The Voice of Podiatrists

Serving Over 14,000 Podiatrists Daily

March 09, 2013 #4,711 Publisher-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2013- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

PM News is beginning a new weekly feature called Quick Poll. Each week, we will post a new poll based on some of the controversial issues discussed in our Comments/Responses section. This is the last day to vote.

Quick Poll
Do you fixate metatarsal osteotomies?

Pregnant Women Need to Wear Stable, Supportive Shoes: NJ Podiatrist

Forget the skinny jeans for a minute. Are you struggling just to squeeze into the shoes you wore before becoming pregnant? It's not in your head, Mama. It's actually in your feet, according to a new study from the University of Iowa that says one of pregnancy's lasting effects can be a larger shoe size.

Dr. Bruce Calligaro

Can you do anything to protect your feet during pregnancy? Fortunately, the answer appears to be yes. According to New Jersey-based podiatrist Bruce Calligaro, DPM, FACFAS, key healthy foot tips for moms-to-be include paying attention to footwear. Choose to wear supportive, stable shoes that fit well. If you can't find comfortable shoes, a podiatrist can provide you with orthotic inserts for your shoes to distribute weight more evenly and support arches.

Source: Jacqueline Tourville, Babyzone.com [3/7/13]

MO Podiatrist is Center of Political Battle

Illinois Gov. Pat Quinn says he just wanted to improve the system at Southern Illinois University when he tried to replace three of its trustees last week. The issue is rooted in a years-old grudge match between Quinn, a Democrat, and SIU's outspoken president, ex-congressman Glenn Poshard, who was Illinois' 1998 Democratic nominee for governor. Much of that conflict has centered on Dr. Roger Herrin of Harrisburg, an SIU trustee and political contributor to Quinn.

Dr. Roger Herrin

Quinn, who has appointment power with the consent of the Senate, named Herrin to the unpaid, seven-member board (plus two student trustees) in April 2011. Poshard has alleged that the administration applied pressure at that time to make Herrin the board chairman. Herrin, a retired podiatrist and businessman, had earlier contributed more than $20,000 in cash and services to Quinn, according to state records.

Source: Kevin McDermott, St. Louis Post-Dispatch [3/7/13]

Employers Pressing Providers for Price Transparency

Large companies are ratcheting up efforts to make providers more accountable and transparent on quality and price as businesses struggle to control healthcare costs, according to an employer survey. A quarter of large employers now use financial incentives to obtain provider accountability for their care, according to a Towers Watson and National Business Group on Health survey of 583 companies with at least 1,000 employees. By next year, 33% expect to use such incentives.

Some of the incentives intended to encourage high-quality care come in the form of bonuses and penalties applied directly to payments to providers. Others differentiate costs for employees to encourage the use of high-quality providers. For example, 12% of the companies vary their employees' cost sharing based on whether they use designated providers, and 31% of the large employers planned to use such incentives by 2014.

Source: Rich Daly, Modern Healthcare [3/7/13]

Query: Injection Supply Reimbursement

We inject cortisone to treat neuromas and plantar fasciitis. I code the supplies as J1094 (injection, dexamethasone acetate, 1 mg) and J1100 (injection, dexamethasone sodium phosphate, 1mg). The reimbursement is crappy. Am I missing something?

Amanda Bartell, DPM, Jacksonville, FL

Response: No, unfortunately you're not missing anything. Crappy reimbursement is the norm.

Lawrence Horn, DPM, Ridgecrest, CA

Codingline subscription information can be found here

APMA Members: Click here for your free Codingline Silver subscription

RE: Efficacy of Lasers for Onychomycosis (Tip Sullivan, DPM)
From: Michael B. DeBrule, DPM

There is a great review article from Jennifer Ledon from Miami looking at evidence for laser and light therapy for toenail fungus, "Laser and light therapy for onychomycosis: a systematic review." Ledon JA, Savas J, Franca K, Chacon A, Nouri K., Lasers Med Sci. 2012 Nov 20.

There are a lot of variables to consider: which laser to purchase, optimal laser settings, number of treatments, time between treatments, marketing, etc. Most studies are glorified case series (excluding the recent study by Landsman). Landsman, et al. found most patients improved with regard to appearance, but only about one third of patients had both clear nail growth and negative cultures. Laser is a good treatment option without the side-effects of oral therapy, but we need more studies!

Michael B DeBrule, DPM, Richfield, MN, innovativefootcare@gmail.com

RE: Efficacy of Lasers for Onychomycosis (Tip Sullivan, DPM)
From: Adam Landsman, DPM, PhD

I would like to respond to Drs. Katzen and Sullivan regarding their impressions on laser therapy for onychomycosis. I was disturbed by Dr. Sullivan's description of his tests of the laser for the treatment of onychomycosis. In my opinion, this type of anecdotal observation is really misleading for a variety of reasons. Among my strongest concerns are the following:

-There is no doubt that fungus and bacteria are heat labile. Apply enough heat and they die. This is very strongly supported in the literature. The question is...

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

RE: Efficacy of Lasers for Onychomycosis (Burton Katzen, DPM)
From: Marc Katz, DPM

I can understand Dr. Katzen's frustration and difficulty having to deal with telling patients that laser did not work. Well many of our colleagues really don't care if it works; it pays their Lexus payment. The other issue is that we listen to salespeople who don't know anything about onychomycosis. They only know how to sell lasers and do what is in their best interest. They may tell you that their laser is so amazing that it will kill all fungus in just one treatment! And it will also clean out your garage for you too!

Laser is an excellent option to treat the chronic nail condition known as onychomycosis. Laser treatment is not a cure. It is part of a comprehensive treatment plan for fungal nails.  Patients require maintenance treatments to keep the chronic condition controlled. They require lifetime topicals and should use a Steri-shoe. Does anyone complain to their dentist that they need to have their teeth cleaned multiple times per year? Do they complain that their teeth aren't 100% white and that they still need to pay? No! Because dentists explain the real story to their patients as we should be doing with ours. They are not afraid to treat chronic mouth infections and make you pay cash each time forever.

Adopt the dental hygiene model like I do, and let's make podiatrists the experts for treating this chronic nail condition! All it takes is honesty.

Marc Katz, DPM, Tampa, FL, dr_mkatz@yahoo.com

RE: Numbness in Foot When Driving (Olga Luepschen, DPM)
From: Gino Scartozzi, DPM, Stephen Doms, DPM

In light of the fact that lower back issues were ruled out by means of MRI and nerve conduction velocity tests, I suggest a complete arterial vascular work-up including arterial ultrasonography to rule out any stenoses. Particular points of interest for study of these stenoses may be about the femoral-popliteal and aorto-femoral regions. When in a seated position, these stenoses can develop a clinical manifestation, and are relieved while leaving such position.

Gino Scartozzi, DPM, New Hyde Park, NY, Gsdpm@aol.com

When I was a student at PCPM (class of 1980), we had a similar case in clinic. We discovered that the male patient drove a car with a center console. He would rest his right leg against the console when driving. He was developing neuropraxis of the common peroneal nerve. The nerve was compressed from the console to the fibular head. He adjusted his driving technique and it resolved.

Stephen Doms, DPM, Hopkins, MN, sdoms@aol.com

RE: Vacation Policy (John Scholl, DPM)
From: Scott Hughes, DPM

The vacation policy in our office is: 1 year of service =1 week vacation. 5 years = 2 weeks. 10 years = 3 weeks.

Scott Hughes, DPM, Monroe, MI, dr.scotthughes@gmail.com

RE: Your Feet Can Get Larger as You Age: FL Podiatrist
From: Robert S. Schwartz, C. Ped

As a pedorthist and shoe fitter for the past 40 years, my staff and I have observed a much more dynamic change in foot size in adults than one size for 70 or 80 year olds. Our feet continue to elongate and flatten by our middle thirties. Feet continue to “grow” from gravity and years on the concrete planet. Our feet also have to accommodate added weight and activities. That is why most shoe retailers who measure and fit feet will tell you that 80% of the adult population are wearing shoes smaller (shorter and or narrower) than their feet. We urge all foot care professionals to have their patients leave their shoes on so that you can see if the shoe style and size is at the root of their problem.

Robert S. Schwartz, CPed, NY, NY, rss@eneslow.com

PRACTICE FOR SALE - WEST PALM BEACH FLORIDA

Well established successful West Palm Beach practice grossing $475K with excellent reputation and good referral base. Consistent new patient growth, great opportunity with increased gross revenue and surgical growth potential. EHR implemented with meaningful use criteria met. Great area to live and work. Serious inquires E-mail wpbfootdrs@gmail.com

PRACTICE FOR SALE - MISSION VIEJO, CA

Relocating to Tulsa. Great opportunity to buy my office. Located at Mission Hospital. Gross income 2012 was $560,000. Approximately 1300sqft with 3 treatment rooms, digital x-ray and fully computerized. Will consider all offers. Call David at 949-702-1052 or david@missionviejofootcare.com

PRACTICE FOR SALE - CORONADO, CA

Unique opportunity to purchase a very well established practice in beautiful San Diego. Hospital privileges available. Large and stable patient and referral base with consistent new patient growth. Why not practice where people vacation and retire? Willing to stay for transition. Inquires please email pestibear@gmail.com

PRACTICE FOR SALE - LOS ANGELES, CA

Practice is in Boyle Heights area since 1998. 70%MM the rest consist of Cash/PPO/HMOs. Last 4 years grossed between 200-350k in a down economy. Constant referrals from PCPs in the area. Includes Padnet, and all podiatry equipments. Asking 130k. Please email me only footdoc525@yahoo.com

PRACTICE FOR SALE - SOUTHWEST FL

Multilocation multidoctor practice in beautiful Southwest Florida . Practice has grossed over seven figures consistently and currently shows 10-15% growth in revenues with increase in new patients and patient visits. EHR is already implemented with meaningful use criteria met. Practice has been professionally evaluated by Provider Resources. Only serious inquiries to this email address. This is a great practice in Paradise and a good opportunity for the right doctor or doctors. Email to: practiceforsaleswfla@gmail.com

ASSOCIATE POSITION -  NY AND NJ

Highly ethical, motivated self starter wanted. Must be willing to work hard. Must have excellent people skills. There is partnership opportunity if you are willing to work for it. This is not for everyone. No whiners, and no slackers. Send C.V. to ddfcfootdoc@gmail.com

ASSOCIATE POSITION - EASTERN SHORE OF MARYLAND

Seeking highly motivated, ethical, enthusiastic associate to join successful, well-established practice located in close proximity to Maryland and Delaware beaches. Certified/qualified by ABPS with rearfoot experience preferred. The practice incorporates surgery, wound care, sports medicine and general podiatry. Fully equipped office with diagnostic ultrasound, fluoroscopy, vascular testing, radio frequency ablation, six treatment rooms and three satellite offices. Main office has accredited ambulatory surgery center. This opportunity has excellent salary potential with benefits for the right individual. Send CV to dpmkthomas@gmail.com.

ASSOCIATE POSITION - NORTHWEST IOWA

A well-established, midwest multi-physician practice with strong hospital affiliations seeking FT podiatrist. Applicant should be well trained surgical physician, completed a 12/24 month residency, & board eligible. Practice offers high surgical volume, advanced wound care and good mix of general podiatry. Competitive salary, excellent benefits. Fax resume: 712-258-9977.POSITION AVAILABLE -BALTIMORE MARYLAND

Confident, surgically trained associate position available to join well-established practice locations. Leading to ownership within 3 years! Great salary and benefits. Will train on practice management, business management, and billing. Call 301-514-9781.

ASSOCIATE POSITION - HOUSTON, TEXAS

PSR 24+/ Equiv. DPM, Texas license, Busy diverse practice. Greater Houston Area, Guaranteed Salary and benefits All Aspects of Podiatric Medicine and Surgery. Board eligibilty, Bilingual A Plus. Send CV to Randal Lepow at rmldpm1@att.net

ASSOCIATE POSITION - DAYTON, OH

Join a well-established modern practice in Dayton, Ohio. Excellent reputation and referral base. Base salary $120,000, benefits and bonus structure. EMR, diagnostic ultrasound, Padnet vascular studies, CO2 lasers, all aspects of DME. We seek a surgeon that is well-trained and personable to join our group of 4 podiatric surgeons. Would like to have this individual buy in to the practice eventually. Please send CV and to Ohiodoctors@aol.com

ASSOCIATE POSITION - ST. LOUIS

Multi-location group practice seeks motivated DPM with initiative and leadership skills to contribute to our growing group practice. Foot Healers Podiatry Group enjoys a strong reputation within St. Louis and looking for the right individual to complement our team. Must have the confidence to lead you own clinic and the willingness to draw on the expertise that exists within our group. Base salary starts at $100k and no limit to your earnings as you grow YOUR practice. We also offer malpractice coverage, health insurance, 401k, group bonus/profit sharing. Please send CV to jmurray@foothealers.com and visit our website www.foothealers.com.

ASSOCIATE POSITION - WASHINGTON, DC/ MD SUBURBS

Prominent, established two office practice seeking well rounded, personable, ethical individual with sharp medical and surgical skills. Must be 24/36 month trained, ABPS qualified or certified. Partnership opportunity with ownership potential. Competitive salary with benefits package. Please send CV to ponyrunner66@gmail.com

ASSOCIATE POSITION - ORANGE COUNTY, NY

Looking for a highly motivated surgical trained podiatrist in the Orange County, NY (West Point area). Hospital, wound center and surgical center affiliated. It is a busy practice that covers hospital inpatients, Wound Center, and takes ER call. The applicant has to be trained in all foot surgery and be able to handle advanced diabetic wound care. The practice is a 1 hour car ride from NYC and is close to hiking, fishing ,skiing and state parks. Please Email a CV and contact info to clsp4@yahoo.com

ASSOCIATE POSITION - LEXINGTON, KY

Associate needed at fast growing, million dollar practice in beautiful Lexington, KY. All new office structure with gait analysis, med spa and heel pain center in prime location. Amazing benefits and chance to work alongside a forward-thinking podiatrist. Email emenold8@gmail.com with your resume.

ASSOCIATE POSITION NEEDED FOR CENTRAL FLORIDA

FT/PT associate needed for nursing home work. Great compensation and a great way to supplement your income. Must be willing to travel. Contact us at (786) 975-2090 or fax to (847) 674-2113 you may also email to feetwork@aol.com.

ASSOCIATE POSITION - NORTHERN MICHIGAN

Tired of your current position? Looking to grow my practice in beautiful northern Michigan. Come and benefit from my years of hard work. Practice has just the right balance of hospital work, surgery and office. This is not a “gimmick” based practice, but a well integrated part of the medical community. Contact me if you are extremely interested in northern Michigan. Salary plus incentive based contract. Send CV/ letter- MichiganPod@gmail.com

ASSOCIATE POSITION - CENTRAL FLORIDA

Associate position for busy practice in Central Florida. Competitive salary with complete benefit package available. Please send resume to cmedders@atlanticpodiatry.com

P/T ASSOCIATE NEEDED QUEENS & NYC

PSR-36+ board qual/Cert. Highly motivated, Confident, Ambitious podiatrist with Excellent patient communication skills required! F/T possibilities in future. Base Sal. With Incentives. Spanish and Greek speaking a plus. Please respond with cover letter and resume to: hansfeet@aol.com

ASSOCIATE POSITION - SOUTHERN CALIFORNIA

Requiring full-time podiatrist (PSR-24 or greater) in established Practice situated in a foothill community of Southern California. There is an existing patient base and a strong support team. Compensation is performance based with practically an unlimited earning capability. A possible buy-in is negotiable. Send resume to office@uplandpodiatry.com , titled, "Podiatrist".

POSITION AVAILABLE - WEIL FOOT ANKLE & ORTHOPEDIC INSTITUTE - CHICAGO

Weil Foot Ankle & Orthopedic Institute is expanding their presence in the Chicago metropolitan area and suburbs and is recruiting qualified podiatric surgeons. A three-year residency is required and a podiatric fellowship is preferable. Current practicing podiatric practitioners in Chicago and surrounding area are also welcome to join our rapidly expanding practice that currently numbers 16 DPMs, a neurologist, an orthopedic surgeon, and a primary care sports medicine physician. For more information contact: info@weil4feet.com or call Stephanie Spiegel, COO at 847-390-7666.

PODIATRIC SPORTS MEDICINE FELLOWSHIP - ORANGE COUNTY CA

July 1, 2013 and ending July 31, 2014. $60,000/year, medical, dental, malpractice, and CME allowance. APPLICANTS MUST BE ABLE TO OBTAIN A CALIFORNIA LICENSE. Letter of interest, and CV to: Philip Radovic, DPM, Fellowship Director, Email: Info@feetfixer.com

SPACE AVAILABLE - NYC & LI

Office to sublet and share - 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. Also availability E 22nd between 2nd and 3rd and E 70th off 3rd. Turn-key operation - no investment needed PODO2345@AOL.COM 516-476-1815

EQUIPMENT FOR SALE - COMPLETE AMFIT ORTHOTIC FABRICATION SYSTEM

Complete Amfit Orthotic Fabrication System with Footfax SL Contact digitizer-3 years old. System includes milling machine, 2 PCs, all cords, parts, hardware and assorted insole blanks. $45K New, Asking $10K. E-mail inquiries to: sportsmed@fdfac.com.

EQUIPMENT FOR SALE - USED Q-CLEAR LASER

Still under warranty. New laser head just added. First Best Offer. Marketing and training included. Dr. Zuckerman will train you. e-mail with questions to mook863@comcast.net

PM News Classified Ads Reach over 14,000 DPMs 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 14,000 DPMs. Write to:bblock@podiatrym.com or call (718) 897-9700 for details. Weekly ad rates start as low as $115 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

• To Post a message, send it to:    bblock@podiatrym.com
• Notes should be original and may not be submitted to other publications or listservs without our express written permission.
• Notes must be in the following form:
  RE: (Topic)
  From: (your name, DPM)
  Body of letter. Be concise. Limit to 250 words or less). Use Spellchecker
  Your name, DPM City/State
• Subscribers are reminded that they have an ethical obligation to disclose any potential conflicts of interest when commenting on any product, procedure, or service.