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September 13, 2007 #3,039 Editor-Barry Block, DPM, JD

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Both Foot and Shoe Sizes Can Vary: FL Podiatrist

When 1,200 runners took an online survey about their shoes and injuries, doctors were surprised to learn that most of the injuries occurred in shoes less than 6 months old -- during the break-in period. Expensive $120 shoes were just as likely to cause the wearer problems as $20 shoes, the survey found.

Dr. Robert Duggan

“Have the salesperson measure your feet. Nearly everyone has one foot that's larger than the other. One manufacturer's size 11 may be another shoemaker's size 10, so don't insist that you wear a particular size,” says Dr. Robert Duggan, an Orland, FL podiatrist.

Source: Linda Shrieves, Orlando Sentinel [9/11/07]

NYCPM Holds Second Annual Residency Fair

On Friday, September 7, the New York College of Podiatric Medicine (NYCPM) held its second annual Residency Fair, at which representatives from forty-six hospitals talked with students about the hospitals’ externships and residency programs. Virtually all second- and third-year students attended, as did many first- and fourth-year students.

Representatives from forty-six hospitals talked with students during the recent NYCPM Residency Fair.

The New York State Podiatric Medical Association and NYCPM co-sponsored a lunch that kicked off the three-hour Fair. According to both students and the hospitals’ representatives, the Residency Fair was an extremely successful and informative event.

Hospitals Lax on Infection Prevention: Leapfrog Group

A survey conducted by Leapfrog Group showed 87% of hospitals do not take all recommended steps to prevent different types of hospital-acquired infections, the quality group announced.

The Leapfrog Hospital Quality and Safety Survey of 1,256 hospitals asked about three common infections and reported the percentage of hospitals that fully complied with prevention policies: aspiration- and ventilator-associated pneumonia (38.5%); central venous catheter-related bloodstream infection (35.4%); and surgical-site infection (32.3%). In addition, 35.6% of hospitals followed hand-hygiene practices, and 30.7% vaccinated staff against flu.

Leapfrog officials said the low results indicate that hospitals need to increase their use of safety protocols.

Source: Jean DerGurahian, Modern Healthcare [9/10/07

Query: INBONE Fusion System

Does anyone have any experience utilizing the INBONE Fusion System by Reiley Orthopedics (www.reileyorthopedic.com) ? It’s used for fusions such as 1st met-cuneiform, T-N and STJ . It is an interesting concept. Any surgical pearls would be appreciated.

David Sterling DPM, Santa Maria, CA

Query: Recordkeeping Requirements

I am considering combining my practice with a group of other podiatrists in the community. This has tremendous upside potential, however, I was recently made aware that a few of the doctors in this group have a history of poor recordkeeping and that notes from patient visits are rarely kept, and the doctor(s) simply uses the "superbill" from the previous visit to remind himself what has transpired. If I join this group, what legal ramifications may I be subject to?

Name Withheld

Editor’s comment: PM News does not provide legal advice. In the 21st century, documentation is the cornerstone of any well run practice. This applies to medical malpractice as well as billing. The recordkeeping you have described represents a time-bomb, which can explode at any time. If you are associated with these sub-standard practices, you could be implicated as well.

If the practice is otherwise compliant, you should accept a position only on the condition that these critical deficiencies be immediately remedied. This concept should be memorialized in writing.

RE: Unusual Presentation Of Diabetic Neuropathy ( Edward Orman, DPM)
From: Multiple Respondents

Simeon Locke, MD published a landmark paper in JAMA in 1964 entitled, "Diabetic Amyotrophy." This paper elucidated the clinical and pathophysiologic effects of this disorder in this age group of male patients with DM. The pathology indicated single fiber atrophy of the skeletal muscles in the thighs and pelvic region. It is usually self-limiting, with clinical improvement, but residual weakness does persist. Your patient appears to have these characteristics. It would be worthwhile to look at this manuscript.

Geoffrey M. Habershaw, DPM , Boston, MA, Geoffrey.Habershaw@bmc.org

Dr. Orman’s patient may very well suffer from diabetic motor neuropathy. This is very much underappreciated, and is in fact quite common. Have the MRI of the foot examined for the normalcy of muscle mass. Treatment is with remittive therapy to improve nerve function, including the use of alpha lipoic acid 600mg daily and also Metanx ( L-methyl folatem B6, B12). Physical therapy and bracing are also important.

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

I suggest checking him for Guillain Barre syndrome. I had a case similar to this a few years ago which turned out to be GBS.

David Cornell, DPM, Omaha, NE, Myfootdr@aol.com

While diabetes and vit b12 deficiencies can both cause peripheral neuropathies, the extent of the symptoms and the rapid progress of the symptoms would lead many doctors to suspect that there is something else going on. The two diseases cited might be red herrings in this case. Muscle biopsy may be in order. Nerve biopsy of appropriate nerve tissue might also be in order. I would recommend working with a neurologist prior to doing any invasive testing.

In the case presented you indicated that MRI's were taken. What anatomic regions were studied? Were the tests limited to the lower extremity? Were brain MRI's taken? Conditions such as MS which affect the brain can also account for sudden and progressive weakness and then some regaining of strength. The onset of MS can be very insidious in its early stages. Other diseases such as ALS and its variants can also be very insidious in the beginning. Other questions that should be asked are: Does the patient feel worse in a hot bath? Does the patient have difficulty swallowing or chewing? Another issue that has to be looked into is what caused a low vit 12? Was it a lack of intrinsic factor or caused by a reaction to Metformin? To sum this up, there are a lot of questions to be asked a lot of tests to be done and when you get the answer I hope that you will keep us all informed.

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

RE: Consumers Research (Lloyd S. Smith, DPM)
From: Steven H. Goldstein, DPM

Although the website looks official enough, the bottom line is you get nothing for free. It is safe to assume that they mass mail their letter to most. Recipients are the ones paying to have the plaque made. I did this last year, purchased the plaque, put it in my waiting room, and many patients did notice it and comment. They just mailed me another invitation that I received last week so I figured one plaque is enough.

Ironically, I was in an orthopedist’s office last week and he had one on his waiting room wall for orthopedics. They must do this is most fields and make a fortune. Everyone likes to be recognized as being the best, the top, special, etc. So I would say it is safe to say they get a large percentage of docs to commit. They are no different than the 10 or so Who's Who that send the same type of letter, but want to sell you the book, plaque package.

Steven H. Goldstein, DPM, Wayne, NJ, stevefootdr1@cs.com

RE: Low Medicaid Payments (Gregory B. Nellis DPM)
From: Neil H Hecht, DPM

First-There is a financial incentive in the specific sense of Title XIX regarding the podiatrist being redefined as “physician” as we are for Medicare. A new classification for us would probably remove the restrictions that you mentioned including private office treatment, consultations, radiographic services, and surgical care. A new classification might not result in significantly better reimbursement, however it would probably give us equal reimbursement as the MD/DO practitioners for the same work.

Second-In California, we also do not receive the additional 20% payment for the Medi-Medi crossover patient. We did many years ago. I don’t know why it’s legal, but it does seem to encourage the medically indigent Medicare patient to seek and receive care.

Third-Regarding Dr. Nellis’ comment that “we are going broke from lack of payment and/or coverage for our skills and hard work”, I couldn’t agree more. We all need to be our own best advocates. We must not accept contracts that pay badly and undervalue our services. Although we are not permitted to collectively bargain, we are permitted to express our own opinions regarding this subject. My opinion: stop selling yourself cheap.

Neil H Hecht, DPM, Sherman Oaks, CA, drhecht@sbcglobal.net

ASSOCIATE POSITION (NON-SURGICAL) HOUSTON, TX

Full time non-surgical podiatrist needed for the Harris County Hospital Clinics. A Baylor College of Medicine staffing will be obtained. Competitive salary and benefits. Fax CV to G. Lepow 713 790-9320 or email CV to lepowft@cs.com

ASSOCIATE POSITION – MISSOURI

Due to growth, we will have a position available about February or March for an experienced podiatrist. Should have significant cases toward board certification or be board certified. Partnership available. Missouridpm@yahoo.com

ASSOCIATE POSITION - WISCONSIN

Our group practice is seeking caring DPM's for FT & PT opportunities available in the Eau Claire, Wausau, and Stevens Point regions. We offer an excellent compensation package and a family-friendly flexible schedule. Please fax or email resume to (920) 468-1235 or caringwi@healthdrive.com, or please call Dianna DeMond at (920) 366-6762.

ASSOCIATE POSITION- NORTH LOS ANGELES COUNTY

Full scope of podiatry. Requires usual skills in surgery, medicine and biomechanics. Must be self-starter and highly motivated. Two full days per week. May soon increase to three days per week. All billing and administrative aspects handled by staff. Can practice autonomously. footguy1@pacbell.net

ASSOCIATE POSITION - LOUISIANA

2-location (Baton Rouge / Villa Platte) Louisiana practice has an immediate opening for an associate with option to buy, written into the contract. Earn, learn and buy! We won't let you fail. Great pay with benefit package. Send CV to American Doctor Sales, fax 614-918-3001

NY/NJ METRO PRACTICE FOR SALE

Sellers motivated! Contact American Doctor Sales 614-918-3000 or email sell_my_practice@yahoo.com 10-year financing available with working capital loans - we can get'r'done!!!

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-773-292-4800. Fax 773-342-4201 -E-Mail sschneider@homephysicians.com -- www.homephysicians.com

IN-NETWORK PODIATRIST WANTED – MANHATTAN

Busy Manhattan Office (2 locations) needs IN-NETWORK PODIATRIST, Can start immediately-Do not reply unless you are in with all plans Plz respond to gelus07@yahoo.com

ASSOCIATE POSITION SANTA FE, NEW MEXICO

Immediate opening for PSR 24/36 individual in three office practice. We are looking for an ethical, hard working, well trained Podiatrist. Partnership available. Please Fax CV to sfpodiatry@aol.com

ASSOCIATE POSITION – LOUISVILLE, KY

Immediate opening for multi-office podiatric practice specializing in general podiatry, high volume orthotics, surgery, and advanced wound care. Looking for a motivated, surgically trained podiatrist. Partnership opportunity. Competitive starting salary, benefits, and pension. Please submit: CV, letter of intent and references to: jbroyles23@yahoo.com

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