The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

July 13, 2010 #3,908 Publisher-Barry Block, DPM, JD

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Barefoot Runners are Asking for Trouble: MO Podiatrist

“Barefoot running is definitely becoming more popular,” admits podiatrist Louis Aquino of Foot and Ankle Center. “The concept is good, but I disagree entirely with the reality.” He is a firm believer in orthotics (prescription arch support inserts) for correcting deficiencies in foot function, and says the reality of starting to run barefoot after years of wearing shoes is asking for tendonitis, plantar fasciitis, and stress fractures.

Dr. Louis Aquino

Aquino thinks running, in general, is an overuse of the foot. “It’s great cardiovascular exercise, but it takes its toll on the feet, bones, joints and the lower back,” Aquino says. “In early childhood, beginning walkers use the bare foot as a sensory organ to help them learn their place in space. Once that is accomplished, shoes should be worn. Anywhere you go, there are hard surfaces, and runners can’t run on those surfaces without consequences.”

Source: Mary Jo Blackwood, RN, MPH, Ladue News

NY Podiatrist Announces Candidacy For State Assembly Seat

Dr. Harold Paez, a podiatrist from Far Rockawy, is running for the 23rd Assembly District seat in Queens, NY. Paez, vice president of the Rockaway Republicans has the support of the Southern Queens Republican party, the Conservative party, and most likely, the Independence party. He also has the support of Councilman Eric Ulrich, who recently won in this politically-active district. Paez believes that this is a winnable seat, and with the support of New York State podiatrists, a podiatrist can be seated in Albany in 2011.

Dr. Harold Paez

Dr. Paez outlined a growing concern with the expanding size of the state and federal government. He cited a case in Idaho where a group of orthopedists have been indicted on conspiracy charges by the Justice Department under the direction of Attorney General Eric Holder. Dr. Paez cites this case as an example of the federal government over-reaching into the private sector by forcing medical practitioners to accept government mandated price controls or face criminal charges.

SD Podiatrist Reachs Out to Patients in Area Towns

Dr. Chad Stapp, an Aberdeen podiatrist, travels to Bowdle and Roscoe twice a month and Faulkton and Redfield about once a month. He started hitting the road “three years ago when I started my practice, just to increase patient load,” Stapp said.

Dr. Chad Stapp

But he has continued it. “It's a good service to provide to the smaller communities (and) give support to the smaller hospitals as well, too,” Stapp said. The downside is being away from his Aberdeen office. “But still I go there because I've been going there. It's just kind of nice to service those areas.”

Source: Jeff Bahr, Aberdeen News [7/10/10]

Editor's Note: PM News is proud to present excerpts from Meet the Masters.

Bret Ribotsky: What would you do to change the curriculum of the podiatry schools?

Dr. Paul R. Scherer

Paul Scherer: Number one, more research methods need to be instilled in students. They don't need to learn how to do the research, but how to evaluate the research. I do not think we do enough of that, and we are just starting now.

The second thing is to educate the educators. We have people in our schools who have educational faculty positions because of their reputation, and maybe because of their skills, which is good, but they may not know how to teach. I know that at the California School at Samuel Merritt they have just begun to send their faculty to learn education. This is an old idea that happened in Southern California in the late '70s and early '80s, but died. I think it is vitally important that we educate our educators (on how to teach).

Dr. Steven Kravitz

Meet the Masters is broadcast each Tuesday Night at 9 PM (EST). This week's show features Dr. Steven Kravitz, executive director of the American Professional Wound Care Association. You can register for this event by clicking here

Health Plans Process 1 in 5 claims Incorrectly: AMA Study

Nearly 20% of all claims processed by health plans have errors, costing the healthcare system billions each year, according to the American Medical Association's third annual National Health Insurer Report Card. With about $210 billion spent on claims processing annually, the study found claims to be costly. The healthcare system could save $15.5 billion each year if the industry's accuracy rate improved to 100%. Each percentage point improvement would save about $777 million, the study said.

Additionally, eliminating the time spent on claims processing red tape, which has been estimated to be the equivalent of five weeks annually, would give physicians more time to spend on direct patient care. The blame for this 20% error rate lies mostly with the complexity of the system and a lack of streamlining among payers, according to the report card, which looked at claims errors for the first time.

Source: Pamela Lewis Dolan, AMNews [6/28/10]

Protect Your Productivity

Wait until 11 a.m. to look at your e-mail messages each day. If you open them first thing in the morning, you waste your most productive time of the day.

Don’t worry—anyone who sent you urgent messages will call to follow up.

Source: Adapted from How to Succeed in Business Without Trying So Damn Hard, Robert Kriegel, Warner Books via Communication Briefings.

RE: Osteochondroma (James W. Clark, DPM)
From: Gino Scartozzi, DPM, C. Reilly, DPM

It has been my experience that these lesions (osteochondromas or exostoses cartilaginea) are usually present at the dorsal and distal aspect of the distal phalanx of the hallux. They usually have a traumatic etiology or in rare cases have a familial link. The term "enchondroma" or "chondroma" designates a benign tumor in the substance of a bone with cortical expansion/encroachment of the surrounding bone.

Surgical excision would be accomplished with pre-operative avulsion of the toenail prior to surgical prep while the patient is under IV sedation. A "fish-mouth" or transverse skin incision just plantar to the nail bed can be done. Blunt dissection of the distal phalanx via periosteal elevator of the dorsal and distal aspects of the distal phalanx is then performed. Resection of the tumor is then accomplished via bone nippers. 
 
Gino Scartozzi, DPM, New Hyde Park, NY, gsdpm@aol.com

This is more likely a sub-ungual osteochondroma, a benign tumor common in this age group. The treatment, based on the image, would be partial removal of the overlying distal nail plate, transverse incision to bone/cartilage, and aggressive resection of the cartilaginous/bone mass (to metaphyseal bone). The overlying nailbed/skin may not be amenable to primary closure (scary, but will heal very nicely). Therefore, apply a gelfoam plug, adaptic, antibiotic, and compression dressing. The wound will heal and the bone will remodel leaving minimal or no disruption for a normal recovery and nail growth in this case. Mother Nature takes over and, in most cases, the toenail/distal phalangeal tuft will heal and appear normal. Pearl: Don't be afraid of aggressive resection in this age group.
 
C. Reilly, DPM, Chicago, IL, pododoc1@msn.com

RE: Digital Scanners for Orthotics (Kenneth Meisler, DPM)
From: Charles Morelli, DPM, Chad McDaniel, PhD

Some of you may be missing the big picture when it comes to digital scanning. I am sure many of you know that a number of these companies that accept digital images do not make a "custom orthotic" but rather they "customize" a pre-fab shell. Did you know that?  Now for all I know, this might be the best way to make an orthotic, but what it is not is a custom device that has been made from scratch. Should we be spending anywhere between $4,000-$8,000 for a scanner that then does nothing more than provide an image that a computer will place up against a pre-fab "thermopressed polypropylene shell" to see which one will be the closest match; and then the lab will add the appropriate posting based on the values you write down on you prescription form?  And, they use a material that is softer than most, which means that they are probably making more of an accommodative device, rather than a functional one. So, where's the custom device?
 
I know there are labs that accept digital scans and do, in fact, make a custom device from scratch. What bothers me is that they tell you that they are doing one thing, when in fact, they are doing another. It's all about full disclosure, so make sure you ask. If you don't mind spending thousands of dollars on a customized pre-fab that you will charge hundreds of dollars for, then this is right up your alley.
 
Charles Morelli, DPM, Mamaroneck, NY, podiodoc@gmail.com

As a podiatric digital scanner developer, I want to concur with and re-emphasize the "watch for" points that Dr. Jeff Root enumerated in his recent comments on digital scanning in podiatry, comments he made in response to Dr. Meisler's earlier, positive, report on the use of the plantar foot scanner that my company has developed.

My company, Envisic LLC, started development of our VeriScan scanners more than 10 years ago. From the beginning, we wanted to be able to build scanners that...

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

RE: Internet-Based Software Systems (Tip Sullivan, DPM)
From: Elliot Udell, DPM

The government wants all physicians to have Internet-based electronic medical records systems. Its goal is to be able to link all systems over the Internet, so theoretically, a physician seeing a patient in Seattle will be able to access the patient's prior medical records which may have been generated in a doctor’s office in New York City. Once this system gets going, there will be more software needed to link the different systems to each other. This too will entail expense.
 
Because the EMR business is extremely volatile and no one knows for sure what demands the government will make on us to get the stimulus money, the wisest approach might be to go with a system that is either free or close to it. One such system is called practicefusion.com. 
 
Elliot Udell, DPM, Hicksville, Elliotu@aol.com

RE: Podiatry’s Limited License (Russell F. Trahan, DPM, Bryan Markinson, DPM)
From: Thomas Brosky, DPM, Noah A. Blumofe, DPM

One of the problems I see is that we still don't have mandatory post-graduate education. Until we make it mandatory to do a 3-year surgical residency, we will not evolve. The discussions of flip-flops, shoes, and padding are reflective of this problem. Let’s face it; we are our own worst enemy. The quality of surgical residency training is the only way to begin to change the public's and medical community’s perception of podiatry.

Thomas Brosky, DPM, Oakwood, GA, drbrosky@gmail.com

I agree with Dr Markinson. We should be celebrating our skills and successes, not lamenting on our "failures and defects." I just spent the better part of nine months trying to get a non-adherent patient’s plantar wound closed. I worked around...

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

RE: Arrested Podiatrists  (Bryan C. Markinson, DPM)
From: Bret M. Ribotsky, DPM

I believe Bryan has hit a nail on the head with his linguistic hammer. It’s time to stop the bitching and give up the "story" of why the (fill in the blank) is stopping you from having abundant riches and the life that you have dreamed about. For the past year, each week on Meet the Masters, your colleagues have given you the keys to the kingdom. Each of the 48 Masters, so far, have shown you how to excel, regardless of the type of practice you have. Strategies on how to deal with the current market and how to thrive are in each free hour lecture. For example: how to develop a research aspect to your practice and earn an additional 100K a year, how to market your practice and gain at least 20 additional new patients a month, how to add new revenue streams to your practice, etc. And all of this value is there for you for FREE. 

If you are one of the 43% who are earning under $75K a year and you are not taking advantage of the free mentoring at PodiatricSuccess.com, then shame on you. Each of you had what it takes to graduate from podiatry school. I know that each of you can raise your income, once you lose the story of why you think you can't. People are here to help you. We have a great profession, with problems like all businesses.

Bret M. Ribotsky, DPM, Boca Raton, FL, ribotsky@yahoo.com 

RE: Discharging a Neo-Nazi (Richard Jaffe, DPM)
From: John McCord, DPM

I always had a high tolerance for the quirks of my patients, but zero tolerance for bigots and hate groups. I visited the concentration camps in Dachau and Terezin in my travels, which further deepened my intolerance of Nazis and so-called Neo-Nazis.

I had a patient who was falling apart due to diabetes and a rough life-style. He was an aging "biker." We established a good relationship as I struggled to keep his legs on him. He began showing up with biker symbols such as SS lightning bolts on his belt. He finally showed up one day wearing a ball cap with a swastika on the front. This was my limit. I closed the exam room door and told him I enjoyed talking with him, but I hated the Nazi party more than I liked him. I told him that he could still be my patient but if he ever came in wearing that Nazi crap again, I would only treat his feet but no more friendly visits or conversation. He apologized and I never saw any of his Nazi symbols again. He remained my patient until I retired.

Hate is a big and complex issue. I don't have the solution except to keep it away from my family and my practice. I also try to hate the ideology rather than the individual.

John McCord, DPM, Chehalis, WA,  jhmccord@yahoo.com

Editor’s note: This topic is now closed. No further letters will be published.

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

PRACTICE FOR SALE – MAINE

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

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

POSITION AVAILABLE - SOUTHERN CALIFORNIA 
 
Very well established, multiple location group practice has immediate opening for associate doctor. Attractive compensation and benefit package offered. E-mail resume to mrsmcmackin@aol.com

PODIATRISTS NEEDED NATIONWIDE

Podiatry referral company has thousands of diabetic patients nationwide in need of immediate service. We are looking for podiatry practices interested in joining our network to receive referrals. Email coasttocoastpodiatry@yahoo.com

ASSOCIATE POSITION - VIRGINIA IS FOR LOVERS

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

PODIATRIST NEEDED - BROOKLYN, NY

Position available for 2-3 days busy office in large medical group. HIP credentialed. email resume to hallux62@aol.com

PM News Classified Ads Reach over 12,000 DPM's and Students

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