The Voice of Podiatrists

Serving Over 10,000 Podiatrists Daily

December 11, 2007 #3,114 Editor-Barry Block, DPM, JD

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MO Podiatrist Opens Another Office/Foot Care Products Center

A new Foot Healers Podiatry Center has opened in Creve Coeur, MO. Foot Healers was the first to bring a unique approach to podiatry by combining a doctor's office and retail foot care products store under the same roof.

Dr. Thomas Chad Hewitt

Podiatric physician, Thomas Chad Hewitt, DPM, leads the new office. Foot Healers provides comprehensive treatment for the ankle and foot, while going to great lengths to create a patient-friendly environment. Everything from the training of the employees to the design and décor of the office are strategically designed to make the patient feel welcome and at ease. Foot Healers carries an extensive line of more than 500 foot care products including orthotic inserts, compression hosiery, and diabetic shoes. The center also features a special computer with a step-pad that measures the shape and pressure distribution of feet in order to select the appropriate orthotics.

"We are excited to be in Creve Coeur and to be more conveniently located for patients in Mid County and North County," explained Dr. Hewitt. "And hopefully this will help encourage more people to get help for foot problems and heel pain."

Source: St. Louis Today [12/9/07]

OK Podiatrist and Family to Dance in Nutcracker

The entire Dr. James Webb family will be dancing in this year’s performance of the Bartlesville Civic Ballet’s production of The Nutcracker.

Dr. James Webb and Family

Jim and Rhonda (Rizzo) Webb are Bartlesville natives, both graduates of Bartlesville’s College High School. Dr. Webb holds two Board certifications in podiatric surgery and podiatric orthopedics and has practiced podiatric medicine in Bartlesville for 13 years.

Jim and Rhonda will make their stage debut as parents in Act 1, Scene 1, along with their son Jimmy, who is playing the role of Fritz this year opposite Elle Denyer as Clara. Dr. and Mrs. Webb share their children’s enthusiasm. “We decided to participate this year because it may be the only opportunity for our whole family to participate together,” said Rhonda. During practice, Dr. and Mrs. Webb have enjoyed watching Jimmy learn his role as Fritz.

Source: Community Examiner-Enterprise [12/7/07]

Democrats Finally Lead In Campaign Donations From Health Insurers

For the first time in 15 years, health insurers, their employees and trade associations are sending a majority of their political donations to Democratic candidates and groups. While some industry observers say the switch in donations has been fueled by the threat of increased regulations under a Democrat president, health insurers say the donations merely reflect last year's power shift in Congress.

So far, 58% of contributions made by health insurers, pharmacy benefit managers (PBMs) and trade associations to federal candidates and parties for the 2008 election cycle went to Democrats, according to Federal Election Commission data compiled by the Center for Responsive Politics (CRP). By contrast, 44% of such contributions went to Democrats in the 2004 election cycle, and they received just 40% in 2000.

Source: Health Plan News [12/ 6/07]

Query: Digital X-Rays or Fluroscope?

We are opening a new office and are concidering either a digital x-ray system or fluroscope. We have no x-ray equipment and will be starting from scratch. I have read some articles of practitioners with digital systems, but rarely anyone with fluroscope. Any comments pro and con about either systems? Cost benefits?

Kevin Pham, DPM, Sacramento, CA

RE: Malpractice Case Challenges IA Podiatrist’s Qualifications
From: Lee C. Rogers, DPM

The board certification process in podiatry requires "fixation." This is unfortunately illustrated by the negligence case against the hospital in which Dr. Michael Arnz practices. While I do not know Dr. Arnz personally, I am familiar with his credentials having seen his picture on the wall of Dr. Gary Jolly's practice in Connecticut as a graduate of the Reconstructive Foot an Ankle fellowship. Regardless of the claim against Dr. Arnz, which was settled, the claim against the hospital is quite disturbing. The process for board certification by ABPS is unnecessarily long. While most of our allopathic colleagues can be board certified immediately out of residency after sitting for an exam (and orals for some specialties), in podiatry, the ABPS requires one to be "board qualified" for a period of time.

Try explaining the term "Board Qualified" to hospital medical staff offices - I have, they don't understand the concept since we're the only specialty that has such a distinction. Furthermore, ABPS requires that you have at least 4 years of clinical experience, regardless of how many surgical cases you acquire. What does that say about the confidence that the ABPS has in the CPME approval of residencies? Why can't a graduate of a CPME approved residency be board certified upon the completion of residency and passing of a written/oral exam? The process to become board certified by ABPS can be up to 7 years.

Because of this confusing, long process, it has now resulted in a lawsuit questioning the qualifications of a "more-than-qualified" surgeon. How will hospital credentials committees look at an ABPS "board qualified" surgeon now? Will we not be credentialed to perform reconstructive cases until certification (7 years)? ABPOPPM has recognized this dilemma and now allows graduates of a PM&S 36 to sit for written and oral examinations after residency. In light of this situation, ABPS should re-examine their certification process.

Lee C. Rogers, DPM, Des Moines, IA, Lee.C.Rogers@gmail.com

RE: H & P's versus "Clearance for Surgery" (John Roseman, DPM)
From: Multiple Respondents

At our hospital the podiatrist is responsible for his patient's H&Ps. The H&P is needed as matter of course for any admission, if there is an abnormality found on the history or physical, then as any other physician would do, you contact the medical manager of the patient to obtain medical clearance, explaining your surgery, anesthesia and your concern, if deemed necessary. The other subspecialty surgeons also don't treat the conditions you mentioned but still do their own H&Ps. Obviously it's a matter of one's comfort, competence and confidence level.

Angelo J. Bigelli DPM, East Providence, RI, toedocri@aol.com

If podiatrists are to do full body history and physicals, will we be taking on a responsibility to certify a patient worthy of elective surgery when there are gaps in our general medical training. Let’s call a spade a spade. Even though we train for four years to get our doctorates and do anywhere between one and four years of residency training, our knowledge of internal medicine is not the same as that of a physician who spent four years of residency focused solely on internal medicine, is board certified in medicine and handles internal medical cases all day long. I attend our hospitals orthopedic meetings regularly and very often when cases are discussed I hear the common phrase uttered by MD and DO orthopedists: "send that patient to a medical doctor for clearance."

Since we have the right in many localities to do complete history and physicals, many of us will opt to do them and it is incumbent that a course such as the one designed by Dr. Levy be taken before certifying a patient’s general physical health. In a case where the patient has numerous medical problems, my gut feeling is that you do what the orthopedists at my hospital would do. Send that patient for clearance to internal medicine rather than place your stamp of approval on it. That way, if some untoward systemic event should happen intra or post-operatively, no one can claim that you were ill-qualified to have allowed the person to undergo the elective procedure.

This February, The American Society of Podiatric Medicine is co-sponsoring an intensive two-day full body history and physical course under the guidance of Dr. Len Levy at Southeast Nova University in Florida. This will be taught by internists and neither sponsoring group is making a nickel of profit on the program. .

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

Editor’s Note: An extended-length note by Dr. Rosenblatt appears at:
http://www.podiatrym.com/letters2.cfm?id=16967&start=1

RE: Educating The Medical Community About Podiatry (Mike Boxer, DPM)
From: Mike Boxer, DPM, Barry Mullen, DPM

To answer Dr. Agostinelli's question as to how long I spend with a new patient, the answer is anywhere from thirty to forty-five minutes. The history is obtained in the consultation room and that takes between five and ten minutes. The physical exam takes fifteen to twenty minutes. All physical findings are dictated to a podiatric assistant as the exam is conducted so that no time is wasted recording the findings. The reason the history is reported in the report to the referring podiatrist or referring MD or DO is because that is the way it is done in the medical community. That seems to be the standard.

I would like to thank Dr. Gramuglia for the kudos. Yes, there are instances when I do act as an expert. First, I would like to inform Dr. Gramuglia that I have been teaching podiatric residents how to do surgery for over forty years. As a matter of fact, I surgically trained one of the former presidents of the ABPS. Patients who are injured when their DPM screws up are entitled to be compensated. When a PT nerve is cut during an EPF procedure because the incision was incorrectly placed, that patient is entitled to some compensation. I actually save many more DPMs from med mal cases than I ever testify against and most years, I only testify one to three times.

Mike Boxer, DPM, Woodmere, NY, MCBDPM@aol.com

Editor’s Note: An extended-length note by Dr. Mullen appears at: http://www.podiatrym.com/letters2.cfm?id=16964&start=1

FULL OR PART-TIME POSITION WANTED – LOS ANGELES COUNTY

Well-trained podiatrist looking for a full or part-time position in Los Angeles County area. Professional, motivated, courteous and interacts well with patients and staff. Recently completed Kaiser 3-year surgical training program. CV and letters of recommendation available upon request. samiam_dpm@yahoo.com or 818-693-4790.

ASSOCIATE POSITION/ BUY-IN-COASTAL SOUTHEAST NC

Excellent opportunity for well trained, articulate, hardworking individual competent in all phases of practice. Long term position available with buy-in also an option. Strong salary and benefits. Gorgeous coastal area. Don't miss this one! Contact kinggy@atmc.net

ASSOCIATE WANTED - CHANDLER, AZ

A well-established, ethical solo podiatry practice wishes to expand its current surgical services by hiring a full time associate with PSR-24/36 training which includes strong surgical rear-foot and ankle reconstruction, diabetic limb salvage (AZ is a no amputation state) and ER trauma. ABPS qualified/certification required. Applicant must be personable and caring to patients. Practice in an office base within a state-of-the-art orthopedic surgical hospital environment and plenty of future expansion capabilities for a bright, eager, reliable associate. Email complete CV with current references and photo to footdoc352@cox.net

PRACTICE FOR SALE-CENTRAL WYOMING

Come enjoy the great outdoors. Growing practice. Established referral patterns. Full hospital privileges available. No nursing home care. No HMO’s. Few PPO’s. Great opportunity for surgical growth for the right individual. Currently grossing $200,000+ with 20 hours patient contact. E-mail for more info at mvfc@wyoming.com

ASSOCIATE POSITION - CHICAGOLAND AREA

We are a large multi office practice that covers from the Chicago area to Northwest Indiana. We are currently looking for two hard working motivated individuals to join our practice in these two areas. It is a long-term opportunity with unlimited growth potential in all phases of podiatry for the right person. Please contact for more information @ m-lacey@footexperts.com

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 -- www.homephysicians.com

PRACTICE FOR SALE (OR ASSOCIATE POSITION) - QUEENS, NY

Practice available. Terms available to work as an associate towards partner/ownership, or buy practice outright. Excellent opportunity for motivated podiatrist. Busy practice grossing $400K without surgery. Medicare 70%. Surgically trained podiatrist can significantly increase income. Close to hospitals and transportation. Call (646) 373-8921.

PRACTICE FOR SALE - SOUTH CAROLINA

Upstate SC practice of 25 years. Retiring. High Volume. 65% routine foot care, 35% surgery. Several nursing homes. Plenty of opportunity for growth. Grosses over $450,000.00 yearly. Hospital and Surgery Center privileges. Financials available upon request. Serious inquiries only! Beautiful area. Contact: Carolinafootdoctor@yahoo.com

PART-TIME PRACTICE FOR SALE - FLUSHING, NY

40 year old part time practice for sale. Priced for quick sale. Please contact me at footdoc60@gmail.com. Serious inquires only please

ASSOCIATE POSITION - SOUTHERN ILLINOIS

Tired of Nursing Home Care? Ready to join a well-established practice with 2 Board Certified Foot Surgeons? If you are a personable, ethical and responsible, hard-working podiatrist with interest in conservative care, including sports medicine, this may be the position for you. Competitive salaries, 401-K, health insurance, paid vacation and more. Please forward CV with references to nrussell@neondsl.com

ASSOCIATE WANTED – NEW YORK IMMEDIATE OPENING

Busy multi-dimensional practice; 70 miles north of New York City . Currently five (5)-doctor practice. looking to expand – all phases of podiatric medicine. contact: (845) 454-8308 EXT: 106

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