The Voice of Podiatrists

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March 21, 2008 #3,199 Editor-Barry Block, DPM, JD

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Bunion Surgery Has Less Than 1% Complication Rate: PA Podiatrist

There are dozens of surgical procedures for removing bunions and correcting other conditions, like arthritis or bone spurs, which can be caused by them. "Surgery varies from patient to patient and each patient's situation is different so each bunion is an individual procedure," said Dr. Robert Mendicino, a podiatric surgeon, director of the Foot and Ankle Institute of Western Pennsylvania, and chairman of foot and ankle surgery at West Penn Hospital.

Dr. Robert Mendicino

Do bunions return? "Once in a blue moon you will get one that comes back," Dr. Mendicino said. As with any surgery, there also can be complications, but they too are the exception rather than the rule. "Generally in our practice," Dr. Mendicino said, "we have a less-than-1-percent complication rate and that includes recurrence, infections, scarring, the whole list. ... [and] a lot of that is directly related to two issues: non-compliant patients and acts of God or stupidity. If you fall down a flight of steps, it's an act of God. If you get drunk at a Pirate game and fall down a set of bleachers, that's an act of stupidity."

Source: Pohla Smith, Pittsburgh Post-Gazette [3/19/08]

Scope of Practice Definition Could Force TX Podiatrist to Quit

A state appeals court recently sided with medical doctors when it determined that the state board that licenses podiatrists exceeded its authority in defining the ankle as part of the foot. "You don't have an ankle," said Mark Hanna, a lawyer for the Texas Podiatric Medical Association. "The foot actually includes the ankle. If you took the foot off the leg, there is nothing lying there that's the ankle."

Dr. Thomas Zgonis

San Antonio podiatrist Thomas Zgonis completed four years of training after podiatry school and specializes in reconstructive foot and ankle surgery. "I have saved all these diabetic patients' feet" from being amputated, he said. "All of a sudden you wake up one day and you question this?"

Zgonis said he will have to quit his practice if he has to cut off his practice at the ankle. "It would be a disaster. These people are crazy," he said.

Source: Associated Press [3/19/08]

New Fraud Leads to Increased Scrutiny

The Wall Street Journal on Wednesday examined how as the private sector is increasingly providing more Medicare and Medicaid services, new types of fraud are "cropping up that are harder to spot, more complicated to prosecute and potentially more harmful to patients," prompting the federal government to increase scrutiny of managed care. States and the federal government began shifting Medicaid and Medicare beneficiaries to managed care plans in the 1990s to control program costs, and many believed the shift also would reduce fraud because "companies would have strong incentives to prevent overbilling by doctors, hospitals and other medical providers -- and to avoid cheating the government themselves," the Journal reports. However, some states reduced the number of health care fraud investigators, and a recent federal review of health programs for low-income children found that states mostly rely on HMOs to regulate themselves.

The Journal reports that traditional fraud prevention for government programs consisted of "policing doctors, hospitals, dialysis centers and the like to catch overcharges or billing for treatment never provided." However, according to the Journal, "[m]anaged care fraudsters profit by ... shortchanging patients or physicians to cut costs while collecting preset fees from the government," as well as by "refus[ing] to enroll unhealthy people, skimp[ing] on paying doctors or deny[ing] patients care." Regulators say "they are realizing they must become more attuned to more-complex scams carried out by sophisticated corporations," the Journal reports. The Journal also profiled several fraud cases in Pennsylvania, California, New York, Texas and Virginia that "have provided a wakeup call for regulators" and "illustrate the potential for fraud and authorities' growing understanding of its scope."

Source: Theo Francis, Wall Street Journal, [3/19/08]

Query: Squamous Cell Carcinoma

I have a 32 year old male patient which presented with a granulomatous lesion subungually of the hallux. I did an excisional biopsy which came back squamous cell carcinoma. The pathologist recommended complete excision. Has anyone dealt with a lesion in this area and how aggressive would you be in removal?

Austin Reeves, DPM, Texarkana, TX

RE: Texas Appeals Court Overturns Scope of Practice Definition
From: Vince Marino, DPM, Michael A. Conway, DPM

So what chain does Texas Podiatric Medical Association President William Hinkley, MD work for? I, for one, will not use them anymore.

In California our laws specifically give us the ability to practice within the full scope of our training including the ankle and soft tissue structures of the leg that affect the ankle and foot. Perhaps other states should look up the wording utilized in California and promote it to their respective legislators.

Vince Marino, DPM, San Francisco, CA, drmarino@marinofootandankle.com

Editor’s note: The pathology lab in question is Ameripath.

I would like to take the opportunity to respond to Dr. Kornfeld's comments in regard to our scope of practice fight. Dr. Kornfeld has known about podiatry his whole life. He may have practiced podiatry for 27+ years since his graduation from NYCPM in 1980, but he has not been involved in the profession of podiatry for the past 12+ years, since he ceased being a member of our state association and the APMA.

Dr. Kornfeld surely knows the podiatry he practices in 2008, is very different from what his father used to do in 1950. The changes, in New York, only came about through the hard work of the NYSPMA and its dues-paying members. Dr. Kornfeld (and all non-members) enjoy the benefits of the hard fought scope of practice victory we won in this state approximately ten years ago. Today, in NY, we again find ourselves in the trenches with a new scope of practice battle to increase our scope to include the ankle and soft tissue to the knee.

This battle will also be won. Not today, maybe not tomorrow, but one day, through the dedication of NYSPMA, its loyal members who pay dues, take time out of their busy lives to visit legislators in Albany (and Washington DC), and send their hard-earned money to NYPAC (& APMA-PAC ) the job will get done.

What happened to our good friends in Texas is a setback, for sure, but it should serve to make all of us stronger, and more determined to accomplish what we have to through the legislature. Please join the fight in your area. Get "involved" in Podiatry and make this a better profession for all who practice Podiatry. If you want to be an MD, go to medical school. (Just don't turn against us after you graduate.)

Michael A. Conway, DPM, APMA-PAC Coordinator, NYS, Massapequa, NY, mikeswae@optonline.net

RE: Painful Nails in Patient With Raynaud's Disease (Harry Goldsmith, DPM)
From: Bryan C. Markinson, DPM

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Editor’s note: This extended-length note can be read at: http://www.podiatrym.com/letters2.cfm?id=18554&start=1

RE: Doctor of Plant Medicine (DPM)?

A teenager told me today he was referred by his regular doctor for treatment of a gardener's wart. I said do you mean a farmer's wart or a cultivator’s wart or maybe a planter's wart. "That's right a plantar's wart he replied."

Art Hatfield, DPM, Long Beach, CA

PRACTICE FOR SALE - LAWRENCE, KANSAS

Great place to live and raise a family (college town). 250+ K yearly gross with good potential for growth. Good mix of general podiatry, sports medicine, and surgery. Hospital privileges available. 4 treatment/procedure rooms and well-equipped. Fully computerized. Partnership in a 4-office medical building. Partnership is for sale. Inquires to foothlr@sunflower.com 785-842-4225.

ASSOCIATE POSITION – GREATER MILWAUKEE, WI

Great opportunity: our busy multi-physician, podiatric group practice, with multiple locations, strong hospital affiliations and faculty positions with PM&S-36 residency program, is seeking a full-time RRA BQ/BC, PM&S-36 surgically trained doctor. Applicant should be well trained in all aspects of surgical and conservative care. Candidate should be ethical, hard working and outgoing physician to join our practice. Commensurate pay with incentives and benefit package. Definitive plan leading to partnership tract. Contact: Daniel Hellman, M.D. @ 414.831.0512 or by e.mail @ hellmandr@gmail.com

PRACTICE FOR SALE -ORANGE COUNTY, NEW YORK

Busy, part-time, twenty-two year old practice for sale. Easily expandable to full time. Grossing over $225,000 on three days a week. Great potential for growth. Price negotiable for immediate sale. Please reply to ASB310924@aol.com

ASSOCIATE POSITION - SULLIVAN COUNTY, NY

ASSOCIATE Wanted To Be fast tracked into PARTNERSHIP. 6 doctor group with one partner anxious to retire.. DON'T MISS THIS OPPORTUNITY. Check out our website www.footcaregroup.com then e-mail me to arrange a visit mhudes@footcaregroup.com

EQUIPMENT FOR SALE

Podiatry chairs, X-Cel x-ray machine, extremely reasonable prices. E-mail reversoman@aol.com

PRACTICE FOR SALE – GULF COAST TEXAS

If you enjoy palm trees, beaches and outdoor sports then why not live and work on the sunny coast of Texas . 17-year established practice grossing approximately 500K, with a 4 day work week. Located across from major trauma center and in the most heavily populated part of town. Large diabetic population. Office can support 2 podiatrists easily. Serious inquiries only. oda512a@aol.com

EXPANDING IN SOUTH-WEST FLORIDA

Seeking an associate for a well-established, busy, multiple-office practice. All aspects of podiatric medicine and surgery. Must have completed a 24-36 month residency and at least board eligible in forefoot surgery, preferably in forefoot and rearfoot surgery. Competitive salary with excellent benefit package. If interested, please fax CV to 941-639-0026 or e-mail it to Awilliam33@aol.com

PART OR FULL TIME ASSOCIATE POSITION - NEW YORK, NY

Busy, thriving Manhattan Podiatry offices looking to hire part or
full-time in-network Podiatrist for growing private practice. Please, only in-network doctors apply. Send resume and list of in-network plans that you participate in to: Rachel@FootCareofNewYork.com

ASSOCIATE WANTED – NEW YORK IMMEDIATE OPENING

Busy multi-dimensional practice; 70 miles north of New York City . Currently four (4)-doctor practice. looking to expand – all phases of podiatric medicine. contact: (845) 454-8308 EXT: 106

TEXAS - SEEKING ASSOCIATE TO FULL PARTNER

Busy multi-physician podiatric group with 2 locations seeking BQ/BC surgically trained doctor. Applicant should be well-trained in all aspects of surgical and conservative care. Seeking ethical, hard working and outgoing physician to join our 4-physician group. Excellent quality of life in suburban Houston, near NASA and the Gulf of Mexico. Email CV and cover letter to Dr. M. Rockett at Mrockettman@comcast.net

FULL-TIME ASSOCIATE WANTED - CHATTANOOGA,TN

Well established, well-respected surgical/medical practice seeking full time associate. Send CV/ inquiries to: chattfootdoc@yahoo.com

ASSOCIATE POSITION - FT. MYERS/CAPE CORAL FL

Great opportunity for BE/BC established DPM or podiatric surgical resident with strong surgical skills. Well-established podiatric practice offering high surgical volume, advanced wound care, PT, vascular diagnostics and large diabetic population. Exceptional pay with incentives for high performers. Generous benefit package. Relaxed lifestyle, golfing, boating, fishing, close to beautiful SW FL beaches. Please send CV with references to janekelly331@msn.com

PART TIME PRACTICE W/ PROPERTY FOR SALE, BLOOMFIELD, NJ

Very busy 3 days/week. All modern equipment including digital x-ray and recently remodeled office suite. Office over 1300sf with 3 treatment rooms, large consultation room and second private office suite with full bathroom. Located in a professional building with plenty of parking on a main road. Bus stop in front. 2 blocks off Garden State Parkway. Please contact doccapo@yahoo.com

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