The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

December 26, 2011 #4,341 Publisher-Barry Block, DPM, JD

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Don't Let Sore Feet Trip Up Your Travel Plans: APMA President

Whether you travel for business or pleasure, whether you fly, drive or take a train, there's one other mode of transportation you'll almost certainly use on your trip: your feet. During the course of a regular day, the average person walks 8,000 to 10,000 steps, but that number can increase dramatically when you're traveling. From inappropriate footwear to long stretches of inactivity in cramped cars or airplane seats, traveling can be hard on your feet. 

Dr. Michael King

"Exploring a new destination with family and friends, or getting to that important business meeting on time should not involve having to struggle with foot pain," says Dr. Michael King, a podiatrist and president of the American Podiatric Medical Association (APMA). "By following basic foot care practices, travelers can help ensure that foot pain doesn't slow down their enjoyment of the journey."

Source: Milwaukee Journal Sentinel [12/22/11]

FL Podiatrist Publishes Sclerotherapy Manual for Podiatrists

In order to provide podiatrists with the tools to effectively diagnose and treat varicose veins and spider veins, Dr. Cynthia Marzouka-Losito and Crown Medical have recently published The Complete Sclerotherapy Guide for Podiatrist. 

Dr. Cynthia Marzouka-Losito and her new book

Dr. Marzouka-Losito oversees three South Florida facilities dedicated exclusively to the treatment of varicose veins and spider veins. She is an adjunct professor in the Department of Biology at Miami Dade Community College and is an adjunct faculty member at the Barry University College of Podiatric Medicine.

Obama Signs Measure Averting Doc Pay Cut

President Barack Obama on Friday signed a payroll tax-cut bill that averts a 27.4% cut in Medicare physician reimbursement. The House of Representatives this morning approved the Temporary Payroll Tax Cut Continuation Act of 2011 by unanimous consent. The law prevents the cut in Medicare physician reimbursement by freezing federal payments to physicians at their current rates for two months.

Moments earlier, the Senate approved the measure, which also extends for two months a middle-class payroll tax cut, unemployment insurance and the nation's primary welfare program, Temporary Assistance for Needy Families. The legislation also includes a change that House Republicans wanted on the bill that the Senate approved last weekend to help businesses implement the two-month tax change.

Source: Rich Daly and Jessica Zigmond, Modern Healthcare [12/23/11]

RE: Partial Non-union Subtalar Joint Arthrodesis (Judd Davis, DPM)
From: Kevin K. Lam, DPM

Yes, that 90% non-union can be the cause of her pain due to micro-motion. There appears to be micro-motion at the screw threads in the calcaneus, with lysis noted. I would remove the screw, resect the non-union to bleeding bone. Most likely, a bone graft will be required; autogenous being the best. Then use two plantar screws for fixation.  Add in BMP, external bone stimulation, and NWB for up to 12 wks. Check Vitamin D3 levels and pre-albumin levels too. 

To be 100% sure, do a Lidocaine injection into the STJ. After 5 minutes, do your same ROM test to see if the pain is gone, if it is, then revisional fusion is the answer.

Kevin K. Lam, DPM, Naples, FL, KLAMDPM@HOTMAIL.COM

RE: Chronic Rash in 14 Year Old (Bruce Krell, DPM)
From: G Dock Dockery, DPM, Gary S Smith, DPM

This is most likely a case of "Localized Granuloma Annulare" by the description of the case and clinical photos. This should be confirmed by taking two 2-mm punch biopsies from a representative area of the lesion and sending them to Bako Pathology Laboratory for a dermatopathology confirmation.
 
Localized granuloma annulare is not often symptomatic and it has a tendency towards spontaneous resolution within 2 years in 50% of cases, although lesions may last weeks to decades. Recurrence, often at the same site, is noted in 40% of cases reported in the literature. Reassurance is often all that is necessary.
 
If the patient or parents are very concerned, then the localized lesions may be treated with potent topical corticosteroids, with or without occlusion for 4-6 weeks, as well as with intra-lesional corticosteroids. See: Dockery G. How to Detect and Treat Granuloma Annulare, Pod Today, 17(12), 2004. podiatrytoday.com/article/3342
 
G Dock Dockery, DPM, Seattle, WA, gdockdockery@aol.com

I had a patient with the same rash in my office last year as a referral from the PCP when treatments from the dermatologist failed. Multiple blood tests had been done, from STDs to connective tissue disorders. I had been seeing some odd rashes with Lyme's disease and her test came back positive as well. Antibiotic treatment for Lyme's disease seemed to relieve the symptoms. This could be just a coincidence and I don't know how prevalent it is where you are from, but it's worth a blood test.
 
Gary S Smith, DPM, Bradford, PA, penndoc@verizon.net

RE: Medical Waster Removal Contract (Robert Bronfman, DPM)
From: George Jacobson, DPM

We had a similar problem with Stericycle several years ago. They have an automatic renewal clause in their contracts, with increases in fees. They bought the company we used, and we never signed a new agreement with them, so we had some leverage. The dermatologist next door was paying $200 more for the same size box that we pay $26 for after we negotiated a new fee with a 5% increase and no fuel charges for 3 years.

They come to several offices in my building and tacked on a ridiculous fuel surcharge fee for each office in the building and service many buildings on the same block.  The fuel surcharge is a rip-off in our case, as they already service the building. When gas goes down, they and many other companies don’t automatically reduce or remove the fuel surcharge. I have systematically gotten rid of all companies that don’t correct the problem and take advantage of us.
 
George Jacobson, DPM, Hollywood, FL, FL1SUN@MSN.COM

RE: Selling Old X-Rays for Silver (Michael J Felicetta, DPM)
From: Ken Hatch, DPM

Try  Esquire Trading  (954- 484-7755). They are located in Florida, but pick up in Eastern U.S.

Ken Hatch, DPM, Annapolis, MD,  KLHDOC@aol.com

RE: Holiday Staff Bonuses (Lloyd Nesbitt, DPM)
From: Lynn Homisak, PRT

I want to weigh in on this from a consulting, staff, and personal perspective...and I couldn't have said it any better than Dr. Nesbitt! Wages, bonuses, and benefits do not necessarily provide employee job satisfaction, but it is the absence of them that can lead to their dissatisfaction - especially if they are given one year...then stopped the next! An end of year bonus is a "gift" and we give gifts to people whom we want to make happy. Bonuses should be given to tell staff they are appreciated.

Doctors, if you do not appreciate your staff, or feel they don't appreciate YOU, do yourself a favor and get new staff. However, if you do appreciate them, I agree 100% with Dr. Nesbitt - willingly and unbegrudgingly bonus them for their year-round efforts. Gifts given from the heart and rooted in appreciation will be returned to you in rewards far more valuable than the dollars you give! I speak to you from years of experience!

Lynn Homisak, PRT, Renton, WA, lynn@soshms.com

RE: Why Not to Work of Saturday
From: Bob Levoy

This discussion reminds me of the doctor who put a hand-lettered sign up in his reception area that read: "Starting January 1st, Daddy's office will be closed on Saturdays." It was signed, "Debby and Billy". He didn't get a single complaint.

Bob Levoy, Great Neck, NY, blevoy@verizon.net

RE: OH Podiatrist Finally Realizes His Dream to Pitch at Fenway
From: Jeffrey Kass, DPM

I would just like to say that Boston not signing Dr. Dick Dawson was not the Red Sox's first mistake. As a Yankees fan, I thank them for Babe Ruth; as a podiatrist, I thank them for Dr. Dawson.

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

RE: MN Podiatrist Supports Statewide Single Payer Health Insurance System
From: Richard M. Maleski ,DPM

At the ACFAS conference in 2011 in Ft. Lauderdale, the keynote speaker was the CEO of Kaiser-Permanente. After his speech, the audience was invited to ask questions. My question was this: “The proponents of a single payer system claim that we could save $400 billion per year in administrative costs by going to a single payer system of health insurance…1) is this true?  2) if it is true, is there any movement within the private sector to try to implement a plan that could produce these kinds of administrative cost savings?” His answer: “To the first part of your question…

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

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

ASSOCIATE POSITION - HAWAII (OAHU) 

Full-time position available. Join this fantastic practice in paradise. Diagnostic ultrasound, Digital X-Ray, EHR, Surgical Privileges, Competitive Salary plus benefits package. Send CV toyoleven316@yahoo.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 - 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 NEEDED - NORTHERN CINCINNATI, OHIO (FAIRFIELD)

Lead to partnership &/or buy practice. Well-established, reputable & successful (700K collection annual) 25+ year practice. Newer 2k sq.ft office condo & w/5 tx rooms, Aver.80 new patients monthly, full hospital privileges, DME, Padnet, digital x-rays. Inquires to email: gsherwood1@cinci.rr.com

ASSOCIATE POSITION - SOUTHWEST FLORIDA

Immediate position for associate to partnership for a surgeon that is BQ/BC by ABPS. Must be a PSR-24 or PM&S-36 trained. Excellent start salary with bonus. Must be ethical, self-starter, hard worker, team player. Willingness to learn/work as part of a team. Great ancillaries & surgery facility. Must be proficient in rearfoot/ankle surgery. Email CV with letter of intent to: susmitad86@yahoo.com

ASSOCIATE POSITION - NEW JERSEY

Associate/Partnership available to energetic doctor(s) or willing to merge into larger group/multi-specialty practice. 25% Medicare, 75% Privates/HMOs, No Medicaid. 8,500 visits per year. Diversified hospital/office wound care, hospital/ASC surgery, and general podiatry. 27 years of excellent local reputation. 2,700 sq ft office opposite hospital in desirable Monmouth County. capstops@aol.com

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 - ALBANY/CAPITAL DISTRICT AREA

Immediate position available with generous salary, fringe benefits and percentage. All phases of Podiatry. For more information please contact Dawn at (518) 828-6516 or fax your resume to(518) 828-9510.

ASSOCIATE POSITION - NAPLES, FLORIDA

Great opportunity for PSR- 24/36 BE/BC podiatrist with strong surgical skills to join multi-office practice. Hospital privileges available at 648 bed hospital system, 200 bed hospital system and multiple surgical centers. Candidate should have the skills and desire to perform rearfoot/ankle surgery. Florida has a great scope of practice law and we rotate for ER call. Candidate needs to be ethical and motivated. Established practitioner or new practitioner. In a cover letter tell me why you should be selected for the team. Email cover letter and CV with subject line "I am your new team member." toDrgordon@gulfcoastfootcare.com

ASSOCIATE POSITION - TEXAS

Practice in Houston is looking for PSR 24/36, BE/BC trained doctor. We are situated in an affluent area with a large medical community with EMR, diagnostic ultrasound, digital x-ray, multi use laser and our own surgery center. We seek a highly skilled surgeon, well-trained in trauma, wound care and rear foot reconstructive procedures willing to learn and incorporate into our “system.” Must be outgoing, goal-oriented, motivated and positive. Partnership available after successfully attaining the first year’s goals. Compensation includes excellent salary, health benefits, paid vacation and CMEs. Please send CV, references and letter of interest to faajobs@gmail.com

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