The Voice of Podiatrists

August 29, 2006 #2,674 Editor-Barry Block, DPM, JD

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Not Exactly the Maggots Podiatrists Use: Armstrong

Two months ago, Charlena Sims was recuperating from toe amputation surgery in Manor Care nursing home in Oak Lawn, IL. When a staff member came in to change the dressing on her right foot, she discovered live maggots feasting on the wound, according to a lawsuit filed last week in Cook County Circuit Court.

"It's often a reflection on the cleanliness of the facility, of the environment," said Dr. David Armstrong, professor of surgery and assistant dean at the Rosalind Franklin School of Medicine's college of podiatry in North Chicago. "Generally, the only time we find maggots on a wound [is when] someone's in pretty bad straits," he said. "They may have been out on the streets for a while, or been something of a shut-in, and haven't been able to take care of themselves."

It is unclear when or how the fly larvae got into Sims' wound, but Armstrong said they had probably been there for several days, given that they were big enough - and numerous enough - to be noticed. "It's not exactly appetizing," Armstrong continued, "and our unit has seen the worst of the worst. But we look at them as medical devices rather than the crawly little critters you see."

Source: Valerie Dowdle, Chicago Defender, [8/21/06]

Paperwork, Low Pay Driving Physicians From Medicaid

Fewer physicians are accepting Medicaid patients, and those who do are becoming increasingly concentrated, according to a new national study. Low and slow reimbursement and the heavy paperwork burden are largely to blame.

The study, conducted by the Center for Studying Health System Change, found that in 2004-05, almost 15% of physicians reported receiving no Medicaid revenue, up from 13% in 1996-97. About 21% reported accepting no new Medicaid patients in 2004-05 -- a rate six times higher than for Medicare patients and five times that for privately insured patients.

Source: Beth Wilson, AMNews, 9/4/06

Practice Size Counts

Care for Medicaid patients is becoming more concentrated among large group and institutional practices. The percentage of physicians accepting no new Medicaid patients:

Source: Center for Studying Health System Change, August, 2006

Query: Onycholysis in a 2 Year Old

I recently saw a 2 year old with onycholysis of several nails, recurring since she was 7 months old. History non-remarkable, exam revealed no inflammatory or nail bed changes, family history non-remarkable.

Onycholysis in a 2 Year Old

Any diagnoses/suggestions will be appreciated.

Jay Kerner, DPM, Baldwin, NY, aikiman44@aol.com

RE: Wide Steel–Toed Shoes (Miki Hori, DPM)
From: Robert S. Schwartz, C. Ped

Most molded shoe manufacturers, including Eneslow offer custom-molded, steel-toed shoes for very wide feet. Contact your current molded shoe vendor or look on the Pedorthic Footwear Association website www.pedorthics.org under Pedorthic Marketplace and you will find all vendor members. There you can find the list of molded shoe manufacturers.

Robert S. Schwartz, C. Ped., New York, N. Y. rss@eneslow.com

RE: Medicare Holiday
From: Paul Busman, DPM

The Medicare "holiday," which Congress ordered, will allow the federal government to move $5.2 billion in Medicare expenditures to the next fiscal year, which begins on Oct. 1.

Hey, what a great idea! Hold back on your obligations at someone else's expense just for your own convenience! Maybe I can hold back on my rent until it's more convenient for me to pay it. Or my electrical bill. Or my malpractice insurance...

Paul Busman, DPM, Troy, NY, BREWERPAUL@aol.com

HOUSE CALL PRACTICE FOR SALE – SOUTHERN CALIFORNIA

House Call practice for sale which includes approx. 400 patients and continued referrals. Perfect for solo practitioner. Extremely easy and profitable practice to run. Yearly gross of over $200K. Current DPM is retiring. Financials will also be provided. Please contact ccipinc@ccipinc.net

ASSOCIATE POSITION - NEW JERSEY

Seeking associate for practice in Ocean County area. Seeking a hardworking, ethical, energetic and well trained (PSR 24/36) individual. MUST be willing to do all aspects of podiatry! Competitive salary and benefits package. E-mail CV to NJFEET@aol.com

PRACTICE FOR SALE – SOUTH FLORIDA

Miami-Dade and SW Ft. Lauderdale, well established surgical practice for sale. This one has everything. Surgery, Orthopedics, Pediatrics, Trauma, ER, General Podiatry. Participates in all local and national managed care plans. $850,000 but will discount depending on amount up front. Mature, serious inquires with business experience preferred. Email response to podfootdocs@aol.com

ASSOCIATE WANTED – SOUTH FLORIDA

Miami-Dade and SW Ft. Lauderdale, well established surgical practice needs part-time podiatrists to assist in surgical cases and patient volume. Email response to podfootdocs@aol.com

ASSOCIATE POSITION - NEW ENGLAND

Terrific Opportunity Now Available in growing New England practice. Well established and respected practice with new, large office space, latest technology, very helpful staff, loyal patients and solid referral base. Close proximity to hospitals with modern surgical suites. Opportunity for shared ownership. Prefer 24 month PSR with clinical practice experience or an experienced doctor looking to improve their situation. E-mail CV and particulars to NEAFC3@aol.com

HOUSE CALL PRACTICE OPPORTUNITY- CHICAGO / NORTHWEST INDIANA

Chicago-Home Physicians specializes in house calls to the elderly homebound. Full and part-time positions available in Chicago/Northwest IN. Competitive Compensation, including malpractice. Contact Scott Schneider. Phone-773-292-4800. Fax-773-486-3548. E-mail sschneider@homephysicians.com www.homephysicians.com

ASSOCIATE POSITION – TUCSON, AZ

Associate needed for practice in Tucson and Southern Arizona, seeking a hardworking, ethical, and well trained individual. MUST be willing to do all aspects of podiatric medicine and surgery, competitive salary is negotiable. E-mail CV to drd@premiersurgeons.com

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