Discovering the Hidden Revenue in Your Practice

Dr. McDannald encourages practitioners to look beneath the surface for ways to grow their practices.

Key Takeaways

• Podiatry practices: Existing patients may represent overlooked opportunities when they are unaware of services such as custom orthotics, shockwave therapy, laser treatment, or regenerative medicine, or when previously treated patients become overdue for follow-up.
• EMR data: A typical practice may have 200–500 overdue patients; at a 15% rebooking rate and $200 average visit value, re-engagement could generate about $6,000 monthly without additional marketing spend.
• Practice analysis: Review patients unseen for ≥12 months and EMR reports by diagnosis; combine these data with local demographics to identify patient populations and services relevant to the practice.

Please note: This content is a direct transcript, capturing the authentic conversation without edits. Some language may reflect the flow of live discussion rather than polished text. 

Transcript

Jennifer Spector, DPM: Welcome everyone to another episode of Podiatry Today Podcasts, where we bring you the latest in foot and ankle medicine and surgery from leaders in the field. I'm Dr. Jennifer Spector, the Associate Editorial Director for Podiatry today, and I am so excited to chat with our guest, Dr. Jim McDannald. He is the founder and director of Podiatry Growth. He's been a guest with us multiple times. And today we're going to chat a little bit about the definition of growth in your practice and how maybe there are some ways to look differently at how to grow your practice. Welcome back, Jim, and let's get started. So Jim, many podiatrists assume that growth in their practice automatically means finding new patients, but are they perhaps overlooking some opportunities within their existing patient base? 

Jim McDannald, DPM: Yeah, absolutely. I think, like you mentioned, when most podiatrists think about growth, they kind of default to how to get more patients in the door, how to get more patients on my schedule, which usually means more ad spend and maybe more SEO, more of something, right? But the highest margin revenue is usually already in the building. It's kind of sitting in two places that most clinic owners overlook. The first being is that patients you're already seeing maybe have no idea what else you offer. The diabetic foot exam patient or the routine nail care patient who doesn't know that you treat ingrown toenails, prescribe custom orthotics or know what shockwave is, those are great opportunities right there that are already in your clinic. If you never present those options, they'll never know who to refer to you or that you actually offer those things in your practice. 

We sitting in our clinics all day and we know all the things we do, but patients are only there for 30 minutes or an hour every so often. So that's an important component. The second thing is that patients who come in and get better and they just disappear. So heel pain six months ago resolved, they never came back to follow up, never picked up orthotics or just didn't come in for a follow-up appointment. That's not a patient problem. That's a real revenue leak. A typical practice has 200 to 500 overdue patients sitting in EMR who already trust you and already know where you're located at. So even a conservative, maybe like 15% rebook rate of some of those patients at an average value of $200 can be 6,000 additional dollars to the practice every month with no additional spend or additional cost. So the reframe I'd give your current patients reflect your current marketing, not just your actual. 

They don't really reflect your actual market opportunity. So new patients are the most expensive way to grow. The patients you've already earned are kind of the cheapest ones. 

Jennifer Spector, DPM: For sure. And it strikes me that it might not just be the most financially expensive, but it can be the most bandwidth expensive too, because if you're just piling on more and more and more patients, there's a finite number of hours in the day. So perhaps this is a way to work smarter, not necessarily harder. 

Jim McDannald, DPM: Yeah, absolutely. And there's definitely some tools out there that can be helpful. But yeah, like you said, it's about working smarter, not harder. And like you said, the more you're trying to get new patients in the door, usually it is a bit more expensive. 

Jennifer Spector, DPM: Well, and speaking of tools, how can practices use their data, demographic data or patient records to identify candidates for say some of these additional services that are out there that you might be able to offer like orthotics or shockwave therapy or laser treatment or regenerative medicine? 

Jim McDannald, DPM: I'd say there's kind of two main data sources here and both are a little bit underutilized. The first is census data and understanding where you're located physically as a clinic. Maybe you have one location or two or three locations, but you can get a general sense of the income, age distribution, insurance coverage, all by zip code. You can cross reference this by utilizing tools like ChatGPT or Claude if you don't want to dig through the data yourself, but a high percentage of active retirees with above average household income points to things that could be potentially good for shockwave or laser candidates. A lot of young professionals points to maybe custom orthotics or more sports medicine opportunities. Most marketing companies never look at who actually lives in your zip code. They want to give you a templated website and some diagnosis and treatment pages, but they're not really drilling down into the specifics of your local zip code and your local demographic area. 

A lot of them will run the same playbook for a practice in downtown Miami that they'd run for one in rural Ohio. And now, like I said, with tools like ChatGPT and Claude, you can ask what are the demographics and higher income households within 10 to 15 minutes of my practice? And you'll get usable data that you can use in your marketing. The second source is your own EMR. You can run reports by diagnosis, plantar fasciitis and Achilles cases are shockwave candidates, fungal nails are laser candidates, chronic tendon cases are regenerative candidates. So these people are already your patients. It's a matter of just kind of digging into your EMR and using it as a tool to see where are the kind of ideal patients you want to have come back into the practice, where are they located at and how can you reach them? 

And there's different types of software tools and email outreach you can do. They don't know that you exist as an option for them potentially. So if you can flag them in your EMR, get out these, there's sometimes software or sometimes just some manual reporting as far as getting these patients back in the door. At this point, you can stop guessing about what to promote, understand what you like to do in your practice and try to be seen by more new patients, but also the patients that are already in your EMR. 

Jennifer Spector, DPM: So the community-based thought process is so interesting to me because I really haven't heard anybody talk about that. You hear folks talk about who is your ideal patient and attracting that into your practice, but at the same time, you have to consider the community and the population around you that you're working with. So figuring out that match and figuring out that population base I think is such a key factor here. 

Jim McDannald, DPM: No, absolutely. It's going to help you make better decisions, right? If the place where you're getting your sports medicine patients is maybe a zip code 10 to 15 miles away from you, maybe that's a sign where you should spend a little bit more on your marketing in those areas, whether it be Google ads or Instagram ads or just making sure that you're maybe sponsoring a local 5K in that area so that they know you exist and you become that kind of expert of choice for them if they do tend to have injuries. But there is a lot of information that's publicly available. I think that's one of the interesting things about some of this demographic information, especially in the US, we're lucky to have the census data to pull from. And sometimes when you're looking at demographics, it's not about excluding people from your care, but if you can really hone in on those types of patients that are going to benefit the most from your care, it's a win-win for you as a clinic and for the patients themselves. 

Jennifer Spector, DPM: It sure is. And so for folks that maybe get a little bit intimidated by data and reports, what is one simple data point or evaluation that every podiatrist should review this month to help them uncover some of those hidden revenue opportunities? 

Jim McDannald, DPM: Yeah, I would first pull the count of patients that you haven't seen in 12 months or more. That's usually pretty easy on some of those things. So most clinic owners have never really run that report and are generally surprised by the number, which is usually kind of in the hundreds. So then do the napkin math. So the number of either overdue patients or the patients you haven't seen in the last year times a conservative, maybe like 15% rebook rate, times your average visit value, that single number reframes the entire growth conversation in a way, because it's revenue you've already earned the trust, these patients already trust you. You just haven't asked those patients either to come back yet or to let them know you exist so that someone in their network and their family, a neighbor of theirs can come back and see you. So if you want to run a second one, I would say run an EMR report on a single high value diagnosis. 

Maybe it's your plantar fasciitis patients or it's fungal nails. Look at how many of those patients you never heard about your kind of cash pay options. Those two gaps are something you can definitely look at into this month and then make some good decisions moving forward about how to fill those gaps up. 

Jennifer Spector, DPM: Well, thank you so much, Dr. McDannald, for sharing your points of view on this. I think it definitely gives us all some food for thought in examining sources of revenue that might be hiding beneath the surface. We're going to have you back for a couple more episodes coming up, so we're all really looking forward to that. And in the meantime, thank you to our audience as well. Be sure to follow this and other episodes of Podiatry Today Podcasts on your favorite podcast platforms.