The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

December 20, 2010 #4,041 Publisher-Barry Block, DPM, JD

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Charcot Patient Credits SD Podiatrist for Saving Her Life

If you have diabetes, but don't keep it under control, there are a number of negative side-effects, even deadly consequences that can result from it. Marilyn Aase credits her foot doctor at Avera Sacred Heart for saving her foot, her leg, and possibly her life. Aase went to Avera Sacred Heart Hospital to find out why her left leg hurt so badly. Doctors diagnosed her with arthritis and consulted Dr. Scott Torness with the Avera Foot and Ankle Clinic about an infected ulcer on the other leg. Marilyn is diabetic and has severe neuropathy in that foot.

Dr. Scott Torness

But things weren't fine. Dr. Torness discovered she has acute Charcot foot. Dr. Torness says, "They don't feel pain because they don't have feeling in their feet. Their foot looks swollen and they don't think much about it. They start walking on it and when the blood flow is increased to the foot, it washes the bone out. Bone gets weak, and subsequently starts to fracture."

Source: Naeve Brown, KSFY-TV (ABC) [12/17/10}

IFAF Donates $5,000 to Yucatan Crippled Children’s Project at BUSPM 

Barry University’s School of Podiatric Medicine (BUSPM) recently received a $5,000 donation from the International Foot & Ankle Foundation for Education and Research, (IFAF) formerly known as the Northwest Podiatric Foundation. The money will support the ongoing charitable medical missions of the Barry’s Yucatan Crippled Children’s Project (YCCP). Thanks to the YCCP, which is approaching its 15th anniversary, more than 6,700 crippled and indigent children of Yucatan, Mexico have been treated with the help of podiatric physicians and surgeons from the Barry’s School of Podiatric Medicine as well as podiatric physicians and surgeons from IFAF. The IFAF funds will be used by the YCCP to help buy supplies and equipment for future humanitarian trips.

(L-R) Alejandro Ojeda Manzano, Director of Rehabilitation, Progreso; Dr. Dock Dockery;  Dr. Byron Hutchinson;  María Magadán Alonzo, President, DIF Progreso; Dr. Miriam Gutiérrez Flores, Director, DIF Progreso; and Dr.  Keith Kashuk.

Dr. G. Dock Dockery, chairman of IFAF, along with Dr. Byron Hutchinson, and the Board of Directors, recently traveled to the Yucatan as part of the medical team for the YCCP. Dr. Dockery presented Dr. Keith Kashuk, co-director of the YCCP, with the gift from IFAF. The donations were contributed by 31 friends and colleagues of Dr. Dockery, in his name, specifically for the YCCP.

GA Podiatry Group Puts a Sock in Homelessness with Holiday Drive

Clean socks are something we take for granted. But, if you’re homeless, the lack of clean, dry socks is a discomfort that can also lead to serious foot problems including infections and frostbite.  During the holiday season, Village Podiatry Centers is sponsoring their first “Put a Sock in It” drive to collect new socks and monetary donations for two homeless shelters.

Village Podiatry Centers’ staff collect socks for holiday drive.

The goals are 5,000 pairs of new socks and $5,000 in donations. Doctors and staff are asking for help from patients and the local communities to assist The Atlanta Day Shelter for Women and Children, and the Macon Rescue Mission. Both organizations serve thousands of homeless clients and the needs are growing.

Query: Digital X-Ray Comparison

I am moving offices soon and will be (finally) implementing digital x-rays. There seem to be several different digital x-ray units available. I would appreciate thoughts as to the differences between the systems, including cost(s).

R. Alex Dellinger, DPM, Little Rock, AR

RE: Austin Complication (Simon Young, DPM)
From: Gino Scartozzi, DPM

Regarding Dr. Simon's letter, I believe I may not have clarified myself properly regarding my using the fifth metatarsal head as a "fixed" point. My transverse cut does not "aim" for the fifth metatarsal cut as a matter of routine. In my original post, I stated that if the first metatarsal and fifth metatarsal are the "same" in length, my cut toward the fifth metatarsal head will be with a loaded position. If the fifth metatarsal is shorter in length, the transverse cut is made proximal-medial to distal-lateral fashion by the mm shortening (beyond the fifth MPJ) that I noted pre-operatively. My selection of the fifth metatarsal head is used because it is an easily identifiable point to palpation. I believe we are talking about the same surgical concept but just using different "fixed" points. I hope my clarification remedied this point.
 
In regard to the orientation of the closing base osteotomy, McGlamry, et al. have found that base wedge "cuts" made perpendicular to the first metatarsal allow for a post-operative metatarsus elevatus. To avoid this potential pitfall, the base wedge "cut" for the closing base is made from dorsal-proximal to plantar-distal. 
 
Gino Scartozzi, DPM, New Hyde Park, NY, Gsdpm@aol.com

Since we are talking about Austin bunions and axis guides, etc., I would like to add a story from when I was a student at NYCPM. There was a doctor at the college, Anthony Hernandez, DPM, who I believe at the time was the chief of surgery at the college. I was rotating through the surgery dept and I went to ask him how the heck are these doctors doing these Austin cuts free-handed. I don't get it, I told him, I couldn't make a 60 degree angle on a piece of paper. How am I ever going to make one on a bone? He looked at me and smiled and said, "sure you can." He pulled out his pen and a piece of paper and drew a 60 degree angle. I pulled out my tractograph and measured Dr. Hernandez's angle and it was exactly 60 degrees. I told him it was luck, and once again, with his angelic smile, he laughed. He told me he could do it another 10 times. My response was... 
 
Editor's Note: Dr. Kass' extended-length letter can be read here.

RE: Medicare Reimbursement Vs. Inflation (Stephen Doms, DPM)
From: Multiple Respondents

Dr. Doms chose an E&M code to make his point. That is a skewed figure because Medicare has made a concerted effort over the past 10 years to increase reimbursement for 'cognitive' services and decrease reimbursement for surgical/procedural services. This was done to increase the number of family physicians and decrease the number of specialists. Podiatry is primarily a procedural specialty. I would be interested in the same comparison for CPT 28296 over the past 30 years.

Rich Rettig DPM, Philadelphia, PA, rettigdpm@gmail.com

Perhaps things are different in Minnesota than here in Florida, but in 1995 and 1997, we received CMS guidelines that made "office visits" no longer valid. We have since been required to follow a very complicated formula for the determination of "Evaluation and Management" levels of care. In Florida, our participating amount for CPT 99213 is approximately $45. The participating amount for CPT 99214 is approximately $90, but we all know that podiatrists will infrequently bill for this because our limited-scope license makes it very difficult to meet all the criteria. There is no direct comparison between "office visits" and the criteria necessary to bill for a particular "evaluation and management" level. Perhaps a comparison of procedure codes (for instance, CPT 28290-28298) would be more realistic for podiatrists.

Richard A. Simmons, DPM, Rockledge, FL, RASDPM32955@gmail.com

Inflation is not the only cost a physician needs to be concerned about. I’m concerned with the tax rate and the costs of doing business which are not at all in alignment with reimbursement rates. Did you know that Social Security was presented to the American populous as never to exceed a total of 6% taxation? It is currently 12.4%. Forty years ago, Congress made a promise to “…never establish a physician’s fee schedule or interfere with doctor-patient relationships.” Then, in 1992 a Medicare fee schedule was established. Physician fees through Medicare have subsequently been cut 50%, to date, in adjusted dollars. With the slated future cuts, coupled with the rate of inflation, by 2012 physicians will be receiving 25% of the original fee schedule.

Since 2001, family coverage premiums increased 78%. Don’t get me started on the rise in cost of medical supplies, malpractice insurance, and a multitude of other costs and regulations in the business of medicine that never existed previously. When everything is put on the table, I can’t imagine one can make a very convincing argument that physician reimbursement rates are on par with physician costs.

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

RE: DUI and Orthotics
From: Neil A Burrell, DPM, Michael Forman, DPM

I would tell them to go to hell, and hopefully they lock him up and throw away the key. 

Neil A Burrell, DPM, Beaumont, TX, nburrell@gt.rr.com

I find it hard to believe that any reader of PM News or any other medical professional would write a letter justifying an individual's inability to ambulate properly due to worn orthoses, and therefore fail a drunk driving test.
 
Rather than express the rational outrage at such a request, I would merely answer that "I am  unable to provide that documentation" and leave it at that.
 
Michael Forman, DPM, Cleveland, OH, IM4MAN@aol.com

RE: WA Podiatrist Receives Hospital Physician Excellence Award of Merit
From: Michael M. Rosenblatt, DPM

John McCord is far too modest to trumpet his accomplishments in Central Washington State. He was recently awarded several prizes by his local hospital. Besides being an accomplished pilot, he is also an accomplished actor of professional quality. He has a powerful knowledge of classical music. But there's more to this truly Renaissance man than just those qualities.
 
John represents the acme of how a podiatrist relates to his community and profession. To John, the humanitarian practice of podiatric medicine and surgery is and was his total commitment. He saw what the value of the art of podiatric medicine and surgery was through a wider looking glass than was only merited by state law. His contribution to his community was whole-hearted and unapologetic. He respects himself, our patients, and our professional totally ... even if we are limited to the foot and structural ankle.
 
His colleagues, both allopathic and "restricted" view Dr. McCord as a complete physician and surgeon who has given more to his community than he ever took from it. We could all learn from his example. 
 
Michael M. Rosenblatt, DPM, San Jose, CA, Rosey1@prodigy.net

RE: Plan Exit Strategy When Forming Company: MO Podiatrist
From: David Helfand, DPM

I completely agree with Dr. Holekamp, and that is why I started the Physician’s Business Academy and Village Podiatry Centers. When we were all in podiatry school, residency, and first starting in practice, we relied on a number of mentors to teach us how to practice medicine. Unfortunately, we were not taught the business side of medicine and were not properly trained on how to run a practice.

The days of simply seeing more patients and increasing your services and waiting for the checks to roll in to create your wealth are slowly coming to an end. The 21st century physician will require skills that have not been taught in...

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

ASSOCIATE POSITION - CHICAGO 

Weil Foot & Ankle Institute, Des Plaines, IL (www.weil4feet.com) is seeking associate position in summer  2011. This 15 member podiatric medical and surgical group is internationally acclaimed. Twelve locations throughout Chicagoland, with a 3 operating room surgery center, MRI’s, computerized footprint analysis, orthotic and brace laboratory, radiofrequency coblation technology, extracorporeal shockwave devices, PRP and  clinical research program. Successful candidate will have completed a 3-year residency, experience in wound care, trauma, and sports medicine. Competitive salary, bonuses commensurate with experience and training. E-mail letter of interest and CV to Harriet Kass, HR, hkass@weil4feet.com 847-390-7666

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 - NEW YORK CITY

One of the fastest growing podiatry practices in New York City and Queens seeks a podiatrist who participates with HealthFirst, Fidelis, and other Medicaid plans. Preferably a Spanish speaking podiatrist. Contact me at Podocare@aol.com

ASSOCIATE POSITION - BOSTON

CPME Board certified podiatrist wanted to join Orthopedic & Arthritis Center at Brigham & Women’s Hospital, Boston, MA. The position is per diem, 2 days/ week. Interested candidates should send their CV to: Brenda Surowiec, Orthopedic & Arthritis Center, 75 Francis Street, Boston, MA 02115. Or email to bsurowiec@partners.org

ASSOCIATE POSITION - CT (FAIRFIELD AND NORTH HAVEN)

Join one of the largest podiatric groups in Connecticut. Well-established and progressive offices, including EMR, digital x-ray, vascular and NCV studies, Pinpointe and CO2 lasers, diagnostic ultrasound and electrical stimulation therapy. You can expect a full schedule of patients the day you start, and a very competitive salary. For more info, www.GreatFootCare.com. Send resume and current photo to Dr.Kassaris@yahoo.com. Applications due by Jan 31st.

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) 293-5984  or e-mail to mets724@gmail.com

ASSOCIATE POSITION – NEW YORK

Busy, well-established for 35 years, multi-site practice in upstate New York looking for licensed podiatrist who is ready for a thriving practice. Must be highly motivated, personable and great with patients. Competitive salary and benefit package. Send CV or letter of interest to associateinfoot@yahoo.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 - SOUTHWEST FLORIDA

Immediate opening. Well-established multi-office practice with EMR, Digital x-ray, and more. Seeking full-time associate with PM and S-36 training. Independent and highly motivated. Must be BC/BS in rearfoot and ankle with confidence in complex reconstructive cases. Full benefits package, competitive salary. Email CV to: JLH459@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: A-Storjohann@footexperts.com

ASSOCIATE POSITION - WILMINGTON, DELAWARE

Largest Practice in Delaware - well organized eight doctor multi-office practice. Seeking PM&S36+ trained podiatrist who wants to perform rear-foot surgery, EMR/Digital X-rays/PADnet/Ultra-sound/Surgery Center, etc. Associated with a PM&S36+ residency program. Call Chris Savage, DPM 302-658-1129.

ASSOCIATE POSITION - SAYREVILLE, NJ
Part time position for growing second office, 8 hours a week. Potential for growth and more days/hours. PSR/36 preferred. Can start immediately. E mail CV to advancedfoot1@aol.com

ASSOCIATE POSITION - MICHIGAN - (OAKLAND COUNTY)

Outstanding opportunity for associate in well-established practice, general & surgical podiatry forefoot, rearfoot & ankle (full or part-time). Well-trained, responsible, motivated with good communication skills, ABPS qualified or better. Send CV & letter of interest to: PodiatristWanted@AOL.com. All replies kept strictly confidential

BOSTON UNIVERSITY LIMB PRESERVATION FELLOWSHIP PROGRAM

Boston University Medical Center has a accredited fellowship position. Become an expert in Limb Preservation, Tissue Repair and Regeneration. Be part of this unique Fellowship at a major teaching facility. During this time, you would be expected to become a knowledgeable expert who will contribute significantly to research, surgical procedures, teaching, and innovation. Requirements: Completion of a two or three year surgical residency; Candidate must possess a commitment to an academic career in Podiatric Medicine and Surgery. Submit a CV and letter of interest to: Erin Springhetti erin.springhetti@bmc.org and  Dr. Vickie Driver Vickie.driver@bmc.org or if questions call 617-414 6821.

PRACTICE FOR SALE - BOSTON, MASSACHUSETTS

40 year old updated practice with outstanding potential. Within 5 miles of Boston hospitals and 5 blocks from train station. Buy the practice, equipment and goodwill for a reasonable price. Excellent opportunity for resident or second location for practicing podiatrist. Multiple referral sources. Email vshdeep@yahoo.com

PRACTICE FOR SALE - MARYLAND, DC SUBURB

Own your own practice and be your own boss. 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. Owner will stay on as needed for easy transition. dpmpracticeforsale@yahoo.com

PRACTICE FOR SALE SPACE TO SHARE - MANHATTAN

Lic. podiatrist with an active practice to share space in a State-Of-The-Art professional medical office in the Midtown area. Newly renovated, modern office with spacious Tx rooms with cherrywood cabinets and granite countertops. X-ray equipment on site. Please call Dr. Robert H. Singer @ 212-921-5775 to view space.

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

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