The Voice of Podiatrists

Serving Over 9,000 Podiatrists Daily

February 21, 2007 #2,815 Editor-Barry Block, DPM, JD

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Cosmetic Foot Surgery Can Modify Toes, But Beware of "Foot Face-lift": TX Podiatrist

Dr. Bhavesh Shah is a San Antonio podiatrist who can turn twisted toes into beautiful little piggies. "We can shorten, lengthen, flatten, raise it just so it fits more with the shoes," Dr. Shah explained. He said women are having toe tucks to make their toes look thinner, toe cleavage procedures to make their toes look sexier, and toe shortening by getting part of the bone cut off to keep that second toe from sticking out like a sore thumb.

Dr. Bhavesh Shah

"Some toes are really short," Dr. Shah said, "We can even lengthen bones nowadays. It's called callus-distraction." They attach a device to the bone and, over time, it stretches out your toe. Cosmetic foot surgery can cost anywhere from $200 to $10,000, depending on what you have done.

Dr. Shah has a warning for those thinking about having a foot face-lift. "You are going to be walking on it, and you will experience pain if something goes wrong," he explained. "Every step you take, so you have to be realistic when it comes to cosmetics."

Source: Mandi Johnston, WOAI (TX) [7/18/07]

MO Podiatrist Enjoys Midwest Lifestyle

Dr. Geoffrey Bricker, 52, a podiatrist at Doctor's Hospital in Springfield, MO, grew up in Pennsylvania, going to Penn State for my undergraduate and finishing there in 1975. He then went to Temple University School of Podiatric Medicine, and completed a residency at the V.A. Medical Center in Topeka, KS.

Dr. Geoffrey Bricker

He was looking for a place in the Midwest because Pennsylvania was crowded with podiatrists and he wanted to go to what he thought was an underserved area. He had visited Springfield at the suggestion of another podiatrist, and liked it. He liked the size of the town and all the lakes in the area and that was it.

He sees 20 to 30 patients a day, and one day a week he performs between four and six surgeries — mostly at Doctor's Hospital, but also at St. John's. and also has privileges at Cox. He also consults at Missouri State University one day a week with the athletic program. His main hobbies are watersports. He likes to go sailing, wave-running and fishing and also enjoys biking and weight lifting. He's a black belt in kempo karate.

Source: Howard Simmons, Springfield News-Leader [2/19/07]

EHR Market to Grow by 13.5% in Next Four Years: Report

The electronic health records (EHRs) market is primed to grow at a rate of 13.5% during the next four years, and will top $4.8 billion by 2015, according to a new study by Kalorama Information. The report, "U.S. Market for EMR Technologies," predicts the 13.5% compound annual growth rate (CAGR) to remain stable until 2009. At that point, the study projects an additional two percentage points growth annually until 2012, where it will remain steady at 19.5% CAGR until 2015, according to Kalorama Information.

So what's causing the increase in growth? The study reports that the creation of national standards for EHRs, and recent increases in funding for the development of regional health information organizations have and will give a huge boost to the health IT market.

Source: Today in E-Health [2/13/07]

Query: Flatbed Scanner for X-Rays

I am switching over to a digital x-ray system, however I want to digitize the old x-rays on my current patients as they return to the office. Is anyone aware of a flatbed scanner that has a transparency adapter and accommodate a 10 x 12 x-ray. I found an Epson model, but it was close to $3,000 with the transparency adapter.

Ken Meisler, DPM, New York, NY

Editor’s comment: One idea is to use a digital camera to do this. This is more time-consuming that having an a commercial-grade scanner with an automatic feeder.

Query: CPT 64550 & TENS

I recently read that CPT 64550 (application of surface [transcutaneous] neurostimulator) is the CPT code for a TENS unit application. This is an untimed code, and is not within the 97 series codes where other "physical therapy modalities" are listed.

This is confusing, because I would have thought that TENS would be considered a physical therapy modality, identical to electric stimulation. If it is within the local carrier determination (LCD) for "Physical Medicine," under which code is it listed?

Paul Kesselman, DPM, Woodside, NY

Response: Initial application of a TENS unit, CPT 64550, is not a physical therapy service. The TENS is placed on the patient's skin by the physician, and the patient takes the unit home for self-use. It is to "reduce" pain, not stimulate muscle.

If you are performing therapeutic electric stimulation (not with a TENS unit), then you bill CPT 97032...which is a physical medicine/therapy modality treatment subject to Medicare local carrier determinations (LCDs) or non-Medicare payer guidelines.

Harry Goldsmith, DPM, Cerritos, CA

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RE: Power Naps (Bob Levoy)
From: David E. Gurvis, DPM, Paul Busman DPM

I started that back in 1968 when I started undergrad school and hate missing mine to this day. It was called being slothful and lazy back then, but I never cared. To this day, the staff leaves the office for lunch, locks up, and I take over the procedure room table for my nap. Wake up, and it’s a whole new day.

The staff is on their own, but they often do the same. And since my wife may be reading this, NO, they don’t get to share my procedure room table. They have to find their own spot.

David E. Gurvis, DPM, Avon, IN, deg1@comcast.net

Personally, I find them counter-productive. When I fall asleep and then wake up my body seems to think that it's "tomorrow" and I feel quite disoriented. I'm far better off using that 20 minutes off to go take a walk.

Paul Busman DPM, Troy, NY, BREWERPAUL@aol.com

RE: APMA State Leader as an Expert Witness (Bryan Markinson, DPM)
From: Multiple Respondents

I personally believe it is a conflict of interest and agree with the editor’s response to Bryan Markinson DPM. There are plenty capable podiatrists who are not elected members of the association who can perform this function in a more than adequate fashion.

Bob Rampino, DPM, President Elect, NYSPMA, rdrdpm@yahoo.com

While I agree in principle with Dr. Markinson's comments, with specific respect to this case, there appears to be a clear conflict of interest. The defendant and plaintiff's expert witness obviously know one another and share some history together. From that standpoint, he/she should not be allowed to testify unless the defendant has no objection, for the courts are not privy to any pre-existing animosity or personal conflicts that may exist between those two individuals. The fact that one is prepared to testify against another involving a case, that at least from the defendant's standpoint appears to harbor minimal merit, wreaks of personal conflict, which should never be allowed to enter in a court of law.

As for so-called "expert witnesses" in general, as part of a much needed malpractice tort reform, a screening process should be instituted involving a pre-appointed panel of 5 "judges...say 3 of specialists commensurate with the specialty involved in the case and 2 attorneys (1 plaintiff and 1 defense) to determine whether a given "expert witness" meets the qualifications long before a case goes to trial. In addition, an expert witness' testimony should be closely scrutinized by the same panel who approved his/her appointment empowered to levy punitive measures against any witness who falsifies or grossly embellishes his/her testimony. I find it simply amazing what people will say to earn a buck, and in some cases, with no legal recourse for the defendant. The system, as it currently is constituted, has significant flaws and needs reform if we are all to enjoy rates commensurate with our specialties and risk factors. That's not even mentioning the fact that we are the only civilized country who hasn't adopted a "loser pay" system of court fee compensation.

Barry Mullen, DPM, Hackettstown, NJ, YAZY630@AOL.COM

What makes one an expert witness, hmmmm....? One thing we all should agree on is that solely holding a position in our Society does not make you an "expert" in podiatric medicine or surgery. We should also all agree that our "elected" leaders be held to the highest ethical standards. Is it ethical to "advertise" your position in our Association, while serving as an expert witness? Would this not imply, or at least mislead the jury, that this qualifies the podiatrist as an expert? Yes, it's true that ALL experts state their credentials in an effort to show their qualifications. The difference is that, in our Association, there are many guidelines that restrict what members can and cannot "advertise."

What do we do when an "elected" leader's testimony is ethically questionable? My humble opinion is to let these testimonies be reviewed, and have these leaders become "unelected" and removed from our association. Let our "dues-paying" members know about these testimonies, and give them an opportunity to rethink their previous vote. Ethics committees do not work when it is a leader being reviewed. Dr. Markinson acknowledges that there is "green slime" in the system, but does not offer any solutions. I challenge Dr. Markinson to write a resolution that would prevent or at least deter unethical testimony by Association leaders. It is time to stop acknowledging the "slime" and find ways to clean it up before it ends up at your door.

From: Nicholas D'Angelo, DPM, Brooklyn, NY, Skitoast@aol.com

ASSOCIATE WANTED - NORTH CAROLINA , CHARLOTTE AREA

Incredible opportunity to join a busy, well-established group practice. Looking for a self-motivated, hard-working individual seeking to become a partner. Hospital and surgery center privileges. Salary plus percentage, 401k and real estate opportunities. Send CV to universityoffice@ bellsouth.net

ASSOCIATE WANTED - BOCA RATON-DELRAY BEACH AREA

Full time for growing practice-surgical training a plus-hard working a real plus-opportunity of a lifetime-partnership after 1yr. Need Florida license. Fax resume to 561-865-2225

SOUTH CENTRAL PENNSYLVANIA-PM&S 36 ASSOCIATE WANTED

Large, busy podiatry group looking for associate interested in future partnership. Practice facilities and technologies include: Surgical Center, Physical Therapy Department, six appointment locations, EMR, MRI and Digital X-ray. Full compensation and benefit package offered. Mail CV to Martin Foot and Ankle, 1203 S. Queen St. York, PA 17403 or email business administrator, johnreitzel@comcast.net.

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 -MINNESOTA – PRIME MINNEAPOLIS SUBURB

Busy, well-established, full-scope podiatry practice, seeking highly motivated podiatrist for a full-time position with potential partnership opportunity. Looking for PSR 24+ individual. Excellent opportunity for long-term growth with unlimited income potential. E-mail CV to employment@associatedpodiatrists.com or fax to (612) 866-5875 Attn. Jennifer.

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 – WASHINGTON, DC

Associateship leading to full purchase or immediate sale. 25 Year old practice located in a hosp. w/ full surg privileges. Large number of diabetic patients and referrals. Fully equipped with x-ray, topical hyperbaric oxy units, 4 tx rooms and more. $400K on only 3 days a week. Will finance with generous terms and stay to introduce. Owner leaving area. Contact R. Benjamin, DPM jhallux@yahoo.com or 202-841-5545

SEEKING RESIDENT FOR PSR-24 POSITION: BALTIMORE, MD

Mercy Medical Center -Position for a highly motivated individual with completed non-surgical residency or one desiring additional surgical training in well-established Podiatric Residency Program. Busy metropolitan hospital with high surgical numbers and inpatient care. Resident is integral member of multidisciplinary team. Begins mid June 2007. Includes competitive salary/benefits. Send inquiries to rsher18@yahoo.com

ASSOCIATE POSITION – NY & CONNECTICUT

Opportunity to be a part of a prestigious and well-established large Orthopaedic and Rehabilitation practice, with locations in Stamford, CT and West Harrison, NY. Looking for a Podiatrist to join an already busy practice with opportunity to build. We have state-of-the-art offices with MRI, digital x-ray, paperless charts, physical and occupational therapy. Applicants should be Board Certified or Board Eligible. Competitive salary and benefits. For further information on the practice, log onto WWW.NYCONNORTHO.COM Interested candidates should forward their C.V. to: Cliff Katz, Executive Director ckatz@nyconnortho.com

PART-TIME ASSOCIATE POSITION - BRONX, NY

Part-time associate position with real potential for full time. Two days a week (one day-in office; one day-house calls). Associate will have an opportunity to work with a very ethical and hard-working podiatrist. Competitive salary + incentive compensation. Please email CV to scottdeis@aol.com

ASSOCIATE POSITION- MINEOLA, NY

Excellent opportunity in fast-paced well-established podiatry practice for full time associate, all phases of podiatry including surgery, biomechanics, orthotics and routine foot care. Begins July 2007. Includes competitive salary and benefits. Please send CV and letter of interest to: cfcsteve@optonline.net

PRACTICE FOR SALE -NORTHERN CALIFORNIA

Great opportunity to own a well-established turn-key podiatry practice located in modern medical office building in East Bay; Electronic billing, good payor base, no HMO contracts; biomechanics, general podiatry with great potential for surgery. Please send CV and letter of interest to: norcalpod@hotmail.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

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