College Offers Accelerated DO Program For DPMs

By Brian McCurdy, Associate Editor

   Adding a new twist to the ongoing debate about dual degrees for podiatrists, the Nova Southeastern University College of Osteopathic Medicine (NSU-COM) recently announced that two podiatrists have enrolled in the college’s new, accelerated doctor of osteopathic medicine (DO) program. College officials say the program is the first of its kind developed specifically for DPMs.    The program was formulated in association with the American Board of Podiatric Orthopedics and Primary Podiatric Medicine, according to Leonard A. Levy, DPM, MPH, an Associate Dean for Education, Planning and Research at NSU-COM in Ft. Lauderdale, Fla. The program leads to a DO in three years and Dr. Levy says it saves one year of podiatric medicine and Surgery-24 residency.    After students finish a year of classes to supplement their medical knowledge, Dr. Levy says they then take required clinical rotations in medicine, family medicine, emergency medicine, surgery, obstetrics and gynecology, psychiatry, pediatrics and rural medicine at hospitals and clinics affiliated with NSU-COM.    Those with DPM/DO degrees will be able to offer enhanced care for patients with podiatric problems or pedal problems with systemic manifestations and in patients with concurrent medical conditions unrelated to the lower extremities, notes Dr. Levy, a Professor of Family Medicine and Public Health at NSU-COM. He says the program will teach DPMs to use osteopathic manipulative medicine as an adjunct to podiatric medicine.    Khiem Vu, DPM, one podiatrist who enrolled in NSU-COM’s osteopathic program, concurs. He says he wants to learn more about the medical management of systemic diseases of the lower extremity.     “As podiatric physicians, we often are asked to manage specific podiatric manifestations of systemic disease and we are very well trained and qualified to do so,” says Dr. Vu, a graduate of Barry University. “However, in certain cases, we often have to limit our treatment for the patient because of the underlying systemic disease. By increasing our training to manage the medical aspect of the patient, podiatric physicians can provide comprehensive care in a timely fashion for the patient.”    Richard Bui, DPM, agrees. A graduate of Barry University, Dr. Bui has also enrolled in the DO program and believes it may be helpful when it comes to treating those who need prompt attention for conditions that are not specific to the foot and ankle.     “My hope is that DO program will help enhance my confidence when approaching patients who need immediate attention in regard to medical problems, such as diabetes management or heart problems,” notes Dr. Bui.    Both Drs. Bui and Vu also completed one year of their podiatric residencies to be eligible for the program.

Will The DO Degree Enhance Referrals And Revenue?

   Dr. Levy says the dual degree may increase patient referrals for podiatrists. He points out that some patients, especially those with concurrent health problems and with medical problems that have podiatric manifestations, may have more confidence in seeing DPMs who are also fully licensed physicians.    Dr. Bui agrees that having both degrees will increase the attractiveness of podiatry among the public due to the convenience of being treated in “one-stop shopping.” Referrals would increase for those with a DPM/DO since doctors will be confident that one will take good care of their patients.     “The elderly population will be two-thirds of the population in the decades to come,” says Dr. Bui. “Of course, they will want a physician who can treat them from head to toe rather than go from specialist to specialist to get the treatment they need.”    A DPM with a DO degree and license will be able to join medical organizations, such as the American Medical Association, that will enhance their ability to interact with both DOs and MDs, according to Dr. Levy. He says they may also be able to enhance the level of hospital privileges they acquire, including the ability to perform general history and physical exams on their patients. In that same vein, Dr. Vu asserts that referrals will increase because allopathic and osteopathic physicians are aware of the training required to obtain a DO degree and should be more confident sending patients to podiatrists with DO degrees.    An additional degree may also increase revenue, according to Dr. Levy, who notes the DO degree may enable DPMs to provide a broader scope of care and therefore be better able to compete for managed care contracts. Dr. Bui concurs, saying revenue from HMOs would “pour in” due to the increased demand of the services of DPM/DOs.    While some hospitals are unwilling to let podiatrists obtain patient histories and perform physical exams, Dr. Levy says DPMs with dual degrees would be able to perform their own histories and physical exams in hospitals. As Dr. Vu notes, there would also be increased revenue from the number of procedures a DPM/DO could perform and the additional CPT codes he or she can use.    As DPMs learn about osteopathic medicine, Drs. Bui and Vu says they are in a position to educate DOs about the extent of podiatric practice and how their knowledge of podiatry can help DOs understand the potential impact of cardiovascular and endocrine diseases on the musculoskeletal system of the lower extremity. Dr. Bui emphasizes that a proactive referral to a podiatrist may help prevent significant lower extremity problems caused by the progression of these diseases.

Study Notes Efficacy Of rhPDGF For Diabetic Foot Infections

By Brian McCurdy, Associate Editor    While the efficacy of using growth factors to treat wounds has been well documented, a recent study shows some intriguing results for an emerging recombinant human platelet-derived growth factor (rhPDGF) in treating chronic diabetic foot ulcers.    Researchers of a multicenter, randomized trial in India used the topical gel Healace 0.01% (Virchow Biotech) to treat 53 patients while treating 58 with a placebo, according to a recent study in WOUNDS: A Compendium of Clinical Research and Practice.    After 10 weeks of treatment, researchers discovered patients in the rhPDGF group showed a 40 percent higher incidence of complete healing compared to the placebo group. During that same time period, patients in the rhPDGF treatment group had an average time to healing of 46 days compared to 61 days for the placebo group, according to the study.    Lawrence Karlock, DPM, has used rhPDGF often to manage both diabetic and other lower-extremity ulcers, and has had mixed results.     “In some instances, the growth factor appears to kick-start the healing process in a stagnant chronic wound,” says Dr. Karlock, a Fellow of the American College of Foot and Ankle Surgeons. “However, some cases show no benefit at all in using this expensive product. I still only recommend it for the chronic wound and don’t use it as a primary early topical modality.”    On the positive side, Dr. Karlock notes such growth factors are easy to use, quickly dispensed and patients tolerate them well. However, he notes that only one growth factor is present to administer to the wound. Dr. Karlock says he would like to see a product with multiple growth factors in one package.

Can Custom Orthotics Help Treat Juvenile Idiopathic Arthritis?

By Brian McCurdy, Associate Editor    Custom orthotics can be helpful for a great number of podiatric complaints but are they effective for children with idiopathic arthritis? A new study in the Journal of Rheumatology shows that children with this condition have decreased pain and increased mobility when wearing custom orthotics.    As part of the study, researchers treated 40 children with juvenile idiopathic arthritis with either custom semi-rigid orthotics with shock absorbing posts, OTC flat neoprene shoe inserts or supportive athletic shoes with medial longitudinal arch support and shock absorbing soles.    Researchers found that the children wearing custom orthotics experienced “significantly greater improvements” than the other two patient groups in terms of pain, speed of ambulation, limitations in activity and disability level.    OTC inserts and athletic shoes showed a reduction in pain but otherwise had no significant effect on the study’s evaluation measures, including mobility and quality of life, according to the study.    Many podiatrists treat patients with juvenile idiopathic arthritis and the study shows custom orthotics can be more beneficial than OTC products for the condition, according to Matthew Garoufalis, DPM. He believes the results of the study can be extrapolated to show a benefit for adults with arthritis.    While OTC products can aid patients, Dr. Garoufalis says custom orthotics can capture the unique qualities of foot structure to specifically address the individual’s foot.     “Think in terms of eyeglasses,” offers Dr. Garoufalis, the Chairman of the American Podiatric Medical Association’s Clinical Practice Advisory Committee. “If you were nearsighted or farsighted, an OTC product may not help you as much as a prescription pair of glasses. A similar analogy can be used with custom orthotics.”

In Brief

   Pfizer recently acquired Vicuron Pharmaceuticals, a biopharmaceutical company with two products under New Drug Application review at the FDA. The products are anidulafungin for fungal infections and dalbavancin for gram-positive infections.    As the Podiatry Insurance Company of America (PICA) celebrates its 25th anniversary, the company announced that John E. George, DPM, has been elected as the Chairman of the Board of Directors.

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