The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

November 24, 2011 #4,314 Publisher-Barry Block, DPM, JD

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WesternU Raises Diabetes Awareness

November is National Diabetes Month. The Western Diabetes Institute joins the National Diabetes Education Program (NDEP) in raising awareness about the importance of setting goals and making a plan to prevent type-2 diabetes and diabetes-related complications. Diabetic patients are advised to have their feet examined by a podiatrist regularly because of the very high complication rate that directly impacts the foot, said Jonathan Labovitz, DPM, FACFAS, College of Podiatric Medicine Associate Professor and Department Chair, Medicine, Surgery and Biomechanics, Medical Director, Foot & Ankle Center.

Dr. Jonathan Labovitz

“Diabetes is the second leading cause of lower extremity amputations in the United States with a five-year mortality rate of around 50 percent for ulcers that form on the foot,” he said. “This is a higher mortality than breast cancer and colon cancer. The ulcers form in almost 20 percent of diabetics during their lifetime and are usually directly impacted by numbness, poor circulation, and/or changes in the foot structure. The podiatrists at the Foot & Ankle Center have specialized training in saving limbs through early intervention and the highest quality care.”

UK Podiatrist Offers Advice for High Heel Wearers

Dr. Tariq Khan, a consultant podiatrist at a leading hospital in London, has offered some simple techniques and solutions that will allow you to wear your favorite heels without causing long-lasting damage.

Dr. Tariq Khan

If you have a wobble-board, practice for an hour or so in the week before you wear high heels to strengthen your ankles and reduce the risk of sprains. Alternatively, if you own a pair of MBT-style exercise shoes, wear them to and from work. Don’t overdo it though, as Dr. Khan says wearing these too often can throw out your posture.

Source: Daily News and Analysis [11/22/11]

Use of Retail Clinics Skyrockets  

The use of retail medical clinics is rising swiftly, and a new study finds the clinic users tend to be younger, wealthier, and in better health overall than their peers who went to a physician's office or an emergency room for care.

Rand Corp. researchers found that the use of retail clinics rose 10-fold between 2007 and 2009, based on a review of data for 13.3 million commercially insured patients younger than 65. During the period studied, 3.8 million members of that population made at least one clinic visit. The researchers' findings are published in the latest issue of the American Journal of Managed Care.

Source: Joe Carlson, Modern Physician [11/22/11]

Depreciation Bonus and Section 179 Deductions Set to Expire 12/31/11

Recently, the U.S. Federal government made a change to the tax code which provides unprecedented incentives for investing in manufacturing technology. Specifically, the U.S. Federal government has increased "Bonus Depreciation” to 100% on qualified assets, which includes  software. This level of “Bonus Depreciation" is up from 50% last year. Simply put, this level of tax incentive to stimulate business investment is unprecedented. It is also very temporary as this provision is set to expire at the end of 2011.

Separate to this provision, the Section 179 deduction for capital equipment purchases, which includes software, has been increased from the previous limit of $250,000 to $500,000. This change will be in effect through the end of 2011.

Source: depreciationbonus.org

Small Steps Matter

Making daily progress at work remains one of the most powerful motivators. Employees who achieve frequent small wins feel more upbeat and passionate about their work.

As a doctor, take time at the end of each day to review team members’ achievements and setbacks. Plan tasks for tomorrow that allow employees to see progress. Benefit: Boost motivation and you also increase creativity, a key element in this rapidly changing healthcare environment.

Source: Adapted from “The Power of Small Wins: Interview With Teresa Amabile,” Matthew E. May via Communication Briefings

Query: Meaningful Use Exemptions for Height and Weight

I use Practice Fusion and have recently begun taking BP, temp, pulse, and respirations, but NOT the height and weights of patients. The vital signs "exception" from CMS states that there can be an exception if we do not believe that height and weight and BP are NOT relevant to our practice. I think that weight is important inasmuch as the wear and tear on the body, but height? BP is important. My question is, "How are colleagues who've qualified for the meaningful use gotten around this?" Have they taken weights on 50% of their patients? Do they just ask for the weight?  

R. Kurt Meier, III DPM, Brick, NJ

RE: The Blood Pressure Discussion
From: Leonard A. Levy, DPM, MPH

I cannot believe that in 2011 we still have to discuss whether or not podiatric physicians can take a person’s blood pressure. This should not be even an item of discussion. We claim to be physicians. We see patients. We are required to examine them in order to make a diagnosis and provide care. Providing care, even in a community practice, often requires the administration of drugs as “mundane” as a local anesthetic. How dare we do any of this without at the least determining if a patient has a relatively normal blood pressure? Not to do so puts patients at potential risk. It is an integral part of our practice.

This does not mean that we made a diagnosis of hypertension. However, if someone presents with an abnormal blood pressure, sending that patient for further evaluation by their primary care physician is appropriate. Furthermore, we are a unique profession often seeing patients more frequently than their primary care physician. If at each visit we note that a person’s blood pressure is climbing, that patient needs to be referred to a primary care physician. What a tremendous service we can do for the patient. 

In addition, we did not provide treatment that might put them at risk. Finally, it would send a loud and clear message to both patients and the healthcare community of the extent of our role as physicians. Let’s move on. To bring up even minor concerns that taking a blood pressure may be “dabbling in another profession” or has something to do with “meaningful use” is at this point in our evolution just mud in the water. We have more important issues to discuss.
 
Leonard A. Levy, DPM, MPH, Ft. Lauderdale, FL, levyleon@nova.edu

RE: Foot Strike Patterns in Recreational Runners
From: Kevin A. Kirby, DPM

In my posting yesterday, I unfortunately failed to include the full reference for the paper I mentioned on foot strike patterns in recreational and sub-elite runners. Here it is: Larson P., Higgins E., et al.:  Foot strike patterns of recreational and sub-elite runners in a long-distance road race. J Sports Sciences, 2011 Nov 18, Epub ahead of print. For those who are interested, here are the percentages and references for only two other scientific studies that have measured the percentages of heel striking, midfoot striking, and forefoot striking runners in road races.
 
753 runners were analyzed at the 9 km point of 10 km, and the 20 km point of marathon races and were found to be 81% RF strikers, 19% MF strikers & 0% FF strikers (Kerr BA, Beauchamp L., et al.: Footstrike patterns in distance running. In Nigg BM (Ed.), Biomechanical Aspects of Sport Shoes and Playing Surfaces, University Press, Calgary, 1983, pp. 135-142).
 
283 elite international runners were analyzed at the 9.3 mile mark of a half-marathon and were found to be 74.9% RF strikers, 23.7% MF strikers and 1.4% FF strikers (Hasegawa H, Yamauchi T, Kraemer WJ:  Foot strike patterns of runners at the 15-km point during an elite-level half marathon. J Strength Cond Res, 21:888-893, 2007).
 
Kevin A. Kirby, DPM, Sacramento, CA, kevinakirby@comcast.net

RE: Wavelengths for Laser Treatment of Onychomycosis (Marc Katz, DPM)
From: Jeffrey Kass, DPM,

The point of my original posting and Dr. Udell's follow- up was to try to ascertain if one laser was indeed better than others. There are many wavelengths currently being marketed to our profession. I was reaching out for feedback from those who may have experience to "weed out" what is true and what is false. When you say, "we are talking toenails, not life", while true, we are also talking reputation and honesty.

I have no desire to pull an "Emperor's new clothes" on a patient. While giving no guarantee is definitely a smart idea - I don't need to purchase a machine that is not going to work. Just because I told the patient, "you pay at your own risk" doesn't absolve me from performing due diligence to ascertain which of these machines is the best. There have been claims of 75 -85% success. Is this true? Are we talking about superficial onychomycosis? What about the full nail thick involvement?

PinPointe claims one treatment is required; others claim 3-4 treatments. These machines have been out long enough to get some constructive feedback from our colleagues. Dr. Katz says that he likes the 1320 wavelength. Can he share feedback with us? How many treatments? Success rate? Length of time for success? Any particular protocols he follows?

Jeffrey Kass, DPM, Forest Hills, NY Jeffckass@aol.com

RE:  Sinus Tarsi Implant Surgery (Michael Grahma, DPM)
From: Narmo L. Ortiz, Jr., DPM, Dennis Shavelson, DPM

I agree with Dr. Graham's explanation of the code, as I believe he is "telling it like it is", plain and simple. Not all dislocations are disarticulations, but all disarticulations are dislocations. The prefix "dis-" comes from the latin meaning "apart" or "away". When applied to the term "dislocation", it means that the bone or joint in question is apart or away from its intended and original anatomical position or "location", and is not necessarily due to trauma alone.
 
Narmo L. Ortiz, Jr., DPM, Marietta, GA, nlortizdpm@embarqmail.com

I am a big believer in the power of a well-placed HyProCure implant into the feet of patients possessing the flexible rearfoot functional foot types. It is the implant I have used and continue to recommend. I consider Dr. Graham to be one of the most innovative minds in podiatry. However, I have also been around. After being told to bill this code or that diagnosis by companies, later they backed down from defending me when I was asked to refund the money I was paid (with interest) because I had billed or coded improperly or illegally.
 
So, plain and simple, Dr. Graham, if podiatrists use the diagnosis and billing codes you are suggesting, will you and your company stand by us if insurance companies make demands for return of payments or worse? Until then, the debate remains just that, and has no place in our testing codes in order to get them accepted with its associated personal risk.

Dennis Shavelson, DPM, NY, NY, DrSha@foothelpers.com

RE: The World's Youngest Future Podiatrist?

Jenna Purdy, Future Podiatrist

My daughter Jenna, now age 5, stars in this video which was presented at the AAPPM Fall Meeting at the Lago Mar Resort in Fort Lauderdale, FL.

Jonathan Purdy, DPM, New Iberia, LA

ASSOCIATE POSITION - TAMPA BAY AREA

Excellent opportunity to join a well-established multi-office group practice in the beautiful Tampa Bay area starting July 1, 2012. We are seeking a highly motivated, ethical and personable physician with a Florida license. Competitive salary, excellent benefits and partnership track. Please email or fax CV tothesykeshome@aol.com  (813) 254-8262

ASSOCIATE POSITION - CENTRAL VALLEY/SOUTHERN CA

Seeking associate with partnership availability. Must be highly motivated and have good patient skills and personality. Salary excellent with all paid benefits/incentives including malpractice/401k and profit sharing. Compassionate and well-trained for immediate position. Surgery Center and hospital-based with no HMOs/no rest homes. Bilingual in English and Spanish preferred. Offering a permanent position/partnership in a multi-million dollar hi-tech practice with Partnership also in Surgery center. Please e-mail CV and short bio to: Tonya@wetreatyourfeet.com

ASSOCIATE POSITION – NORTHERN CALIFORNIA / BAY AREA

We’re looking for someone entrepreneurial who can help grow our practice. Must have great people skills, clinical/surgical skills, and positive demeanor. California license required. Send your CV and cover letter to cvpodiatrist@gmail.com

ASSOCIATE POSITION - NORTHWEST IOWA

A well-established, midwest multi-physician practice with strong hospital affiliations seeking FT podiatrist. Applicant should be well trained surgical physician, completed a 24-36 month residency, & board eligible. Practice offers high surgical volume, advanced wound care and good mix of general podiatry. Competitive salary, excellent benefits. Fax resume: 712-258-9977 Diane Coulter, Office Manager.

ASSOCIATE POSITION – NEW YORK CITY/ LONG ISLAND

Beautiful weather year round & near the Coast. Opportunity for Early Buy-in. Seeking associate or new residency graduate to join practice. Must be PSR-24/36 trained. Multiple locations. Full range of services with new facilities. E-mail cover letter & CV to melissafoot@pol.net

ASSOCIATE POSITION - BAKERSFIELD, CA

Busy surgically-oriented group in Bakersfield, CA searching for 4th doctor. Wound care center privileges. All 3 current surgeons have 3+ years post-graduate training. Send letter of interest with CV to:aghams2@aol.com

ASSOCIATE POSITION - UPSTATE NEW YORK

Outstanding Opportunity. Our medical surgical group is recruiting a well-trained licensed podiatric physician. Located in Beautiful upstate NY. Full hospital privileges, as well as working with two residency programs. Must be highly motivated and great with patients. Opportunity for growth. Competitive salary and benefit package. Please send CV to associateinfoot@yahoo.com

ASSOCIATE POSITION - SOUTH/CENTRAL PENNSYLVANIA

PSR-24/36 trained individual for busy practice in family-friendly college town. Seeking personable, ethical, motivated individual to join our well established practice providing all aspects of podiatric care. Competitive salary and benefits package. Reply with letter, CV and photo to Jagerone@aol.com.

ASSOCIATE POSITION - DAYTON, OH

Join a well-established modern practice in Dayton, Ohio. Excellent reputation and referral base. Base salary $120,000, benefits and bonus structure. EMR, diagnostic ultrasound, Padnet vascular studies, CO2 lasers, all aspects of DME. We seek a surgeon that is well-trained and personable to join our group of 4 podiatric surgeons. Would like to have this individual buy in to the practice eventually. Please send CV and to Ohiodoctors@aol.com

ASSOCIATE POSITION - MARYLAND

Looking for 3rd associate. Must be personable, well trained and highly motivated. Great locations in Southern Maryland, including an Ambulatory Surgical Center. We currently have EHR, digital radiography, dispensing center and PADNet. Looking for immediate hire! Please send CV to:myfeetfeet@aol.com

ASSOCIATE POSITION - EAST TENNESSEE

30 year old practice with 5 offices in greater Knoxville area seeking ethical, personable, hardworking, team player. $160,000 base salary with bonus incentives and benefits. Post-residency experience a plus. Please send resume to ddavidphawk@yahoo.com

ASSOCIATE POSITION - TEXAS

Well established, expanding podiatric medical and surgical practice with multiple locations Northeast of Dallas, Texas. Modern offices with EHR, digital radiography, Padnet vascular studies and laser. We offer a competitive salary and benefits package for a motivated, ethical, personable and well trained PSR/36 or board equivalent. This individual will also assist managing the residency program. Send resume (CV)to northtexaspodiatry@yahoo.com along with a letter of intent

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

SPACE AVAILABLE - NYC & LI

Office to sublet and share - East 60th Manhattan, and Plainview, Long Island. access to an MRI, Joint Commission certified operating rooms, digital x-ray, diagnostic ultrasound, and access to a multi-specialty ambulatory surgical center. Also availability E 22nd between 2nd and 3rd and E 70th off 3rd. Turn-key operation - no investment needed 516 476-1815 PODO2345@AOL.COM

PODIATRY OFFICE TO SHARE - SEATTLE, WASHINGTON

Fully equipped podiatry office in North Gate area of Seattle. Office located in medical professional building near I-5. Office has 3 treatment rooms, 3 physical therapy rooms, direct digital x-ray, PAD- net, NCV testing equipment, physical therapy equipment. Please contact us: website Tel. 425-643-8901isbinc2006@gmail.com

CPME-CERTIFIED WOUND CARE FELLOWSHIP

Open position available Jan.31, 2012. St. John`s Episcopal Hospital, Far Rockaway New York. State-of-the-art wound care center. All aspects of wound care including hyperbaric oxygen & reconstructive surgery. One year, excellent salary & benefits. Must have completed approved residency and passed boards. Contact Mariann (718) 869-7256

EQUIPMENT FOR SALE - CLASS FOUR LASER- USED K-LASERS

I have used K-laser for sale. Still in Warranty. Used for plantar fasciitis, Achilles tendonitis, neuroma, arthritic conditions and even fungus toe nails This laser is portable, re-chargeable and can be move from room to room or office to office. This isn't the cold laser that you see. It is a 10 watt laser. We have used this laser on NFL sports players. For those that understand a good laser. E-mail David Zuckerman, DPM for Details and pricing. footcare@comcast.net

EQUIPMENT FOR SALE - SUPERPULSE 45 WATT PEAK POWER LASER ( LUMIX2)

Superpulse 45 watt peak power Laser ( lumix2) used once or twice. This is a real superpulse 910nw up to 100,000 HZ. Great Laser Used in the super bowl by the Green Bay Packer Why am I selling? I have too many lasers in my office now ( six) This is a great laser for plantar fasciitis. Achilles tendonitis. Lightweight portable. easy to use, fully programmable Sold to first person under $$12,000 You will NEVER get a laser like this at this price. Enjoy. it I just have too many lasers. David Zuckerman DPMfootcare@comcast.net

PRACTICE FOR SALE – NANAIMO, BRITISH COLUMBIA, CANADA

Have you ever dreamed of owning a practice where...you can see 0-50 patients daily * average 100 new patients monthly * have zero accounts receivable * gross $480K per year * live in a beautiful community with skiing, hiking, fishing, and boating on your doorstep. This could be yours! If interested contact pistone@telus.net or call 250-754-4192.

PM News Classified Ads Reach over 13,500 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 13,500 DPM's. Write to bblock@podiatrym.com or call (718) 897-9700 for details. Weekly ad rates start as low as $109 for a 50-word ad 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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