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Economic downturn

Discussion in 'Practice Management' started by twirly, Nov 28, 2008.

  1. twirly

    twirly Well-Known Member


    Members do not see these Ads. Sign Up.
    I am interested to know how the current depression is affecting Podiatry.

    I have noticed a definate decline in patient numbers recently. Not just a decline in new patients but existing patients extending their return for routine treatment or only contacting when they can no longer manage.

    Local industry (& I understand that nationally it is a similar picture) appears to be in dire straights. Corus (formally British steel) now owned by the Indian firm Tata, has dismised its contracted employees, placed an indefinate block on overtime & dictated Rotherham plant employees must take 3 weeks leave at Christmas due to a decline in orders.

    Some of my patients have been laid off with 2 days notice!

    A significant number of patients have been told they now have a shorter working week (3 days) due to 'the current financial climate'.

    http://www.doncasterfreepress.co.uk/free/Sharp-rise-in-jobless-.4733089.jp

    The local village has seen 5 shops close with a 2 week period (this includes only those located just on the high street, not considering smaller premises in more rural locations).

    My questions: 'Is this just the beginning? :sinking:
    Has your practice noticed signifiant change?
    Is the global picture similar?
     
  2. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    In my wifes clinic, they are getting even busier and she is looking for another Podiatrist to help with the extra work.
     
  3. davidh

    davidh Podiatry Arena Veteran

    Hi,

    It's affecting Britain hard, but some areas will be worse hit than others.

    Mandy, you can equate it to the Miners Strike in the 80's. My Practice then dropped by 50% almost overnight, but survived and grew again.

    I think this time the experts are predicting an upturn in a couple of years.

    Cheers,

    David
     
  4. twirly

    twirly Well-Known Member

    I could do with topping up my tan Craig. (I am usually sporting 'dark grey' although I feel 'dark white' is more en' vogue this season).

    I'll send my CV.

    Any offers for Crane drivers in OZ? 'Himself' works for Corus? :bang:

    :boohoo:
     
    Last edited: Nov 28, 2008
  5. Cameron

    Cameron Well-Known Member

    Twirly

    It is difficult to make direct comparisons between countries and regions for example in WA there is a mineral boom with a significant part of the population with money to burn. Now whether they seek out private podiatry is not too clear.

    For Oz so far anyway there has not been so drastic measures as shortened working weeks or major industry closures. However the country is not immune from the downturn of the global ecomony and likely to face this full on in the coming year. The government keeps these things quiet meantime and fills our heads with what wonderful things they have done to avoid the inflation.

    Difficult to say what will transpire but it is likely to affect disposable income groups and with the potential threat the government may remove non essential subsidies then we may see a different social picture emerge in the coming twelve months, I am sure of that. The number of free soup kitchens and roofless people is increasing alarmingly so if that is a litmus then we have not seen the worst, here.

    In the UK it is probably better to compare to periods of sustained inflation in the past. From recollection established practice survived but it became more difficult to start practices from scratch when disposable incomes were directed to cover bare essentials. More pods stayed in the public sector for security (an option not so available in the land downunder).

    The original podiatry schools in the UK and Australia started as free foot hospitals during the Depression.

    Have a good weekend
    toeslayer
     
  6. Brummy Pod

    Brummy Pod Active Member

    Twirly,

    Myself and other colleagues in my area have definitely found it quiet recently. This week has been abysmal. The hairdressers around the corner have also found it dead this week.

    A colleague of mine was speaking to someone "who works for a major chiropody supplier" and was told that EVERYONE across the country is grumbling/feeling the pinch.
     
  7. George Brandy

    George Brandy Active Member

    Hi Twirly

    This last 12 months to 2 years has seen a significant change in the providers of footcare on the open market. We have seen the NHS engaging with Age Concern and Social Enterprises in developing services for low risk foot care and nail cutting.

    We are seeing increased avaliability of appointments for more specialised services within primary care, particularly MSK.

    GP's now offer increased inhouse services by non-podiatrists offering foot care and they themselves are ruling the roost with nail surgery.

    We are also seeing increasing numbers of graduates who cannot obtain NHS posts having to start private practices or offering domiciliary services - therefore we are finding greater competition within the private sector.

    All these changes impact significantly on private practice and now the downturn of the economy.

    Yes our practice has been significantly quieter this year compared with last year - but more noticeably since September. Regionally we have always had a poor economy compared with the South. Industry and manufacturing has always come and gone, house prices remain one of the cheapest in the UK so perhaps we will fair better than some others. Only time will tell.

    I think it crucial by now that we have all looked at our financial positions and trimmed off all the non-essentials. Do not rest on ones laurels either. Now is the time to up the marketing and PR.

    Interestingly I thought it time to contact my Business Bank Manager to see what solutions she could offer. Diddly squat! Not even a small overdraft facility. But after a 10 minute critique of my business and outgoings she did give me the number for Merchant Banking Services so I could invest in a card reader and a prefilled, by her, credit card application arrived the next day awaiting my signature to be returned in a hand addressed envelope, by her, with two 1st class stamps attached to it. This has gone for shredding leaving me wondering what all the promises to small businesses by Gordon Brown were all about and why the banks are still pushing credit facilities?

    Chin up and keep smiling,

    GB
     
  8. Brummy Pod

    Brummy Pod Active Member

    "and they themselves are ruling the roost with nail surgery."

    And what is they're regrowth rate???!!!

    "We are also seeing increasing numbers of graduates who cannot obtain NHS posts having to start private practices or offering domiciliary services - therefore we are finding greater competition within the private sector."

    The key here is to provide a unique selling point.
     
  9. davidh

    davidh Podiatry Arena Veteran

    Hi all,

    George, you said:
    "We are also seeing increasing numbers of graduates who cannot obtain NHS posts having to start private practices or offering domiciliary services - therefore we are finding greater competition within the private sector."

    Bill Liggins, myself, and some others predicted this would eventually happen three or four years ago on the ThatFootSite forum. The recession just speeded things up a little.

    I believe that marketing an individual Practice (or indeed private Podiatry in the UK) will make very little difference to the overall situation.

    Too little - too late:sinking:


    Regards,
     
  10. davidh

    davidh Podiatry Arena Veteran

    The thing is - no one is interested (until their nails start to grow again).

    UK patients will not, in the main, be interested in paying for nail surgery if they can get the same job (you and I know it is not, but the patient has just been told by the nice Receptionist or Nurse that it is) done by the GP for nothing.

    Even the number of insured patients has dropped in my clinics. In the UK we (as a profession) have just not prepared for this, and consequently are floundering big time.

    :bang:
     
  11. Cameron

    Cameron Well-Known Member

    Dave et al

    "I believe that marketing an individual Practice (or indeed private Podiatry in the UK) will make very little difference to the overall situation."

    I do agree. I think there is a general misunderstanding about the macro-miracle of marketing which costs a lot and achieves remarkably little. Time and circumstances will preclude financial encouragement from the banks for the foreseeable future so it would appear prudent for small business to consolidate and pay off debt. Niche care is driven by consumer demand and when disposable income is short demand drops leaving only the bread and butter stuff i.e cut and come again (or clip and chip as they say downunder)

    The tide will turn but it is likely to take a couple of very lean years. The only consolation being everyone is doing it tough.

    toeslayer
     
  12. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    I treated a medical specialist this week. We spoke of the woes of the economy, and he happly stated, "yes, but medicine is recession proof!".

    And in most countries this is true. The medical profession generally holds the key to the golden goose of public health funding, and no matter the position of the economic cycle, they do well.

    As Cameron has said, and I agree, I think PR, marketing and all of that has limited bang for buck.

    The best thing the UK, NZ and Australian professions could do is fund some prominent political lobbyists, donate to the political parties in power, and argue for equity in payment for the provision of services that medicine provides with generous taypayer funds.

    If the government pays a GP to do a nail surgery, but not a podiatrist - they why the heck should this be the case? Change the rules and we can prosper. Hell, even propose that we undercut the going rate for a GP to do it! At least we get "on the books".

    LL
     
  13. twirly

    twirly Well-Known Member

    Thank you George et al,

    I appreciate all of your replies. In response to Georges' points: 1). My bank (HSBC) offered to increase my £200.00 overdraft facility at my request to £400.00 for an arrangement fee of £100.00!!! I declined, & in reality I think it has confirmed my lack of loyalty to that particular organisation & as a member of the Federation for Small Business I will be taking my account to the Co op. for free business banking. (This is an action I should have taken some time ago! my fault entirely for putting it off until tomorrow!). I understand from an article I read some time ago that an individual is more likely to divorce, move house or change career than change banks. Time to rethink my financial future methinks.

    2). I too was offered a card reading machine, for a pre-agreed fee, a 2 year minimum contract & a charge on each transaction. The banks prefer 'wired' money as cheques & cash take more time/staff to input. I also understand that the staff member who procures the initial contract receives commission. Again I declined ( I also declined the credit card).

    3). I will try to remain calm. (This is set to become my mantra for the forseeable future).

    Again, many thanks to all who responded.

    Mandy
     
  14. George Brandy

    George Brandy Active Member

    David, I don't understand why you think the recession speeded things up a bit?

    Podiatrists employed within the NHS has been steadily reducing over the last 5 or 6 years so predicting an influx into the private sector was hardly a difficult thing to do.

    Sadly, and again as both you and Bill have no doubt predicted, the Strategic Health Authorities have commissioned the development of an Assistant Practitioner to fill unmet need. There is a once again a point of NHS saturation before the technician grade is readily available.

    With increasing referral from social enterprises (Age Concern et al) plus an ability in most PCT's for patients to self refer to Podiatry, waiting lists for new patient contact with the NHS Podiatrist is once again increasing. The wait for contact locally has increased from 18 weeks to 12 months.

    So with no marketing -cost effective fly leafleting in those rumbling moments of epmty appoints throughout the day - how does one propose to promote oneself to those who lose patience with the free system?

    GB
     
  15. davidh

    davidh Podiatry Arena Veteran

    George,
    You asked:
    "David, I don't understand why you think the recession speeded things up a bit?"

    Bad choice of words. I suppose what I meant was that the recession has highlighted the situation for us.

    Clearly, every Practice has to do what it feels is right for it to survive. However it is an unfortunate fact that if there is no money around (and in some areas this is indeed the case) then patients are not going to seek treatment as often, or even at all if (for example) they can buy an inexpensive home remedy.
     
  16. cornmerchant

    cornmerchant Well-Known Member

    Toeslayer

    You said


    "and when disposable income is short demand drops leaving only the bread and butter stuff i.e cut and come again (or clip and chip as they say downunder) "

    I think this is the crux of the matter. Many Pods have proclaimed that they dont do 'cut and come again' as if it was a dirty word, and that they "didnt do all that training" just to cut toenails" .

    Well, its wake up and smell the coffee guys- That is where your income will be coming from for the next year or so, but if you have turned the work away in the past it may not come knocking at your door.

    If you want to sit back and see it out without making any effort to get work your way, so be it, but GB is right in my opinion, a little marketing cant hurt as there will still be newcomers requiring podiatry regardless of the economic crisis.

    My humble opinion of course

    Cornmerchant.
     
  17. Dido

    Dido Active Member

    Let's remember that in a recession

    money doesn't disappear it just changes hands

    For economic purposes I would divide the UK footcare market into 3 sectors:-

    1.Those specialist practices that sell mainly high-priced units eg: orthotics/podiatric surgery. They rely on the Pareto factor where 80% of their income comes from 20% of the clientelle.
    2. Those generalist practitioers who have a good range of services available at varying costs, from simple nail cuts to nail surgery/ mid range orthotics.
    3. Those practices at the bottom of the footcare market who sell low price units and rely on high turmover ie; the "pile 'em high sell 'em cheap" philosophy.
    These use very small profit margins to keep the price low. Most of the unregulated fall into this category.

    In a recession, 1 & 3 are most likely to fail.

    1. has put "all their eggs in one basket" and should have diversified 6 months ago to stop an acute cash flow problem.
    3. cannot trim their profit margins any more. The cost per unit may be only £12 for a nail cut but the mainly elderly clientelle will no longer be prepared to pay it every 6 weeks. If the practitioner is locked in to a 6-week trading cycle, then without new customers the operation will fail. With profit margins so low there will be little spare cash for marketing.

    In a profession where the generalist private practitioner is often treated as second class by the "specialist" I can see a reversal of fortunes occuring.

    Dido
     
    Last edited: Nov 29, 2008
  18. R.E.G

    R.E.G Active Member

    Dido,

    An interesting scenario, but I'm not too sure I agree. I certainly do not agree with the great GB (Gordon not George).

    So.

    1) the specialist, well in this recession are the high earners really going to be hit? Is their 'disposable' income not so massive 21.5 million bonus going to be affected? Sadly somehow I think not. So is the Pareto effect going to cushion this group?

    3) 'Pile em high and sell em cheap' well what exactly do these 'merchants' have to achieve to 'break even'? Costs + an hourly rate better than benefit or minimum wage?

    So No 2 interesting, IMO those long established practices, which have minimum debts and another income stream may 'sit it out'. Those that rely on 'Practice income' will find it hard and I suspect eventually revert to 'price war tactics'. That IMO would be disastrous.

    Marketing - well possibly it's worth a try, but if there is no market you can spend a lot of 'ineffective money'?

    I suggest that in the climate we find ourselves in we listen very carefully to out clients, and learn from what they are saying .

    In the meantime I have a very good recipe for Spam stuffed with pigs live in Bovril gravy for Xmas dinner.
     
    Last edited: Nov 30, 2008

  19. Mandy:

    Business is still very good for me here in Northern California in my full time practice where I specialize in musculoskeletal disorders of the foot and lower extremity. One of my favorite sayings when people ask me how I'm doing in the current poor financial climate:

    "As long as there is obesity and gravity, my practice will always be busy."
     
  20. Cameron

    Cameron Well-Known Member

    netizens

    It was during the Great Depression that promoters profited by staging endurance events and contests of every torturous sort. One pinnacle of endurance madness was the 1928 transcontinental foot race across North America. This was a 3,400 mile race from Los Angeles to New York. The purse $25000 for the winner and $23500 to be split among nine runners up. These were quite considerable monies for that time. The marathon attracted 421 competitors and each had to pay $100 entrance fee. The event was the brainchild of a professional promoter CC Pyle and was supported by Dr William Scholl, a shoemaker turned foot physician. The press dubbed the event the Bunion Derby because of the punishment to the feet of the competitors. At the beginning of the race reporters nicknamed Pyle, Cash and Carry and by the end he had earned the dubious title of Corn and Callus Pyle. Everything that could go wrong with this event did. The feat (excuse the terrible pun), was well enough organised and Pyle had taken the precaution of contacting manufacturers of shoes, foot salves and pads, sun tan oil, and many of the local towns on route associations, but otherwise disaster be dogged the event. Sponsorship monies salvaged some the disaster but the 'event of the decade' was destined to go the same way as the Titanic. By the first day 222 runners had dropped out from heat exhaustion and one poor fellow was the victim of a hit and run accident. Race aids engaged to give the runners vital water as they crossed Mojave Desert did not turn up and more competitors dehydrated. Host towns backed out as the field dwindled and disasters mounted as the runner made groun towards the finishing point. Needless to say expected crowds failed to materialise along the way and the event went belly up. 573 hours 4 minutes and 34 seconds after the starting pistol was sounded, Andy Payne, a 19 year old Cherokee won the race. He collapsed from exhaustion after receiving his prize money. There were only four thousand people in the eighteen thousand seated arena to welcome the 55 runners who eventually completed the race. The Bunion Derby lost CC Pyle a pile of money and the only consolation the promoter could take was self credit for introducing mega marathon runs. Dr William Scholl on the other hand (or should it be foot) came out a winner. As he had done before with his National Cinderella Foot Contest, a country wide search to find the most beautiful female foot in America, he took no time to tie in his product range of corn, callus and bunion pads to the runners and general public that followed the race. The 1920's saw other forms of endurance marathons namely dance-athons. The simple principle was for couples to outdance all others. The craze lasted well into the thirties where record numbers of unemployed men and women desperately danced as much for the modest prize money as to lose themselves in the obliviation of fatigue. The dance marathon did not display humanity at its best. Hallucinations were frequent with dancers fighting imaginary foes or leaving the dance floor pursued by imaginary villains. The last couple on the floor, won the enddurance contest. The prize monies were poor but what drove people to these excesses was faddishness and the half promise of a brief moment of fame. Often at the larger dancathons there were shioe salesmen on the sidelines purveying their wears as well as other vendors selling food, drink and foot care salves. Breaks were taken hourly, so couples could be quickly revitalised by side line masseurs. There were numerous reported deaths and in 1933 the Governor of New York signed a bill that made dancing beyond a reasonable eight hours a criminal offence.


    toeslayer
     
  21. It is likely that the full impact from the banking crisis will take some time to filter through to the general economy - with the real prospect of fiscal and econonomic collapse a reality for many countries. In the UK, the banks are being propped up with taxpayer's monies and from funds borrowed by HMG via Treasury bonds. Interesting to see other industries now asking for government bailouts - car manufacturing, charities & etc. Only petrochemicals and utilities seem to be profitable in the current climate. Wouldn't it be nice to see government money being made available to support private podiatric practice??

    Unfortunately it looks likely that all podiatrists in the private sector will be affected to some degree or another - and those with practice loans and other debt will be facing much uncertainty in the months to come. There is an excellent online resource with the Consumer Action Group which gives superb advice on dealing with everything from bank charges, debt collectors, bailiffs, utility companies and other unpleasant low-life. http://www.consumerforums.com/index.php

    The following extract is from a BBC report into the debt collection industry - well worth a read if you are facing problems with finance...
     
  22. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    I just posted this in the Practice Management forum: Surviving the economic downturn


    The latest issue of Chiropractic Economics has two article with practical tip, many of which are relevant to podiatry practice:

    What do DCs do now?
    Survival Tips for "What Do DCs Do Now?"
     
  23. Boots n all

    Boots n all Well-Known Member

    Not a blip on the screen here everything is traveling smooth as, we are a little on the recession proof side l guess.

    Diabetics require regular shoes and orthosis as do many of my CP and arthritic clients, at this stage the government is still paying well, as for the privately funded clients...pain rules, so we are busy no matter what.
     
  24. R.E.G

    R.E.G Active Member

    Interesting as Newsbots posting was it is a little out of date, quoting expectations for November.

    I suggest things have moved rapidly on.

    Only yesterday the top bosses of the 3 US auto giants offered to work for a $ next year, and this is yesterdays news from a relative over the pond.

    So they had a big company meeting yesterday to explain the Layoffs and talk about the recession. They asked for money saving ideas etc.
    Just said that the bottom had fallen out of the market and potential jobs had gone up in smoke, and even signed contracts had been voided or placed on indefinite hold.
    The company said from what they could gather this was across the board in the US and the world cited layoffs at one of the biggest and most diverse Arch. firms in the world HSK.
    *** had always told me that Arch. gets hit hard during recession and are often some of the worst effected.

    When architecture stops it says investment has stopped and all the 'belts' are being tightened.

    Today it is expected that the bank of England will lower interest rates to the lowest level EVER, even before the US and Oz were invented.

    So it may not have hit yet but it will, pain or no payne.

    Casandra.
     
  25. What is lamentable is the failure of the professional bodies - SoCaP in particular - in developing and promoting a comprehensive strategy for practice growth in the private sector. The resistance to establishing a Faculty of Private Practice or a dedicated business development unit/commercial division within the Society in recent years was, in my opinion, a lost opportunity which may in the coming months be something all sectors of the profession will come to regret. Much has been written on the level of unmet need within the foot health market at the inability of the NHS to provide a comprehensive care system for the whole population, indeed limited resources have necessitated a reduction of care to only those with high risk conditions - something that has forced many vulnerable patients into the private sector - to which many of those cannot afford. Given the prevailing economic conditions, this will place many patients - and private practitioners in an unenviable position in the coming months and years. Where is the use of the private sector in augmenting NHS care as proposed by the government a few years ago? The Society has a golden opportunity in promoting the use of its private practitioners in this area but has singularly failed in doing so. Instead of advocating the use of charities and voluntary groups in delivering low-cost footcare, NHS managers and DoH advisors - many of whom are Society members - have by their actions, denied those practitioners in private practice the ability to access NHS work which could have provided a guaranteed income in these troubled times.

    A failure of leadership, vision and professional direction.
     
  26. Lawrence Bevan

    Lawrence Bevan Active Member

    My understanding is that mortgages in Australia have been doled out at 5-7 times earnings as much as they were in the UK = the average aussie is in pretty deep debt. Property has boomed and everyone is a property developer.

    The unravelling of the financial system has yet to hit but it will and when it does its very easy to feel the squeeze under the weight of a large home loan. Given the weakening of the Aussie dollar I think that the financial markets are already planning on a significant
    weaknening in the economy. Even the commodity rich states will suffer in a deflationary world economy.

    So get some candles and a tin hat!!!!
     
  27. Boots n all

    Boots n all Well-Known Member

    l guess you have not seen the price of tin lately ! might have to use something else for the moment :D
     
  28. joejared

    joejared Active Member

    My business is actually successful most likely in part because of the recession, but I need to work out the details with the admins before I discuss it too much. Per capita, however, most of my customers are either stagnant in terms of growth over the past couple of years, and many have suffered losses of volume of as much as 20% directly due to the recession we're now officially in. In the past 6 months, my client base has increased by 50%, with the only real bottleneck being having time to train my new customers and the manpower to run my machines to produce components. At a guess, I see this period of our economy as a time where the big businesses will suffer mostly of their own weight, and the smaller non-corporate companies with lower overhead will continue to grow and thrive because of the low overhead advantage. My own goals involve taking the bottom out of the market of one product, while not sacrificing in any way in terms of quality, and from the looks of my backlog already, I've succeeded.
     
  29. Cameron

    Cameron Well-Known Member

  30. Those afficianados of doom and despair will particularly enjoy the tantalising vision of the future by the BBC's Robert Preston writing in The Times today. Roll on the revolution.
     
  31. Cameron

    Cameron Well-Known Member

  32. Jeremy Long

    Jeremy Long Active Member

    I can claim two observations among our offices: elective surgical procedures are down compared to prior years, and we are ending our largest gross and net pedorthic quarter ever.

    One particular example is what we termed, "canning feet". First when fuel prices were high (and associated costs of food and other consumer goods were, as well), then when the housing market really plunged, a larger portion of our local population started raising gardens or expanded their personal produce production. When it came time to harvest and store their goods, women throughout the Appalachians suddenly found themselves standing on hard floors for hours at a time, seemingly in unison. This "canning" process brought us both an invasion of new heel pain patients and old patients who returned after many years of successful pain-free living.

    Does anybody else see this kind of agricultural bubble of patient traffic?
     
  33. DAVOhorn

    DAVOhorn Well-Known Member

    Dear All,

    OH MY:boohoo:

    WHERE'S ME RAZOR BLADES:butcher:

    BETTER REDUCE ME FEES TO $1.00 :deadhorse:

    regards David AAAAAARRRRRRRRRGGGGGGGGHHHHHHHHHHHH

    WHUMP

    as he hits the dec..............:drinks
     
  34. Cameron

    Cameron Well-Known Member

  35. Cameron

    Cameron Well-Known Member

  36. Cameron

    Cameron Well-Known Member

  37. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Here is an interesting paradox:

    PMNews are reporting:
    Yet there is this post on the StudentDoctorNetwork:
     
  38. Cameron

    Cameron Well-Known Member

  39. kitos

    kitos Active Member

    I'm glad to say that for me business is very brisk and new patient numbers increasing week on week.

    I guess different parts of the country will suffer in different ways but so long as nails grow, callus appears, corns hurt (and eyesight goes and bending over becomes more difficult) and the diabetic population grows ~ the good ones will stay in business.

    Nick
     
  40. David Smith

    David Smith Well-Known Member

    Hi all

    Last year was my best ever and this years till march was going great. Then It got a little slow but March for me has historically been slow anyway. The turnover for march turned out to be average for the month. April felt really slow with appointments down but surprisingly turnover was well above average. This month seems slow again but I've been selling a lot more OTC orthoses than usual so turnover is keeping up. I keep a good stock of OTC's and leave the gate open to reintroducing them to customers who baulk at the price of custom. I've increased the price of OTC so that I make more profit. EG OTC £95 = £70-£75 profit for about 3/4hour work. Whereas custom is £260 for maybe 3 hours work for £140 profit, therefore profit per hour ratio is greater with OTC.

    Strangely enough I've have a large influx of former clients returning to me. They often phone saying Oh Mr Smith I haven't been to you for a while but I saw your advert in the paper and I've been meaning to book an appointment, will you take me back on your books again? (like I'm going to say No, No sorry no place for fickle customers in my practice DERRR!)

    I think they've tried the rest and come back to the best - Hey that's my view and I'm sticking to it (think positive :drinks)

    My point is - are things slower or is it just perception driven by expectation?
    I kept my advertising and marketing going and I've done a few campaigns to target specific customers i.e health professional like osteopaths, physios, G.P.s other pods for referral for gait analysis. The army and prison service for comfort insoles and biomechanical services. So far there have been a few sales from those areas but I figure as things get better again I will have built a high profile and will take off at a run.

    I think when in private practice and especially when sales volume may be reduced
    we have to look at where we can increase profit margins. Remember turnover for vanity but profit for sanity. You may question ethics of increased profit margins but if you can't pay the bills and so have no practice then you can't be very ethical with your non existent clientele.

    Cheers Dave
     
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