The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

January 08, 2010 #3,748 Publisher-Barry Block, DPM, JD

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We've just mailed the January 2010 Podiatry Management. This special 236-page issue contains over two dozen practice management articles. You'll also find our usual assortment of features, including our columns, and a CPME-approved CME.

January 2010 Podiatry Management

Hydration is the Key to Treating Dry Skin: TX Podiatrist

Dry, itchy skin is bad enough, but when eczema or psoriasis  gets serious, you may make the transition from considerable discomfort to full-fledged torture. Your skin can crack, leaving painful slits that bring agony with even the most basic body movements such as stretching. Doctors call these cracks skin fissures. You will probably call them something a little more colorful. Hands and feet are the most likely spots for cracked skin, but there are other vulnerable places, too.

Dr. William Van Pelt

"Sometimes the feet are so dry that they crack, particularly on the heel and between the toes--and these cracks are like little portholes for infection," says Houston podiatrist William Van Pelt, DPM, former president of the American Academy of Podiatric Sports Medicine. "Women who wear open-backed heels and slides are particularly prone." Here's how to take the fire out of painful fissures. "The best way to treat very dry skin is to hydrate it every night," says Dr. Van Pelt. "Each skin cell is like a little sponge, so each night before going to bed, I recommend soaking your feet, or whatever part of your body is especially dry, in warm water for about 20 minutes. During this soak, the skin cells will absorb water. Then pat yourself dry."

Source: Dean Richards, Kansas City Health Examiner [1/3/10]

Barry to Celebrate 25th Anniversary

Barry University’s School of Podiatric Medicine will celebrate its 25th anniversary in 2010 and, to celebrate, will host a casual and fun “Barefoot Ball” Jan. 21, 2010. The Florida-themed gala will take place at the Caribe Royal Resort in Orlando, FL during the Florida Podiatric Medical Association’s (FPMA) annual Science and Management Symposium.

Dr. John Nelson

"There will be a lot of surprises in store for our alumni,” said Dr. John Nelson, interim dean for the School of Podiatric Medicine. “In addition attendees of the FPMA symposium will be excited to know that ticket prices are very reasonable, including a free menu for children 12 and under. It will be a great way to spend an evening with family and still renew friendships with colleagues.”

The School of Podiatric Medicine has made notable progress since its modest beginning in 1985; there were 18 students in the first class, no clinics, and only one hospital affiliation. Today, the school has nearly 200 podiatric medical students, with over 250 hospital based clerkships. The school boasts a 36-month podiatric medical and surgical residency training program and more than 1,100 graduates.

MI Podiatrist Working to Establish MI Boxing Hall of Fame 

Stuart Kirschenbaum is a podiatrist by trade, so he can certainly appreciate how the term, ‘The shoe is on the other foot,' applies to him. In addition to his medical work, the Franklin resident has been involved in athletics - mostly boxing - for 42 years, and has served in various positions for several sports halls of fame, including the Michigan Sports Hall of Fame, the International African-American Sports Hall of Fame, and the Athletes with Disabilities Hall of Fame. But Kirschenbaum recently found himself on the other side of the fence as the former golden gloves fighter, boxing judge and Michigan boxing commissioner was inducted into the Michigan Jewish Sports Hall of Fame.
 

Dr. Stuart Kirschenbaum

Today, Kirschenbaum continues to practice podiatry and remains on the board of the Michigan Jewish Sports Foundation. Additionally, his chief project is founding a Michigan Boxing Hall of Fame. Kirschenbaum has been working on the project for about two years. He hopes the boxing hall will “keep the legacy of the sport alive - it has been in the state for well over 100 years right now. This was something that was lacking and it's a passion of mine to see this succeed.” He adds that he's negotiating with “one of the major business families in Detroit, to establish a permanent home for this hall of fame.”

Source: Mike Rosenbaum, Hometown Life [1/3/10]

Query: Bleomycin Injections

Injections of Bleomycin is used by many podiatrists for the treatment of recalcitrant verrucae. It’s also expensive and its use is obviously off-label. For those who use this method for treating verrucae, how have you managed the financial aspects of it?

Elliot Udell, DPM, Hicksville, NY

Query: Joining a Large IPA

I am currently looking into joining a 200-physician IPA. The initial costs and quarterly dues to join the IPA are significant. I am wondering what other DPMs who are part of IPAs think of them. Do they find it worth the investment? Is the higher negotiated fee schedule significantly more than that received as a solo practitioner?

Name Withheld (New Mexico)

RE: Chronic Itching and Vesicular Eruptions (Arthur Lukoff, DPM)
From: Todd Monroe, DPM, Gary S. Smith, DPM

It looks like pustular psoriasis to me. There is no cure. Lotrisone and occasionally "bag balm" may help, but it will always come and go.
 
Gary S. Smith, DPM, Bradford, PA, penndoc@verizon.net

At first glance, this appears to be a deep integumentary fungal/yeast infection with puritis. Get a good recent family history of travel and exercise as this patient may have been exposed to a dermatophyte at some point. In these cases, I get liver function tests and basic blood panels for baseline records, then begin either Diflucan or ketaconazole at your comfort level. I start with ketaconazole 200 mg po daily until the lesions are gone, then an additional week of therapy. Lastly, I use halobetasol 0.05% for 7 days, then D/C the topical pending follow-up evaluation.
 
Dig into this patient's history to help find the answers. Repeat labs after the oral antifungal as well. Note: The condition may worsen prior to improving as the deep skin eruptions clear prior to improving. The topical steroid will help with the itching, while the oral medications kill off the deep infection. Keep us posted please.

Todd Monroe, DPM, Aberdeen, SD, the1docholiday@hotmail.com

RE: Covered, Then Non-Covered Orthotics (Michael Forman, DPM)
From: Richard A. Simmons, DPM, Barry Mullen, DPM
 
In addition to the other suggestions, might we try to call them anything other than "orthotics?"  If I remember correctly, one of the functions of these devices is to position and maintain the subtalar joint in its neutral/optimal position. We take elaborate measurements and tediously hold the foot in its neutral position while casting. The term "orthotic" refers to a device that straightens. A biomechanically-measured device that maintains the subtalar joint in a neutral position during the stance phase of gait does not straighten anything, but helps to maintain the center of (our body's) gravity over the foot.  Therefore, a biomechanical-subtalar-joint-positioning-device exceeds the criteria of L3000 or L3030.  L3000 and L3030 are devices that lay people can purchase after standing on a pressure sensing mat at the drugstore.  Dr. Scholl's advertises and sells orthotics. We should not expect the lay public to know that the term is meaningless as we try to justify hundreds of dollars more for our devices. Stop selling "orthotics" and start dispensing biomechanical subtalar joint positioning devices. If the patient wants an "orthotic" simply point him/her to a Dr. Scholl's orthotic dispensing display.

Since it appears that this battle with the insurance companies is one that individual doctors must take on (as opposed to local societies or state components), it is strongly recommended that a healthcare attorney review contracts before the doctor joins. Make sure, through your attorney, that the contract language is consistent with your understanding of the contract.

Richard A. Simmons, DPM, Rockledge, FL, rasdpm32822@aol.com

Editor’s Note: Dr. Barry Mullen’s extended-length letter appears at:
http://www.podiatrym.com/letters2.cfm?id=31705&start=1

RE: My New Career as an Orthotist ({Name Withheld} Ira Baum, DPM)
From: Michael M. Rosenblatt, DPM, Bob Kornfeld, DPM

Dr. Ira Baum, DPM decried the fact that podiatry is heading into a surgical specialty, and that this threatens its existence as a “separate” profession. While I do have some areas of agreement with his post, I also disagree.  Podiatry residency is definitely focused toward surgery. But real world intervenes. Many podiatry patients don’t need surgery and/or there are better treatment methods, including active treatment of nail fungous (rather than just grinding), to injection therapy and, of course, orthopedic treatment. There are a myriad of other treatment methods and needs as well.
 
Many of these pay more than some surgeries. The market will solve many, if not all, of Dr. Baum’s concerns. Name Withheld became an orthotist because he could not find his financial footing being a podiatrist, not because he was/was not trained as a surgeon. The problems he had were not based upon his treatment preferences, but rather the “inability” to earn enough. He was terrified of additional debt.
 
Young podiatrists receive almost NO financial training. An exception to this is the Ohio College of Podiatric Medicine’s new practice management curriculum. But there is a history too. Dr. Bernard Egerter provided us with important practice management training years ago at OCPM. I still remember his lectures. The one I enjoyed most was his method to rejuvenate an “old” practice. I used it myself. None of his advice was “surgical.”
 
Name Withheld slid from one failed associateship to another. It did not have to be that way. It still doesn’t. 
 
Michael M. Rosenblatt, DPM, San Jose, CA, Rosey1@prodigy.net

I must say it saddens me to hear that ANY podiatrist in this day and age should have trouble making a living, let alone a very lucrative one. This says so much for the current lack of respect for podiatrists by insurance companies as well as the continued willingness by podiatrists to sign contracts that do not put bread on the table. How can you feel self-respect if you allow yourself to be controlled this way? This is a very sorry state of affairs and will not be fixed by the Obama healthcare reform. If anything, it will just get worse. I applaud any doctor who works the problem and finds his way out of a very unsatisfying career, whether as an orthotist or anything else. However, it is my position for many years that ANY podiatrist who drops out of all of the networks, finds the right niche, and does the right marketing will absolutely thrive as a podiatrist. Why throw it all away? 
 
Bob Kornfeld, DPM, Manhasset, NY, Holfoot153@aol.com

ASSOCIATE POSITION FULL-TIME - SUBURBS OF CHICAGO

PSR 36 - month-trained podiatrist needed for busy suburban Chicago practice. Full benefit package included. If interested, please email your curriculum vitae to foot1st@yahoo.com

PRACTICE FOR SALE - CENTRAL FL

Practice and medical building for sale, in beautiful, high quality of life, growing area, Central Fl.; 2000 sf bldg. fully equipped/ designed for podiatry; excellent location, features & exposure; near hospital, wound and HBO center. Great opportunity for expansion & investment; good insurance climate. 352-223-2713 / E-mail: windnwave@earthlink.net

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 a full-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

PRACTICE FOR SALE - MAINE

20+ year, full scope, turn-key practice. Retiring seller will assist in transition. Excellent expansion potential, superb place to raise a family. mainefootdoc@yahoo.com

DREAM PRACTICE OPPORTUNITY - OKLAHOMA

Use forefoot, rearfoot, wound skills in ideal small city with nearby lake. No buy-in costs. No limit on income. EMR. Act fast. OK State License deadline is 1-30-10 and test is comprehensive. Personality preferred over ego. Email julietburk@gmail.com or call 918-931-1425 for details.

ASSOCIATE POSITION – ILLINOIS

Quality Podiatry Group provides quality services to residents at long term care facilities. We are currently offering full-time or part-time positions for motivated ethical podiatrists. Immediate openings are available. If interested, fax curriculum vitae to 847-674-2113 or e-mail to feetwork@aol.com

ASSOCIATE POSITION - MASSACHUSETTS

PSR-24 trained podiatrist for busy multi location practice, high volume and high-tech. Seeking energetic individual for high volume of patients with multiple needs. Orthopedic, sports medicine, wound care, pediatric orthopedics and surgery skills required. Looking for immediate hire for the right candidate with possibilities for partnership. Contact Debbie Roberts debbierobertsm4@hotmail.com

ASSOCIATE POSITION – NORTH AND CENTRAL FLORIDA

Quality Podiatry Group of Florida provides quality services to residents at long term care facilities. We are currently offering full-time or part-time positions for motivated ethical podiatrists.  Immediate openings are available. If interested, fax curriculum vitae to 847-674-2113 or e-mail to feetwork@aol.com

PRACTICE FOR SALE - ALABAMA, GULF COAST

Established 26 year old practice for sale. Owner desires to sell and relocate. Practice operated 25 hours per week. Mixture of surgery and general podiatry. MD referrals. Surgery center and hospitals in close proximity. Highly profitable. Priced to sell. Seller will lease office to buyer. Call Mike Crosby at 1-888-776-2430 or email at mcrosby@providerresources.com

ASSOCIATE POSITION - BROOKLYN, NY 
 
Full or part-time position available for a busy well-established podiatry practice in downtown Brooklyn. All phase of podiatry. Modern office with EMR, Ultrasound, digital x-rays with a great support staff. Must be highly motivated, ethical, with good communication and clinical skills. please email resume to tkd@gishpuppy.com

ASSOCIATE POSITION - HUDSON VALLEY, NY

Recruiting a podiatrist who enjoys doing surgery! We are a seven–doctor podiatry group and we’re great to work with. A residency program is attached to our practice. Interviews will begin shortly for this special position. Please forward CV to: healthyfeet4ever@yahoo.com

ASSOCIATE POSITION-CHICAGO AREA

Medical-surgical podiatry practice seeking full-time associate, future partnership opportunity. Start with full schedule. In Elgin, IL 45 minutes from downtown Chicago. Established 75+ years, new state of the art facility. 5 minutes from new, high-tech hospitals. Excellent relationship with other specialties, high physician referral base. PSR-24/36. Email resume to kenjacoby18@gmail.com

ASSOCIATE POSITION – CINCINNATI, OHIO

This is your once in a lifetime opportunity to join one of the most successful practices in the United States. We do not have a seniority system. If you are motivated and have completed a PSR 24-36 residency, your income is limited only by your enthusiasm and desire to achieve. Email resume to khart@cincinnatifootcare.com

ASSOCIATE POSITION - MINEOLA, NEW YORK

Full-time associate position with future partnership potential available with busy multi-office practices on Long Island. Must be proficient in all phases of podiatry with emphasis on surgery, biomechanics and RFC. Minimum standards include either a three-year PSR, or board qualified/certified status with ABPS. Existing hospital privileges with a NY based facility helpful. Interested doctors are encouraged to e-mail their CV to mets724@gmail.com

PRACTICE FOR SALE - TENNESSEE

Well established practice for sale. Full scope medical and surgical practice including DME. Exceptional practice with a high volume of new patients. Excellent hospital and surgical center privileges with investment opportunity. Great area for a family and the outdoorsman. 731-446-7285/E-mail nraines@charter.net

PRACTICE FOR SALE - FLORIDA—CENTRAL/SOUTH

Turn-key operation grossing $570,000 annually based on one full-time doctor. Great opportunity for growing the top-line. Surgery is only 14% of the professional man-hours; it can significantly increase income. Medicare makes up 64% of revenues. Seller will assist with transition. Call 863-688-1725, ask for Chas.

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