The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

July 31, 2009 #3,610 Publisher-Barry Block, DPM, JD

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Patients Need to Inspect Feet for Early Signs of Melanoma: MA Podiatrist

While all types of skin cancer, including squamous cell and basal cell carcinoma, can be found on the foot, the most common is the most serious form, melanoma. Symptoms can be as subtle as an abnormal-looking mole or freckle found anywhere on the foot, and often go unnoticed without routine foot exams.

Dr. Thanh Dinh

According to foot and ankle surgeon Thanh Dinh, DPM, FACFAS, early diagnosis is key to effective treatment for the condition. But because people aren’t looking for the early warning signs or taking the same precautions they do for other areas of the body, often times skin cancer in this region is not diagnosed until later stages.

“I advise my patients to regularly inspect their feet, including the soles, in between their toes and even under their toenails, for any changing moles or spots and to have any suspicious areas promptly examined by a foot and ankle specialist,” Dr. Dinh explains.

Barefoot Not For Everybody: PA & DC Podiatrists

Podiatrist Howard Palamarchuk, director of sports medicine at Temple University's Gait Study Center, said he believes that running shoes might not always be beneficial. "We encase our feet in a box, and those muscles never develop," Palamarchuk said. But he added: "As a medical practitioner who specializes in the foot, I'd say there are some people who should not even attempt to run barefoot."

Dr. Howard Palamarchuk

These include diabetics and others who do not have full feeling in their feet (peripheral neuropathy), as well as people with certain conditions — including club foot, very high arches, or legs that differ in length — that prevent their feet from absorbing shock well.

Dr. Stephen Pribut

Stephen Pribut, the former president of the American Association of Podiatric Sports Medicine, concurred. "Too much structure (in running shoes), for many people, is not a good thing," he said. "But I don't think everyone is made to run barefoot." Pribut believes that humans evolved not just to walk, but to run.

Source: Karen Knee, The Wichita Eagle [7/28/09]

Negotiators Reach Agreement on House Healthcare Bill

Negotiators on the House healthcare reform bill have reached an agreement that seeks to shave $100 billion from the cost of the bill and delays a vote in the full House until September. The agreement, reached by the White House, House Speaker Nancy Pelosi (D-CA) and members of the House Energy and Commerce Committee, paved the way for Rep. Henry Waxman's (D-CA) panel to resume its negotiations on the bill. At least four of the seven fiscally conservative Blue Dog Democrats on the panel have signed on to the agreement, said Rep. Mike Ross (D-AR), chairman of the Blue Dog Health Care Task Force.

Public plans under this agreement will be authorized to negotiate rates with providers instead of establishing Medicare rates, to create a more level playing field between public and private options in the bill. Ross also clarified that the public option would remain an option, and “not be mandated on anyone.” State-based “co-ops” will also be offered as a coverage option, he said.

Savings will be achieved through various measures, such as increasing the premium cap from 11% to 12% of income, and establishing a hospital value-based purchasing system, Ross said.

Source: Jennifer Lubell, Modern Healthcare [7/29/09]

Should You Pass Off This Task?

“I can do it faster myself” may be the No. 1 excuse leaders use for not delegating. Of course you can do it faster—you have both experience and expertise. However, if you choose the right candidate for the job, that person quickly will gain speed and competence. To determine if delegation is the right choice, answer these questions:

• How much time is available to complete the job? If the job is a rush, do it yourself this time but start planning now to hand it off next time. Tip: Let the person observe you, ask questions and discuss results.
   
• Could you find time to redo the job if the person does not perform it properly? Build time for review and rework into your delegation schedule.
   
• What consequences will you face if the job is not completed on time? Work with the employee until the person gains expertise so that you gain confidence in his or her ability to perform the task.

Source: Adapted from “Successful Delegation: Using the Power of Other People’s Help" via Communication Briefings

Query: New or Used Autoclaves

I am in the market for an autoclave. My 35-40 year old Ritter finally costs too much to repair. Can anyone suggest a brand or model that has performed well, with little maintenance? I do not require a lot of bells and whistles.
 
Laura R Lefkowitz, DPM, Beverly Hills, CA

RE: Swimmer with Cramps in Arches (Alan Mauser, DPM)
From: Ira Meyers, DPM

One other thing to consider would be chronic exertional compartment syndrome. I have had a few tri-athletes with resting pressures above 50mmHg. Although it’s not very feasible to swim with the catheter in the posterior compartment, a resting level may be useful.

Ira Meyers, DPM, Huntingdon Valley, PA, idmrun@aol.com

RE: Online Scheduling for Multiple Offices (Mark Wolpa, DPM)
From: Steven N. Solomon, DPM,JD

Something that I am hearing about more in New York is the website ZocDoc.com, which has been in the media. It allows patients to search for a doctor that accepts their insurance and to then book an appointment online. I have met a number of people over the past six months who have told me that they used the site to find a doctor for a same day or next day appointment.

If there is something like this where you practice, you may want to give it a try. I do not know the details of joining or managing your schedule, but I would think that you would be able to access and control your appointments.

Disclosure: I have no financial interest in the company.

Steven N. Solomon, DPM,JD, New York, NY, LegalFoot@yahoo.com

RE: Dragon Naturally Problem (Bruce Krell, DPM)
From: Denis Russell, DPM

This is a perfect question for KnowBrainer (knowbrainer.com), the de facto expert on DNS. These are extremely knowledgeable people who deal with problems such as this on a daily basis. The forum is very educational and may provide answers to your problems.

Denis Russell, DPM, Fountain Valley, CA, rdenisr@sbcglobal.net

RE: Vision 2009
From: Elliot Udell, DPM

We, as podiatrists, cannot bemoan the fact that " some/many in the general medical community still belittle our training...disregarding the true breadth of our schooling ...and complexity of our post-graduate training."

As my mentor, Dr. Lawrence Harkless has always said, "This is a wonderful opportunity!" It's a chance for us to educate other medical specialists about who podiatrists are and what we can do. You can't blame others if they are ignorant about our profession. It's our responsibility to educate them.

Kathy Satterfield, DPM, San Antonio, TX, vksatterfielddpm@aol.com

I invite those in the non-podiatric medical community who think that there are significant deficiencies in our knowledge of medicine as it relates to the practice of our profession, to take a peek at the academic discussions and high level debates right here on PM News.
 
To get to the core, however, of what Dr. Finkelstein may be alluding to, let’s ask ourselves this: When the image of a doctor comes up in our minds, is it always the image of an internist?  In order to be a good podiatrist, ear nose and throat specialist, psychiatrist, dermatologist, ophthalmologist, etc., one need not be a 'guru" in all facets of internal medicine. Surgical specialists rarely can be. At the mandatory orthopedic/podiatry meetings at our hospital, there are discussions of interesting cases. In some of the discussions, the chairman of the department will often say, "send this patient to a medical doctor", meaning one of the internists.

What this MD/orthopedist means is that although he is an excellent orthopedic surgeon and keeps abreast of the orthopedic literature, he recognizes that no one in the room is up on every nuance in internal medicine, and it is best for the patient that an internist be consulted. This does not mean that he is any less of a doctor. To the contrary, he is being a better physician. We podiatrists need to think this way, and not feel that there is something lacking in us if we don't have the same knowledge of every facet of internal medicine as we would expect our personal primary care physicians to have.
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com
 

LOCUM TENENS – TEXAS

Looking for locum tenens to work about 3 weeks for me while I am out for an operation. Need Texas license and obviously need malpractice.  Tentative dates are: Last week in August 09 - first two weeks of September. Need to be able to see variety of post-op patients, and otherwise, general podiatric practice and common office procedure (nail, etc.) skills. Salary/terms negotiable. If interested, please call, 409-466-7401 and mention this ad.

ASSOCIATE POSITION - FLORIDA

Busy practice in East Central Florida in search of full-time podiatrist to perform routine foot care in office and nursing home. Competitive salary and full benefits available. Reply to jrdpm@bellsouth.net

PRACTICE OPPORTUNITY - CINCINNATI, OH
 
Well-established practice located in medical/professional building minutes from hospital. Many referrals, three satellite clinics and two assisted living facilities to keep you busy. Associate leaving due to family emergency-need to either find an associate or sell ASAP. Contact bjadpm@hotmail.com for more details.

NEEDED CHICAGO -- NW IND & BALTIMORE/WASHINGTON, DC PODIATRISTS 

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists in Chicago, Northwest Indiana, and Baltimore, MD. 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 – ILLINOIS 
 
Quality Podiatry Group provides quality services to residents at long term care facilities. We are currently offering full-time or part-time positions for motivated ethical podiatrists. Immediate openings available. If interested, fax curriculum vitae to 312 225-9366 or e-mail feetwork@aol.com

ASSOCIATE POSITION – PACIFIC NORTHWEST

Russian-speaking podiatrist needed. Looking for well-rounded, recently out of residency, podiatrist. Would you like to raise your family in our beautiful Pacific Northwest? We are well-established and fast growing multi-office practice with all aspects of podiatry. Attractive compensation, malpractice and medical insurance provided. Contact Dr. Ilona Barlam at 206-661-9644.

ASSOCIATE POSITION - WASHINGTON — WEST PUGET SOUND

Well-established, two-doctor practice in all phases of treatment looking to replace associate who is leaving the area. Looking for energetic, affable, surgically-trained DPM to take over associate position leading to partnership. Satellite office and adjacent multi-disciplinary ASC available for use and possible partnership. Silverdale rated 92nd in best 100 locations in Money/CNN 2009 poll. See link . Contact and résumé at pwa@kitsappodiatry.com

PRACTICE FOR SALE - ALABAMA, GULF COAST 
 
Established 26 year old practice. Owner desires to sell and relocate. Operated 25 hours per week. Mixture of surgery and general podiatry. MD referrals. Surgery center and hospitals in close proximity. Highly profitable. Priced to sell. Will lease office to buyer. Call Mike Crosby at 888-776-2430 or email mcrosby@providerresources.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, ABPS Qualified minimum needed to obtain hospital privileges. Associate position is open for partnership or purchase. Contact robert.nunberg@comcast.net 

PRACTICE FOR SALE – WESTCHESTER COUNTY, NY

Established 30+ year old practice. Well respected podiatrist in beautiful Westchester County Owner ill and needs a quick sale. Mixture of surgery and general podiatry. Hospitals in close proximity. Will lease office to buyer. Call Mali McGrinder at 914-434-1663.

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for a full-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to fmassuda@footexperts.com

ASSOCIATE POSITIONS - CALIFORNIA

Podiatrist needed for busy North Hollywood office. Part-time Monday-Friday 8am-2:30pm. No weekends and no call. Pay negotiable. New podiatrists are encouraged to apply. Please email resume and salary request to Coasttocoastpodiatry@yahoo.com

PRACTICE FOR SALE - FLORIDA—CENTRAL/SOUTH

Turn-key operation grossing $570,000 annually based on one full-time doctor. Great opportunity for growing the top-line. Surgery is only 14% of the professional man-hours; it can significantly increase income. Medicare makes up 64% of revenues. Seller will assist with transition. Call 863-688-1725, ask for Chas.

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