The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

November 10, 2009 #3,697 Publisher-Barry Block, DPM, JD

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IL Podiatrist Discusses High Heels and Bunions

Podiatrists such as Bela Pandit say this time of year there are plenty of younger women who have bunion pain but don't realize what's causing it. "Everybody wants to wear the high heeled boots and they start to notice it a lot more. Some people think they are growing something there but it's actually their natural bone just dislocated out of joint," said Pandit.

Dr. Bela Pandit

Bunions are aggravated but not caused by shoes. Those pointy high heels can play a role by crowding the toes making the pain more intense and the deformity worse over time. "It's never going to go away. Either you surgically fix it or you conservatively treat it," said Pandit.

Source: Christine Tressel and Sylvia Perez, WLS (ABC-TV) [10/29/09]

AAPPM Presents B.C. Egerter Award to Bakotic

The American Academy of Podiatric Practice Management (AAPPM) has presented its 2nd Annual B.C. Egerter Award of Excellence to Brad Bakotic, DPM, DO at its Annual Fort Lauderdale Practice Management Meeting. This award is named after Bernhardt C. Egerter, DPM, the founder of AAPPM.

AAPPM Board of Trustees presents Dr. Brad Bakotic with the B.C. Egerter Award of Excellence at the AAPPM Fall Practice Management Workshop .

In presenting the award, AAPPM president Dr. Jeffrey Frederick said, "Dr. Bakotic is a prime example of someone who has given back to his profession in support of podiatric education, including practice management."  Dr. Bakotic is the founder of Bako Pathology Labs, and has been instrumental in increasing awareness of the importance of performing biopsies.

LA County Society Holds Successful PPAC Fundraiser

The L. A. County Podiatric Medical Society held its second annual “One Voice” event on November 7, 2009 at Spago Restaurant in Beverly Hills. Jack Morgan, DPM, Vice President of Central East division of the society developed a concept to strengthen the economic and political power of podiatric medicine. The goal is to raise money for political action and awareness of the strength of the profession when podiatrists speak with one common voice.

Podiatrists at One Voice PPAC Fundraiser

Dr. Comfort and Blaine Laboratories returned this year - each contributing $5,000 to this event. New sponsors were Innovative Diagnostic Medical Group and Healthnet Home Health, each contributing this generous sum as well. L. A. County podiatrists who attended the event donated $299 per couple to CalPPac. The evening included elegant dining and entertainment.

Armstrong Named "Cure Award" Winner by American Diabetes Association

David G. Armstrong, Professor of Surgery and Director of the Southern Arizona Limb Salvage Alliance at the University of Arizona College of Medicine was given the American Diabetes Association's "Cure" award at a black tie gala held this weekend for his group's work in amputation prevention. "This is a honor that I share with our SALSA team, our Department and with our University", noted Dr. Armstrong, a past board member of the American Diabetes Association. "We have found that putting people together really makes a difference. The secret sauce that makes up SALSA is teamwork." 

Tania and David Armstrong Arrive at the Awards Gala

Armstrong, a podiatrist and researcher, has produced more than 270 peer-reviewed manuscripts and helped to develop the key classifications and guidelines that serve to direct diabetic foot care around the world. His SALSA unit, co-directed by renowned vascular surgeon Dr. Joseph Mills, has served as a model for care regionally, nationally, and internationally.

Editor's Note: PM News is proud to present excerpts from Meet the Masters.

Bret Ribotsky: What new ideas have you put into your practice in the last couple of years that have made a difference?

Dr. Allen Jacobs

Allen Jacobs: I think the biggest challenge is combining academics and practice management in the area of the diabetic foot. I think there is more to diabetes than cutting toenails, providing skin care, and selling shoes or socks and lotions to the patient.  I think our charge is to reduce the amputation rate, and if we look at everything that has been published, it says that when you add an intensive foot program to a diabetic clinic, you reduce major amputations by 70%. You do not do that by simply cutting toenails, trimming calluses, and selling shoes. You take the time to evaluate circulation. For example, I do a lot of  Doppler studies at baseline (a CPT 93922). I am not doing it to make money. I am doing it because, when I take a history and physical, I find that a lot of patients have undiagnosed or untreated peripheral arterial disease.

Meet the Masters is broadcast each Tuesday Night at 9 PM (EST). This week's theme is a practice management roundtable. You can register for this event  by clicking here

Query: Source for Unsecured Loans

I have accumulated a lot of debt on my credit cards to keep my office open. This has stemmed from Medicare’s California carrier getting things screwed up earlier this year. I had to mortgage my home and office to stay open while Medicare got its act together. In the past, I have gone to buy/lease companies to buy equipment. I have a good credit rating. Does anyone know of companies that will loan to docs consolidation loans, unsecured?

Name Withheld

RE: Painful Callus, Unresponsive to Conservative Care  (Megan Lawton, DPM)
From: Multiple Respondents

The one treatment that I have consistently had success with for over 30 years for the treatment of intractable plantar keratoses has been a product made by Bergmann Orthotic lab called the Balance Inlay. The impressions must be taken with the patient lying in the supine position, and the lesion must be marked with a special marker provided by the lab. When casting, I hold the patient's foot in neutral position, but the experts at the lab do not feel that it is always necessary to do this. I suggest you speak directly with them.  Even if the lesions do not go away entirely, they will cease to be painful. Patients who have been compliant with using the orthoses have all been happy with them. 
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

These lesions appear to be caused by a plantarflexed second metatarsal, and the big toe lesion is also probably caused by hypertrophied bone or possibly a sesamoid bone. The x-rays could be helpful for possible surgical evaluation. I noticed the second toe was not long; however, this still could be a plantarflexed second metatarsal. I would probably do a second metatarsal osteotomy or possibly a second metatarsal plantar condylectomy, if I was concerned about the relative length of the second metatarsal. The big toe lesion will probably resolve by taking out the offending bone causing the lesion. These lesions do not appear to be warts, and I doubt if excising them would be successful. I have no experience using alcohol to treat these kinds of lesions; however, I have had a high degree of success with bone surgery.

Ed Cohen, DPM , Gulfport, MS, ECohen1344@aol.com

Hallux IPJ skin lesions, like the one depicted here, generally result from supernumerary sesamoid bones within the FHB. Medial column roll off at toe-off from overpronation of the STJ in compensation for several structural pedal issues overloads the medial column of the foot. Sesamoid excision should resolve the lesion, but the pathomechanics still need to be addressed. The etiology of 2nd metatarsal IPK's is much more variable. Long and/or plantarflexed 2nd metatarsal, pre-dislocation syndrome, hallux limitus w/accompanying metatarsus primus elevatus (structural or functional), short 1st metatarsal, fully compensated forefoot varus and equinus are all in the differential diagnosis. Thorough biomechanical exam and pedal x-rays, both weight-bearing and non-weight-bearing would be helpful in corroborating the etiology.

Lastly, and most importantly from my perspective, I'd be remiss if I didn't question why the "calluses" appear to ulcerated. Was this the result of an extremely aggressive in-office skin debridement, or might a health issue exist with this 32 year old patient that affects his integument? There's no mention of the patient's medical history.

Initially, I will assume nothing was uncovered during the initial examination...but could something have been missed? I'd return to that area and start asking questions for one generally doesn't encounter skin ulceration in healthy 32 year old patients, even if significant biomechanical or structural pedal issues exist...so, I'd be suspicious and start searching for DM, or an occult collagen vascular disease to start. A full medical work-up, family history, background check. and review of systems with blood work is indicated before any additional surgery is contemplated; once that is performed, if an occult systemic process is uncovered and then effectively medically managed, then I'd proceed with additional surgery that addresses the supernumerary sesamoid and 2nd ray.

Barry Mullen, DPM, Hackettstown, NJ, yazy630@aol.com

RE: Faye Frankfort and Healthcare Legislation
From: Nicholas Sol, DPM

The recent House of Representatives vote on HR 3962 was critical for DPM's. HR 3962 includes the Title XIX language defining DPM's as physicians in the Medicaid program. None of this would be possible without the legislative know-how and effective advocacy of the APMA and, especially, Ms. Faye Frankfort. There has never been a more critical time for DPM's to have a voice in Congress. We have only one seat at the "legislative table" and it's labeled APMA. Thank you, APMA. Thank you, Ms. Frankfort.

Nicholas Sol, DPM, Colorado Springs, CO, drsol@thewalkingclinic.com
 

RE: Dictation/Transcription Service (William Miller, DPM)
From: Multiple Respondents

I've been using Viva Transcription for the past six months and have been very pleased. Reasonable rates, decent accuracy, and one-day turn-a-round. It's a web-based system which allows you to access your chart notes from any computer. You also have the ability to edit, fax, print, and perform full-text searches from online records. They can be contacted at vivatranscription.com/ or 1-877-848-2462.
 
Chris Seuferling, DPM, Portland, OR, cseuferling@comcast.net

The dictation service we have used for several years is m-scribe.com/ They are great, easy, and fast.

David E. Samuel, DPM, Chester, PA, desamuel@comcast.net

Several hundred podiatrists consider G&L Transcription (gltranscription.com) one of the best transcription services. We offer very competitive rates, discounts for macro/template usage, and online medical records. We are currently designing and will be releasing a podiatric EMR application in 2010. 

Gary Froonjian, G&L Transcription, Inc., gary@gltranscription.com
 

RE: Podiatrists and Flu Shots (Ray McClanahan, DPM, Kathleen Neuhoff, DPM)
From: Elliot Udell, DPM, Leonard A. Levy, DPM, MPH

Dr. McClanahan is correct. Giving a seasonal  influenza vaccination at this point in time is clearly out of scope of practice for podiatrists. By no means should it be inferred that we should undertake this unless there is a legal change in scope of practice allowing this. In the state of New York, our governor issued a directive allowing podiatrists and dentists to give H1N1 vaccinations at clinics in order to meet what is perceived as a public health emergency. In essence, he temporarily broadened our scope of practice.

The APMA is studying this issue. Since podiatrists and dentists have extensive training in giving injections, we would be as qualified or even more qualified to give an IM injection than a nurse practitioner working in a drug store, or as in some cases, grocery stores. Should the patient develop a complication from the vaccine, the patient would be sent to the hospital ER or his or her internist for follow-up care, and this would apply equally as well to the ancillary medical professionals giving these injections at drug stores and other locations. Dr. Neuhoff also makes a good point. The paperwork is extensive and there is little or no economic remuneration for administering swine flu vaccines.
 
There is an even greater issue lurking behind the scenes. The economic remuneration for giving all sorts of vaccinations is low and many primary care doctors are not ordering enough flu vaccines. This could lead to a public health problem in the future and perhaps podiatrists and dentists can be legally empowered to prevent it. 
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

Ray McClanahan, DPM, and Kathleen Neuhoff, DPM stated that influenza has no pedal manifestations, and podiatrists do not treat symptoms of influenza and should not be involved in influenza care, including the vaccination process. They also stated that if there is time to be involved in the legislative process, podiatrists would be much better off working towards podiatric goals.

Certainly, in ordinary situations, these remarks are perfectly correct.  However, in addition to being Associate Dean, I have been Director of the Center for Bioterrorism and All-Hazards Preparedness for the College of Osteopathic Medicine of Nova Southeastern University since 9/11 which includes prevention and response in a pandemic, so I fully understand the concern of these podiatric physicians. However, when demand greatly stresses the emergency response system, as in the instance of Katrina and in the devastating 1918 Spanish flu pandemic that killed about 50 million people world-wide, the situation is quite different. 

There is a history where the governor of a state or the federal government granted certain people permission to engage in care that they are not ordinarily permitted to do.  For example, in 1918 medical and dental students were declared to be physicians by the federal government. After Katrina, physicians not licensed in Louisiana were granted by the Governor the right to provide care to hurricane victims. Such situations do not change one’s license but provide temporary resources for an emergency response required under very unusual situations.

Leonard A. Levy, DPM, MPH, levyleon@nova.edu

ASSOCIATE POSITION - MINEOLA, NEW YORK

Full-time associate position with future partnership potential available with busy multi-office practices on Long Island. Must be proficient in all phases of podiatry with emphasis on surgery, biomechanics and RFC. Minimum standards include either a three-year PSR, or board qualified/certified status with ABPS. Existing hospital privileges with a NY based facility helpful. Interested doctors are encouraged to e-mail their CV to mets724@gmail.com

ASSOCIATION POSITION – NORTH CAROLINA

Cornerstone Health Care, one of the largest physician-owned and managed multispecialty groups in the Southeast, is seeking two podiatrists for offices located in the Piedmont Triad of North Carolina. Cornerstone has over 280 providers in 60 locations. Physicians benefit from centralized billing, contracting, and human resource, while maintaining autonomy over office practices. A state-of-the-art EMR system by Allscripts provides instant access to all Cornerstone patient records. Send CV to page.redpath@cornerstonehealthcare.com

ASSOCIATE POSITION - EAST CENTRAL FLORIDA

Wanted podiatrist for well-established practice in East Central Florida. Fulltime position to perform routine foot care in the office and nursing homes. Competitive salary and full benefits available.  Reply to jrdpm@bellsouth.net

ASSOCIATE POSITION-SOUTHERN CALIFORNIA, INLAND EMPIRE

2-office multi-doctor practice looking for ethical, dependable doctor to work 3-4 days per week. State-of-the-art, long established practice. Needs a team player which may lead to buy-in for the right doctor. Must be ABPS BC/BE. High surgical volume. Send cover letter and CV to bkatzman2@earthlink.net

ASSOCIATE POSITION - NORTHERN VIRGINIA/DC SUBURB

Excellent associate practice opportunity leading to partnership for PSR 24-36 foot and ankle surgically-trained physician. Currently 4-doctor/2 office practice in fast-growing area, expanding to 5 doctors. Hard working, personable, highly-motivated individuals needed. Great opportunity with excellent salary and benefits. No nursing homes. Top hospitals. Fax CV with references to 703-491-9994

ASSOCIATE POSITION - MISSOURI

Expanding multi-location practice seeks motivated individual to contribute to growth. Practice enjoys strong reputation and name recognition. Prefer candidates with interest in partnership opportunity. Established locations available for PSR 24+ and includes incentive comp with benefits/coverage. Please send CV to jmurray@foothealers.com or call John Murray at 314.842.3875.

ASSOCIATE POSITION – MINNESOTA

Well-established podiatry clinic located in the Twin Cities area has an immediate opening for a full-time podiatrist. The clinic is located just minutes from a surgery center as well as 2 major hospitals. Associate position is also open for partnership or purchase. Please email CV and inquires to rmccoy@associatedpodiatrists.com

ASSOCIATE POSITION - NW IOWA (SIOUX CITY AREA)

Well-established, diverse, growing practice. Excellent referral base. Seeking an ethical, hardworking, motivated, caring podiatrist to fill a full-time position. Multiple hospital affiliations. Generous income with room for growth, leading to partnership for the right candidate. See our community www.siouxlandchamber.com. Fax CV, resume, three references to 712-258-9977.

OFFICE SPACE/ MRI RENTAL – NYC, LI

Turn-key space available, daily, monthly; East 60th off Park Ave, East 22nd St. off 3rd Ave, Hicksville and/or Plainview Long Island. JACHO-certified operating rooms available, as well as all surgical equipment and anesthesia. Extremity MRI Rental. Stark compliant. All exams read by board certified radiologist. Call for details. 516 476-1815

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.

PRACTICE FOR SALE- SEATTLE, WA

Beautiful office for sale in the heart of Seattle, WA. Newly renovated, 2,500 sf, new digital x-ray, vascular lab, state of the art physical therapy equipment, paper-less system, all new podiatric furniture and equipment, popular podiatric products store and beautiful diabetic shoe display. Office is located in the medical building and open 3 days a week. Great opportunity for expansion to full-time. Please send us a letter of interest to the: podiatrygroup@yahoo.com

ASSOCIATE POSITION FULL-TIME - SUBURBS OF CHICAGO

PSR 36 - month-trained podiatrist needed for busy suburban Chicago practice. Office and diagnostic equipment state-of-the-art. Full benefit package included. If interested, please fax your curriculum vitae to 847.352.0270 or email to foot1st@yahoo.com

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

ASSOCIATE POSITION - PHOENIX, ARIZONA 
Part Time/Full Time well-trained, ethical and hard working graduate of a PSR 24+/36 Residency to join our growing multi-location practice. Good mix of Surgery/Pediatric/General Podiatry. ER/Hospital Call a must. Very modern offices with EMR, U/S, Digital X-Ray, ESWT, Vascular Testing. Excellent referral base, and a well-trained staff. Base salary, bonus structure, benefits. Current AZ License a Must. Please e-mail CV and references to azpodiatrists@hotmail.com

DIABETIC RURAL OUTREACH PROGRAM - FLORIDA AND GEORGIA

Seeking DPM to join our program due to a high demand for Podiatric Care to off-site settings in SNF, ALFs and House Calls. Applicants must be willing to travel and must have experience. Current State License, Medicare and Medicaid numbers required. Seeking highly motivated individuals who can be team players, yet work independently. Must have strong work ethic and excellent communication skills. APPLY: Fax CV to: 866-258-9993 include 3 professional references. Please provide the geographic area where you can provide services. Further information call 800-779-8551 or email: info@DROPInternational.org. Visit our website

ASSOCIATE POSITION – RESEDA, CA

Podiatrist needed in Reseda, CA office 2-3 days/wk, 6hrs/day @ $375/day to senior community. Please have an active Medicare #. Position starts immediately. Please email CVs to coasttocoastpodiatry@yahoo.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

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.

ASSOCIATE POSITIONS – MARYLAND

Are you motivated, personable and enjoy working with the elderly? We are offering full or part-time positions in Maryland. Our group, Podiatry Management Services, provides care to the elderly in Nursing Homes, Assisted Living, Senior Homes, Adult Daycare and other similar facilities. Please e-mail your c.v. to drhprosen@comcast.net or fax to 410-486-2049 or call Dr. Herbert Rosen at 410-580-0255.

ASSOCIATE POSITION – BROOKLYN, NY

Busy medical office in Brooklyn seeking part-time podiatrist. Good conditions. (718) 259-6666 phone (718)259-7000 fax, email zg0109@yahoo.com

PODIATRISTS CHICAGO/NW IND/BALTIMORE/WASHINGTON, DC

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 Jake Shimansky, Director of Physician Recruitment. Phone-773-342-5221 FAX 773-486-3548-E-Mail jshimansky@homephysicians.com www.homephysicians.com

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