Query: National Shortage of Meperidine
I have used Demerol for my post-op patients for years to control acute pain for the first 3 days or so. There are several reasons that I prefer it over other narcotic pain meds, and I have prescribed most all of them over the years. Recently, I have been informed by a local pharmacy that there is a national shortage of meperidine and I was wondering if I was told the truth. FDA did have a warning about a shortage of IV meperidine for PCA use, but I did not find any info on the oral form. Is anyone else aware of this?
Tip Sullivan, DPM, Jackson, MS
Query: Custom Hallux-Toe Latex Shields
Are there any companies that still make custom hallux-toe latex shields?
Joe Boylan, DPM, Ridgefield, NJ
Query: Lamisil Discontinuation
The FDA Drug Shortage List has Lamisil 250mg as being discontinued by Novartis. It will be available until the end of April 2019. We have already had one pharmacy unable to fill a Lamisil prescription. Is anyone else feeling the impact of the discontinuation of Lamisil?
Catherine Yack, DPM, Huntsville, AL
Query: Government Shutdown and Medicare Payments
Does anyone know if the shutdown will delay Medicare payments?
Larry Aronberg, DPM, Lake Worth, FL
Query: Digital Camera to Upload to EHR
I'm looking for a digital camera that will transmit in a HIPAA-compliant manner via Wi-Fi or cable to my EHR. Any suggestions?
Richard Willner, DPM, New Orleans, LA
Query: TayCo External Ankle Brace
Does anyone have experience with the TayCo external ankle brace for treating posterior tibial dysfunction?
Frank DiPalma, DPM, Athens, GA
Query: Source for Quality Disposable Nail Clippers
Does anyone have information on suppliers of quality disposable nail clippers?
Mark Hinkes, DPM, Nashville, TN
RE: Source for Shoe Horns
I am hoping that your readers may assist in my search for a supply of 20-50 shoe horns. I am currently serving the veterans in Springfield, MA and always have a shoe horn handy to assist in helping put shoes on their feet. There are many requests from them and I only have my one remaining shoe horn. I have been unable to locate any store where I could purchase a supply to provide at no charge to these veterans.
Charles F. Ross, DPM, Pittsfield, MA
Query: Podiatric Cancer Registry
Are all DPMs in a risk group? Almost every week, we learn of a fellow DPM who has passed on due to some type of cancer. I wonder if there is something we are all exposed to that might be increasing the risk of specific cancers among DPMs. Many have been reported with lymphoma and pancreatic CA which makes me wonder.
My request is that one of our researchers, schools, or the APMA consider developing a registry so that real data can be generated. When I started podiatry school in the '80s, there was a thought that testicular cancer incidence was higher among DPMs and the thought at the time was that the use and grinding of Rhoadur (that we all used in orthotics) was responsible, causing this material to be removed from the market.
Bret M. Ribotsky, DPM, Boca Raton, FL
Query: Affordable Ultrasound Machine
My old ultrasound machine finally died. As much as I would love to get a $16,000 machine, it is impractical at this time. There are a number of lower level machines in the $6,000 range that are probably more technically advanced than my old one. What can my colleagues who use US regularly suggest for a new machine?
Ron Werter, DPM, NY, NY
Query: Billing Service for Small Practice
I am need of a billing service that is willing to work with a small solo practice in IL. Any recommendations would be appreciated.
Gary Trent, DPM, Chicago, IL
Query: Recommendations for X-Ray Systems
We are a busy surgical practice in need of a new x-ray system. Can anyone recommend a system with which they’ve been satisfied? (No rep responses please).
Christopher Stewart, DPM, Charlottesville, VA
Query: Injections for Fibromas
I am considering adding Vitrase (hyaluronidase) and/or Xiaflex (collagenase) to my injection treatment offered for fibromas. I would appreciate any comment on dosage and cost, or information on a supplier for both.
Tip Sullivan, DPM, Jackson, MS
Query: Dealing with Specialists Who Don't Send Referral Letters
For many years. I referred my patients presenting with peripheral vascular disease to a very prominent and respected vascular specialist in my area. He was not only an excellent diagnostician and surgeon, but always sent me timely reports on the management of our mutual patients. Unfortunately, this doctor passed on and all of his patients were turned over to an equally prominent vascular specialist. The only problem is that this new specialist does not send reports nor does he return phone calls.
This past month, one of my patients with recurring ischemic ulcers went back to this doctor at my request. Not only did he not sent me a report, but he did not return phone calls to either me or the patient and the only line of communication is when the patient actually sees him in his practice.
PVD has legal exposure, especially if the patient's condition worsens and s(he) needs an amputation. With no reports or any return phone calls, I am the one who will be left standing without a leg if the patient should decide to sue. Needless to say, I do not refer any new patients to this doctor, but the ones who are already using him have no intention of changing. Our insurance companies warn us to have documentations from specialists but how do we as podiatrists handle cases when a specialist does not believe in sending reports?
Elliot Udell, DPM, Hicksville, NY
Query: Hands-on Refresher Course in Traumatic Ankle Repair?
I am an ABFAS certified podiatrist with training in ankle reconstruction. Because of state laws, I have not done a traumatic ankle repair in many years. Does anyone know of a certified hands-on refresher course to recommend?
Tip Sullivan, DPM, Jackson, MS
Query: Chart Reviews
It seems now that the chart review companies - namely Ciox Health and Change Healthcare which work for Fidelis and Affinity are now getting more aggressive and asking for over 100 charts now at a time or more (in some cases over 200). When I told Ciox that I charge 25 dollars per chart, they said they would tell Fidelis this and they would either lessen the number of charts asked from me which was 115 or pay for the charts. Fidelis called my office and stated, "we don't negotiate and we don't pay [for charts]." It seems that as practitioners, we are at their mercy with no support no defense. Any constructive thoughts would be appreciated. I have left 10 messages and emails with my provider relations rep. with Fidelis and have received no reply.
Query: Podiatrists' Median Income
I am writing questioning podiatrists’ annual median income. I read on PM News from Career Cast's top 10 highest paying jobs that podiatry is #8 at $124,830. My associate is starting his 4th year with me and is asking for a substantial raise. He is already making above this amount. He quoted research that he has done from Salary.com that states the median base salary for our area is $192,738, which I can’t fathom is correct. Can anyone comment on this large discrepancy?
He is generating income for the practice but is falling short on some of his duties. He comes to work late. He works his shift but nothing more. He is not doing any marketing. He is not following protocols. He has a base salary and has a bonus structure. I am having a hard time giving him a raise with the information that I read on PM News.
Editor's Note: The Annual Median income for a solo practitioner reported in Podiatry Management's Annual Survey was $123,250.
Query: ESWT Service in Florida
When I was in the Northeast, I utilized the services of ESWTUSA to provide shockwave therapy for my patients; however, they do not service Florida. Any recommendations for ESWT vendors who will bring the machine to my office and provide treatment for patients?
Jay Seidel, DPM, Deerfield Beach, FL
Query: Problem Obtaining Health Insurance
I was wondering if anyone is having the following problem in obtaining personal health insurance. My wife (who works for the practice full-time) and I were considered a group and were able to get health insurance at the group rate. Now I have to apply as an individual and with 7 children being covered; we are looking at about $2,300 per month with a $13,000 deductible. This is totally unaffordable. Any comments?
Mark Stempler, DPM, Staten Island, NY
Query: Removing False Patient Reviews
What can we do about online reviews that are patently false and malicious? While most reviews are positive, there is one patient review on Google and now other sites attacking my character, surgical skills, and expertise, submitted by a person WHO HAS NEVER BEEN SEEN OR TREATED BY ME. She claims her surgery was in 2007 and she is still posting reviews nearly 12 years later. Realizing “hell hath no fury like a woman scorned,” she has the wrong guy/gal. Can an attorney do something?
Martin V. Sloan, DPM, Abilene, TX
Query: Podiatry's Adjusted Gap Difference
A dentist friend forwarded this chart to me asking why there is so much of a difference between podiatry and the other health professions.
Adjusted Gap in Real Annual Earnings
I do not know. Any ideas?
Neil Scheffler, DPM (Retired), Baltimore, MD
Query: In-room vs. Virtual Scribes
I have a question for those of you DPMs who are using either in-room or virtual scribes. What are the pros and cons of each? Which would be the easiest to implement? I have been looking into virtual scribes, but am not sure which would be the most satisfactory.
Shari Lewis Kaminsky DPM, Florissant, MO
Query: Difficulty Finding Local Anesthetics for Office Purchase
We are unable to purchase any local anesthetics due to the manufacturing shortage, including 2% lidocaine plain. How are other podiatrists handling this situation? Are there any sources/vendors who are still able to get local anesthetics? Any feedback/information would be appreciated.
Margaret Portela, DPM, Union City, NJ
Query: Source for in-Office Dispensing
I am looking for a company to provide my office with products such as skin softeners with urea, topical antifungal agents, and cheaper alternatives to Metanx. Can anyone provide some good options?
Dan Methuselah, DPM, Columbia, SC
Query: Disposable Instrument Kits
I had a rep in the office earlier peddling disposable surgical trays; specifically, one kit that was a nail nipper and an emery board. The other kit he demonstrated was a P&A kit - with an English anvil type nail splitter, elevator, beaver handle, and file. These were fully disposable kits and appeared to be of decent quality. They also are selling a "wound debridement kit". The nail kit was $10. The P&A kit was about $20.
My question is this: is autoclave sterilization "not good enough" anymore? He said that medicine was going to all disposable instrumentation eventually and that fungal spores could survive steam sterilization. I did quick math and figured if I paid $10 for a kit for every nail debridement, and $20 for every nail procedure, my profit margin would really suffer!
R. Alex Dellinger, DPM, Little Rock, AR