The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

April 06, 2010 #3,824 Publisher-Barry Block, DPM, JD

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Infrared Laser is Most Effective Treatment for Onychomycosis: TX Podiatrist

Podiatrist Dr. Gabriel Maislos says chronic toenail fungus has been tough to treat. "Historically, we had topicals that were 8 percent effective. Then you had the pill, Lamisil, but as you know, it can have an adverse effect on your liver, and it's only 70 percent effective. Now, we have the laser, which is 87 percent effective," he said.

Dr. Gabriel Maislos

The doctor follows a grid-like pattern, passing an infrared laser over the toenail to kill the pathogens causing the infection, leaving the nail and surrounding tissue intact. "We're able to kill the fungus at the source," said Dr. Maislos.

In a clinical trial testing one brand of laser, the infection was eliminated in 50 percent of toenails tested after four treatments. Six months later, 76 percent of patients had clear nail growth. Doctors say it usually takes about four months to see a difference as the nails grow out. The treatment costs about $1,000.

Source: Jean Enersen, KING 5 News [4/3/10]

NJ Podiatrist Coordinates Holiday Food Distribution

A Holiday food drive, which dates to the 1990s, distributed 135 bags of food — each with enough to provide two senior citizens with meals for this Easter-Passover weekend.

Dr. Hal Ornstein

The food distribution, also done at Thanksgiving, fills a gap at holidays when meals programs may not be operating, said Gene Young, 56, owner of Mighty Young's Appliance, here. Young, with Hal Ornstein, a local podiatrist, coordinated the food drive, working with the township Department of Senior Services.

Source: Joseph Sapia, Asbury Park Press [4/3/10]

New Medical Schools Open, but Physician Shortage Concerns Persist

Not a single allopathic medical school opened its doors during the 1980s and 1990s. But since 2007, more than a dozen allopathic schools have started the Liaison Committee on Medical Education accreditation process. Another 10 are under discussion, and five osteopathic medical colleges have opened.

The surge in new medical schools is taking place as the Assn. of American Medical Colleges predicts a shortage of at least 125,000 physicians by 2025. Hopes among educators and physician leaders are high that the new schools can help underserved areas and spur local economic growth.

But some experts on work-force issues say new schools are not enough. They say that without more federal funding for residency slots or changes in the doctor payment system, the schools are unlikely to avert an overall work-force shortage or address the undersupply of primary care physicians and general surgeons.

Source: Kevin B. O'Reilly, AMNews [3/29/10]

Editor's Note: PM News is proud to present excerpts from Meet the Masters.

Bret Ribotsky: What has been the distinction between running a business and running a practice?

Dr. Howard Dananberg

Howard Dananberg: My favorite concept about running a business is that there are three critical factors: focus, focus, and focus.  You have to stay focused on what is your message, what you are trying to treat, and how you deliver that care. It starts when patients come to your office, from the first minute they walk in that door. It's how the person who greets them says hello. It's how patients are answered on the phone, how they are talked to, and how you ask for money. All those things have to be thought through and then smoothly and elegantly executed. If you do those things, and combine them with excellent care, you can help your practice to succeed.

Dr. Janet Simon

Meet the Masters is broadcast each Tuesday Night at 9 PM (EST). This week's show features Dr. Janet Simon, Executive Director of the New Mexico Podiatric Medical Association.  You can register for this event by clicking here

Query: Stiff Joint, Post-op Bunion Surgery

Can anyone give a good explanation as to why some bunion surgery patients do so well post-op, with great range of motion and very little pain, while some patients have the opposite. I have a 74 year old woman who never had pain and has a great deal of motion, while a 35 year old gentleman had a fair amount of pain and has a stiff joint. I do understand that the more pain there is, the less likely the patient is to mobilize the joint following the surgery. What do you do, 8-12 weeks out, about that stiff post-op joint?

Alan Mauser, DPM, Louisville, KY

Query: PadNet vs. Revo System

We have a large group practice and are trying to decide whether to purchase a PadNet system or a Revo system. We are hoping we can get some feedback and recommendations from our colleagues who have either one of these systems, or have possibly used both units.

Marc Goldberg, DPM, Olney, MD

RE: Parkinson’s Disease (Gary Bjarnason, DPM)
From: Arnold B. Wolf, DPM, Philbert Kuo, DPM

My first focus would be to pursue a CNS defect beyond what would typically be seen in an "uncomplicated" Parkinson's case. I would first find out what neurodiagnostic evaluations/findings currently exist (MR, PET, CT scans, and so on...to evaluate for possible CVA, neoplasia, MS, etc.) that may help to determine the primary cause of the subsequent flexor spasticity that you're describing.

Clinically, did she demonstrate any pathologic reflexes? Are there areas of sensory abnormality identified? What lab work was performed? Presentations such as this require a "full field view" because more than one disease process may exist. Finally, the measures you describe are essentially palliative. The "bracing" direction I would take would protect against exacerbation of the equinovarus position you describe.
 
Arnold B. Wolf, DPM, Sterling Heights, MI, omnifootcare@prodigy.net

I have a patient who had pain and swelling in both feet that resolved after she had surgery for her Parkinson's at a university hospital (I think it was Duke University).

Philbert Kuo, DPM, Chesapeake, VA, philbear@pol.net

RE: Dorsally Contracted 5th Toe (Alan Berman, DPM)
From: Greg Caringi, DPM

I'm not sure that you can lengthen the extensor tendon sufficiently to diminish the risk of recurrence. I have done a V-Y skin plasty combined with capsulotomy and extensor tendon transfer with good results. I do not use a K-wire, but I could see the need. I simply release the extensor tendon distally and suture it into the capsule/periosteum surrounding the neck of the 5th metatarsal (Hibbs concept). You could also use a drill hole or an anchor for the same purpose. It works well and I've never seen a cosmetic or functional problem.
 
There may be exceptions, but I think it is a bad idea to routinely perform a phalangeal head resection with this combination. This destabilizes the PIP joint and permits the resected phalangeal shaft to dorsiflex into an undesirable position, creating a new set of problems. I recently saw a patient with this situation following a colleague's surgery. The patient was very unhappy.
 
Greg Caringi, DPM, Lansdale, PA, drgregc@msn.com

RE: Chart Documentation and Forensics
From: Michael Forman, DPM

We have all been warned about altering a chart. This week, I heard a lecture by a board certified forensic specialist who deals with handwriting analysis. You would be a fool if you think that you can outsmart these people.  Without going into detail, they have so many methods of determining when things are written that I don't believe anyone could get away with that. DON'T DO IT.
 
If, after reviewing your chart, you find that it is incomplete, there is no reason that you can't add a note that further explains your findings or your thinking. Make sure the note is in chronological order and is dated and signed on the day you write it. Never obliterate a note or "white it out.”  You may draw a single line through a note that is incorrect, then date the time that you drew the line.  
 
Michael Forman, DPM, Cleveland, OH, IM4MAN@aol.com

RE: Allscripts (Judith Rubin, DPM)
From: Chuck Ross, DPM

I recently attended a meeting at my hospital whose purpose was to inform all physicinas about the hospital's IT research into a dedicated EMR system. We were informed that over 200 physicians, techs, etc. were involved in the processm and they evaluated three of the top programs currently being utilized around the country.
 
Their recommendation was Allscripts, and that is what is being utilized by some of the largest hospitals ,and is being utilized by almost the entire balance of the State of MA and Eastern NY-Albany area. This is also being offered as a user-friendly version to the private practitioners in our area in an attempt to minimize costs despite the proposed reimbursement for purchasing our own programs. My concern has been a clearer definition of "meaningful use", so I was quite pleased to learn about my hospital's investigatory process. Over 100 people at this meeting unanimously voted to continue investigating and negotiating with Allscripts.
 
I wanted a program that would easily interface with the hospital, and this may be my solution. Should you require any additional information, please feel free to contact me, and I will see that our IT people respond in kind.
 
Chuck Ross DPM, Pittsfield, MA, cross12@nycap.rr.com

RE: 21% Medicare Reduction (Dale Smith, DPM, Lawrence, Rubin, DPM)
From: Chuck Ross, DPM

I guess I must be living in the Garden of Eden or Utopia. I also presented the 21% cuts to my patients, and I found them to be genuinely concerned and fully understanding of what this would mean to me and all physicians as well as the potential long-term effect on healthcare.
 
In discussions with several medical colleagues, they have indicated a willingness to go back to law school or seek some other means of employment as a 21% reduction in reimbursements actually equals about a 40% pay reduction. Many, if not most, of my patients have stated that they would sign a letter protesting such a cut, to whomever I deemed appropriate. 
 
Several weeks ago, I was chastised for suggesting that all physicians take a 2 week vacation (but arrange for care to the seriously ill).  How come Congress never has a problem voting for a salary increase for themselves? Dr. Lawrence Rubin writes that we must take care of ourselves, but I suggest that a more powerful lobby would be the millions of seniors who we believe depend upon us for service. Would they be willing to offset this 21% cut and when does it stop? 
 
Maybe, this is the time to see how important we really are to the medical community. This may also resolve the residency shortage situation as well. I truly believe that if this cut takes place, that ALL medical professions will see a dramatic decrease in applicants, and there will ultimately be a significant decrease in the quality of medical care for future generations as the best and brightest may not be enticed into sacrificing many years and dollars for a mere pittance upon graduation. My half full glass seems to be coming half empty. Does anyone have a refill available?

Chuck Ross, DPM, Pittsfield, MA, cross12@nycap.rr.com

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

I read Dr. Smith's post three times before deciding to comment. First, I respect the long history of Dr. Smith's service to our profession in a multitude of positions. I am sure that his reticence to be critical is born only out of love for our craft. However, he states...

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

PART-TIME POSITION - CHICAGO AREA 

Immediate opening to provide podiatric services in nursing homes within 30 miles of downtown Chicago 2 to 3 half days a week.  Competitive package and $500 signing bonus paid after 6 months of service. Contact Dr, Brian Aronson at 773-775-0300 or BA@podiatryplus.net

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.

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

ASSOCIATE POSITION – CALIFORNIA

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

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

ASSOCIATE POSITION - CONNECTICUT

Associate needed full or part-time for Nursing homes in Connecticut. Need hard-working, ethical individual. Must have CT license. Excellent salary. Please call Zina (347)307-4333 for additional information.

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