The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

April 26, 2011 #4,144 Publisher-Barry Block, DPM, JD

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APMA and SVS Presidents Team up for Foot Health Awareness Month

"Walking is great exercise for the feet," said Robert Zwolak, MD, president of the Society for Vascular Surgery (SVS). Both podiatrists and vascular surgeons agree that good blood flow is essential for foot health. A brisk 30-minute walk every day is just what the doctor ordered. 

Dr. Michael King

"Feet are our foundation," said Dr. Michael King, president of the American Podiatric Medical Association. "Healthy feet are fundamental to the quality of our daily lives. We need to take care of them every day, and see a medical professional if they begin to hurt." Vascular surgeons and podiatrists work closely to access and treat patients with severe foot problems.

Source: Foster Folly News (FL) [4/24/11]

Podiatrists and Students Man Medical Tent at Boston Marathon

April 18th marked the 115th running of the Boston Marathon. 27,000 runners participated, and many were treated in the medical tents manned by physicians of all specialties, including a team of 33 podiatrists and students led by Dr. Jonathan Kaplan. 

Podiatric volunteers at 2011 Boston Marathon

Volunteering to assist the runners were Drs. Howard Palamarchuk, Paul Heffernan, Paula Marella, Richard Baker, Joel Segalman, Neal Zomback, Richard Cullen, Kirk Neustrom, Lori Lundberg, and Scott Aronson. All of these volunteers have been treating the runners at this event for 15 years or more. Also volunteering were students from NYCPM, TUSPM, OCPM, and residents from the Cambridge residency program.

NH Podiatrist Collects 1,000 Shoes for Soles4Souls

Patients and staff of Core Podiatry donated more than 1,100 pairs of shoes to those in need through the Soles4Souls program. Podiatrist James Dolan, DPM heard about the Soles4Souls charity from his wife, and soon the entire Core Podiatry office on Hampton Road was involved in the cause. Patients and staff brought pair after pair of unused shoes for the Soles4Souls charity, which distributes shoes free of charge to people in need.

Dr. James Dolan and staff

Since 2005, Soles4Souls has given away more than 5.5 million pairs of new and gently worn shoes to people in more than 125 countries. "Patients were very enthusiastic, some of them even brought in dozens of pairs of shoes on multiple trips to the office," said Dr. Dolan. "We were able to collect 1,106 pairs of shoes and are hoping to collect more than 2,000 pairs of shoes when we take part next year."

Source: Seacoastonline.com [4/24/11]

AZ Podiatrist Not Surprised by Results of Study on Diabetics and Footwear

Many patients with diabetes fall short on foot care and footwear, according to a new study. Failure to perform recommended foot care and wearing inappropriate footwear can set diabetic patients up for foot ulcers. Ulcers are painful and potentially serious. Most diabetic patients polled for the study said that they know proper foot care and properly fitting shoes are important. But they don't always follow through, according to Stephen Ogedengbe, MD, a researcher at the University of Benin Teaching Hospital in Benin City, Nigeria. 

Dr. David G. Armstrong

"The study [result] doesn't surprise me," says David G. Armstrong, DPM, MD, PhD, professor of surgery and director of the Southern Arizona Limb Salvage Alliance at the University of Arizona College of Medicine, Tucson. The study confirms what Armstrong observes with some patients, he tells WebMD. "The doctor and nurse can tell the patient something [about proper footwear]. Just because we tell them doesn’t mean they are going to be motivated to make changes."

Source: Kathleen Doheny, WebMD Health News [4/22/11]

Editor's Note: PM News is proud to present excerpts from Meet the Masters.

Bret Ribotsky: What would you tell somebody who is trying to ethically maximize reimbursement?  

Dr. Paul Kinberg

Paul Kinberg: I would tell them to absolutely do it. You have to bill ethically and honestly for everything you do. Many podiatrists tend to be a little bit paranoid. They tend not to bill for everything that they have actually done. They tend not to bill to the highest level that they can for everything they have done. I suggest that they do that. Now conversely, there are some podiatrists out there who think they are God’s gift to humanity and overbill for everything. They are going to get into trouble for overbilling. 

Dr. Vicki Driver

Meet the Masters is broadcast each Tuesday Night at 9 PM (EST). The next segment will feature diabetes researcher Dr. Vicki Driver. You can register for this event by clicking here

Query: Amazing Charts

I am looking for feedback from anyone who is using Amazing Charts about duration of usage, ease of use, template creation, and learning curve?

William H. FitzPatrick DPM, CPed, Albuquerque, NM

RE: Post-op Nail Complication (Juliet Burk, DPM)
From: Michael M. Rosenblatt, DPM

Doctors of all kinds are "excoriated" in the media and by insurance companies for "unnecessary" tests and procedures. It is often impossible to predict ahead of time which procedure or diagnostic test will turn out to be "unnecessary." X-rays are in that category. Juliet Burk, DPM, advised us of a case of hers where there was a post-op complication of a nail surgery. She "listened" to her patient when it was reported that the patient's children "frequently stepped on her toe." X-rays revealed a fracture. I would be glad if she were my podiatrist.

When there is a complaint of pain in an area where there is anatomic bone, it is necessary to take an x-ray, no matter what the insurance company demands. Even though we have extraordinary pressures to reduce utilization generally, we must still be responsible to our patients, not insurers. If you practice to reduce utilization, it is inevitable that you will eventually miss an important test. A jury will not consider your statement that you "want to avoid unnecessary tests or procedures" as a defense. You may stay longer on a particular insurance panel, but I guarantee that you won't take part in the "savings" generated by that insurer's bottom line, and they will do everything possible to continue to squeeze you down to lower and late paying fees.

Michael M. Rosenblatt, DPM, San Jose, CA, Rosey1@prodigy.net

RE: E-mail Medicine
From: Will Parker, DPM

Over the past year, I have experienced a significant increase in known patients contacting me by e-mail for medical advice regarding their conditions. At first, I did not mind the communications as the questions were along the lines of “when did you say I can play golf again?” I now regularly receive photos of wounds with questions like “does this look infected,” or “should I be worried?” Patients do not understand the position that they put us in with these communications. I try to be diplomatic and explain that it is not in their best interest for me to make a clinical decision based on a 1 megapixel smartphone picture taken in a poorly lit room.

I recently told a patient not to e-mail me with such photos and discussed my reasons. He continues to do so and says that he is now sending “high quality” photos. He missed the point. I don’t do telemedicine! I am not suggesting that there is no place for real telemedicine applications, but patients these days are trying to avoid a co-pay on an office visit, or they are too busy to make an appointment. I am interested in the experiences of others in this area. How do my colleagues handle this? I don’t want to seem like a jerk to my patients, but this is not good medical practice on many levels. By the way, I do print and scan ALL e-mail communications from patients into their electronic charts.

Will Parker, DPM, Conway, SC, parkerdpm@starlinx.com

RE: CryoProbe (Mark Aldrich, DPM)
From: G Dock Dockery, DPM

I have tried just about every aspect of wart therapy with success, to some degree, with all methods. In some cases, I have combined three or four different modalities and drugs to fight certain resistant warts. Some leading research has stated that debridement with topical 60% salicylic acid is still the best treatment for warts, based upon review evidence-based medicine papers. I don't find this to be the best choice for many warts.

As a consultant to CryoProbe and a speaker on the use of cryotherapy for the treatment of warts and other benign skin lesions of the lower extremity, I am very enthusiastic about the product and the results. Personally, it is the best cryo unit that I have ever used. As far as I can tell, there are no evidence-based studies comparing the CryoProbe to liquid nitrogen or any other freezing agents.

I think that the CryoProbe success rate for most lesions is around 90% and for plantar warts, it is close to 80%. I don't...

Editor's note: Dr. Dockery's extended-length letter can be read here.

RE: Exogen Bone Healing System (Russell Trahan, DPM)
From: Vince Marino, DPM

Dr. Trahan in his post on Exogen Bone Healing System states, “ It indeed has an FDA indication for fresh fractures.” Of course, the Exogen reps will also tell you the same thing - that Exogen is the only bone stimulating system indicated for the treatment of fresh fractures. According to some of them, the Exogen unit is the next best thing since sliced bread.

What they often fail to tell you is that there are only limited types of fresh fractures that the FDA gave the indication for. As taken directly from Exogen’s website...

Editor's note: Dr. Marino's extended-length letter can be read here.

RE: Coming Down a Peg (Douglas Milch, DPM)
From: Jon Purdy, DPM

I don’t think there is a person on the face of this Earth who hasn’t later realized they’ve been going through the day with a fly down, bogey in the nose, or any other dishevelment. I remember one particular day I was running late for clinic. I blew into the office, set my things down, and speed walked to the first patient room. I ignored my assistant trying to interrupt my harried pace, “Dr. Purdy, Dr. Purdy” as I responded with, “Yes, I know.” I shot into the first room and saw my patient. I came out to grab the next chart when she finally got through to me and said, “Dr. Purdy, I wanted to ask you if you had planned to brush your hair this morning.” It’s always nice to try change, but I’m not sure patients will respond well to the “rock star” look while going through a pre-op visit.

It is for this exact reason, part of the medical assistant’s training is geared toward the routine of getting the office ready to see patients. In particular, giving me the once-over to double check for the bogey.

Jon Purdy, DPM, New Iberia, LA

EQUIPMENT FOR SALE - COOL TOUCH LASER

Cool Breeze Cool Touch CT3 plus laser used for ugly, unsightly, toe nail infections. Less than six months old. Great price won't last long. Considering a laser? We also have the Q- Clear Q- switch laser too. This laser is perfect for you. Also a used Lumix 2 laser, best price today. Dr. Zuckerman is in the Fort Lauderdale area and will demo these lasers on your patients. E-mail footcare@comcast.net

PRACTICE FOR SALE - MARYLAND, DC SUBURBS

Great opportunity. Well established and equipped practice for sale. Office includes state licensed Ambulatory Surgical Center. Present owner is retiring but will stay on as needed for smooth transition. Average gross over past 3 years is $575 K. dpmpracticeforsale@yahoo.com

SPACE AVAILABLE- NYC & LI

Office to sublet and share - East 60th Manhattan, and Plainview long island. access to an MRI, Joint Commission certified operating rooms, digital x-ray, diagnostic ultrasound, and access to a multi-specialty ambulatory surgical center. Turn-key operation - no investment needed 516 476-1815 PODO2345@AOL.COM

ASSOCIATE POSITION AVAILABLE - THE BRONX

Excellent hospital based opportunity. Inpatient & Outpatient Care. Busy clinics. Large diabetic population. Practice all aspects of Podiatric Medicine & Surgery. Requires Surgical Skills. CV to nealblitz@yahoo.com

ASSOCIATE POSITION – NEW JERSEY

Associate wanted full-time, for practice in East Orange NJ PSR 24-36 trained. Must be motivated to grow practice, especially build wound care and surgical services. Buy-in possible after the 1st year. send CV to Drfoot44@gmail.com

ASSOCIATE POSITIONS - NW INDIANA, CHICAGO AREA

2 Full-Time positions open - One for Northwest Indiana and one for the Chicagoland area. Must have 2-year surgical residency. Must be motivated and a self-starter. State License required. If interested email: f-massuda@footexperts.com

ASSOCIATE POSITION - CT - (FAIRFIELD AND NORTH HAVEN)

Join one of the largest podiatric groups in Connecticut. Well-established and progressive offices, including EMR, digital x-ray, vascular and NCV studies, Pinpointe and CO2 lasers, diagnostic ultrasound and electrical stimulation therapy. You can expect a full schedule of patients the day you start, and a very competitive salary. For more info www.greatfootcare.com. Send resume to Dr.Kassaris@yahoo.com

ASSOCIATE POSITION - NEW YORK CITY & QUEENS

One of the fastest growing podiatry practices in New York City and Queens seeks a podiatrist who participates with HealthFirst, Fidelis, and other Medicaid plans. Preferably a Spanish speaking podiatrist. Contact me at Podocare@aol.com

PODIATRIST NEEDED - NY/QUEENS/LI

Must be min. PSR-3 with excellent training. Experienced in billing, selling non-covered services, products, Patient medical and surgical exp. with good rapport/comm. skills necessary. Unique position working in offices, clinics, hospital with orthopedist, podiatrist, P. therapists. P/T, F/T available. Growth, income potential and partnership opportunity excellent. A chance to use all your skills; foot, ankle and more. Please respond with cover letter and CV to hansfeet@aol.com

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