Jay Lieberman, DPM, FACFAS,.

My father and his brothers worked as slave laborers during World War II. My father-in-law survived Buchenwald concentration camp.  All of them learned some very important life lessons during their horrific experiences.  My father would say, "invest in your own two hands."  My father-in-law would say, "invest in yourself and your education."  “Save a few nickels in case of emergency,” has always been their credo.  As we all know, people are now questioning this conventional wisdom.  They are wondering if their savings are safe and if traditional investments are going to help anyone reach their goals.  Investing in your home has always been a no brainer.  Now, however, for many people in our country, this has turned out to be a failed strategy.  Putting money away in a pension plan was considered a fail-safe for those hoping to retire comfortably sometime in their life. 

Time to Go EMR?

We have to be in tune with the best ways to increase our own productivity.  For example, in years to come, everyone will be expected to use an EMR (electronic medical records system).  They will be required, so we had better start preparing ourselves.  Ask yourself if you are truly ready for an EMR.  The other question to ask is whether the technology is ready for you.  This represents a big investment at a time when medicine is in limbo.  SO DO YOUR RESEARCH.  There will be many requirements for interoperability and HIPPA compliance.  Look at what the government has in mind. 

Digital x-ray systems are also a large investment and may not seem to be worthwhile on first look, but once in place will probably save a lot of time and labor costs. 

Make Your Office Space All It Can Be

Not every investment has to be a large investment.  Podiatrists are without a doubt the specialist of the foot and ankle.  Our practices have to look as such.  Look around your office.  Is your carpet clean and hygienic?  Are the floors clean and free of stains?  Are there any tears in your treatment chairs?  Are you using a pressure cooker in lieu of an autoclave.  Are instruments free of rust?  Lab coats clean?  Bathrooms tidy and smelling good, well stocked with bathroom supplies?  All of the above are small investments, but can reap real financial returns in terms of patient’s respect for you and your practice.

Improve Communications

A wireless intercom is also a low cost item, which will make your staff much more efficient.  No more getting up to look for the doctor or the doctor getting up to find a nurse. No more need to shout.

Ultrasound, For You?

Many podiatrists believe that the benefits of a diagnostic ultrasound machine far outweigh the costs.  The newest machines are sophisticated and extremely helpful from a diagnostic standpoint.  I can see the benefits in a multitude of situations.  For example, there are the times when I would like to know a little more about the integrity of the posterior tibial tendon.  It would be helpful in the differential of a presenting problem if I could easily distinguish between a fascial tear and chronic fasciitis.  It would be nice to distinguish pre-subluxation syndrome, plantar plate tear, or neuroma in the second web space.  Knowing if something is a cyst or a solid tumor would have real value.  All of these queries could be answered with an ultrasound device.  You have to examine your own practice to determine the cost benefit relationship for you. 

Lase that Nail?

Will the new laser devices that address nail fungus help your bottom line by increasing the number of patients that request care not covered by insurance?  Or will it consume too much time and manpower in your practice?  On the other hand, you have to wonder if having a laser will generate enough positive buzz about you being an early adopter of new technologies that the result will be an increase in your practice volume. 

A Better Vascular Exam?

PAD is certainly a very hot topic in the geriatric population and it is a good idea to screen appropriately for occlusions.  But how many people need a comprehensive Doppler evaluation?  Look at the Agency for Healthcare Research and Quality Guidelines.

What's the ROI?

If you are unimpressed with 2% interest, try any of these investments and surely, you will see benefits that go way beyond 2%.  However, how will you really be able to tell if any of these investments will work for you?  How effectively is your capital being used to generate profit?  A good return on investment(ROI) means that investment gains are positive in relation to investment costs.  

Return on Investment  

By far, I feel the best investment in my life and the lives of my children has been education.  At the age of 50, my wife went back to school to get her MBA from the University of Florida.  I am pushing both my kids to go to graduate school.  For me, my surgical boards were the last test I will ever take, but I love being a life long learner.  I attend one major conference a year.  Last year, it was a limb salvage conference and this year it will be ankle arthroscopy.  A practice management seminar or two wouldn’t hurt either.  I spoke with Alan Sherman the other day about the early days of PRESENT.  In those days, we called our efforts an experiment in online medical education.  Would physicians embrace it?  If you are reading this, you probably know that they did embrace it and came to appreciate the benefits of online education.  Cherish  PRESENT Courseware while you are a resident.  It is probably the best body of knowledge you will come across.  Online education will have positive benefits without adding too much to your business expenses in general.  As far as the interest rate you are getting for watching it, there is just no telling.

What do you think?

We at PRESENT love hearing from you, and look forward to learning from you.  I encourage you to post your interesting cases in the eTalk section of PRESENT podiatry to promote our collective knowledge.  We look forward to hearing from you!

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