The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

July 23, 2008 #3,305 Editor-Barry Block, DPM, JD

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“Detoxifying” Pads Pose Risk to Injured Feet: OH Podiatrist

At the request of her podiatrist, Dr. Brian Ash, Pam Thomakos tried out some heavily advertised foot pads that supposedly pull toxins out of the body. She wore them for a few nights because of heel pain. She said they didn’t ease her pain.

Dr. Brian Ash

While wearing the pads might not hurt your feet, putting off other treatment you might need to see if the pads do work could affect your health adversely. Ash said, “For example, if you are walking around with a stress fracture and try something like this, and you continue to walk on it, you are going to continue to get worse.”

Source: 13WHAM-TV - Rochester, NY [7/21/08]

Something’s Fishy About This Callus Removal

Ready for the latest in spa pampering? Prepare to dunk your tootsies in a tank of water and let tiny carp nibble away. Fish pedicures are creating something of a splash in the D.C. area, where a northern Virginia spa has been offering them for the past four months. John Ho, who runs the Yvonne Hair and Nails salon with his wife, Yvonne Le, said 5,000 people have taken the plunge so far.

Doctor fish thrive on dead skin.

"This is a good treatment for everyone who likes to have nice feet," Ho said. He said he wanted to come up with something unique while finding a replacement for pedicures that use razors to scrape off dead skin. The razors have fallen out of favor with state regulators because of concerns about whether they're sanitary.

Ho was skeptical at first about the fish, which are called garra rufa but typically known as doctor fish. They were first used in Turkey and have become popular in some Asian countries. Ho said the hot water in which the fish thrive doesn't support much plant or aquatic life, so they learned to feed on whatever food sources were available — including dead, flaking skin. They leave live skin alone because, without teeth, they can't bite it off.

Source: Associated Press [7/21/08] via Arthur Gudeon, DPM

Healthcare Access Problems Surge Among Insured Americans

Middle-income insured Americans are increasingly experiencing health care access difficulties that are more commonly associated with their lower-income counterparts and the uninsured, according to two recent reports. These troubles include delayed or unmet needs for medical care, high insurance deductibles and difficulty getting in to see physicians.

One in five Americans -- 59 million people -- reported delaying or not getting needed health care in 2007, up from one in seven in 2003, found a June 26 Center for Studying Health System Change report. "We've been tracking access to care for 10 years, and this is by far the biggest change that we've seen in those 10 years," said Peter Cunningham, PhD, study co-author and senior fellow at the center. Of those reporting an access problem last year, 43.5 million had insurance, compared with 25.9 million in 2003.

Source: Doug Trapp, AMNews [7/21/08]

Consider Hiring Older Employees

Findings of a study by Days Inn show:

• It took the same length of time to train younger workers and those over age 50 to operate a computer system. But the recruitment and training for older workers and training costs were lower because older workers remained on the job three times as long.

• Older workers proved to be more flexible in accepting work assignments.

Source: Customer Service Newsletter

Query: EMR Programs

I am looking into EMR and have narrowed the search (I think) down to DOX Podiatry and Medinotes. I would appreciate any opinions on these programs.

Andrew L. Vincent, DPM, Winchester, VA

Query: Expert Witness Billing

I recently was asked to testify in a malpractice case, and I was wondering how to bill for this. I spent one hour at the court house, but spent four hours in round trip travel time. Also, this case was postponed from a previous date in which I had to take another day off from the clinic. Can I charge for this?

Darrin Dallegge, DPM, Sterling, CO

Response: When you bill for court time, you need to bill at least one-half day, and preferably one full-day. The purpose of billing that fee is NOT for testifying, but for compensation for patients that you could have seen that day. Your fee should be based on what you normally bill in a day.

Remember you still need to pay your staff, rent, utilities, malpractice, and other operating expenses for the day you testify.

Barry H. Block, DPM, JD, Forest Hills, NY

Codingline subscription information can be found here

RE: To Biopsy or Not? (Larry Aronberg, DPM)
From: William Sachs, DPM, Bret Ribotsky, DPM

I had a similar patient recently (elderly and of Mediterranean decent). His biopsy was consistent with Kaposi's sarcoma.

William Sachs, DPM, Toms River, NJ, wmasachs@gmail.com

Maybe I’m missing something. Biopsy or not to biopsy? To me it’s like x-ray or don't x-ray? I have never seen a malpractice case from ordering too many tests, but there are many cases when a test was not done.

Do the biopsy. If you need help, ask? I am sure there is a person in your area who can help. If not, just go to a dermatologist as a patient, as I am sure they will find something to biopsy. Incidentally, I always suture close punch biopsies.

Bret Ribotsky, DPM, Boca Raton, FL, Ribotsky@doctorbret.com

RE: EMR and Red-Green Color Blindness (Name Withheld)
From: Zac Childress, Brandon Macy, DPM

I contacted the Medinotes training department regarding this matter and there is no way, currently, to change the default color scheme of the objects in a note or note template. They did suggest that we enter this as an enhancement request.

You may want to try changing the background color of the note and/or note template to another color other than white. While in a note or template, select Tools (at the top of the screen), then Options, then Colors. Here you can pick another background color. I'm not sure if this will work, but it might be worth a try.

Zac Childress, Oxford, MI

As the inquiring doctor said, for each of the templates, blue text appears (along with black and green) as is, while red items are to be clicked on and opened up to expand on the data, make choices, etc. While a bit labor intensive upfront and it would require the aid of somebody who can see the different colors, I’d suggest going into the "object" area and edit each template to change all the red text items to all caps. Since it is red text, the caps shouldn't appear if unused and once clicked on, it gets converted to green/black text in normal fonts.

It might not solve all the problems, but it could go a long way to making your life easier.

Brandon Macy, DPM, Clark, NJ, bmacydpm@comcast.net

RE: Dictation Software [Joshua Prero, DPM]
From: Multiple Respondnents

I use the Medical Version, Dragon Naturally speaking 9.1. I have been using it for 16 months now and I am very happy. It has been very accurate and efficient. The tech support is great, though I have rarely had to use it. It cost me about $700, then $50 to upgrade, and in the long run I have saved $3,300 in dictation for the year. .

Lou Nordeen, DPM, Mechanicsville, VA, onefoot7@gmail.com

I have been using Dragon for over one year. It is really great. I did not spend any money on dictation other than the costs of getting Dragon initially. I recommend you get the Pro version with podiatric vocabulary from a reputable vendor and a good microphone. I am using Mark H . Michael, Voice Recognition Systems, P. O . Box 24405, Lexington, Kentucky 40524, (800) 631-8255. He installed the program for me and provides free unlimited support.

Adnan Shariff, DPM, Okeechobee FL, adnanshariff@yahoo.com

Editor’s Note: Dr. Solomon’s extended-length letter appears at: http://www.podiatrym.com/letters2.cfm?id=20897&start=1

EQUIPMENT FOR SALE

Podiatry Chairs - Midmark 117, Hill with surgical screen and 2 Boyd each $1,500. Multiple hand held podiatry instruments - both surgical and non-surgical available. Paraffin Bath $20, X cell unit 1993 works perfect, just $2000. Office equipment-desks, 4-line phone system, add on hold and more available too! Email: ahappyfoot@yahoo.com for more info.

ASSOCIATE WANTED IMMEDIATELY – NEW YORK

Part-time or Full-time for group practice Fast track to partnership. Located in Orange & Sullivan County, NY. Commute from adjoining counties to see how it fits. Monroe, NY office is only 1 hour from Manhattan. All phases of podiatric care. Call Dr Marc Hudes 845-807-8864. Check out our practice website

ASSOCIATE POSITION WITH OPPORTUNITY FOR PARTNERSHIP

Group practice located on NY-PA border with excellent growth in the area’s industrial, retail, and college campuses. Surgical privileges in medical centers in NY and PA. This position will involve rotating through multiple office locations, and wound care centers. Local insurance reimbursement involves mostly private pay PPO models. We are looking for an ABPS Board Qualified podiatrist to join our team. Candidates would need to obtain licenses in NY and PA, and become ABPS certified to maintain hospital privileges. Base salary starting at $85,000 plus bonus plan incentive, vacation, and health/mp insurances. Forward CV to prefprovider@hotmail.com

PODIATRIST POSITION – SOUTHERN CA

Medical group in Southern CA seeking a residency trained DPM. Practice includes general podiatry, biomechanics, wound care, surgery, diabetic feet, trauma. Part-time position available may lead to full-time. Excellent salary/benefits. Position available in mid July 2008. Please reply to E-mail: slowed2@yahoo.com; 4476 Tweedy Blvd, South Gate, CA 90280.

ASSOCIATE WANTED – NORTH EAST PA

A well-established academic solo multi-faceted podiatric practice wishing to expand surgical services by hiring another podiatrist with PSR 24/36. No competition, no foot fellows; diabetic limb salvage, plastic surgery techniques, strong surgical rear foot and ankle reconstruction needed. Plenty of future expansion capabilities for a bright, eager, dedicated and ethical doctor. Future buy-out. fgsddpm@verizon.net

ASSOCIATE POSITION - CENTRAL VIRGINIA

Well-established, two-office practice located in beautiful central Virginia. Completely automated hi-tech offices. Full scope of foot and ankle care. Board qualification/certification required. Hospital and surgery center privileges available. Base salary, incentive plan, and benefits. Submit letter of introduction and CV to jdisabato@vfasa.com

ASSOCIATE POSITION – GEORGIA

Atlanta area need a full-time or part-time associate for a 25 years old well-established practice ,well rounded surgery and routine, please email your CV to superrang@bellsouth.net

BIOMECHANICS FELLOWSHIP – NEW YORK

Neoteric Biomechanics (patent pending) Nine-Month Fellowship: At The Foot Typing Center® in New York City. Practice, Research, Publish and Credentialize Yourself In This New Paradigm. $36,000 Stipend. New York License Required.Fax Interest to: 212 288 3034 or apply to Dr. Shavelson @ drsha@lifestylepodiatry.com.

ASSOCIATE POSITION - LONGVIEW, WASHINGTON

Seeking podiatrist for immediate opening in well established podiatry clinic in Longview, WA. Typical podiatric practice, offering biomechanics, surgery, diabetic care, sports medicine. Excellent pay, with incentives for high performers. Malpractice, medical insurance, licensing, CME covered by employer. Please send resume and background references to Michele@nwfootankle.com

ASSOCIATE POSITION - BOSTON, MA

Associate wanted, Full-time or part-time, for busy long time, well established, and well rounded practice. Good mix of general podiatry and surgery. Office will generate approximately 100+ surgical cases per year. Must have surgical background for this practice, ABPS Qualified minimum needed to obtain hospital privileges. Associate position is open for partnership or purchase. Contact robert.nunberg@comcast.net

PODIATRISTS NEEDED - CHICAGO --NORTHWEST INDIANA

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists. We are located in Chicago and Northwest Indiana. Full and part time positions are available. Competitive Compensation including malpractice. Contact Scott Schneider. Phone-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com Visit our website

ASSOCIATE POSITION – CALIFORNIA

Central Valley/Southern CA. Salary excellent with all paid benefits/incentives including malpractice/401k and profit sharing. Surgery Center and hospital based with no HMOs/no rest homes. Bilingual in English and Spanish. Offering a permanent position/partnership in a multi-million dollar hi-tech practice. E-mail CV to: Tonya@wetreatyourfeet.com

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