The Voice of Podiatrists

September 23, 2006 #2,696 Editor-Barry Block, DPM, JD

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OR Podiatrist First to be Appointed to OR Medical Board

Lisa A. Cornelius, DPM of Corvallis, OR took office as the newest member of the Board of Medical Examiners. Dr. Cornelius is the first podiatric physician appointed to the Board under 2005 legislation adding a podiatrist to the panel as a 12th member. Dr. Cornelius was appointed by Governor Kulongoski to a three-year term expiring Feb. 28, 2009, at which time she may be reappointed to their second and final terms.

Lisa A. Cornelius, DPM

Dr. Cornelius was a member of the Board’s Advisory Council on Podiatry from 2003 until Dec. 31, 2005, when the Council was abolished under the same legislative action that added a podiatric physician to the Board. As the Board’s podiatrist member, Cornelius is by law ineligible to vote on any matters other than those relating to podiatry. She is allowed to take part in all Board discussions.

Dr. Cornelius is in solo private practice in Corvallis, and is also affiliated with Good Samaritan Medical Center in that city. She is a past vice president of the Oregon Podiatric Medical Association, and is a member of the American Podiatric Medical Association and the American College of Foot and Ankle Surgeons. She earned her doctorate degree in podiatric medicine at the California College of Podiatric Medicine, and served a podiatric surgical residency at Pacific Coast Hospital in San Francisco.

Source: OR BME Report [Late Summer 2006]

Docs Slow to Make Use of E-Mails to Patients: Report

Physician use of e-mail to communicate with patients "is growing slowly and remains low," despite strong interest from the public and among policymakers, the Center for Studying Health System Change said in a report. About 24% of 6,600 physicians participating in a 2004-05 survey said they had secure e-mail available to them to communicate clinical information to patients. About 20% said they had secure e-mail available in a similar poll in 2000-01.

Use of e-mail for physician-patient communications is most common at larger practices, but much of the recent growth occurred among smaller practices, the center said. It noted that financial considerations remain a barrier, as implementing an encrypted e-mail system is more expensive than regular e-mail and physicians are less likely to be reimbursed for electronic consultations than in-person consultations. Physicians also fear e-mail communication will add to their workload, although studies have shown e-mails can improve efficiency and patient satisfaction, according to the report.

Source: Andis Robeznieks, Modern Healthcare [9/21/06]

Revised “Middle Ground” For 2007 Reimbursement Proposed

House Ways and Means Subcommittee on Health Chair Nancy Johnson (R-CT) on Wednesday met with physician groups to discuss legislation that would stop a 5.1% reduction in Medicare physician reimbursements that is scheduled to take effect Jan. 1, 2007, CQ Today reports. Physician sources familiar with the discussions said Johnson proposed a 1% reimbursement increase for all doctors in 2007, with an additional 1.5% increase later in the year for physicians who agree to report quality-of-care data to the government. According to one source, Johnson proposed "a longer-term solution to the Medicare physician payment formula in the out-years."

Last week, AMA rejected an offer by Thomas that would have blocked the 5.1% reduction an increased reimbursements by between 2.5% and 2.8% in June 2007 for doctors who agreed to report quality-of-care data to the government.

CQ Today via American Health Line, [9/21/06]

Query: Fungal Transmission in Nail Salons

Does the multiple use of a single nail polish from client-to-client in a manicure shop have the possibility of fungal transmission? Is nail polish a culture medium or could transmission be through nail applicators?

Neil H Hecht, DPM, Sherman Oaks, CA

RE: Heel Pain in Obese Patient (Charles Ross, DPM)
From: Multiple Respondents

You have exhausted your conservative treatment, and a surgical release of a portion of the plantar fascia will have severe negative biomechanical consequences, especially with an obese patient. I would suggest that you try high energy, single treatment, ESWT using the Dornier EPOS Ultra. Make sure you measure the length of the abnormally thickened plantar fascia and direct the ESWT along the entire area. If the abnormal plantar fascia is over 20 mm in length, I increase the total pulses 500 to 1000 over the 3800 recommended standard.

Robert Scott Steinberg, DPM, Hoffman Estates, IL

Doc@FootSportsDoc.com

We as podiatrists have not yet addressed and properly counseled our patients who present with problems secondary to obesity. Dr Ross vividly presents one example. Others include pedal complications associated with late onset diabetes.

At the APMA Scientific Meeting, Dr. Emma Patterson, a bariatric surgeon and Dr. Lisa Young, a renowned professor of nutrition, explained causes of the obesity "epidemic" in America and how to make a timely and proper referral for moderately overweight and obese patients. It is the standard of care to send our diabetic patients to endocrinologists and our patients with vascular disease to PVD specialists. The time has come for us to be proactive in referring overweight and obese patients to bariatric surgeons and/or nutritionists for counseling. New minimally invasive procedures in the field of bariatric surgery and fine tuned methods of nutritional counseling may make referrals to these specialists a new standard of care for podiatrists.

Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

Eneslow has had good success with obese patients with heel pain using numerous pedorthic options. Of late, the most successful has been the use of MBT footwear. For the record, most of the heel pain patients (95%) are wearing shoes smaller than their feet and need a longer, wider size. Many need shoes with more support such as firm medial counters, reinforced shanks and higher heels. Semi-rigid orthotics have also proved beneficial.

Robert S. Schwartz, C. Ped., New York, NY, rss@eneslow.com

Unless the patient is 6'4" tall, he falls into the obese classification of the BMI chart. Add to that, the long standing and repetitive sprains that allow the foot to "collapse" under the massive forces generated by locomotion. (Force=Mass * Acceleration) The compressible accommodative or the flexible (semi-rigid) functional orthotic cannot resist the forces that continue to sprain with each step. Failure may be "guaranteed" if the impression capture method is "semi-weight-bearing" (either the foam box or traditional positioning by the technician) and the orthotic manufacturer adds the typical "expansions" (plaster or computer).

An orthotic like the Texas Foot Brace, molded over a replica of the foot that has been corrected by the Biaxial (R.O.Lundeen), Triaxial (Lundeen) or Orthofunctional (Glick) technique can resist the forces and provide comfort.

Jack Glick, DPM, jglick@afo-lab.com

My office has had success using ESWT and recently with Cryosurgery. Both methods seem very safe and can be done with just a local. Cryosurgery does involve a small incision, but I have never seen any problems with healing. In both cases, the patients usually tolerate the procedures well with no real "down time.”

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

RE: Legal Implications of Off-Label Use of Drugs (From: Elliot Udell, DPM)
From: Ken Malkin, DPM

I believe there are several considerations before using a drug off-label. One is the benefit/risk ratio of using a specific drug for a specific off label consideration. Safety of a drug is always a balance between the potential benefits against the potential adverse effects. While a drug may tip the balance towards approval for one medical condition it may not have the same weight when used for a different clinical condition. A drug that may manage a disease which results in serious morbidity may be approved despite it having a more serious side-effect profile. So using the drug for a less serious condition may not outweigh the risks. The approval of a new drug in the same class (NSAID) is also weighed against the side-effect profile of the entire NSAID class.

A second consideration is that the FDA-approved dosage of a drug effective for an indicated condition that has been extensively studied may be very different that that required to treat an off-label condition. Probably the first consideration before prescribing off-label should be why you are considering using this drug for this condition or in this manner to begin with. Have you read papers published on the use of the drug for an off label condition, especially those in peer-reviewed literature? .

Ken Malkin, DPM, Caldwell, NJ drmedicare@aol.com

IMMEDIATE ASSOCIATE NEEDED - PHILLY SUBURBS

High volume office-based practice suburban Philadelphia. Full-time office, near hospitals for surgery, consults, and in-house pt. care. Candidate must be hard-working dedicated to pt. care and well-trained. Needs to be personable. PSR12/24/36 Board Certified/Eligible required for a fast-paced, fun atmosphere to work. Email CV and contact info to: mrgpod@hotmail.com Or fax CV to 610-668-5175.

NURSING HOME ASSOCIATE NEEDED- PHILA AREA

Extremely high volume nursing home and home care practice. Well-established and respected Suburban Philadelphia practice seeking an associate who is hardworking. Full-time or part-time available. Very busy practice which can be worked every day and be very lucrative for a hard-working individual. No nursing home further than ½ hour away from office. Email CV and contact info to: mrgpod@hotmail.com or fax CV to 610-668-5175

PRACTICE FOR SALE – SOUTH FLORIDA

Miami-Dade and SW Ft. Lauderdale, well established surgical practice for sale. This one has everything. Surgery, Orthopedics, Pediatrics, Trauma, ER, General Podiatry. Participates in all local and national managed care plans. $850,000 but will discount depending on amount up front. Mature, serious inquires with business experience preferred. Email response to podfootdocs@aol.com

EQUIPMENT FOR SALE - Computed Radiography System

SCANX 12 digital imaging system is a computed radiography system (CR). Replacing film and plates can be reused thousands of times. Saves images to your computer. CPU and monitor included. Purchased 2004. Asking $15, 000. Call 970-232-1717 for additional information. Product information found at www.allproimaging.com

ASSOCIATE POSITION - ARIZONA

Excellent opportunity for an experienced DPM looking for a change or young podiatrist looking to jumpstart their practice. Practice is well- established over 25 years, successful and a large volume in the Phoenix metro area. Current AZ license preferred as position is available immediately. The right person will join as a salaried associate leading to partial ownership in the group practice. Email CV and inquiries to: scfcs@cox.net

ASSOCIATE POSITON - SOUTHEAST TENNESSEE/ NORTH GEORGIA

Immediate position available or will wait for the right individual. Unique practice opportunity in growing multi-physician/multi-office practice. Well established/cutting edge within the medical community. Close proximity to hospitals as well as opportunity to become involved with a free standing podiatric surgical center. Must be BQ/BC. Minimum PSR/24. Competitive salary, bonus structure and benefits. E-mail CV to afcjen@hotmail.com

PRACTICE & BUILDING FOR SALE – SOUTHERN CALIFORNIA

30 year established practice in southern California. Includes Medicare certification, modern surgery center building, attached office and treatment rooms, equipment. 2.5 days office hrs per week –gross 240K per year. Can expand to 5 days. $1.5 Million. Contact Dr. Beal (951) 780-4782 or email rbeal10269@aol.com

ASSOCIATE POSITION – NEW ENGLAND

Opportunity in growing New England practice. Well established and respected practice with large office and surgicenter, latest technology, great staff, loyal patients and solid referral base. Close proximity to hospitals, full scope practice. Opportunity for partnership. Prefer 24 month PSR with clinical practice experience or an experienced doctor looking to improve their situation. E-mail CV and contact info to: Footdoc-office@usa.net

ASSOCIATE WANTED - SOUTH FLORIDA

Miami-Dade and SW Ft. Lauderdale, well established surgical practice needs part-time podiatrists to assist in surgical cases and patient volume. Email response to podfootdocs@aol.com

ASSOCIATE POSITION-INDEPENDENT CONTRACTOR – FLORIDA

Florida License / Medicare and Medicaid numbers in effect and active. High income potential for hard working, ethical and honest DPM great for semi-retired. Transportation a must. FAX CV or Resume to 1-727-785-4697.

HOUSE CALL PRACTICE FOR SALE – SOUTHERN CALIFORNIA

House Call practice for sale which includes approx. 400 patients and continued referrals. Perfect for solo practitioner. Extremely easy and profitable practice to run. Yearly gross of over $200K. Current DPM is retiring. Financials will also be provided. Please contact ccipinc@ccipinc.net

ASSOCIATE POSITION - NEW ENGLAND

Terrific Opportunity Now Available in growing New England practice. Well established and respected practice with new, large office space, latest technology, very helpful staff, loyal patients and solid referral base. Close proximity to hospitals with modern surgical suites. Opportunity for shared ownership. Prefer 24 month PSR with clinical practice experience or an experienced doctor looking to improve their situation. E-mail CV and particulars to NEAFC3@aol.com

PRACTICE FOR SALE/ASSOCIATE/PARTNERSHIP - WASHINGTON, DC

A 26 year old practice for sale in hospital's attached medical building. Fully equipped. All aspects of podiatric medicine;surgery. Large diabetic practice with wound care clinic. Large referral base with loyal patients. Charcot, forefoot, rearfoot, orthopedics. Residency required for privileges. Moving but will stay for transition. Associateship until purchase. Will finance sale with adequate down-payment. Serious inquires only. Contact scottr0666@yahoo.com

PRACTICE FOR SALE – SOUTH FLORIDA

Miami-Dade and SW Ft. Lauderdale, well established surgical practice for sale. This one has everything. Surgery, Orthopedics, Pediatrics, Trauma, ER, General Podiatry. Participates in all local and national managed care plans. $850,000 but will discount depending on amount up front. Mature, serious inquires with business experience preferred. Email response to podfootdocs@aol.com

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