The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

September 03, 2009 #3,639 Publisher-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2009- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

MO Podiatrist Discusses Heel Pain

An aching or stinging sensation in the heel is among the most common patient concerns, says Dr. John Holtzman, a podiatrist with Missouri Foot and Ankle in St. Louis. “People who spend a lot of time standing on hard floors, especially without properly supportive shoes, and athletes who put a lot of pressure on their feet from running or jumping, often report heel pain,” he says. The causes vary, and determining the underlying problem is the first step.

Dr. John Holtzman

Most heel pain is caused by plantar fasciitis, an inflammation of the tissue band (fascia) connecting the heel bone to the base of the toes. “People often notice pain from plantar fasciitis when they stand up first thing in the morning,” Holtzman says. This is because the plantar fascia tends to contract when pressure is removed from the foot. Standing up requires the plantar fascia to stretch, irritating the inflamed tissues.

If left untreated, plantar fasciitis can result in heel spurs, which are calcium deposits that form on the heel bone and appear as bony protrusions in x-rays. These spurs also can cause heel pain. Holtzman says other potential culprits include bursitis, an inflammation of the fluid-filled sac (bursa) that lies between the Achilles’ tendon and heel bone, and other inflammatory conditions, such as arthritis.

Source: Connie Mitchell, Ladue News

Half of Large Practices Net Bonuses From Medicare P4P Demo

The Obama White House has indicated it will continue the move toward more pay-for-performance in Medicare, despite mixed results for physicians in the P4P demonstrations it inherited from the previous administration. On Aug. 17, the Centers for Medicare & Medicaid Services disclosed findings from three ongoing programs -- including first-year results from a small-practice demonstration -- and announced the start of three new value-based purchasing demonstrations.

Third-year results were revealed for the Physician Group Practice Demonstration, which is in its fifth year of operation and is slated to end March 31, 2010. Although CMS has extended the demonstration twice beyond its initial three-year limit, the agency said it does not anticipate extending the program again.

All 10 of the large physician groups participating in the program achieved benchmark performances on at least 28 of 32 quality-of-care measures, which cover diabetes, congestive heart failure, coronary artery disease, hypertension and cancer screening. Groups can receive up to 80% of the savings they generate for Medicare by reducing medical complications and hospitalizations. But only five groups in the third year received performance bonuses, totaling $25.3 million. One group that achieved benchmark performances on all 32 measures -- Park Nicollet Health Services in St. Louis Park, Minn. -- did not receive a bonus.
 
Source: Chris Silva, AMNews [8/3109]

Editor's Note: PM News is proud to present excerpts from Meet the Masters. Full versions of these interviews will appear in Podiatry Management Magazine.

Bret Ribotsky, DPM: How would you say you define success today?

Lowell Weil, DPM: Success can be in many different forms. It can be a financial success, it can be self-esteem. I think when we wrap it all up together, success is being very happy of what you do, waking up in the morning and saying I enjoy going to wherever I am going to work. It's being with people who are not only a lot of fun but, are productive mentally, stimulating, and at the same time it's being able to make a good living and be your own boss, where you can’t get dinged in this type of economy. That to me is success, and having respect from your family, being able to have everyone around you say that this is a person who really cares about what he or she is doing. 

Meet the Masters is broadcast each Tuesday Night at 9 PM (EST). This week's guest is  PM Hall of Famer, Stanley Kalish, DPM, an internationally noted surgeon, teacher, and inventer. You can register for this event  by clicking here.

Query: Non-Fixated Osteotomies

Are any of my colleagues still performing non-fixated lesser metatarsal osteotomies in selected cases? Can these non-fixated osteotomies still be defended as being within "standard of care"?

Arden Smith, DPM, Great Neck, NY

Query: Can Solo or Small Group Practices Survive?

Can the solo, or small group private practice with its rising overhead expenses survive outside of the current "fee for service" model?

Arden Smith, DPM, Great Neck, NY

Editor’s comment: There is a significant difference between a solo and a small group practice. In every PM Annual Practice Management survey in the past decade, podiatrists in group practices have earned over $10,000 more per practitioner than those in solo practices. We expect that differential to grow even more in the coming years. Solo practitioners are slowly, but surely, becoming extinct, but will likely still survive (while group practices flourish) for the foreseeable future.

RE: Dealing With Depressed Patient (Donna M Alfieri, DPM)
From: Elliot Udell, DPM

Many people with emotional disorders such as clinical depression tend to hide them from doctors who are not directly involved in addressing these disorders. The fact that this patient opened up to you, Dr. Alfieri, says some very positive things in the way you relate to your patients. The ultimate therapeutic goal, from a podiatric perspective is to refer her to a mental health professional. As you discovered, making a mental health referral is perhaps the most difficult referral to make. Patients perceive of such referrals as: being made wrong, perceived as being crazy, not taken seriously, etc.

The way to handle it from the perspective of a podiatrist is to "be with the patient" and listen carefully to her story. Something is generating these feelings and she may need to express it and to your credit feels comfortable expressing it to you. Once she feels convinced that you care about her and calms down, the next step is to explain to her that you want her to see a mental health professional in the same way you would want her to see an endocrinologist if she had diabetes. It’s important to have the names and phone numbers of these professionals in your community. I published more than one paper on this topic, and may even have notes from a formal course I gave at the Pennsylvania College as part of their psych program. If you or any reader is interested, I will send copies of what I have. 
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: Membership in Medical Discount Buying Group (Mark Aldrich, DPM)
From: Chris Mahaffey, CAE, Michael Forman, DPM

The ACFAS group purchasing program is with E-Surg/Amerinet, the largest medical supplies distributor in the nation. We have no affiliation with MDBG whatsoever. ACFAS members can access this service at amerinet.esurg.com/acfas or call Michelle Brozell at ACFAS for more information, 773-693-9300 x1312.

Chris Mahaffey, CAE, Executive Director, ACFAS, Mahaffey@acfas.org

Our office uses MDGB for most purchases. They have contracts with many suppliers such as Meyer Distributors. They generally save us money, although we continue to shop for price. We are quite satisfied and feel that we save money.
 
Michael Forman, DPM, Cleveland, OH, IM4MAN@aol.com

RE: Podiatric Surgeons and Generalists (Arden Smith, DPM)
From: Eric M. Hart, DPM, Elliot Udell, DPM

I've heard the same type of comment from orthopedic surgeons who specialize in foot and ankle care--many of them feel that podiatrists should ALL fill this role of a generalist. I've also heard the same comment from podiatrists who are well-trained in more complex foot and ankle surgery and would like to see greater surgical numbers.  I strongly believe that all podiatrists should be surgically trained with uniform residencies, but it is reasonable that some of us may be better suited for certain cases and that's where we need to do a better job of simply referring to one another. 

I'd like each of us to ask ourselves "who" we would have perform our foot or ankle surgery when and if it was needed. This came up in my residency training, when I saw a podiatrist attending ask a local foot and ankle surgeon to fix their simple ankle fracture. There were plenty of local podiatrists who would have done an excellent job, but were not asked to do it. I'm sure that case sent a message to every surgical tech, nurse, anesthesiologist, scheduler, and orthopedist in the OR that day. If we talk the talk, we have to be willing to walk the walk.
 
Eric M. Hart, DPM, Bismarck, ND, erichartdpm@gmail.com

Dr. Smith’s suggestion that podiatry become subspecialized in the way general dentists are toward oral surgeons is an ideal scenario which would be good for the public and ultimately good for our profession. I too have been in practice for over 30 years and one of the great failings I've  seen of surgical specialists within our profession is that they know how to accept a referral from their non-surgical colleagues but don't have the foggiest idea how and when to send the patient back to the referring general podiatrist.

To the contrary, most will keep the patient forever. I have witnessed this too many times with too many well known surgical podiatrists who should know better. An oral surgeon will not do cavities because he or she knows that if he does not send the patient back to the general dentist, that will be the last time he will see a referral from that dentist. The same holds true with general surgeons and primary care practitioners. It would be nice if we could mimic these other professional relationships. They are grounded in good business sense. Perhaps our practice management societies and surgical societies can devote time to teaching their members rudiments of making and accepting referrals from other podiatrists. 
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com
 

RE: APMA Demands Retraction From Arizona Congressman
From: David Kleinbrodt, DPM

On Fox News with Neil Cavuto, Rep. John Shadegg (R-AZ) likened podiatry to acupuncture and aromatherapy, and said it was "an esoteric demand that no one wanted or needed."  I hope everyone here writes this congressman a letter. Click here to send your letter.

David Kleinbrodt, DPM, Woodland Hills, CA,  dgkdpm@yahoo.com

RE: Addante Receives FIP Lifetime Achievement Award
From: Howard Dananberg, DPM

As his first resident, I would like to congratulate Joe on an award that was long overdue. He certainly marched to the tune of his own drummer, and along the way, conveyed a self-confidence to young podiatrists, making them extremely proud of who they were and what they did. The self-assurance that he instilled in me has lasted throughout my career and I have always thanked him for that. By taking his enthusiasm overseas, his efforts have surely advanced podiatric medicine, podiatric surgery, and podiatric psyche in Europe.

Howard Dananberg, DPM, Bedford, NH, howiedbpg@aol.com

Seeking well-trained ABPS board certified/qualified foot surgeon for surgical practice with national foot/hand/orthopedic surgery group. Excellent salary/benefits. E-mail CV and cover letter to: slb99@pdq.net

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for a full-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to fmassuda@footexperts.com

LOCUM TENENS POSITION – PHOENIX, AZ

Locum Tenens position available in West Valley Phoenix office beginning September 15th. Salary negotiable. One to two days a week in a friendly and casual office. Please direct all inquiries to drlaurel@cox.net.

ASSOCIATE POSITION - MARYLAND

Full time, hard-working, happy and personable Foot Surgeon needed for busy and growing practice in Frederick and Hagerstown Maryland. PM&S-36 or more required. We have a well-rounded, high tech practice with all types of pathology encountered in our two offices and in two local hospitals as well as our on-site accredited and certified ASC. Very competitive compensation. Please send your CV to drmichaels@rfainstitute.com

ASSOCIATE POSITION – NORTH CAROLINA

Very busy practice in Western North Carolina, seeking Full-time Associate with hospital and surgical training. If interested please fax resume to 828-252-2272 or e-mail to mfas828@aol.com

EQIPMENT FOR SALE - ORTHOTIC FABRICATION SYSTEM

Amfit Orthotic Insole Fabrication System with Footfax SL Contact digitizer- For Sale Machine, Laptop, rolling bag, small inventory of shoes, insoles, all cords, parts and hardware Asking $10k.OBO! Please contact Jeff at Jhunt@psbank.net for further information, pictures.

PRACTICE FOR SALE - FLORIDA—CENTRAL/SOUTH

Turn-key operation grossing $570,000 annually based on one full-time doctor. Great opportunity for growing the top-line. Surgery is only 14% of the professional man-hours; it can significantly increase income. Medicare makes up 64% of revenues. Seller will assist with transition. Call 863-688-1725, ask for Chas.

NEEDED CHICAGO -- NW IND & BALTIMORE/WASHINGTON, DC PODIATRISTS

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists in Chicago, Northwest Indiana, and Baltimore, MD. 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 - NEW JERSEY

Established successful practice in Central New Jersey seeking PT/FT Associate. PSR 24/36. Please forward CV to rpg145@gmail.com or fax 908 753-0199.

ASSOCIATE POSITION WANTED- METRO NEW YORK AREA

Associate position wanted for full-time or part time. Diverse practice to include general podiatry, as well as surgery. Hospital privileges available. E-mail CV along with cover letter to rrranch7@yahoo.com

ASSOCIATE POSITION - FREDERICK, MD

Well-established and growing 2 office state-of-the-art practice located in medical/professional buildings. EMR, Digital X-ray, Ultrasound, DME provider, etc. Competitive Base Salary plus bonus, malpractice, health insurance, etc. PSR 24 minimum/Board Qualified or Certified with ability and desire to take ER call. If interested, forward CV to DOCSBNB@aol.com

ASSOCIATE POSITION - BOSTON, MA

Associate wanted, Full-time or part-time, for busy long time, well established, and well-rounded practice. Good mix of general podiatry and surgery. Office will generate approximately 100+ surgical cases per year. Must have surgical background, ABPS Qualified minimum needed to obtain hospital privileges. Associate position is open for partnership or purchase. Contact robert.nunberg@comcast.net

PM News Classified Ads Reach over 11,500 DPM's and Students
 
Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 11,500 DPM's. Write to  bblock@podiatrym.com or call (718) 897-9700 for details. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451 Ext 110

• To Post a message, send it to:    bblock@podiatrym.com
• Notes should be original and may not be submitted to other publications or listservs without our express written permission.
• Notes must be in the following form:
  RE: (Topic)
  From: (your name, DPM)
  Body of letter. Be concise. Limit to 250 words or less). Use Spellchecker
  Your name, DPM City/State
• Subscribers are reminded that they have an ethical obligation to disclose any potential conflicts of interest when commenting on any product, procedure, or service.