The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

January 04, 2011 #4,054 Publisher-Barry Block, DPM, JD

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MO Podiatrist Provides Advice on Buying Winter Shoes

Winter weather requires specialized footwear. Unfortunately, many people buy UGGs or cheap imitations. "The problem with cheaply made shoes is that they have soles which don't provide traction on slippery surfaces," says podiatrist Dr. Timothy Oldani.

Dr. Timothy Oldani

Support is also a problem. "One of the things you can do is to insert a custom-made orthotic or pre-fabricated insole into the boot to add support," says Oldani."Socks should be worn with winter boots to prevent skin infections, such as athlete's foot, which can spread to the nails, says Oldani.

OH Podiatrist a Front-Runner for Cincinnati City Council

Some major decisions are expected in the next few days, such as who will replace Republican Chris Monzel on the Cincinnati City Council. Monzel won election to the Hamilton County Commission in November and will replace Democrat David Pepper, who didn't seek re-election. Frontrunners to replace Monzel on the council are Amy Murray and Dr. Brad Wenstrup.

Dr. Brad Wenstrup (Photo Malinda Hartong)

Wenstrup, who lives in Columbia Tusculum, is a podiatrist and a U.S. Army veteran who served in Iraq. A political newcomer, he was the GOP candidate for mayor against incumbent Democrat Mark Mallory in 2009. Mallory won, capturing 54 percent of the vote.

Source: Kevin Osborne, Cincinnati City Beat [12/29/10]

When to Add New Staff

Medical practices are expected to add jobs in the immediate future, according to government surveys. But how do you know if the time is right to hire more staff members? There are several signs that it is time for a practice to add full-time staffers, such as when patients complain about how long they are placed on hold when they call in. When they call, can they get through on the first try? Are physicians complaining that patients are not in an exam room when they are supposed to be because staffers are weighed down with other duties? Have physicians been added to a practice, and do they have the support to do their jobs? Have new service lines increased patient volume?

Looking at benchmarking data from organizations such as the Medical Group Management Assn. may offer insight into appropriate staffing levels. Practices with more than one office also can create their own benchmarking data by comparing the workflow of each office.

Source: Victoria Stagg Elliott, AMNews [12/27/10]

Speed Through Word Documents

Master some basic keyboard shortcuts to trim the time you spend working on projects in Microsoft Word. Here are a few favorites:

• F4. Use that key to repeat your last action, such as applying a formatting style.
• F5. That key brings up the Go To box; use it to jump to another page.
• Ctrl + Home. Press those keys together to jump to the document’s beginning.
• Alt + Tab. Switch from one screen to the next when you press that key combination.

   Source: Communication Briefings [January 2011]

Query: Achilles Procedure With Distal Incision

Does anyone have a literature reference for an Achilles lengthening or  repair being performed without making an incision proximal to the level of the talus?

Daniel Chaskin, DPM, Ridgwood, NY

RE: Undiagnosed Diffuse Skin Lesions (Elliot Udell, DPM)
From: Robert Bijak, DPM

While we may be splitting hairs, one must differentiate between laboratory medicine involved with fluids such as blood and urine, and solids like hair and skin. My emphasis was on the fluids which lend themselves to standard chemical quantification. Naturally, in tissue pathology which is more QUALITATIVE, there is room for interpretation. MRI, etc. is not considered laboratory medicine so that does not apply here at all.

I would venture to state that most pathologists would consider their slide diagnosis more scientific than the purely clinically one made in an office. The point is, they are symbiotic. I still feel strongly that the lab interpretation has the greater weight, and more often than not confirms the diagnosis in the majority of cases.

Robert Bijak,DPM, Clarence Center, NY rbijak@aol.com

RE: Practice Fusion (Steven Frydman, DPM)
From: Elliot Udell, DPM, Roger L. Friedman, DPM

Our office is in the process of converting from Medinotes to Practice Fusion. We are  still in the early stages of this transition. Practice Fusion has a very good selling point. It is free as opposed to many other programs that sell for 15,000 dollars or more or require the kind of monthly fees that could pay for a brand new car. Practice fusion boasts over 50,000 doctors using their program. The rep whom I spoke with on Friday said that he alone has coached over 40 podiatrists who are using his program. They are very well staffed with online helpers who are there to give immediate help. It is also a very complete program, with e-prescribing as well.
 
Having used Medinotes for 12 years, I would stay with it in a heartbeat if I had the choice. It has served me well. Unfortunately, Medinotes is not a certified program and Allscripts that now owns Medinotes has no desire to get it certified. I would love to hear from other doctors who have made the transition from Medinotes to Practice Fusion.  
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

In my opinion, the best feature of Practice Fusion EHR is that you can try the program before you decide if you want to use it. I know of no other EHR that allows this (if there are any, I would appreciate a heads-up). Each physician has his/her own style of charting and by trying the program, you can determine if you will be able to adapt to the constraints of it. For the unbeatable price of free, it has some very nice features, but the feature-set is quite basic.

I have tested Practice Fusion using Dragon Dictate, and it does a satisfactory job of producing medical records quickly and accurately (I found a nice demo video at ehrtv.com/practicefusion-dragonmedical/). Advantages: Web based; simple to use; free. Disadvantages: Limited feature-set and customization; For integrated billing you must purchase services through kareo.com/. While the saying goes, “you get what you pay for” I would say you actually get much more with Practice Fusion, and I feel it is a definite usable small-practice solution coupled with Dragon. Try it for yourself to see if you can work within the limitations.

Roger L. Friedman, DPM, Elyria, OH, Roger@RogerFriedman.com

RE: X-Ray Comparison (Martin R. Taubman, DPM, MBA)
From: Gayle S. Johnson, PMA, Barry Mullen, DPM

After much deliberation, our office switched to digital x-rays a week ago. It seems that the new system will not cost us any more than what we paid every month for film and chemistry for this four-doctor practice. 

Even after just a few days of use, while still in the learning process, our doctors are very impressed with the system and the results that we are getting. The staff time saved by eliminating processor maintenance is significant. A week ago, it took more than three minutes to see a finished film. Today, it took slightly more than half a minute. So far, we are very pleased that we made the change.

Gayle S. Johnson, PMA, Edmonds, WA, gaylejohnson@footzine.com
 
Our group echoes Dr. Taubman's sentiment. The image quality obtained via digital x-ray far surpasses that created from traditional radiographs, even with automatic processing. Digital x-rays' biggest advantage is its contrast adjustment capability. The enhanced images may detect foreign objects in soft tissues, or the most minute cortical disturbances to help corroborate stress fractures or OM, which often remain undetected for several weeks following the onset of symptoms (when utilizing conventional radiographs). The delay in diagnostic corroboration is a critical factor linked to healthcare delivery quality.

In addition, the need for additional image outsourcing, such as Tc scans or MRI's, is often reduced. This is especially germane to the competitive athlete when diagnostic corroboration is often time-critical. Lastly, the reduced medical costs incurred by patients and insurance carriers can only enhance one's negotiating power.
 
From a practice management perspective, the fact that the image appears on your treatment room computer screen provides "eye candy" for patients who leave the office impressed with this technological advancement. The subsequent referrals generated from an impressed patient, who now visualizes your office as a component of the cutting-edge of technological advancement in healthcare delivery, more than accounts for the additional revenue required to purchase the unit. This practice management pearl should not be underestimated. The only regret is not purchasing a digital x-ray unit as soon as it became available in the medical market place.
 
Barry Mullen, DPM, Hackettstown, NJ, yazy630@aol.com

RE: X-Ray Comparison (Martin R. Taubman, DPM, MBA)
From: Richard A. Simmons, DPM, Simon Young, DPM

A concern (for newer technology) that I have heard, but not seen discussed in this forum is that the cost of medical-technology never seems to come down. I have seen the same medical-technology electronics at the same multi-thousand dollar prices for more than a decade, yet I have seen consumer-technology electronics (for instance, HDTVs) fall from over ten thousand dollars to under one-thousand dollars in the same time frame. All the while, the medical-technology hardware and software has barely changed.

Other than providing the profession with lavish seminars paid for by new practitioners or others who are upgrading to today's technology, why doesn't the price adjust downward on these devices?
 
Richard A. Simmons, DPM, Rockledge, FL,  RASDPM32955@gmail.com

Granted digital x-rays are, in general, an improvement to conventional x-rays. They are a superior product in a large group practice with a high x-ray volume. I have seen and used several different systems at my local hospital, as well as evaluated x-rays on CD. I disagree strongly that digital x-rays improve quality of patient care. I don't feel that they offer any significant improvement in diagnosing pathology.
 
Everyone loves electronic toys. Unless you have a patient or insurance base which will reimburse you for your added costs or unless you are a high volume x-ray user, digital x-rays are an unnecessary expense. I still would use my dollars on a diagnostic ultrasound unit, a symbiotic modality to our x-rays, which I feel in conjunction with x-rays, does augment patient quality of care. 
 
Simon Young, DPM, NY, NY, simonyoung@juno.com

RE: Phone System Recommendations (Jack Reingold, DPM)
From: Carl Solomon, DPM

Dr. Reingold describes the need for a phone system in a solo practice. Many options are more than he needs.  I suggest surfing Ebay for a phone system with a Key Service Unit (KSU) and individual stations. There is an abundance of them and they are reasonably priced. I believe they would also be compatible with VOIP. Most do offer intercoms and capability for music on hold.

Carl Solomon, DPM, Dallas, TX, cdsol@swbell.net

RE: The Passing of John Carson
From: Joe Agostinelli, DPM

A true "gentleman" and someone who has left his mark on our profession for all time. John was the "prime mover" for ensuring that military and VA DPM's were integrated into the medical communities of those institutions. Each of our military and VA DPM's need to know that we could not have advanced in these government entities without John's guidance and work behind the scenes. One instance of many I can think of when John actually "saved" our military podiatry program occurred in 1986 when there was a directive from the Department of Defense to "civilianize' the military DPM program because "other professions" could do what we do.

John worked round the clock in Washington, DC, making the rounds of key congressman on various committees to eventually "squelch" the effort to replace our uniformed DPM corps in the military services. John also encouraged me to be involved in the APMA/House of Delegates and was instrumental in having our Federal Services Podiatric Medical Association grow and prosper, even having our members for the first time on APMA committees, to illustrate that our military and VA DPM's were vital to our professions' growth. Although this is a time of sadness for many of us, if we close our eyes and think of John Carson, we will have a smile on our lips and a song in our hearts remembering our times with him.
 
Joe Agostinelli, DPM, Niceville, FL

RE: Big Foot Visits Podiatrist's Office

New York City was recently hit with 20 inches of snow. Apparently, Sasquatch tried to get an appointment at my Rego Park office.

Big Foot Visits Podiatrist's Office

Source: Submitted by Dr. Arthur Gudeon   

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

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 - 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

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

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.

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

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