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Fees - How do private practitioners calculate their charges?

Discussion in 'United Kingdom' started by Graeme Franklin, Nov 13, 2004.

  1. Graeme Franklin

    Graeme Franklin Active Member


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    Good evening everybody.

    Calculation of charges has always been an interesting subject for me. It seems many practitioners charge a similar fee to their competition on the assumption the competition is making stacks of cash. This is rarely the case as I haven't seen many pods driving Golf GTI's, Audi's, BMW's, Porshe's, Bentley's etc. Even established practitioners are very cautious of increasing charges. Why is this, are they afraid of offending the patients? There has to be a happy balance: if every new patient enquiry results in an appointment then your charge is too low, conversely, if it results in the patient going elsewhere you are charging too much. The problem is most pods err on the side of caution because they do not like rejection or confrontation. As far as I am concerned salesmanship is part of the job and rejection comes with the territory. Rejection should be welcomed because without it you do not know if you are charging enough.
    So what percentage of rejection should we be aiming for, or are we all playing boringly safe?

    Best regards,
    Graeme
    :) :) :)
     
    Last edited by a moderator: Jul 13, 2008
  2. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    There are 4 ways:

    1) What the market will stand
    2) What the person down the road is charging
    3) What the 3rd party funders pay/reimburse
    4) Zero-based budgeting (Add up the costs of runing the business and how much you want to make and divide that by the number of patients to be seen)

    The problem is when you do (4), it is usually very different to (1), (2) and (3) :confused: .... don't figure :eek:
     
    Last edited: Nov 13, 2004
  3. dmdon

    dmdon Active Member

    Hi all

    I used to play 'boringly safe', until a couple of years ago when I grasped the bull by the horns and totally 'went for it'.

    I see on average 5-8 pts by way of home visit per day Mon - Thurs, Friday I take off, Saturday is my busiest day and can see up to 18 - 20 pts both in a surgery and afterwards via h/v's. (surgery fee's are slightly less)

    I give myself 6-8 weeks holiday a year, buy a new car every 2-3 years (no, not a BMW usually a (reliable) Honda), if the car don't work, I don't work!

    On average I get 2-4 new enquieries a week out of them maybe 1, or at a push 2 will ask for treatment. New patients I try to see almost immediately, they seem to be impressed on relaibility I have also found that the phone rings when:

    a). After the school run.
    b). After 'Trisha'
    c). Christmas week all the way up to xmas eve
    d). When the inetrest rate comes down
    e). Late on a Friday evening when there is an important soccer game the next day (OC)
    f) Prior to summer holidays
    g). When the new yellow pages comes out

    Fee's I charge start at £28 for first visit and £20 for subsequent visists, this is regardless of the treatment. Orthotic treatments command a substantially higher fee of course, and I get 1 - 2 a month. Fee's go up annualy by £1.

    Fees are applied/charged for all pts no exceptions, negotiating is like the kiss of death, if people can't afford my fees they go else where with no hard feelings, or they say "I'll get back to you on that"

    When I arrived to the area I phoned around to all the local chiropodists and introduced myself and asked what they charged and their scope of practice (here we go again the 'S' word) the majority were helpful a coulple dismisssive. I then took slightly above the average fee and worked from there.

    Regards

    David D

    ps, I also got a good accountant (worth their weight in gold!)
     
  4. Graeme Franklin

    Graeme Franklin Active Member

    Hello David D,

    Thanks for your extensive reply; it seems my posting hasn't aroused much interest. Obviously pods like earning low salaries!
    Very approximately my conversion rate is 90% although I haven't done an exact analysis. I charge £24 for clinic appointments, pay rise pending in the New Year.
    The point I was trying to make, perhaps somewhat poorly after having a few beers, was that there are many practitioners who are afraid of charging too much for any patient. This may account for the general low charges in the UK. I don't understand why many people charge less for their domicilliary visits than Scholl charge for their clinic appointments.

    Cheers,
    Graeme.
     
  5. dmdon

    dmdon Active Member

    Hi Graeme

    I did post on another site (the one beginning with S) that all chiropodists in any given area should get together, have a beer, become friends and agree on a minimum charge, this should to some extent rule out the £5 a shot, (or less), guys and give those who are serious to this profession a chance at making a decent living out of it.........I was then , in not so many words, accused of proposing to try and form a cartel!

    I think at times we are our own worst enemies, its no wonder there isn't much communication (except on here that is) :)

    Now if you will excuse me I must go and tend my poppy fields

    Cheers

    David D
     
  6. steven

    steven Member

    work or hobby?

    Hello all,

    recently starting out in private practice has been a steep learning curve. One of the points that became apparent very quickly, was that patients/customers will tend to pay what you ask of them. WITHIN REASON, however it tends to be harder getting conversion rates from phone enq.. with a higher fee.

    But i would say that if they are going to visit you, then they are going to visit you. And unless there is a problem, in the patients eyes, they will continue to visit you.

    The comments on fees are almost a means of boasting to family and friends, as long as the product/service quality exists.

    In general i have adopted the view that those people whome seek regular podiatric treatment will not/do not notice the difference between a low or high price in real world terms. In that they will still be able to eat and pay the bills, visit favorite holiday destinations etc.

    I also accept that not every customer is my customer :eek:

    Being a realist i am also aware of the smaller number of patients that are in pain, cannot see an nhs pod in a timely fashion and are suffering as a result of inadequate expendable income.

    Given the fact that i only really see musculo-skeletal complaints and biomex at the moment this can be a problem, and i am 'too soft'. In that the package will be altered to suit the individual concerned.

    As ever we learn from our patients, i was recently advised to charge more and accept that it is not affordable to everybody. Hmmmm... :D

    Anyhow did i hear mention of a cartel!

    I would be on the street charging £5-£10 as i know some do, linking to the tittle of 'work or hobby'?

    Kind regards

    steven.
     
  7. dmdon

    dmdon Active Member

    Hi Steven

    I wasn't boasting, just stating a fact......or have I got the wrong end of the stick???

    Cheers

    David D
     
  8. steven

    steven Member

    wrong end! i'm with you on this one!

    Hi david,

    sorry, that was as clear as mud :). Trying to post between jobs as usual.

    I an with you on this one.

    regards steven
     
  9. Ronnie Coles

    Ronnie Coles Member

    Charges

    Hello David,
    How right you are, I believe you should charge what the market will stand but mainly what you are worth, if the £5 and £8 pods out there want to work for that then let them. They cannot be making a living unless cutting corners.

    PS I liked your idea first time round of a cartel, dentist do it

    Ronnie
     
  10. Tim VS

    Tim VS Active Member

    Hi Graeme et al. One of my favourite subjects! I've noticed in recent months a number of domiciliary chiropodists in my area retiring or 'quitting'. I would not be at all surprised if many of them are the cheapskates who have realised they cannot survive under the new regs. Interestingly, patients who have come to me from some of these el cheapo chiros, (I have had fees of betwen 5 and 10 pounds quoted to me!) are now paying more than double at my rates, and seem to have no qualms about doing so, once the initial shock has worn off. At the end of the day, if you are providing a good service then I believe you can charge a reasonably high rate, possibly higher than the competition, as I do in some cases. It is all a matter of confidence at the end of the day, which sadly many chiropody practicioners seem to lack.


    T
     
  11. davidh

    davidh Podiatry Arena Veteran

    Not necessarily.......
    Bear in mind that this is a world-wide forum. In other countries (or in specialist fields even in the UK - ie surgery or biomech) podiatry fees are directly influenced by what the medical insurance companies will allow.

    A specialist podiatrist working in those fields can charge anything from £50.00 upwards for a consultation. Gait analysis, orthoses, and surgical procedures raise additional charges. The total for consultation, gait analysis, casts, prescription orthoses and follow-up in my clinics is over the £500 mark.
    The pod surgeon I work with charges similar amounts for a surgical procedure + follow-ups.

    Cheers,
    David
     
  12. dmdon

    dmdon Active Member

    Hi all

    Going slightly wide of the mark, earlier this year I had to see an ENT consultant (no, I'm fine thanks for asking :D ), it cost my insurance company £250 initial consultaion....in at 2pm, in my car on the way home at 2.10pm...two follow up consultations at £150 a go, both under 10 mins, and in fact I think the last one was about 5 mins.

    Now thats what I call a fee :)

    Cheers

    David D
     
  13. Tim VS

    Tim VS Active Member

    B##**y 'ell!! :eek:

    Knew I should have paid more attention in Biology lessons at school :)



    Tim
     
  14. steven

    steven Member

    super duper delux medical pediure?

    Medical pedicure, £85 for 45 mins would be very nice on a full list. I just have to develop a french accent and at least, some culture?.....Damn counts me out :mad:

    David, are the fees you mention typical, and accepted with the mainstream providers of health insurance?

    regards steven
     
  15. Lucy Hawkins

    Lucy Hawkins Active Member

    fees

    Hi to all.

    I looked at fees in the local private hospitals about five years ago to find out what was being charged for a simple ingrowing toe nail op. The hospital in Hove quoted about £120 for a consultation, £600 for the op and more for any follow up and redressing. In Eastbourn the rate was £100 for the consultation and £450 for the op again with extras. That would be a nail bed resection or partial resection.

    Also a patient went to the local private hospital with a VP. The appointment lasted about five minutes. The patient showed his foot, the consultant froze the leision and the patient left. No debriding or padding or anything else. The fee £120, and if he wanted it done again, that was another £120! He went elswhere.

    Boots wanted from £170 for a PNA, which I think was quite fair, though I don't know what was included. An SRCh in Eastbourne was charging £75 last I knew, I think it's worth double that.

    Fees in general are lamentably low. I think that there is a lack of understanding of what business costs really are. There is your rent, materials, transport, your wages, administration, depreciation, your training and CPD etc. which everyone knows. Your wage cost is what you think you are worth. If you take some equivalent NHS rate, and why should you be paid any less, you have to add on all the extras, sick pay insurance, NI, pension etc., and consider the extra hours you do, it will surprise you just at how much you have to take in fees.

    As a rule the fee also defines your service just as price defines a product. Take perfume, the content cost pence, the packaging pounds, the marketing and branding even more, and on the shelf a small fortune, £40 for 50cl thats £2000 per litre, and it sells. At £14 you will attract a £14 customer, many will not trouble you if you charge £24. But £24 customer might feel it's not worth the risk going to a £14 chopper. The £24 service must be better, after all if you can get it others must think so too and anyway you are worth it. There is no point in charging a low fee just because you have low overheads, you should enjoy the benefit.

    Access to NHS patients may not be a good idea. I have heard of independent providers being paid £14 - £16 per treatment (Bexhill). To make that pay you have to give an NHS 20 min appointment service. Have you wondered why NHS dentists pack the patients in. They are not happy bunnies at the moment. Public sector finance is different as there is always another wad of money down the line. For example their pensions are not funded, which may yet cost us 10p in the pound in income tax. I don't trust them to come up with a fair reward, neither do I wish to sell my soul. I suspect that insurance based payment would be much better.

    What you sell is a service which has benefits for the customer. It is the perceived benefits that the customer pays for. It is those benefits which you should market

    As for pedicures, I believe our French friend is charging £100 in Claridges.

    By for now
    Luke Hawkins
     
  16. davidh

    davidh Podiatry Arena Veteran

    £50 for a consultation is probably the lowest a specialist podiatrist doing medical insurance work would charge............ but yes, mainstream providers accept this level of billing :) .

    To make it quite clear though, this is for specialist work. A podiatric surgeon may or may not have a degree in podiatry (usually they will), but they have done extensive post-grad training, and been examined at theory-level and practical-level. A podiatrist carrying out biomech work (gait analysis, orthoses etc) will have some post-grad quals (the "gold standard" in the UK is probably an MSc in biomech or bioeng).

    Most medical insurance companies will require the podiatrist to have been qualified (read SRCh, or HPC-reg as it is now) for five years.
    They will also require the patient to have been referred by an NHS Consultant.
    Many podiatric surgeons hold this title and can legitimately see their private patients with only a GP referral. They can also refer on to a pod who specialises in biomech, which is how I see many of my patients :) .
    Regards,
    David
     
  17. davidh

    davidh Podiatry Arena Veteran

    I recognise that it may not be wise to take in NHS patients via a local contract :eek: . NHS contracting-out would have to be properly set up at national level, with up-front monies available to set up a practice, with guaranteed income levels, and with contracts which ensure continuity.

    20-minute appointments for routine care are fine. I worked like that in private practice for years - no problems.
    Cheers,
    David
     
  18. steven

    steven Member

    Thanks david,
    far better than the small print on schedules!

    Looks as though CPD pays in the end :)

    regards steven
     
  19. alex catto

    alex catto Member

    Private Practice

    I have to say that it's a real treat to see colleagues actually wanting to talk about the business of private practice. I think the HPC is going to be a wake up call to the profession in the UK. Serious money is going to be extracted from registrants for the privalage of allowing them to continue treating their patients. It could well be that the practices that are going to survive the next few years will only be the ones that can AFFORD to keep up with the legislation. (We've all had our premises surveyed for asbestos as required haven't we? See the fee your surveyor charges you!)

    My practice survives on high quality "core value" chiropody. I hate the term "cut an come again" The PNA's Biomex etc. I regard as jam on the bread. As has been said, patients pay for benefits, and we make their visit to us a very pleasant experience. I don't understand why certain sections of our profession denigrate "routine" treatments. If an OAP is willing to pay my "routine fee " of £35 rather than go half a mile up the road to the free NHS clinic, this must make some kind of a point.
    As regards fee structuring...I'm with the school of " work out all your expenses, then work out what you want your practice to deliver in the way of t/o having factored in time off, and divide the figure by the number of patients you have to see to obtain that figure." It's not rocket science. Private practice is all about perception. How your patients percieve you and your practice. Look and feel successful and that's what you'll become. Our American colleagues have known this for years and it's about time we caught up!

    And IT WORKS. For what it's worth, I worked 32 4day weeks (no Sats.) last year, drive an Merc SLK and thoroughly enjoy my life. If I can do it, believe me anyone can.

    Get together in the pub regularly as we do in my area. Talk to each other and you'll find you all have the same business problems. Try visiting each others practices...there's a novelty! But you'll learn from each other. Keep up the dialogue!!
     
  20. davidh

    davidh Podiatry Arena Veteran

    Hi Alex,
    Thanks for your posting.
    I also enjoyed your recent, very informative article on PP in Podiatry Now.

    As a successful private practitioner, may I ask canvass your opinion on a matter being debated elsewhere on this site?

    How would you feel about taking on a quota of NHS patients - either into your existing practice, or into a (new) branch practice? You probably would not want to work this yourself, given your quoted clinic hours, which I think are pretty realistic.

    Many of us who have been around a bit :eek: remember the last time this was done, and the fiasco which resulted from these patients being withdrawn from private practice at very short notice (a month if I remember correctly).

    The new proposal would circumvent this by nationally-agreed contracts, which I guess would include;
    having monies available up-front (either in the form of a low-interest loan or as part of 1st-year income) for practice establishment, realistic notice of withdrawal of patients (or withdrawal of labour by the pod), payment up-front for work being carried out, etc.

    Good for you on driving a merc. I do like to see pods in decent cars :) !
    Cheers,
    David
     
  21. alex catto

    alex catto Member

    NHS pts. in PP

    Dear David.......I'm glad you enjoyed the article! I too was around when The Halsbury Report was implemented, and many practices lost their NHS patients.This, as you will also recall, was after the same practices had been continually asked by the local health authorities to take on more NHS patients.(remember that?) It should also be remembered that The Society continually warned practitioners NOT to take on too large a case load of NHS pts. Just in case.....they were proved right.

    However, in retrospect, it showed just how few "private" practices there were at that time, with many losing up to 60% or more of their case loads.When the dust settled, the practices that survived agreed that they were actually better off financially, for this created waiting lists where none had existed before and the same pts. had now to pay for treatment if they couldn't wait. (In my area of Richmond Surrey.......pre Halsbury, all NHS chiropody was carried out in Private surgeries)

    Anyway, after that trip down memory lane....yes I would take on a NHS case load BUT only because I have a "spare " surgery that could be utilised. You're right.......I wouldn't treat them. I'd employ an associate, pay him/her more than the NHS and still be profitable. This would only be viable on a fee per treatment basis at around the current NHS "contact fee" or whatever they call it of £20. See 3 pts an hour........and watch the waiting lists shrink!!

    BUT BUT BUT...........If we're talking a dental model of payment with an annual one off fee per patient, and having to get permission for extra/specialized treatments.......then I don't think I'd be interested. The figures would have to stack up, and I can just imagine the admin involved.

    Any NHS work would be run as a separate part of the business. Just in case!!!! I certainly would NEVER rely on it for ANY part of my main income, and wouldn't consider taking on a new surgery for NHS unless you had a cast iron contract with your Trust. Which I don't think you'll get!

    Hope my ramblings add something to the debate.

    Alex
     
  22. Hello Alex

    I can see we're going to have an interesting chat when we meet up! You make comment about a system of payments for practitioners who take on a component of NHS work. Can I offer some observations?

    The problem government will have with a per item or per capita fee is the same one that blighted the dental service before it pulled out from NHS work - namely it does not provide value for money and is ripe for exploitation. With podiatric care (more so than dental care) if a per item fee is set against each patient visit, there would be little incentive for the practitioner to adopt a more curative regime into their clinical practice. For example, when a patient presents with footwear-related dorsal 4th PIPJ corn, best practice would be to remove the lesion and either modify the footwear with a balloon stretch or have the patient purchase new shoes. But if the practitioner were to receive a fee each time the patient presented to his or her surgery with the same problem the natural tendency would be to forgo the footwear element of the care. In essence it would promote (and I know you dislike the term) ‘cut & come again’ practice. From the NHS and government point of view this would not represent value for money and from a professional perspective it would anchor the profession firmly in the palliative care regime of the 1970’s.

    That said I can fully understand why from a business standpoint, you would be happier with a per item scheme! Dentists milked the NHS system for all it was worth before the government pulled the plug and lowered the fees. If we are to go down the line of having an established general podiatry practice network in the UK which encompasses both fee paying and state supported patients then we need to devise a system of remuneration that is sustainable and favourable to all parties. Remuneration can take other forms than just a managed care fee (supported by caveats for complex conditions – as you noted). There can be practice development grants; funding for staff and equipment; incentivisation payments for screening programmes.... ad infinitum. That way if you have a national footcare scheme for cutting toenails in the elderly you might have a 'fee' of (say) £5.00 levied to the patient but receive additional payments from the State to support the practice, thus increasing your income to a respectable and desirable level. To achieve that platform we must first, as a profession, convince government that podiatric practice is an important facet of modern society and has an undeniable value which is worth supporting. Oh and using a volunteer army and denegrating general podiatric practice to 'social care' - and yes, allowing the regulator to make an ass of standards within the body of the profession - does little to convince anyone that the practice of podiatry has any real 'value'. That is why we must quickly rethink our professional strategy if we are to make real progress in practice establishment.

    I’m not at all against podiatrists earning six-figure incomes and neither are politicians, providing there is a measurable improvement in the nations foot health. Payment by results rather than by numbers; quality rather than quantity. That is the only way to go.

    Kind regards

    Mark
     
    Last edited: Nov 23, 2004
  23. alex catto

    alex catto Member

    Hello Mark,
    All your observations are valid, and I admit my last posting was based on a purely business footing rooted in the here and now.

    You've summarised the dilema beautifully!! When NHS work was done in PP surgeries I seem to recall the pt paid 15p (!) towards his treatment. You are quite right .......the Govt are not going to be exploited again as they were by the dentists. I don't think we'll get a fee per treatment deal much (as you say) I'd like it!!

    However, I've to be convinced we'll get a decent deal for preventative podiatry as well. What happens to the pts. who won't/can't afford to e.g. get shoes that an orthotic will fit? If we
    discharge them why not do the same to un co operative smokers in the hospital system? Someone's got to treat them, and they need treatment. How's about a speciality post in palliative care? That's novel!! Make a change from diabetes!

    As you say.......lots to discuss!! But at least Private practitioners ARE starting to talk!

    ....if we can prove our case re: improving the nations foothealth then we might get a decent deal. But I can't help thinking it's a long way off.......and would you trust a government with the statistics!!

    I'm all for the profession going forward, but as far as the NHS is concerned, I'd want a decent deal and decent assurances. (not have my NHS pts taken away at 6weeks notice like last time)

    And we haven't talked about the surgery inspections that would have to be carried out..........or the admin . Never mind about your receptionist.....who's for practice managers??!! Still, as I said, if the deal stacked up, It MIGHT just be worth it. Who knows

    Best wishes, Alex
     
  24. Alex

    I think it’s going to be a long dinner.

    All your points are valid and I can tell are borne out of years of experience. There are a lot of issues that we need to look at. Say for example a patient qualifies for state care but refuses to comply with your advice [No Mr Catto, I’m not wearing those shoes, there’s nothing wrong with my Van-Dals!] and she wants treatment to her troublesome corns every four weeks. To a certain extent that situation already exists in NHS practice and sometimes the problem – like the corns – is intractable. Especially when the patient complains about your persistent reminders and the management bow to her pressure!

    My own view in these cases is that the patient should bear the cost of the treatment and if we are to have a general practice scheme there has to be effective mechanisms in place to address all these circumstances. It’s much more complex than just contracting services out!

    You touched on a very important point when you mentioned inspecting practices. Not only do I believe that the profession needs a dedicated regulator, I also think it essential that we have a Podiatry Practice Board which will advise, inspect and uphold standards – from premises and equipment through to patient management and fraud prevention. Such a body would also be responsible for payments and agreeing fee structures and as such will have to operate at a local level but within a nationally agreed framework. Good jobs for podiatry managers when the existing service is cut to a small core salaried workforce – Stephen Moore take note!

    I’ll try and finish the objectives and strategy proposal that I started on the SCP forum recently by the middle of next week but I have an email box that has become quite ridiculous in recent days – yesterday I had nearly 130 to give a reply to! You are right – people are starting to talk, and that’s no bad thing; it’s about time this profession woke up!

    Kind regards

    Mark
     
  25. podrick

    podrick Active Member

    fees

    as an american practitioner i found this discussion about fees among our british colleagues not to different from what we are going through.in the states podiatry is covered is by both public and private insurance plans.however,many practitioners are being squeezed by shrinking fees and ever rising costs of operation.
    many of more successful practitioners are resorting to the dental model of time efficiency and to office dispensing.we are desperate to find new sources of income.the point for us is that when the government sets your fees. it is very hard to get the public to pay higher cash fees.
    in the states american podiatrists do drive beamers and benzes.we just can't afford them.
     
  26. davidh

    davidh Podiatry Arena Veteran


    See?
    I KNEW other pods couldn't afford their cars :D !
    Cheers,
    David
     
  27. Pod on sea

    Pod on sea Active Member


    I recently looked into getting an entertainer for my daughter's 6th birthday. If I have a 'fairy' come to the house and play games and do craft activities for 2 hours with 6 little girls, it will be £120. She's also very booked up! By the sounds of it most pods don't charge as much as £60 an hour. The mind boggles- are fairies worth more than Pods? Could we put our fees up if we wear a fairy outfit in clinic I wonder?
     
  28. Dido

    Dido Active Member

    I think you have hit the nail on the head, Pod-on-Sea, :good:

    Alex Catto made a prediction on this thread in 2004 which seems to becoming a reality :-


    Here are some prices I have been quoted/have paid for work :-

    The plumber charged me £2000 labour for fitting a new bathroom - assuming that he worked a 40 hour week then that equates to £50.00 per hour.

    The chap who mended the washing machine charged me £70 (which included a small part) and was in the house 15 minutes.

    My vet charges me £35 for my cat's yearly boosters, and I am in the surgery about 10 mins.

    The tree surgeon charged £300 for cutting down and removing a diseased tree from my property. It took him about 3 hours (and then I presume he would have to dispose of the wood.)

    These are not complaints but just a few examples for comparison.

    Does anyone know where I can buy a fairy outfit?

    Dido
     
    Last edited: Aug 15, 2009
  29. DAVOhorn

    DAVOhorn Well-Known Member

    Dear All,

    In my humble experience Pods usually think of a number and HALVE IT :butcher:

    Then their competitor undercuts them a bit more:bang:

    So Pod goes for market share in the $10.00 market.

    What do you Pay your Dentist, Optician etc etc or even your Placebo Therapist.

    Seriously the fees here in Sydney are not great but Govt Schedule fee tends to set fees here.

    As a Profession we really undervalue our selves, skills and the relief from pain our skills provide.

    Look at your local HAIR EMPORIUM and think to yourself many of my clients go there once a week. Cogitate this and then reflect upon your fees.

    Do you want to see thirty $10.00 pts per day or 10 $30.00 pts per day or 3 $100.00 per day.

    All the above result in earnings of $300.00 per day but your costs vary wildly.

    Remeber the expression that my FEE represents excellent value:drinks

    As i am by nature a lazy illigitimate child, doing less for more has a pleasant ring to it.

    regards David
     
  30. david3679

    david3679 Active Member

    I like the thread of this posting as it has pods talking about charges.

    I run a two practice set up with also a residential home side to the practice.

    I average my hourly charges for when I work at a minimum of £80 per hour.
    That is for a chiropody treatment.
    when I do nail surgery that rises to £200 per hour
    when I do orthotics the hourly rate rises to £500 per hour
    the treatment charges in the residential homes are lower but is designed on a through put basis and is done b y an associate.
    I learnt a lot from a chiropractor i worked closely with for four years before setting up my own dedicated clinic.

    One comment is patients are funny folk. I had a lady who would see me once every 8wks and asked why I charge £25 do "do her Corn" she then proceded to tell me how she went to a Chiropodist in a market once a week at a £5 every week and why didn't I charge the same. I said why doesn't your other chiropodist do your corn for you. Her response was she isn't very good at that.!!

    Don't figure

    Dave
     
  31. Graeme Franklin

    Graeme Franklin Active Member

    Ah, an old thread revisited!

    Things have moved on since 2004 and so have fees.

    Clinic £36, nail surgery £250, bespoke orthotics £400.

    What are other people charging nowadays?

    Regards,
    Graeme
     
  32. Jacqui Walker

    Jacqui Walker Active Member

    Interesting reading - having recently moved to a new area was stagered when registering with my dentist that I had to pay a fee of £50.00 to be ACCEPTED :confused:on to their client list, and my last visit cost £36.00 for the privilege of a check up that took a total of three minutes from my bottom hitting the dentist chair to me walking out the door. And guess what - I'll turn up in 6 months time and be subjected to paying £36 for another set of non-treatment :deadhorse: So having weighed up what everyone else is saying, the price is going up and I don't mind if the next few prospective clients say they'd rather go elsewhere! (anyone know where I can by an SLK? ;)
     
  33. dgroberts

    dgroberts Active Member

    On a related note can anyone tell me what is an accepted fee share in %age terms for an associate working in an established practice.

    I may (or may not) be offering to do an odd evening or Sat morning session as well as my full time NHS work. I have a figure in my head per hour that I'm willing to do this for and wondered what arrangements other folk worked to.




    On another related note. How do PP earning compare with NHS?
    I want to do it but really rather apprehensive about investing a lot of time and money only to find myself no better off!

    Top band 6 pod in the NHS will be on £33,463 and have a pension and benefits (hols/sick pay etc) that are said to be worth another say 20% of that. You would need to making a gross salary of circa 40k to compete in PP. Also bear in mind that is for a 37.5hr week.

    So, are people making it pay??


    BTW that 20% addition is something I read in an official NHS publication regarding pensions but I can no longer find it?

    Other think to bear in mind I suppose is that we will probably not have an NHS pension as such when I come to retire. "They" are "tranforming Community Services" and it soiunds a bit scary! Glad my wife has a secure and well paid job :D
     
  34. Lawrence Bevan

    Lawrence Bevan Active Member

    This raises many points but 1 relating to the NHS pension. Basically the public sector pension is "off-balance sheet" (hidden) in terms of government spending. There's a good reason for this - its in huge deficit - total public sector pension deficit is probably heading towards the trillions not billions! If this was on the official balance sheet the UK would be officially bankrupt and the IMF would be in charge - and they would slash public sector budgets probably by 20-30%. But because they are off-balance sheet doesnt mean these deficits dont exist - they do - and will have to be acknowledged at some point!

    They are thus unsustainable so they ultimately simply wont be paid out - unless this government succeeds in stoking up so much inflation that all the deficits are made to seem small - but by the same token the same pension wont be enough to by a loaf of bread....

    But back to Podiatry the current NHS pay makes an interesting comparison. If we do some sums:

    subtracting NHS annual leave allows 44 working weeks in a year. If we assume you saw patients for 30 of your 37.5 hours thats 1320 patient contact hours.

    If we say NHS pay with benefits is 40K then that requires a minimum profit of £30 per hour. Thus if turnover was £60 per hour and overheads 50% that would be just enough to be equal NHS pay. If there was 1 DNA or cancellation not filled per year or any practitioner sickness then the pay would obviously be less than NHS.
     
  35. Pod on sea

    Pod on sea Active Member

    I agree with the previous post that it's hard to make a lot of money in private practice. Believe me, turning over £80k + is no easy task. Remember there's no paid holiday, paid-for CPD or sick pay. I reckon that now, after 21 years since I qualified, I would probably earn more in the NHS. However, I like being the captain of my own ship, and flexibility to work when I chose (within reason). The best way to make a lot of money is to employ a few staff and run a multi chair clinic, and rent out space to other practitioners.But that takes a big investment and a lot of risk.
     
  36. david3679

    david3679 Active Member

    this thread is almost going full circle and coming back to the thread do we have a job or a business.
    It is very difficult to run a practice and get on that generates good income without being dependant on the primary practitioner. The issue comes back to how you set your business up. do you set it up to generate money without you. or do you set it up to generate income while you are enjoying yourself.

    I made a mistake of building a practice that was totally dependant on me I was generating an income of £150K
    I didnt want to continue playing in the fast lane and wanted a business model to move away from single practitioner dependancy and build a business that generated money without me. Stressful to start almost from stratch but its about being able to balance lifestyle and work challenges

    Dave
     
  37. Pod on sea

    Pod on sea Active Member


    Indeed...sounds like the only way in the long term. Would you be willing to divulge if you achieved your aim and what you did?
     
  38. Pauline burrell-saward

    Pauline burrell-saward Active Member

    I charge £24 treatment, had hoped to put that up but recon the "credit crunch" put paid to that this year.
    Orthotics £300.
    nail surgery £250.

    If you undertake General podiatry, I feel you will never make as much money as NHS but you make up for it with "life style"

    holidays when you choose( unpaid off course), what hours you chose,day off when you wish.
    no one tellng you what to do and how to do it.

    for me that means much more than the gravy train thats the nhs.
     
  39. david3679

    david3679 Active Member

    Pod on sea

    That is a process that I am still doing. The biggest problem that i noticed about a practice dependant on a single practitioner was the promotion of the practitioner themself. I have a very good reputation in the location that i work with numerous practitioners recommending my skill set. The easiest way to resolve the single practitoner problem was the introduction of a brand. the skill set needs to be understood and taught to any associates. Patient retention is also an area that is often overlooked as its about income.

    I am about half way though my transititon period, 10 months in and is stressful. However in 10 months time i should have a business that will generate 10 k a month by two associates when i am not their.

    I have a practice that has ten clinic rooms and numerous professionals to rent that space. As the practice grows then i will have two different businesses. One the rental of the building with myself as a tenant and second one a successful podiatry business. The difficult part is knowing when you require an associate to help and not looking at it as income you could have earned. The importance is patient experience and journey though your facility

    if you have a specific question ask away
    Dave:drinks
     
  40. Lawrence Bevan

    Lawrence Bevan Active Member

    Of course NHS pay is one comparison but I fully expect that with the forthcoming bankruptcy/debt default of the UK "plc" public sector pay is going down, down, down.
     
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