The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

September 15, 2008 #3,348 Editor-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2008- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

Harkless to Receive Georgetown Distinguished Achievement Award

Lawrence B. Harkless, DPM, will receive the 2008 Georgetown Distinguished Achievement Award in Diabetic Limb Salvage in ceremonies the morning of September 19, 2008. The award will be presented at the Georgetown University Hospital Conference on the Team Approach to Diabetic Limb Salvage in Washington, DC, by conference co-chairs Christopher E. Attinger, MD, Richard F. Neville, MD, and John S. Steinberg, DPM, and Joy Drass, MD, MBA, president of Georgetown University Hospital/MedStar

Dr. Lawrence B. Harkless

Dr. Harkless has been a mentor to many hundreds of podiatric residents and interns, a pioneer in integrating podiatric medicine into mainstream medicine, and a dedicated diabetes educator and diabetic foot researcher. Now, at the peak of his career, he has accepted the challenge of becoming the dean of a new college of podiatric medicine in Southern California.

“Legions of young residents and interns developed their skills under Dr. Harkless’ tutelage, but more than that, for many of us, Dr. Harkless was instrumental in our developing a lifelong interest in medical education,” said Dr. Steinberg. “In my own case, I owe much of my passion for education to Larry Harkless,” Dr. Steinberg said. Dr. Steinberg was a fellow at the University of Texas Health Science Center at San Antonio during Dr. Harkless’ tenure there and later served on the faculty at UTHSCSA.

Podiatric Volunteers Mark Emotional 9/11 Remembrance

September 11, 2008 was an emotional day for many of the podiatrists who served as volunteers in the aftermath of the World Trade Center attack. The ceremony began at 8:46am with the four significant bell ringings at St. Paul's Chapel. The podiatrists stood for a while with the families and some of our volunteers during the victim's name readings at Zucotti Park near Ground Zero.

Bill Graham (L) with Drs. Arthur Gudeon and Nancy Clark

Dr. Nancy Clark, and Bill Graham of the NYCPM, who were instrumental in establishing the St. Paul's Podiatric Service, along with Dr. Arthur Gudeon, who organized hundreds of podiatrists from the New York State Podiatric Medical Association and other APMA components, attended a luncheon. The camaraderie and reminiscences of those podiatrists and the volunteer crew continues. The volunteers then went down to Battery Park and signed one of the beams that will be part of the WTC/GZ Memorial, and then back to spend some time with the "family" of volunteers that had spent the eight months post 9/11/01 in St. Paul’s.

House Panel Discusses Doctor Payment Overhaul

Witnesses at a House Ways and Means Health Subcommittee hearing on Thursday discussed potential methods for overhauling the Medicare physician payment system, CQ HealthBeat reports. American Medical Association President Nancy Nielsen said that if the 20% payment reduction scheduled for Jan. 1, 2010, takes effect, many doctors will stop seeing Medicare patients. Former CMS Administrator Gail Wilensky said, "I am very worried about what is going to happen to physician participation" under the current "sustainable growth rate" system.

The SGR aims to minimize incentives for physicians to order excessive care for the purpose of increasing their income. Wilensky said the current system is flawed because individual doctors who act responsibly cannot influence the system enough to avoid cuts. She added that by setting 100,000 individually-tailored SGRs, CMS could give doctors incentives to order only appropriate services, thus lowering Medicare costs. According to Wilensky, another option could be to bundle payments to health care providers by paying a set amount per patient during a period of time to discourage use of excessive services.

Source: CQ HealthBeat via American Health Line [9/12/08]

4 Key Beliefs Increase Success

The successful people whom you admire share certain attitudes. To emulate their success you must share the following beliefs:

1. "I have suceeded." View the past as a prologue, not as a closed chapter.
2. "I can succeed." Believe that you have the capability and potential to create desirable outcomes. Believe in the power of your personality, talent, brainpower and the like to influence others and steer situations to your benefit.
3. "I will succeed." Based on your experience and past success, such optimism is well-founded.
4. "I choose to succeed." Make an active choice to do the things you must to gain the benefits you desire.

Source: Adapted from The Management Gurus, edited by Chris Lauer

Query: Fat Grafting for Atrophied Feet

A 25 y/o Indian man is getting married and the custom is for the bride’s parents to wash his feet prior to the marriage. He is afraid that if they see his feet, he will be deemed unworthy of marriage and be rejected. He wants his feet fixed. I am a bit perplexed as to what, if anything, can be done.

Atrophied Feet

He has all the bones present, but they are atrophied. I have told him that he will have to live with what he has as I believe any surgery would be extensive and risky. Having said this, I thought fat-grafting, after using skin expanders to bulk up the foot would be easiest and most effective for the least amount of risk, but I have no experience with that procedure. Any help would be appreciated. I would consider sending this patient to someone else who feels confident that they could help him.

Ivar Roth, DPM, Newport Beach, CA

Query: Chiropractors and Orthotics

I am inquiring as to the licensure of chiropractors in the state of New York. It seems that more and more chiropractors have gone into the orthotic business here. Many of my patients are being sold Foot Levelers for their pedal pathology. I have also had patients counseled by chiropractors that the functional posted orthotics I have made are "wrong" and that they should purchase Foot Levelers from them. What is going on here? Is this within the scope of their licensure? Are they actually licensed to treat foot pathology? I think that they have done an amazing job of maximizing what they are treating.

Bob Kornfeld, DPM, Lake Success, NY

Editor’s comment: Perhaps imitation is the sincerest form of flattery. Readers are invited to read a recently-published article titled “How can chiropractic become a respected mainstream profession? the example of podiatry.”

RE: Arthroplasty of Proximal Phalanx (Sandy Schustek, DPM)
From: Multiple Respondents

Sub hallux callus formation is usually pathognomic of “functional” hallux limitus. I would be interested to see full AP and Lateral weight bearing x-rays for review. Does the patient have adequate dorsi-flexion in full weight-bearing stance (relaxed)?

Tim Vogler, DPM, High Point, NC, Timothy.Vogler@cornerstonehealthcare.com

I have performed a few of these (including taking out the IP joint sesamoid) and they all worked out fine for plantar IP joint lesions. I do not see the need to destroy the 1st MTP joint with a Keller if it is not in bad shape.

Philbert Kuo, DPM, Chesapeake, VA, philbear@pol.net

I would first make sure that I tried all of the "biomagic" that I could before surgery. One thing that might help is have the pt stand in normal angle and base and try to dorsi-flex the hallux. Then put the STJ in neutral position and try it again. I would bet that there is a name for that maneuver that doesn’t immediately come to mind. I would be willing to bet that this relatively young man has a functional hallux limitus and probably had one when you did his original sx. I would encourage you to make sure that you have fabricated a true Root functional orthoses cast in a NWB classic technique. I might even cheat a little and plantarflex his first ray during casting. I was taught this technique by an old biomagician guru (Chris Smith, DPM) and I would bet if you searched his name or maybe Kevin Kirby, DPM you might get some insight.

From a surgical standpoint, you are obligated to figure out what is causing this recurrent lesion before you surgically address it. Is it a functionally dorsi-flexed first ray (probably)? What is the position of the 1st met relative to the talus on a lat WB XR? The XR of the digit that I see appears to have a shadow where the previous IPJ sesamoid was? I would not do an arthroplasty of the IPJ. If I just had to do surgery, I would consider IPJ fusion, making sure there was not a functional limitus.

Tip Sullivan, DPM, Jackson, MS, tsdefeet@msfootcenter.net

RE: Misrepresentation in New York Times Article
From: Doug Richie, DPM

Yesterday, PM News published part of my interview with Gretchen Reynolds which appeared in the New York Times. Ironically, I provided this interview the day after attending Dr. Block’s lecture in Kona regarding guidelines for interviews with the press. I asked Ms. Reynolds if I would be able to proof and approve any of my quotes for this article and she was true to her word that all of my quotes were read back to me for approval.

What I failed to check was the remainder of the text of the article which could be attributed to my interview. I was not aware that an orthopedic surgeon was also interviewed for this article, and that her views would be portrayed as consistent with mine. At no time did I state that custom foot orthotics were "pricey" and I never quoted any research which would indicate that pre-fabricated gel inserts purchased at Walgreens would be equivalent. We are all aware that there is no such research relevant to gel inserts, and that the previous published article from Pfeffer, et al. showing superior performance of wool heel cushions had numerous flaws.

I am a strong advocate of the efficacy of custom foot orthoses to treat plantar heel pain, and have been extremely critical of previous published studies showing success of off- the-shelf insoles. I would anticipate that many of your subscribers would be offended by the misinformation contained in this article relevant to the efficacy of custom foot orthoses which was provided by another doctor interviewed by the author. I intend to notify the author of my similar resentment of her portrayal of the role of custom foot orthotics in the treatment of plantar heel pain.

Doug Richie, DPM, Seal Beach, CA, DRichieJr@aol.com

RE: CMS 10-Year Record Retention Requirement (Neil Hecht, DPM)
From: Richard W. Boone, Sr.

The 10-year record retention requirement cited by Dr. Hecht's informant applies ONLY to the records of something called a "Medicare Advantage Plan." From my reading of the entirety of Part 422 of the Code of Federal Regulations, it is pretty clear to me that the 10 year records retention requirement specified in Section 504 DOES NOT APPLY to the clinical records of treatment provided by a practitioner in private practice in his or her own office.

Before any physician changes his or her own records retention practices based upon this alleged "10 year requirement," it would be advisable to seek the counsel of a healthcare attorney knowledgeable about the records retention requirements in the physician's home jurisdiction. There very well may be a requirement that you keep your records for 10 years in your state but, if such a requirement exists, it probably doesn't exist because of Section 422.504.

Richard W. Boone, Sr., Health Care Attorney, Fairfax, VA, RWBoone@aol.com

RE: False Testimony by Expert Witness (John Doolan, DPM)
From: Alan J. Cantor, DPM, Craig J. Campbell, DPM

This being the 7th anniversary of the attacks on the United States, I, along with most in the NY area go through this day with a sense of internal solemnity. As a former volunteer firefighter for 27 years on Long Island, the numbers of "Brother firemen" killed on that day haunt us each day. Several years ago, 13 volunteer firemen were admitted to our burn center from an explosion, the single largest mass admission in our center’s history. The Discovery Channel actually followed the plastics/burn team, and one morning, our Chief of Plastics/Burns said to me, "I wish I understood the brotherhood of the fire department. Can you explain this to us"?

Very easily, my response stated that in the "Fire Service" one is accepted and trusted by fact that "the department is not about "I" or "me", rather, it is about "we" and "us" first and foremost.

Connecting the thought process: the "brothers in podiatry" who willfully testify against another "brother" in a false and planned testimony: NEVER join a fire department! The "hired legal eagles" we see each day in print would find when they declared a "May Day" while in distress, that "the radios malfunctioned amongst the brotherhood"! Fuel for thought on various levels.

Alan J. Cantor, DPM, East Meadow, NY, ajcdpm@aol.com

I am sure that Dr. Doolan is an excellent practitioner. I am sorry that he had to go through all these hassles to ultimately win his case. Unfortunately, in today's society we are all potentially subjected to litigation. I also think that the vast majority of these allegations are frivolous. I don't know if this is proper in this forum because I am bringing my personal feelings into play, but here goes.

Dr. Gary Saphire is a dear friend of mine for almost twenty years. He is my mentor, my friend, and like a brother to me. He is entitled to his expert opinion even if Dr. Doolan disagrees with it. Dr. Saphire is one of the finest human beings I have ever met in my life. I know for a fact that in a quiet way he has helped countless numbers of his colleagues with difficult cases, difficult patients, and difficult situations. I ask PM News if it would be appropriate for Dr. Saphire to give his reply to the allegations and accusations that he has been subjected to. Let's try our best to unite as a profession.

Craig J. Campbell, DPM, Staten Island, NY, docdo675@aol.com

Editor’s comment: PM News welcomes Dr. Saphire’s explanation of his sworn testimony.

ASSOCIATE POSITION – NEW JERSEY

Part-time podiatrist 1-2 days per week for busy medical/surgical practice in Englewood, NJ. Must have New Jersey license and malpractice. Must have excellent skills in both C&C and surgery. Must be very personable, friendly and ethical. Could lead to a good opportunity for the right person. Please Contact By Email: LADYFOOTDOCTOR@AOL.COM

PARTNER WANTED - COLORADO

State-of-the-art practice with EMR and digital x-rays, in our physician-owned Medical Office Building and Surgical Hospital. Focus on Sports Medicine, pediatric and adult flatfoot, bunion surgery, and homeopathic care. Great opportunity for self starter. Please send CV and letter of introduction to: greg@stilwellfeet.com.

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 full-time podiatrist in a multi practice location in the Chicagoland and Northwest Indiana area. Must have two years of surgical residency. Please e-mail resume to d-kitchens@footexperts.com

ASSOCIATE POSITION - NORTHERN VIRGINIA/DC SUBURB

Excellent practice associate leading to partnership opportunity for PSR 24-36 foot and ankle surgically-trained physician. Currently 4-doctor/2 office practice in fast-growing area, expanding to 5 doctors. Hard working, personable, highly-motivated individuals needed. Great opportunity with excellent salary and benefits. No nursing homes.Top hospitals. Fax CV with references to 703-491-9994

PRACTICE FOR SALE – CALIFORNIA

Practice is available immediately for sale in sunny Capitola, CA. The office space is available for lease or month-to-month. The practice has a loyal patient base which is mostly home visits and skilled nursing facilities in Santa Cruz county. The practice can be moved to another location or merged with an existing practice. Asking price $35,000.00. dtarsky@gmail.com

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

ASSOCIATE POSITION - CALIFORNIA

Looking for OUTSTANDING 3-year residency-trained Dr. July 2009. This is the first Concierge odiatry practice in the U.S. Applicant MUST have been in top 10% of their class, Have excellent residency training and personality to match, {the total package}. This practice is about excellence and service. Contact. Ivar E. Roth DPM/MPH, ifabs@earthlink.net 949-650-1147

MINNESOTA - IMMEDIATE OPENING

Well-established practice with 8 offices in the Minneapolis metro area seeking a highly motivated PSR 24/36 trained podiatrist for a full time or part time associate position. ABPS certified, qualified or eligible preferred. Excellent income potential with benefits including health insurance, malpractice insurance, relocation expense, association dues, license fees, hospital dues, continuing education expense. Possible buy-in or buy-out in future. Heavy emphasis on surgery and sports medicine with minimal RFC. Please e-mail CV to footandankledoc22@hotmail.com

PRACTICE FOR SALE - MINNESOTA

Minnesota-2 well established prime office locations for sale in the Minneapolis suburbs. Great income potential with large MD referral base .Can purchase one or both offices together. 175k gross/ each office. Owner will help with transition. Please e-mail minnesotadpm@live.com

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 – VIRGINIA

Well-established 2-office private practice in central Virginia, completely automated, modern, full scope of foot and ankle care. Position requires hindfoot/ankle reconstructive and trauma surgery experience. External fixation experience helpful. ABPS BQ/BC. Competitive base salary, incentive plan, malpractice, health insurance, retirement plan, vacation & other benefits. Partnership option available. Forward CV and letter of intent to: admin@vfasa.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

WEEKLY SPECIAL - One week of ads (5x) for $89 One month of ads (20x) for $340 .

PM 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 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.