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Value for money for foot orthoses

Discussion in 'Biomechanics, Sports and Foot orthoses' started by nigelroberts, Aug 4, 2006.

  1. nigelroberts

    nigelroberts Active Member


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    Dear All

    Thought you would just like to hear a short tale from todays clinic. Patient presents with heel pain. Has been doing his research on the internet and thought he would save time and the NHS some coffers. Approached a firm approx' 300 miles from where he lives. Several telephone conversations later and he is happy to travel for his 98% success rate cure, approx' costs £700. He arrives, sees a man in a Saville Row suit, no diagnosis offered following discussion of his symptoms; straight into the sales pitch. 'Clinician' asks about footwear habits and pronounces that it would be adviseable to have 3 pairs of orthoses to cover all eventualities......... and as at all good estabilishments he has had his fill and asks for the bill.....£2300.
    Now I have visited the website of the 'firm' concerned and thankfully they are not from the profession of podiatry. The senior 'clinician' who claims the 98% success rate, says he prescribes 3000 pairs of orthoses a year. I think that works out at £2100000/year.
    It's amazing what you can earn with no morals and an ability to keep a straight face.

    Has anyone heard of more expensive orthoses than that?

    Cheers

    Nigel
     
  2. Admin2

    Admin2 Administrator Staff Member

    For those outside the UK, £700 = US$1335 = AUD$1744 = CAD$1506 = NZD$2134 = ZAR$9128 = EUR$1037
     
  3. Jamie

    Jamie Active Member

    You don't say if your patient refused to pay up?

    I think the term the guy uses is "Orthotic Consultant". The only way these people will be stopped is through Trading Standards taking them to court and giving them bad publicity in the Press. They could probably get the company on the 98% success rate as False Advertising - To use that statistic he will have had to have kept a record.

    The only way to counter this and to fight off the "Quacks" is to raise the Public Perception of Podiatry to a level where the Public understand that there are Professionals who are properly trained in advanced care for Feet. Until then they will continue to accept this abuse.

    The Price of the most expensive pair of Podiatry Prescripted Orthoses that I have heard of in the UK is £1500 - supplied out of Harley Street.

    Were they better value for money than those your patient was offered? Who knows - at least the "Clinican" was qualified and has Professional Indemnity Insurance.

    Cheers

    Jamie
     
  4. Lawrence Bevan

    Lawrence Bevan Active Member

    3000 per year

    45 weeks per year = just under 70 pairs a week. Busy chap...
     
  5. slaveboy

    slaveboy Member

    hi all

    treated one of his patients for plantar fasciitis she also bought 1 pair for trainers, 1 pair for dress shoes and 1 pair for ordinary shoes at a total cost of 1500 pounds.

    They subsequently did not work because they are not orthoses but in fact insoles with a heel cup.

    I treated her and now 100 percent painfree. I advised her to return and she did and got her money back all 1500 pounds. i have heard in the grapevine he is either being sued or has been sued if it is the same guy.

    sb
     
  6. Graeme Franklin

    Graeme Franklin Active Member

    Interesting thread.

    So what would a decent professional fee be for casted orthoses with 2-3 check-ups afterwards?

    Graeme
     
  7. slaveboy

    slaveboy Member

    we charge 265

    but london i think is more around the 350-500 mark

    sb
     
  8. davidh

    davidh Podiatry Arena Veteran

    Hi Graeme,

    I work on £640 (in the Midlands).
    That covers initial consultation, computer gait analysis (if needed), casting, laboratory-fabricated prescription orthoses, and follow-ups.
    My fees when I worked in Harley Street were a little more, but not much.
    Regards,
    davidh
     
  9. Jamie

    Jamie Active Member

    David,

    You are right to raise the costs of Treatment. My arguement is more philosophical and marketing based than Clinical but I hope you think has some relevance to the debate.

    In March 2005 I asked a question about the "value" of an Orthosis on the Jisc Mail - in a thread called "Patient vs. Clinician Orthosis Decisions".

    One of the replies from America, which I admired greatly, pointed out that it is not the initial cost but the "value" of the device to the patient that is important. This value should be measured in what the patient would be prepared to pay if you removed their device after a month's successful wear..... Thus justifying a high price if successful in treatment.

    The problem from a Podiatry Marketing perspective is how the high costs are perceived. In previous Threads on this website, especially about the Runners World Article, the "Outsiders" view of Orthotic Treatment has been tainted by the perceived high price. I believe the Runners World Journalist wanted to do a Watchdog style hatchet job but the Professionalism of the Podiatrists involved countered the negative approach.

    There is a saying about "making hay while the sun shines", so if you can charge that much then do it and retire on the proceeds after a couple of years. There are plenty of business models which show that Huge Profit products have a short product life cycle and are unsustainable in the long term without a proper foundation. There are exceptions but very few.

    In the rarified world of Harley Street with expensive rents and "machines that go bing" (Monty Python) the customers will pay £1000+ for Orthotic Treatment. There is also the Placebo effect especially if the patient is a footballer, if it doesn't cost £1000+ and is not gold plated it won't be any good.

    In the more down to earth world what prices do you think will be accepted in the long term?

    Work out your built in overheads and running costs for your time, equipment and premises then add the cost of the device and don't forget the costs of gaining the experience it took to be able to prescribe the device in the first place. Then add a Profit margin. But please, please, please show some restraint.

    Best Wishes

    Jamie

    PS - On the other side of the coin, I have spoken to 2 NHS Podiatrists today who are being stopped prescribing Custom devices because of NHS Budgetary constraints. What a wonderfully diverse world we live in.
     
  10. davidh

    davidh Podiatry Arena Veteran

    Hi Jamie,

    Some here may think my fees are high :eek: .
    I don't need to justify them, but I'm happy to explain them, in the context of what my patients expect, and what they receive in the way of podiatric healthcare.
    BTW my fees can be very much lower - not everyone needs orthoses, and not everyone who needs orthoses needs gait analysis or prescription orthoses.

    I should start off by saying that the vast majority of my patients are referred by their GP or by an Orthopaedic or Rheumatology Specialist. I also work closely with a Podiatric Surgeon. Probably 70% of my pts have medical insurance - most UK insurance companies will pay for consultation, gait analysis, casting and follow-ups, leaving the patient with a bill of £240 for their orthoses.

    My initial consultation appointment is used to talk to the patient, establish a rapport, and carry out an examination leading to a diagnosis (or check the right diagnosis has been made by the referring physician). I also explain costs and make sure the patient is happy with those before we proceed.
    I don't directly charge for my time in chasing x-rays, filling in notes, nor for letters to be sent out to the referring physicians, and sometimes to other health professionals. Nor do I make a charge (other than the lab fee) for orthoses which are sent back for alteration or refurbishment.
    However, I'm aware that I spend time carrying out these duties, and construct my overall fees accordingly.

    Computer gait analysis is not always necessary, but I like to carry it out. It's a great education tool for pts, and as well as providing a baseline of how that pt walked (on a hard, flat surface) on that day, it usually gives up bits of info that I can use when writing a prescription.
    I charge for casting, and for the orthoses. I make one further charge, for the 1st follow-up appointment. I expect to see all pts at least once more, but over 70% attend for further apppointments, either for monitoring, or for treatment (usually cross-frictional massage, which is also included in the overall fee). As some others do, if a patient is unhappy with their orthoses I am happy to refund them (only the orthoses cost).

    My direct costs include laboratory fees, and postage to the USA and back. Then there are Secretary fees, and my room rental (I have consulting rooms at 3 private hospitals). I have a sneaking suspicion, when I see total fees of under £300 (not unusual in the UK in my experience) that people simply don't count up all the hidden work that orthoses work (when orthoses are properly prescribed and followed up) entails.

    In closing, I agree with the USA response you quoted. Patients are not paying for a couple of pieces of cleverly-shaped plastic. They are paying for a total, or (in a minority of cases) partial resolution to their problem. In all cases the probable outcome has been discussed, both with the referring physician (usually), and with myself before treatment.
    Regards,
    Davidh
     
  11. Graeme Franklin

    Graeme Franklin Active Member

    Charging say £350 seems about right to me. Of couse they have to be comfortable and go some way towards alleviating symptoms.
    The problem arises if /when the patient for whatever reason wants their money back for an intractable problem or due to unrealistic patient expectations. This would wipe out the gains from 2-3 pairs of successfully prescribed orthotics. Pushing the prices higher!!

    G.
     
  12. Jamie

    Jamie Active Member

    Hi David,

    Thanks for your reply and as you describe your business you justify your costs to cater for your high end target market and specialists are always going to see the most in need. Believe me I am not averse to profitability and certainly not people selling Orthoses - but a pity you don't trust the UK labs (which is for another debate).

    One of my concerns comes from a meeting with a Specialist children's shoe shop in an affluent part of the South East. The owner was keen to link in with a Podiatrist and invited them to do a weekly clinic as part of his service allowing the Pod free access and a non - commission relationship believing it would be good for his reputation and benefit his business.

    All was going fine until a few months into the arrangement his customers came back to buy new shoes and complained of the high costs the Podiatrists charged. Evidently each child patient was being prescribed a pair of Orthoses for £350, plus the follow up costs were extra plus it was £350 for the next pair when the child had grown out of the first pair and needed recasting.

    There might have been a clinical need for a few Children, but parents at the school started comparing notes, concerns were raised about the shop in the PTA. - Not good for the shop's business and the Podiatrist probably bought a new car.

    David in one of your posts you advocate the results you have seen in your training workshops with a simple bit of cork and with the ranges of Preforms available there are viable alternatives to the high cost solution. NHS clinicans have to make decisions and often use the approach of fast tracking patients into custom devices based on highest clinical need using lower level preforms when appropriate. In a lot of Private Practice Clinics Podiatrists have to take the same approach.

    The highest prices for a Moulded EVA (Frelon style) insole and wedge I have heard of is £75 a profit of at least £72. Trading standards were involved.The Canadians at the Ideal Home Show and other transient venues make more profit than that.

    My view is that in the long term the Quackery will become exposed and it is important that Podiatrists maintain separation from this when it comes. Ten years ago SCP members were not allowed to put up more than a brass plaque to advertise their presence. There is still a balance to be found for how the Profession - in the UK at least - promotes itself and rises above the Quacks.

    Any ideas?

    Cheers

    Jamie
     
  13. Lawrence Bevan

    Lawrence Bevan Active Member

    I think the area where it gets problematic is "profit" on the orthotics themselves. Or in pricing schedules that show a one off price for the device + appointments. I myself am guilty....

    It has all been said many times before of course but it is tricky trying to defend both a high professional fee and a profit on a device. Historically "professionals" charge for their "time" at a rate that reflected their whole input and the time of their employees ie they might spend 3/4 hr with a pt but a further 1/2 hr writing reports, notes, letters etc. Also historically anything prescribed is down to a further 3rd party - Pharmacist, Orthotist etc.

    Charging a high hourly rate is fine, of course up to a limit, and is going to be influenced by overheads.

    Putting it simply, charging £72 pounds for assessment, prescription/provision of a freelen plus perhaps an offer to see for followup + £3 for the freelen is ok. Charging £75 "for the freelen" is open to suggestions of "profiteering".

    As to what is a reasonable hourly rate, if you saw 3 pts an hour a the rate Boots were charging for routine callous treatment you'd be charging £78/ hour. My Chiropractor sees 4/hour at £30 = £120/hour. Many Orthopods charge £200+ for initial consultation not including x-ray and this is often unspecified period of time as they will see more than one pt at a time!

    Everything has a lifecycle and things are changing in orthotic therapy. Its becoming more known about but as a result the market is filling with non-Pod prescribers and non-healthcare professional "prescribers". Also prefabs are becomming better and there use is justifiable. So I guess we have all to take note and keep ahead of the game?
     
  14. davidh

    davidh Podiatry Arena Veteran

    Cheers,
    davidh
     
  15. davidh

    davidh Podiatry Arena Veteran

    Laurence,

    You said:
    "I think the area where it gets problematic is "profit" on the orthotics themselves. Or in pricing schedules that show a one off price for the device + appointments. I myself am guilty...."

    I find it useful to look at orthoses as similar to eyeglasses. You, the professional, are fitting the eyeglasses (orthoses) to help a specific problem.
    Your client (patient) reasonably expects that you know what you are doing, and that the eyeglasses (orthoses) will do what you say.

    The only difference to my mind is that there are a few more variables with orthoses than with glasses (the ground, footwear, joints etc), so it may take a little longer than with glasses to reach the agreed-upon outcome.

    Charging a realistic, fixed, all-in cost allows the client (patient) the security of knowing they aren't going to run up extra bills if they need to return. It also allows the practitioner the security of knowing that any problems can be dealt with speedily, since the client (patient) will happily return if the orthoses are not doing the job/ don't fit certain shoes etc.

    Regards,
    davidh
     
  16. Jamie

    Jamie Active Member

    Hi david,

    Thanks for that.

    1 - I would say that the standard of UK labs has vastly improved both in Technology developments and fabrication skills. There is also more of a crossover from the Orthopaedic companies into the NHS and Private Sectors in Podiatry offering increased choice and better prices - But a clinicans choice should be protected so if it works for you stick with it.

    2 - There are dangers with linking the Preforms available to Professionals with those sold over the counter in Pharmacies. As you say it is difficult to justify charging more than from Boots but they are pretty low level products, try sectioning them at the heel to see what correction they actually give. I am sure it has been a successful comercial decision to sell them OTC to the consumer, it was a pragmatic decision to cut out the Professional and they are now on QVC. I know of one website selling the "Professional" level Preforms direct to the public and that is more worrying

    Again another debate - What happens if a person buys a pair buys a pair of functional insoles OTC and the next day they fall off the pavement and under a bus. Will it go legal?

    3 - Type of Car is seen as the biggest motivational factor for a Sales Representative. Nothing wrong with that at all but accept it as such.

    4 - Not sure about a sheltered life - I had a hard paper round. Dealing with the NHS is all about price and cost not value, it makes me cynical.

    5 - Valid point about the Training. The HPC is in place to sort it out. The fact it hasn't and probably never will but that is politics. It should have propelled the Profession as a whole forward but.........

    Best Wishes

    Jamie
     
  17. davidh

    davidh Podiatry Arena Veteran

    Cheers,
    davidh
     
  18. Jamie

    Jamie Active Member

    Dear David,

    Let me ask your opinion.

    1 -I have spoken and lectured to Podiatrists and Students on many occasions about Orthotic Provision and Material Science at Conferences and at Universities. As an "occasional" Educator I would hope my audiences find my talks informative, relevant, interesting and enjoyable, feedback forms on my efforts are generally pretty positive.

    In your experience of workshops training Practitioners to practice Biomechanics. Do you think that your trainees should be aware of all the aspects of Orthotic Treatment available to them, even if only to make the choice themselves that a Treatment/device would not be suitable. I know this is difficult in a 2 day course.

    My point is that there are tens of thousands of pairs of "Professional" and low level Preform insoles used by Podiatrists in the UK. That is a fact. There are also Customised Devices - both Casted and CADCAM. There are simple insoles with pads and wedges and Heel Lifts made of Cork, etc, etc, etc... These are all tools in the Orthotic Armoury available - as well of course as stretching, manipulation and simply taking the time to heal with no intervention.

    It truly makes no odds to me what option is used as long as the Trained Practitioner makes the informed choice. It might be dificult as a High level Specialist to "associate" yourself with the lower level products but as an Educator in such a broad subject I would have thought it was imperative to include all options.

    2 -The only duty of a Clinical Professional that really matters is to know his/her limitations. There are Graduate and Non Graduates in Podiatry who would benefit from learning that lesson. If you are a post qualification educator you are in a position to reinforce that.

    That is why I am against the Snake oil merchants - they have no limitations.

    3 - David, I am happy to discuss privately the state of UK Podiatry and what is really rotten at the core but probably best not to have an open discussion on this Forum. Safe to say that I am a lot more positive about SCP than I was 3 years ago and we are stuck with the HPC.

    Kind Rgds

    Jamie
     
  19. davidh

    davidh Podiatry Arena Veteran

    Best wishes,
    davidh
     
  20. Jamie

    Jamie Active Member

    This is a Philosphical debate rather than clinical....please feel free to ignore.

    Hi David,

    1 - Training - Thanks for putting some of my fears at rest. They stem from the potential of Commercial CPD Companies to overtly influence those with a lower level knowledge and perhaps the inability to make the right treatment choices.

    The CPD Points system with submitted course validation is now irrelevant with the HPC's CPD Portfolio taking its place. With the written "Essay" quality inspection - to demonstrate understanding of newly learnt techniques - starting soon there should be some interesting developments, lets hope there are not too many car wrecks ahead for individual Practitioners who rely too heavily on CPD teaching and a certificate at the end of the day. It depends how stringent the HPC QA inspectors will be, which to be fair to the HPC (For a change) has yet to be seen.

    I would partly agree with the ongoing argument in lower level Podiatry/Foot Healthcare about skills being as important as ability to read, undertake and disseminate research. But as people wish to expand their knowledge and are offered learning opportunities the Commercial CPD companies have a duty of care for their Trainees. With your aftercare programme you have covered my concern but do you take my point that you are in a respected position of Trust and are looked up to. I enjoy speaking to Final Year students best because I am an alien creature from the real world outside academia and often the questions they ask me have pushed me to stretch my own boundaries of thought, I can normally hold my own.

    A thought for you - If I did a Yachting course to increase my knowledge and from misuse of the knowledge learnt sank my boat by crashing into a lighthouse. Would it be fair for my insurance company to sue my instructor for negligence.

    Biomechanics Treatment > Change of Gait > Fall off Pavement > Under a bus > Relatives Sue Prescriber > Prescriber's indemity insurance company sues Teachers for CPD Company's public liability insurance :rolleyes: Perhaps I shouldn't read any more John Grisham books on holiday.

    2 - SCP fees - Another thought for you - I think the SCP fees are reasonable value for money. As a percentage of a Professional's salary they are not too painful (Admittedly not what my wife said recently). SCP runs a relatively compact secretariat in the middle of London and offer services to Podiatrists as well as necessary management of Professional issues and endeavours to meet politicians, even if I don't believe they will be effective in changing their policies. The Special Interest Groups who feed into the SCP build bridges for the Profession and the SCP is starting to coordinate them better. I am particularly pleased that they have had the foresight to employ a Communications Manager with a good web and marketing background, which colours my next point to you.

    My point to you about the SCP fees is that I can see a case (already proposed by Akbhal) for them being increased to £1000 with the surplus being put into a marketing campaign to raise the Profile (The Brand) of the Profession. The extra cash would cover the costs of Podiatrists going out to be champions to promote the Profession, increased co-ordination of promotional efforts and literature, Researched Strategic planning to give direction for the future, proper focused marketing. Lets raise Podiatry's game. Private Practitioners will see increased business more than covering the cost of the fee rise. NHS Pods will see an increase the perception value to the NHS and DofH perhaps leading to a 1 scale raise on Agenda for Change. Universities will see higher intakes, thus raising the quality of potential students, the Trade will sell more to busier practices wanting higher quality products, You can put up the price of your Orthotics...... All for an increase in revenue of nearly £5million (£600 extra x 8000 members).

    It won't happen because the percentage of Podiatrists in the UK who actually care enough about the Profession to accept the raise isn't high enough and those who might entertain the idea will be dragged back down by the apathetic. There will also be those who think the SCP should keep its head down and not help promote the opposition and those who wouldn't trust the SCP to deliver. It would drag the Profession up by the bootstraps but would need 3 years to kick in and lets face it the negativity would kick in with the 1st and 2nd renewal statements.

    .......That is what you call thinking out of the box and is why I think the SCP are actually doing ok. They are aspiring to be more dynamic and responsive, which means a lot. I tried to support the Foot Health Council because it was a neutral body but it became mired in politics and ran out of steam. SCP is the biggest game in the Podiatry town and I can't see that changing, neither can I see the distrust between the bodies evaporating in the present political climate.

    Now theres some thoughts for you.

    Best Wishes

    Jamie
     
  21. davidh

    davidh Podiatry Arena Veteran

    Hi Jamie,
    You said:
    "1 - Training - Thanks for putting some of my fears at rest. They stem from the potential of Commercial CPD Companies to overtly influence those with a lower level knowledge and perhaps the inability to make the right treatment choices."

    We go as far as we can to ensure our delegates can actually practice what they are taught. We do try to be objective about all treatment modalities.

    You then said:
    "I would partly agree with the ongoing argument in lower level Podiatry/Foot Healthcare about skills being as important as ability to read, undertake and disseminate research. But as people wish to expand their knowledge and are offered learning opportunities the Commercial CPD companies have a duty of care for their Trainees (some cut)".
    As a top-up degree-er myself I also do some mentoring of those contacts who are doing top-up degrees (I mentor six or so currently) - obviously at no charge. We also encourage people onto top-ups where practicable - not just the SMAE/ARU degree, but those offered by other Uni's, such as Brighton and Southampton.

    You then said:
    "A thought for you - If I did a Yachting course to increase my knowledge and from misuse of the knowledge learnt sank my boat by crashing into a lighthouse. Would it be fair for my insurance company to sue my instructor for negligence."

    No. We would argue that your insurance company should have checked both my boating credentials and boating Course before insuring you to sail around a lighthouse. You are not, after all, the only one who reads John Grisham :D .

    You then said:
    "2 - SCP fees - Another thought for you - I think the SCP fees are reasonable value for money. As a percentage of a Professional's salary they are not too painful (Admittedly not what my wife said recently). SCP runs a relatively compact secretariat in the middle of London and offer services to Podiatrists as well as necessary management of Professional issues and endeavours to meet politicians, even if I don't believe they will be effective in changing their policies. The Special Interest Groups who feed into the SCP build bridges for the Profession and the SCP is starting to coordinate them better. I am particularly pleased that they have had the foresight to employ a Communications Manager with a good web and marketing background, which colours my next point to you."

    No problem with the SCP fees. However the fees I pay are lower, and I contend that the BChA do as much useful Profile-raising as the SCP.

    Then you said:
    "My point to you about the SCP fees is that I can see a case (already proposed by Akbhal) for them being increased to £1000 with the surplus being put into a marketing campaign to raise the Profile (The Brand) of the Profession. The extra cash would cover the costs of Podiatrists going out to be champions to promote the Profession, increased co-ordination of promotional efforts and literature, Researched Strategic planning to give direction for the future, proper focused marketing. Lets raise Podiatry's game. Private Practitioners will see increased business more than covering the cost of the fee rise. NHS Pods will see an increase the perception value to the NHS and DofH perhaps leading to a 1 scale raise on Agenda for Change. Universities will see higher intakes, thus raising the quality of potential students, the Trade will sell more to busier practices wanting higher quality products, You can put up the price of your Orthotics...... All for an increase in revenue of nearly £5million (£600 extra x 8000 members).

    It won't happen because the percentage of Podiatrists in the UK who actually care enough about the Profession to accept the raise isn't high enough and those who might entertain the idea will be dragged back down by the apathetic. There will also be those who think the SCP should keep its head down and not help promote the opposition and those who wouldn't trust the SCP to deliver. It would drag the Profession up by the bootstraps but would need 3 years to kick in and lets face it the negativity would kick in with the 1st and 2nd renewal statements."

    I'm not a fan of chucking money at anything in the hope that something positive will happen. Is this not what Akbal's proposal entailed?

    Incidentally, I almost started to believe the SCP was changing :) after they voted to let grandparented become full members.
    What happened?
    A few weeks ago a grandparented colleague tried to join as a full member. The SCP membership secretary seemed to know nothing about the resolution!
    Hmmm...... :cool: .

    Good discussion Jamie.
    Regards,
    davidh
     
  22. Jamie

    Jamie Active Member

    Hi DavidH,

    This forum jousting is addictive. Last post for a while at a conference for a couple of days.

    Podiatry is changing and I am far more positive than I was 3 years ago.

    I went on a business course recently. One of the "nuggets" was about organisational behaviour and split all organisation workers into 4 categories. Do you think it fits Podiatry? :rolleyes:

    1 - :) +ve Players - Self evident - High energy people who get stuck in - coild be CEO could be the Cleaner.
    2 - :) -ve Spectators - People who watch and are happy to pat the players on the back saying "well done WE did it"
    3 - :( -ve Ghosts - Empty uniforms, people who have a countdown on their screensaver waiting for the day they retire.
    4 - :( +ve - Terrorists - High Energy People who actively do damage to the Organisation.

    I nearly posted that on TFS after a particularly bad spate of posting then thought it wasn't worth the hassle.

    I meet a lot of players in Podiatry, people who give a toss. Perhaps I have been a Terrorist myself at times and I do think a bit of negativity has its uses. At the moment the Players are all pulling different ways and there are far too many Terrorists (METAPHORICAL ONES if anybody is reading this). Do you think we can cut through the politics and bring the Players onside?

    Marketing The best marketing talk I ever heard was by a Statistician, a Professor of Mathematics at Kellogg School of Business in Chicago. He made Marketing as Scientific as Podiatric Biomechanics and was a rivetting speaker. Give a good marketing manager the budget and it could be spent very effectively indeed, especially with a bit of street smarts, it won't include TV ads I promise.

    Cheers

    Jamie
     
  23. R.E.G

    R.E.G Active Member

    David and Jamie

    This is an interesting discussion, but seems to have drifted away from the theme.

    I have just returned from a monthly 'biomechanics instruction/discussion group'. A (in my opinion) fascinating group of PPs and NHS employees, old diploma grades, old degree grades and very recent degree grads.

    Tonight's topic was modifications to preform orthotics.

    So I am really lucky, I left Uni with a sceptical opinion of Bio, having learnt how to cast and manufacture orthotics, including all the theoretical measurements etc, was then exposed to some very 'practical' bio company sales people, with practical approaches to non casted products, then Dr Spooner, then the MSc graduates from Stafford, and now S Bloor, founder member of the Podiatric Biomechanics Group and closely associated with Vectorthotic. (David you are not a top up degree pod, the diploma was the degree equivalent, not the Smae stuff you are supporting, why do you do this?).

    So I have yet to listen to a unifying theory, however I have met people with much greater knowledge of the 'conditions or deviations from normal, they encounter,' and their 'logic' for their orthotic intervention.

    However it still seems to me that 'it' is somewhat of an art.

    Perhaps like other artists some will command greater fees for their products than lesser known names?

    My 'style' is very much trial orthotics on preforms followed by more permanent customizable products. If working for USA insurance companies and they want casting fine!

    Income from my approach, poor, effectiveness, good. I see my problem is I am a bad salesperson, and find it very difficult to move outside of evidence based medicine.

    So let's look at costings.

    Assume average 30 min fee £25.(mid range?)
    Bio exam 30 mins
    Trial wedging and making of trial orthotic (double sided tape on X line?) 30 mins?

    So 2*£25 + materials £10 = £60.

    Life of this product perhaps 1 year depending on activity. If problem resolves and client wants to go for permanent product (try vectorthotic or Algeo's equilavent, both very adaptable).

    Cost of device £25, say 30 mins to adapt and 30 mins to issue = £75.

    Is this good value for money? Not for me but possibly for my client. The use of preforms is supported by EBM.

    I must say that if I was dealing with elite athletes etc my approach would be different and I would probably pass on to one of my trusted peers.

    I have started a new theme for 'value for money from Podiatry bodies fees' as I think it is a separate but important issue. :D

    No have not.

    Perhaps Ed can do this for me :confused:

    David. Jamie

    Nothing to add tonight, but yes what could the profession do with 5 million?

    Thing is Jamie in my opinion until the 'Profession' unites it can go nowhere. Our division frustrates all people of 'vision', and it is not just about profit?

    Bob


    Regards

    Bob
     
    Last edited: Aug 11, 2006
  24. davidh

    davidh Podiatry Arena Veteran

    Hi Bob,
    Interesting post.

    However :cool:
    You said:
    "(David you are not a top up degree pod, the diploma was the degree equivalent, not the Smae stuff you are supporting, why do you do this?). "

    And in the interests of accuracy I want to make three things clear.
    1. The old Diploma was not equivalent to a degree in podiatry/podiatric medicine.
    2. Although you are correct, I did the old diploma, I also did a BSc(Hons) Pod Med Top-up degree in the early 90's.
    3. The only "SMAE stuff" I support is their LA Course, run in conjunction with ARU. The practical part is particularly well-run.

    I like your costings breakdown and have started another thread on that topic here:
    http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=2592

    Regards,
    david
     
  25. davidh

    davidh Podiatry Arena Veteran

    Hi Jamie,
    You said:
    "I meet a lot of players in Podiatry, people who give a toss. Perhaps I have been a Terrorist myself at times and I do think a bit of negativity has its uses. At the moment the Players are all pulling different ways and there are far too many Terrorists (METAPHORICAL ONES if anybody is reading this). Do you think we can cut through the politics and bring the Players onside?"

    Are the Players really pulling different ways, or do the professional bodies (and this may well be my own version of a conspiracy theory) tend to stir things a bit?

    Why, for example (and I'm not bashing the SCP per se, it just so happens that they are the biggest prof body in the UK) is it not common knowledge amongst UK Podiatrists that medical insurance companies are perfectly willing to pay certain podiatry fees (surgery and biomech/consultations) provided a few simple critera are met?
    :confused:
    Cheers,
    david
     
  26. Heather J Bassett

    Heather J Bassett Well-Known Member

    Davidh, re refunding cost of orthoses? We had this debate today, to refund or not to refund. I could not come up with another profession that refunds if the device does not work. My $750 spectacles are not refundable if I am not happy, I have one week to decide if there is something wrong with the script and then it all over. Splints, cam walkers, dental crowns, surgery, physio, antibiotics and many other treatments are not refunded if they do not work. Where do we draw the line. If they give 10% improvement - 90% improvement. Are we guaranteeing they will work? To what degree? Interesting debate? Well it was in our clinic, what say you?
     
  27. davidh

    davidh Podiatry Arena Veteran

    Hi hj--ray,

    I feel happy offering a refund if things don't work.
    Why?
    We can't, no matter how clever we are, sort out every pt.

    I'd rather give the odd disgruntled pt a refund and get rid of them (maybe one every two years?). I feel happy about that.

    When I see a pt I look towards agreeing what we can and cannot do with the patient. This may not be a full cessation of symptoms BTW.
    The only pts generally, that I have problems with are those (usually male) pts who have senile dementia which I didn't pick up on in the first consult (my fault), or who go on to develop dementia during the treatment.

    I think refunding is a personal choice. I can defend my reasons for doing so, not sure I can defend or justify the concept, except to say that we are a young profession, and I think we really need to be seen to be squeaky- clean.

    What was the concensus of opinion in your Clinic BTW?
    Cheers,
    david
     
  28. Heather J Bassett

    Heather J Bassett Well-Known Member

    Hi David
    Ahhh, yes the dementia, so true, seen the odd case or two myself. We as yet do not have a concensus--the great debate continues.
    We refunded a disgruntled amnaesic female client this week. Her complaint a corn came back!? First refund that has been requested and issued for primary care in 26 years, not bad??? Again was not worth the hassle.
    By the way its about 3.15 am here an a Friday night.
    I've been to Pod Anonymous but its not helping with the addiction.
    Hi from downunder and goodnight
    regards hj
     
  29. Heather J Bassett

    Heather J Bassett Well-Known Member

    Hi Jamie, I am surprised you can get away with your 4th category.
    Heard of a legend Aussie cricketer called Dean Jones, he flippantly used this term on radio about an onfield player. Instant sacking, sent home in disgrace, publicly apologised to all. Now trying to save face.
    How times are changing
    regards hj
     
  30. R.E.G

    R.E.G Active Member

    David

    Not too sure this is totally relevant and possibly readers may find our bickering tedious, but :eek:


    Hi Bob,
    Interesting post.

    However
    You said:
    "(David you are not a top up degree pod, the diploma was the degree equivalent, not the Smae stuff you are supporting, why do you do this?). "

    And in the interests of accuracy I want to make three things clear.


    1. The old Diploma was not equivalent to a degree in podiatry/podiatric medicine.



    Technically you are correct, but practically I disagree, I believe Cameron wrote something on the history of Podiatry education. My point was that you went through a period of intense education and extensive ‘practical’ training, the change to ‘degree’ arguably was the inclusion of ‘reflection’ the inclusion of Hons was the teaching of research methods.

    All very credible, so although you associate with a cohort from a different background you cannot denigh your roots?



    2. Although you are correct, I did the old diploma, I also did a BSc(Hons) Pod Med Top-up degree in the early 90's.


    3. The only "SMAE stuff" I support is their LA Course, run in conjunction with ARU. The practical part is particularly well-run.


    From what I see you are correct and congratulations to them, but being on the editorial board of the Smae Journal surly says you ‘support their stuff? FHPs an all.

    I like your costings breakdown and have started another thread on that topic here:
    http://www.podiatry-arena.com/podia...read.php?t=2592


    That does not appear to have gone anywhere.

    Bob :)
     
  31. davidh

    davidh Podiatry Arena Veteran

    Hi Bob,
    You said:
    "I like your costings breakdown and have started another thread on that topic here:
    http://www.podiatry-arena.com/podia...read.php?t=2592

    That does not appear to have gone anywhere."

    That in itself is perhaps indicative of podiatry in the UK, although I hoped a few pods from USA and elsewhere may have joined in.

    I find it incredible that we as a profession (I'm talking UK here) haven't grasped the importance of medical insurance. Did you know there are around 7,000,000 people with private medical insurance in the UK today?
    Big area to develop.
    If I, as a patient had medical insurance, and the local Pod had not bothered to register with my insurance company as a provider - guess what?
    I'd go to a physio, osteopath or chiropractor who had bothered to register, and could allow me to recoup at least some of my fees back.
    That's one of the reasons (perhaps bigger than we think) why UK patients do not necessarily go to a Pod as their first port of call for foot pain.

    What frustrates me about this is that it's fundamental to being in PP, and every qualifying UK Pod should be appraised of the facts about medical insurance, and how to become a recognised medical insurance healthcare provider.
    (If anyone wants to know please email me).

    Cheers,
    david
     
  32. R.E.G

    R.E.G Active Member

    David

    7 million, now that does surprise me. :)

    Hope you can cope with the number of requests?

    Mine is on it's way.

    Bob
     
  33. Jamie

    Jamie Active Member

    Hi HJ,

    In the UK we have the Political Correctness thing too. Regarding the "T" word I guess we are a bit more hardened to it here, with a lot of people having personal experiences over the last 30 plus years. The guy who did the lecture was an ex-policeman and the course had been organised by the NatWest Bank, so was not a "mickey mouse" affair - bit I can't say that in a dreogatory sense anymore either.

    I have been trying to think of a more pertinent and PC word to describe the "active negativity" concept but have had difficulty.

    David - I no longer believe in the Machiavellian theories of Professional Bodies with a Jame Bond Villain figure pulling the strings at S.P.E.C.T.R.E. At the SCP recently there has been some pretty open debate and some good initiatives to move forward. Sometimes I despair at the lack of joined-up thinking in the Podiatry Hierarchy but Podiatry Clinicians are taught to practice autonomously.

    As an "influencer" to non Graduate Podiatrists - what do you think is a positive way for the Stakeholder Groups to work together - Either on or off the Forum - perhaps better off.

    Kind Rgds

    Jamie
     
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