The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

August 11, 2008 #3,320 Editor-Barry Block, DPM, JD

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We would like to thank the more than 100 podiatrists who have already completed our annual online survey. This survey, which takes about 15 minutes to complete, provides the entire podiatric community with valuable information. In addition, those who participate can help elect the next inductees into PM's Podiatry Hall of Fame and be eligible for valuable prizes.

We encourage you to particpate in this important practice survey at www.podiatrym.com/survey. Enter the contest by sending Question #43 (no answer necessary) to bblock@podiatrym.com along with your name and address. Entries remain valid throughout the course of the survey, so the earlier you enter, the more drawings you wil be eligible for.

FL Podiatrist Warns of Nail Salon Risks

An indulgent afternoon at the spa may seem like the perfect way to get your footsies ready for their close-up. But if you put your feet in the wrong hands, you may end up wishing you could hide them away in your winter boots. There are health risks associated with all that soaking, buffing, cutting and polishing. "It can and it does happen," says Dr. Marc Katz, a podiatrist at Advanced Podiatry in South Tampa. "And when you think about the sheer volume of pedicures that are done every day in nail salons, you want to take some measures to guard against potential health concerns."

Dr. Marc Katz

Katz warns patients against using the jet footbaths at nail salons. If the plumbing isn't cleaned properly, the tubs can be the source of potentially dangerous infections. The jet and pipes used to soak feet collect the hair and skin of customers, and the combination of warm water and dirty jets is a breeding ground for bacteria.

Katz says salons that don't properly sanitize equipment can put customers at risk for diseases such as hepatitis B and C, as well as HIV. "If you pierce someone's skin and they bleed and you don't clean it properly, it could happen. The sterilization is the most important thing."

Source: Home News Tribune [8/7/08]

FL Podiatrist Elected Chief of Staff at S. Florida Baptist Hospital

The Medical Staff of South Florida Baptist Hospital (a 150-bed Hospital in Tampa Bay, which is part of the BayCare Health System) has elected Martin T. Girling, DPM as its new Chief of Staff.

Dr. Martin T. Girling

Girling, a podiatrist, who has been a member of South Florida Baptist Hospital's medical staff for 16 years, was elected as the Chief of Staff by his peers. He has served on the Executive Committee for the last 5 years as a Member at Large, Secretary, Treasurer, and President-elect.

Dr. Girling who is board-certified by the American Board of Podiatric Surgery, also has been named The Co-Director of the Hospital's "Center for Hyperbaric Medicine and Wound Care" along with Jill Roehr, MD a local general surgeon. Girling has been in private practice in Plant City since 1991.

NJ Podiatrist Pleads Guilty to Altering Audited Medicare Charts

Dr. Michael Schmierer, 62, a partner in Advantage Foot and Ankle Centers, pleaded guilty Thursday, Aug. 7, in U.S. District Court in Trenton to one count of obstructing a federal audit. Schmierer's podiatry practice ran centers in Old Bridge, East Brunswick, South Amboy and Linden. In September 2003, Advantage was audited by a Medicare contractor responsible for detecting Medicare fraud.

Medicare requested 25 original medical records of patients who had been treated at Advantage. Advantage had submitted claims for reimbursement for those treatments. Authorities said Schmierer and co-conspirators re-wrote patient notes in seven of the 25 requested files to enhance the claims sent to Medicare. Schmierer admitted that the seven records had been altered to justify the billing, authorities said.

Schmierer faces a maximum of five years in prison and as much as a $250,000 fine at his sentencing scheduled for Nov. 18, but sentencing guidelines call for a sentence of 12 to 18 months in prison. He is free on a $100,000 bond.

Source: Cloe Cabrera, Tampa Tribune [8/7/08]

Create a Deadline for Your Success

The clock is ticking, and your opportunities for this week, this month, and this year are fleeting. To take advantage of the opportunities that surround you, you must create a sense of urgency. The key: deadlines. When you set a "do by" date or time, your deadline will:

• Build Commitment.
• Enforce Accountability.
• Create urgency.

Once you set a dealine, start making progress towards your goal, with one eye on the clock and the other on the prize. Monitor your progress and adjust as necessary. To maintain that important sense of urgency, remind yourself and others of the deadline.

Source: Adapted from "Create a Sense of Urgency," by Gary Ryan Blair.

Query: Fracture of Medial Sesamoid

My patient is a 17 y.o. female whose life revolves around dancing barefooted. I first saw her in 1/08 and via examination and x-rays diagnosed her with a fracture of the medial sesamoid. This condition had been present for 2-3 months prior to seeing me. She has tried rest, immobilization, CAM walker with rocker-bottom, and no dancing for months. Two months ago, she was basically pain-free, so I allowed to go back to dancing to tolerance. She returned last week with her initial symptoms. An MRI last week confirmed a fracture of the medial sesamoid (no aseptic necrosis). My dilemma is that if I surgically remove the medial sesamoid, I may weaken the flexor apparatus, forever leaving her with problems because she lives to dance. I would love to hear other opinions as to my options.

Barrett E Sachs, DPM, Plantation, FL

RE: Traumeel for Posterior Heel Pain (Jeffrey Kass, DPM)
From: Elliot Udell, DPM, Jay Kerner, DPM

Dr Kass's findings that injecting a homeopathic product to treat Achilles tendonitis yielded no results, is par for the course. I urge anyone considering the use of homeopathic products to first read the article on homeopathy in the June 2008 issue of Consumer Reports. It explains in a concise way why homeopathy is no better than a placebo. It also explains that the product is so diluted that there is not a single molecule of product in the vial. Consumer Union's gripe in their article is that drugstores should not have homeopathic preparations on shelves next to real medications because uneducated consumers might think that homeopathic preparations have medicinal efficacy, which they do not. The patients may also take these products for a serious illness and get worse when there are proven medications out there for the same conditions that really do work.

The article quotes the Lancet which cites numerous studies that show homeopathic products to be no better than a placebo. Now I do realize that some doctors want to prescribe these products. They are good moneymakers. Some patients believe in them with religious fervor and will gravitate toward doctors for these injections. In that case, be honest with the patients. Tell them what homeopathy is: show them the article in Consumer Reports. Then the patient will not confuse what you are injecting with a real medication and morally and ethically you will be off the hook.

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

When the doctor who initiated homeopathic therapy in the US was questioned about the virtually non-existent amount of the 'active ingredient' in homeopathic meds, his reply was that it actually worked “in spirit.”

Jay Kerner, DPM, Rockville Centre, NY, Aikiman44@aol.com

RE: Projections of Supply and Demand for Podiatric Physicians (Justin C. Jex, DPM)
From: Ross E. Taubman, DPM, Carl Solomon, DPM

It is important to note that the study in the July/August edition of JAPMA, done by the Work Force Center at the State University of New York at Albany, demonstrated that DPMs currently provide only 40% of the foot and ankle care in the United States. If there are fewer DPMs, one could argue that the remaining DPMs might be busier in their practices. But at what cost to the profession? A decreasing market share for DPMs that will lead to other, less qualified providers of foot and ankle care providing a greater proportion of that care.

This is an ominous sign for all of us that should awaken the profession to greater promotion of the expert services that podiatric physicians provide and a need for each of us to help recruit the most highly qualified applicants for our schools. If each APMA member recruited just one highly qualified applicant per year to our schools, we would have an applicant to matriculant ratio of 180 to 1! This would make our schools the most highly selective of all medical schools.

Ross E. Taubman, DPM, President, APMA, retaubman@apma.org

Surveys and statistics can bolster either side of the argument of whether there's a demand for more podiatrists. I don't have very strong feelings one way or the other, but here's a way to cut through all that and find out, at least in a given area. Call a bunch of offices and tell them you have a bunion or hammertoe that you need fixed. See if you can get an appointment in a day or two. If most of those offices can get you in that fast, there's no demand for more providers.

Carl Solomon, DPM, Dallas TX, cdsol@BaylorHealth.edu

RE: Projections of Supply and Demand for Podiatric Physicians (Justin C. Jex, DPM)
From: Leonard Levy, DPM, MPH

Dr. Jex’s comment is an understandable response if one only looks at current conditions in podiatric medical practice. However, when projecting what both the need and demand will be for podiatric medical care in the future, it fails to address the facts. First, there is a rapidly aging population in the United States destined to increase both in numbers and in the proportion of people over the age of 65 (i.e., from 12.3% of the population to about 20 % by 2020.). These people are at great risk for podiatric problems intrinsic to the pedal extremity as well as due to chronic diseases with manifestations in the foot and ankle (e.g., diabetes, cardiovascular disease, renal disorders, post-CVA, arthritides, etc.).

Furthermore, those age 85 and over will need even more podiatric medical care. In addition, there is a growing epidemic of type-2 diabetes that not only includes older people, but children (who like older people) have diabetes, and will experience complications affecting the foot. Another important issue is that many diseases that in the past were acute in nature have been converted to chronic disorders. Also, like in the MD and DO community, one must consider that in the next few years a major percent of podiatric medical practitioners will be leaving practice mainly because they will be reaching retirement age.

Finally, the spectrum of podiatric medical practice today has expanded during the last quarter century and, as a result, not only does today’s DPM have a longer list of responsibilities especially but not limited to surgery, many more years are spent being trained than was the case for current podiatric physicians. Most future DPMs today spend seven years in training, including a combination of four years of professional school and three years of residency. This increases the lead time before a new podiatric physician is ready for practice, exacerbating the projected shortage of DPMs. The time to prepare for the future need and demand for podiatric medical care is now.

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

ASSOCIATE POSITION OPPORTUNITY IN MULTI SPECIALITY GROUP PRACTICE - ILLINOIS

Christie Clinic is a large Multi-Specialty Group practice located in Champaign, Illinois. We are seeking a PSR-36 ABPS Board Certified or Board Eligible podiatrist to join a well-established Podiatry department. Must be competent in all phases of podiatric care, Surgical and Conservative. This position will involve rotating through multiple office locations with surgical privileges available at two medical centers and two outpatient surgery centers. Very competitive salary, bonus plan, vacation, and health/mp insurances. Forward CV to wpierce@chrisiteclinic.com

ASSOCIATE POSITION WITH POTENTIAL FOR PARTNERSHIP - NJ

Associate needed for multiple location practice in Bergen County N.J. Full or Part-time hours available. Reply by E mail to dr_toefu@hotmail.com

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

IMMEDIATE POSITION AVAILABLE TN/GA

We're in search of a motivated, well-trained DPM who is great with patients. Our well-established multi-doctor, multi-office practice is located in Southeast Tennessee/North Georgia. Must have Tennessee or Georgia license. Please reply via email to ikraus@sprynet.com

PRACTICE FOR SALE MN: PRIME LAKES AREA

Great place to live and raise a family. 400+K yearly gross with continued growth and potential. Good mix of general podiatry and surgery. Hospital privileges available. Fully computerized, electronic notes with capability to go completely paperless. Recently remodeled office, 5 tx/procedure rooms, well-equipped in owner occupied building (for sale or lease). 260 402-7490.

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

ASSOCIATE POSITION – CALIFORNIA

Coast to Coast Mobile Podiatry Group Seeks Podiatrist with Nursing Home contracts! Join our group and let us handle the back-breaking task of billing and managing your patients. This will equal great compensation for you. Please email us back at coasttocoastpodiatry@yahoo.com

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