The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

November 13, 2010 #4,010 Publisher-Barry Block, DPM, JD

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Surgery Sometimes Necessary for Unresponsive Neuromas: CT Podiatrist

To deal with neuromas, the majority of the time, conservative treatment, consisting of wider or more cushioned shoes, custom orthotic devices, cortisone injections, and padding around the area, can alleviate the pain. One last resort before considering surgical intervention is a series of injections using a 4 percent solution of alcohol mixed with local anesthetic, a procedure known as sclerotherapy.

Dr. Brian Fullem

"One runner I treated tried all of the above, including sclerotherapy, to deal with pain in her foot that was bad enough to interfere with her training, said Briam Fullem, DPM, a Connecticut sports podiatrist. "When none of the conservative treatments brought relief, she elected to undergo surgical excision of the nerve. Like most foot surgery, hers was performed on an outpatient basis. She was running within four weeks of her surgery. Nine years later, she's still pain-free at her former neuroma location."

Source: Running Times Magazine [November 2010]

Scholl Student Receives NSF-CMMI Student Participation Grant

Lydia Regis, a Scholl’13 student, has been chosen to receive a Student Participation Grant from the 2011 NSF-CMMI Research and Innovation Conference, to be held in Atlanta, Georgia, January 4-7, 2011.

Lydia Regis

This is the second award that she has received for her excellent research study. Last summer, she demonstrated the benefit of an innovative game-based virtual reality technology for improving balance and postural compensatory strategy during sensory-altered conditions.

APMWA Announces 25th Annual Student Writing Competition

The American Podiatric Medical Writers Association has announced its 25th Annual Student Writing Competition.

• All papers MUST be non-technical in nature. Appropriate subjects include practice management, ethics,or any topic that would be suitable for a lay publication.
• There is no word limitation. Papers will be graded for content, style, grammar, neatness, and overall impact.
• First prize will be one thousand dollars ($1,000.00), sponsored by an APMA Educational Foundation endowment from Dr. and Mrs. Steven Berlin, and recognition in the APMA NEWS and the APMWA Newsletter. Honorable Mention Certificates may also be awarded.
• This competition is open to ANY enrolled podiatric student.
• Entries must be received by 4/1/11 via e-mail at bblock@podiatrym.com
• Entries become the property of APMWA, which may arrange publication of the entry.

PA Podiatrist Fears that Gas Drilling Could Open a Pandora's Box

The controversial fracking process arrived in Lake Township with little noise - save for the low hum and the occasional clanging metal emanating from Encana Oil & Gas USA Inc.'s exploratory gas well. The work, which could take up to five weeks, signaled a pivotal moment in the progression of the natural gas industry here. Should the process work, many residents in the area could eventually cash in on natural gas royalties.

Dr. Thomas Jiunta (photo courtesy of the (Wilkes-Barre, PA) Times Leader)

But should something go wrong, people like Dr. Thomas Jiunta, a podiatrist who founded the Gas Drilling Awareness Coalition, believe it could taint the region's water supplies. "We asked for something that we may regret," Jiunta said, stopping his black car to scan the well site. Jiunta worries that the community "opened a Pandora's box of problems." 

Source: Andrew Staub, Citizen's Voice [11/11/10]

The Elements of a Weekly Management Meeting

In a large group practice it is vital to have weekly management meetings called Level-10 meetings with your leadership team. Your leadership team usually consists of the visionary of the group, the integrator or COO of the group, and the head of marketing, operations and finance. Depending on size, you might have the integrator and head of operations in the same role. Usually, you will have 5-7 people on your leadership team. Weekly 90-minute leadership meetings are essential to develop a cadence, pulse, and routine to keep everyone informed on what the right hand and left hand are doing in your practice.

There are five key points of a solid meeting pulse that must be adhered to every week: Meetings must 1. be on same day every week. 2. be at the same time every week. 3. have the same agenda format every week. 4. start at same time every week. 5. end on time every week.

Source: David Helfman, DPM, Atlanta, GA

Query: Lower Extremity Complaints S/P Knee or Hip Replacement
 
I would be interested to know if any of your readers have encountered an increase in the number of patients presenting with lower extremity complaints following knee and or hip replacement procedures  (same side or contralateral)? It would seem inevitable, and I am not sure that our orthopedic colleagues evaluate gait prior to or post-procedure. I do know that they make every attempt to avoid LLD, but there are other considerations that may not be addressed (as we know from evaluating patients for gait imbalances on a daily basis). I would be interested to know if anyone has seen this reported in the literature.
 
Chuck Ross, DPM, Pittsfield, MA

Query: Medicare Coverage for ESWT

Does Medicare pay for ESWT "high energy" with a regional block in a hospital and/or office setting? Our office has had a couple of Medicare patients inquire about the ESWT for plantar fasciitis.

Connie Lewis, Office Of Michael DiGiacomo, DPM, Oakland, CA

Response: I can't speak for other Medicare carriers, but in California, CPT 28890 (high energy ESWT) is a covered service. The problem is the payment. The current non-facility total RVUs (includes expenses of the machine in the office) is 8.68; facility total RVUs is 5.98.

Tony Poggio, DPM, Alameda, CA

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RE: Procedure for Flail 4th Toe (David Weiss, DPM)
From: Multiple Respondents

The flail toe could be treated with a fifth metatarsal head transposition to the fourth metatarsal. Simple - I've done it for brachymetatarsia with success.

Geoffrey Bricker, DPM, Springfield, MO, geoffreybricker1@msn.com

I will leave it up to the more accomplished surgeons to debate what would be the best procedure to do for this deformity for someone else, but as a practical matter for this person, I saw red flags waving away as I read the posting. First, the refusal to have the procedure that was recommended and then wanting a quick fix. This has trouble written all over it.

Sam Bell, DPM, Schenectady, NY, dpmbell@aol.com

Dr. Weiss did not inform us why his patient rejected his proposed syndactly procedure. The idea itself is not a bad one. I do think the 4th toe has contracted proximally, and even if a syndactly was performed, some type of skin plasty, i.e, a v-to-y would be necessary. I also agree the quickest recovery would likely be a digital amp, but if your patient rejected the syndactly idea, she would probably reject the amputation suggestion.

My advice at this point would be to tread with caution. Do not allow your patient to dictate to you "what she wants." I say this, as it sets you up for possible future conflict. Your approaches are logical. Simply, give the patient her options and the realistic expectations that are associated with them. Then she has the option to chose from your choices. Adhere to your instinct. If you feel the patient will be a problem, don't be afraid to let the patient walk. Good luck. If you end up performing the surgery, please share the outcome with us.
 
Jeffrey Kass, DPM, Forest Hills, NY, Jeffckass@aol.com

RE: Positional  Reddish/Purplish Blotches (Michael J. Ryan, DPM)
From: Robert Bijak, DPM

Consider "granuloma annulare" as a presumptive diagnosis and do a biopsy to find out what it really is.  

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

RE: Stop Disparaging Our Residents
From: Enid Goris, DPM

I would like to address a matter that at times seems to go unnoticed.  Many fine residents are graduating after receiving stupendous training, and yet attendings who overlook these residents, at times, will make disparaging remarks about the skills of such graduating residents. Case-in-point, I recently had the pleasure of working with the chief resident at St. Barnabas Hospital in the Bronx. I was told by a fellow colleague who has overlooked this particular resident's work, as well as that of many other residents, that the "residents graduating now are not skilled enough, not adequately knowledgeable and can't even suture."

Well, my colleague was incorrect. This chief resident was not only capable of suturing, but he was on the money with his skills and knowledge of the procedure (and no, it was not a hammertoe). I was honestly impressed and wrote a letter to his director thanking him for allowing this resident to assist me, and for making a superstar out of this podiatrist. I send this comment with the hope to enlighten others not to allow fellow colleagues to prematurely influence the impression of the many hard-working residents that graduate each year.

Enid Goris, DPM, Bronx, NY, enidgoris@yahoo.com

RE: Monitoring Employee Use of the Internet (Emilio A. Goez, DPM)
From: Marc Garfield, DPM

If you have a smartphone, you can install “phonemypc" for $9.95. This gives you a spy option, whereby it will let you observe, without having any effect on what the user is doing or take a snapshot of the desktop. You can also install Real VNC on each computer for free, and you can observe activities periodically from your desktop or laptop. You can let employees know it is installed, and then have them sign a company policy that says that any use of computers for non-business purposes is grounds for termination. Use the Real VNC periodically to update files and programs so they know that it works. 

Note: Real VNC requires you to use a browser to adjust “port forwarding settings” of your router. This is easy to do, but may go beyond some users' comfort level. There are other small fee programs such as gotomypc.com that do not require these types of adjustments. Windows comes with a remote PC tool, but as a spying tool, would disrupt the staff’s use of the computer, and would require re-entering a password for them to get back to work. There are also programs that you can purchase over the Internet to secretly capture history and time spent on program use.  Make sure your staff has corporate/office e-mail addresses, so that there is no reason to use their personal account in the office. Most office websites and many corporate Internet accounts allow for multiple email accounts. 

Marc Garfield, DPM, Williamsburg, VA, mgarfield1@cox.net

SEEKING EMPLOYMENT OPPORTUNITY - NORTHERN, NJ

Looking to relocate my current position closer to home. I am honest, ethical, punctual and hard-working. PM and S-36 trained with over four years of work experience. Seeking a full-time employment opportunity starting as an associate with the potential for partnership in the future. If interested, please contact footdoctor36@gmail.com

IMMEDIATELY AVAILABLE- PHOENIX, AZ
 
A great opportunity to join and gain ownership interest in a well- established, diversified practice in Phoenix, AZ. Seeking motivated, ethical, well trained, personable AZ licensed DPM with excellent office management and clinical skills in all phases of Podiatry. Practice is state-of-the-art and encompasses all phases of podiatric care. New and established practitioners are welcome, or someone who would be open to merging a smaller practice with ours. Board Qualified/Certified required. Please send CV email phxpod@gmail.com

PART-TIME / FULL-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

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 - PHILADELPHIA, SOUTHERN NEW JERSEY

Seeking motivated, independent foot & ankle surgeon to join large practice. Our multi-office practice covers all aspects of foot and ankle pathology, including heavy hospital volume. Offering competitive salary and benefit package. Send CV and two references to bleich5252@yahoo.com

ASSOCIATE POSITION – IOWA CITY AREA

Modern practice seeking a well-trained (PSR 24/36) associate to start immediately. Excellent opportunity for an energetic, hardworking individual with strong surgical and medical skills. Solid referral network and 13 years of growth. Come live in the Iowa City area and enjoy the quality of life and stability of a Big Ten University community. Competitive salary and benefit package available. If interested, fax CV to 319-354-1014 or e-mail to dave@341foot.com

ASSOCIATE POSITION - MICHIGAN - (OAKLAND COUNTY)

Outstanding opportunity for associate in well established practice, general & surgical podiatry forefoot, rearfoot & ankle (full or part-time). Well-trained, responsible, motivated with good communication skills, ABPS qualified or better. Send CV & letter of interest to: PodiatristWanted@AOL.com. All replies kept strictly confidential

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.

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 - 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

POSITION AVAILABLE -  NAPLES, FLORIDA

Great opportunity for PSR- 24/36 BE/BC podiatrist with strong surgical skills to join multi-office multi-doctor practice. Hospital privileges available at 648 bed hospital system, 200 bed hospital system and multiple surgical centers. Florida has a great scope of practice law and we rotate for ER call at all 4 hospitals. Candidate needs to be ethical and motivated. Established practitioner or new practitioner OK. Fax CV to (239)566-8778 or Email CV to Drgordon@gulfcoastfootcare.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 - SOUTHWEST FLORIDA

Immediate opening for the right candidate. Join a well-established podiatric group in Southwest Florida. We are a multi-office practice with EMR, Digital x-ray, and more. Seeking full-time associate that is PM and S-36 trained, personable, independent and highly motivated individual. Must be BC/BS in rearfoot and ankle with confidence in complex reconstructive cases. Full benefits package, competitive salary, excellent lifestyle. Please respond to JLH459@aol.com

TRAUMA FELLOWSHIP - FOOT & ANKLE

Broadlawns Medical Center in Des Moines, IA is currently accepting applications for its 12 month trauma surgery fellowship beginning August 1, 2011. Fellowship to include advanced techniques in all foot and ankle surgery with an emphasis on lower extremity trauma, reconstruction & total joint replacement. Residency training required. Competitive salary and benefits. Please submit a letter of interest, CV, and 3 letters of recommendation to: Ben Olsen, DPM, Director: Foot and Ankle Trauma Fellowship, Broadlawns Medical Center, 1801 Hickman Road, Des Moines, IA 50314, 515-282-7927, bolsen@broadlawns.org

PRACTICE FOR SALE - CONNECTICUT

Outstanding solo practice for sale in northern Fairfield county, CT. Shared space with other medical professionals. Very low overhead. Grossing almost $300K on 30 hours per week. Referrals from three different primary care physician offices. If interested e-mail CTPodiatry@gmail.com

PRACTICE FOR SALE - MARYLAND, DC SUBURB

Own your own practice and be your own boss.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. Owner will stay on as needed for easy transition. dpmpracticeforsale@yahoo.com

ACTIVE PRACTICE FOR SALE - NYC

Part-time practice, capable of expansion to full-time, desirable Mid-town Manhattan location, fully-equipped, established for over 30 years. Doctor is retiring. (212) 247-5148 Fax (212) 581-0148.

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