The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

September 19, 2008 #3,352 Editor-Barry Block, DPM, JD

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Wear The Right Shoe at The Right Time: WI Podiatrist

Long-term flip-flop wear can lead to pain from your feet...to your back. Unlike shoes that are sturdy and offer support, flip flops offer no arch support, heel cushioning, or shock absorption. According to the American Podiatric Medical Association, people often suffer foot pain, tendonitis, and even sprained ankles, if they trip.

Dr. Kerry Dernbach

Kerry Dernbach, DPM, a podiatrist at the Marshfield Clinic says, "...the issue with flip-flops is their lack of support. Many people are wearing them as their main footgear in the summer months, and they're starting to have a lot of pain because of that; a pain that results from gripping the sandal with your toes, and altering the way your foot hits the ground."

Dernbach says, "...make sure you are wearing the right shoe for the right activity...if you can go running, wear a running shoe...make sure you have a shoe that you're going to be comfortable in... a wide toe box, good brand name shoe."

Source: WAOW TV-9 (Wisconsin) [9/17/08]

AZ Podiatrist Bases His Entire Practice on Housecalls

The doctor is in ... your home. As long as that doctor is James Bodmer. Bodmer is a podiatrist with over 30 years of experience, all of it in Arizona. Bodmer is a firm believer of the house call, and so he'll visit his patients at home or at work to help them with their foot problems. "We come to you, which is a new concept," he said.

Dr. James Bodmer

Bodmer decided to base his practice primarily on taking house calls. The most obvious benefit for the patient, he said, is the patient can get help according to their own schedule. And just because it's a house call, he said, does not mean the patient does not get exceptional care. "We can pretty much do everything in their homes that we can do in an office," he said.

Conducting home visits is a benefit to Bodmer as well, in that he does not have to set up an office for his practice. "We don't have to worry about a lot of overhead with setting up an office," he said. Bodmer added if the patient is uncomfortable with him coming to their home, they can also set up a appointment in Bodmer's house.

Source: Sean Dieterich, The White Mountain Independent, [09/16/2008]

Portable Devices Pose Serious Challenges to Protecting Patient Privacy

With the news that a crime ring has been caught after trying what amounts to drive-by hacking, covered entities (CEs) should be aware that their wireless networks and portable devices such as iPhones and BlackBerrys are not necessarily secure, experts say. Nearly a dozen people have been charged with various counts of computer intrusion, fraud and identity theft, among other charges, for their parts in a crime ring that allegedly hacked into nine major retailers' wireless computer networks. The feds allege that the conspirators stole credit and debit card numbers through "wardriving," which involves one person who drives a car around while at least one passenger in the car attempts to gain access to a wireless network via a laptop computer.

Once inside the networks, the hackers install "sniffer" programs to capture information, the feds explain. In this case, the conspirators concealed the data they obtained in encrypted computer servers located in Eastern Europe. They sold some of the credit card numbers to other criminals, the feds allege.

CEs could be targeted in similar schemes and should ensure that their wireless networks are adequately encrypted, says Shane McGee, a Washington, D.C.-based attorney with Sonnenschein Nath and Rosenthal. "More and more, CEs are using wireless because it allows mobility…and hopefully CEs' networks are designed and configured using stronger encryption protocols."

Source: Report on Patient Privacy [9/17/08]

When You Delegate, Empower as Well

When you expect ypur staff to take on the responsibility of a delegated task, you need to give them corollary powers. Allow them to do the following:

• State opinions
• Criticize you and you plans, as long as the criticm is constructive.
• Ask questions.
• Offer recommendations

Important: Be sure to thank them for their contributions, and invite them to offer suggestions to improve every project you assign.

Source: Adapted from Becoming a Successful Manager by Jack Grossman and J. Robert Parkinson.

Query: Regenesis Provant System

Has anyone had any experience using the Regenesis Provant system for heel pain? The rep came by the other day and said that some practitioners were starting to utilize this modality in this manner. I am always open to new options if there is evidence to support their use, especially non-invasive ones. I have used this system for wound closure with mixed results.

David Dragoo, DPM, Omaha, NE

Query: Dealing With Employees Who Forget to Punch In and Out

What recommendations do you have to enforce the staff consistently to punch in or out. If not, what discipline do you recommend? Do you have levels of response (eg.,. verbal, written) for the staff continuously forgetting?

Cheryl Martinetti, PMAC, Howell, NJ

RE: MRSA and Planned Onychoplasty (Alan Mauser, DPM)
From: Steven H. Goldstein, DPM

There may not be a standard of care that is documented, however, when common sense and sound medical judgment prevail, one would wait until you get at least one negative bacterial culture, if you follow the old-time hospital standard. When I was trained, two negative cultures would allow one to perform the nail surgery.

If this patient is prone to recurrent infection, you may want to place him on Bactrim DS 1-2 days prior to the scheduled surgery.

Steven H. Goldstein, DPM, Royal Palm beach, FL, stevefootdr1@cs.com

RE: Risks of Prescribing Opiates For Chronic Pain
From: Barry Mullen, DPM

Just as I am a staunch proponent that our specialized license precludes us from treating systemic disease (like hyperglycemia, hyperurecemia etc.- not talking about their pedal manifestations), I'm also an advocate that chronic pain sufferers, whose etiology is incurable, should be managed by...pain management specialists. Their expertise and overall knowledge base in all aspects of patient care is far superior to ours because they deal with these individuals every single day of their practice lives. So, why wouldn't you, in the best medical interests of your patient, refer your patient to the specialist best positioned to manage a chronic, incurable medical issue?

That said, my observation over 25 years is that the vast majority of specialists who treat patients with acute painful conditions grossly UNDER-prescribe pain medication during the acute pain management phase of treatment. I suspect one can also be held accountable for under-prescribing medication that leads to pain and suffering, as well as over-prescribing. If your expertise and experience pales in comparison to a specialist in that discipline, consult them. You're much more apt to be sued by hanging on to a patient, delaying diagnosis or treatment, or worse, mismanaging them.

Barry Mullen, DPM, Hackettstown, NJ, yazy630@aol.com

RE: Hurricane Ike and Utility Interruption Insurance
From: J. Ressler DPM

My sympathy and prayers go out to the victims of hurricane Ike. I live in South Florida and just about ten days ago, I was playing out the scenarios of what could happen if Ike hit our area as South Florida were smack in the middle of the cone at the time. My biggest fear was family's safety followed by my office and practice making me wonder, "What if my office was put out of commission for a prolonged period of time?" Some of my office fears were put to rest by a phone call I received from my State Farm agent a few years ago. He told me of a policy called UTILITY interruption.

This policy covered loss of income and overhead expenses in the event of a power failure or no water. The cost was very minimal. Unlike business interruption, which covers only physical damage to your office, UTILITY interruption insurance will cover loss if your office utilities are interrupted for more than eight hours. Three years ago, when we were hit by hurricane Wilma, my office was without electricity for almost one week. It turned out this policy covered all expenses, including overhead and loss of income. I just needed to supply the adjuster with expenses, including a tax return to prove income loss. I received a check in about six weeks!!!

Although hurricane Wilma caused a great deal of damage, a call from my insurance agent one year prior, to sell me this seldom-heard UTILITY interruption policy provided me with a true week's paid vacation. The next year, I called my agent to purchase the maximum amount of coverage in the event of a longer shut-down of my office due to a hurricane. A call to your insurance agent could be very beneficial..

J. Ressler DPM, Lauderhill, FL, RedWingCrzy@aol.com

RE: Hyperbaric Oxygen Chambers (Joe Gonzalez, DPM)
From: Wm. Barry Turner, RN, DPM, Kazu Suzuki, DPM

I own three free-standing wound care centers in North Georgia. In each of these facilities, I have full-body hyperbaric oxygen chambers. None of these facilities are affiliated with hospitals, though I do have hospital privileges. I bill and I am paid by Medicare, Medicaid, as well as other insurance carriers for providing HBO services. There are certain requirements and restrictions that you must follow. It is an expensive investment and a great adjunct to wound care. If you want, you can e-ail me for more information.

Wm. Barry Turner, RN, DPM, North Georgia, claret32853@gmail.com

I think your best bet is to lobby your wound center to purchase the chambers. The capital expense for the monoplace (individual) chambers aren't that high, I believe $120-150k per chamber; but to be reimbursed by Medicare and other payors, the hyperbaric clinic has to be hospital-based (resides on the hospital campus), not privately owned. Also, DPMs cannot legally supervise the HBO treatment, as we cannot examine the patients' ears (out-of-scope problem).

HBO clinic can be very profitable for the hospital, while it doesn't benefit you financially. Having said that, HBOT is a wonderful adjunctive therapy for wound care. I've personally witnessed many limbs/fingers/toes saved after severe infection or traumatic amputations. Sechrist industries (sechristrind.com) is the leading manufacturer of monoplace HBO chambers and they have some resources on their website.

FYI, "topical" hyperbaric chambers -- the ones that you put the patient's arm/leg in a box -- do not have enough clinical evidence and not reimbursed by Medicare or any other payors in the US at this time.

Kazu Suzuki, DPM, Los Angeles, CA, kazu88@gmail.com

RE: False Testimony by Expert Witness (Walter Perez, DPM)
From: James De Meo, DPM

Dr. Doolan served as my chief resident; as such I can attest not only to his training, but his surgical skills and acumen. He was outstanding and stood way above his peers. His surgical skills and judgments were top-notch. He is one of the finest and brightest foot and ankle surgeons we have in our profession! I know firsthand that Dr. Doolan was taught, and practices above the standards of care, especially when it comes to conservative therapies. As every well-trained foot and ankle surgeon knows, these structural abnormalities we face every day in practice do not always respond well to conservative care, and therefore require surgical management. As someone who worked side-by-side with Dr. Doolan, I find it very hard to believe that he would ever deviate from the standard of care.

I do not know Dr. Saphire personally, nor do I know anything about his training or surgical skills, so I cannot comment on these, however, what I can comment on, is by Dr. Saphire’s own admission, that he testifies an awful lot. This scares me. It is very unsettling that in a court room, under oath, anyone can say whatever they want. What's even scarier is that they do it for money.

It is time we stop accepting that getting sued is to be expected. It is only to be expected if we keep allowing "experts" to give their opinions, even if they are inaccurate. Yes, everyone is entitled to their own opinion, but they should be held accountable for their statements when it directly impacts other practitioners. It is time we as a profession identify and hold accountable the people in our profession who give false testimony. I applaud Dr. Doolan for bringing this topic to the forefront of our profession. Then again, it doesn't surprise me; he always does the right thing.

James De Meo, DPM, Scarsdale, NY, drjdemeo@aol.com

PRACTICE FOR SALE - CORAL GABLES FLORIDA

Well-known practice for over 20 years. Excellent location on Coral Way with heavy traffic, great visibility and plenty of parking. Busy, fully-equipped, full- time office with established patients. Grossing over 300K with tremendous growth potential. Office is currently open and ready to take over immediately. For additional info contact QVAN@aol.com or 305-975-5516.

ASSOCIATE POSITION - NORTHERN VIRGINIA/DC SUBURB

Excellent associate practice opportunity leading to partnership for PSR 24-36 foot and ankle surgically-trained physician. Currently 4-doctor/2 office practice in fast-growing area, expanding to 5 doctors. Hard working, personable, highly-motivated individuals needed. Great opportunity with excellent salary and benefits. No nursing homes.Top hospitals. Fax CV with references to 703-491-9994

PRACTICE FOR SALE - OREGON, WILLAMETTE VALLEY

Established practice in beautiful Willamette Valley of Oregon. Provider practices fulltime and has a well-established patient base with a strong patient flow. Practice is well-positioned for new growth and development. Doctor will transition after sale providing introductions to local referrals and healthcare facilities. Surgery privileges at local hospital and surgery center. Oregonpractice@comcast.net

PRACTICE FOR SALE - MAINE, SOUTHERN

Well-established practice located in Southern Maine seeking an associate. This is the only podiatric provider in the community. All services are office and hospital-based. No nursing homes. Senior doctor desires to bring an associate in to become partner. Strong patient base with very small amount of palliative care. southernmainepractice@comcast.net

PARTNER WANTED - COLORADO

State-of-the-art practice with EMR and digital x-rays, in our physician-owned Medical Office Building and Surgical Hospital. Focus on Sports Medicine, pediatric and adult flatfoot, bunion surgery, and homeopathic care. Great opportunity for self starter. Please send CV and letter of introduction to: greg@stilwellfeet.com.

ASSOCIATE POSITION – VIRGINIA

Well-established 2-office private practice in central Virginia, completely automated, modern, full scope of foot and ankle care. Position requires hindfoot/ankle reconstructive and trauma surgery experience. External fixation experience helpful. ABPS BQ/BC. Competitive base salary, incentive plan, malpractice, health insurance, retirement plan, vacation & other benefits. Partnership option available. Forward CV and letter of intent to:admin@vfasa.com

IMMEDIATE POSITION AVAILABLE TN/GA

We're in search of a motivated, well-trained DPM who is great with patients. Our well-established multi-doctor, multi-office practice is located in Southeast Tennessee/North Georgia. Must have Tennessee or Georgia license. Please reply via email to ikraus@sprynet.com

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PM Classified Ads Reach over 11,500 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 11,500 DPM's. Write 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 Ext 110.

PODIATRISTS NEEDED - CHICAGO -- NORTHWEST INDIANA

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists. We are located in Chicago and Northwest Indiana. 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

Part-time podiatrist 1-2 days per week for busy medical/surgical practice in Englewood, NJ. Must have New Jersey license and malpractice. Must have excellent skills in both C&C and surgery. Must be very personable, friendly and ethical. Could lead to a good opportunity for the right person. Please Contact By Email: LADYFOOTDOCTOR@AOL.COM

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 full-time podiatrist in a multi practice location in the Chicagoland and Northwest Indiana area. Must have two years of surgical residency. Please e-mail resume to d-kitchens@footexperts.com

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