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I know this has kind of thing has been aired before but needed to vent. Saw a pt yesterday who had not been getting on with the devices supplied by a consultant pod. She had been back and in response to her comment that there did not seem to be much success his response (apparently) was to say "give it more time". She was not venting anything or complaining about the pod but did feel that she was not being helped so came elsewhere.

The need to vent is that this lady was apparently charged £1900 for a single pair of orthoses (now that can be broken down how you want). I'm all for making a profit and earning a living but does this seem a too excessive?

Ian

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wow... was this pod paying for rent in a harley street address or for a new £1mil sunseeker

Hi CEM

No Harley street fees, a private hospital room to rent though but I guess this pales in comparison to the fee charged. I am still astounded. I guess it should not make any difference as to the age of the pt but this one was in their seventies. Mind you, that kind of money would not be easy to replace whether employed or retired!

Still having been covetous of my script writer cousins Aston Martin yesterday I am tempted

Seems we can slag off people who may who "buy" qualifications but accept that placing "Consultant" in front of the name ligitamises extortionate (?) fees!
Ian

Dumb Aussie question here - but what does the 'consultant' in consultant pod mean? Down here we are all just Pods (except a few Pod Surgeons who have specific quals and fellowship of the College etc).

cheers,

Felicity

Felicity

The prefix 'Consultant' has various meanings in the UK depending on the context of the situation.

Within the National Health Service this title is used to identify the highest medical grade e.g. surgeon/physician. Rooted in the evolution of socialised health care in the UK, the physicians and surgeons earning a healthy crust in private practice would, altruistically devote, out of a sense of ?duty, some of their time to those hospitals attending to the needs of patients unable to pay for medical care and would thus enter those hospitals and offer services in a 'Consulting' capacity.

In constructing the NHS Aneurin Bevan (the father of socialized health care in England) and faced with substantial opposition from the 'Consultants' entered into a pact, offering powerful fiscal incentives, as without the 'Consultants' the 'new' National Health Service would be unable to function. This set the scene for the Consultants to become a powerful group in this massive organisation.

The modern day Consultant will be the clinician, put bluntly, at the top of the game with specific duties and responsibilities, funding allocations and resources e.g. hospital beds etc.

Traditionally this is a title reserved for the 'doctor'. The profession of Podiatry in England was the first to make a dent. Able to secure the title Podiatric Surgeon, this evolved over the years and drawing on the medical model, the Consultant Podiatric Surgeon was born. Again with various additional hooks, resources, duties and responsibilities in the management, as well as provision of clinical services etc. In most cases this title wasn't just 'assumed' and would require ratification from the Faculty of Surgery and in agreement with the employing health body. In my case for example, I have a substantive contract and the title assigned to my post is that of 'Consultant Podiatric Surgeon'.

One powerful incentive for adopting this title legitimately is the fact that many private Insurance companies traditionally would accept claims only if the treatment is directed by the 'Consultant'. Those insurance companies will apply specific criteria to identify the 'legitimate' (?) Consultant. By tradition those who have held the title and then withdraw from the NHS may continue to use it.

We have also witnessed over the years a gradual weakening in the medical professions’ stronghold, and ‘Consultant’ posts have emerged in other professions traditionally considered ‘allied’ or ‘auxiliary’ to medicine e.g. Nursing posts etc.

Without a doubt the above is a crass oversimplification but I hope this sheds some light on the situation.

Outside of the NHS there are many types of 'Consultants'. The title is not protected in law in any sense. Consultant Business Manager, Surveyor, Contact Lens Provider, Financial Analyst etc etc.

It strikes me as very unusual for a Consultant Podiatric Surgeon (who are really the only legitimate holders - with the exception of one Consultant Pod in Diabets - I know, as I sit in the DoH pannels to approve them!) to prescribe this kind of care for that much money. Most I know often only prescribe at lab cost or a very small mark up. It may have been one of the surgical faculty but more likley one who has 'adopted' a consultant title, perhaps not illegally, but certainly immorally given its meaning in the UK.

Just to add to Deiter's excellent (I thought) explanation of Consultant in the context of the UK and NHS, I hold consultancies at three private hospitals in the UK, although I have never held an NHS Consultant post. This is by no means a unique situation, and although theoretically we can legitimately call ourselves Consultants, the term Honorary Consultant, or (the term I prefer) Consulting Podiatrist, seems more appropriate.

As Deiter also mentioned, most medical insurance companies in the UK want treatment sanctioned by a Consultant holding (or who has held) a Consultant post in the NHS. This poses no problem for those motivated enough to ensure they have good post-grad training, and who can be bothered to forge links with Pod Surgeons, Orthopods and Rheumatologists, most of whom are only too happy to refer appropriate patients on.
Regards,
david

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Old guys rule!

Thank you for the very clear and concise explanation! I have got to confess, I find it a bit curious, as the uber-egalitarian podiatry world down under just doesn't have this inbuilt hierarchy. It seems to be a good system in many ways, as it does give practitioners something to 'strive' for in terms of professional status. Will it withstand the less gentlemanly, Marquis of Queensberry environment of the modern Podiatry?

An inexcusible form of greed

That is Excessive, I paid $350 for my custom molded orthotics, they were super thin and molded right onto my feet, ready in 10 mins!

Wow, I am doing practicum for a pod who charge $389.oo Aussies for a standard pair by a lad with fully computerized scanning. Add in a office visit fee of $50.oo.
They last anything from a year to 8 years!
I am having fun!

Ian, what you received is termed a Direct Molded Orthotic, and should have a lower service fee. Although this is certainly an example of perspective, in my estimation paying $350 for a DMO is excessive. When an actual patient mold is created prior to the manufacture of a custom device, there should be a fee increase commensurate of that advanced service/expertise.

That said, unless perhaps it's personally blessed by spiritual deity of one's preference, paying $3000 USD for any durable medical foot device is ethically questionable.

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Jeremy Long C Ped
Smoky Mountain Foot Clinic

This is unfortunatly true. I can think of a company who sold orthotics, lets call the perish and bawl, who described their staff as "biomechanic consultants" and "senior biomechanic consultant".

No doubt blinged the masses.

R

This thread seems to be going a bit off topic. Regardless of the practitioner dispensing the orthotics and their title, do we really think £1900 is 'too much' for a pair of orthotics? Personally, I think you can charge whatever you like as long as you think you're worth that amount. It's a free market and if your orthotics don't work, and/or you're too expensive then you won't trade for long.

There seems to be a lot of suppressed anger at the parish and bell fee structure coming out on that thread too. I don't get it. We will probably never no the whole truth about their decline, but moaning about how much they charged because you don't charge as much as they did isn't going to help anyone. This comment is not directed at you Ian, I'm merely diverting from your thread (sorry).

Kevin Kirby wrote a nice Precision Intricast newsletter some moons ago about putting a price on pain. It's well worth a read. Also, have a look at what our dental colleagues charge, or opticians before worrying about other people's fees for orthotics.

"This comment is not directed at you Ian"

No offense read in it and none taken Bob. Indeed I can see where you are coming from. In this ladies case it was the complete lack of professional follow up and care that got me most. That should have been part of the price.

Cheers
Ian

Yes. I guess if your fees are relatively high, you really ought to be offering the BEST service possible. We should all be doing this anyway as professionals treating the foot and associated structures.

Bob and Ian:

"The Meaning of 'True Value' in the Medical Marketplace", May 1995 Precision Intricast Newsletter, in: Kirby KA: Foot and Lower Extremity Biomechanics: A Ten Year Collection of Precision Intricast Newsletters. Precision Intricast, Inc., Payson, Arizona, 1997, pp. 275-276.

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Sincerely,

Kevin

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Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

e-mail: kevinakirby@comcast.net

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
**************************************************

Thanks for that Kevin. A very nice article it is too.
Have a good weekend.

Like it or not, great doctors(of any kind) have the ability to present, market and sell their care to the patient and their support systems. A great elective surgeon presents 10 times and goes to the OR 3 or 4, not 10 times.
In my opinion, a professional degree and additional professional titles deserve a higher fee for services provided by those with 200 hours of working in an orthopedic shoe store and without the ability to function as a primary care provider or someone taking a weekend or website based course and becoming "Certified" because of the rigors involved in their foundational training.
That said, Part of Root's gift to Podiatry was that he provided a strategy created the public percetion that DPM's sat at the top of the biomechanical pyramid.
Our foundational knowledge in biomechanics was applied to a new theory that in the late 70's-80's made the orthotic accepted as an adveance to the arch support. I remember the sticker shock when I dispensed a $250 orthotic compared to the then gold standard $50 arch support.
Over time, the "doc has been removed from the box" and the professional title alone does not deserve automatic excess when it comes to fees. Scanners, foam casting, three degrees varus rearfoot posting, post to cast and laboratories that service shoe stores the same as they service professionals have made the $22 of plastic and crepe professional device no better than high tech OTC orthotics (thank you Dr. Payne).
Many on this Arena seem to believe (Graham and Dananberg and others excluded) that creating a "modern" language and research explaining why we suffer will create the strategy necessary for the public to once again place those practitioners at the top of the pyramid. If you check orthotic or biomechanics on spellcheck, they still come up missspelled today! Now look up GAIDS or Midfoot Spring Stress and see how much weight they have in the public domain.
My opinion is that until a new paradigm emerges that uses everyday language and a fresh and new presentation that akin to STJ Neutral is marketable to the foot suffering public and the medical community, professional fees will seem more and more excessive as in this case.
In addition, guarantees like "money back" if unsatisfied, "5 years on the therloplastic shell if the devices are refurbished", 60 days unlimited visits until the devices are either working or refunded along with devices that look cosmetic and "actually work" should add to the professional fee of the devices dispensed.
If I am dispensing a BMW orthotic, with marketing tools that convince the orthotic purchasing public of their value, with guarantees against failures and lemons and I stand by the product with my time and energy to "get them right", my orthotics should be high priced because thay are worth it.
In practice, using a sense of charity, I quote my fees ($800) and then adjust them (down to the lab fee or even pro bono) if the patient cannot afford them. If the $3500 orthotics support the needy part of a practice, I think that serves the community of that practice admirably. If it buys $300 baseball bats for your children, that is greed.
My fear is that eventually, in a mall kiosk setting or shoe store (Foot Solutions for example), patients will be able to purchase the very same orthotics that DPM's are tauting as the best (MASS for instance) making the professional fees the "ripoff" that you are correctly calling this consultant.
I am assuming that most of you, like me, have families and have devoted a decent piece of your lives to become and maintain yourselves as professionals at one level or another and that sacrifice entitles us to MAKE MONEY. On this very site, there are those who give lectures, run labs and sell books that I am sure are not dispensed without recompense? If you think that medicine should be a non for profit profession come clean and donate your bank account to charity before mocking a doctor making money.
I hope The Arena is wrong in that orthotic manufacture is heading to scanning and foaming taking the "doc out of the box" but it is my belief that a caring professional with a scientific education and a drive to improve service and modalities over time (In Practice) will always be able to serve a community better on the front lines of battle better than a computor, research paper or the internet.
“The doctor learns that if he gets ahead of the superstitions of his patients (or colleagues) he is a ruined man; and the result is that he instinctively takes care not to get ahead of them.” George Bernard Shaw
Dennis