In this special interview, Dr. Hartley Miltchin shares his wisdom in building a successful concierge model podiatry practice specializing in minimally invasive foot surgery in Toronto, Canada.
Do you want to listen to what a successful concierge podiatry practice would be like?
Dr. Miltchin practices in Toronto Canada for almost 40 years, and he will share his wisdom, pearl, and tips in building a highly profitable and rewarding concierge model practice in this special interview.
If you want to contact him, his email address is doctortoe@aol.com
Enjoy this awesome interview episode and get into action!!
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Hello, this is Dr. TJ Ahn. As always, I'm bringing super guests into my interview and share their experience and knowledge Pearl's life wisdom of how they, how they create a successful practice. And today I brought special guest Dr. Harley Miltchin. He practices in Toronto, Canada.
He is, well-known, MIS minimally invasive for surgery expert, and you know, he's very active in social media. And also he's been helping so many, so many patients who have, who have Bunion and hammertoe et cetera, with minimally invasive surgery techniques. So without further ado, this is sort of informal interview. So we're going to almost like kind of chat over the coffee type of interview.
So Dr is here please. You know, if you can tell us a little bit about yourself, how you got here. Okay. I was born and raised in Toronto, Canada. I actually call it toe Ronto Canada. It's more apropos. And I spent seven years in Chicago. I went to the Illinois college of podiatric medicine when it was called that not sure.
And I spent three years with one of the pioneers of MIS and learned a great deal. I learned more in the first four or five months, spending time with him than I did four years in podiatry school. Now, the challenge was I knew I was going to return home to Canada and the province that I practice in had some real backward challenges that I had to face.
And they were pro basically politically motivated and that's for a whole other discussion. But for example, being a podiatrist, which there's very few podiatrists in Canada and in my city of about three and a half million, there's about 12 podiatrists, about four of them do any surgical procedures. So we as podiatrists, can't call ourselves doctors. We can't use that prefab.
We can't order lab tasks. We can't prescribe narcotics or opioids. I mean, I can cut people's bones. I can do osteotomies, but I can't prescribe for example, Tylenol number three. So we're very limited in how we practice we're we work under the socialized medicine model. So what that means is we have a card it's called the Ontario health insurance plan or for short old hip.
So each individual has a card. So if we have to go to a family doctor, let's say, or a specialist or the hospital, we show the card it's paid by the government. We have no copays. The doctrines, the doctor bulls, et cetera, which is different than the United States. Of course. So really when I came back to Canada,
not only did the population not know what a podiatrist is or what they do, and if they were going to have their Bunyan corrected, they were going to an orthopedic surgeon in the hospital because they didn't have to pay. So I needed to change the mindset of these people and say to them, well, you can have it done the traditional way, or I have this unique way where you can go back to work.
I'm not going to have to prescribe narcotics for you. You're not going to have the same pain. I'm not going to use pins, wires, screws, staples. You won't be in cast and crutches for four, four months and sit on your couch and not be able to work. And I gave them all the benefits. So what I decided to do was I wanted to educate the family doctors who not only didn't know about minimally invasive surgery,
because realize podiatrists didn't have hospital privileges. So we had to do everything in the office. Are we talking about, this is like back in the nineties, It still exists. So, so you were talking when you, when you came up with this challenge is because this is great topic. A lot of podiatrists currently all over the world, they're facing these challenges that you have had,
you know, many years ago in United States, the same thing. We're kind of afraid or not afraid. It, we can see this is coming in United States, you know, socialized medicine or similar to socialized and almost socialized medicine it's coming. So this is going to be great topic for doctors, especially who are practicing here. So you're talking, you start,
you face these challenges all the way, years back, and then you'd kind of develop this mindset shift and this, this Kind of a Model it's very important to change the mind set of your patients. I mean, I still, to this day, I'll have patients who come to me and if I say I can correct your Bunyan for a hundred dollars,
they're not interested. They want it paid by the socialized medicine. So they'll go to the hospital and have there been any incorrect that I last, I changed their mindset, show them the benefits of MIS and then we proceed. But anyone in the world who's facing barriers. You can always overcome barriers. If you think about it and you do it properly.
So for example, family physicians, where I practice have no clue what MIS is. They only know the hospital, what I call the traditional approach under the socialized medicine model. So what I do, I can't order lab tests, podiatrists aren't allowed to. So what I do is I say to the patient, listen, your family doctor knows you better than I do.
Probably doesn't know the benefits of MIS. So I'm going to open the lines of communication. I'm going to prepare a letter and outline the procedures I want to do on your foot or feet. What we use, what we don't use. So we've repair a standardized letter with the name of the procedure. And one of the things we say is we use 1% plain Xylocaine because if you add epinephrin,
they freak out because they think if you inject epinephrin the person's going to have a major problem. I say, there's no internal fixation. There's no sutures patient can re go back to their life within 48 hours, et cetera, et cetera. I tell the patient, you take this letter to your family doctor. And what I want return is your family doctor,
to agree with the benefits and understand the benefits of MIS and say that you're okay, you're this patient is fit for the procedure. Yes, I get some doctors will send me EKG, blood studies, your analysis, etc. That's all fine and good. But basically all I want to hear is that the patient's fit for the procedure. So that allows me to educate the family doctor who knows nothing about fi VMIs Model.
So I love that idea because I do send my patients, you know, even if you know America here in the United States, we don't, it's not required to have pre-op clearance by family doctor. I still send them anyway. And you know, I do send pre-op clearance medical clearance with few lab tests, et cetera. But most of the family physicians here either,
they don't know what MIS is a difference. So I think I like that idea. I kind of learned that at least educate this family doctor. So we can somehow also in addition, create some referral networks. So they, they get educated about MIS. So let's say Harley, you send that type of standardized letter. I'm talking about more real realistic set up like 10 people.
If you send them to family doctor, how many actually bring them and agree Almost all of them. If they take that letter, I know they're serious about having the procedure because once they find out my fee, if they can't afford it, or they're not interested, they're not taking the letter. But I would say the majority of people nine out of 10 people follow up with that.
And once we received the letter or they've received the letter of clearance, we do, what's called a preoperative exam where I bring them in. I asked them if you have questions, I do a Doppler exam, which we're not allowed to do a podiatrist can do Doppler examinations. I repeat, I go over the procedure again. I answered their questions. I take preoperative photographs.
I go over the risk risks again, and the sign that consent, we give them a preoperative instruction sheet, and then we're good to go. So there is a follow up to the family physician once the procedure has been completed, but that's for another webinar, but it's very interesting. I don't think anyone else on the planet does what I do and the family doctors,
they just love it. So since I started doing it, I get a ton more of referrals from family doctors. Cool. So let's kind of change our gear a little bit, talking about a few minutes with MIS. I know you are big proponent and believer in MIS of course, because you've been performing MIS and you see great results. So tell me a little bit that in a marketing perspective,
I love how you, you know, send messages to social media, that real MIS you call, you know, your, your techniques real MIS. So can you like speak a little bit about that reason behind it or idea behind? Okay. That's quite simple. I've been doing MIS procedures exclusively for the past 39 years and I'm actually getting good at it.
So anyways, yes, I promote MIS the best I can, but there's a lot of people out there who are calling their procedures, minimally invasive, for example, or hypoplasty. I don't know if you've ever watched the lap of PLAs the video on YouTube or joined the webinar because I have, that's the furthest thing for minimally invasive procedures. There's the Cinderella procedure.
There's the key whole procedure. There's now the mini bunny, which they call minimally invasive. I don't see it that way. I call it the real minimally invasive, because I tell patients, I said, I tell them I don't make incisions because it's a ManTech. I make posts. I've never used the stick. So in my head incisions require you their sutures or staples to be closed.
I don't use sutures. So I don't consider it an incision. And in fact, when I go into a Bunion consult, I show them this picture. I don't know if you can see it. Yeah. Oh, okay. No, I showed them this picture or I show them this picture. And then I say, I see you want it done the traditional way.
That's what you're going to have in your feet. You want it done the minimally invasive way. You, you won't have a scar. You won't have stitches. You'll be back to work in 48 hours. As far as pain Advil, Aleve will take care of it. You can go to the gym, you go walk, you can do elliptical, stationary,
bike, upper body exercises, but you're not going to be sitting on your couch for four to six months recuperating. It doesn't work that way. So if they, if I can get a patient in front of me and explain the difference between the traditional approach and the MIS approach, of course, they're going to choose the MIS approach. But the pandemic be shut down for four months.
Gave me a lot of time to think about how was practicing 30, 40, 50 people in a day. And do we want warts and ingrown toenails? And the Romas stopped those. And it was just crowding my day. And then if a person needed a bunion surgery, we do it after we see patients. Well, as you know, some patients frustrate you,
they push you to the limits. And then for MIS, even to this day, I get very psyched up and I concentrate a lot. And I just didn't feel right doing surgical procedures after I saw all those patients. So I've streamlined my PA my practice. So I'm referring out all those people that have been groans wards, the Romas, stubbed, toes,
whatever I do bunions. in fact, I labeled myself the Bunion King and that's, and the name of my practice is accent on feet. Branding is very important. Finding a niche is very important. If you go to podiatrists sites and look under services, you'll see 30 services they provide. Well, so does everybody else, but if you're good at something,
just provide that service. You'll be busy enough. Find your niche, branded use social media. I didn't grow up with social media. So this is all new to me, but I hired an agency that takes care of everything. As long as you provide content and social media works. Awesome. Yeah. So that's basically totally aligned with what I'm helping with.
Other colleagues that, you know, I tell them basically three steps, three pillars is what, where number one, you gotta find your niche. Number two, brand yourself with proper marketing and number three, learn how to communicate with patients about cash pay. And these three pillars has to be based in the middle circle is a mindset. So proper mindset.
That's the beginning of everything, which people don't like to hear about it. Oh, Oh, usually people say, there we go again. Here's a, here's a mindset again. But once they get into, Into this transformation and I see they, everybody, every single doctor that I helped say TJ you're right. The mindset was the most critical thing.
But then yeah. Niche with MIS for me, exactly how you said it. I notice the same thing. Every podiatry, most podiatry website go there and I call it all our car T service a to Z everything. And you're not differentiating yourself and you're diluting yourself from what you love the most. So if you find, even if it's, non-surgical,
I'd say if you find few niche that you love and brings you enough profit margin, though, we have to think about finance side. So if your niche is the cheapest service to please don't, you know, find something unique, valuable to patient and competitive edge to it, choose that as a niche. And then you really go for that, like kind of all in,
but I see you, you are the prime example, prime test, okay. Prime example of that action, taking action, choose your niche. And then you call Bonnie and King or real MIS that, you know, definitely caught my attention. And of course it would be knowing each other for years. But I think Harley, you made the right move from 30 to 40 patients seeing all kinds of different problems to now focusing on only few MIS procedures.
That's what I've been now getting known in Chicago. So, Well, if, if you're passionate about MIS you have good outcomes, listen, I don't need anything more than the head of the metatarsal calls. This the li I'm fine, because that's what we get calls about. Listen, I charge $8,500 for a Bunyan, which takes me eight to 20 minutes to do so it's not unheard of on a Friday.
We can turn the room over. And then our it's not unheard of for me on a Friday to do six of them, but I'm not seeing other patients, but I'm offering something other people can't, they they're willing to pay for the MIS because of the benefits. And I convince them there are benefits. In fact, I have women that come in with stacks,
a hundred dollar bills. They don't want their husband to know how much they're paying for their bunny. Correct. But I, listen, I don't have to deal with coding. I don't have to deal with insurance companies. The doctor bulls, all that crap you guys got to deal with when you can do the, by the end, I get paid.
That's it. So, yeah, I have no account receivable, but that's my, I only take one insurance plan in United States. Now I do not think it's concierge service, Concierge service for you. Yeah. So again, in America, though, in the United States, because of the PPLs and some insurance that I kind of accepted the idea and then transfer a little bit so that I call it hybrid concierge.
So, but same concept in the background, it's really direct model patient to doctor, doctor, to patient. There is no insurance company involved in between and you offer them the best service package and experience to patients and these patients. I know, you know, and I know they pay because they see the value. There is a value. And if I can leave you with anything because you and I have had many discussions over the years,
and you started off as a traditional surgeon and developed your MIS skills. But you understand that you understand MIS, you understand how to develop a practice properly. You've got a going and anybody out there who's thinking about MIS and you should be because pretty soon the insurance companies, aren't going to be paying the $4,700 for a lot, but the lap, a plus the play a and they're going to give you a 15% bonus.
If you do the procedure within your office, listen to Dr. Ahn sign up to his courses. They're great. They're wonderful. I've sat in on some, the cadaver labs are incredible. Dr.Ahn has a lot to offer you, especially if you're starting out. Even myself, I pick up tips from Dr. Ahn all the time, and it would really be who view to listen as much as possible the doctor on because he gets it.
Thank you, Hartley. So yeah, I mean, you know, I'm, I'm all about action oriented, you know, I'm, you know, originally from South Korea all by myself, I was 19 years old and I had to learn survival skills in the United States. And, you know, I didn't speak good English at the time. So I guess just the,
my life around that 19 years old and up by myself, that kind of gave me a lot of that real action, survival skills. And I can, I guess I develop that sense that 2014, when Obama care start pushing and the old reimbursements started going down and HMO's and H C H a C or start popping up, I see there's a no future for traditional style of a medical practice.
And I saw the MIS and that was my epiphany. And ever since then, 2014, I started meeting all these great mentors and friends like Dr. Holly, here, there are different ways to thrive in your practice, not just survive. I want to emphasize this is golden opportunity. Join the early wagon still MIS now is becoming mainstream for many reasons,
political, economical, financial reasons. If you're not accepting this reality and still be stubborn about traditional approach to survive in the, in the, your podiatry practice is going to be difficult. But again, I have proven to my own practice and also so many other doctors I've helped through my programs. That's the only reason why I developed, I was just tired,
sick, and tired of seeing colleagues going under or going down, or all these surgery centers started start closing down. You know, there are ways for me to help you. So, you know, for example, I college, I said, I offer private group cadaver led through my mentorship program and also annual big cadaver lab, which is coming actually in July this year,
2021 in an orthopedic learning center, Hey, listen. Now orthopedic orthopedic society in the United States. Now they're going into real MIS because they see the benefit to patient and also practice. Yeah, That's true. The, the cadaver lab, which I think is scheduled July 16th in Rosemont, Illinois, you're going to learn more in that weekend than any other conference.
I sit on the board of the Midwest podiatry conference, and I can tell you it's so academic, but the people who, the real passionate people in an MIS, they love to share their information and their skills. We're, we're a group of giving people and you certainly will learn things. Yes, there's a learning curve. Like anything else, we don't expect you to take the,
the cadaver seminar and, go to your office and do a bunion. It takes some practice and it takes some skill. It looks easier than it is, but if you try it, you like it. You're getting good patient incomes. You've found your niche. And that's so, so important. You've got guys out there who are trademarking, certain techniques that they use on Bunions.
Those people are egomaniacs, as far as I'm concerned, just do what makes patients happy and MIS has incredible benefits over what I called the traditional approach. And yes, you're right. TJ a lot of the orthopedic doctors are holding seminars in MIS so they can see the future of where this is heading, because hospitals aren't going to pay those exorbitant amounts for internal fixation.
They're just not, and they want to keep people out of the hospitals. Sure. So, great interview today. I'm gonna put Dr. Miltchin contact info in the bottom of this interview. So if you want to contact him, is that okay, doc, to share your, And I also video a lot of procedures that I do, and I have a YouTube channel too.
If anybody's interest that anybody wants to contact me, I'd love to speak to you. Awesome. And as always below the video, if you want to take your practice to the next level with MIS look at the below, look at the information below, and also let's say, Hey, I don't want to MIS right now, but I want to learn more about concierge practice,
more in a systemic approach through niche marketing and sales techniques and persuasion techniques, communication skills. So again, contact me. I have a mentorship programs to help you. And this upcoming July 16, 17, that cadaver lab, very limited seats already. Half of tickets are sold. As of this, this interview, I just opened up Hartley. I just opened that registration two days ago,
and then immediately opened the registration page. Half of them sold already. So only 20 some 24 or 25 seats available. But anyway, I know that will be sold out. So, you know, jump, make sure jump in, make sure you get still early movers advantage. When it in, in terms of MIS side, you know, not still not many doctors can do.
So learn these wonderful surgical techniques as, as your alternative treatment. And I know 10 out of 10 that I've, I've encountered. They say all great to have alternative techniques, but I see they do it exclusively after a year or two. And they, because they see so much benefit for over MIS. But anyway, thank you Harley for joining. We shouldn't do this again and different topics,
and I'd love to invite you to chat more. I've got a lot of things I'd love to share, especially practice management that I'm positive, no one else does in their own practice. And I'm, you know, I'm always willing to share with everybody listened to Dr. Ahn He knows he understands what he's talking about with MIS join the MIS revolution.
It's the way of the future. And please everyone stay safe. Thank you so much, Charlie. And everybody, thank you for listening or watching. This will be available through podcasts then also YouTube and other social media. So again, thank you, Hartley, and have a great day. Thank you for having me.