The Voice of Podiatrists

Serving Over 10,900 Podiatrists Daily

May 27, 2008 #3,256 Editor-Barry Block, DPM, JD

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AZ Podiatrist Is Surgical Innovator

Dr. Kerry Zang of the Arizona Institute of Footcare Physicians in Mesa is performing a new surgical technique for common foot conditions. This new treatment, called the Isogard system, was developed by Koby Surgical and allows surgeons to perform procedures through a small incision while surrounding tissue is protected from trauma.

Dr. Kerry Zang

Zang said these techniques can greatly reduce recovery times and technical difficulty associated with traditional surgery procedures used to relieve foot pain caused by the condition known as Morton's neuroma and the heel pain associated with plantar fasciitis.

These new techniques are performed by inserting the Isogard device through the incision after preparatory instruments have created channels above and below the ligament or fascia. Once the desired section of ligament or fascia has been released, one or two small stitches are used to close the incision.

Source: Angela Gonzales, The Phoenix Business Journal [5/23/08]

FL Podiatrist Arrested on Racketeering and Money Laundering Charges

Three suburban Boca Raton men played roles in a multi-million dollar South Florida sports betting ring, the Broward County Sheriff's Office announced this morning. Dr. Michael Schwartz, 40, a suburban Boca Raton podiatrist, Samson Mandell, 33, a manager at a Boca Raton sports bar, and Eric Spinosa, 30, were arrested Thursday night on racketeering and money-laundering charges.

Dr. Michael Schwartz

Broward sheriff's investigators said Schwartz' suburban Boca Raton office was used as a money drop for the operation, which started at least eight years ago and functioned as a go-between for dozens of bettors and a Costa Rican gambling company, Chappy's Sports Gambling and Bookmaking, set up by the conspirators as part of the scheme.

Schwartz, who graduated from the New York College of Podiatric Medicine, became licensed in Florida in 1995, according to state records, which also lists him as a doctor in good standing. "I don't know why a man in his profession would do something like this," said Broward sheriff's Detective Sgt. Tony Lanza. Bail was set at more than $1 million each for Schwartz and Mandell, who were taken into custody in Palm Beach County.

Source: Michael LaForgia, Palm Beach Post [5/23/08]

Med Schools Asked To Shun Drug Firm Freebies

Free lunches, pens or trips to resorts from drug companies should not be accepted. Ghostwriting of pharmaceutical research should be prohibited. And participation in industry-backed speakers' bureaus should be discouraged.

A report by the Assn. of American Medical Colleges calls for these and other restrictions to limit drug and medical device companies' interactions at the nation's medical schools and teaching hospitals. The report's recommendations seek to free the educational environment of industry marketing activities, put buffers in place when industry funding is accepted, and distance physicians and trainees from sales representatives' influence, medical leaders said.

Recommendations for academic interactions with drug and medical device firms include:
• Gifts from industry should not be accepted, on or off campus.
• Drug samples should be distributed through a central system, such as a campus pharmacy.
• Access to physicians by sales reps should be by appointment and outside patient care areas.
• Speakers' bureaus sponsored by industry should not include faculty.
• Food should not be provided by industry reps, except at CME events.
• Travel payments should not be accepted.
• Ghostwriting, in which authors represent industry research as their own, should not be permitted.

Source: "Report of the AAMC Task Force on Industry Funding of Medical Education to the AAMC Executive Council" via Myrle Croasdale, AMNews [5/26/08]

Avoid Front-Line Meltdowns

Patient service demands both energy and patience. Direct interaction with the public requires a constantly upbeat attitude—even though it is not easy or satisfying to help all patients.

Strategy: Give front-line employees controlled opportunities to “decompress,” by allowing them to vent their aggravation occasionally. Invite your employees to weekly meetings wherein they can share their best and worst patient stories of the week. Employees can receive pats on the back for the best experiences, moan and groan about their worst calls, and share suggestions for how to work successfully with difficult patients in the future.

Best of all, such sessions engender feelings of camaraderie between front-line workers that increase their ability to serve patients with care every day.

Source: Adapted from Appreciation in Action by Noelle Nelson

Query: Skin Lighteners

I have a patient who requests a skin lightener. She is African-American of medium complexion. She has darkened areas at the dorsal aspects of the IPJ's, but no hyperkeratosis. She would like the area to look lighter, especially for the warmer weather months. If anyone knows of an effective skin lightener, Rx or OTC, I would appreciate any help you could give.

Chuck Langman, DPM, King of Prussia, PA

Query: Ethics of Fee Splitting

I work as a new associate in a large group practice. Last week, I accidentally discovered that when we refer out a patient for an MRI, the practice receives a $50 gift card ,which the partners give to their wives to spend. Is this allowed?

Name Withheld

Editor’s comment: PM News does not provide legal advice. This practice is referred to as fee-splitting or a kickback and is both illegal (under Medicare and in most jurisdictions) and unethical. The 2008 APMA Code of Ethics spells this out very clearly:

BE2.11 The podiatrist neither accepts nor offers commissions in any form or manner on fees for professional services, referrals, consultations, pathology services, radiology services, prescriptions, or other services or article supplied to patients. Division of professional fees or acceptance of rebates from fees paid by patients to radiological, pathological, laboratory, shoe stores, or other establishments is inappropriate.

RE: Conflicts of Interest (Richard Boone, Esq.)
From: Barry Mullen, DPM, Michael M. Rosenblatt, DPM

Mr. Boone has raised several excellent medical ethics points ...and yes, to my knowledge, healthcare providers don't receive formal medical ethics education during their professional training. With respect to healthcare provision, when a physician "owns" a vested interest in any product or service being delivered, the following questions need to be answered in the affirmative in order to avoid conflict of interest issues and their associated medical ethics violation(s). Is the product or service: 1) medically necessary? 2) medically appropriate? 3) in the best health care interests of the patient?

If one can answer yes to ALL 3 questions, then I see no conflict of interest when a physician financially gains from a legal "self-referral" to a vested service/product he/she "owns." That's a win-win scenario for patient and healthcare provider. Since we aren't "not for profit" professional entities, that is the ultimate objective any healthcare provider strives for in the provision of professional care.

Conflict(s) of interest occurs when ANY of the 3 questions cannot be answered in the affirmative. When this occurs, then by default, service over-utilization occurs. The resultant physician financial reward then serves as the ends to a means which violates medical ethics and cannot be justified or condoned on any level.

Barry Mullen, DPM, Hackettstown, NJ, yazy630@aol.com

Richard Boone, JD, a frequent contributor to PM and defender of podiatrists suggests that it is "improper to refer your patient to a surgical center in which you retain a financial interest."

Doctors own and operate surgical centers more or less "naturally" because they have the abilities, skills and resources to own and operate them. Rather than seeing this as an "ethical" problem, I see it as a matter of honest disclosure.

It makes ethical sense for a doctor to disclose that you have a financial interest in the surgical center, and as a part of this disclosure, make the choice available to the patient for a different venue, if that is their choice. Then, leave it up to the patient. It is also within ethical boundaries, to outline advantages and disadvantages for each choice, for your patient.

A number of businesses exercise what is called "vertical integration." It is not considered "unethical" for oil companies to own their own fields, production and distribution facilities, as long as they don't engage in "price fixing" with other companies.

I must admit that I tire of Government and other respondents constantly limiting the ability of physicians to survive financially and pay their bills. The cost of podiatric education is enormous. Podiatrists and all physicians are under enormous pressures and stultifying regulations that other businesses and professions don't have to face. Ethics count. Inform your patient and leave it up to them.

Michael M. Rosenblatt, DPM, San Jose, CA, rosey1@prodigy.net

RE: Conflicts of Interest (Alan Kalker, DPM)
From: Robert Scott Steinberg, DPM, Allen Mark Jacobs DPM

Dr. Kalker stated: "25 years ago conference lectures were less supported and talks were of much higher quality." First, saying lectures were of much higher quality 25 years ago is absolutely untrue. Second, Dr. Kalker's post makes me think he has his own agenda. Ethically, Dr. Kalker should come clean and tell us what his agenda is. I am left with the perception that Dr. Kalker must have missed all the Midwest Podiatry Conferences. True, even the best-prepared lectures can be boring because, let’s face it, there aren't many earth shattering new treatments, just re-working of old ones with little proof of better outcomes. I think most of us have accepted that, and it creates little drag on our lives, and while refresher lectures aren't all that exciting, they are important.

As for medical equipment and drug companies adversely influencing your practice, if that is true, you have greater problems. If you can't evaluate things on their own, and feel too weak to avoid being unduly influenced by free dinners and pens, how are you able to practice?

Robert Scott Steinberg, DPM, Schaumburg, IL, Doc@FootSportsDoc.com

One aspect of the corporate dominance of postgraduate education has not been discussed. That is the fact that corporate sponsorship restricts the topics covered at meetings. How many more times do you want to hear the same lectures (sometimes different speakers) ? There are many more topics that need discussion at our meetings which ARE NOT covered, and it seems as though we are getting the same lectures over and over again at every meeting. Ethics is just one example.

There are certainly exceptions. The No Nonsense Seminar, the ACFAS annual meeting, are examples wherein you are simply asked to speak of a topic, with or without corporate sponsorship. There are many young people who ought to be presenting, but do not have the corporate ties and are therefore never asked. The reverse is also true.

As for the suffering that the "lecturer/educator" seems to be subjected to (according to the PM News posts) I have a solution; get a job and run a practice like the rest of us do. If you want to depend on lecturing to make a living, don't complain about the circumstances.

Allen Mark Jacobs DPM, St. Louis, MO, allenthepod@sbcglobal.net

EQUIPMENT FOR SALE

Relocating satellite office and selling redundant equipment, all less than 2 years old. Koven Smartdop45 - $2995 Scan X Digital X-ray - $17995.00 SIUI CTS 5500 Diagnostic Ultrasound and cart with printer - $4695 Chattanooga Therapeutic Ultrasound - $495. Please call Priscilla at 281.313.0090 if interested.

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.

EQUIPMENT FOR SALE - POLAROID X-RAY FILM

Polaroid 803 x-ray film for x-rays - 41/2 boxes, 2 Cassette holders,
Polaroid processor. doctorcerillo@verizon.net

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 Visit our website

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 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

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