Don Pelto, DPM - Podiatry Practice Mastery

Don Pelto, DPM
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🚀 Podiatry Practice Mastery — Grow Your Podiatry Practice to $1M+ Without Working More Hours Are you a podiatrist ready to scale your practice to 7 figures and beyond — without burning out? Podiatry Practice Mastery is the podcast for growth-driven podiatrists who want to increase revenue, improve patient flow, and build efficient systems — without adding more clinic hours or sacrificing their quality of life. - Get my Free Million Dollar Practice Formula - https://www.podiatrypracticemastery.com/

  1. FEB 12

    Most Valuable vs. Least Valuable Patients

    Most Valuable vs. Least Valuable Patients Why are some pods stuck below $1M despite working nonstop? In this episode, Don reviews a recent run of patients and categorizes them into “most valuable” and “least valuable.” The difference isn’t about patient importance—it’s about revenue structure, service mix, and scheduling strategy. Certain visits generate only an X-ray follow-up. Others represent 5–15x the revenue of a standard office visit. If you want to understand why some practices accelerate toward $1M–$2M while others stall, this breakdown makes it concrete: fracture follow-ups, routine rechecks, and low-yield visits must be scheduled differently than shockwave packages, orthotics, DME, and injectables. ⸻ Timestamps (Total: 6:44) [00:00] Why Patient Mix Matters Not all visits generate equal revenue—understanding the difference is key to scaling. [00:40] Least Valuable Example: Fracture Follow-Up Initial fracture care pays well, but 4-week follow-ups often produce only an X-ray. Solution: limit visits and double-book into 10-minute slots. [01:25] MVP: Lipazana Injection $1,500 fat pad replacement—high-value, easier to explain than some biologics, strong candidate selection. [02:05] MVP: Bilateral Lunula Laser + Fungal Kit $1,500 laser plus $200 dispensing kit—bundling increases case value. [02:40] MVP: Bilateral Plantar Fasciitis with Equinus Two night splints, foam roller, structured dispensing—maximize bilateral opportunities. [03:15] Shockwave Strategy Shift (3 → 6 Treatments) Six sessions improve compliance, keep care in-house, and prevent PT from “getting the credit.” [04:00] MVP: Shockwave + Orthotics Combo Midfoot arthritis and plantar fasciitis cases combining packages for stronger outcomes and revenue. [04:45] Lipazana #2 and Advanced Cases Repeat high-value procedures for heel fat pad atrophy and post-surgical patients. [05:20] Least Valuable: Post-Op and Stress Fracture Rechecks Often limited to imaging reimbursement—schedule efficiently. [05:50] MVP: DME and Balance Braces Repeat DME (every 5 years) significantly boosts revenue and long-term patient value. ⸻ Key Takeaway Scaling your practice isn’t about seeing more patients—it’s about structuring your schedule so high-value services (DME, packages, injectables, shockwave) drive revenue while low-value follow-ups are compressed efficiently. ⸻ Conclusion Audit one week of patients and classify them: MVP or low-yield. Then restructure your template—double-book follow-ups, protect 20-minute revenue-generating slots, and build packages around high-impact treatments. Your path to $1M–$2M isn’t volume alone—it’s intentional case mix management.

    7 min

  2. FEB 12

    Late-Career Moves That Actually Increase Profit

    Late-Career Moves That Actually Increase Profit You’ve got 5–10 good years left—how do you grow without wasting money or energy? In this episode, Don answers a series of tactical questions from established podiatrists who want stronger profitability, better positioning, and more control over their schedule. From restructuring routine care to improving Google reviews, raising orthotic prices, and evaluating marketing vendors, the theme is clear: systems—not hustle—drive the next level. If you’re in the back half of your career and want to work less while earning the same (or more), this episode lays out practical first moves that don’t require massive reinvention—just disciplined restructuring. ⸻ Timestamps (Total: 10:13) [00:00] Back Half of Career: First Three Moves Block low-value visits into one day, consider hiring a scribe, and double down on services you enjoy and that produce revenue. [01:25] Closing the Google Review Gap High-review competitors win because of process. Use QR cards or automated systems (e.g., Swell) to consistently request reviews. [03:00] Why Reviews Matter for Referrals Patients and referring providers check reviews—volume signals credibility. [03:40] Competing with Retail Insert Stores Study their presentation model. Use dynamic demonstrations (gait review, imaging, education) and confidently prescribe orthotics. [05:10] Pricing and Belief in Orthotics If you’re charging $350, reconsider your pricing and your confidence. Strong presentation + belief reduces returns and increases acceptance. [06:40] Evaluating a $400/Month Marketing Company At that price point, expectations must be realistic. Ensure basics are done first: Google Business Profile, SEO, email list, tracking numbers—before running paid ads. [08:00] Transitioning Away from High-Volume, Low-Pay Work Block routine care, reduce low-value follow-ups, increase per-visit value with procedures, DME, and packaged services. [09:05] Working Less While Making the Same Opt out of low-paying insurance plans, tighten scheduling, protect 20-minute high-value slots, and intentionally take time off. ⸻ Key Takeaway If you want your final 5–10 years to count, don’t overhaul everything—tighten your schedule, increase per-visit value, systematize reviews and marketing, and eliminate low-margin distractions. ⸻ Conclusion If you’re aiming to work less but earn more over the next five years, start with one structural shift: block low-value care, upgrade your review process, or reassess your payer mix. Small operational discipline compounds fast—and in the back half of your career, that leverage matters most.

    10 min

  3. FEB 12

    Niche Down Without Losing Revenue

    Niche Down Without Losing Revenue Everyone says “niche down”—but what if 80% of your schedule is routine care? In this episode, Don answers a practical question many podiatrists face: how do you transition from a generalist, routine-care-heavy practice into a more profitable niche without blowing up your schedule? He outlines two paths. First, make routine care more profitable by expanding services around those patients. Second, strategically reduce routine care through block scheduling and focused marketing. The key isn’t abrupt change—it’s structured transition. ⸻ Timestamps (Total: 4:37) [00:00] The Niche Dilemma When most of your schedule is basic foot care, how does specialization realistically happen? [00:40] Option 1: Make Routine Care More Profitable Expand beyond nails: compression garments for edema, ABIs, annual diabetic foot exams, Onyfix, KeryFlex, matrixectomies, orthotics, and fat pad injections. [01:45] Gradual Integration Strategy Introduce higher-value services slowly within your existing routine-care base. [02:15] Option 2: Reduce Routine Care Strategically Block routine visits into one dedicated day or half-day (“Toenail Tuesday” model). [02:50] Control Your Marketing Message Advertise only what you want to see—plantar fasciitis, Achilles tendinitis, shockwave, orthotics—on your website, blog, and in-office materials. [03:25] Make Low-Value Visits Less Convenient Reduce unnecessary follow-ups (paronychia, matrixectomy, fracture care) and tighten post-op scheduling. [04:00] Use Freed Time Intentionally Spend more time on higher-value conditions, increase DME dispensing, and build systems around services you enjoy and that grow revenue. ⸻ Key Takeaway You don’t niche down overnight—you control scheduling, tighten follow-ups, expand services strategically, and market only what you want to see. ⸻ Conclusion If you’re stuck in a routine-care-heavy model, choose one lever this month: block scheduling, service expansion, or marketing repositioning. Small structural changes compound over time. If you want the full framework for transitioning toward a $1M practice, review the Million Dollar Practice Formula and start implementing step by step.

    5 min

  4. FEB 12

    Adding Fat Pad Injections to Your Practice

    Adding Fat Pad Injections to Your Practice Do you have patients with painful fat pad atrophy who aren’t improving with pads and orthotics? In this episode, Don shares his first experience using Leneva (fat pad replacement injectable) for a patient with severe forefoot fat pad atrophy. After hearing about it at a recent conference, he implemented the treatment in-office—complete with consent workflow, storage protocol, injection technique, post-op plan, pricing strategy, and marketing rollout. This is a practical breakdown of how to evaluate, introduce, and operationalize a new regenerative-style offering—from patient selection to filming a YouTube explainer. If you’re considering adding higher-value procedures to better serve chronic pain patients, this gives you a real-world starting point. ⸻ Timestamps (Total: 5:48) [00:00] Why Consider Fat Pad Replacement? Managing painful calluses and fat pad atrophy when orthotics and pads fail. [00:45] Discovering Leneva at Conference Initial exposure, hesitation with similar products, and deciding to trial it. [01:30] Office Setup and Financial Workflow $500 deposit, ordering and freezing protocol, consent forms, and tissue documentation. [02:10] Injection Technique Step-by-Step V-block anesthesia, thawing and drawing with 18-gauge needle (noting 20-gauge may offer better control), retrograde injection technique, and even distribution under the metatarsal head. [03:40] Post-Procedure Protocol Sterile strip closure, offloading padding, surgical shoe, 3 days heel weight bearing, 2 weeks protected weight bearing, gradual transition back to shoes. [04:30] Pricing and Case Selection $1,500 per 1.5cc syringe; typically one per metatarsal head depending on severity. [05:05] Marketing the Procedure Recording a YouTube video using CapCut, uploading via Google Drive, adding subtitles, and educating patients through email outreach. ⸻ Key Takeaway If conservative care isn’t enough for fat pad atrophy, adding a structured, well-priced in-office injectable option—supported by proper workflow and marketing—can improve outcomes and elevate revenue per case. ⸻ Conclusion If you’re evaluating whether to introduce regenerative or specialty injectables, start with one diagnosis, build your consent and pricing structure carefully, and document the process. Have you added fat pad replacement or similar procedures to your practice? Share your experience—what worked, what didn’t, and how patients responded.

    6 min

  5. FEB 12

    Full Schedule, Flat Revenue? Fix Your Case Mix

    Full Schedule, Flat Revenue? Fix Your Case Mix Is your schedule packed with routine nail care—yet your revenue doesn’t match your effort? In this episode, Don answers a question shared by Jim McDonald from Podiatry Growth: how do you shift toward higher-margin care without losing the steady income from routine visits? It’s a common challenge, especially for doctors inheriting established routine-care-heavy practices. Don outlines a practical strategy: consolidate routine care into structured block time, then intentionally use the freed-up schedule for higher-value services, marketing, or new technology. He also explains how to ethically increase revenue per routine visit through appropriate exams, diagnostics, and in-office services—without abandoning that patient base. ⸻ Timestamps (Total: 3:30) [00:00] The Core Problem: Busy but Underpaid A full schedule dominated by routine nail care that doesn’t translate into strong revenue. [00:40] Strategy #1: Block Routine Care Into One Day Designate one full day (e.g., Fridays) strictly for routine care to protect the rest of the week. [01:30] Upgrade the Model: Add a Nail Tech Transition from a full day to a half-day of routine care by leveraging support staff. [02:00] Protect the Other Days for Higher-Value Care Use open time for plantar fasciitis, advanced treatments, marketing outreach, or learning new technologies. [02:30] Increase Revenue Per Routine Patient Add appropriate services such as DME for wound care, ABIs for diabetic patients over 50, and annual foot exams to elevate reimbursement ethically. ⸻ Key Takeaway Don’t eliminate routine care—control it. Block it into dedicated time and intentionally build higher-value services into the rest of your week. ⸻ Conclusion If your schedule is full but margins are thin, restructure before you work harder. Choose one step this month—block scheduling, staffing support, or adding appropriate in-office diagnostics—and measure the difference. If you’ve successfully shifted your case mix, share what worked.

    4 min

  6. FEB 12

    Busy but Broke? Fix the Real Bottlenecks

    Busy but Broke? Fix the Real Bottlenecks Are you seeing 25–30 patients a day—and still not building wealth? In this episode, Don shares a listener win from Australia using “Good–Better–Best” treatment sheets, then dives into a bigger issue: why some podiatrists producing $300K–$500K still feel financially stuck. The problem isn’t always volume—it’s structure, service mix, and scheduling strategy. He outlines three practical levers: packaging treatment options to reduce decision fatigue, consolidating low-revenue routine care into dedicated blocks, and increasing in-house, revenue-generating services. He also shares a marketing update on urgent care referral postcards—and the importance of tracking every campaign with dedicated numbers. ⸻ Timestamps (Total: 13:54) [00:00] Listener Win: $1,600 from One Treatment Sheet Jackson implements a Good–Better–Best format and closes a comprehensive $1,600 care plan. [01:30] Three Treatment Sheet Models Checklist prescribing, Phase 1/Phase 2 (insurance → non-covered), and Good–Better–Best packaging. [03:30] Why Packages Reduce Decision Fatigue Bundling services simplifies patient decisions and increases case acceptance. [05:00] Busy but Broke: The $300K–$500K Trap High daily volume doesn’t equal profitability—especially if everything is insurance-dependent. [06:30] Strategy #1: Block Your “Low-Value” Visits Consolidate routine nail care into a half or full dedicated day (e.g., “Toenail Fridays”) to protect higher-value clinic time. [08:30] Strategy #2: Increase Revenue per Patient Ethically Incorporate shockwave, orthotics, AFOs, regenerative options, in-house imaging, and other services instead of sending them out. [10:40] Strategy #3: Tighten Follow-Ups and Use 10-Minute Slots Reduce unnecessary follow-ups and book simple cases efficiently to free 20-minute slots for higher-value visits. [12:00] Urgent Care Marketing Update Distributing urgent care postcards to shoe stores—and the key lesson: always use tracking phone numbers to measure ROI. [13:10] Final Encouragement and Sharing Wins Invite listeners to share successful systems and marketing ideas. ⸻ Key Takeaway If you’re busy but not profitable, fix structure—not effort: package treatments, consolidate low-revenue visits, increase in-house services, and track every marketing initiative. ⸻ Conclusion What’s one bottleneck in your practice right now—case acceptance, scheduling, service mix, or tracking? Identify it, adjust one system this month, and measure the result. If you’ve implemented something that worked, share it. Your win could help another podiatrist move closer to the million-dollar mark and beyond.

    14 min

  7. FEB 12

    What $1M Providers Do Differently

    What $1M Providers Do Differently How are some podiatrists producing $750K–$1M per provider—without working twice as hard? In this episode, Don breaks down the practical differences between busy practices and high-producing ones. It’s not magic—it’s math, structure, and service mix. From daily visit targets to packaging protocols and opting out of low-paying insurance, he outlines the operational shifts that drive real per-provider growth. He also answers a second key question: how do you evaluate whether adding cash services like shockwave will actually pay off? Don shares how to think through break-even math, leverage demos, and structure packages so new technology funds itself. ⸻ Timestamps (Total: 8:10) [00:00] The $1M Question What are $750K–$1M providers doing differently day to day? [00:45] Start With the Math 20–25 patients per day at ~$200 per visit = ~$4,000 per day → ~$1M annually. [01:45] Separate Profitable vs. Non-Profitable Visits Block routine care into a half day, double book strategically, and protect 20-minute higher-value slots. [02:40] Add and Automate Services Imaging (X-ray, ultrasound), in-office procedures, orthotics, DME, and dispensing should be systematized—not optional. [03:40] Package Everything Fungal kits, equinus kits, shockwave bundles, laser packages—reduce friction and increase case acceptance. [04:45] Track Daily Production Use a daily tracking sheet to monitor imaging, DME, procedures, dispensing, packages, and follow-ups. [05:20] The Elephant in the Room: Insurance Mix Opt out of low-paying plans that prevent sustainable margins. [05:50] Adding Cash Services Without Fear Use break-even spreadsheets, demo equipment (“puppy dog close”), and shadow experienced doctors. [07:10] Simple Break-Even Thinking Often one package per month covers the equipment payment—the rest is upside. ⸻ Key Takeaway High-producing practices don’t rely on volume alone—they optimize per-visit value, package services, automate imaging and DME, track metrics daily, and make disciplined payer decisions. ⸻ Conclusion If you’re stuck below your target revenue, don’t work harder—tighten your math. Audit your daily visit value, block low-margin care, package your services, and run the break-even numbers on one new technology this quarter. If you want the framework Don references, download the $1M Practice Formula and start implementing step by step.

    7 min

  8. FEB 12

    Coverage Gaps and Ownership Mentality

    Coverage Gaps and Ownership Mentality Are unplanned absences quietly straining your practice more than you realize? In a smaller private practice, even one physician out can create ripple effects across scheduling, workflow, and patient experience. In this episode, Don shares a candid look at what happens when a four-doctor practice temporarily loses one provider to paternity leave—while another is briefly sick. The result? Overloaded schedules, disrupted routines, and subtle but meaningful stress on care delivery. He breaks down the operational realities: managing overflow follow-ups, compressing 10-minute slots, covering nail care days, and balancing quality with efficiency—even with the support of a scribe. More importantly, he challenges associates and future partners to think beyond “time off policies” and consider the ownership mindset: how reliability, availability, and coverage impact revenue, culture, and long-term opportunity in a smaller group. ⸻ Timestamps [00:00] Practice Update and Current Strain A fourth doctor out on paternity leave, another briefly sick—how quickly a four-doctor practice feels stretched thin. [01:15] The Good: Scribes and Maintaining Quality How a scribe helps preserve patient interaction and care quality despite increased volume. [02:05] The Scheduling Squeeze 20-minute visits, added 10-minute slots, and the difficulty of absorbing another doctor’s follow-ups without running behind. [03:10] Routine Care Disruptions Covering nail care days and how small workflow changes add stress and reduce perceived quality. [04:20] Medical Leave vs. Business Reality The ownership dilemma: respecting leave policies while recognizing daily revenue impact ($4,000–$5,000 per doctor per day). [05:35] Evaluating Associates and Partners Why reliability, sick time usage, and time-off patterns matter more in smaller practices than large group or HMO settings. [06:45] Ownership Mentality in Action A story from early career: going the extra mile to avoid missing clinic—and how that influenced partnership perception. [08:00] Final Reflection: Balancing Time Off and Responsibility The tension between personal time and business sustainability—and why awareness matters. ⸻ Key Takeaway In a small practice, every physician-day materially impacts revenue, workflow, and patient care—so hiring and partnership decisions should factor in reliability, coverage planning, and true ownership mindset. ⸻ Conclusion If this resonates with your experience—either as an owner or an associate—consider how your practice handles coverage, leave policies, and expectations around ownership. What systems could reduce strain when someone is out? Share your thoughts or challenges, and let’s continue the discussion.

    4 min
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🚀 Podiatry Practice Mastery — Grow Your Podiatry Practice to $1M+ Without Working More Hours Are you a podiatrist ready to scale your practice to 7 figures and beyond — without burning out? Podiatry Practice Mastery is the podcast for growth-driven podiatrists who want to increase revenue, improve patient flow, and build efficient systems — without adding more clinic hours or sacrificing their quality of life. - Get my Free Million Dollar Practice Formula - https://www.podiatrypracticemastery.com/

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