The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

April 12, 2012 #4,434 Publisher-Barry Block, DPM, JD

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TX Podiatrist Stresses Risks of Obesity and Sedentary Lifestyle

Dr. Jeff Ross, podiatric surgeon and associate clinical professor at the Baylor College of Medicine, an Eagle Scout alumnus, and co-chair of the Governor's Advisory Council on Fitness and Exercise in Texas is outspoken on a greater risk facing all youth - the health-related dangers of lifestyle and diet.

Dr. Jeffrey Ross

Ross emphasizes that as risky as violence and substance abuse are, youth born after the year 2000 are more likely to be harmed by obesity and type-2 diabetes than by all other risk factors combined.

Source: Rob Bartlett, Houston Chronicle [3/30/12]

Athletes Require Sport-Specific Shoes: UK Podiatrist

This is the year when many people will be inspired to get active and dig out their sports shoes. But while exercise and sport offer undoubted benefits, it’s vital to look after your feet. As part of its annual Feet for Life Month in June, The Society of Chiropodists and Podiatrists is raising awareness of the importance of foot care in sports.

Nav Walia

Nav Walia, from Mypod Foot Clinic in Kidderminster, says: “Exercise is essential for good health, but sports can put a lot of pressure on your knees, hips, back, neck, and feet. When we play different types of sports, we use our body and our feet in different ways. It’s therefore vital to wear a sports shoe designed to support your body’s movement for that particular sport."

Source: The Kidderminster Shuttle [4/10/12]

APMWA Announces 26th Annual Student Writing Competition

The American Podiatric Medical Writers Association has announced its 26th Annual Student Writing Competition.

• All papers MUST be non-technical in nature. Appropriate subjects include practice management, ethics, law, education, or any topic that would be suitable for a lay publication.
   
• There is no word limitation. Papers will be graded for content, style, grammar, neatness, and overall impact.
   
• First prize will be one thousand dollars ($1,000.00), sponsored by an APMA Educational Foundation endowment from Dr. and Mrs. Steven Berlin, and recognition in the APMA NEWS and the APMWA Newsletter. Honorable Mention Certificates may also be awarded.
   
• This competition is open to ANY enrolled podiatric student.
   
• Entries must be received by 4/15/12 via e-mail at bblock@podiatrym.com
   
• Entries become the property of APMWA, which may arrange publication of the entry.

Take Listening to the Next Level

Even a good listener can become better. Elevate your listening skills with these best practices:

•  Pause. Not interrupting the speaker is the first step. Wait a few seconds before you respond, in case the other person has more to say. A person often will clarify a point or revise a statement when allowed a few extra moments to think. And a speaker who has completed what he or she wanted to say will be ready to listen to you.
•  Jot notes. Withholding your comments allows you to listen carefully and not rush to speak. But do write down questions you want to ask or points to make so you don’t forget them when it’s your turn to speak.
•  Follow up. End the conversation by committing to what you will do as a result. Develop a system for filing your conversation notes so that you always follow up promptly. Example: Immediately add tasks to your to-do list.

Source: Adapted from “Hotel Management Tips—the Power of a Good Listener,” Jack A. Turesky, Hospitality Net via Communication Briefings

Query: Onychomycosis in a Ten Year Old

My patient is a ten year old male with no contributory PMH. He has a history of mild injury to the left hallux 3 years ago. The nail had blood under it but never fell off and then grew out. Since then, the nail has had white thickening, migrating from the end of the nail back closer to the base. No other nails are involved. Cultures taken were positive for trichophyton spp. Topicals have been ineffective.

Since the FDA states that efficacy and safety have not been established for children, I am hesitant to start this kid on Lamasil. I am not aware of any dosage adjustment needed. Any thoughts on using pulse-dosing or another method for treating documented onychomycosis in a otherwise healthy pediatric case?
 
Tip Sullivan, DPM, Jackson, MS

Query: Board Certification and Non-Surgical Privileges

Hospitals can require board certification for operating room privileges, but can a hospital require board certification for non-operating room podiatric privileges?

Daniel Chaskin, DPM, Ridgewood, NY

Editor's Note: PM News does not provide legal advice. Hospital privileges are generally defined in the hospital bylaws. If other medical specialists can obtain non-surgical staff privileges, there should be no reason why a podiatrist can't obtain similar privileges.

RE: Excisional Biospy (Joe Borden, DPM)
From: Stephen Musser, DPM, Robert J. Snyder, DPM

This sounds like it may be a granuloma after a traumatic episode. First, make sure the patient is off all medications that can thin the blood. Second, check for allergies and use local anesthetic that has epinepherine, either 50/50; or because its on the bottom of the heel, use local with epinepherine only. Third, 'good ole' ice, compression, and elevation. Make sure the patient has somebody to drive him home so that he can keep the leg elevated in the backseat. Let us know what the diagnosis was.
 
Stephen Musser, DPM, Cleveland, OH, ly2drmusser@gmail.com

The vascular nature of this lesion concerns me. You may want to consider taking several 3 mm punch biopsies first (i.e.: 12 and 6 o'clock).  Once pathology has returned, you can make a more informed decision concerning treatment options and potential referrals.
 
Robert J. Snyder, DPM, MSc, Tmarac, FL, DrWound@aol.com

RE: Metatarsus Adductus in a 14 Month Old (Edmond F. Mertzenich, DPM)
From: Gino Scartozzi, DPM
 
Although the child has started walking, I recommend that the metatarsus adductus can and should be treated. One would have to rule out a concomitant equinus and varus deformity of the foot which may be overlooked as a mild clubfoot deformity.
 
The use of a Beebax bootie which the child can wear at night and when napping can be helpful, even if surgical intervention will be required. The forefoot region of the boot can be adjusted slowly over time by abducting the forefoot onto the rearfoot component of the shoe. The rearfoot (subtalar joint) component of the shoe can be adjusted to a position of inversion relative to the forefoot component of the shoe to prevent talo-navicular subluxation. The further use of orthoses is helpful to maintain the correction obtained.
 
Gino Scartozzi, DPM, New Hyde Park, NY, Gsdpm@aol.com

RE: Bunionectomy Complication (Alan Berman, DPM)
From: Tip Sullivan, DPM

First you must figure out why she has limited motion— STJ, PTT, etc. I would then explain in detail and in lay terms what is going on and very non-accusatorily let her know that perhaps her post-op therapy may have been lacking. I would not implicate any other surgeon in any “malpractice.”

Given your description, and if she had not improved with therapy, I would take her to the OR and try an aggressive joint manipulation under anesthesia. I have actually broken toes doing this, so be careful. I have found that recurrent hallux limitus is very difficult to surgically address successfully with open joint surgery.

If I did not get at least 90 degrees motion from the shaft of the first met DF and 20 degrees in PF, I would proceed with surgery. I would start with an aggressive soft tissue release. Then, if necessary, follow with a Roger Mann-like chylectomy of the met head and base of the proximal phalanx. This will probably do the trick, but it does not address the etiology of the original hallux limitus. Many years ago, I purchased a “JACE” 1st MTPJ ROM post-op continuous passive ROM (CPROM) machine which I use on selected cases. I strongly suggest some sort of CPROM, especially if you do not do an osteotomy. I would try to functionally treat the limitus, if possible. Of course, recurrent hallux limitus could be treated with an arthrodesis, but I would try to wait until her sports career is over for that unless totally necessary due to pain and inability to play.
 
Tip Sullivan, DPM, Jackson, MS, tsdefeet@MSfootcenter.net

RE: Service Dog (James Lucarelli, DPM)
From: Richard A. Simmons, DPM

The U.S. Department of Justice clarified many of the rules concerning the Americans with Disabilities Act. This became effective March 15, 2011 and can be found here.

Concerning service dogs: “A public accommodation shall not ask about the nature or extent of a person's disability, but may make two inquiries to determine whether an animal qualifies as a service animal. A public accommodation may ask if the animal is required because of a disability and what work or task the animal has been trained to perform. A public accommodation shall not...

Editor's Note: Dr. Simmons' extended-length note can be read here.

RE: Aggeus Healthcare
From: Michael J. Schneider, DPM

I retired from a 24 year podiatry practice in Vail, CO last September. It took about a month before I realized that I still had much to offer the profession that I had enjoyed for those many years. I had seen advertisements in PM News and the APMA News for podiatrists to work for Aggeus Healthcare which is a company that services nursing homes and skilled care facilities throughout the country.

I contacted them and, after going through the training process, I have been working for Aggeus since January 2012. My wife, who worked with me in my Vail office was hired as my assistant. I would advise any podiatrist, who is either looking to supplement income or to work full-time, to contact Aggeus Healthcare. This company is run and staffed by energetic dedicated people who go beyond limits to accommodate the professionals that they employ to serve their facilities.

Michael J. Schneider, DPM, Vail, CO, podiatristoncall@gmail.com

RE: E-Prescribing Program (Alan Meyerberg, DPM)
From: Marc Garfield, DPM
 
It is these types of issues that trouble me about 5010, ICD 10, ICD 11, MU, and PQRS. We all accept this garbage from government mandates/incentives; then we find out later that the fine print is: third-party payers win and you lose. On my EMR discussion board, Dr. Meyerberg’s issue is a growing problem. In coming years, there will be additional 2% penalties for not submitting PQRS adequately and properly, in addition to eRx penalties.  MU penalties will be up to 5%.
 
What makes it more interesting is that many secondaries kick out the G8553 and PQRS codes and make you resubmit your secondary claims. The fact that they changed the eRx codes a couple of years ago also adds to the challenge of a process in which there is no recourse for correction despite actually using the eRX on nearly every Rx you write.
 
Marc Garfield, DPM, Williamsburg, VA, mgarfield1@cox.net

RE: Practice Fusion and Flash
From: Steven Kaniadakis, DPM

Practice Fusion (PF) has announced that they'll be updating or offering a "a whole new set of features." PF says users will need Adobe Flash or they will be "unable to log in." My past experience is that Apple-related products do not come with this program. Likewise, some Android users may need to get the program for their hardware. Mac OS, iPad, or iPhone users need to install Flash to avoid potential problems.

Steven Kaniadakis, DPM, St Petersburg, FL stevenkdpm@yahoo.com

ASSOCIATE POSITION - MARYLAND

Looking for 3rd associate. Must be personable, well trained and highly motivated. Great locations in Southern Maryland, including an Ambulatory Surgical Center. We currently have EHR, digital radiography, dispensing center and PADNet. Looking for immediate hire! Please send CV to: myfeetfeet@aol.com

ASSOCIATE POSITIONS - MULTIPLE STATES

Podiatrist Needed in Missouri, Nebraska, Iowa, Minnesota, North Dakota, South Dakota, Texas, Colorado, Wisconsin, Indiana, and Oklahoma. Expanding multi-state medical practice seeking podiatrists to service long-term care community residing in nursing homes and assisted living facilities. We offer an established patient base, scheduling, equipment allowance and cover travel expenses. Provide generous compensation, bonus opportunities, disability, health insurance benefits, malpractice coverage and flexible scheduling. Looking for a Podiatrist with excellent skills, able to provide expert and compassionate care to patients. Email CV to: careers@aggeus.org or call 773-770-0140 x300/x305. www.aggeus.org

ASSOCIATE POSITION - KANSAS CITY, MISSOURI

Kansas City may be the perfect move for you and your family. I am looking for an entrepreneurial minded associate who wants to grow and then own part of an already successful practice. If you are the right candidate for this associate position, you will enjoy a competitive compensation package and you will be working with a doctor who is as committed to your success as he is his own. Go to: www.YourFutureInPodiatry.com for full details.

ASSOCIATE POSITION - ATLANTA, GEORGIA AND SURROUNDING COUNTIES

Village Podiatry Centers, LLC: Immediate openings for board eligible or certified, 3-4 year trained surgical physicians. Equity based model, Excellent salary and benefits to start depending on qualifications. (Average physician salary is 2-3 times industry median salary).Full benefits included. Access to practice owned surgery centers, pathology lab, imaging center(s), and other in house ancillaries. Very selective process: must be flexible, well trained, and must participate in our "Physician Training Program." You live off income and retire off wealth! Serious inquiries only! E-mail: David N. Helfman, DPM, FACFAS atdhelfman@vpcenters.com

ASSOCIATE POSITIONS, PART TIME - CA & TX

California- San Diego, San Jose, Los Angeles; Texas- Houston, Dallas. The duties include: Diagnosis and treatment of onychomycosis using Pinpointe Laser in our facilities. Office hours are 9am-9pm 7 days a week; schedule for shifts is very flexible. Email CV to ofer@lasernailtherapy.com

ASSOCIATE POSITION - SENIOR CARE DIVISION - ATLANTA, GEORGIA

Village Podiatry Centers, LLC: Immediate openings for physicians who are interested in caring for the elderly in nursing homes throughout Georgia. Full time position. Excellent salary, benefits, and opportunity for growth. Must understand the coding/billing process and have excellent documentation skills. You don't have to be board certified in foot or ankle surgery for this position.
If interested, please contact Dr. Helfman at dhelfman@vpcenters.com

ASSOCIATE POSITION - ILLINOIS

Established, progressive, busy Chicago practice seeking PSR 24/36 individual with good people skills to join 3 man group. Senior Associate retiring. Excellent opportunity leading to partnership for energetic, motivated, ethical professional. Submit CV to JAF@APLfeet.com

PHYSICIAN FOR CLINICAL RESEARCH DIVISION - ATLANTA, GEORGIA

Village Podiatry Centers, LLC: If you have experience in running clinical research trials and would like a full time position in managing and overseeing multiple clinical research trials for our growing group, please contact Dr. Helfman @ dhelfman@vpcenters.com. Excellent salary, benefits and equity opportunity for the right individual.

ASSOCIATE POSITION - MANHATTAN

Podiatrist needed for busy state-of-the-art offices in Manhattan. Offices are located near Penn and Grand Central Station. Along with CV, please provide medical plans that you are currently participating in. Please forward your information to roni@myfcny.com

ASSOCIATE POSITION – FLORIDA

Emerald Coast on the North Shore of the Gulf of Mexico, a well-established group practice with multi-offices, seeking an associate with opportunity for partnership for a PSR-24/36 Doctor well-trained in foot/ankle/diabetic problems/wound care/surgical and medical podiatric care, covering 3 area hospitals, NO nursing homes. e-mail letter of interest, CV, and references to basewedge@yahoo.com

ASSOCIATE POSITION - TENNESSEE/NORTH GEORGIA

Multi-physician, Multi-office practice looking for motivated new associate leading to partnership. We are a busy practice with state of the art technology: EHR, Digital X-ray, Diagnostic Ultrasound, PADnet, EPAT machine. Applicant should be PMS 36/Board Qualified/Certified. Applicant should be ethical, personable, hard working and interested in providing all aspects of podiatric care to our patients. Competitive Salary and benefits. All interested candidates please send a CV with two letters of reference tomybestnewjob@gmail.com

ASSOCIATE POSITION - PART TIME - OCEAN COUNTY, NEW JERSEY

Looking for PSR 24/36, board eligible preferred. Busy podiatric practice with up to date EMR & practice management program. Practice currently offers digital x-rays, ultrasounds, vascular studies and laser treatment. Good mix of general podiatry, wound care and surgery. Must be ethical, hardworking and committed to quality patient care. NJ license needed. Competitive salary and benefits. Send cover letter and resume to: AOKNDPM@gmail.com

ASSOCIATE POSITION - UPSTATE NEW YORK

Surgical based, multi-office practice in Upstate New York looking for a highly motivated podiatrist to join our group. Base salary plus incentive. Opportunity for growth. Email resume and cover letter to: professionalfootcare@live.com

ASSOCIATE POSITION - SEATTLE, WA AREA

Established podiatric clinic looking for an associate to join our team, 5 offices located around the greater Seattle, WA area. Great base salary, benefits and friendly work environment. Please send resume to: seattlefootdoctor@yahoo.com

PRACTICE FOR SALE - SOUTH NEW JERSEY

Great practice for sale, lease it, work in practice, rent-free first year, associateship possible. Must have NJ licensure have own TIN participation for Horizon, Cigna, Aetna, etc. Retiring. Anyone is welcome to make offer or come up with other ideas. Contact footcare@comcast.net

PRACTICE FOR SALE - AUSTIN TEXAS

Great opportunity for new practitioner or an additional office. 18 year practice with large patient base. Current physician transitioning to part time then retiring to pursue another business opportunity. Start turn-key without need for a bank loan. Great area to live and work. Susieintx@aol.com (512) 565-6634

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 516 476-1815 PODO2345@AOL.COM

PM News Classified Ads Reach over 13,500 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 13,500 DPM's. 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.

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