The Voice of Podiatrists

Serving Over 10,800 Podiatrists Daily

April 12, 2008 #3,218 Editor-Barry Block, DPM, JD

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Feet are at Greater Risk for ‘Weekend Warriors' – MI Podiatrist

Men who turn to athletics as an extracurricular activity subject themselves to a greater risk of injury to the heel, toe and ankle, according to podiatrists with the American College of Foot and Ankle Surgeons (ACFAS).

Dr. Molly Judge

Dr. Molly Judge, D.P.M. and ACFAS fellow, said “weekend warriors” -— men who often participate in sports for recreation — may not consider the stress they place on their feet and ankles. They also tend to “walk off” an injury, nurse it and continue their activities as usual, not realizing the potential consequences, such as a ruptured tendon. Judge practices through her offices in Lambertville, MI. and Port Clinton.

“It's intuitive to me to say that men will have a higher tendency in general to be a weekend warrior even in their advanced years. We [in the profession] tend to think of the age 30 and above in men because of the weekend warrior mentality,” Judge said.

Source: Scott McKimmy, Toledo Free Press, [4/4/08]

Drug Companies to Reveal Grant Practices

For years, the nation's largest drug and medical device manufacturers have courted doctors with consulting fees, free trips to exotic locales and sponsoring the educational conferences that physicians attend. Those financial ties in most cases need not be disclosed and can lead to arrangements that some say improperly influence medical care.

Now, under the threat of regulation from Congress, the two industries are promising to be more forthcoming about their spending. A dozen of the nation's leading drug and device makers have told Sen. Charles Grassley, R-IA, that they have plans or are working on plans to publicly disclose grants to outside groups. The details will be provided on each company's websites.

In a few states, such as Vermont and Minnesota, drug companies must disclose certain payments to physicians. Baxter International, Inc. told Grassley that it could support legislation setting a national disclosure standard, but it's critical that the standard pre-empt state laws.

Source: Kevin Freking, Associated Press [4/11/08]

Query: Duty to Provide Interpreter Under ADA

I was just asked by a deaf couple to provide an interpreter for them when they come to the office next week. I contacted the University to set it up, and they provided a contract for an interpreter for a cost of $130 plus travel. The disabilities act states that I have to provide it at my own expense. How can that be? I have to put out about $150+ dollars to see the patients? Is there any way to recover the costs? Why would I want to provide this service, if it costs me to see them? I don't understand why the federal government would force you to see patients at your own expense. I was also told that if I refuse to see these patients I can be sued for discrimination. Is there anything I can do?

Randy Bernstein DPM, Dearborn Heights, MI

Editor’s Note: PM News does not provide legal advice. The cost of complying with the ADA is shared by all businesses, such as buildings which must provide access ramps and airlines which must provide wheelchairs. The only way you can limit your expenses is to shop around for a lower-priced interpreter or to learn sign language.

Query: CME Accreditation

Has anyone started the process of DME accreditation? I responded to one post that listed the approved organizations. I contacted "Accreditation Commission for Health Care Inc.," and ordered a spiral book...."Accreditation Checklist for Success."

The only problem is that they later informed me that they are not accrediting podiatrists. I contacted another organization... and have received no reply. I am in an unusual situation in that I fabricate my own AFOs, and desperately need to start this process. Any advice from someone who is currently engaged with accreditation would be appreciated.

Carl Ganio, DPM, Vero Beach, FL

Response: Out of the eleven agencies which CMS has given the ability to accredit DME suppliers there are really only 5 or 6 which would be appropriate for podiatrists.

Two of the original eleven have merged together (after CMS made their announcement), and several cannot accredit anyone who dispenses custom devices. Several others are way too expensive and more suitable to large facilities/hospital or laboratories. That leaves only a few suitable to accredit podiatric offices.

For podiatrists who have a large DME practice (like myself), I think it would be foolish to wait until CMS and Congress get their act together. This may never happen. For the few thousand dollars, it just may not be worth it. In addition, there is no guarantee the private insurers follow suit and implement this same system regardless of what CMS and Congress do or don't do.

I am currently weighing my options, and should be able to report back with more information on this within the next week or two.

Paul Kesselman, DPM, Woodside, NY

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RE: Injectible Cortisone Dosage
From: Multiple Respondents

I find this topic fascinating in that it shows the wide variation in how we do injection therapy, even among some of the most respected people in the field. This is especially important in that most podiatrists use steroid injections as a significant part of their treatment for many conditions.

I personally try to treat most conditions conservatively before injection therapy. I try treating plantar fasciitis with strappings and exercises, and neuromas with wide cushioned shoes and met pads. If there is little or no relief then I might go to injection therapy, and a significant portion do not require injections. I then start with Lidocaine and Dexamethasone. I appreciate Dr. Markinson's comments but sometimes I do get significant relief with dexamehtasone. If that is not successful we will try Lidocaine with Dexamethasone and Kenalog mixed. If I am injecting for a neuroma I will inject it under ultrasound guidance directly into the neuroma, as per the recent study done at the Hospital for Special Surgery.

I hope to see an article in Podiatry Management or a lecture at a scientific meeting about injection therapy and steroid choice and doseages. I think it is such a common procedure that obviously needs more discussion.

Kenneth Meisler DPM, New York, NY, kenmeisler@aol.com

What I have learned from the discussions, is not to mix DepoMedrol with an anesthetic to avoid flocculation. Instead I will block the site first with lidocaine/Marcaine, then with a second injection into the now numb area, instill the pure DepoMedrol where needed.

Thanks to all who responded.

John Moglia, DPM, Berkeley Hts., NJ, drjohnmoglia@aol.com

RE: AMA’s Scope of Practice Report (Don Arenson, DPM)
From: Harold W. Vogler, DPM

I agree fully with Dr. Don Arenson's position on the ultimate objective of the AOFAS and their parent, AAOS associations. Make no mistake, the AAOS and AOFAS have a formalized agenda to continue to restrict and restrain podiatric practice nationally--their preferred arena seems to be State by State legislatively when possible, as they have considerable political power in their collective organizations. If they could, they would eliminate us but that will not happen. There are not enough of them and their training remains insufficient for the full spectrum of sophisticated foot & ankle work. These anti-podiatric AAOS & AOFAS programs are well-funded, organized, and have designated high profile "orthopedic haters" in charge of the "podiatric oversight committees" that historically have attempted to obstruct podiatric surgeons in every venue possible, over the years.

This is one reason it took more than 15 years to solve the H&P problem with JCAHO and CMS! This is mostly at the "organizational level" and not the rank and file orthopedists that generally are coming around in their perceptions of foot & ankle surgery regarding designating podiatric surgeons for this work even within their own group practices. The AOFAS are the worst of the bunch as they are brain washed further during their short fellowships by more mature orthopedists that have historically hated podiatric physicians as competitors dating back to the early 1970's. They are all vulnerable, as their training still falls considerably short of most podiatric surgical programs and few can earn a living doing exclusively foot & ankle work, thus they are again diluted in their overall orthopedic practice skill aimed at the foot & ankle.

We will prevail over these groups. In fact, the more aggressive posture these two groups generate against us, the greater our resolve & the stronger we get. It is easy to compete against these groups; just do quality work and take good care of your patients and forget about their juvenile petty assaults--our organizations will deal with these people and their hateful attitudes.

Harold W. Vogler, DPM, Sarasota, FL, hvogler@soa.md

ASSOCIATE POSITION - NORTH CAROLINA

Beautiful area; Thriving economy. Seeking Nice, Well Trained Associate who can Work Independently (experience a plus). Unique "Associate Security" Clause so that you control your destiny. Send resume and cover letter to greatpodjob@yahoo.com

ASSOCIATE POSITION - MONTANA

Two Doctor group seeks individual with 3 years of surgical training. This well-quipped office deals with all types of reconstructive foot surgery. Diabetic foot fellowship desirable. Practice includes two physical therapists that work on-site. Rural setting with excellent outdoor activities. Competitive salary and benefit packages with opportunity for partnership. Respond to: jclough@sofast.net or Fax to: 406-761-7219

ASSOCIATE WANTED – NEW YORK IMMEDIATE OPENING

PODIATRISTS NEEDED - CHICAGO --NORTHWEST INDIANA

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists. We are located in Chicago and Northwest Indiana. Full and part time positions are available. Competitive Compensation including malpractice. Contact Scott Schneider. Phone-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com -- www.homephysicians.com

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

PRACTICE FOR SALE – WESTERN WASHINGTON

Magnificent natural scenery in unique area of Washington state. Seller owns condo with ASC built for podiatry practice. The layout was designed to provide maximum efficiency for patient, doctor, and staff. Located within sight of hospital and medical community. Over 25 years established podiatric medical practice with potential to grow beyond $400K gross. 386 597-5766

PRACTICE FOR SALE - BUFFALO'S KENSINGTON SECTION

Established satellite practice. In urban metropolitan area on a busy commercial street corner - commercial building with an attached retail store that allows easy advertising of the podiatric medical practice. Gross $170K+ at 2 ½ day per week. Great potential for growth. 260 402-7490

ASSOCIATE POSITION – VICTORIA, BC

Beautiful Victoria, B.C. Canada on the ocean, fast growing area. Associate for multi-office full scope practice. Licenser exam to be given in June 2008. Reply to dr.cole@shaw.ca

ASSOCIATE POSITION – NW INDIANA (1 HR FROM CHICAGO)

Caring, hardworking podiatrist needed to join our busy practice. We offer great pay and benefits. Must be highly motivated, have a great bedside manner and superb surgical skills (forefoot and rearfoot surgical training a must). E-mail resume to friendlyfootcare@comcast.net or fax resume to (219)662-7290. Learn about here

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