Why I Prefer Having A ‘Mom and Pop’ Podiatry Practice

What is the best practice model for today’s podiatrist? I can tell you from experience that I have tried just about everything and I think I have figured it out.

Most of us have had the same dream starting out in podiatry school when we envisioned our practice as an empire. In your dream, you may have envisioned multiple offices blanketing all corners of the metropolitan city. Most of us dream and think big because we are motivated and intelligent people. After all, that is what got us to where we are now.

When I finished residency, I started to work as an associate for a well-established podiatrist. After a year, I started to buy into that practice. I think I did that because that was what I was supposed to do. I soon realized, for multiple reasons, that I was doing the wrong thing. The podiatrist that I was working with at the time was gracious enough to return the money that I paid him and I ultimately left to find work in a larger city.

For a while, I worked in a physician-owned multispecialty clinic. There were benefits such as having all specialists under one roof and linked electronic medical records to facilitate patient care. It was easy to bounce a case off an orthopedist, dermatologist, rheumatologist, etc. It was comforting feeling knowing that you had a team working with you.

However, I realized that I was just a number in the grand scheme of things. My contract could be terminated at any time. The business folks running the practice could tell you that “you are not working hard enough” or “your numbers are down,” or “you can’t buy that for the office because we found an alternative that is cheaper.”

I have also worked as an independent contractor in other podiatrists’ offices. Generally speaking, I was given patients that had the worst contracts such as capitated HMOs and the like.

I have started podiatry offices from scratch, literally with no patients to speak of. I have watched my practice grow throughout the years. I have had associates work with me but they have not lasted long. I am not sure if it was me or them, but I have learned what works for me.

I have found that the simpler you keep it, the better. I have two offices, one of which I will phase out after the lease runs out. I own my main office building and have two employees, a receptionist and a medical assistant. I can still see 30 patients a day and that is enough for one day. If I see any more than that, I feel I am rushing and not providing adequate time and care for my patients. With a small staff, I personally know everything that is going on at any time. My employees have to be efficient and responsible for their actions.

I have limited hospital staff memberships (only two hospitals) so I do not have to travel all over the place. I do not take emergency room calls and do not do hospital consults unless it is for my existing patients. That way, my schedule is very predictable. It took years to build a practice like that. I personally do not want to be at the hospital after office hours to do an incision and drainage. I personally do not like to do wound care so I refer these patients out to a wound clinic. You do not have to do everything. Pick and choose, and pretty soon you will be doing exactly what you want to do.

Yes, there are downsides for a “mom and pop” podiatry practice such as needing practice coverage when you are out of town or not being able to share costs and utilize economies of scale as large groups can do. Just remember that you can always make more money. However, stress and conflict in your practice will eventually undermine everything that you have worked to achieve. My modus operandi is the KISS principle (“Keep It Simple Stupid”). It works for me.



Anonymoussays: July 1, 2009 at 9:33 am

I hear you, Dr. Fishco. It sounds like you've had all the types & styles of practices that Podiatry has to offer. The Cool thing is that before you were an "old man" you got it "right or the way you wanted it to be.
After 3 major offices in southern Orange Co. Calif., with up to 6 associates & 5 hospital, 6-8 podiatric residents, I came back to the Veterans Administration.
I was in the VA back in the 80s. I liked it. I was happy there was an opening in my city,
I agree , KISS, works every time. Glad you got your practice life where you want it. That is the beauty of our profession. Isn't it great!

Timothy J. Byron, DPM, MS

Chief , Podiatric Surgery, VA, Med .Ctr. Nashville, TN.

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misterscruffsays: July 7, 2009 at 1:12 pm

I completely feel you. I am a medical assistant (graduated from http://www.scitexas.com a while back) and I have had experience with both big hospitals and small medical offices.

With big hospitals, I frequently heard words and ideas associated with corporations. Management would be constantly concerned with how long the patient requires care, patient turnover, avoiding law suits, and hiring marquee doctors that attract more patients.

With smaller medical offices, we were more concerned with the happiness and health of our patients. Big difference.

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Anonymoussays: July 9, 2009 at 1:18 pm

Dr. Fishco:

I couldn't agree with your outlook more. I have been a solo
practitioner for many years now and it's been wonderful. KISS works everytime!

Dr M.B. Lawson
Winnetka, IL

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