The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

October 30, 2010 #3,997 Publisher-Barry Block, DPM, JD

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PA Podiatrist is Among Doctors Paid By Pharmaceutical Companies on Posted Database

Warren Joseph is a podiatrist on a mission. He wants the medical world to become better informed about the devastating consequences of diabetic foot ulcers. He says he has no problem that Pfizer, the world's largest drug company, pays him to get the word out. Since 2009, the Roxborough foot doctor has made $67,000 in speaking fees, plus $4,600 for consulting and $13,000 in expenses. The bigger point, Joseph says, is that diabetic foot ulcers cause more than 80,000 amputations each year. By getting the word out, "I'm saving limbs," says Joseph, who specializes in treating diabetics.

Dr. Warren Joseph

He is among thousands of doctors in the United States who are paid by the companies making the drugs they prescribe. Many critics see this as a conflict of interest that's damaging to the medical profession and, ultimately, patients. They question whether doctors can be objective about prescriptions when drug companies pay them handsomely. Last week, a database showing how much money the seven biggest drug firms have paid physicians was launched by the non-profit investigative reporting group ProPublica. The list covers 17,700 individuals who have amassed $258 million in payouts since 2009.

Source: Faye Flam, Philadephia Inquirer [10/28/10]

Brothers Appointed as President and VP of AR Podiatric Medical Association

Drs. Kenneth P. Seiter Jr., and Jason L. Seiter, were appointed president and vice-president, respectively, of the Arkansas Podiatric Medical Association at the group’s annual meeting in October. They will serve two-year terms. Drs. Kenneth and Jason Seiter are brothers who provide general podiatry as well as foot and ankle reconstructive surgery at Sparks Foot and Ankle Center.

Drs. Kenneth P. Seiter Jr., and Jason L. Seiter

The purpose of the Arkansas Podiatric Medical Association is to provide annual education to podiatrists, discuss political action regarding podiatry, promote the profession of podiatry, and ensure quality service to patients from podiatrists in Arkansas.

Source: The City Wire [10/27/2010]  

OR Named in Memory of Beloved NY Podiatrist    

Over 70 doctors, friends, and families gathered on Wednesday night at the Gramercy Surgical Center on the East Side of Manhattan to honor the memory of Dr. Robert Piccora, a talented podiatric surgeon and residency director who passed away suddenly in March of this year.

(L-R) Mrs. Myrna Piccora with children Christine and Nicholas

Dr. Piccora was the former head of the Department of Podiatric Surgery at St. Barnabas Hospital in the Bronx. Among the notable podiatrists in attendance to pay tribute to Bob were Drs. Renato Giogini, Michael Trepal, and Kevin Jules from the New York College of Podiatric Medicine, and Dr. Robert Rampino, past president of the New York State Podiatric Medical Association.   

No-Nonsense Seminar Well-Received

The Greater Texas Education Foundation held their first "No Nonsense" Seminar, October 22-24, 2010 at the Hotel Monteleone in New Orleans.  It was attended by 100 DPMs and according to Samuel Mendicino, DPM, FACFAS, Chairman of the meeting, "The relaxed, casual approach was well-received by the audience and faculty. The feedback was very positive and we plan to repeat this seminar in Key West in October 2011."

GTEF Faculty, "No Nonsense" Seminar, New Orleans, 2010

The Greater Texas Education Foundation supports the West Houston and Kingwood Medical Center's PM&S-36 residency programs in Houston, Texas.

New Scan Technology Positively Identifies Patients

Being identified at UW Health is now a hands-on experience. Check-in clerks are using devices that scan vein patterns in palms to link patients to their electronic medical records. The scans can also help emergency room staff identify patients unable to speak.

Hand Scanner (Photo: John Maniaci)

Until the scanners were introduced this month, patients gave their name, date of birth, address and other information when entering UW Hospital or UW Health clinics. But errors can occur because some patients have the same names, said Mike Sauk, UW Health's chief information officer. Insurance fraud and identify theft also are concerns, Sauk said. "With the palm scanner, there is no doubt who you are," he said. "And if you're unconscious, we just need to have a palm."

Source: David Wahlberg, Wisconsin State Journal [10/26/10]

Query: Web-Based EMR Systems

I am researching EMR providers and it seems to me that a "web-based storage" system has an advantage over an "in-office server" system when the practice has more than one office. Is this true? What are the advantages and disadvantages of a web-based system?
 
Kevin McDonald, DPM, Concord, NC

Query: Patient Balances and Rescheduling Office Visits

I need some information regarding the handling of patients who are ignoring (not paying) their statement balances. Can we, technically, not schedule patients until they pay their long-standing balances? We don't want to discharge them from our practice, just postpone their non-emergent appointments...until they pay their account. We would certainly see patients with emergencies.

I would like to print the following on their statements: "Failure to pay this balance may result in future appointments being rescheduled."  Would this be reasonable? Is it ethical?

Name Withheld by Moderator

Response: My suggestion would be to refrain from putting the suggested statement in your form. I recommend that you simply handle this on a case by case basis. While I have not researched this, I believe that a Medicare participating doctor can decline to accept a patient in the first instance, but once he or she does so, you must continue to see them or terminate the relationship (versus just putting them in suspended animation as you suggest).

From a risk management perspective, I also don't like the suggested language - it could be used against you by a disgruntled patient in a number of ways if there were any problems with your care.

J. Kevin West, Esq., Boise, ID

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RE: Long-Standing Tumor (Tip Sullivan, DPM)
From: Donald Arenson, DPM, Bryan C. Markinson, DPM

The tumor appears to be a neurofibroma. Check the patient for cafe au lait spots.  The best advice....leave the tumor alone.  Complete resection will be impossible and recurrence rates are extraordinarily high.

Donald Arenson, DPM, Elmhurst, IL  darenson@pol.net

Dr. Sullivan presents an interesting case of a very large tumor reportedly of ten years duration and asks for recommendations. I recommend the following: MRI WITH contrast before any "incision." If the tumor is vascular - get rid of it - send to either an interventional radiologist or vascular surgeon. If not vascular, perform a needle biopsy with Tru-Cut type device, or open incisional biopsy and closure.

When results become available - if benign, plan an excisional biopsy with perhaps a plastic surgery consult for redundant skin management. If malignant, refer to a musculoskeletal orthopedic oncology surgeon.

Bryan C. Markinson, DPM, NY, NY, bryan.markinson@mountsinai.org

RE: Long-Standing Tumor (Tip Sullivan, DPM)
From: Charles Morelli, DPM

During our most recent trip to Nicaragua, my colleague Jeffrey Siegel from Philadelphia, saw a patient who presented with a similar condition. One of the residents videotaped the entire surgery and a 9 minute video of that surgery is posted on Youtube. 

Watching this video may help you in dealing with your patient. You had mentioned that you are considering a staged procedure. One thing we were rarely able to do when we got to Central America was to perform any "staged" procedures. The entire procedure usually needs to be addressed at that time. What I can tell you is that we have heard that this patient is doing very well, that there was no need for any plastic reconstruction, nor was there any soft tissue damage or complication post-operatively. After excising a large ellipse of skin and then the tumor, the incision was successfully closed primarily.  
 
Charles Morelli, DPM, Mamaroneck, NY, podiodoc@gmail.com

RE: Pfizer No Longer Detailing Podiatrists? (Lesley Wolff, DPM, MS)
From: Multiple Respondents

I have found that the only detail representative that still comes to my office is the Pfizer rep. They are much more stingy with samples, but I would say a minimum of once a month, and sometimes he stops by twice a month.

Frank Lattarulo, DPM, NY, NY, doclatt@aol.com

That would be news to me as well. I am a speaker for Pfizer and they detail my office frequently. At the least, my reps have not heard of this. I will report back should I hear something differently.
 

Jon Purdy, DPM, New Iberia, LA, podiatrist@mindspring.com

I have found that the only detail representative that still comes to my office is the Pfizer rep. They are much more stingy with samples, but I would say minimum of once a month, and sometimes he stops by twice a month.

Frank Lattarulo, DPM, NY, NY, doclatt@aol.com

I do not know if Pfizer is still detailing podiatrists, but isn’t there is a bigger ethical issue here? Why do you need detailing from a drug company salesperson in the first place? The information they give you may not be accurate and is usually biased. This may influence you to choose more expensive drugs, which may not help your patients in the long run. Also, do you accept drug samples, free lunch, or small gifts from these representatives? These actions may also influence your treatment decisions.

Personally, I do not interact with drug representatives. I do my homework using less biased sources: major medical journals, continuing education conference lectures, the PDR, Internet forums, and speaking with fellow physicians. I do not accept drug samples or gifts at my office. Please consider ending your relationship with Pfizer and all drug representatives.  Say goodbye to sample pills, lunches, dinners, cookies, caramel rolls, mugs, pens, post-it notes, and golf balls. Please visit the website (nofreelunch.org/faqs.htm)  to learn more about this ethical dilemma.

Michael B. DeBrule, DPM, Marshall, MN, Dr.DeBrule@InnovativeFootCare.com 

RE: New Twist on Podiatric Privileges (Ivar Roth, DPM, MPH)
From: Dale Shrum, DPM, Gregory Eirich, DPM

This sounds like restraint of trade. I would contact the local PICA attorney, Keith Greer, Esq. He has defended podiatrists for, I believe, over 20 years. He is located in San Diego. His number is  (858) 613-6677.

Dale Shrum, DPM, La Quinta, CA, dshrumshome@aol.com

I practice in Orange County where the hospitals you mention are located. Your issues are certainly concerning for us as a profession in this area. Some questions that come to mind are whether your current hospital will be doing any orthopedic surgery at all, and if so, why did they eliminate podiatric surgery? If they are moving all orthopedic surgery to the other hospital, then it sounds like you have no recourse. If you need to switch your cases to the other hospital, then as with all hospital affiliates, you will need to reapply for privileges. What the requirements will be are established by the medical staff. 

These are issues that the APMA/CPMA and the Orange County Podiatric Medical Association have been addressing since their inception. Non-members reap the benefits of the precedents established by the national, state, and local associations without being affiliated. As a member, I have phone numbers of resources that I could contact in a heartbeat who would go to bat WITH me. Your situation is difficult, but if you choose to be part of your associations, I know you would have doctors, attorneys, and business managers helping you out. Membership has its privileges. As a profession, we want the best for you and podiatry.

Gregory Eirich, DPM, Tustin, CA, geirich@cox.net

RE: The Future of Medicine (Bob Kornfeld, DPM)
From: Daniel Grapel, DPM

While I appreciate DR. Kornfeld's ability to turn his practice into an insurance-free entity, I strongly believe that this approach is totally unrealistic for an overwhelming number of podiatrists. Positive thinking about professional success is important, but I think somewhat exaggerated. Today's economical and political climate are very bleak and the future of medicine is approaching a low level of socialized medicine similar to the Soviet system of the past. The cost of education is completely out of proportion.

In addition, I would like to state the political incorrect fact that our specialty is an elective service. Our society must have orthopedics, cardiologists, vascular surgeons, urologists, and internists in order to survive. We are a small profession that does not have much political clout. Due to competition and economic pressure, most podiatrists have NO choice but to depend on corrupt insurance companies. Unfortunately, the socialist Obama's administration is helping to destroy this once great health system.

Daniel Grapel, DPM, Bayside, NY, danipod@aol.com

RE: Devolution of Healthcare (David Secord, DPM)
From: Neil H Hecht, DPM

After reading Dr. Secord's PM News posting, all I can say is “Whew!” The public doesn’t remember or understand that private third-party reimbursement originated as a “socialist” function when numbers of people pooled their monthly share into a “kitty” to help pay for medical expenses in an era when doctors began to need actual money for their services as opposed to bartered items.

The administration of such a “socialist” endeavor (the medical “kitty”) eventually evolved into the modern “insurance” company—Now, not actually selling “insurance”, but rather selling a form of managed minimal reimbursement to the suppliers of the care (read “providers- nee: doctors”) while extorting the demanders of care (read “consumers-nee: patients”). How canny of this administering business endeavor to control both supply and demand! That’s why...

Editor's Note: Dr. Hecht's extended-length letter can be read here.

RE: VPMA's Insurer Sues to Recover Embezzled Funds
From: Jean Kirk

Technically, the Keeney Corp is being sued by Travelers Insurance and Casualty. That suit is not on VPMA's behalf, however. The association currently has no relationship with Travelers.

Jean Kirk, Virginia Podiatric Medical Association, vpma@uptonassociates.com

RE: CA Podiatrists Discuss RUC’s Evaluation of CPT Codes (Don R. Blum, DPM, JD)
From: Lee C. Rogers, DPM, James W. Stavosky, DPM

We appreciate the opportunity to respond to Dr. Blum. LCR was interviewed by the reporter for 90 minutes and had follow-up e-mails and phone calls. JWS was interviewed in two phone calls. Other nationally-known podiatrists were also interviewed and not quoted. It's apparent that her goal was to be critical of the RUC process and use any statement to make her point. The statement about "7 minutes to apply a Dermagraft" was taken out of context. She sent LCR a clinical vignette with times to complete all the components of the evaluation and treatment (pre-service, intra-service, and post- service).

LCR told her that the treatment of a 15-year-old girl with a 20% surface area burn was in no way similar to a 60-year-old diabetic with a foot ulcer. While it may take less time to actually apply the skin substitute in a diabetic foot ulcer, there are many more co-morbidities and risk of complications than treating a healthy 15-year-old girl. It was emphasized that the pre- and post-service work was more extensive. She insisted on calculating only the time it took to remove the tissue from the... 
  
Editor's Note: Dr. Roger's and Stavosky's extended-length letter can be read here.

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.

ASSOCIATE POSITION - SOUTHERN MI (NOT DETROIT!)

Associate To Partner Position-Salary/Bonus/ Benefits. Part of podiatrist group. All phases of surgery, forefoot/rear foot/ankle…whatever you want. Great chance of obtaining all cases needed for board certification in your first year! Area has lots of lakes, change of seasons, within a couple hours of Chicago. If interested email: paulapmac@gmail.com

ASSOCIATE POSITION - PHILADELPHIA, SOUTHERN NEW JERSEY

Seeking motivated, independent foot & ankle surgeon to join large practice. Our multi-office practice covers all aspects of foot and ankle pathology, including heavy hospital volume. Offering competitive salary and benefit package. Send CV and two references to bleich5252@yahoo.com

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

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.

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

IMMEDIATELY AVAILABLE- PHOENIX, AZ

A great opportunity to join and gain ownership interest in a well- established, diversified practice in Phoenix, AZ. Seeking motivated, ethical, well trained, personable AZ licensed DPM with excellent office management and clinical skills in all phases of Podiatry. Practice is state-of-the-art and encompasses all phases of podiatric care. New and established practitioners are welcome, or someone who would be open to merging a smaller practice with ours. Board Qualified/Certified required. Please send CV email phxpod@gmail.com

ASSOCIATE POSITION - CALIFORNIA

Busy, surgically-oriented practice in Bakersfield, CA seeks ABPS qualified/certified surgeon to join our existing two surgeons. Must be hard-working and honest. Strong reconstructive surgical practice with trauma privileges and wound care center/diabetic limb salvage center. Starting in December or January. E-mail CV to aghams2@aol.com

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

ASSOCIATE POSITION - SOUTHWEST FLORIDA

Immediate opening for the right candidate. Join a well-established podiatric group in Southwest Florida. We are a multi-office practice with EMR, Digital x-ray, and more. Seeking full-time associate that is PM and S-36 trained, personable, independent and highly motivated individual. Must be BC/BS in rearfoot and ankle with confidence in complex reconstructive cases. Full benefits package, competitive salary, excellent lifestyle. Please respond to JLH459@aol.com

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

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

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

PRACTICE FOR SALE - WEST VIRGINIA

Immediate opportunity for podiatrist to have your own practice without a loan. I have an 8 y.o. primary care practice with two offices that avg. between 110-135 pts/week. CPED on staff, established diabetic shoe business as well as braces, orthotics, etc. We do CDFE, PADNET(ABI with PVR) exams, and have Traknet DPM EMR system. Both offices are nicely equipped. Ample space for surgery suite, physical therapy, etc. You are set up and ready to go with a full patient load. You can pay me 7% of your gross for 10 years and its all yours. (304)523-3338, (304)453-5458, (304)617-7665, jmfeltner@yahoo.com

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

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 12,500 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.

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