The Voice of Podiatrists

Serving Over 14,000 Podiatrists Daily

April 27, 2013 #4,753 Publisher-Barry Block, DPM, JD

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CA Podiatrist Discusses Bunions

“Do you have a bony bump on your big toe? If so, it just might be a bunion!” said California Podiatric Medical Association Director Rebecca Moellmer, DPM. Dr. Moellmer is a podiatric physician and surgeon on faculty with the College of Podiatric Medicine at Western University of Health Sciences in Pomona, California.

Dr. Rebecca Moellmer

“Many people with bunions suffer from discomfort and pain as a result of the constant irritation caused by the friction and rubbing of the enlargement against footwear,” said Dr. Moellmer. Treatment options vary depending on the severity of the bunion and the amount of pain it causes.

Source: Bio-Medicine [4/24/13]

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
Is your office handicapped accessible?
Click HERE for Results

South African Podiatrist Not Gaga About Lady Gaga's Shoes

Lady Gaga’s “little monster” fans are not the only ones going gaga over the eccentric singer. Shoe addicts have also taken a liking to Gaga’s latest-over-the-top-fashion-choice, the heel-less shoes. Janine Smith, a Hillcrest-based podiatrist, said the extra pressure on the ball of the foot could cause unbearable pain, bunions, or a broken ankle. “Because there is no even distribution of pressure, the muscles and points have to work extra hard to balance your body,” she said.

Janine Smith / Lady Gaga's Heel-less shoes (Photo AP)

This “unnatural” way of wearing the shoe could cause shortening of the Achilles tendon, said Smith. “People who wear such shoes might, in the long run, find it difficult to wear a flat shoe and might even injury themselves while wearing it,” she said.

Source: Nondumiso Mbuyazi, IOL [4/25/13]

WI Podiatrist & Wife Launch Healthy Vending Machine Business

Dr. Jeff Osbourne and his wife Sandy, parents to three teenagers, have partnered with HUMAN Healthy Vending - the nation's leading franchisor of healthy vending businesses - to ensure that the greater Milwaukee community has convenient access to healthful foods and beverages.

Dr. Jeffrey Osbourne

Jeff Osbourne is a physician, specializing in podiatry, and has been servicing the Milwaukee area for the past 20 years. "I am a physician and have seen a dramatic increase in diabetes, obesity, and hypertension in my patients. I believe that poor eating habits play a big role in these preventable conditions," said Jeff. "I want to be a part of the solution and provide greater access to healthful, affordable and convenient foods."

Source: Individual.com [4/25/13]

Podiatrists Rank 23rd Best Career in New Survey

It's official, podiatry is the 23rd best job in the world. That's according to a new survey by the website CareerCast.com, who have analyzed and ranked 200 careers. The jobs were ordered according to five criteria: physical demands, income, stress, work environment. and hiring outlook.

Actuaries came in first, followed by biomedical and software engineers. Although podiatrists came behind optometrists (8) and chiropractors (11), they beat out dentists (42) and surgeons (51) on the list.

Source: John Hall, Mydailynews.com [4/25/13]

Query: ADA and Obesity

I had a new patient today who is 450 lbs and wheelchair-bound. Even though my office is ADA-accessible, her wheelchair (extra wide) was just barely able to be pushed through the doorways. Beyond this, it hung up on the threshold between the reception room and the hallway and one of my assistants has pulled a muscle trying to get her over the threshold.

Obesity is not covered under the ADA to my knowledge, but she is disabled (osteo-arthritis of the knees). Do I have any valid options to send this patient elsewhere? I can only make so many accommodations for disabilities without tearing our walls and doorways. Suggestions?
 
David E. Gurvis, DPM, Avon IN

Query: Documenting Use of Scribe

We have started using scribes in our office to document our patient encounters. I recently was instructed that we need to document the name of the scribe on the medical record. Is this correct?

Daniel Albertson, APRN, Office of Paul Krestik, DPM, London, KY

Response: The scribe should be the person logged into the EHR. When completed, the note should reflect that the doctor used a scribe to input the information into the medical record. The note should be reviewed and signed by the doctor. Both the doctor's and the scribe's name will show at the conclusion of the note.

David J. Freedman, DPM, CPC, Silver Spring, MD

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RE: ToeMobile Great Toe System (Gordon Phillips, DPM)
From: Charles Morelli, DPM

As to a patient who takes immunosuppressants for a kidney transplant, the answer to your question as to how to handle them is to speak with the doctor who prescribed them, and let him/her tell you how to handle them. That being said, there is "usually" nothing you need to do. If the patient sustains a post-operative infection, then the meds may be adjusted to compensate for any oral or IV antibiotics that may be needed.

Pre-op and post-op x-rays

This past week, there have been one or two other posts regarding the first MPJ, and how to address the deformity present. For the hallux varus patient, I don't believe...

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

RE: Non-Specific Bone Marrow Edema Syndrome
From: Pat Caputo, DPM

The radiologist might be spot on. "Non-specific bone marrow edema" is also called transient or migratory regional osteoporosis. Certainly, her age group is not discussed in the literature, so a pediatric rheumatology or better yet endocrine consult is very highly suggested, especially in the absence of trauma. In the meantime, I would treat it like a Sudeck's atrophy or early AVN; and tell her it may take months, which is why the radiologist said to follow up with an MRI in 3 months. When the patchy MR presentation resolves, so do the symptoms. She is at risk for fracture in the short term, in addition to pain.
 
I had "bone marrow edema" in my early 40s in one hip and then the other, and 10 years later in one shoulder and then the other. I did a fair amount of research which included anecdotal discussions with some prominent endocrinologists from Johns Hopkins and UPENN as well as a prominent musculo-skeletal radiologist from Jefferson Med in Philadelphia. I was treated in the shoulders with IV Aredia. I'm not sure if it helped, as it still took months to run its course. It is more common in middle age men and pregnant women, so again I would definitely do a diagnostic work-up on the teenage girl.
 
Pat Caputo, DPM, Holmdel, NJ, capstops@aol.com

RE: Non-Specific Bone Marrow Edema Syndrome
From: Patrick J. Nunan, DPM, Michael M. Rosenblatt, DPM

I had a similar case in a 15 year old softball player. The MRI was read initially by radiologist at a children's hospital and then again by an independent MRI radiologist, both who called it multiple stress fractures. She was initially seen by a Med/Peds specialist who ruled out most metabolic diseases. Her Vitamin D levels were extremely low, especially for her age. She was placed on a Vitamin D regimen by her PCP. Orthotics were made to reduce biomechanical stresses. She was immobilized in a CAM walker as well. Follow-up MRI showed improvement. She was able to return to normal activities without pain, but did not return to competitive softball.
 
Patrick J. Nunan, DPM, Huntington, WV, pjndpmrun@aol.com

In any young person who has bone marrow changes, it is important to consider Gaucher's disease, which occurs often in Ashkenazy Jews, but can also occur in other populations. You might more likely see avascular necrosis of the femoral heads as well as hepatospenomegaly. A low platelet count would also be expected.
 
A hematologist would do a bone marrow biopsy to look for Gaucher's cells. This is not a typical presentation of the disease, but a bone marrow biopsy is the next step.
 
Michael M. Rosenblatt, DPM, San Jose, CA, Rosey1@prodigy.net

RE: Post-Op Hallux Varus  (Kel Sherkin, DPM)
From: Don Peacock, DPM

This case is a perfect example of when minimally invasive procedures can be implemented with very little risk to the patient, and at the  same time, achieve superb results. It would not make sense to fuse her first metatarsal phalangeal joint if it is non-painful. Fusion of the first metatarsal phalangeal joint should only be considered in long-standing varus deformity with associated structural changes in the first metatarsal phalangeal joint, and only in cases where correction is not achievable in any other way. 

Her condition could easily be corrected both cosmetically and functionally by performing a minimally invasive reverse Akin osteotomy. This procedure can be performed in the office under local anesthetic. The procedure would not require fixation. Another advantage you would have performing minimally invasive correction would be that the soft tissue structures would realign themselves in response to the wedge osteotomy that you created, and the flexor tendons will pull in more normal position. This could all be achieved without going back into the joint and causing further scarring. Also, you can take advantage of the concept of bone plasticity which would give you three weeks to splint the toe in the desired position.
 
Don Peacock, DPM, Whiteville, NC, peacockdpm@gmail.com

RE: Patients' Requests for X-Rays (Joseph Borreggine, DPM)
From: Michael Brody, DPM

You should NEVER email patient information. It is a HIPAA violation.

Personally Identifiable Information (PII) must be protected by your practice. Personally Identifiable Information is any information that can be used to distinguish or trace an individual's identity. This includes:

Full Name
Maiden Name...

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

RE: Billing for Missed Appointments (Olga Luepschen, DPM)
From: Bill Deutsch, DPM

Dr. Luepschen wants to know if she can bill for missed appointments.  My suggestion is not to embark on this course. I don't know if it's legal or not, but I think it's not the way to go. My suggestion is to have staff call patients a day or two before the appointment to reconfirm. If you have patients who make a habit of not showing up, I suggest calling that day to reconfirm. There are all sorts of reasons a patient may not show: inclement weather, feeling ill, work demands, family problems, being given a follow-up appointment when the patient may feel no need for one, etc. It's part of having a controlled practice and establishing a rapport with patients. And then, of course, there are some patients you could easily do without.

Bill Deutsch, DPM, Valley Stream, NY, woollfy1@yahoo.com

RE: Purchasing a Digital X-Ray System (Laura R Lefkowitz, DPM)
From: Michael L. Brody, DPM

Your X-Cel x-ray machine is the source of the x-rays. When you take an x-ray of a patient, the rays go from the X-Cel to a "plate". When discussing digital x-rays, it is the plate and the method of developing the plate that is digital. You can use your existing X-Cel with any digital x-ray system. You will be replacing the plates, films, and processor with a digital system.

There are two types of systems available: CR and DR. Each system will claim it is better than...

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

RE: Replacement for Fabco? (Paul Taylor, DPM)
From: Michael Felicetta, DPM
 
We have been using MEDI-RIP by a company called Hartman from Moore Medical. It is a one-inch material similar to Coban.

Michael Felicetta, DPM, Toms River, NJ, DrMFoot@aol.com

RE: Podiatry's Secret Problem (Michael J. Schneider, DPM)
From: Robert Kornfeld, DPM

Dr. Schneider's assessment of inappropriate billing may be correct in his experience; however, here in NY, when I was in the Medicare program, I had very few non-covered routine care patients simply because it was too easy for them to find podiatrists who billed for a covered service instead. I have had some of my "snow bird" patients come back from Fla. to show me EOBs from DPMs who assured them that Medicare pays and collected (not billed) hundreds of dollars for a visit in which nail and callus debridement was performed. I believe this is a pervasive problem and is going on in more offices than we would like to admit.

Robert Kornfeld, DPM, Manhasset, NY, Holfoot153@aol.com

RE: 104 Applicants Not Matched for Residency Positions
From: Andrew Cassidy DPM, MS

Once again, the leaders of our schools and the CPME have missed the boat. I was one of those unmatched residents 13 years ago. I ended up with an unmatched residency that was new and not up-to-par compared to other residencies. I ended up  opting out of that residency's second year and then had to try the match system the next year.

As a person going through the match a second time, I can tell you that there is a stigma attached to it, whether they deserve...

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

PODIATRIST SEEKING EMPLOYMENT - CHICAGOLAND AREA 
 
Personable, well trained ABPS Board Certified podiatrist with 10 years experience seeking associate position or buy-in opportunity in the Chicagoland area. Please email inquires to ewcv5@hotmail.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

ASSOCIATE POSITION – MISSOURI

Podiatric medical group seeks PSR24-36 individual who is interested in working with former residency director who can enhance your already strong training. Full scope practice with the cases to fast track to board certification. Four hospital affiliations, certified surgical suite in office, ultrasound, EHR Certified Stage 2. We are located close to St. Louis for day use. Exceptional school system in a low crime, low cost of living area. E-mail resume to: drfootski@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 - 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 – 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

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 - 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 - 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.

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.

 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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