The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

August 07, 2009 #3,616 Publisher-Barry Block, DPM, JD

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We encourage you to participate in this important survey at www.podiatrym.com/survey Completing this anonymous survey provides us with valuable data, which we will publish in the February 2010 issue of PM. It also makes you eligible to win thousands of dollars of valuable prizes. Enter by sending Question #43 (no answer necessary) to bblock@podiatrym.com along with your name and address.

The Podiatric Practice Manual

This week's prize is a copy of The Podiatric Practice Manual by Joseph Borreggine, DPM (Value $99)..

This is also your opportunity to vote for the next DPM and Non-DPM inductees into the PM Podiatry Hall of Fame.

Some Patients Ashamed of Their Feet: IL, PA Podiatrists

Summer footwear only increases the opportunities to feel foot shame. Some of the stuffiest workplaces now accept open-toe shoes, and flip-flops are a de facto uniform of the college-aged. Yet a paradox is at play. We paint our toes more than ever, but most of us don’t take the time to care for the rest of our feet. “We pay more attention to our toes than our heels,” said Dr. Marlene Reid, a podiatrist in Naperville, IL.

Dr. Marlene Reid

Dr. Nicholas Romansky, a podiatrist with two offices near Philadelphia, PA, said he had patients so ashamed of their feet that they didn’t allow their spouse or fiancé to see them. “They have sex with socks on,” he said. “Some people think their feet are ugly. You see nice hands, but feet take a beating.”

Dr. Nicholas Romansky

That’s in part because of neglect. “People don’t think about their feet until they fail them,” Dr. Romansky said, adding that many of his patients think soapy water is all that’s needed to clean the feet and don’t bother to rub with a washcloth. “We need to be proactive,” he said. “Most Americans are always in a rush or too fat to bend over.”

Source: Catherine Saint Louis, New York Times [8/5/09]

TUSPM Podiatrist Discusses Buying Children's Shoes 

Choosing shoes for children can sometimes be a challenge. Children often prefer fashion over comfort. Parents tend to weigh on the side of practicality and cost. All personal preferences aside, Kieran Mahan, DPM, a podiatrist with Temple University School of Podiatric Medicine, recommends looking for a shoe with some flexibility (the front of the shoe should bend slightly when walking), and a moderate amount of stiffness at the back (to support the heel). He prefers a supportive sneaker or Oxford because these shoe styles provide comfort and support in the classroom and on the playground.

Dr. Kieran Mahan

Mahan also recommends choosing a shoe with breathable materials to prevent build-up of moisture inside the shoe, which can increase the risk of athlete’s foot. Children who select synthetic materials or shoes that don’t readily breathe should have more than one pair, then rotate their use to allow each pair to dry out thoroughly. Mahan discourages passing shoes down through the family or wearing someone else’s shoes because infections, like athlete’s foot or plantar warts, can be carried in the shoes and transmitted to the new wearer.

Source: Carolyn Murray, WCDB-TV [8/3/09]

Inspector General Questions Docs' Billing Practices

HHS' inspector general's office is concerned that unqualified people are providing medical services for which physicians bill Medicare but don't personally perform.

A new report examines a sample of 2007 Medicare claims in which more than 24 hours of services were billed for a single day, using the category as a roundabout way to get at the services not personally performed by the billing physician. Medicare covers but doesn’t explicitly track these services, considered “incident to” the physician’s direct care. The review found that 21% of such services in the sample were performed by someone without the appropriate credentials to do so, representing $12.6 million in paid claims.

“We are concerned about the potential scale of this problem,” the report states. The report recommends that the CMS adopt a code modifier to allow monitoring of these claims. In its response to the inspector general's office, the CMS agreed with the goal of generating better data but called the suggestion “operationally difficult” for providers.

Source: Gregg Blesch, Modern Healthcare [8/6/09]
 

Use the Back of Your Business Card to Promote Podo-Pediatrics

On the back of your business card print a picture of your child’s feet. Pay him/her $2,500 Per Year for the modeling fee, as you would pay a similar fee to an ad agency. This will inform people that you treat children on a regular basis, and allow your child to have earned income to start an individual IRA. This is a great way to start out a new doc in a practice.

Source: Rob Levine, DPM.  For information about  the American Academy of Podiatric Practice Management, visit www.aappm.org

Query: Dealing with a Disgruntled Employee

I had to fire an employee after multiple warnings, lies by her, and her inability to correct the problems. She had worked as my office manager for over 4 years and went downhill over the past year. The day she was fired, she stated that I would be sorry because she has a lawyer (of course!)

She then claimed that she injured her back and developed carpal tunnel on the job. This is the first I had ever heard of any problem. In addition, she was the administrator of our Workers Compensation and did not file a claim and surely knows the process! Of course, with her lawyer in action, now our WC carrier has to take care of the claim.

I wonder if she will sue for something else? How can I protect myself? I have extensive documentation regarding her termination and all events leading up to the event.

Name Withheld

Editor’s comment: PM News does not provide legal advice. Disgruntled employees can create havoc. They often lodge complaints with various regulatory agencies. The best defense is appropriate documentation.

It’s important to be aware of the red flags often displayed by disgruntled employees and address issues early in the process. Employees should be happy with their working environment, and attention should be focused on the staff’s body language.        
 

RE: Squamous Cell Carcinoma
From: Ira Weiner, DPM

Recently, a 61 year old female presented to the outpatient wound care center with what was originally diagnosed as a venous ulceration. It is on the posterior lateral aspect of the calf. I biopsied the ulcer in 5 representative locations and all were negative. She was debrided and grafted with GraftJacket. She healed completely in a relatively short period of time. Approximately one month after healing, she returned with the same ulceration in the same place. Her referring physician insisted it was a venous ulceration as did infectious disease. 

Squamous Cell Carcinoma

I had the pathologist look at it to determine where he thought would be the best place to biopsy it, which is marked by the arrow in the picture. It turned out to be squamous cell carcinoma. 

I suppose the reason for posting this is that regardless of what we are presented with, if we feel the report initially is wrong (which in retrospect was in this case), it needs to be followed up again and we should feel free to re-do the biopsy. She is scheduled for excision and grafting in the next two weeks.

Ira Weiner, DPM, North Las Vegas, NV, vegasfootdoc2005@yahoo.com

RE: Patient with Recurring Infections Dorsal to the Left and Right Fourth Interspace (Elliot Udell, DPM)
From: Multiple Respondents

As we have all experienced, patients with recurrent cellulitis have diminished capacity to fight subsequent infections due to lymphatic damage and/or chronic edema. I have a subset of these patients, who along with the infectious diseases specialists, are kept on antibiotics for up to 6 months post last infection, specifically for the prevention of rapid re-infection. For the most part, this has been successful.

Bryan C. Markinson, DPM, NY, NY, Bryan.Markinson@mountsinai.org

Years ago, I had a patient with essentially the same history. She was in her mid 20's and a hairdresser. The problem had been going on for a few years with the same pattern-recurrence, I&D, antibiotics, resolution, recurrence, etc. I followed the same protocol as you for a couple of recurrences. Although the x-rays were negative for foreign body, I decided to explore the area. What I found was a hair strand, deeply walled up in the interspace. I removed the mass and used the appropriate antibiotics. As I can recall, the post-operative period was uneventful. I followed her for a couple of years and to my knowledge the was no recurrence. I am not saying your patient's problem is the same. But a foreign body is not out of the question.
 
Howard Lepolstat, DPM, (Ret.), Sun City West, AZ, TeachrComp@aol.com

Since it was not addressed in Dr. Udell’s query, he should rule out concomitant urinary tract infection and/or clinical/subclinical pyorrhea?

Richard A. Simmons, DPM, Rockledge, FL,  rasdpm32822@aol.com
   

RE: Meet the Masters is a Success
From: Richard Pollak, DPM

I thoroughly enjoyed the first Meet the Masters program featuring Lowell Weil, DPM. Dr. Weil was my residency director thirty years ago. I have always revered him as the top podiatrist in the country. I also felt Bret Ribotsky, DPM did a wonderful job of interviewing Dr. Weil.  I found Bret to be prepared, thorough, and entertaining. This program is a wonderful start to allow our colleagues to learn from the great podiatry leaders within our profession.

I look forward to future interviews of podiatric legends on Tuesday nights.

Richard Pollak, DPM, San Antonio, TX, drpllk@hotmail.com

RE: American People Don’t Want Rationed Healthcare
From: Todd Rotwein, DPM, H. David Gottlieb, DPM

I am happy to see that J. Boylan and Jon Purdy have come over to the (liberal) Democratic side of the aisle. Dr. Boylan in his advocacy of negligence suits against insurance companies (maybe we could deflect the attention of the malpractice lawyers who make our lives miserable), and of government regulation of insurance companies.  Dr. Purdy, meanwhile, in his love of competition in the market place (perhaps he would like the federal government to order the dissolution of the near-monopolistic insurance giants). Welcome.

Todd Rotwein, DPM, Hempstead, NY, drdpm@aol.com

I currently work for a government-run healthcare [the Veterans Administration] after having been in private practice for over 20 years. When I was in private practice, rationing was called 'denial of benefits' and 'retroactive recoupment of overpayments' and was based primarily on the profit/loss analysis of private insurance companies. There were multiple 'rules of engagement' to learn in dealing with each company, and once those rules were learned by a large number of doctors, the companies changed the rules! How many times did I wish for only one set of rules to learn, as well as having them not be determined by the financial need for profit by a company on top of the obscenely large salaries of their executives.

Instead, I now work in an environment where the only real goal is the improved health of my patients. I see my patients when they need to be seen, the electronic record system is incredible. I have near instant access to test results, x-rays, 3-D CT scans, MRI's, etc., as well as full access to their entire medical records. I can communicate with the entire range of medical professionals involved with our patients' care at one time, in one place. Frankly, I wish I were eligible to receive the same care, in the same facilities, as my patients get now. Government healthcare? Bring it on!
 
H. David Gottlieb, DPM, Baltimore, MD, hdavidgottliebdpm@gmail.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.

ASSOCIATE POSITION - SUBURBAN DETROIT AREA

Home care doctor needed immediately for growing home care practice in the suburban areas of Detroit. Must have own vehicle and good driving record. Excellent opportunity for the right individual! email cv to: metrohomefootcare@gmail.com

PRACTICE FOR SALE-VIRGINIA (SOUTHEAST)

Very busy office near Williamsburg. Currently, a satellite office 2 days a week. Great opportunity to make office full-time. Grosses approx. 130,000/year. The office has everything needed to start practicing. All included. Must sell. If interested, e-mail totalfootcareva@hotmail.com

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 - NEW JERSEY

Established successful practice in Central New Jersey seeking PT/FT Associate. PSR 24/36. Please forward CV to rpg145@gmail.com or fax 908 753-0199.

ASSOCIATE POSITION - ILLINOIS

Excellent opportunity for qualified candidates in Northern Illinois/Western suburbs of Chicago. Growing two office practice searching for an associate to grow into a partnership. Full-time position, PM&S-36 board certified or qualified physician in forefoot and rear foot surgery. Multiple hospital and surgery center affiliations. e-mail DrTina@DrTinaOnline.com

ASSOCIATE POSITION – CHICAGO

South Side Chicago practice seeks podiatrist. Practice focuses on general podiatry, surgery, biomechanics, and diabetic foot care. Candidate should be surgically trained, certified/ working toward certification by ABPS. Surgery in office and hospital with residents. Base salary w/bonus incentives, paid malpractice insurance, benefits. Contact. ChicagoDoctor2009@yahoo..com or 773-632-7042

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. Call 206-661-9644.

ASSOCIATE POSITION - SOUTHERN CALIFORNIA

Excellent Opportunity, Full-Time or Part-Time, in busy and expanding podiatry practice. Offices located in Los Angeles and San Bernardino Counties. Fantastic Compensation. No Nursing Homes! Looking for at least one DPM now and one in July 2010. Spanish is helpful. Please send an e-mail to scpods@yahoo.com

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 

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

FOR SALE: MICROVASC UNIT

Excellent Condition, Never Used, New 14K, BEST OFFER. All-Pro 2010 X-Ray processor, used, great condition, Includes cassettes BEST OFFER
NYCPodiatry@gmail.com

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

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