The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

March 30, 2010 #3,818 Publisher-Barry Block, DPM, JD

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Ugg Imitators Could be Worse Than Originals: MD Podiatrist

Dr. Jim Christina, a podiatrist and the Director of Scientific Affairs for the American Podiatric Medical Association says, "Ugg knockoffs that have essentially no support probably would be worse than your traditional Ugg boot, but Uggs are not a great supportive type of footwear. They call them comfort footwear."

Dr. Jim Christina

As far as either the Uggs or their imitators breaking women's feet, Dr. Christina thinks that's an overstatement, but warns that some women have to be very careful. "Everybody's feet are different," says Dr. Christina. "Some people have very stable feet that aren't going to flatten very much; some people have high-arched feet that can actually benefit from something that is absorbent and cushioning, and then some people have feet that flatten excessively. When you get into the latter category, yes, those people should not be doing prolonged walking in any type of footwear that doesn't provide good support."

Source: Joanna Douglas, Sign of The Times

AZ Podiatrist is First to Keynote at OSU Wound Healing Seminar

David G. Armstrong, Professor of Surgery and Chair of the University of Arizona's Southern Arizona Limb Salvage Alliance (SALSA) provided the keynote lecture via video uplink at the 2010 Ohio State University (OSU) Symposium on Wound Healing and Hyperbaric Oxygen. "This was such an honor to be invited to participate in this conference", noted Dr. Armstrong, "It was especially terrific that I could join my colleagues Dr. Vickie Driver and Chris Attinger."

Dr. David Armstrong Prior to Video Keynote to OSU Wound Care Seminar

Chaired by renowned OSU scientist Prof. Chandan Sen, Armstrong became the first ever podiatric surgeon to provide the keynote at the program as well as the first to do it by video feed. "The feedback was terrific and I do look forward to the next visit-- whether real or virtual, said Armstrong."

IA Podiatrist Studying to Become a Master Naturalist

Mark Intlekofer of Maquoketa spent the day in heaven Saturday. More precisely, the gardening and nature buffs soaked in the gorgeous sights, scents, sounds -- and helpful speakers -- at the 2010 Flower and Garden Show at the QCCA Expo Center. "Homegrown vegetables have a flavor so much richer than anything store-bought," agreed Mr. Intlekofer, a retired podiatrist who's studying at University of Illinois Extension Service to become a master naturalist.

Intlekofer has 55 acres of timberland and an orchard where he grows apples, pears, plums, mulberries, raspberries, and strawberries. He wants to volunteer to teach people to be ecologically conscious -- to prevent erosion, to protect flora and fauna, and use rain barrels, he said.

Source:  Jonathan Turner, Quad Cities Dispatch, Argus [3/27/10]

Alleged Improper Treatment of Foot Fracture (MI)

Facts: Plaintiff was a 50 year old married female who was unemployed. A foot fracture was allegedly improperly treated by defendant podiatrists and plaintiff claimed a permanent disability as a result. Defendants argued that they met all the standards of care. A Macomb County jury returned a verdict of no cause of action in favor of all defendants.

Plaintiff Brenda Kaloustian fell off a ladder and suffered a severe right foot fracture. She sought treatment at defendants’ office. She was treated over the course of her recovery by all three podiatrists at the practice. Plaintiff claimed defendants failed to cast her foot at a 90 degree angle, causing her Achilles tendon to shorten. As a result, she claimed difficulty flexing her foot.

Plaintiff alleged that defendants failed to meet the standard of care by not casting her fractured foot at an appropriate angle. She argued that it caused permanent flexibility problems.

Defendants contended that the standard of care did not require casting at a 90 degree angle and that plaintiff had a pre-existing congenital foot condition (pes cavus, or high arch) which caused her problem. Defendants did not dispute her flexing problems, but argued that plaintiff failed to mitigate her damages by refusing to undergo corrective surgery.

Result: Defendant’s verdict

Plaintiff’s Expert: David Touchton, DPM, Port Huron, MI
Defendant’s Expert: Charles Kissel, DPM, Warren, MI

Source: The Michigan Trial Reporter

Obama Supports Physician "Secret Shoppers" to Fight Fraud

In his March 10 speech, Obama said he supported legislation sponsored by Sen. Thomas Carper (D-DE) that would require all government agencies with annual budgets of more than $1 million to perform recovery audits on all of their programs.

The president also expressed interest in a proposal by Sen. Tom Coburn, MD (R-OK), to have physicians and other health professionals go undercover by posing as patients to root out fraud. Obama included it among several other GOP ideas in a proposed revision of pending congressional health reform legislation. Dr. Coburn tried to amend the Senate health reform bill with a provision that would direct the Dept. of Health and Human Services to establish a demonstration project for the undercover investigations.

Source: Chris Silva, AMNews [3/22/10]

Things That Don’t Belong in e-mail

Protect yourself—and avoid legal hot water—by keeping these topics out of electronic messages:

1. Criticism regarding performance issues. Written criticism allows employees and colleagues to brood over your comments. Deliver criticism verbally, following up with written comments only to document poor performance as necessary.

2. Slurs or inappropriate comments. Racial, gender and religious comments are always inappropriate. If you would not say it out loud or print it in your employee newsletter, you should not write it in an e-mail message.

3. Gossip about colleagues. Typing it into an e-mail message is no better than whispering it around the water cooler. If you cannot speak openly about the news you heard, do not speak about it at all.

4. Humorous, sarcastic or tongue-in-cheek comments. You can make such comments face-to-face, when your inflection, facial expression and gestures make your intentions clear. However, when recipients read your e-mail message, you will not be there to interpret for them, and they may take it the wrong way.

5. Personal news. If you would be embarrassed to have everyone in your profession read the details of your love life, weekend adventures, or political views, do not commit them to e-mail.

Source: Adapted from The Voice of Authority: 10 Communication Strategies Every Leader Needs to Know, Dianna Booher, McGraw-Hill via Communication Briefings.

Query: Digital X-Ray System

I am considering purchasing a digital x-ray system. Which systems should I be aware of? Likes and dislikes? Any input by readers would be much appreciated.

Michael J Marcus, DPM, Montebello/Irvine CA

RE: MASS Theory (Calvin Britton, DPM)
From: Doug Richie, DPM

Dr. Britton's comments reflect a current challenge facing the podiatric biomechanics community today. We have many so-called "authorities" on biomechanics surfacing who advocate new theories simply as a platform to promote their commercial interests in a foot orthotic lab. Dr. Britton points out that Dr. Ed Glaser is a "mechanical engineer" which is a credential Glaser himself commonly suggests in his lectures and articles. Yet, a review of Dr. Glaser's CV reveals that he has no degree (undergraduate or graduate) in mechanical engineering. I would suggest that Dr. Britton and others who buy into a compelling infomercial about a new breakthrough orthotic theory investigate the credentials of the proponent of this theory. 

At the California School of Podiatric Medicine, we prefer featuring instructors who have completed a legitimate post-graduate residency training program, are Board Certified by ABPS or ABPOPPM, and have published original research in the field of podiatric biomechanics.
 
Doug Richie, DPM, Seal Beach, CA, DRichieJr@aol.com

RE: Scanning vs. Casting for Orthoses (Robert  Bijak, DPM, Jeff Root)
From: Multiple Respondents

Making orthotics is an integration of art and science. It is a skill that some doctors choose to develop and others do not. Foot surgery is an integration of art and science which some foot doctors develop and may be more skillful than others. I have had amazing results when the correct orthotic is given to a patient - and equally fine results when the correct procedure is used for a patient. The number of variables in a foot surgery can be just as high as what Dr. Bijak explains are associated with "orthotics". Given the choice between having surgery or using an orthotic or brace - I would have to go with the orthotic treatment plan - for it has the lower number of variables and the best chance of positive treatment.
 
M. Joel Morse, DPM, Washington, DC, Foxhallfoot@aol.com

I read Dr. Robert Bijak's post that we as podiatrists have to act as "honest" brokers in the fabrication and dispensing of orthoses to our patients. With this phrase, I am in total agreement. However, the rest of the post is problematic to me. There were several representations of points of view which I think fall short.

First, the representation that we have to honestly assess the "variability" of these devices and have to understand why insurance companies may not want to pay for these devices does not sit well with me. But the question or fault of "variability" lies with whom or what? I have always had a saying when teaching residents..."crap in.....crap out!" I will grant you that even in the best of a clinician's hands, a very small percentage of patients do not tolerate an orthotic or require further modification of orthoses.

However, it has been my experience that …
 
Editor’s note: Dr. Gino Scartozzi’s extended-length letter can be read here.

As I stated in previous posts, the number of orthotics provided by DCs, PTs, Good Feet Stores,  DOs, drug stores,  Wal-Marts, and biomechanical departments in real universities all over the world,  surpasses the number of RX's by DPMs in the U.S. With millions of non-DPM orthotics out there, you would think there would be failure rates in the 90th percentile, but that's not the case. Many patients do very well with non-DPM orthotics, so the claim that we do it better is not substantiated in real life. I don't see Dr. Scholl going out of business and a podiatry school is named after him. 

Root's own theories have been questioned, and flaws pointed out routinely in PM News and other posts. It's a little bit of alchemy, a lot of salesmanship, and a nod to bygone days when foot doctors and chiropody were closer. Do you think that those residents who are going to be required to do 3 years of post-graduate training are going to want to grind the rhoadur and heat it after walking the hallowed hospital halls?  The old ways are dying out and a new profession is emerging.

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

RE: Changing to Billing Service (Peter Smith, DPM)
From: Marc Garfield, DPM

I know there are several people who will speak highly of various billing services. However, this is a switch that you may very well regret. A billing service will frequently charge you a $500-$3,000 set-up fee. The fees deter you from changing services because you know that you will require an additional outlay for the next billing service, or downtime for training the next biller in your office. You can always fire an incompetent employee, but a billing service will usually lock you into a contract and make you prove they are not measuring up to industry standards (which are weak at best). 

Less expensive services route work overseas, and your patients may be speaking to someone with a heavy international accent. Domestic billers generally charge 8, 10 or even 12%. If you are a small practice, billing services tend to look at your office as less important to them as they are prioritizing where to focus their own resources, despite what they may tell you. 

Some services have checks sent to an account they control, and disperse your money after they remove their fees. This is unacceptable, particularly since you do not know if they will perform to your satisfaction. 

Good software may be worth the money that you fear spending. I agree that this is overwhelming and intimidating. But, at this time, if you have a moderate amount of Medicare, then you are going to be required to shift to computerized records AND billing software anyway. Good software can make it possible for the physician to perform the primary claim submissions with very little time and effort. GatwayEDI mails statements for 60 cents per statement. Then, you may only need your biller part-time for the phone calls, appeals, re-submissions and collections. Your biller should be trained on your system, in your office, so you can run your reports anytime and monitor performance through metrics that you control.

Marc Garfield, DPM, Williamsburg, VA, mgarfield1@cox.net

RE: New Medical Symbol

A patient came into the office today and gave this to me. 

New Medical Symbol

New Medical Symbol  --  To prepare for the new healthcare reform package, we felt it necessary to develop a new medical symbol that accurately depicts the Healthcare Plan you will be getting.

Source: Dan Waldman, DPM, Asheville, NC

ASSOCIATE POSITION - SW FLORIDA, BEACHES

Well-established podiatry practice with excellent mix office/surgery seeking full-time associate PSR 12-36. Excellent salary & benefits for the right hardworking, personable candidate. Email resume to capecoralpodiatry@live.com or fax to 239-573-9201

ASSOCIATE POSITION – CALIFORNIA

Looking for a motivated Podiatrist to join a rapidly growing practice in Los Angeles. Excellent compensation. Please reply to coasttocoastpodiatry@yahoo.com

ASSOCIATE POSITION - SAN FRANCISCO, CALIFORNIA

We’re seeking an energetic and enthusiastic Associate to help our thriving non-surgical practice grow. We provide state-of-the-art sports medicine, trauma and lower extremity care. Excellent compensation package. Visit our website to apply.

PRACTICE FOR SALE - MIDDLE TENNESSEE

Turn-key operation ideal for new practitioner. Two locations each with 3 exam rooms, x-ray room, large waiting room, and ample parking.  Excellent locations and growth potential. All equipment and furniture included. Seller happy to discuss extensive financial and professional information. Priced to sell with good reputation, website, and assistance with transition if needed. Call 931-446-5724 for additional information.

ASSOCIATE POSITION - BALTIMORE/WASHINGTON REGIONAL AREA

Multi-faceted practice (routine care to trauma) seeks associate with Maryland and/or Pennsylvania license. Great opportunity for partnership. Looking for pleasant personality. We have multiple offices. Contact butler@qis.net. or call at 410-848-6800 and ask for Dr. Butler.

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

ASSOCIATE POSITION-BERKELEY, CALIFORNIA

We are seeking an energetic individual to join our multi-office practice in Northern California. PSR 24+ with a California license is required. Partnership position is possible with an excellent long term business opportunity for an enthusiastic and motivated individual. Please send resume to Mwolpafootdoc@yahoo.com

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.

TWO YEAR FELLOWSHIP IN RECONSTRUCTIVE FOOT SURGERY AND RESEARCH

2-year fellowship at Beth Israel Deaconess Medical Center, a primary teaching hospital for Harvard Medical School. Fellows have clinic, perform complex reconstructive procedures (external fixation, flaps, Charcot reconstruction), and conduct clinical research (20%). Fellows train residents and receive appointment to Harvard Medical School faculty. Excellent salary/benefits. Program begins SEPTEMBER 1st, 2010. Must have completed PSR-36 or similar. Submit applications to: Dafny Suazo at dsuazo@bidmc.harvard.edu Include CV, letter describing goals and any research interests. Deadline: April 30, 2010. Beth Israel Deaconess Medical Center and Harvard Medical School are Equal Opportunity Employers.

FULL-TIME PODIATRY OPPORTUNITY - BOSTON, MA

HealthDrive is seeking a caring podiatrist to join our group practice. We currently have a FT non-surgical opportunity available in the Boston, MA area. We offer a competitive salary, Paid malpractice Insurance, health and dental Insurance, long & short term disability, flexible schedule (No weekends), established patient base, equipment, supplies and complete office support provided. If interested in this opportunity, please call Maria Kelleher (toll free) at 877-724-4410 or email caring@healthdrive.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.

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

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