When Dr. Edwin Hart III had an innovative idea to create an event for The Goldfarb Foundation that had never been done before, he placed a random call seeking the expertise of a fishing guide. The recipient of this call was Russell Parks. Russell was tasked with creating an unforgettable experience on the water just outside The Goldfarb Foundation's educational meeting. The fly-fishing guide created a memorable experience for experienced outdoor enthusiasts and newcomers alike, which has become an annual event that many look forward to. 

We caught up with Russell Parks of Fly Fishing Outfitters of Missoula, Montana, to ask him why podiatrists should go on this trip scheduled this year to take place September 23rd through September 27th, as he has been the tenured guide of this trip, responsible for cultivating memories that our members have appreciated, along with Event Chair Edwin Hart III, DPM. He tells us “With hundreds of miles of water at our fingertips, we never run out of fishing options for the clients we provide fishing instruction to,” including The Goldfarb Foundation’s group. 

Russell is no stranger to the great outdoors. He has been fly fishing since the young age of 12 in Texas and has lived and worked in Montana for 26 years, passing along his tips to our participants appreciating the guided expertise he provides.  

Those considering booking this event should know they can attend alone or bring their family and friends. While education is at the center of this activity, many attendees are non-DPMs and not even doctors. Continuing education credits are available for those DPMs who wish to earn them at a reasonable price. Russell says, “This is a great opportunity for podiatrists to not only get their continuing education credits but get that recharge that we all need in our lives. Rest and Relaxation, combined with meeting requirements, seems like a fantastic setup that we are glad to provide.”

Guests will arrive via the newly remodeled Missoula Airport, and accommodations are at the DoubleTree Missoula-Edgewater, which is ten minutes from the fishing excursions. The event is chaired by Dr. Hart, who ensures guests have the experience of a lifetime while also running a well-organized event. Dr. Hart encourages anyone considering attending to "make their reservations and plan to renew themselves, while leaving surprised that you picked up a new sport! “Tracey Vlahovic, a regular lecturer for The Goldfarb Foundation, left this meeting doing just that after being recognized for catching the biggest fish in the group!

For those still on the fence about trying something new, Russell encourages you to come out and have fun, without worrying about expectations- “you do not need any fishing experience to attend the Montana Meeting.” He is dedicated to teaching rookies and experienced enthusiasts to learn something new and have fun. It is a great way to spend time in the beautiful outdoors, make memories, and strengthen your network - all while fulfilling educational requirements. 

To learn more about September’s event, “The Montana Meeting,” visit https://www.goldfarbfoundation.org/CME-Meetings/2026-Montana-Meeting. Information about Missoula Fly Fishing Outfitters can be found at https://missoulaflyfishingoutfitters.com/.

I rented this space for 11 years while I built this practice, adding patients I treated out of this facility. The costs associated with remaining in this space increased, and the pandemic created an environment in which my overhead increased by 40%, making it apparent that I needed to prioritize looking at other options for my practice. I quickly learned that rent may not be the best option with real estate pricing going up, and I decided to get serious about building acquisition for my podiatry practice to stabilize my monthly expenses.

Purchasing a building for your business is a big task but also gratifying!

This journey's two most challenging components are finding the right real estate and obtaining financing. Finding a trusted professional to navigate this journey can be helpful. For some, this may come from their network and referrals from other professionals. Fortunately, in my case, my husband is a Business Banker, so I started this process on the right foot!

It was evident throughout this process that having a good financial institution and the right professional in my corner improved the outcomes.

In searching for the perfect spot, I quickly learned that I might benefit from exploring options that include smaller buildings or older homes that have been turned into offices vs. focusing on a larger building and subleasing space to tenants to make the cost of entry more affordable. I found a spot in which I could walk to from my home which seemed meant to be! I hired contractors to make the updates that were needed. It was rewarding to have the opportunity to ensure that my work environment had a homey feel. I have received lots of compliments from patients who appreciate the warm, inviting environment this new space has provided. There were times throughout the process that were a little stressful, but the contractors did a great job, and the project turned out great.

In reviewing the outcomes, I'm thrilled to report that I cut my overhead by half by purchasing real estate for my practice! I am making payments to myself, instead of a property management company or a landlord, ultimately increasing my wealth. The purchase of the building stabilized one of my most significant expenses, and I have reaped the benefits available from a tax perspective. I alleviated the worry of a landlord increasing my rent or not renewing a lease which would result in business interruption. 

Having real estate as an asset on my business books will be helpful for me down the road as I approach retirement. Generally, a health care practice is considered easier to sell when real estate is included because it increases the overall value of the sale, which may attract more buyers and command a higher price. It also opens up additional options when looking at retirement options which may include the sale of the property or leasing it and generating passive income.

Podiatrists in private practice may want their own building and could do some due diligence in their early years of practice.

For podiatrists who are just starting a business, getting a line of credit may be a good idea, as banks prefer lending money to businesses with some experience. A line of credit may be a great move to help with overhead costs, and it will help develop a relationship with the bank, which could help when it is time to get a loan, such as a real estate loan for your business.

Acquiring this property has yielded so many positive gains in my life that extend beyond numbers. I can confidently continue to serve patients in a community that I love being a part of. I get to remain close to home and access my family with ease. I am able to enjoy all the rich culture Pennsylvania has to offer. This decision has been such a positive experience that I am honored to share with others that may be considering purchasing property for their podiatry practice.

Shelly Levulis, DPM, specializes in foot and ankle surgery, wound care, and diabetic foot care. She graduated from Temple University School of Podiatric Medicine and practices in Edwardsville and Dallas, Pennsylvania. Dr. Levulis serves on the Board of the Pennsylvania Podiatric Medical Association.

Here are eight ways giving back to the community can significantly boost not only a small business’s reputation but also its bottom line:

1. Building Trust and Credibility In a world where consumers have endless options, trust and credibility are vital for any business. When you actively contribute to your community, whether through charity events, sponsorships, or volunteering, you demonstrate a commitment to more than just making a profit. This commitment resonates with customers who are increasingly looking to support businesses that align with their values.

Why It Matters: Trust Equals Loyalty: Consumers are more likely to stay loyal to a brand they trust. When you invest in your community, you build a relationship of trust that can turn customers into long-term advocates.

Word-of-Mouth Marketing: A strong reputation in the community often leads to positive word-of-mouth marketing, which is one of the most effective forms of advertising for small businesses.

How to Start: Support Local Causes: Identify causes that resonate with your business’s mission and values. Whether it’s supporting a local food bank, sponsoring a youth sports team, or organizing a charity drive, these actions help establish your business as a community partner. Be Consistent: Community involvement should not be a one-time event. Regular contributions and participation help to solidify your business’s role as a reliable and dedicated member of the community.

2. Enhancing Brand Visibility Community involvement is a powerful tool for increasing brand visibility. When your business participates in or sponsors community events, your brand is exposed to a wider audience. This exposure can lead to new customers who might not have discovered your business otherwise.

Why It Matters: Local Recognition: Sponsoring a local event or participating in community activities puts your brand in front of potential customers in your immediate area. People remember the businesses that support their community.

Media Coverage: Local media outlets often cover community events, giving your business free publicity. Being featured in the local news, whether in print, online, or on television, can significantly boost your visibility.

How to Start: Participate in Community Events: Attend and sponsor events that align with your business values. This could include local fairs, parades, charity runs, or community clean-up days. Collaborate with Other Businesses: Partner with other local businesses for community initiatives. This not only increases your reach but also fosters a sense of camaraderie among local entrepreneurs.

3. Building Relationships and Networking Giving back to the community is not only about goodwill but also about building relationships and expanding your network. By engaging with other local businesses, community leaders, and residents, you create opportunities for collaboration, partnerships, and growth. Why It Matters: Strengthened Business Ties: Collaborating with other local businesses on community projects can lead to stronger business relationships. These relationships can result in partnerships that benefit your business in various ways, such as co-marketing opportunities or shared resources.

Networking Opportunities: Community events provide a natural setting for networking. You can meet potential customers, suppliers, and other stakeholders who can contribute to your business’s success.

How to Start: Engage with Local Business Groups: Join local chambers of commerce, business associations, or networking groups. These organizations often host events and initiatives that provide opportunities to give back while building relationships.

Host Community Events: Organize events that bring together different parts of the community, such as networking mixers, charity fundraisers, or local market days. These events allow you to interact directly with community members and other business owners.

4. Strengthening Community Ties A strong business-community relationship is mutually beneficial. By giving back, your business helps to create a thriving community, which in turn supports your business. Strengthening these ties ensures that your business remains a trusted and valued part of the local community.

Why It Matters: Community Support: A business that actively supports its community often receives support in return. This can be particularly important during challenging times, as community members are more likely to support businesses they feel a connection with.

Long-Term Relationships: Building strong ties with your community fosters long-term relationships that can sustain your business over time. These relationships can lead to repeat customers, referrals, and a more stable customer base.

How to Start: Focus on Local Impact: Prioritize initiatives that have a direct impact on your local community. This could include supporting local schools, sponsoring neighborhood improvement projects, or contributing to local charities.

Be Involved in Community Decision-Making: Participate in local government meetings or community boards where decisions that affect the business environment are made. This involvement not only helps you stay informed but also allows you to advocate for your business and community.

5. Enhancing Brand Image Your brand image is how the public perceives your business, and community involvement plays a significant role in shaping that perception. By aligning your business with positive community actions, you can enhance your brand image and attract customers who prioritize social responsibility.

Why It Matters: Positive Perception: A business that is known for giving back is often viewed more favorably by the public. This positive perception can translate into increased customer loyalty, higher sales, and a stronger market position.

Brand Storytelling: Community involvement gives you compelling stories to tell about your brand. These stories can be shared through your marketing channels to connect with customers on a deeper level.

How to Start: Promote Your Community Involvement: Share your community efforts on social media, your website, and through local media outlets. Highlight the positive impact your business is making and encourage others to join in your efforts.

Incorporate Community Giving into Your Brand Identity: Make giving back a core part of your brand identity. For example, you could develop a tagline or brand message that emphasizes your commitment to the community.

6. Strengthening Relationships with Customers and Employees Giving back to the community isn’t just about external relationships. It’s also about strengthening bonds with your customers and employees. People like to be associated with businesses that reflect their values, and employees are often more engaged and satisfied when they feel their work contributes to the greater good.

Why It Matters: Customer Loyalty: When customers see that your business is actively involved in improving the community, they’re more likely to develop a deeper connection with your brand. This connection fosters loyalty and can lead to repeat business.

Employee Engagement: Employees who participate in community service projects often feel more fulfilled and connected to their work. This can lead to higher job satisfaction, reduced turnover, and a more positive workplace culture.

How to Start:

Engage Customers in Your Efforts: Involve your customers in your community initiatives by hosting events or campaigns that allow them to participate. For example, you could organize a donation drive where customers receive a discount for contributing to a local charity. Encourage Employee Involvement: Create opportunities for your employees to get involved in community service. This could include paid volunteer days, team participation in charity events, or matching employee donations to charitable causes.

7. Differentiating Your Brand In a competitive market, standing out from the crowd is crucial. Community involvement can be a key differentiator that sets your business apart from competitors. When customers see that your business is committed to making a positive impact, it can influence their decision to choose your brand over others.

Why It Matters: Unique Selling Proposition: Your commitment to community service can become a unique selling proposition (USP) that distinguishes your business from competitors. This USP can be highlighted in your marketing materials and communications to attract customers who value social responsibility.

Positive Associations: Customers are more likely to associate your brand with positive qualities such as generosity, compassion, and integrity when they see your business giving back.

How to Start: Highlight Your Community Efforts: Make sure your community involvement is visible. Share stories, photos, and updates on your website, social media, and in-store. This not only informs customers but also invites them to join in your efforts.

Incorporate Giving into Your Business Model: Consider ways to integrate giving into your regular business operations. For instance, you could donate a percentage of sales to a local charity or create products that support a cause.

8. Fostering Long-Term Success Community involvement is not just about short-term gains. It’s about building a foundation for long-term success. Businesses that consistently give back often find that their efforts pay off in the form of sustained growth and a loyal customer base.

Why It Matters: Sustainable Growth: A strong reputation built on community involvement can lead to stable, continued growth. As your business becomes more embedded in the community, you’ll likely see increased customer loyalty and advocacy.

Resilience in Tough Times: Businesses with strong community ties often receive support during challenging times. Customers and community members are more likely to rally around a business they feel connected to, helping it through economic downturns or other difficulties.

How to Start: Develop a Long-Term Community Engagement Plan: Create a strategic plan for your community involvement that aligns with your business goals. Consider how your efforts can evolve over time and what impact you want to make.

Measure Impact and Adjust: Regularly assess the impact of your community involvement. Gather feedback from customers, employees, and community members to ensure your efforts are effective and meaningful. Giving back to the community is more than just a nice gesture. It’s a strategic move that can enhance your small business’s reputation, build trust, and foster long-term success. By actively participating in community initiatives, you demonstrate that your business is not only committed to making a profit but also to leaving a positive impact on the lives of those who support it. The relationships built through community involvement can be some of a small business owner’s most valuable assets. In the end, the goodwill generated by giving back can lead to a stronger, more resilient business that stands out in the hearts and minds of your customers.

PaySmart is a payroll provider located in Mechanicsburg, Pennsylvania, supporting small businesses in the Central PA region. We are dedicated to helping small businesses take care of their payroll needs. To learn more information about how PaySmart may provide payroll solutions, please get in touch with us at 717-766-1777. Our New Client Concierge is waiting for you!

Here are seven ways small business owners can bring their workplaces together during the holiday season:

1. Host a Holiday Party or Gathering A holiday party is a timeless way to bring your team together to unwind, celebrate, and socialize outside of the typical work environment. Whether formal or casual, holiday gatherings encourage camaraderie and offer an opportunity for employees to connect.

Here are some ideas: Themed Parties: Add a festive twist with themed events like “Ugly Sweater” or “Winter Wonderland.”

Virtual Parties: Engage remote teams with virtual holiday games, trivia, and gift exchanges. Family-Friendly Events: Include families to create a more inclusive, community atmosphere.

2. Organize a Gift Exchange A gift exchange, such as Secret Santa or White Elephant, can also be a fun, lighthearted way to build camaraderie among employees during the holiday season. Here are some tips to keep to keep in mind during planning:

Set a Budget: Make sure to set a reasonable price range to ensure participation without financial pressure. Keep It Inclusive: Choose neutral themes to ensure everyone, regardless of their holiday traditions, feels comfortable participating.

Prioritize Thoughtfulness: Encourage personalized, creative gifts rather than focusing on price, making the exchange more meaningful.

3. Plan Holiday-Themed Team-Building Activities Holiday-themed team-building exercises are a fun way to boost engagement and bring employees closer together during this busy season.

Here are some ideas: Scavenger Hunts: Create holiday-themed contests with small, festive prizes.

Bake-Off Competitions: Encourage employees to share their favorite holiday treats.

Decorating Contests: Host office decorating contests with categories like “Most Creative” or “Best Holiday Spirit.”

4. Show Appreciation Through Thoughtful Gestures The holidays are a great time to express gratitude for your employees’ hard work. Thoughtful gestures, whether big or small, can make employees feel valued and appreciated.

Here are some ideas:

Personalized Notes: Send handwritten thank-you notes that acknowledge specific contributions from the year. Bonuses or Extra Time Off: Offer holiday bonuses or additional time off to show appreciation.

Recognition Awards: Host an informal ceremony to recognize outstanding employees with fun awards.

5. Give Back to the Community Together Incorporating a spirit of giving during the holidays builds team camaraderie and strengthens your business’s connection with the local community. Participating in charitable activities fosters a shared sense of purpose between you and your employees. Here are some ideas: Charity Drives: Organize donation drives for food, clothing, or toys. Volunteer Days: Plan a group volunteer event to support a local cause. Sponsor a Family: Partner with a local organization to sponsor a family in need during the holiday season.

6. Create a Festive Workplace Atmosphere Adding holiday decorations and festive elements to the office can enhance the holiday spirit, making the workplace warm, joyful, and inviting. This will boost employees’ moods and increase their excitement about coming to work each day. 

Here are some ideas: Decorate the Office: Add lights, garland, and holiday décor to communal spaces.

Seasonal Treats: Offer festive snacks like cookies or hot cocoa in the breakroom. Holiday Music: Play holiday music during lunch breaks or other casual moments to lift the mood.

7. Reflect and Celebrate the Year’s Achievements The end of the year is an excellent time to reflect on the team’s accomplishments. Celebrate successes, highlight key contributions, and acknowledge the hard work put in throughout the year. This will help employees feel appreciated and noticed for their contributions and efforts.

Here are some ideas: Year-End Recap: Share a presentation or memo highlighting major milestones and individual contributions.

Goal-Setting for the New Year: While celebrating achievements, start a conversation about goals for the coming year and encourage employee input. Bringing your team together during the holiday season fosters a sense of unity and belonging, enhances workplace morale, and leaves lasting positive impressions. Whether through holiday parties, team-building activities, appreciative gestures, or community involvement, small business owners can create an atmosphere of joy, reflection, and celebration. The festive season provides the perfect backdrop to strengthen workplace connections, reflect on the year’s achievements, and set the tone for a successful year ahead.

PaySmart is a payroll provider located in Mechanicsburg, Pennsylvania, supporting small businesses in the Central PA region. We are dedicated to helping small businesses take care of their payroll needs. To learn more information about how PaySmart may provide payroll solutions, please get in touch with us at 717-766-1777. Our New Client Concierge is waiting for you!

For those who are unfamiliar, LinkedIn is a social media platform specifically designed to help professionals make strategic connections to expand their networks. Users employ LinkedIn to show off their work experience and any recent professional opportunities they took part in and stay informed on what their network has been doing. Additionally, businesses can place job postings on the platform that professionals can apply for directly from the social media platform.

Here are five reasons why small business owners may want to consider using LinkedIn when searching for job candidates:

Seventy-three percent of patients keep a "mental scorecard" on their likes and dislikes about their healthcare provider's office, a new study from EHR company ModMed and OnePoll found. 

LEARN MORE!

A: Customer service takes on a lot of different forms in our practices…and the telephone is one of the most impactful ones! If you are “all about customer service,” you are familiar with the theory that one dissatisfied person will tell 9 or 10 other people about their poor experience. Those are numbers you do NOT want to see multiplied. Prospective patients may be influenced – just from one lousy phone encounter, and I do not need to tell you that that is bad for business!

Knowing that your staff possesses the power to either draw your patients in or chase them away, putting the right person in that seat becomes much more critical to your practice-building efforts. Your receptionist is responsible for delivering that first impression, which is a tall order for a new patient who may not yet know your physician skills or charming personality. Greeting every caller as a welcomed guest requires a constant, conscious effort, not just when they feel like it.

Surprisingly, doctors often entrust their staff with such a significant tool as the phone without ensuring they have the necessary training in phone etiquette. While everyone may know how to answer a phone, it does not mean they can manage patient calls effectively. By providing proper training or refresher courses, you can ensure that your staff understands the importance of professionalism and empathy in patient interactions.

 Sometimes, patients indeed drive us to our limits. Still, instead of reacting defensively or angrily, trained personnel would know how to communicate with this individual and follow proper protocol for a successful outcome. Going head-to-head with the patient is not the right path; it only irritates them further, resulting in their leaving the practice.

As a rule, a patient calling to complain about a bill is not meant as a personal attack; they want information. So, suppose staff know enough to remain calm, LISTEN to gather information, control the conversation [with open and closed questions], and provide them with answers instead of a run-around. In that case, they can easily take the phone call more constructively.

If you are suspicious that your staff is mishandling your phone calls, try disguising your voice, call your office, and hear what your patients hear. This is not an exercise in “tricking” staff, but rather one to educate them in best telephone practices. If you think this tactic is sneaky, warn your staff that you will call anonymously. They will either know their stuff or not, and if they cannot appropriately manage the call, then ONE, they should not be in that seat…or TWO, they should receive better training. On the other hand, if they CAN oversee it, it is another reason to praise and congratulate them for a job well done!

Here is what you should be looking for: Is your phone answered in a friendly, helpful, polite way? Is your practice name identified? Are you put on hold [without you are ok] and left there for an eternity? Or worse yet…disconnected? Are you given incorrect information in response to a question? Are you given unauthorized medical advice!? Are you made to feel that your call is unimportant or that speaking to you is inconvenient? Do you feel rushed off the call? In the end, did you think the call was worth your while? And finally, would you call again?

We do not want you to lose your patients or your patience, so consider making some changes now that will make you proud and put your practice in the “customer service spotlight!”

The following is a six step outline that can help you put one together. 

Step One: Recruitment

• Where should we look to find new recruits?
  • Schools, social media, patients, eateries, internet job sites (Monster.com, Indeed, etc.), hairdressers, gym, anyone in hospitality (customer service positions, i.e. hosts, waitstaff, valet, front desks, etc.) Chat it up! Let people/patients know you are searching.
• How can existing staff help in the search?
  • Individuals tend to hang out with those who exhibit similar personalities. Ask your staff: “Are there more of YOU out there?” “What about the job attracted YOU?”
  • Staff input helps to evaluate the practice’s current staffing needs. Where is help most needed? In what ways do they see a new hire affecting workflow? (Good or bad)
  • Put an Employee Referral Program in place as an incentive for them to help.

Step Two: The Hiring, Interview, and Selection Process

• Assess application responses
  • Pay attention to “red flags” on resumes and eliminate those that do not meet your needs.
  • Follow up: Set up appointments for first interview.
    • Decide who will conduct this interview – Doctor or Manager
    • Use a standard questionnaire for consistency and fairness to compare apples to apples; take notes to review later.
    • Have your favorite interview questions ready. Refrain from asking illegal ones.
      • If you encourage an open dialogue with your interviewee, they may offer information you are not allowed to ask.
    • Initiate role playing scenarios – focus on behaviors, words, expressions.
    • Discuss basic job descriptions, wages & benefits, hours, travel.
    • Meet and greet staff; are first impression personality clashes obvious?
    • Highly recommended to set up a second interview for those who seemed promising! Learn as much as you can before pulling the plug on your selection.

Step Three: Orientation

• Conduct a facility walk-through with new employee on day one. Best to start them on a Tues or Wed as Mondays typically are a little too hectic.
• Formal introduction to staff and practitioners.
• Match peer mentor to new recruit.
• Assign email account and login info.
• Have new employee spend adequate time with Office Manager (or the like) to:
  • Review and sign all necessary work-related paperwork.
  • Explain workplace culture, set practice goals and milestones; help them understand the importance of their participation as a team player.
  • Set up a training schedule.
  • Review employee policies and handbook for rules; conduct and disciplinary actions; workplace safety.
  • Explain job, employee, and employer expectations.
  • Review the performance review process; how, when, why?
  • Present a thorough review and understanding of their detailed job description and responsibilities. Prioritize primary and secondary duties.

Step Four: Training (MAKE the time!)

• As part of active work duties, all new employees regardless of hired position should report to the following positions (requiring their focus for a one week period in each position) to shadow, understand associated tasks, and observe interactions of each role. This is mandatory and in coordination with the components of a Successful Proactive Training Model (described in detail below).

  Some observations entail:

  • Doctors (observe doctor-patient interaction, instruments, protocols, podiatric vocabulary and commonly treated conditions, supplies, etc.)
  • Medical Assistant (Proper patient rooming and exam room setup, sterilization, inventory, documentation responsibilities, etc.)
  • Receptionist (phone, scheduling, patient data, collections, patient communication, etc.)
• Components of a successful proactive training model:
  • Demonstrate task, 1) Explain HOW, 2) Clarify importance, 3) Encourage questions, 4) Trial Time to observe and monitor, 5) Allow them to perform task solo.
• Require note taking as a learning tool – notes should be checked daily for accuracy.
• Cross training.

Step Five: Job Expectations that should be reviewed regularly with ALL Staff/Team members (new and existing)

• Professionalism
• Risk Management
  • HIPAA Confidentiality/breaches/consequences
  • OSHA Compliance
  • Legal Scope of practice
• Communication Skills (The patient/Staff connection)
• Customer Service
• Basic knowledge of podiatric medicine
• Dealing effectively with difficult personalities
  • Demanding, Complainer, Perfectionist, Disrespectful, Chatterbox, RUDE…. Abusive?
• Competence, Accountability

Step Six: Retention

• GOOD MANAGEMENT and Leadership!
  • Incentives
  • Inspiring, fun work environment
  • Employee rewards, appreciation and engagement opportunities
  • Fair Compensation & Benefits
  • Growth Opportunities
  • Employee surveys: Because it is unlikely that every staffer is motivated by the same thing, the best thing to do is to ask and FIND OUT.

Turnover is expensive AND disruptive! A strong onboarding process will considerably increase the likelihood of a voluntarily longer-term, happier employee.

BACKGROUND

SOLO Laboratories has long sponsored The Goldfarb Foundation and its events. The PA-based small business is committed to supporting our association and its members in the long run.

With SOLO’s custom orthotics being manufactured and serviced in our home state of Pennsylvania, the PPMA team decided to visit SOLO Laboratories in the PA Dutch town of Kutztown and learn more about their footprint to share with our members. PPMA caught up with the organization's leadership team, Jaimyn, Kent, and Jon, who hosted us to tour the lab and its offices.

HISTORY

We learned that SOLO Laboratories was founded in 1983 by Barry Sokol, an entrepreneur with a background in orthotics labs and medical sales experience; Mr. Sokol had a passion for service. The company’s name is an acronym for Serve Others Love Others (SOLO), which is expressed in caring for their customers and employees.

MADE IN PA

While the company has grown since its humble beginnings in a shed, now occupying two buildings in Kutztown, evidence of SOLO’s mission is also carried out in how it treats its employees.

SOLO Labs has been awarded one of Pennsylvania's Top 50 Places to Work. Their skilled employees consistently meet and exceed production and quality standards, which includes a turnaround time of less than six days from receipt of the order until the UPS Tracking Number is assigned upon shipment to the customer, which is rather impressive for the team those crafts over 200 custom made orthotics daily for customers all over the United States.

SOLO customers include large healthcare networks and small podiatrist offices. Their presence has grown due to word of mouth amongst the podiatry community based upon the name they have made for themselves by providing an exceptional product and quality service that can be trusted.

TECHNOLOGY

To fulfill the company’s mission statement, the small business that started in a shed invested in improving its technology to exceed customer expectations.

PPMA members may be fascinated to learn more about this history as we have members who may have begun their career casting for custom orthotics and may still be doing so. An unknown fact is that SOLO Labs pioneered the TOM-CAT foot scanning system. The company has successfully lowered the entry barrier to foot scanning with an iOS application named viSo. The app can be downloaded at no cost to an iPad and used to scan for orthotics. Members can upload the scan, transferring this information instantly from the office to the lab, saving our members a ton of time and hassle in mailing orders and calling on the phone to ensure receipt. In addition to the time savings, our members can feel confident that these scans, which are as accurate as casting, will result in a custom-made orthotic being shipped within six days of receipt, which can be tracked via UPS. Our members can have the orthotics sent directly to the patient or our member’s office.

SOLO believes that this investment in technology will allow podiatrists to spend more time treating their patients while SOLO handles the lab work on their patient's behalf.

Podiatrists may schedule virtual in-services for training to help increase confidence when transitioning into a new technology. SOLO also provides free training to members who may not feel comfortable transitioning to using an application on an iPad as a scanner. SOLO provides order consultation via email and phone at their Kutztown location; additionally, an online portal is available to track order status, print invoices, and pay your bill.

The lab continues to investigate and acquire new technologies, such as 3D scanning and 3D printing, to continue achieving and improving results.

SOLO LABS BY THE NUMBERS

They craft over 200 pairs of orthotics daily by hand for patients throughout the United States. Customers include patients of independent podiatry offices and large healthcare networks.

Family-owned SOLO Labs has been manufacturing and developing new technologies based in Kutztown for over 40 years.

SOLO LABS CAN BENEFIT MEMBERS

Members who have a relationship with SOLO Labs benefit from adding a solid revenue stream, saving administrative time in managing orders, and confidently prescribing a product of excellent quality that the patient will benefit from for a long time. Additionally, PPMA members who work with SOLO Labs can feel confident that they are supporting a local business in Pennsylvania manufacturing a PA product that they stand behind while they are committed to continuing to serve PPMA members for some time.

Members who wish to learn more about how to work with SOLO Labs can visit their website at www.sololabs.com or call their office and speak with someone at 1-800-765-6522. The SOLO team is committed to supporting PPMA members, and custom orthotics are a way for the patient to experience relief from numerous conditions. 

A Private Insurance Advisory Committee representative deals with changes in private insurance. Most of the 50 states attended this meeting.

We discussed multiple issues with Medicare and private insurance. The conversion factor this year is reduced by 2.18. However, this should have zero impact on podiatry payments. We hope this stays the same. I'll keep our membership posted with any changes.  

We discussed the proper use of modifiers, such as modifier 25, when a procedure and evaluation and management are done on the same day.  We also discussed callus care being kicked out on the same day as nail care for some insurances, like Aetna. APMA is working hard to continue monitoring this; supposedly, Aetna has fixed it. 

We discussed the new “Final Rule” in depth. This was passed to protect Medicare customers confused by Medicare Advantage plans. Advantage plans will no longer be able to offer less than what Medicare. So hopefully, the Advantage plans that only allow at-risk foot care four times a year will need to change this to the Medicare LCD guidelines in your area. 

Dr. Jeff Lehman talked to us about MIPS.

Members who want to file a QPP exception application must do sobefore January 2, 2024. You can find this application onwww.gpp.cms.gov. You will need to fill out why you have an extreme and uncontrollable circumstance that would not allow you to participate in MIPS this year.

I will keep our membership posted with any other further updates as APMA and PPMA continue to monitor issues with billing and reimbursements. Another great benefit of membership in PPMA!

https://www.hmpgloballearningnetwork.com/site/podiatry/blogged/how-much-should-you-be-paying-your-podiatric-medical-assistants

Compliments of Podiatry Today

Role playing different common scenarios helps reveal many of the soft skills (like communication & interpersonal skills, time management – working under pressure, composure, compassion, self-motivation, decision making, creativity, adaptability and work ethic) that otherwise go undetected with your typical interview. It also brings to light some of their problem solving and customer service qualities. Sure as shooting, your applicant will come prepared. He/she are familiar with the types of questions and has spent time practicing all the right answers. If they’ve been at this for a while, chances are their acting skills are perfected. Their intent is to fool you into thinking they are the best candidate for the job. Maybe they are; maybe not. Don’t be fooled.

Here is a typical example of a rehearsed, verbal response:

· Interviewer: “There are times when our schedule sometimes run late. How would you handle an irritated patient who was waiting longer than she expected?”

Applicant: “Well, I would explain to her that there was an emergency that caused us to run a little late. I’d give her the option of waiting a little longer or reschedule her to another time.”

Perfectly canned response. She practiced it and delivered it with scripted confidence. But, what if the patient expressed continued discontent (as they many times do)? Satisfied? If you end the questioning there, you’ve really just only seen what the interviewer wants you to see.

Here’s what role playing will do with the same question, but asking the applicant not to recite her response, rather to act it out in real time.

· Interviewer: “There are times when our schedule sometimes run late. I’m going to be that irritated patient who was waiting longer than she expected and I’d like you to be my new assistant. Show me how you’d handle this patient’s complaint.”

Acting as the irate patient, don’t go easy on her. Be overly-sensitive. Demanding. Critical of not only her, but the practice. Say things like, “This isn’t the first time I’ve had to wait more than 30 minutes. How many times does this have to happen before this practice learns to schedule properly?” Ouch.

As the applicant takes on her new role, you observe her body language. Are the words she uses and the tone of her voice satisfying to you? Does she look you in the eye? Sound genuine? Does she remain composed even though the patient (you) give her a hard time or does she crack under pressure? Does she get defensive? Make up some flimsy excuse or worse yet, promise it will never happen again? Are her words congruent with her actions? Is she apologetic and empathetic? Is she able to calm the patient by thinking quickly on her feet to offer a satisfying solution? Finally, how would you feel as a patient having interacted with her, face-to-face?

The same rules can be applied during subsequent in-house routine training sessions or at a staff meeting where everyone can participate. Present various scenarios – in the treatment room, on the phone, responding to clinical questions, etc. Then, don’t just ask how they would handle each situation, but let

them show you. Of course, role playing is only one piece of the hiring and training puzzle; a piece you really don’t want to be missing. It can help to capture your star employee. Don’t underestimate its payoff.

Ms. Homisak, President of SOS Healthcare & Management Solutions, has a Certificate in Human Resource Studies from Cornell University School of Industry and Labor Relations. She is the 2010 recipient of Podiatry Management’s Lifetime Achievement Award and recently inducted into the PM Hall of Fame. Lynn is also an Editorial Advisor for Podiatry Management Magazine and recognized nationwide as

• Think things through. Is this a last resort? Is there a chance you could potentially improve this employee’s performance before letting him/her go?
• Be sure you follow company policy re: your disciplinary process, written reviews, etc.
• Be sure you have adequate documentation concerning their poor work performance (including specific verbal warnings).
• Is your decision a valid one? Be sure you have “non-discriminatory legal reason” to fire.

• Please email lynn@soshms.com for a list of questions you can and cannot ask during an interview.

If it is apparent that dismissing your employee is the best option, take note of these practical suggestions to help with the actual face-to-face encounter in an appropriate manner…

• Be brief – terminate in the first 7-10 minutes.
• Don’t chit-chat – be direct – Don’t postpone the inevitable.
• Be prepared for emotional outbreaks (anger, crying, etc.)
• Listen…But do not become defensive or argumentative.
• Stay focused and repeat the main message…Don’t allow yourself to be distracted by their offer to change or make things better.
• Don’t attempt humor – While you might want to soften the blow, it’s not funny to them.
• Don’t blame the employee – What’s done is done…his/her “lousy job” is not the focus anymore
• Don’t say you understand – Sympathize but don’t empathize – you don’t really know what they are feeling.
• Don’t offer to help – It contradicts your actions.
• Don’t agree to “think about it” – Make a clean break.
• Make no reference to age, sex or race, even casually.

After the actual dismissal takes place, it’s important to take care of a few additional details:

• Informing co-workers. Don’t pretend it didn’t happen. Instead say something like “despite repeated warnings …” to give them reassurance that they won’t be next; followed by “out of respect for employee’s privacy…” explaining the reason for not revealing details. It is also strongly recommended to avoid disparaging words about the employee. Not only are they non-professional but also deterrent to employee morale.
• Dealing with reference calls from future potential employers. Keep the call short. “She did work here; she no longer works here.” Stick to dates & salary confirmation; beware of any potential for liability involving defamation of character.

Finally, here’s a checklist of “things to do”:

• Collect keys, any office properties, office handbooks, employee manuals, computer disks, etc.
• Change any internal passwords assigned to this employee to prevent any outside access to office technology.
• Pay employee any accumulated wages and benefits due them and complete any necessary forms (vacation, sick days, bonus, etc.)
• Conduct exit interview for purposes of learning, awareness and improvement on the part of the Practice.

Ms. Homisak, President of SOS Healthcare Management Solutions, has a Certificate in Human Resource Studies from Cornell University School of Industry and Labor Relations. She is the 2010 recipient of Podiatry Management’s Lifetime Achievement Award and recently inducted into the PM Hall of Fame. Lynn is also an Editorial Advisor for Podiatry Management Magazine and recognized nationwide as a speaker, writer and expert in staff and human resource management.

If so, then follow along.

These easy tips will improve cash flow, increase marketing potential, strengthen staff competence, and even manage your time and systems.

Let the countdown begin!

10. Monitor the money handlers.

Introduce standardized money handling protocol and embezzlement safeguards. Regulate how each phase of the money is to be handled (patient collections, recording, receipts, end-of-day reconciliation, depositing) and by whom. It is also a good idea to conduct unannounced spot checks to start.

Note: Staff need to understand that financial safeguards are not implemented due to a lack of trust; rather, they are a necessary business mechanism. If anyone is uncomfortable or shows signs of resistance, consider it a red flag.

9. Stay “in the know” by receiving weekly and monthly financial data as well as quarterly productivity reports, including the status of account receivables, aging, credits and refunds, clean claims analysis, and denial/appeals progress reports.

8. Make sure your daily schedule indicates patient balances owed so the front desk staff can collect them at the time they collect patient copays. For more effective outcomes, encourage staff to be proactive in their collection efforts by stating, “Your copay/balance today is…” rather than asking, “Would you like to pay your past due balance today?”

7. Increase your market acumen. Ask yourself, “What makes our practice so special?” and build on your unique strengths. It wouldn’t hurt to get some insight into what your competitors offer that you do not.

6. Use your patient emails to stay in contact with them. (Think: practice updates, educational info, newsletters, birthdays, etc.)

5. BUMP UP staff training! Give staff the proper knowledge and tools to maximize their output to grow and succeed - in their career and your practice.

4. Tap into the staff’s strengths and talents in order to assign proper placement. A team that feels challenged and enjoys what they do will apply themselves in a much bigger way, whereas improper job placement creates a less energic, slower-paced employee.

3. When managing your appointment schedule, be realistic. If a procedure takes 30 minutes, do not schedule a brief 10–15-minute time slot. Time align your procedures so staff can schedule appropriately and keep an on-time schedule. And note your start time. Arriving and starting 10 minutes late is enough to snowball in a schedule backup. If you can’t be on time…BE EARLY.

2. Make the time to regularly review current operating systems. Monthly staff/office meetings are a very effective place to have this discussion. Ask for and listen to staff input. The front line is likely more aware of daily obstructions. Give their ideas a shot, innovate. And try new strategies for at least six weeks at least before invalidating their potential.

1. Send new patients to your website or portal to fill out their registration forms in advance of their visit. Don’t age-discriminate (for example, assuming Medicare patients cannot comply). Advise them to send forms electronically (the best) or ask if they have access to a computer/printer. Their cooperation will save a solid 15 minutes when they arrive, and you will receive a much more accurate/comprehensive health history as a bonus!

Bonus Tip: Don’t let those empty appointment times go to waste. PLEASE insist that your staff use a waitlist to at least attempt to fill cancelations and holes in your schedule. I can attest that patients scheduled weeks/months in the future would genuinely appreciate an opportunity for an earlier appointment.

Is that what phone training in a medical office has become?

The telephone is a patient’s very first personal contact with the practice. A vital communication tool responsible for practice building and management. Why, then, is it that doctors do not require professional training in proper phone skills and etiquette? Not just for their receptionist, how about the entire staff?

After years of consulting experiences (combined lately with crazy stories I’ve had with personal medical encounters), it is evident that not all physicians know what goes on at that front desk, particularly on the phone. That is, not until they overhear an uncomfortable conversation they wish they hadn’t. I can’t tell you how often a client has come to me sounding the alarm, saying, “I can’t believe what I just heard my staff say to a patient on the phone!” It is at that point that reality sets in.

Unfortunately, if new job applicants indicate they have experience as a receptionist on their resume, it is often mistakenly assumed that they possess excellent telephone skills. It might further be misconstrued that answering phones is “just another standard job” that receptionists have indeed mastered. However, that is rarely the case. Too many “receptionists” cannot pass that test, presenting an unpleasant first impression of the entire practice.

This leads me to wonder…

• Are doctors aware of the information their staff communicates (whether it is accurate or medically advised?)

• Do they assume that all their employees professionally conduct themselves on the phone by utilizing proper tone, volume, and attitude in their voice?

• Do they know whether (or not) staff SMILE and are courteous when they speak on the phone, or are they bothered by the interruption?

• Do staff (intentionally or unintentionally) abuse the hold button - losing patients, literally and figuratively, as a result?

• Can they diffuse angry, disgruntled, and abusive patient situations and take appropriate action to resolve issues?

• Do doctors know if staff remain focused on welcoming patients in or shutting them out because they feel stressed or overwhelmed?

• Do docs feel that sending new staff for proper training only unnecessarily delays their start date? Is the cost of professional training a deterrent factor?

It may appear I blame staff for all the transgressions – not so. Unless they receive specific “how to” instruction and official training, they will do what they do, right or wrong, good or bad – and believe there is no problem. It all goes back to management. The more self-made protocol that slips by uncorrected, the more they will trust that their way of (mis)handling things is okay.

Because of its impact on the practice, many successful doctors consider the office phone as relevant as the essential clinical equipment – x-ray, ultrasound, etc., ensuring that those tools are in optimum working order and professionally maintained. Telephone training is no different. Phone skills also need to be professionally maintained. I would even go so far as to say that annual training and refresh are necessary. Anyone in practice responsible for answering the phones and speaking with patients, other medical offices, hospitals, or vendors…must know how to handle those calls effectively. Mishandling is not an option.

If formal training is not currently possible, commit to a time that is. In the meantime, schedule and conduct in-house training sessions. These should include discussing common scenarios, role-playing, customer service etiquette, problem-solving, medical advice no-nos, opening and closing calls, and turning phone inquiries into appointments. If webinars are available, take advantage of this alternate resource.

Don’t wait until you overhear an uncomfortable conversation. It could be too late. Get staff the training they need now. And remember, you don’t have to train all your team – just the ones you want to keep!

The Peterson-Kaiser Family Foundation Health System Tracker shows Healthcare is nearly 4% under projected levels based on pre-pandemic growth rates. The Great Resignation hit Healthcare Providers very hard.  So too, many staff members resigned.  Patients are noticing.  A recent HealthDay/Harris Poll shows 25% of Americans have noticed or personally experienced the impact of staffing shortages in health care and more than half of respondents blamed staffing shortages for delaying them from receiving needed care.  Any Podiatry practice which is hiring for healthcare jobs is experiencing both existing staffing issues and recruitment challenges.  

Podiatry practices face several challenges in recruiting for any position.  Let’s just consider just four challenges practices have in hiring:

1. Aging Workforce

According to the US Department of Labor, workers 55 and over now make up 25 percent of the labor force — up from 13 percent in 2000.  Every resignation of a cherished “elder” employee stings.  Significant tribal knowledge is lost.  This impacts healthcare delivery in all facets of a Podiatry practice.  Medical experience is lost, and the reduced administrative prowess of front-office and back-office staff noticeably impacts day-to-day operations.

2. Burnout

There is unprecedented pressure on Podiatry facilities and staff.   The Association for Advancing Physician and Provider Recruitment reports one-third of physicians are considering retiring early which would exacerbate aging-related retirements.  Administrative burnout is real, too.  Burned out administrative staff are less proficient at their jobs and this leaves patients feeling overlooked and unhappy BEFORE they even get to see the Podiatrist.

3. Shortage of Qualified Individuals

Hiring for every role in a Podiatry practice is faced with a shortage of qualified individuals.  Data from the American Association of Colleges of Podiatric Medicine (AACPM) shows decreasing enrollment in Podiatry school since 2015.  Finding qualified associates can be a challenge, as a result.  Post-secondary vocational or technical education in administrative work is not as common as it once was.  Many Podiatry practices are faced with hiring people with no experience in healthcare administrative roles hoping they can develop into the dynamic, multi-tasking gatekeepers who greet patients in a positive and friendly manner.  A secondary impact of the shortage of qualified potential hires is longer hiring timelines. 

4. Hiring Costs

Months and months of inflation, the movement of calling for an increased minimum wage of $15 per hour, educational debt, and many other factors have driven up hiring costs for administrative staff who can make more in warehouse jobs.  The average medical school graduate owes $250,990 in total student loan debt.  This fact drives the decision making of potential Podiatry associates. Salaries are a significant portion of expenses for a practice.  All of this rests against the reality that when adjusted for inflation in practice costs, Medicare physician pay declined 20% from 2001 to 2021 according to the Federal Register, Medicare Trustee’s Reports and US. Bureau of Labor Statistics. 

Podiatry practices cannot function well without addressing hiring issues.  No doubt, this is made more challenging in an environment where candidates overwhelmingly hold most of the leverage.  

Here are four tips for creating a mindful and calculated approach to deal with the hiring process:

1. Recommit to Your Purpose

Podiatry practices furnish good work opportunities in a rewarding space.  Few medical specialties present the opportunity to see and connect so frequently with patients as Podiatry does. The patient base for Podiatry practices skews older in age. Podiatry practices are places of healing, but also social hubs for elderly patients.  The Podiatrist and their staff often are frequently the only social interaction some elders get.  It is important, enriching work for Podiatrist and staff.  That should shine through in job descriptions and interviews.  This recommitment emotionally helps with burnout. 

2. Work Can Be Ageless

As much as the aging workforce presents challenges, it is simultaneously presenting opportunities.  Workers are aging and CHOOSING to remain in the workforce longer as life expectancies grow, and inflation erodes Social Security and other fixed income assets.  Workers over the age of 65 comprise 7% of the workforce currently.  That is expected to grow to 23% in 2028.  The AARP and other organizations offer programs for connecting older workers to jobs.  In many cases, these older workers possess skill and experience in the highly complex administrative roles which benefit a Podiatry practice.

3.Permit Flexibility

Don’t unnecessarily fetter yourself to old paradigms.  For example, can a former full-time position be handled with two part-time hires?  This can build in resiliency in your workforce.  Your organizational knowledge won’t be one person deep.  Time off is built into two roles offsetting burnout.  Does a hire have to have healthcare experience?  Perhaps that over 55, former law firm receptionist trains up easily enough to be the friendly face your patients love and a multi-tasking beast of an employee administratively.  Can the former Vet Tech make a great Medical Assistant?  Challenge every assumption you’ve ever had regarding how you have executed hiring in the past. 

4. Be Candid and Direct with Job Descriptions

Too much focus can be placed on relevant experience as a surrogate for job qualifications.  Be clear about the specific responsibilities.  Make sure job descriptions reflect what your brand is (1. Recommit to your purpose).  Explain what you need from the role for which you are hiring and what the practice can provide them in return.  This will help you get focused batches of resumes for review. 

The challenges faced by Podiatry practices in hiring go beyond these scant few mentioned and are many.  Regardless of which negative, even panicky, feelings these challenges present, Podiatrists and Practice Managers will continue to have hiring needs and must develop plans to appropriately meet those needs.  It is perfectly fine and appropriate to feel stressed and overwrought with the task.  Acknowledge the difficulty and remember successfully negotiating the hiring process is essential to increasing your own morale, your employees’ morale and creating a workplace where everyone feels valued, more productive and engaged. 

That is a business which has better attractiveness to current and potential talent.   

Vascular disease affects many people, especially those with a history of smoking or diabetes. Patients have narrowed or calcified blood vessels that cause poor blood outflow to the extremities. This may result in cold toes or feet. A medical history and clinical examination consisting of a thorough vascular exam are necessary. Symptoms may include pain at rest, a few steps or blocks upon ambulation, and cold feet that do not resolve with warming. Patients should have noninvasive studies to check the flow status in their lower extremities to assess the patency of the major arteries of the foot. A vascular referral might be needed, as well as an angiogram to determine the location of the occlusion(s). Untreated peripheral vascular disease can lead to ischemic changes and gangrene with chances of limb loss.

Another vascular phenomenon causing symptoms of cold feet is Raynaud's (disease and syndrome). In addition, trauma, cold, stress, or scleroderma can lead to vasospasms constricting vessels flowing to the feet. Symptoms include extreme sensitivity to cold temperatures and possible changes in color, such as blue or purple tones in the cold and redness when warmed. Treatment is warming the feet with socks or placing yourself in a room with higher temperatures. Some patients may also take more drastic lifestyle changes by relocating to states with warmer weather.

 Other culprits causing cold feet symptoms could be related to medications such as beta-blockers, migraine medications, and pseudoephedrine. These medications can cause constriction of blood vessels causing symptoms of cold feet.

           Peripheral neuropathy is a condition of degeneration of axons of distal nerves causing numbness or perceived coldness to the area once supplied by the nerve. Although common in patients with diabetes, it can also be seen in conditions such as alcoholism, malnutrition, hypothyroidism, and chemotherapy. Vitamin deficiency, such as that of B12 and folate, can cause demyelination of nerves leading to peripheral neuropathy. In addition, iron deficiency anemia, which is an iron deficiency, and therefore hemoglobin production, directly affects the amount of oxygen reaching tissues in the body. Thus, an appropriate amount of blood may not reach the far extremities and toes, causing symptoms of cold toes.

           Hypothyroidism, the 2nd most prevalent endocrine disorder after diabetes, is another culprit of cold feet. Patients unable to create sufficient thyroid hormone cannot thermoregulate their body temperature. Other systemic diseases that can lead to cold feet are hyperlipidemia, which damages and constricts blood flow through inflammation and atherosclerosis of arteries, and diabetes, which causes glycosylation and calcification. Therefore, it is crucial to get regular blood work and follow up with a primary care physician who can provide the appropriate referrals.   

            Symptoms of cold feet, while a cause of normal reaction of the body to decreasing external temperatures, should not be dismissed. They may indicate underlying vascular, systemic, or endocrine diseases that a specialist should further evaluate. Podiatrists are crucial in identifying factors that can lead to cold feet, so a multidisciplinary approach is recommended across multiple subspecialties.

Contributors:

• Jane Pontious, DPM Clinical Professor, Dept. of Podiatric Surgery TUSPM
• Kushkaran Kaur, DPM, MS

1. Kersting, Jonas, et al. "Guideline-Oriented Therapy of Lower Extremity Peripheral Artery Disease (PAD)–Current Data and Perspectives." RöFo-Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren. Vol. 191. No. 04. © Georg Thieme Verlag KG, 2019.
2. Crockett, David, and Daniel Bilsker. "Bringing the feet in from the cold: Thermal biofeedback training of foot-warming in Raynaud's syndrome." Biofeedback and Self-regulation 9 (1984): 431-438.

It would be interesting if a genie suddenly appeared and allowed us to grant three wishes. By each of us, I mean doctors, staff, and patients. Endless wealth aside, what would you wish for?

If you're planning the "wish for more wishes" strategy, you are straightaway in defiance of the genie's wish-granting rules that clearly state: "Three wishes, to be exact. And ixnay on the wishing for more wishes. That's it. Three. Uno, dos, tres. No substitutions, exchanges, or refunds." In other words, DENIED!

No, these perceived wishes could only be granted under one condition – that they help to improve said relationships at work. And, if they also prove profitable thanks to a deeper understanding of one another, so much the better.

Of course, I am still determining what each group would wish for, but I imagine it would be something along these lines. 

Doctors: 

#1 – Increased practice efficiency and productivity.

#2 – Less disruptive staff turnover. 

#3 – More patient compliance with medical care.

Staff:

#1 – Better management and appreciation.

#2 – Doctors who are more mindful of the schedule. 

#3 – Patients who follow office policies.

Patients:

#1 – More value and respect for MY time.

#2 – More quality time with the doctor; feeling less rushed through my visit.

#3 – Better communication between doctor and patient.

While I'm not a Genie, the above "wishes" are all granted (well, achievable) merely by making simple changes and implementing fundamental practice management strategies. It is also well noted that the wants and desires of each group tend to overlap. Therefore, one can effectively tackle two or more 'wishes' with just one swipe of the genie lamp. BONUS!

Doctors, since you know that "it all starts at the top," there are certain things you can start on today that will make you the hero who turns many of these wishes into reality! So let's begin with the call for better management.

Management. Do you know where you fall on the management scale as an employer? If you recognize that your management skills could help, why not give staff an anonymous management survey? Get into their heads and learn where you potentially need to catch up. Then be open to making some changes. Any effort (small or large) does not go unnoticed and will be appreciated. 

Appreciation. Try not to let a day go by where you don't offer a simple and genuine "thank you." It's not complicated; sometimes, that's all it takes to build a more gratifying work culture. What's more, it just might be the thing that prevents staff from leaving. Feeling more satisfied and appreciated daily often leads to increased productivity. Worth a try! 

Patient waits. Long wait times can make patients feel disrespected and their time undervalued. Remember to consider the role that you can play in keeping an on-time schedule. Stick to appointment times, observe how and when backups occur, limit excessive chit-chat, and #1 - arrive and start on time. Briefly review each day's schedule with your staff and implement effective protocols and policies to improve poor scheduling habits. Please don't dismiss their insight – they are on the front lines; hear the patient's gripes and know things you don't know! 

Some areas that may need new focus; late arriving patients, appointment reminder notifications, realistic treatment-time alignments, overbooking, no-shows, and interruptions. Monitor progress made and modify as required. Do nothing, and guess what? You will accomplish that - nothing.

Patient communication. Patients don't expect more time than necessary, but they expect adequate QUALITY time with their doctors. This includes better communication, time for questions/answers, active LISTENING, and understanding of their concerns. In addition, they want empathy and compassion for their pain and clear, doable orders they can follow. Delivering a higher, more influential level of communication will also positively affect compliance—better outcome – better for everyone. 

Staff communication. To improve staff communication – hello, communicate! Converse with them, learn about them, and try to meet their employment needs. Treat them fairly. Schedule routine team meetings and listen to their ideas/concerns. Perform on-the-spot and annual performance reviews that support their career advancement. Have an open-door policy that inspires back-and-forth dialogue, not just your monologue. Don't ignore their grumbles. The respect you give them will come back tenfold.

Office efficiency. Efficiency-minded practices start by having consistent Standard Operating Procedures in place. Simple, whole systems can turn a chaotic practice into one that runs on autopilot. Also, prioritize structured, educational training programs (telling is not teaching) so staff can confidently and effectively participate in hands-on patient care. Incorporate one-on-one demonstrations, scripting aids, conferences, mentorships, webinars, etc. Make it your goal to develop STAR employees, not mediocre ones. Share with staff the big picture (your practice mission), and set goals to help achieve practice efficiency and success that benefits the entire team. Then watch what happens.

And there you have it. Quoting Antoine de Saint-Exupéry, from his book Le Petit Prince - The Little Prince, "A goal without a plan is just a wish." Without actionable steps, your dream/wish is a wish. Don't stop. Pursue your dream. Dream it, create a goal, develop a plan, and implement that plan. Your wish will come true.

1. Avoid the one brand fits all strategy.

Two of the biggest pitfalls are #1 suggesting the identical shoe to all the patients and #2 presenting a specific name brand and not a particular type of shoe. One big mistake people make with running shoe suggestions is giving the same suggestion to all of their patients. 

What we will see throughout this article is that different foot types and pathologies require other qualities in their footwear. So, if the identical shoe is recommended for all patients, then a subset of those patients will be in the wrong shoe. What we see is that there is significant variability in quality and also type of shoe within certain brands. It is not uncommon to see someone having been given just the name brand to get, and they often pick the worst shoe for their foot type from that name brand.

2. Gain an Understanding of Basic Running Shoe Anatomy to be able to make good recommendations that are customized for your patients.

Knowing the components and their purpose is critical to help you better understand running shoes.  

The Upper:

The quarter refers to the rear and sides of the upper that covers the heel. The heel tab, collar, and cuff are all extra pads and cushions to help protect the malleoli and Achilles. One of the essential parts of the quarter is the heel counter. The heel counter is a firmer material, either externally or as an insert, to reinforce and support the heel. This is why it is vital to counsel your patients to untie their shoes before they take them on and off. Stepping and pushing into tied shoes will damage the heel counter which impacts the integrity of the shoe. The size and firmness of the heel counter can vary. For instance, the heel counter will be stiffer and more prominent in a motion control shoe, as this can improve rear foot stability. In more minimalist shoes, the heel counter will still be present however may be thinner, smaller, and less firm.  

The Vamp refers to the part of the upper that goes from the toe box to the quarter. Most modern running shoes and many walking shoes will be a lightweight, flexible, and breathable materials. Most of these are woven knit or mesh. An essential part of the upper is the tongue. Of course, the tongue protects the foot from lace pressure. Tongues can either be free (meaning they are only connected at the distal edge) or gusseted. A Gusseted tongue is stitched in place or attached to the midsole by a flexible fabric. 

The purpose of a gusseted tongue is to protect the foot from dirt and debris entering the shoe. You will find this in many trail running shoes, hiking boots, snow boots, and work boots.

Outsole:

The outsole is commonly referred to as the tread pattern of the shoe. The treads used for traction will vary based on what type of surface the shoe is designed for. For example, a road running shoe will have small, low profile, uniform, shallow, lightweight, and flexible treads. On the other hand, trail running shoes, like snow tires, will have deeper treads for better traction. 

The outsole pattern is one of the significant differences between Road and Trail running shoes. Trail running shoes are further broken down into light versus technical trail shoes. Light Trail shoes will be for harder-packed trails and will have deep treads that a still lightweight and flexible. Technical trail shoes are for softer, muddier trails, so the footprints are much more profound, thicker, and firmer.

Last: 

The last is the form that the shoe was made on. There are three main types of lasts. The curve last is very common in lightweight and less supportive shoes such as racing flats and spikes. In a curved last, when looking at the shoe's footprint, there will be a lazy C-shaped curve bisecting the heel, curving toward the great toe. A straight last is found in motion control and orthopedic stability style shoes. They are heavier but more stable, with the bisection of the heel and the forefoot forming a straight line. Finally, most running shoes on the market are a Semi-curved last, a hybrid between the two. There are also differences in how the components of the shoe are attached.   In slip-lasting, the shoe's upper is glued and stitched directly to the midsole, which allows the shoe to be lighter. In comparison, with board lasting, the upper is attached to a board which is then placed on top of the midsole. This is used in more stability-type shoes, but the tradeoff is that it is heavier. There is also a combination lasting which uses a board last method in the heel and a slip last method in the forefoot, which allows for a stable heel and a more flexible toe.

Midsole:

The midsole is the part of the shoe that has seen the most change, advancement, and controversy in the past decade. This is also where we will start seeing more differences of opinion as to which type of midsole is best and where the current hot-button topics in footwear design are. The midsole is typically a shock-absorbing material such as polyurethane or EVA foam. Brands then also add their additional elements, such as air or gel. There are two essential terminologies when describing the midsole: the stack height and the offset (AKA drop). These terms are related but not the same, and it is essential to know the difference. 

Stack height refers to the amount of shoe material between your foot and the ground, essentially how thick the midsole is. A lower stack height will have a more natural ground feel with less cushioning. A higher stack means a more considerable amount of material for a more cushioned feel and a higher degree of shock absorption. The offset refers to the height difference of the midsole between the rearfoot and the forefoot. A low offset is defined as 0-6 mm.  A high offset is typically between 7-12 mm, meaning that the heel height is 7-12 mm higher than the height of the forefoot. However, a high-stack height shoe can have a low offset (a maximalist shoe), so it is essential to distinguish these terms. In the question of what type of heel offset and stack height are better, the answer is that it depends on several factors such as, but not limited to strike pattern, BMI, and injury history.  

One factor to consider is the foot strike pattern. Foot strike means what part of the foot contacts the ground first, the rearfoot, midfoot, or forefoot, when running. A shoe with a low offset and a low stack height lends better to a midfoot or forefoot strike. A low offset and high stack height shoe can also be appropriate for mid to forefoot strikers. A runner with a rear foot strike will need more shock absorption and cushioning at the time of a heel strike. Therefore, a rearfoot strike will typically be in a higher stack height and/or a higher drop shoe for better shock absorption. When looking at the different types of shoes (minimalist vs. maximal vs. traditional) in conjunction with foot strike patterns, it is not that one of these has more injuries. It is that they have different injury and force loading patterns.  

Someone who is a heel striker and wearing a higher drop shoe will place a more significant eccentric load on the quadriceps during running gait. They will have a higher vertical load but lower shear stress at the ankle, greater impact through the knees, hips, and back, and an increased degree of ankle dorsiflexion and knee extension at the contact phase of gait. These runners will potentially have an increased risk for anterior knee pain, tibial stress fractures, shin splints, and possibly plantar fasciitis. Someone who is a forefoot striker will shift the eccentric load away from the quadriceps and to the gastroc-soleus. They will have a more significant impact and shear stress at the ankle and MTPJs, higher max peak force, and more ankle plantar flexion and knee flexion at contact. These runners will potentially have an increased risk for calf muscle strain, ankle instability events, forefoot pathology, and, debatably, Achilles tendinopathy. There are two recommendations/theories that are starting to emerge. One is that if someone is switching to a shoe where the offset is > 4 mm different than their current shoe, it is advisable to transition to that new footwear to avoid overloading structures gradually. Another is that some suggest switching up the type of shoe and the foot strike pattern during running training to help prevent repetitive loading on the same musculature.

Arch Support:

There are several ways that arch support can be built into the running shoe design. One method is straight and board lasting.  In the more traditional type of running shoes, arch support was achieved using a medial post of higher-density material in the midsole to help prevent excess pronation. This was the key component defining a "stability" shoe. Stability shoes can be broken down into mild-moderate-high stability based on the volume and size of the higher-density medial midsole post. However, a couple of the running shoe brands are getting away from the medial posting and shifting more towards what is called a J-frame. This is a thinner J-shaped higher-density material insert in the midsole that wraps around the lateral heel and extends through the medial longitudinal arch. This higher-density material does not encompass the entire thickness of the midsole like the medial post does. Rather than push the foot out of pronation, this technology tries to stabilize the foot in a neutral position. Arch support can also be achieved by adding a rigid shank. The shank is a supportive structure integrated between the midsole and the outsole that runs through the area underneath the arch. A more rigid shank ensures that the shoe will not flex under the area of the arch, offering more stiffness and support through the midfoot.

Outsole/Midsole Stiffness and Rocker:

This is how much flexibility there is to bend between the heel and the toe. Traditional stability, motion control, and maximalist shoes tend to be stiffer. In comparison, a minimalist shoe will tend to be much more flexible. This is another debatable topic regarding which is best, and the decision is primarily based on individual needs. There has been limited data in a few studies that show that recreational runners and walkers who wear overly thin and flexible soles while also building distance too quickly can have an increased risk of forefoot pathology.  

There is a current trend in marathon race shoes to be extremely stiff. For example, a maximalist shoe with a carbon fiber plate in the midsole was used to run the first sub-2-hour marathon. As these shoes are being talked about more, it is essential to discuss with your patients that this type of stiff carbon fiber-plated marathon running shoe is designed for elite runners to improve their running economy during a long race, and they are not designed for everyday training shoes.  

A forefoot rocker helps transition the foot quicker to the push-off phase of gait and helps propel the body forward. Almost all running shoes will have a slight rocker, and the degree can vary quite a bit between brands and models. Another emerging trend in running shoes is to have more of a forefoot rocker built into the shoe. The rocker can start at the level of the toes, MPJs, metatarsal midshaft, or more proximal to encompass the entire forefoot. The more proximal the rocker begins, the more help the shoe offers to help propel motion forward. Shoes with a higher degree of forefoot rocker will benefit those patients with significant hallux limits and other forefoot pathology.  

Toe Box:

It is important to make patients aware that the width of the toe box frequently does not correlate with the width of the shoe. The difference in the last size in wide vs. regular-width shoes is the volume of the midfoot. Not all wide-width shoes have a wide toe box. When looking for a wider-toe box shoe, you must counsel your patients to look for specific brands and models, as this is more of a design feature and not a product of the shoe width. Patients with bunions, tailor's bunions, and interspace neuromas can benefit from a wider toe box. In recent years, with some of the newer running shoe brands that focus on a broader toe and more of an anatomically foot-shaped shoe becoming more popular, many other brands are starting to integrate this feature into some of their models.  

Types of Shoes:

After reviewing the basics of shoe anatomy, here is a breakdown of the various categories of shoes on the market.  

Minimalist Shoes: Lightweight, low stack height, low drop, with a more natural feel. This type of shoe lends towards the forefoot to midfoot strike. Very similar to a lightweight racing flat.  

Barefoot shoes: A minimalist shoe. It will have very little to no midsole, be very lightweight, have a 0 drop, and have outsole flexibility. Best suited for a small subset of forefoot strikers.

Maximalist Shoe: High stack height, firmer sole, low drop, forefoot rocker with a lightweight but cushioned bouncy feel. This shoe can be utilized with all foot strike patterns and is popular with forefoot pathology patients and those needing more shock absorption. They can be divided into neutral and stability models.

Traditional shoe: A moderate stack height and high offset shoe. These shoes are further broken down into neutral, stability, and motion control.  

Neutral shoe: has no additional arch support features built into the shoes. Traditionally recommended for a neutral foot type or mild supinator

Neutral Cushioned Shoe: a neutral shoe with additional shock absorbing and cushioning material, such as more air or gel incorporated into the midsole. For those runners needing more shock absorption, and traditionally recommended for over supinator's.  

Stability Shoe: It is further broken down to mild-moderate-high stability based on the components that add additional pronation support to the shoe. Traditionally mild to moderate overpronators.

Motion Control Shoe:  Will have all the features that add support and stability, a straight last, board lasting, rigid shank, and higher density extensive medial posting that wraps around to the lateral rearfoot. This type of shoe will be significantly more stable but also much heavier. Patients with severe overpronation, obesity, or instability in the rearfoot will traditionally be recommended this type of shoe.

3. Lastly, How to Make the Best Shoe Recommendations:

While discussing the various aspects of shoe anatomy, it has become evident that many factors go into shoe selection. Unfortunately, there is not a one size fits all approach, and the best way to make shoe suggestions is to individualize the recommendation to the specific patient. Historically and traditionally, we used solely foot type to determine what shoe a patient should be in, but it is more complicated than that.

The critical factors to consider are:

• Individual Needs
• Running Surface
• Foot Strike Pattern
• Foot Type
• Injury History
• BMI
• Experience Level
• Training Distance/Intensity
• Race/Performance Expectations

Sources:

• Metabolic and Performance Responses of Male Runners Wearing Three Types of Footwear: Nike Vaporfl y 4%, Saucony Endorphin Racing Flats, and Their Shoes. 
•  Hébert-Losier K, Finlayson SJ, Driller MW, Dubois B, Esculier JF, Beaven CM. J Sport Health Sci. 2020 Nov 29:S2095-2546(20)30163-0.
• Biomechanical Differences of Footstrike Patterns During Running: A Systematic Review With Meta-analysis. Journal of Orthopaedic & Sports Physical Therapy. Published Online: September 30, 2015Volume45Issue10Pages738-755. https://www.jospt.org/doi/10.2519/jospt.2015.6019
• Three-Dimensional Biomechanical Analysis of Rearfoot and Forefoot Running. Orthop J Sports Med. 2017 July 24;5(7):2325967117719065. doi: 10.1177/2325967117719065—eCollection 2017 Jul.
• Rearfoot, Midfoot, and Forefoot Motion in Naturally Forefoot and Rearfoot Strike Runners during Treadmill Running. Journal of Applied Sciences. Alessandra B. Matias 1 , Paolo Caravaggi 2 , Ulisses T. Taddei 1 , Alberto Leardini 2 and Isabel C. N. Sacco. Appl. Sci. 2020, 10, 7811.
• Hoenig T, Rolvien T, Hollander K. Footstrike patterns in runners: concepts, classifications, techniques, and implications for running-related injuries. Dtsch Z Sportmed. 2020, 71: 55-61. doi:10.5960/dzsm.2020.424
• Anatomy of a Running Shoe – with Infographic. Website: https://www.runningshoesguru.com/ content/anatomy-of-a-running-shoe-with-infographic/
• How to Pick the Best Running Shoes Website: https://www.runningwarehouse.com/ learningcenter/gear_guides/footwear/how_to_pick_running_shoes.html
• Guide: Flexible vs. Stiff Running Shoes. Website: https://runrepeat.com/guides/flexible-vs-stiff-running-shoes

Bill's wish for incoming students would be that in addition to private study, students should be active in fostering and creating a community that facilitates open dialogue and learning from one another.

Bill was the type who would have loved and embraced the technological advancements so critical to the improvement and advancement of society, science, and medicine. He would be so proud to celebrate 50 years of the Goldfarb Foundation.

Providers and their staff typically need to know where to find guidance regarding coding, coverage, medical necessity, limitations, documentation requirements, and more. Often this guidance differs based on the third-party payer. However, in many cases, this guidance is free and readily accessible online. 

Medicare 

Medicare is a national program, but it is administered locally by Medicare Administrative Contractors (MACs). There are seven Part B MACs in the United States. Some of the Part B MACs have large jurisdictions, including 13 states, and some have small jurisdictions, including only two states.  

Providers and staff must know which Part B MAC has jurisdiction over their state. When navigating to Part B MAC's website, providers can find a list of policies. Part B MAC's Local Coverage Determinations (LCDs) can be found here. LCDs guide coverage, medical necessity, limitations, documentation requirements, and more. In many cases, an LCD is accompanied by a Local Coverage Article (LCA) that offers guidance regarding coding. Part B MACs choose to issue LCDs for certain services. Different Part B MACs issue LCDs for additional assistance. For example, one Part B MAC may have an LCD for ulcer debridement, while another may not. Perhaps even more important to understand is that two different Part B MACs' LCDs may have additional guidance. This is why it is so essential for providers to look for advice from their own Part B MAC rather than from national forums in many cases. Furthermore, providers in one Part B MAC's jurisdiction may not find the correct guidance if speaking to a colleague about coverage guidelines if that colleague practices in a state that falls under the jurisdiction of a different Part B MAC. A provider in Pennsylvania may be subject to guidelines other than a provider in New York State for certain services. 

The Part B MAC with jurisdiction over Pennsylvania is Novitas Solutions. It is good practice for providers to review the list of LCDs issued by their Part B MAC. Pennsylvania providers can find a list of active Novitas LCDs here:  https://www.novitas-solutions.com/webcenter/portal/MedicareJL/LCD?type=active

It is also recommended that providers and their staff subscribe to the e-mail listserv of the Part B MAC, which has jurisdiction over their state. Updates to these coverage determinations are shared via these listservs. Pennsylvania providers can and staff can subscribe to the Novitas e-mail listserv here:  https://www.novitas-solutions.com/webcenter/portal/MedicareJL/pagebyid?contentId=00007968

When providing Part B services to Medicare beneficiaries, guidance regarding coding, coverage, medical necessity, and documentation requirements comes from the Part B MAC, not from Medicare. Most of the time, the question, "What are the Medicare guidelines for ________" is the wrong question, and instead that question should be, "What are my MAC's guidelines for ________?" Most of the time, the question, "How frequently does Medicare allow payment for ________" is the wrong question, and instead that question should be, "How frequently does my MAC allow payment for ________?" Most of the time, the question, "Does Medicare cover ________" is the wrong question, and instead that question should be, "Does my MAC cover ________?"   

DMEMACs 

Just as the Part B MACs issue LCDs, the DMEMACs do the same. There are only two DMEMACs in the United States, and Pennsylvania falls under the jurisdiction of Noridian DME MAC. It is recommended that providers who prescribe and supply DME review the list of LCDs issued by their DME MAC. Pennsylvania providers can find a list of active Noridian DME LCDs here:    https://www.cms.gov/medicare-coverage-database/reports/local-coverage-final-lcds-contractor-report.aspx?contractorName=5&contractorNumber=389%7c1&lcdStatus=all

Furthermore, it is recommended that providers and their staff who are involved with prescribing and supplying DME subscribe to the e-mail listserv of the DME MAC, which has jurisdiction over their state. Updates to these coverage determinations are shared via these listservs. Pennsylvania providers can and staff can subscribe to the Noridian DME MAC e-mail listserv here:   

https://naslists.noridian.com/list/area.html;jsessionid=705DA7FB579C1D830D30F96AE8E13EF7?lui=ez723q4d&mContainer=2&mOwner=G30392x2n39372t36

Non-Medicare Payers 

Non-Medicare third-party payers may also issue coverage determinations. These are often found on the website of the third-party payer. However, in some cases, third-party payers do not issue coverage determinations and instead default to the coverage guidelines of the Part B MAC policies, which have jurisdiction in the state where the services were provided. Therefore, providers should check with each third party to whom they submit claims to see what coverage policies each of their third-party payers have issued. Sometimes, the coverage guidelines for the same service or product may differ from one patient to the next, even within the same practice in the same state, if different third-party payers have other coverage guidelines for the same service. 

No Coverage Policy 

Sometimes, a third-party payer needs a coverage policy for a specific service. For example, none of the Part B MACs have an LCD for the service of a bunionectomy. In the absence of a coverage policy, most third-party payers, including the Part B MACs, state coverage, and frequency considerations are based on medical necessity. This includes the presence and documentation of the medical need of the service performed and the product dispensed.  

Summary 

Unless providers outsource this type of work, they need to know where to find the third-party payers' coverage guidelines to whom they submit claims. When it comes to Medicare beneficiaries, this means knowing who the provider's Part B MAC and DME MAC are. For non-Medicare payers may require reviewing some policies, depending on how many third-party payers the provider submits claims to. Providers can stay current with these policies by subscribing to the listserv of the third-party payer. 

Marketing to attract new patients is vital. Creating a strategy to attract new patients can be nerve-wracking, especially when dedicating most work hours to patient care and office management.

Marketing agencies may knock on your door, pitching campaigns that sound good. Often the costs seem steep, and you may be uncertain what works. Fortunately, you are a part of an association here to support your career by offering opportunities to network with other podiatrists and obtain relevant news!

Many techniques and strategies could work for you.

Here are three ways to attract new podiatry patients.

1. Create and maintain a robust digital presence.

If you do not already have a website, you will want one. The website should include bios, office hours, contact information, location information, and information about conditions treated.

If you are a podiatrist that does not have your practice, you can still benefit from getting an updated headshot or updating your bio online.

Patients choosing a podiatrist will want to see your face and know a little about you and your qualifications before making an appointment.

2. Get involved in your community.

What opportunities are there to network to get your name out there?

Perhaps you could join your local chamber of commerce. Consider hosting an event and inviting potential referral partners to see your location and learn more about your services.

Consider sponsoring a 5K and distributing literature about your practice.

3. Leverage the opportunity to increase referrals through existing patients and other reputable sources.

Your existing patients can be your most significant source of referrals. Prospective patients often do not seek a podiatrist because they don't know about the treatment of podiatry and conditions. Existing patients aware of the conditions you treat can then refer loved ones to your practice. Ensure your office has adequate signage, brochures, and materials that incorporate all your offerings.

Some podiatrists have found a strategy and a budget that works well for them!

When meeting with an advertising agency, one should ask questions when you are unsure. If you don't know what questions to ask, perhaps you have a friend or mentor, such as another podiatrist or business owner, who can give you some advice!

Keep working hard to get your name out there, and your practice will achieve growth,

PPMA is an association dedicated to the greater good of podiatrists in Pennsylvania. To learn more, visit PPMA at www.ppma.org. 

According to the Boy Scouts, "Be Prepared" means "you are always in a state of readiness in mind and body to do your duty." Similarly, we in the medical profession should follow that advice and "be prepared" for unexpected crises because often, it's not IF it happens; it's when.  

If you think, "Oh, that can't happen here," think again. How often have you seen PM news report cars plowing through podiatry office buildings and demolishing a practice? Granted, this crisis example may be extreme, and frankly, I'm at a loss regarding how one prepares for that catastrophe. However, there ARE emergencies that we may face that are much more common. It is in these moments of potential crisis that preparedness is our friend.  

How prepared are you in these more likely situations: Patients in medical distress, fires, computer crashes, destructive weather, data loss from power outages, injuries and accidents, chemical spills, belligerent patients, theft, bomb scares, terrorist attacks, active shootings…pandemic outbreaks?? More specifically, have you created a Disaster Action Plan for each one? If not, when would be an excellent time to get started?  

I could outline some comprehensive steps to take in each of the above situations, but space would not allow it. Instead, here is an overview of measures for the more common scenarios that you should consider creating a disaster action plan for your office. By the way, making this plan to avert a crisis is an excellent and worthwhile topic for you and your staff to discuss at your next staff meeting. Please put it on the agenda. 

Medical distress: Have a recognizable verbal signal, "STAT," that alerts everyone in practice to be present and aware. Upon doctor's direction, follow emergency protocol (dial 911, retrieve O2, Ambu bag, emergency kit, etc., assist doctor, calm patients.) Everyone should have a distinctive role to avoid confusion, running around helplessly and wondering what to do. 

Fire: Remember grammar school and participating in fire drills? Why should that not apply here? Know where your fire extinguishers are, alert the fire department (911), help all patients evacuate the building and do not re-enter without an OK from the fire department. Have annual inspections, and create and post an escape plan. 

Injuries and accidents: What if a staffer on a stepstool falls and is injured? Or does a patient slip on a wet floor or trip to the treatment room? Make sure the person is offered outside medical attention if needed. Then take measures to prevent similar injuries. All accidents should be reported immediately to the doctor, office manager, and OSHA coordinator, and an injury claim should be filed. 

Chemical spills: One of your staffers are setting up for a matrixectomy when the phenol bottle tips over and spills over the counter, onto the floor, and their skin. Every office should have a spill kit with PPE and materials to avoid spread. Follow MSDS instructions for that chemical, and alert people nearby. If needed, utilize the eyewash station, properly dispose of hazardous waste, and report spills to a manager and OSHA coordinator.  

Belligerent patients: We tend to tolerate the destructive behaviors of some patients. However, it should not be ignored if patients demonstrate abusive – physical or verbal – personalities with the doctor, staff members, or another patient. Rather than the victim taking matters into their own hands, make it clear WHO should deal with the accused individual and then WHAT further action needs to be taken. If setting boundaries does not work and you cannot ease the situation, notify authorities and discharge this individual from the practice.  

In each case, it helps to "Be Prepared." Train now and be safe, not sorry. The goal is to keep you, your staff, and your patients safe. 

Note: I have a 9-page (double-sided) "Emergency Action Plan Template" to help you customize your specific plan. Just email me for a complimentary copy – lynn@soshms.com.  

Inflation continues to affect not only our personal lives but also our professional lives as private practitioners/business owners. 

The big difference between us as private practitioners/business owners and the examples I gave you is that we cannot adjust our prices to compensate for the increased cost of supplies/equipment in our offices. 

For example, restaurants can increase the prices on their menus to make up for the difference in their increased cost of items/goods.

On the other hand, we can not increase our copays or reimbursements from the insurance companies because we are on a controlled fee-based schedule set by Medicare and the insurance companies. 

In my private office, the cost of medical supplies, office supplies, and equipment has increased significantly compared to 2020. 

Something has to be done! 

As many of you know, there is a national injectable lidocaine shortage. I read some information online about why we have difficulty finding and buying one of the most used injectable anesthetics in our practices. 

According to https://www.ashp.org/drug-shortages/current-shortages/drug-shortage-detail.aspx?id=88, Pfizer has lidocaine presentations on shortage due to manufacturing delays and increased demand. 

According to https://pipelinemedical.com/blog/why-is-lidocaine-in-shortage/

“there was an increase in the demand for anesthetics during the pandemic. Many hospitalized intubated patients required anesthesia to avoid the discomfort and pain associated with it. This increased demand, resulting in a less obvious but anticipated shortage of local anesthetics such as lidocaine.”

As we all know, what happens when there is a supply shortage and increased demand? Prices will skyrocket. I’m anticipating this is what we’ll see happen with this lidocaine shortage and the other medical supplies that have significantly increased.

I also recently saw an article about our state representatives and their salaries in our local paper.  

One sentence captured my attention. 

“State representatives serve two-year terms with the salary this year set at $95,432.14 and raised annually by the inflation rate.”

It got me thinking that we, as healthcare professionals, who worked through the beginning and most challenging stages of the covid pandemic, ironically, are the ones who are unable to get our reimbursements adjusted due to inflation, unlike the previous examples mentioned in this article. 

My goal is to help our medical professionals/business owners continue successful practices by increasing our reimbursements from Medicare and other insurance providers based on the current inflation rate. 

I request that our PPMA members have your accountants put together a cost of supplies report from 2020, compare it to 2022, and email it to our executive Director Michael Davis. I would also like to have the APMA pair up with the AMA and fight for our private practitioners/business owners of all medical professionals & specialists, from primary care doctors to dermatologists, neurologists, cardiologists, etc. 

Any recommendations or suggestions would be helpful from our PPMA members. 

I appreciate your support of PPMA, and we will continue to do whatever we can to keep our profession thriving and responsibly working together!

Lynn Homisak, PRT, SOS Healthcare Management Solutions

“It’s not my job!” What do those four little words do to YOUR insides? For me? It rivals the shrill sound of fingernails raking slowly across a blackboard. It does not matter who the recipient of this toxic phrase is – whether an employer or a co-worker – it is irritating to the senses to say the least. Sadly, it is also why many doctors are reluctant to create written job descriptions for their practice. Their concern is that assigning a fixed list of duties puts limitations on their staffs’ efforts; so (in their minds) it is better not even to have one. Well, I could not disagree more.

Allow me to explain.

One of my functions when I go into a medical practice is to determine if tasks are well delineated to assure each employee contributes to a seamless workflow. When I ask to see staff job descriptions, my hope is to receive well-composed, updated documented narratives for each job title that includes the salary range, educational requirements, and necessary technical and soft skillsets for that position. What I am given instead is an outdated task list or nothing at all. Why does this matter? Because it is never surprising to find that without a ‘comprehensive job description’ there exists; a redundancy of duties, system breakdown, confusion, imbalanced workload, and unqualified personnel (often not their fault). Add to that…disgruntled staff (and docs).

It is at the initial hiring interview, that employees need to be informed of what the prospective job entails. This is best accomplished with a well-written job description that outlines the distinction between primary and secondary tasks, responsibilities, expected outcomes, wage expectancies, and protocol associated with the position. It is far more sensible to make applicants fully aware of job expectations BEFORE you hire them to avoid potential surprises after they have accepted the position. In many cases, this “surprise” has led to staff leaving shortly after their hire.

The hiring interview provides the perfect opportunity to also discuss the workplace culture; explaining that regardless of the “job position” their role as a team member requires stepping in and helping where and when needed. Sharing your…yes, “well written job description” with them at this point provides insight. Insight for you and the applicant whether they are suitable for the position based on your needs and requirements. This document also serves as a guideline, helping new employees to familiarize themselves with criteria upon which their performance will be evaluated and preventing misunderstandings down the road.                                          

That brings us to the offensive phrase, “it’s not my job.” This destructive attitude (and make no mistake; it IS an attitude) can flow from an employee’s poor work ethic or surface later as the product of an unsupportive work environment (i.e., poor management, existing employee cliques, etc.). It has little if anything to do with a written job description.

It is important, however, to clarify at the onset that the scope of their job may extend beyond the tasks listed. Adding “and any other duty required of me” as a catchall phrase at the end of each job description, makes it clear to employees that if additional duties are required, they are expected to pitch in. In other words, “it’s ALL your job.” This destroys the “it’s not my job” mentality before the mentality destroys the practice. It is an effective concept provided it is clearly pointed out, and acknowledged, preferably in writing, by each employee.

Ideally, it would make more sense to hire people who demonstrate soft skills, are team and purposeful; have like-minded personalities, and view their employment as a career, not as just another “job.” This information is not always evident in their resume. That is why striking up a shared conversation with applicants is far more eye-opening in understanding their values and aspirations and determining whether they would be a good fit for the practice.

Raise your hiring standards by establishing what type of people you want working for you. Do not settle. You deserve better. Don’t you deserve the best?!

Poor or insubordinate employee behavior is not only unacceptable; it is destructive and any employer willing to ignore or put up with it, is responsible for creating an undesirable workplace culture. Rest assured, nothing crushes the productivity of a great employee quicker than watching their employer tolerate a bad one.

If you still find that your employee succeeds in making the claim “It’s not my job” as a rational position, it is (quite simply) because they can. And at that juncture, the bigger question is…who lets them?

“Staff Attitude?! Whatever!”

Staff attitudes and behaviors most definitely have a direct impact on the attitudes and behaviors of our patients. In fact, studies showing over and over again that their attitude alone can play a major role in patient satisfaction, and that’s got to make you wonder just how adversely a patient is affected when exposed to a staff person who rarely smiles or one who thinks that an irritating, nail-scraping-chalkboard “whatever” response is ever appropriate! I’m sure that any malpractice insurance company would agree that an employee’s confrontational attitude is enough of a reason to turn a patient’s unanticipated surgical scar or unexpected (surprise) bill into a full-blown malpractice lawsuit; whereas, a more attentive (caring) attitude can actually help to smooth things over and prevent one from happening. 

While staff cannot be expected to carry the ball alone through these types of conflict, everyone must stop and realize that (just like the doctor), their individual attention and handling of each patient is impressionable and even pivotal in “what might happen next.” In short, the attitude of your staff can make or break your practice.  

Make no mistake. The attitude of the practice starts at the top…with the doctor. And you’ve heard this before…it’s not the doctor’s job to make staff happy, only to provide an environment that allows them to be happy. So, if ongoing quality patient relations and providing exceptional customer service are important to you; and taking measures to improve the overall attitude of your practice is something you want to seriously take hold of, here some suggestions to get you started:

1. Be very particular when hiring staff and trust your gut-instincts. If they project a warm, caring personality during the interview, most likely they will carry that through to your patients. If you see them as unfriendly, non-caring and inattentive, so, too, will your patients. Thinking that you will “just hire them temporarily” (in a pinch) until someone better comes along…or expect that their attitude will approve in time is risky. Could be their “temporary” employment can cause some long-term damage.

2. Once developed, do not take your employer/employee relationship for granted. Whether your staff is there for 30 days or 30 years, it should always be one that is built on mutual respect…with plenty of open communication, including making the time to listen or hear them out.

3. Encourage them to achieve a greater knowledge of their work and profession – through certification, association membership, educational and motivational seminars, in-house training, webinars, etc.  Don’t underestimate staffs’ personal and professional growth. It is an important piece of feeling good about themselves, which in turn motivates self-esteem, job satisfaction and a positive job attitude. Stagnancy does the complete opposite.

4. Schedule regular employee evaluations to ensure that everyone’s needs and expectations are being met. Evaluations are needed to help staff improve and move the practice forward. Sadly, too many staff complain that they never get evaluated. Their gripe? “I just want to know how I’m doing and if I need to improve in any area.” Step up to the plate and do evaluations for your staff. Do them for the practice. 

5. Openly and honestly discuss their salary and/or benefits on a regular basis. I suggest doing this during their annual evaluation. Make sure increases are based on a variety of qualifying factors (including job performance); not just longevity. If anyone would like to receive a copy of our Compensation and Benefits Statement to help employees understand their full compensation package…please email me at lynn@soshms.com. 

6. Help build their self-worth through consistent doses of praise for jobs that are “well done!” Verbal appreciation (a simple “thank you”) is as good for the soul as it is music to their ears and can surely increase the quality of an individual’s work performance.

7. Everyone makes mistakes. Point theirs out in private; NOT public and remember that mistakes are also opportunities to learn and improve. Especially do not ridicule, admonish or embarrass them in front of your patients or their co-workers. Take into consideration that these insensitive (sometimes impulsive) actions not only point out their weaknesses to uninvolved observers, but it makes you look like a bully employer.

8. Make an all-out effort to include staff as part of your practice “team” with the understanding that what benefits the whole of the office ultimately benefits them individually. Listen and be open to their ideas. Doing so not only makes them feel valuable, but their ideas may actually enhance practice growth and success.

9. Help them brush up on their communication (and attitudinal) skills when dealing with different types of personalities by insisting they attend seminars focusing on this very important aspect of their job. You might even consider going with them, for it truly is a financial investment that benefits everyone and pays back every single day…ten times over!

Increasing Office Efficiency

The top five tips you need to know for running your office correctly

As a physician, you have many responsibilities, from patient care to business management. A well-run practice provides peace of mind, increased revenue, and happier patients. However, finding that path to a smoothly operating and efficient office is not easy.

This article will provide tips that I have found helpful and pertinent to a productive office space. These tips include a thoughtful blend of embracing new age technology coupled with reasonable ole bedside manner, quality of care, and improved patient experience.

1. Online Scheduling - as a mother of three, it is often difficult to have a free minute to make a phone call, much less finagle through work and school schedules to find a mutual time and date while talking to an office team member on the other line. Having online Scheduling is helpful to the patient. It lessens the load on your administrative team, allowing those team members to focus on physically present patients in the office. Of course, patients can still call the office to ask essential questions, but this will decrease calls and scheduling errors.

2. Provide online email and text reminders - this will drastically reduce the number of missed appointments and no-shows. Further, if a patient needs to cancel, you can easily have a link sent for a reappointment reminder. 

3. Modernize new patient paperwork and X-ray appointments - providing the patient an online platform to complete new patient paperwork or sending this via mail weeks in advance allows the patient to complete these questions at home while reviewing medications, all at their leisure. I have also found it helpful to schedule patients 15 minutes early for an “X-ray” appointment before their appointment time. This strategy allows the physician to remain on schedule as closely as possible. 

4. Better your break room - what keeps the office running? Staff! Workplace burnout is both bad for your employees and your profit margins. Providing a welcoming environment offers your staff a small getaway from patient demands and a relaxing place to eat lunch or unwind. This update can be as minor as a sofa and a single brewer coffee machine. Your staff and their well-being will be an investment in your practice.

5. Cross-train employees - this proves to be a “well worth it” practice that will pay off long term. It does require an initial investment and learning curves, but a well-trained employee will be able to fill in when a coworker calls off sick, and another is on vacation. Investing in training and development shows your practice values the culture of flexibility and teamwork. Delegating your office manager the task of ensuring each employee cross-train a colleague over time (possibly at slow times like midsummer/Christmas) to cover duties increases appreciation of each important office role that allows the office to run smoothly. 

These tips will provide the physician with the path to a more efficient and productive practice coupled with a thriving work environment. Furthermore, including staff in monthly meetings and valuing team feedback is equally successful in encouraging better practice management and better patient care. Remember, anything that is worth chasing takes time and enthusiastic support. Working toward the goal of efficiency will provide stamina to propel forward in this ever-changing field we call health care.  

But life's lessons do not stop there. With knowledge and experience as teachers, we can learn something new every day. Or at least we should! Sometimes the best management lessons are found when we least expect them and in the most specific and unpredictable settings. Simplicity is where the true genius lies. Let me explain.

What I learned from going to my hairdresser:

Some people do not belong in the receptionist's chair. As I sat in my stylist's chair, it was painful to my management consultant's ears to overhear how the receptionist answered her phone. Her welcome opening was hardly welcoming. There was no greeting, no inflection in her voice, and her response to what I suspected was a request for an appointment became a missed opportunity. "No, there are no openings." Period. No offer to look ahead in the schedule, no recommendation to accommodate this customer, no thank you for calling! Barely a goodbye. Does the owner even know that her "style" is turning customers away? As the assigned receptionist of a beauty salon OR a doctor's office, they are the "Director of First Impressions"; good manners and a pleasant, polite, engaging, helpful personality should be mandatory. Their attitude can make or break a business (or a practice). Some off-hours training is crucial, where role-playing and appropriately overseeing phone calls and turning them into appointments can be taught. Sadly, it is not.

• A confident professional can work and talk at the same time. 

I have been to some hairstylists who think that they need to stop working to have a conversation with their customers. This standstill approach to hair cutting involves stepping away from the customer's head, poised with scissors and comb in hand, to tell (or listen to) a story. Being a good listener is one thing, but, no joke, it turns a one-hour appointment into two. Similar complaints have been made against podiatrists who wield a scalpel or nail clipper until they finish their conversation. Little wonder that patient schedules sometimes run behind.

What I learned from going to my dentist:

• A patient's fear and trepidation can be minimized, and adherence optimized. 

Introducing scary needles and instruments or not fully understanding WHY a procedure is necessary can be a frightening experience for a patient. However, the dentist (or doctor) who takes the time to explain what will be done thoroughly communicates what one can expect to feel during and after the procedure can put the patient more at ease. What is more, patients seem more willing to adhere to associated recommendations when they understand the consequences of non-compliance.

What I learned from going with my mother to her doctor:

• Doctors need to manage their time with their patients. 

Patients love when doctors take an interest in them and engage in personal stories and conversations. Patients DO NOT love when they become prisoners of these personal stories and discussions for over an hour. OMG, in this case, TWO hours! Many patients will walk out if they are kept waiting due to mismanaged time. Building customer relations does not mean talking incessantly. It means mutual respect and knowing how and when to draw the line between enjoyable conversation and long-winded rambling. Oh yes and staying on schedule is a big plus.

What I learned from going to a restaurant:

• Hiring people who love what they do pays off. 

A restaurant experience has so much to do with the served food. It is also about the people who serve the food—employees who love what they do exceptionally reflect strongly on the business. Excellent, efficient service combined with good-natured personalities are substantiated reasons for customers to return and refer friends and family.

What I learned from being a management consultant:

• If you do not change anything, nothing will change.

I applaud doctors who want their practice and staff to be more efficient, productive, and consistent in their standard protocols. They acknowledge that a pair of outside eyes can offer new perspectives and ideas, help create an on-board team mentality, and often recognize what is working well. Yet, when it comes to implementing recommended changes, there exists a reluctance. Usually, the desire for immediate outcomes dominates the recommendation to slowly eat the elephant, one bite at a time, turning efficient changes into a time-consuming and overwhelming project and landing them right back to where they started. Elephants aside, Dr. Albert Einstein responds: "If you always do what you always did, you'll always get what you always got."

PPMA wants to provide every opportunity to communicate with our members. This includes providing a strong presence on social media to share relevant information, as well as support and engage with our membership.

Currently, PPMA has accounts on the following social media channels:

• Facebook

• Instagram

• LinkedIn

• TikTok

• Snap Chat

PPMA regularly updates Facebook, Instagram, and LinkedIn accounts. We regularly respond to comments, as well as share relevant content that is of use to our members.

That is not enough for us!

We want to help increase YOUR digital footprint!

You may be asking how can PPMA help improve our digital footprint?

By Liking or Following our pages we will then be able to locate YOUR social media channels, follow your brand, and share any applicable content with OUR followers.

When your brand’s social media posts are shared, the algorithms show your posts to more followers, which results in increased reach.

It is important for PPMA to support our members as well as educate them in areas in which they could improve their business which include social media and marketing for their business. 

Private Message

If you have content that you think our members would be interested in kindly private message us on YOUR preferred social media channel!

Darco provides foot and ankle products to various markets, including podiatrists. This includes post-operative shoes, walking boots, products designed to help patients suffering from plantar fasciitis, wound care offloading products, and ankle bracing products.

   Darco headquarters are here in Huntington, WV.

   Darco’s products provide a healing platform for patients as they adjust from the acute phase to rehab, and finally back to their normal footwear. 

FOUNDER STORY

   The provider has been serving the podiatric community since 1985! Darco was founded by a podiatrist by the name of Darrel Darby, DPM. Dr. Darby was a graduate of the Ohio School of Podiatric Medicine. He was president of APMA in 1976.

   Dr. Darby created the first modern-day post-op shoe after seeing many patients being given various kinds of shoes to use when recovering from surgery or foot trauma. He listened to patients’ complaints about being uncomfortable. Like many small business owners, he started the company out of his home garage. Darco’s first run of the shoe was successful. His efforts eventually led to Darco becoming the largest manufacturer and distributor of foot and ankle products in the world! 

   Dr. Darby’s solutions have a reputation for innovation and high quality. This has led the company to expansions that include an international presence. International locations include Suffolk, UK, Raisting, Germany, Shang Hai, China, and Darwad, India.                                  

PHILANTHROPY

Dr. Darby was a big advocate for podiatric education and as such, Darco has donated over $500,000 to the podiatry schools for scholarships!

DOING BUSINESS DURING THE PANDEMIC

   Podiatrists interested in learning more can contact us by phone or email. We often set up a Zoom session to help podiatrists learn about our products and answer any questions they may have. We also can provide product training for the application and use of our products via Zoom. 

   All companies have been impacted by COVID-19. Representatives from Darco are not able to attend as many professional conferences. The in-person interactions with clinicians or our distributors have been replaced with virtual sessions held via conference calls or Zoom sessions. 

   The transportation issues experienced at many United States ports have delayed product shipments resulting in a lean inventory at times. The increased transportation and raw material costs have impacted our business resulting in us raising prices to keep up with the increased costs.

    Darco accepts direct calls from patients regularly that need advice on what shoe to use for recovery or what size product to get. Most patients are not familiar with these types of products. The employees take pride in servicing the customers explaining the ins and outs so that the patient is satisfied.
GOING THE EXTRA MILE

   There have been instances in which a patient may be facing financial hardship and Darco has sent products at no charge just to do good and it has resulted in a positive experience for both the patient and the employee.

By Lynn Homisak, PRT

Whatever happened to gratitude in our world?

Sadly, our country has always known inequality; but it's become worse, and as a nation, we are more divided than ever.

Have we forgotten, amid our differences, how to be kind, civil, or tolerant of each other?

Has it come to the point that we don't even want to share the planet with someone who doesn't share our views? Is "thankful" something we only feel obligated to think about once a year in November? Does everything we do have to end up with the finger gesture from the car or a scornful comment to someone without a face-covering during a crisis? What is it that stokes the mean spirit in us, to the point in which destroying the lives of fellow citizens by any means possible has become just another day?

Someone, quick! Please get me a pair of much-needed rose-colored glasses to see the good in people again.

I know it's there! It may be that I am too much an optimist, but I think we need a boost in compassion and a little more understanding; show a little more gratitude towards each other.

I've been feeling this way for a while. It became clear to me the other day as I sat in the reception area of my doctor's office, awaiting my appointment.

I happened to overhear a patient expressing her gratitude to my doctor as she left the office. She pointed out how appreciative she was of the care she received that day.

My eavesdropping on their conversation was unavoidable as this very vocal patient was within earshot of where I was seated. Her comments were flattering and mainly focused on her experience with the medical assistant. "Karen was so great," she said. "She took excellent care of me, made sure I was comfortable, and kept poking her head in the room while I waited to let me know how much longer you would be and to make sure I was comfortable. You might not realize it, but little things like that make a difference to us patients. I hope you recognize what a good nurse she is and thank her for being so caring."

I smiled publicly and cheered silently!

I always love hearing some good employee feedback.

The doctor's response, however, was not what I expected. Nor was it, in my opinion, professional. A simple acknowledgment was all this patient looking for. Instead, what she (and everyone else in the reception room) heard was, "Well, I don't have to thank my staff for being nice to my patients. That's their job. That's what they get paid for. If they weren't (nice), however, they would surely hear about it from me!"

As a patient, witnessing this unfortunate scenario allowed me my interpretation. He would undoubtedly point out to his staff all unsatisfactory conduct and silently ignore their generally excellent behavior. Are these qualities of a successful practice?

My viewpoint might be better explained by sharing Sam's story.

Sam was a little league baseball coach. From the dugout, he heard one of his players complain to another. "Coach only sees what he wants to...he only sees the times I miss the ball!" The coach turned to his player and assured him that coaches do see everything! "Then why, Coach, do I only hear it when I do something bad or outstanding. What about all the stuff I regularly contribute that helped make ours a winning team? Don't you ever notice the little thing we do? Don't they matter too?" 

The coach still argued that he saw everything but shamefully admitted that the "expected" things are sometimes just taken for granted. He thanked the young player for bringing this to his attention. He needed to hear it. From that point on, he vowed to be more aware and recognize his players, even at the "un" expected times.

Similarly, the patient I described made a point of sharing her experience, and it was something the doctor needed to hear.

It is not uncommon for doctors to be unaware of daily activities while busy treating patients.

After all, they can't be everywhere all the time. However, as managing physicians, they need to be aware of staff responsibilities; the inadequate, the exceptional, and everything in between. Where to start?

For one, it would be helpful if doctors did self-awareness checks and occasionally noticed what may appear routine activity, yet vital to the efficiency of the practice.

When they do, let staff know that these everyday tasks are appreciated. Show well-deserved gratitude to the staff. Not only because "it's their job," but because it will lead to repeat behavior, higher morale, job satisfaction, and if that wasn't enough…greater productivity.

Two, start a new habit of beginning or ending staff meetings by saying nice things.

It helps by balancing gripes or complaints that may arise in our practices with positivity every day. Managers can go around the room and suggest each employee verbalize some gratuitous words of encouragement about a co-worker, their manager, or doctor, even a brief uplifting patient story.

Go for the smile!

Receiving compliments at the beginning of a meeting can help break the ice and encourage participation, leading to new, more constructive ideas.

If you choose to do so at the end of the meeting, everyone leaves on a high note, feeling a positive boost.

And three, it would help to make gratitude a routine occurrence.

You will see a change in staff attitudes simply by saying thank you. Not just a contrite, "let's get this out of the way, thanks," but a sincere "thank you" for a specific act of service.

Employees can tell the difference between a nondescript pat on the back vs. a true expression of gratitude.

Expressing gratitude is something you can do every day. Do it three times every day. It doesn't cost a thing!

Indeed, an ambitious doctor who can express gratitude to staff is purposeful.

Employees are not exempt from this exercise. Gratitude works both ways. Put your heads together and start the ball rolling by making simple changes to create a more gratitude-contributing climate.

Your internal efforts may not change the way people treat each other outside of the practice, but if we all aim a little higher, we just might set a great example.

That would indeed be a step in the right direction!

• Diabetes Awareness Infographic (PDF)
• Diabetes Awareness African Americans (PDF)
• Diabetes Awareness COVID (PDF)
• Diabetes Awareness Health Disparities (PDF)
• Diabetes Awareness Intro (PDF)
• Diabetes Awareness Undertreatment (PDF)

• Diabetes Awareness African Americans (JPG)
• Diabetes Awareness Infographic (JPG)
• Diabetes Awareness COVID (JPG)
• Diabetes Awareness Health Disparities (JPG)
• Diabetes Awareness Intro (JPG)
• Diabetes Awareness Undertreatment (JPG)

Some of you may recall a very dated (1965) TV commercial “Mother, please! I’d rather do it myself!” The message of course was to get relief from a particular aspirin, rather than suffer the headache-induced stress brought about by (in this case), an interfering mother. Undoubtedly, many of us are “I’d rather do it myself” people, and while our intent is not to grouch on those around us, there is a refusal or resistance to change our ways. Enter Effective delegation. The answer to the “DIY” cry!

To clarify – delegation is not just about unloading tasks because you don’t want to do them or because they are too difficult or boring. It is about carefully selecting, empowering, and trusting capable individuals to take on specific tasks. Then transferring the decision-making responsibilities to the assignee in such a way that they are granted full ownership of it. It’s intention? To help reclaim your time, reduce your stress, and increase efficiency and productivity – all of which can lead to added practice value.

While there are tremendous advantages to delegating, the push-back (or barriers) by naysayers are not far behind. Of course for some, it’s nothing more than benign habit (“I’ve always done it myself”), an unwillingness to change, or fearing a loss of control. Others believe “I’m the best; no one else can do it like I can!” And include the standard refrain, “it’s easier just to do it myself.”  

Many doctors, by their own admission, have found it particularly difficult assigning hands-on tasks to their staff. Perhaps because they feel a duty and obligation to their patients, or a combination of reasons listed. Additionally, there is the fear they could risk malpractice. Others that might consider delegating do not want to take (or claim not to have) the time to train. My favorite though, is the worry of patient disapproval. (“Patients expect ME to treat them, not my staff.”) I don’t doubt that a handful of patients may prefer the doctor’s attention; however, the ability to convince them ultimately rests on how the doctor presents. If a physician is confident that his or her well-trained staff are capable of performing a particular task, it follows that patients will too. Few would question a dental assistant prepping for a root canal. In fact, you would be surprised if the dentist was the one who cleaned your teeth.

Every successful endeavor has a form of this hierarchy. The auto shop has ‘Bud” the seasoned mechanic who takes on engine repairs and assigns ‘Jimmy’, the young new hire, oil changes and flat tires. The Executive or Head Chef manages the kitchen while sous chefs, line cooks, and prep chefs work many jobs to prepare restaurant meals. The bank president rarely if ever works the teller position. Brad Pitt has a stunt double; and as good as he may be, you will never see Tom Brady kick a field goal.

To be clear, some resistance is valid because not everything can (or should) be delegated. There are indeed limits and stepping over that line is unacceptable. However, no one is suggesting that staff perform bunion surgery, suture-close capsules, administer injections, or deep wound debridement, all which of course, would define unprofessional, even unlawful conduct. There are tasks, however, that can be considered suitable.

Conscientiously select those jobs that can be directly trained/learned and are personally comfortable for you to let go (administrative or patient hands-on). Once staff have become capable and confident in their performance and can prove that they are able to handle more, they’ll need one-on-one instruction and guidance. For example, show them and explain how to prep a patient for a procedure, apply pads post-palliative, acquire preliminary patient history, assist in surgical procedures, and with adequate training and supervision are achieved, take orthotic impressions. Being able to delegate such tasks allows for simultaneous revenue streams. While you are giving an injection, they can productively apply and instruct a patient in proper night splint use.

Proper delegation requires three critical steps:

1. Choose the right person when delegating assigned tasks. Expect some initial mistakes, remembering that mistakes (recognizing and correcting them) are part of learning and development. Keeping in mind, that too much leniency or mistakes unchallenged will result in YOU re-doing the work - accomplishing nothing.

    

2. Be sure to clarify and manage (not micromanage) the job. Detail the reasons why and how something needs to be done and insist on quality as an end result. Remember, people are not mind-readers, so unless you successfully communicate your expectations, they cannot possibly understand how best to meet them. If you are vague, they are left to their own interpretation and that is a set-up to fail. Then review and supervise their progress.

    

3. Provide Incentive; praise, and reward the action – especially for a job well done.  Everyone likes to feel their work and efforts are appreciated.  Spell out what in particular they are being commended for by saying, “Sue, the patient history you took today was very thorough…made my work much easier!”  Rewards (not for simply doing the task – but excelling at it) are a great morale builder. In fact, self-confidence, appreciation and rewarding good behavior often results in repeated good behavior. 

If the barriers that prevent us from letting go are self-induced, so too are the remedies that can allow us to reverse course and welcome the help of others. Just think of it. Reduced demands of your time. Increased efficiency and productivity. Additional revenue opportunities. A more fulfilled, confident, reputable and devoted staff. Less stress; less headaches. All because of the decision to put that “do it yourself syndrome” to rest. And without the use of any OTC medicine. Plop, plop, fizz, fizz – Oh what a relief it is! 

• Satisfaction surveys after a visit (think star-rating)
• Yearly check-ins with patients
• Guaging interest for further learning (Provide a checklist of topics to see what your audience may want to learn about. Use the responses to write blog and social media posts)
• Learn how you can adapt to meet your patient's needs (Ask how your office can serve them better. It could be as simple as offering appointments one hour later on Wednesdays or the ability to request an appointment online.)

• Keep surveys to 5 questions or less
• Use different question types (multiple choice, drop down, rating, input, etc)
• Make sure you provide an immediate thank you message
• Consider offering an incentive for filling out the survey (if appropriate)
• Follow up within 24-48 hours regarding any responses that require attention or clarification

I’ll admit. I commiserate with doctors (employers/parents/coaches/teachers) or any leader when they hear the words, “It’s not my job” after asking why an assigned task was neglected or incomplete. To be fair however, I have similar compassion for staff when they hear, “That won’t work here!” after offering a new suggestion for improvement. Both sound like nails screeching on a chalkboard or a fork grating across a china plate! Eeeccchhh! Both expressions are toxic from auditory, motivational and common sense perspectives. Instead of the traditional face crunch every time we hear these words, we would do much better to understand why they are said and how to prevent hearing them ever again.

It’s usually implied (if not stated) that job descriptions are the culprits of the phrase “It’s not my job”; however, it is generally the product of an unsupportive work environment or an employee’s poor work ethic. If the employee is not team-oriented, does not align with the practice culture or sees their employment as just a “j-o-b” as opposed to a career, every job-related thing they do is a struggle.

Similarly, if the employee has a decent work ethic at the onset but turns bitter once on board, it’s likely due to an uncooperative culture. For example, maybe they were getting a disproportionate number of extra jobs dumped in their laps that prevented them from getting their primary tasks done – while other co-workers seemed to always get a pass. Perhaps they were continuously assigned tasks that they were not properly trained in, or not within their skillset or comfort range. Finally, bad performance could simply be the result of bad management. How can you avoid all of this? Three simple guidelines: hire for personality, build a positive work environment and manage staff the way you’d like to be managed.

In order to address the mind numbing, “That won’t work here!” comment, we have to talk about change and why that typical first reaction to a new idea is to resist it. Truth is, many times it is simply the WAY people are approached, rather than the change itself that causes resistance. Let’s say a practice sends the staff to a conference where they are exposed to many new efficiency strategies. When they return, staff are eager to implement the new stuff they learned so they enthusiastically approach their doctor with several pages of things they “need” to do differently. Unfortunately, the doctor was not there and doesn’t share their enthusiasm and in fact, feels a little threatened by change. As a result he/she pulls back and without even hearing what’s involved or knowing the potential outcome, the automatic response is “That won’t work here!” Ouch. Talk about an energy killer!

If the approach was less overwhelming; if the staff presented just one or two top ideas; and if they had laid out what was involved along with the potential outcomes…the doctor would be able to process it much easier and resistance levels would drop significantly. When offering up a new idea, avoid going in like gangbusters. Instead, take a more reasonable approach:

“Doctor, thanks for sending us to the conference. There’s one thing we learned there that we are eager to share with you and feel it would benefit the practice. (State the idea and the benefits) I’ve done some research and the costs to make the change are minimal-to-none. (Present anticipated costs, if any) Basically, here’s what would be involved. (Outline x,y,z actions needed)  Susan (or whoever will be responsible) has already offered to do (x and y) to get things started and I’ll tackle (z). If we try it for about 2-3 weeks, we’ll have a good indication of whether or not it will work for us (Point out that it takes approximately 21 days for any change to take effect.) I’m pretty confident this will make our practice more efficient, however, if it doesn’t work to your satisfaction, we’ll agree to go back to doing things the way we did before.”

By the way, this strategy works in reverse too; e.g., if the doctor plans to implement new policy and needs staff to be on board.

If you are absolutely, positively 100% satisfied your office is flawless, perfectly fine-tuned, and couldn’t be better… there is no need to make changes and you have already spent too much time reading here. If however, you want to continue improving your practice, well then, change needs to be part of that process. Whether the doctor initiates some new ideas or the staff does…for the sake of progress, have an open mind, lose the de-motivational “It won’t work here” and consider an “Ok, let’s try” response. You won’t be sorry.

Originally shared in the July/August 2021 PPMA Newsletter

Are you a micromanager? Answer yes to any of these?...

• Feel like you are the only one who can do things right and therefore must DO everything yourself;
• Refuse to delegate or share responsibil-ity for the above-mentioned reason;
• Constantly point out to employees things they have done wrong but ignore or fail to compliment what they do right;
• Do not trust that employees can accom-plish their work on their own, without you observing their every move;
• Feel a need to babysit employees;
• Do not make time to participate in employee training, guidance, and support; yet get annoyed when certain, expected outcomes are not achieved;
• Put little trust in their ability to prop-erly accomplish tasks;
• Believe your employees “just don’t get it” and never will;
• Make yourself unavailable when staff have questions; or are bothered when asked;
• Feel it necessary to be informed and take control of every detail of every situation;
• Feel your voice is the only one that matters in what should be a productive “dialogue” with staff during meetings or performance reviews;
• Feel completely exhausted, drowning in work, AND bordering on burnout at the end of the day;
• Have difficulty prioritizing critical vs. routine tasks (everything is critical in your eyes);
• Must approve every action – big or small;
• Expect perfection rather than excel-lence (you consider errors a sign of incompetence);
• Wonder why your staff is not motivated;
• Have an inordinate amount of employee turnover;
• Focus too much on undesirable results and too little on strategies to reorganize and improve;
• Feel reluctant to accept new ideas because change is hard or “This is the way we’ve always done it.”

...then, read on!

Truth is that micromanaging stems from several things. For example, dealing with one negligent employee can lead an employer to think ALL employees need constant watching and none can be trusted. Or it could be the result of an employer’s innate desire for perfection; something they think only THEY can achieve. Finally, some employers may have difficulty understand-ing where that line is between good and bad management because while possibly busi-ness trained and clinically proficient, they never received proper guidance to manage. Some micromanagers acknowledge their controlling behaviors; others dismiss it as part of doing business.

If you have responded “yes” to many of the checks above but refuse to “come clean” …hold on to your ivory tower, because you have the makings of a micromanager! This article is not intended to target anyone in particular; however, as the saying goes… “If the shoe fits…”
The best part… it is never too late to turn things around.

WELCOME TO THE MICROMANAGER’S 10 STEP PROGRAM: 

1. Delegate some tasks to staff that will help you gain more confidence in them. After doing so, take a step back, let it go and see what they are capable of. Guidance and instruction are necessary and always appreciated; breathing down their necks is not. Neither is babysitting them. Initially, expected outcomes may not be consistent with your standards, but allow them to start small, discuss ways to improve, and build your trust through their accomplishments.

2. Employees really CAN undertake essential tasks without your involvement if given the chance to prove themselves. They may even surprise you! Refrain from requiring your approval for every little decision. Give praise freely. Allow the necessary space for employees to present and solve problems on their own without your input.

3. It is important to have a handle on the business side of the practice. And it is important to request and review regular reports to keep informed. Rather than concen-trate on every little, microscopic detail, look instead for progress made and the big picture outcome. Discuss potential modifications and encourage suggestions to improve.

4. Try not to make mountains out of molehill errors. Mistakes are not only expected; they are an excellent and necessary source of learning.

5. Do not be afraid to place others in charge of certain tasks (i.e., running the staff meeting). Assigning them responsibility helps build their strong character and gives you the opportunity to develop confidence in their abilities.

6. Stop insisting that doing everything yourself will save time. Teaching staff how and why tasks are done a certain way will allow you to spend YOUR valuable time being the doctor. As you should.

7. Refrain from second guessing every decision or action your staff takes and recognize that YOUR way is not the only RIGHT way to do something. Think of it this way. 4 + 4 = 8, but so does 3 + 5. Do not shut out alternate pathways that may prove more productive and efficient.

8. Seek out thoughts and participation from staff. If given the chance, their observance of patient flow and activities firsthand offers unique, front line ideas towards the advancement and growth of the practice.

9. It is not necessary to stay on top of your employees. Part of their commitment, enthusiasm and motivation comes from having challenges, as well as the space and freedom to be a creative and an inclusive member of the team.

10. Take a good hard look at your style of management and whether it directly impacts the frequent staff turnover or low employee morale. Many times, an anonymous employee survey can offer constructive criticism and define specific areas of unintentional neglect.

In the end, the best way to determine if you ARE a micro-manager involves a bit of self-analysis and honesty. Just ask yourself, “Would I enjoy or want to work for someone like me?” If your answer is an unequivocal “yes”, you pass. Carry on. If not, a good recovery program involves taking a “One Step at a Time” approach to reach a desired goal and ‘engage in what is right’. You can do it! 

Originally published in the Mar/Apr 2021 PPMA Newsletter

“Practice management” encompasses a variety of organizational skills that help to, well, manage your practice. That includes managing your finances, employees, standards of operation, and time. Regarding time, if I had a nickel for every instance someone said to me, “There are just not enough hours in my day,” I’d be uber rich on nickels. That said, I believe introducing my five proven time management methods (below) will help open some eyes in the office on how to be more time-conscious. Then, if one or two or all of them could become routine, who knows? They just might, in time, even eliminate some unwanted headaches, and crazy-talk here, make your practice work for you. In fact, I KNOW they will!

1) Plan and Prioritize. 
It helps to have effective tools to keep you and your day on task. In other words, plan your work and work your plan. Start by keeping a neat work area. You can work a lot faster when everything is in its proper place. Second, create a list of “things to do” and put it on paper so you can visualize it. Any of these simple approaches will work: 

• Jot down random tasks as you think of them and in no particular order; 
• Organize your task list according to categories, i.e., outgoing phone calls, errands, correspondence, projects, misc., etc. Then, tackle by group; 
• Differentiate urgent tasks from non-urgent and important from not important, focusing on the urgent and important ones first; and finally, 
• Partition your work day into hourly slots and fill each time-frame with tasks you want to accomplish. Of course, 
• Checking off tasks on ANY “to do” list means you have, in fact, “done” them. Revel in your productivity!

2) Structure your day for best achievements. 
Don’t ignore your internal clock. That means working in coordination with your own energy levels by scheduling more activities and work during your energized time and less during those lazy times. It is proven that during your prime, energized time, your batteries are charged, your brain is ON, and your focus is good. But when you are in slow mode and dragging, so too does your brain. By the way, doctors should also consider taking this approach when creating their patient schedule. Late riser? Start late, work late. Early riser? Well, you get it. The start of your day, whenever that is, is your most productive. Be sure to start on time! Not doing so is the #1 reason we fall behind schedule. Don’t forget to use automation when available; it’s there to make your life easier. Take advantage of it.  

3) Do not Procrastinate.
Nike® had the right idea, “Just do it!” However, for 20 percent of our population who are chronic procrastinators, that is easier said than done. Something or someone holds them back from starting and/or completing what they set out to do. We all know you can’t fix something if you don’t know what that something is holding you back. If that sounds familiar, try a little introspection. Ask yourself why by finishing this statement, “I’m avoiding this task because …” Your response might provide all the insight you need to forge on. If certain projects feel overwhelming, start small. Small action is still action. You’re on your way.

4) Don’t Multitask, Delegate. 
There is a part of us that thinks we can effectively multitask. And for some things we actually can because we’ve developed a “we can do this in our sleep” mentality that enables us to accomplish menial, routine, mindless tasks, like walking and talking at the same time. But the term “multitasking” was created for computers, not humans. 

Our brains are not wired to multitask. In fact, our IQ is lowered by as much as 10 points, and we are said to be 50 percent LESS effective and accurate when we try to juggle two or more things at the same time. When we do, we spend more time correcting errors, redoing work, and overlooking important steps. It leads to less focus, less productivity, and far more stress. 

Experts agree. In order to do a job well, we must concentrate on one thing at a time. Start it. Finish it. Begin the next task. Now, if you find you have too much on your plate, rather than trying to take it all on yourself, ask for help. Remember, though, you do not delegate a task because it is too difficult or boring, you do so because someone else (a staffer or co-worker) possesses the proper skills and is perfectly capable to pitch in. 

Another reason is to help them learn and expand their responsibilities. That’s the essence of teamwork. After all, Nick Foles did not win the 2018 Super Bowl, the Philadelphia Eagles TEAM won the Super Bowl!

5) Eliminate Distractions and Time-Wasters. 
Determine where you are wasting your minutes that lead to wasted hours. Is it the phones, emails, unlimited social time with patients or co-workers, unnecessary paperwork, or not being able to make prompt decisions? Identify them, then slowly weed them out and voila! Suddenly, there will be more room for productive ones. Maybe it’s because I’m entering the “Autumn” of my life (Medicare enrollment will do that to you!), but I don’t have to tell you that each minute we are given is a valuable commodity. Until we value our time, we fail to care how we spend it. Isn’t it about time we started caring?

Originally published in the Nov/Dec 2019 PPMA Newsletter

Do you conduct patient satisfaction surveys? They can be a little scary, I know, hearing potential patient complaints, especially if they are left waiting in the reception area for longer than expected. Yet, that is exactly the reason WHY you should do them. If there is a customer service problem, you need to know about it, and you need to fix it. Remember, if they don’t tell you, they are very likely going to tell 10–12 other people. Negative chatter spreads fast, and it’s never pretty! 

Here’s the reality. The function of a patient satisfaction survey is to help keep a finger on the pulse of the practice and determine what it is that makes your practice stand above the competition, or not. They are effective in providing key insights into your patients’ thoughts, which is important because meeting their needs is an ongoing priority. They help define why patients keep coming back, why they suddenly leave. Additionally, they serve as a gauge to monitor what operational systems are working to the advantage of the practice, and conversely what improvements need to be made.  

Best Survey: Short, Anonymous, Onsite
As far as the best type of survey, some offices prefer issuing a short three-question survey that patients can fill out at the discharge desk. Others, an online survey that they can complete at home. Personally, I’ve always liked a third option. The short, anonymous patient survey done onsite. Yes, having the patient fill one out while they are there in your office effectively captures their real-time impressions based on their experience and the type of care they received. Anonymous surveys always tend to yield more honest evaluations. And like it or not, that’s what you want.

Putting it on your website is always good to accommodate those patients who are willing to offer feedback at their convenience, but it should not be your only approach. Not many patients actually make a point of following through, even though they say they will. You will get a much higher rate of participation overall in-person—they’re a captive audience, very few will refuse to fill one out—than you would with an Internet version. 

One Page/One Side Survey
My suggestion is keep it short but not too short (one page, one side); as I have found this to be most effective. Asking your patient to quickly circle three (3) very general questions and then hand it back to the person who asked them to fill it out is by far the most simplified and uninformative version of patient feedback. However, it rarely pinpoints necessary change. That being said, for an intermittent, ongoing shot in the arm, “The Super Short (3-question) Survey” can still be available on the counter year round.

One Full Month Annually
It is beneficial for your practice to initiate annual surveys for one full month out of the year, to get a realistic assessment. I like doing them in March, sort of a “Spring Cleaning” effort towards change. 
Questions asked should cover several critical areas, e.g., appointment, facility, staff, and doctor. You’ll also want to provide a closed receptacle; consider getting a big old-fashioned single slot mailbox complete with a flag and a lock to place on the discharge counter. This allows them to return their survey, again anonymously, before leaving the office. You’d be surprised at how many patients are anxious to “drop” their survey into the mailbox!

So, do conduct your survey! And, please don’t ignore your patient’s comments. Any complaint they may have is one worth addressing. You asked, now make it a point to follow through. 

Get tips on creating a patient survey in this article!

Originally published in the Sept/Oct 2017 PPMA Newsletter

Originally published in the Sept/Oct 2020 PPMA Newsletter

Originally published in the Sept/Oct 2018 PPMA Newsletter

“What happened to Mrs. Baker today?” asks the doctor. “She had a two o’clock appointment and didn’t show up.”  Patient no-shows are a daily scheduling occurrence that is more common than any of us would care to admit. Why do they happen? What do we do about them? And finally, how can we prevent them?    

Originally published in PPMA's Sept/Oct 2019 Newsletter