About half of new small businesses fail within the first 5 years, according to the Small Business Administration. How can a pedorthist who is starting a practice beat the odds?
“First and foremost, choose your mentors well,” Libby McGraw, CPed, former president of Centennial Lakes Pedorthics Center in Edina, Minn., said.
Peg Lucas-Swisher, CPed, co-owner of Sole Comfort Shoes Inc. in Albuquerque, N.M., added that pedorthists need to hire a good lawyer and accountant. Ed Gildehaus III, CPO, CPed, owner of Central Prosthetics and Orthotics in Lexington, Ky., said that one cannot overdo the market research.
McGraw, Lucas-Swisher and Gildehaus are ABC-certified pedorthists who beat the odds. McGraw, who lives in Victoria, Minn. is a past president of the Pedorthic Footwear Association (PFA), part of whose mission is to enhance the effectiveness and efficiency of the certified and licensed pedorthist. She said certified pedorthists who begin a practice should know every aspect of pedorthics – fitting shoes, custom shoes, shoe modifications and foot orthotics – to provide the best services for their patients.
“They do not necessarily have to do all these things themselves, but they do need to understand how each component works so the finished package can work optimally,” she told O&P Business News.
Find a mentor
McGraw said new certified pedorthists must keep current with new studies, techniques and materials. She is happy to mentor new certified pedorthists.
Additionally, she said new certified pedorthists should join the PFA.
“Attend classes and symposiums,” she advised. “Network with your peers. Everything you learn will translate into better care for your patients, which I think is the bottom line for running a successful business.”
PFA president Randy Stevens, CPed, COF, agreed that starting certified pedorthists belong in the PFA. He said the organization has been a vital part in establishing his practice, Randy Stevens Family Footcare in Harrisburg, Pa.
“Being a member of PFA has allowed me to network with my other pedorthic colleagues who are also members of PFA and not have to try to re-invent the wheel,” he said.
Individual and vendor members, he said, have made it possible for him to support the referring physicians and patients he currently serves. He said PFA staff answered his questions and assisted him in setting up his practice, as well as provide books, manuals and shipping, bankcard and marketing materials and brochures.
Know the community
Kristi Hayes, CPed, is also positive on the PFA. She is co-owner of Shane’s Foot Care Center in Seattle and also PFA secretary-treasurer.
“No one educates pedorthic professionals better or is a backbone to a successful business like PFA,” Hayes said. “Lean on your pedorthic community. Within PFA membership there are many pedorthists who will help you build your business and assist you with tough cases.”
Lucas-Swisher is also happy to assist rookie pedorthists.
“The best piece of advice I can give is know who you are,” she said. “You cannot be all things to all people; do what you do best and do it to the best of your ability, and you should be fine. Understand what you don’t know and learn about it. Ask questions and continue your education, both in pedorthics and business management.”
But query the right people, Lucas-Swisher cautioned.
“Don’t [only] go to the vendor sales reps for advice – remember it is their job to sell shoes. Call other pedorthists around the country and see what works for them,” she said.
She also recommended that certified pedorthists starting a practice should hire a consultant, learn about tax liability and not rely on reimbursement. She also suggested having a bank line of credit can get one through the rough times.
Take care of business
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“You have to know your referral base, the startup costs and the inventory costs. All those business decisions are so critical.”
Gildehaus agreed that taking care of business is vital.
“You have to know your referral base, the startup costs and the inventory costs,” he said. “All those business decisions are so critical. If you have a vast amount of inventory and it is not moving, you are stuck with it.”
A good way to keep inventory from piling up is a business plan with 5 years of projected numbers, Lucas-Swisher said. She added, “Know your cash flow and capitalization.”
And the competition, she added. “Make sure that your area is not saturated. Even though there are not that many pedorthists around the country, they tend to be gathered in specific areas. Lay your groundwork – [visit]… parking lots and buildings before you lease and buy.”
No matter the location, a pedorthics practice needs good insurance coverage, Lucas-Swisher said. She advises for new business owners to learn about liability and not forget to purchase ‘key person’ insurance.
“If something happens to you – you can lose everything with no income,” she said.
Likewise, she said not to go into business for the wrong reasons.
“Some people think that the ‘Therapeutic Shoe Bill’ is a cash cow and that [it] is the only reason for their practice,” Lucas-Swisher said. “Medicare can yank the chain at any minute and then you are up the creek without a paddle.”
Build a solid business plan
Steve Bramel, CPed, owner of Family Shoe in Danville, Ky., is still paddling, thanks to a solid business plan.
“Without a business plan you are committed to pursuing, you might as well be driving at night on a curvy road without headlights – you will crash,” he said. “The business plan is a must, especially if you are borrowing money from a financial institution.”
Bramel said that for him, becoming certified as a pedorthist was easier than being a small business owner. Building a referral base is a big part of his small business, and he has worked hard to build relationships with as many doctors, nurses, nursing homes, home health services or any other allied health care professional as he could find.
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“Without a business plan you are committed to pursuing, you might as well be driving at night on a curvy road without headlights.”
Likewise, Michelangelo Scafidi, CPed, COF, owner of Michelangelo’s Foot Comfort and Pedorthic Shoppe in Norridge, Ill., said beginning pedorthists should try to get affiliated with a hospital, clinic or doctor’s office to generate a large number of referrals. He also suggested new pedorthists attend professional shows and health fairs.
“Speaking engagements also are a big source of referrals, whether it is to other health care professionals or the target audience,” he said.
Scafidi said pedorthists starting a practice should get a Centers for Medicare and Medicaid Services provider number and try to get in as a provider with the local Blue Cross Blue Shield or other insurance contractors.
Stock inventory
When introducing himself to referral sources, Bramel said he discovered that initially, one cannot inventory every possible item he needs. His initial inventory consisted of about $15,000 worth of shoes for fitting stock.
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“Make sure that your area is not saturated. Even though there are not that many pedorthists around the country, they tend to be gathered in specific areas.”
Scafidi also said that starting pedorthists should have an adequate fitting stock if they are not going to stock a wide variety of footwear. He advised them to have other products the patients use – compression stockings, seamless socks, over-the-counter orthoses and other lower limb devices.
“Use a point of sale system – they are great for tracking customers, inventory, and both good and bad products,” he said.
Dale Cohen, CPed, owner of George Allen Shoes in Blue Island, Ill., said it is good to begin a pedorthics practice with a fitting inventory.
“You carry a few different styles of shoes in maybe three different lasts – not that much in the way of inventory,” he said. “If somebody wants a different color or a different closure system, you can special order shoes for them – as opposed to putting out $25,000 or $30,000 and having a lot of shoes in the store. You don’t want to get stuck with shoes that don’t sell.”
Choose vendors
Bramel said new pedorthists should use vendors who are relatively close, so if they have to order, the delivery time is reduced.
“You will spend more time on shipping, and while this initially will reduce your margins, eventually you will see some positive growth. As your cash flow increases, you can slowly begin to stock additional items that sell well in your market,” he said.
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“I had the best training in every aspect, or I am sure I would have had more fears than I did to venture out on my own.”
Stephanie Massie, CPed, has the same advice.
“Know your community well, and if you don’t, begin light in your [shoe]…selections – the community will tell you what they need to have,” said Massie, who owns Heart to Sole, a comfort shoe store in Fairview Heights, Ill.
Bramel said it is also a good idea to carry at least one strong seller to attract clients. For him, Crocs are key.
“Not only do they bring in doctors, nurses and other health care professionals, they also bring in the common man, woman or child without any sort of foot problems,” he said.
These people, he said, may know someone with diabetes or has the need for pedorthic services. Having a key item in stock provides the starting pedorthists with the opportunity to discuss pedorthic services, and it is the best form of free advertising available.
“Do not miss any chance to jump on the pedorthics soapbox,” Bramel said.
Learn marketing techniques
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“Running a small business was a tremendous culture shock for me. There is so much more one has to know when one runs a small entrepreneurial organization.”
Before he became a certified pedorthist, Bramel was a customer service representative for a large publishing company. Likewise, Bob Schwartz, CPed, owner of Eneslow, The Foot Comfort Center in New York City, worked for a large company before starting his pedorthics practice.
“Running a small business was a tremendous culture shock for me,” Schwartz said, who was in sales and marketing. “There is so much more one has to know when one runs a small entrepreneurial organization.”
His background in sales and marketing practices helped him understand how to use sales and marketing skills to grow a small business, he said. He was able to train his sales staff on how to enlighten customers, both doctors and consumers, in the value of pedorthics to improve foot disorders and enhance their lives.
“As a marketer, I understood the need to go to potential and existing customers and enroll them in the idea that Eneslow was a comprehensive footwear and footcare resource for all their lifestyle needs” Schwartz said. “Since we could not afford to do expensive, large-scale consumer advertising, we tried to educate them on the services we offered and how our services would help them. As is true today, consumer word-of-mouth drove the business.”
Contribute back
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Randy L. Brown, CPed, owner of Brown’s Enterprises in Washington, Mo., said successful pedorthists give to the profession as well as take from it.
“Contribute back…in money and time, mentor and listen to others,” he told O&P Business News.
Gildehaus said listening to the patient is crucial. There has to be a high level of confidence between the patient and the practitioner – that is the key to success, according to him.
“You have to know their concerns – shoe style, going to church, the pain they have, whatever. Then you have to work toward that main issue and try to accommodate the patient the best you can,” he said.
Brown agreed.
“If you can make your patients comfortable, it will increase their compliance, which should hasten their recovery. So as you consider biomechanics, anatomy, techniques and intervention modalities, please add comfort to your equation,” he said.
Put yourself in the patient’s position
Brandon T. Jones, CPed, COF, a staff pedorthist at Fletcher’s Shoes and Custom Made Orthotics in Franklin, Tenn., said he tries to make patients comfortable by putting himself in their position. Many of his patients have had to change their lifestyles because of foot pain and lack of ambulation.
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“Going the extra mile only takes about 2 more minutes. But if you develop friendships with your patients, they will come back to see you as opposed to going somewhere else.”
He advised new pedorthists to let the patient know you care about them and their feet.
“Going the extra mile only takes about 2 more minutes. But if you develop friendships with your patients, they will come back to see you as opposed to going somewhere else,” he said.
Jones said it is also important to take time to get to know the patient.
“Be serious if they want to be serious, or joke with them as you are getting them fixed and feeling better. Shake their hand when you go back to the lab and say ‘There is light at the end of the tunnel,’” he said.
Consider other questions
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“Your smallest loss is always your first loss. Give them a refund; don’t argue with them, it is only bad public relations.”
Lucas-Swisher said new practitioners can best serve their patients by considering what she calls “the main questions in life – who, what, where, when, why and how. The who will be, Who am I? Then, What type of pedorthics do I want to practice? What will I need to set up the practice?
“Where will I practice and where will my referrals come from? When am I going to do this? Why do I want to do this? Now comes the how – How will I put this all together? When these questions are answered, it will become clear as to whether this is what they really want to do.
“Some people come into the practice not understanding that it is a business as well as a practice. They get disillusioned, and some go broke,” she said.
Massie said a good way to stay in business is to decide your best area of pedorthics and start there. She is especially comfortable with the elderly population and has a passion for protecting patients with diabetes, so her store is more orthopedic than trendy.
Learn from veteran pedorthists
Massie said new pedorthists can learn much from veterans, as she did. Massie worked for Edith James, CPed, owner of Comfort Shoe Specialists in St. Louis.
“I had the best training in every aspect, or I am sure I would have had more fears than I did to venture out on my own,” she said. “Edith James not only trained you in pedorthics but also [trained you to find] strength within yourself.”
James agreed with her pupil that beginning pedorthists need to decide who and what they want to be to the world. “To thine own self be true,” James said.
Be true to the government, too, she added, whether paying payroll taxes or Medicare.
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“Decorate your facility with a theme that is inviting and promotes interaction.”
Dennis Janisse, CPed, said new pedorthists need to make up their minds about what kind of practice they are going to establish. Janisse founded Milwaukee-based National Pedorthic Services.
“Ours is a clinical type of pedorthic business, so the vast majority of business we do is third party payment,” he said. “If you are going to have that type of practice, you better make sure you have the right support, the right training and the right people to negotiate the contracts, so you can get the maximum amount of money that is due you.
“You do need to get as much as you possibly can and as quickly as you can from the payers. You have to have the right people internally and externally to help you do that.”
Janisse added, “A lot of certified pedorthists love to work with their hands and really care about their patients. But if you don’t make any money, you won’t be able to do what you love to do long.”
He said it is vital to build good, strong relationships with primary referring sources.
“If you have a good relationship with the physician – you understand him and he understands you – that makes you, the pedorthist, an extension of that physician’s practice. If you don’t treat the patients right and give them what they need, that reflects on the doctor, and you are going to quickly lose that doctor,” he said.
Would-be pedorthists might consider an internship with a good pedorthics practice, said Marjorie Bonsall, CPed, of San Jose, Calif. She owns four Foot Solutions franchise stores and is footwear consultant to the Foot Solutions company.
Have patience
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“Customers are attracted by a good comfort footwear selection with selective updates and imaginative showcasing.”
Patience is a plus in a pedorthist, too, she said.
“Immediate resolution of a customer’s problem is not always possible,” she said.
Bonsall said customers are attracted by a “good comfort footwear selection with selective updates and imaginative showcasing.”
Sheryl McCain, CPed, agreed.
“Decorate your facility with a theme that is inviting and promotes interaction,” said McCain, owner of The Shoe Fits in Indianapolis, Ind.
Bonsall said keeping a pedorthics facility tidy is important. She explained that a well-groomed, trained staff also promotes customer confidence and acceptance of recommendations for pedorthic applications.
Build customer awareness
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Paid advertising, not just word-of-mouth, wins customers’ confidence, too, Massie said.
“Have in the budget [sufficient] funds for advertising and always put in a $10 off coupon. My community has some great direct mail magazines,” she said.
She said every ad she buys pays for itself the next day after the ad runs.
McCain said advertising can make or break a new pedorthics practice. She said beginning practitioners should talk to others in the profession and get opinions about the types of commonly advertising used.
McCain added, “Stick to at least three different medias and keep them consistent at all times.”
Advertise and use word-of-mouth
Scafidi said his best advertising is word-of-mouth, from patients and doctors. However, he cautioned that every practice is different and what works for him may or may not work for someone else.
“Big print ads for pedorthics just don’t seem to bring in the people the way they used to. The Internet has been a source of referrals, whether it is from manufacturers’ Web sites or our own. The phone book is overpriced, but a necessary evil.”
Scafidi also said that rookie pedorthists need to know they will never please everyone all the time. While on the board of directors for the Board for Certification in Pedorthics, he has seen a number of ethics cases filed against certified pedorthists – not for ethics issues, but rather for business disputes.
“Sometimes you have to take a lump or two and move on,” he said. “Your smallest loss is always your first loss. Give them a refund; don’t argue with them, it is only bad public relations.”
