The Voice of Podiatrists

Serving Over 10,600 Podiatrists Daily

January 22, 2008 #3,147 Editor-Barry Block, DPM, JD

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Topaz Procedure More Successful Than Open Heel Surgery: IL Podiatrist

Some experts say up to 40 million Americans have heel pain. "The band of tissue at the bottom of the foot gets inflamed and it pulls and it gets tight and that causes pain," says Marlene Reid, D.P.M. a podiatric surgeon at the Family Podiatry Center in Westmont, IL. And that pain can be debilitating. "I've had patients that have told me they crawl. It's so painful to walk that they crawl," Dr. Reid says.

Dr. Marlene Reid

Now Dr. Reid is healing heels with radio-frequency energy. "You go through the skin without actually opening it up, without actually doing an incision," Dr. Reid says. After mapping out the target points, Dr. Reid delivers the radio-frequency energy with a wand. It breaks up scar tissue and increases blood flow.

"The success rate so far is much greater than open heel surgery," Dr. Reid says. Called the Topaz procedure, it takes less than 20 minutes. It's covered by most insurance plans and patients are generally back on their feet -- pain free -- in less than two weeks.

Source: Ivanhoe’s Medical Breakthroughs [1/21/08]

FL Podiatrist on a Mission For Diversity, Social Justice

Wayman Boggs is a retired podiatrist and is presently employed as a mental health worker at the Pasco County Detention Center, counseling inmates. He is presently serving as president of the NAACP in Hernando County. “The mission of the NAACP is to fight for social economic and political justice for everyone. One of our goals is to eliminate racism from the face of our planet.” Says Boggs.

Dr. Wayman Boggs

The NAACP has a number of standing committees, including an educational committee, which is designed to identify educational problems in the community; a health committee; a legal redress committee, and a religious affairs committee, all designed to promote fair play and equality for everyone. “We hold annual events at local churches, including the annual events to mark Dr. Martin Luther King Jr. Day.”

“My duties with the NAACP are time-consuming, and I work full-time, but when I have the time I like the outdoors and also enjoy a quiet day at home reading. I also enjoy visiting Pine Island and being by the water.” says Boggs. He is an avid reader and movie-goer. “I love movies, and I love to read, usually motivational types of books.”

Source: Jean Hayes, St. Petersburg Times [1/20/08]

Health Spending Outlay Tops $2 Trillion, But Spending Growth on Doctors Declines

While the national health spending growth rate increased slightly in 2006, the percentage rise in expenditures on physician services slowed markedly, due largely to a small Medicare pay increase and its private-sector fallout, according to a new report by the Centers for Medicare & Medicaid Services. Overall national health spending reached $2.1 trillion, up 6.7% from $1.97 trillion in 2005, states the CMS report, published in the January/February Health Affairs. The 2005 growth rate was 6.5%.

This moderate increase was possible because of a broad-based slowdown in spending growth in many categories, including physicians and clinical services. These expenditures increased by 5.9% in 2006, down from 7.4% in 2005, found in the report, "National Health Spending in 2006: A Year of Change for Prescription Drugs." For the first time since 1999, physician spending increased more slowly than the gross domestic product.

The small size of Medicare's physician payment update in 2006 played a role in the decelerating physician spending, said Cathy Cowan, a CMS economist and one of the report's co-authors. "[Physician and clinical] price growth slowed significantly, in part, due to the Medicare payment update, which was 0.2%, and the impact of private payers somewhat following Medicare's lead," Cowan said.

Source: Doug Trapp, AMNews [1/28/08]

Query: Bromidrosis

I have a 60 year male executive with 18 month history of foul foot odor. He has seen other practitioners and has tried many OTC products, drysol (he uses everyday), RX and OTC anti-fungal products (although no clinical evidence of tinea). He is doing everything necessary hygienically including wearing a new pair of socks daily. All these things have not helped to his satisfaction. His odor will occur within 2 hours of footwear use. H&P is basically unremarkable with the exception of extremely dry skin from overuse of drysol. I took a fungal and bacterial culture and placed him on minocycline and formalyde spray and he will F/U soon.

Melissa Gaffney, DPM, Johnson City, TN

Query: The Use of PA's in the Practice of Medicine

I've been noticing something in my locality and wonder whether this represents a national trend. When the profession known as "physicians assistant" first came into being, these young men and women were exactly that: assistants to physicians and in most offices in which I was as a patient, they practiced under the close scrutiny of the doctor in charge. Now things seem to be changing. I am noticing that the PA's are treating patients, even when the doctor is not present. They write prescriptions, make diagnoses, order lab tests.

In one office, I was told that before the main doctor sees a patient, the PA first examines the patient, treats the patient, and only after several visits will the MD or DO see the patient. Some of these PA's seem medically sharper than their bosses. I just wonder if the medical profession will structure itself in such a way that the physicians will no longer be practicing medicine, but will just become administrators of physicians assistants and nurse practitioners. the economics certainly makes sense.

Elliot Udell, DPM, Hicksville, NY

RE: Resistant Verruca (Richard Burnell, DPM)
From: Multiple Respondents

Dr. Burnell might want to consider a mechanical treatment for this patient. If the warts are under the hallux, the patient may have a functional hallux limitus. You may want to treat her with a custom foot orthotic that utilizes a 1st ray cutout, not just a first metatarsal head cutout. Balancing for any limb length issues is helpful as well. I have had many patients with recalcitrant warts in this area of the foot that improved within a few months solely thru orthotic therapy.

Bruce Williams, DPM, Merrillville, IN, uwalk4me@comcast.net

I have been using a pulsed dye laser for 10 years. It works well for resistant veruccae. It causes little or no scarring in my experience, however it can also require multiple treatments. Check with local dermatologists in the area; one will probably have one because they are used for hemangiomas and cosmetic procedures.

Ken Meisler, DPM, New York, NY, Kenmeisler@aol.com

In our 2002 retrospective anecdotal JAPMA study of nearly 200 children (and approximately 300 additional cases since w/ similar results), cimetidine was 85% successful eradicating verruca at a total daily dose of 25 mg/kg (divided dosing schedule). These results closely paralleled those of the treatment's originators, Seth Orlow and Amy Pallor. General colleague feedback has been positive, though some failures do occur. When cited to me, upon questioning my colleagues, many failures have been linked to under-dosing. It's safe even at 25 mg/kg / day, inexpensive and is incredibly gratifying when it works. Based on what has already been tried, barring medical contraindications, your 13 year old sounds like a perfect candidate.

At this point, there's nothing to lose. Consider sharing the article with the parents, dose it properly and exhibit some patience waiting for its effect. Our study plotted duration of successful therapy against symptom duration and a correlation exists, so, assuming your patient's warts have been present for a year or longer, it's likely the medication may take 12 weeks before it exerts its immune system enhancement effect.

Barry Mullen, DPM, Hackettstown, NJ, YAZY630@aol.com

Editor’s Note: An extended-length letter by Dr. Bryan Markinson appears at: http://www.podiatrym.com/letters2.cfm?id=17551&start=1

RE: Employee Sick Time and Vacation Time
From: Jon Purdy, DPM

We use one week of vacation for employees that have finished one year of employment with us. This is continued through year four. After that it becomes two weeks of paid vacation. We insist that they take block time off (at least a week at a time), as we all need time away or burn out will set in. We do not let them take it to cover other types of days off.

As far as sick and personal days, we don't pay for those. We used to but it became apparent to us that employees are generally more concerned with what they make per hour rather than small benefits. We calculated what their standard pay would produce from former paid personal and sick days (about 14 per year). We then gave that to them as a per hour pay raise. It was between fifty cents to a dollar an hour. This has served several purposes. It stopped us from having to track these days. It got rid of complaining when we had to work a holiday where they would assume that they had the paid time off rather than coming into work for time and a half. It also gives the employee and incentive to come to work rather than use the time off. If they are not here, they are not getting paid.

Of course, we have other benefits that are substantial such as 401-k, profit sharing, and health insurance. We have found this to be a superior system.

Jonathan B. Purdy, DPM, New Iberia, LA, jpurdy@mindspring.com

Established practice in Ocean County seeks hardworking, ethical, energetic and well-trained (PSR 24/36) individual. Practice provides EMR, digital x-rays, ultra-sound and NCV’s. Must be willing to do all aspects of podiatry! Competitive salary and benefits package. E-mail CV to NJFeet@aol.com

ASSOCIATE POSITION - NEW YORK CITY

Excellent opportunity for foot/ankle surgeon, Manhattan and Brooklyn Associate position leading to possible partnership. Requirements: Two years enrollment in a surgical residency program Qualities of self-motivation and impeccable skills in forefoot and rear-foot surgery. Package Includes: Malpractice insurance, Health Insurance plus salary, Incentives. Terms negotiable Email CV to Manfootcare@aol.com 212-349-7676

SEEKING ASSOCIATE WITH POTENTIAL TO FULL PARTNER

Busy multi-physician podiatric group with 2 locations seeking BQ/BC surgically trained doctor. Applicant should be well-trained in all aspects of surgical and conservative care. Seeking ethical, hard working and outgoing physician to join our 4-hysician group. Excellent quality of life in suburban Houston, near NASA and the Gulf of Mexico. Email CV and cover letter to Dr. M. Rockett at Mrockettman@comcast.net.

INTERVIEWING AT NEW YORK CONFERENCE: JAN 25-26TH

Looking for well-trained (PSR- 24/36) personable, energetic practitioner to join multi-office practice in the beautiful Hudson Valley. Well-rounded practice including general podiatry, high volume orthotics, and reconstructive surgery. Outstanding opportunity to work into partnership. Competitive starting salary, bonus incentives, benefits, and pension. Submit: CV, letter of intent and references to: footassociate@yahoo.com

Unique & rare opportunity for a Japanese-bilingual podiatrist. Seeking motivated, conscientious, and ethical individual with excellent people skills for associate leading to ownership or a buyer for immediate purchase. No nursing homes & well-established referral base. Serious inquiries only. E-mail letter of introduction, photo and CV to: socaldpm@gmail.com

ASSOCIATE POSITION- CONNECTICUT

Established Practice looking for PSR 24/36 trained surgeon. Must have experience and be responsible for all surgical cases for the
practice. EMR and digital x-ray in new 6-treatment room office.
Hospital privileges available. Connecticut has a new ankle law for the
Properly-trained DPM. Competitive salary, benefits, and bonus. Great area to raise a family. Fax resume to 860 243-5790

PODIATRISTS NEEDED - CHICAGO --NORTHWEST INDIANA

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists. We are located in Chicago and Northwest Indiana. 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 -- www.homephysicians.com

ASSOCIATE WANTED – NEW YORK IMMEDIATE OPENING

Busy multi-dimensional practice; 70 miles north of New York City . Currently five (5)-doctor practice. looking to expand – all phases of podiatric medicine. contact: (845) 454-8308 EXT: 106

PRACTICE FOR SALE - SOUTH CAROLINA

Upstate SC practice of 25 years. Retiring. High volume, high grossing. 60% routine foot care, 40% surgery. Several nursing homes. Plenty of opportunity for growth. Hospital and Surgery Center privileges. Financials available upon request. Serious inquiries only! Beautiful area. Contact: Carolinafootdoctor@yahoo.com

ASSOCIATE POSITION- KANSAS CITY, MO

Excellent opportunity for a hard working, ethical podiatrist to join a vibrant, successful and growing podiatric medical and surgical practice. Dedicated, supportive staff with strong marketing and medical knowledge. Must be board eligible/certified. PSR/24. Partnership opportunity. Competitive salary, bonus structure, benefits. Wonderful place to raise a family. Fax CV to 816-455-8901

ASSOCIATE POSITION – VIRGINIA

Must have Virginia license. Requires 24 to 36 month Residency. Permanent position with potential buy in. Includes all phases of Practice excluding nursing homes. Competitive Salary and Benefit package. Please send Resume including salary requirements and availability date to needpodjob@yahoo.com

PART-TIME PRACTICE FOR SALE - FLUSHING, NY

40 year old part time practice for sale. Priced for quick sale. Please contact me at footdoc60@gmail.com. Serious inquires only, please

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