The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

October 02, 2009 #3,664 Publisher-Barry Block, DPM, JD

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DC Podiatrist Discusses OA of the Hallux

Though experts don't know how many people have OA of the big toe, they agree it is more common as we pass the half-century mark. "Because you push off the big toe with every step, it gets lots of wear and tear," explains Erika Schwartz, DPM, a spokesperson for the American Podiatric Medical Association.

Dr. Erika Schwartz

As the joint's cartilage wears down, it may feel stiff or hurt when you walk, a condition dubbed hallux limitus. Eventually, the joint may stop moving altogether--a painful condition called hallux rigidus. Some people also develop an overgrowth of bone, or a bone spur, on top of the joint, which many patients mistake for a bunion.

Source: Catherine Winters, Prevention [9/30/09]

OCPM Third Classroom Completed with Generous Donation

This past July, the third classroom addition at the Ohio College of Podiatric Medicine (OCPM) was completed in time for the start of the fall semester. Students were welcomed back to school with a brand new, high-tech, state-of-the-art, 150-seat classroom to begin learning in a new, professional setting. To complete the celebration of the third classroom, OCPM received a very generous major gift of $250,000 from the Darby Family to name the third classroom the "H. Darrel Darby, DPM Lecture Hall." Dr. Darby was an OCPM alumnus from the class of 1956 and a recent inductee into the prestigious OCPM Hall of Fame Society. 

Dr. H. Darrel Darby

"When my family and I went on a tour of the new OCPM facility, we were amazed at how advanced the college was in terms of what it offers today's podiatric student", said Laura Darby (wife of H. Darrel Darby).  "My husband was very proud of OCPM, the podiatric community, and podiatric medical education.  Our family felt the best way to pay tribute to Darrel and maintain his legacy would be to name this beautiful classroom in honor of him. This is, we feel, the best way to support the podiatry profession and give back to his alma mater."

H. Darrel Darby, DPM Lecture Hall

Query: 11 YO Ballet Dancer with Ligament Laxity

What can be suggested for an 11 yo female ballet dancer with ligament laxity and tremendous flexibility? She is now being trained to go en pointe, and has started to complain of pain in her legs and feet.  I’m not sure if any damage is being caused by this, but are there braces or other devices out there that are being used for these scenarios? Are there ones that are accepted by the dance instructors as well as the dancer? I am trying to strengthen her legs and ankles with Theraband strengthening exercises, but I am wondering what else can or should be considered?

Charles Morelli, DPM, Mamaroneck, NY
 

Query: Orthotics Made by a Physical Therapist or Orthotist

You have treated a patient and recommend custom orthotics. The patient then goes to either a physical therapist or orthotist for the orthotics, who then calls you for a prescription for the device.  What to do? Go ahead and give the prescription or refuse the prescription, not knowing what the patient will actually get?

Alan Mauser, DPM, Louisville, KY
 

RE: Toe Fracture Treatment (Mark Aldrich, DPM)
From: Multiple Respondents

Excise the base of the phalanx and syndactylize the toe to the adjacent toe.   

Dwight L. Bates, DPM, Dallas, TX, dlbates04@yahoo.com

I had a similar case but I was the second opinion a year later. The patient (44 y.o. female) developed significant arthritis to the metatarsal head as well as the base of the proximal phalanx. I used a Wright Medical lesser MPJ implant and the patient did beautifully.  She plays tennis 10 hrs a week with no problems.
 
Eugene A. Batelli, DPM, Clifton, NJ, ebatelli2001@yahoo.com

The question was asked "whether to try to fixate the fracture fragments or remove the base of the phalanx." I wouldn't do either. Fuse the first MPJ, distal Akin, 2nd hammertoe arthrodesis, remove the fractured fragment, arthroplasty, reduce the dislocation, and use a K-wire. There are a multitude of ways to reduce the dislocation, and what you choose will depend on what needs to be done intra-operatively to achieve that goal.

Charles Morelli,  DPM, Mamaroneck, NY, podiodoc@gmail.com

RE: Uncooperative Daughter (David E. Gurvis, DPM)
From: Dwight L. Bates, DPM

I recommend that Dr. Gurvis contact Adult Protective Services.

Dwight L. Bates, DPM, Dallas, TX, dlbates04@yahoo.com

RE: Unannounced Inspection for DME Compliance (Bret Ribotsky, DPM)
From: Robert M. Gaynor, DPM,  Joseph Borreggine, DPM

Dia-Foot has created a CD with all the pertinent forms needed to pass a Medicare inspection or audit. The forms on the disc follow the supplier guideline requirements. The CD's are given to our customers to meet Medicare requirements. 
 
Robert M. Gaynor, DPM, President, Dia-Foot, NAILCUTTER@aol.com

Can Dr. Ribotsky clarify what he means by "required licenses and zoning?" We have a sign in front of the building with my name and phone number (listed with DME). Is that sufficient? All of our complaints are not in a log book. We fill them out, have the patient sign it, and scan it into their chart...is that okay?

I have liability insurance through Selective Insurance Group. Do we list them on the policy as "the certificate holder?" We have an Rx on file for the item(s), but what does "maintenance of supply" mean?

Joseph Borreggine, DPM, Charleston, IL, footfixr@consolidated.net

Editor’s note: The 26 Supplier Standards can be downloaded here.

RE: CCHIT Certification and "Meaningful Use" (Phillip L Forni, DPM)
From: Michael Brody, DPM, Ira M. Baum, DPM

Dr. Forni states that my letter is very misleading.  He states "In fact, many vendors that have paid the $30,000 will not have a certified EMR program recognized by HHS or ONC, the only organizations that matter." I feel compelled to reply to his statement.

First, you need to understand how the bureaucracy is structured. ONC makes recommendations to HHS. HHS makes the final decisions. HHS had only recognized one organization to provide certification of software - that is CCHIT.

Second, Companies that paid to have their software certified last year and paid $30,000 must now be re-certified to meet meaningful use. Having software that is certified today does not mean that the software meets the requirements of meaningful use. HHS and ONC 'recognize" those previously certified software programs, but software certified prior to today does not meet the ARRA requirements for Meaningful Use and is not eligible for the incentive payment.

Michael Brody, DPM, Commack, NY, mbrody@tldsystems.com

Phillip L Forni, DPM is absolutely correct. There are many vendors trying to sell EMR programs. It seems that one of the methods that will reduce the number of vendors will be through legal requirements which will, in effect, cause most of these vendors to be unable to revise their programs to meet the standards due to the cost of revision. 

Ira M. Baum, DPM, Miami, FL, ibaumdpm@bellsouth.net

RE: Obama’s Healthcare Plan  (Arden Smith, DPM)
From: Multiple Respondents

There are many reasons why healthcare is more costly to deliver here in the United States compared with all other industrialized countries. But a full 20-25 percent of every dollar paid to private health insurance companies, and I'm not sure how much for for-profit hospitals, is going for just that, profit. That is a burden not shared by the healthcare systems in Great Britain and Canada, the two great Beveridge models, and France, Germany, Switzerland and Japan, the Bismarck models. Why do shareholders of these corporations need to profit from our healthcare system?

I think there are plenty of businesses for Wall Street to invest in without hospitals or insurance companies. My apologies go to any PM News readers invested in insurance companies and hospitals, but I just don't think we can afford that luxury anymore. 25% of the 2.5 trillion dollars expected to be spent on healthcare in the US in 2009 is (if I got my zeros right) $625 billion extra dollars per year that, if applied to patient care instead of going to profit, would, by itself, pay for much better healthcare for all of us, and reasonable payments to doctors. In Europe and Japan, insurance companies are still all private and are allowed to profit on extra features, e.g., single room, Botox, upgraded nursing homes. And they are quite profitable...and there are hundreds of companies.  They just don't profit on the basic healthcare insurance packages.

Alan Sherman, DPM, Boca Raton, FL, asherman@podiatry.com

With all due respect to all the physicians who have contributed with wonderful insights to this subject, myself included, we are all preaching to the choir. The main problem with healthcare is not the system (other than what the politicians have been able to do and undo), but it is OURSELVES! WE, the medical profession in general, are NOT UNITED as a whole. Yes, there is the AMA, APMA, and the multiple other medical societies, fellowships, and organizations; but, are we ALL truly united as a single voice to say: STOP the nonsense? Sadly, we are not!

Do we all have the "guts" to pick a certain day of the week and say to the Country: "We are ALL stopping medical care for 12 hours today!" and see what happens? As unrealistic as this comment may be, the lack of unity in our profession is so REAL! That is why the business people and the lawyers saw what an amazing and profitable business healthcare is and took it from our own hands!

We can blame our medical forefathers for complacency, lack of business skills, and for the overbilling abuse of services rendered. But we can blame ourselves as well because we only are looking out for ourselves. The "pot of gold" is now almost empty, and still there will be some trying to get the "dust" left for themselves.

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

Editor’s Note: An extended-length note by Dr. Jacobson appears at: http://www.podiatrym.com/letters2.cfm?id=29259&start=1

OFFICE SPACE/ MRI RENTAL – NYC, LI

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

SEEKING ASSOCIATE - MIAMI FL

Buy-in and purchase if you are interested. Well-rounded practice (EMR, Digital X-R) seeing 250+ pts/wk. 30 yrs same location. Competitive salary +benefits + incentives. I am winding down my practice after 30 yrs. Will feed you my surgical load until you generate your own. Send resume to doctorinhialeah@aol.com

LOCUM TENENS/ASSOCIATE—PHOENIX

Busy multi-location practice in South East Valley seeks immediate well-trained personable individual. Part time Locum position may lead to permanent part-time, full-time, and buy- in potential if desired. Please send letter of interest and C.V. to AzToesRus@aol.com

ASSOCIATE POSITION – LOS ANGELES

Well established Los Angeles-based practice seeking a surgically trained, highly motivated, well-trained podiatrist. We have a very busy multi-office practice with state of the art podiatric equipment. Must be dependable, honest, and an ethical individual. This position is available immediately. Send resume and your email address to desierec@kimfoot.com

ASSOCIATE POSITION - WASHINGTON, DC

Interested in working in Washington D.C.? Our group is looking to add a highly motivated, hard working, well trained podiatrist to our practice. Must have surgical training. We have a very busy multi-office practice. We practice state of the art podiatry with EMR and digital radiography. Associate to partner on a fast track for the right person. E-mail CV and cover letter to Washingtonpod@aol.com

ASSOCIATE POSITION (SURGICAL) – CONNECTICUT

Connecticut Surgical Group is seeking a Board-Certified podiatrist to add to our Surgical Podiatry division based in Central Connecticut. This podiatrist will provide all aspects of Podiatric care with a focus on wound and surgical care to a well-established patient base. We require PSR-36 training and board certification or eligibility, excellent surgical and wound care skills, a strong focus on providing compassionate care to our patients, and the ability to work as part of a team in a group practice setting. To apply please visit our website . EOE

ASSOCIATE POSITIONS - INDIANA/OHIO

PrimeSource Healthcare is a leading provider of mobile, on-site healthcare services at long-term and skilled nursing facilities. Our exceptional growth has created an immediate need for traveling, independent contractors of podiatry services in Indiana/Ohio. Earn between $175k and $225k per year. E-mail CV to kwright@pshcs.com. Visit us at pshcs.com.

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: MARYLAND (KENSINGTON/ROCKVILLE/SILVER SPRING) 

Very busy, 3-office practice has immediate openings for established practitioners looking to relocate, moonlight or consolidate into our group. Graduating residents, we will need your help in July!  Established, successful associate practitioner has decided to relocate allowing a unique transition to assume a very busy schedule. All the bells and whistles-EMR, digital x-rays, ultrasound, computerized scheduling, certified ambulatory surgical centers, hospital referral base. Please send cover letter and resume to mddpmassociate@comcast.net 

DIABETIC RURAL OUTREACH PROGRAM - FLORIDA

We are seeking ethical, motivated podiatrists to treat homebound diabetic patients in Central and North Florida. Minimal travel. Must have valid Florida License and Active FL Medicare and Medicaid numbers. FAX CV TO 866- 258-9993 or call 800-779-8551.

EQUIPMENT FOR SALE- ARTOSCAN EXTEMITY MRI

In excellent cosmetic and working condition. Originally an A model, upgraded to a model D. Looking to sell the MRI because additional space is needed in the office. Price to sell. Picture can be seen at by clicking here Contact baileymeans@yahoo.com for any inquiries

EQUIPMENT FOR SALE - ORTHOTIC FABRICATION SYSTEM

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 $8k. OBO! Please contact Jeff at Jhunt@psbank.net for further information, pictures.

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.

EQUIPMENT FOR SALE - AMFIT ORTHOTIC MANUFACTURING MACHINE

Includes digitizer, fabricating mill, new updates have been added and enough supplies to pay for the machine in the long run. At $200 per pair = about $28,000. Selling FOR $25,000, O.B.O, F.O.B. americanfoot@email.com or 405-733-2783.

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 - SOUTHERN CALIFORNIA

Looking for board certified/board eligible ABPS associate to join a multi doctor practice with 2 offices. May lead to eventual buy-in and purchase. Must have minimum 2-year residency and comfortable with rearfoot procedures and diabetic care, ER call. Must be dependable, honest, ethical individual. Send cover letter and CV to familyfootcenter@earthlink.net

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