The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

August 27, 2009 #3,633 Publisher-Barry Block, DPM, JD

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IA Podiatrists Provide Back-to-School Shoe-Buying Advice

Ideally, kids should be wearing lace-up shoes with good cushioning, arch support and stability, said Dr. Kirk Neustrom, a podiatrist at Metro Foot and Ankle in West Des Moines.

Dr. Kirk Neustrom

"Running shoes, in my opinion, are the best shoes made," Neustrom said. "(They are) well-designed, and a lot of effort and biomechanic evaluation goes into running shoes." Neustrom said while kids love to wear flip-flops and Crocs, they should be worn only for short periods of time.
  

Dr. R.D. Lee Evans

"Growing pains" that kids ages 8 to 13 experience are exacerbated by flimsy footwear, said Dr. R.D. Lee Evans, a podiatrist with Des Moines Orthopaedic Surgeons. Once you've found the perfect pair of shoes, make sure kids tie their laces. It may be cool for kids to leave their laces untied, but that makes shoes less stable and kids more accident prone, Evans said.

Source: Des Moines Register [8/24/09]

TUSPM Podiatrist Advises Against Surgery for "Cankles"

According to podiatrists, the average ankle size is about 10 to 11 inches around; men's ankles may be a little larger. The American Podiatric Medical Association does not recognize cankles as a medical problem, but according to Dr. Kathya Zinszer, a physician at Temple University's School of Podiatric Medicine, cankles can be caused by all types of medical issues. "Things like diabetes, hypertension, cardiovascular risks, sometimes just lymphedema," says Zinszer. "All of those can lend themselves to deformed ankles or what people are [calling] cankles." But Zinszer says that most cankles are "God-given."

Dr. Kathya Zinszer

Zinszer has seen patients try to alter their cankles. Some people turn to ankle liposuction, which can cost anywhere between $4,000 to $8,000, depending on how extensive the ankle-shaping need is. But Zinszer doesn't recommend liposuction because it can do more damage than good. "The foot, the lower extremity, has a lot of neuromuscular structures," she says, explaining that by removing some of the tissue, nerves and vasculature can be damaged, creating an even bigger problem.

Source: Val Willingham, CNN [8/24/09]

Physicians' Operating Costs Rise Faster Than Revenue

The top concerns among medical group practices this year are operating costs rising faster than revenue; maintaining physician compensation while reimbursement declines; and choosing and implementing an electronic health record, according to a study released by the Medical Group Management Association. Those were the same top concerns listed in last year's survey. In this year's survey, the fourth-highest concern was collecting from self-pay patients and those with high-deductible health plans and health saving accounts.

For the second year in a row, practices ranked managing finances in the face of uncertain Medicare rates as the fifth-highest concern. Recruiting physicians was the sixth-ranked concern, down from fourth last year. Respondents were also asked how the recession was affecting their practices: 36.6% say that they had postponed capital expenditures; 34.7% are seeing a rise in uninsured patients; 34.5% froze hiring; and 33.9% have cut operating budgets.

Source: Modern Physician [8/24/09]

Query: Residency Opening For Older Podiatrists?

Are there any approved PSR residency openings for older podiatrists? After several years of premature retirement, I'd like to "get up to speed." I am currently licensed and ABPS certified.

Robert Bijak, DPM, Clarence Center, NY

RE: Protocol NaOH Matricectomy (Irwin S. Linker, DPM) 
From: James C. Ricketti, DPM

I am the inventor of the Phenol EZ Swabs (Pedinol). One application of phenol on the swab for 60 second per border is used. No other timing is needed as with NAOH. Post-operative drainage ranges from 2 to 4 weeks depending upon the age of the patient and medical condition. It can be performed with great success in the presence of infection. Success rates are 98.2% as per studies by Pedinol Pharmacal, Inc. Phenol is quick, easy, and dependable. 90% of nail procedures performed in America are by phenol and only 8% are with NAOH. Why is that?  For more statistics or studies, call Pedinol Pharmical.
 
James C. Ricketti, DPM, Hamilton Sq., NJ, drj4foot2002@netscape.net

RE: Income Per Patient (Michael Cohen, DPM)
From: Greg Mowen, DPM, Bret M. Ribotsky, DPM

Several years ago, I heard one of Dr. Guiliana's lectures. My office was also at about $60 per pt. We decided to offer expanded services and products. For instance, we added ABI/ Doppler exams, venous testing, and nerve testing. My office was then also able to provide patients with some of the products that may help their conditions: support stockings, vitamin supplements, OTC orthotics, etc. This increased our revenues above the $90 mark without having to increase patient numbers. Most of our practices have older patients. They appreciate the convenience of getting some needed testing and products without having to go outside the office.

Greg Mowen, DPM, Ventnor, NJ, gregmowen@comcast.net

Just a brief word of thanks to Dr. Cohen for enjoying and finding value from Meet the Masters, and sharing his comments with the PM News world  While I enjoyed the responses to Dr. Cohen's question from Drs. Hultman, Kornfeld, and Purdy, I did not see an answer. Go to more meetings, drop poor insurance plans, and realize that an average is not a goal, are not solutions to the question. Michael wanted to know what the average income per patient was over a full year. I did the math in my office and I was surprised that it was almost 63 dollars a patient encounter. 

I guess doing an Austin for under $600 and taking x-rays for under $20 is not something that is sustainable. Yes, in South Florida, Medicare is the top insurance, with others paying 30-40% less. I have withdrawn from all HMO's and reduced almost all PPO's to just a few.  I was looking for the best, value-based profit center in my office, and after the aesthetic business, my Dr. Comfort shoe sales were next. So, to increase my average income per patient, my goal will be to provide more diabetic shoes and socks each month.  What are others going to do?
 
Bret M. Ribotsky, DPM, Boca Raton, FL, ribotsky@yahoo.com

RE: We're Medical Doctors (Alan Sherman, DPM)
From: Leonard A. Levy, DPM, MPH, Barry Mullen, DPM

As someone who has been deeply immersed in this controversy for decades, I more than understand the frustration of Michael M. Rosenblatt, DPM, of San Jose, CA. However, podiatric physicians do in fact practice allopathic medicine. That designation (i.e., allopathic medicine) refers to a system of health care as differentiated from the system used by osteopathic physicians who also employ various forms of manipulation and a broad philosophy of holistic care or other systems that include homeopathy and naturopathy. The only difference between DPMs and our MD colleagues is that we do not have a complete license to practice medicine. By choice and history, we have carved out a medical practice that specializes in the prevention, diagnosis, treatment, and rehabilitation of problems in people affecting their pedal extremity (yes, we do not treat feet or ankles but people who have them).

If we want to expand our license, it is necessary for our practitioners to complete the additional studies required to become eligible for an unrestricted medical license. Today’s discussion in our profession includes at least two approaches to this. One is to make the curricular modifications necessary in our schools to try to accomplish this. The other is for DPMs to complete additional studies in an accredited school that provides the MD or DO degree (e.g., Nova Southeastern University, College of Osteopathic Medicine, DO Program for DPMs). Either of these paths has been and still is the target of significant, ongoing contentious debate within our profession. It will be interesting to see what the outcome will be.  

Leonard A. Levy, DPM, MPH, Fort Lauderdale, FL, levyleon@nova.edu

Editor's Note: Dr. Mullen's extended-length letter appears at:
http://www.podiatrym.com/letters2.cfm?id=28390&start=1

RE: Timing of Charging for Orthotics (Paul Kesselman, DPM)
From: Narmo L. Ortiz, Jr., DPM

Dr. Kesselman answered this question the best. Nevertheless, I agree with Dr. Weil in charging the insurance company at the time of casting. It never ceases to amaze me that the medical profession is the only "business" where the service or procedure is done first and then you wait to be paid later (if they pay at all), at whatever reductions are calculated by the insurance companies. Most businesses I know charge you before or at the time the service or product is delivered. Why should we be different?

Narmo L. Ortiz, Jr., DPM, Cape Coral, FL, nlortizdpm@embarqmail.com

RE: EHRs Have Open-Source Software Alternatives
From: Michael L. Brody, DPM

The article on Open Source Software has some interesting comments.  Open Source Software has some significant advantages over 'commercial software' and it has some significant disadvantages.

First let’s look at the advantages....

Editor's Note: Dr. Brody's extended-length letter appears at: http://www.podiatrym.com/letters2.cfm?id=28393&start=1
 

RE: Recommended Ultrasound Text
From: Sanjay Gandhi, DPM

Drs. Ben Pearl and Martin Wendelken did a very good job with the diagnostic ultrasound article in the August issue of Podiatry Management. With rapid advances in technology, I agree with continued training and a standardized curriculum for the practice of ultrasound. Over the years, the spectrum of indications for diagnostic ultrasound in the foot and ankle has broadened drastically.  With the advent of high resolution ultrasound, we are able to provide more cost-effective and better quality of care for our patients. The future of ultrasound in podiatric practice is very bright. We, as practitioners, need to enhance our knowledge and upgrade our skills with the advancement of technology.

Drs. Ben Pearl and Martin Wendelken mentioned a few resources available on diagnostic ultrasound. They, however, failed to mention a really good and complete resource for podiatric ultrasound. Drs. Cozzarelli and Thapar have offered a very comprehensive and easy-to-read and follow textbook for podiatric ultrasound. Musculoskelatal Ultrasound of the Foot and Ankle, by Drs. Cozzarelli and Thapar talks about the physics, the techniques, applications, artifacts and the language of ultrasound. The chapters on vascular ultrasound and tarsal tunnel give you an idea of where the future of ultrasound is really headed. This book is filled with ultrasound pictures on every aspect of podiatric pathology that can be diagnosed with ultrasound technology. This is the only textbook that I have found helpful in my learning of ultrasound, and I have found myself referencing this book quite often during my routine ultrasound use in private practice.

Sanjay Gandhi, DPM, Manalapan, NJ, sgandhi2000@yahoo.com

ASSOCIATE POSITION – NORTH CAROLINA

Very busy practice in Western North Carolina, seeking Full-time Associate with hospital and surgical training. If interested please fax resume to 828-252-2272 or e-mail to mfas828@aol.com

Amfit Orthotic Insole Fabrication System with Footfax SL Contact digitizer- For Sale Machine, Laptop, rolling bag, small inventory of shoes, insoles, all cords, parts and hardware Asking $10k.OBO! Please contact Jeff at Jhunt@psbank.net for further information, pictures.

ASSOCIATE POSITION - MARYLAND

ASSOCIATE POSITION – CENTRAL FLORIDA

Growing practice east coast of central Florida looking for full or part-time associate willing to buy into practice. PSR 24/36 Please contact: pfk4@yahoo.com.

ASSOCIATE POSITION - CAMBRIDGE, MA

This well-established practice in podiatric medicine and surgery presently has two office locations and a rehabilitation hospital with a focus on wound care. This is a fast-moving environment that continues to grow and necessitates a podiatrist who is eager and willing to support this growth. Candidate must have completed a surgical residency. This is a full-time position but will entertain part time yet requires an individual who is flexible with coverage as needed. Send CV and Letter of Interest to: dmost5@aol.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 - 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.

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 - FREDERICK, MD

Well-established and growing 2 office state-of-the-art practice located in medical/professional buildings. EMR, Digital X-ray, Ultrasound, DME provider, etc. Competitive Base Salary plus bonus, malpractice, health insurance, etc. PSR 24 minimum/Board Qualified or Certified with ability and desire to take ER call. If interested, forward CV to DOCSBNB@aol.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-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

LOOKING FOR ASSOCIATE POSITION  – CHICAGO, IL

I am a hard working and Ethical Podiatric Surgeon looking for Associate/Partnership position in the Chicagoland area. Please contact A773K@aol.com  or cell phone (713) 992-6113. 

ASSOCIATE POSITION - DALLAS/FORT WORTH AREA

Seeking well-trained ABPS board certified/qualified foot surgeon for surgical practice with national foot/hand/orthopedic surgery group. Excellent salary/benefits. E-mail CV and cover letter to: slb99@pdq.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

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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