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£12 DOM fee

Discussion in 'United Kingdom' started by Cambs Pod, Feb 12, 2014.

  1. Ros Kidd

    Ros Kidd Active Member

    Tony I am confused that after your posts on the thread regarding iatrogentic injury and malpractice that you debrided a necrotic ulcer that bled, removed bone all in a patients home. Sometimes the DOM fee surely should include "sorry mate this needs a specialist clinic", that takes just a few seconds to say and advice that saves more that $$$.
    Ros
     
  2. Yes very much so. I'm sure I am not alone in feeling perplexed, confused, bemused and sometimes annoyed with some of your posts, Tony. When first you made an enquiry regarding iatrogenic injury in a higher risk patient, I had assumed you were an advanced practitioner when you remarked
    Clearly, by what you have written since, it would appear you now have a visiting practice and fighting competition at the lower end of the market. Whatever your origins you seem slightly detached from the work that many of your colleagues do in private practice - perhaps I can give a little insight.

    Whilst a significant percentage of my caseload is good old fashioned routine foot care - which, after an initial assessment (£80) normally attracts a fee of £50 plus sundries. This would account for around 30% of my work. The remained may be a mix of podiatry care - strains, sprains, bursae, biomech and orthoses, sports injuries (predominately footballers through the FA scheme), minor surgery, medico-legal work, and, increasingly, wound care. These patients I usually fee at my normal hourly rate of £150 - so that may be an £80 initial assessment and diagnoses and repeat appointments for Rx or reviews. Sometimes they are short 10-15 min appts, sometimes longer, depending on what I need to do. I invoice similar with VP patients.

    My fees are calculated on the time spent with the patient - but at an hourly target of £150. That means that someone with PF who attends for low dye strapping and ultrasound for 4 weeks might attract a fee of around £250-£300. If I feel orthotics may help, then they are charged the same rate for casting, video (if necessary), fitting and review plus the cost price of their devices - and this may be as much as another £500 depending on the type of orthoses prescribed. I charge £380 for a PNA and TNA plus the time cost for dressings. I usually do all the subsequent dressings myself and in 30 years have never had any post-op complications. It would take me an hour to do a house call, hence the charge stated previously. I try to work only three days each week as I have many other interests which take up a great deal of my time, but this is difficult as I now have a full diary for two weeks ahead now and have to do the odd extra day just to catch up.

    I think the measure of success to being a successful practitioner is not how much money you earn, but what your patients think of the service they receive from you. If you were to go back and read your posts in the various threads you have contributed to over the last three or four weeks, you may realise you have come across as having a rather cavalier attitude to the care of patients - and that of course is just an unfortunate manifestation of your writing style - as I'm sure it must be otherwise. If I may give a little advice that was once offered to me by another colleague many years ago on another forum - when you write a post, go away and think about it. Come back and revise it, then sleep on it - and post it in the morning. Think how it comes across to others. That will enable you - as Robert Burns said many years ago - "to see ourselves as others see us". I repeat that advice as you have taken a step that many of our colleagues haven't done - in asking questions online under your own name. That is a commendable step - and you will find here, in Pod Arena, a valuable resource for your professional practice and your patients. Don't abuse it - add to it, with your own style and wit - and respect your colleagues that have taken the time to respond to your queries, even though you may not agree with them. For in time, you might, if you listen and are willing to learn. Good luck.
     
  3. foot rott

    foot rott Banned

    Hi
    Just joined the arena.

    having read through this post I am a little confused about all you lot in private practice.

    Having only ever worked in the NHS can I ask a Question about some of the statements on here?
     
  4. davidh

    davidh Podiatry Arena Veteran

    Feel free. Having worked in both the NHS and private practice extensively I should be able to give an answer of sorts.
     
  5. W J Liggins

    W J Liggins Well-Known Member

    I will also be happy to answer any question which I am able to. Firstly, I suggest that you give some cognisance to professional courtesies. The use of terms such as "all you lot in private practice" is not professional and is likely to cause private practitioners to ignore your postings. I do understand that this may be your writing style, or simply an unfortunate a lack of education in the English language, but you are far more likely to obtain useful answers when you frame your questions with a degree of respect.

    Allo the best

    Bill Liggins
     
  6. Podess

    Podess Active Member

    Hello footrot,
    I would be pleased to answer any questions you have (to the best of my ability).

    I have worked in both the NHS and Private Practice.

    regards

    Podess
     
  7. Fliss

    Fliss Active Member

    I have to stick up for footrot, "all you lot in private practice" was obviously just a figure of speech, I personally didn't find it disrespectful. Footrot is new to the forum and hopefully hasn't been put off by your comments. Isn't the importance of forums, getting together and discussing topics rather than commenting on people's style of writing? it seems rather petty and inapproriate. While I respectfully understand some people have been on here for years, "fresh blood" is just as important, so please try not to put off the newbies.
     
  8. Fliss

    Fliss Active Member

    So, you feel sorry for my patients having to pay my fee, even though at the time you had no idea what that fee was (I have since stated it my previous reply). Now you are saying that your hourly target is £150. I wonder how your patients justify paying your over inflated fees that are triple or even quadruple the average? Why don't you take on some 'social responsibility' and offer fees that don't need to meet your 'target'. And what about 'better trained'? How do you know which patients know what better trained is? And if they need that reassurance of this supposed 'better training'? I have a first class honours degree, not like most of my patients know or care about that. All they know is that they a get great deal from my visits, they are happy, 'reassured' and thankful for my care. What exactly is it you think you offer that I and everyone else do not for your huge £150 ph?
     
  9. Fruit pastilles, home made soup, good looks and clean clothes, a sense of humour and all my own teeth. And the occasional song. Cheap at twice the price, Floss...and you wouldn't come close.
     
  10. foot rott

    foot rott Banned

    I had to comment on this as found it disgraceful the smug way you seem to dish out comments.
    I have been reading some of the comments and posts made on this and the BSc one by you mark tony and belinda.

    I will not be using this site again after this post and no doubt one of you will find some form of smug type response.

    I have worked in the NHS for many years and have seen many changes.
    During this time I have never met or worked with anyone that had not completed a full time 3-4 year course.

    I am aware of the HPC and the changes with registration, but we are stuck with them and like it or not have little control.

    Regarding charges it seems that some odd fees get charged in the private sector but I am unable to comment as something I know little about.

    It would be good for you to let your fellow private colleagues know what it is you do for the fee as it may help them in their work.

    I think you all need to respect every comment and opinion as after all is that not what this site is about!
    Ed
     
  11. Podess

    Podess Active Member

    Hi Footrott,
    There are some posters on here who act like pompous asses IMO but don't be put off. :D

    regards

    Podess
     
  12. davidh

    davidh Podiatry Arena Veteran

    I think most of us do, provided the comments and opinions are sensible.

    However - you have only posted seven times. In four of those posts you have been:
    ???????? (you didn't even bother to comment at all).
    Confused.
    Disgusted.
    Affronted (Some of us/our comments/attitudes are (whisper it) disgraceful).

    On one of your posts you gave some of us the benefit of a character analysis.
    (I came out rather well I thought:D)

    You will not mind me pointing out the obvious - on the evidence of your posts thus far you seem to be here not to learn or contribute, but to disrupt.

    If a person genuinely wants to contribute, have a grouse (but not go on and on), ask sensible questions and meet fellow colleagues they are made welcome by the vast majority of posters.
    Troublemakers tend to receive short shrift.

    Disclaimer: The above is personal observation only, and not necessarily forum policy.
     
  13. davidh

    davidh Podiatry Arena Veteran

    Hi Fliss,

    Having already answered "Edward" I thought I would chance a comment on this post from you.

    Most of us have been here for a long time (check the post-counts). We do welcome genuine new posters, and tend to be quite a supportive bunch, and not only on here, but in the real world - to students, trainee Pod Surgeons, and fellow practitioners wanting to know more about a particular aspect of pod care.

    I'm sure your advice to us to "not put off the newbies" is well-meaning, but honestly, it's misplaced.
     
  14. Fliss

    Fliss Active Member

    Hi David,

    I see your point, and yes my suggestion was well-meaning of course, but maybe comments/opinions etc could generally be communicated with a little more thought as to how they may be perceived by the recipient? I'm aware it is sometimes more difficult to convey opinions in writing rather than in person, for example, something that you meant light heartedly if spoken can be perceived completely differently when read. But hey, that's technology for you! Also, personally I do have respect for the voice of experience and welcome expertise but it can come across in a way that can be perhaps not as it was intended. I also respect the fact that opinion will always differ.
     
  15. davidh

    davidh Podiatry Arena Veteran

    Thanks for coming back Fliss.

    Just heard tonight that more than two posters in this thread are probably the same person.
     
  16. Fliss

    Fliss Active Member

    Obvious 'side step' to answering me properly, but regardless, you forgot arrogant and egotistical.

    I wouldn't want to thanks, you're not my type in every sense.

    It is quite clear you think you are above me and probably everyone else on here. What you fail to understand is that you know nothing about me, whereas you and your information are freely availble to view. Based on what I know about you and what I know about myself, you are deluded.

    You're opinions are obviously based on your own inflated ego and I quite frankly, have no time for someone like you.

    Welcome to my ignore list 'Mork',

    Have a nice day.
     
  17. Fliss

    Fliss Active Member

    Ah, right ok.
     
  18. Podess

    Podess Active Member

    David H,
    You said

    and just how does that statement contribute to the discussion here?

    In fact TBH I can't see any of your posts making much of a contribution.

    If you think so little of those that have dom practices ( you label their owners "lazy" after all ) why are you even here?
     
  19. davidh

    davidh Podiatry Arena Veteran

    Nice personal attack in which you hope to distance yourself from the poster who has been using several names on this thread.......:rolleyes:.



    :sinking:
     
  20. Podess

    Podess Active Member

    David H,
    Your post does not answer my question about your presence here when you don't seem to contribute anything positive to the thread.

    In one breath you say you want to give advice, then in another you "throw stones" at those who are working in the dom sector.

    Then this was your response to "Footrott"

    "People in glass houses" etc.

    I hope the new posters will come back to the thread and give their perspective on the OP.
     
  21. Did you really expect a considered reply? You join the site and adopt a whinge, moan and criticise attitude - which is not only embarrassing to your colleagues but clearly to yourself, as you are unwilling to identify yourself. In many ways you exemplify what is wrong with UK Podiatry. Not saying you don't have a valid view or nothing to add to the profession, but constantly focussing on the negative, sniping at colleagues - without having the decency or honesty to put your name to it is not only cowardly, but ultimately self-defeating. As you are unable to command a reasonable fee for your skills, your practice is obviously lacking in some areas and you would no doubt benefit from some advice and guidance from your colleagues here - by why should they?

    Goodbye.
     
  22. Hey Fliss

    This is such a complex issue - I work for the NHS but also work privately - my private patient's are DOM visits only. If you are in a rural area it often means travelling much further distances

    If I see someone on their own i charge £35 for the first visit and £33 thereafter. Now I have a friend in London who charges £200 for a home visit - you read that correctly £200!! Now he hates doing home visits and runs a 'premium' for very high end clinics and says for any less it just isn't worth his time

    But...and this I find hard - I 'inherited' a nursing home from a colleague who was scaling down before retirement and he charged £12 per patient, yes you are seeing 10 people in one place in a go and it is very regular work but it pains me to do it for so little. There is an FHP who also works there who charged £12 - I raised my fee to £13 and so did she

    I have a colleague who works in WSM and charges £10 per nursing home patients and he owns his own business

    I think we all just have to make our own decision on how much our time is worth? (without making ourselves bankrupt in the process)


    Claire


     
  23. Just in case you think I'm retorting in kind - I am not. If you are struggling to charge fees commensurate with your practice skills, then you are either in the wrong area - or targeting the wrong patients. No doubt it is difficult in rural areas where population density is low or in areas of urban deprivation - but there are very successful podiatry practices in these areas too. It just takes longer to build a good reputation - and hence a good practice when market dilution is minimised. We know the foot health market is a mess - and as long as we don't have functional closure, it will remain so. But the reality is if your practice is geared towards social nail care/palliative chiropody - then you will face competition from those who are quite happy to work for the fees you complain of. You make the practice you want - I do not particularly like doing house calls and my fee reflects that. If the patient finds this too expensive they have plenty choice elsewhere and I am happy to give the telephone numbers of my colleagues who can meet their needs.
     
  24. Fliss

    Fliss Active Member

    Hi Claire,

    Thanks for your comments and openness regarding fees. From the information gathered from this thread and chatting to pod friends I'm thinking of increasing my home visits (people alone) to be more inline with the area I'm now in (not that I moved far but I need to update my fees) I currently charge £20 for alone people and £16 for care homes.

    Have you thought of increasing your care home fee? that is low, I know you inherited it, but in an ideal world you should be charging more than FHP. Also, I have found that care home managers (from experience) will try and get you as cheap as possible, it's different when the relatives are paying. One CH manager tried to say the previous pod charged £10, (this was when I first graduated and started out) and I said I charge £16 and explained about my training etc and said that was my fee and I wasn't prepared to move on it, he accepted it.

    You do make a good point, we do have to decide what our time is worth and we have to decide what we are charging and stick to it, enough to be fair but also enough to survive.

    :D
     
  25. Claire72

    Claire72 Active Member

    Hi Fliss
    Thanks for the comments (#87) to my question addressed to DavidH, regarding whether to stay with podiatry or leave it. Apologies for the delay in my response, however, please be assured that your passion for your business illustrated in your comments throughout this thread have made me even more determined to start my own doms practice. Whilst some of my options also suggested by DavidH are feasible, it would almost certainly involve working for someone else; which I have identified as the reason why I am clinging on to starting a private practice; the appeal of working for myself and 'bootstrapping' it override any desire to have my skills graded/ranked by the NHS or at the discretion of any employer.

    I believe that there is a need for podiatrists in the dom field; in conjunction with my own research I would use the businesses of Fliss and Suzanne from this thread alone as evidence that successful practices can emerge from dom start-ups. (Blinda, Steve and Mark posting here all receive enquiries about doms). I don't believe that just because the market is awash with all manner of practitioners charging low fees, that podiatrists should therefore abandon it. As a podiatrist I know I am in the best position to offer treatments starting with and including the most basic of nail care, not least for the reasons mentioned by Blinda (#11). But I agree with DavidH, the general public do need to be better informed about the role of podiatrists, and that is my job as a podiatrist - because my career depends on it!

    Fees - every type of business has the fee issue of course, but I feel confident in stating that no female in the UK over the age of 8yrs would pay £3.50 for a haircut.

    Claire - not the same as Kennedy Does Feet Claire.
     
  26. anthony watson

    anthony watson Active Member

    was doing a Dom today for a patient with very long OX nails (not been cut for over a year)

    Just as i finished his wife let the smallest dog I have ever seen into the room ( I thought it was a guinea pig !)

    It ran over to the plastic apron I had on the floor and grabbed the large nail I had taken off the 1st (about 2 inch chunk ) and ran off.

    As the dog was so small it looked like a large bone in its mouth!

    The best bit was watching his wife trying to catch the dog.
    Made me chuckle all day.

    That was worth me giving her a £12 dom fee for the entertainment!
     
  27. Suzannethefoot

    Suzannethefoot Active Member

    Dogs do like to chew on the nails don't they! Yuk!
     
  28. anthony watson

    anthony watson Active Member

    do all these type of posts go nowhere but into arguments?

    yer dogs most think I am a vet and try to bite me!

    Smokers are worse on doms the smell stays in you for the rest of the day.

    Doing doms onetime and the patients son was smoking a joint in the kitchen!

    wonder what policy covers that!!
     
  29. foot rott

    foot rott Banned

    hi
    in response.

    how am I on here to disrupt?

    I have spent some time reading the past and present posts by a number of "regular" veterans.

    And if I were a new pod reading them it would have put me off podiatry for life!

    This thread was about charges for Home visits and the feeling that £12 was to little.
    so I have something to add.

    Having just put my farther in a local nursing home I was informed that the fees for podiatry are £8.00.
    The podiatrist is a BSc, HCPC, and has a large private practice.

    The standard price in this area for a home visit is £18 - £20.

    I am not in private practice myself but feel the fees seem to be as much as patients I ask think they should pay.

    It seems that a lot of podiatry is supplied at home and competition is steep.
    Possible contracting to the NHS may help.
    Some podiatrists seem to be doing this on here.

    thanks
    Ed
     
  30. Cambs Pod

    Cambs Pod Member

    "And if I were a new pod reading them it would have put me off podiatry for life!
    This thread was about charges for Home visits and the feeling that £12 was to little.
    so I have something to add.

    Having just put my farther in a local nursing home I was informed that the fees for podiatry are £8.00.
    The podiatrist is a BSc, HCPC, and has a large private practice.

    The standard price in this area for a home visit is £18 - £20.

    I am not in private practice myself but feel the fees seem to be as much as patients I ask think they should pay."



    No wander patients has such a low view of our profession with this sort of attitude.

    For £8, I wander what the standards of notekeeping, hygiene are?
     
  31. foot rott

    foot rott Banned

    sorry
    :D
    Just stating what the facts are as I find them.
    and just repeating what patients have told me.

    Don't have any attitude either way as not in private practice.

    But seems to be a hard thing to get started at those prices.

    best of luck
    Ed
     
  32. Suzannethefoot

    Suzannethefoot Active Member

    A colleague of mine recently retired, at 79 years old!
    He had a surgery in the past, but as he became part time, he switched to just home visits. His charges ranged from £12 to £22. He gave me all his record cards when he retired and told all the patients that I would be willing to take over. I wrote to all the patient, stating my fee, which I set at £25. I do charge £27 for home visits, but thought that extra £2 might just give some of them a heart attack! One house where there are three people, I offered them a fee of £20 per person.

    Approximately 80% of his patients have accepted my charge and are now my patients, I encouraged as many as possible to come to me, as I really want to stop taking on new home visits now that I have my surgery. Several of the patients could not understand why he had charged so little and had been trying to encourage him to put his prices up for years. He had worked part time, seeing four or five people a day over four days a week for five years, since his wife had died. It was his social life. The money was not really important to him. I think many of the people charging lower fees are older practitioners, who don't really need the money, but just want to keep busy.
     
  33. simonfeet

    simonfeet Active Member

    I charge £50 for new dom patients. Invariably when I ask about their medical history & medication, they are shocked or question the necessity. There's the rub,so many so called professionals undermining the standards of the profession.
     
  34. anthony watson

    anthony watson Active Member

    what do you take at your medical history?

    what assessment tests do you take?

    Just wondering

    Thanks
    Anthony
     
  35. simonfeet

    simonfeet Active Member

    Well circumstances vary due to the cognitive level of the patient & if low, the ability of myself to deduce from any drugs present what health problems they have.
    Then the patient's, feet skin quality,circulation. Usually if I suspect a problem & this maybe related to their health problems , simple tests of sensation.
    Really this is not an exhaustive summary. Look ,after 30 years in practice,gut feeling plays a part. If I dont feel the patient is unable to give me satisfactory information, I assume high risk. In so many ways,domicillary treatment is a compomise in comparison to in surgery treatment.
     
  36. Simon Ross

    Simon Ross Active Member

    "In so many ways,domicillary treatment is a compomise in comparison to in surgery treatment."

    Elaborate, on this statement please!
     
  37. foot rott

    foot rott Banned

    hi

    is the taking of a medical history an extra in treatment?

    Just it sounds like it is something special and not part of normal treatment.
    I don't do any private work but assess all home visits in the normal way.

    Do we need to do sensation tests as matter of course on non diabetic patients?

    Not having a "dig" but some pods on this site seem to think taking a history is something special.

    Thanks
    Ed:D
     
  38. foot rott

    foot rott Banned

    sorry, forgot to ask how been high risk alters treatment.

    just ask as been high risk usually results in having more rapid access and early returns.
    How does that work in private podiatry as I assume the fee is the same for a 3/12 or a 1/12


    Thanks
     
  39. Podess

    Podess Active Member

    Footrott,

    Where did you get that idea from? Taking a medical history is an essential part of treatment, and so is keeping it updated.

    A medical history is part of the process when assessing a new patient. It does take more time so some pods may charge extra for the first appointment.

    I would check the pedalpulses on a new patient but unless they were high-risk/candidate for nail surgery, I wouldn't necessarily use the doppler.

    It would depend on the treatment required. A dressing appointment (10 mins) would attract a smaller fee than a full treatment.
    If a patient has many at-risk factors, especially being at high-risk for ulceration, I would try to get them under the care of the local NHS Specialist Podiatry Clinic as I feel that would serve them better.
     
  40. Fliss

    Fliss Active Member

    Hi Claire,
    Sorry for my delay in replying. I'm really pleased that something good has come out of this thread, you go for it I say, give it your best, nothing ventured..... If it works out for you, which I hope it does, fantastic! If not, then at least you have tried and can try another avenue. Glad you're not giving up on something you are passionate about. :D
     
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