The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

August 23, 2010 #3,938 Publisher-Barry Block, DPM, JD

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TX Podiatrist Discusses Neuromas

Neuromas are a common foot problem that may occur, which Dr. Leslie Campbell, a practicing podiatrist on staff  at the Presbyterian Hospital in Plano and Allen, Texas describes as "a nerve entrapment in the ball of the foot," causing a burning feeling in that area, as well as "numbness or cramping in the lesser toes, most commonly the third and fourth, and pain often traveling up the outside border of the foot."

Dr. Leslie Campbell

Relief is often directed toward wearing a wide toe-boxed, low heeled shoe, and cushioning. Anti-inflammatories including cortisone as well as orthotics may reduce the need for surgical intervention."

Source: Joanne Eglash, Associated Content (Yahoo) 8/13/10]

Use Orthotics Only in Neutral Shoes: TX Podiatrist

Place an orthotic insert only in a neutral shoe, which is a sneaker without all the foot-bolstering bells and whistles, says Jeffrey Ross, DPM, a podiatrist in Houston. "An orthotic adds arch support and stabilizes your heel and forefoot - everything you need for your foot if it overpronates," Dr. Ross says.

Dr. Jeffrey Ross

This means that putting an orthotic into a stability-style shoe, which already has those features built-in, would be overkill. "The double support would prevent you from pronating enough," he says. Your foot needs some rolling inward and outward for a natural strike and push-off.

Source: Rachel Sturtz, Fitness Magazine [July 2010]

Podiatrist's Rock N' Roll Shoes on Display at Canadian Exhibition

An exhibit of rock and roll memorabilia to be displayed at this year's Canadian National Exhibition in Toronto will include shoes once worn by Jimi Hendrix, Madonna, Rod Stewart, and Barbra Streisand. All are from the private collection of Toronto podiatrist Hartley Miltchin, who has made collecting celebrity footwear a bit of an obsession.

(L-R) Chubby Checker signs his checkered boots for Dr. Hartley Miltchin.

Miltchin owns about 350 pairs of shoes once worn by celebrities and sports figures, including Chubby Checker's custom black-and-white checkered boots and a pair of Shaq O'Neal's size 23 Reeboks. The CNE has asked him to loan the shoes with a rock 'n' roll pedigree for its exhibit, "The History of Rock and Roll."

Source: CBC News [8/19/10]

Judge Tells MI Podiatrist With 3 Wives "Pay up or Go to Jail"

A metro-Detroit podiatrist who made national headlines when it was revealed he had three wives, including one living in Rochester Hills, was in court this morning on back child support, and faces 14 days in the Oakland County jail if he doesn’t come up with the cash. Kenneth Mitchell, 49, must pay $3,500 in attorney fees by Friday, and another $10,000 by Sept. 1, or he will go to jail, Oakland County Circuit court judge Cheryl Matthews told him.

Source: LL Brasier, Detroit Free Press [8/18/10}

The Process of Merging – Part 4b

Here is what is going to happen from this point forward in the process, using guidance from the merger team:

Once the facilitator and leadership team meet with the legal and accounting team, you will get an estimated cost to put this together.Try to get them to give you a flat rate rather than an hourly rate to put the deal together. Once this is done, you will need to assess each physician and calculate how much each physician or physician group needs to fund. Let’s say the upstart costs are $200,000 and you have 20 physicians, Each physician should put in $15,000 and the group should  keep a $100,000 reserve in the bank. No matter what you are quoted, there always are unforeseen expenses and you don’t want to come back and get more money.

Source: David Helfman, DPM, CEO, Village Podiatry Centers, PC, dhelfman@vpcenters.com

Query: Subpoenaed for Deposition

I have been served with a subpoena to provide a deposition about injuries sustained by my patient injured at a supermarket. The deposition is at the request of the defendant supermarket. They have scheduled the deposition at a time and date not convenient for me, during  my office hours.

What are my rights? Must I change my schedule or can I request a change at my convenience? Can I bill for my time? What other issues should I address?

John Moglia, DPM, Berkeley Hts, NJ

Editor’s Note: PM News does not provide legal advice. You can certainly request a time convenient to you. You can also request to the defendant that you be compensated for your lost time from work. Testimony is based on your records and opinions and is never dependent on whom, if anybody,  reimburses you for your time. Since you have been subpoenaed, the defendant generally has no legal responsibility to compensate you. However, since defendants usually don't want an unhappy witness, such requests are generally granted. Should you require specific legal advice, you should contact an attorney in your state, as state laws often vary.

RE: Painful Venous Conformation (Robert Fridman, DPM)
From: Tim Vogler, DPM, Ronald W. Hines, DPM

This patient's condition definitely requires angiography for diagnosis and potential "mapping." This will most likely reveal a A-V malformation. I wouldn't consider operating on this patient without a fellowship-trained vascular surgeon as co-surgeon. The potential for complications (blood loss, disrupted arterial supply, disrupted venous return) is much too high otherwise.

Tim Vogler, DPM, High Point, NC, tav@yadtel.net

I recently had a young patient with similar symptoms (severe pain on the bottom of the heel) and the MRI looked similar to your patient's. The radiologist said this appears to be a ganglionic cyst. I aspirated the area and injected cortisone and sent the aspirate to pathology. They read it as fluid consistent with a ganglionic cyst. Her pain improved for only a few days and then got severe again, so an excision was done. In surgery the lesion did not appear to be a ganglion so I did a frozen section that was read as a Schwanoma. I got a call from the pathologist the next day telling me the final report was a synovial cell sarcoma. 

I sent her to an orthopedic oncologist who repeated the MRI with contrast. It appears I got all of the lesion out, but that recurrence is likely because wide normal margins were not possible in this area due to it butting up against the calcaneus. The treatment choices became amputation or radiation, and the patient opted for radiation. The oncologist says her prognosis is not very good. My feeling is (now anyway) we need to have a very high index of suspicion in soft tissue lesions. Getting other opinions, like you are doing on this forum, is always a good idea. It might be a good idea to have an orthopedic oncologist look at the MRI and listen to your story. Let us know the outcome.
 
Ronald W. Hines, DPM, Oklahoma City, OK, rwhines@sbcglobal.net

RE: Swiss Compression Technique (Elliot Udell, DPM)
From: Larry Kobak, DPM, JD, Ivar E. Roth, DPM, MPH

Dr. Udell's gratuitous swipe at minimal incision surgery is not accurate. The majority of malpractice suits at the time Dr. Udell refers to, involved limb and foot loss with patients having arterial insufficiency, usually diabetic patients. These days, as an attorney who defends podiatrists against professional discipline, I can tell you firsthand that podiatrists of all stripes often are accused of promising more than they can deliver! 
 
Larry Kobak, DPM, JD, Abrams, Fensterman, Fensterman, Eisman, Greenberg, Formato & Einiger, LLP, lfkobak@gmail.com

When I read this, I just thought this was another way to explain that they were using A-O screws for the bunion surgery. No big deal.  Isn’t it the standard of practice these days to be able to go back to work after a bunion operation right away? I have been telling this to my patients for the last 25 years with no problems. Of course, there is always the exception to the rule, such as firemen, airline stewardess, etc. But in general, 95% of my patients go to work immediately after the surgery.

Ivar E. Roth, DPM, MPH, Newport Beach, CA, ifabs@earthlink.net

RE: The Residency Shortage (Gregg Young, DPM)
From: Robert Scott Steinberg, DPM, Dennis Shavelson, DPM

Maybe, we can hear from those who would like to start a residency program, but find the mounds and mounds of ever-increasing paperwork and rules from the CPME far too daunting. I would also like to hear from those who have been successful in negotiating with their hospitals. What worked?

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

When I graduated from NYCPM, there were about 17 residency slots and I was fortunate to get one of the prime ones available. This meant that there were hundreds of graduates who were in the same kettle as the 12 graduates that Dr. Young describes.

I started a preceptee program in 1980 (sponsored by NY State and NYCPM) with Simon Young, DPM that lasted 11 years which allowed graduates to spend one year in our practice. Preceptees received a certificate of completion from NYCPM and NY State that became acceptable for them to continue their careers. 24 DPM’s graduated the precepteeship and, at last count, 21 are ABPS-certified. Names like Kesselman, Young, Stuto, Sciandra, Ostroff, Diaz, and Snyder come to mind as some who have become residency directors and leaders of our profession. I am very proud of this accomplishment.

I welcome one (or more) of these 12 graduates without a residency match to contact me so we can devise creative alternatives for this rising group. Advanced training in biomechanics may be one such path. The move by our leaders for mandatory three-year surgical training has divided our profession into operative and non-operative DPMs at a time when unification is so important. These men and women need advocates.

Dennis Shavelson, DPM, NYC, NY drsha@lifestylepodiatry.com

RE: Cosmetic Foot Surgery is a Matter of Semantics: NY Podiatrist
From: David Gurvis, DPM

1) A patient comes in and complains about "crooked toes", or, choose your complaint.Upon questioning, the patient has no pain, no limitations of ADL, no loss of day-to-day function, is able to wear shoes that she wants, and simply does not like how the foot looks - THAT is cosmetic. It would be billable under the CASH CPT code, at full fee, and I won't do it. That is a wrong reason to do any surgery on the foot. 

2) A patient comes in with a long second toe and is unable to wear the shoes appropriate to her age and job-related duties secondary to pain. THAT is NOT a cosmetic surgery, as pain and loss of function is involved and should be billed to the insurance company and not charged as cosmetic surgery for cash. To take cash and call that cosmetic is fraud. 

The dilemma? I do not get faced with this often here in the Midwest "corn belt", while my colleagues in NYC, Chicago, and so on are having to deal with it.

3) What about the woman who does well in nearly all shoes, even fashionable shoes, except the newest and more extreme  fashionable heels and pointed toes? Sure, almost any patient will feel better in a pair of wide diabetic shoes. And some really do have appearance requirements at work regarding footgear, but where is the line?

Example 1 is clearly cosmetic and should not have surgery. Example 2 is clearly functional and surgery is justified but billing as a cosmetic procedure is not. But what about the dilemma in example #3? I made my examples in black and white, while I am aware there are certainly shades of grey. I am trying to see well thought-out opinions from my colleagues since this cosmetic surgery concept has gotten blurred. Opinions?

David E. Gurvis, DPM, Avon Indiana deg1@comcast.net

RE: Referral Source Analysis (Brandon Macy, DPM)
From: Rem Jackson

Thank you, Dr. Macy, for the smile your note produced on my face when I read your note. Your example is the exception which proves the rule, but hope and prayer is not a good marketing program (Note to those of you preparing to write to tell me that prayer is good in all things – I concede the point and agree with you wholeheartedly, so no need to write).  But the Yellow Pages simply isn't a good investment in the year 2010. I have advised hundreds of professionals to stop sending their money to the Yellow Pages and devote more time and resources to their web-based marketing, their referral marketing, their internal marketing, and their external marketing. Scores have done it, and none regret it. They have lost only one thing – the bill from the Yellow Pages.

I do have a thought about how to encourage more referrals. This new patient should continue to hear from you regularly in an educational format (newsletters, CD’s, letters, postcards –really there are dozens of ways to accomplish this). As you continue to stay "top of mind" with her, she will “evangelize” you and your good service and caring manner to others just like her. Think of her as one of the Apostles preaching the good word about Dr. Macy. If you could get twelve new patients just like her, you could get a lot of traction. This model has worked remarkably well in the past.  

Rem Jackson, CEO, Top Practices, LLC.  

ASSOCIATE POSITIONS – MULTIPLE LOCATIONS 
 
Looking for podiatrists to join group to work in nursing facilities in: Texas (Ft. Worth, Dallas, Houston), Philadelphia, Northwest Pennsylvania, Delaware, Upstate New York, Massachusetts (Brockton). Please respond to: doconcall02@aol.com

MANHATTAN - FULL-TIME POSITION

Available for a Board certified/qualified podiatrist (PSR-24, PM&S-36 ). Located in Downtown Manhattan in a multi-specialty  Orthopaedic office. We have a high-volume practice that treats routine care, trauma, sports-related injuries, hospital consults, and ER Consults. Contact fscudese@seaportortho.com

ASSOCIATE POSITION - SW FLORIDA

Golf, Boating and Beaches - Great opportunity to join a well established Podiatry Practice. Excellent mix office/surgery, motivated experienced staff. Seeking full time Associate PSR 12-36. Excellent salary & benefits, early buy-in for the right hard-working, personable candidate. Email resume to capecoralpodiatry@live.com or fax to 239-573-9201

ASSOCIATE POSITION - FREDERICK, MARYLAND

Fredericks premier group practice is located only 45 minutes from both DC and Baltimore. Immediate opening for a minimum PSR 36 Podiatrist for full time position. We have it all: EMR, digital x-ray, ultrasound, ASC, etc. Excellent salary with bonus structure and benefits. Please email resume to docsbnb@aol.com

PODIATRY POSITION AVAILABLE – WISCONSIN

Affinity Medical Group, an integrated health care organization in East Central Wisconsin, is seeking a BC/BE Podiatrist for our Appleton location. This is a General Podiatric practice opportunity including routine care, sports medicine, and surgery. The Appleton area offers a unique quality of life, combining a family centered, university community with all season recreation, a nationally acclaimed educational system, and a diverse and growing economy and population. For information, contact or send your CV, to: Sara Roth, Affinity Medical Group, Physician Recruitment, Phone: 800-722-9989; Fax: 920-727-4350; E-mail: sroth@affinityhealth.org Visit our website at: www.affinityhealth.org EOE.

IMMEDIATELY AVAILABLE- ASSOCIATE POSITION -CT (FAIRFIELD AND NORTH HAVEN)

Great opportunity. Join one of the largest podiatric groups in Connecticut. Well-established and progressive offices. Electronic medical records, digital x-ray, diagnostic ultrasound, Padnet vascular studies, nerve conduction studies, pinpoint and CO2 lasers, electrical stimulation and ultrasound therapies. Seeking a well-trained, personable, and highly motivated individual. Please send resume and current photo to dr.kassaris@yahoo.com

ASSOCIATE POSITION - MANHATTAN

Associate needed in Upper West Side area one day a week for house calls. Earn reasonable income with virtually no overhead. Immediate employment available. Call me ASAP 201-491-2173 or email myfootdoctor2@aol.com

FULL-TIME ASSOCIATE NEEDED FREDERICK/HAGERSTOWN, MARYLAND

Reconstructive Foot & Ankle Institute, LLC needs full-time DPM at least PMS 36 to join premier group in Frederick/Hagerstown, MD. ASC, EMR, DR-digital radiography and ultrasound, Vascular/nerve testing, DME, retail store, strong hospital affiliations, salary, bonus and benefits. Respond to drmichaels@rfainstitute.com

ASSOCIATE POSITION – NEW YORK

Busy, well-established for 35 years, multi-site practice in upstate New York looking for licensed podiatrist who is ready for a thriving practice. Must be highly motivated, personable and great with patients. Competitive salary and benefit package. Send CV or letter of interest to associateinfoot@yahoo.com 

FELLOWSHIP OPPORTUNITY - OHIO

UH Richmond Medical Center is announcing a Podiatry Fellowship: INFECTIOUS DISEASE/WOUND CARE. Accepting applications now for the one year (9/1/10 to 8/31/11) fellowship. Fax a letter of intent and CV to 440-585-6141 attention Donna Ayres. Applicants must have completed a PM&S 36 or equivalent. Interviews are scheduled 8/20/10. This fellowship includes all aspects of a multidisciplinary faculty and clinical opportunities in medical and surgical wound management. Weekly schedule includes surgery, fellow’s clinic time as well as journal club and one research project. The Fellowship has been approved with provisional status by the Council on Podiatric Medical Education.

PRACTICE & STATE LICENSED ASC FOR SALE (MARYLAND, DC SUBURB)

Full-time 38 yr old podiatry practice with state licensed surgical center. Fully equipped with digital x-ray, diagnostic ultrasound, 2 orthotic scanners, computer network, and well-equipped surgical suite. Retiring owner will stay on as needed for transition. Email dpmpracticeforsale@yahoo.com

PRACTICE FOR SALE – MASSACHUSETTS

Solo Practice Grossing over $700K yearly 4 days a week. Mostly surgical with heavy emphasis on peripheral nerve patients and pediatrics. General bread and butter podiatry as well. No Medicaid very little Medicare. Very modern office. 30 minutes north of Boston. Modern new equipment (digital x-ray, ultrasound, computer network, etc.). Great referral network. Website included. Option to buy the condo 3500sq ft. Have PICA practice evaluation to show you. Call 978-944-7789 for details.

PRACTICE FOR SALE - DALLAS, TX

Prestigious North Dallas location; 24 year old practice; excellent mix of hospital surgery, office surgery, orthotics, general podiatry, web site, electronic claim submission. Retiring owner will stay for transition. Owner financing available. dallasfootdr@yahoo.com

MEDICAL SPACE AVAILABLE- MANHATTAN

Multispecialty Medical Building with 24/7 doorman. Prime Luxury Building and Location, Gramercy, Stuyvesant, Peter Cooper Area. 305 Second Avenue (17th-18th). Prior tenants past 23 years; podiatrist, dentist (plumbing/electric intact), internist. Ideal for podiatry, co-share with dentist, MD, etc. (flexible lease terms). E-Mail; jbdrun@aol.com Phone; 480-951-2480.

PM News Classified Ads Reach over 12,000 DPM's 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 12,000 DPM's. Write to bblock@podiatrym.com or call (718) 897-9700 for details. 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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