The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

January 01, 2009 #3,438 Editor-Barry Block, DPM, JD

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Podiatry Runs in the Family

This family has got sole. We're talking professionally. For four generations, Toepps and Neuhoffs of this area have handed down a passion for foot care, removing bunions, looking after diabetic wounds, easing the pain of heels and going toe-to-toe with ingrown nails.

Frank C. Toepp poses with his daughter, Kathleen Toepp Neuhoff; granddaughter Carolyn Rose Neuhoff; and his wife, Rosemary Toepp.

The practice of podiatry, helping others while having time for a full life with family, has attracted generations since Frank C. Toepp Jr. graduated from the William M. Scholl College of Podiatric Medicine in Chicago in 1933. The school now is part of the Rosalind Franklin University of Medicine and Science.

His sons Frank Toepp III ('52) and John Toepp ('57), Frank's daughter Kathleen Toepp Neuhoff ('93) and Kathleen's daughter Carolyn ('07) all earned degrees from the school, apparently the longest line among its more than 5,000 graduates. Chances for a fifth generation appear strong: Carolyn recently married Anthony Cole, who was a year ahead of her at Scholl. Both are doing their residencies in Phoenix, AZ.

Source: Gene Stowe, South Bend Tribune (IN) [12/30/08]

NJ Psychic Correctly Predicts Podiatry Student’s Future

Nicole Reardon of Rockaway, NJ comes from a long line of women who have turned to clairvoyants to foresee the future and glean insight into their lives. Following in the footsteps of her mother, aunt, and grandmother, Reardon first visited psychic medium Frank St. James while she was still a senior majoring in behavioral neuroscience at Fairleigh Dickinson University in Madison.

Nicole Reardon

Now, on the cusp of medical school, Reardon -- who turned 23 on Sunday -- sought another glimpse into the crystal ball and her prospects to become a podiatrist. "I believe in all of this," said Reardon, who celebrated her birthday with a reading by St. James on Sunday afternoon. "I don't guide my life by (the readings), but they're fun and I enjoy them. It's fun to predict the future."

The psychic was proven right when Nicole was accepted to the New York College of Podiatric Medicine where she will begin her studies this Fall.

Source: Tehani Schneider, The Bergen Record (NJ) [12/29/08]

CMS Cracks Down On Equipment Suppliers

The CMS said it has revoked billing privileges for more than 1,100 medical equipment suppliers in Southern California and South Florida, and has suspended payments to a number of home-health agencies in the Miami-Dade, FL area. Additionally, the agency released a final regulation that requires certain medical equipment suppliers to first post a surety bond of at least $50,000, according to a written statement from the CMS.

Under the regulation, certain suppliers of durable medical equipment, prosthetics, orthotics, and supplies are required to post a bond by Oct. 2, 2009. Newly enrolling suppliers, however, must meet the requirement by May 4, 2009.

In Dade County, the CMS suspended payments to 13 out of more than 300 home-health suppliers and has ordered pre- and post-payment reviews, validation of claims that are submitted by physicians in high numbers, and verification that those physicians are actually caring for Medicare beneficiaries.

Source: Matthew DoBias, Modern Healthcare [12/30/08]

Query: Exit Strategy

I am age 60 and plan to work another 5-10 years. I do well and have had a good practice life. I want to make advance plans for retirement so I am not faced with an “end of practice” crunch-time wise, or financially wise. It seems to me, that taking in a partner with intentions to buy-in is preferable to waiting until the last minute and trying to sell- but where does the money come from?

I bill over 600K a year, and with HMO’s etc, I collect about half of that. After paying staff and myself, and daughter’s tuition, and so on, there isn’t enough free cash left over with which to pay an associate what he or she would be worth. What innovative ideas do any of my colleagues have about taking in someone, and making exit plans?

Name Withheld

RE: Dry Needling With Steroid for Chronic Heel Pain (Robert Chelin, DPM)
From: Multiple Respondents

Although I have not performed dry needling for treatment of plantar fasciosis, I have for the last 6 years been using ultrasound-guided steroid injections using a 25ga 1 and 1/4" needle, and making multiple stabs into the fascia under direct visualization. I have found this to be very effective. I have had some patients who were treated by injections elsewhere, and they reported minimal improvement, but it seems the US-guided technique works well and is consistent with the needling technique. Of course, you should consider doing an EPF at this point, as too much steroid may preclude anything else. Cold laser can be attempted, but requires frequent and chronic treatment.

Peter J. Bregman, DPM, Tewksbury, MA, Footdoc@painfreefeet.com

While I have not had any experience with dry needling protocols, I have had good success (nearly 90% improvement with the seven feet operated on in the last 18 months, anecdotally of course) with the percutaneous "TOPAZ" procedure. This is a non-destructive technique that potentially creates an "angiogenesis" effect to help heal the plantar fasciosis that has taken place. Patients are able to ambulate within days and the procedure takes only about 12-15 mins under tourniquet. I like this procedure as a precursor to any EPF or Koby-guard techniques due to its ease and quicker recovery, not to mention that you can always go back down the road and "release" the fascia, if necessary.

Mitch Barber, DPM, Laurel, MD, mbarberdpm@gmail.com

When focusing on heel pain, consider other differential diagnoses: Tarsal tunnel, posterior tibial tendonitis/PTTD, spinal radiculopathy or DJD, rheumatological causes-R.A., psoriatic, lupus, and tumors, for a start.

Simon Young DPM, NYC, NY, simonyoung@juno.com

RE: Refusal to Treat AIDS Patient (Name Withheld)
From: Multiple Respondents

I was saddened to read the post about the "name withheld" patient who in his own words "looked at the chart and walked away." Why would you do that? The patient had gangrene and a positive venous duplex. Who better than you to treat the patient? If you felt this was more of a vascular consult, then at least write up the chart and make the appropriate referral. Was it the AIDS that scared you away? If the patient was a nice elderly patient with good insurance would you have walked away? I am disappointed you were worried about your legal obligation...the person you walked away from is a human being...

Jeffrey Kass, DPM, Forest Hills, NY, Jeffckass@aol.com

There are many solutions to this. The doctor who "belonged to a big medical group that has their own podiatrist" asked for a "consult." First, "Consult" does not, in and of itself, demand "treatment"; in fact, it excludes it. A consultation is an opinion. In this case, it would be very easy to justify ordering/recommending a vascular surgeon "consultation", and allow the vascular surgeon to make the decision whether to amputate or not, and at what level any amputation may heal. Second, the doctor requesting the consult may not trust the judgment or treatment of "his" podiatrist, and may actually be paying you a compliment. Third, treatment for late-stage AIDS may only need to be supportive in nature, since surgical procedures/amputation may indeed be medically contraindicated. Keep your mind and options open.

Robert A. Boudreau, DPM, Tyler, TX, rbftdoc@aol.com

Editor’s note: An extended-length note by Richard Gosnay, DPM appears at: http://www.podiatrym.com/letters2.cfm?id=23850&start=1

RE: PA Podiatrist & Orthopedist Cite Need for Diabetes Awareness
From: Kenneth Meisler, DPM

I read with interest the comment by the orthopedic surgeon about how much we, as podiatrists, know and are capable of. It reminded me of something that happened to me. My wife and I had just gotten into our car after getting coffee for our drive to upstate New York for the weekend. I was startled and a little scared when someone came over to the driver’s side and knocked on the window. I rolled down the window with a little trepidation when he said, "You might not remember me. My name is Dr. Jones. I'm a neurologist and you cured me. I never cure anyone; all I do is diagnose them, and they get worse. My fascitis was so bad I couldn't run for months and "you cured me, thank you."

As we struggle with scope of practice laws, insurance reimbursements and other negative aspects of medicine I know that I have gotten many primary care doctors to refer to podiatrists first for any foot and ankle problems. It is the great care we provide patients that will eventually break down all of the barriers to parity.

Kenneth Meisler, DPM, New York, NY, kenmeisler@aol.com

PRACTICE AND BUILDING FOR SALE - MIDDLE TENNESSEE

Two locations each with 3 exam rooms, x-ray room, large waiting room, and ample parking. Excellent locations and growth potential. All equipment and furniture included. Seller happy to discuss extensive financial and professional information. Priced to sell. Call 615-290-6766 for information.

EQUIPMENT FOR SALE – X-RAY MACHINE

2010 All-Pro Imaging X-ray Machine for film up to 10” x 12”. Included – Extra Duplicating Film, Duplicator, Paper Safe, Cleaning Kit, Kodak Roller Transport Clean-up Film & Operators Guide. This machine is in excellent working condition, it does show use. We will send pictures.$1500.00 & shipping. Contact: durango@onlineoutpost.net 970-259-7795.

POST GRADUATE PODIATRIC RESEARCH FELLOWSHIP

Boston University Medical Center and Boston University School of Medicine. This unique fellowship at a major teaching facility is a two-year opportunity, during which he/she would be expected to become a knowledge expert who will contribute significantly to research, teaching, and innovations in limb preservation and tissue repair. Requirements: Completion of a two or three year surgical residency; Massachusetts license-eligible, ABPS Board Qualification-eligible. Candidate must possess a commitment to an academic career in podiatric medicine and surgery. Annual Salary: Year 1 $61,000, Year 2 $66,000. Submit a CV and letter of interest to: vickie.driver@bmc.org

ASSOCIATE POSITION – CINCINNATI, OHIO

This is your once-in-a-lifetime opportunity to join one of the most successful practices in the United States. No seniority system. If you are motivated and have completed a PSR24-36 residency, your income is limited only by your enthusiasm and desire to achieve. Fax resume, including photo, to: 513-577-7261 or E-mail resume to Kroesch4poh@aol.com

ASSOCIATE POSITION WANTED - GEORGIA,TENNEESSEE OR ALABAMA

I am looking for an opportunity to be a full-time associate with a well-established podiatric facility; I have worked in a private office setting for four years with surgical privileges at Wellstar Kennestone Hospital and Windy Hill Hospital and Banks Jackson Commerce Hospital. Rick Thornton, DPM, 312-752-7713 E-mail, rico_t16@yahoo.com

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for part-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to f-massuda@footexperts.com

ASSOCIATE POSITION MONTANA

Great opportunity for a PSR-24 or 36 residency trained individual to join a dynamic two doctor group with physical therapy. Needs good FF surgical skills, RF a bonus. Beautiful office and great area of the country for outdoor recreation minded individuals. Opportunity for partnership after employment. Reply to: jclough@sofast.net

ASSOCIATE POSITION -SOUTHERN NEW JERSEY

I’m looking for podiatrist who wants additional practice hours. Perfect for combining your own practice with an additional income. Must be on Aetna Insurance, Horizon Blue Shield, Medicare, and most commercial carriers. I am looking for someone who has a desire to learn how a very successful practice is run, so that I will be able to have time away from my practice. The payscale is based on straight Commission. Could lead to partnership or sale. E-mail contact information, CV, and why you would be perfect for this opportunity. Contact foot.care@verizon.net

PODIATRISTS NEEDED CHICAGO -- NW IND & BALTIMORE/WASHINGTON, DC

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists in Chicago, Northwest Indiana, and Baltimore, MD. 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 Visit our website

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