Why Do Podiatrists Charge So Little? Can I put My Clinical Fees Up?

 

In my 32-year career as a podiatrist I have worked both in public and private practice podiatry settings and have always been saddened and frustrated by how little we are valued in terms of being respected and rewarded for our expertise.  In the private sector there is such a recalcitrance to charge accordingly for what we do. Podiatrists are always afraid of putting up their clinical fees. I have just been through this dilemma myself, when considering whether to increase my fees to reflect my high level of expertise and years of invaluable experience, and to set myself apart from my less experienced colleagues.

My quandary started with the problems associated with booking patients in with me to do the more complex procedures that only I can perform which my colleagues cannot. As great and as proficient as they are, they are still building on their skill sets. Consequently, my waiting list times have risen exponentially. This could be considered a great problem to have, but is also presents a ‘double-edge’ sword scenario. Patients must wait many weeks for a specialist consultation and treatment. There is then the additional logistical problem of no appointment availability for necessary follow-ups. If I put up my fees to reflect my level of expertise will I free up some capacity? Those who do not want to pay extra to see me, which is minimal, can see one of my competent ‘cheaper’ colleagues. Unfortunately, there is the danger of alienating certain patients, which I genuinely would hate to do. Many of my patients have become friends over the years. Ultimately it will all come down to cost and whether they value me enough or dare I add their feet to pay the extra? Time will tell.

The whole decision process has been a difficult one, so I put it to my staff and a couple of my patients. Staff agreed without feeling professionally undermined that there should be some sort of differential clinical fee and those consulted patients did not see it as a problem. One gentleman informed me that he paid £35 a time to get his dog’s nails clipped! Another patient told me her recent haircut and blow dry was £65 and a visit to the dental hygienist £45. We all know that if you call-out a plumber or electrician they charge a fortune for just stepping over your doormat.

Podiatrists need to earn a living, pay their bills and if they are running a private clinic like myself need to factor in the over-head costs. We are also expected to keep our current learning updated, with Continual Professional Development (CPD) demands. This can be costly, and if we want to keep our practices advancing we should consider investing in the latest podiatric technology. All very expensive.  I therefor come back to ask the question: “why are podiatrists afraid to charge accordingly to reflect their qualifications and expertise?”

The problem is deep rooted in the podiatry profession and amongst the public. Feet are considered very low priority. It is almost as if feet being positioned at the bottom end of the body deserve a low ranking. They are low standing (no pun intended), so does that make podiatrists low standing? This unfair view permeates throughout society and amongst other health professions. Podiatry is commonly considered to be one of those unglamorous professions, with a kind of revulsion attached to it; “Ooh I couldn’t do your job”. There is an underlying consensus that cutting toenails, removing hard skin and corns is unsavoury so therefor should be rewarded accordingly to reflect the ‘eugh!’ factor. It is after all, some would say, such a seemingly simple task to do, with no reflection on the skill set, qualifications required; “You are only cutting my nails”.

Podiatrists have allowed this low opinion of what they do to percolate throughout the medical world, hence we do not charge what we really are worth. There is a huge discrepancy from clinic to clinic. Yes, we must consider and base our fees on the demographics of the clinical location e.g. no point charging London prices in a small urban area, but our fees must not undervalue our skill set. Check out what the local hairdresser if charging.

As a professional group, we generally are not very good at marketing ourselves and raising the bar to influence and change public opinion. Many people are not aware of what it is we can do. There is still the antiquated notion prevailing that we simply are chiropodists. The term podiatrist being a new fancy name. No, we are not.  Podiatrists are degree trained and are specialists in all matters related to lower limb footcare, to include for example complex wound healing, lower back pain and so forth. We need to clearly differentiate Podiatry from Chiropody, to avoid the confusion and misunderstandings. Chiropodists are not degree trained and have limited scope of practice. They cannot perform difficult surgical procedures like a podiatrist.

Our expertise and foot related knowledge base far exceeds other medical specialities who treat feet e.g. GPs, physiotherapists and osteopaths. Podiatrists have an extensive skill set to ensure good foot health. Podiatrists consequently play a big role in keeping individuals ambulant, which is vital to their mobility and independence.  A regular visit to a podiatrist is akin to getting a regular dental or eye check-up. Preventative medicine is key to good health. Feet should not be put at the bottom of the pile and considered irrelevant to health. A haircut should not be given more priority and canine nail clipping charged the same. As a profession, podiatrists should raise their game to keep pushing their professional boundaries forward and be respected and rewarded accordingly. Charging cheaply keeps the low opinions of podiatry down. We must not propagate the situation.

All this to justify my price increase. Yes, I am going to put my fees up and am proud to do so. I am worth it after all, l just hope my patients think so? I will keep you posted. Will the effects of Brexit make me rethink?

 

Katrina Waller’s fees go up to £42.00 1st November 2017