The Voice of Podiatrists

Serving Over 14,509 Podiatrists Daily

August 03, 2013 #4,839 Publisher-Barry Block, DPM, JD

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Unmatched Residency Placements Currently Stand at 80

The American Association of Colleges of Podiatric Medicine (AACPM) provides periodic status reports on residency placements from Match Day. The following is residency placement data as of July 26, 2013:

Class of 2013 Placements: Placed in Residencies 516 (90.2%)
Not Eligible/Not Seeking Training 11 (1.9%)
To Be Placed 45 (7.9%)
Total 572 (100.0%)

Class of 2012 and Earlier Placements:
Placed in Residencies 24 (40.7%)
To Be Placed 35 (59.3%)
Total 59 (100.0%)

When taking the overall placement stats into consideration, 86% (540) of the 631 residency applicants have found residency positions thus far this year. With nearly 2% (11) of residency applicants not seeking or ineligible for placement, it leaves just over 12.7% (80) total applicants that have yet to find a residency position for the 2013-14 training year.

Source: AACPM

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NY Podiatrist Discusses Sever's Disease

With children becoming more involved in sports at a younger age, the number of young athletes with overuse symptoms is increasing. One of the most common overuse syndromes is called Sever's disease. It is a painful condition that affects an athlete's heel. "I think boys are a tad more common. Certainly any high impact sports a lot of times, whether its baseball, football, soccer," said Dr. Mark Ginsburg, a podiatrist.

Dr. Marc Ginsburg

"Typically it is right where the Achilles tendon attaches to the bone, so that growth center which is known as the calcaneal apophysis can become inflamed," said Ginsburg. Symptoms are not easy to spot. There is no swelling and no warmth. Oftentimes, the patient experiences severe pain when both sides of the heels are compressed. The condition can be chronic. In mild cases, rest, anti-inflammatories, and cushioned soles in the athlete's shoes can all be used as treatment. "I'd use ice followed by heat. We might have to put some sort of orthotic or heel cup in their shoe," noted Ginsburg.

Source: Marcie Fraser, Capital News 9 Albany (7/31/13]

NY Podiatrist Discusses Humility of Lubavitcher Rebbe (Rabbi)

In 1977, when Dr. Elliot Udell graduated from the New York College of Podiatric Medicine, after doing a residency at Maimonides Hospital, he opened an office in Crown Heights. "Part of the reason I chose Crown Heights was that, although not being Chabad Lubavitch myself, I had a very nice feeling toward the Chabad community. Of course, before I opened up my office in Crown Heights, I wrote to the Rebbe to ask for a blessing.

Dr. Elliot Udell

And an answer came back that the Rebbe would give me a blessing on one condition — that the halachic authority of Crown Heights would rule that I was not violating Jewish law concerning unfair competition, meaning that my opening a practice would not put someone else out of business and deprive him of a livelihood. The Rebbe was very strict about this issue—that one person wouldn’t harm another in this way. I did what he asked, and then he gave me a blessing."

Editor's note: This entire story can be read here.

Source: Encounter [7/27/13] via Dr. Howard Dinowitz

Podiatric Life Skills Talks at No Cost on PRESENT Podiatry

The PRESENT Residency Education Summit Conferences during the past two years have all featured a series of 15-minute Life Skills talks in which experienced residency directors and those in leadership positions mentor residents in areas of career planning. These talks have been among the most popular and well-received programming at the ResEd Summit Conferences.

Dr. Michael Trepal

PRESENT e-Learning Systems has announced that 14 of these talks have now been made available on the PRESENT Podiatry website at no cost as a service to the residency education community and to young podiatrists across the country.  

AAPPM Board Members Meet with CA Podiatrist at APMA Meeting

Lee Rogers, DPM, candidate for U.S. Congress in California’s 25th district, met with the American Association of Podiatric Practice Management (AAPPM) board members Hal Ornstein, DPM, Andy Bhatia, DPM, and Melissa Lockwood, DPM to discuss issues affecting podiatrists in private practice and in groups.

“Lee has a detailed knowledge of the challenges facing our members,” said AAPPM Chairman, Dr. Hal Ornstein. “Whatever your party, whatever your politics, we need people in Congress who understand healthcare and can take the initiative to improve conditions for patients and doctors.”

Query: Removing & Replacing Surgical Screws

My patient had a plate and screws put in over three months ago, but the osteotomy has not completely healed. Two of the screws are loose, and I need to remove and replace them with a larger one. May I bill for removal and replacing of hardware?

John Jurcisin, DPM, New York, NY

Response: This is a rather unique situation, but I think it would be reasonable to bill this procedure using CPT 20680 (removal buried rod, wire screw, deep). You are beyond the 90-day (Medicare) post-operative period, so no modifier is necessary. There should be no additional charge for the reinsertion of new screws.

Your other option would be to code this using an unlisted code and provide a copy of the operative report with your billing. Request a peer review.

Howard Zlotoff, DPM, Camp Hill, PA

Codingline subscription information can be found here

APMA Members: Click here for your free Codingline Silver subscription

RE: Freiberg's Infraction in a 14 Year Old (B. Lee, DPM)
From: Robert Baron, DPM, Dennis Shavelson, DPM

Are you sure it is a Frieberg's infraction? Marrow signal changes of the metatarsal head on MR tend to be non-specific but could represent a stress response (contusion) or even a subchondral fracture which can be easily overlooked. How long was she symptomatic before seeking professional care? I recommend a follow-up MR in 6-8 weeks or before allowing her to resume any strenuous physical activity.
 
Robert Baron, DPM, Willowbrook, IL, robert4261@aol.com

Without seeing x-rays or vascular studies, biomechanically, the logical thing to do is to reduce the load, function, and responsibility of the 2nd ray in the weight-bearing life of this young girl so as to optimize her potential and reduce the need for invasive procedures.
 
I suggest utilizing your current paradigm; maximize the care that you offer her with a multifaceted plan including foot beds, muscle engine training, along with activity and lifestyle adjustments. Refer her to a dedicated, skilled biomechanically-oriented podiatrist if you are not so specialized.

Dennis Shavelson, DPM, NY, NY, drsha@foothelpers.com

RE: Cyclist with Bilateral Forefoot Pain (Mark Aldrich, DPM)
From: Robert Scott Steinberg, DPM, Tip Sullivan, DPM

What you describe is a very common problem for cyclists. Though he has a negative Mulder's sign, he is most likely still suffering from neuritis, and though he has a high quality cycling shoe, if it is a road shoe, it is narrow.  To begin treatment, place met pads on the shoe's insoles, and have him go for a ride. If they help, next do a biomechanical exam and order an orthotic appropriate for the shoe he is wearing. If they are road shoes, there isn't much room and they are narrow. If that is the case, send a cast to JSB Orthotic Lab in Englewood, FL, and write for a thin TL2100, with met pads, no TL2100 under the heel, full length top cover with 1/16" STS extensions. This is the cycling orthotic I and JSB's owner, Scott Becker, designed a number of years ago. More questions? Call me: 847-885-8806

Robert Scott Steinberg, DPM, Schaumburg, IL, Doc@FootSportsDoc.com

You have described typical “hot foot” described by many cyclists, and in the literature. I have found the following to be as effective:
 
Use the widest shoe as possible— you can take the shoe to a shoe repairman and have slits put in the forefoot. First, try canting the shoe with a material placed between the shoe and the cleat. Second, try in-shoe forefoot posting. I have actually made full-length graphite orthoses from heel to toe with intrinsic and extrinsic posts. You might suggest pedaling technique change - increase the upstroke force.
 
This is a problem that there is no formula for. One can certainly use the principles of a very precise biomechanical exam to help, but in my experience, this is a problem that requires multiple tweaks. Another suggestion is to video him on a stationary set-up, so you can slow it down and make adjustments. After further review of symptoms, I also suggest consideration of “functional” tarsal tunnel which can also be the cause of  hot foot and would require a slightly different biomechanical approach.

Tip Sullivan, DPM, Jackson, MS, tsdefeet@msfootcenter.net

RE: Unmatched Residency Placements Currently Stand at 80
From: William Deutsch, DPM

When I graduated in 1976, there were 5 schools of podiatry with class sizes of 50-60 or so students, and there was still a residency shortage. The difference was that there were only a smattering of states that required residency for licensure, and the ability to do surgery or gain hospital privileges depended upon your ego, chutzpah, and whom you knew. You could still make a living without surgery or even accepting insurance if you were a good salesman and had average skills. Surgery on a see-one, do-one basis was still possible, and if you had average luck, you could avoid an untoward event for several years.

Obviously, lack of residencies for graduating students is only part of the problem. Incoming podiatry students still don't know what...

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

RE: Unmatched Residency Placements Currently Stand at 80
From: Richard Gosnay, DPM

One consistent sentiment seems to run through all of the comments regarding the large number of new podiatrists who have not moved on to post-graduate training this year. The students, current podiatrists, retired podiatrists, and educators who have written about the subject are uniformly appalled. Obviously, our new colleagues who are living this nightmare are frustrated and angry. I hope that they get some measure of comfort from knowing that a great many of us do care about their situation.

There have been many suggestions about what should be done. These suggestions vary widely. Many seem to be illogical and born more out of frustration than of critical analysis of what is possible. I hope that we, as a profession, will...

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

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.

PRACTICE FOR SALE- CONNECTICUT

Well-established, 35-year-old reputable practice/condo with approx 2,500 Square ft. Grossing approximately $450,000. Outside Hartford area. All phases of podiatry. Contact drsch52@hotmail.com

PRACTICE FOR SALE - NORTH CAROLINA

Rapidly growing start up practice in rapidly growing college town in Eastern North Carolina. Excellent teaching hospital nearby with privileges available. Must sell due to health reasons. Serious inquires only. Reply to drcivatte@gmail.com

PRACTICE FOR SALE - HUNTINGTON PARK, CA

46 years same location. Unsurpassed visibility on corner of major intersection. 3 fully equipped treatment rooms. Perfect opportunity to build a strong practice. Must retire due to age. Selling price $30,000 firm. (323) 588-1179 MTWF. evaonofre@hotmail.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

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 - ROCHESTER, MN

Rochester Clinic, a multispecialty practice, is seeking a BC/BE podiatric physician. The physician will provide all aspects of podiatric practice, including sports medicine, wound care, primary care, and surgery. Rochester is the third largest city in the state, and boasts top-rated public schools. Please send resume or inquiry to Careers@RochesterClinic.com

ASSOCIATE POSITION – VIRGINIA

Established private practice, strong referral base.  Hospital and surgery center privileges. Two locations with modern offices. ABPS qualified or certified. Competitive compensation package. Potential for position to lead to partnership. To apply, please email a letter of intent and CV to Practice Administrator at: vaposition@yahoo.com

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 - FLORIDA

Associate wanted for an established 25 year old practice. PSR24 or 36 would be preferred. Excellent opportunity. Please send CV or letter to bafamt@aol.com.

ASSOCIATE POSITION - SOUTHEAST MICHIGAN

Seeking a quality-oriented, patient-focused PSR trained associate for a fast paced, established group practice in Southeast Michigan. This is a secure, long-term position. Emphasis on diabetic foot and wound care.  Our outstanding staff allows you to concentrate on optimal patient care without the responsibilities of practice management. Partnership possibility for the right individual. If you are highly motivated, ethical and have good communication and clinical skill, please forward you C.V. to:cfsdr@yahoo.com

POSITIONS AVAILABLE - CONNECTICUT

Looking for podiatrists to see residents in Nursing Homes. Great opportunity for supplemental or full time income. Email inquiries to phasetwopodiatry@gmail.com

ASSOCIATE POSITION – PENNSYLVANIA

Associate Wanted for busy, multifaceted podiatry practice in Chester and Delaware counties, Pennsylvania. Seeking PSR-24/36 trained podiatrist for full/part time associate position. Two offices and hospital privileges. Send CV and letter to: 123bunion@gmail.com

POSITION AVAILABLE - MASSACHUSETTS

Boston Medical Center. Full-time career opportunity: surgery, diabetic foot care, wound care, general podiatry, resident training & research. Split position: (90%) on-site BMC and (10%) off-site health center clinics Boston University School of Medicine Academic appointment. Requirements: Completion of 24-36 month surgical residency. Please forward CV and letter of interest to:Erin.walker@bmc.org

ASSOCIATE POSITION - DAYTON, OHIO

Join an established group practice in Dayton, Ohio excellent reputation, large referral base.  Base Salary$120,000, benefits and bonus structure. EMR;diagnostic ultrasound; Padnet; CO2 and Cutera Laser for nails, all aspects of DME. We need well trained personable PSR24/36 surgeon. Future Buy-in available. Please send CV to Ohiomedical@aol.com

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.comor 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.

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