The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

February 09, 2010 #3,775 Publisher-Barry Block, DPM, JD

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Diabetics Should Have Any Changes in Feet Checked: NY Podiatrist

"Diabetes is increasing unbelievably," said Dr. Erik Sims, a podiatrist with offices in Poughkeepsie and Fishkill. He said 25 to 30 percent of his patients are diabetics who come to him for foot problems related to their condition. Those foot problems are a result of nerve damage in the extremities and a compromised immune system.

Dr. Erik Sims

Diabetics may not feel common irritations on their feet, from a rubbing shoe, for example. These can worsen quickly and become infected wounds. In very extreme cases, complications lead to amputations. Sims works with patients to prevent that extreme outcome. His biggest advice to diabetics is to check their feet every day and have any change checked out by a doctor.

Source: Kathleen Norton, The Poughkeepsie Journal [2/7/10]

NV Podiatrist Returns From Haiti With New Perspective on Life

Disasters can bring out the best and worst in mankind, and in some instances, become forever life-changing experiences. Local podiatrist Dr. Tim Mooney, who works at Fallon's Banner Churchill Community Hospital, recently returned from earthquake-riddled Haiti where he and four other doctors offered their expertise in helping Haitians in the town of Leogane.

Dr. Tim Mooney

“Probably more has happened in my life than what I gave to them,” Mooney said. The doctor visited Haiti about 20 years ago while on his Mormon Mission. Mooney came away from his recent trip with a new perspective. “I hope that we can realize that we can do so much more for so many other people, but I also hope that we realize that we can do so much more for our neighbor,” he said.

Source: Kim Lamb, Lahontan Valley News (NV) [2/6/10]

"I'm Sorry": Why is That So Hard for Doctors to Say?

When you hurt someone, saying "sorry" may seem like the least you can do. But when the hurt occurs in the medical arena, offering an apology is not so easy. Thirty-five states have laws offering some kind of legal protection for physicians who express regret or empathy to patients who experience an adverse event. But laws vary in what they protect from admissibility in court. Most insurers discourage doctors from apologizing for fear it could hurt them in court, and lawyers often advise against it.

Physicians may have good reasons to steer clear of apologizing, some lawyers say. "If [the apology] becomes an admission that's usable in a malpractice case, it could affect the ability to defend the case," said Steven I. Kern, a senior partner at Kern Augustine Conroy & Schoppmann, a Bridgewater, N.J.-based law firm that specializes in representing physicians. "Most insurance companies say that if you as the insured do something that affects our ability to defend the case, we're not going to cover it. Going out and saying 'I'm sorry' not only is going to adversely impact any ability to defend the case, but may well relieve you of that insurance coverage."

Source: Kevin B. O'Reilly, AMNews [2/1/10]

Offer Deserving Staffers an Ovation

Don’t leave employees wondering if you notice all the effort they put forth. Make your appreciation unmistakable, by giving them a standing ovation when they do something great.

Go to the Playfair Web site at www.playfair.com. Enter your name  and e-mail address and the name and e-mail address of the person you want to recognize. Playfair will send that person an animated standing ovation that the recipient can replay whenever he or she needs a motivational boost.

The service is free, and you can even personalize it by adding information about why the recipient deserves special thanks. It’s a fun idea that could make a deserving employee’s day.

Source: Adapted from “You Deserve a Standing Ovation,” playfair.com via Communication Briefings

Complimentary Codingline Subscriptions for APMA Members

APMA and Codingline* announced a strategic relationship by which APMA members can receive complimentary subscriptions to Codingline APMASilver Codingline's foot/ankle coding and reimbursement moderated listserv. Codingline APMASilver allows subscribers to submit foot and ankle coding and reimbursement questions, respond to or comment on posted questions from others, and access the Forum on the Codingline Web site to search the Codingline Forum for past questions and responses to hundreds of previously discussed topics.

Codingline APMASilver is only available to APMA members (one per member). It allows for the registration of one email address (although APMA members must register, they can, if they wish, substitute the email address of an office manager, billing person, or other key staff person). The listserv email frequency is twice a day.
 
If you are interested in a complimentary Codingline APMASilver subscription, click here to register.  If you cannot remember your APMA member ID, call (800) ASK-APMA.    If you have any questions regarding Codingline APMASilver (or other Codingline packages), contact Harry Goldsmith, DPM at hgoldsmith@codingline.com.
 
*Codingline is an independent company, and is neither owned nor operated by APMA.

RE: Dwight Freeney Ankle Injury (Amol Saxena, DPM)
From: Nick Taweel, DPM, DPT

I completely agree with Dr. Saxena, as my experiences are exactly the same.  I too practice in a tertiary setting that treats the local NFL, NHL, and MLB teams. Over the past five years, we never operated on any patient with an acute ankle sprain, whether they are professional or not. I commonly encounter an ankle sprain patient who presents with MRI films in hand for a second opinion or take-over care for surgery. Many of these patients have only grade one sprains upon clinical exam, but the term "tear" or "poorly visualized ligament" is within the body of the MRI report. Their previous podiatric surgeon commonly tells them that surgery is needed to repair the tear. This seems logical to the patient who is quite perplexed when I tell them that conservative treatment is indicated for isolated acute lateral ankle sprains.

In these cases, the previous surgeon is treating the MRI more so than the patient. Mostly, all of these patients do very well with conservative treatment and return to full function with no detectable mechanical laxity. Some have residual functional instability (that most likely pre-existed the injury) and primary repair of the ligament would not have prevented this, and may even decrease the effervescence of joint mechanoreceptors. I feel that the rush toward surgery is due to either gross misconception or an example of our profession's expanding surgical bias.
 
Nick Taweel, DPM, Philadelphia, PA, ntaweel@gmail.com

RE: Off-Shore MD Degrees for Podiatrists (Hermoz  Ayvazian , DPM)
From: Thomas Graziano, DPM, MD

In response to the recent inquiry, I completed such a program at the University of Health Sciences in the British West Indies. I also had a Master's in physiology before I went to podiatry school, so the school accepted my first two years and allowed "advanced placement."  In medical school here or outside the U.S., the 3rd and 4th years are comprised of core clinical rotations and electives. The core clinical rotations that I had to complete included family medicine, OBGYN, surgery, psychiatry, pediatrics and internal medicine. I also had to complete 7 elective rotations.  In addition, I had to test out of each of the core clinical rotations in order to graduate.

It was a wonderful but extremely strenuous and exhausting two years.  Believe it or not, I did this after 23 years in practice and did not do it to change professions. I did it to complement my professional knowledge. It also strengthened the love I have for what we do. We, as podiatrists and foot/ankle surgeons, play an extremely valuable role in the healthcare arena. Embrace what you do and strive to do it better than anyone else. Once you do, there is no one out there who will deny your skill or your position.

Thomas Graziano, DPM, MD, Clifton, NJ, TGrazi6236@aol.com

RE: ABPS Examination Statistics
From: Robert Bijak, DPM

It was never my intention to be on the negative side of podiatry, but you can't hide the truth. I recently read some disturbing statistics listed in the ABPS Newsletter. Of 521 candidates taking the Part 1 Certification exam in foot surgery, only 61% passed. Of 314 candidates who took the Part 1 Certification in reconstructive rearfoot and ankle surgery, only 57% passed. Some specialty!  Unlike orthopods, podiatrists divide the foot, and a large number fail the rear foot part, and many fail the forefoot part. 

We call ourselves podiatric physicians, foot specialists. We say that the MD doesn't know anything about the foot, and yet we have so many failures in our own exams. And this is to say nothing about those who don't even qualify to take the exams. I'm sorry; I get no pleasure exposing my own profession’s weakness. The ABPS budget shows nearly 5 million dollars in revenue last year, and we have all these failures. Maybe we should throw more money at the problem. Ladies and gentlemen, please take school administrators, specialty boards, and residencies to task. If we are the specialists, why are so many of us failing in our own specialty, the foot, let alone the ankle or leg!  Remember I'm just the messenger. I am not responsible for this reality. Incompetence and apathy are.
 
Robert Bijak, DPM, Clarence Center, NY, rbijak@aol.com

RE: EMR Change-Over (James J DiResta, DPM)
From: Multiple Respondents

I disagree 100% with James J DiResta, DPM regarding his statement, "My advice is to educate yourself well and 'think outside your podiatry box'. My EHR is a PCP-friendly system with integrated practice management and billing. In choosing an EHR/EMR, look at PCP and hospital-friendly systems first and then see how it works for podiatry second."

The future of health information technology in this country is going in the following direction: On the top will be the National Health Information Network (NHIN). Attached to the NHIN will be various Health Information Exchanges (HIE). Your EMR will be attached to the HIE. In about five years, you will be able to send information from your EMR to any EMR in the country, as long as both have a path to communicate with the NHIN.

Some hospital-promoted EHR programs allow communication to the Hospital system, but this is the minority. Dr. DiResta is practicing in Massachusetts. Massachusetts and New York are far ahead of the rest of the nation in implementation of health information exchanges (HIEs). Therefore, in his community, he may have the ability to communicate with other physicians via a HIE but his situation is the exception rather than the rule. As long as you obtain a product that is certified, you will have all of the advantages that Dr. DiResta is speaking about in about 5 years, and outside of a few spots in this country, there is no advantage to selecting the 'PCP' preferred EMR. Because no matter which certified EMR product you select, it will not speed up the process.

Disclaimer: I am a member of the Provider Perspective Technical Committee of HITSP, an organization that is publishing the accepted standards for communication between EMR software products.

Michael L. Brody, DPM, Commack, NY, mbrody@tldsystems.com

Editor’s note: Dr. Marc Garfield’s extended-length letter can be read here.

RE: From Evidence-Based Medicine to Marketing-Based Medicine
From: Bryan C. Markinson, DPM

Michael Turlik, DPM asks, "Is it possible that drug and device manufacturers manipulate podiatric publications?" Of course, he is not really asking this. He understands all too well, and has made it his raison d'etre to demonstrate how polluted, if we allow it, we potentially can be by big Pharma and the medical device manufacturers. I work with colleagues who have been paid in the millions to …

Editor’s Note: Dr. Markinson’s extended-length note can be read here.

Bryan C. Markinson, DPM, NY, NY, Bryan.Markinson@mountsinai.org

SPACE AVAILABLE  With MRI– NYC/LI

Turn-key office space, East 60th and 22nd St. Manhattan and Plainview, Long Island. Available extremity M.R.I and dynamic ultrasound (East 60th St Manhattan and Plainview, LI). Tests are run by DPM and read by board-certified radiologist. Call for rental agreement. Satisfies Stark laws (516) 476-1815.

ASSOCIATE POSITION - W FLORIDA, BEACHES

Well established podiatry practice with excellent mix office/surgery seeking full time associate PSR 12-36. Excellent salary & benefits for the right hardworking, personable candidate. Email resume to capecoralpodiatry@live.com or fax to 239-573-9201

ASSOCIATE POSITION - TEXAS

Wonderful opportunity! Successful multi-office, multi-professional practice seeks well-trained new and established podiatric physicians with expertise in sports medicine, podopediatrics, rearfoot/ankle surgery, or hospital podiatry. A must to be outgoing, motivated, and personable with a dedicated hard-working ethical desire to become a winner. Send resume, current photo and letter of interest to sierrajip@gmail.com

PRACTICE FOR SALE - NORTHWEST CHICAGO SUBURBS

17 year-old surgical practice for sale. Practice sees a wide variety of foot and ankle pathology and is largely referral especially regarding surgical patients. Two offices fully equipped. Lease or purchase of office condo also possible. Doctor willing to stay Please email inquiries to crystallakefootandankle@live.com

PRACTICE FOR SALE - FLORIDA—CENTRAL/SOUTH

Turn-key operation grossing $570,000 annually based on one full-time doctor. Great opportunity for growing the top-line. Surgery is only 14% of the professional man-hours; it can significantly increase income. Medicare makes up 64% of revenues. Seller will assist with transition. Call 863-688-1725, ask for Chas.

ASSOCIATE POSITION FULL-TIME - SUBURBS OF CHICAGO

PSR 36 - month-trained podiatrist needed for busy suburban Chicago practice. Full benefit package included. If interested, please email your curriculum vitae to foot1st@yahoo.com

ASSOCIATE POSITION-INLAND EMPIRE, SOUTHERN CALIFORNIA

Associate needed full or part-time for multi office practice. Must be ABPS BC/BQ. Hard working, ethical individual who is looking to a possible partnership opportunity. Looking for current licensed or resident completing program this spring. Email CV to bkatzman2@earthlink.net

ASSOCIATE POSITION – CINCINNATI, OHIO

This is your once in a lifetime opportunity to join one of the most successful practices in the United States. We do not have a seniority system. If you are motivated and have completed a PSR 24-36 residency, your income is limited only by your enthusiasm and desire to achieve. Email resume to khart@cincinnatifootcare.com

ASSOCIATE POSITION - MARYLAND

Associate needed to join a multi-office podiatry practice in the Baltimore MD Region. Desired candidate should be surgically trained with Board Eligible / Certification. You must be hard-working, ethical, compassionate and confident in your abilities to deal with pathology, patients, staff and fellow physicians. Patient base is already established. Excellent income and growth potential for the right associate. Please forward a cover letter and resume and availability to FootDocMaryland@Gmail.com

EQUIPMENT FOR SALE – MICROVAS

Microvas Unit for sale in good condition, 1 year old. Works well for various conditions we treat.Joining multispecialty group and unable to bring unit. Best offer. Please e-mail inquiries to footdoctor@verizon.net

ASSOCIATE  POSITION - MONTANA

Great opportunity for a PSR 24 or 36 residency trained individual to join a dynamic two doctor group with physical therapy.  Needs good FF surgical skills, RF a bonus.  Beautiful office and great area of the country for outdoor recreation-minded individuals. Opportunity for partnership after employment. Please reply to: jclough@bridgemail.com

PRACTICE FOR SALE – WASHINGTON STATE 

Kent (20 miles South of Seattle) 15 year part time practice. Share office with two MD’s. Midmark 417, ExCel X-ray and processor Ritter M9 autoclave, instruments. Owner retiring. VERY REASONABLE PRICE. Call Martin Lynn @ 206.355.3701 Leave Message; or Email at mlynn@wport.com

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for a full-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to f-massuda@footexperts.com

ASSOCIATE POSITION – ILLINOIS

Quality Podiatry Group provides quality services to residents at long term care facilities. We are currently offering full-time or part-time positions for motivated ethical podiatrists. Immediate openings are available. If interested, fax curriculum vitae to 847-674-2113 or e-mail to feetwork@aol.com

ASSOCIATE POSITION - MASSACHUSSETTS

Full-time/Part-time podiatrist needed for a busy nursing home practice. Please send inquiries to debbierobertsm4@hotmail.com

ASSOCIATE POSITION – MISSOURI

Expanding multi-location practice seeks motivated individual to contribute to growth. Practice enjoys strong reputation and name recognition. Prefer candidates with interest in partnership opportunity. Established locations available for PSR 24+ and includes incentive comp with benefits/coverage. Please send CV to jmurray@foothealers.com or call John Murray at 314.842.3875

OFFICE SPACE TO SHARE - NYC

Wanted- Licensed podiatrist to share space in a State-Of-The-Art medical office in the midtown area. Please call Dr. Robert Singer (212) 921-5775 or e-mail dr.roberth.singer62@netzero.net

ASSOCIATE POSITION - SAN FRANCISCO, CALIFORNIA

We’re seeking an energetic and enthusiastic Associate to help our thriving non-surgical practice grow. Located in the heart of San Francisco, we provide state-of-the-art sports medicine, trauma and lower extremity care. Excellent compensation package. Submit CV with cover letter to: sfsportsmed@yahoo.com

ASSOCIATE POSITION - MARYLAND/D.C AREA

We are looking for an energetic and well-trained podiatrist to join our rapidly growing group; we have offices in Maryland and D.C and are in need of someone who is hard-working and growth-oriented. This candidate must be a graduate of a PM&S 36 residency program or have the equivalent in practice experience. We are looking for the person that wants to make this area their home and become an integral part of our group. If interested, e-mail your CV and cover letter to washingtonpod@aol.com

ASSOCIATE POSITION - NORTHERN VIRGINIA/DC SUBURB

Excellent associate practice opportunity leading to partnership for PSR 24-36 foot and ankle surgically-trained physician. Currently 4-doctor/2 office practice in fast-growing area, expanding to 5 doctors. Hard working, personable, highly-motivated individuals needed. Great opportunity with excellent salary and benefits. No nursing homes. Top hospitals. Fax CV with references to 703-491-9994

PM News Classified Ads Reach over 12,000 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 12,000 DPM's. Write to bblock@podiatrym.com or call (718) 897-9700 for details. 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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