Costs and figures... startup Solo podiatry office

Started by Feli
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The joke here is the guy isn't even a podiatrist.

I'm sure non-podiatrists ask just as many inappropriate questions during interviews as we do 😉

The real lesson for people getting into this line of work is that being an MA often has no real qualifications. Many of the people we hire are crush a mouse dumb. They routinely have personal and life drama problems that approach the level of insanity of our patients

I saw a tiktok or reel or whatever where a NP was venting about how hard it was to find assistants for her budding practice. The comment section was full of MAs suggesting she wasn't offering enough pay. They all thought very highly of themselves, like they had a very unique and valuable skillset.

For me the most important things to look for are ability to plan and regulate emotions. Everything else is trainable.
 
Why do you talk like this? This is the best troll on here
No sir you have never met @BubbaWub he is a legend around these parts. Some say he is but a humble podiatrist cutting one toenail at a time fulfilling his patients wants and needs. Others May say he's a nonfellowship-trained reconstructive foot and ankle surgeon. Others say he's like the keyzer soze of podiatry.
 
You guys might be surprised what happens if you find good people, show them training and the goals, and give them some freedom and trust.

"Trust men and they will be true to you; treat them greatly and they will show themselves great." -Emerson

It's easy to fear overpaying ppl who will do crummy and leave regardless, but if you attract the better ones and support their growth, it can be a wonderful thing. 👍
 
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We have an x-ray machine in our office but not utilized often. I mainly reserve this for my post-op patients to check bone healing and hardware. Or sometimes for walk-in traumas to make a quick decision regarding conservative vs. surgical management.

We have an imaging center in the area so everything gets sent over there. To me this is more medlegal than anything else. Some patients want a copy of their images on a disc and a written report to be sent to their jobs, lawyers, etc. The imaging center can handle all that. I am not gonna do that for a meager $35 reimbursement.
 
We have an x-ray machine in our office but not utilized often. I mainly reserve this for my post-op patients to check bone healing and hardware. Or sometimes for walk-in traumas to make a quick decision regarding conservative vs. surgical management.

We have an imaging center in the area so everything gets sent over there. To me this is more medlegal than anything else. Some patients want a copy of their images on a disc and a written report to be sent to their jobs, lawyers, etc. The imaging center can handle all that. I am not gonna do that for a meager $35 reimbursement.

This is a great point. With all things in a business, you need to decide what you want to outsource. Whether it's radiography or bookkeeping, everyone's situation is unique, and you're not a cheapskate if you crunch the numbers and base your decision on that
 
Hey everyone.

So I was quoted $7,500 to build my website. I thought that was outrageous. I worked so hard to build my own and learned so much and I’m very happy with it. Everyone I showed it to was super impressed (both medical and non medical people)

If you want me to build your own message me. I won’t charge the outrageous $7500 I was quoted. I can get it done for $3,000.

Just message me. Don’t want to make my own post here to advertise but thought I could help out anyone who posts here or lurks.

Thanks!

(Don’t nuke me mods just a podiatrist trying to pay off his student loans)
 
Hey everyone.

So I was quoted $7,500 to build my website. I thought that was outrageous. I worked so hard to build my own and learned so much and I’m very happy with it. Everyone I showed it to was super impressed (both medical and non medical people)

If you want me to build your own message me. I won’t charge the outrageous $7500 I was quoted. I can get it done for $3,000.

Just message me. Don’t want to make my own post here to advertise but thought I could help out anyone who posts here or lurks.

Thanks!

(Don’t nuke me mods just a podiatrist trying to pay off his student loans)
Meme Incoming
 
Hey everyone.

So I was quoted $7,500 to build my website. I thought that was outrageous. I worked so hard to build my own and learned so much and I’m very happy with it. Everyone I showed it to was super impressed (both medical and non medical people)

If you want me to build your own message me. I won’t charge the outrageous $7500 I was quoted. I can get it done for $3,000.

Just message me. Don’t want to make my own post here to advertise but thought I could help out anyone who posts here or lurks.

Thanks!

(Don’t nuke me mods just a podiatrist trying to pay off his student loans)
This is the way.
 
Yes sir you motivated me.

Maybe I missed it, but how far out from residency are you now that you're starting your own practice?
And also, are you in an area that's pretty underserved or are you opening up in an area with a sizable amount of other podiatrist already?
 
This is a great point. With all things in a business, you need to decide what you want to outsource. Whether it's radiography or bookkeeping, everyone's situation is unique, and you're not a cheapskate if you crunch the numbers and base your decision on that

Hey, he's talking about me!

I'm doing my own bookkeeping. I really feel like it gives me a great opportunity to understand my finances and expenses. I spent an hour on it this week going through every account/button on Xero teaching my wife, but I could have done it myself in 10 minutes and been up to date. At my last office, my partner fired an office manager who had done our Quickbooks work and he wanted to pay the office accountant $1400 a month to do the bookkeeping. Fancy people want fancy prices. Started implementing rules so future income reconcilation will be even easier - everything Novitas, Cigna, BCBS will just be a click to reconcile. I really feel like this is one of the parts of a business that an owner needs to understand completely before they pass it off to someone else. I also think there's something hilarious about paying someone else to input your receipts for you. You potentially already have to pull the invoices out of your accounts so by the time you put together everything someone else needs you'll already be about 10 minutes from the job being done. But to each their own.

I also changed all my air filters. Office has -6-, but after I changed them I decided that next time I would go longer because they didn't look that bad. Past office again paid someone to do this for us. We didn't buy the filters so I'm sure there was an upcharge there too.

Sprayed weeds in my parking lot a week ago and did some edging. Laid mulch. The past owner had planted groundcover in a front bed and it was climbing over into and covering part of a handicap ramp at the corner of the street. Cut it all back.

What's funny to me about all these things is yeah - if I saw 25-30 people a day and was swamped I could just pay someone else. But I'm not really doing that much work and the most I've seen in a day is 13 people. The act of spraying/cutting weeds taught me something more valuable - I don't need a yard crew coming out digging me for $200 every other week with nothing actually to cut. There's not enough work for them. I've had the building for like 3-4 months and it took the dead of summer and me being out of town for a weekend for things to get out of hand and lead to 1 partial morning of work. What I really need to do is - patch the parking lot. The places where weeds are growing are minor damage spots in the parking lot. If I clean them and patch them there won't be weeds there.

All of this will seem laughable to hospital people being showered with money, but I'm out here trying to spend an hour a week getting stuff right in the hopes that I can turn my prior "keep 40%" situation into a "keep 50-60%" situation. Yeah, the same amount of time into podiatry work should produce more income, but I already played that game at my last office. No amount of increased work seemed to produce increased income. I'm controlling the cost side this time.
 
All of this will seem laughable to hospital people being showered with money, but I'm out here trying to spend an hour a week getting stuff right in the hopes that I can turn my prior "keep 40%" situation into a "keep 50-60%" situation. Yeah, the same amount of time into podiatry work should produce more income, but I already played that game at my last office. No amount of increased work seemed to produce increased income. I'm controlling the cost side this time.

Hey man, all power to you. I bet after a year or so you will be making bank and be happier doing it. Sometimes I wish I could do PP instead but I think it takes so much work and sacrifice to get a good setup that I just don’t think I’m willing to go through that at this point. Would be nice though because I like clinical podiatry much more than surgery tbh.
 
Doing your own bookkeeping is educational because you can see where your money is going and who your payees are. So I would definitely recommend it starting out. But Quickbooks isn't as intuitive as it's made out to be. I quickly realized I was making mistakes and the amount of time it would have taken me to fix the mistakes would be a misallocation of my time. As I have told my staff and colleagues, the most expensive component of anything we do is the doctor's time. My bank and cc statements every month are 4-5 pages long. So we have the same firm who does our tax prep take over our bookkeeping. Their website advertises "Can you afford your own hourly rate?"

YMMV
 
So - small hilarious "fraud?" today.

Received 2 supplement/secondary checks for patients with Traditional Medicare + Humana. I happened to look at the supplement EOB because it was from Humana and the $5 check fee above triggered me. No check fee, thank goodness. I then realized that Humana was claiming a discount on the supplement payment because of another contract that I have through my IPA that has -nothing- to do with this at all.

Essentially my IPA has a contract with an irregular network (I've never seen a single patient who has it) to the tune of 90% of billed charges. Sounds great if you can get it. Humana has been using this contract to reduce our supplement payment by 10% claiming that the discount from that network applies. I called said network. Shockingly, they answered the phone right away. They promised to review the claims. They are not owned by Humana - so how does Humana have the right to use a benefit from their contract.

A 10% discount of 20% of the bill is a 2% discount - I don't claim this is a lot. But will essentially be on every service for any patient who has Humana as a supplement and its just part of the never ending transactional costs that I think are eating away at our line of business.
 
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So in the spirit of transactional costs. Medicare secondary/supplements like to pay via Zelis who then tries to ding you for a large credit card fee. You can call Zelis and demand that they switch to sending checks, but you still have to deposit/bring these checks to the bank and they still will take staff time to reconcile and post. According to people complaining online, the second you deposit a virtual credit card Zelis tries to switch you back to cards and away from checks.

So I asked AI for help on this and their suggestion was confusing - Select Health Epayments Center. Which is owned essentially by Zelis and Zelis somewhat goes out of their way on this not to help you. Like I emailed a question and it took them a week to get back to me. Everything is slow. And when I tried to look up Select Health it kept taking me to some network in Colorado/Utah etc.

Turns out - you have to individually enroll for each insurance that uses this system and so theoretically each insurance will have their own portal/set-up. I had created an account for Select Health but it applies to nothing else. The epayment center business will have a different insurance name in front of it each time for you to find and try to enroll with.

So today I set up with "Old Surety Life" who are a fairly common Medicare supplement payor. Again - the goal is to make secondary payments be EFTs and force them to send their ERA to Trizetto so that my staff don't have to do anything and I don't have to deposit these checks. Ideally if they send the ERA to Trizetto then my staff don't have to sit there and enter the billing/EOB in.


This is who I set-up today. Looking forward to receiving checks from some more supplements so I can figure out where else to do this. Suspect some may be through Echo Health or some other site.
 
This is insanely TFP and might require a meme

But

Would it be smart to advertise to nail salons for onychomycosis treatment and more specifically ingrown nails 🙂
 
This is insanely TFP and might require a meme

But

Would it be smart to advertise to nail salons for onychomycosis treatment and more specifically ingrown nails 🙂
Good SEO work will be much higher yield than mining the mother lode of keratin for more keratin.
 
1. I finally did my PCI compliance today. Such a nuisance and blah - it has to be done every year. My EHR-connected-credit-card company will ding me like $100 a month for non-compliance. For anyone who hasn't had to do it - they quiz you on how you accept/charge credit cards and then force you to fill out surveys attesting that you protect credit card data, don't write down card numbers etc. Its a nuisance and as far as I can tell Square/Helcim etc don't require it.

2. Yesterday, 1 AC unit, I have 2, started putting out hot air. My nurse told me "the heater is on". LoL. AC is on the roof and it was 100+ yesterday. Probably was 110-120 on the roof. It started running today and the AC company told me they couldn't find anything wrong with it. They told me the next time it stops working to call and they'll try to come straight out and catch it. I was going to joke that if the bill was big enough I'd quit podiatry to do HVAC repair - but no bill.

3. Spent some time reading about depreciation on buildings last night and I'm very excited to learn more.

4. Got 2 more secondary payment/notifications today. Immediately contacted both to set-up EFTs.
Have already done Old Surety. Am working on TransAmerican Life Insurance and MedMutual Protect. I know I sound like a broken record, but we're stopping the bleed.

5. Got my first UHC/AARP EFT in my bank account so good to know its working.
 
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Got my first batch of rejections today from UHC

No idea what all these error codes mean but we're talking zero dollar payments on well documented level 3s without procedure...

Was pretty demoralizing
It is also possible that your initial denials relate to some sort of administrative issue or problem on the back end. When I started we submitted to BCBS without any problem at all. However, once we submitted to Medicare they dened all of our x-rays. It turned out there was some sort of box that we weren't clicking related to how the referring and rendering provider was set-up - something like that. I literally told my receptionist - look for some sort of box-17 you haven't clicked and it was something like that.
 
I am a 1st year resident. I know I’ve been shut down before, and I am hesitant to disclose too much information about myself as I don’t want to have repercussions from my program.

I have no intentions of practicing podiatry. It’s a stable “job” with a paycheck but I am actively searching for anything to do instead.
I have always dreamed of owning my practice. I went into this profession with that end goal, but now I am reminded daily by my attendings that private practice is no longer feasible. So why finish the residency if the whole reason I went into this (own a practice) is impossible? Is there merit to finishing residency if I am looking to transition? Or would finishing residency just be 2 more years of sunken cost
 
I am a 1st year resident. I know I’ve been shut down before, and I am hesitant to disclose too much information about myself as I don’t want to have repercussions from my program.

I have no intentions of practicing podiatry. It’s a stable “job” with a paycheck but I am actively searching for anything to do instead.
I have always dreamed of owning my practice. I went into this profession with that end goal, but now I am reminded daily by my attendings that private practice is no longer feasible. So why finish the residency if the whole reason I went into this (own a practice) is impossible? Is there merit to finishing residency if I am looking to transition? Or would finishing residency just be 2 more years of sunken cost
I also wonder sometimes if it’s really the money with podiatry I hate or if economy just sucks for younger people as a whole right now and I’m having grass is greener syndrome
 
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I am a 1st year resident. I know I’ve been shut down before, and I am hesitant to disclose too much information about myself as I don’t want to have repercussions from my program.

I have no intentions of practicing podiatry. It’s a stable “job” with a paycheck but I am actively searching for anything to do instead.
I have always dreamed of owning my practice. I went into this profession with that end goal, but now I am reminded daily by my attendings that private practice is no longer feasible. So why finish the residency if the whole reason I went into this (own a practice) is impossible? Is there merit to finishing residency if I am looking to transition? Or would finishing residency just be 2 more years of sunken cost
It’s not impossible, just harder. Same for owning any medical office.
 
you sort of contradicted yourself with “I have no intentions of practicing podiatry” and it is also your dream to open a solo practice?

Yeah it will be hard. Yeah a lot of things in life could be easier but you’re already pretty deep in and already have taken out all your loans.

Also you’re posting in a thread where the OP literally has made it work.
 
Finish it out so you at least have the credentials.
You are also getting paid (minimally) while you do it so you can at least afford to eat.

It will give you time to plan your next move.
Finish your residency.
Get board certified in something.
Become a rep or run some management position of some healthcare related product after you get out
 
I also wonder sometimes if it’s really the money with podiatry I hate or if economy just sucks for younger people as a whole right now and I’m having grass is greener syndrome
Part of it may be grass is greener syndrome.

I envy some of my medicine colleagues. I've seen their paychecks.

I've also seen the BS they put up with and the amount of work it takes to make those paychecks.

We only have to deal with the foot. That's it.

They're dealing with 5+ comorbidities. Add a combative patient personality to that and - yeah no thanks.

I've also seen the opposite. Finance bros making upper echelon surgeon income- getting burnt out and internally wanting to do something that gives a better purpose instead of selling their souls. Enough to want to walk out on their job completely.

I tell them theyre insane for even considering a healthcare field and the crap they see on TV is completely unrealistic with the stuff they'll have to deal with day in day out.

But again to them, what I do -and again I'm no where near the level of some of the more successful people on here- is a breath of fresh air compared to what they do.
 
I don't really understand the giving up before you try thing. You were told it would be rough. You did it anyway. Now put yourself out there and be a winner.

If you are already years into podiatry then you can't even claim that you were lied to by the people pushing the ACFAS survey

Option 1.Get a hospital job through luck, skill or perservance. Spend the rest of your days wondering who these whining losers on SDN are. Stop posting. Start cold calling. You are 1000 cold calls away from your dream.
2. Take a lesser job and work at it until you get an institutional, ortho, MSG, or hospital job.
3. Save money and start your own private practice. Take ownership. Be awesome? Make it work.

I did number 3. My former patients are seeking me out. I had a very positive conversation with an ortho group about referring to me. And quite frankly - this is the way. I'm doing more admin than I'd like, but I'm putting in the steps to spare myself future admin. I'm controlling my expenses and increasing revenue.

My former office is still sending me Athena collection reports. The collections from last office have crumbled from $70K to $38K to $28K. I bet they have further to fall. I asked my partner to let me make changes to the offices. He refused. Now he is paying for all the things he wanted to keep on a fraction of the income.
 
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Great insight. Thank you all.
It’s tough to grind through residency call weeks when it seems the light at the end of the tunnel is actually just the headlights of a train that’s about to run you over. That’s how it feels sometimes looking at opening a practice or trying to find a job in my desired area.

But to everyone’s credit, other jobs I’ve looked into might not be as nice. But then again when I see friends working 9-5 making 130-150k with room to grow to 200k+ in finance or other white collar jobs I do get very envious and regretful about my decision

Thankfully I do enjoy podiatry for the most part. Just concerned about my financial well being. And I am a frugal person
 
A patient just stole my nail nippers. Private practice is dead! 😡

But seriously. Comes in with a wound with a hallux PIPJ dorsal extension dislocation, possible Charcot, extensive wound care, hammertoes. I'm sitting there trying to figure out what to do / how to stage everything and all they want to do is steal my equipment that I purchased on ebay.

I know what Feli would say. He'd say I dodged a bullet. 😉
 
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Great insight. Thank you all.
It’s tough to grind through residency call weeks when it seems the light at the end of the tunnel is actually just the headlights of a train that’s about to run you over. That’s how it feels sometimes looking at opening a practice or trying to find a job in my desired area.

But to everyone’s credit, other jobs I’ve looked into might not be as nice. But then again when I see friends working 9-5 making 130-150k with room to grow to 200k+ in finance or other white collar jobs I do get very envious and regretful about my decision

Thankfully I do enjoy podiatry for the most part. Just concerned about my financial well being. And I am a frugal person

Touche!! this is literally the best way to describe podiatry as a profession.......observing residents over the years I've noticed the PGY3s who act most gangster are the ones who get the biggest serving of humble pie when they get out!!
 
PE is a fad and not everyone wants to go to a big hospital system, pay a facility fee for a regular appointment, pay for parking, and so on. Position yourself to be different from them and patients will find you.
 
There's two types of complaining. There's complaining after a rational assessment of a bad situation driving a search for solutions. And then there's complaining just to express yourself. SDN is a poor substitute for a therapist office, so decide if you're choosing correctly?

Being a private practice podiatrist feels a lot like the character Johnny Rico in Starship Troopers. Your best friend goes into military intelligence doing psy-ops and your girlfriend pilots star cruisers. Meanwhile you're stuck in the infantry watching them pass you by. But in the process, Johnny Rico has the most interesting story. Plus he got Dina Meyer who aged much more gracefully than Denise Richards.

So I guess what I'm saying is that you can get the finance job and the comfortable life and end up with Denise Richards and all her implants and fillers, or you have the struggle of podiatry and an interesting life story and maybe Dina Meyer who unfortunately died on screen, but it's not an entirely bad second place prize
 
A patient just stole my nail nippers. Private practice is dead! 😡

But seriously. Comes in with a wound with a hallux PIPJ dorsal extension dislocation, possible Charcot, extensive wound care, hammertoes. I'm sitting there trying to figure out what to do / how to stage everything and all they want to do is steal my equipment that I purchased on ebay.

I know what Feli would say. He'd say I dodged a bullet. 😉
Its always the people with half their leg coming off that are most concerned with ensuring their nails are trimmed properly
 
has anyone found a place to buy Cantharone?
If you call a few compounding labs you will find someone who will make you a cantharidin/cantharone topical solution. What you can't get right now is Cantharidin + Podophyllin + Salicylic Acid. Everyone I've spoken to says Podophyllin is on national back order till at least September.

I bought an 80% trichloroacetic acid solution and its not working for me. No one is responding / reacting etc. I'm sitting there worrying about chemical burns and the patients are coming back saying no pain / non response / no-nothing.
 
If you call a few compounding labs you will find someone who will make you a cantharidin/cantharone topical solution. What you can't get right now is Cantharidin + Podophyllin + Salicylic Acid. Everyone I've spoken to says Podophyllin is on national back order till at least September.

I bought an 80% trichloroacetic acid solution and its not working for me. No one is responding / reacting etc. I'm sitting there worrying about chemical burns and the patients are coming back saying no pain / non response / no-nothing.
yes the tca 80% doesn't work. doesn't blister. doesn't really do anything. i used that for awhile and my only benefit to the patients i think was me debriding it before they used salicylic acid at home. i think silver nitrate sticks are more effective even
 
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I've been doing biweekly sessions of debridement + AgNO3. I also on first visit give away a vial of bakodx's verrustat (17% salicylic acid in retinyl palmitate). This has worked as well as cantharone ever did for me with much less pain.
 
I never really had any success for 5-FU or with Imiquimod. There are articles out there on most of these topicals where people advocatte performing them with needling, but if you are going to stick a needle in a patient then I can't help but wonder if you'd be better off just cutting it out.

I was looking up candidate antigen, but it appears cost prohibitive ie. the bottle is $500 on Henry Schein. You also use a different code 11900 and Medicare pays $50 for it. There's no J code for the antigen.

I could buy some silver nitrate, but I'm still bummed out over TCA doing jack. How many bottles of ineffective caustic chemicals am I going to buy (yeah, I know, you can buy sticks). I also tried applying phenol to a few people after a debridement and hilariously no one reacted to that either which is amusing because if you cut the wart out and apply phenol afterwards you can often get a substantial response.

I've been reading about bleomycin - a 15U bottle is only $20. There's some discussion online about how you dilute it with sterile saline and then inject it with 30gauge insulin needles. The people doing it suggest you can refrigerate it for a month. I bring this up not because I'm super excited about doing, but just because - we get taught about things, but we never really get taught how to implement them.
 
From what I can tell a lot of the fluorouracil success depends on if the patient is actually applying it daily which can be a challenge especially in children and teenagers. It sounds stupid but I think duct tape (in combination with daily efudex or salicylic acid) actually can help because it peels off layers of the wart when they remove it daily.

Anyone here tell parents to have their kids take cimetidine for warts?