The Voice of Podiatrists

Serving Over 14,000 Podiatrists Daily

May 27, 2013 #4,780 Publisher-Barry Block, DPM, JD

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Going Sockless Not Healthy For Feet: NY Podiatrist

Wearing dress shoes without socks is like wearing a tie without a shirt. First, "it definitely puts you at greater risk of fungal infections," says Dr. Vera Halbfass, a podiatrist at the Healthy Feet Center in New York.

Dr. Vera Halbfass

"Your feet will sweat more and nothing will absorb the sweat. What's worse is you can get a fungal infection of your nails, which is very ugly and very hard to treat."

Source: James Tarmy, Bloomberg Business Week [5/23/13]

Laces Better for Kids Than Velcro: Aussie Podiatrist

Velcro has put the shoelace-tying ability of our children in a twist. While kids used to be able to tie their own laces by the age of five or six, they are now learning the skill as late as nine or 10, according to a study. But Lisa Mayo, a member of the Australian Podiatry Association, believes laces are "always better than Velcro."

Lisa Mayo

"Laces take time and patience to learn but it is the best investment for our children's foot health," Ms. Mayo said. "Tying up laces is a skill children should learn early because it provides better fine motor control and strength in their fingers for other skills, like pencil grip and writing."

Source: news.com.au [5/25/13]

AZ Podiatrist Re-enacts Role of Civil War Officer

Dr. Dale Feinberg (Photo: Craig Fry)

Dr. Dale Feinberg of Yuma made a Civil War presentation Wednesday to seventh-grade students in Tony Harman’s class at Yuma Lutheran School. Feinberg, portrayed Confederate Maj. Gen. ZZ Mutazarnik and dressed in an authentic period uniform. He is preparing to embark on a cross-country trip to take part in several Civil War re-enactments, including one at Gettysburg.

Source: Yuma Sun, [3/24/13]

Query: Status Post Motorcycle Accident

This gentleman presented to my office with the following pathology: There are multiple other metatarsal and digital fractures, but my main concern is the rear foot and the depression near the calcaneocuboid articulation. Any insights into repairing this would be greatly appreciated.

Status Post Motorcycle Accident

CT Report: There is a severely comminuted fracture of the cuboid bone. Much of the articular surface is involved. There is involvement of the proximal articular surface of the calcaneus, with a substantial depression of a portion of the proximal articular surface up to 5 mm. There is fracture of the plantar lateral aspect of the navicular with modest comminution. There is comminuted minor fracturing of the anterior process of the calcaneus.

Query: ORIF of Dislocated 4th Digit

What code should be used for an open reduction internal fixation (ORIF) of a dislocated 4th digit? The patient failed closed reduction, and we had to go to ORIF with pin fixation.

Saera Arain-Saleem, DPM, Elmhurst, IL

Response: You didn't mention where the dislocation occurred. Consider one of these codes based on the actual site of the dislocation:

CPT 28645 - open treatment of dislocation, metatarsal-phalangeal joint dislocation with or without internal or external fixation, or

CPT 28675 - open treatment of interphalangeal joint dislocation, with or without internal or external fixation.

Howard Zlotoff DPM, Camp Hill, PA

Codingline subscription information can be found here

APMA Members: Click here for your free Codingline Silver subscription

RE: Non-Union of the Hallux IPJ
From: Jefferson J. Mennuti, DPM

If you are only considering surgical correction for the non-union, then you would have to remove the implant, pack the deficit with auto-graft marrow, which you can get from the calcaneus, and use 2 compression Nitanol staples, one medial, one lateral. If you feel there would be lack of cortical purchase, consider a locking plate rather than the staples.

Jefferson J. Mennuti, DPM, Orange City, FL, dr.mennuti@gmail.com

RE: Fluoroquinolone Toxicity (David Secord, DPM)
From: Robert Kornfeld, DPM

Dr. Secord wants "proof" that what I am asserting is supported by the literature. In fact, there is no paucity of literature regarding flouroquinolone toxicity syndrome. If you have not heard of fluoroquinolone toxicity syndrome, I suggest you do your own literature search as soon as possible. The question that always needs to be answered is why do these severe reactions only affect the people that they do. That is where the genetic research is applicable and is beginning to answer many questions.

In terms of the SNPs and their relationship to this toxicity syndrome, this is all emerging science and...

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

RE: Documenting Radiological Findings (Name Withheld)
From: Theresa Hughes, DPM

This is the template that I use. This was developed by my coding department as a template to hit all the required material.

DICTATING PHYSICIAN:
HISTORY:
EXAM:
QUALITY: (CLEAR, BLURRY)
FINDINGS:
IMPRESSION:
FURTHER STUDIES:
Sign, date and time
 
Theresa Hughes, DPM, Galesburg, IL, Theresa.M.Hughes@osfhealthcare.org

RE: Square.com (Andy Dale, DPM)
From: Adnan Shariff, DPM

I use Square app in my satellite offices. It works great. Patients enjoy signing on the ipad or you can use a phone. However, I recommend using an ipad as it easier to see and read - and easier for patients to sign. You can also put pictures you take with the ipad of all your supplies and put in the prices, and just click on the pictures to add those items to the total. However, unless you buy a separate printer, available from Square, you have to text or email them the receipt. Patients don't usually mind.

I don't use it in my main office because my monthly cost is less than the cost Square charges. But to buy a machine for each office would be too much. In addition, with the ipad, you can have patients sign forms such as DME receipts on the ipad that is connected to your EMR.
 
Adnan Shariff, DPM, Okeechobee, FL, adnanshariff@yahoo.com

RE: Staff Makes it Difficult to Get Appointments (Name Withheld)
From: Kathleen Neuhoff, DPM

When I have encountered this problem in the past, I have established a bonus payment system for "filling the appointment book." Establish what constitutes a full schedule i.e., 90% of all available appointments full, establish a bonus such as $50 per filled day. Be sure to establish the fact that the patients must also SHOW UP for the appointments! Have a staff meeting dedicated towards brainstorming for filling the appointment book. 

Ideas such as trying to fill the least desirable appointments first, moving patients forward from later dates to earlier ones if they are open, reviewing old files (by hand or EHR) to find overdue patients and calling them to come in, reminding patients of their upcoming appointments, making sure that all patients have their next appointment scheduled before leaving, etc. This had been most effective for me with one person in charge of filling the schedule, but it can probably be used for the entire team also.

Kathleen Neuhoff, DPM, South Bend, IN, vetpod@aol.com

RE: Staff Makes it Difficult to Get Appointments (Name Withheld)
From: Gary Docks, DPM

Your ghost caller with symptoms of diabetes and an ingrown toenail was not given a same-day appointment after you specifically told your office manager and receptionist to do so, can only mean one thing. Who the hell is running this practice? The only acceptable response would be how long have you been working here NOT INCLUDING TOMORROW? You need to take control of this situation.

I faced that situation many years ago and nipped it in the bud quickly. The question is, did you put a limit on how many patients you wanted to see in a day or perhaps after watching you, THEY decided for you how many patients would be seen. Do you spend a lot of time with each patient? Take control of your practice or don't complain. After your ghost caller verified your suspicions, unless they had a good explanation for their actions, I would make sure that the door to your office hit them in the ass on their way out. Pull the plug and take some management classes to prevent this from happening again.

Gary Docks, DPM, Beverly Hills, MI, gwdocks@aol.com

RE: New Study Confirms Hereditary Link for Bunions
From: Elliot Udell, DPM

Research studies that show a hereditary link for bunions and hammertoes are missing part of the picture. With the exception of some rare cases, bunions and hammertoes develop over time. The hereditary link is not with the actual structural deformities but with abnormal biomechanics leading to abnormal pronatory forces that ultimately lead to bunions and hammertoes.
 
My first office, over 30 years ago, was in a Chassidic/Hispanic neighborhood, and most of the families had lots of kids. I observed that if "mother" or "grandmother" had severe bunions, the kids tended to have biomechanical problems, often early flexible hammertoes, and very early HAV deformities. Since social services paid for orthotics, I made custom orthotics for all of these kids, and over a period of ten years, I found that the kids who used the orthotics and upgraded them when their feet grew, did not develop bunions and hammertoes. Siblings that left their orthotics in the closet eventually started to develop serious structural deformities.
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

PODIATRIST SEEKING EMPLOYMENT - PORTLAND, OR AREA

Motivated, highly surgical trained podiatrist seeking employment opportunity in the Portland, OR or Vancouver, WA area. Both hospital and office-based training. Please email inquiries to poddoc3890@gmail.com.

PRACTICE FOR SALE - SOUTHWEST FL

Multilocation multidoctor practice in beautiful Southwest Florida . Practice has grossed over seven figures consistently and currently shows 10-15% growth in revenues with increase in new patients and patient visits. EHR is already implemented with meaningful use criteria met. Practice has been professionally evaluated by Provider Resources. Only serious inquiries to this email address. This is a great practice in Paradise and a good opportunity for the right doctor or doctors. Email to: practiceforsaleswfla@gmail.com

PRACTICE FOR SALE - WEST PALM BEACH FLORIDA
 
Well established successful West Palm Beach practice grossing $475K with excellent reputation and good referral base. Consistent new patient growth, great opportunity with increased gross revenue and surgical growth potential. EHR implemented with meaningful use criteria met. Great area to live and work. Serious inquires E- mail wpbfootdrs@gmail.com

PRACTICE FOR SALE IN CENTRAL FLORIDA 

33 year old practice grossing $550k seeing an average of 40 patients per day. Possible owner financing for both practice and large office building. Five year average profit margin of 35%. New Listing. For more information call Chas Smith at 863-688-1725 or email Chas@cpalliance.com

PRACTICE FOR SALE - CALIFORNIA

Unique opportunity to purchase a very busy 50 year old practice in Coronado Ca. Large and stable patient and referral base with consistent new patient growth. Low overhead. Priced to sell. Great staff. Hospital privileges available. Willing to stay on for transition. Inquiries please email foothold@msn.com

IMMEDIATE OPENING OR PURCHASE IN DALLAS TX  

Turnkey in Dallas’ beautiful and prestigious Uptown neighborhood:   modern, fully furnished office in 24/7 security high rise and large patient base. There is tremendous growth potential in this affluent and diverse area. Perfect for new practitioner, to share, or second office.  afc1dfw@gmail.com

ASSOCIATE POSITION - CENTRAL FLORIDA

Associate wanted for well-established practice in central Florida. Experienced support staff, malpractice coverage and health insurance provided. Excellent opportunity for a promising future, this position will provide for the possibility of partnership in the future. To apply please go to www.yourcareerinpodiatry.com

POSITIONS AVAILABLE - UPSTATE NY, DOWNSTATE NY, AND BUFFALO AREA

Looking for podiatrists to see residents in Nursing Homes. Great opportunity for supplemental or full time income. Email inquiries to phasetwopodiatry@gmail.com.

ASSOCIATE POSITION - VIRGINIA

Well-established practice in Arlington Virginia looking for first year associate DPM perhaps leading to purchase of office. Office is one block from metro and has onsite private parking for patients. Present owner is retiring but will aid with smooth transition. This practice has been in the same location for the 40 years and has an excellent referral base. Must be licensed to practice in the state of Virginia. Please contact drmichaelfine@aol.com. Cell Phone 703-582-5999.

PODIATRISTS NEEDED - LOS ANGELES, CA
 
Home Foot Care, Inc. Is looking for motivated podiatrists to provide quality mobile care to our home-bound patients. Flexible schedule, independence, great compensation. If interested, please email resume to homefootcare@hotmail.com

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 - 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 fixafoot@cox.net

ASSOCIATE WANTED - CENTRAL/SHORE AREA - TOMS RIVER, NJ

FT/PT Looking for a HIGHLY motivated, organized, ethical associate. EMR/digital 20/20 x-ray/NCV/vascular testing all on premises. Trauma, DM, wound care & large routine & children mix. Must have NJ license. Should be Board Qualified/Certified Potential for future BUY-IN Send CV to toesec@aol.com

ASSOCIATE POSITION - NAPLES, FLORIDA

Great opportunity for PSR- 24/36 BE/BC podiatrist with strong surgical skills to join multi-office practice. Hospital privileges available at 648 bed hospital system, 200 bed hospital system and multiple surgical centers. Candidate should have the skills and desire to perform rearfoot/ankle surgery. Florida has a great scope of practice law and we rotate for ER call. Candidate needs to be ethical and motivated. Established practitioner or new practitioner. In a cover letter tell me why you should be selected for the team. Email cover letter and CV with subject line "I am your new team member." to: Drgordon@gulfcoastfootcare.com

ASSOCIATE POSITION- DAYTON, OHIO

Join an established group practice in Dayton, Ohio excellent reputation, large referral base. Base Salary$120,000, benefits and bonus structure. EMR; diagnostic ultrasound; Padnet; CO2 and Cutera Laser for nails, all aspects of DME. We need well trained personable PSR24/36 surgeon. Future Buy-in available. Please send CV to Ohiomedical@aol.com

ASSOCIATE POSITION - MASSACHUSSETS

Located near Boston. 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 - BEVERLY HILLS CALIFORNIA
 
Established foot and ankle specialty group looking for an experienced podiatrist. This position entails making rounds at local hospitals, skilled nursing facilities and having scheduled office appointments. Must be comfortable with all aspects of podiatric care and will be doing no less than the hiring partners. Full-time position with a competitive salary. Looking for someone with a great bedside manner, energetic and will to go the extra mile to make a positive difference. Send CV to administrator@footnankledoc.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

PODIATRIST FOR NURSING HOME CARE - MASSACHUSETTS

Excellent Opportunity. Seeking independent physician for growing nursing home podiatry care Work independently, make your own hours. Must do own billing. YOU KEEP 100% OF PROFITS. Must be personable and have good patient skills. Acquisition fee based position. Please e-mail CV and short bio to: americanmobile@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 - NEW AEROLASE YAG LASER

Brand new Aerolase Yag Laser Bought Feb 2013- Never Used Paid $35,000. Will sell for $25,000. Contact Kathy (352) 867-1155 or Michael after 7pm (352) 816-1155.

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