The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

February 18, 2010 #3,783 Publisher-Barry Block, DPM, JD

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Stretching Can Prevent Some Foot Ailments: DC Podiatrist

Each time you take a step, your foot is forced to carry two times your body weight, says Arnold Ravick, DPM, a spokesman for the American Podiatric Medical Association, Bethesda, MD. When you run, the pressure is six or seven times your body weight, or several tons. Typical foot ailments that develop from overuse or improper care include arthritis, tendonitis, joint and muscle problems, and plantar fasciitis, a common type of heel pain.

Dr. Arnold Ravick

Ravick suggests standing on your tip-toes for 30 seconds. Repeat five times. Then sit back on your heels for 30 seconds, and repeat five times. Ravick recommends performing these stretches at least once a day, preferably right before you go to bed because muscles tighten overnight. Stretching at night helps you to circumvent pain instead of just trying to fix it once you have it. If you run, Ravick suggests stretching before, after, and also at night.

Source: Anna Sachse, Gettysburg Times

Scholl to Hold Diabetic Foot Symposium in Honor of Retiring Dean

This free symposium, to be held April 21, 2010, is intended to honor the leadership of Terence B. Albright, DPM, Dean of the Scholl College of Podiatric Medicine who is retiring on June 30, 2010.  The keynote speaker will be Andrew J.M. Boulton, FRCP, MD, MRCP, MB, Professor of Medicine at the Diabetes Research Institute of the University of Miami, who will address “The Diabetic Foot in 2010.” Dr. Boulton is the author of eight books and more than 300 articles on diabetic complications, diabetic neuropathy and the diabetic foot.

Dr. Terence B. Albright

Noting Dr. Albright’s enormous contributions to Scholl College, Dr. K. Michael Welch, President and CEO of Rosalind Franklin University, acknowledged Dr. Albright’s “administrative and visionary acumen” as the former President of Scholl College, appointed in 1997, who initiated its merger with the University in 2002. Dr. Albright then assumed the role of dean in the institutional transition.

“Dr. Albright returned Scholl College to a pre-eminent position among colleges of podiatric medicine in the United States,” said Dr. Welch. “For the first time he introduced a research agenda for the college, embraced interprofessional education, transitioned to a four-year allopathic curriculum and ensured that the college was an integral part of the growing success of Rosalind Franklin University.”

MI Podiatrist to be U.S. Taekwondo Referee Vice-Chair at 2012 Olympics 

Dr. Trevor Neal of the Sturgis Foot and Ankle Clinic will be in Las Vegas and it won’t be related to his training as a physician. Neal will attend the 2010 U.S. Open Taekwondo Championships and will be inducted as the U.S. referee vice chairman for taekwondo for the summer games in 2012. Neal is mild-mannered and soft spoken. His patients may not realize he  is also a devout student of the martial arts — the art of warfare. He’s a taekwondo 4th dan (degree) black belt.

Dr. Trevor Neal

Neal co-authored “Taekwondo Gyorugi (Sparring) Rules and Regulations,” the bible for taekwondo referees in the 2012 games. Neal will be the U.S. referee vice chairman and will assign referees for the summer games.

Source: Terry Katz, Sturgis Journal [2/12/10]

Query: Pain at Tip of Right Hallux

This is an 18 y/o young lady with a complaint of pain at the tip of her right hallux. Her history includes past surgery about six years ago which involved a lengthening skin graft for a plantar skin contracture of the hallux. She has done well until recently. The toe has a mild contracture at the MPJ, the plantar skin is not tight. The toe tapers at the end with no subcutaneous fat pad. You can see the taper of the toe on the x-rays. The nail is fairly normal, but prominent distally.

X-rays of Painful Hallux, Distal

She wants something done. I am planning on an avulsion of the nail with a resection of the distal 1/3 or the phalanx and reconstruction of the distal fat pad, if possible. The other consideration is a fusion of the IPJ to correct the slight contracture of the IPJ. Any suggestions are welcomed.

Alan Mauser, DPM, Louisville, KY

Query: Jay Geier's Scheduling Institute

Has anyone dealt with the Jay Geier's Scheduling Institute? "They called my office pretending to be a patient with heel pain and secretly recorded the conversation with my receptionist. They then put the dialogue on a CD-ROM and sent it to me so that I could, "Truly hear how poorly new patients are being handled and why I should use their services." I called them and stressed what a horrible way this was for them to do business. This was followed by a letter which came AFTER the CD stating that the content of the package I would receive was in no way, shape, or form meant to be shared with my staff! That they would not be held responsible for the potential resistance or sabotage related to the irresponsible distribution of this incriminating evidence.  This is all from a company who is trying to get work from me. Isn't it unlawful to record a dialogue without consent? I would appreciate comments.

Gary Gugliada, DPM,  Staten Island, NY

Editor’s comment: PM News does not provide legal advice. The answer to this question is complicated and cannot be fully addressed in this forum. In short, twelve states require, under most circumstances, the consent of all parties to a conversation. Those jurisdictions are CA, CT, FL, IL, MD, MA, MI, MT, NV, NH, PA, and WA.

Assuming that you registered your telephone number, this could also be a violation of the “no-call” list since the purpose of the call was, in essence, a commercial solicitation.

RE: Surgical Options for HAV in 16 Year Old (Richard Frost, DPM)
From: Robert Hilkemann, DPM

I would consider doing an opening base wedge osteotomy of the first metatarsal, and using an Arthrex opening plate to hold the osteotomy open.
 
Robert Hilkemann, DPM, Omaha, NE, rhilkemann@aol.com

RE: MD Logic EMR (Mario Dickens, DPM)
From: Multiple Respondnets

We are also a one-doctor practice. We transitioned to MDLogic after a failed attempt at a competitor's EMR. After researching several systems, we came across MDLogic and saw nothing else like it on the market. It is everything they say it is. Our clinic went paperless within a week after on-site training. There have been no glitches since start-up, and we could not be happier. It may be slightly more expensive than some others on the market, but if you can't use a system or have to decrease your patient load while implementing, what is advantage? The main selling point of the system is that your clinic does not have to stop or slow down (outside of the two day training) to set up templates or learn the system. It's "restaurant style" menu is impressive and user-friendly, and support is always available and prompt. 

Kathleen Arp, Arp Foot and Ankle Clinic, ozarkfoot@suddenlinkmail.com

I have used MDL for the past several years. The touch screen system is unique, and we prefer it over dictation systems. Overall, it’s an excellent system and very stable. Their support team is available and helpful. They remain behind the times in some respects: Rx module, reports by diagnosis/procedure, standardized forms, to name a few. New updates are infrequent. If they get themselves moving, they could be dominant in podiatry!

Ira J. Gottlieb DPM, Pasadena, MD,  igottlieb@chesapeakefootandankle.com

MD Logic seems to be a great product. I personally know many people who are happy with it. However, before buying an EMR, consider the ARRA requirements which will probably require CCHIT certification, or have an individual practice pay for “site-specific certification” and consider the future of your billing software and process. In order to get the maximum benefit from an EHR/EMR, you need direct linkage to an affordable, but highly effective, billing solution.

MD Logic takes the approach that they will make a top EMR and let another company focus on the best billing; this sounds great until you realize that you will incur additional cost and support fees, and have to rely on another piece of software to link the two together. Moreover, be aware that the one thing we know about ARRA is that it will require electronic prescribing. Surescripts seems to be largest player in this, and you may want to consider an EMR that is also Surescript-certified.

Never buy an EMR based on a demo. Find someone who is using the system, and find out if their practice flow is similar to yours, and do a site visit if possible. Read at least 20 sample notes from another user (not the rep) with the patients’ names removed, and decide if those notes look professional and represent your practice well. If vendors are promising certification, keep in mind that if that certification is not in place within 10 months, you could forego a year (possibly up to $14K) of ARRA remuneration.

Marc Garfield, DPM, Williamsburg, VA, mgarfield1@cox.net

RE: How Long to Keep Charts (Barry Finkelstein, DPM)
From: Randolph C. Fish, DPM

I am faced with the same problem - Many boxes of old charts in my basement taking up space. The state of Washington will allow scanning and converting the written chart into an electronic one, but this is the reply I received after checking with the WSPMA attorney: 
 
"If there is no question of authenticity then it would be fine. However, occasionally and if the stakes are high enough, the destruction of any original and reliance on a copy creates problems.  An aggressive opposing counsel or the IRS will take the position that the documents could have been altered prior to copying or scanning and any evidence of tampering on the original has been compromised by you.  In the world of litigation, that is called "spoliation of evidence." If the court decides you spoiled the evidence, your opponent gets the benefit of a presumption that the original would have been damaging. This is a 'judgment call' and the judge might equally conclude it was done in the ordinary course of business and no spoliation can be found, so you can take the risk, but if it’s an important document, don't."
 
Of course, who decides what is an important document and what isn't? In advance? I am currently in the process of switching to an EMR, and plan on scanning everything. 
 
Randolph C. Fish, DPM, Tacoma, WA, rcfish1@juno.com

RE: Stuart Varney Comment
From: Andrew Cohen, DPM

Did anyone else hear Stuart Varney's comments (Fox News) on the Sean Hannity radio show 2/9/10? In an argument with Bob Beckel he said, "Bob the way not to fix healthcare is forcing states to provide coverage for PODIATRY and marriage counseling." Check the transcripts! Are any of my colleagues upset or angry with statements made by such individuals? It sounds like Mr. Varney needs to be educated. Shouldn't we as a profession respond to Mr. Varney, Fox News, and to the Hannity show.

Andrew Cohen, DPM, Saginaw, MI, ahcfootdoc@aol.com

RE: Financial Impact of Pre-Fabs (Dennis Shavelson, DPM)
From: Jon Purdy, DPM, Tip Sullivan, DPM

I don’t think anyone is suggesting that custom orthotics and OTC orthotics are the same. I think the general concept is that it takes a couple of weeks to get a custom made orthotic, so what can be done in the meantime? There are also those patients who are not willing to pay the out-of-pocket cost for orthotics. The choice of giving a patient nothing while they wait for their custom orthotics is probably trumped by providing an interim pre-fabricated device.  And, for those unwilling to pay for custom, a pre-fabricated is definitely better than nothing. 
 
I believe the initial question was, “Will this impact the delivery of custom orthotics to patients?”  With the scenarios above, and the fact that patients do benefit from a simple arch support, I think the answer is that it would most likely maintain, if not increase, demand for custom orthotics. 
 
I’m not sure I see the big difference in providing a “foot centering pad” versus a full-length pre-fabricated arch support.  It really becomes, what I would consider, an insignificant ideological difference of providing something over nothing, or having patients fending for themselves. At the very least, I have chosen what I think is the best pre-fabricated device to dispense to my patients.  
 
Jon Purdy, DPM, New Iberia, LA, podiatrist@mindspring.com

I am amazed that one of our colleagues is charging $800 for custom orthoses. I notice that this podiatrist practices in New York City. Perhaps that is the explanation. I am sure that there are some of us who believe that, in some way, $800 is a justified fee; and I am sure that some who read this will compare the benefits of well-constructed orthoses to the benefit of surgery, and compare the cost of orthoses to hammertoe repair or something similar. I am sure that there are some of us out there who think enough of ourselves to charge that much--we are worth it. At least with surgery fees, there are usual and customary fees (RVS), and just because I might consider myself "the best" foot surgeon (or "the best" bio-magician), I would not charge any more for a particular surgery than someone who might be fresh out of a training program.

It seems similar in principle to those implantable devices that cost so many thousands of dollars for a small piece of metal. I just have to ask myself how could this small piece of metal cost so much money--and I get the usual--"Oh!! you have to consider the research, support of sales staff", and many more reasons -excuses-to pay $2000 for a small piece of metal that is probably worth a couple of bucks. It just does not seem to be right. One of the arguments (excuses) that I hear is "everybody charges that much." Oh yeah! That's a good reason? I wonder, is there any reliable data regarding what a national or even regional average cost of a custom made orthosis is? I can tell you that the lab that I use for orthoses manufacture is much less than $125, and my mark-up is about 150%, which is much less than a 600-700% mark-up mentioned in the posted letter.
 
Tip Sullivan, DPM, Jackson, MS, tsdefeet@msfootcenter.net

Editor’s note: According to the recently released PM Practice Management Survey, the average fee charged for a pair of custom orthotics is $405.50.

ASSOCIATE POSITION - TEXAS

Dynamic, growing practice in Dallas/Fort Worth area, seeking surgically trained, Board Certified/Board Qualified Podiatrist. Excellent salary and benefits compensation package, for the right candidate, with partnership/buyout opportunity. Contact/Send resume to: jmh6122@yahoo.com

PRACTICE FOR SALE: TENNESSEE 

Established 30-year full-scope podiatry practice. Excellent hospital and surgery center privileges with investment opportunities. Fully equipped 2200 sq.ft. office across from hospital. High volume of new patients, DME, and local referral base. Great community for a family and the outdoorsman. Reply to tnfootdr@gmail.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. Please reply to: jclough@bridgemail.comASSOCIATE 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

ASSOCIATE POSITION-INLAND EMPIRE, SOUTHERN CALIFORNIA

Associate needed full or part-time for multi office practice. Must be ABPS BC/BQ. Hard working, ethical individual who is looking to a possible partnership opportunity. Looking for current licensed or resident completing program this spring. Email CV to bkatzman2@earthlink.net

ASSOCIATE POSITION – NEW YORK

Great opportunity to share “state-of-the-art” offices and equipment in mid-town Manhattan and White Plains with Board Certified podiatrist. Out-of-network or participating providers welcome.  Please call 212-704-4310 for additional information and fax your CV to 212-704-4311.

ASSOCIATE POSITION – LONG ISLAND 
 
Busy Bellmore, NY office. Motivated, board certified, hard-working, experienced in all phases of podiatry. F/T, P/T hours available. excellent salary, call 516 242-7540 or Fax Resume 516 826-9036 or email jobke@aol.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 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

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 -  MICHIGAN - (OAKLAND COUNTY)

outstanding opportunity for associate in well established practice, general & surgical podiatry forefoot, rearfoot & ankle (full or part-time). Well-trained, responsible, motivated with good communication skills, ABPS qualified or better. Send CV & letter of interest to: PodiatristWanted@AOL.COM

PRACTICE FOR SALE - MIDDLE TENNESSEE

Practice and building for sale. 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 931-446-5724 after 5PM CST.

ASSOCIATE POSITION - INDIANAPOLIS, INDIANA

Hospital clinic practice with a large volume of all patient types. In need of 1-2 podiatrists, willing to work as a team and make a career in Indianapolis. One - two year residency training can be medical or surgical. Excellent income and ownership possible. Curriculum vitae to twz1001@sbcglobal.net

ASSOCIATE POSITION - MARYLAND/D.C AREA

We are looking for an energetic and well-trained podiatrist to join our rapidly growing group; we have offices in Maryland and D.C and are in need of someone who is hard-working and growth-oriented. This candidate must be a graduate of a PM&S 36 residency program or have the equivalent in practice experience. We are looking for the person that wants to make this area their home and become an integral part of our group. If interested, e-mail your CV and cover letter to washingtonpod@aol.com

ASSOCIATE POSITION - NORTHERN VIRGINIA/DC SUBURB

Excellent associate practice opportunity leading to partnership for PSR 24-36 foot and ankle surgically-trained physician. Currently 4-doctor/2 office practice in fast-growing area, expanding to 5 doctors. Hard working, personable, highly-motivated individuals needed. Great opportunity with excellent salary and benefits. No nursing homes. Top hospitals. Fax CV with references to 703-491-9994

SPACE AVAILABLE With MRI– NYC/LI

Turn-key office space, East 60th and 22nd St. Manhattan and Plainview, Long Island. Available extremity M.R.I and dynamic ultrasound (East 60th St Manhattan and Plainview, LI). Tests are run by DPM and read by board-certified radiologist. Call for rental agreement. Satisfies Stark laws (516) 476-1815.

ASSOCIATE POSITION - W FLORIDA, BEACHES

Well established podiatry practice with excellent mix office/surgery seeking full time associate PSR 12-36. Excellent salary & benefits for the right hardworking, personable candidate. Email resume to capecoralpodiatry@live.com or fax to 239-573-9201

OFFICE SPACE TO SHARE - NYC

Wanted- Licensed podiatrist to share space in a State-Of-The-Art medical office in the midtown area. Please call Dr. Robert Singer (212) 921-5775 or e-mail dr.roberth.singer62@netzero.net

PRACTICE FOR SALE - NORTHWEST CHICAGO SUBURBS

17 year-old surgical practice for sale. Practice sees a wide variety of foot and ankle pathology and is largely referral especially regarding surgical patients. Two offices fully equipped. Lease or purchase of office condo also possible. Doctor willing to stay Please email inquiries to crystallakefootandankle@live.com

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.

PM News Classified Ads Reach over 12,000 DPM's and Students

Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 12,000 DPM's. Write to bblock@podiatrym.com or call (718) 897-9700 for details. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451

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