The Voice of Podiatrists

Serving Over 14,507 Podiatrists Daily

July 20, 2013 #4,827 Publisher-Barry Block, DPM, JD

A partner of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2013- No part of PM News can be reproduced without the
written permission of Barry Block

Key to Treating Hallux Rigidus is Early Detection: VA Podiatrist

According to the American College of Foot and Ankle Surgeons, for those with the common degenerative disorder known as hallux limitus in its earlier stages, and hallux rigidus later on, everyday motion such as walking, stooping, and climbing stairs can be a struggle. The good news is that proper treatment can bring tremendous relief. "If you have this condition, your big toe hurts - but it doesn't have to," says Laurence Rubin, DPM, FACFAS, a foot and ankle surgeon in Richmond, VA. Rubin has seen numerous patients with pain in the big toe (called the hallux), and he notes that many of them have ignored the problem for years.

Dr. Laurence Rubin

"People with this disorder seem to suffer much longer than they need to," he says. "They're often pleasantly surprised when they find out their problem can be fixed. If we catch the condition early, we can relieve the symptoms by conservative measures, but if it has progressed to the point where the joint is destroyed, we have fewer conservative options," says Rubin.

Source: Health News Digest [7/15/13]

LAST DAY TO VOTE

Quick Poll
Would you use a Sears tool to replace a cast cutter if it worked as well??
Click HERE for Results

Lawnmower Accident Led to Career for MI Podiatrist

Dr. Luke Madsen knew as a high school student in Truman that he wanted to go into medicine, but a lawn-mowing accident when he was just a little boy helped steer him toward his career as a podiatrist. When I was young, I had a lawnmower accident with my foot. I needed more than 100 stitches. They basically put my foot back together," he said.

Dr. Luke Madsen with wife Sarah and their son Matthew

Madsen grew up on a farm between Fairmont and Truman and graduated from Truman High School in 1998. He excelled in the sciences, earning a full scholarship for his bachelor's degree. He took a couple of years off before medical school to work at the Mayo Clinic in Rochester in the operating room labs. "I saw a lot of aspects of medicine before I went to podiatric medical school," he said. He decided on podiatry, which brought him to the Detroit area for a three-year residency.

Source: Meg Alexander, Fairmont Sentinel [7/18/13]

High School Students Observe AZ Podiatrist Performing Surgery

Six seniors-to-be at River Valley High School are doing a little learning before the start of the school year next week. The six students  are participating in the M*A*S*H (Multiple Avenues of Successful Healthcare) program at Valley View Medical Center in Fort Mohave.

River Valley students observe surgery at Valley View Medical Center (photo: Cat Smith)

Student John McPhail watched eagerly as Dr. Scott Boggs, a doctor of podiatric medicine, worked on the patient’s foot to correct a bunion deformity. When asked what his thoughts were on the surgical procedure, McPhail said, “A lot goes on in the surgical room, and they work fast but efficiently when performing on a patient. I think this was a great way for our age group to get a feel of how a hospital functions, especially in the surgery department.”

Source: Cat Smith, Mohave Valley Daily News [7/18/13]

Query: PADnet Concerns

Our vascular surgeon who reads our PADnet results recently backed out because he felt that Medicare was no longer going to pay for reading or performing them. Does anybody know anything about this?
 
Gary S. Smith, DPM, Bradford, PA

Query: Coding Polydactyly Surgery 

What is the correct CPT code for removal of supernumerary toe and metatarsal in a 6 year old with post-axial polydactyly? I'm thinking CPT 28140 (removal of metatarsal) and CPT 28820 (amputation of toe). Is this correct?

Brandon Wilde, DPM, Pocatello, ID

Response: There are potentially 3 choices depending on the work done:

1) CPT 28341 - Reconstruction, toe, macrodactyly; requiring bone resection;
2) CPT 28344 - Reconstruction, toe(s); polydactyly;
3) CPT 28810 - Amputation, metatarsal, with toe, single.

Removing the metatarsal and toe is equivalent to a ray resection, so I suggest option 3 here, unless you do something differently.

David J. Freedman, DPM, CPC, Silver Spring, MD

Codingline subscription information can be found here

APMA Members: Click here for your free Codingline Silver subscription

RE: Repair EHL Rupture? (Joe Gonzalez, DPM)
From: Jeffrey Kass, DPM

The patient stated he noticed the hallux is floppy. The information then provided in the query was "the patient has no complaints and isn't really interested in surgery." The question posed was whether an IP fusion could suffice, or should the doctor push for an EHL repair.

My response is - don't do anything. The patient has no complaints and does not want surgery. He realizes the toe is floppy as he mentioned that. If he does not want a floppy toe, then surgery is his option.

Your idea of a hallux fusion would work. After all, this is a common procedure for a hammered hallux. In effect you are doing a Jones tenosuspension without having to tack down the proximal end of the EHL tendon. Alternatively, a primary repair, even delayed, likely will have good results if the tendon is caught beneath the retinaculum.

I wrote a review article "Extensor Hallucis Longus Tendon Injuries; An In-Depth Analysis and Treatment Protocol." in JFAS 1997 Jan-Feb: 36 (1) 24-7.

Jeffrey Kass, DPM, Forest Hills, NY,  jeffckass@aol.com

RE: Setting the Record Straight on Debridement of Calluses in Diabetics
From: Alan Sherman, DPM

Are amputations caused by podiatrists? A position statement by controversial low-carb guru Richard Bernstein, MD has been circulating in various forms since August 2012, blaming all foot amputations in patients with diabetes on debridement of calluses. DiabetesCare, the well-respected Journal of the American Diabetes Association, this past April 2013, republished the letter.

The misinformation in this letter has been reproduced enough, and I think it’s time that it be corrected. Here is the letter. The issue is his sweeping generalization and ridiculous misquoted statistics. Bernstein calls....

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

RE:  Inexpensive Cast Cutter (Tom Fitzsimons)
From: Ross E. Taubman, DPM, Joseph Borreggine, DPM

PICA’s policy does not set the standard of care, and as such, does not tell our policyholders what they can or cannot use in their practice. Rather, PICA’s policy covers our policyholders for the entire scope of practice in a given state. That scope of practice is determined by the individual’s state licensing board. As long as a policyholder has a valid license and is practicing within their scope of practice, PICA will cover their claims, as long as all other policy provisions are met.

Ross E. Taubman, DPM, PICA President and Chief Medical Officer, RTaubman@picagroup.com

Here is a malpractice case on the improper use of a cast cutter...so it really does matter what device you use to remove a cast...if you use it improperly and cause an injury, then you may be liable.

Joseph Borreggine, DPM, Charleston, IL, footfixr@consolidated.net

RE: Charles Lombardi, DPM's Discussion on "Meet the Masters" (Michael Rosenblatt, DPM)
From: Charles M Lombardi, DPM

It is regretful that Dr. Rosenblatt chose to interpret my frustration as arrogance, but as anyone with ears could listen to the post without his commentary. I never said anyone did anything underhanded, but said the "grass roots" of the profession chose the track we are on. That being said, Dr. Rosenblatt feels he was blindsided by this shortage of positions and blames the powers (whoever they may be) for not informing the profession of this impending problem.

The fact is anyone could search the APMA website and pull out the documentation that indeed the powers did see this coming 5-7 years ago, and good people worked on this for years. It was their hard work that softened the blow. I did not see Dr. Rosenblatt's commentary 4 years ago or even two years ago. I must wonder why - maybe rather than being blindsided, he was blindfolded! I feel it is pundits like him who, by his own admission, have not been involved in education for 30 years, best keep their mouth closed. It is the people who don't do anything, then blame everyone else, who are the real problem, not the people that make decisions (some good, some bad). At least they tried. I cannot say that of Dr. Rosenblatt.
 
Charles M Lombardi, DPM, Bayside, NY, Chazdpm@aol.com

RE: Charles Lombardi, DPM's Discussion on "Meet the Masters" (Michael Rosenblatt, DPM)
From: David Gitlin, DPM

The readers of PM News are lucky to have Dr. Rosenblatt's interpretation of Dr. Lombardi’s “Meet the Masters” interview. Unfortunately, his interpretation is somewhat off-base. The interview presented the history of the present residency shortage situation from someone involved in every aspect of podiatry education. He was not there to “defend himself impassionedly” - nor does he need to defend himself for any reason whatsoever.

As for “coldness” toward the recent graduates, he simply said it was a difficult situation with no easy solutions. With all due respect - I think Dr. Rosenblatt may need to listen to the broadcast again.
 
David Gitlin, DPM, NY, NY, uwdave@hotmail.com

RE: PM News Now Reaches Over 14,500 Subscribers
From: Hal Ornstein, DPM

Barry, congratulations on reaching 14,500 readers! You continue to amaze me with your dedication to our wonderful profession and by sharing your many blessings. I recently read that “Life is the train, not the station”, which clearly describes your journey. When PM News reaches 15,000 readers, I will make a donation in your name to support podiatry students to recognize your efforts and as a thank you for all you have done to advance podiatry.
 
Hal Ornstein, DPM, Howell, NJ, hornstein@aappm.org

RE: PM News Now Reaches Over 14,500 Subscribers
From: Mike Rosenblatt, DPM

Barry, it is with great pleasure that I congratulate you on your accomplishment, borne of great effort, hard work, and countless hours in front of your computer "correcting" letters and building issues of Podiatry Management Magazine and PM News.
 
Frankly Barry, you made it look easy. But we both know that this is not true. You are the example of someone who sticks with it, despite a very difficult start, and utterly refuses to give up. THAT alone is a legacy to anyone who has it tough, and faced many obstacles.
 
Nothing was given to you. Every new motion, you generated yourself. You sat through three years of difficult law school studying (sometimes) very boring material and committed it to memory for exams. The hard work you put in just never seems to stop. If someone asks for an example of what success is, and why it happens, they need only to look at you.
 
Mike Rosenblatt, DPM, San Jose, CA, Rosey1@prodigy.net

RE: WI Podiatrist Survives on Patients' Ignorance
From: Robert Bijak, DPM

"Name withheld" asks: Is no one responsible other than the perpetrator?  NO! He's a big boy now and is responsible for his actions. Trying to excuse bad behavior by blaming it on the rest of society takes the focus of responsibility and PUNISHMENT from where it belongs. It is a utopic liberal idea that sharing everything, even the blame, is a good thing. When you spare the rod, you spoil the child (society).

Robert Bijak, DPM Clarence Center, NY rbijak@aol.com

RE: Unmatched Residency Placements Currently Stand at 86 (H. David Gottlieb, DPM)
From: Brian Homer, DPM

With the obvious shortage of podiatric residencies, I do not understand the discontinuation of non-surgical residency programs. Taken directly from the CPME website: "Changes were made to the CPME 320 and 330 which became effective July 2011. One of the major changes was the creation of a single three-year category. All programs are scheduled to transition to the new model by 2013.

Podiatric Medicine & Surgery Residency (PMSR).

Podiatric Medicine & Surgery Residency with Reconstructive Rearfoot and Ankle Certification (PMSR Cert)."

Not all podiatric graduates need to be surgically trained nor want to be surgeons. It would only seem feasible that these types of nonsurgical residencies would be easier to get approved, i.e., void of the surgical case volume requirement, and could also accept more students per year for the very same reason.

Action MUST be taken by CPME to guarantee each graduate from podiatric medical school the ability to qualify to earn a living following graduation. The non-surgical residencies MUST be reinstated.

Brian Homer, DPM, Clawson, MI, drbhomer@gmail.com

BUSINESS FOR SALE: TOE-FOOD CHOCOLATES & CANDY

Toe-Food Chocolates & Candy (www.toefood.com) is an established candy company specializing in creative foot-themed chocolates that has supported the podiatric community for over 30 years. Ideal opportunity for family member to run in house. Serious inquiries only please. Email: MwolpaFootDoc@yahoo.com

PRACTICE FOR SALE - PHILADELPHIA

Established podiatry practice in the Northwest section of Philadelphia. Fully equipped office with 3 treatment rooms. Currently part-time with great growth potential to expand to full-time. Contact dgvc88a@gmail.com

PRACTICE FOR SALE - NORTH DAKOTA

Turn-key opportunity. Established non-surgical practice for sale in booming economy of North Dakota. Staff knowledgeable  compliant with EHR/Meaningful use. Solo practitioner grossing over $400,000 annually, 3.5 days/week. Hospital/OR privileges available. Local bank familiar with practice and willing to work with financing. Interested, contact Worhart@live.com.

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 - MISSION VIEJO, CA

Relocating to Tulsa. Great opportunity to buy my office. Located at Mission Hospital. Gross income 2012 was $548,000. Approximately 1300 sq ft with 3 treatment rooms, digital x-ray and fully computerized. Will consider all offers. Call David at 949-702-1052 or david@missionviejofootcare.com

EQUIPMENT FOR SALE - DIOWAVE 15 WATT, PORTABLE 980 LASER

This is a used multiple function laser, plantar fasciitis, Achilles tendonitis, joint pain. nerve pain, post surgical, warts, toenail  problems, two-year plus warranty, MSRP: $25,000. E mail Dr. Zuckerman at footcare@comcast.net. for questions and pricing.

ASSOCIATE POSITION - SOUTHERN CALIFORNIA
 
Very busy, two location group practice seeking a full-time, self motivated and hard working podiatry associate. Competitive salary and benefits are offered. Please email CV to: footcare4all@aol.com

ASSOCIATE POSITION - HUDSON VALLEY NY

Part time position in busy practice leading to f/t. Looking for well trained minimum PSR-12 with great technique and people skills for part time leading to f/t position in fast growing practice. Competitive salary with huge growth potential. Send cover letter, CV and work experience to: PodassociateNY@gmail.com

ASSOCIATE POSITION - EASTERN SHORE OF MARYLAND

Seeking highly motivated, ethical, enthusiastic associate to join successful, well-established practice located in close proximity to Maryland and Delaware beaches. Certified/qualified by ABPS with rear foot experience preferred. The practice incorporates surgery, wound care, sports medicine and general podiatry. Fully equipped office with diagnostic ultrasound, fluoroscopy, vascular testing, radio frequency ablation, six treatment rooms and three satellite offices. Main office has accredited ambulatory surgery center. This opportunity has excellent salary potential with benefits for the right individual.  Will consider preceptor. Send CV to dpmkthomas@gmail.com 

ASSOCIATE POSITION - MARYLAND, DC, PA

A podiatrist is needed for the Baltimore, Washington, Pennsylvania area. Partner for the corporation. Surgery center, emergency room call and a hospital location. All areas of podiatry. Established practice. Salary and commission. Fax resume 410-857-4227 or email at butler@qis.net

ASSOCIATE WANTED - NEW YORK

Well-trained experienced surgical podiatrist for busy Bronx and White Plaines offices. Associate working for partnership, if desired. Send Resume to bronxpodiatry@yahoo.com

ASSOCIATE POSITION - SOUTHERN NEW JERSEY

Excellent opportunity for a full time podiatrist to join busy group practice! Surgery, wound care, sports medicine. Affiliated with residency program. Personable and great communication skills a must! Competitive salary, bonus, benefits package. Send CV to footdoc22@gmail.com

ASSOCIATE POSITION - NORTHWEST IOWA

A well-established, Midwest multi-physician practice with strong hospital affiliations seeking FT podiatrist. Applicant should be well trained surgical physician, completed a 12/24 month residency, & board eligible. Practice offers high surgical volume, advanced wound care and good mix of general podiatry. Competitive salary, excellent benefits. Fax resume: 712-258-9977. 

ASSOCIATE POSITION - CALIFORNIA

Associate wanted for multi-office, multi-doctor practice. Full Time, Self-motivated, highly skilled team player with surgical, wound care and palliative skills. Offices in Northern California Coast, CA License necessary, salary negotiable with possibility of partnership in future. Send CV and letter to: srfctysc@gmail.com

ASSOCIATE WANTED - WESTERN NEW YORK

Wanted well trained podiatrist for IMMEDIATE position. Busy high volume surgical practice with multiple locations, EMR, Digital X-Rays, hospital and surgical center privileges. Good base salary with incentive, and benefits including health insurance. EXCELLENT OPPORTUNITY to grow. Send resume to: WNYDPM@gmail.com

ASSOCIATE POSITION - CENTRAL FLORIDA

Associate wanted for well-established practice in central Florida. Experienced support staff, malpractice coverage and health insurance provided. Excellent opportunity for a promising future, this position will provide for the possibility of partnership in the future. To apply please go to www.yourcareerinpodiatry.com

CENTRAL FLORIDA - ASSOCIATE POSITION

Busy two doctor practice seeking the help of an ambitious associate to help handle the patient load. Position will lead to partnership for the right individual. Two office practice with hospital, surgery center and wound care center privileges. Good mix of surgery, wound care and general podiatry. Great salary with incentives, benefits, malpractice. Must have FL license. Suburban setting, close to attractions. Please send cover letter, CV and copy of surgical log to footpainbegone@gmail.com. 

ASSOCIATE POSITION - MARYLAND

Associate position for podiatry office on Maryland’s Eastern Shore. Certified ambulatory surgery center on-site.  Will consider preceptor. Please fax letter and CV to 410-749-6807

LOCUM TENENS OR ASSOCIATE POSITION AVAILABLE - ARLINGTON, VIRGINIA

Perhaps leading to long-term relationship, or locum tenens for about 90 days. Starting date is as soon as residency trained, Virginia licensed podiatrist. New equipment- x-ray machine, digital processor, EMR, and treatment chairs. Must be a self-starter, confident & hard working. Computer literate. If interested, please call 703-582-5999 (C) , 703-237-0841 (H), or e-mail drmichaelfine@aol.com

ASSOCIATE POSITION - TAMPA BAY

Live, play and practice in the Tampa Bay area. Associate leading to partnership in a well-established, expanding group practice. Excellent salary and benefits in this dynamic medical/surgical practice. Come join our caring, compassionate, motivated staff. Position open immediately but we will also consider 2014 residency graduates. PSR-36 or PSR-24 with rearfoot/ankle training required. E-mail cover letter, CV, surgical log and references to rvalins18@aol.com

ASSOCIATE POSITION - CONNECTICUT

Looking for an associate with 3-year residency training for a practice in Connecticut. Interested in all aspects of podiatry including  foot/ankle surgery and wound care. Hospital located close by with appointment to staff readily available. Will lead to partnership Please send CV to: dsharnoff@hotmail.com

ASSOCIATE POSITION - SF BAY AREA

East SF Bay Area associate wanted for 3-office practice. CA License and PSR-24 minimum. All aspects of podiatry. Need to be highly motivated, a self-starter and be able to start Aug. 1, 2013. Salary BOE. Send CV to drscivally@sbcglobal.net

NEW JERSEY LICENSED PODIATRIST SEEKING FT EMPLOYMENT

Over 10 years’ experience in Durable Medical Equipment. Board Certified in Wound Care (ABWM). Established relationships with VNAs, Hospices, NHs and ALFs. Strong interpersonal skills. Taught Practice Management to podiatric residents. Please contact me at toedoc1@comcast.net for CV, resume and references.

PM News Classified Ads Reach over 14 ,500 DPMs and Students

Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 14,000 DPMs. Write to: bblock@podiatrym.com or call (718) 897-9700 for details. Weekly ad rates start as low as $115 for a 50-word ad. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451

• To Post a message, send it to:    bblock@podiatrym.com
• Notes should be original and may not be submitted to other publications or listservs without our express written permission.
• Notes must be in the following form:
  RE: (Topic)
  From: (your name, DPM)
  Body of letter. Be concise. Limit to 250 words or less). Use Spellchecker
  Your name, DPM City/State
• Subscribers are reminded that they have an ethical obligation to disclose any potential conflicts of interest when commenting on any product, procedure, or service.