreme Court on Jan. 18 agreed to hear California's appeal of a lower court's decision blocking certain pay reductions for the California Medicaid program, Medi-Cal. The state Legislature passed several rounds of cuts beginning in 2008 to offset budget shortfalls.

The Supreme Court will review the state's appeal on one question: whether private parties have the right to sue in federal court to enforce federal Medicaid law.

Source: Alicia Gallegos, AMNews [1/31/11]

Query: Repair Companies for PDM and MTI

I would appreciate any suggestions for repair companies for PDM and MTI podiatry chairs.
 
Jayne Ferris, Baltimore/Annapolis, MD

RE: Radiographs and Plantar Fasciitis (Michael Forman, DPM)
From: Howard E. Friedman DPM, Michael M. Cohen, DPM

With respect to the discussion whether x-rays are standard of care in treating heel pain, I would like to mention two studies to consider. First, the Ottawa Ankle Rules, which provide guidelines as to when x-rays are required for ankle sprains, are based on a multi-center study published in the British Medical Journal in 1995. The rules do not recommend an x-ray for every ankle sprain. Second, the National Cancer Institute released preliminary results of about 30,000 patients to determine if smokers will benefit from screening CT scans. The results are not clear as to the risk/benefit rewards. The results were detailed in the January Harvard Health Letter.

In any event, our discussion as to the benefits of x-rays for every patient presenting with a painful heel for the first time is only a collegial discussion without some evidence to tip the scales in one direction or another. Does one positive finding substantiate the cost and x-ray exposure for thousands? Or is there one positive finding out of hundreds? We need to consider issues of patient care along with public health. Of course, even with the Ottawa Ankle Rules, the physician has discretion to ignore the rules and order an x-ray.

Howard E. Friedman DPM, Suffern, NY hefriedman@earthlink.net

With all due respect to my colleague Dr. Michael Foreman, I must take issue with his statement that radiographs are the standard of care for plantar heel pain. While I applaud his determination to provide good patient care, the literature simply does not support this. At least as it relates to the initial visit.

In a study involving 215 heels, it was concluded that routine radiographs are of limited use in the initial evaluation of adults presenting with non-traumatic heel pain, and should be reserved for those who do not improve or have an unusual history or physical signs. This study also found that...

Editor's Note: Dr. Cohen's extended-length letter can be read here.

RE: Radiographs and Plantar Fasciitis (Carl Solomon, DPM)
From: Ben Pearl, DPM, M Turlik, DPM

Dr. Solomon makes an excellent point about how defining the standard of care for a particular condition can be arbitrary.

I think many of us would agree that with a supporting clinical history of plantar fasciitis, an ultrasound would give more information in the vast majority of cases in terms of fat herniation, level of damage to the fascia, etc., but convention by most podiatrists has been to get x-rays. As the reimbursement for limited ultrasound studies has been more than 50% decreased (approaching the cost of x-rays), the question arises as to whether a previously expensive study can be used more liberally. Medical necessity is what the insurance companies want to see in terms of diagnostic study selection.

Ben Pearl, DPM, Arlington, VA, abenpearl@netscape.net
 
Standard of care is not a medical term, but a legal concept.(1) After being involved in a malpractice case, practitioners become very familiar with this concept and it tends to drive their healthcare decisions. While it is obvious to me that obtaining radiographs on every new patient with typical symptoms and signs of mechanically-induced heel pain inflates healthcare expenditures without improving patient outcomes, I can understand why podiatric physicians would obtain some form of imaging. Healthcare reform will occur ideally without biased information and not without malpractice reform.

Advocates of EBM should read the following article about litigation and practice guidelines.(2)

1 JAMA. 2007;297:2633-2637
2 JAMA 2004; 291:15-16

M. Turlik, DPM, Cleveland, OH, mmturlik@aol.com

RE: Universal Training of Podiatrists and Parity (Narmo Ortiz, DPM, Geoffrey Bricker, DPM)
From: Simon Young, DPM, Luke Hunter, PS4

I can appreciate Dr. Ortiz's frustrations. Shame should only befall our younger generation of adults who embrace aberrant behavior rather than good social, professional, ethical, and moral principles. Who is to say that parents, schools, educators, attendings have not tried to modify these behaviors to no avail. They probably did. We must not paint all the younger generation with the same brush though, since the majority are good decent people. I think, as professionals, a call to action is warranted. Contact your hospital's residency director and see how you can participate in training our future colleagues. It really won't require a significant effort. You will learn, and also impart the social, ethical, and moral skills and in a positive manner, you will impact our colleagues in training.

Simon Young, DPM, NY, NY, simonyoung@juno.com
 
I think I speak for most of my generation when I say Dr. Bricker's reply is both offensive and ill-formed, and I would request an apology but I doubt one would be given. I think his sentiment of "the next generation isn't as good as ours" is an opinion that has been expressed for many past generations, so to hear that he has a problem with our generation is of little surprise. I find people tend to remember themselves as better than they actually were (physically, mentally, etc.), and I often think this is the case when people complain about others while comparing it to who they "were" in the past.

My reply to him would be to ask about his generation's work ethic? A recent 20/20 episode pointed out how...

Editor's note: Luke Hunter's extended-length letter can be read here.

RE: Providing Post-op Care (Justin Sussner, DPM)
From: Multiple Respondents

I am distressed that after a week of postings on this topic, not one of our colleagues took the position that if they knew and trusted the operating surgeon, they would do the post-operative care. There are even billing code modifiers for surgery only and post-op care only. Do we distrust so much? Is professional jealousy so profound that we can’t help our patients in this way? Are our egos so fragile?

This lack of spirit of cooperation, even on much lower levels of care, is sad in my opinion. Hiding behind malpractice risk to shield your hurt ego is very anemic in my opinion. Food for thought? Or am I being stupid?

Bryan C. Markinson, DPM, NY, NY, Bryan.Markinson@mountsinai.org
 
I have, on many occasions, provided the aftercare for patients. Sure, sometimes it is an ego buster but often when providing good aftercare, including therapy, orthotics, etc., the pay is better than the surgical fee and patients are truly grateful. It has also allowed me to establish nice rapport with some world-famous surgeons in Philly and Baltimore, some in NY, etc.

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

Since I live in South Florida, I seem to do this many times a year for physicians who perform surgery in the Northeast just before the patients leave for Florida for the winter. Most of the time, the physician who is doing the surgery calls me and gives me a heads-up about the patient. Regardless, I have not found this to be a problem from my end. We have many fine surgeons in the profession who have a real expertise in specific procedures, and I find seeing their work an advantage.

On occasions, I need to repair a slipped capital fragment, etc. I reached a point where I don’t take it personally. I know how good I am as a surgeon, and having the patient have the surgery elsewhere does not bother me. I get to take care of the patient's post-surgery care, and then I’m able to take care of the patient without having the global period to worry about.

Bret M. Ribotsky, DPM, Boca Raton, FL, ribotsky@yahoo.com

RE: Employee Embezzlement (Name Withheld)
From: Jeffrey Kass, DPM, Name Withheld

Call the police. Your employee needs to be arrested. You state the employee was trusted. She broke the trust and now must face the consequences.

Jeffrey Kass, DPM, Forest Hills, NY, jeffckass@aol.com

I would like to thank Dr. Barry Block and all the PM News readers who provided excellent advice on how I should handle this situation. On Friday, I met with the district attorney, and today my receptionist was arrested. I have retained an attorney, and I will be suing the bank that opened the fraudulent account in my practice's name.

A preliminary accounting shows that I have been embezzled out of at least $50,000. I implore my colleagues to put in place adequate safeguards to prevent this from happening. I may never recover the money, but if my story can help others, then all will not have been in vain.

Name Withheld

RE: APMA Takes Swift Action on Defamatory Video (Stanley R Kalish, DPM)
From: Multiple Respondents

Dr. Kalish - you should be proud. It is because of people like you that our profession is what it is today and continues to make strides. It is why and how the profession has gone from chiropody to podiatry. G-d willing one day, my scope of practice will also rise above the ankle. A public thank-you for all that you have done and continue to do for the profession.
 
Jeffrey Kass, DPM, Forest Hills, NY, jeffckass@aol.com

For those who wish to view the defamatory video, here's a transcript of it. "An orthopedic doctor, an orthopedist, is an actual medical doctor who underwent regular medical training, [and] has an MD. So [an orthopedic surgeon] did 4 years of medical school, one-year intern ship, then 5 years of residency in orthopedic surgery. Podiatrists are not medical doctors, they don’t have any real official medical training. Actually, they...

Editor's note: Dr. Purdy's extended-length letter can be read here.

I agree that we should try to take the "high road" when dealing with these attacks upon our profession. I have been dealing with this type of rhetoric for 25 years. Whether it was gaining hospital access, surgical privileges, or serving as an expert in a malpractice case (sometimes instigated by similar rhetoric), this type of negative information has been frequently disseminated by those on the other side. Having said that, there are times when we must directly, and with the same passion, repudiate obvious misinformation.

Recently, I had someone involved in state government say that she was told that...

Editor's note: Dr. Mendicino's extended-length letter can be read here.

ASSOCIATE POSITION - CALIFORNIA

Busy office in Long Beach, CA is seeking a well-trained, motivated podiatrist to join their busy office. Applicants must have completed a surgical residency program and must have exceptional skills in all aspects of podiatry especially rear-foot surgery, sports medicine and biomechanics. Send letter of interest and CV to footman991@gmail.com

TEXAS- WONDERFUL OPPORTUNITY!

PART-TIME/FULL-TIME PODIATRIST NEEDED - INDIANA

Part-time full-time Podiatrist needed for our Indiana offices. Must have Indiana license. Must have completed two years of surgical residency. If qualified email to f-massuda@footexperts.com

ASSOCIATE POSITION - NEW YORK CITY

One of the fastest growing podiatry practices in New York City and Queens seeks a podiatrist who participates with HealthFirst, Fidelis, and other Medicaid plans. Preferably a Spanish speaking podiatrist. Contact me at Podocare@aol.com

ASSOCIATE POSITION - OHIO/INDIANA

PrimeSource Healthcare, a leading provider of mobile, on-site healthcare services at long-term and skilled nursing facilities. Our exceptional growth has created a need for traveling, independent contractors of podiatry services in Ohio/Indiana. Earn between $175k and $225k per year. E-mail CV to Kris Wright, kwright@pshcs.com. 847-580-5960. Visit us at pshcs.com.

ASSOCIATE POSITION - SOUTHERN CALIFORNIA

Douglas Richie, DPM is seeking a well-trained, motivated podiatric physician to join his two office practice located in North Orange County, California. Applicants must have completed a 3-year residency program and must have exceptional skills in reconstructive foot and ankle surgery, sports medicine and podiatric biomechanics. This is a salaried position with a goal of long-term buy-in for equity ownership. Send letter of interest and CV to drichiejr@aol.com

IMMEDIATELY AVAILABLE- ASSOCIATE POSITION - DAYTON, OHIO

Join a well-established modern practice with an excellent reputation and referral base. Base salary $100,000 and benefits with a bonus structure. EMR, diagnostic ultrasound, all aspects of DME, Padnet vascular studies, and CO2 lasers. We seek a surgeon that is well trained, personable and motivated to join our group of 3 Podiatric Surgeons. Would like this individual to buy in the practice eventually. Please send resume to ohiodoctors@aol.com

ASSOCIATE POSITION - CT - (FAIRFIELD AND NORTH HAVEN)

Join one of the largest podiatric groups in Connecticut. Well-established and progressive offices, including EMR, digital x-ray, vascular and NCV studies, Pinpointe and CO2 lasers, diagnostic ultrasound and electrical stimulation therapy. You can expect a full schedule of patients the day you start, and a very competitive salary. For more info, www.GreatFootCare.com. Send resume to Dr.Kassaris@yahoo.com. Applications due by Jan 31st.

ASSOCIATE POSITION - BOSTON

Board certified podiatrist (ABPS, ABPOPPM) wanted to join Orthopedic & Arthritis Center at Brigham & Women’s Hospital, Boston, MA. The position is per diem, 2 days/ week. Interested candidates should send their CV to: Brenda Surowiec, Orthopedic & Arthritis Center, 75 Francis Street, Boston, MA 02115. Or email to bsurowiec@partners.org

PART-TIME / FULL-TIME PODIATRIST NEEDED ASAP - CHICAGO 

Part-time podiatrist needed for 2 offices in Chicago with an average of 20 hours/week. Must have Illinois license. Must have completed 2 years of surgical residency. If qualified, email to: A-Storjohann@footexperts.com

SHOCKWAVE MACHINE FOR SALE

D-Actor 200 by Storz Medical. High Frequency Extracorporeal Pulse Activation Treatment (EPAT) System. A little over a year old, excellent results for plantar fasciitis and Achilles tendonitis. Must sell; practice merger. Selling for $18,000 (new machine >30K) Will include onsite training if necessary. Email footdoc21@gmail.com

EQUIPMENT FOR SALE - COOL TOUCH LASER

Cool Breeze Cool Touch CT3 plus laser used for fungus toe nail infections Less than six months old. Great price won't last long. Considering a laser? We also have the Q- Clear Q- switch laser too. This laser is perfect for you. E-mail footcare@comcast.net

EQUIPMENT FOR SALE - MICROVAS UNITS

Two lightly-used microvas units, 16-lead machines (included) , $7,000 each or best offer for both. Great therapy modality: edema, neuropathy pain, increases peripheral flow, increase soft tissue healing. Great practice from vascular surgeons sending patients for treatment, pays for itself. Unit will come with the charger. jhalvorsen@familyfootandlegcenter.com

BOSTON UNIVERSITY LIMB PRESERVATION FELLOWSHIP PROGRAM

Boston University Medical Center has a accredited fellowship position. Become an expert in Limb Preservation, Tissue Repair and Regeneration. Be part of this unique Fellowship at a major teaching facility. During this time, you would be expected to become a knowledgeable expert who will contribute significantly to research, surgical procedures, teaching, and innovation. Requirements: Completion of a two or three year surgical residency; Candidate must possess a commitment to an academic career in Podiatric Medicine and Surgery. Submit a CV and letter of interest to: Erin Springhetti erin.springhetti@bmc.org and  Dr. Vickie Driver Vickie.driver@bmc.org or if questions call 617-414 6821.

PRACTICE FOR SALE - MARYLAND, DC SUBURBS 
 
Be an owner not a worker. Well established and equipped practice for sale. Office includes state licensed Ambulatory Surgical Center. Present owner is retiring but will stay on as needed for smooth transition. Average gross over past 3 years is $575 K. dpmpracticeforsale@yahoo.com

SPACE AVAILABLE- NYC & LI

Office to sublet and share with DPM and chiropractor, East 60th Manhattan, and Plainview long island. access to an MRI, Joint Commission certified operating rooms, digital x-ray, diagnostic ultrasound, and access to a multi-specialty ambulatory surgical center. Turn-key operation - no investment needed 516 476-1815 PODO2345@AOL.COM

SPACE AVAILABLE - BRANSON, MO

Great opportunity to develop a podiatry practice in a four condominium Branson office building with a growing ophthalmology practice along with a well established optometry practice and a multi-disciplinary ambulatory surgery center in Branson, a top ten retirement destination.The available condominium is a grey box so it can be build out to specifications. Rental and/or ownership options are available for this condominium. Practice development financing and ASC ownership available for the right doctor. Great schools and affordable lakeside or golf course living available. Contact Dr. James Bureman @ jbureman@missourieye.com or 417-861-5839

PM News Classified Ads Reach over 12,500 DPM's and Students

Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 12,500 DPM's. Write to bblock@podiatrym.com or call (718) 897-9700 for details. Weekly ad rates start as low as $109 for a 50-word ad THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451.

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