The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

October 24, 2011 #4,287 Publisher-Barry Block, DPM, JD

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If the Shoe Doesn't Fit, Return It: PA Podiatrist

“You should never have to break in a pair of shoes. It’s all about buying the right shoe for the right activity,” says podiatrist Dr. Mallory Eisenman, who sees patients in Center City and Northeast Philly. “If you buy a pair that doesn’t fit, the shoe will always win.” If you continuously jam your feet into shoes that are too small, there’s a good chance you’ll develop corns, calluses or bunions, which could lead to more serious problems like bone spurs, joint pain and arthritis.

Dr. Mallory Eisenman

You should put new shoes through their paces at home for a while before you take them outside. “Wear them around the house for an hour straight,” says Eisenman. “If it doesn’t feel good after that, return them.

Source: Sarah Scarpa, Philadelphia Magazine [10/21/11}

Docs Need More EHR Training, Survey Suggests

Physicians need at least three to five days of training to feel satisfied with their electronic health-record system. Proper use of the EHR functions required for meaningful-use incentive bonuses took two weeks of training—but almost half of the doctors responding to a recent survey reported that they received three days or less of EHR training.

The survey was conducted by AmericanEHR Partners, an online community developed by the American College of Physicians and Cientis Technologies. The survey showed that the findings of previous surveys were confirmed, that participating physicians noted a higher level of satisfaction if they had a hand in selecting the system they used.

Source: Andis Robeznieks, Modern Healthcare [10/21/11]

RE: Alleged Unnecessary Surgery (New Jersey)

Facts: On Nov. 17, 2006, plaintiff Gerald Dorsey underwent surgery on his right foot, performed by defendant podiatrist. The surgery sought to address complaints of right foot pain and decreased range of motion. Following the surgery and an appropriate recuperation period, Dorsey claimed continued foot pain and discomfort that he expected would have been alleviated by the surgery. He presented to another podiatrist who eventually performed two additional “corrective” surgeries.

Plaintiff's counsel alleged that the initial surgery Dorsey underwent was improper and unnecessary under the circumstances and a deviation from the standard of care. Dorsey alleged that defendant deviated from podiatric standards of care by...

Editor's note: This extended-length case can be read here.

Result: Defendant's verdict ($0)

Plaintiff's expert witness: Lawrence G. Lazar, DPM; Washington, DC
Defendant's expert witness: Harold D. Schoenhaus, DPM; Philadelphia, PA

Query: SuperGroup Formation In Maryland
 
I recently received an e-mail concerning the upcoming meeting and formation of a podiatric supergroup in Maryland. The 2-hour video that was attached to the e-mail touted that the justification for doing this is to negotiate higher reimbursements and to lower costs of supplies as some of the advantages of joining. The upfront cost of $2,000 is of minimal risk, but the annual 7-7.5% increase in group-associated overhead seems to greatly off-set any potential material gain.  Have other groups been successful in getting a 20-25% increase in fees for services from the private payors?

M. W. Aiken, DPM, Baltimore, MD

RE: Not So fast to Criticize Suturing Nails
From: Robert P. Thiele, DPM

Sewing the nail plate back to the nail bed is described in the literature. It has been advised that a stent (nail plate/non-adherent material) be placed between the eponychium and the nail bed after a nail bed laceration repair. This is used to prevent adhesions between the eponychium and the nail bed. Others have suggested that sewing the nail plate back to the nail bed after repair decreases the tenderness post repair. 

I would personally not use the nail plate for this nor "foil suture packaging" after a nail bed repair. I think the foil picture may have been an attempt to stent the eponychium. It was just a poor choice of material. Petroleum gauze/piece of silicon or non-adherent material have been described for this procedure.

Robert P. Thiele, DPM, Denville, NJ, drthiele@comcast.net

RE: Mitek Bone Anchor (Mark K. Williams, DPM)
From: Kevin Lam, DPM

Arthrex’s Bioanchor Screw is probably one of the best for the PT tendon. The 5.0 mm is great for this application, because it provides great tension control and early ROM without a worry about it pulling out, etc. If you have never tried it, your rep would be a great help. It is very simple to use. They even have the suture bridge version now for the PT tendon repairs, but I’m not too sure about that as the 5.0 anchor itself is way strong enough. The #2 fiberwire is a very strong suture also.
 
Kevin Lam, DPM, Naples, FL, klamdpm@hotmail.com

RE: Bleomycin Now Available Again
From: Keith Gurnick, DPM

Bleomycin (Blenoxane) which is used "off-label" for plantar and other foot warts had been on back order because three manufacturers of the generic version ran out and it became in short supply. I wanted to let PM News readers know that today, I finally received 2 vials from my local pharmacy.

My bottles were manufactured by Teva Pharmaceuticals and the NDC code number is 0703-3154-01 with an expiration date of 07-14. If your pharmacist or supplier has told you that it is unavailable, it is currently available again.

Keith Gurnick, DPM, Los Angeles, CA, keithgrnk@aol.com

RE: PAs and Podiatrists (Elliot Udell, DPM)
From: Seema Ramcharitar-Amante, DPM, RPA

I am a DPM and also a PA. Unfortunately, my PA education about the foot lasted about two days in duration. On my first job as a PA, my supervising physician expected me to inseminate infertile women. I had no idea what I was doing. Three weeks later, I became so good at it that patients were requesting me. I left to do research in HIV and eventually excelled at that also. After graduation, your supervising physician is supposed to guide you until he feels that you are competent in the field he practices in. Like all professions, there are good and bad PAs. I was recently ill and needed a pic line placement. The PA gave me the choice of him or a physician. I felt that he was competent and confident so I chose him, and all went well.

Don't always blame the PA ...sometimes patients choose an orthopedist over  a podiatrist because of false assumptions. I work with an orthopaedic group, and they hire me to assist in their foot cases. I usually perform the entire case. They are humble and admit to not having the skills concerning feet. Everyone needs experience..maybe that PA will one day become excellent. A desire to excel and enjoy your profession is what separates us.

Seema Ramcharitar-Amante, DPM, RPA, NY, NY, pamperurfeet@aol.com

RE: Stay Away from Trimming Toenails (Peter Vannucchi, DPM)
From: Robert Bijak, DPM, Dennis Shavelson, DPM

I think Dr. Vannuccii is getting a bad rap. My dentist doesn't clean teeth. That doesn't mean he hates dentistry or has a big ego. It's simply a matter of delegation of duties beneath your skill set. There's nothing wrong with utilizing your time or skills to your best advantage. And, I do believe it makes the dentist look more like an authority when he just comes in after the cleaning to do an oral cancer check and look for other pathology. There is no particular glory in cutting a toenail or grinding an arch support. Be a doctor and delegate, and then you'll get respect.

Robert Bijak, DPM, Clarence Center, NY rbijak@aol.com

When I was the DPM at Memorial Sloan Kettering Cancer Hospital in NYC, I eagerly attended patients who were there for two months or more. They were tired, weak, and suffering the ill-effects of chemo; most of them were dying. They and their families were so grateful when I “trimmed” their toenails, relieved an ingrown nail, or a small infection. I knew I had given them fuel to fight on. I saw smiles on their faces and sensed joy in their hearts as if I had just repaired their clubfoot. I gave them dignity and comfort as only a skilled doctor could do.

My memories of what I did for those patients are just as fervent as the ones I have after seeing my residents put the last stitch on a triple arthrodesis. Those toenail trimmings, which didn’t pay for my time, as well as many other services that I perform will someday get me into heaven. Dr. Vannucci’s stern position puts one more nail into the coffin of the profession I so love.
 
Dennis Shavelson, DPM, NY, NY, drsha@lifestylepodiatry.com

RE: OH Court Rules That Podiatrists Need ABPS Certification for Staff Privileges
From: Thomas Graziano, DPM, MD

Knowledge, medical or otherwise, is like music. It is a universal language that is available to anyone who desires to achieve it. The ability to translate that knowledge into practical use appears to be the dilemma. Certainly, some in our profession who have been unable to achieve board certification are excellent surgeons with pristine surgical outcomes. And some are not. That goes for those that are certified as well. Whatever category one sees themselves in does not give them a right of entitlement. There has to be some sort of guideline that hospitals can use to fairly judge whether or not someone should have surgical privileges at their institution. I don't believe that hospitals have "singled out" podiatrists for...

Editor's note: Dr. Graziano's extended-length letter can be read here.

Part-time practice for sale or lease. Flexible terms, will consider lease with option for sale. Structured for a fast sale, first option on real estate. Great opportunity for a start-up or satellite with immediate income. Call 201-573-0555 or 551-574-0776 billfeet@aol.com

PRACTICE FOR SALE - ARKANSAS

Busy, well established practice of 13 years grosses 160K/year for the past 5 years, while working 3.5 days/week. Nursing homes available. 50% Medicare, average of 15 new patients/week. Doctor retiring. Please call 800-983-4194 for more details, or e-mail contactus@podiatrypracticeconsultants.com

ASSOCIATE POSITION - MARYLAND

Multi-office group seeks highly trained surgical associate to join us. Prefer person with frame and trauma experience. Our practice is state-of-the-art and has all modalities: EMR, PadNnet, on-site billing, diagnostic US, PRP, digital x-ray, etc. Excellent salary, bonus structure and benefits with partnership available. Please forward CV and letter of intent to docsbnb@aol.com

FULL-TIME ASSOCIATE POSITION - SOUTHERN NEW HAMPSHIRE

Well-established, rapidly growing practice. Motivated, ethical and personable with well-trained PSR-24/36. Modern office with complete EMR, digital radiography, diagnostic ultrasound, and laser. Competitive salary/benefits package. If interested please email your CV, letter of intent and references to: NHFootDoc@yahoo.com

ASSOCIATE POSITION - SOUTH WEST FLORIDA

Full-time associate positions for an established group practice in Southwest Florida. Willing to train the right new graduates. Job will involved all aspects of podiatric care. You must be ambitious, hard-working and should have good people skills. Please e-mail your resume/CV to contactus@ankleandfoot.net

ASSOCIATE POSITION - NYC and SW CONNECTICUT

Podiatrist needed in Nassau county to start immediately. Flexible hours 2 days a week. Please emailpittpod@gmail.com with inquiries.

ASSOCIATE POSITION - LOS ANGELES COUNTY, CA
 
Interested in hiring a part-time leading to full-time podiatrist for northern Los Angeles County busy practice. Possibly leading to associateship. Please e-mail CV to avfootdoc@mail.com or fax to 661-265-1877.
 

ASSOCIATE POSITION - EAST TENNESSEE

30 year old practice with 5 offices in greater Knoxville area seeking ethical, personable, hardworking, team player. Extremely competitive base salary with bonus incentives and benefits. Knoxville is consistently ranked in top 5 places in U.S. Post-residency experience a plus. Please send resume toddavidphawk@yahoo.com

ASSOCIATE POSITION - FLORIDA/N.W. FLORIDA- TALLAHASSEE AREA

Home of Florida State University. Great university town! Well established full scope solo physician with busy practice. Looking for a full time associate leading to partnership in a short time. Great general practice with 2 locations. Staff privileges with 2 local hospitals and 2 surgery centers. Offering competitive salary, health insurance. Will need forefoot and rearfoot surgical competency. Friendly office with fun staff that’s easy to work with. Call/Text – 850-510-4371.

ASSOCIATE POSITION – IOWA CITY AREA

Seeking associate physician to join practice to cover both private practice and some nursing home facilities. Comprehensive package including Salary, Travel and Bonus benefits. Email cover letter and CV to melissafoot@pol.net.

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