The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

August 18, 2008 #3,326 Editor-Barry Block, DPM, JD

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Congratulations to Jonathan King, DPM of Clinton Township, MI our First weekly survey contest winner, who has won a copy of Principles and Practice of Podiatric Medicine (2nd Ed.) by Leonard Levy and Vincent Hetherington (Value $235)

TempTouch®

This week's prize is a TempTouch® donated by Diabetica Solutions Inc. (Value $99.95) . To enter the contest, complete the survey at www.podiatrym.com and send us question #43, along with your name and address. Be sure to vote in the survey for the 2009 inductees in the PM Podiatry Hall of Fame. All entries are eligible for future weekly prizes, so enter early.

TUSPM's Mahan Provides Back-to-School Shoe,-Buying Advice

When it comes to school shoes, podiatrist Dr. Kiernan Mahan recommends shoes that can handle both the playground and the classroom. "I think the shoe that fits the bill for most of those things is a sneaker-type of shoe or an oxford kind of shoe," Dr. Mahan of Temple University School of Podiatry said. He also recommends choosing a material that lets feet breathe like leather or other natural materials. If your child has sweaty feet, getting an extra pair can help.

Dr. Kiernan Mahan

"Even if you had a couple of pairs of shoes, where you let them wear a different pair of shoes the next day, so that the first pair can dry out, sometimes that can be very helpful," Dr. Mahan said. As for the fit. Dr. Mahan said,"When you push your thumb down at the end of the shoe, the edge of your thumb should be feeling the edge of that toe." Keep in mind, the big toe may not be the longest toe. Also, you want to look for a shoe that bends, but also has good support especially at the back of the heel; that way kids can put their best foot forward come school time.

Source: Ali Gorman, WPVI [8/15/08]

GA Podiatrist Creates Podiatric Staff Positions at Atlanta Hospitals

Dr. David Helfman opened his first podiatric office in Smyrna in 1992. Soon afterwards, he recognized the need for physicians to be freed from daily practice management to focus on patient care. Using this business model, he began attracting like-minded partners. Today, the former solo practice has become Village Podiatry Centers (VPC), the largest podiatric surgical practice in the southeast.

Dr. David Helfman

“It’s a challenge to maintain efficiency with 23 physicians in 19 offices,” says Dr. Helfman. “The reward is in providing the full range of care. Our specialties range from pediatric to diabetic and senior care. We’ve been able to attract this caliber of talent with our commitment to patient care and to our physician’s quality of life,” says Dr. Helfman.

Among the medical community, Dr. Helfman is known for advancing the podiatric field through greater integration with primary and specialty care. “Village Podiatry Centers is at the cutting edge of medical and surgical technologies. Our physicians have attained the first podiatric staff positions at several Atlanta hospitals, including Emory Crawford Long, Saint Joseph’s and Piedmont Hospital due to our training and skill,” he says.

Source: Atlanta Hospital News [August 2008]

Medicare DME Bidding Program on Hold

A new Medicare program designed to lower costs and prevent fraud in the durable medical equipment arena was as short-lived as the most recent payment cut to physicians. The legislation enacted last month that reversed the July 1 rate reduction also delayed for 18 months a DME competitive bidding program that had gone into effect the same day. If Congress had not decided to stop the program, it would have limited Medicare coverage of selected equipment in 10 metropolitan areas to suppliers that submitted winning bids in a process completed earlier this year. With the cancellation of the bids, seniors in all areas can continue to receive their power wheelchairs, oxygen supplies, diabetic mail-order supplies and other previously restricted equipment from any supplier that bills Medicare.

Durable medical equipment suppliers will try to use the next 18 months to convince Congress that competitive bidding is not necessary to cut costs, the American Assn. for Homecare's Tyler Wilson said. Also, CMS must tackle its DME fraud problem by moving forward with plans to accredit legitimate suppliers and exclude firms that cannot make the grade, he said.

Orthopedic surgeons are worried that some physician-suppliers will be forced to compete with large supply firms to provide "off-the-shelf" orthotics, such as braces, splints and other appliances. "I don't believe they can tweak the program enough to get it to the point where we can outbid the big companies," said Robert H. Haralson, MD, the American Assn. of Orthopaedic Surgeons' executive director of medical affairs. Dr. Haralson worries that a failure to exempt physician-suppliers from any future rounds of bidding would force those doctors to stop offering the convenience of in-office equipment.

Source: David Glendinning, AMNews, [8/18/08]

Double Your Brain Power - Part 3

You probably sometimes wish that you could think faster, grasp new information quicker and recall more of what you read and hear. You can with these tips:

• Rely on graphic devices to increase your reading speed and to help you zero in on the main points in books and other publications. Examples: italics, boldface, underlining, bulleted lists, charts, graphs, etc. As you go through pages, ignore regular text and scan only for these devices. When you find one, slow down and read these sections more carefully.

• Boost your thinking power by taking the time to really think about the answers to these questions about a situation, some information, or a problem: What seems to be the key idea here? Does this resemble or parallel anything I’ve learned or experienced? Do I still have a nagging question about any part of this? When I put everything together, what do I see as most important?

Source: Double Your Brain Power: Increase Your Memory by Using All Your Brain All the Time by Jean Marie Stine.

Query: Evenup

What experiences do PM News subscribers have with a new device called the Evenup?

Evenup

This device is used to prevent a limb-length discrepancy when a patient is wearing a cast on the contra-lateral side.

Brad Castellano, DPM, Duluth, GA

RE: Use of Tourniquet with Sickle Cell Trait (William Sachs, DPM)
From: Barry Mullen, DPM, Tracy M. Reed, DPM

While Dr. Yeager's personal experience utilizing tourniquets w/out incident for several patients w/ sickle cell trait is noteworthy, the literature warns of potential tourniquet induced sickle cell crisis. The bottom line is that it is irrelevant how many prior cases were done w/out incident, for all it takes is one iatrogenic tourniquet induced crisis. These are documented. So, the question begs, why even take the risk? The prudent advice is to simply perform the case "wet" and avoid this known potential complication.

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

People with sickle cell trait usually do not have the same complications with tourniquets as people with sickle cell disease. In the disease, it is not recommended to use an ankle tourniquet. As a person with sickle cell disease who recently had knee surgery with the use of a tourniquet, I have had complications with excessive post-op swelling which my surgeon directly linked to the tourniquet use. People with sickle cell trait don't exhibit symptoms of sickle cell disease unless put under extreme conditions, such as prolonged high altitudes, exercise induced dehydration, or excessive heat. As long as your patient has not had any previous sickle cell type of issues (i.e., crises) or co-morbidities, I would have no problem using an ankle tourniquet for the case.

Tracy M. Reed, DPM, St. Louis, MO, mstmr@att.net

RE: Residency as a License Requirement (Tip Sullivan, DPM)
From: Narmo L. Ortiz, Jr., DPM, Daniel Chaskin, DPM

Dr. Sullivan brings a great point for discussion. Although I applaud APMA vision for 2015, and knowing that it is well-intended to benefit the profession as a whole, I wonder if past and present generations of podiatrists will be left behind from the benefits we should all attain in the future.

Aside from the licensing issue brought by Dr. Sullivan, there are also no contingencies made for physicians that completed a one, two, or even three year residency program under the classifications of RPR, PPMR, POR, and/or PSR as to what capabilities or scopes of practice will we be allowed to pursue.

The point I want to make is: in comparing the MS licensing dilemma with the requirements of Board Certification by ABPS, no one is allowed to become rearfoot certified unless they have completed at least two years of a PSR residency program. Who knows if after 2015, no one with less than a PGY-3 program will be allowed to seek rearfoot certification.

There are plenty of podiatrists out there that have had excellent residency training without a two year PSR, who have sought rearfoot training here and/or abroad, yet are not allowed to seek rearfoot certification. In summary, our profession has still not defined as to what will become of those of us who have not completed a PGY-3 program.

Narmo L. Ortiz, Jr., DPM, Cape Coral, FL, nlortizdpm@embarqmail.com

Residency training that was performed in 1984, for example, is outdated and not related to current competence. A podiatrist that completed such outdated training has a better chance of obtaining staff privileges and state licensure that requires residency training than a currently recertified currently competent podiatrist who did not complete such outdated training.

This does not benefit the public who are our patients and such a residency requirement should be constitutionally intolerable if the residency training being required is not current.

Solution: Eliminate residency requirements for podiatrists who graduated in the 1980's and who never had the opportunity to complete such training.

Daniel Chaskin, DPM, Ridgewood, NY, podiatrist1@optonline.net

ASSOCIATE POSITION - WEST CENTRAL MN

Associateship possibly leading to equity ownership. Compensation package of $100,000. Option for partnership or purchase as soon as associate feels ready. 260 402-7490.

ALL PRO 2010 X-RAY PROCESSOR FOR SALE

2 years old, excellent condition, monthly maintenance/cleaning done by NJ X-Ray. Includes processor, leveling base, chemical draining hoses, water hose, two 10x12 x-ray cassettes and 1 box of brand new x-ray film. Instruction manual and extra washers/parts also included. Asking price $2,500 + shipping costs. For inquiries, email nefootandankle@optonline.net

PRACTICE FOR SALE - TEXAS

10 year old Dallas practice for sale. All phases of podiatry including: surgery, routine care, orthotics, diabetic care, etc. grossing $185,000 on 3 days per week. Middle income area with hospital privileges available. please respond to: footdoc8390@yahoo.com

ASSOCIATE POSITION - BOSTON, MA

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