The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

May 24, 2011 #4,168 Publisher-Barry Block, DPM, JD

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Some Flip-Flops Offer a Superior Amount of Stability and Support: APMA President

Are your flip-flops harming your foot health? The wrong footwear is often the chief cause of foot pain, and many types of flip-flops can cause foot problems due to lack of support and other factors, according to the American Podiatric Medical Association (APMA). The wrong flip-flops can leave you vulnerable to sprained ankles, ligament injuries, and a higher incidence of cuts, scrapes, and stubbed toes. 

Dr. Michael King

“During the warmer months of the year, many podiatrists treat a greater number of foot problems that can be traced back to wearing flip-flops,” said Michael King, DPM, president of the APMA. “However, people don’t have to give up wearing this type of footwear altogether. There are certain types of flip-flops that offer a superior amount of stability and support than others.”

Source: Ann Pietrangelo, Care2.com [5/11/11]

AAPPM Midwinter Conference Celebrates 50th Anniversary

The American Academy of Podiatric Practice Management (AAPPM) Spring Conference at FireSky Resort in Scottsdale, Arizona was a tremendous success as a joint venture between the AAPPM and the Arizona Podiatric Medical Association. 334 podiatric physicians, staff, and 60 exhibiting companies were in attendance for the 4-day conference this past weekend. Attendees for both associations heard from dozens of experts in the profession. 

AAPPM President Jeffrey Frederick Addresses AAPPM Spring Conference Attendees

AAPPM President Jeffrey Frederick, DPM commented, “This joint venture meeting with the Arizona association added a new dimension to AAPPM’s growing membership and continued changing AAPPM conference format. AAPPM continues to explore new locations and venues to spread the practice management opportunities for podiatric physicians throughout the United States.”

MN Podiatrist Under Investigation Amid New Complaints

Six years ago, a Twin Cities podiatrist faced serious complaints about his practice. Among other misconduct, Dr. Robert Mullin botched several surgeries by cutting too much bone from patients' toes and withheld money owed to patients and insurers to preserve his cash flow, according to the Minnesota Board of Podiatric Medicine. Since then, Mullin has faced more complaints. A former patient won a court judgment against the physician last year for charging twice for the same service. Another patient sued over an allegedly bungled hammertoe surgery -- it was the seventh malpractice lawsuit against Mullin in Hennepin County since 1997, records show.

Podiatry board President Dr. Stephen Powless said his agency continues to investigate Mullin's practice. "The resolution to the problem can't come quickly enough for me," said Powless, a Park Nicollet podiatrist. "I have spent my career improving our training and making our profession better. People like this really get to me, because it paints us in that light."

Source: Star Tribune, [5/22/11]

Editor's Note: PM News is proud to present excerpts from Meet the Masters.

Bret Ribotsky: How does PICA choose its experts? 

Dr. Jerry Brant

Jerry Brant: We have a stable of experts and our attorneys in their respective states who can recommend experts. Our claims department would have to approve those experts because we are paying the bills. We set parameters on the expertise and on the fees that they can charge. We try to keep control of expenses. Today, we deal with more complex and difficult cases. Twenty years ago, you just found a good podiatrist in your area and used him as an expert. These days, you have to go out and find a corresponding vascular surgeon, an orthopedic surgeon, an economist, and the list goes on and on. That really makes expenses go up. 

Dr. Bryon Hutchinson

Meet the Masters is broadcast each Tuesday Night at 9 PM (EST). The next segment will feature residency director,  Dr. Bryon Hutchinson. You can register for this event by clicking here

Query: Niacin, Cherry Juice and Acute Gout (Marc Garfield, DPM)

Dr. Garfield mentions to "check their vitamin list for Niacin." Is Niacin good or bad for gout patients (& why)? If they should be taking it, at what dose?

Dr. Garfield also mentions that "fresh or frozen cherries work well." I have heard of patients getting relief from drinking a lot of cherry juice. Is this antidotal or does this have a specific action in the treatment of acute gout?

Tom Silver, DPM, Golden Valley, MN

Query: Insurance Verification (Richard Simmons, DPM)

Dr. Simmons encourages us to use Checkmedicare.com to verify Medicare deductibles, etc. Is there a similar site for private insurance?

Michael Forman, DPM, Cleveland, OH

RE: Cracked Arm of Smart Toe Implant (Jay Hassenfratz, DPM)
From: Multiple Respondents

I had the other side of the implant crack on my patient. I spoke with a surgeon who had more experience with the implant than me, who stated he never had to take one out, and that they all fused. Mine did. At three weeks, with what appears to be good bone-to-bone apposition, I would leave it alone. Also, that part of the implant is to prevent distraction more than rigidity. At three weeks, I suspect the site is not going to open up.

Jack A. Reingold, DPM, Solana Beach, CA, footdoc@san.rr.com

I would contact the manufacturer and inform them of this as soon as possible as this may be a failure of a piece of medical equipment. Concurrently, I would contact my professional liability carrier. I would hold off on any surgery until you get instructions from the manufacturer.

Richard A. Simmons, DPM, Rockledge, FL RASDPM32955@gmail.com

SmartToe, although a good implant and my primary implant use, has the disadvantage of occasionally breaking. The toe seems relatively intact, so I would immobilize it for four weeks and you will likely get arthrodesis. Taking them out can be a challenge and, because it is not a break at the joint line, may cause difficulty and further complications.

I recommend Immobilization for four weeks, followed by radiographs and a clinical exam. It is likely that the patient will have the pain disappear. If the patient has pain at the end of the period, you can take it out and fuse the toe another way.

David L. Nielson, DPM, Roanoke, VA, pampantla@hotmail.com

RE: Idiosyncratic Reaction to a Foot Injection (Elliot Udell, DPM)
From: Robert Kornfeld, DPM

This is not an idiosyncratic reaction at all. It occurs in patients whose cortisol levels are elevated. Cortisol elevation leads to increased levels of Th2, thereby causing neurotransmitter imbalance, leading to spiking histamine levels. What you are seeing in your patient is caused by a sudden release of histamine. This is a patient who should not be given any cortisone injections of any kind unless the adrenal component is addressed.

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

RE: Unidentified Fixation (Richard Jaffe, DPM)
From: Bob Rampino, DPM

I truly believe that there should be federal legislation so that all screw heads are uniform to prevent this problem. It is truly in the best interest of the patient and we should take a leadership role.

Bob Rampino, DPM, Bronx, NY, rdrdpm@yahoo.com

RE: Source for Dexamethasone (Michael DiGiacomo, DPM)
From: Larry Kollenberg, DPM

Your supplier did not give you the full story. It is true that dexamethasone is not available. This is due to problems with the two major manufacturers of the drug. Both have been cited by the FDA and are having numerous problems, not only with supplying dexamethasone but with many major electrolytes and other products. There is a current national back-order which may or may not be relieved sometime next month.

For those interested, the FDA website has a listing of all drugs on national back-order medications. (fda.gov/drugs/drugsafety/drugshortages/default.htm)

Larry Kollenberg, DPM, Pharm D, Baltimore, MD, lkollenberg@hotmail.com

RE: Cerner EMR in a Clinical Setting (Lea Elliott, DPM)
From: Alicia Teausant, DPM

After having used the worst, most frustrating user-unfriendly NextGen system in residency, I have used the Cerner EMR in a clinic and hospital setting at Virginia Mason Medical Center in Seattle. It is very user-friendly. I found it well-organized and easy to learn. It is a wonderful way to keep track of notes/studies for each patient, as well as a great computerized tracking system for keeping track of messages to back and front staff about patients - all kept within that patient's record automatically.

I recommend having the dictated clinic notes uploaded in automatically from your transcription service. That's how we used it. As a I used this from a fellow/associate aspect after it was already implemented and did have a 2-day training session through VMMC, I am not sure of your lease agreement terms for system support and what it would take to set up how you want it done in your office. It does make sense to have your notes linked to the hospital for better continuity of care for your patient.

Alicia Teausant, DPM, Great Falls, MT, aliciamtea@gmail.com

RE: To Be or Not to Be an MD/DO (Paul Kruper, DPM)
From: Michael M. Rosenblatt, DPM

We need to split this into two parts: Dr. Paul Kruper reminds us that the podiatry license includes the ability to treat dermatologic, orthopedic, diabetic and other ramifications of foot and ankle disorders. The full range of podiatry is, in fact, very wide and permits most podiatrists the opportunity to earn a good living. The issue of the expanded degree, however, is a separate political and practical matter.

Discrimination against podiatrists due to the limited license exists in most governmental and legal venues, and causes podiatrists all manner of (exhausting) continuing battles for legitimacy. It would be an incredible relief not to require each new generation of podiatrists to fight this same, recurrent and expensive effort. Imagine what we could do (in research and public health) if spared the collective expense of political fund-raising!

Then, there is the matter of employment opportunity, which the expanded DPM MD/DO would offer. These opportunities are not trivial. When we consider the options available to us as MDs and DOs, there is simply no comparison.

Michael M. Rosenblatt, DPM, San Jose, CA, Rosey1@prodigy.net

RE: Podiatrists' Responsibility When Taking Patients' Blood Pressures (Peter Harvey, DPM)
From: Bret M. Ribotsky, DPM

My office always takes vitals: BP, HR and weight for every patient on every visit. We have done this since the 1995 E&M guidelines were published. When I see an abnormality, I call the cardiologist/internist. I have called 911 on a few occasions in the past 15 years, and when the patient refuses to go, I tell them I have a "no dying" policy in my office, and I will do whatever it takes to save their leg or life, even if they don't want it (they smile and go along).

I am just as much a part of the "medical team" as the urologist, orthopedist, or dermatologist, and I believe it starts with a foundation of being a great physician first. As many have alluded to on Meet the Masters, "success and wealth is uncovered once you start looking above the ankles."

Bret M. Ribotsky, DPM, Boca Raton, FL, ribotsky@yahoo.com

ASSOCIATE POSITION - SW FLORIDA

Huge opportunity. Are you an outstanding person? Would you like the freedom to utilize your talents to the max? Opportunity awaits right candidate. Excellent mix of office/surgery motivated/experienced staff. Full Time Associate PSR 12-36. Great Salary/Benefits, Bonus Package, Unlimited Potential, Buy-In Opportunity. Email resume to podiatry22@yahoo.com

ASSOCIATE POSITION – NEW YORK

Well-established, multi-doctor podiatry practice with offices in Putnam and Westchester counties. Compensation based on productivity. Excellent opportunity for recent residency graduate to build skills and learn practice management. Full-time preferred but right part-time candidate will be considered. Email cover letter and CV to: Podiatry2011@gmail.com

ASSOCIATE POSITIONS - TEXAS

Texas licensed podiatrists needed in San Antonio and Austin. Great paying positions for full or part-time. Well established, unique mobile podiatry practice servicing senior living facilities. Business office locations in both cities with excellent support staff for your assistance and scheduling. Check us out before looking elsewhere. Find us at www.footmobile.com Reply with cover letter and CV to doctor.cohen@yahoo.com with a cc: to lisa.schulze@yahoo.com or call us at 210-495-6477.

ASSOCIATE POSITION - MARYLAND

Looking For The Best. Busy practice. F/T associate possibly leading to partnership. Seeking sharp, honest and hard-working associate who is extremely personable. Board Certified or eligible. Exceptional surgical skills and training needed, but is just as important to diagnose accurately. Excellent salary and benefits. Email CV to Marylandfootcare@live.com

ASSOCIATE POSITION - SOUTHERN MI (NOT DETROIT AREA)

Leading to partnership for rapidly growing 3-physician group practice. Must be residency trained and willing to learn and follow our very successful business model. Salary plus incentive. If you're unhappy with where you're at now this may be the answer! If, interested send CV to: paulapmac@me.com

ASSOCIATE POSITION- NEVADA

Well established 22-year practice in Las Vegas/Henderson, Nevada seeking full-time associate. General podiatric care with moderate amount of surgery to be done in local hospital or surgery center. Competitive salary and benefits. Modern office in new area. Please respond by email to lvfootandankle@gmail.com

ASSOCIATE POSITIONS - NW INDIANA, CHICAGO AREA

2 Full-Time positions open - One for Northwest Indiana and one for the Chicagoland area. Must have 2-year surgical residency. Must be motivated and a self-starter. State License required. If interested email: f-massuda@footexperts.com

ASSOCIATE POSITION – NEW YORK

Great opportunity to share “state-of-the-art” offices and equipment in mid-town Manhattan and White Plains with Board Certified podiatrist. Out-of-network or participating providers welcome. Please call 212-704-4310 for additional information and fax your CV to 212-704-4311

ASSOCIATE POSITION – IOWA CITY AREA

Modern practice seeking a well-trained (PSR 24/36) associate. Excellent opportunity for an energetic, hardworking individual with strong surgical and medical skills. Solid referral network and 13 years of growth. Come live in the Iowa City area and enjoy the quality of life and stability of a Big Ten University community. Competitive salary and benefit package available. If interested, fax CV to 319-354-1014 or e-mail to dave@341foot.com

ASSOCIATE POSITION - WA (KIRKLAND, SEATTLE, EVERETT, AND REDMOND)

Join one of the fastest growing podiatry practices in Washington state. Must be motivated to grow practice. Competitive salary and benefits. For more information go to seattlefootdoctor.com. Send resume to seattlefootdoctor@yahoo.com

ASSOCIATE - POSITION - SOUTHEAST GEORGIA & SOUTH CAROLINA

Seeking recent residency graduate to join practice. Must be PSR-24/36 trained. Multiple locations. Full range of services with new facility. E-mail to melissafoot@pol.net

ASSOCIATE POSITION - NEW YORK CITY & QUEENS

One of the fastest growing podiatry practices in New York City and Queens seeks a podiatrist who participates with HealthFirst, Fidelis, and other Medicaid plans. Preferably a Spanish speaking podiatrist. Contact me at Podocare@aol.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. Turn-key operation - no investment needed 516 476-1815 PODO2345@AOL.COM

PRACTICE FOR SALE - SOUTH CAROLINA

$800,000+ gross, single location practice needs well trained, energetic podiatrist. Confidential inquiries carpodpract@gmail.com

PRACTICE FOR SALE - HOUSTON, TEXAS

28 year old busy, progressive practice for sale with an excellent reputation and well established referral base. Well trained, dedicated, supportive staff. Excellent cash flow $475K income after overhead. EMR, digital x-ray, diagnostic ultrasound. Free standing building also available with large outdoor sign. Owner retiring and willing to stay part time during transition. softechpodiatrist@gmail.com

PRACTICE FOR SALE - MISSION VIEJO, CA

Relocating to Tulsa. Great opportunity to buy my office. Located on Mission Regional Hospital Campus. Gross income 2010 was $340,000. Approximately 1300 sq ft with 3 treatment rooms, digital x-ray and fully computerized. Only 3 years old. Will consider all offers. 949-702-1052. David Stoller, DPM (Family Footcare) david@missionviejofootcare.com

PRACTICE FOR SALE - MARYLAND, DC SUBURBS

Great opportunity. Well established and equipped practice for sale. Office includes state licensed Ambulatory Surgical Center. Present owner is retiring but will stay on as needed for smooth transition. Average gross over past 3 years is $575 K. dpmpracticeforsale@yahoo.com

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