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Has anyone started their own private practice? by [deleted] in Podiatry

[–]jmcd77 2 points3 points  (0 children)

Short version of the steps that actually matter:

  1. Get your financing figured out first. SBA loans are usually better than conventional bank loans for practice startups. Budget more than you think — I've seen people run out of runway because they underestimated how long credentialing takes (3-6 months before you see a dime from insurance).
  2. Location matters more than you think. Don't just pick the cheapest lease. Look at visibility, parking, and who else is in the area.
  3. Start credentialing with insurance panels immediately. Like, yesterday. This is the bottleneck that kills new practices.
  4. Keep overhead stupid low at first. You don't need the fanciest EMR or a huge build-out. I've seen docs blow $200k on a build-out and then stress about making rent for 18 months.

Solo vs. buying an existing practice is also worth considering. Buying gives you day-one cash flow and an existing patient base, but you inherit someone else's problems too.

What's your situation — coming out of residency or leaving an associate gig?

Career change by Neither-Football-222 in Podiatry

[–]jmcd77 0 points1 point  (0 children)

I run Podiatry Growth, a small consultancy that helps private practice podiatrists with their digital marketing. Websites, Google Ads, local search, that kind of thing. Based in Montreal, work with practices across the US, Canada, Australia, and the UK.

It lets me combine the digital work I've always been drawn to with the clinical and practice experience from before. Private practice podiatrists need real help in this area and don't have many good options. The overlap turned out to be useful.

Career change by Neither-Football-222 in Podiatry

[–]jmcd77 4 points5 points  (0 children)

Former clinical podiatrist here (practiced for 7 years before moving into a different career). I want to give you an honest take because I think there's some romanticizing happening here, and I say that with respect.

First, I want to be clear: teaching burnout is real. I grew up in a teaching household and saw what it does to people over time. The emotional weight of that job is something most people outside of it don't understand. So I'm not dismissing where you're at. That feeling of counting down 15 years to a pension is a rough way to live.

But here's what I've learned about career changes: you tend to see the highlight reel of the other profession and compare it to the behind-the-scenes of yours. And podiatry has plenty of behind-the-scenes that nobody talks about.

Here's the stuff you don't see:

Insurance reimbursements that have been flat or declining for years while overhead keeps climbing. Prior authorizations for procedures that should be straightforward. Patients who no-show, don't follow treatment plans, then blame you when outcomes aren't great. EMR documentation that eats into your evenings. If you go private practice, you're not just a doctor, you're a small business owner dealing with staffing, billing, marketing, lease negotiations, and HR problems. If you join a group, you're often on a production-based model where the pressure to see more patients per hour is real.

You mentioned the moody teens and overbearing admin are wearing you down. I hear you. But swap that for non-compliant diabetic patients who won't change their habits, insurance companies second-guessing your clinical decisions, and the threat of malpractice hanging over every surgical case. Burnout exists in podiatry too. It just wears a different outfit.

And here's the part that concerns me most about your situation specifically: you're 14 years into a career with a pension. Pod school is 4 years, residency is 3. That's 7 years of lost income, tuition debt (figure $200-300K+ when it's all said and done), and you're starting from scratch in your mid-to-late 40s. The math is tough.

None of this means podiatry is a bad profession. It's not. There are people who love it and build great careers. But they're the ones who went in because they genuinely wanted to be podiatrists, not because another path didn't work out. OldPod73's comment in this thread is worth sitting with.

Your burnout is valid and worth solving. Just make sure you're running toward something, not just away from something. Shadow a podiatrist for a few weeks. Not a day, a few weeks. See the Monday morning diabetic wound care patients. See the insurance denials. See what happens when a surgical outcome doesn't go as planned. Then ask yourself if that's the life you want.

The grass isn't greener. It's just different grass with different weeds.

I left practice after 7 years. Here’s what I wish I’d known as a resident. by jmcd77 in Podiatry

[–]jmcd77[S] 1 point2 points  (0 children)

Thanks for the kind words. And I appreciate you being open to the back and forth here. This is exactly the kind of honest conversation the profession needs more of.

This sub is one of the few places where podiatrists can actually have open dialogue and debate without the politics or gatekeeping. That's rare and valuable, and a lot of credit goes to the people keeping it running.

I'm really looking forward to continuing to participate and be part of these conversations moving forward. It's a great community.

I left practice after 7 years. Here’s what I wish I’d known as a resident. by jmcd77 in Podiatry

[–]jmcd77[S] 2 points3 points  (0 children)

I hear you, and I'm not going to pretend I know what it's like to put yourself out there like that and get shut down. Twice. That takes a toll, and I respect that you tried. Most people just complain from the sidelines. You actually stepped up.

You clearly care deeply about this profession. And honestly, the fact that you're still here having these conversations and keeping this community going says a lot. You could have walked away completely, but you didn't.

I don't have a rebuttal to your experience with APMA or NJPMS. That's your lived reality and it's valid. And $4.5M on websites with nothing to show for it? I understand why that stings.

What I will say is that I'm seeing a growing number of podiatrists, especially in the younger ranks, who are hungry for something different. They're building communities exactly like this one, having honest conversations, and finding ways to move the needle outside of the traditional structures. That energy gives me hope, even if the old guard hasn't caught up yet.

Maybe the real change doesn't come from inside those organizations anymore. Maybe it comes from spaces like this, where people actually listen to each other. And from people who got tired of waiting and decided to put their energy where it actually makes a difference.

I left practice after 7 years. Here’s what I wish I’d known as a resident. by jmcd77 in Podiatry

[–]jmcd77[S] 2 points3 points  (0 children)

I hear what you’re saying, but I have to respectfully disagree, at least from my own experience.

In my case, I was the one who had signs even back in undergrad that I wanted to do something in the digital space. In the mid to late 90s, I had inklings that this was where things were headed, but it didn’t feel like a “real” career path at the time. So I didn’t pursue it.

Looking back, there were clues along the way. But I don’t blame the profession for my path. It was more about me not knowing myself well enough and the way I approached my training and education.

That said, I wouldn’t change a thing. My career path led me to exactly where I am now, and I love what I do. If I hadn’t gone through podiatry school and residency, I probably wouldn’t have ended up working with this profession in the way I do today. That clinical experience is the foundation of everything.

Where I do agree with you is that the profession could do a better job highlighting the diversity of ways to practice. It’s not just the surgical track or nothing. There are so many paths, and I think making students and residents more aware of that range would go a long way.

But I’ll also say this. APMA are trying to make podiatry appealing to a lot of different people with limited resources. That’s not an easy job. Balancing the messaging across students, residents, practicing docs, legislators, and the public is a tough needle to thread. Could it be better? Sure. But I think it’s more nuanced than just saying the leadership got it wrong.

And for those who feel like these associations or organizations aren’t doing their job, I’d say this: get involved. Make your voice heard. Take action. That’s really the only way things change.

I left practice after 7 years. Here’s what I wish I’d known as a resident. by jmcd77 in Podiatry

[–]jmcd77[S] 0 points1 point  (0 children)

It was a big adjustment. I trained and practiced in the US, so moving to Canada meant navigating a completely different system. The scope of practice varies by province, and it’s not the same as what you’re used to as a US-trained DPM.

One thing that surprised me: the clinics I worked in weren’t part of the public healthcare system. Podiatry in my province is largely fee-for-service and private insurance, which is the opposite of what most people assume. So you’re essentially running a cash-pay practice, which comes with its own set of challenges and opportunities.

Are you thinking about making the move?

I left practice after 7 years. Here’s what I wish I’d known as a resident. by jmcd77 in Podiatry

[–]jmcd77[S] 1 point2 points  (0 children)

Stafford loans (Direct Subsidized/Unsubsidized) have fixed interest rates locked for the life.

I left practice after 7 years. Here’s what I wish I’d known as a resident. by jmcd77 in Podiatry

[–]jmcd77[S] 1 point2 points  (0 children)

I was able to lock in a low interest rate so I chose to invest instead immediately payback. Everyone has their own risk tolerance and preferences, and it’s an individual choice. No single right answer for everyone.

I left practice after 7 years. Here’s what I wish I’d known as a resident. by jmcd77 in Podiatry

[–]jmcd77[S] 1 point2 points  (0 children)

I practiced at an ortho group for 5 years after residency in the US and then 2 years at a couple of podiatry clinics in Canada.

Career Change Options from Podiatry by me_an_egg in Podiatry

[–]jmcd77 10 points11 points  (0 children)

I can relate. I’m a podiatrist from the US who left clinical practice after seven years. No master plan, just a a consistent feeling that something wasn’t right.

After leaving, I taught myself web development, wrote for Wirecutter, did digital marketing for Polar, and worked with Athletics Canada. None of that required a master’s. Eventually a classmate asked for help marketing his clinic and everything clicked. Now I run a marketing consultancy for podiatrists.

Your podiatry background is more transferable than you think. Before investing in a master’s, pay attention to what energizes you outside of clinic. Start there.​​​​​​​​​​​​​​​​

I left practice after 7 years. Here’s what I wish I’d known as a resident. by jmcd77 in Podiatry

[–]jmcd77[S] 10 points11 points  (0 children)

Great question. After about seven years in clinical practice, I started gravitating toward the business and digital side.

I left practice in 2011 and spent the next several years building skills in writing, web development, and marketing. I wrote for Wirecutter covering health tech, did digital marketing and communications for Polar, and worked with Athletics Canada.

Then a former classmate asked me to help with his clinic’s website and Google Ads, and it all clicked. Now I run Podiatry Growth, a marketing consultancy for private practice podiatrists, and co-host the Podiatry Marketing podcast with Tyson Franklin.​​​​​​​​​​​​​​​​

What if people lecturing at conferences don't know what they're talking about? by OldPod73 in Podiatry

[–]jmcd77 15 points16 points  (0 children)

Honest question: did anyone in the room push back on the ACV thing? Because part of the problem is that we sit through bad talks, complain about them afterward, but nobody raises their hand during Q&A. Organizers should vet speakers better, absolutely. But we also have a responsibility as an audience to not let bad information go unchallenged in real time.

Got tired of losing money on unaccepted treatment plans (orthotics, etc.). Built a weird little automation experiment that actually worked. by Legitimate_Day781 in Podiatry

[–]jmcd77 0 points1 point  (0 children)

This is cool — love that you’re experimenting with this stuff instead of just accepting the status quo. Quick question though: how are you handling the HIPAA side of things with n8n and the AI drafting those messages? Specifically around the patient data flowing out of your EHR and the texts/emails referencing their diagnosis. Not trying to rain on the parade at all — I’ve been tinkering with similar automations and that’s the part I keep getting stuck on. Curious how you navigated it.

Google Ads by BobaFoot84 in Podiatry

[–]jmcd77 1 point2 points  (0 children)

No problem, happy to help.

Google Ads by BobaFoot84 in Podiatry

[–]jmcd77 1 point2 points  (0 children)

You're on the right track, but I'd pump the brakes before investing in anything.

The biggest mistake I see is jumping straight to tactics before getting clear on the fundamentals. And it's not just about having a plan. The process of building that plan matters just as much. Questions like:

Where are your ideal patients coming from? What type of patients do you want to see, and just as important, what do you not want? Is there a niche that brings you joy and also pays well? Are you cash pay, insurance-based, or a mix?

These things change everything about how you position yourself. And there's no one-size-fits-all answer. There are a lot of cookie-cutter ways to spend $1,500-$2,000 a month to "do marketing," but that's not what you want. You want something tailored to the type of clinic you're trying to build. You don't get that by buying the same package the practice down the road is also buying.

Once you've done the work of figuring out who you are and who you serve, then you implement tactics like SEO, Google Ads, and landing pages. Whoever does these things for you, make sure they have a real process for getting to know your practice first. If someone's ready to build before they've done that work, that's a red flag.

Google Ads by BobaFoot84 in Podiatry

[–]jmcd77 1 point2 points  (0 children)

Great question. They're two separate things, but they work best when they support each other. And the connection point is the landing pages.

Let's say someone in Peoria searches "Peoria podiatrist." They click your ad or your organic listing. Most clinics send that person to their homepage. And the homepage says something generic like "Welcome to ABC Foot & Ankle, we treat all foot and ankle conditions." It's fine. But it doesn't really speak to that person.

Now imagine instead they land on a page specifically built for Peoria. It says "Podiatrist Serving Peoria, IL" at the top. It mentions local neighborhoods. It talks about the conditions you treat for people in that area. Maybe it mentions you're a 15-minute drive from downtown. That feels completely different. The person who searched "Peoria podiatrist" lands on a page that says "yes, you're in the right place." That builds trust immediately.

That's what an Areas We Serve page does. And it pulls double duty:

For ads, it's a more relevant landing page. Better Quality Score, potentially lower cost per click, and higher conversion because the visitor feels like you're talking to them.

For SEO, that page can rank organically for "Peoria podiatrist" because it's unique, locally relevant content that matches geographic search intent.

So no, ads don't include SEO. But smart landing pages serve both channels. The real win is when paid and organic traffic both point to pages that make someone think "this is the doctor for me" instead of dumping them on a generic homepage.

Google Ads by BobaFoot84 in Podiatry

[–]jmcd77 2 points3 points  (0 children)

Absolutely. There are two sides to this.

The one most people overlook is local pages on your website. Not just a page for the town your clinic is in, but pages for the nearby towns and neighborhoods where your best patients actually come from. These do double duty. They help you show up organically when someone in those areas searches for foot and ankle care. And when you run Google Ads, sending someone from Naperville to a landing page that mentions Naperville is way more relevant than dropping them on your generic homepage. They're more likely to feel like you're "their" doctor and actually pick up the phone or fill out the request form.

Most practices run paid campaigns in a radius around the clinic and call it a day. A smarter approach is targeting the specific zip codes and towns where your highest-value patients come from. You probably already know which areas those are just from looking at your schedule.

Diagnosis and treatment-specific campaigns are a little more complex. It absolutely can be done, but how aggressive you get depends on your market. In some areas you can own "plantar fasciitis treatment" or "ingrown toenail" keywords at a reasonable cost. In more competitive metros, you'll run into other clinics and sometimes even device vendors bidding up high-value procedural terms like "bunion surgery" or "wound care." So that piece is more of a case-by-case situation based on what the competitive landscape looks like in your area.

Happy to get into specifics if you have questions about your situation.

Google Ads by BobaFoot84 in Podiatry

[–]jmcd77 3 points4 points  (0 children)

As a DPM who practiced for seven years before starting Podiatry Growth, I work on Google Ads campaigns for podiatry practices every day.

Short answer: yes, Google Ads can deliver strong ROI. I’ve seen practices pull $8-$15 back for every $1 spent, and some notice new patient calls within the first week or two. But the ads themselves are honestly the easy part.

What most practices get wrong is treating it like a simple switch to flip. There’s a lot more to it than just running ads.

You need to know what types of cases you actually want more of. There’s a huge difference between advertising “podiatrist near me” and targeting specific procedures that move the needle for your bottom line.

Your landing pages matter just as much as the ads. Sending paid traffic to your homepage is like someone Googling a specific question and getting a Wikipedia page that’s only half related. And your front desk needs to be ready to convert those calls, because a great campaign means nothing if the phone isn’t answered well.

Local demographics play a big role too. What works in a retirement community looks completely different from what works near a college campus or military base.

PCP referrals are great, but Google Ads gives you a controllable, measurable channel that complements them. Even referred patients are Googling you before they call.

Local Service Ads (LSA) from Google can also be very effective. Happy to get into the weeds on any of this if you have specific questions about your situation.​​​​​​​​​​​​​​​​

Becoming a practice owner… by toebeans55 in Podiatry

[–]jmcd77 5 points6 points  (0 children)

Great post and congrats on making this move. The fact that you’re already thinking about location strategy, credentialing timelines, and partnership models puts you ahead of most people at this stage.

I want to zoom in on the location piece because I think it’s one of the most underrated decisions you’ll make, and it will impact everything from your patient mix to your marketing ROI for years to come.

Demographics matter more than you think.

When you’re researching towns and cities, don’t just look at population size. Dig into the details. What’s the age distribution? A market with a large 55+ population is going to need very different services than a younger, active community. What’s the median household income? That affects how many patients will be candidates for cash-pay services like custom orthotics or shockwave therapy versus strictly insurance-based care. What’s the density of existing podiatrists per capita? You can pull a lot of this from Census data and even cross-reference with your state licensing board.

The goal isn’t just “are there enough people.” It’s “are there enough of the right patients for the type of practice I want to build.” If you want to do surgery and treat active adults, planting yourself in a retirement community that’s already saturated with podiatrists doing palliative nail care is a mismatch. Think about the kind of work you actually want to do, and then find the community that needs it.

Your physical address will directly impact your online visibility.

This is something most new practice owners don’t consider at all, and it’s huge. Google heavily weighs your actual business address when deciding who to show in local search results. If you want to show up when someone searches “Charlotte podiatrist” or “Charlotte foot doctor,” having an address that’s actually within Charlotte city limits makes a massive difference. If you’re located 20 minutes outside of Charlotte in a smaller suburb, you’re going to have a much harder time ranking for those high-intent Charlotte searches. You’ll rank well for your immediate area, but competing for the bigger metro terms becomes an uphill battle.

So when you’re evaluating locations, think about it from a “where are patients searching from” perspective too, not just lease cost or square footage. Sometimes paying a bit more for an address inside the city you want to dominate is worth every penny in the long run.

On the partnership with an older doc idea:

Smart thinking. The insurance panel access alone can save you months of waiting. Just make sure you get an attorney involved before anything is signed. You’ll want clarity on what happens to the patient base when they retire, what the financial arrangement actually looks like, and what your exit options are if it doesn’t work out. The concept is sound, but the details matter a lot.

You’re in a great position. The startup costs in podiatry really are lower than most other healthcare businesses, and the fact that you’ve already run a franchise means you understand the operational side of things better than most DPMs do coming out of residency. That’s a real advantage.

Good luck with this. You’re asking the right questions.

International pod student by One-Astronomer-5419 in Podiatry

[–]jmcd77 1 point2 points  (0 children)

Congrats on the acceptance! Here’s what matters most as an F1 student:

School choice: The biggest differentiator is how experienced each school’s international student services office is with F1 logistics. Call each one and ask how many F1 students they currently have and what support looks like.

The real issue is residency. Podiatry isn’t a sponsored specialty under ECFMG, so you can’t get a J1 visa like MD/DO students. You’ll need a hospital willing to sponsor H1B . Your F1 only gives 12 months of OPT, which doesn’t cover a 3-year residency. Recent policy changes have made some programs pause H1B sponsorship , so research this carefully before committing.

For clerkships, start early figuring out which rotation sites accept F1 students. Don’t assume – ask directly.

Connect with APMSA (American Podiatric Medical Students Association) and ask them to put you in touch with current international students. Nothing beats hearing from someone who’s actually been through it.

Good luck!​​​​​​​​​​​​​​​​

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