The Voice of Podiatrists

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September 13, 2010 #3,956 Publisher-Barry Block, DPM, JD

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We’ve just posted the September 2010 CME titled:

By Drs. David Yeager and Hyim Baronofsky

You can Earn 30 CPME-Approved CME Contact Hours Online

 Earn 15 Contact Hours for only $139

FL Podiatrist Recommends Laser for All Nails, Even if Only a Few Appear Infected

Offer an effective treatment for toenail fungus and the world will, apparently, beat a path to your door. Several local podiatrists have recently acquired a laser that's designed to quickly, safely and painlessly kill the unsightly and potentially dangerous fungus that takes hold under some people's toenails. They've been seeing a steady stream of patients willing to pay hundreds of dollars for the treatment.

Dr. Fred Kussel

"We got the laser a few months ago and we've been really busy ever since," said Clearwater podiatrist Dr. Fred Kussel. The treatment generally kills the fungus completely in one to three sessions, but it may take time for discoloration to disappear. The treatment is not inexpensive. Kussel charges $699 to treat all 10 nails, which he recommends even if the fungus is only evident in one or two toes, since this pesky condition can so easily recur.

Source: Marty Clear, St. Petersburg Times [9/10/10]

NY Podiatrist Receives "Hero of Reform" Status from Former NYC Mayor

Dr. Harold Paez, candidate for NY State Assembly in the 23rd District, received recognition of his status as a “Hero of Reform” by former Mayor Edward Koch and his political action initiative: NY Uprising.

(L-R) Edward Koch and Dr. Harold Paez

In a statement received by the campaign office, the former Mayor of New York City and Founder of NY Uprising, states: “I applaud Harold Paez as a “Hero of Reform” for signing the three New York Uprising pledges. This year voters are counting on candidates to commit to specific reforms in advance, as Harold has done. I look forward to working with him to see them swiftly implemented should he be elected.”

NJ Podiatrist Delivers Welcome Address at Ramapo College

For the second year in a row, John V. Guiliana, DPM, MS had the honor of delivering the Welcome Address to over 2,500 incoming freshman and their parents at Ramapo College in  New Jersey on Sunday, August 29th. In a humorous delivery, the theme of his talk focused on the "transition" that parents and students will go through in this new journey, as well as the importance of staying "connected" to each other.

(L-R) Dr. Peter Mercer, President of Ramapo College, Stephanie Guiliana, Dr. John Guiliana

Dr. Guiliana serves on the President's Parents Council at Ramapo and has a scholarship fund for 4th year students who commit to furthering their education through graduate studies. He has influenced numerous students to pursue podiatric medicine as their career choice, including his son Stephen who is a second year student at OCPM. Dr. Guiliana is a Trustee of the American Academy of Podiatric Practice Management.

Editor's Note: PM News is proud to present excerpts from Meet the Masters.

Bret Ribotsky: What unique activities or events have you done which helped build your practice?

Dr. Christian Robertozzi

Christian Robertozzi: Certainly the biggest practice builder I recommend is sending letters to the physicians for each patient. I try to hang out with and learn from other people who are successful and tap their brains, and see what things that they are doing. We have done a lot of community focus-type of fundraisers. For instance, near Christmas, we had a day that was dedicated to the "toys for tots" program. In lieu of paying a fee, patients brought in a toy. We did a similar thing for Thanksgiving for cancer patients. Patients brought in some type of food, whether it is a turkey or perishable food or canned food, and we waived our fee.

Dr. Allen Selner

Meet the Masters is broadcast each Tuesday Night at 9 PM (EST). The next segment  will feature Dr. Allen Selner, podiatric medicine’s Infomercial king (Phase 4 Orthotics).  You can register for this event by clicking here 

Dial Back High Turnover Rates

Employee retention should be at the top of your leadership to-do list, especially if your practice is facing higher-than-usual rates of employee turnover. What can you do to hold on to valued employees without offering salary increases? Here are two low-cost strategies:

•  Build relationships. Do your employees believe that you care about them? Do they trust you? A recent Gallup Poll revealed that those are the key indicators of employee satisfaction and productivity.
•  Make work more stimulating and more fulfilling. Take your employees to clinical and practice management conferences. They will tackle the work more enthusiastically, and you will be surprised at their creativity and commitment.

Source: Adapted from “Success Coach: Keep More Employees While Keeping Costs Low,” Michael Crom, The News-Press via Communication Briefings

Query: American Imaging Nerve Conduction Studies

I received a call from a company, (American Imaging) about performing nerve conduction studies on my patients in my office. They would come in and perform testing on my patients who have symptoms of neuropathy. The company would receive  the insurance payment and only reimburse me for an hourly rental of my office and staff. I see a great deal of diabetics with neuropathy symptoms and believe this would greatly aid in the completeness of my exam and general treatment of these patients. Has anyone else been involved with this type of company and financial  agreement? Input would be greatly appreciated.

Jack Ressler DPM, Lauderhill, FL

RE: Bromhydrosis/Hyderhydrosis (Darryl Burns, DPM)
From: Pete Harvey, DPM

As with the underarms, no moisture = no odor. The odor is caused by the bacteria multiplying in a moist atmosphere. The bacteria will be relatively inactive in a dry environment.

I have had excellent results with having the patient apply unscented Extra Dry spray or antiperspirant to the plantar skin at bedtime and after the morning shower. Extreme perspiration may require several applications daily. If the patient’s skin is always in direct contact with the shoe lining, then this must also be controlled. This also works well with verruca patients.

Pete Harvey, DPM, Wichita Falls, TX, pmh@wffeet.com  

RE: Recalcitrant Ingrown Nails (Arti Chopra Amin, DPM)
From: Dennis Shavelson, DPM

The patient may have  a compensatory functional hallux extensus as a reaction to a flexible forefoot functional foot type. The forefoot PERM is highly dorsiflexed and the forefoot SERM-PERM separation is great. This means that instead of using the 1st MP joint as the forefoot rocker, he is using the hallux IP joint, which is causing the hallux toenail to have increased repetitive micro-trauma into his tight sport shoe. This results in the hallux toenail being clinically injured ("The Pathogenesis of Toenail Dystrophy", Shavelson, Bakotic, Podiatry Management, June 2006).

Concomitant biomechanical care, foot type-specific, will reduce the mechanical component of this (and so many other) closed-chain complaints in a manner that no other practitioner is capable of performing.

In my experience, once explained these facts, the patient and the parents will want you to proceed with a casting, stat,  in addition to the care you are rendering to the injured toenail. The result will be a pleased patient who functions better.

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

RE: Remembering 9/11
From: Kathy Fallon, DPM

I had the privilege to serve as a podiatric volunteer after 9/11 at St. Paul's church at Ground Zero. I recently prepared a YouTube Video for the Anniversary of 9-11. I invited everyone to view this video by clicking here.

Kathy Fallon, DPM, Armonk, NY, celticcherub@gmail.com

RE: Changing a Medical Record Under Threat (Aimee Judy, PMAC)
From: George Jacobson, DPM

We saw a new patient who filled out our history form in their own handwriting. The patient checked off NO to having been seen by a podiatrist in the past and checked off "No" to injury. The patient described typical heel pain along with other atypical pains in the tarsal tunnel distribution and lateral musculature. She checked off that she was in "GOOD HEALTH". I dictated that the patient stated that she was in good health. I gave her an injection for the heel pain. I  saw the  patient three weeks later, and all of her symptoms resolved. I stated that in my second dictation. She wanted to get a copy of my notes.  Guess what happened?
 
The patient's doctor (an orthopod) called us irate and demanded that I change my note. The orthopedist didn't like that my note reflected that the patient stated "that she was in good health," and didn't like that the leg and nerve pain resolved 100% (I deemed it compensatory pain)  along with the plantar fasciitis.
 
On my day off, the patient came into the office crying and told my secretary that she had previously been in an accident and was under an orthopod's care (and probably the attorney's care too). My secretary charted the encounter. The patient scheduled an appointment to see me. The patient had seen another podiatrist and told him told about the accident. The podiatrist did not want to get involved, so the patient said that she lied to us to get treatment. I told her my note cannot be changed. I also pointed out that the statements were in writing, leaving no interpretation by me in my notes. They were quotes. The patient signed it. I dictated an addendum with the additional history. 
 
I hate getting involved in other people's legal cases. It happens a few times a year. It happens less since refusing Workers Comp. cases.  
 
George Jacobson, DPM, Hollywood, FL, fl1sun@msn.com  

ASSOCIATE POSITION - BLOOMFIELD, NEW JERSEY

Part-time office, part of larger practice looking for associate with well-rounded podiatric skills. Board qualified a must. Ground position leading to partnership. Please email CV to doccapo@yahoo.com 

POSITION AVAILABLE - NEW YORK

Well-established, multi-doctor podiatry practice with offices in Putnam and Westchester counties. Compensation based on productivity. Excellent opportunity for recent residency graduate to build skills and learn practice management. Full-time preferred but right part-time candidate will be considered. Email cover letter and CV to: podiatry2011@gmail.com

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 - SAN ANTONIO, TX

Immediate opening for motivated podiatrist with good people skills.  Associateship leading to partnership for the right applicant to help develop fast growing Northside San Antonio Texas practice. Attractive office and beginning income. CV and letter of interest to sadpmoffice@gmail.com

ASSOCIATE POSITION - FREDERICK, MARYLAND

Well-established 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

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 & BEACHES

Great opportunity to join a well established podiatry practice. Excellent mix office/surgery, motivated experienced staff. Seeking full-time Associate PSR 12-36. Salary $100 Thousand + bonus package with benefits, early buy-in available to right candidate. Email resume to capecoralpodiatry@live.com or fax to 239-573-9201

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.

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

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