The Voice of Podiatrists

Serving Over 14,000 Podiatrists Daily

April 26, 2013 #4,752 Publisher-Barry Block, DPM, JD

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NY Podiatrist Discusses Orthotics

When medical office manager Kim Becktold developed an inflamed foot after hip-replacement surgery, she didn't need to look far for help. Her boss, North Shore University Hospital's chief of podiatry, Dr. Michael Pliskin, came to the rescue. He molded custom orthotics for her feet so one leg wouldn't put too much pressure on the outside of her right foot and cause a painful condition known as plantar fasciitis. Thanks to the orthotics and new sneakers that fit just right, Becktold said her feet are fine. "I feel so much better," she said.

Dr. Michael Pliskin

Custom-made orthotics aren't cheap, however, and insurance companies often don't cover them, he said. Pliskin said the price can be as high as $500 for each foot. Though custom-made orthotics are available online, Pliskin doesn't recommend them. "Online foot orthotic devices do not incorporate a doctor's evaluation and treatment," he said. "If a patient orders a device online, they may not get the proper materials or correct device for their condition. The device may not fit, and the patient may not benefit from the device."

Source: Randy Dotinga, Newsday [4/23/13]

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.

Quick Poll
Is your office handicapped accessible?
Click HERE for Results

MI Podiatrist Appointed to State Podiatry Board

Governor Rick Snyder has appointed Dr. Vicki Anton-Athens of Grosse Ile to the Michigan Board of Podiatric Medicine and Surgery. Cyrus Farrehi of Grand Blanc also was named to the nine-member board, which assists the Michigan Department of Licensing and Regulatory Affairs with overseeing the practice of more than 840 Michigan podiatrists.

Dr. Vicki Anton-Athens

“Vicki and Cyrus are great choices for this board,” Gov. Snyder said in a press release. “I appreciate their willingness to serve and I am confident they will do good work on behalf of the Great Lakes State in these roles.” Athens is president of the Brownstown-based Athens Podiatry Group, and brings more than 30 years of experience in the practice of podiatric medicine and surgery.

Source: Lena Khzouz, Saline Reporter [4/24/13]

SteriShoe Makers Launch Blog

Shoe Care Innovations (“SCI)”, makers of the SteriShoe® ultraviolet shoe sanitizer, have launched a blog with helpful, practical information to answer patients’ pressing questions about foot health and hygiene. Each week, it features articles on diabetes, toenail fungus, foot odor, athlete's foot, and all the latest treatments. The SteriShoe® Blog is designed to inform and inspire the general public in adopting the "best practices" for foot care and to encourage them to be compliant about podiatrists' foot care recommendations. 

Adam Ullman

Adam Ullman, President of SCI states, “We have designed this blog to be informative and easy to read; a source of information about foot health and hygiene and as a place to debunk common myths and misconceptions about foot care.” The blog can be found at blog.sterishoe.com. SCI allows podiatrists to directly link the blog to their websites.

Query: ToeMobile Great Toe System

A 60 year old active female presented with complaint of a painful right big toe. The patient stated that she has had this problem for 2-3 years and it's getting worse. She related that at this point, different types of shoes don't help and the pain is "slowing her down." She also related that bending the toe up and down is painful. The patient related that she's taking Ibuprofen 800mg everyday for comfort. PMH: HTN, Graves disease (she's taking an immunosuppressant). Her neurovascular status is intact. Bony medial eminence noted 1st MTPJ right; painful ROM 1st MTPJ noted.

Painful Hallux

My plan is to use the ToeMobile Great Toe System since the patient didn't want her toe fused. Does anyone have experience with this system? How would you handle the immunosuppressant drug she's taking?

Gordon Phillips, DPM, NY, NY

Query: Patients' Requests for X-Rays

With the advent of digital x-rays, many hospitals and medical practices do not or no longer have the ability to copy x-rays. So, when a patient, a lawyer's office, or insurance company requests copies of x-rays, what are most doing when there is no way to get copies? As a remedy, I have actually taken a digital pictures of the x-rays on a view box and emailed them, but there are always concerns about electronic security and violating HIPAA when I do that. Any other suggestions would be helpful.

Joseph Borreggine, DPM, Charleston, IL

Query: Purchasing a Digital X-Ray System

I currently have a 10 year old X-Cel machine. Any suggestions for buying a digital x-ray system? What are some of the costs and benefits I could see with the change? I am a solo practitioner, so I have nobody to share the cost with me.

Laura R Lefkowitz, DPM, Beverly Hills, CA

RE: Non-Specific Bone Marrow Edema Syndrome
From: Barry Mullen, DPM, Todd Lamster, DPM

CRPS is most definitely in the differential diagnosis. Carefully recheck the trauma history, level of pain, and begin looking for early tropic/vasomotor cutaneous changes. Refer this patient to a physiatrist or neurologist for confirmation and appropriate PT.

Barry Mullen, DPM, Hackettstown, NJ, Yazy630@aol.com

With a report of "possible leukemia" a referral to her PCP or oncologist/hematologist is in order. Also, was a CBC or CMP completed? Furthermore, if you were to remain on this case following referral, my next step would be performing a bone biopsy. I would do this in the OR setting, using a Jamshidi needle, under fluoroscopic guidance. Consider taking bone from both the talus and calcaneus to assist you in making the definitive diagnosis.

Todd Lamster, DPM, Phoenix, AZ, tlamster@gmail.com

RE: Post-Op Hallux Varus (Kel Sherkin, DPM)
From: Ed Cohen, DPM

Some of the most important factors to consider are: the patient's chief complaint was a shoe  problem, the 1st MPJ is pain-free, the 1st metatarsal head is fine, and the cause of the problem was an over-corrected IMA. I consider this to be a mild hallux varus compared to the usual hallux varus that presents to my office. My procedure of choice would be a reverse Akin osteotomy (lateral wedge osteotomy of the hallux base) which would also reverse some of the soft tissue deformities. This would make the big toe straight and allow the patient to wear a nice shoe and add quality to her life.

I have used this procedure many times and...

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

RE: Replacement for Fabco (Paul Taylor, DPM)
From: Brian Kiel, DPM

To replace Fabco, order Co-Wrap self-adherent bandages. We order the one inch rolls. It is supplied by Hartmann-Conco. It is actually better than Fabco because it is more flexible and easier to use. We order it from North Coast Medical 800/821-9319.

Brian Kiel, DPM, Memphis, TN, Footdok4@gmail.com

RE: Mobile Credit Card Processing (Philbert Kuo, DPM)
From: Kelly Malinoski, DPM

I have used the Square card reader and Squareup.com app on my iPad for patient payments since I opened in January of 2012. I have had absolutely ZERO problems with this form of payment. Patients are impressed with the "new technology" and ease of receiving their receipt via email, via text message, or we can print it out for them. I love it, the staff loves it, and the patients love it.

Kelly Malinoski, DPM, Naples, FL, kellymalinoski@me.com

RE: Podiatry's Secret Problem (Steven Moskowitz, DPM)
From: Karen Malley Banks, DPM

I am a “call it like ya see it” podiatrist. Every time the subject comes up about billing for nail care, I feel the need to offer a bit of caution. No matter how “clean” you feel about NOT billing Medicare for nail care, you can’t make general statements about coverage without examining the patient.

I personally know a podiatrist who got busted for UNDER-utilization. He went into a nursing home and told them...
 
Editor's note: Dr. Banks' extended-length letter can be read here.

RE: Legit or Kickback? (Adnan Shariff, DPM)
From: Michael Forman, DPM

Dr. Shariff is treading on thin  ice with this deal. A kickback occurs when you are paying or receiving value for referring patients. The company that is offering neurological testing ON YOUR PATIENTS is paying you for the referral. If they use a whole day in your office, what would be a "fair market value?" I don't know what your office lease is, or how much space they are going to use, but it seems to me that $150 for a one-day lease might not be a fair market value.

What will you do to earn the $150 per hour they offer. You are not doing the testing nor are you interpreting the results of the test. It appears that they are paying you $150 per hour for you to refer a patient to them. It is my feeling that this smacks of a clear violation of the Anti-kickback legislation.

By the way, I seem to remember a colleague of ours who ran afoul of the government for just such a scheme. I believe he lost his license and did jail time. If you wish to proceed, you must contact a healthcare attorney.

Michael Forman, DPM, Cleveland, OH, im4man@aol.com

RE: AMA Initiative to Target Diabetes, Heart Disease (Robert Creighton, DPM)
From: Lawrence M. Rubin, DPM,

I agree with Dr. Creighton's suggestion that the APMA be involved in multidisciplinary efforts to help control the epidemic of diabetes and pre-diabetes. But we don't have to wait for the APMA. Every podiatrist can act almost immediately to effectively help fight  the "War Against Diabetes" in his or her own community. There are clubs and organizations everywhere that are looking for speakers at their meetings. So, call your local Chamber of Commerce which can probably send you a list of organizations and other groups (such as companies that have corporate wellness programs) looking for speakers.

Make contact with these groups  and offer to give a talk about the importance of having a personal exercise program which, along with other benefits, will help prevent type 2 diabetes. In your talk, you can explain the importance of taking care of painful foot problems in order to be able to walk and exercise comfortably. Develop an interesting and informative talk, and before you know it, groups and organizations will be calling you and inviting you to speak. And, by the way, in the course of doing good for your community, you will have fantastic publicity and will start seeing new patients wanting you to help them get rid of their painful foot problems so they can become more active. Win/Win for everyone. Give it a try.

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

RE: 104 Applicants Not Matched for Residency Positions (Brian Kiel, DPM)
From: Jeff Kittay, DPM

I am sitting in my office, once again open-mouthed at what I am reading in PM News. Did I really just read posts from established doctors that state outright that some/most of the unmatched 104 are unqualified to be doctors and should consider another line of work?  To my knowledge, every one of these 104 graduated from an accredited school and passed all sections of the National Boards, thus establishing themselves as qualified doctors.  

In any group, there will be students at the top of their class, and those who, for a variety of reasons, do not perform as well academically. Regardless, they are all called "doctor". To place the blame for the unmatched students on their quality, or lack thereof, is patently unfair and does them a genuine disservice. "Realizing that perhaps medicine was not for you" is elitist in the extreme and atypical of Dr. Kiel's usually accurate comments.

No one is condemning the entire profession, only those in positions of authority for years who knew that this problem was coming and did little to prepare for it. While they may be suffering some embarrassing slings and arrows at the moment, the 104 are stuck with a degree and title they cannot use and insurmountable debt they cannot pay.
 
Jeff Kittay, DPM, Boston, MA, twindragons2@verizon.net

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.

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

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.

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 - MASSACHUSSETS

Busy multi-office podiatry practice looking to expand. Need extremely energetic dedicated individual. Must be PSR 12-24 trained, EMR, laser, vascular testing the works. Must have sense of humor. MA License, NH License A+! Surgery, sports medicine, pediatrics, shoe store. Please send resumes to resumesent11@comcast.net.

ASSOCIATE POSITION - CENTRAL VALLEY/SOUTHERN CA
 
Seeking associate with partnership availability. Must be highly motivated and have good patient skills and personality. Salary excellent with all paid benefits/incentives including malpractice/401k and profit sharing. Compassionate and well-trained for immediate position. Surgery Center and hospital-based with no HMOs/no rest homes. Bilingual in English and Spanish preferred. Offering a permanent position/partnership in a multi-million dollar hi-tech practice with Partnership also in Surgery center. Please e-mail CV and short bio to: Tonya@wetreatyourfeet.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 - 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 – NORTHERN CALIFORNIA/SF BAY AREA
 
We’re expanding, seeking podiatrist to join multi-office practice. Must have great people skills, bedside manner, and positive demeanor. California license required. No nursing home visits. Prefer private practice experience. Send CV and cover letter to: ebpod2008@gmail.com

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 - 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 - 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 – 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.

ASSOCIATE/PARTNERSHIP  MIAMI/KENDALL FLORIDA

Podiatrist with interest in foot and ankle surgery and comprehensive foot and ankle care. Pathway to partnership/ownership available. Send CV and information: ibaumdpm@bellsouth.net

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 - 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.

POSITION AVAILABLE - CENTRAL FLORIDA

Two doctor practice looking for an associate to take retiring doctor's position with partnership opportunity for the right person.  Competitive salary, health insurance and incentives. Two offices serving a diverse number of routine, surgical and wound care patients. Two years surgical residency training and FL license required. If interested in this great opportunity please e-mail CV, surgical log and references to toesrus7@yahoo.com.

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

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 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."

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.

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