The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

April 05, 2010 #3,823 Publisher-Barry Block, DPM, JD

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IL Podiatrist Provides Heel Height Tips

A lot of trends have come and gone: corsets, hip huggers, shoulder pads. But high heels seem to be here to stay, and getting higher all the time. George Bucciero, a Streeterville podiatrist, said. "It throws off your legs. It throws off your knees. It throws off your lower back, and it concentrates pressure on the ball of your feet. It's tough."  No, this podiatrist isn't going to rain on your fashion parade, but he can offer some tips to keep your toes more comfy.

Dr. George Bucciero

"A rubber sole, a chunky heel, 2 inches is adequate," said Bucciero. "The height of the platform decreases the relative height of the heel." Bucciero says some women, especially flat-footed women, benefit and feel better wearing moderate-sized heels. And he points out even gym shoes, if worn too often, can be bad for your feet because they're just too soft.

Source: Roseanne Tellez, CBS TV [3/31/10]

CT Podiatrist Adds Podiatric Touch to Religious Ceremony

About 100 people came to a Maundy Thursday afternoon service, and more than 30 received new shoes donated by Bob’s Stores. More received vouchers, socks and foot-care kits. Student nurses from Gateway Community College helped care for the people’s feet, and Ceasar Irby, a podiatrist from Stratford, examined any participant needing special attention.

Traditional Maundy Thursday Foot Washing in Connecticut

“Any time you’re providing services to the less fortunate, it’s a good thing, and I think they appreciate it,” Irby said. Those who live on the streets tend to spend most of their waking hours on their feet, have a hard time keeping shoes and socks dry in wet weather and are less likely to seek medical attention.

Source: Ed Stannard, New Haven Register [4/2/10]

Query: Parkinson’s Disease

A 70 year old female friend has been diagnosed with Parkinson's disease about three months ago. During this time she has developed unilateral severe hammertoes, an equinovarus deformity of her foot (no heel contact in stance), and a shuffling gait (starting to be fenestrating). She is complaining of foot pain on the 5th MTP joint (no callous) and the TP tendon at the malleolus and navicular tuberosity.
 
Questions: 1) Does PT help, and for how long? I have her husband stretching her out now. 2) Would an AFO help? If so, would you limit dorsiflexion to minimize walking strain? Would this contribute to the equinovarus as you are no longer actively dorsiflexing the foot? 3)  Any other suggestions?
 
Gary Bjarnason, DPM, Roanoke Rapids, NC

Query: Message on Hold System

I am seeking a podiatry-specific, or even better, a custom practice-specific message on hold telephone system for the brief time my patients are waiting. Any input is appreciated.

Scott A. Werter, DPM, Myrtle Beach, SC

RE: Neuropraxia? (Catherine Yack, DPM)
From: Barry Mullen, DPM

When in doubt...think gout. Acute onset, w/inflammation and rapid resolution. No history of trauma. Any chance you are post-menopausal? Medical history? Medicinal history? Family history? Food and beverage intake history in the 24 hours preceding the "attack"? The answers to those questions may shed some light...but that's my best clinical call based on the limited historical information provided.

Barry Mullen, DPM, Hackettstown, NJ, yazy630@aol.com

RE: Dorsally Contracted 5th Toe (Alan Berman, DPM)
From: Robert Boudreau, DPM, Stephen Pirotta, DPM

I would also do a "Z" plasty lengthening of the skin dorsally at the MPJ, as well as put a .045 K-wire for 4-6 weeks, in addition to what Dr. Berman is planning on doing.

Stephen Pirotta, DPM, Bentonville, AR, iwillctrnow@yahoo.com

Maybe this is a simplistic way of looking at this complex problem, but what about MPJ amputation of the 5th digit? I had a salesman several years ago who had severe congenital overlapping, 5th toes bilateral. He did not want an extended recovery time, due to job requirements and obligations. After discussing all possibilities with him, 5th toe amputations were discussed and agreed upon. He was back at work in 1 week, and in 2 weeks was back at pre-op activity levels and dress shoes. It's not an option for everyone, but in certain cases, this is a wonderful alternative.
 
Robert Boudreau, DPM, Tyler, TX, rbftdoc@aol.com

 RE: Passing of Dr. Bruce Letvin

It is with great sadness that I report the passing of my closest friend and colleague, Dr. Bruce Letvin. He was disabled from podiatry practice in Manhattan Beach, CA about 10 years ago, but had been teaching college science courses locally the past 5 years. Bruce suffered complications of an aortic aneurysm early this morning in Torrance, California. He was 54 years old. He is survived by his lovely wife Jane, and two daughters Serena and Shauna. 

Marc G. Mittleman, DPM, Torrance, CA

RE: Proex Online (Joe Borden, DPM)
From: Ira Meyers, DPM, Brian D. Battles, DPM

I have been using Proex online about 3 years. It’s about 95% accurate with a 2-day turnaround. As a backup, I keep all my voice files on an external drive. You do need to spell people’s names. Otherwise, there are no problems.

Ira Meyers, DPM, Huntingdon Valley, PA, idmrun@aol.com

I have been using (www)totalmedtranscription.net for over a year. I have been very happy with their work. It costs. $0.06/line.   

Brian D. Battles, DPM, Groesbeck, TX, battlesbrian@hotmail.com

RE: 21% Medicare Reduction (Dale Smith, DPM)
From:  Multiple Respondents

According to many sources on TV and radio, many believe, including CMS, that when the Senate comes back and holds their vote on this issue, they will past the legislation needed to put this issue off, for a short time, yet again. Interestingly, a few Senators have said that this cut needs to stay, in order to pay for the new Obama healthcare plan recently passed. So, it is not a slam dunk that this Bill will pass. If it does not pass and the 21% cut remains, you can expect that multiple primary insurance carriers will follow suit soon. If that happens, it could be devastating.

However, if that did happen and we could get most all physicians to leave all of their insurance contracts, then everybody would be on a cash basis, and they would get paid for what they do (think of that). We would still bill insurance companies for the patients, so they can get reimbursed, have no more headaches or endless rules, and allow the market economy to determine the price of medical care. I don't think this would happen, but it would be nice.

Samuel Cox, DPM, Goodyear, AZ, scoxdpm@gmail.com
 
I've had the same experience with my patients as Dr. Dale Smith regarding the Medicare pay cuts. Patients have very little regard for our skills and services (not just medical, but also billing and pre-authorizing tests, etc.) anymore since doctors are seen as a commodity. A urologist in Florida has the right idea. Look up Dr. Jack Cassell.
 
I ran across this quote that sums up the Federal mandates on the medical system. It's from Reason Magazine, May 1975 (excerpt in the May 2010 issue): "One fact is certain: once a compulsory medical system is established, even if bankrupt or totally unsatisfactory, it is never abolished. Always, means will be found to perpetuate the system, even if the means negate the purpose of the ends; and, in such circumstances, when conflicts arise between political objectives and financial realities, invariably the doctor becomes the first victim." -Thomas G. Boland, "Compulsory Medicine: Past, Present and Future"
 
Public response? panem et circenses "More bread and circus!"
 
Dan Waldman, DPM, Asheville, NC, DPMcareer@aol.com

Dr. Dale Smith’s recognition of his patients' indifference to the impact of Medicare’s 21% physician payment cut emphasizes an important point: We cannot depend on anyone else but ourselves to survive under healthcare reform.  Although the fine points of the new healthcare system are yet to be detailed, the big picture is clear. Our present managed-care delivery system and the way patients are channeled to us will change dramatically under government control. 

It will be necessary for physicians to focus on prevention and to reach quality performance goals, such as in the PQRI. The upside of this is that, on both a national and local level, if we as podiatrists develop and can deliver quality assurance programs that contain costs and improve outcomes in foot and ankle conditions – we  will not only survive, we will have what it takes to thrive under healthcare reform.

Lawrence M. Rubin, DPM, Las Vegas, NV, lrubindoc@aol.com

RE: Allscripts (Judith Rubin, DPM)
From: Chris Majewski, DPM 

Allscripts, a podiatry-friendly EHR that is CCHIT-certified, has worked out very well in my office. The medical record, e-prescribing, and practice management modules work together seamlessly and Allscripts seems dedicated to keeping pace with the changing medical system.

Chris Majewski, DPM, Silver Spring, MD, christofoot@hotmail.com

RE: Digital X-Ray System Michael Forman, DPM)
From: Jeffrey Kass, DPM

While there is no law that states you need to offer x-ray services in your practice, I do feel strongly they should be part of every practice. Case in point: Patient presents to your office status post trauma - Mr. Smith here is a referral to the radiologist for x-rays...please return after getting them. Aside from the inconvenience, treatment may be delayed. Is it illegal? No. is it good practice? I don't think so. Radiology equipment is part of a podiatry practice.

Is digital imaging cost-effective? I agree with Dr. Forman. I am not convinced it is. All the companies would like you to believe it is. But, there are expenses related to the digital imaging as well. Reimbursements keep going down, and unless you have a high volume practice, it will take years to pay off the cost of the equipment.

I made the jump because the quality of films started to decrease. My automatic developer had gotten contaminated a few times, and then there were scratches on my transport rollers, etc. I got to the point where I was fed up with my machine. Had a patient asked me for a copy of my films, I would have been embarrassed to give them. Once I reached that point, I knew I had to make a change. Will I recoup my money invested? I guess eventually I will. In how long? I don't even want to think about it. Am I happy I made the change? Definitely. 
 
Jeffrey Kass, DPM, Forest Hills, NY, jeffckass@aol.com

RE: Attracting New Podiatric Students ( Bryan C. Markinson , DPM)
From: Lloyd S. Smith, DPM

I respect Dr. Markinson for his expertise in issues related to science, but  his opinion on the post-graduate training of DPMs is an opinion deserving of critique. The availability of DPM residencies is dependent on the cumulative college admission class. If 600 DPMs graduate each year, we need 600 residency slots. But, what happens during lean times when we have 500 one year and then, boom times occur, and we have 700 the next? Having trained residents for over 30 years, there is simply no way our residencies can adapt. Programs are lost during the lean years and need to be resurrected when things change. This is a supply and demand problem that may be easy to critique but impossible to solve.   
 
I had a prospective podiatry student shadow me today. Do we want to denigrate our profession, or face the reality of shifting supply and demand? Our profession will forever need to adapt. A positive attitude will allow our current students to become the leaders of the future. Let's support them by creating the residencies needed for them to succeed. Let's commit ourselves to providing every graduate a 3-year comprehensive residency program. Let's not get lost in a temporary residency program shortage in order to denigrate our future. 

Lloyd S. Smith, DPM, Newton, MA, lloydpod@yahoo.com

RE: Attracting New Podiatric Students (Peter Smith, DPM)
From: Bob Kornfeld, DPM

While I totally understand Dr. Smith's reticence to allow his children to become podiatrists (or any other physician specialty), I do not think that we are in a "bad" profession. I do believe that doctors, as a profession, adopted a victim mentality and fell prey to all kinds of insurance regulations that made the insurance companies "the doctors" and us the technicians.

I do not know how any doctor agrees to accept a payment that...

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

PRACTICE & BUILDING FOR SALE - MIDDLE TENNESSEE

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. Website and marketing material included. Seller happy to assist with transition. Priced to sell with financing available 250k. Call 931-446-5724.

ASSOCIATE POSITION – NEW YORK

Podiatrist Needed Immediately - RFC only. $45/hr working for the state prison system. Clean and safe. Easy money to help pay the bills. Several shifts available. If interested, E-Mail hansfeet@aol.com.

EQUIPMENT FOR SALE - PADNET+

Padnet+ vascular testing unit Includes Unit, Dell laptop, all cuffs and cart. Pay what I owe on lease ($19,000) + Shipping. Call 856-783-2800 or E-Mail Feet1@comcast.net

ASSOCIATE POSITION – CALIFORNIA

Looking for a motivated Podiatrist to join a rapidly growing practice in Los Angeles. Excellent compensation. Please reply to coasttocoastpodiatry@yahoo.com

EQUIPMENT FOR SALE – MICROVAS

Microvas Unit for sale. Less than 1 year old and in perfect working condition. Pads included. Best offer. Please e-mail inquiries to podiodoc@gmail.com

CANADIAN PODIATRISTS COME BACK HOME!

An Edmonton, Alberta group of DPM’s requires an additional Podiatrist. Interest in biomechanics essential. Given Canadian visa restrictions, this position is open only to Canadian Citizens or permanent residents. Very attractive compensation package. Fax C.V. or letter of interest to: (780) 483-5796.

ASSOCIATE 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

ADVANCED RESEARCH AND SURGICAL FELLOWSHIP

Boston University Medical Center has two unique fellowship positions Become an expert in Limb Preservation, Tissue Repair and Regeneration. Be part of this unique Fellowship at a major teaching facility. During this time, he/she would be expected to become a knowledge expert who will contribute significantly to research, surgical procedures, teaching, and innovations in limb preservation and tissue repair. Requirements: Completion of a two or three year surgical residency; Candidate must possess a commitment to an academic career in podiatric medicine and surgery. Annual Salary: Year 1 $61,000, Year 2 $66,000. Submit a CV and letter of interest to: erin.springhetti@bmc.org

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-BERKELEY, CALIFORNIA

We are seeking an energetic individual to join our multi-office practice in Northern California. PSR 24+ with a California license is required. Partnership position is possible with an excellent long term business opportunity for an enthusiastic and motivated individual. Please send resume to Mwolpafootdoc@yahoo.com

ASSOCIATE POSITION - SOUTHWESTERN PA

Suburban Pittsburgh. To work in an established practice and also a new office scheduled to open in  August 2010. Future partnership buy-in possibilities. Rearfoot credentials needed to expand the established practice, and to maximize the potential in the new practice. Competitive salary, benefits. 724-337-4433.

ASSOCIATE POSITION – CALIFORNIA

Looking for a motivated podiatrist to join a rapidly growing practice in Los Angeles. Will hire immediately. Excellent compensation. Please fax CV to: 310-652-3669.

FULL-TIME PODIATRY OPPORTUNITY - BOSTON, MA

HealthDrive is seeking a caring podiatrist to join our group practice. We currently have a FT non-surgical opportunity available in the Boston, MA area. We offer a competitive salary, Paid malpractice Insurance, health and dental Insurance, long & short term disability, flexible schedule (No weekends), established patient base, equipment, supplies and complete office support provided. If interested in this opportunity, please call Maria Kelleher (toll free) at 877-724-4410 or email caring@healthdrive.com

ASSOCIATE POSITION - SW 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

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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