The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

February 22, 2011 #4,090 Publisher-Barry Block, DPM, JD

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Retired PA Podiatrist Teaches Residents the "Art" of Medicine

Becoming a good doctor takes more than knowing how the human body works and what medications to use for certain ailments. You wouldn't expect to find young doctors at the Barnes Foundation in Merion, Pennsylvania. But that's where we found a group of residents from Abington Memorial Hospital. They were there for a special lesson - not about brush strokes, or color placement.

Dr. Sheldon Weintraub

Dr. Sheldon Weintraub, a retired podiatrist - and volunteer at the foundation - helps the residents sharpen their observation skills by studying the way the art and artifacts are assembled. Dr. Weintraub says that in medicine, even little things can be important. "If a patient is leaning forward, they might have asthma, maybe not, but maybe. If their skin is a little purplish, they might have a vascular problem," he says.

Source: Ali Gorman, RN, WPVI-TV [2/18/11]

OR Podiatrist Develops App for Disseminating Track News for Runners

At a recent four-mile race for charity, Eugene podiatrist Dr. Jim McDannald straddled a bicycle to cheer on his wife, who was running the race, and to show off a new smartphone app he has developed called Track Geek. The application, available for iPhones and Android phones, is basically a news aggregator for serious track enthusiasts.

Dr. James McDannald

The idea came to him while watching the Olympic trials here in 2008, when he realized he wanted more up-to-the-minute coverage on his iPhone. “Apps were still new,” he said. “You had to search around on Google to find track news. That was really slow.” He has spent his own time and money since then to develop Track Geek, which sells for an annual fee of $1.99. “We had 5,000 downloads last year,” he said. “And 1,000 so far this year.”

Source: Bob Keefer, Register-Guard [2/14/11]

PA Podiatrist to be Named "Man of the Year" by Kidney Foundation

Dr. Jay Schnitzer has been chosen to be honored by The National Kidney Foundation of Delaware Valley (Philadelphia area) as the "Man of The Year."  Schnitzer received a transplanted kidney in 2009 from a patient he had operated on. Since that time, he has reached out to dialysis patients, post-transplant patients, and has taken part in many focus groups concerning kidney disease and the lower extremity.

 

Dr. Jay Schnitzer

Schnitzer currently counsels about thirty patients undergoing the process which saved his life almost two years ago. The honor will be presented in Center City Philadelphia at The Kidney Foundation Ball on March 12, 2011.

Editor's Note:  PM News is proud to present excerpts from Meet the Masters.

Bret Ribotsky: What do you think about the proposed name change of the American Board of Podiatric Surgery to the American Board of Foot and Ankle Surgeons?

Dr. Michael Downey

Michael Downey: I think that is probably not a bad thing. I am all for keeping our identity as podiatrists, but by the same token, I am all for advancing our profession in the eyes of the American public. I think it can be confusing at times what the word "podiatric" means. Before everybody jumps on me and says, "hey you know we need to keep our identity as podiatrists," we must realize that we have not done a good job at teaching everybody what podiatry means. We have been trying to do that for the last 50 years, significantly trying to teach what the word podiatry means when it was switched from chiropody. I do not know that we have met the goals that we wanted to achieve in that regard, and I think the degree change where we talk about going to DMD or DPM/MD or some type of dual degree is a good idea. I also think the name change of the board would serve the  best interests of our profession as well, if it can be accomplished.

Dr. Jeffrey Ross

Meet the Masters is broadcast each Tuesday Night at 9 PM (EST). The next segment  will feature Sports medicine guru Jeffrey Ross, DPM, MD . You can register for this event by clicking here

Query: Black Pigmentation in Diabetic Patient

My patient is a 66 y/o diabetic man who quit smoking over two years ago. The previous hyper-pigmented spots on the dorsal aspects of both feet over the central met-heads and shins have turned black, and rather abruptly so. These areas do not itch or cause pain, there is no dermatitis evident, and the areas are not raised. He has no claudicative symptoms. He does not have chronic edema issues. He is active, and an avid golfer during the summer. His meds have not changed. If any of my colleagues could provide some insight on the cause for this discoloration, I would appreciate it.

Mark Aldrich, DPM, Antigo, WI

Query: Scheduling Problems for Bunionectomies with Joint Replacement  (Medicare)
              
Due to the Medicare changes effective January 1, 2011, hospitals and surgical centers are receiving a much lower payment for a bunionectomy. Apparently, the reimbursement is so low that they cannot afford the cost of the joint replacement from any the manufacturers.  I was given the same information after calling several hospitals in the Los Angeles area. Even if the joint replacement manufacturer discounted their price to $500, the hospital was still unwilling to book the case. The only apparent option would be if the patient directly paid for the implant. Some hospitals may still be scheduling this type of surgery because they are unaware of the Medicare reimbursement changes.
 
Has anyone determined how we can perform a First MP joint replacement surgery on a Medicare patient in 2011?
 
Joshua Kaye, DPM, Los Angeles, CA

RE: Foot Lift (John Moglia, DPM)
From: Robert Chelin, DPM

I have been providing this option to my patients for many years. Certainly it provides an option over metatarsal osteotomies and orthotics. Dermal fillers, like everything else, have evolved over the years .

The most recent hyaluronate fillers seem to be very promising, with a lengthy period of durability and sustainability. Risks and complications that I have seen are granuloma formation at the injection site, but this can easily be handled with a steroid injection. The other risk/complication can be a sensitivity reaction to the filler itself. You might consider a patch test first. The last thing is that all fillers in the foot are for off-label use, so perhaps a release form would be recommended.

Robert Chelin, DPM, Toronto, Canada

RE: EHR/EMR Gouging (JM Cortez, DPM)
From: Elliot Udell, DPM

Dr. Cortez is "on the money" when he says that he feels EHR/EMR companies are gouging doctors by charging mammoth sums of money for their programs. The way they are getting away with this is that physicians are under the impression that they will be getting 44K plus, for implementing a certified EHR program, and therefore eighteen to 28 thousand dollars for a program appears affordable. There are problems with the way doctors are thinking. First of all, any stimulus money paid by the government will take place in increments over a five year period. Readers should visit the government website (cms.gov/EHRIncentivePrograms/) and see the list of "hoops" that have to be traversed in order to satisfy "meaningful use."

Some of these measures are easy, but others are complex and quite ambiguous and who knows how many of us will ultimately satisfy all of the requirements. Another factor is that some of these companies that are offering expensive EHR programs might be bought out by larger companies or might go bust, and if you've leased the program via a leasing company, you will still owe them the money. In our office, we are currently using Practicefusion.com which is a free program. Is it the best program? Probably not, but their tech support is terrific, the program satisfies the government requirements, does e- prescribing, and if the program ceases to exist, we've lost nothing because the program costs nothing.
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: Low Cost Lasers
From: Simon Young, DPM, John Strisower

Medical equipment is sold in multiples of cost in the same manner as pharmaceuticals. An opening wedge osteotomy plate is $1,300, excluding screws which are $150 each. $400-$500 screws, outrageously expensive power equipment, lasers, EHR/EMR. Go to your local garage - pneumatic equipment that you can throw off the Empire State Building and it will still work from the best manufacturer costs hundreds of dollars.

I don't care how good the precision or quality control, including research, there is no reason for these costs except for gross profits. A manufacturer makes more profit on a plate or screw than we get for doing the procedure.

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

Lasers specifically designed for a given use or indication perform substantially better than a general purpose laser used for a multitude of functions. Development costs of legitimate lasers (or any other medical devices) are very substantial. While there are dozens of companies making lasers for many uses that have been tried on nail fungus, none has yet to do the required basic science, clinical studies, and regulatory work needed to demonstrate safety and efficacy with clearance by the FDA for treating patients with onychomycosis, except the PinPointe FootLaser. The multi-year regulatory processes in the USA, Canada, and Japan (with the required clinical data) alone can cost millions of dollars.

The PinPointe FootLaser has achieved clearance from the FDA, Health Canada, and the European Union specifically for the treatment of...

Editor's note: John Strisower's extended-length letter can be read here.

RE: H&Ps for Podiatrists
From: Multiple Respondents

Not being able to do H&Ps is not a big deal. I suggest making friends with a hospitalist. I have my H&Ps done at pre-op testing. They are more than happy to have the work, and this is a referral source for you as well.

Bill Trabulsi, DPM Tampa, FL, trab3@msn.com

And now the dominoes begin to fall… Those of my colleagues who do not believe we are adequately trained to perform a history and physical exam on a patient should now concede the ability to prescribe medications and perform invasive procedures. Whether you realize it or not, you are or should be performing a history on a patient prior to any of the activities we do on a daily basis in practice. Are you not aware of the allergies your patient has prior to prescribing medications that can produce anaphylaxis or other systemic events? Are you not assessing cardiovascular status prior to entertaining any invasive procedure on the lower extremity? Do you not consider systemic causes for the clinical manifestations that you see in the lower extremity? Clearly, most of us would agree that an individual with significant co-morbid conditions should be evaluated by the appropriate specialists. I would state that even the seasoned general internist will request cardiology clearance from a cardiologist if there is significant history. 

Well-trained podiatric practitioners have been exposed to internal medicine/general medicine rotations through training. My surgical residents perform outstanding H&Ps frequently more comprehensive than those I have seen from my allopathic colleagues. For those who do not feel qualified to perform an adequate H&P, please continue to employ the help of our allopathic colleagues. But do not throw the entire profession under the bus regarding our inadequacy to perform what I consider a daily event in my practice.

Michael H Theodoulou, DPM, Cambridge, MA, michaelhtheodoulou@msn.com
 
Perhaps a significant misconception that fosters this hot debate stems from lack of differentiation between the performance of an H&P vs. medical clearance. They represent two completely different evaluations! While I opine that podiatrists are as well trained as any MD/DO specialist with respect to the knowledge base required to perform a basic H&P relative to the performance of lower extremity surgery, that is a FAR cry from their ability to medically clear a patient about to undergo high-risk anesthesia. That knowledge base deficiency transcends ALL surgeon specialists, even ones who managed a one month rotation in OB/GYN, to take one ridiculous example!

Since most patients taken into an OR for a foot or ankle procedure undergo some ancillary...

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

RE: H&Ps for Podiatrists (Charles M Lombardi, DPM, Adam Budny, DPM)
From: Robert Bijak, DPM, Narmo L. Ortiz, Jr., DPM

If what Dr. Lombardi and Dr. Budny say is true, then why do we have a limited license? Why are we DPMs, not MDs? Why have medical schools if podiatry schools produce equivalent graduates?  If what they say really is true (and I wish it were), why  is there no parity in reimbursements and legal standing? Why doesn't the APMA and membership sue for discrimination if we are equal. The answer is we are NOT, and I have regretted it since 1976.
 
I admire Drs. Lombardi and Budny's zeal for podiatry and their efforts to protect the image, but guys, really. Until the state feels as you do, and unshackles us from our limited license chains, your 3-year, rotating residents are still foot doctors no matter what euphemisms or palette you paint with. 
 
If the Drs. believe so strongly, their emphasis should push for DPMs to take USMLE,I,II,III. Then we would be DPMs with an UNLIMITED license like MDs and DOs. Podiatry is trying to build its house at the roof (residency) instead of the foundation (schools), and you know that's a losing proposition. 

Robert Bijak, DPM, Clarence Center, NY rbijak@aol.com

One of the ways that this debate could finally be settled is if Medicaid accepts our denomination as physicians and all states provide an equal scope of practice to all. Hello APMA?

Dr. Bijak, most of us understand your position, but please take the time to visit your nearby medical center that has a well-known podiatric residency program, and ask to spend a day rotating with the residents. Perhaps your position may change as to what we can do now.

Nevertheless, it is upon all of us and our professinal organizations to educate the politicians, our colleagues, and the public on what we do and the value of our specialty. The P in the DPM degree should not cause you shame, as it also stands for Progress, Professionalism, and Perseverance.

Narmo L. Ortiz, Jr., DPM, Cape Coral, FL, nlortizdpm@embarqmail.com

ASSOCIATE/OPPORTUNITY - PHOENIX 
 
Established practice seeking motivated min. PSR24+ personable, ethical, motivated person to join state-of-the-art multi-office locations. Partnership/Ownership opportunity in practice, real estate, surgical center. Also interested in existing practitioner to merge or work part time. Contact AZPODAssociate@aol.com  Must be pursuing or have AZ license.

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 - NE GEORGIA SUBURB

Immediate opening for PSR24/36, ABPS Qualified or Certified individual. Hosp/Amb. Surg. Ctn privileges available. Good chance of partnership or practice purchase in foreseeable future. Send resume/CV to gramps395@yahoo.com

ASSOCIATE POSITION NYC (PART TIME)

Manhattan (East Harlem) Community Health Center. Experienced podiatrist with commitment to providing quality care. Bilingual Spanish a plus Please forward resume and cover letter including salary requirement. FAX: (212) 360-6149 Email: orodriguez@boriken.org

TEXAS- WONDERFUL OPPORTUNITY!

Successful multi-office, multi-professional practice seeks well-trained new and established Podiatric Physicians with expertise in one of these areas: 1. Sports Medicine/Biomechanics/Gait Analysis, 2. Podopediatrics, 3. Diabetic Specialist, 4. Ankle & Rearfoot Surgery/Ankle Arthroscopy. A must to be really good in this niche, be outgoing, motivated, and personable with a dedicated hard working ethical desire to become successful. Send resume and letter of intent to sierrajip@gmail.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

TWO ASSOCIATE POSITIONS - WEST CENTRAL FLORIDA

One in general podiatry, second with surgical residency. Good diagnostician, compassionate, hard-working individuals needed for high-tech group practice. flpodiatrist@tampabay.rr.com

ASSOCIATE POSITION - WEST CENTRAL FLORIDA 
 
A great opportunity to join a very busy, well-established, diversified practice in Clearwater, FL. Seeking an associate who has the drive and desire to work hard, has strong work ethics, and is very personable. BC/BE and minimum PSR24 +. We offer competitive salary and benefits. Send resume to Jaye@fdn.com

ASSOCIATE POSITION - CHARLOTTE, NC

Well-established multi-office practice looking for personable, motivated associate leading to partnership. Excellent opportunity in a growing area. Contact charpodiatry@gmail.com

ASSOCIATE POSITION/PARTNERSHIP - CHICAGO

Chicago Podiatric Surgeons, one of Chicago’s leading podiatric practices, is searching for a FT podiatric surgeon. Applicant must be a personable and confident surgeon with ability to manage surgical patients independently and be at least board qualified. High compensation. Will be working in new 7000 sf state of the art office in AN upscale Chicago neighborhood. Ownership/partnership opportunities. Send letter of intent and CV to drcarr@chicagopodiaty.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

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

EQUIPMENT FOR SALE - COOL TOUCH LASER

Cool Breeze Cool Touch CT3 plus laser used for ugly, unsightly, 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. Dr. Zuckerman is in the Fort Lauderdale area and will demo this lasers on your patients. E-mail footcare@comcast.net

FELLOWSHIP OPPORTUNITY
 
Applications are being accepted for the Central Kentucky Diabetes Management Fellowship. Dr. Jonathan Moore, former UTHSC Diabetes Fellow, OCPM adjunct faculty, AAPPM board member and national lecturer and author on diabetes and practice management related topics is director and founder. Don't miss out on the most unique, dynamic fellowship in Podiatric medicine. Learn latest advances in Diabetes management/surgery along with knowledge to run and grow a successful practice. Generous stipend, full benefits and free housing in resort setting. Email CV and letter of interest to: jmoore@aappm.org  Visit our website

PRACTICE FOR SALE - MARYLAND, DC SUBURBS

Great opportunity. 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

PRACTICE FOR SALE - BOSTON SUBURB

A 12+ year practice, including all equipment is for immediate sale. Average gross is $100K while being open only one day weekly. The ability for increased growth potential is obviously excellent with increased hours. Doctor is looking for serious offers only. Reply to shop@thefootdoctor.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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