The Voice of Podiatrists

Serving Over 10,800 Podiatrists Daily

April 28, 2008 #3,231 Editor-Barry Block, DPM, JD

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ACFAS Members Vote to Reject APMA Membership Requirement

The following statement has been issued by the American College of Foot and Ankle Surgeons (ACFAS):

“Sixty-six percent of eligible ACFAS members voted earlier this month in the referendum on ACFAS membership requirements. Of the 5,787 eligible voters, 3,834 members voted by mail, fax, or electronic ballot between April 3 and 18, 2008. The results of the referendum were:

53% - "I support the ACFAS Board of Directors' decision to preserve my ability to choose professional memberships as permitted in the current bylaw. I accept that ACFAS will require membership only upon a new member's initial admission into ACFAS."

47% - "I reject the Board of Directors' decision and support changing the bylaw as amended below. I accept that ACFAS will require APMA membership at all times during my ACFAS membership."

The Board of Directors met via conference call on April 23 to discuss the results. The Board respects both the majority and minority of voters on this issue and is especially grateful that a record number of members participated in this vote. We look forward to continuing our work with APMA on the crucial issues facing our profession and creating a new relationship between our two organizations.

Amendments to the ACFAS bylaws require a 2/3rd majority for passage, therefore the proposed amendment was not adopted and the Board will honor its current membership requirements policy.”

Ross Taubman, DPM, president of the American Podiatric Medical Association responded by saying “APMA is disappointed by the decision of the ACFAS Board of Directors. APMA has a responsibility to uphold its bylaws.”

Cardiologist Teams Up With IL Podiatrist to Save Diabetic Patient's Leg

Bernice Smith of Maywood already had lost her right leg to diabetes, and now her left leg was in danger of amputation. But there was a chance her leg could be saved if adequate blood flow could be restored. Smith's podiatrist, Dr. Ronald Sage of Loyola University Hospital, referred her to Loyola interventional cardiologist Dr. Robert Dieter, who lives in Glen Ellyn.

Dr. Ronald Sage

Using a catheter, Dieter performed a difficult balloon angioplasty in a major artery in Smith's left thigh, similar to the technique cardiologists use to open clogged heart arteries. Dieter placed a stent to keep the artery open. The procedure restored blood flow to Smith's leg, which had started to turn gangrenous because it wasn't getting enough blood. Although Sage had to amputate Smith's toes, the rest of her leg was spared. "I can't stop thanking both of them for saving my leg," she said.

The number of amputations is increasing due to the aging population and increased incidence of diabetes, Sage said. Sage is a professor of orthopedic surgery and rehabilitation at Loyola University Chicago Stritch School of Medicine.

Source: News Blaze [4/25/08]

NJ Podiatrist's Online Care Helps Educate, Assure Potential Patients

Mary Ann Reese suffered with foot pain for several weeks while she went from doctor to doctor, trying to figure out what was wrong. Then she found myfootshop.com, the Web business of podiatrist Jeff Oster. There she started asking questions online, joined one of the forums and, in the long run, learned a lot about her feet.

Dr. Jeff Oster

She found Oster to be knowledgeable and familiar with the surgery required, so she drove the two and a half hours from her hometown to his Newark office. "I couldn't believe that Dr. Oster would take the time to answer 10, if not hundreds of e-mails," Reese said. "I really appreciate finding someone like that."

Oster said the Web site offers a unique way to integrate local, hands-on care with a Web-based practice. While some aspects of medical care need to be provided in a hands-on manner, Oster, who has practiced podiatry since 1983, started myfootshop.com eight years ago to help educate people about foot and ankle problems. "A smarter healthcare consumer is going to heal faster and spend their health care dollars more wisely," Oster said. "We've found a unique way to integrate Web-based care and hands-on local care. In fact, we often recommend patients jump on the Web site before coming to see us in the office."

Source: L.B. Whyde, Advocate [4/25/08]

Query: EMR Without Billing Software

Is there a standalone EMR program that does not have billing components, but will simply allow me to be more efficient and maintain electronic records and generate billing codes? Most of the packages I see, try to sell themselves based on integrated functions. While I understand the efficiency of such integration, I am looking to merely convert to electronic clinical recordkeeping without disturbing my smooth sailing billing ship.

Will Parker, DPM Conway, SC

RE: Emotional Distress Over Dystrophic Nail (Hans Blaakman, DPM)
From: Jeffrey Kass, DPM

Dr. Blaackman specifically mentions that the nail has not been tested. Why not test it for presence of fungus? If it is positive for fungus - oral terbenafine might solve the problem. If it is negative, and there is an obvious subungual exostosis that might be causing the problem, I see nothing wrong with surgically excising the exostosis in an attempt to "cure" the dystrophic toenail. As long as you have explained in detail to the patient the logic for trying the procedure. I was a little puzzled by your comment "Due to the previous nail removals, I am not convinced that resecting the exostosis with or without avulsion of the nail will "normalize" the toenail upon regrowth." If the exostosis is causing the dystrophy, that may be the reason it hasn't normalized after prior resections.

Jeffrey Kass, DPM, Forest Hills, NY, jeffckass@aol.com

RE: Standard of Care – MRSA (Jeffrey Kass, DPM)
From: Kazu Suzuki, DPM, Sloan Gordon, DPM,

The question is, why would you take a culture of an ulcer, if it is not clinically infected? Our skin is never sterile, so we shouldn't expect the wounds to be sterile either.

One may argue that you are obligated to treat this MRSA on medico-legal basis. I would say that you should not treat this "culture result," unless you are convinced that the wound is clinically infected or critically colonized (therefore preventing the wound from healing) by this particular strain of MRSA.

I recommend an article, "Increased bacterial burden and infection: the story of NERDS and STONES (PMID: 17008815 )" by Dr. R. Gary Sibbald. He has done excellent research and written multiple articles on bacterial burden on wounds.

As for the topical treatment, I prefer silver dressing and Cadexomer Iodine ointment (ie. Mepilex Ag, Iodosorb gel) to treat MRSA colonization, as opposed to a pharmacologic agent, Mupirocin cream/ointment (Bactroban). For your information, Bactrim DS two tabs bid or Clindamycin 300mg qid is the empirical oral MRSA treatment of choice in my area. I also recommend that you work with your local infectious disease doctor, if you were to treat the patient with systemic antibiotics or consider doing topical MRSA de-colonization treatment.

Kazu Suzuki, DPM, Los Angeles, CA, kazu88@gmail.com

If a culture comes back positive for MRSA and it's from an ulcer or open wound, I would suspect that with the culture report there would be a sensitivity report as well. This should give one the ability to choose a drug regimen, .i.e,. one with the lowest MIC.

With regard to the treatment, I would think that a soft tissue infection would require treatment for MRSA, e.g. Clindamycin, Bactrim, Zyvox, Doxycycline with a PO regimen with the lack of constitutional symptoms (lymphadenopathy, lymphangitis) or any of the current meds on your local hospital's antibiogram.

I think in this current milieu, MRSA should be treated aggressively as it is rampant (at least in this part of the US) and a topical would be insufficient.

Sloan Gordon, DPM, Houston, TX, sgordondoc@sbcglobal.net

RE: DPM’s Working With MD’s
From: David Schofield, DPM

My congratulations to Drs. Cropper, Nolan, and McCormick. Not only are they forging a "deal" with FOA, they are forging into the future. This type of discussion and activity with our allopathic colleagues is the only true way to attain our parity goals. I know it is not easy. We all have friends who are MDs and they have political connections. It is time to start networking and building positive strong relationships. If more of us were able to do what the fine doctors in Sarasota, FL have done and continue to do, the success of Vision 2015 is clearly in sight.

David M. Schofield, DPM, Past President, APMA, david.schofield@yahoo.com

RE: Sol Balkin, DPM
From: Jerome A. Tirsch, DPM

During my 35 years in podiatric practice, I sent Dr. Sol Balkin numerous patients with plantar lesions that were resistant to my treatments and might be helped by silicon. The vast majority of my patients were helped by him, and if he thought that the use of silicon was not indicated, he would call or write me back. He once even came to my office in person to discuss the problem..

I had seen him and his lovely wife Janelle, very often at podiatric meetings, and somehow he remembered almost all my referrals to him and their outcomes, although some of them were years in the past. There goes another podiatric giant who can never be replaced.

Jerome A. Tirsch, DPM, Chatswoth, CA

ASSOCIATE POSITION – NW INDIANA (1 HR FROM CHICAGO)

Great opportunity for financial and personal success. Start at $150K plus incentive compensation, good benefits, and ownership potential. Must be highly motivated, have a great bedside manner and excellent surgical skills (forefoot and rearfoot). E-mail resume to friendlyfootcare@comcast.net or fax resume to (219)662-7290. Learn about us here .

ASSOCIATE POSITION – FLORIDA

Emerald Coast on the North Shore of the Gulf of Mexico, a well-established group practice with multi-offices, seeking an associate with opportunity for partnership for a PSR-24/36 Doctor well-trained in foot/ankle/diabetic problems/wound care/surgical and medical podiatric care, covering 3 area hospitals, NO nursing homes, Please fax a letter of interest, CV, and references to 850-862-5470, e-mail ecpodiatry@aol.com

PRACTICE FOR IMMEDIATE SALE- MT. VERNON, NY

Great opportunity Centrally Located on Busy Street corner in Fleetwood, Mt. Vernon. 15 year old practice... 2 days a week... May easily be expanded Low overhead ... Computerized billing. Fully equipped 2 treatment rooms Grossing $80,000 Call 914-572-3624

SEEKING RESIDENT FOR PSR-24 - BALTIMORE, MD (MERCY MC)

Position for a highly motivated individual with completed non-surgical residency or one desiring additional surgical training in well-established Podiatric Residency Program. Busy metropolitan hospital with high surgical numbers and inpatient care. Resident is integral member of multidisciplinary team. Begins mid June 2008. Includes competitive salary/benefits. Send inquiries to rsher18@yahoo.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

ASSOCIATE POSITION - PITTSBURGH, PA

Excellent opportunity to join busy and established practice for 27 years. Must be graduate of PSR 24+/36 Residency. Terms negotiable. 30-40 hours per week. $100,000+ guaranteed. Please fax resume to (412) 563-0740.

PRACTICE FOR SALE - CORAL GABLES, MIAMI AREA (FLORIDA)

Beautiful location in the heart of Miracle Mile. Excellent opportunity for a starting practitioner. Most insurances accepted. Good mixture of surgical and general podiatry. Fully equipped with low overhead. Located in a professional building, with referrals from other doctors in the same building. Contact zoesar@aol.com or call 786-877-5149.

ASSOCIATE POSITION - CONNECTICUT

Nice community outside of New Haven. Well-established, busy practice seeking part-time or full-time associate. Excellent opportunity for a highly motivated and ethical professional. Must have good patient skills. PSR-12 or higher with excellent skills required. Send resume and cover letter to fax # 203-439-7916.

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

PRACTICE FOR SALE - EASTERN WASHINGTON

Established practice located in the fastest-growing city in the state of Washington. Enjoy the lifestyle available in the area. Practice is directly across the street from the hospital - surgery center located within the hospital, and podiatric surgical privileges are not restricted. Gross $200K+ at 4 days per week. Can easily grow. 260 402-7490

ASSOCIATE POSITION - SAN FRANCISCO, CA

San Francisco East Bay. Surgical associate needed for expanding 3 board-certified podiatrist multi-location practice. BE/BC in RRA a must, but should enjoy all aspects of podiatric medicine and surgery including teaching. Looking for long-term commitment, potentially leading to partnership. Fax cover letter and CV to 510-581-7779

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

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