The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

November 26, 2010 #4,021 Publisher-Barry Block, DPM, JD

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Surgery is Not the First Option for Bunions: IL Podiatrist

The evening before I interviewed podiatrist Dr. John Mytych, two friends and I happened to play the ugly foot contest. My ugly bunion won. My friend Jane said recuperating from her bunion surgery took a long time. “Don’t do it unless you can’t walk,” she said. Mytych, who opened his Geneva practice in May after seven years in a group practice in Elgin, offered a similar recommendation. “If your daily activities are affected; you can’t do sports and activities you like to do, then yes, have bunion surgery.”

Dr. John Mytych

Of foot surgery in general, Mytych said, “I’ve talked patients out of surgery. I’ve talked them into it. Surgery is not the first option. But if they’ve tried many treatments over the years that have not worked, then they should consider surgery.”

Source: Batavia Sun [11/23/10]

Socks are Necessity for Homeless; TUSPM Professor

How many times have you seen a man on a steam grate dressed for winter except for his swollen bare feet? Everyone collects coats, but who thinks to give socks? And yet doctors and homeless advocates say the feet suffer the cruelest fate of life on the streets. "The feet are a portal to the rest of the body," explains Kathya Zinszer, chair of Temple University's School of Podiatric Medicine, who runs clinics at area shelters.

Dr. Kathya Zinszer

Lara Carson Weinstein, a physician at Jefferson Medical College who works with Project H.O.M.E., tells me she treated "at least seven" homeless patients in the past year who lost toes or feet to the streets. These sobering statistics led Chestnut Hill College professor Tom Costello to launch the aptly named nonprofit The Joy of Sox. Its mission is simple: Put new, clean socks on cold, aching feet. Costello may team up with Zinszer to distribute the remaining 1,080 pairs this winter. Coats and hats are holiday staples, Zinszer acknowledges, but her patients' lives depend on a charity rarity: "a six-pack of clean cotton socks."

Source: Monica Yant Kinney, Philadephia Inquirer [11/24/10]

Army Podiatrist Briefs Medical Group on Diabetes Awareness

Diabetes is the sixth leading cause of death in the United States, claiming more than 180,000 victims annually. Part of the debilitation of diabetes is the effect the disease has on feet, resulting in painful sores, immobility and potential amputation. However, with attention and preventative measures, some effects may possibly be avoided.

Dr. Hjalmar Contreras, podiatrist with 633d Medical Group, briefs members of Team Langley on preventive measures and symptoms of the various diabetic diseases (Photo: Ashley Hawkins)

According to Maj. Hjalmar Contreras, 633d Medical Group podiatrist, diabetic foot infections are the most common reason for hospital admissions among diabetic patients, accounting for 25 percent of all diabetic admissions. “Without proper care, diabetic patients may develop ulcers on their feet, which occur in 15 percent of diabetic patients,” said Contreras.

Source: Ashley Hawkins, DVIDS [11/23/10]

NY Podiatrist Inspires Eagle Scout to Collect Shoes For The Homeless 

Over two months, Eric Louis has amassed a mountain of shoes. Each day the 16-year-old collects new and used boots, sneakers, shoes and sandals from area residents and adds them to the stack in his family's White Plains home. Louis is running a community shoe drive, collecting donations of gently used and new shoes to give to the homeless. Inspired by the annual shoe drives held by Dr. Bruce Pinker of Suffern, he began the effort as part of an Eagle Scout project.

Dr. Bruce Pinker

Pinker, a podiatrist, says people often donate money and clothing to charities for the homeless, but footwear is overlooked. The need is critical, he says, because the shoes can help prevent frostbite, injuries, infections, and ease the suffering of homeless diabetics who may have problems with their feet because of the disease. Louis' work "is very gratifying. I feel proud," Pinker says. "It reinforces that I know I'm doing the right thing."

Source: Dwight R. Worley, LoHud.com [11/21/10]

CMS Finalizes Its Physician Supervision and ‘Immediately Available’ Requirements

CMS has shaken up physician supervision requirements again, this time in the final 2011 outpatient prospective payment system (OPPS) regulation announced Nov. 3. The rule finalized a new method for supervising certain outpatient therapeutic services and set in motion a plan to adapt supervision requirements to different services. CMS also revamped the definition of “direct supervision” to give providers more flexibility, the agency says. The provisions affecting physician and non-physician practitioner (NPP) supervision of hospital outpatient therapeutic services is a hot spot, because of controversy over the mandate itself and the trouble some hospitals have complying with it.

Generally, CMS requires direct physician supervision for all outpatient therapeutic services, which means that supervising physicians must be “immediately available.” But now, CMS has finalized a two-tier approach to supervising “nonsurgical extended duration therapeutic services,” a new category made up of some observation services, infusion and injection. Non-surgical extended duration therapeutic services require direct physician supervision only at the “initiation of the service.” When patients are stable and the rest of their treatment can be delivered under general supervision, physicians can shift to the lower supervision level, which can be provided by phone. The combination of direct and general supervision is less onerous than mandating direct supervision throughout the entire service.

Source: Nina Youngstrom. Report on Medicare Compliance [11/24/10]

Re-purpose Your Web Videos by Customizing Your Waiting Room TV Programming

Personalize your waiting room programming by editing in your original web videos. Educate patients about how YOU practice podiatry with discussions about how you treat various foot and ankle conditions, including the technology you offer. Customized video content also helps you promote the products you dispense in your office and share success stories from other patients.  

Source: Gary Ignotofsky

Query: Unusual Fungal Nail Cultures

On a fungal nail culture, I recently obtained the result irpex lacteus.  Researching it quickly on the Net, it appears to be some form of plant pathogen. Is anyone familiar with this fungus, and if so, do they know if terbinafine, itraconazole, or fluconazole will work on it. 

Edmond F. Mertzenich, DPM, Rockford, IL

Query: Opting Out of Medicare for Office Only

While opting out of Medicare is certainly the attractive answer, I pose a question to my colleagues who have had the courage (and good fortune) of opting out. This obvious solution seems to make perfect sense in my office. Each year, I systematically have opted out of one insurance. First it was GHI, then it was Healthnet, 1199, and the dreaded Beach Street in subsequent years. It has made no difference in my practice regarding losing patients. The ones who stayed have paid me cash and it more than made up for losing others.

What do you do in the case of your hospital practice? I simply can't imagine being able to do this, seeing 20-25 patients on the morning I cover our wound institute. I see these patients weekly, and many of them are nursing home patients who simply have no money. Then what? Likewise, covering the hyperbaric treatments weekly? How can I opt out of my practice's Medicare patients but not the hospital consults, wound institute, and hyperbaric treatments? 

Frank Lattarulo, DPM, NY, NY

RE: APMSA Urges Profession’s Intervention to Avert Residency Crisis
From: Multiple Respondents

We are writing this letter in response to the Urgent Request published yesterday by Zackary B. Gangwer, APMSA President. First, we want to assure all of the students in each of the nine schools that the profession is aware of this residency crisis and that the profession is moving in a coordinated manner on the immediate and the long-term fronts to eliminate the shortage that the ASPMA President described.

The message that we want to convey to the APMSA is that the Goldfarb Foundation, the APMA, the AACPM, COTH, CPME, ACFAOM, PMAP and each and every state podiatric medical association have an acute understanding of the shortfall and its impact on the students. All of the stakeholders know that you are our collective future in that you are the continuation of our profession.

The final tally of residency shortage was...

Editor's Note: The extended-length letter written by Drs. Thomas Ortenzio and John Marty can be read here.

I am the Chief of Podiatry and Director of Podiatric Medical Education at St. Barnabas Hospital, Bronx, New York. Currently, we have 16 residents in our PM&S-24 and 36 Programs. I blame CPME, its rules, and ridiculous regulations for the shortage. Several program directors feel the same way as I do.

I am planning on cutting the number of residents that I will take in July 2011 solely as a result of the policies that CPME implements which have made my job as a residency director more and more difficult each year, only creating more paperwork, and actually decreasing the time that I can spend teaching. 

Now they have implemented a new CPME 320 with more and more of the same rules and regulations. After reading it, the only conclusion I can make is that I need to decrease the number of positions, to make sure that  I have enough time to implement them, even though the hospital's resources could easily allow for more, not less, residents.

Emilio Goez, DPM, Bronx, NY, docforfeet@yahoo.com

RE: APMSA Urges Profession’s Intervention to Avert Residency Crisis (Roody Samimi, DPM)
From: Bruce Lebowitz, DPM, Peter Smith, DPM

Back in 1972, there were ten finalists being interviewed for the five slots in the Maryland podiatry residency program. Dr. Donick spoke to all of us as a group before the interviews and asked if we would agree to a decrease in pay in order to choose six of us. We all agreed; it gave us each a better chance of getting a program. I submit that each program consider reducing the pay and accepting more residents.

Bruce Lebowitz, DPM, Baltimore, MD, brucelebowitz@gmail.com

Dr. Samimi offers some options for students who don't get a residency, but I fear that his reply demonstrates the same lack of understanding demonstrated by the schools. It is, or at least it should be, the main purpose of any school of higher education to prepare its students for their career ahead. It is unconscionable that the podiatric schools are accepting 75 more students than there are residencies. That practice must stop immediately. Greed on the part of the colleges can be the only reasonable explanation for accepting more students than there are residencies. 

How can anyone sleep at night knowing that they have enrolled someone else into a four-year, extremely expensive academic adventure when they know that there may be no chance of their getting a license after completing all of the work asked of them? And suggesting that the unfortunate graduate do something else 'for as long as it takes' to finally get a residency is even more absurd. What happens next year when there are all of that classes' graduates PLUS this years' 75 applying for too few slots. It is absolutely ludicrous! The first and immediate step is that the schools must be limited to accepting only the number of students for which there are residencies. It is the right thing to do, and there is no reason to delay.The whole situation is an embarrassment to this profession! 
 
Peter Smith, DPM, Stony Brook, NY, ps84@bc.edu

RE: Foot And Ankle Hardware and Airport Security (Charles Morelli, DPM)
From: Bruce R. Lawrence, DPM
 
An article "Detection of Orthopaedic Foot and Ankle Implants by Security Screening Devices" was published by Bluman, Tankson, Myerson, and Jeng in Foot & Ankle International Journal, December 2006/Volume 27/Number 12. This comprehensive article will answer any questions about implanted foot and ankle devices and whether a particular device will set off a security alarm. 

Bruce R. Lawrence, DPM, Oceanside, CA, brldpm@cts.com

RE: Pain-killers Darvon, Darvocet Withdrawn at FDA Request (Robert Kornfeld, DPM)
From: Elliot Udell, DPM
 
I am certain that Dr. Kornfeld is savvy enough to know when to not use "alternative therapies" and resort back to what he was taught in medical school. This is not true for many alternative practitioners who rely totally on unproven therapies when classical therapies are indicated. This past year, a dear friend of mine was diagnosed with bladder cancer. The urology/oncology team said that based on the type of tumor and the extent of its invasion, with immediate aggressive surgery he would  survive. Instead, he opted to follow the therapies of an herbalist and took all sorts of  herbal and homeopathic potions in lieu of having surgery and chemotherapy. On his death bed, he admitted that had he known, what he then knew, he would not have followed the advice of a charlatan but would have heeded the voices of doctors at Sloan Kettering. 
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

ASSOCIATE POSITION - CALIFORNIA

Busy modern office in Silicon Valley. All phases of podiatry. Office has EMR and digital x-ray. Looking for well trained associate with surgical and biomechanical background with California license. Good opportunity for buy in to the practice. Send resume to dlmed4@gmail.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 – 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 - 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

IMMEDIATE OPENING - GEORGIA

Multi Office Specialty Group seeking a Qualified, Motivated, Surgically-trained Board Eligible/Certified Podiatrist to join our Practice. Must be licensed in the State of Georgia. Salary and Benefits commensurate with experience, etc. Interested Candidates please forward updated CV to: Executiveinfo1@yahoo.com 

PODIATRIST NEEDED - NY (ALBANY/HUDSON)

2 hours North of NYC. Busy podiatric practice all phases of podiatry. Full-time position available immediately/possible part-time considered. competitive salary, fringe benefits package. NYS license required. If interested e-mail resume to footspecialistassopc@yahoo.com or fax to 518-828-9510 or call 518-869-5799 ask for Lori.

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 - LEADING TO PARTNERSHIP - MARYLAND/DC

High volume, state-of-the-art podiatric practice in prestigious Montgomery County Looking for a highly motivated, well trained podiatric physician to help manage a very busy in-patient and out-patient based practice. Minimum of PSR-36 with interest in hindfoot surgery, ankle reconstruction, and complex wound care. Salary and benefits are commensurate with the position...and exceptional opportunity for the right individual. Please send CV and a letter of interest to adassili@gmail.com

ASSOCIATE POSITION - TAMPA BAY AREA

Excellent opportunity to join a well established multi-office group practice in the Tampa Bay area starting July 1, 2011. We are seeking a hard-working, ethical and outgoing physician with Florida license. Salary commensurate with training plus benefits. Please email or fax CV. podiatryfl@yahoo.com 813-254-8262.

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 - 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

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 - 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

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