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Hi everyone.

This topic came up on another forum - I thought it would be interesting to compare what a Consultation and or bio-exam costs around the world.

Figures from the UK (fairly typical of one strata of private practitioner).
Please note that this Podiatrist is a graduate of some years experience
(Thanks Bob).

"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 to point out that UK Medical Insurance Companies will happily pay (perhaps not happily) up to £120 per consultation to a degree-trained podiatrist (not necessarily at Master's Level), provided the Pod has been in post-qualification practice for a specific number of years, and (not always but usually) the patient has ben referred by an appropriate Consultant (who holds a substantive NHS Contract, and is usually Orthopaedic, Rheumatology or Pod Surgeon). This is fact, and IMO is either a very well-kept secret, or suggests that the vast majority of UK Podiatrists are not happy charging realistic fees because they are not sure what they are doing (only my opinion).

One other point - I personally think all my patients are important. I would not make an extra effort for an elete athlete, although I may tailor their treatment programme differently.
For those who didn't see my fees, I charge £90 for a 1st consult, and go on from there.
Regards,
david

David

Seems like we agree for once, we would both 'tailor' our treatment programmes differently for 'elite' athletes.

You could well be right that the 'vast majority of UK Pods.....are not sure of what they are doing'. Or could it be that the vast majority of Pods in the UK have not chosen to specialise in musculo skeletal podiatry and have little knowledge of the unique requirements of various sports, or the space to employ sophisticated gait analysis equipment, so when faced with such clients, ethically acknowledge their limitations and refer on, as do GPs, to the specialists?

As far as medical insurance goes again I am sure you are right, but are the vast majority of UK pods exposed to such patients?

So please explain how you convert a £90 initial consultation into a £600 charge for orthotics.

Bob

Hi Bob,

Musculoskeletal podiatry is part and parcel of our general work (wasn't 30 years ago, but certainly should be now). Your undergraduate training should prepare you to take this on board.
When I was a chiropodist, in a private chiropody practice, in the NE of England, I fitted several pairs of prescription orthoses each week, I think the charge then (1979) was around £175 inclusive. This was before I'd done any degrees or had fancy letters after my name.

Choose your gait analysis equipment to fit your room. I use Tekscan (I've listed how useful I find it on another thread here). It fits and can be used satisfactorily in a smallish Consulting Room.

Bob, the vast majority of UK Pods are perhaps not exposed to pts with private medical insurance - their fault. It's there, and certainly physios, osteopaths, and most other graduate healthcare professionals take advantage of it. Do we UK Pods really think so little of ourselves that we don't feel we can share this? It certainly seems like that from where I'm sitting.

You asked my fee structure?
This is for a guaranteed agreed-upon outcome.
gait analysis = £180.
Casts = £80.
Orthoses = £240 (shells guaranteed for life by the lab - they also make orthoses small enough to fit in ladies fashion footwear, which still work quite well).
Follow-up = £50.
I think you'll find that including my consultation fee (30 minutes) that comes to £640. I should also add that although Med Ins pays for consultation, casts etc, they do not normally pay for orthoses, and pts are happy to pay for these (and often a 2nd pair once they see them working) themselves.

Regards,
david

David

Just when I thought we were ‘getting on’.

Thanks for the introduction ‘Figures from the UK (fairly typical of one strata of private practitioner).
Please note that this Podiatrist is a graduate of some years experience
(Thanks Bob)’. :) I had not realised I was a member of a strata, would be very interested to see your explanation of the strata. If you are implying I am a cheap underachiever, remember I live and practice in an idyllic part of the country, my choice, no traffic except when the City dwellers take their annual holidays.


’Musculoskeletal podiatry is part and parcel of our general work’ but David I understood you do not do any general work?

‘Your undergraduate training should prepare you to take this on board.’ Yes but like medical doctors we learn all but it can take years to become a ‘specialist’?


’When I was a chiropodist, in a private chiropody practice, in the NE of England, I fitted several pairs of prescription orthoses each week, I think the charge then (1979) was around £175 inclusive. This was before I'd done any degrees or had fancy letters after my name.’ I am tempted to say goody for you but that would be childish.

’Choose your gait analysis equipment to fit your room. I use Tekscan (I've listed how useful I find it on another thread here). It fits and can be used satisfactorily in a smallish Consulting Room.’ Sorry but aimed steps on to a force plate is not my definition of ‘gait analysis’. However a great machine that goes ‘ping’.


’Bob, the vast majority of UK Pods are perhaps not exposed to pts with private medical insurance - their fault.’ Probably but exactly how big is that market, remember you are talking about the Vast majority. It's there, and certainly physios, osteopaths, and most other graduate healthcare professionals take advantage of it. Do we UK Pods really think so little of ourselves that we don't feel we can share this? It certainly seems like that from where I'm sitting. Unfortunately I do not think there is such a thing as ‘we UK Pods’, perhaps if there was we would not be having this debate?

You asked my fee structure?
This is for a guaranteed agreed-upon outcome. Now that is interesting, a point taken up on another posting, if the outcome is not achieved do all monies get refunded or just the orthotic cost £240.
gait analysis = £180. Ok but just seems at best a way to confirm your Bio exam/ help in your prescription.
Casts = £80. Ok probably about right at £180 per hour.
Orthoses = £240 (shells guaranteed for life by the lab - they also make orthoses small enough to fit in ladies fashion footwear, which still work quite well). But how much did they cost you, could be thought of as double accounting?
Follow-up = £50. Is this optional?
I think you'll find that including my consultation fee (30 minutes) that comes to £640. I should also add that although Med Ins pays for consultation, casts etc, they do not normally pay for orthoses, and pts are happy to pay for these (and often a 2nd pair once they see them working) themselves. What at £240 again?

While I may seem to be challenging your charges I am in fact jealous, :( also having just paid £350 for spectacles I am a bit of a hypocrite and believe it can be done. As I said I am a rotten salesman and when describe the pricing structure of orthotics to my patient cohort get gasps of horror.

Is anyone else going to join in? Perhaps some of the graduates of your Bio workshops, and the fees they are achieving.

Bob


__________________

Hi Bob,

You said:
"I had not realised I was a member of a strata, would be very interested to see your explanation of the strata. If you are implying I am a cheap underachiever, remember I live and practice in an idyllic part of the country, my choice, no traffic except when the City dwellers take their annual holidays. "
There was no question of that. I live in a sleepy village myself and I'm very jealous of my time and my family-time.
I used your post as an example of how many pods in the UK (the strata is simply that section of Podiatrists in the UK who do a little biomech, attend lots of lectures by lots of experts (actually - most are "experts")) have not costed their biomech work out properly (IMO), have not looked at the huge benefits biomech could confer upon their pts and their Practice, and depend too much upon their professional body (whether that be the Inst, the Alliance, the BChA, or the SCP).
Big strata!
My opinion!

At the end of the day, you admit to looking at other professional fees and being jealous. Good.
What are you going to do about it?
Regards,
david
BTW, if you ever want to sit in on one of my clinics, just give me a shout :)

David

'What am I going to do about it'

An excellent question (jealousy is not really one of my emotions, unfortunately being competitive is).

The simple answer is nothing.

Unless some one comes up with a better 'plan/model' of orthotic provision than what I see today. Every man and his dog flogs 'insoles'. Your 'niche' market is enviable but how do you 'role it out' to all?

My example of spectacles seemed to me to be achievable because the benefits are easy to demonstrate, varifocals releases the 'old git' problem of 'lifting glasses', hence bl***y expensive. So how do we do that to feet.

Perhaps Jamie has some ideas?

Cannot let you go on this one,'worst patients are males with dementia or become demented while being treated', I 'specialise' in dealing with 'learning difficulties' never thought of trying to sell them orthotics, but should they need them I would not discriminate against them, but is their biomechanical abnormalities their biggest life style issue? :)

It's Friday night, time for the wine, have a good weekend

Bob

Hi Bob,

There's a time and place for wine.

The time is now - the place is, er, here - for me anyway
As they say up North - hey-ho hooch!

have a great weekend,
david

My fees, working in the South East

Initial assessment: £30
Gait Analysis: £100
Prescription Orthoses £250
Casting fee £50
Follow up £30

The patient pays no more after this. I undertake to pay for any alterations or adjustments for the lifetime of the devices (lifetime guarantee from the labs I use), including a recast if necessary. This seems like a reasonable deal to me, and I rarely have problems with patients paying these fees on the whole. I don't quite understand the reluctance to charge high fees. I just payed £200 for a pair of specs, which I expect will need replacing in 2 years or less, and £400 quid for a crown form my friendly non - NHS dentist!

"Basic" chiropody £32

Orthotics: £360 all in (assessment, casting, fitting and follow-up visits until patient is happy)

G.

Thanks for your imput guys.

Bob, you wondered if some of our students/delegates would join in this debate. These are two.

Regards,
david