The Voice of Podiatrists

Serving Over 14,601 Podiatrists Daily

August 14, 2013 #4,848 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

Attention Verizon Subscribers: Some Verizon.net subscribers did not receive yesterday's PM News. If you did not receive the issue dated August 13, 2013, click here.

 PM News to Highlight Unmatched Graduates

If you are an unmatched graduate, PM News wants to help you obtain a residency position or other opportunities. Simply send us a short description of your qualifications (100-word limit) along with a color headshot (optional) to pmnews@podiatrym.com  We'll post it in PM News for residency directors and other interested parties to view.

Court Ruling Will Benefit Podiatrists: PPMA Executive Director

A Commonwealth Court ruling raises the likelihood that hospitals, doctors, and other medical providers next year will receive more than $100 million in refunds or credits from a state-run medical malpractice liability fund.

Michael Davis

Michael Davis, executive director of the Pennsylvania Podiatric Medical Association, said providers have to pay into the fund to keep their licenses, so the ruling is a welcome relief. “We will have an accurate assessment, as opposed to an arbitrary assessment,” he said. Keeping the fund from building a surplus would keep it from “becoming a target for the Legislature,” Davis said.

Source:  Brian Bowling, Pittsburgh Tribune Review [8/13/13]

NY Podiatrist Joins NY Senator Schumer at Leadership PAC Event

NYSPMA Vice-President Andrew Shapiro, DPM joined Senator Charles Schumer at a recent Yankees baseball game, benefiting Senator Schumer's Leadership PAC. Senators Charles Schumer (D-NY) and Chuck Grassley (R-IA) recently introduced S 1318, the Helping Ensure Life- and Limb-Saving Access to Podiatric Physicians (HELLPP) Act in the U.S. Senate. This bill is identical to HR 1761, a companion bill in the House.

(L-R) Sen. Charles Schumer and Dr. Andrew Shapiro

Unlike previous legislation that has focused solely on recognizing DPMs as physicians under Medicaid, the bipartisan HELLPP Act includes multiple comprehensive reforms and goes further to ensure podiatric physicians will continue to save lives, limbs, and healthcare dollars. This would be a significant improvement to patient access to quality foot and ankle care and tremendous savings for the Medicaid and Medicare programs.

MD Podiatrist Discusses APMA Seals of Acceptance/Approval

The American Podiatric Medical Association (APMA) has a rating system for footwear. The program is called the APMA Seal of Acceptance/Approval, and the results can be found on the organization's website. Here's how it works: Manufacturers submit their products for review, and a panel of practicing podiatrists study the shoes to see if they meet certain standards and promote foot health.

Dr. James Christina

The committee does its work in complete anonymity, according to Dr. Jim Christina, director of scientific affairs for APMA. He stresses that the footwear industry has no way of knowing who is actually conducting the evaluation. The rating program covers everything from dress shoes to athletic gear and sandals. Christina says podiatrists see a lot of injuries related to footwear. Using the wrong shoe for a sport is one big source of trouble, as is too much time spent in high heels or flip-flops.

Source: Paula Wolfson, WTOP [8/12/13]

OH Podiatrist is Big Ten Football and Basketball Official

Yes, they are the referees, and for one longtime football and basketball official, Dr. Denny Morris, it has been a labor of love that started in his formative years. While the 1975 Elida graduate will tell you he didn’t excel in sports growing up, that may have been exactly the reason for his interest in officiating. “I did play baseball in school, but otherwise, I really wasn’t a great athlete, but I think because of that, I turned my interest to refereeing as a way to be involved in something I really liked.”

Dr. Dennis Morris

During Morris’ college years at Bowling Green, in addition to laying the groundwork for what is now a successful career as a podiatrist, Morris also began receiving more opportunities to officiate. While Morris has no immediate plans to retire from either sport, he’s also realistic that he’s a lot closer to the finish than the starting line. “Listen, I know I’m sort of in the twilight of this, but I certainly hope I have a few more years in me, especially with Big Ten football, which I love. A lot of that will depend on my health, though," Morris said. “I don’t want to reach a point where the games become too fast and I’m more of a burden to my crew than an asset. However it goes, I feel really blessed to have had a great run."

Source: John Grindrod, The Lima News [8/12/13]

Query: Non-union Following a Lapidus Procedure

I carried out this procedure on a healthy 40 year old female 11 months ago. She has no discomfort, the medial arch is stable and she has returned to some gym work. I have concerns, however, as there is no sign of bony union and a clear gap is seen. I have fully advised the patient of this and have explained that the stability is only being maintained by the metalwork. The patient declines further surgery stating that she is content.

I have mentioned the possibility of a bone stimulator. Does anyone  have experience with this equipment, bearing in mind the time lag? I am reluctant to leave things as they are without exploring every avenue.

Barry Francis, Consultant podiatric Surgeon, London, UK

Query: Surgery on Hearing-Impaired Patient

I am scheduling a 5th metatarsal osteotomy on a patient who is hearing-impaired. We communicate by writing notes (thankfully, she did not insist that I provide a translator).  I have my normal consent form, but should I literally write out the entire planned procedure, recovery risks, etc.? I did keep the notes we wrote during the initial visit, but they are very "casual." Any suggestions would be great.

Jeffrey Worman, DPM, Largo, FL

Response: While I'll leave the legal opinions to the healthcare attorneys, informed consent means that the patient has been told of the risks, benefits, alternatives, etc. of a procedure such that they 1) can understand what they have been told and 2) can make an informed decision as to whether or not to proceed with the procedure.

So, by whatever means it takes to convey this information, that's what you need to do. If they do not speak English, you need to have a translator. In this case, given the treatment will be surgical, I  think you would want to absolutely make sure that the patient completely appreciates the nature of the treatment. If there is a family member who can sign, maybe they should be in the room to help ensure that communication is not a problem. Alternatively, you can get a professional signer. Sometimes a hearing-impaired telephone can be helpful.

Tony Poggio, DPM, Alameda, CA

Codingline subscription information can be found here

APMA Members: Click here for your free Codingline Silver subscription

RE: Severe Heel Pain After Plantar Fasciotomy (Mark Aldrich, DPM)
From: Dan Klein, DPM, Daniel Waldman, DPM

I suggest evaluation for medial calcaneal nerve injury. Perhaps RF treatment may give relief. Radio-Frequency treatment has proven to be successful in these cases.

Dan Klein, DPM, Ft. Smith, AR, toefixer@aol.com

Many of my patients with acute and chronic plantar fasciitis have benefited from MLS laser therapy. I have been using the MLS Laser from Cutting Edge for 8 months and am impressed with its efficacy in many challenging cases. I have my patients come in 2 to 3 times a week for a month for the laser treatments. Understanding proper laser settings and area(s) treated is critical for a successful outcome whether treating plantar fascia, tendonitis, neuromas, or other anatomic regions. 

Daniel Waldman, DPM, Asheville, NC, dpmcareer@me.com

RE: Staged Procedures for Digital Deformities (Ivar Roth, DPM, MPH)
From: R. Kurt Meier, III, DPM, Jeffrey Kass, DPM

I have been in practice for 22 years, and I have done bilateral procedures and single procedures.  Usually, if it's digital, I have no problem operating on both feet at the same time. I try NOT to do bunions at the same time. In my experience, patients tend to "favor" the less painful foot in the immediate post-operative period. It always seems that the "good" foot winds up with a clinically worse result, even though the same procedure was done on both feet. I present both options to patients, and will do bilateral bunions if the patient REALLY wants to get it done, but I, personally, would opt for one foot at a time if it were my feet. I treat patients like I would treat family members, and would suggest to family members to have one at a time.
 
R. Kurt Meier, III, DPM, Brick, NJ, icfeet@tellurian.com

I respectfully disagree with Dr. Roth regarding bilateral foot surgery. First off, I always have my patients' best interest in mind and don't base my operative decisions on financial gain. This is evidenced by my performing pro bono and capitated cases. I think it is common sense that one should have a "good foot to stand on."

The greatest surgeon could have unexpected post-op complications. Unless, of course, the greatest surgeon is always paired with the most compliant patients, who never have any allergic or foreign body reactions, etc.

I try my best to keep up on current literature. JFAS is full of unilateral forefoot complications - I could only imagine the problems the patients would encounter if those procedures were done bilaterally. I hope that those who have had success performing bilateral cases continue to do so. Some of us might prefer the conservative approach. Please don't insinuate that we all do this for monetary gain or that we are following old wives' tales. Some of us still have pure motives.

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

RE: Maximalist Running Shoes are In, Minimalist Running Shoes are Out
From: Kevin A. Kirby, DPM

I just wanted to clarify a point that I made in my recent posting about the new "maximalist" running shoe, the Brooks Transcend. The Brooks Transcend was "unveiled" at the Outdoor Retail Summer Market trade show held in Salt Lake City on August 1, 2013. However, the Transcend won't be on store shelves until February 1, 2014. The maximalist running shoe, Hoka One One, has been on specialty running store shelves for three years. Sorry for any confusion this has created.
 
Rumors also have it  that many of the major running shoe manufacturers will be introducing new "maximalist" running shoes in 2014. Much of running shoe manufacturers' ability to design thicker, more cushioned, yet relatively light running shoes seems to be due to the recent development of newer midsole materials that allow these new running shoe sole constructions to occur. It is an exciting time in the history of running shoe development that every sports podiatrist should try to stay abreast of.
 
Kevin A. Kirby, DPM, Sacramento, CA, kevinakirby@comcast.net

RE: Diagnostic Ultrasound (Bryan Markinson, DPM)
From: Michael Forman, DPM, David E. Gurvis, DPM

It is no wonder that Dr. Markinson wonders about the fluid injected in a plantar fascial treatment. I wonder as well. However, the first scenario deals with someone who injected a dorsal ganglion ten times. Now come on Bryan, that is not the  fault of an ultrasound machine. The doctor was obviously a goof ball.

Michael Forman, DPM, Cleveland, OH, im4man@aol.com

Regardless of the utilization of ultrasound or not, 10 injections of a steroid into a ganglion cyst seems to fall beneath the standard of care. I think that is the issue here, rather than the use of ultrasound, which is peripheral. As to Dr. Markinson's musings about how much steroid would remain in the body of the plantar fascia, I “guess” that it is mostly due to the nature of the structure, but I cannot, of course, prove it. Your study would be most interesting if indeed it could be accomplished morally in a manner where it could be measured.

If a new technology comes along, and...

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

RE: CA Podiatrist Discusses Heel Pain and Achilles Tendonitis
From: Steve Pribut, DPM

I am aware of the news section highlighting what is said by and of podiatrists in the news media. And I realize how difficult it can be to educate the journalist interviewing you on topics of which they know little.

I wanted to point out once again information about a battle I believed we had won years ago. It is the battle of words and thoughts that chronic tendon issues are not "tendinitis" but considered tendinopathy. PM News has covered this well and there is a recent CME that reviews this and other running issues in two parts. This and other articles over...

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

ASSOCIATE POSITION - CENTRAL FLORIDA

Associate position for busy practice in Central Florida. Competitive salary with complete benefit package available. Please send resume to cmedders@atlanticpodiatry.com

ASSOCIATE POSITION - LONG BEACH, CA

Immediate opening available for a DPM with 2 or 3 year residency . Prefer some work experience, but with the right qualifications and can-do attitude, will consider newly out of residency. Full-time needed, must be willing to work hard and provide excellent care. We have a very fast paced, busy practice and lots of great patients. Please send your resume/c.v. and a brief note citing what you are looking for in your career to: Mil2RN@gmail.com

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 POSITION - SOUTHEAST MICHIGAN (MI LICENSE REQUIRED)

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 CV to:cfsdr@yahoo.com

ASSOCIATE POSITION - CENTRAL PA

Looking for an associate with 3-year surgical residency. The physician will provide all aspects of podiatric practice, including sports medicine, wound care, and foot and ankle surgery. Competitive compensation package. Partnership opportunity for right person. To apply, please email, letter of intent and CV to stringernyc@hotmail.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

ASSOCIATE POSITION - NYC METRO AREA  

Must participate with HealthFirst, Affinity, Fidelis health plans (2 of 3 OK). Preferably on staff at Bronx or Manhattan hospitals or surgicenters. Excellent opportunity for quick partnership. email CV torrranch7@yahoo.com

ASSOCIATE POSITION – NORTHERN CALIFORNIA/SF BAY AREA

We’re seeking a podiatrist to join multi-office practice. Must have great people skills, great bedside manner, and positive demeanor. California license required. No nursing home visits. Prefer private practice experience. Send CV and cover letter to: ebpod2008@gmail.com

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

ASSOCIATE TEXAS- NORTH DALLAS AREA.

Great opportunity for the right individual. Seeking well trained (PSR 24+), ethical, hard working, motivated individual. Full scope of podiatry including office, hospital and surgery center work.  Partnership opportunity available for the right individual. Well rounded practice with competitive salary/benefits package. Seeking an individual with superior surgical and personal skills to join our two location, two doctor practice. Please send letter of intent and CV to DPMopening@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 - BRITISH COLUMBIA, CANADA

Beautiful Victoria, British Columbia, Canada on the Ocean, fast growing area, Associate for Multi-office full scope practice Reply to dr.cole@shaw.ca

ASSOCIATE POSITION – VIRGINIA

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

OFFICE AVAILABLE - TACOMA, WA

Podiatry clinic available for podiatrist one or two days a week. Current doctor does no bone surgery. Perfect for someone wishing to supplement a current office or a new practitioner looking to get his foot in the door in the Puget Sound area. Email CV and cover letter to 4MYFEET@sbcglobal.net.

NEW PRECEPTORSHIP POSITION NOW OPEN

Philadelphia based multi-doctor practice offering preceptorship. Unique practice blending ‘traditional’ podiatric services with acupuncture, sports medicine and podiatric pain management. Individual must be motivated, personable and have strong computer skills. Please respond by email with resume and  CASPR application. Selection process will be completed quickly, so please respond timely if you are interested. ediamond7@comcast.net

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.

EQUIPMENT FOR SALE - NEXUS LASER

Nexus 10W laser for sale, 1 year old still under warranty with option to extend. Portable with battery, excellent condition. Has soft tissue ablation head and bio-stimulation head. Built-in protocols. Best offer e-mail tmacklin.podiatrygroupofga@live.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

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 - STAMFORD, CONNECTICUT

Well rounded general and surgical podiatry practice in beautiful Stamford, CT. 35 years. Walk to the hospital and OR. $350k gross / 4 days per week. May lease present office space. Super office manager. Practice offered @ $100k. jefre1@msn.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

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.