The Voice of Podiatrists

Serving Over 14,000 Podiatrists Daily

April 20, 2013 #4,747 Publisher-Barry Block, DPM, JD

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IL Podiatrist Discusses Flip-Flops 

The American Podiatric Medical Association warns that lightweight sandals (flip-flops) can increase the likelihood of experiencing tendinitis, stress fractures, and other injuries. “The biggest thing is it doesn’t offer the foot a lot of support,” said Dr. Larry Ketner, a Peru, IL podiatrist. Also, since flip-flops are not well secured to the feet it’s easy to trip and stumble while wearing them. That may seem like a silly health concern, but Ketner said, “they bring in a fair amount of business.”

Dr. Larry Ketner

The problems tend to be worse for those who wear flip-flops for long periods of time. An otherwise healthy person may not notice many foot problems, but someone who already is in poor physical condition could face the most problems, he said. Ketner advised staying away from cheap models; instead, he said, try to choose a flip-flop that provides some cushioning and arch support and those with a “cupping nature” that hold the foot.

Source: Matthew Baker, Illinois Valley News Tribune [4/18/13]

PM News has begun 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. Straw polls are not scientific and do not represent standards of care. LAST DAY TO VOTE

Quick Poll
Do you hire people who smoke?
Click HERE for Results

15 NYCPM Students Assist Wounded at Boston Marathon Bombing

On Monday April 15th, fifteen students from the New York College of Podiatric Medicine (NYCPM) volunteered on the medical team for the Boston Marathon under the guidance of Dr. Jonathan Kaplan. They were there to assist with the treatment of the various injuries obtained by the runners crossing the finish line. They could not have imagined that Monday April 15th would turn out to be a day that will probably be forever engraved in their minds. At about 3 PM, two bombs went off near the finish line at the Boston Marathon. The explosions occurred just a short distance away from the medical tent where the students were stationed.

Fifteen NYCPM students were volunteers on the medical team at the Boston Marathon.

In the mist of the confusion after the two blasts, and with all types of emotions stirring up inside them (fear, anxiety, shock, distress), the students collected themselves and began assisting the other health professionals with the wounded that started pouring into the tent. They comforted each other and did all that they could to assist the injured.

Comfort is the Key to Selecting Running Shoes: UK Podiatrist

How the are you actually supposed to pick a pair of running shoes? Podiatrist Ian Griffiths suggests it's about comfort. "All decisions could and should be based on one main factor in my opinion: comfort. Believe it or not, comfort has been linked to injury frequency reduction and is thought to be the most important variable for sports shoes, and a focal point for any future sports shoe development. We all know that comfort is subjective and subject-specific, so with that in mind, only the wearer can confidently choose the most appropriate shoe for themselves."

Ian Griffiths

"Be wary of the shop assistant/podiatrist who tells you the exact make and model shoe which is best for you. What one person finds comfortable will differ greatly from another; perhaps this is why some people find that stiff supportive shoes work best for them, and others discover that barefoot running is the answer to their long history of injury woes," says Griffiths.

Source: Lifehacker [4/19/13]

NY Podiatrist Walks For a Cure

About 40,000 Americans are diagnosed with pancreatic cancer each year. 33 months ago, Dr. Arthur Gudeon of Rego Park learned that his wife, Susan, was one of them. “She was diagnosed in July 2010,” Gudeon said. “Luckily, we caught it early enough that she could battle through it and stay with us as long as she did.” A few months after Susan’s diagnosis, Gudeon came across the Lustgarten Foundation, the nation’s largest private foundation dedicated to funding pancreatic cancer research.

Dr. Arthur Gudeon (C) with Sue's Crewers

In October 2010, Gudeon signed up to walk on behalf of his wife. Sue died in December 2012, weeks before she was scheduled to enter a clinical trial. Despite Gudeon’s partner of 34 years no longer being with him, he decided to participate in the New York City walk on Sunday. Gudeon, who has continued to work part-time as a podiatrist, said that the most important thing is that people become informed.

Source: Queens Chronicle [4/18/13]

SGR "On Sale" Increases Chance of Congress Scrapping It

Some see the stars aligning for a once-in-a-lifetime shift in the way clinicians are paid. But the future physician payment system could end up looking a lot like the past. An increasingly common refrain in Washington health policy circles is that “the SGR is on sale.” That is, the cost of scrapping the mechanism that determines physician payments from Medicare, called the sustainable growth-rate formula, dropped earlier this year. That development theoretically increases the likelihood Congress will take action to replace the SGR, as well as the fee-for-service model on which it is built.

The cost of tossing the SGR and its hated cuts dramatically dropped in February when the Congressional Budget Office revised estimates for repeal and a 10-year freeze in physician payments. The new calculation dropped the cost of scrapping the SGR from an August 2012 estimate of $245 billion to $138 billion, down about 44%.

Source: Rich Daly, Modern Healthcare [4/19/13]

Query: Evidence of Revalidation

I have not received a revalidation request, but I am registered and up-to-date with PECOS. What am I, besides looking through all those lists regarding the letters sent out by CMS since 2011, supposed to check to see if my registration is valid or not?

Joseph Borreggine, DPM, Charleston, IL

Response: If you didn't get a notice for re-validation, don't, I repeat, don't go on a fishing expedition looking for a fish that ain't out there. Medicare has its own archaic system for deciding who needs to re-validate and when. I have a friend who just moved his office two months ago and, of course, had to change his Medicare enrollment. Guess what, he just received a notice he has to re-validate.

Medicare's answer, "Oh, you just changed your address." His response to them was, "I thought when I changed my address, I was also given the opportunity to change and/or validate other portions of your enrollment. This should therefore negate the need to re-validate." Their response: "NOPE!" In short: you'll know when you need to re-validate by the letter you receive.

Paul Kesselman, DPM, Woodside, NY

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RE: Bacterial Infection of Nail? (Jay Kerner, DPM)
From: Dennis Shavelson DPM

This patient’s biopsy reflects the repetitive microtrauma form of onychodystrophy, where there is a relatively normal nail plate competing with “additional” nail-like material being generated directly from the nail bed upward.

This nail unit (not matrix) hyperkeratosis eventually laminates to the nail plate forming a thick nail, but before then, a microscopic space exists between them. This space often contains bacterial growth as described here (although not usually fulminate). There can also be lint and other debris occupying this void under the microscope.

This “Ugly Toenail” classifies traumatic nail dystrophy in the Bakotic-Shavelson Classification System for Dystrophic Toenails (Bakotic B, Shavelson D: The Pathogenesis of Dystrophic Toenails; Podiatry Management, p133-140, August 2006) and needs a larger shoe and/or a foot centering orthotic, and not a laser or an antibiotic.

Dennis Shavelson DPM, NY, NY, drsha@foothelpers.com

RE: Bacterial Infection of Nail (Jay Kerner, DPM)
From: Martin V. Sloan, DPM

I had similar reported  findings after I submitted a nail specimen to a major pathology lab to rule out onychomycosis. The report said "bacterial overgrowth with no fungal elements seen," and identified this same staph organism, Staph hemolyticus. The patient acquired her condition at a nail spa and wanted it resolved. So I put her on an appropriate anti-staph antibiotic (not Cipro) for a time, and the condition resolved. I don't know whether it was a colonization or an infection, but that debate could be extended to the dreaded fungal toenail as well.

Martin V. Sloan, DPM, Rowlett, TX, martinsloan@me.com

RE: Wart Covered Foot (David Kahan, DPM)
From: Stephen Musser, DPM, Barry Mullen, DPM

Treat the underlying hyperhydrosis. Continue current treatment for 4-6 weeks including debridement along the way. If there is no clinical improvement/resolution, try adding Efudex cream covered at night time, followed by morning application of a Sal acid medication. Let them know Efudex is not cheap!
 
Stephen Musser, DPM, Cleveland, OH, ly2drmusser@gmail.com

Consider Tagamet 25 mg/kg P.O. in divided doses. This is the perfect indication. It's affordable and often effective for recalcitrant multiple verruca. For additional information, see: Cimetidine as a First Line Treatment for Pedal Verruca; Mullen et al; JAPMA Vol 95, No. 3; May/June 2005
 
Barry Mullen, DPM, Hackettstown, NJ, yazy630@aol.com

RE: Accommodating Disabled Patients (Name Withheld NJ)
From: Steven Finer, DPM

I have been on the second floor of a building since 1978. I never would have considered it  if there  was no elevator. Over the years, you will lose 10% of potential patients. Would you put in a tiny door blocking extra tall or obese people?

Steven Finer, DPM, Philadephia, PA,  thefiners@yahoo.com

RE: Competency of APMA Leadership (Allen Jacobs, DPM)
From: Steven D Epstein, DPM

Everyone except Dr. Jacobs is concerned that no one in APMA and its affiliates be blamed, while acknowledging that yes, there is a problem. This is nothing more than saying "mistakes were made." Yes, mistakes were made -- by the people in charge -- and not just now but in the past. It is time our leaders own up to this, past and present, or mistakes will continue to be made. This does not mean that our leaders are bad people, only that they have made mistakes. And yes, we should probably vote them out, even if they admit their mistakes, because they are probably incompetent; that's what a healthy organization does. It's not personal, but when employees screw up, they have to go.

Steven D Epstein, DPM, Lebanon, PA, sdepstein@yahoo.com

RE: TRAKnet Announces New and Improved Support Line
From: Hal Ornstein, DPM

While TRAKnet had shortcomings in the past, its future looks very bright! TRAKnet and Revenue Cycle Management (RCM) were recently acquired by Nemo Capital Partners, LLC, a group of podiatrists who has had their fingers on the pulse of the needs of their colleagues for a long time. Each has vast experience in the world of EHRs.
 
I personally know each of these podiatrists very well and can state with conviction that they have the wisdom, passion, hearts, and fortitude to do their very best with TRAKnet and RCM. I know that in the coming months this software will become all that it can be, and that it will address the needs of the users on all levels. While it will take a bit of patience on our parts, I am confident that the Nemo team will not disappoint. They have concrete plans for the software’s enhancement and have assembled a great team of experts. They vow to listen to and communicate with their fellow colleagues.
 
I want to be clear that I am not in any way an investor in Nemo or TRAKnet, nor will I have any financial gain at all from this transition.
 
Hal Ornstein, DPM, Howell, NJ, halo@footdoctorsnj.com

RE: 104 Applicants Not Matched for Residency Positions
From: J. Marshall Devall, DPM

I am sitting on my patio on my day off, reading Podiatry Management. Barry Block's editorial focuses on a fact we all at residency programs already know: over 100 graduates are scrambling for residency positions this year. We have received some heartbreaking correspondence pleading for positions. Some students must have e-mailed every program.

Scott & White was approved for two more positions, going from four to six, which we also feel we could manage with excellent training. We continue to expand our program by leaps and bounds, not only at...

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

RE: 104 Applicants Not Matched for Residency Positions
From: Jeffrey Kass, DPM

I was wondering if there was any update on the residency crisis other than CPME offering to allow existing programs the ability to increase their residents if they wanted. This "solution" is at best anemic as evidenced by the response the current programs have given. Is this the best and only response we as a profession can offer?

Fellowships are typically offered after residency programs. I propose we do things backwards as after all, this is how we seem to have gotten into this quandary. Offer these deserving students fellowships. I propose mandating the podiatry schools open one-year fellowships for...

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

RE: Outrageous Shoe of the Day

Were these heels bought on the Web?

Source: Submitted by Pearl Herman

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

PRECEPTOR WANTED - CHICAGO

Preceptorship at a State Licensed and accredited Surgical Center in Chicago. Over 2,500 cases annually in podiatry. orthopedics, general surgery, pain management and neurosurgery. Preceptor will be involved in assisting surgeons and scrubbing into cases. Rotations in anesthesiology and 2 months in internal medicine at local teaching hospital. Salary of $ 52,000, plus health benefits and vacation. Housing provided. Do NOT send transcripts or Board scores. Preference will be given to 2013 graduates of the College of Podiatric Medicine. in Chicago.  Send letter of request to: Advanced Ambulatory Surgical Center, Inc. 2333 North Harlem Ave. Chicago, IL 60707. Attn: Dr. Hrywnak.

EQUIPMENT FOR SALE - FOX YAG LASER

Mint condition, still under warranty. Unit is portable & includes all the accessories. $14,500.00. Call 727 586-3668 or 727-321-310.

EQUIPMENT FOR SALE - BIOMEDIX PADNET SYSTEM
 
PADnet is clinically valuable, provides fair financial return with medically appropriate testing and seamlessly integrates with the complete suite of BioMedix® products and services. One year old. In Excellent condition. Buyer pays for shipping. Please contact Rhonda Daggs at info@footanklecenters.com

EQUIPMENT FOR SALE - PADNET AND MIDMARK 417 PODIATRY CHAIR

Both in excellent condition. Asking $8,000 for PADNET and $3,000 for chair. Inquire (516) 922-0502 or bombbustr7@aol.com

PRACTICE FOR SALE - BROOKLYN, NY

28 year old practice in a desirable part of Brooklyn. EHR certified with stage 1 criteria successfully met. Practice has room to grow. Good mix of Medicare hazardous foot care; surgery and wounds. Low overhead. Priced to sell. Email Inquires to brooklynpracticeforsale@gmail.com.

PRACTICE FOR SALE - VIRGINIA

62 years consecutive private podiatry practice, excellent referral base, busy, modern equipment; X-Cel Xray machine, digital Tigerview scanner, Traknet EMR, and 3 new Midmark chairs for the doctor and patient. Virginia license is required. Please contact Dr. Fine at drmichaelfine@aol.comor 703-582-5999.

PRACTICE FOR SALE - SIOUX CITY, IA, TRI-STATE

Solo practice, established over 40 years. High volume, general care with surgical and orthopedic mix. Surgical privileges at 2 major hospitals. Deferred financing available. Contact: Medical Office, PO Box 4516, Sioux City, IA 51104.

 PODIATRIC MERGERS - CHICAGO AREA

Weil Foot Ankle & Orthopedic Institute is expanding their presence in the Chicago metropolitan area. We are interested in discussing merger with current  podiatric practitioners in Chicago and surrounding area. Practices that have a minimum of 5 to 25 years of activity are welcome to meet with us and visit our rapidly expanding practice that currently numbers 18 DPMs, a neurologist, a rheumatologist, 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.

ASSOCIATE POSITION – CENTRAL VIRGINIA
 
Two office practice, well established, modern offices. ED trauma call, good mix of medicine and surgery. Excellent compensation package. Please email letter of intent and CV to jdisabato@vfasa.com

TWO FOR TEXAS

Desiring to grow our group of successful medical and surgical professionals.  We are seeking an exceptional Podiatric Physician and Surgeon with great interest and talent to serve as 1) Our Diabetic Foot Care Team Leader or 2) Our Sports Medicine Team Leader.  Send CV, letter of interest, and current picture to:  greatdoctors1@gmail.com

ASSOCIATE POSITION - PUERTO RICO

Looking for a well motivated surgically trained podiatrist for a 20 years old hospital based multi office practice . Candidate must be personable, ambitious, and knowledge of SPANISH language a must. Hospital surgical privileges available with heavy load of High Risk Diabetic Foot patients. This position leads to PARTNERSHIP, and eventually ownership. Offices located near San Juan Metro area near Beaches, great schools, and major shopping malls. Please send CV to medicopodiatra@aol.com.

ASSOCIATE POSITION - MARYLAND, DC, PA

A podiatrist is needed for the Baltimore, Washington, Pennsylvania area. Partner for the corporation. Surgery center, emergency room call and a hospital location. All areas of podiatry. Established practice. Salary and commission. Fax resume 410-857-4227 or email at butler@qis.net

FT OR PT ASSOCIATE - SOUTH JERSEY

Great opportunity for FT or PT associate starting July 2013 in established practice in South Jersey. EMR, FDA-approved Lasers for fungus. Will work with Board Certified/Qualified podiatrist. Must have New Jersey License. Diverse practice in a nice area with a pleasant environment. e-mail CV at hhfootdoctor@gmail.com

ASSOCIATE POSITION - NORTH CENTRAL, NJ

Well established busy solo physician seeking a well trained podiatrist (PMS 36) to join our growing practice. Bilingual English Spanish a big +. Competitive salary/benefits package. Send CV to email: njpod2013-1@yahoo.com

ASSOCIATE POSITION - NEW JERSEY

Immediate opening for a full time podiatrist in a rapidly expanding multi-office practice in central New Jersey. Well established referral base with full admitting hospital privileges. Compensation is performance based with patients scheduled from day 1. Wonderful working conditions. Applicant must have at least PSR-24 surgical training. Valid NJ license and Medicare number is required. Applicant should also be familiar and competent in podiatric surgery, biomechanics, trauma, PRP, wound care, and ultrasound diagnostics. Participating insurance #'s a plus. Please fax resume to: (609) 259-6637

ASSOCIATE POSITION - SUBURBAN WASHINGTON

Busy 4 office practice in suburban Washington, DC seeing highly motivated individual for full time associate position leading to partnership. Minimum PSR 24. Competitive salary and benefits.  Respond to mlmltm@aol.com

ASSOCIATE POSITION- HUDSON VALLEY REGION, NY

Hudson Valley Foot Associates has a great opportunity available!  We’re a high-volume, diversified, multi-office group practice utilizing state-of-the-art modalities. Great growth for a personable and motivated DPM.  Please visit www.hvfa.com and forward cover letter with CV to info@hvfa.com.

ASSOCIATE POSITION - SOUTH CAROLINA

South Carolina's largest provider of foot care is a multi-doctor, multi-location practice currently seeking a highly skilled, personable, and hardworking physician to join our TEAM. South Carolina License is necessary. Above average salary and benefits. Please send Letter of Interest and CV to scdpmjobs@gmail.com.

ASSOCIATE POSITION - SOUTHERN CALIFORNIA COAST

Wanting full-time podiatrist (PSR-24 or greater) in 30+ year established practice situated in coastal community just south of Los Angeles.  Building out a new office near hospital. Compensation is performance based with practically an unlimited earning capability. A possible buy-in is negotiable. Looking for someone to take over practice in the future.  Excellent opportunity for young ambitious doctor.  Send resume to asbf@pacbell.net, titled, "Podiatrist".

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 - NORTH TEXAS

Associate position available. Located 50 miles from Dallas. All phases of Podiatric care with no ER call. PSR 24 required. Hospital privileges & strong referral base. Practice has EMR, digital X-ray & on site vascular testing. Very competitive salary and benefits. Please send CV to Footdoc3143@gmail.com

ASSOCIATE POSITION - HAMPTON ROADS VIRGINIA

Needs to be highly motivated, INDEPENDENT and surgically-trained to join a successful 40+ year practice surrounded with water sports, beaches and hiking. PSR24/36 ; well versed in forefoot and rearfoot surgery, diabetic wound care, sports medicine and diagnostic ultrasound. Please email CV & cover letter to feetloveus@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.

ASSOCIATE POSITION DETROIT SUBURBS

Multi-location practice seeks individual with excellent surgical training.  Practice is well established for over 30 years.  EMR’s available, ultrasound, Doppler & circulation testing, digital x-ray.  Buy in opportunity as owner plans on retiring in 2016 or sooner.  Please send cover letter with CV to footlaw@hotmail.com

ASSOCIATE POSITION – MARIETTA, GA
 
An associate is needed for a dynamic practice located in Marietta, GA, a suburb of Atlanta. We are looking for a well trained, motivated and personable candidate. This is a great practice opportunity. 2 years or more of a surgical residency is required and practice experience is a bonus. Our office has a licensed and certified surgical center. This is a modern practice with ultrasound, digital x-ray and EMR. We offer a competitive salary and benefits along with potential for partnership. Please e-mail your cover letter, curriculum vitae, letter of references and picture to light@eastcobbfoot.com.

PODIATRIST NEEDED - VAN NUYS, CA
 
Looking for reliable, honest and motivated podiatrist to assist with house calls to patients home residence and various health facilities.  Candidate must be willing to drive throughout the San Fernando Valley and the greater Los Angeles areas. Flexible schedule. If interested, please email resume to homefootcare@hotmail.com

ASSOCIATE POSITIONS – MARYLAND (FULL-TIME/PART-TIME)

Are you motivated, personable and enjoy working with the elderly? We are offering part-time positions in Maryland. Our group, Podiatry Management Services, provides care in Nursing Homes, Assisted Living, Senior Homes, Adult Daycare and other similar facilities. Please e-mail your CV to: drhprosen@verizon.net or fax to 410-486-2049 or call Dr. Herbert Rosen at 410-580-0255.

SEEKING FULL OR PART-TIME PODIATRIST - NEW JERSEY

An outstanding practice opportunity! We are searching for a dedicated and caring full time or part-time podiatrist to join our growing endocrinology practice that is devoted to quality patient care and conveniently located in Englewood, NJ. The office is less than ten miles from Manhattan. Competitive salary and benefits package offered. For further details, please call Victoria at (917)655-9009 or email resume to cvsschwartz@aol.com

ASSOCIATE POSITION - UPSTATE NY

Busy multi-specialty practice of PCPs, general surgeons, OB-GYN, podiatric surgeons looking for a full-time podiatric associate in  Upstate NY, Binghamton, Finger Lake Region. Great Benefits, opportunity for partnership. Must be highly motivated, personable and be Board qualified/eligible. Our podiatrists have over 100 years combined experience. Please send CV to associateinfoot@yahoo.com or fax 607-723-1567.

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."

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.

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