The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

October 05, 2010 #3,975 Publisher-Barry Block, DPM, JD

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We've just added a new article titled " How to Approach Orthotic Modifications" by Jay D. Segel, DPM to our website.i

Dr. Jay D. Segel

You can access this interesting and informative article by clicking here.

Medicaid Cuts Cost More Than Money: AZ Podiatrist

The Arizona Health Care Cost Containment System is slashing life-saving coverage for tens of thousands of people. These budget cuts could have devastating consequences. Patients, even those with diabetes, no longer will be allowed to see a podiatrist to prevent foot sores that can lead to amputation. University Professor Surgery Dr. David Armstrong says, "In this case, prevention really does pay." He says, "The most common reason people with diabetes will end up in a hospital is not for high blood sugar or heart attack or a stroke. It's for their foot."

Dr. David G. Armstrong

Consider this. It costs from $75 to $100 for a once-a-year visit with a podiatrist who can prevent a dangerous diabetic foot sore. Amputation can cost up to $100,000. And there's the human cost. "When a person with diabetes loses a leg, half of these patients are dead in five years," Dr. Armstrong says. Dr. Armstrong says an annual visit with a podiatrist reduces the risk of amputation by upwards of two-thirds.

Source: Barbara Grijalva, KOLD (CBS) [10/1/10]

KY Podiatrist "On the Fence About" Barefoot Running

Dr. Orla Rooney, a podiatrist with Lexington Clinic, said she's on the fence about barefoot running. "I don't think the research has shown enough light on it to really make the determination" about how healthy it might be, she said.

Dr. Olga Rooney

Part of her reluctance to endorse the trend comes from the people she sees in her office who are having trouble with their feet. They have stress fractures or cuts, which she sees as potential side-effects from barefoot running.

Source: Mary Meehan, The Record, [10/3/10]

Insurers Drop Child-only Coverage on Eve of Health Reform Mandates

New requirements under health system reform took effect Sept. 23, including some that the administration said would protect patients from many of the worst insurance industry abuses.

But the transition didn't go entirely as planned. A few days before rules took effect, many insurers said they would stop selling new child-only policies, citing requirements that the plans said made such policies too risky. The insurers included the five largest private-pay plans by enrollment -- WellPoint, UnitedHealth Group, Aetna, Cigna, and Humana -- and some nonprofit BlueCross BlueShield plans.

Source: Emily Berry, AMNews [10/4/10]

Invite Feedback

Form the habit of ending conversations with an open-ended question like “What else do you want to talk about?” or “What questions do you wish you had asked?”

Source: Adapted from Built on Trust, Arthur Ciancutti, McGraw-Hill, via Communication Briefings

Query: Bilateral Hallux Pain

I have a 30 y.o. male Hispanic with a 3-4 yr history of sharp hallux pain, bilateral. The pain is between the nail bed and IPJ of both big toes. The pain is random, but occurs frequently throughout the day and night. He describes it as very sharp (knife or pin stick sharp). He had seen a podiatrist (nail removal, bone spurs and IPJ pathology checks, injections of IPJ, and EHL insertion), all unsuccessfully. The family Dr. tx'd with NSAIDs and analgesics (Vicodin did not stop the pain). He was referred to a hematologist and neurologist for evaluation (Exam and NCS were negative). Labs, CBC and Chem panel - neg. Pedal vascular, neuro exam, and x-rays were normal.

His only relief when it hurts is not pain meds, but "2-3 shots of Tequila." He also mentioned that NyQuil has actually worked at night. He is not seeking pain meds nor taking any other meds. I dispensed Nitro-Bid as a trial medication to evaluate if it can duplicate the effects of alcohol. Any ideas?

Darryl Burns, DPM, Monterey, CA

Query: Best Credit Card Service

I currently do not accept credit cards and was looking to add this service. I understand that there are different rates or monthly charges for the service. I was wondering if the readers can share which companies they are dealing with and possibly what kind of rates to expect. 

Jeffrey Kass, DPM Forest Hills, NY

RE: Ethical Dilemma (Ivar Roth, DPM, MPH)
From: Shari Lee, PMAC

The question of ethical dilemma is not necessarily the real problem. Yes, the doctor may have been liable, but the patient is the one who has to decide what to do. You do not know what she went through to get the problem under control. It sounds like she has been involved with pain management and is now free of her problem. I believe you may be more upset that you believe she can have another surgery and have the problem corrected. This is easy to say, but not so easy for someone who has had a failed surgery and suffered, and finally gotten relief.  I too would refuse any further surgery from any doctor, unless that doctor were willing to sign on the dotted line that he would completely fix it or he would then be responsible for another failure.

I have direct empathy with how the patient feels through my personal experiences.  So maybe you could put yourself in her shoes too. Not everyone wants to be on permanent disability, but when a surgery goes bad, and in my case it was three, you don't let anyone ever cut on you again, unless it is a life-threatening situation.  Maybe this will help Dr. Roth see the other side of the picture.

Shari Lee, PMAC, Columbia, SC, midlandspodiatry@bellsouth.net

RE: Extortion By Patient
From: Name Withheld

I had a similar case years ago. I will not go into the details, but events caused the patient to seek care elsewhere, and he was left with a couple of hospital/surgery center bills which amounted to somewhere between $500-600. I was up to my ears in divorce lawyers, a new practice buy-in, etc. and did not want to fight a case which would be emotionally and financially challenging. I contacted PICA, and had them draw up a letter for me. The letter indicated the amount that I was paying to settle the patient's bills.

I paid the hospital and surgery center directly... which I would recommend if possible.  The letter clearly stated that there was no admission of guilt, and that the patient waived any rights to sue me for this matter. I also wrote the patient a letter indicating that I would sue him for liable and slander if I ever heard one peep out of him bad-mouthing me around town. You have your rights also. It is a shame that patients feel they can manipulate us and the system this way. In fact, he was very pleasant, and really didn't feel that he was doing anything wrong at all.

Name Withheld
 

RE: Cosmetic Foot Surgery (Richard Boone, Esq.)
From: Bret Ribotsky, DPM

Why would any podiatry license be limited by the reason for the procedure? Please understand that there is a line that should never be crossed, (Like having a foot shortened to wear the shoes of her new husband’s previous wife’s shoe collection – true story). If an 84 year old patient elects to have a toe amputated after failed previous treatment, is this cosmetic surgery?

I agree with Mr. Boone, that if insurance does not cover the planned surgery, then the consent process needs to be more involved.  I live in a community where Botox is administered by nurses and dentists. We have general practitioners doing breast augmentation in their offices. Weekend courses are everywhere teaching lasers, and filler and Botox treatments. I do not see the medical licensing boards even attempting to control this level of abuse. We live in America, and I believe we all have the right to make an informed decision (even if stupid), and that is the price we pay for democracy. As Dr. Block and many masters have advocated, the time for removing the scope of practice limitation on our licenses is NOW.

Bret Ribotsky, DPM, Boca Raton, FL, ribotsky@yahoo.com
 

ASSOCIATE POSITION - MASSACHUSETTS

Well established, multi-office, group practice, North of Boston, seeking a well-trained (PSR 24/36) Associate to start July, 2011. This is an excellent opportunity for an energetic, hardworking individual with strong surgical and medical skills, desiring a fast-track opportunity for partnership. Our practice is well rounded in all aspects of forefoot/rearfoot reconstructive surgery, pediatrics, sports medicine and general care. Competitive salary and benefit package available. Send a cover letter, CV, and two letters of reference to: drfleishman@nefootankle.com. Visit our website at www.nefootankle.com for more information about our practice.

ASSOCIATE POSITION – LONG ISLAND

FT/PT Associate position available with busy multi-office podiatry group on Long Island. Our practice is state-of-the-art, and encompasses all phases of podiatric care. We welcome new practitioners, or someone who would be open to merging a smaller practice with ours, and benefitting from our practice management overlay. We also invite residents graduating in 2011 who want to practice on Long Island to apply for this position. Compensation includes competitive salary and bonuses. Vacation pay and malpractice insurance are also offered with a full time position. Serious candidates should fax their CV's to (631) 293-5984.

ASSOCIATE POSITION – LONG ISLAND, NY

Associate full-time. Well-established, busy, well-rounded podiatry practice looking for a motivated podiatrist. Suffolk Co. LI NY. Board eligible, Board certified PSR-24/36 trained. Fax resume to 631-581-0857

ASSOCIATE POSITION - NEW JERSEY

Ambitious podiatrist needed for part-time work in Bergen County office, nursing homes, rehabilitation centers and assisted living facilities. Hours are flexible. PRS 24 needed. Candidate should be hardworking and willing to travel throughout Bergen County. Please send CV to facnj@yahoo.com or fax 201-599-5960.

ASSOCIATE POSITION - NYC, NY

Part/time, full/time associate for busy, well established multi-doctor, multi-office NYC group. Seeking motivated, ethical, NYC licensed DPM with excellent office management and clinical skills in all phases of Podiatry. Board Qualified/Certified preferred. Salary plus incentives, pension/medical/dental. Partnership potential. Fax CV to 631-369-6570.

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

ASSOCIATE POSITION - WEST COAST, FLORIDA

Outstanding opportunity for PSR-36 graduate to join successful group podiatry practice in Summer 2011. Seeking a sociable, articulate graduate who is confident in rearfoot and ankle reconstructive cases but also enjoys all phases of podiatry. Long-term opportunity for the right candidate with generous pay and benefits. Reply to jwicks@cortezfootandankle.com

ASSOCIATE WANTED - DELRAY BEACH FLORIDA AVAILABLE IMMEDIATELY

Rapidly growing well established practice seeking part-time leading to full-time. PSR 12-36. Great opportunity for highly motivated, personable individual. Please reply by emailing a CV to nursebsf@aol or fax (561) 498-9068.

ASSOCIATE POSITION - WEST CENTRAL FLORIDA 
 
A great opportunity to join a  very busy, well established, diversified practice in Clearwater, Florida. We are seeking an Associate who is BC/BE and highly motivated, minimum PSR24+. We offer a competitive salary and benefits. Please send your resume to Jaye@fdn.com

PART-TIME PODIATRIST NEEDED ASAP CHICAGO

Part-time podiatrist needed for 2 offices in Chicago with an average of 20 hours/week. Must have Illinois license. Must have completed 2 years of surgical residency. If qualified, email to f-massuda@footexperts.com

NORTHEAST OHIO PODIATRY OPPORTUNITY

Western Reserve Senior Care, an innovative home visit practice that makes visits to seniors in assisted living facilities and SNF’s, is recruiting for a Part-Time Podiatrist. Make a true difference as you make visits to homebound seniors while managing the full scope of podiatric disease. This opportunity offers a perfect balance of superb lifestyle and excellent compensation. Practice is affiliated with world class health systems in Cleveland, OH. Email CV to wmills@westernreserveseniorcare.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

PRACTICE FOR SALE - NORTHEAST COLORADO/SOUTHWEST NEBRASKA 
 
Practice is a good mix of biomechanics, diabetic care and surgery.  Revenue could be increased by well-trained surgeon. No HMO's. Low overhead. Only podiatrist in the area. Please contact mld9439@live.com for more information.

PRACTICE FOR SALE - MARYLAND, DC SUBURB

Great opportunity. Retiring after 38 years in practice at the same location. Practice is fully equipped with digital x-ray, diagnostic ultrasound, computer network, orthotic scanner and state licensed ambulatory surgical center that is fully equipped. Owner will stay on as needed for easy transition. dpmpracticeforsale@yahoo.com

AMBULATORY SURGICAL CENTER PRIVILEGES AVAILABLE - NJ

Privileges available in a new 2 ORs. New certified multi-specialty ambulatory surgical center in Fairlawn, NJ - 8 minutes to the George Washington bridge. Specializing in podiatric surgery. Center will pick up and return patient home. Syndication is available. Center will accommodate doctors in Manhattan, Queens, Brooklyn, Bronx, Staten Island, and long Island. Will assist in getting NJ License. Call for information (516)476-1815 e-mail podo2345@aol.com. To view center, go to FAIRLAWNASC.SHUTTERFLY.COM

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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