The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

March 25, 2009 #3,502 Publisher-Barry Block, DPM, JD

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Wayne B. Wolf, DPM

Dr. Wayne B. Wolf, DPM, 63, of Mars, PA died Saturday, March 21, 2009.

Dr. Wayne Wolf

Dr. Wolf was the chief of the podiatry section of the VA Pittsburgh Healthcare System. He was the past president of the Pennsylvania Podiatric Medical Association and a trustee of the Podiatry Foundation of Pittsburgh. He was in private podiatric practice from 1970 until 2005. Dr. Wolf was on the National Board of Podiatric Examiners and on the faculty of UPMC Podiatric Residency Program.

Contact Dermatitis Often Confused With Fungal Infection: MI Podiatrist   

Debra Morway of Pontiac, MI just wanted a simple pair of shoes to wear to work. Instead, she said she ended up in the hospital in horrible pain, and this wasn't the first time. "There's no words I can even say to say how much pain all day and all night, for months," said Morway. "She had enough of an infection in her feet that I had to admit her to the hospital," said podiatrist James Westbury at Northpointe Foot & Ankle in Berkley.

James Westbury

Westbury has been treating Morway for almost 20 years and diagnosed her with contact dermatitis. Experts said contact dermatitis is an inflammation of the skin caused by contact with certain substances, such as soap, cosmetics or jewelry. Allergy tests found Morway was sensitive to a chemical called paraphenylenediamine (PPDA). It's found in many products, including hair dyes, furs and rubber goods, including many brands of shoes. "Part of the shoemaking process, there's a black rubber that goes into the composition of shoes in the soles, which has been known to be a cause of the contact dermatitis," said Westbury. In Morway's case, experts said the chemical causes burns, splits and cracks between and around her toes that take months to heal.

"I don't think I've seen anybody that had this severe a case in probably all the years I've been taking care of people," said Westbury.  Westbury said Morway's case is extreme, but many more people could suffer from a less severe reaction and not realize their shoes are to blame. "It's so often missed because it can resemble an athlete's foot, a fungus infection," said Westbury.

Source: Click on Detroit [3/23/09]
 

APMA HOD Concludes on High Note

The 89th Annual House of Delegates (HOD) of the American Podiatric Medical Association concluded today on an optimistic note. Among the highlights of today’s session was an address by Sen. Barbara Mikulski (D-MD), who told the assembled delegates “I’m going to make sure that podiatry is at the table, not under it.”  Ms. Mikulski was presented the APMA’s President’s Award by Ross Taubman, DPM.

Also addressing the HOD were Richard Gephardt, former Majority leader of the US House of Representatives and Mario Turnanovic, DPM, President of the Canadian Podiatric Medical Association.

The following awards were presented:

APMA Award of Excellence: Jon Hultman, DPM, MBA and David Armstrong, DPM, PhD.

Dr. John Hultman receives APMA Award of Excellence From APMA Immediate Past President Dr. Ross Taubman

APMA Rising Star Award: Robert Smith, DPM, MSc, RPh and Stephanie Wu, DPM
APMA Executive Director’s Award: Jim Rathelsburger, Executive Officer, CA Board of Podiatric Medicine

APMA Election Results

President: Ronald Jensen, DPM
President-Elect: Kathleen Stone, DPM
Vice-President: Michael King, DPM
Treasurer: Joseph Caporusso, DPM
Board of Trustees:  Dennis Frisch, DPM, R. Daniel Davis, DPM, Matthew Garoufalis, DPM, and Seth Rubinstein, DPM (2-year term).
HOD Speaker (2010): Mark Schilansky, DPM
JCRSB: Gregg Young, DPM  
 

PA Podiatrist Discovers That Joining Competitors Reduces Costs

Charter Partners, in  Hampton, NJ is a company that brings competitors together. So far, Charter Partners has 14 groups representing more than 100 businesses in 18 states, including podiatrists, golf courses, restauranteurs and bus companies. Among Charter Partners' new members is Mark Maehrer, a podiatrist with Kramer & Maehrer in Bethlehem, PA. He admits he was reluctant when first approached in December about joining a group that included competing podiatrists.

Dr. Mark Maehrer

But the prospect of shared buying power compelled him to attend a meeting, because his clerical staff doesn't have time to call medical supply vendors and credit card processing companies to negotiate rates. "Common buying power is one of the great benefits of joining," Maehrer said. "Right from the start, we realized we were paying way too much for our rate on our credit card machines. When it was all said and done, we saved 30 to 40 percent on credit cards." The podiatrists in the group are now talking about forming their own malpractice insurance company, Maehrer said. "It's sort of an investment of faith, but we thought it was a good concept and we thought we'd give it a try," he said.

Source: Spencer Soper , The Morning Call, [3/21/09]

Query: Alcohol Injections Without Local Anesthetic

I have a patient who has numerous allergies, including an apparent allergy to all types of local anesthetics. This patient requested that I use ETOH injections to treat her neuroma, only she doesn't want me to dilute the alcohol  with local anesthetic, but rather some other agent that she is not allergic to. My questions are: Has anyone tried diluting their alcohol with a substance other than a local anesthetic, such as sterile saline? And if so, did injecting the 4% alcohol without local anesthetic cause immediate or delayed pain at the injection site? 

Dan Methuselah, DPM, Columbia, SC

Query: Pain Pump System

What is the most cost-effective, user-friendly pain pump system for pain control for elective foot cases?
 
Mario Dickens, DPM, Chattanooga, TN

RE: Botox for Hyperhydrosis (Stephen Kinard, DPM)
From: R. Alex Dellinger, DPM

I have been using Botox for recalcitrant hyperhydrosis for several years now following the protocol mentioned and have had great success. On average, it lasts 6-9 months - and I have not done this on anyone unless they have failed other treatments. I tried contacting the company (local rep) and buying the product from them, but he wouldn't sell it to me because of "its off-label use" (that didn't make sense to me but he wouldn't sell it). So, I just called a plastic surgeon I know and when I need it, I buy it directly from his office at his cost. He uses a lot, so I probably get it cheaper than if I were buying direct.

R. Alex Dellinger, DPM, Little Rock, AR, raddpm@yahoo.com

RE: Sural Nerve Biopsy
From: Lee C. Rogers, DPM

The sural nerve biopsy is a very useful tool in the diagnosis of peripheral neuropathy. It must be used appropriately and sent to a lab where they have expertise in reading these, preferably by a neuropathologist. I use the Peripheral Nerve Lab at the Mayo Clinic in Rochester, MN. They will send you a kit and instructions on how to package the biopsy. I feel like I have to refute a few points made in previous comments. Firstly, the epidermal nerve fiber density (skin biopsy) is for the diagnosis of neuropathy, but can't differentiate types of neuropathy. It is a good research instrument. The sural nerve biopsy can be used to uncover common non-diabetic causes of neuropathy - certain CMTs, vasculitis, amyloidosis, and demyelinating neuropathies. 

The sural nerve biopsy should never be the first investigation in someone with diabetes and signs of nerve dysfunction. A battery of lab tests and electrophysiological tests should be first employed. If these tests fail to uncover the etiology of the neuropathy, and you suspect something other than diabetes, then a sural nerve biopsy can be helpful. The sural nerve should only be biopsied if there is dysfunction in its distribution. One shouldn't be overly concerned with the sensory deficit left by the biopsy (whole or partial), since the benefits outweigh the risks in the appropriate situation. See the article Bevilacqua, et al. The Technique of the Sural Nerve Biopsy. JFAS 2007;46:139-142.

Lee C. Rogers, DPM, Des Moines, IA, Lee.C.Rogers@gmail.com

RE: PM News Marks Issue #3,500 & 15th Anniversary
From: Gayle S. Johnson, Jon Purdy, DPM

Congratulations on the 15th anniversary and the 3500th issue of PM News! The PM News blend of education, information, news and networking is a great resource for the podiatric community. Thank you for the gift of your time and effort in producing this forum. I look forward to the next 15 years!

Gayle S. Johnson, Edmonds, WA

Hats off to Barry Block. What a feat. I don’t know how he finds the time being Vice Chair of the Resolutions Committee of the HOD, running the Hall of Fame Luncheon, producing PM Magazine, being the Executive Director of the American Podiatric Medical Writers Association, and the dozen other things he does for this profession. Without Dr. Block and his service, there would be a lot of podiatrists in the dark. What a well done, much needed, and fun forum. You have propelled this profession forward much more than most will ever realize. Thank you Barry.

Jon Purdy, DPM, New Iberia, LA

RE: Associate  Compensation (David Zuckerman, DPM)
From: Multiple Respondents

As someone who was an associate and now a partner, I think that if there is a good relationship and incentive for future advancement, I would suggest a straight salary. Yes, this may not be motivating for the eat what you kill mentality, but there may be a place for straight salary. First, both the associate and the employer will know the fixed cost/salary. The other aspect would be that there will be more teamwork and more opportunity for the associate and to learn the business practice of the employer. This eliminates the inter-office competition for new patients. It gives the employer more flexibility for molding the future of the relationship.

Maybe I am wrong, but I did a low basic salary with a 40% after 2.5 of my salary. It worked ok, but there was a little tension about patients and bonuses for that year. The second year was a higher salary, but  33.3% which seems to be the number that works for other specialties. Still there was competition for patients. As a partner, there is more synergy because we are in the same boat. Anyway, I think that the first year should be a fair straight salary.

Justin C. Jex, DPM, Houston, TX, jcjex@juno.com

Some 'seasoned' doctors expect new associates to remain loyal and grateful when you pay them peasant's wages. If a doctor is too overextended to offer a reasonable compensation, don't hire an associate! You just make yourself and the profession look bad and cheap. We spend the same for education as other medical profession, but somehow, on average, we're the lowest paid. Some doctors think they're doing new docs a favor by starting them off at $50,000-60,000!  So, to all the economically sensitive (cheap) doctors out there thinking of bringing in a new doctor, check your bottom line twice before offering an anemic compensation package.
 
Mario Dickens, DPM, Chattanooga, TN, mariodickens@hotmail.com

This is a discussion thread that I will save and give out to all my third year residents when they ask me 'What's a fair percentage to be paid?" This is a conversation that comes up every year and many [almost all in my opinion] residents don't understand the economic realities of practice nor the increased expenses that the hiring doc takes on when bringing in an associate. 

My personal experience is that 40% of collectibles is a very fair and workable percentage, even for patients brought in from prior practice. When I worked for someone else, I was quite happy to pay them 60% for the headaches of dealing with the billing and staff in addition to the building overhead. This was equal to or even less than my own overhead at the time.

H. David Gottlieb, DPM, Baltimore, MD, hdavidgottliebdpm@gmail.com

Editor's note: This topic is now closed.

RE: Mitch Pokrassa, DPM

Only today did I learn of the death of one of our great men- Dr. Mitch Pokrassa; I met him perhaps some 28 yrs ago at the Baja Project where we did some wonderful work together. I am so disappointed to learn of this loss to all of us and podiatric medicine. May he rest in peace.

Harold W. Vogler, DPM, Sarasota, FL

ASSOCIATE POSITION NEW YORK

Podiatrist needed for private clinic setting in N.Y.C.  All RFC, no stress, $40+/hr. Great opportunity to earn some easy extra money. For more info. And details call (917) 880-6639 or e-mail: hansfeet@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 WANTED - FLORIDA

Associate needed for a dynamic multi-doctor practice in the Tampa Bay area. Partnership opportunity for the right candidate. Preference given to a PSR 24+ resident completing their education this spring/summer, and must have a Florida license. Well-established practice, high tech with EMR and digital x-rays, with specialties in sports medicine, surgery and wound care. No nursing homes or HMO's. Excellent hospital privileges available. Choose an area of practice concentration that you are passionate about and enjoy a lifestyle for yourself and your family that is second to none. E-mail: kimvelez@tampabay.rr.com
 

ASSOCIATE POSITION - CHANDLER/GILBERT/PHOENIX, ARIZONA

Seeking a well-trained, ethical and hard working graduate of a PSR 24+/36 Residency to join our growing multi-location practice. This is a practice with a nice mix of 35% surgery/trauma, 20% diabetic/wounds, 25% biomechanics, 20% pediatric. ER Call. Opportunity for partnership at 2 surgery centers. Very modern offices with EMR, U/S, Digital X-Ray, ESWT, Vascular Testing Machine. Excellent referral base, and a well-trained staff. Board eligible/certified a plus. Competitive salary, bonus structure, benefits. Please e-mail CV and references to FootAnkleAZ@aol.com

OFFICE SPACE/ MRI RENTAL – NYC, LI   
 
Turn-key space available, daily, monthly; East 60th off Park Ave, East 22nd St. off 3rd Ave, and 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 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 f-massuda@footexperts.com

CASE CONSULTING

Dennis Shavelson, DPM is now accepting referrals of difficult cases involving biomechanics, surgical complications, non-healing wounds diagnostic and treatment dilemma’s and subtalar stenting from DPM’S. Full reporting with second opinion only, rapid return after care and assumption of care options. Medicare and Out-of-Network Only. (212) 288-3668 or drsha@lifestylepodiatry.com 

PRACTICE FOR SALE - CENTRAL FL

Practice sale, in beautiful, high quality of life, growing area; 2000 sf bldg. fully equipped/ designed for podiatry; excellent location, features & exposure; near hospital, wound and HBO center. Great opportunity for expansion; good insurance climate. 352-357-7499 / E-mail: windnwave@earthlink.net

PRACTICE FOR SALE-SOUTHEAST MICHIGAN-BRIGHTON

Great opportunity. Established 11 years. Excellent location. Large illuminated sign on busy main road. Mid to high income growth area.  Supplies, furniture, and equipment included: X-Cell X-Ray w Hope Autoprocessor, Pelton-Crane Autoclave, Parks Lab, Bircher, Burton Floor Light, OR with Lighting, bone instruments and power equipment, Midmark Chairs. Quality 1,350 sf build-out. convenient parking. Must sacrifice. Call (248) 565-5266. Docpod@aol.com

NEEDED CHICAGO -- NW IND & BALTIMORE/WASHINGTON, DC PODIATRISTS

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 Scott Schneider. Phone-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com Visit our website

PRACTICE FOR SALE – FLORIDA 

Who wants to continue making good money in a down economy, and would like to live in Florida on the coast? I have been working for 45 years and have had enough. My business grosses over $900,000 a year and nets over S250,000. I see approx. 40 patients a day and am sitting on a little gem. Office space is approx. 2,000 Sq. Ft. Hospital surgical center very close. If you are seriously interested, I help you get  qualified for a loan. Large scope of practice in Florida. $525,000. Contact me at Hagen5644@yahoo.com 

PM Classified Ads Reach over 11,500 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 11,500 DPM's. Write to  bblock@podiatrym.com or call (718) 897-9700 for details. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451 Ext 110.

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