The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

March 12, 2009 #3,491 Publisher-Barry Block, DPM, JD

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Safety is Key Advantage of PinPointe Laser: NY Podiatrist  

Toenail fungus, an embarrassing problem, affects 20 million people. There aren't a lot of effective treatment options. Creams or ointments often don't work and antifungal pills can be potentially toxic to the liver. There is a new way to treat it without medication – the PinPointe laser. The specially designed laser beam goes through the nail and kills the fungus. It's a 30-minute treatment that is relatively painless. The treatment has shown promise, but because it is new, there are no long-term studies.

Dr. Stuart Mogul

“Probably half of my patients have fungal nails,” says Dr. Stuart Mogul, a Manhattan podiatrist. “Once the fungus gets into the toenails, it is extremely difficult to get rid of. Treatments such as creams and ointments often don’t work and or pills may have potential side-effects. The good thing about this therapy is that it is safe.”

The laser does generate some heat, which can be uncomfortable at times. The cost of this treatment is about $1,000 and it is not covered by insurance.

Source: Sapna Parikh, MD, Fox-5 TV (NY) [3/10/09]

NH Podiatrist States the Financial Case for Preventive FootCare

State lawmakers took their budget hearing on the road last night to hear directly from the people.  More than 200 people packed the Salem High School media center, mostly to testify about saving programs in danger of being axed. The rest who came watched the hearing on a television in the school cafeteria. "I look forward to your suggestions of how we can deliver essential services and not have anyone pay for them," said State Rep. Marjorie Smith, D-Durham, who moderated the session..

Dr. Stanley Gorgol

"I don't want to be in your position," said Dr. Stanley Gorgol, a Salem podiatrist, as lawmakers prepared for lengthy heartbreaking stories — from mothers whose children suffered from cancer or drug abuse and were saved by state programs and from doctors who pleaded with legislators not to cut relatively inexpensive programs that deliver preventive medicine to the poor.

"We get paid pennies on the dollar," Gorgol said, adding it cost $25 for the state to allow a Medicaid patient to see a podiatrist for preventive care. By comparison, it would cost $75,000 to amputate a foot, he said.

Source: Margo Sullivan, Eagle Tribune [3/10/09]

Take Steps Toward Better Reviews

Performance reviews should be more than an “annual” event. Change your approach to performance reviews throughout the year. Think of them as a process, not an event.

Look at it from employees’ viewpoints. They go about their work all year, doing their best or their worst, as the case may be. Then, suddenly, once a year, the boss lays down the law. Is annual feedback really the best way to guide employees and boost their performance?

Better: Regularly forge connections, recognize success, identify obstacles and determine where improvement is needed. Ask specific questions: “Do you have the right tools and equipment to do the job?” “What is going well? What isn’t going well?” “Who has been particularly helpful to you?”

When you use that approach, you build reviews on a strong foundation of year-round communication. Neither you nor your employees will be surprised at what you hear during formal reviews, because both parties will be aware of issues and concerns.

Source: Adapted from “Performance Review 2.0: Eight Ways to Overhaul Your Employee Evaluation System,” by Quint Studer via Communication Briefings

Query: 5 Y.O. with Nail Problems Due to Lack of Distal Phalanx

I recently evaluated a 5 y.o female for a chief complaint of pain and dystrophy of the left hallux and second toenails present since birth. The nail on the hallux was severely shortened, thickened and the distal tip of the toe was overriding it. The second toenail grew dorsally (upwards) but was of normal size and color, etc. An x-ray showed that the distal phalanx of the left hallux was only one third that of the right distal phalanx, with no growth plate noted. The second toe lacked a distal phalanx and had a middle phalanx that was just a few millimeters in size.

The question is what to do about the left great toenail and pain associated with the distal entrapment, which while problematic, has not yet caused an infection or significant disability. Long-term what might the prognosis be for the development of the left first and second digits?

Pete Smith, DPM, Lancaster, PA

Query: Indigent Medical Care Program

I was solicited by a family currently living in a southern Caribbean Island, to help their ten year old son, who sustained a displaced spiral-oblique fracture of his tibia after being hit by an automobile. He was treated in his country with casting and immobilization. However, the fracture is currently in a non-union state and requires fixation, which the surgeons in that country do not have available. Is there anyone aware of any hospital or non-profit groups who have an indigent medical care program that would assist this family in receiving the proper care here in the US?
 
Will Alexander, DPM, Atlanta, GA
 

RE: New Light-Based Technology for Onychomycosis
From: Bryan C. Markinson, DPM

At the 13th Annual Council for Nail Disorders annual scientific meeting, held on March 5th, in San Francisco, the chief scientific officer of Nomir Medical Technologies, Eric Bornstein, DMD, delivered a talk to an international audience entitled “Near-Infrared Light Based Treatment for Onychomycosis.”  This captivating and well-received talk detailed the discovery of the technology and invention of the Noveon laser for treatment of onychomycosis. The wavelengths used are completely safe and result in a direct kill of dermatophytes at physiologic temperature. The company just completed a study in onychomycosis which will be presented to the FDA at the end of the month.

Disclosure: I am a consultant to Nomir Medical Technologies.

Bryan C. Markinson, DPM, NY, NY, Bryan.Markinson@mountsinai.org
 

RE: Alternative to Moore Garnet Disc
From: Robert Teitelbaum, DPM

Recently, E.C. Moore Co., Inc., which supplies the discs for podiatric debridement, has had difficulties with what they say are their "raw materials" from which they produce these discs.  Particularly affected was the extra coarse type that I have been trying to get since December. Fortunately, I found that they have an "Adalox" type of brass-centered disc that is nearly equivalent to the garnets I previously used.  Adalox is the name for their aluminum oxide disc. They are also priced the same. The highest grit is 'coarse', but I have found them nearly equivalent to the extra-coarse disc in durability and performance. 

This should provide a viable alternative until Moore sorts out their production problems.
 
Robert Teitelbaum, DPM, Naples, FL, mfvandange@aol.com

RE: Voice Recognition Software (Tom DeBenedictis, DPM)
From: Mark K. Johnson, DPM

I have used Dragon (currently 9.5 Professional) for the past 7 years.  Get a good microphone, speak clearly without slurring, and use a computer with 2-3 Gigs of RAM minimum (Duo-Core or Quad Core) - highly accurate.  The New Dragon Medical 10 has [  ] bracket fields for templates and default macros and specific medical specialty vocabularies- you may want to look into that as well. You can't dictate into Dragon at a lightning rate of speed with good results. 

Mark K. Johnson, DPM, West Plaines, MO, DDR004@centurytel.net
 

RE: Podiatry Must Speak With One Voice (Judith E. Rubin, DPM)
From: Tip Sullivan, DPM

I wish we all had the chutzpa and fire that Dr. Rubin has. I would like to invite her to come practice in Mississippi. We all need to have a fire lit under our backsides occasionally. Thank you.

Tip Sullivan, DPM, Jackson, MS, tsdefeet@msfootcenter.net

RE: What to do in the Face of the Projected Medicare Cuts? (Jeffrey Kass, DPM)
From: Robert Scott Steinberg, DPM, Mark Levine DPM

Better than expecting the APMA to shoulder this load, it is easy for everyone of us to do something. Find out when your Congressman/Congresswoman and Senators will be in their home offices and schedule an appointment. Then, start showing up at their fund raisers, well at least those in your price range. Golf outings and more casual gatherings can give you more chat time. Volunteer to work on their campaigns. You and your family can work the phone banks and call friends and tell your patients about the issues. While our elected officials want big money, more than anything, they want votes. Write letters to the editors on their behalf if they will protect medicine from these cuts.  I would also let someone know at the APMA about your meetings, so they can build a working file.

This would also be a good time for organized medicine to stand up in unison. 
 
Robert Scott Steinberg, DPM, Schaumburg, IL, Doc@FootSportsDoc.com

I think this goes way beyond the government paying the doctors more money. A few points:
 
1) The Obama administration is pushing big-time for universal healthcare. They are placing the blame on the doctors when we complain about the cuts. This seems to be the politically expedient thing to do, and something the administration seems to be doing on other issues. Will people out of work cry for the doctors? It makes sense to deflect the blame off the administration.
 
2) Major insurance companies now have their fees based as a percentage of Medicare fees and stand to make millions due to the cuts.
 
3) Congress will not have the spine to give the doctors a "21% raise" in this economic climate. Congress gets a CPI raise yearly by doing NOTHING, talk about spines!
 
It appears to me that doctors haven't yet "drawn a line in the sand" and as always we'll react after the fact. I can envision the politicians telling the people that the doctors have to take a little less due to the economic climate. I have no problem taking a bit less if we were getting a CPI increase yearly, but our total increase has been something in the nature of 2% the last 8 or 9 years, so how much more do the doctors have to sacrifice? If Congress corrected the system years ago, we wouldn't be going through this again like we do every year.
 
I implore everyone to call, e-mail, and snail mail your congressmen and senators weekly and tell your colleagues to do the same. And start NOW! I think we're in the fight of our lives.
 
Mark Levine, DPM, Middle Village, NY, MarkLevineDPM@verizon.net

PRACTICE FOR SALE-SOUTHEAST MICHIGAN-BRIGHTON

Outstanding opportunity. Eleven year established-earn 200K. Excellent location in mid to high income growth area.  Turn-key, all equipment and furniture included. High quality 1,350 sf build-out. Large illuminated sign on busy main road, convenient parking. Must sacrifice due to illness. Priced to sell. Call (248) 565-5266.  Docpod@aol.com 

ASSOCIATE POSITIONS – CALIFORNIA

Three podiatrists needed for busy North Hollywood office. Full-time Monday-Friday 8am-2:30pm.  No weekends and no call. Pay negotiable. New podiatrists are encouraged to apply. Please email resume and salary request to Coasttocoastpodiatry@yahoo.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

OFFICE SPACE/ MRI RENTAL – NYC, LI   
 
Turn-key space available, daily, monthly; East 60th off Park Ave, East 22nd St. off 3rd Ave, and Plainview Long Island. JACHO-certified operating rooms available, as well as all surgical equipment and anesthesia. Extremity MRI Rental. Stark compliant. All exams read by board certified radiologist. Call for details. 516 476-1815

ASSOCIATE POSITION -SOUTHERN NEW JERSEY

I’m looking for podiatrist who wants additional practice hours. Perfect for combining your own practice with an additional income. Must be on Aetna Insurance, Horizon Blue Shield, Medicare, and most commercial carriers. I am looking for someone who has a desire to learn how a very successful practice is run, so that I will be able to have time away from my practice. Payscale to be discussed. Could lead to partnership or sale. E-mail contact information, CV, and why you would be perfect for this opportunity. Contact foot.care@verizon.net

ASSOCIATE POSITION – HOUSTON, TX

Associate needed for 30 Year Houston practice. 2 offices, each located in growing medical center. Heavy surgical/office practice with minimal RFC. Tremendous opportunity for personable self starter. English & Spanish would be a big asset.PM&S-24 and PM&S-36 graduate welcome. Texas license required. Reply to ssssmosk@aol.com

PRACTICE FOR SALE - CENTRAL FL

Practice sale, in beautiful, high quality of life, growing area; 2000 sf bldg. fully equipped/ designed for podiatry; excellent location, features & exposure; near hospital, wound and HBO center. Great opportunity for expansion; good insurance climate. 352-357-7499 / E-mail: windnwave@earthlink.net

NEEDED CHICAGO -- NW IND & BALTIMORE/WASHINGTON, DC PODIATRISTS

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists in Chicago, Northwest Indiana, and Baltimore, MD. 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 Visit our website

PRACTICE FOR SALE or ASSOCIATE WANTED – SOUTHEAST OHIO 

Well-established, two-office practice in Southeast Ohio for sale. Seller currently works 3.5 days per week. Gross >$300K, Net ~$140K.  Excellent locations and growth potential. All equipment and furniture included. Seller is willing to help with transition, Ohio Licensure. Contact seller at bjadpm@hotmail.com for more information.

ASSOCIATE POSITION- CALIFORNIA

Associate needed for coverage in the office, nursing homes and facilities in Orange County Southern California. Surgical as well as C&C. Will help to get on staff at St. Jude Medical Center. Please contact Dr. Lee for more information at (714) 333-5837 or by e-mail to chinuklee@yahoo.com

ASSOCIATE POSITION – NAPLES, FL

 Great opportunity for PSR- 24/36 BE/BC podiatrist with strong surgical skills to join multi-office practice. Hospital privileges available at 648 bed hospital system, 200 bed hospital system and multiple surgical centers. Florida has a great scope of practice law and we rotate for ER call at all 4 hospitals. Candidate needs to be ethical and motivated. Established practitioner or new practitioner OK. Base salary, percentage, benefits including 401K. Fax CV to (239)566-8778 or Email CV to Drgordon@gulfcoastfootcare.com

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