The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

November 15, 2008 #3,401 Editor-Barry Block, DPM, JD

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American Society of Podiatric Surgeons Established as New APMA Surgical Affiliate

The APMA Board of Trustees has announced the formation of a new APMA-recognized surgical affiliate …the American Society of Podiatric Surgeons, Inc. (ASPS). ASPS is a separate 501(c)(3) surgical society. The Society’s mission will be to promote the advancement of podiatric surgery through education and research. The new society will function under its own bylaws and will be directed by an interim governance body to be named in the near future. Ratification of ASPS as the new surgical affiliate will need to occur at the March 2009 House of Delegates

The 2008 APMA House of Delegates authorized the APMA Board to take interim action in granting recognition to a new affiliated organization that may elect to seek recognition for an area previously covered by a recognized organization. When the American College of Foot and Ankle Surgeons (ACFAS) chose to no longer comply with the APMA Bylaws, it was no longer eligible to be considered as the APMA surgical affiliated organization.

"The formation of the American Society of Podiatric Surgeons (ASPS) as the new APMA-recognized surgical affiliate is an exciting new beginning for our members. As the surgical education and research affiliate, ASPS will be an outstanding resource to assist the APMA in its ongoing advocacy efforts on behalf of our members, said APMA president Ross Taubman, DPM. "ASPS, along with our podiatric medicine and orthopedics affiliate, the American College of Foot and Ankle Medicine and Orthopedics (ACFAOM), are the perfect complements to APMA as we move the profession towards meeting our parity goals set forth in Vision 2015."

Current efforts are focused on establishing the governance and structural foundation for the new organization, but it is anticipated that within the next several weeks ASPS will be ready to begin inviting eligible APMA members (those who are certified and qualified by the American Board of Podiatric Surgery) to apply to ASPS. Initial plans also call for the creation of three membership categories (Fellows, Associates and Members).

Source: APMA

DC Podiatrist Discusses Treatment for Pigeon-Toed Gait

Question: I’m completely pigeon-toed and hate it. Can I change the way my feet turn?

Answer: In most cases, the inward curve straightens out as you grow, so says Arnold Ravick, DPM, of the American Podiatric Medical Association. This is because as your pelvic bone widens, your legs naturally start to turn out. By the time you finish growing, your feet should be pointing normally.

Dr. Arnold Ravick

If you don’t want to wait it out, you can lessen the inwardness of your feet. “Activities like biking and in-line skating force the legs and feet to face outward,” says Dr. Ravick. Speak to a podiatrist about insoles for your shoes and special exercises.

Source: Girls' Life (MD) [11/12/08]

SALSA's Armstrong Named Honorary Visiting Professor at Cardiff Univ Medical School

Dr. David G. Armstrong, Professor of Surgery and Director of the Southern Arizona Limb Salvage Alliance was conferred the title of Honorary Visiting Professor of Medicine at Cardiff University School of Medicine in the United Kingdom. "From the pioneering stem cell work of 2007 Nobel Prize Winner Sir Martin Evans to the groundbreaking wound healing work of my long time friend Professor Keith Harding, the University continues to blaze an important path in research and patient care," noted Armstrong.

Dr. David G. Armstrong

Armstrong and Harding recently developed the Transatlantic Healing Collaborative, which has helped launch education for clinicians and researchers in the field of tissue repair and wound healing between their two units. Armstrong continued "I look forward to working with the Wound Healing Research Unit to make our alliance even stronger." Armstrong becomes the first podiatrist named as Honorary Professor at the University.

Query: First and Second Ray Reconstruction S/P Joint Implant

I have a 58 year old lady that presented with a significantly shortened first ray of the right foot after having a silicone implant placed in the first MTPJ seven years ago by an orthopedist. The diagnosis was severe DJD with hallux limitus. The second metatarsal was shortened as well in an apparent attempt to preserve the parabola. She had gait problems from the onset with the hallux unable to purchase on the ground. X-rays show that the proximal phalanx of the hallux and base of the first metatarsal are suffering significant destruction from the implant.

First and Second Ray Reconstruction Sp Joint Implant

Has anyone any experience or insights into removing the implant, packing the void areas with lypholized bone and DBX (or similar) bone paste, allowing it to heal and solidify, then on a later date, performing a distal sliding osteotomy or utilizing a Ilizarov frame to elongate the first and second rays, then either replacing with a different implant or fusing the first MTPJ?

James Breedlove, DPM, San Luis Obispo, CA

Query: Granuloma Excision with Nail Avulsion

What would be the code for granuloma excision along with nail avulsion of the same border as the granuloma side?

Syed Ghani, DPM, Sterling Hts., MI

Response: I would NOT bill separately for resection of granulation tissue when performed jointly with an avulsion. In my own experience, I am far more likely to perform a matrixectomy in such instances, rather than an avulsion, but my opinion regarding separate billing for the granulation tissue would not change.

Documentation of granulation tissue may well help to support a higher level E/M when billed jointly with the vaulsion, or matrixectomy.

Rick Horsman, DPM, Olympia, WA

Codingline subscription information can be found here

RE: CR vs. DR X-ray Systems (Eugene A. Batelli, DPM)
From: Multiple Responses

I was in shock to hear Drs. Eugene A. Batelli and DPM, Larry Kosova, DPM have had such problems with the DR X-ray system. My partner and I have had the unit since April and have had the best experience. We average 25-35 x-ray exams a day and have had excellent films. The speed is great, about 5-10 seconds, which is great for closed reductions of toes (I do it right on the x-ray stand).

The DR films have great clarity and only get "grainy" when I zoom in to very high magnification. The only problems I have had was when there is a Windows update. The computer needed to be restarted. The techs at 20/20 have responded both times in under 10 minutes and fixed the problem (Turn off the auto update). When the unit was installed the tech gave us his personal cell phone as well as the other technicians.

The company has been wonderful and the sales person calls once or twice a month just to "check up." It has been the best money I have spent in the practice. I have no financial relationship with 20/20. I’m just a very satisfied customer.

Timothy James Henne, DPM, Clermont, FL, tjhennedpm@hotmail.com

I have been using the 20/20 DR system for 5 months now, and have been very satisfied with the product and service that 20/20 provides. DICOM image picture quality is fantastic - better than any other I researched - without having to worry about cassettes and film. Upload time is about 30 seconds, just slightly longer than it takes to get the patient situated for the next x-ray. In the 5 months I have been using the system, I have not noticed any slowing of the system. Uploaded films can then be instantly viewed from any other computer on the network. MaS and kVp do not need to be changed because presets are a part of the system, and determined during set-up for each view. I purchased a used X-cel x-ray machine to use with the system and it has worked flawlessly.

Service from 20/20 has been excellent and very timely. Questions and problems have been minimal and have been solved quickly via either telephone conversation or remote access into my system. I have been very satisfied with the system, and 20/20’s service team.

Ryan Taylor, DPM, Heber City, UT, rdtpod@gmail.com

I read Dr. Batelli's comments about his 20/20 CR and DR systems. I also have the 20/20 CR system. I agree with Dr. Batelli that the images are "crystal clear and the software is easy to use." I disagree with his concern about the 2 minutes to process the film. His unit is much slower than the current models. When taking x-rays with the newer 20/20 CR systems the slowest part of the procedure is positioning and taking the x-ray. The machine can process the film faster than you can position and take the next film. I know there are many podiatrists who are very happy with their 20/20 DR systems and know that 20/20 will make every effort to make all of their customers satisfied. There are currently more than 500 podiatrists using 20/20-Reina systems.

I have found 20/20 support to be excellent. I have not had my machine inoperable for more than 5 minutes in more than one year. My prior digital x-ray unit had to be replaced twice in the first 2 months; it was not a 20/20 or Reina unit. I welcome any calls or visitors to talk about digital x-rays. It was one of the top 5 ideas I have implemented in 30 years of practice.

Kenneth Meisler, DPM, Digital Imaging Consultant, 20/20 imaging, kenmeisler@aol.com

RE: Reduced Hours and Counseling Can Helps Doctors Avoid Burnout
From: Elliot Udell, DPM

A number of years ago I was feeling burnt out. A friend of mine who is a pulmonary specialist and another friend who is an anesthesiologist told me about a short three-day and one evening program that really made a change in the way they approached the practice of medicine and life itself. The program is called the Landmark Forum and it is virtually given in every major city in the world.

It is not a practice management program, even though many doctors take the course and improve facets of the way they practice. It will put vim and vigor into your practice and after taking it, you will enjoy what you are doing much more. It is also far less expensive than traditional counseling. If anyone is interested in this program, the website is Landmarkeducation.com. Key in your city and you can find a free introduction to the program near to where you live or work.

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

RE: Merging Existing Practices (Name Withheld)
From: Michael Forman, DPM, Marc Platt, DPM

Name Withheld wanted to know of a system where the busier podiatrist would not be unfairly compensated. I have always been of the opinion that, "You eat what you kill." That is, each DPM receives the same percentage of profit that he produces. As an example, if three docs are together and run on a 60% overhead, and the total practice does $1,000,000 with a 40% net; there is $400,000 to split. If Dr A produces 60% of the gross, Dr. B 30%. and Dr. C 10%, they are compensated at that rate.

Doc / Gross percent receives pays to overhead

Dr A $600,000 60% 60% of the net ($240,000) 600,000 - 240,000 = $360,000

Dr. B $300,000 30% 30% of the net ($120,000) 300,000 - 120,000 = $180.000

Dr. C $100,000 10% 10% of the net ($40,000) 100,000 - 40,000 = $60,000

If Dr. C, who may be the new associate, is unhappy with his share, the answer is "work harder, smarter, and make more money."

Each doctor is then paying his share of the overhead. That is, Dr. A is getting 60% of the net, and he is using 60% of the office resources, but he is also paying 60% of the overhead, which he should (he uses more Band-Aids, DME supplies, etc.

I also suggest that each doctor pay his own malpractice premium and their health insurance through their own corporation. If one of the partners gets tagged by a large settlement and his/her premium goes up, the other partners do not have to share in this increase in costs. You are going to have to discuss this with your financial people and your attorneys. The solo practitioner is soon going to be archaic. Merge together and lower your overhead.

Michael Forman, DPM, Cleveland, OH, IM4MAN@aol.com

Editor's Note: Dr. Platt's extended-length letter appears at: http://www.podiatrym.com/letters2.cfm?id=23107&start=1

RE: AAPPM Presents Initial Egerter Award
From: Dennis Shavelson, DPM

I would like to offer my congratulations to our editor for receiving this well-deserved initial Egerter Award of Excellence from AAPPM. Few of us realize the amount of energy, diplomacy, and thankless time Dr. Block has invested in PM News. His ability to maintain focus and eliminate personalization and deviation for so many worthwhile topics is a gift that will be hard to replace should he decide to retire.

To provide a perspective, I have been debating my new biomechanics paradigm on another listserv. The members are professional educators, researchers, and practitioners who are academic and represent a great wealth of information. Unfortunately, due to the lack of an editor with the skills of Dr. Block, the forum is like an untamed jungle of personal comments, deviated thoughts, and downright meanness that has to be waded through. We all owe Dr. Block for his many contributions to the profession.

Dennis Shavelson, DPM, NYC, drsha@lifestylepodiatry.com

ASSOCIATE POSITION – ST. LOUIS, MISSOURI

Excellent opportunity for PSR 24-36 foot and ankle surgically-trained physician. Looking for hard-working, personable, highly-motivated individuals to join our group and build their own practice. Position leading to partnership. Great opportunity with excellent salary and benefits. Please e-mail CV and references to cavallinig@foothealers.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 part-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to f-massuda@footexperts.com

ASSOCIATE POSITION AVAILABLE-MIDTOWN MANHATTAN

CASE CONSULTING

Dennis Shavelson, DPM is now accepting referrals of difficult cases involving biomechanics, surgical complications, non-healing wounds diagnostic and treatment dilemma’s and subtalar stenting from DPM’S. Full reporting with second opinion only, rapid return after care and assumption of care options. Medicare and Out-of-Network Only. (212) 288-3668 or drsha@lifestylepodiatry.com

PODIATRISTS NEEDED - CHICAGO -- NW IND & BALTIMORE/WASHINGTON, DC

PODIATRIST NEEDED—SEATTLE, WA

Established podiatric practice in Seattle, WA is looking for licensed podiatrist for part-time leading to full-time position. Need help with Adult Family Homes and Nursing Homes as well as in the office. Flexible schedule and attractive compensation. For all details please call 206-661-9644.

PODIATRIST - JAMES H. QUILLEN COLLEGE OF MEDICINE

East Tennessee State University, James H. Quillen College of Medicine is seeking a board eligible/board certified at time of hire podiatrist. The position is clinical and the candidate should be interested in a broad range of podiatry medicine. The position is a non-tenure track position at the Assistant/Associate Professor and contingent upon outside funding. Interested applicants should submit a curriculum vitae to: William Browder, M.D., Professor and Chair, Department of Surgery, East Tennessee State University, Box 70575, Johnson City, TN 37614, e-mail – browder@etsu.edu. ETSU is an equal employment opportunity employer.

EQUIPMENT FOR RENT - EXTREMITY MRI

Now you can rent an extremity MRI, have the scan performed, read by a board-certified radiologist and derive all the income. two convenient locations, Manhattan East 60th street between Park and Lexington, and Plainview, Long Island. Conforms to the Stark amendment; call for information (516) 476-1815.

ASSOCIATE POSITION – MASSACHUSETTS

Excellent opportunity for a highly-motivated, entrepreneurial individual to join a very successful, rapidly growing multi-office practice, North of Boston. Seeking a PSR-24/36 trained podiatrist to join our group. We offer a competitive salary/benefit package with the opportunity of partnership after one year, for the right individual. Send CV and letter of interest to drfleishman@nefootankle.com

PRACTICE FOR SALE - CALIFORNIA

Podiatry practice for sale, including all equipment. Doctor has spent 46 years building this successful practice in the wonderful community of Redlands, California. This is an incredible bargain for a young podiatrist. Come continue the legacy that the doctor has spent decades building. Email: syzygydoc1@yahoo.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 –GEORGIA

A well-established practice in South Georgia seeks a full time PSR-24/36 trained podiatrist. Excellent benefit package. Please send CV to agriffin@southernpodiatry.com. For more information, visit our website

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