The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

September 30, 2010 #3,971 Publisher-Barry Block, DPM, JD

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Rocker Shoes Good Only for Selected Patients: CA Podiatrist

Rocker shoes all make similar alluring promises: burn more calories, tighten your glutes, improve your posture, etc. Podiatrists and personal trainers say some of the promises may be true, but everyone's different and will get different results. Craig Garfolo, a California podiatrist, has tried Shape Ups but wasn't convinced that they would benefit him. He does suggest them for some of his patients with certain types of foot and ankle troubles. "Shoe therapy can certainly be an important part of treating foot problems and can sometimes be just what the doctor ordered," Garfolo said.

Dr. Craig Garfolo

"The bottom line is that each of these shoes are similar yet have their own little tweaks," he added. Garfolo doesn't recommend one brand over another, but he advises trying them out in the house for a couple of days so you can return them if necessary. "As with many things, one person may love them and another not at all."

Source: Ann Sheldon Breitler, Stockton Record [9/28/10]

IL Podiatrist Discusses Preventive Foot Health

Continuing its efforts to educate, inform and empower the people of Chicago, SAVE THE PATIENT, a not-for-profit patient-focused organization hosted its 25-minute live call-in show, “Community Health,” on Chicago Access Network (CAN-TV) on Monday, September 27, 2010 on Channel 21.

Dr. Neal Frankel Treats Patient

Monday’s program featured Dr. Neal Frankel, Director of A Foot & Ankle Centre, which specializes in foot and ankle surgery and sports medicine. He discussed preventive measures for proper foot and ankle health and what steps to take to avoid sports injuries to the foot and ankle. Dr. Frankel is President of Advanced Foot & Ankle Specialists, a network of credentialed podiatrists from Illinois, Indiana, and Wisconsin, whose efforts have improved the way foot care is delivered to patients.

Source: Guliz Sonmez, Chicago Tibune [9/25/10]

MO Podiatrist Re-Appointed to Gentic Advisory Board

Gov. Jay Nixon has announced his appointment of Dr. Tracy M. Reed, of Florissant, to the Missouri Genetic Advisory Board. The committee advises the Missouri Department of Health and Senior Services in all genetic programs including metabolic disease screening programs, hemophilia, sickle cell anemia, and cystic fibrosis programs.

Dr. Tracy Reed

Dr. Reed is a board-certified doctor of podiatric medicine in private practice and is a fellow of the American College of Foot and Ankle Orthopedics and Medicine. The Governor has re-appointed her for a term ending April 9, 2012.

Source: Kirksville Daily Express and Daily News [9/27/10]

Query: Rotation Flap for Squamous Cell Cancer

I have done my share of flaps for various skin lesions and cancers, but I have one that is leaving me wondering. The patient has a squamous cell carcinoma in situ on the plantar aspect of the left 3rd toe and would like to try to avoid an amputation. In any other location, guided by frozen sections, I would do a rotational (or other appropriate) flap to cover the excisional defect.

Squamous Cell Cancer

This lesion is just slightly distal to the flexion crease, so my flap base would have to start on the plantar ball of the foot and cross the flexion crease. Has anyone done a flap in that location? How did it work? Can the flap cross a point of motion like that and hold up? I strongly feel the excision would be too wide to cover in this location, and I will end up deciding to do a primary toe amputation. Suggestions welcome.

David E. Gurvis, DPM, Avon, IN

Query: Extortion By Patient

We have a patient who underwent an osteotomy and was extremely non-compliant in the post-operative period. He took off his walking cast and played a softball game, for example. Not surprisingly, he developed a non-union. We provided a bone growth stimulator to him at no charge, but the surgical fracture failed to heal. He was offered another surgery, but elected to have it performed by another doctor, who subsequently left the patient with a bill around $1,500. Now the patient has approached us to "take care of his bill or he will sue."

Clearly the case, if filed, would be extremely defensible, but the cost of the lawyer and subsequent increased premiums even if we win would be higher than the amount we are being extorted for. This is certainly novel, and in exchange for a signed release by the patient preventing him from suing, it looks like we are going to fork over the money for the bill. I feel like turning him over to the cops, but I imagine that would cause him to sue for sure. What is the world coming to when doctors get extorted by patients? Has this ever happened to anyone else? What should I do?

Name Withheld

RE: Cosmetic Foot Surgery (Gary S Smith, DPM)
From: John Scheland, DPM

While I agree with Dr. Smith's point regarding the questionability of cosmetic foot surgeons, I take issue with the comment that physicians are no longer the example of moral character and good judgment.  Physicians are the LAST example of moral character and good judgment! Who is the shining example if we are not? Politicians? Lawyers? Bankers?  No other profession has taken the financial, regulatory and public relations assault like the medical profession. Yet despite these pressures, as a whole, it is the members of the medical profession who maintain the high level of professionalism and integrity that remains unmatched by any other profession, bar none! 

Dr. Smith's comments are reflective of the fact that we have lost control of the narrative within our own profession. We let insurance companies determine how much our services are worth; we let lawyers determine standard of care and let politicians portray us as less worthy of public trust than they are (what a joke!).  When I take someone's child to the operating room, I understand the level of TRUST given to me by the hospital, state, and most importantly the parents. If that trust isn't manifest of moral character and good judgment, I don't know what is.  
 
John Scheland, DPM, Clarks Summit, PA, limblengthener@yahoo.com

RE: Cosmetic Foot Surgery (Gary S Smith, DPM)
From: Richard Boone, Esq.

Physicians who are considering doing foot surgery for purely cosmetic reasons would be well advised to consider the legal and risk management ramifications of such procedures before agreeing to perform them.
 
From the legal point of view, a purely "cosmetic" procedure presents the physician with special problems in terms of payment and reimbursement as well as special issues in terms of informed consent, to mention just two examples. In other words, you cannot get paid in your usual manner, and you should not even consider using your normal consent form.

From the risk management standpoint, cosmetic procedures have historically generated a higher rate of malpractice claims than other forms of surgery. The cosmetic procedure is only a success if the patient is subjectively satisfied with the appearance of the foot following the procedure. Usual standards of judging clinical outcomes are not always applicable. And there may even be questions about whether your malpractice policy covers such procedures. 
 
My point isn't that one should avoid doing "cosmetic" foot surgery. That's really up to the individual physician, and there is no legal prohibition against cosmetic foot surgery so long as it is within the scope of practice in your jurisdiction. But a cosmetic foot procedure is legally very different from a normal therapeutic procedure, and the surgeon needs to consider and make adjustments for those differences before the procedure begins.
 
Richard W. Boone, Sr., Fairfax, VA, RWBoone@aol.com

RE: Meaningful Use Requirements (Mark K Johnson, DPM)
From: Alan L. Bass, DPM

It is not necessary to have billing software in order to meet meaningful use requirements. EMR software must meet meaningful use requirements. Unless you choose to send out your billing to a billing service, practice management software that includes both EMR and billing should be the way to go to make it all-inclusive. APMA recently held a webinar to discuss EMR and meaningful use. This webinar is in the archives on the APMA website.

It is important that you choose a software that meets all the requirements. The government recently selected CCHIT to be one of the certifying bodies to determine if an EMR program meets meaningful use. No matter what program you select, even if it has previously been CCHIT-certified, it must now meet the meaningful use standard. TRAKnet DPM, is an all-inclusive practice management system that incorporates EMR, billing, scheduling, and inventory management all in one system. They are in the process of not only being CCHIT-certified, but will also meet the meaningful use standards.

Disclaimer: I am a paid consultant for Biomedix Vascular Solutions, the makers of TRAKnet DPM

Alan L. Bass, DPM, Manalapan, NJ, abassdpm@optonline.net

RE: Scope of Practice (Charles Lombardi, DPM)
From: Daniel Chaskin, DPM, Robert Bijak, DPM

I respectfully must disagree with Dr. Lombardi and agree with Dr. Robert Bijak. I am thankful to Dr. Bijak for encouraging podiatrists to complain about  our profession as it is. I am very grateful to Dr. Bijak for bringing up the topic of “forgotten podiatrists.” This, I define as podiatrists who are unfairly discriminated against because they did not complete baseline criteria, an outdated certified residency training program not related to their current competence.

If baseline residency criteria is required, it should be required to be current. This problem is now worse because of the residency shortage and that not every podiatrist can currently obtain a podiatric residency. I am very grateful to Dr. Lombardi for all that he has taught me, and I am grateful to have benefited from listening to his lectures.

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

In answer to Dr. Lombardi's questions to me. First: No, I never started a residency. In my day, most podiatrists were lucky if they could get THEMSELVES in a small DO hospital and do a simple McBride. Most podiatrists, then, had little or no training post-podiatry school themselves. The schools left us out in the cold. Second: have you ever mentored a student or ever talked about podiatry. Yes, I have. I told them in all honesty, if they could get into medical school, go there first. I told them about the political infighting in podiatry. I told them about the reluctance of the profession to work for a full scope license, the lack of parity, and how podiatrists...

Editor's note: Dr. Bijak's extended-length letter can be read here.

RE: Does My Insurance Cover This?

Loaner Foot?

Source: Submitted by Steve Abraham, DPM

PART-TIME PODIATRIST NEEDED ASAP CHICAGO

Part-time podiatrist needed for 2 offices in Chicago with an average of 20 hours/week. Must have Illinois license. Must have completed 2 years of surgical residency. If qualified, email to f-massuda@footexperts.com

NORTHEAST OHIO PODIATRY OPPORTUNITY

Western Reserve Senior Care, an innovative home visit practice that makes visits to seniors in assisted living facilities and SNF’s, is recruiting for a Part-Time Podiatrist. Make a true difference as you make visits to homebound seniors while managing the full scope of podiatric disease. This opportunity offers a perfect balance of superb lifestyle and excellent compensation. Practice is affiliated with world class health systems in Cleveland, OH. Email CV to wmills@westernreserveseniorcare.com

IMMEDIATELY AVAILABLE- ASSOCIATE POSITION -CT (FAIRFIELD AND NORTH HAVEN)

Great opportunity. Join one of the largest podiatric groups in Connecticut. Well-established and progressive offices. Electronic medical records, digital x-ray, diagnostic ultrasound, Padnet vascular studies, nerve conduction studies, pinpoint and CO2 lasers, electrical stimulation and ultrasound therapies. Seeking a well-trained, personable, and highly motivated individual. Please send resume and current photo to dr.kassaris@yahoo.com

ASSOCIATE POSITION – LONG ISLAND, NY

Associate full-time. Well-established, busy, well-rounded podiatry practice looking for a motivated podiatrist. Suffolk Co. LI NY. Board eligible, Board certified PSR-24/36 trained. Fax resume to 631-581-0857

ASSOCIATE POSITION - WEST COAST, FLORIDA

Outstanding opportunity for PSR-36 graduate to join successful group podiatry practice in Summer 2011. Seeking a sociable, articulate graduate who is confident in rearfoot and ankle reconstructive cases but also enjoys all phases of podiatry. Long-term opportunity for the right candidate with generous pay and benefits. Reply to jwicks@cortezfootandankle.com

ASSOCIATE WANTED - DELRAY BEACH FLORIDA AVAILABLE IMMEDIATELY

Rapidly growing well established practice seeking part-time leading to full-time. PSR 12-36. Great opportunity for highly motivated, personable individual. Please reply by emailing a CV to nursebsf@aol or fax (561) 498-9068.

ASSOCIATE POSITION - FREDERICK, MARYLAND

Well-established group practice is located only 45 minutes from both DC and Baltimore. Immediate opening for a minimum PSR 36 Podiatrist for full time position. We have it all: EMR, digital x-ray, ultrasound, ASC, etc. Excellent salary with bonus structure and benefits. Please email resume to docsbnb@aol.com

PRACTICE FOR SALE - NORTHEAST COLORADO/SOUTHWEST NEBRASKA 
 
Practice is a good mix of biomechanics, diabetic care and surgery.  Revenue could be increased by well-trained surgeon. No HMO's. Low overhead. Only podiatrist in the area. Please contact mld9439@live.com for more information.

PRACTICE FOR SALE - MARYLAND, DC SUBURB

Great opportunity. Retiring after 38 years in practice at the same location. Practice is fully equipped with digital x-ray, diagnostic ultrasound, computer network, orthotic scanner and state licensed ambulatory surgical center that is fully equipped. Owner will stay on as needed for easy transition. dpmpracticeforsale@yahoo.com

AMBULATORY SURGICAL CENTER PRIVILEGES AVAILABLE - NJ

Privileges available in a new 2 ORs. New certified multi-specialty ambulatory surgical center in Fairlawn, NJ - 8 minutes to the George Washington bridge. Specializing in podiatric surgery. Center will pick up and return patient home. Syndication is available. Center will accommodate doctors in Manhattan, Queens, Brooklyn, Bronx, Staten Island, and long Island. Will assist in getting NJ License. Call for information (516)476-1815 e-mail podo2345@aol.com. To view center, go to FAIRLAWNASC.SHUTTERFLY.COM

MEDICAL SPACE AVAILABLE- MANHATTAN

Multispecialty Medical Building with 24/7 doorman. Prime Luxury Building and Location, Gramercy, Stuyvesant, Peter Cooper Area. 305 Second Avenue (17th-18th). Prior tenants past 23 years; podiatrist, dentist (plumbing/electric intact), internist. Ideal for podiatry, co-share with dentist, MD, etc. (flexible lease terms). E-Mail; jbdrun@aol.com

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