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. 1D AGO

    Conference Takeaways on Shockwave Therapy 2026

    How do you stay ahead with shockwave therapy when the technology, protocols, and pricing models keep evolving? In this episode, Don shares practical insights from attending the American Society of Shockwave conference for the second time. He reflects on what worked well, what didn’t add much value, and—most importantly—what he’s changing in his own clinical protocols. From adjusting treatment intensity to reconsidering pricing models, the meeting reinforced how quickly shockwave therapy is evolving across specialties including podiatry, sports medicine, PM&R, physical therapy, and chiropractic care. Don also explores emerging ideas around athlete recovery, bundled treatment pricing, and how clinicians are communicating the value of shockwave therapy to patients. If you’re using shockwave—or considering expanding how you offer it—this episode provides real-world insights on clinical technique, patient conversations, and practice strategy. ⸻ Timestamps [00:00] Conference Overview Don shares his experience attending the American Society of Shockwave meeting and the value of networking with colleagues across specialties including PM&R, sports medicine, chiropractic, and physical therapy. [01:16] The Biggest Challenge: Explaining Shockwave to Patients Why patient education—and especially the financial conversation—is often the hardest part of implementing shockwave successfully. [02:03] Downsides of the Conference Sessions covering unrelated areas like urology and Alzheimer’s, lack of CME credits, and the time commitment of a full weekend meeting. [02:55] Equipment Insights: Radial vs. True Shockwave Discussion on how radial devices are increasingly viewed as pressure waves rather than true shockwave therapy, and why Don values having both radial and focused devices. [04:00] A Major Clinical Takeaway: Use Lower Intensity Experienced clinicians tend to treat with lower energy and slower frequencies. Don plans to experiment with lighter treatments and evaluate outcomes. [05:09] Learning Resources and Training Mentions communities like Shockwave Hub and other training opportunities, but emphasizes that the best learning often comes from visiting another doctor’s clinic. [06:02] Choosing Conferences That Fit Your Practice Why Don is shifting toward sports medicine conferences rather than surgical meetings based on his current practice focus. [06:35] Pricing Strategies for Shockwave Therapy Discussion with a colleague charging $400 per session and offering bundled treatments including EMTT, leading Don to rethink his own pricing structure. [07:56] Considering Bundled Treatment Packages Idea of packaging shockwave with orthotics and amniotic injections to simplify the patient decision and present a comprehensive care plan. [08:49] Platelet Lysate and Emerging Biologic Concepts Overview of platelet lysate and how it differs from traditional PRP. [09:23] Insurance Reimbursement Challenges Some insurers are beginning to reimburse shockwave at very low rates, raising questions about whether clinicians should bill insurance at all. [09:58] Using Medical Image Upload Platforms An interesting tool that allows patients to upload MRIs for review, potentially creating opportunities for remote second opinions and consultations. [10:19] The Future: Shockwave for Recovery and Prevention Emerging use of shockwave not just for injury treatment but also for recovery and injury prevention in athletes, including post-race recovery protocols. ⸻ As clinicians gain more experience with shockwave therapy, protocols tend to shift toward lower energy treatments, clearer patient communication, and bundled pricing models that better reflect the value of care.

    10 min

  2. 6D AGO

    Managing VAs, Patient Recall, and Treatment Acceptance

    Managing VAs, Patient Recall, and Treatment Acceptance Description Are your virtual assistants actually producing value—or just filling hours? Many practice owners turn to virtual assistants for marketing and administrative help, but managing them effectively can be a challenge. When work is billed by the hour, tasks can expand to fill the available time, making it difficult to control costs or ensure meaningful results. In this episode, Don shares lessons from managing virtual assistants by shifting from hourly expectations to task-based assignments. He also discusses practical patient recall strategies, the role of automation in reactivating past patients, and a communication framework that improves patient acceptance for higher-value treatment plans like shockwave therapy. ⸻ Timestamps [00:00] The Problem With Hour-Based Virtual Assistants Why VAs often expand work to fill the number of hours allocated. [00:50] Moving to Task-Based Management Assigning specific deliverables with defined time limits to prevent time bloat. [01:50] Examples of Task Allocation for Marketing VAs Weekly newsletters, SEO page updates, ad monitoring, and call tracking. [03:05] Using Automation to Recall Patients How ModMed’s Clara helps follow up with patients who miss appointments. [04:05] Combining Clara With Additional Recall Systems Using automation tools to continue follow-up once the EMR recall system stops. [04:50] Identifying High-Value vs. Low-Value Appointment Slots Structuring the schedule to prioritize higher-value visits. [05:40] Creating 10-Minute “Buffer Slots” Using shorter appointment slots for quick visits or patients likely to cancel. [06:20] Using Newsletters to Reactivate Patients How regular email communication occasionally brings former patients back. [06:55] Why Manual Recall Systems Are Labor-Intensive Staff-driven recall processes require significant time and organization. [07:30] Exploring Automated Recall Platforms How tools like Banzai can automatically identify and contact inactive patients. [08:05] Improving Patient Acceptance With Better Communication Using future pacing and good–better–best treatment frameworks. [09:00] Presenting High-Value Treatment Plans How to introduce comprehensive treatment packages like shockwave, injections, and orthotics. [09:40] Avoiding Discounts While Adjusting Treatment Plans Instead of discounting, remove components from the treatment package. ⸻ Key Takeaway Managing systems—not just people—is critical in practice growth. Whether working with virtual assistants, scheduling patients, or presenting treatment plans, clear structure and automation help reduce wasted time while increasing practice revenue. ⸻ Conclusion What systems are you using to manage virtual assistants or reactivate patients in your practice? If you’ve implemented automation or structured workflows that improved efficiency, share your experience. Conversations like these help practice owners refine the systems that drive growth.

    10 min

  3. 6D AGO

    Unlocking Revenue Hidden in Your Patient List

    Unlocking Revenue Hidden in Your Patient List Description Are you sitting on thousands of past patients who could come back—but never do? Most practices focus heavily on attracting new patients, yet the biggest opportunity often lives inside your existing patient database. The challenge is figuring out how to reactivate those patients without overwhelming your staff with manual phone calls and recall lists. In this episode, Don breaks down the systems he has tried to bring past patients back into the practice—from email newsletters and manual recall lists to a new AI-powered platform that automates patient reactivation. He explains how the system identifies inactive patients, launches targeted outreach campaigns, and automatically drives them back to online booking—turning your EMR into a powerful revenue engine. ⸻ Timestamps [00:00] The Challenge of Reactivating Old Patients Why most practices struggle to generate revenue from their existing patient database. [00:45] Email Newsletters That Bring Patients Back How a weekly email newsletter keeps patients engaged and occasionally drives appointments. [01:35] Tracking Calls From Email Campaigns Using dynamic phone numbers to track which patients return from email marketing. [02:05] The Traditional Manual Recall Method Pulling lists from the EMR and having staff call patients for follow-ups like diabetic care or DME. [03:00] Why Manual Recall Systems Often Fail The operational challenges of organizing lists and assigning staff to make recall calls. [03:40] Discovering an Automated Reactivation Platform Introduction to the company Banzai and how it integrates with EMRs like ModMed. [04:30] The Background Behind the Platform Built by the creators of PatientPop, which previously focused on generating new patient reviews and leads. [05:25] How Automated Patient Reactivation Works Using AI to analyze your database and launch automated campaigns to bring patients back. [06:15] Examples of Reactivation Campaigns Shockwave follow-ups, orthotics recalls, or patients who haven’t been seen in over a year. [07:00] Automated Messaging Cadence How the system sends a sequence of texts and emails over several weeks to encourage booking. [07:35] Rebooking No-Shows and Cancelled Patients Automatically reaching out to patients who missed appointments if staff cannot reach them. [08:00] Understanding the Revenue Opportunity How the dashboard estimates potential revenue from inactive patients in your database. [08:20] Pricing and Return on Investment Typical pricing structure and why many practices recover the cost quickly. ⸻ Key Takeaway Your patient database is one of the most valuable assets in your practice—automated reactivation systems can turn inactive patients into a consistent source of revenue without adding staff workload. ⸻ Conclusion Have you implemented any systems to reactivate patients from your database? If you’ve found a strategy that works—or if you’re exploring automation tools like this—share your experience. Conversations like these help practices uncover new ways to grow using the patients they already have.

    9 min

  4. 6D AGO

    Simplifying Shockwave Pricing in Your Practice

    Simplifying Shockwave Pricing in Your Practice Description How should you price shockwave therapy if your practice already offers laser treatments? Many podiatrists successfully implement laser therapy packages but run into confusion when adding shockwave therapy. Should the treatments be offered separately? Should the pricing change? And how do you keep it simple for patients and staff while still reflecting the value of the treatment? In this episode, Don walks through a practical approach to transitioning from laser-only packages to regenerative treatment bundles that include shockwave. He explains how he structures visits, when he charges for office visits versus procedures, and how ultrasound imaging helps patients understand why shockwave therapy is recommended. ⸻ Timestamps [00:00] A Question About Transitioning to Shockwave A podiatrist asks how to introduce radial shockwave therapy when she already offers a six-treatment laser package. [00:50] Combining Laser and Shockwave Into One Package Why bundling treatments into a single regenerative package can simplify patient decision-making. [01:40] Example Pricing Structure Charging $250 per session and building a six-session regenerative package around that model. [02:30] Avoiding Confusing Pricing Options Why offering laser and shockwave separately can create unnecessary complexity for patients. [03:10] Should Shockwave Be Discounted With an Office Visit? Some doctors bundle procedures into office visits, but Don explains why he prefers keeping them separate. [04:05] Structuring the Shockwave Treatment Plan Initial evaluation, follow-up imaging, weekly treatments, and the final visit that reviews the next steps. [05:00] Weekly vs. Every-Two-Week Shockwave Protocols A discussion of alternative treatment schedules used by some physicians internationally. [05:40] Delegating Shockwave and Laser to Staff How training staff to perform treatments can improve efficiency in the practice. [06:10] Using Ultrasound to Guide Treatment Decisions Why ultrasound imaging helps reveal tendon pathology that patients cannot see externally. [06:50] Ultrasound Billing Strategy Charging per foot once for ultrasound and using it primarily as a diagnostic and educational tool. [07:10] Typical Patient Workflow First visit X-ray, second visit ultrasound, then deciding whether shockwave therapy is the appropriate treatment. ⸻ Key Takeaway When introducing shockwave therapy into a practice that already offers laser, simplify the decision for patients by bundling regenerative treatments into one clear package and using ultrasound imaging to guide and justify the treatment plan. ⸻ Conclusion How are you pricing regenerative treatments like laser or shockwave in your practice? If you have a system that’s working well—or if you’re trying to figure out how to implement one—share your experience or reach out to continue the discussion.

    8 min

  5. 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

  6. 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

  7. 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

  8. 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
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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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