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March 06, 2010 #3,797 Publisher-Barry Block, DPM, JD

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We’ve just posted the March 2010 CME titled:

By Vicken Pamoukian, MD and Damien DE Collibus, R-PAC

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Running Barefoot Not For Everyone: NH Podiatrist

Dr. Frederic Schwartz, a New Bedford podiatrist cautions that running barefoot is not for everyone. "My attitude is that the foot is designed to function in an ideal environment. That would be landing on a soft surface that molds to the foot and cushions the impact. But we don't live in a natural environment. All that concrete and asphalt is tough on the skeletal system. My own first choice in footwear is high-end running shoes."

Dr. Frederic Schwartz

He added, "Horses and dogs run on their metatarsals because they are so fast. A horse's hoof is essentially a toenail. But we're not designed to be toe runners. We're built for heel-toeing." Nevertheless, Schwartz said, there are many notable exceptions. "There are no photos of (Boston marathon champ) Bill Rodgers running that show his heel touching the ground."

Source: Don Cuddy, South Coast Today [3/4/10]

PA Podiatrist Finds Running and Podiatry Inseparable

Ira Meyers has run a lot of miles in his day — over 75,000 and counting. And for this Ambler resident, putting in the footwork is a less taxing job than putting in the legwork of planning a race. "It's a heck of a lot easier to run the race," said Meyers, who just finished overseeing the Ambler Area Running Club's 11th annual Frostbite 5-Miler Feb. 20.

Dr. Ira Meyers

Meyers himself has a stellar race record. In 1982, he nearly had an opportunity to race in the Olympics, falling short of the qualifying time for the marathon by just three minutes — a time that would qualify him today. In 1985, Meyers won the Long Island Marathon, and a year later, he crossed the finish line first in the Philadelphia Marathon.

He currently practices at Montgomery Podiatry Associations in Huntingdon Valley, where his wife, Teresa Tobin, is one of his partners. Meyers said being a runner and being a podiatrist have become inseparable. "A lot of the time when I'm out on a run, I'm gonna get asked an injury question — that's part of it," he said.

Source: Thomas Celona, Ambler Gazette [3/2/10]

NY Podiatrist Part of Ribbon-Cutting For New Medicaid Health Center

Chemung County officially opened its Medicaid health center in Elmira on Tuesday, the first clinic of its kind in New York state, county Executive Tom Santulli said. By better managing Medicaid use among the 4,000 patients, Chemung County hopes to save hundreds of thousands of dollars or more each year.

(L-R) Drs. Sam Thompson, Thomas Mitchell, David Schofield, and Chemung County Executive Tom Santulli (Photo: Eric Wensel)

But that could just be the tip of the iceberg, said one doctor who attended Tuesday’s opening. By managing care, the center will be able to keep patients healthier by stopping disease before it starts. By preventing illness and disease, the system saves money. “I know we’re going to be successful at it,” Dr. David Schofield said.

Source: John Zick, Corning Leader [3/3/10]

$1,475,000 Settlement for MD's Failure to Diagnose Charcot Foot

Harris County, TX: A diabetic man who has lost the ability to walk and may have to undergo amputation below the knee has recovered $1,475,000 in a lawsuit he brought against the doctor who failed to diagnose the condition responsible - Charcot Foot.

David Luna alleges that in 2006 he had continued swelling of his leg and foot and alerted his doctor at a Diabetic Centers of America facility to the fact. Luna claims that his physician told him that the swelling was a by-product of his diabetes and that he would have to live with it. However, Luna later sought the opinion of a podiatrist who diagnosed him with Charcot foot, and the podiatrist contended Luna must have been suffering from the condition while he was seeing his original doctor.

Luna claimed that the failure to diagnose Charcot foot led to ulcers and infections, and as a consequence, he can no longer walk and may even have to have his leg amputated below the knee. Luna's original doctor argued that he performed all adequate testing and that Luna never complained about his foot after his first visit. The jury awarded Luna and his wife $2.27 million in damages, but it was reduced due to the patient's comparative negligence.

Source: Lawyersand Settlements.com

Query: Foot and Ankle CME Opportunities for Physical Therapists

I work with a few physical therapists who provide wonderful care for my patients without having a strong background in foot/ankle pathology. One of them asked me for recommendations on conferences or CME opportunities related to the foot/ankle for PT's. I'd love to give them some good recommendations, but have no personal knowledge of PT-specific events for foot and ankle pathology. Any suggestions would be greatly appreciated!

Eric Hart, DPM, Bismarck, ND

RE: Pre-Fab Gait Plate (Jeffrey Kass, DPM)
From: Larry Huppin, DPM

I create pre-fab gait plates by using a ProLab Kiddythotic two sizes too large for the patient – so that the anterior edge extends just distal to the MPJs. To create a gait plate to reduce in-toeing, I then grind the front edge at an approximately 30 degree angle so that the orthosis extends distal to MPJs 5 and 4, but is proximal to MPJs 3, 2 and 1.  

Disclosure:  I am medical director for ProLab Orthotics.  

Larry Huppin, DPM, Seattle, WA, lhuppin@gmail.com

RE: Jacobs to Be Inducted into PM Podiatry Hall of Fame
From: Stan Cohen, DPM, John Visser, DPM

Editor’s Note: The complete version of Dr. Jacobs’ letter from yesterday’s issue which was incorrectly linked can be read here.

Congratulations on the election of my dear friend, Dr Jacobs. He is one of the best minds in our profession and a gifted natural teacher.

Stan Cohen,DPM,  Yuma, AZ, sjcohen@pol.net

I am a former resident of Dr. Jacobs. He instilled in me a passion for learning that I have never lost. It was truly an honor to have been under his directorship. He has one of the brightest minds I have ever encountered. He truly deserves this honor.

John Visser, DPM, Creve Coeur, MO, tsarhjv@aol.com

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

I know how Dr. Borreggine feels, because I was in the same situation 6 years ago. Looking back, in retrospect, I can see that the economy in my town changed. Many factories closed, and many of my Medicare patients had moved or died. We were not able to replace these losses, because many people did not have insurance. It got real quiet at our office, and it was not pleasant. With finances running low, I decided to close the practice and go work at a local clinic. For me, it has been a good experience. We have recovered from the hardship, and our family has been able to keep a roof over our head. My wife finished college, and we are now pursuing our MBA’s. 

It was the hardest thing to close the practice; for me, it was like putting a stake in my heart. It took me a long time to recover emotionally. I had a lot of time to think, and was able to come out of it stronger. I had contemplated re-inventing myself, but the clinic option provided me with more professional growth. Good luck in your journey. Feel free to contact me. 

Edmond F. Mertzenich, DPM, Rockford, IL, doctoreddpm@verizon.net

Joe, I feel your pain. I practice in a rural area of Northern California, and finished a residency in 2001. This is my second career. I turn 50 in July and I find myself with more time to ponder my age and the future, now that patient load has dropped. The economy here is brutal, few jobs and an increasing number of the county's residents on disability and SSI, and that was BEFORE the recession hit, so you can guess how I'm doing. There are several factors hitting me; some have been echoed by the responses to your letter. High deductibles, fewer insured people, other physicians taking on foot problems because they have the time and they need the revenue.

I see this in the bungled nail surgeries that show up. I see this in the referral notes that document, "Will order patient diabetic shoes." I never used to see that. I began looking for the answers on-line and learned that my county is number 44 out of all counties in the U.S. for having the fewest number per capita of privately-insured citizens. I will persevere as long as I can. Many specialists who work in this town maintain dual offices here and in the next city North. I had always hoped to avoid the dual overhead situation.

John Swaim, DPM, Redding, CA, PodTexDoc@aol.com

I sympathize with the changes that have been seen in your practice.  You can do everything right, and not be busy. I don’t know what the exact problem is or how it can be corrected. There is no question that the dynamics have changed. Podiatry Management has been stating for years that the trend is, or that it may be more efficient, to join a group practice. I think that is wise. Also, in my community, there is definitely a shift towards hospital-employed physicians.  Certainly, I would assume that the natural desire would be to support the physicians within your own setting; thus, referrals outside the hospital would be difficult to receive.

Interestingly enough, probably my greatest number of referrals come not from physicians but rather their allied providers, such as midwives, nurse practitioners, physician assistants, and their staff. So, consider them as your potential referral sources as well.

One observation I would point out is that we are such a “NOW” society - especially within our profession. The ingrown toenail that has plagued a patient for 6 months suddenly needs to be corrected this afternoon when they call at 11:00 today to make an appointment.  My patients will come to my office at 1:30 for their 2:00 appointment and tell my receptionist that they need me to hurry because they have a 2:00 dentist appointment. And the very patients who sit for 2 hours to see their family doctors for the last 40 years are the same patients who grow impatient if they have to wait 10 minutes in my office. Perhaps, my office efficiency has created it, but I do believe being timely and efficient is now important to draw patients.

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

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

Editor's note: Extended -length letters by Drs. Brian Kashan,  Bob Kornfeld, and Howard Friedman can be read here.  

RE: Medicare Cuts (Chuck Ross, DPM)
From: Dan Waldman, DPM, Al Musella, DPM

The vote to hold off on the 21% Medicare fee cut is a very temporary fix. We will be going through the same motions next month recommended by the APMA: call, fax and write your congressperson, notify your patients, etc. Let's face it: the insurance companies and Federal government are succeeding in making doctors a commodity. They see no benefit in quality care. They want us to sit down, shut up, do their billing/paperwork and take meager payments while their CEO's and shareholders reap the profits. 
 
I'm reviewing all my contracts and plan on dropping most in the next few months. Imagine if all doctors simply said "NO MORE" in a unified voice. It's time for an "Atlas Shrugged" event. Any other "Dr. John Galts" out there?
 
Dan Waldman, DPM, Asheville, NC,  DPMcareer@aol.com

I was trying to find an easy way for our patients to pressure Congress about the Medicare cuts, so I turned to the AARP website. I would think this would be front-page news, asking all members to call Congress... then I remembered - they are an insurance company also and stand to gain significantly with a 21% cut - so why fight it? And they complain about conflicts of interest with podiatrists accepting pens from drug companies.
 
Al Musella, DPM, Hewlett, NY, Musella@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

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

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