The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

July 02, 2011 #4, 196 Publisher-Barry Block, DPM, JD

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Thin Rubber Flip-Flops are the Worst: IL Podiatrist

Summer's hot weather and casual sensibilities make it difficult to summon the will to go through the socks-and-shoes routine, making sandals seem more appealing. But allowing your feet to breathe can come at the price of injury. CBS Pittsburgh had a podiatrist try out summer footwear and evaluated the damage it did to his dogs.

Dr. Neal Frankel

He offered a damning analysis of flat rubber flip-flops: “"These are the worst," Dr. Neal Frankel says. "Number one, they're very flimsy; there's no support whatsoever. Number two, they're made out of rubber — so they're very hot. There's no breathing at all." Tendonitis, blisters and rashes can all result from sandals. And since plastic straps can pinch your feet, the podiatrist advises going with leather or fabric.

Source: Phil Villarreal, CBS Pittsburgh [6/29/11]

Bad Feet Leads to 50 Year Marriage of CT Podiatrist and Wife

Fredricka Goldstein's bad feet helped lead her to her future husband. When "Freddie" was a young child on Long Island, NY, a doctor recommended she get orthopedic shoes. So she was taken to Stillman's Shoe Store in Huntington for her shoes. Years passed, during which, of course, Freddie periodically needed new shoes. One day, Mrs. Stillman made a suggestion to her son Lawrence Stillman, a student at Hofstra."Fredricka Goldstein is a nice girl from a nice family. Why don't you call her up and take her out?" This began a life-long romance. 

Dr. and Mrs Lawrence Stillman in 1961 and Now

The Stillmans just celebrated their 50th anniversary with lunch at their favorite restaurant, the Hopkins Inn in Washington. What advice can they share on having a successful marriage? "Communication is very important. Sometimes a loss of hearing acuity can avoid a host of problems," Larry joked. "Don't answer too quickly. Women never forget. Choose your words carefully and speak slowly."

Source: Carolyn Mueller, Stamford Advocate [6/30/11]

One in 10 Electronic Prescriptions Contains an Error: Study

Electronic prescriptions are as likely as handwritten ones to contain errors, according to a study from a group of Boston-based researchers. The study, "Errors associated with outpatient computerized prescribing systems," is published online in the Journal of the American Medical Informatics Association. The report is based on a retrospective study of 3,850 computer-generated prescriptions received by a commercial outpatient pharmacy chain in three states in 2008.

A clinician panel reviewed the prescriptions to identify and classify medication errors, potential adverse drug events (defined as those that might cause patient harm) and the rate of prescribing errors by prescription type and by system type. The researchers found at least one error in 11.7% of the prescriptions reviewed. "About one in 10 computer-generated prescriptions included at least one error, of which a third had potential for harm," the researchers wrote. "This is consistent with the literature on manual handwritten prescription error rates."

Source: Joseph Conn, Modern Healthcare [6/30/11]

RE: Obligation to Accommodate Hearing-Impaired Patient

A 40 year old deaf and mute patient was referred for onychomycoses and potential oral antifungals along with lab test monitoring. He is emphatically demanding a certified American sign language interpreter. We are having trouble locating such an individual, but were advised to expect a rate of $170/per visit.

Obviously,with numerous visits, the costs will run into the hundreds of dollars, with our reimbursements being a fraction of that. Do we have any rights or help regarding this situation ? The patient is dual eligible for Medicare/Medicaid.

Name Withheld

Editor's comment: PM News does not provide legal advice. The Americans with Disabilities Act requires that the practice provide these services at no cost to the patient. This is a federal, not a state law, and insurance does not cover interpreters. The law applies only when a hearing-impaired patient requests such services. Failure to comply with this law can result in hefty fines.

The latest guidance from Health and Human Services says that while the requirements apply to a black-and-white issue, the reasonable steps a physician, practice, or institution may be required to take are somewhat gray. "Smaller recipients with more limited budgets are not expected to provide the same level of language services as larger recipients with larger budgets," HHS stated. "Reasonable steps may cease to be reasonable where the costs imposed substantially exceed the benefits."

Barry Block, DPM, JD, Forest Hills, NY, bblock@podiatrym.com

Query: Signature Log

I hand-write my records and initial them. Does a signature log have to be signed by a notary?

Alan Gitersonke, DPM, Granite City, IL

Response: I know of no law that would require that the signature in a physician's log needs to be notarized. The important elements are the signature and date.

Barry Block, DPM, JD, Forest Hills, NY

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RE: Failed Keller (Judd Davis, DPM)
From: Robert S. Schwartz, CPed, Jefferson J. Mennuti, DPM

While you’re deciding on surgical revision, try a metatarsal rocker sole with the apex just proximal to the 1st met head. Twenty degrees of dorsiflexion should be enough to off-weight the 1st met and assist propulsion. A longer shoe with a high toe-box is also indicated.

Robert S. Schwartz, CPed, NY, NY rss@eneslow.com

This is a classic board-type question. Answer: the surgeon was heavy-handed with the saw, and cut the FHL. A primary repair may bring the hallux back down. However, I am quite sure the tendon has retracted! If there is a significant gap, consider a graft. But of course, if this was a board exam, the correct answer would be fusion.

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

RE: Call for Practice Management Preceptors
From: Hal Ornstein, DPM

As many of you know, the American Academy of Podiatric Practice Management (AAPPM) is working hard to provide a meaningful experience to the graduates of our podiatry schools who have not been matched in a residency program this year. We have created the Practice Management Preceptorship (PMP) that will place a graduate in a private practice setting to learn how to effectively and properly run a practice. This will also help to increase the chances of getting a residency next year.  We understand that this preceptorship program is not a solution to the residency shortage, but at least it gives these graduates an opportunity while applying for a residency next year.
 
We have received an incredible outpouring of support from practitioners across the country to open their doors and hearts to these graduates. Unfortunately, finances do not permit many of the graduates to relocate for the PMP experience.
 
You do not need to be a member of AAPPM to participate. Please step up and help our young colleagues. To learn more about the PMP program, please visit our aappm.org or contact Shawna at swyatt@aappm.org to sign up and to get information. Thank you!
 
Hal Ornstein, DPM, Howell, NJ, toetoe@optonline.net

RE: Where Is Organized Medicine? (Robert Kornfeld, DPM)
From: Arden Smith, DPM

Driving to my office today, I was inundated with very powerful radio ads from the nurses union because they might have to contribute a little bit more for their health insurance. The thrust of the ads...they work hard, they save lives, they sacrifice, AND they have families and "have to live and pay bills."

During my [5 minute] lunch [a cup of coffee], a NY Post headline caught my eye, "Teachers sue over new state ratings system." Heck, they want us to walk around like baseball cards with our stats on our backs, and we say, "beat us some more."

I can't think of any other group of professionals, or any workers for that matter, who work the hours that doctors work under...

Editor's Note: Dr. Smiths' extended-length letter can be read here.

RE: The Passing of Howard Marshall, DPM
From: Hal Ornstein, DPM

As a senior at the Ohio College of Podiatric Medicine, I was one of the fortunate students to do my final year of school at the southern campus of the California College of Podiatric Medicine. Most of this program was taught by Howard Marshall, DPM. He was such an excellent and passionate educator. He would often make us all laugh, but at same time, he got his point across, providing a unique and valuable educational experience. I so looked up to Dr. Marshall. He taught me and other students that being a physician was all about taking care of people. He has touched and changed the lives of many, and his family should know the true giant he was in our profession. God bless.

Hal Ornstein, DPM, Howell, NJ

RE: A Real Pain in the Neck (Calvin Britton, DPM)
From: Gino Scartozzi, DPM

Dr. Britton's photograph of this "palliative-induced" injury certainly justifies a workers' compensation claim and also makes for an innovative podiatric technique for a tracheotomy!

Gino Scartozzi, DPM, New Hyde Park, NY, Gsdpm@aol.com

RE: Wait Until My Wife Hears About This

Yesterday, I was treating a patient for heel pain. Upon reviewing his recent x-ray with him, I explained that although he did not have a heel spur, the pain and swelling was due to little micro tears of the ligament pulling away from the bone. Before the patient left, he turned to me and said, “I will have to explain to my wife about my foot. What did you say about the micro sperm?

Joan Sciller, DPM, Euclid, OH

TURN-KEY PODIATRIC OFFICE - CALIFORNIA

Fully equipped modern suite with built-ins at Mission Regional Medical Center, Mission Viejo CA. Four treatment rooms, New Midmark chairs, x-ray/processor, phone system & much more. $45,000/assume lease. Call Jackie, 949-493-8020.

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 516 476-1815 PODO2345@AOL.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 emailcontactus@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 $760K, most surgery is currently being referred out. Financing available. Please call 800-983-4194, or email contactus@podiatrypracticeconsultants.com

PRACTICE FOR SALE - NANAIMO, BRITISH COLUMBIA, CANADA

Have you ever dreamed of owning a practice where... you can see 0-50 patients daily .. .average 100 new patients monthly have zero accounts receivable ... gross $480 M per year .... live in a beautiful community with skiing, hiking, fishing and boating on your doorstep. This could be yours! If interested contact pistone@telus.net or 250-754-4192.

PRACTICE FOR SALE - MISSOURI

Well established, but still growing. Grossed over $300,000 last year. Located in a thriving medical community. Good payer mix. All aspects of podiatry needed in the area. Do not let this opportunity to own your own practice pass you by. Contact footdoc2002@yahoo.com for more information.

PRACTICE FOR SALE - MISSION VIEJO, CA

Relocating to Tulsa. Great opportunity. Located at Mission Regional Hospital. Sale price $205,000 including supplies. Gross income 2010 was $340,000. Gross income 2011 estimate $420,000. Approximately 1200 sq ft with 3 treatment rooms, digital x-ray and fully computerized. A/R available at 50% discount. 949-702-1052. David Stoller, DPM (Family Footcare)david@missionviejofootcare.com

ASSOCIATE POSITION - SAN DIEGO

Well-established practice is seeking an associate with the opportunity for a future partnership position. Great location and medical environment. Must have a California license and an interest in the full range of podiatric services. Please email resume and cover letter to ethuen@hotmail.com

ASSOCIATE POSITION/PART TIME - ORANGE COUNTY CALIFORNIA

Experienced podiatrist - 2-3 days/week, two office locations in beautiful south Orange County California. Exceptional opportunity for seasoned semi-retired practitioner. Fax or e-mail Resume and LOI to 949-488-0868 Info@feetfixer.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 - CENTRAL NEW JERSEY

Seeking associate for busy, growing practice located in Toms River, Ocean County. Looking for PSR 24/36, board eligible doctor. Basic podiatry a must. Practice has a up-to-date EMR and practice management program. Digital x-rays, ultrasound, laser, vascular studies. Excellent opportunity for highly motivated and ethical DPM. Send CV to toesec@aol.com

ASSOCIATE POSITION - SOUTHEAST GEORGIA

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 - 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

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