The Voice of Podiatrists

Serving Over 10,900 Podiatrists Daily

May 24, 2008 #3,254 Editor-Barry Block, DPM, JD

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Block/ McCord Debate MD Degree Debate Video Released

If you weren't luck enough to attend this year's Florida Podiatric Medical Association’s Scientific and Management Meeting, you can now download and view the debate between Podiatry Management’s Editor Barry Block, DPM, JD and Podiatry Today columnist John McCord, DPM. Simply click here .

Drs. John McCord (L) and Barry Block

McCord argued that if podiatrists received MD degrees, it would only confuse the public. He claimed that many potential students would use this mechanism as a backdoor to medical school, and would then abandon the profession. He read several letters from podiatry students who believed that the degree would actually decrease the already diminished applicant pool.

Block, who has been a leading advocate for the degree change for over 25 years, presented the case that the attainment of the MD or DO degree was the only way to achieve true parity and an unlimited scope of practice. He lauded APMA’s Vision 2015 as a necessary plan to achieve this goal. He asserted that such a move would save the profession millions of dollars in lobbying efforts in a never-ending battle to include podiatrists in legislation which limits the definition of physicians to MD’s and DO’s. He also pointed out that having an MD would attract more qualified applicants to our colleges.

Foot Care Begins at Birth: NY Podiatrist

Dr. Mark Friedman, president of the Northeast Division of the New York State Podiatric Medical Association, sees children every day in his Albany office. Friedman said the bulk of what he sees in kids under 18 is flat feet, ingrown toenails, plantar warts and stress fractures from sports injuries. “I would say that once a child starts to walk, if you notice any abnormalities, or there is a genetic predisposition toward problems with your feet, a child should be seen by a podiatrist,” he said.

Dr. Mark Friedman (Photo Marc Schultz)

Pediatric foot health starts soon after babies are born. Caring for your baby’s feet is no different from the care you provide to the rest of the body, said Friedman. “Get a pair of baby nail clippers to trim their nails and concentrate on trimming them straight across the toenails to avoid ingrown toenails,” said Friedman. Also, be sure to thoroughly dry your baby’s feet after a bath. If the skin seems dry, apply moisturizer, avoiding between the toes.

Additionally, purchase an activity gym that will allow your baby to move his legs and feet around to help strengthen muscles in preparation to walk. Most children will begin walking between the ages of 10 to 18 months. “In general, kids 18 months to 2 years don’t need to have heavy shoes on most of the time because their feet are growing,” said Friedman. “If they are in the house and the floor is clean, they can just wear their socks most of the time.”

Source: Kathy Ricketts, The Gazette [5/22/08]

IL Podiatrist Sponsors Bike Tour

On Saturday, May 10, Dr. H. Craig Fox played a vital role in the Three Rivers Bike Tour in Channahon. The tour passed through his new office at U.S. Route 6, so he provided a water stop for the participants, including free water bottles and a water filling station.

Dr. H. Craig Fox (Left) With tour organizer and a few participants.

Fox, a podiatrist, treats all conditions of the foot and ankle. He received his doctorate from Des Moines University and completed his residency training at Michigan Hospital Medical Center in Detroit. He is a member of the American Podiatric Medical Association, the Illinois Podiatric Medical Association, and the American Academy of Podiatric Management.

Source: Morris Daily Herald [5/20/08]

Employees More Productive When Standing

If you want employees to improve performance, ask them to work standing up. Or at least get them to take stand-up-and-stretch breaks.

Why: Research at the University of Southern California shows that people digest complex facts and make better decisions when standing. Some absorbed information 40 percent faster when standing.

Says Max Vercruyssen, who conducted the research: “The more complex the information to be processed before making a decision, the more novel the thought, the greater the benefit.”

Source: USA Today

Query: Injectible Silicon

I am wondering if anyone performs silicone injections anymore. I am specifically interested in treating fat pad atrophy of the heel. I have a patient with severe atrophy of the left heel. She has had a triple fusion and has developed fat pad atrophy over the last 8 years. Any thoughts on silicone injections or implants for the heel?

Louis W. Nordeen, DPM, Mechanicsville, VA

Query: Pantalar Arthrodesis & Coalition Resection

I performed a pantalar arthrodesis. Pre-operatively, I noted that the patient had a medial facet tarsal coalition which I resected through a separate incision during the case in order to realign the subtalar joint. The extra work for this procedure was significant. Can I bill for the coalition resection in addition to the pantalar arthrodesis?

Jon Goldsmith, DPM, Omaha, NE

Response: Since the basic procedure would involve some bony remodeling/resection to fuse the subtalar joint anyway, the coalition resection would be inclusive of the overall pantalar fusion procedure. The need for a second incision is not really a determining factor in whether a procedure is separately payable.

If you feel that there was significantly more work required because of the coalition, and you were willing to waiting additional weeks or months to have the claim processed, you could consider appending the procedure with a "-22" modifier which may ultimately increase your payment (or not). Make sure you clearly document why you feel the additional work was significant (over CPT 28705 performance).

Tony Poggio, DPM, Alameda, CA

Codingline subscription information can be found by clicking here

Query: Chronic Ankle Sprain (David T. Taylor, DPM)

Assuming absence of a talar or tibial lesion, I would perform stress views and look for talar tilt and anterior drawer signs. Chronic lateral ankle instability would need your procedure of choice. With the high ankle sprain and tear of the tib-fib ligament, there may be diastasis on weight-bearing that you don't want to miss. In that case, consider use of the tight rope by Arthrex.

Jon Purdy, DPM, New Iberia, LA, podiatrist@mindspring.com

RE: Hookworm Infection (Cynthia S. Ferrelli, DPM)
From: Carl Ganio, DPM, Jonathan B. Purdy, DPM

The visible tracks from the cutaneus larva "migrans" are due to the inflammation produced by the organism as it burrows along its merry way. I have had success with ethyl chloride, or similar "cold sprays" to freeze the skin at the advancing margin. It may take several applications. Also, I have used Mintezol (Thiabendazole, <Merck Pharm>) with success. It is dosed 2 doses on consecutive days.

Carl Ganio, DPM, Vero Beach, FL, drcarlganio@bellsouth.net

There is no need to cut out a hookworm infection. It is self-limiting within about 6 weeks. Humans are a dead end hosts for these parasites. I have successfully killed one using cold spray. Liquid nitrogen can also be used but frostbite can occur with both, especially on the sensitive skin of a 6 year old. Just ahead of the serpiginous trail, where there is normal skin, is where the larva will be. Freeze the little guy at that point. If there is persistence or any systemic symptoms, get blood work and look for eosinophilia.

Jonathan B. Purdy, DPM, New Iberia, LA, podiatrist@mindspring.com

RE: Conflicts of Interest
From: Multiple Respondents

As a Council on Podiatric Medicine (CPME) approved sponsor of continuing medical education, APMA along with approximately 70 other approved sponsors, strictly adheres to the rules set forth in CPME Document 720. APMA is committed to providing fair, impartial, and objective professional education to podiatric physicians and surgeons.

APMA, in its annual report to the Council "...demonstrates its independence, absence of commercial bias, disclosure of required information and relationships, appropriate management of funds from commercial interests, and appropriate management of advertising and exhibits." In addition, APMA has created a Compliance and Integrity Process to ensure the scientific objectivity of its educational programs.

Glenn B. Gastwirth, DPM, Executive Director,CEO, APMA, gbgastwirth@apma.org

Call me an egomaniac for loving the part of my professional life that puts me in front of my colleagues to share with them the unique training and experiences with which I have been blessed. Guilty! Call me greedy for wanting to make up (and barely at that) what I lost by leaving my very busy practice for 1, 2 or 3 days to give a talk. Guilty! Call me crazy for assuming that I get called for what’s in my brain first, and whether or not I can be sponsored second. I can handle it!

Allow some headline-getting egregious scientific behavior paint the broad brush of “biased and polluted” to all those who are paid speakers? Not a chance. And all the DPM’s who march in step with the elitists who think that a pen given out to your secretary causes undue influence ought to reflect on their own sense of pride, and professional ethics, and really consider whether or not we would be better off without CME support. Harvard and Stanford, with hundreds of millions of dollars in the bank, do not even allow a drug rep on the premises. WOW! Doesn’t that convince you that these rules immunize their doctors and researchers from bias? Not on your life.

All of us should look to be critical of all information presented in a constructive way. To dismantle totally the system in place will not only cause skyrocketing CME costs, but will force physicians to admit that they get much of their medical information in these venues. How shocking!! And as is always true, podiatry can afford it the least.

Bryan C. Markinson, DPM, NY, NY, bryan.markinson@mountsinai.org

Dr. Goldstein and Dr. Kesselman are both correct. Clinical conferences and seminars are financially dependent upon corporate sponsorships. Pharmaceutical firms will often pay a speaker as well as give a large sum of money to the conference itself in the form of a grant if their product is promoted. Some will even train the speakers on what to say so that the lecture has the appearance of being purely educational but the doctors attending will walk away prescribing their medication. The really good seminars will have a mixture of company as well as convention-sponsored talks. This prevents the convention from becoming a collection of "infomercials."

The bottom line is that without any support, our conventions, as we know them, will go the way of the dial telephone and manual typewriter. In most cases, when I lecture at conferences, I am privileged to be subsidized directly by the conference itself. If I live near the convention, I often forgo any honorarium but I cannot afford to fly all over the country lecturing on my own dime. I wish I could. The ethical standard that I impose on myself when I do get subsidized is that I mention it to the audience at the beginning of the talk. I then give a lecture on a topic which, in most cases, has nothing to do with the company or product. I will not take a subsidy from a company unless I have previously used the product and believe in its value to patients. Not every company will work with me in this way and I've sadly had to forgo some speaking invitations. The system is far from perfect and in some cases lends itself to ethical flaws but until we find a better way to subsidize our post-doctoral programs, corporate partnering is here to stay.

Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

ASSOCIATE POSITION - SAN ANTONIO, TEXAS

Seeking three-year trained resident for associateship, hopefully leading to partnership. Competent in all phases of podiatry particularly reconstructive rearfoot surgery. Outstanding opportunity for the right individual. Reply to Richard Pollak at 210-692-0279, or fax resume to 210-692-0028 or e-mail drpllk@hotmail.com

SOUTH CENTRAL PENNSYLVANIA-PM&S 36 ASSOCIATE WANTED

Large, busy podiatry group looking for associate interested in future partnership. Practice facilities and technologies include: Surgical Center, Physical Therapy Department, 6 appointment locations, EMR, MRI, Clinical Trials and Digital X-ray. Full compensation and benefit package offered. Mail CV to Martin Foot and Ankle, 1203 S. Queen St. York, PA 17403 or email johnreitzelmfa@aol.com

ASSOCIATE POSITION: BALTIMORE, MARYLAND

Seeking motivated and outgoing individual for part-time position in very comfortable office with a great working atmosphere. Office is turn-key with ASC in a fantastic location. Must be ABPS eligible. competitive salary + incentive and part-time benefits are available. CV to 410-602-9781.

ASSOCIATE POSITION – LEHIGH VALLEY, PA

Large medical/surgical practice centered in Lehigh Valley, PA looking for exceptionally trained podiatrist. Excellent opportunity for income as well as potential partnership. E-mail resume to jkaufman@lvfoot.com

INTERNET FOOT THEMED CANDY BUSINESS FOR SALE

Well-known foot-themed chocolate and candy company with over 6,000 customers. Unique products with trademarked names for seasonal (Mistle Toes, Valentoes, etc.) as well as everyday (A Foot of Feet, Twinkle Toes, etc.). Excellent opportunity to generate income from home with an established business. Serious inquiries to Mwolpa@ToeFood.com

ASSOCIATE WANTED - KNOXVILLE, TN AREA

Busy multi-doctor, multi office practice heavily weighted in surgery. PSR-24 + experience preferred. Part-time also available. Area consistently ranked in top five areas of country to live, work or retire. Ranked third in country 2008 Boaters magazine for boating destination. First year guarantee $150,000 plus bonuses and benefits. Send cover letter an c.v. to davidphawk@adelphia.net

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 - ILLINOIS

Quality Podiatry Group provides quality services to residents at long term care facilities. We are currently offering full-time or part-time positions for motivated ethical podiatrists. Immediate openings available. If interested fax curriculum vitae to 312 225-9366 or e-mail feetwork@aol.com

PRACTICE FOR SALE - FLORIDA

Well-known practice in Coral Gables,FL for over 20 years. Excellent location on Coral Way with heavy traffic, great visibility and plenty of parking. Busy, fully equipped, full-time office with established patients. Grossing over 300K with tremendous growth potential. Office is currently open and ready to take over immediately. For additional information contact QVAN@aol.com or 305-975-5516.

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 POSITIONS – MARYLAND

Are you motivated, personable and enjoy working with the elderly? We are offering full or part-time positions in Maryland. Our group provides care to the elderly in Nursing Homes, Assisted Living, Senior Homes, Adult Daycare and other similar facilities. Please e-mail your cv to drhprosen@comcast.net or fax to 410-486-2049 or call Dr. Herbert Rosen 410-580-0255

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