The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

February 24, 2011 #4,092 Publisher-Barry Block, DPM, JD

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Call for Nominations - Podiatry Management's 2011 VIP List

Every five years, Podiatry Management Magazine publishes its "Most Influential Podiatrists" list. This list is compiled by the editorial board of PM. We invite nominations of individuals for this prestigious honor. Please send nominations along with a brief statement of why this podiatrist belongs on the VIP list to bblock@podiatrym.com. Self nominations will be accepted. 

Podiatrists Discuss Laser Treatment of Onychomycosis

A growing number of doctors are offering an expensive laser procedure they say zaps away a common fungus that causes ugly, discolored nails. Published data on laser treatment for nail fungus is scant, but early results suggest it is a reasonable option for people who don't want the side-effects of oral medications. So far only one company's laser has received FDA clearance for toenail fungus: PinPointe USA Inc., of Chico, CA received clearance in October to market its laser for "the temporary increase of clear nails" in patients. Two companies, Nomir Medical Technologies Inc. of Brooklyn, NY, which first applied in 2009, and CoolTouch Inc., of Roseville, CA have applied for FDA clearance for the nail-fungus purpose and are waiting for an FDA decision.

Drs. Warren Joseph and Bryan Markinson

Philadelphia podiatrist Dr. Warren Joseph, who is a consultant for Nomir and a former consultant for PinPointe, says: "I think it is a really interesting, viable alternative, but I want to see published data." His advice to patients: "Ask for the evidence—and not just before-and-after pictures."

"Patients and some doctors have this expectation that because it's a laser treatment, once you zap it, it's gone forever," says Dr. Bryan Markinson, chief of podiatric medicine at Mount Sinai School of Medicine, who has been a paid adviser to Novartis and owns stock in Nomir and serves on its medical-advisory board. "That totally ignores the fact that this is an infectious disease and that recurrence is a certainty" unless good prevention measures are taken.

Source: Laura Johannes, Wall Street Journal [2/22/11]

New Vital Sign: Degree of Patient's Online Access

Searching online for health information is the third most common online activity behind checking e-mail and using a search engine, finds a new survey by the Pew Research Center's Internet & American Life Project. But that doesn't mean physicians should assume that everyone has access to the Internet when it comes to patient education and communication. In fact, the survey showed that those who might need access to online information most are least likely to own an Internet-connected computer.

Patient use of the Internet has moved beyond what physicians used to refer to as Dr. Google -- the stacks of information printed from a Google search that patients would bring to the exam room. So much of healthcare is moving online that many physicians assume that everyone uses the Internet. But that assumption could lead to patients missing out on important information, or being unable to access certain tools. So experts and analysts recommend that doctors start asking their patients whether they have Internet access -- or whether a loved one or advocate does.

Source: Pamela Lewis Dolan, AM News [2/21/11]

Query: Botox for Hyperhidrosis

What have been your experiences with Botox injection to the plantar aspect of the feet for severe hyperhidrosis that has failed multiple topical and other treatments?

Stephen Levin, DPM, Tampa Bay, FL

Query: Etransmedia Billing Company
 
What experiences have PM News readers had dealing with Etransmedia billing service? In the past year, they have purchased Professional Billing Group and Strategic Medical Resources. 
 
Tejas R. Pandya, DPM, Troy, NY

RE: Lichen Planus (Larry Dorman, DPM)
From: Thomas A. Graziano, DPM, MD

Mild forms of lichen planus are usually responsive to topical corticosteroids. More severe forms, particularly ulcerative lichen planus, require oral prednisone with follow-up intermittent doses (e.g., every other day dosing). Ultraviolet light treatments can be combined with the above in more severe pruritic cases. The condition can be self-limiting, but unfortunately is recurrent.
 
Thomas A. Graziano, DPM, MD, Clifton, NJ, TGrazi6236@aol.com

RE: Black Pigmentation in Diabetic Patient (Mark Aldrich, DPM)
From: Gino Scartozzi, DPM
 
The etiology of these lesions can be due to any number of causes. My recommendation is that a skin biopsy of the lesion be performed, along with fungal and bacterial cultures.
 
These lesions presented in the anterior leg segments and dorsal extensor surfaces may be consistent with acanthosis nigricans. The pathologic tissue presentation of these lesions reveals regions of hyperkeratoses with hyperpigmentation and papillary thickening of the dermal tissue regions. There is a correlation with the development of these lesions along with higher levels of insulin resistance. This is especially seen in diabetic patients.
 
Other causes of these lesions may be due to microangiopathic skin changes. These "infarcts" of the arterial or venous plexi may present as punctate hyperpigmented lesions. These would be seen in diabetic dermopathy (especially with thermal injury or exposure) and pigmented purpuric dermatosis (where there is extravasation of red blood cells from arterial-venous plexi.) The patients may describe these lesions as "itching" or "burning."
 
Fungal and bacterial etiologies can create these hyperpigmented lesions and require a culture.
 
Gino Scartozzi, DPM, New Hyde Park, NY, Gsdpm@aol.com

RE: Orthotic Recommendation (Tyler Brahm, DPM)
From: Jeff Root, Dennis Shavelson, DPM

Dr. Brahm indicated he is looking for a “relatively soft” orthosis for a patient who severely over-pronates and who also has a plantarflexed 1st metatarsal base and navicular.  Without knowing the patient’s biomechanical information, history, and treatment objective, it is a little difficult to make a recommendation.  However, Dr. Brahm’s brief description of the foot suggests the possibility of adult acquired flatfoot, Charcot foot, or some other condition that has compromised the structural integrity of the medial arch of the foot.

Some patients with this foot type may benefit more from a conventional functional orthosis or even a functional AFO than from a softer type of orthosis. That said, many labs do offer an intermediate option or hybrid device.

A hybrid orthosis typically has a thinner, more flexible shell such as one made from high density polyethylene, which is filled on the plantar surface with EVA, Poron, or similar foam.  Dr. Brahm’s patient sounds like a potential candidate for a hybrid orthosis because it provides a degree of functional control yet is less rigid. The foam filler can be reduced in-office to make the device even more flexible, if needed.

Jeff Root, President, Root Lab Inc., jroot@root-lab.com

Dr. Brahm defines his biomechanics by asking for a soft orthotic request. The accommodative device that results from this request destines his patient to accept further degeneration and quality of life reductions. In fact, with small acculturative bumps, DPM’s can offer sophisticated cases like this corrective, professional care that separates us from C.Peds and robotic STJ neutral casters.

Foot Centering theory, from this distance, would speculate...

Editor's note: Dr. Shavelson's extended-length letter can be read here.

RE: Practice Fusion (George Jacobson)
From: Elliot Udell, DPM, Justin Sussner, DPM
 
Dr. Jacobson has asked many important questions about changing from paper notes to EMR. The most important question which is seldom asked is whether it's important to keep a paper back-up of your notes. The answer lies in whether the system you choose stores the notes on your computer or on the software company's computer. If it's the latter, then you should make a copy of your notes because if the EHR company goes out of business, in one night you could lose all of your patients' notes. If the notes are stored on your own computer, and you choose not to make paper back-ups, you should invest in one of the online back-up systems so that if your computer crashes, gets stolen, or burnt in a fire, you will be able to restore your notes.
 
E-prescribing is another story. At this point in time, I still find handwriting prescriptions to be faster. Many pharmacies are also not thrilled with e-prescribing because when you send a drug store an e-script, they go through the work and fill your order. If the patient decides not to pick up the medication, the pharmacy did a lot of unnecessary work and if it's a compound or an ointment where the label is attached to the tube, the pharmacy may be in for an actual loss.
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

After 'playing around" with the system for approximately six months, I have officially began using Practice Fusion EMR. While by no means perfect, I believe it offers a good interface and combination of features. The fact that it is free is also a big selling point, but quite honestly, it would be worth paying for. I also love the fact that it is web-based, as I have two offices, and don't want to maintain two servers or constantly use a remote connection (which will slow you down) or sync data (which will eventually corrupt data.)

I have slowly began to use it, beginning with...
 
Editor's note: Dr. Sussner's extended-length letter can be read here.

RE: A Call for Unity and Action Against Insurance Companies (Denis LeBlang, DPM)
From: Jeffrey Kass, DPM
 
The simple answer is that professional teams have the right to collective bargaining; we don't. I echo every sentiment in your posting and have, over the years, been posting similar requests. It is a frustrating fight. The bottom line is - it seems that the "Sherman Act" renders us powerless. Everything is "a process", and "takes time." I remain optimistic as I prefer it to depression. I am here for your cause - sign me up.
 
Jeffrey Kass, DPM, Forest Hills, NY, Jeffckass@aol.com

RE: The High Price of Medical Equipment (Simon Young, DPM)
From: Paul Busman, DPM, RN

In the hospital OR where I work, some of the carts for difficult intubation, pediatric intubation, IV's, etc. are bright red Craftsman tool carts from Sears. These sit in the holding area where patients wait just prior to going to the OR. Patients often joke about this, but I point out that these durable carts probably cost about 1/3 the price of the "official" carts from medical suppliers; plus they carry Sears' lifetime warrantee. We ALL pay the cost of high priced medical supplies!

Paul Busman, DPM, RN, Clifton Park, NY, paul@busmanwhistles.com

RE: EHR/EMR Gouging (Michael Brody, DPM)
From: JM Cortez, DPM, Alan Bass, DPM

You have to be kidding me? We are now comparing a software program to the automobile. Whether I drive a Kia or Mercedes does not matter to anyone, except maybe my neighbors. The big difference being no one is going to penalize me for driving the economy car over the luxury car. No one has written a bill that you have to drive a luxury car or you will be deducted 2% in reimbursement. And this year's car model has not seen a price increase ranging anywhere from 300% to 400%, just because the Federal Government will reimburse you if you use the program.  But like the automobile salesman, we are being swindled and this system is being made mandatory. I am talking about the EMR companies lining their pockets at the expense of our fellow podiatrists. 

I have programmed computers and do my own IT support. I have also consulted for a local vendor coming out with their own EHR/EMR program. I put their program through the paces and gave them my input. I did not benefit in any way nor receive any compensation. I have worked as a programmer. I know the time it takes to write the program, implement it, test it and fix any bugs. This is nothing new to me, but it still does not justify the sudden huge increase in price. 

JM Cortez, DPM, Simi Valley, CA, jmcdoc@roadrunner.com
 
Let me start out by saying yes, I am a paid consultant for Biomedix Vascular Solutions, the makers of TRAKnet DPM, a certified EHR/Practice management program, eligible to receive the stimulus money.

I have been following the conversation on PM News, and while people may not agree with me, the one thing the conversation is missing is that EMR has been around for quite some time now. This is not something new. I consider myself an early adopter, implementing EMR into my practice almost...

Editor's note: Dr. Bass' extended-length letter can be read here.

RE: H&Ps for Podiatrists
From: Multiple Respondents

Are we all on the same page regarding the actual meaning of the H&P? H&P as a part of the pre-surgical work-up is just that: part of the work-up. If done on the patient for the local anesthesia case, only the operating DPM signs off on all documentation. If done for a "regular" anesthesia-involving case, it is a fact-finding tool. Whether it is performed by the PA, PCP/ MD, or DPM - it is usually cleared by the anesthesiologist first and the podiatrist/surgeon second. An H&P, by itself, is not the medical clearance for surgery.

If medical clearance is sought, it is obtained from the PCP, cardiologist, etc. The insurance companies do not even pay separately for the H&P - because the H&P does not equate to the E/M service. That is the reason, fiscally, why the physician extenders/PAs/ residents/house doctors do it - and the DPMs are finally being allowed to do it as well, that is to take an H&P. As to the scope of practice, we are required to sign off on the PA-performed H&P every time, because of the reasons above. I think we should listen to our legal professionals on this forum to clarify the issue of the scope of practice with our signatures on those H&Ps. 

Vadim Glukh, DPM, Richmond Heights, OH, vadimglukh@gmail.com

I have been reading the posts regarding podiatry and the desire/or lack thereof of our profession to perform H&P’s on our patients. I am assuming that everyone is referring to the H&Ps as it relates to the pre-operative examination required for surgery. I appreciate Dr. Lombardi’s comments and all who share his views. I am a classmate of Dr. Lombardi and he was always a leader, and his efforts to advance our profession through the academic and political arenas are truly appreciated.

However, I must agree with Dr. Bijak. I am involved in training 2nd and 3rd year residents...

Editor's note: Dr. Vekkos' extended-length letter can be read here.

This entire argument highlights the need for a podiatric national teaching standard. The problem is, not all schools are paired with allopathic or osteopathic programs like at the Des Moines school. We sat side-by-side with the osteopathic students in all classes for two years of basic sciences, except in an ob class focused on fetal medicine and one psych class. My three-year residency focused and dedicated the entire first year to functioning as any other allopathic intern does their first year regardless of specialty. I did ICU, ER, general, vascular and general surgery right alongside MD and DO interns and was treated no differently and was expected to do everything they were all at a Level 1 trauma/medical institution.
 
To those who, with their limited...

Editor's Note: Dr. Brower's extended-length letter can be read here.

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 AVAILABLE - NY

Busy Midtown Manhattan state-of-the-art practice with 2 locations seeking part time/full time associate. Must be in-network Empire BC/BS. Looking for a personable doctor with immediate availability. Residents Need not apply. DrB@myfcny.com

ASSOCIATE POSITION - WEST CENTRAL FLORIDA

A great opportunity to join a very busy, well-established, diversified practice in Clearwater, FL. Seeking an associate who has the drive and desire to work hard, has strong work ethics, and is very personable. BC/BE and minimum PSR24 +. We offer competitive salary and benefits. Send resume to Jaye@fdn.com

IMMEDIATELY AVAILABLE- ASSOCIATE POSITION - DAYTON, OHIO

Join a well-established modern practice with an excellent reputation and referral base. Base salary $100,000 and benefits with a bonus structure. EMR, diagnostic ultrasound, all aspects of DME, Padnet vascular studies, and CO2 lasers. We seek a surgeon that is well trained, personable and motivated to join our group of 3 Podiatric Surgeons. Would like this individual to buy in the practice eventually. Please send resume to ohiodoctors@aol.com

ASSOCIATE POSITION/PARTNERSHIP - CHICAGO

Chicago Podiatric Surgeons, one of Chicago’s leading podiatric practices, is searching for a FT podiatric surgeon. Applicant must be a personable and confident surgeon with ability to manage surgical patients independently and be at least board qualified. High compensation. Will be working in new 7000 sf state of the art office in AN upscale Chicago neighborhood. Ownership/partnership opportunities. Send letter of intent and CV to drcarr@chicagopodiaty.com

ASSOCIATE/OPPORTUNITY - PHOENIX 
 
Established practice seeking motivated min. PSR24+ personable, ethical, motivated person to join state-of-the-art multi-office locations. Partnership/Ownership opportunity in practice, real estate, surgical center. Also interested in existing practitioner to merge or work part time. Contact AZPODAssociate@aol.com  Must be pursuing or have AZ license.

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 - NE GEORGIA SUBURB

Immediate opening for PSR24/36, ABPS Qualified or Certified individual. Hosp/Amb. Surg. Ctn privileges available. Good chance of partnership or practice purchase in foreseeable future. Send resume/CV to gramps395@yahoo.com

ASSOCIATE POSITION NYC (PART TIME)

Manhattan (East Harlem) Community Health Center. Experienced podiatrist with commitment to providing quality care. Bilingual Spanish a plus Please forward resume and cover letter including salary requirement. FAX: (212) 360-6149 Email: orodriguez@boriken.org

TEXAS- WONDERFUL OPPORTUNITY!

Successful multi-office, multi-professional practice seeks well-trained new and established Podiatric Physicians with expertise in one of these areas: 1. Sports Medicine/Biomechanics/Gait Analysis, 2. Podopediatrics, 3. Diabetic Specialist, 4. Ankle & Rearfoot Surgery/Ankle Arthroscopy. A must to be really good in this niche, be outgoing, motivated, and personable with a dedicated hard working ethical desire to become successful. Send resume and letter of intent to sierrajip@gmail.com

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

TWO ASSOCIATE POSITIONS - WEST CENTRAL FLORIDA

One in general podiatry, second with surgical residency. Good diagnostician, compassionate, hard-working individuals needed for high-tech group practice. flpodiatrist@tampabay.rr.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

FELLOWSHIP OPPORTUNITY
 
Applications are being accepted for the Central Kentucky Diabetes Management Fellowship. Dr. Jonathan Moore, former UTHSC Diabetes Fellow, OCPM adjunct faculty, AAPPM board member and national lecturer and author on diabetes and practice management related topics is director and founder. Don't miss out on the most unique, dynamic fellowship in Podiatric medicine. Learn latest advances in Diabetes management/surgery along with knowledge to run and grow a successful practice. Generous stipend, full benefits and free housing in resort setting. Email CV and letter of interest to: jmoore@aappm.org  Visit our website

PRACTICE FOR SALE - BOSTON SUBURB

A 12+ year practice, including all equipment is for immediate sale. Average gross is $100K while being open only one day weekly. The ability for increased growth potential is obviously excellent with increased hours. Doctor is looking for serious offers only. Reply to shop@thefootdoctor.com

PRACTICE FOR SALE - MARYLAND, DC SUBURBS

Great opportunity. Well established and equipped practice for sale. Office includes state licensed Ambulatory Surgical Center. Present owner is retiring but will stay on as needed for smooth transition. Average gross over past 3 years is $575 K. dpmpracticeforsale@yahoo.com

SPACE AVAILABLE- NYC & LI

Office to sublet and share with DPM and chiropractor, East 60th Manhattan, and Plainview long island. access to an MRI, Joint Commission certified operating rooms, digital x-ray, diagnostic ultrasound, and access to a multi-specialty ambulatory surgical center. Turn-key operation - no investment needed 516 476-1815 PODO2345@AOL.COM

SPACE AVAILABLE - BRANSON, MO

Great opportunity to develop a podiatry practice in a four condominium Branson office building with a growing ophthalmology practice along with a well established optometry practice and a multi-disciplinary ambulatory surgery center in Branson, a top ten retirement destination.The available condominium is a grey box so it can be build out to specifications. Rental and/or ownership options are available for this condominium. Practice development financing and ASC ownership available for the right doctor. Great schools and affordable lakeside or golf course living available. Contact Dr. James Bureman @ jbureman@missourieye.com or 417-861-5839

PM News Classified Ads Reach over 12,500 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 12,500 DPM's. Write to bblock@podiatrym.com or call (718) 897-9700 for details. Weekly ad rates start as low as $109 for a 50-word ad 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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