The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

November 23, 2010 #4,018 Publisher-Barry Block, DPM, JD

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Women Who Elect Surgery Sacrifice Foot Function for Fashion: FL Podiatrist

It's no secret most women love high-heeled shoes, but podiatrist Dr. Dean Dorfman said some patients are going to extremes to fit into their favorite pair. "Some women who have bunions and hammertoes, putting their foot and squeezing it into this shoe, it's basically like putting a square foot and fitting it into a triangular hole. It's not going to work," said Dorfman. So a growing number of women are turning to cosmetic surgery to make their feet fit their favorite style of shoes. "Since 1998, when Sex and the City came out, the prevalence of cosmetic foot surgery has gone up dramatically," said Dorfman.

Dr. Dean Dorfman

Experts said potential patients need to understand this is serious surgery with real risks and long-term effects. "We may give you a beautifully shaped toe and a narrow foot, but it doesn't function as well as it did prior to the surgery. You may get some scar tissue in there that may hinder the range of motion of a toe that bent very freely, that now doesn't bend so well," said Dorfman.
 
Source: ClickonDetroit.com [11/18/10]

WV Podiatrist Joins Orthopedic Practice

Bone & Joint Surgeons at NorthGate Business Park have invited their competition to the practice, and in the process, expanded services for patients. In August, the Charleston orthopedic practice added a podiatrist, Dr. Carrie Gosselink, to the firm, an unusual move in an industry where the two specialties usually don't work together. At Bone & Joint Surgeons, "all of us are generalists, but with specialized interests," said Dr. Clark Adkins, an orthopedic surgeon. But none of the five surgeons at the Charleston practice specializes in the treatment of the foot and ankle, Adkins said.

Dr. Carrie Gosselink (Photo Chris Dorst)

Podiatry started as a field for treating "toenails and cutting corns," Gosselink said. It has evolved in the past 10 years, and medical students are now integrated with orthopedists during their residency, she said. Originally from Texas, Gosselink attended college in Iowa, and then completed her residency at the University of Florida at Jacksonville.

Source: Veronica Nett, Gazette-Mail, [11/21/10]

Hospital Association Asks OCR to Amend or Clarify HITECH Rule on "Agents"

The July 14 notice of proposed rulemaking issued by HHS to implement parts of the HITECH Act threw covered entities and business associates for a loop when it introduced the concept of subcontractors, as well as the notion of agency. In the proposed rule, the Office for Civil Rights (OCR) held that if a business associate or subcontractor were acting as an “agent” of the other, then the covered entity (CE) or business associate (BA) would be liable, or at least share the liability if enforcement action were ever forthcoming.

The question of agency has emerged as a major flash point among CEs and BAs since it was introduced. Commenters on the proposed rule, including the American Hospital Association (AHA), have registered strong opposition to the concept. AHA, in fact, implored OCR to scrap or significantly amend the agency provision, or at least clarify just who is an agent and how a CE would know.

Source: Report on Patient Privacy [11/15/10]

Editor's Note: PM News is proud to present excerpts from Meet the Masters.

Bret Ribotsky: If you could alter the podiatric educational experience, what would you change?

Dr. Harold Schoehaus

Harold Schoenhaus: I would like to see it more aligned to a hospital environment right off the start. Too much time is spent in a classroom environment, and not enough time is spent in a hospital environment. If everybody is going to be very well attuned to what diabetes is about, the complications of it, wound care management, reconstructive cases, and trauma, it needs to be in a hospital environment.  Medical school education changed many years ago to realize that you have got to get students in the hospital environment as quickly as possible. Unfortunately, we have too many students and they end up sitting in classrooms.

Dr. Mark Block

Meet the Masters is broadcast each Tuesday Night at 9 PM (EST). The next segment  will feature podiatric billing and coding expert Dr. Mark Block. You can register for this event by clicking here

When You Can’t Say Anything Nice

Here’s an awkward situation: A former employee asks you for a letter of recommendation—but you do not feel comfortable recommending the person. Should you say so?

Best bet: Think of someone within your practice who has a better impression of the person. Then suggest that the person contact your colleague to ask for a letter of recommendation. That way, you avoid a confrontation, the person will receive a supportive letter, and you do not feel pressed to violate your ethics.

Source: Adapted from One Minute Manners, Ann Marie Sabath, Broadway Books via Communication Briefings

Query: Foot And Ankle Hardware and Airport Security

I am often asked from surgical patients whether or not they will set off alarms at the airport when going through security.  Does anyone know what is the quantity of metal a patient needs to possess in his or her foot in order to set off an alarm? And is there a legitimate or certified card that we can (or need to)  give to a patient after that quantity of internal fixation has been achieved? 
 
Charles Morelli DPM, Mamaroneck, NY

RE: Circulation to Toes, Post-Op (Stephen Pirotta, DPM)
From: Multiple Respondents

I recommend a vascular surgery consult ASAP!  

Dwight L. Bates, DPM, Dallas, TX, dlbates04@yahoo.com

If the digits in question are cyanotic and warm, I would agree with the MD and also elevate the foot to help drain the venous side. If there is a white digit with no capillary return and the toe is cold, then consider dependency with arterial dilating meds.

Vincent Gramuglia, DPM, Bronx, NY, a2onpar3@optonline.net

I completely agree with Dr. Pirotta in that dangling the patient's feet is important as gravity can help to increase perfusion distally. Conversely, when patients have PAD, elevation or keeping the foot level with the heart can create rest pain and one can see pallor in the toes or foot as a result. Therefore, gravity can have a role to play in either increasing or decreasing local circulation in areas of questionable perfusion. I would attempt to further enhance the local circulation with PT blocks, the use of nitro patches, or warming pads to the affected limb. Also, if there are any pins in either corrected toe, remove them immediately if you suspect arterial spasm.

Todd Lamster, DPM, Phoenix, AZ

Have you considered HBO treatment to increase perfusion, angiogenesis and tissue oxygenation? This typically will be approved by insurance only in an outpatient setting.

Jody P McAleer, DPM, Jefferson City, MO, jpmcaleer@gmail.com

RE: Circulation to Toes, Post-Op (Stephen Pirotta, DPM)
From: Elliot Udell, DPM, Bryan C. Markinson, DPM  

Dr. Pirotta introduces a very important topic. How do you handle a situation when another non-podiatric physician gives a patient advice that conflicts with your professional advice? I was involved in a similar scenario. I brought an uncontrolled diabetic patient into the hospital, who initially presented with an infected ulcer on her hallux with cellulitis. I promised the patient that I would do whatever possible to save her toe. In the hospital, the internist called for a vascular consult, and this particular surgeon immediately wanted to amputate the toe. I simply documented my point of view in the chart along with data to back up that the patient had at least a 50/50 chance of recovering with IV antibiotics and good wound care. Because it was documented in the chart, the surgeon backed off and the patient ultimately left the hospital without having lost her toe. 
 
The point is that if you have a good clinical feeling based on knowledge and years of training, and a non-podiatrist disagrees with you, document it along with your reasons. Physicians tend to be very brief when writing up hospital charts but when it comes to clinical disagreements, brevity is not the soul of wit. Document everything so that everyone will see it. 
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

Dr. Pirotta performs surgery on two toes, and tells us the patient was admitted for "questionable perfusion," of the toes post-op. This describes every surgeon's nightmare. Every fourth year podiatry student can walk you through it. He then details a dispute with the MD about whether or not elevation or dependency is better! The patient is on Coumadin and aspirin, but Dr. Pirotta doesn't say why. I hope that while Dr. Pirotta is waiting for his response, a vascular specialist stumbles into the patient's room, so someone, including Dr. Pirotta and his adversarial MD can do something that changes the "questionable status," to "known" status, and then hopefully be able to do something about it. The differential diagnosis is exhaustive, and well taught, which is why this post is so puzzling.

Bryan C. Markinson, DPM, NY, NY, Bryan.Markinson@mountsinai.org

RE: Leonard Levy on Meet the Masters (Brant McCartan, DPM, MBA, Steve Gershman, DPM)
From: Robert Bijak, DPM

To Dr. McCartan, I can't understand how adding an MD or replacing the DPM with an MD would hurt the "appearance of our profession." How can we be hurt anymore? Let's look at reality vs. subjective appearance. We ARE legally limited by ALL states because they recognize our training is not broad enough. That's not appearance; that's law! By legal definition, we do not have sufficient education. That's not perception; that's reality. Do you think we do? Look at your license, limitation and insurance reimbursements. They are not figments of your imagination.

To Dr. Gershwin, While I admire your loyalty to podiatric history, we will not make any more history if we remain static. Hopefully, some foot specialist in the future will say, "I'm glad there were those who had the fore-thought to evolve the profession." Podiatry will still be podiatry, but maybe as a subspecialty, as hand surgery is to orthopedics. You've practiced for 22 years. So you had a good 10-15 years to do well. Can you imagine your future limitations if you didn't evolve? Podiatry's future is narrowing as we see and read every day. An MD degree will be the "Whitlander" to open it up.

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

RE: Impending Medicare Cuts (Barry Mullen, DPM)
From: Marc Katz, DPM, Robert Kornfeld, DPM

How can we as a group be so pitiful as to beg to stop cuts every few months.  We get multiple letters to "please act quickly before they make these cuts."  We are such wimps, with no backbone. We have done nothing to truly stand up for ourselves and where would medicine be without the doctors? We should be the ones in control.

Let the cut go through finally and let everyone see the mass havoc that results in healthcare.  Let masses of doctors drop out of Medicare and UHC that pays 75% of Medicare. That's the only way that the ripple will be felt. I refuse to beg,  because I know in two months, it all happens again.

Marc Katz, DPM, Tampa, FL, dr_mkatz@yahoo.com

I think Dr. Mullen has some extremely valid points about what needs to happen in this country regarding Medicare and healthcare in general. However, this is why I say opting out is the only thing that makes sense. All of his ideas will take years to implement. The only way to make things happen more quickly is to show the government that the game is over, and we are not going to cooperate. Just like a teenager who acts out, no matter how many times you threaten him, if you keep giving him the keys to the car, he will continue to act out. So now it's time to take the keys away and make him pay the consequence.

The government knows that they have the upper hand because doctors have cooperated with Medicare cuts for the past 30 years. If you factor in inflation, Medicare pays about 25% of what they reimbursed 30 years ago for E & M and probably 10% of what they used to pay for surgery. And here we still are cooperating with them. Well, not me. I have too much self-respect to be bullied by a system that treats me like a criminal rather than like a doctor. 

Robert Kornfeld, DPM, Manhasset, NY, Holfoot153@aol.com 

RE: Ridiculous Shoes - Part 6

Now ain't that a kick in the ass?

Source: Submitted by Dr. David Secord

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

ASSOCIATE POSITION - LOUISIANA

Associate position in busy multi-office practice. Must be highly motivated, hardworking and have good people skills. Residency training required. Competitive salary and benefit package. For more information please submit CV and specify your current location and availability. Confidentiality assured. E-mail dpmposition@gmail.com

ASSOCIATE POSITION - NEW MEXICO

Well established, multi-office practice in sunny Albuquerque, NM
is seeking a well-trained (PSR 24/36) associate to start July 2011. Travel required one day/week. Utilize your talent with our "Leg Law" as well as our state-of-the-art practice including digital x-rays, diagnostic ultrasound, PADNet, and an in-office surgical suite. Send your cover letter, CV and 2 letters of reference to:  familyfootww@yahoo.com. Visit our website at www.newmexicopodiatry.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

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

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

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.

WOUND CARE TISSUE HEALING FELLOWSHIP

St. Johns Episcopal Hospital in Far Rockaway, NY currently has one opening for its 12 month CPME-approved Wound Care and Tissue Healing Fellowship beginning immediately. St. John's Episcopal Hospital has a major wound care/hyperbaric oxygen center. Fellows are trained in all aspects of wound care including certification in hyperbaric medicine. Surgical residency training required. Competitive salary and benefits. Please contact Lloyd Bardfeld, DPM, Director: Wound Care Tissue Healing Fellowship, 516-592-7075, tnddawg@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

PM News Classified Ads Reach over 12,500 DPM's and Students

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