The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

June 02, 2011 #4,176 Publisher-Barry Block, DPM, JD

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NY Podiatrist Provides Advice on "Safer" Flip-Flops

If you want to wear flip-flops, experts say to pick them with care and test them out before you buy. "They shouldn't bend or twist easily, and they should only bend at the ball of the foot," said Dr. Neal Houslanger, a podiatrist in Huntington and Patchogue, NY. "You want a flip-flop that is not completely flat. It should have a sort of arch support to cushion the way that you walk." 

Dr. Neal Houslanger

Also remember that flip-flops aren't designed to be worn everywhere. "Don't wear them doing yard work, for sports or for long walks, since they don't have support or protection," Houslanger said. Around the pool or the beach is okay, but he warned that rubber material can cause blisters. Leather is better.

Source: Randy Dotinga, Newsday [6/27/11]

Barry's Yucatan Crippled Children Project Celebrates 15th Year

The Barry University's Yucatan Crippled Children Project (YCCP) is in the 15th year of providing medical and surgical care for unprivileged children with congenital lower extremity deformities living in the Yucatan, Mexico. Dr. Charles Southerland, Professor at TUSPM, is the Founder and Director of the project. Dr. Dock Dockery, Director of the International Foot & Ankle Foundation for Education and Research (IFAF), has been involved from the beginning as a fundraiser, and serves as a Medical Team Leader twice a year. Drs. Keith Kashuk, Miami; Byron Hutchinson, Burien, WA; Chris Bock, Seattle; and Dan Hatch, Greeley, Colorado, also participate annually and bring along podiatric surgical residents from their respective residency programs. 

(L-R) Drs. Aldolfo Rocha (pediatric orthopedist), Gary Dockery, Charles Southerland, and Marissa Miranda (Manager of the hospital).

Recently, the project moved to the Cruz Roja Mexican Hospital de Ortopedia (Red Cross Orthopedic Hospital) in Merida, Yucatan. During the May 2011 trip to Merida, pediatric surgeries were carried out on Friday. The Miami and Seattle Medical Teams screened 96 patients on Saturday at a small clinic in Progreso, Yucatan. Several new pediatric cases were scheduled for the next trip in July.

CA Podiatrist Helps Develop Topical Antibiotic

A Reseda, CA podiatrist who helped develop the topical antibiotic Diabecline has been using it on patients since April. He calls the results incredible. Dr. Ayo Otiko said it saved a diabetic woman last year from a possible foot amputation. Otiko said the woman, 76, had developed flesh-eating bacteria that led to an infected ulcer on her big toe. Even the strongest form of an intravenous drug wasn't working, so the next step would have been to cut off the foot. 

Dr. Christopher Otiko

Otiko stopped the IV drug and started using Diabecline. Within three weeks, everything was cured, he said. "That's never been done before with a topical ointment," he said. "I was amazed." Otiko said most antibiotics kill bacteria with a chemical mechanism. PharmaCline products add a physical form of killing, so the drug is able to physically disrupt the cell wall of the bacteria. That makes it impossible for bacteria to recover.

Source: Sarah Reinecke, Sioux Falls Argus Leader  [05/30/2011]

Medicare ACO Options Added After Criticism

The Obama administration has offered new options for Medicare accountable care organizations to entice wary physicians and other health care professionals to participate in the shared savings concept. The Center for Medicare and Medicaid Innovation on May 17 unveiled a pioneer ACO model for doctors and hospitals that are deemed ready to start coordinating their Medicare patients' care as soon as October instead of waiting until January 2012.

The Centers for Medicare & Medicaid Services, which runs the innovation center, also floated an idea to provide potential ACO participants with startup capital and four training seminars. Through care coordination and a shared savings -- and shared risk -- concept, Medicare officials hope to encourage more efficient, higher quality care in the program.

Source: Charles Fiegl, AMNews [5/30/11]

What to Say When You Negotiate

When you sit down to hash out a deal, avoid calling your conversation a “negotiation.” That word has some negative implications, usually bringing to mind a winner and a loser. Create an atmosphere of confidence and mutual gain. Here’s how:

•  “Let’s come to an agreement on this.”
•  “Are we ready to work together on a plan that satisfies both of us?”
•  “I am here to work with you.”
•  “Let’s discuss the situation and come up with a solution we both feel good about.”
•  “We have a challenge; let’s find a solution together.”

Source: Adapted from Power Phrases: The Perfect Words to Say It Right and Get the Results You Want, Meryl Runion, Power Potentials Publishing, via Communication Briefings

RE: Treating an Unaccompanied Minor (David E. Gurvis, DPM)
From: Dan Klein, DPM

I have treated many patients under 18 without the parent being present. First, I ask if there is a family member (grandparent) or other with power of attorney to accompany the minor. If not, I usually speak to the parent and arrange for a signature consent for a procedure (ingrown toenail, etc.) and have the parent sign. This can be faxed to the parent for signature. I also ask for a copy of the person’s driver license who signs the consent.

Ensure that a chaperone is present in the room to witness all treatment.

Dan Klein, DPM, Fort Smith, AR, toefixer@aol.com

RE: The True Cost of Implementing EMR
From: Robert Eells, DPM
 
We are currently implementing EMR at our podiatry practice, and I have totaled up the expenses thus far. I thought it would be interesting to post the list of my expenses for other DPMs to see, especially those who have yet to take the plunge.
 
EMR software with tax $20,962
New server and 3 PCs    $5,200*
Dragon for my part-time associate $1,140
50 Flash Drives  $285
Scale (High Capacity) $250
IT and related services to set it all up $4,789
Total as of this date  $32,626**
 
*We were surprised to learn that our well-maintained server and PCs did not have the capacity to run the software and had to be replaced.
** Does not include any costs to the office in staff time, miscellaneous expenses, or lost productivity

Robert Eells, DPM, Des Moines, IA, rgeells@gmail.com

RE: EHR Certification Charges (Richard A. Simmons, DPM)
From: Marv Boren, DPM

I am a sales consultant and implementation & training specialist for a podiatry-specific EMR company. I have had the opportunity to discuss EMR experiences with well over a thousand podiatrists. I personally used EMR in my own podiatry practice for over 5 years prior to my retirement last year. Based on my experience, I urge my colleagues to consider the following when incorporating EMR into their practice.

In his response to EHR Certification Charges on 5/30/11, Marc Garfield, DPM made two key points that hit the nail on the head:

1. "You have two years to achieve three-month of level-1 MU."

2. "Don’t convert to a certified EMR for stimulus money. Do it when and if you find a system that works for you."

First of all, you still have plenty of time to qualify for MU. As quoted from CMS' website: "To get the maximum incentive...

Editor's note: Dr. Boren's Extended-length letter can be read here.

RE: Touch Screen Notebook (Laura R Lefkowitz, DPM)
From: Marc Garfield, DPM

There are several considerations before you buy a tablet.

1. Before buying a tablet, contact your vendor for recommended specs and operating system requirements: Ipad, XP (Yes some still only work with XP), Vista, Windows 7, 32 bit or 64 bit OS. MANY programs will not support 64 bit Windows operating systems, and you may need to replace the OS.

2. Weight, a 5 lb, 12 inch fully convertible tablet/notebook gets heavy after a couple of hours. Bigger screens and batteries will cause considerable wrist pain.

3. Power: The new windows slate tablets run off of the “atom” processors, designed for lighter use programs. This will hamper multi-tasking and...

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

RE: Rem Jackson's Top Practices (Peter Wishnie, DPM, Jennifer Feeny, DPM)
From: Sloan Gordon, DPM, Misty McNeill, DPM

I agree wholeheartedly with the comments of Drs. Wishnie and Feeny. Rem is the best for public relations/marketing. However, the caveat with Rem is that he will only take two clients per city. So, for those of us who would love to have Rem's advice and services and private meetings, it is not available to the general population of podiatrists.

You can come to his public meetings; you just can't use his ideas one-on-one due to his client policy. I think the world of Rem and respect him, but I think this should be a fair-and-balanced discussion.

Sloan Gordon, DPM, Houston, TX, sgordondoc@sbcglobal.net

I have been working with Rem for over four years now, and without hesitation, it's the best money I have ever spent on my practice and myself. I opened my practice six years ago in an area already saturated by podiatrists, and since beginning work with Rem, I have had huge success. What I think is best about Rem is that there isn't a magic solution (nor does he claim there is one) for everyone. He treats each practice uniquely and helps you find what the right answers are for your practice.

Misty McNeill, DPM, Elmhurst, IL, mistydpm@yahoo.com

Editor's note: We have received many positive letters about Rem Jackson's Top Practices. Since they all say substantially the same things as previously published letters, we have closed this topic.

RE: Post-Op Cast Application Denial (Tony Poggio, DPM)
From: Jerry Cosentino, DPM

I use non-weight-bearing, post-operative casts on all metatarsal fractures that I create and fixate. This greatly reduces post-operative complications such as bone and hardware displacement, extends my local anesthetic block to 18-24 hours (Marcaine), and reduces post-op pain medication to nearly zero. I also apply the cast with my patient relaxed and under sedation (therefore in the "pointe" position to avoid non-compliance). 
 
Presently, I do not bill Medicare for the cast. Do you think there is a liability with Medicare in appending the casting code with a "-58" modifier - staged procedure in a global period related to the initial surgical procedure?
 
Jerry Cosentino, DPM, Tampa, FL, drgcosentino@gmail.com

ASSOCIATE POSITION - NORTHWEST FLORIDA BEACHES

Excellent opportunity for an energetic, compassionate, hardworking individual with superior surgical and medical proficiency. Recent graduate or experienced practitioner. Excellent salary, benefits and partner-buy in offered, full admit privileges and surgical scope. Fax CV to Ecpodiatry@aol.com

ASSOCIATE POSITION - NY

Opportunity of a Lifetime. Are you the one-in-a-million podiatrist I’m searching for? Do you aspire to greatness? If you have a great smile, great attitude, take initiative, then you should consider this exceptional opportunity. I am seeking a smart, residency-trained podiatrist with great surgical skills to become an associate in one of the top practices in the country. Don’t miss out on this outstanding opportunity! Please email your CV to institutebeaute@aol.com with “Attn: Sophia Johnson” in the subject line.

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 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 - CENTRAL NORTH CAROLINA

Well-established, busy podiatric practice is seeking highly motivated, well-trained and personable associate for full-time position. Competitive Salary and Benefits, Buy-in Opportunity. Interested persons must be actively pursuing or have NC license. Send resume and letter of intent to gpagpa530@yahoo.com

ASSOCIATE POSITION - SOUTHERN CALIFORNIA

Southern California practice looking for highly motivated podiatrist for very busy, two location practice. Excellent salary and benefits offered. Please email resume to mrsmcmackin@aol.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 – 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 - 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 - CANADA

Beautiful Victoria, B.C. Canada on the ocean, fast growing area. Associate for multi-office full scope practice. Reply to dr.cole@shaw.ca

ASSOCIATE POSITION - SOUTHERN NEW JERSEY

Seeking personable, ethical, motivated individual for a growing, well-rounded practice with potential for partnership. Must be PSR 24-36 trained. Competitive salary, incentive and benefits. Email CV to orin915@comcast.net

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 - 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

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 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

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

1-YEAR PODIATRIC SPORTS MEDICINE FELLOWSHIP - MONROVIA, CALIFORNIA

Applicants must have completed a podiatric residency program and must have or be eligible for a California license. Annual stipend: $48,000 and $60,000. If interested, please e-mail your resume with cover letter to the Program's management company at victoriamanagers@gmail.com

PRACTICE FOR SALE - NORTHERN NJ

Well established, part-time practice is for sale in Northern NJ. Digital X-rays, EMR, located in a medical condo building. Surgery 35%, Routine 30%, Average Gross is 130K on 2 half days per week. Practice is expandable to full time with increasing hours and marketing. Real estate available for purchase. Financing available. Please call 800-983-4194, or email contactus@podiatrypracticeconsultants.com

PRACTICE FOR SALE - BROOKLYN, NY

A large, busy practice is for sale in Brooklyn, NY. This practice has been in the same location for over 50 years. Average 150 pts/week, average gross 730K, most surgery is currently being referred out. Financing available. Please call 800-983-4194, or email contactus@podiatrypracticeconsultants.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


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