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I want to answer the question on
why my nail technician now makes

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me look bad. 
This is kind of a tongue in 

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cheek type of a intro here, but 
I've been using a nail tech for 

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about 6 months in my office. 
The the way we use her, she has 

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her own nail salon and she's not
as busy in the morning hours. 

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I guess I didn't know this, but 
the natural progression of 

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salons is a lot of afternoon 
appointments and weekend 

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appointments. 
And so she has her mornings for 

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8:00 and she was excited to work
for us. 

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Now I want to be clear, she was 
not the first one that we went 

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through. 
So a lot of times we try to 

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perfectionize over getting the 
perfect person where I think in 

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the in the beginning you just 
need to get someone because you 

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are bad at training them, you 
are bad at hiring them and they 

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don't know what they're doing 
either. 

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And so we went through a couple 
of ones that didn't stick, but 

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finally the third one stuck. 
And I think this is the same 

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thing as well for a scribe. 
You can't look for the perfect 

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scribe. 
You have to just have a good 

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process. 
And I think you can even say 

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this for employees, right? 
Because employees leave. 

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So it's not really getting a 
perfect employee, it's having a 

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good training system for that 
employee. 

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So Marjorie is her name that 
works with us and she works with

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me Friday mornings, half day and
she does kind of all the nail 

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care. 
So I have appointments usually 

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every 20 minutes, but on routine
days I do them every 10 minutes.

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And then she has her, her 
appointments every 20 minutes. 

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So and she's doing all the nails
and she's, it took me about six 

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months to train her. 
She's doing the nails because 

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that's within her scope. 
I've also trained her to do some

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calluses. 
So I trust her. 

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I've trained her and I am going 
in and seeing each of these 

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patients and doing the notes. 
And then so I go in kind of say 

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hi to the patient and I do or 
morally my scribe does the notes

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and then and then and then 
basically that's it. 

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And then I also evaluate if they
need a diabetic foot exam or I 

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evaluate if they need AB is or 
something else like that. 

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So that's how we use Marjorie. 
Now, why does she make me look 

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bad? 
Well, she makes me look bad 

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because she doesn't make the 
patients bleed as much. 

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That's kind of my joke. 
She, she is a little bit, I 

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don't know if it's more careful 
or maybe I try to get out more 

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of the edges. 
And a lot of times patients come

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out with two or three band aids 
with me, but with with her not 

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as much. 
So less band aids hurts a little

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bit less. 
The patients tell me and they 

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like her. 
She's very good at talking like 

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a lot of these nail techs and 
hair techs and things like that 

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are good at doing. 
So that was that would be my 

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word to you. 
Now it took us, I've been in 

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practice for about 15 years now 
and it took us about 15 years to

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do a nail tech. 
And if I could do it over again,

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if you have a too, too much pent
up routine care that's kind of 

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glutting your schedule because 
those tend to be low value 

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patients, it would be, it would 
behoove you to use a nail tech. 

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Now there are a lot of 
conversations regarding a nail 

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tech. 
There are all is it within their

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scope is should they be treating
patients? 

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Can they be treating Medicare 
patients? 

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I don't want to get into all of 
that. 

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I just find that in in my 
practice, I would be fine doing 

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all the all of them. 
I was doing them all. 

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We have a high comfort level and
she works under me. 

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So basically I'm responsible. 
I'm going to see all the 

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patients. 
I'm always in the office and I 

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only do 1/2 day, so Friday, half
day. 

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So just a thought. 
That's kind of how we do. 

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But we went back and forth with 
my partners of like, should we 

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be doing this? 
Is this legal? 

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Is, is this something that the 
patients would mind? 

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Now let's talk about patients 
perception. 

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So we put them so all the follow
up patients go on her schedule. 

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They just say you're going to 
see the nail tech. 

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I haven't had any patients that 
didn't want her. 

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I have a couple of patients when
they come in, they say I'd 

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prefer to see the doctor just 
because they maybe they like me,

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they like to know about my kids,
things like that. 

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And so I will, I will see those 
ones if they specifically 

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request. 
And, and the way we do it in our

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office is we put a little sticky
note on the door. 

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I don't know how you guys do it,
but the way we do it for seeing 

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patients is we, so we know who's
next. 

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The, the staff puts a little 
sticky note, a little post it 

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note with the patient's 
patient's kind of first name and

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then they put in kind of what 
they're there for. 

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And this makes it a lot easier 
for us. 

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And then we also have a flagging
system to know who's like the 

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first patient, who's the second 
patient, who's the 3rd patient 

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when we have multiple rooms kind
of backed up in our office. 

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The the post it note is also 
beneficial for two other 

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purposes. 
I don't know if you use a post 

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it note, there's probably a 
better way, but I haven't 

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figured it out. 
OK, I, I know some people use 

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like the home screen for their 
computer, like they would put up

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a big almost like a, a 
television that shows what room 

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to go into and what they're 
there for. 

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That might be less paper, 
frankly, but there's another 

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added benefit to these post it 
notes is when I do nail samples,

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I just write what toe or a 
toenail I took and I just put 

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that little sticky note on 
there. 

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Same thing when I do biopsies, I
put the little sticky note on 

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there. 
So it makes it a little bit 

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easier for, for tracking of 
pathology types of things in in 

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the office. 
And also, I know this is going 

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to sound funny, but it helps me 
remember the patient's name 

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because a lot of times there's 
so many patients, I don't 

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remember all the names, 
especially with the newer 

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patient. 
And so having it written down 

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there, I can, I can refer back 
and try to use their first name.

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OK, so this is a recording of a 
Friday. 

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And so the first half of the day
once again was, was with, with 

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Marjorie and seeing routine nail
care. 

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I'm going to go through what we 
saw in the afternoon. 

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So the first patient in the 
afternoon was a 61 year old 

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female. 
She had right heel pain and she 

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got the Pelto special once 
again. 

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Pelto special is the night 
splint foam rolling in morning 

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stretch. 
She got X-rays, she got 

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ultrasound, and she was wearing 
fit flops. 

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I don't know if you know fit 
flops, so I usually recommend 

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UFOs, but I think the fit flops 
are probably OK. 

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She's going to be working on the
soft tissue and if it doesn't 

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get better, she's going to 
follow up. 

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I her her ultrasound was not all
that big. 

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So I think a lot of hers has to 
do with the tightness. 

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And so I think with the taking 
care of the tightness, she'll 

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feel better. 
I did have two care reflex 

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patients. 
One was a 71 year old female. 

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We did bilateral care reflex and
she purchased the kit. 

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The other one was a 38 year old 
female for left care reflex. 

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Now I'm trying to have these 
care reflex patients be seen in 

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my in Marjorie schedule for two 
reasons. 

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One, because it just takes me 
forever to make it look good and

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I tend to get really behind as 
I'm doing them. 

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And it's really not the largest 
check. 

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Maybe it's OK if they're doing 2
nails. 

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So, so 2 nails, I charge 125 for
the first nail and then 50 for 

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the second nail and then we 
charge 75 for the kit. 

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So for two nails, it's a little 
bit better if they're just 

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coming in for one nail or let's 
say the darn thing falls off and

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I'm not charging them at all or 
just doing an office visit. 

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It's not really the most 
beneficial. 

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So I'm, I'd like to have 
Marjorie do more of those. 

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Once again, that's within her 
scope of practice. 

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Next patient was a 65 year old 
female for right Achilles tendon

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pain. 
She is a nurse practitioner 

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dermatology. 
She has some bulbous change. 

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She has a very small bulbous 
change in the back of the 

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Achilles. 
It's not too severe hurts a 

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little bit. 
We talked about her Aquinas that

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she has bilaterally did the 
Pelto special once again, night 

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splint foam rolling, morning 
stretch and I'm not going to see

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her back if if the pain gets 
worse, she'll come back in. 

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But her pain level isn't all the
time and it's not very high and 

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so she would certainly benefit 
from Shockwave and I talked to 

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her about Shockwave, but if the 
pain isn't all that bad, I'll 

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she's not too motivated to do 
that. 

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Next patient was a 66 year old 
man. 

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He's doing Q tenza #2 The only 
struggle I'm still having with Q

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Tenza is the documentation in 
our medical record because 

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there's two options with Q 
Tenza. 1 is like the buy and 

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Bill and the other one it 
meaning that means we buy the 

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product and we build the 
product. 

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And the other one is where it 
goes to a specialty pharmacy and

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we just get the product in. 
So those are kind of the two 

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ways depending on their 
insurance. 

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They, they kind of help us with 
that. 

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And then when they come in and 
we, we apply it, the application

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is really easy and we've, we 
started out by doing everything 

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ourselves. 
Now basically I go in, I see how

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they're doing, staff does the 
vitals, I apply it, put in a 

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timer for 15 minutes, put it on 
the door and then my staff 

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checks them at 15 minutes. 
The vitals checks them at 

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another 15 minutes and then puts
this like gel stuff on there to 

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chelate or to pull away all the 
capsaicin and then they're on 

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their way. 
So I only see them for that must

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be maybe 2 minutes. 
So it's real quick. 

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It does take up a room in your 
in your office because I have to

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sit there for 30 minutes. 
But besides that it was, it was 

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fine and, and he's getting 
benefit from it. 

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Next was a 84 year old man with 
a left hallux Ind and the and 

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the last patient was a 56 year 
old female. 

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So she has, this is kind of a 
challenging one. 

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She has bilateral forefoot pain 
and she's like she works on her 

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feet all day. 
She works in a factory. 

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She didn't really get better 
with what we gave her with the 

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shoe changes with the I gave her
a Medrol dose pack. 

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Another doctor gave her 
gabapentin because it's possibly

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nerve pain. 
It could just be that she's 

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working now. 
I'm not sure if she's just not 

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wanting to work or what, but she
she when patients come in and 

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ask about like FMLA, our family 
medical leave act, I think, man,

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how do you live on that first? 
But I guess if you don't want to

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work. 
So I'm not too much of A 

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stickler for that. 
So I'm going to see her back in 

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two months and she doesn't want 
to work for two months. 

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And I'm thinking, what would I 
do for two months ago? 

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Crazy. 
But that was what she wanted. 

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So and then I said if it's not 
getting better after a couple of

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months, then we'll get an MRI. 
But I don't think there's really

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anything big going on with this 
patient. 

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OK, once again, I hope you guys 
found this beneficial. 

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I am putting together a 
challenge, a practice Podiatry 

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practice mastery challenge. 
We're going to do a six month 

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challenge. 
So if you'd like to be part of 

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it, shoot me an e-mail, e-mail 
dot at Podiatry practice 

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mastery. 
The whole goal would be to 

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optimize, to get your practice 
past your personal production, 

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past the $1,000,000 mark. 
That's what I'm doing with all 

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these podcasts. 
But I find a lot of times it, 

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it's better to have a little bit
of accountability. 

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I was talking to a doctor 
recently. 

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He, he was struggling with some 
simple, simple things. 

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But it, it's not obvious when 
we're in the midst of it and 

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we're really, really busy. 
So if you want to be a part of 

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another group of it'll be only 
podiatrist there. 

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We're gonna have a small group. 
I limited the number. 

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You should be seeing some emails
if you're getting my emails. 

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If you don't get my emails, 
shoot me e-mail and I'll add you

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00:10:44,200 --> 00:10:45,440
to the e-mail list if you want 
that. 

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If you have any questions, let 
me know. 

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I think it would help you 
because I think that 

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accountability can be 
beneficial. 

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Okay, talk to you tomorrow.