The Voice of Podiatrists

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May 19, 2011 #4,164 Publisher-Barry Block, DPM, JD

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Scholl College’s CLEAR Wins Awards at International Diabetic Conference

The research efforts of Scholl College’s CLEAR (Center for Lower Extremity Ambulatory Research) was prominently exhibited at the 6th International Symposium on the Diabetic Foot in the Netherlands May 11-14th. Associate Professor Bijan Najafi and instructor Ryan Crews presented a total of four oral abstracts and were co-authors on two posters. One of Najafi’s presentations was awarded 1st place for the oral abstract competition. The winning presentation was for a CLEAR study evaluating a novel electrical stimulation therapy for improving postural control in patients with diabetic peripheral neuropathy.  

(L-R) Bijan Najafi, PhD and Ryan Crews, MSc

CLEAR’s research was further honored at the conclusion of the conference by its inclusion in Professor Andrew Boulton’s conference summary lecture. The work presented by CLEAR faculty was the result of collaborations with centers in Qatar, the UK, SALSA (Southern Arizona Limb Salvage Alliance), and Boston. Conference organizers and participants duly noted that the participation of 1,000+ delegates representing 80 countries indicated that the once-orphaned diabetic foot has found people willing to care for it.   

Collaborative Podiatric and Vascular Surgical Focus at International Working Group

Delegates from more than 77 nations were on hand for the 6th International Working Group on the Diabetic Foot in Noordwijkerhout (IWGDF), Netherlands this past week. The combined podiatric research units of Scholl's Center for Lower Extremity Ambulatory Research (CLEAR), represented by Bijan Najafi, PhD and Ryan Crews, MS and the University of Arizona's Southern Arizona Limb Salvage Alliance (SALSA) under the leadership of David G. Armstrong, DPM, MD, PhD, Joseph Mills, MD and Manish Bharara, PhD, presided over more than ten lectures, workshops, posters, and program chairmanships.

Younes Jahangiri, MD of University of Tehran, the Iranian delegate with David G. Armstrong, DPM, MD, PhD, USA delegate at this year's IWGDF.

"The level, variety, and collaboration seen in works this year was simply unprecedented," noted David G. Armstrong, Professor of Surgery and Director of SALSA. "The 'toe and flow' was well represented here in Noordwijkerhout. It bodes well for the future in this area." The meeting, held every four years, was preceded by a consensus conference with appointed delegates from each nation. New or updated consensus documents detailing diagnosis and care of peripheral arterial disease, infection, and wound healing were ratified and disseminated this year.

Region Three Conference Awards Presents $10,000 Check to APMA

Coming off the heels of the 62nd Annual Region Three Scientific Meeting held last week, Dr. Leonard Portnoy, General Chairman of the Region Three Scientific Conference has deemed the conference another huge success with more than 650 DPMs and over 100 exhibitors in attendance from all over the country. Lecture topics included updates in dermatology, and diabetic wound care, and presentations by the APMA Coding Committee and the American Society of Podiatric Surgeons.

(L-R) Drs. Leonard Portnoy, Howard Schake, Glenn Gastwirth, Dennis R. Frisch, Harvey Karpo, Michael J. King, and Robert Warkala.

Dr. Portnoy attributes a large part of Region Three’s success to APMA, which over the years has greatly supported the conference. To show its appreciation, Region Three presented several APMA representatives with a check for $10,000 in recognition of the long-term support shown to the Region Three Conference, and the value of APMA coding and scientific lectures.

Are you Fit to be a full-time Physician CEO? - Part 2

Being a full-time CEO is much different from being a full-time  physician. It's not an easy transition if you are used to a structured day in the clinic and performing surgery one to two days per week. I suggest that anyone considering changing positions make sure to have a very good support system during the transition. As the CEO, when things are good, you are "great" but when things are not going so well, you take the blame. As CEO, another issue is to make sure that you know how you are going to get paid by the group. This should be discussed in a very transparent way prior to your transition. Unfortunately, we are trained as surgeons and physicians and corporate America runs by an entirely different set of rules and principles.

Source: David N. Helfman, DPM

RE: To Be or Not to Be an MD/DO
From: Leonard A. Levy, DPM, MPH

A large percent of podiatric physicians in the U.S. have indicated that they favor a degree change (i.e., be able to hold the MD or DO degree). There is no indication that this movement will fade anytime soon. However, if this is decided to be the direction of the profession, no organized forum has been held to determine what changes would be necessary in the education and training of podiatric medical and surgical specialists (the profession needs to realize that there are several). In addition, while there has been general conversation, there has not been a detailed analysis as to the implications to the provision of podiatric medical and surgical care for a society that will have an escalated need for such services.

This information can be acquired by a large representative group in the profession through a strategic planning process. Such a process has been used for years to determine the direction of organizations, professions, and institutions. Perhaps no time in the history of podiatric medicine is a strategic plan needed to determine “what it wants to be” and “where it wants to go.” Obviously, such an initiative is discomforting to some and exciting to others. But none the less, it is a process that is long overdue.

Leonard A. Levy, DPM, MPH, Ft. Lauderdale, FL, levyleon@nova.edu

RE: Substitute for Colchicine (Robert K Hall, DPM)
From: Paul Busman DPM,RN, Mike Boxer, DPM

I used to have great success with sulindac (Clinoril) 200 mg. BID.

Paul Busman DPM, RN, Clifton Park, NY, paul@busmanwhistles.com

Colchicine is a good drug for the treatment of acute gout, but only if administered in the first 24 hours of the attack. If administered to a patient who has had the attack for more than 24 hours, it does not work well. The other problem with colchicine is that in order to stop a gout attack, the drug if administered properly, will cause nausea, vomiting, and diarrhea due to its toxicity.

A fine substitute for colchicine in treating an acute gout attack is to administer a posterior tibial nerve block followed by a periarticular injection of your choice of 1 cc of a local anesthetic together with 4 mg. of dexamethasone sodium phosphate. This will help the patient over the attack just as soon as you are finished administering the two injections. Follow up the injections with an Rx for indomethacin 25 mg. to be taken 2 caps TID (150 mg. a day in divided doses). As soon as the patient is pain-free, decrease the indomethacin from 150 mg. a day to 75 mg. a day to 50 mg. a day, and the last day only 25 mg. A Medrol Dose Pak will also work well, but not as fast as the injections.

Mike Boxer, DPM, Woodmere, NY, mcbdpm@aol.com

RE: CMS Attestation  (Chris Browning, DPM)
From: Mark K. Johnson, DPM

I provided web-based CMS attestation for EHR meaningful use on April 16th. We are using certified software from one of the major podiatry vendors. The attestation process is fairly straightforward using data from your software generated reports. Some items are opted out for podiatry if you, for example, have not given immunizations; or, if you have a zero patient number in the denominator. You receive immediate feedback as to qualification online after completion of the process. The website allows you to track the progress of the "bonus" and currently ours has been sent on to the Payment File Contractor (PFC). It is expected to take 4-8 weeks from the time of successful web attestation until payment is made. I know nothing beyond that at this time.

Mark K. Johnson, DPM, West Plains, MO, DDR004@centurytel.net

RE: Attaining Parity in California (Ira M. Baum, DPM)
From: Jack Morgan, DPM, Michael Cornelison,, DPM

I wish to clarify the excerpt attributed to me here on PM News. First of all, it is important for me to be clear that I was not representing CPMA in my response.  What I meant to say was that it was my understanding that CPMA, CMA, and COA have been working diligently to launch a task force to evaluate the education and training of future graduates of the California podiatric medical schools.  What was printed was only my personal thoughts on a potential outcome of such an evaluation.  I did not mean to imply that this work had already been done or that the outcome would be an MD degree.  I deeply regret any misunderstanding that may have been inadvertently caused by the posting of this excerpt.
 
Jack Morgan, DPM, Los Angeles, CA, JMDPM@aol.com

In light of two recent postings on PM News, (Dr. Morgan’s answer to Dr. Ribotsky’s question, “How is the issue of parity with MDs playing out in California?” and Dr. Baum’s posting “RE: Attaining Parity in California (Jon Hultman, DPM, MBA),” I feel it is imperative to clarify the subject of both postings, because they are inherently intertwined.

Specifically, I need to be clear that the goal of the California Podiatric Medical Association is for all new graduates of podiatric medical schools who then meet the criteria to practice in California to be awarded California’s “Physicians and Surgeons Certificate,” which is an unrestricted license and the same license as MDs and DOs receive in California. This is quite different than pursuing the MD degree itself. APMA's goal for Vision 2015 and ACFAS's goal for project parity is an unrestricted license, which is consistent with CPMA's goal. At the same time, there needs to be a state model, and it is this area in which CPMA is focused.

The leadership of the California Medical Association and the California Orthopaedic Association met with that of CPMA and agreed to...

Editor's Note: Dr. Cornelison's extended-length letter can be read here.

RE: Podiatrist's Responsibility When Taking Patients' Blood Pressures (Peter Harvey, DPM, Elliot Udell, DPM)
From: Wm. Barry Turner, BSN, DPM

I feel that Dr. Harvey's response to Dr. Udell's question was accurate. I do not do BP readings on my nail care patients, unless I do BP on all new patients (with a full set of vital signs and weight). My wound care patients have a full set of vital signs taken at every visit, and if they are diabetic, I do an Accucheck (with a CLIA waiver to allow payment).

Many times over the last 18+ years, I have had to call the patient's PCP regarding an incident of significant BP (high or low). When the BP is potentially dangerous, I still call the PCP, and with the PCP's permission, I will send the patient to the physician's office or the local hospital ER. If the patient refuses to accept my recommendations, I chart it and ask the patient to co-sign the note (basically AMA). If Dr. Udell has a problem with potential litigation from an elevated BP, he may be in the wrong vocation.

Wm. Barry Turner, BSN, DPM, Royston, GA, claret32853@gmail.com

RE: The Passing of Rob Roy McGregor, DPM
From: Moira L. McDermott, DPM

My practice, Lower Cape Podiatry, was fortunate to have Dr. McGregor work with us the last five years he was practicing. His patients traveled far and wide to consult with him and obtain his orthotics. Rob Roy and Barbara very much enjoyed their retirement years on Cape Cod.

Moira L. McDermott, DPM, Brewster, MA

RE: Medicare Trust Fund Exhausted by 2024
From: John F Swaim, DPM

This article in PM News stated that the cause of the Medicare Trust Fund being exhausted is the increasing salaries of physicians. Who are these salaried physicians? I fend for myself (sole proprieter) in an area with constant 16 to 17% unemployment well into the 3rd year of the depression with home forclosures still on the uptick and with gross collections remaining down by 30% from the 07-08' period. I'm curious who these wonderkinds are who reap these ever-increasing salaries that will exhaust the medicare trust? Or is this more negative propaganda toward physicians in general?

John F Swaim, DPM, Red Bluff, CA, podtexdoc@aol.com

1-YEAR PODIATRIC SPORTS MEDICINE FELLOWSHIP - MONROVIA, CALIFORNIA

Applicants must have completed a podiatric residency program and must have or be eligible for a California license. Annual stipend: $48,000 and $60,000. If interested, please e-mail your resume with cover letter to the Program's management company at victoriamanagers@gmail.com

PRACTICE FOR SALE - MISSION VIEJO, CA

Relocating to Tulsa. Great opportunity to buy my office. Located on Mission Regional Hospital Campus. Gross income 2010 was $340,000. Approximately 1300 sq ft with 3 treatment rooms, digital x-ray and fully computerized. Only 3 years old. Will consider all offers. 949-702-1052. David Stoller, DPM (Family Footcare) david@missionviejofootcare.com

PRACTICE FOR SALE - HOUSTON, TEXAS

28 year old busy, progressive practice for sale with an excellent reputation and well established referral base. Well trained, dedicated, supportive staff. Excellent cash flow $475K income after overhead. EMR, digital x-ray, diagnostic ultrasound. Free standing building also available with large outdoor sign. Owner retiring and willing to stay part time during transition. softechpodiatrist@gmail.com

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 – NEW YORK

Great opportunity to share “state-of-the-art” offices and equipment in mid-town Manhattan and White Plains with Board Certified podiatrist. Out-of-network or participating providers welcome. Please call 212-704-4310 for additional information and fax your CV to 212-704-4311

ASSOCIATE POSITION – IOWA CITY AREA

Modern practice seeking a well-trained (PSR 24/36) associate. Excellent opportunity for an energetic, hardworking individual with strong surgical and medical skills. Solid referral network and 13 years of growth. Come live in the Iowa City area and enjoy the quality of life and stability of a Big Ten University community. Competitive salary and benefit package available. If interested, fax CV to 319-354-1014 or e-mail to dave@341foot.com

ASSOCIATE/OPPORTUNITY - PHOENIX (EAST VALLEY)

Established practice seeking motivated min. PSR24+ personable, ethical, motivated person to join state-of-the-art multi-office locations. Partnership/Ownership opportunity in practice, real estate, surgical center. Also interested in existing practitioner to merge or work part time. Contact AZPODAssociate@aol.com Must be pursuing or have AZ license.

ASSOCIATE POSITION - SW FLORIDA

Huge opportunity. Are you an outstanding person? Would you like the freedom to utilize your talents to the max? Opportunity awaits right candidate. Excellent mix of office/surgery motivated/experienced staff. Full Time Associate PSR 12-36. Great Salary/Benefits, Bonus Package, Unlimited Potential, Buy-In Opportunity. Email resume to podiatry22@yahoo.com

ASSOCIATE POSITION - TAMPA BAY, FL

Associate with PSR 24+, needed for a dynamic practice. Well-established high-tech with specialties in sports medicine, surgery, and wound care. No nursing homes or HMOs. E-mail: flpodiatrist@tampabay.rr.com

ASSOCIATE POSITION - WA (KIRKLAND, SEATTLE, EVERETT, AND REDMOND)

Join one of the fastest growing podiatry practices in Washington state. Must be motivated to grow practice. Competitive salary and benefits. For more information go to seattlefootdoctor.com. Send resume to seattlefootdoctor@yahoo.com

ASSOCIATE - POSITION - SOUTHEAST GEORGIA & SOUTH CAROLINA

Seeking recent residency graduate to join practice. Must be PSR-24/36 trained. Multiple locations. Full range of services with new facility. E-mail to melissafoot@pol.net

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

ASSOCIATE POSITION - SOUTHERN MI (NOT DETROIT AREA)

Leading to partnership for rapidly growing 3-physician group practice. Must be residency trained and willing to learn and follow our very successful business model. Salary plus incentive. If you're unhappy with where you're at now this may be the answer! If, interested send CV to: paulapmac@me.com

ASSOCIATE POSITION- NEVADA

Well established 22-year practice in Las Vegas/Henderson, Nevada seeking full-time associate. General podiatric care with moderate amount of surgery to be done in local hospital or surgery center. Competitive salary and benefits. Modern office in new area. Please respond by email to lvfootandankle@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

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