The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

May 10, 2012 #4,458 Publisher-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2012- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

Nail Polish Can Mask Medical Issues: DC Podiatrist

“People like to have pedicures done straight through the summer or even all year long, but the problem with that is nails don’t get an opportunity to breathe,” says Washington podiatrist Dr. Howard Osterman, who notes that chemicals in nail polish can eat away at the top layer of toenails, resulting in changes in color or texture that may or may not be a sign of a true medical issue. “Fungus grows in dark, moist environments, so anything that doesn’t let air dry it out [such as nail polish] can allow fungus to fulminate underneath,” he explains, noting that clear nail polish isn’t any better than colored, since it’s the enamel itself that’s the problem. 

Dr. Howard Osterman

Osterman points out that pretty hues can also mask infections, skin cancer and other medical problems, and he suggests at the very least changing your polish frequently, so you can keep a close eye on the state of your nails.

Source: Carolyn Butler, The Washington Post [5/7/12]

Scholl Dominates the International Post-Graduate Research Symposium

The Dr. William M. Scholl College of Podiatric Medicine had a very strong showing at the 15th Annual International Post-Graduate Research Symposium held on April 21, taking the top three prizes. Of the 20 oral abstracts presented, eight were affiliated with Scholl College, either through CLEAR, the Scholl residency program, or through academic appointment. The following podiatrists won awards: 

(L-R) Drs. Jeanna Fascione and Erin Klein

Second Place: Jeanna Fascione, DPM (PGY2), Resident, Scholl/Advocate Illinois Masonic Medical Center Podiatric Surgical Residency Program Presentation: Baseline Clinical Exam Findings Help to Predict Treatment Success in Patients Receiving Mechanical Support for Plantar Fasciitis
 
Third Place: Erin Klein, DPM (PGY4), Instructor, Department of Podiatric Surgery and Applied Biomechanics at Scholl College and Fellow in Reconstructive Foot and Ankle Surgery at the Weil Foot & Ankle Institute Presentation: Radiographic and Clinical Exam Predictors of Plantar Plate Tears

APMA President Attends National Hispanic Medical Association Event

APMA President Joseph M. Caporusso, DPM, was in attendance at the National Hispanic Medical Association’s (NHMA) 16th Annual Conference last week. NHMA represents the interests of licensed Hispanic physicians in the United States and is playing an important role in addressing healthcare disparities that affect the care of Hispanic patients. Dr. Caporusso is a passionate advocate of equitable healthcare and has engaged APMA in the American Medical Association’s Commission to End Health Care Disparities. 

(L-R) Drs. Joseph Caporusso and Jaime Torres

At the NHMA meeting, Dr. Caporusso met with Jaime Torres, DPM, an APMA member, member of the NHMA board of advisors, and the NHMA Fellow of the Year. Dr. Torres is director of the US Department of Health and Human Services Region 2.  

Source: APMA Weekly Focus [5/8/12]

Deadline for Avoiding 2013 E-Prescribing Penalty Is June 30

Physicians who enjoy an adrenaline spike from doing something at the last minute will jump at this challenge: electronically transmit 10 prescriptions to the pharmacy by June 30 to avoid a Medicare penalty in 2013. The federal government is serious about digitizing healthcare, and in addition to rewarding physicians who e-prescribe for their Medicare patients, it is penalizing those who are still writing on prescription pads or even computer-faxing scripts (a true electronic prescription goes from the clinician's computer to the pharmacy's).

This year, the Centers for Medicare and Medicaid Services (CMS) began to reduce Medicare reimbursement by 1% for physicians and other prescribers who failed to e-prescribe at least 10 times during the first half of 2011. This downward "adjustment," as Medicare calls it, will grow to 1.5% in 2013 and 2% for 2014. Comprehensive information on the government's e-prescribing incentive program (bonuses, penalties, reporting methods, exclusions, and hardship exemptions) is available on the CMS Website.

Source: Robert Lowes, Medscape News [5/7/12]

Doctors Pressured to Write Prescriptions for OTC Drugs

Requests for prescriptions to purchase over-the-counter medicines using flexible spending accounts or health savings accounts have become an unnecessary burden for doctors and patients, according to congressional testimony from physician organizations, patient advocates and representatives of OTC drug companies.
 
Lawmakers are considering the repeal of a health system reform law provision that requires prescriptions for medicines and drugs, even those that have been approved by the Food and Drug Administration to be sold without a physician’s order, before patients can cover the costs with funds from tax-preferred health accounts, including health reimbursement arrangements. The provision took effect in 2011, and physicians report that they now are being saddled with the task of writing otherwise unnecessary prescriptions for medications to fight the common cold, flu or allergies.

Source: Charles Fiegl, AM News [5/7/12]

Query: Chronic Sharp and Occasional Burning Pain

I have a patient with constant sharp and sometimes burning pain in her feet that has been ongoing for the past few years. The pain is diffuse throughout the entire dorsal and plantar aspect of the mid- to rearfoot, and distally. There is no history of trauma. She has been to several doctors with no remedy. We had placed her on Neurontin, Cymbalta, Lyrica, and Savella with no relief. Cortisone injections were also performed with minimal relief. She has no history of back problems and has a negative MRI. Any suggestions for treatment?

Randy Lisch, DPM, Austin, TX

RE: Non-Union and Malunion of Metatarsals (Philip Graham, DPM)
From: Steven King, DPM

Consider a conservative option of utilizing the most rigid advanced composite (carbon fiber) dynamic ankle foot orthotic, with a  deeply cushioned top cover of at least 3 mm of cloth covered Neoprene over 3mm of Poron to soften contact with the hardened composites.  You will find that the rigid spring plate will help transfer the shearing force from this difficult osteotomy and painful 2nd metatarsal to the end of the composite plate and leg bracing. Be selective with the shoes. You will need at least an extra size and a half, and you may need to open up the vamp. The best option for the patient always is to get off the foot, but often doctors hope to give patients medicine they can wear/swallow and comply with.
 
Steven King, DPM, Maui, HI, kingetics@gmail.com

RE: Marfan's Syndrome and Bunions (Tip Sullivan, DPM)
From: Howard J. Lepolstat, DPM

Going back to basic physics and without overdoing the analysis, this appears to be a class-1 lever system --- fulcrum (1st MPJ) in the middle with the force and resistance at either end. There is tremendous joint laxity that maximizes the effects of the pathological forces on that joint, thereby increasing the tendency and reality of the deformity. As in any mechanical system, the forces are going to accumulate at the weakest link in the chain, which is probably the MPJ and secondarily the MCJ. Changing the orientation of the bones (via surgery) will not change that.
 
That being said, it seems the first step is to stabilize the forces as much as possible, which is the function of orthotic devices. From my perspective, the degree to which those forces can be stabilized is the degree to which long-term surgical success can be hoped for. The choice of surgical procedure is a function of the osseous deformities. I may be wrong, but I don't think it is a function of ligamentous laxity, and I don't think a recurrence can be forestalled by surgically correcting the unstabilized foot.
 
Getting this patient stabilized for a significant period of time in the most rigid orthosis he can tolerate can only increase the chance of surgical success. Certainly there can be no downside.

Howard J. Lepolstat, DPM, (Retired), Sun City West, AZ,TeachrComp@aol.com

RE: Podiatrists Portrayed on TV
From: Chuck Ross, DPM

I am not quite certain who else may have been watching, but last night's episode of Bones featured a forensic podiatrist recreating foot steps at a murder site. It might be interesting to note that this is not the only podiatric reference I have seen over the past few weeks on a variety of other shows as well. Has APMA gone "Hollywood"?

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

RE: Is it Time to Bring Back Chiropody?
From: H. David Gottlieb, DPM

An ongoing thread on sterilization shows the split personality of podiatry. The skill with which we have historically eased the pains of humanity's feet is the foundation upon which all our advances have come. Many practitioners still provide valuable services to those who are otherwise unwilling or unable to have surgery using time-tested methods often passed down one to one. These skillful hands can ease discomfort and restore the ability to walk without cutting skin, just by using felt.

Residency training now is surgically geared with a secondary emphasis on biomechanics, but none to little on the old 'c and c' ['corns and calluses' or 'chipping and clipping']. I am actually fine with this. Personally, I found the old practice style to be...

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

RE: Sterilizing Bits Between Debridements (Jeff Kittay, DPM)
From: Jeffrey Conforti, DPM

There are three options for this issue.  
1) Have enough bits on hand for the day's patients and sterilize them at the end of the day.
2) Sterilize bits between patients with a bead sterilizer.
3) Use individual sanding disks that are disposable.

In our office, we use a new sanding disk for each patient. The patient sees a new disk put on, and when we are done, sees us throw it in the trash. They are very efficient to use and come in different grades: X-coarse, coarse, medium, and fine; they work well on callus and nails.

Jeffrey Conforti, DPM, Paramus, NJ, jconfortiusa@yahoo.com

RE: Clinical Summaries: Place of Service (Michael Brody, DPM)
From: Alan Bass, DPM
 
To expand on what Dr. Brody posted, you are required to provide a clinical summary or continuity of care document (CCD) within 3 business days for greater than 51% of patients who receive an E&M service. In regards to meaningful use criteria as a whole, you only need to collect the data on a majority of your patients. If you treat a small percentage of your patients outside of your main practice location(s), those patients may be excluded from capturing meaningful use criteria.
 
Alan Bass, DPM,  Manalapan, NJ, abassdpm@optonline.net

ASSOCIATE POSITION - FLORIDA

Great opportunity for new practitioner or experienced physician looking to relocate to Florida. Practice currently owned by physicians with a solid patient base after over 12 yrs of practice in this area. Current physicians transitioning to part-time (and eventual retirement from the practice) in order to pursue other business opportunities. Seeking a friendly, dependable, independent ‘go-getter’ who can transition in as seamlessly as possible with staff and patients while maintaining the high-quality foot/ankle care on which our reputation was founded.  Start turn-key without need of a bank loan. For more information or to express your interest, please forward your CV to: podiatristsearch@gmail.com

ASSOCIATE POSITION - MIAMI AREA, FLORIDA

Multi-office podiatry group looking for a dynamic and motivated associate to join our practice. Immediate schedule available. Filling in to cover busy schedule and need an energetic associate to expand to your own new office. Competitive salary with bonus incentives.  Two or three year surgical residency preferable. Any candidate that applies should be ABPS qualified or certified. Located close to Miami, FL. Send CV to QVAN@aol.com.

ASSOCIATE POSITION - NEW YORK

Full-time position available immediately in Capital District multiple doctor practice. Good salary with percentage. All phases of podiatry. NYS license required. Email resume to: Lchittenden68@gmail.com or call Lori at 518-577-6171

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 to his own. Go to:www.YourFutureInPodiatry.com for full details.

ASSOCIATE POSITION- PALM BEACH CO, FL

Young, enthusiastic three location dynamic practice seeks motivated, personable associate for full or part time position. Competitive salary, benefits and incentive structure. Please send CV tosflfootandankle@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 to:mybestnewjob@gmail.com

ASSOCIATE POSITION - SOUTHERN CALIFORNIA

Very busy, two location group practice seeking a full-time, self motivated and hard working podiatry associate. Competitive salary and benefits are offered. Please email CV to: footcare4all@aol.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 24-36 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 - CALIFORNIA

Office and hospital-based podiatry group in Bakersfield, CA seeks highly-trained surgical associate to join us. Prefer surgeon with trauma and Charcot reconstructive experience. Staff privileges with 5 local hospitals. Offering health insurance, CME allowance and competitive salary. Must be PSR 24/36 trained, ethical and thoughtful when treating patients. Please forward CV to: aghams2@aol.com

ASSOCIATE POSITION - ST. LOUIS

Multi-location group practice seeks motivated DPM with initiative and leadership skills to contribute to our growing group practice. Foot Healers Podiatry Group enjoys a strong reputation within St. Louis and looking for the right individual to complement our team. Must have the confidence to lead you own clinic and the willingness to draw on the expertise that exists within our group. Starting salary ($100k), plus incentive comp plan, malpractice coverage, health insurance, 401k, group bonus/profit sharing. Please send CV to: jmurray@foothealers.com and visit our website www.foothealers.com

ASSOCIATE POSITIONS - MULTIPLE STATES

Podiatrist Needed in Arkansas, Kansas, Missouri, Nebraska, Iowa, Minnesota, North Dakota, South Dakota, Texas, Colorado, Wisconsin, 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 – ANCHORAGE, ALASKA

Associate wanted for hospital-based podiatry group practice. Full scope of practice. Surgical residency 24month+. Outstanding opportunity, work environment, and recreational pursuits. Fax CV to 907-562-5195, please call 907-562-4958, e-mail us at contactus@alaskapodiatry.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 516 476-1815 PODO2345@AOL.COM

PRACTICE FOR SALE - BALTIMORE, MARYLAND

Established 40+ year old well-rounded practice of both surgical and non-surgical care with special emphasis on sports medicine. Medicare and BS/private insurance base, no Medical assistance. Needs to transition to a confident well trained individual. Purchase can include building. Contact:podiatrypracticesale@gmail.com

PRACTICE FOR SALE — BROOKLYN, NY

This practice has been in the same location for 31 years, seeing 80-100 pts/week, working 4.5 days/week. Grossing $350K and netting close to 70%. All surgery referred out. Low rent, option to buy the building in future. Asking $225K, doctor willing to finance. Call 800-983-4194, or email:contactus@podiatrypracticeconsultants.com

EQUIPMENT FOR SALE - K-LASER

Complete coverage of the therapeutic spectrum on the market. With dual 800 and 970 nm wavelength selectability, power tunable from 0.1 to 12 Watts , spot sizes from 1 – 5 cm2, and frequency modulation from continuous wave through 20,000 Hz, In excellent condition $16,000. Please contact:sunandski400@gmail.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.

• To Post a message, send it to:    bblock@podiatrym.com
• Notes should be original and may not be submitted to other publications or listservs without our express written permission.
• Notes must be in the following form:
  RE: (Topic)
  From: (your name, DPM)
  Body of letter. Be concise. Limit to 250 words or less). Use Spellchecker
  Your name, DPM City/State
• Subscribers are reminded that they have an ethical obligation to disclose any potential conflicts of interest when commenting on any product, procedure, or service.