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June 10, 2013 #4,792 Publisher-Barry Block, DPM, JD

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We’ve just posted the June 2013 CME titled

June 2013 CME

You can Earn 50 CPME-Approved CME Contact Hours Online

IL Podiatrist Discusses Foot Ulcers

“Ulcers occur most often on the ball of the foot or on the bottom of the big toe,” Says Dale Brink, DPM. “Ulcers on the sides of the foot are usually due to poor-fitting shoes. Even though some ulcers do not hurt, every ulcer should be seen by your healthcare provider right away.” With the correct treatment and recommended lifestyle changes, many people with diabetes are able to avoid the most serious consequences of foot problems – severe infection and, in the most extreme cases, amputation of a limb.

Dr. Dale Brink

“Diabetic wound care is a major challenge,” Dr. Brink added. “The disease causes poor blood flow to the extremities. Increasing oxygenation through HBOT brings white blood cells to the wound and causes new blood vessels to grow in the area, which aids in healing.”

Source: NWI Times [6/7/13]

OPEIU Reiterates its Support of Title XIX Legislation

The 26th Triennial Convention of the Office and Professional Employees International Union (OPEIU) was held this week in San Diego. Officers of the growing union were elected, including Michael Goodwin as President and Dr. John A. Mattiacci as a Vice President. Drs. Ed Smith from  Vermont, Michael Wodka from New York, Robert Herpen and Joseph Pasquino from  Pennsylvania served as delegates along with Dr. Mattiacci.

(L-R) Dr. John Mattiacci and AFL-CIO President Richard Trumka

Richard Trumka, President of the AFL-CIO, addressed the convention as did Dr. Mattiacci. President Trumka recognized the Podiatry Guild. Dr. Mattiacci's address focused on the changing nature of medical practices in an economic climate in which doctors' fees are being used by insurers and government to finance a health system in economic transition. The OPEIU convention reiterated its support of the Guild in its efforts to elevate the profession of podiatric medicine and achieve the successful passage of Title XIX legislation.

One in Five Women "Ashamed of Their Feet" - UK Survey

British women are plagued by foot problems, with one in five admitting they are embarrassed by that part of their body, according to a new survey from the College of Podiatry. The organization commissioned a survey of 2,000 adults and found that nine out of ten women had experienced some kind of foot problem.

Podiatrist Lorraine Jones

Podiatrist Lorraine Jones observed that most people will experience some sort of foot problem at some stage, "but we are seeing a lot of cases which could have been prevented, particularly amongst women. We all like to look good but it's important to take a common sense approach to footwear," she advised.

Source: NetDoctor.co.uk [6/7/13]

Aussie Podiatrist Faces Deportation Because of Her Age

A Horsham doctor denied permanent residency because she is too old could have the decision overturned within a month. Warracknabeal podiatrist Wendy Cobbold faces a permanent residency battle. She missed her chance for permanent residency by three years.

Podiatrist Wendy Cobbold (Photo: Samantha Camarri)

Cobbold, 53, moved from England in January 2012 to work at Rural Northwest Health. The health service has nominated Mrs Cobbold for permanent residency but migration agents have told her the application will be flatly denied. “We talk about the need to respect everyone’s culture and diversity so this is discrimination. There needs to be laws and guidelines but 50 is the new 40 – I don’t feel 50 and I have at least 20 years of working life left."

Source: Illawarra Mercury [7/7/13]

Query: AFO Fabrication Licensure?

I have been approached by an orthotics and prosthetics fabricator in Florida who would make my custom-made braces and orthotics. Does he need to have a certain licensure to make my AFOs?

Olga Luepschen, DPM, Sebring, FL

RE: Recurring Skin Lesions
From: Elliot Udell, DPM, Jon Purdy, DPM

I have seen many similar lesions. I like to keep things simple and work upward from there. With an unknown skin lesion step-one is biopsy and send the specimen to a dermatopathologist. If benign, it’s time to break the cycle of formation. I simply apply a high potency steroid under occlusion. It will resolve and may need to be performed from time to time. Many times, never again.
 
Jon Purdy, DPM, New Iberia, LA, podiatrist@mindspring.com
 
This patient might benefit from gait pressure studies in order to determine if there is excess pressure beneath those areas during gait. There are many products available that can perform this study. The one we use is the inexpensive carbon paper based device. The  person walks over it and it determines where there is excessive pressure during ambulation. There are computer-based electrical plates that do the same thing. If it is determined that this is the case, then you can address the problem biomechanically and design a set of orthoses to correct the problem. Such information may also help if you intend to address the problem surgically.
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: Recurring Skin Lesions
From: John Scheffel, DPM

It's hard to tell without x-rays, but I wonder if the initial surgeon performed a flexor tendon transfer instead of just a tenotomy? I had a similar case in which the proximal phalanx was causing a similar problem. The patient had the procedure done years earlier, and all that was left of the proximal phalanx was its base, which was sitting distal-plantar to the met head.

Excision of the base of the proximal phalanx with syndactylization to the adjacent digit addressed her pain. 

John Scheffel, DPM,  Worcester, MA, jscheffel@townisp.com

RE: Facility Fees (Tip Sullivan, DPM)
From: Scott Hughes, DPM

In my community, the hospital-owned outpatient surgery center is reimbursed almost 40% more than the physician-owned surgery center. And an in-patient procedure reimburses almost double that of the physician-owned surgery center.

The explanation I was given is that when the rules were changed to allow physician-owned surgery centers, there was an assumption that they would be over-utilized. The lower reimbursement was a compromise to offset that assumption (sound familiar - more volume makes up for lower reimbursement - doctor math!). The inflated rates for inpatient care are to compensate the hospital for the required indigent care that they provide.

Scott Hughes, DPM, Monroe, MI, dr.hughes@comcast.net

RE: Podiatric Residency Crisis - Where are We? (Bret Ribotsky, DPM)
From: Robert Scott Steinberg, DPM

As of the last report, there are still 92 of the 2013 (and before) graduates, who did not match because there are more graduates than there are residency slots. This is blatantly unfair. The APMA and the CPME have failed to assure that there are enough residency slots. CPME knows exactly the number of students we have, in the too many colleges of podiatric medicine. This is akin to the practice of selling more seats on a flight than there are seats available. But unlike the airlines which have to pay for their greed, it seems that the APMA and CPME think they can skate free. CPME needs to be overhauled. They won't do it themselves, so I expect the APMA to show them the door.

Robert Scott Steinberg, DPM, Schaumburg IL, Doc@FootSportsDoc

RE: CA Podiatrist Uses Minimal Incision with Fixation for Bunion Repair (Randall Brower, DPM)
From: H. David Gottlieb, DPM

I am not a personal fan of MIS, having seen the excesses of the '70s and '80s, but it can have its place. I know Dr. Khosroabadi and I know where he trained and what he is cabable of. Do you have a patient requiring complex ankle and hindfoot reconstruction? He's the man for that whether the case requires internal rod fixation or complex Ilizarov or Taylor Spatial Frames.
 
In fact, Dr. Khosroabadi learned these complex skills at one of the world's foremost centers for limb deformity correction run by internationally respected orthopedic surgeons. These same orthopedic surgeons also perform and teach how to perform corrections through percutaneous means. I've participated in percutaneous cresentric bunionectomies and percutaneous Charcot reconstruction at this same center.
 
Is MIS a sham and disgrace? Only if you don't know how to operate, and perform it blind like it had been in the olden days. These days, there are surgeons with incredible skills who are able to prevent the trauma of wide exposure surgery, and perform surgery under flouroscopic guidance, with knowledge of the anatomy involved, and with the ability to 'go open' and fix something if it goes wrong. Ali Khosroabadi needs no defense, but I offer one here in response to ill-informed but, I hope, well-meaning posts.

H. David Gottlieb, DPM, Baltimore, MD, hdavidgottliebdpm@gmail.com

RE: Staff Performing Routine Foot Care
From: Robert Spalding, DPM

In response to Dr. Plon’s comments, I would like to share my opinion. More and more health practitioners are benefitting from force multipliers in the form of assistants to expand their practice, so must podiatry. An assistant who performs certain tasks well makes a practice more efficient. And an assistant who can work for cash services in place of you makes you more profitable, period.

When I see podiatrists going from bed to bed in nursing homes “professionally treating” or...

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

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ASSOCIATE POSITION - BEAUTIFUL VICTORIA, BRITISH COLUMBIA CANADA

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ASSOCIATE POSITION - TEXAS

Dynamic, busy practice in Dallas/Fort Worth area, seeking surgically trained, Board Certified/Board Qualified Podiatrist, PSR-36 preferred. Excellent salary and benefits compensation package, for the right candidate, who is motivated to work hard. Contact/Send resume to: jmh6122@yahoo.com

PODIATRIST NEEDED: NYC/QUEENS IMMEDIATE OPENING!

P/T Leading to full-time and partnership. PSR-36+ Min. Three office locations; NYC, ASTORIA & SUNNYSIDE QUEENS. All phases of podiatry; including Med., Forefoot, Rearfoot & Ankle SURGERY. Modern offices with all the Hi-Tech. equipment available. Candidate MUST have the skills & knowledge expected, ambitious, hard-working, ethical, detail-oriented and organized. A vibrant patient and staff-friendly personality a MUST! Good base salary, malpractice and % bonus incentive. You should easily surpass your bonus %. Reply with cover letter and C.V. to hansfeet@aol.com.

ASSOCIATE WANTED - MANHATTAN AND NORTHERN NJ

For group practice. Excellent opportunity to be the first podiatrist to join our team! PT/full-time negotiable. Convenient on-site surgical center. Current licensure in NJ and/or NY required. Call Gina 212-223-0716 or email CV to gina@premiersurgicalpavilion.com

ASSOCIATE POSITION - CENTRAL FLORIDA

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ASSOCIATE POSITION - PENNSYLVANIA

Associate Wanted for busy, multifaceted podiatry practice in Chester and Delaware counties, Pennsylvania. Seeking PSR-24/36 trained podiatrist for full/part time associate position. Two offices and hospital privileges. Send CV and letter to 123bunion@gmail.com.

ASSOCIATE POSITION - BAKERSFIELD, CA

Office and hospital-based podiatry group seeking a highly trained surgical associate to compliment our 3-doctor group. Minimum PSR-36 trained with rear-foot reconstructive experience required. Must have CA license and x-ray and fluoroscopy license. Previous practice experience is preferred. Competitive salary and benefits package. Please forward cover letter and CV to modpm@aol.com

WANTED: ASSOCIATE PODIATRIST  - ILLINOIS

4 Days per Week Chicago Practice - will perform all phases of podiatric medicine Accredited JCAHO Surgical Suite. Benefits will cover Malpractice and Health Insurance. Six Figure Base Salary. Inquiries Contact:  Dr. J. B. Jenkins - 773-374-5300

ASSOCIATE POSITION - KENTUCKY

Immediate opening in beautiful Southern Kentucky with 8-provider group with excellent reputation, full-time physical therapy, MRI, CPED/CO on staff along with a full schedule awaiting.  Wonderful place to raise a family, excellent schools and phenomenal quality and cost of living. Excellent compensation package, full benefits, and buy-in opportunity after 2 years. Email a letter of interest and CV: jonkim12000@yahoo.com

ASSOCIATE POSITION - WASHINGTON, DC/ MD SUBURBS

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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 - NASHVILLE TENNESSEE

Want to live and practice in the "It City" Nashville, TN? ISO  well-trained (PSR-36) individual. Located in suburb of Nashville. Hospital and Surgery Center privileges. Rearfoot and Ankle allowed. Base pay, bonus incentives, and benefits. Send resume to Mendozadpm@comcast.net. $1,000 finder's fee paid to referring individual with hiring.

ASSOCIATE POSITION – VIRGINIA
 
Established private practice, foot and ankle reconstruction and trauma management, strong referral base, ED trauma call. Hospital and surgery center privileges. Two locations with modern offices. ABPS qualified or certified. Competitive compensation package. Potential for position to lead to partnership. To apply, please email a letter of intent and CV to: vaposition@yahoo.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. 

SPACE AVAILABLE - NYC & LI

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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 - CHICAGO

Three-office practice; newly furnished; all offices are within 20-30 min of driving; great for one Dr. coverage; well-rounded surgical/diabetic/sport medicine practice; grossing up to $500K/year; can be purchased with real estate or separately. only serious inquiry to dpms2@hotmail.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 - 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

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