The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

October 21, 2010 #3,989 Publisher-Barry Block, DPM, JD

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PA Podiatrist Discusses Treatment of Warts

Warts can be the nemesis of many a kid, and mom who wonders how to get rid of them. And trying to avoid them is tricky at best, doctors say. “It’s like trying to avoid the common cold. Just like some people get colds or allergies or poison ivy, some people gets warts while others don’t,” said Dr. Terry Clarke of Keystone Podiatric. “All of our immune systems and how we react to the environment are different.”

Dr. Terry Clarke

The first line of treatment is usually debridement — or cutting down of the wart — and application of a salicylic acid or a chemical called cantharadin that causes the wart to blister, Clarke said. Patients usually need to return for about six weeks for more treatments and apply salicylic acid daily at home in between visits, he said. “Non-compliance at home is the No. 1 reason that this treatment doesn’t work,” Clarke said. Warts may also be “frozen” off with liquid nitrogen, surgically cut out under a local anesthetic in the doctor’s office, or treated with laser therapy.

Source: Pennlive.com [10/19/10]

Runners' Feet Should Never Hurt: NC Podiatrist

While many runners pay close attention to eating right, stretching, and picking out a cute running ensemble, they often neglect their most important asset: their feet, said Dr. Stephen Kinard, podiatrist at Foot and Ankle Associates of North Carolina in Rocky Mount. “Think about it: Every sport and everything we do, we still have to walk on our feet. More so than anything else you use every day, your feet take the most pounding,” Kinard said.

Dr. Stephen Kinard

Common injuries faced by runners include plantar fasciitis and Achilles tendonitis, which are inflammations that cause heel pain; shin splints; stress fractures; and blisters. What’s worse, foot problems can lead to pain in the shins, knees, hips and lower back, he said. Many runners try to treat these injuries themselves, and sometimes they can, Kinard said. But if the problem escalates or runners are training for a major race, they need to have the injury seen by a doctor. “You get a lot of patients that get stress fractures that are running so much they don’t know it because they are used to their feet running all the time and they think that it is okay. Your feet should never hurt,” Kinard said.

Source: Laura McFarland, Rocky Mountain Telegram [10/18/10]

Orthopedists are Obstacle to Improving Scope Law: NY Podiatrist

New York State’s best podiatrists are moving to other states because of laws limiting them from working on the ankle, says an administrator from the largest and oldest podiatry school located in Harlem. In June, the state Senate passed a measure that will increase the scope of podiatry to ankles. The General Assembly will now vote on the issue.

Dr. Eric Walter

However, this may take some time, explains podiatrist Eric Walter, who is also a member of the New York Podiatric Medical Association. Walter says the association has been trying for more than six years to change this law and has seen some of his best residents leave New York during this period. “Our biggest nemesis is the orthopedic surgeons who feel like we don’t have the right training,” says Walter.

Source: Zaheer Cassim, The Uptowner [10/19/10]

Sentencing Delayed For NY Podiatrist Because of New Charges

A former podiatrist who practiced in Gates, NY, and pleaded guilty to bilking more than $400,000 from Medicare is now facing allegations that he provided patient care without a medical license, according to a Democrat and Chronicle news report. The new allegations against Michael Akyuz accuse him of continuing to trim toenails for former patients, despite surrendering his medical license for three years, and collecting money for the services from the patients, according to the report.

Mr. Akyuz told the district judge that he was clear with patients about no longer being a physician, and that he was attempting to build a business around trimming toenails that didn't require a medical license. However, prosecutors are accusing Mr. Akyuz of knowingly posing as a physician, according to the report. Mr. Akyuz' sentencing has been delayed as a result of the newly emerged allegations. He was initially brought to court because of allegations that he had submitted fraudulent bills to Medicare from 2003-2008 for invasive procedures that were never rendered, according to the report.

Source: Jaimie Oh, Becker's ASC Review [10/14/10]

FL District Court Judge Allows Health Reform Lawsuits by States to Proceed

A U.S. District Court judge in Florida on Oct. 14 said states have jurisdiction to sue the federal government over the health reform law, and specifically its provisions that compel individuals to buy health insurance. Judge Roger Vinson said two of the six counts can proceed, including the individual mandate and Medicaid expansion. On Dec. 16, Vinson will hear motions for summary judgments from the federal government and the states challenging the law.

Arguments in a similar lawsuit filed by the state of Virginia will be heard in federal court in Richmond on Oct. 18. Comparable lawsuits in California and Maryland have been dismissed by judges. U.S. District Court Judge George Caram of Michigan on Oct. 7 ruled that the health reform law is constitutional and that Congress can require people to purchase health coverage.
 
Source: AIS's Health Reform Week [10/18/10]

Start Presentations with a Dynamic Opening

Grab your audience’s attention with your opening words, and you will find it easier to retain it as you move through your prepared remarks. Here are proven techniques for engaging your audience members:

•  A rhetorical question. “If I could guarantee you X, what would that mean for you?”
•  A real question. “How many of you are experiencing X today?”
•  A quote. “As Winston Churchill said during the darkest days of the Second World War, ‘Never, never, never give up.’ ”
•  An anecdote. Share a brief story—real or fictional—illustrating the value of what you are going to say.
•  A startling statistic. “Every year, organizations like ours lose $10 million dollars to …”
•  A demonstration. Do something physical to grab your audience’s eyes. Example: Shred a document to demonstrate your organization’s departure from old policies.
•  Humor. You can lighten the mood and increase rapport if you can set your audience laughing. But do not tell a joke unless you are convinced that you can elicit laughter.

   Source: Adapted from Write to the Top: Writing for Corporate Success, Deborah Dumaine, Random House via Communication Briefings

Query: Bilateral "Burning" Heel Pain 

My patient is a 52 y/o white female with a three-month history of bilateral heel pain (right > left). She described the pain as “pain and burning.” Her past medical history includes COPD, migraine headaches, hypertension, kidney stones, frequent diarrhea, and hypothyroidism. The patient also has chronic neck, low back, elbow and knee pain. Medications include Carvedilol, Diovan HCT, levothyroxine, Singulair, and Vytorin. Physical, radiographic, and ultrasound exam revealed that the patient was suffering with bilateral plantar fasciitis. 

Bilateral "Burning" Heel Pain

Vytorin was discontinued initially with no improvement. Home stretching, home physical therapy, and removable arch padding were applied with no improvement. A round of prednisone and off-the-shelf orthotics worsened the condition. The patient was placed in a CAM walker with only limited success. A dexamethasone phosphate injection provided very temporary relief. Coblation to the plantar fascia on the right heel failed. I dispensed Lyrica and referred the patient to a rheumatologist who found a detectable HLAB27 allele. She was recently placed on Cymbalta. I would appreciate any suggestions.

Howard Gale, DPM, Statesboro, GA

Query: Applying for EMR Incentive Payments

I have just purchased an electronic medical records system for the practice. The system has been approved (CCHIT) for the government's incentive program. How do I apply for the funds?

David T. Weiss, DPM, Richmond, VA

RE: PECOS Deadline Approaching Fast
From: Paul Kesselman, DPM

January 3, 2011 is fast-approaching. Today, the National Government Service Medicare Contractor conducted a webinar on PECOS. It is important to note that NGS is not empowered to change this CMS mandate, yet while they are sympathetic to the deadline, NGS offered no expansion of its provider services capabilities and the hold times are often as long as two hours.

While NGS’ bulletin and webinar claims there is only a 45 to 60 day window for application processing, the reality is the usual time in the ”cue” for a completed application is 90-120 days. Since most applications have some error(s), the reality is that most applications take even more time to complete.

If this CMS mandated deadline is not changed, all claims submitted after January 3rd 2011 which require a referring/prescribing/or ordering entity who is not enrolled in PECOS, will be denied. This includes but is not limited to all at-risk foot care claims, DME, diagnostic testing (inlcuding laboratory and imaging studies), and prescriptions filled by pharmacies under Medicare Part D.

Most important to note is that: Enrolled physicians and non-physician practitioners who do not have enrollment records in PECOS and who submit enrollment applications in order to get their enrollment information into PECOS should not experience any disruption in Medicare payments, as a result of submitting enrollment applications. This is only true if you are not changing your enrollment record (tax identifier, address, business structure, etc.). For this latter scenario, payments will cease until your new enrollment is completed.

I strongly urge all providers to reach out to their CAC reps and their state component societies for further guidance on this very important matter.

Paul Kesselman, DPM, Woodside, NY, pkesselman@pol.net

RE: Doctor (DPM) Doctor?
From: Raef M. Fahmy DPM

I have been reading with interest the posts on PM News concerning the future course of podiatric medicine and surgery. I have been practicing podiatric medicine and surgery for 20 years, and was trained at a surgical residency and entered a private practice. I have also been fortunate enough to become involved in hospital leadership and administration positions, serving as a VP of Medical Staff, President/Chief of Staff, Medical Director of Clinical Informatics, chaired the credentials and MEC committees, and sat on the Board of Directors as a trustee/ member of the executive council, at a non-profit 450 bed hospital with a staff of 550.

What is evolving is a standardization of the delivery of medical care and the education of the healthcare provider no matter the discipline. Podiatry must either change our degree or transform our education and training programs to match the allopathic and osteopathic standards. We perform the same procedures, order the same studies and tests, formulate the same treatment plans, and delivery of quality care. There is no reason to isolate ourselves, complain, and accuse. We eventually will need to match the same standards set for all providers delivering comparable care. That is the reality, and it is coming soon.

Change is the only constant in the current healthcare landscape. Our industry is being held accountable for its outcomes by the federal government and public organizations. The standards for education, training, and current clinical competency for the provider, along with disease management, are in the process of changing and the bar is set high. It is time for our leadership to be proactive and address these issues very soon.

Raef M. Fahmy, DPM, Manchester, NH, fahmyman@pol.net

RE: Twitter This

This patient was Twittering throughout her bilateral hallux matrixectomy procedure today, and then she took this photo after I bandaged her toes. She sent it out to all her friends.

Smile, You're on Candid Camera

I hammed up the bandage a bit, because I knew it would be broadcast.

Keith Gurnick, DPM, Los Angeles, CA

ASSOCIATE POSITION – NORTH, CENTRAL & SOUTHERN 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 are available. If interested, fax curriculum vitae to 847-674-2113 or e-mail to feetwork@aol.com

IMMEDIATELY AVAILABLE- ASSOCIATE POSITION - DAYTON, OHIO

Join a well-established modern practice with an excellent reputation and referral base. Base salary $100,000 and benefits with a bonus structure. EMR, diagnostic ultrasound, all aspects of DME, Padnet vascular studies, and CO2 lasers. We seek a surgeon that is well trained, personable and motivated to join our group of 3 Podiatric Surgeons. Would like this individual to buy in the practice eventually. Please send resume and photo to Ohiodoctors@aol.com

ASSOCIATE POSITION - NYC, NY

Part/time, full/time associate for busy, well established multi-doctor, multi-office NYC group. Seeking motivated, ethical, NYC licensed DPM with excellent office management and clinical skills in all phases of Podiatry. Board Qualified/Certified preferred. Salary plus incentives, pension/medical/dental. Partnership potential. Fax CV to 631-369-6570.

PART-TIME / FULL-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

PART-TIME ASSOCIATE PODIATRIST WANTED - CENTRAL NEW JERSEY

Growing practice in need of an outgoing, hard-working associate. House calls, nursing homes and a busy, well-established office setting. At least a PSR12 preferred. Fax CV to 732 699 1901.

PART-TIME/FULL-TIME PODIATRIST NEEDED - INDIANA

Part-time full-time Podiatrist needed for our Indiana offices. Must have Indiana license. Must have completed two years of surgical residency. If qualified email to f-massuda@footexperts.com

ASSOCIATE POSITION – LONG ISLAND

FT/PT Associate position available with busy multi-office podiatry group on Long Island. Our practice is state-of-the-art, and encompasses all phases of podiatric care. We welcome new practitioners, or someone who would be open to merging a smaller practice with ours, and benefitting from our practice management overlay. We also invite residents graduating in 2011 who want to practice on Long Island to apply for this position. Compensation includes competitive salary and bonuses. Vacation pay and malpractice insurance are also offered with a full time position. Please send your CV by fax (631) 293-3462 or e-mail to mets724@gmail.com

PART-TIME PODIATRIST NEEDED - LOS ANGELES, CALIFORNIA

Busy Podiatrist looking for assistance with patients located in facilities, homes, office etc. Flexible hours, independence, and great compensation. If interested email CV to homefootcare@hotmail.com or call Terri at 323-353-8103.

ASSOCIATE POSITION - NORTHERN NEW MEXICO

Associate needed for a dynamic group practice in Northern New Mexico. We are looking for a well-trained 3-year surgical resident to help us build our practice leading to partnership. In New Mexico we have a leg law. Besides a great professional experience, we have the mountains for skiing, fishing, hunting, and horseback riding. Ideal for an experienced podiatrist looking for a location change. Please send a resume to FootandAnkleAssociates@comcast.net

ASSOCIATESHIP - MARYLAND

A great opportunity to join and gain ownership interest of a well established, diversified practice in Maryland. 2-year residency needed, EHR, ultrasound, ASC, hospital close by with wound care center. Fax resume to 410-749-6807.

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

SPORTS MEDICINE FELLOWSHIP

The Palo Alto Medical Foundation Surgical/Sports Fellowship Aug 1, 2011 thru July 31, 2012. APPLICANTS MUST BE ABLE TO OBTAIN A CALIFORNIA LICENSE. Responsibilities include assisting in all types of foot and ankle surgery (approximately 500 cases), seeing patients in the sports clinic and completing 2 papers/research projects. Benefits include salary of $56,500/yr, medical, dental, malpractice, and CME allowance. Interviews at the Midwest Podiatry Conference Mar 3-5, 2011 & ACFAS Mar 8-10, 2011, but on-site visit is preferred. Minimum 24-month surgical residency training pre-requisite. Send a letter of interest, CV and three letters of recommendation to: Amol Saxena, DPM. HeySax@AOL.com

TRAUMA FELLOWSHIP - FOOT & ANKLE

Broadlawns Medical Center in Des Moines, IA is currently accepting applications for its 12 month trauma surgery fellowship beginning August 1, 2011. Fellowship to include advanced techniques in all foot and ankle surgery with an emphasis on lower extremity trauma, reconstruction & total joint replacement. Residency training required. Competitive salary and benefits. Please submit a letter of interest, CV, and 3 letters of recommendation to: Ben Olsen, DPM, Director: Foot and Ankle Trauma Fellowship, Broadlawns Medical Center,  1801 Hickman Road, Des Moines, IA 50314, 515-282-7927,  bolsen@broadlawns.org 

ACTIVE PRACTICE FOR SALE - NEW YORK CITY

Part-time practice available Mid-town Manhattan. Doctor is retiring. (212) 247-5148.

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

PM News Classified Ads Reach over 12,500 DPM's and Students

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