The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

March 05, 2010 #3,796 Publisher-Barry Block, DPM, JD

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SD Podiatrist Discusses Diabetic Foot Problems

Dr. Travis Venner with Orthopaedic Consultants/Alvine Foot and Ankle Center in Sioux Falls sees a lot of diabetic patients who are having major issues with their feet. Unfortunately, by the time he sees them it's often too late to prevent major surgery because it has gotten so bad. Venner says, "Diabetics will develop two main problems. They develop vascular disease which is when they develop poor circulation down to their feet. They also develop peripheral neuropathy. They can't feel their feet so if their shoes are tight, or they are walking barefoot, patients can get ulcerations. I've had patients come in with thumb tacks, insulin needles in their feet. They stepped on them because they don't feel their feet as well as they should."

Dr. Travis Venner

Dr. Venner says, "I always tell them that every night before they go to bed, they should check their feet to make sure they don't have any open sores or blisters. Do the same in the morning, and during the day I tell them to take off their shoes too to check them over. If they can't see the bottom of their feet, put a mirror on the floor and wave their feet over the top so they can see the bottoms, and if there are any sores."

Source: Nancy Naeve Brown, KSFY [3/2/10]

OCPM Alumni Association Board of Directors Elects New Officers

The Ohio College of Podiatric Medicine’s (OCPM) Alumni Association recently elected new officers at its Board of Directors Annual Meeting. The new officers are:
 
Chairman, Aaron Chokan, DPM, '01
Vice Chairman, Douglas Dockery, DPM, '00
Secretary/Treasurer, Raymond Murano, DPM '84

(L-R) Drs. Aaron Chokan, Douglas Dockery, and Raymond Murano

Also elected to the board were; Drs. Roger Hamm, '03, Frederick Tomassi, '83, and Gary Unsdorfer '84.

Other OCPM Alumni Board Members include: Drs. Jeffrey Baller, Michael Canales, James Canterbury, John Daily, Sam Feinberg, Ronald Freireich, Molly Judge, Jay Lifshen, Bruce Saferin, and Howard Waxman.

One-month Reprieve on Doc Pay Cut

Physicians will get a one-month reprieve from a scheduled Medicare pay cut, and a number of safety net healthcare programs will see some breathing room before they expire under a deal struck between a holdout senator and Democratic leaders. The Senate voted late Tuesday 78-19 to approve a bill that extends by one month doctor payments, COBRA premium subsidies, insurance for the unemployed, and rural Medicare provisions that went dark on March 1. President Barack Obama quickly signed the bill.

The bill costs roughly $10.2 billion, but because most of it was considered emergency spending, lawmakers did not need to offset that amount.

Source: Matthew DoBias, Modern Healthcare [3/3/10]

Obama Backs Reconciliation Maneuver

President Barack Obama gave Congress the green light to use a budgetary process known as reconciliation to pass sweeping healthcare overhaul legislation on a simple majority vote in “the next few weeks.” “From now until then, I will do everything in my power to make the case for reform,” Obama said during a televised speech from the White House. “We have debated this issue thoroughly, not just for a year, but for decades.”

The president, speaking from the White House, knocked down a number of different proposals that some members of Congress had pitched in the months that have passed after Democrats lost a critical Senate seat in January. Obama said that restarting from scratch, favored by Republicans, would not be considered, and added that a piecemeal approach, backed by some Democrats, would also fail to accomplish the broader goals set out by the White House and Congress.

Source: Matthew DoBias, Modern Healthcare [3/3/10]

RE: Pre-Fab Gait Plate (Jeffrey Kass, DPM)
From: Robert Colligan, DPM

I have searched the market high and low for this myself over many years of practice. Currently, I use Langer’s Globotec Junior, which are pre-fabricated pediatric orthotics. I do have to modify the distal edge myself if I want to address in-toe or out-toe. They work pretty well.

Robert Colligan, DPM, Norfolk, NE, rcolligan@MidwestHealthPartners.com

RE: The Passing of Robert Piccora, DPM
From: Frank Lattarulo, DPM

It is with a very sad and heavy heart that I send my condolences to Myrna Piccora and the rest of her immediate and extended family. I had the great fortune of knowing "Pic" on a professional as well as extremely personal basis. Under Dr. Giorgini and Dr. Piccora, I received an unbelievable education during my post-graduate two year surgical residency. Between the two, I received the best of both worlds. Those of you who know them both understand what I mean.

Dr. Piccora was the head of the Department of Podiatric Surgery while I was a Chief Resident at St. Barnabas Hospital in the Bronx in 1985. Those were the days when NYCPM had Drs. Piccora, Springer, Lombardo, Haber,  Hernandez,  Kass, and "Dr. G." I can't imagine any department of surgery at any school having a finer staff. I owe a lot of what I know today to those clinicians and educators.
 
Pic was a kind and generous human being whom I will sorely miss. My fondest memory of him was one day while going on rounds through the ICU of the old Joint Disease Hospital in Harlem. I noticed this very attractive nurse with big beautiful crystal blue eyes. I nudged Pic as though to say, "check out that nurse" only to have him whisper in my ear "yeah not only is she is gorgeous but she's great in bed........I should know that's my wife Myrna!" We laughed about that for years. He was a friend and mentor to me. I will sorely miss Pic and I will never forget him. God bless Robert Piccora and look after his family.

Frank Lattarulo, DPM, NY, NY

RE: Jacobs to Be Inducted in PM Podiatry Hall of Fame
From: Allen Mark Jacobs, DPM

I would like to thank the podiatric community for selecting me to receive the 2010 lifetime achievement award. I am honored by your suggestion that I am worthy of such recognition.

It is my belief that indeed, this is in fact a recognition of the average podiatric physician, which is what I am. Our profession provides ...
 
Editor's note: Dr. Jacobs' extended-length letter can be read here.

RE: Concerns from a Podiatric Physician (Joseph S. Borreggine, DPM)
From: Multiple Respondents

I had the same thing happen at a rural satellite office in 2005/2006 in Michigan. I realized that the factories had closed and the people were just not seeking care because they moved. I had to leave the practice and focus on my main office which has a better local economy: Casino and University and Hospital to support jobs. I am doing well, but I have become dependent on dispensing orthotics and shoes to supplement a declining patient load. I have paid all of my debts and live well within my means in order to be able to retire when I am in my 60s.
 
Connie Lee Bills, DPM, Mount Pleasant, MI, staff@familyfootcare.biz

Dr. Borregine's concerns are but an echo of many practices across the country. Many well-known and respected physicians are going through the same issues. Most of us may think we have it "all covered" when it comes to our practices, but there is always something out there that remains to be explored and discovered.

Since you CAN teach an old dog new tricks, my humble advice is to contact immediately the American Academy of Podiatric Practice Management, join its ranks, and attend their seminars. They are the most dynamic, friendly, and hands-on group of podiatric physicians willing to help anyone succeed in their practice. Last, but not least, a practice management consultant can help you tremendously as well, e.g., Lynn Homisak, et al. at SOS.

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

Dr. Boreggine's letter reminds me of the child in the fable who was the only one in the crowd to publicly say that the king was not wearing any clothes. Many of us are too proud to admit that we are seeing less patients. We falsely blame ourselves or even our profession. Of course, there are some practices that are booming, but I get a great deal of feedback from colleagues I meet, and most are reporting diminished volumes of patients. Part of the problem is the economy. Many people have lost their healthcare insurance along with their jobs. They worry about feeding their families and holding on to their homes, and having pain-free feet is not a life and death issue for them.

Another problem is that many insurance companies, in lieu of raising premiums through the ceiling, are raising co-payments, especially for specialists. My own is going from ten dollars to fifty dollars a visit. The psychology of the average person is that for 10 dollars, they will go frequently to any doctor at any time; for fifty, they will go only when their state of health is dire. A new problem is that many other specialists are taking on aspects of foot care. A well known radiology group in my area is advertising that they do ultrasound-guided neuroma injections. A physiatrist told me that he is doing injections for plantar fasciitis and lecturing to his MD colleagues about it. I truly believe there is a light at the end of the tunnel. The economy is showing small, but positive signs of improving, and people with foot pain will once again realize that podiatrists can bring them greater and longer-lasting relief than other doctors. 
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: Concerns from a Podiatric Physician (Joseph S. Borreggine, DPM)
From: Multiple Respondents

From what I read, it sounds like Dr. Borreggine is not only well qualified, but also well connected in his community. What we do not know is the health of his community. Is the community growing? Are people driving new cars? Is the employment rate high? Are the jobs for the community diversified (that is, many different employers with many employees)? Perhaps what Dr. Borreggine is seeing reflects what is happening in his community. For instance, where I live, we are preparing for the loss of tens of thousands of high paying jobs when NASA scrubs the Shuttle program. The loss of income will have nothing to do with the qualifications of physicians. Remember, too, that your practice will wax and wane over the years. Of the suggestions I could propose: see if there are any groups in the urban areas that need a part-time podiatrist. If your wife is proficient in billing, start a billing company. 

If all else fails, you may simply have to close shop and move elsewhere. Rural areas should realize that physicians bring much more to the communities than the physicians receive in return. If your community does not value your qualifications and services, then you should consider making the move while you can, rather than being forced to change.
 
Richard A. Simmons, DPM, Rockledge, FL, RASDPM32822@aol.com

I can empathize with Dr. Borreggine completely. As a podiatrist in rural Missouri for 20 years, our elective surgical numbers are down significantly in the past few years, and our recent patient volume is down at least 15%. We are inundated with diabetic and PAD patients for an ever increasing percentage of our day. The current economic climate, overall patient attitudes about foot care, incomplete or superficial knowledge of the scope of our training, the growth of urgent care centers, and increasing competition from physicians, mid-level practitioners, nurse managed "foot clinics", and commercial merchandising of "foot scanner - custom fit" shoe inserts may all be having their toll. Perhaps targeted marketing, Internet websites, social networking, patient recalls, or other avenues may be helpful. And of course, the 21% Medicare cuts. We all need to support each other in our profession and have faith that the future will be a positive one. 

Mark K. Johnson DPM, West Plains, MO,  DDR004@centurytel.net

I think all of us that have been in practice for many years have been through this thought process at one time or another. Right now it is slow here in Mississippi (and I am not talking mentally). At times like these, I always look at those podiatrists who have developed other businesses, like Tom Sgarlato, Guido LaPorta, Josh White, and wish I had done something similar. Then, I eventually realize how much I love to do what I do, which sounds like it is very close to what you do. I have realized over the years that I am just not a good multi-tasker. I do a good job at what I do, but do not believe I could keep up the quality of my care and start another business. I have also learned through the school of hard knocks not to invest in businesses that you do not control, or at least know a lot about. I'm kinda like a horse with blinders running for the finish line. The question that I have asked is "What is the finish line?" Death? God has blessed me with the education and skills to help people. I guess I could die with a smile on my face, even as a poor "POdiatrist" (southern dialect).
 
Tip Sullivan, DPM, Jackson, MS,  tsdefeet@msfootcenter.net

RE: Medicare Cuts (Chuck Ross, DPM)
From: Edwin S. Hart, III, DPM

Dr. Ross has the right idea. The fact of the matter is that it is the doctors once again who are...

Editor's Note: Dr. Hart's Extended-length letter can be read here.

RE: Medicare and Non-Par
From: Steven H. Goldstein, DPM

Is the medical field one of the only professions where insurance companies and bureaucrats dictate and control what one can and cannot charge for services rendered? It seems that over the past five to seven years, we have been told that there would be Medicare fee cuts, but at the last minute, we were saved. Now is the time to wake up and realize that one day, maybe today, these cuts will become effective, and they will be here to stay.

Frankly, I do not know how many can afford to sustain 21.5% cuts in fee that are already unjust. Remember, all the other insurance companies seem to follow what Medicare does. I am not sure that a participating Medicare physician can refuse to see patients. That may be a violation of something in the contract that you signed.

No matter what you do, there will always be those to work for rates of pennies on the dollar. One needs to drop out of these plans and start going fee-for-service. Many of those who are very successful have done this. The American Academy of Podiatric Practice Management has been saying this for years. Maybe, more of you should heed the words of speakers such as Dr. Hal Ornstein, and Dr. John Guilana.

Steven H. Goldstein, DPM, Royal Palm Beach, FL, stevefootdr1@yahoo.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

ASSOCIATE POSITION - MICHIGAN - (OAKLAND COUNTY)

outstanding opportunity for associate in well established practice, general & surgical podiatry forefoot, rearfoot & ankle (full or part-time). Well-trained, responsible, motivated with good communication skills, ABPS qualified or better. Send CV & letter of interest to: PodiatristWanted@AOL.COM

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 - UPPER WEST SIDE NY

Great starter practice or satellite office in NY. Looking for new podiatrist who needs to start on his/her own, enthusiastic and flexible hours. Serious inquires only. Office has been used as satellite office, but can easily be expanded to a primary office if your schedule permits. Call 201-491-2173

POST-GRADUATE PODIATRIC RESEARCH FELLOWSHIP

Boston University Medical Center and Boston University School of Medicine. This unique fellowship at a major teaching facility is a two-year opportunity, during which he/she would be expected to become a knowledge expert who will contribute significantly to research, teaching, and innovations in limb preservation and tissue repair. Requirements: Completion of a two or three year surgical residency; Massachusetts license-eligible, ABPS Board Qualification-eligible. Candidate must possess a commitment to an academic career in podiatric medicine and surgery. Annual Salary: Year-1 $61,000, Year-2 $66,000. Submit a CV and letter of interest to: erin.springhetti@bmc.org

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 - CONNECTICUT

Associate needed full or part-time for Nursing homes in Connecticut. Need hard-working, ethical individual. Must have CT license. Excellent salary. Please call Zina (347)307-4333 for additional information.

ASSOCIATE POSITION – NEW YORK
 
Great opportunity to share “state-of-the-art” offices and equipment in mid-town Manhattan and White Plains with Board Certified podiatrist. Out-of-network or participating providers welcome. Please call 212-704-4310 for additional information and fax your CV to 212-704-4311.

PRACTICE FOR SALE – CONNECTICUT

Outstanding practice for sale in northern Fairfield county, CT. Shared space with other medical professionals. Very low overhead. Grossing almost $300K on 30 hours per week. Referrals from three different primary care physician offices. If interested e-mail CTPodiatry@gmail.com

ASSOCIATE POSITION - TAMPA BAY

Associate needed for a dynamic multi-doctor practice in the Tampa Bay area. Preference given to a PSR 24+ training and must have a Florida license. Well-established practice, high-tech with EMR and digital x-rays, with specialties in sports medicine, surgery and wound care. No nursing homes or HMOs. Excellent hospital privileges available. Choose an area of practice concentration that you are passionate about and enjoy a lifestyle for yourself and your family second to none. Kindly forward C.V. to e-mail drcosentino@tampabay.rr.com

ASSOCIATE POSITION - DAYTONA BEACH, FLORIDA

Associate position with buy-in potential. Daytona Beach, Florida Great opportunity for PSR 24-36.trained physician to join state-of-the-art practice. Please forward resume to pfk4@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 or call Martha 909 984-5614.

ASSOCIATE POSITION – NEW YORK

Great opportunity to share “state-of-the-art” offices and equipment in mid-town Manhattan and White Plains with Board Certified podiatrist. Out-of-network or participating providers welcome. Please call 212-704-4310 for additional information and fax your CV to 212-704-4311.

ASSOCIATE POSITION - TEXAS

Dynamic, growing practice in Dallas/Fort Worth area, seeking surgically trained, Board Certified/Board Qualified Podiatrist. Excellent salary and benefits compensation package, for the right candidate, with partnership/buyout opportunity. Contact/Send resume to: jmh6122@yahoo.com

PRACTICE FOR SALE: TENNESSEE

Established 30-year full-scope podiatry practice. Excellent hospital and surgery center privileges with investment opportunities. Fully equipped 2200 sq.ft. office across from hospital. High volume of new patients, DME, and local referral base. Great community for a family and the outdoorsman. Reply to tnfootdr@gmail.com

PM News Classified Ads Reach over 12,000 DPM's and Students

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