The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

December 31, 2010 #4,051 Publisher-Barry Block, DPM, JD

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Timely Referral by PA Podiatrist Saves Life, but Unfortunately Not Limb

On Dec. 1, Harry Lutton, known for his big heart and always available helping hand, went for a routine visit to his foot doctor, Dr. Brian Spencer. “He said he didn’t like what he saw and recommended that I go see Dr. (Edward) Smith,” Lutton recalled as he waited to be discharged from Grove City Medical Center, Dec. 22.

Dr. Brian Spencer

Ultimately Lutton via ambulance arrived in Pittsburgh well after midnight and immediately had surgery. Aneurysms were found blocking the three arteries in his leg. The surgeon was unable to open the blockages, however, and had to resort to amputating Lutton’s left leg.

Source: Carol Ann Gregg, Allied News [12/29/10]

GA Podiatrist Marks 25 Years of Collecting Shoes for the Needy

Local social service agencies work hard to cover their clients' needs from head to toe. During the holidays, Augusta podiatrists concentrate on the latter. For 25 years, Dr. Kent Kronowski has organized a shoe collection for the needy. Kronowski sends a letter to his colleagues in the area, reminding them to collect shoes and donate them to the charity of their choice. Kronowski said that this year his office has collected 350 pairs of shoes since Thanksgiving.

Dr. Kent Kronowski

"We've had less this year than in years past. But, it's not over yet," he said, adding that the collection ends Jan. 7. Kronowski said the generosity of the community impresses him. The veteran foot doctor estimates that his own office has collected an average of 500 pairs of shoes a year since he started. About five other podiatry groups also participate regularly, but Kronowski said that number changes. "My patients come in and say, 'You are collecting shoes again this year, aren't you?' So, there's really no choice. I have to keep it going," he said. "I think it's great that the people care about other people like that."

Source: Lynn Davidson, The Augusta Chronicle [12/26/10]

Use Web Videos to Attract Your Ideal Patients   

Produce and post videos to your website that are targeted to your ideal patients. For example, if you have just invested in laser technology, produce a series of  videos about your new treatment for toenail fungus,  including patient success stories. Be sure to place a link to this video prominently on your homepage and Facebook  wall. Also Tweet about it. For maximum impact, upload your videos to You Tube and syndicate them across as many search engines as possible, using keywords that include the topic of the video, your name, practice name and the location of your practice.

Source: Gary Ignotofsky

RE: Undiagnosed Diffuse Skin Lesions (Bryan Markinson, DPM)
From: Elliot Udell, DPM

Dr. Markinson's points, as always, are well taken. Clinicians should not make "snap diagnoses", but work with  differential diagnoses. Clinical tests, including imaging studies, biopsies, and blood tests, in and of themselves, are rarely diagnoses makers. Tests are used in conjunction with a clinician's impression to help establish a diagnosis and an ultimate treatment plan. Remember, we clinicians are the captains of our ships, not the radiologists, pathologists, or blood testing labs. Many authors of books on evidence-based medicine advise that we approach cases presented to us with "uncertainty", or in other words, with a list of possible diagnoses.

Clinical history as well as proper testing should be used to lessen this degree of uncertainty or narrow the list of possible diagnoses until we reach a point where we feel comfortable enough to treat the patient. In some cases, after all available tests are exhausted and analysis of all available data and clinical history is made, an absolute diagnosis still can't be made. There is still uncertainty. Unlike what is depicted on certain popular television shows, some tests might be too invasive and potentially cause more harm than good. In considering such tests, the clinical picture must be carefully weighed. In either scenario, the clinician has to ultimately combine the science and art of medicine, live with a degree of uncertainty, initiate treatment, and hope for the best.
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: Great Way to Ring in the New Year for Your Office Team
From: Hal Ornstein, DPM

Take advantage of a simple and inexpensive way to show your office team that you care about them, and acknowledge their dedication for a great 2010 in your office. On the night before your last day of the year (after everyone leaves the office) leave a bottle of champagne on each team member's desk with a $1 scratch off lottery ticket and a handwritten note which lists the top ten reasons why it has been a great year in your office. Reason number one should say, "Because of You!"

Hal Ornstein, DPM, Howell, NJ, toetoe@optonline.net

RE: Ethical Dilemma About Miscoding Routine Foot Care (Name Withheld)
From: Bryan C. Markinson, DPM

Name withheld discusses billing irregularities where routine foot care criteria are made up to support the bill. Cardiologists fudge notes to get tests done all the time. Internists write prescriptions for double doses so the patients can get two months worth for one co-pay, etc, etc. I don’t condone this, but I have some more news for Name Withheld: The NUMBER ONE code billed by Foot and Ankle and Rearfoot Reconstructive surgeons in the United States is CPT 11721. That is globally across the country. Although individuals may not bill this as the most frequent code, the profession does as a whole. So, if a college student who really wants to find out what podiatrists do, and researches their billing data as a profession, the student will find that podiatrists are caring for people with six or more PAINFUL (emphasis on painful) mycotic nails more often than they do anything else.That is an ethical dilemma!

Dr. Shavelson is correct when he says, especially to the youngest practitioners, to charge for uncovered services. You will be a happier practitioner from the start, dilemma-free, and in a few years, maybe the whole routine foot care curse, one in which we have proved absolute impotence and incompetence to resolve legislatively or through CMS, will disappear. Diabetologists are sending us patients in droves for these services, unaware and even shocked that these services are largely uncovered even in diabetics. We still can’t get a united APMA/ADA front on the absurdity of the Medicare guidelines.

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

RE: X-Ray Comparison (Michael Forman, DPM)
From: David Zuckerman, DPM

Are digital x-ray units worth the expense? This is a very good question, and it is one which I find important since the patient dollars are getting fewer and fewer. Medicare and Blue Shield cuts and reductions seem to be the talk all the time on PM News, but nothing is really being done. My answer is NO to digital x- rays and I will explain. You need to compare other treatment modalities that you can  purchase for the same amount of money (usually $20,000 plus).

You need to compare what treatment modalities you can purchase and just what impact they will have on your practice. Here is my list of possible choices for comparison:

Q-Clear laser used for off-label...

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

RE: The Passing of John Carson
From: Multiple Respondents

I was stunned and saddened to hear tonight of the passing of John Carson. He had a titanic impact on his adopted profession. We are so much the better because of his adoption. I, like so many of his adoptees, will miss his advice and mentorship. I suppose the best way to honor a man of this caliber is to do our level best to make podiatry better and better.

David G. Armstrong, DPM, MD, PhD, Tucson, AZ

John Carson was a mensch, to quote one of my early mentors when he wanted to give his highest accolade to someone. Most members of our profession will never know, nor will they perhaps appreciate all of the work which John performed for this profession. His legacy lives on, and his accomplishments on our behalf will never be able to be translated into dollars and cents.

Whenever someone makes the statement that the APMA has done nothing for her/him, they besmirch the memory of a man I was pleased to call my friend.
 
Edward R. Nieuwenhuis, Sr., DPM, Wyckoff, NJ

I want to add my voice to the chorus singing John Carson’s praise.  John was a true gentleman who knew the profession of podiatric medicine better than most podiatrists do. His role as the head of Governmental Affairs for APMA was more than just a job to him. He spent untold hours of his own time promoting the profession and was never shy about suggesting innovative strategies and solutions to the issues facing the profession. He never started a sentence with “you” have a problem, it was always “we” have a problem. His work with the Podiatric Health Section of the American Public Health Association was critical to its success, and once again, he put much of his own time into ensuring it survived in those early years. Podiatry would look a lot different today but not for the good work of John Carson.  His memory honors us all!

Jeffrey M. Robbins, DPM, Cleveland, OH

RE: The Passing of John Carson
From: Multiple Respondents

Many of the younger generation of podiatrists do not know about this great man.  When I was on active duty as an Army podiatrist stationed at Fort Meade, MD, near APMA Headquarters, I had several meetings with John. He was largely responsible for changing the rank of podiatrists entering the Armed Forces from first lieutenant to captain. This change has impacted the lives of military podiatrists who served from the mid-1980s to the present day.

Those of you still proudly serving owe a debt of gratitude to John Carson.
 
Evan F. Meltzer, DPM, Jackson, MS

John Carson's passing on Christmas Eve truly marked the end of an era for the profession. For a quarter century, there was no greater champion for podiatric medicine on Capitol Hill. With his casual yet effervescent demeanor, he was welcomed in the halls of Congress; the rest of us just followed along in his wake! John was tireless in his pursuit to further advance the practice and academic arms of the profession, and he was integral in the evolution and development of the podiatric health section of the American Public Health Association.

The profession enjoys its status today largely due to his efforts, and we owe him a debt of gratitude that is priceless. With the issues facing our profession at this time, we shall miss his friendship, nurturing wisdom, and advice. Podiatric medicine has lost its best advocate, and I have lost a true mentor and friend.

Chet Evans, MS, DPM, Bradenton, FL

Those of us who worked with John Carson know the influence he had in advancing podiatric medicine in the halls of Washington, DC. His expertise and abilities directly influenced the passage of major national legislation that affected the entire profession. Most notable was his guidance, his contacts and leadership in passing the Veterans Affairs Omnibus act. This act assisted in promoting podiatric physicians to equality in classification and pay to allopathic physicians.

His loyal devotion and wonderful warm personality were a perfect fit as a representative for our profession. His accomplishments were many and the ease in which he travelled the halls of the Congress as podiatric medicine’s face made our profession proud. John’s passing is a great loss for not only his family but our profession as a whole. 

Richard Stess, DPM, Mill Valley, CA

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 - KENTUCKY
 
Very well established Podiatry practice in Louisville, KY seeks a motivated, ethical practitioner trained in all phases of podiatry including routine care, surgery and wound care to join 2 other podiatrists. By joining our practice you will receive a competitive salary with a bonus structure and benefits. Our practice is equipped with DME, PadNet, Gait Scanner and on site retail store. There is a huge potential to grow your practice with our ideally located facility that has strong affiliation with leading area hospitals as well as 2 local residency programs. For immediate consideration, please forward CV to Samuel10530@yahoo.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.

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 - 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

ASSOCIATE POSITION - SOUTHERN CALIFORNIA

Douglas Richie, DPM is seeking a well-trained, motivated podiatric physician to join his two office practice located in North Orange County, California. Applicants must have completed a 3-year residency program and must have exceptional skills in reconstructive foot and ankle surgery, sports medicine and podiatric biomechanics. This is a salaried position with a goal of long-term buy-in for equity ownership. Send letter of interest and CV to drichiejr@aol.com

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

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