The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

June 28, 2010 #3,895 Publisher-Barry Block, DPM, JD

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Avoid Wearing Flip-Flops for Prolonged Periods: MI Podiatrist

They even sound like their name. What could be more fun than a flip flop? "There's dos and don'ts with flip-flops. I think that they're okay to wear at certain times, but you do not want to be wearing them for a prolonged period of time. They do not give your feet any support," Dr. Shawn Rieser cautioned.

Dr. Shawn Rieser

Not only do they give less support, Rieser says flip-flops can actually make your feet work harder than they have to. "So you end up straining muscles and tendons because you grip the ground with the toes, the end of the flip-flop. You grab and then you change your stride length so then you walk differently. And so you can get heel pain, shin splints, you can get heel pain, arch pain blisters, things like that."

Source: Leslie Toldo, WJRT [6/24/10}

Armstrong Decries Loss of Medicaid for Podiatric Care in AZ 

Arizona's poorest residents are about to lose coverage for foot care, which will put diabetics in greater danger of losing limbs, some health providers say. "Someone looking at a spreadsheet might see a few million dollars and their impression of podiatry is hammertoes and bunions ... but most of us are a gateway for diabetic patients with foot problems," said University Medical Center researcher and podiatric surgeon Dr. David G. Armstrong, co-director of the Tucson-based Southern Arizona Limb Salvage Alliance. The alliance works through clinical care and research to improve foot care among diabetics and to prevent amputations.

Dr. David G. Armstrong

"I can only begin to empathize with the folks on the AHCCCS panel deciding who gets what funding. But this cut shows an astonishing amount of myopia," Armstrong said. "This is eliminating preventive-care visits for people with diabetes. It's not like someone else is going to do this kind of care. The most common reason people with diabetes end up in the hospital is a foot problem." Armstrong's UMC clinic records about 13,000 patient visits per year, and slightly more than one-third of the patients are enrolled in AHCCCS.

Source: Stephanie Innes, Arizona Daily Star [6/26/10]

Region IV Mid-Eastern Scientific CME Seminar Breaks Attendance Record

The APMA Region IV (OH) held its annual scientific program that opened to record registration on Thursday, June 3. Scientific Co-Chairs were Dr. Jeffrey Robbins and Dr. Jordan Grossman. The scientific program, presented by nationally recognized speakers, consisted of surgical and non-surgical topics, as well as tracks on practice management, pathology and MRI.

Silver Gavel Luncheon attendees included: (L-R) Drs. Peter Wiggin (2006), John Buchan (1959), William Munsey (1963), Jerry Ferritto (1992), Marchelle Suppan (1994) and Student Derek Pantiel, scholarship recipient.

The APMA Regional Lecture Series on PAD and pain management were presented on Saturday. Highlighting the event was the meeting of 23 past presidents of OPMA, known as the Silver Gavel Club. They hosted Derek Pantiel, the APMSA President and an OCPM student, who was the first recipient of the Club’s Parliamentary Procedure Leadership Scholarship for 2009.

CMS Proposes 6.1% Cut in Medicare Payments to Docs for January  

Physicians would receive a 6.1% cut to their Medicare payments starting Jan. 1, 2011, under a proposed rule issued by the CMS. That reduction would be in addition to a projected 23.5% cut that is scheduled to take effect Dec. 1, provided that Congress doesn't act to change it. The proposed rule's creation follows a tumultuous debate on Capitol Hill over Medicare's sustainable growth-rate formula. The SGR formula has called for payment cuts to doctors for years, with Congress stepping in intermittently to stop the reductions.

The latest intervention came on June 24, when the House approved legislation to replace a 21.2% Medicare physician pay cut with a 2.2% raise through November. The measure was swiftly signed into law. If Congress doesn't act later this year, however, that 21.2% cut will reappear on Dec. 1, a CMS spokeswoman said. Taking into account the 2.2% increase physicians will receive through November, the net result will be more like a 23.5% cut, she said.

Source: Jennifer Lubell, Modern Healthcare [6/25/10]

Query: MAC (Apple) EMR System

Is anyone using a MAC (Apple) EMR system? If so, what system? How does it compare to Windows-based systems in terms of features, ease of use, and cost?

Alan Mauser, DPM, Louisville, KY

RE: Integretive Podiatric Medicine (Daniel Grapel, DPM, Arnold B. Wolf, DPM)
From: Dennis Shavelson, DPM, Bob Kornfeld, DPM

Editor's Note: This topic has been closed. To read the letters from Dr. Shavelson and Kornfeld, click here.

RE: Mystery Shoppers  (Chad Schwarz)
From: Dwight L. Bates, DPM

When I was in practice, I routinely used mystery shoppers. I had various personal friends make and change appointments on the phone, and behave deliberately difficult. Also, I had friends posing as real patients come to my office and go through the whole patient experience. Later, I told each office employee exactly how they had been graded. If they graded well, I gave them a small gift. If they performed poorly, I counseled them. If the same office employee graded poorly twice, I fired her. The mystery shoppers cost me almost nothing. My employees seemed to actually enjoy the experience. 

Dwight L. Bates, DPM, Dallas, TX, dlbates04@yahoo.com

RE: Medicare Fee Reversal
From: Peter Smith, DPM

I was so excited to hear that I was NOT getting a 21% pay cut that I immediately called my landlord to share the good news. I also told him that because of all of the politicians' ineptness, uncaring, and downright repugnant delaying of this decision, I would not be receiving any Medicare checks for June services until early/mid July, and therefore, my rent check would be understandably late. I asked him where he wanted to meet to celebrate my good fortune, but he just said, "Late fees begin to accrue on the 6th of the month," and hung up! I wonder why he was in such a bad mood?
 
Peter Smith, DPM, Stony Brook, NY, ps84@bc.edu

RE: The Super Group Practice Model, How Do I begin? (David Helfman, DPM)
From: Edmond F. Mertzenich, DPM

Dr. Helfman is very correct in recommending good counsel to get a super group going. Getting a group together is more than just cobbling together a few doctors and having a management organization help you. Doing a venture on the cheap is doomed to years of frustration, at the least, and frequently failure.

Instead, it needs to build around a team concept. There needs to be a mission and a vision statement. Systems need to be in place to make sure the staff is trained and coordinated. A marketing concept is needed to spread the good word about your organization. These are just a few of the things that need to be looked into.

The key is to make sure that everyone functions like a team. They have to be like the sled dogs of the Iditarod Great Sled Race. All the dogs, and the musher, are pointed in the same direction to reach the goal.  The team cannot be like a herd of cats (which do their own thing).  In the business world a herd of cats will fail.

Edmond F. Mertzenich, DPM, MBA candidate, Rockford, IL, doctoreddpm@verizon.net

RE: Retail Custom Orthotics
From: Jeffrey Conforti, DPM, Paul Liswood, DPM
 
There is NO way that stepping on a pressure plate, or standing in a foam box can give you a properly fitted orthotic. The pressure plate cannot measure the height of the arch to give you the support needed regardless of the 'algorithm' used, and standing on a foam impression box puts your foot in the exact pronated position that you do not want. Sitting, with the STJ held in the correct position, and locking the midtarsal joint while pushing the foot into foam, however, will give you a correct cast.
 
Patient education is the key. We explain to our patients that a foam Dr. Scholl product will just collapse under body weight, and then we show them a sample custom orthotic to evaluate the rigidity. We also have them try on a good pre-made orthotic like the BodyTechLab devices that I am a consultant for to see how it helps them. This education helps us dispense about 20 pairs of orthotics per week.
 
Jeffrey Conforti, DPM, Clifton, NJ, jconfortiusa@yahoo.com

I would like to compliment Mr. Kraus of Langer labs for his excellent article regarding how podiatrists are losing the market share of orthotics to retail stores and orthotists. I applaud him for pointing out the importance of biomechanical evaluations and doctors prescribing high quality devices. I know that Langer has always believed in quality biomechanics preformed by a podiatrist as the best way to make an orthotic.

I recently had an experience where a patient of mine told me that she was leaving my office to go to a shoe store for orthotics. She said she got a pair last year from the same store and was very happy. I asked her to show me her orthotics and she pulled out a gorgeous pair of Langer orthotics. Could this be true? Is Langer getting into the retail orthotic business that Mr. Kraus cautioned us about in his excellent article? How can a podiatrist build a relationship with an orthotic lab when that lab is doing business with shoe stores? How can I tell my patient that the orthotics that  I dispense are superior to the ones from the store, when the store is dispensing terrific Langer orthotics? 

Paul Liswood, DPM, Brooklyn, NY, dr.liswood@verizon.net

PRACTICE FOR SALE – NORTH DAKOTA

Established practice grossing over $460,000. One doctor, 24 to 30 hours per week. Minimal surgery at present. Hospital privileges available. No nursing homes. No Medicaid. 22% Medicare; balance primarily BS/BC, private payers. Turn-key. Surgical patient base if buyer wishes to cultivate to readily augment income. EMR in Place. ndfoctdoc@hotmail.com

PRACTICE FOR SALE - MINNESOTA

Practice Grossing over $500K yearly. Good mix of surgery, orthotics, DME, diabetic care, general podiatry. Commute < 5 miles to work. Friendly Midwest lakes area with arts, good schools, affordable living, restaurants, shopping. Option to purchase building. Will consider associate to buy-in/ buy-out. Midwestpractice@gmail.com

CANADIAN PODIATRISTS COME BACK HOME!

An Edmonton, Alberta group of DPM’s requires an additional Podiatrist. Interest in biomechanics essential. Given Canadian visa restrictions, this position is open only to Canadian Citizens or permanent residents. Very attractive compensation package. Fax C.V. or letter of interest to: (780) 483-5796.

ASSOCIATE POSITION - BRITISH COLUMBIA

Beautiful Victoria British Columbia, on the ocean, fast growing area. Associate for multi-office full scope practice. Interviews at APMA meeting in Seattle July 15-18 Reply to dr.cole@shaw.ca or phone 250-516-7440.

ASSOCIATE POSITION - FREDERICK, MARYLAND

Fredericks premier group practice is located only 45 minutes from both DC and Baltimore. Immediate opening for a minimum PSR 36 Podiatrist for full time position. We have it all: EMR, digital x-ray, ultrasound, ASC, etc. Excellent salary with bonus structure and benefits. Please email resume to docsbnb@aol.com

ASSOCIATE POSITION - SOUTHERN CALIFORNIA

Full-time 3-DPM group in South Bay of LA County. Minutes from best living in LA County. Practice is an excellent mix of surgery, general podiatry, diabetic care, and DME. Beautiful office with EMR, Digital X-ray and Orthoses, etc. Please e-mail cover letter, and resume to footcareone@verizon.net

PODIATRISTS NEEDED NATIONWIDE

Seeking a part-time or full-time podiatrists to provide podiatry house call and diabetic shoe fitting services to patients nationwide. We are a podiatry management company and have contracts with clients that have 1,000’s of established patients and all we need are hard-working good doctors to service them. We offer an excellent compensation package with benefits and the opportunity to build a fairly large practice very quickly. coasttocoastpodiatry@yahoo.com

PRACTICE FOR SALE – MAINE

25 year full scope in medical building, podiatrist friendly hospitals, appreciative and cooperative patients, excellent expansion potential, physician referrals. Wonderful place to raise a family. Retiring seller will stay for transition. mainefootdoc@yahoo.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

TN PRACTICE FOR SALE (SOUTH OF NASHVILLE)

Active, established practice with new equipment (digital x-ray, ultrasound, computer network, etc.). Great referral network with an excellent scope of practice. Turn-key operation with seamless transition. Grossed over $350K last year. Call 931-446-5724 or e-mail mchad500@gmail.com

ASSOCIATE POSITION – COLORADO

Excellent opportunity to grow and expand a practice in the northern front range, Great compensation package with buy in potential. Desire individuals with motivation to succeed and grow professionally, Please fax CV and letter of interest to; 970-351-0940.

ASSOCIATE POSITION – LOS ANGELES AREA

Busy podiatry practice in South Bay, Los Angeles area looking for associate podiatric physician. Part-time initially. Good opportunity for young or established physician looking for additional work, income. Well established practice, large patient base, competent staff. Please send CV, respond to berstein.david@gmail.com

MANHATTAN MEDICAL SPACE AVAILABLE

Multispecialty Medical Building with 24/7 doorman. Prime Luxury Building and Location, Gramercy, Stuyvesant, Peter Cooper Area. 305 Second Avenue (17th-18th). Prior tenants past 23 years; podiatrist, dentist (plumbing/electric intact), internist. Ideal for podiatry, co-share with dentist, MD, etc. (flexible lease terms). E-Mail; jbdrun@aol.com Phone; 480-951-2480.

ASSOCIATE POSITION - SOUTHEAST GEORGIA

Beautiful weather year round & near the Coast. Opportunity for Early Buy-in. Seeking associate or new residency graduate to join practice. Must be PSR-24/36 trained. Multiple locations. Full range of services with new facilities. E-mail cover letter & CV to melissafoot@pol.net

LIMB PRESERVATION RESEARCH AND SURGICAL FELLOWSHIP

Boston University Medical Center offers a unique fellowship position. Be part of this unique opportunity at a major internationally-known teaching medical center. During this time, he/she will become a knowledge expert who will contribute significantly to research, surgical procedures, teaching, and innovations in limb preservation and tissue repair. Requirements: Completion of a two or three year surgical residency; Annual Salary: Year 1 $61,000, Year 2 $66,000 plus excellent benefits. Submit a CV and letter of interest to: Erin Springhetti @ erin.springhetti@bmc.org and Dr Vickie Driver @ vickie.driver@bmc.org

ASSOCIATE POSITION – LONG ISLAND 
 
Busy Bellmore, NY office. Motivated, board certified, hard-working, experienced in all phases of podiatry. P/T hours available. excellent salary, call 516 242-7540 or Fax Resume 516 826-9036 or email jobke@aol.com

ASSOCIATE POSITIONS – TEXAS

Full-time podiatrist(s) needed in Austin or San Antonio. Current Texas license required. Unique mobile podiatry practice. Better pay, fine working conditions with excellent support staff. Check out our website www.footmobile.com. Reply to footcenter1@sbcglobal.net

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