How many orthotics?

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Hi,

I have a question for those of you in private practice.

I run a small practice with pretty much all patients frail aged who attend for general treatments.

I have a real interest in biomechanics and orthotics manufacture, and would like to know how many orthotics (either prefab or custom made) private podiatrists would prescribe in an average week??

I probably prescribe 10 custom made devices in a year, if that. People here just don't have the money to pay for them.

I am hoping to eventually move to an area where there are more working people that are in a position to use orthotics. But because of my GT only workload, I have no idea of how many orthotics an average Podiatrist would prescribe? - I am completely out of the loop.. And I am interested to know..

Many thanks guys

HC

 

Where are you? I would average 1-3 pairs a day. I don't do much general nailcare.

If you network with your local physios/ GPs, and let them know what you can do, you will see more biomechanical cases. Plus doing some specific advertising to target the general public with common musculoskeletal injuries is worthwhile.

 

I would agree with Phil. I am in private practice and will be plain. 10 pairs a year in a private practice will lead to bankrupt. What do you intend to pay yourself? What do you want to earn? What do you need to earn? Between two practitioners we do 600 to 750 pairs of foot orthoses per year. That does not include the orthotic and prosthetic devices we do from neck to toes. I have a partner and a staff of two receptionists and 1 technician. We have 4200 square feet of space. It all costs money. Materials cost money. Staff raises and medical coverage cost money. It all depends on what you are in it for and what your motivation is and what you need to live I suppose.

 

Many thanks to Phil and Orthican, and to the very kind users who have private messaged me.

Wow, this has been a HUGE eye opener for me. It would really be the "norm" to do up to 20 pairs of orthotics in a month ?!!

I obviously need to seriously need to look at the way I run my practice and get into a larger regional or city area.

All I do is nail care, all day every day. You have given me a lot of inspiration, thank you. !!

 

Wow, this has been a HUGE eye opener for me. It would really be the "norm" to do up to 20 pairs of orthotics in a month ?!!

I think that would depend on the thrust of your clinical business and business model. Orthoses (of any type) are certainly not the thrust of business for me and play only a very small part in my business model, being supplied only when seemed appropriate.

I also think it will depend on where you are and the patient population you serve and /or generate.

 

"If all you use is a hammer, all you see is nails!"

* Old proverb from someone much wiser than me! Applicable to any profession...

 

I prescribe orthotics in those instances in practice where I have developed a treatment paradigm for my patients that includes them.

Each and every patient that I dispense devices to has always been treated as if they were my son, friend or relative and I truly believe they will benefit from biomechnaics as part of care.

I have presented the concept to the patient as a plan of care and do not proceed unless the patient is confident that orthotics deserve a try.

I offer a money back guarantee that their outcome will be positive as I cannot guarantee clinical success.

I have foot typed the patient and educated them on foot centering biomechanics. They have passed a test drive using foot centering pads as a preclude to proceeding with a cast and Rx.

I have payment plans and reduce my fees when they are in need as often, they refer quality patients my way as referrals that more than add to the bottom line.

If only ten patients of yours a year need orthotics, how can you, in good conscience, find a way (for profit and to prevent bankrupcy) to dispense 20 a month?

Orthocan sounds like a businessman to me and not a doctor. I would sooner reduce the size and scope of my clinic than force me to find income streams based on my personal economic needs.

If you are in such a poor area that cannot afford the orthotics they need, I would consider opening up a part time clinic in an area that can afford them and divide my time in the two neighborhoods and offer free or charity orthotics to your poorer patients when supported by your wealthier ones.

Dennis

 

Gee, thanks ......(sarcasm)

With all due respect you actually have no idea what I do. Please do not pretend you do and dismiss and belittle me by your presumptive assertion as to what I "am". It insults your intelligence more than my position when you do. And it also says a lot more about you than me.

The question was kindly raised by hard corn regarding what others are doing related to numbers. I answered plainly and without self indulgent nonsense.

But drsha just so you are made more "aware" I only provide foot orthoses to about two thirds of the total cases of feet we see. I charge 360 dollarsCDN for custom made foot orthoses follow ups and adjustments included. The others are given advice or referral for free. (Am I too expensive for the public drsha?) We see many, many people per year. Foot orthoses are only 20% of the total orthotic and prosthetic work we do. We follow up with ALL of them on an ongoing basis and have had many, many patients as clients following them from children well into adulthood.

If it sounds like I am a bit short with you maybe it is because I have had a long day and I just got home and your comment about me struck me the wrong way. I spend typically 10 to 14 hrs a day running a busy practice providing a full scope of prosthetic and orthotic devices to patients suffering a large range of difficulties I doubt some of which you would even be aware of. So don't even go there with me. Because you have no idea what I do in a day and trust me, my scope involves a hell of a lot more than just feet. My income is what it is because we are trusted by the public. How do I know this? Simple. A great many of the clients we see are referred by others who have received service from us and still do. We are regularly referred to by all four orthopedic surgeons here as well as almost all the MD's. The hospital calls us to come after hours for all their orthotic and prosthetic consultation.

I really wish I did not have to get into all that but hey, your comment was asinine and without much thought or respect for someone you do not know nor do you know what I do or how much I care. Not that I need any from you to feel good about my day as my patients give me the feedback I need to feel fine about what I am doing.

So feel free to judge the people you know as I'm sure they enjoy you doing it. And I'm sure you have many friends resulting from such judgments. But try to refrain from putting your foot in your mouth with those you do not know. Because contrary to your personal opinion there are others out there who actually care a great deal about what they do in a day and always put the patient first. And do me a favor. Do not speak of me like you know "what I am" or "what I do". I have never ever done so with anyone here and never will. Respect is a two way street and typically it is earned. So far you have earned none of mine. And I need none of yours.

 

Dennis,

Do you run a business? Or is it not-for-profit?

Health care is business. You provide your skill for a fee. You might even patent your ideas to sell to others, hypothetically.

Given the dubious nature of the underlying theoretical model of your biomechanics paradigm, I think it's a bit rich criticising the ethics of a practitioner you don't know.

Phil

 

Dear Orthocan:

I am sorry to have done what I did in order to prove a point. Welcome to the club.

In reality, I am part of your choir, not the jerk that you correctly labeled me as.

I should have used to alert you to my sarcasm but that would have dampened the hurt and insult that I caused you which I am now trying to repair that I myself have experienced here.

In 2008, after The Arena published my patent application and without any knowledge of who I am, what my history was or what my motives are, I was labeled a profiteer, a money hungry entrepreneur, a charlatan and worse as my motives for my work. My parents were called mutants and photoshopped versions of Dr Sha's Turd products were posted on this site. I have a long career as a hard working, pro-podiatry, pro-biomechanics patient advocate and caretaker that was totally overlooked

Like you, I am a healer, an educator and a dedicated profession whose patients and profession rest higher on my value chart than my net worth. I could have made money selling paint but I chose podiatry.

I knew all along that you were a sincere, hard working, dedicated healer and caretaker and your posting more than proves it. We all deserve to live comfortable lives commensurate with the price that we have paid to get to where we are. I like you, will not stand for bullying and asinine statements without reaction. However, I tend to fight fire with fire and you tend to fight it with a fire extinguisher. Thank you.

Go back and read some of the posts that continue even today to be mean, prejudged, fabricated and overstated.

You hit the nail on the head when you stated that "your comment was asinine and without much thought or respect for someone you do not know nor do you know what I do or how much I care".

Craig owns this site and runs ads and profits from its existence. He doesn't like when I point that out to him. We all realize the amount of time and energy he selflessly devotes to The Arena. Dr. Kirby''s three books are not peer reviewed, they are sold for profit and he markets and promotes them heavily but we all know that that is not his prime agenda.

I pulled you down to see if you could come up with a better and more tactful response than I have used for these years and you have.

I will now reply to the hurtful, fallacious and inappropriate comments of others with your timely and useful response:
"With all due respect you actually have no idea what I do. Please do not pretend you do and dismiss and belittle me by your presumptive assertion as to what I "am". It insults your intelligence more than my position when you do. And it also says a lot more about you than me".

and I owe you big for the unfair treatment I gave you when you offered wonderful advice on his thread to the original poster.

Dennis

 

Apology accepted.

 

Dear Hard Corn:

I have advice for you from afar which I have divided into 10 statements so that we can micromanage your reactions to them.

1. I think rather than questioning how many devices we make a week, it would be better to ask how many times we believe an orthotic will genuinely help the patient (that would be the number of presentations you make a week). I would then calculate how many times you are casting for one a week. Successful EBM based, biomechanically passionate practitioners, should be casting about 35-60% of their presentations IMHO. This becomes a better gauge.

2. This means that depending on your diagnostic skills, your trust in you and your labs ability to make a great orthotic that is truly individualized and your ability to present the case, you should be able to hone in on those areas where you are weak and need upgrading. Do not make the mistake of prejudging your patients ability to pay for your foot centering and adjacent care and avoid a biomechanical presentation if they need your care.

3. When I am presenting to a senior citizen, I focus on a complete plan of care. I determine, based on my EBP, what my device, shoe modifications, lifestyle adjustments and a compensatory threshold training program to maintain and possibly upgrade their quality of life and their ability to wear shoes with greater comfort and style. I do not push devices on 400 pound couch potatoes. I look for those who want a more youthful quality of life for years to come. I especially focus on those who are avascular, diabetic, overweight as well as those with foot types that I can improve for presentations.

4. On the IOV, I foot type all patients and give them visuals, demonstrations and a brochure on their functional foot type that they can take home and discuss with family and friends.

5. I do a stance and gait eval with and without applying a set of foot centering pads under their feet that allows me to demonstrate the improvement in their posture and function these pads can accomplish. This includes a lift for the short side if I diagnose TIP.

6. I then, after getting permission, apply a set of the foot centering pads into their existing shoes, a shoe insole or an existing orthotic as a test drive for a week or so. I explain that if the pads are helpful, my custom foot centering orthotics will be even more helpful and more permanent.

7. If the test drive is successful, the patient usually wants to be cast and now price becomes the focus of our discussion. If the test drive is unsuccessful, I saved the patient and myself an unnecessary casting and fabrication and further discussion.

8. I quote my fees (lets say you have a lab fee of $130 US dollars and dispense at $500) and wait for a reaction.
They either cast away or tell me the fee is too high.
I then explain that I accept extended partial payment plans and credit cards.
If they still resist casting, I state that I realize that my devices are expensive but that when they work, they are well worth the investment but I simultaneously offer them a money back guarantee during the first 4 weeks post dispense if they are not working.
If they still resist casting, I admit that my lab fee is $130 and ask them what they are willing to pay and I negotiate a fee (some will say $135). I negotiate upwards or cast them for the $135 charitably.

9. I do not dispense OTC devices as I think they do not accomplish what foot centerings can deliver and more important, they will not support feet well enough for the adjancent parts of the plan to work. My rational also includes the thought that if I believed OTC devices work well, why would I be presenting my custom devices in the first place? I give them brands and suggestions for OTC devices but explain that I will not work with them or modify them and suggest they discuss my orthotics with me in the future if their OTC devices fail.

10. Over time, you will be presenting more, casting more and practicing biomechanics at a level that will improve your intrapersonal skills as you become seasoned.

The simple language of foot centering, the use of more understandable architectural terms in addition to standard physics and engineering terminology make biomechanics more presentable and digestible even by seniors. The experiential materials and real time test drive provide a clearer understanding of the opportunity you are giving a patient to work with you, biomechanically.

The whole process takes about 10-15 minutes after the initial speed bumps from the learning curve.

Good fortune, no matter what.

Dennis