The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

October 13, 2010 #3,982 Publisher-Barry Block, DPM, JD

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Tight Toe Boxes, Painted Nails Invite Foot Problems: TX Podiatrist

Tight toe boxes can lead to hammertoes, bunions, corns, and ingrown toenails that, in later stages, could also require surgery. "I'm a woman, so I know," says Karen Wasserman, a Dallas podiatrist and owner of Treat Your Feet. "I love beautiful shoes, and they're gorgeous. But if you look at the shape of a shoe and the size of the shoe, and there's no way that shoe fits your foot, you're inviting problems."

Dr. Karen Wasserman

Even your painted toes may be harmful to your health, Wasserman warns. Constant use of nail polish can encourage nail fungus, which in early stages is easily treatable, but quickly can become difficult to cure.

Source: Daphne Howland, Dallas Morning News [10/5/10]

Today's Podiatrist Goes Live

APMA today launched the second phase of its Today's Podiatrist campaign which promote podiatrists' capabilities as 21st-century physicians, surgeons, and specialists.

www.Todayspodiatrist.com

A new website, www.todayspodiatrist.com, provides information for the campaign's three target audiences: patients, students interested in a medical career, and medical professionals.

Source: APMA Daily eNews [10/11/10]

FL Podiatrist Appointed to Diabetes Advisory Council

Gov. Charlie Crist appointed Dr. Melvin Price of Bradenton to the Diabetes Advisory Council. Price, 54, is a podiatrist with Manatee County Rural Health Services.

Dr. Melvin Price

Price has previously served as Chair of the Florida Department of Health Medical Quality Assurance Board of Podiatric Medicine. He also plays the saxophone for ProjectSRQ.

Source: Bradenton.com [10/11/10]

MA Plan Star Ratings Will Add Three Diabetes Measures Next Year

CMS is changing its Medicare Advantage (MA) plan star ratings beginning next year to put more emphasis on chronic care management, and plans need to shift their systems and strategies in keeping with this. There will be 36 measures that CMS will judge MA plans on for star ratings next year, up from 33 this year, noted consultant John Gorman, CEO of Gorman Health Group, LLC.

All of the new ones, he pointed out, stem from the “unpacking” of a diabetes care measure into four separate diabetes measures. The four assess providers’ performance in conducting eye exams of diabetics and checking for kidney disease, blood-sugar levels, and cholesterol levels.

Source: James Gutman, Medicare Advantage News [10/8/10]

Survey Reflects How Physicians Feel

For the Physician's Practice Annual Great American Physician Survey,  1,400 doctors were asked dozens of questions about what they think, how they feel, and what they want. Here’s a summary of responses:

•  The vast majority like being physicians and are satisfied with their choice of specialty. Yet a sizable minority would have made some change in their career path, if they’d known earlier what they know now.
•  They're happy: The vast majority gave themselves an 8 or 9 on the Happy Scale of 1 to 10. Median score: 7.5.
•  They’re healthy: Most have a primary-care physician of their own and try to take her advice. They mostly eat right and get regular exercise.
•  They’re worried: Nearly half think primary-care docs will eventually be extinct, replaced by cheaper non-physician providers.
•  More than a quarter have been sued for malpractice, and defensive medicine is rampant: Almost three out of four admit to having practiced it.
•  Some 87 percent believe they are poorly represented in Washington, and that their needs are largely ignored by politicians.

 Source: Shelly K. Schwartz, Physician's Practice [9/27/10] via Dr. Hal Ornstein

Make Progress with Checkpoints

Add a reality check to your business plans by including clear targets and solid timelines alongside goals. When you begin to plan, you may develop big ideas, lofty goals and endless possibilities. To keep from becoming lost in the “someday” nature of long-term goals, plan for actual progress and immediate, sustainable results.

Bonus: Measurable outcomes and feet-to-the-fire timelines not only ensure that you make real progress, but also keep you motivated during tough times. When you see that your practice is meeting goals and you are crossing items off your to-do list, you will find it easier to keep moving forward.

Source: Adapted from Business Plans Kit for Dummies, Steven Peterson, Peter Jaret and Barbara Findlay Schenck, Wiley via Communication Briefings

Query: Prevention of "Bed Bugs"

Does anyone have suggestions for the prevention of infestation of “Bed Bugs” in their podiatric medical offices? Here in Monmouth County NJ , bed bugs have been documented in movie theatres and senior housing and public schools, as well as upscale retail stores and even the classy Waldorf – Astoria hotel across the river in New York City.

I am most concerned about waiting room furniture and treatment chairs. It is readily apparent that these pesky insects need professional extermination once they are found in your home or office, but I would like to prevent that cost and embarrassment. Currently, we wipe down treatment chairs with antiseptics after each patient.  The waiting room chairs get a Lysol spray at the end of the day, but not between every patient; that would be extreme (I'm not sure if Lysol spray kills bed bugs anyway). Any thoughts?
 
Pat Caputo, DPM, Holmdel, NJ

Query: Xerosis E/M Coverage: NGS Medicare

Can I justify an office visit for the diagnoses of xerosis and onychomycosis with NGS Medicare using an OTC cream treatment recommendation? I'm hearing mixed reports of NGS Medicare not covering treatment for xerosis anymore.

Zia Barkatullah, DPM, Chicago, IL

Response: Xerosis is a condition you are treating, and E/M is part of the treatment you are rendering.

If you are following the bullets in 1997 E/M documentation guidelines, prescribing an OTC medication to a patient potentially qualifies the medical decision-making requirement for the low level E/M code. Check your Part B carrier guidelines.

Syed Ghani, DPM, Sterling Hts., MI

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RE: Hemangioma (Brent Rubin, DPM)
From: Bryan C. Markinson, DPM

Dr. Rubin wants to know of any special precautions before he surgically excises a hemangioma. I assume this is a soft tissue and not a cutaneous lesion. I have several comments:

1) Is it painful or somehow inhibiting normal activity and/or footwear choices? Is it growing larger? If not, leave it alone.

2) Have you never excised one? From your question, it sounds like that is a good possibility. They are usually embedded in fat and difficult to totally visualize. If you accidentally incise the lesion and it exsanguinates, it will shrink to a size that will make already difficult visualization impossible (been there). Even with the best surgery, recurrence is common and repeat excisions become debilitating.

I personally have excised three such lesions in a five-year period under the watchful eye of a musculoskeletal oncologist. At the conclusion of the last one, I vowed never to do it again. I send all my hemangioma patients (maybe three per year at most) for an interventional radiology consult for the possibility of embolization of the lesion. When possible, the procedure, while not a walk in the park, is much more reliable (but not a certainty) for shrinking the mass without the possible complications of open surgery.

In either case, in my opinion, these lesions are difficult and should be left to the expertise of the interventionalists, or surgeons who more commonly handle them, such as musculoskeletal oncology surgeons/vascular surgeons/ or rarely, podiatric surgeons sufficiently experienced.

Bryan C. Markinson, DPM, NY, NY, Bryan.Markinson@mountsinai.org

RE: Is Parity Achievable?
From: Name Withheld

I've been a reader of PM News for the past two years and have read with interest the comments of podiatrists around the country regarding parity. I was fortunate to train at one of the top three-year surgical programs in the country with two very prominent podiatrists. During my third year of training, I was the chief resident at a level-I trauma center. I then went on to a one-year fellowship at one of the top fellowship programs in the country, where I performed 1,500 cases, 70% hindfoot cases. After that, I did a month overseas at a trauma center, followed by an additional AO fellowship.

I joined a multi-speciality group in an area with a large orthopedic group. I was granted foot privileges, however, for the past year I've been struggling to acquire ankle privileges (fusions and fractures). The hospital came up with an advanced class of privileges and wanted the blessing of the head of orthopedics at the hospital who ironically is a "foot & ankle" orthopod. He refused, stating that podiatric residency and boards are not governed by the same body as allopathic boards, and therefore he did not believe I was qualified to do such cases.

I have achieved the highest level of training that our specialty has to offer, yet the same struggles that everyone is facing still stands. So, I ask if Vision 2015 will bring on any changes?

Name Withheld

RE: Moaning and Groaning (Drs. Bijak, Sullivan, Kesselman, et al.)
From: Bryan C. Markinson, DPM

My love and devotion to this profession, and my fair and fraternal treatment of colleagues is unquestioned. I have called things as I see it, and have had respectful disagreements, never hostile, occasionally along the way. Dr. Bijak has become notable for his critiques and open dialogue about what is negative about podiatric medicine as a profession. Although he definitely lacks tact, I find most of his observations regarding the limitations of the DPM degree DEAD-ON.

I also respect the opinions of others calling for him to demonstrate how he himself has tried to make things better, however, that is totally unfair. One should be able to speak negatively of our profession without necessarily being a leader, educator, innovator, or egomaniacal blowhard! The MD world is opening 12,000-15,000 new freshmen seats. Any primary care MD out of training can get a job anywhere in the country in any state on any day for $160,000 a year. One thing I know for certain: If I was a college student pondering over career choices, I would pay very close attention to some of the things he has to say. It would be good for all of us to do the same. We discredit him as a whiner potentially to our own peril.

Bryan C. Markinson, DPM, NY, NY, Bryan.Markinson@mountsinai.org

RE: Private Practice to Clinic Employment
From: Jennifer B. Ryder, DPM
        
Be careful with non-compete clauses as they could limit you if you change your mind. Some groups use the RVU system for reimbursement. This can be an issue for podiatrists because there are no RVUs assigned for orthotics, AFOs, and diabetic shoes unless you negotiate them.

Will your new group provide your malpractice tail for your private practice? Will you have to use their malpractice insurance or can you keep your own?

Jennifer B. Ryder, DPM, Rapid City, SD, jenbenryder@yahoo.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

PART-TIME/FULL-TIME PODIATRIST NEEDED - INDIANA

Part-time full-time Podiatrist needed for our Indiana offices. Must have Indiana license. Must have completed two years of surgical residency. If qualified email to  f-massuda@footexperts.com

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. Please send your CV by fax (631) 293-3462 or e-mail to mets724@gmail.com

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

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

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

ASSOCIATESHIP - MARYLAND

A great opportunity to join and gain ownership interest of a well established, diversified practice in Maryland. 2-year residency needed, EHR, ultrasound, ASC, hospital close by with wound care center. Fax resume to 410-749-6807.

ASSOCIATE POSITION - TEXAS

Established podiatry practice in Houston, TX has an opportunity for a well-trained associate to start immediately. Great opportunity for a new graduate or established solo practitioner looking to join a successful practice with a fast track to partnership. Practice is modern and offers all of the latest equipment and technological advances available in podiatry. Aside from seeing patients and providing outstanding care, individual must be personable, passionate, and willing to help market themselves to referral sources as part of a plan implemented by our business development coordinator. Salary with bonus and benefits available. Send cover letter, CV and 2 letters of reference to houstonpod@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

IMMEDIATELY AVAILABLE- ASSOCIATE POSITION - DAYTON, OHIO

Join a well-established modern practice with an excellent reputation and referral base. Base salary $100,000 and benefits with a bonus structure. EMR, diagnostic ultrasound, all aspects of DME, Padnet vascular studies, and CO2 lasers. We seek a surgeon that is well trained, personable and motivated to join our group of 3 Podiatric Surgeons. Would like this individual to buy in the practice eventually. Please send resume and photo to Ohiodoctors@aol.com

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 - ST. LOUIS, MO 
 
Leading group practice looking to add one podiatrist to established location. Group's podiatrists enjoy incentive compensation plan (production and sharing group profits), benefits including health and malpractice, and supported with integrated practice management and EMR systems. Perfect opportunity for solo practitioner to join group setting. Could also be part time opportunity for the right individual.  Please forward CV to StlPodGroup@gmail.com

PRACTICE FOR SALE - SW LOUISIANA

Only full-time podiatrist in city of 30,000. Great economic base of oil refineries and numerous petrochemical companies as well as riverboat casinos. Located in sportsman’s paradise. Practice comes with 2600 sq. ft. office building and all supplies. 7 area hospitals. Reasonably priced. Contact peshdpm@pol.net

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

PRACTICE FOR SALE - NORTHERN CALIFORNIA
 
Rare opportunity. Busy all around practice, including pediatrics. Hospital guarantee of $200,000 for first year. Ready to retire. Will stay on for transition. Low price of $130K. E-MAIL tracy.podiatry@comcast.net or call: 209.835.4276 

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

PM News Classified Ads Reach over 12,500 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 12,500 DPM's. Write to 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.

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