Chair, road or bench: the hour has three prices
Every scheduling choice in a foot clinic is a finance choice, because one chiropodist hour can treat patients in the clinic, cover a nursing-home round, or assess and cast for orthotics that bill weeks later. Each use has a different margin once it is loaded honestly: the road hour carries drive time, the vehicle and the chair time it displaces, while the bench hour looks slow until the dispensing revenue it seeds is counted back into it.
We build that comparison into a monthly view, margin per hour by setting, and it changes behaviour fast. Rounds get clustered into tighter routes, assessment slots stop being bumped for routine care, and the case for delegation becomes visible: an employed foot-care nurse covering routine care and rounds at a wage frees chiropodist hours for the work only a chiropodist can do, and the hire clears the moment those freed hours refill.
The bench is a working-capital machine
An orthotics program earns well and ties up cash while doing it. Each pair moves through four stages, and every stage has a cash event that can stall:
| Stage | Cash event | What stalls it |
|---|---|---|
| Assessment and casting | Deposit in, lab order committed | Patients waiting on insurer predetermination |
| Fabrication | Lab invoice falls due | Remakes the clinic absorbs |
| Dispensing | Balance collected | Finished pairs sitting uncollected on the shelf |
| Claim | Patient reimbursed or direct bill settled | Declines that turn into refund conversations |
The levers are unglamorous and effective: a deposit sized to cover the lab's invoice so fabrication never runs on the clinic's cash, lab payment terms negotiated against your actual dispensing cycle, and a remake rate tracked monthly so a drifting cast process shows up in the numbers before it shows up in margins. The 3D scanner decision belongs here too, modelled as remake reduction and casting time recovered on your own volumes, not bought on a rep's promise. Pricing reviews sit on the same page, because lab costs move, and a pair priced two years ago can drift under its loaded cost without anyone noticing before year-end.
Rounds priced to clear their loaded cost
A long-term-care contract is a price, and the loaded cost it must clear includes travel time, consumables, the vehicle and the clinic revenue the trip displaces. Homes also pay on their own cycle, so a growing rounds book quietly becomes a growing receivable, and that lag belongs in the forecast rather than in a surprise. We model each contract on its own: some clear comfortably, some clear only when an employed nurse delivers them, and some are worth renegotiating with the numbers on the table. Route design matters as much as price across a region the size of the GTA, where two badly sequenced homes can consume a clinical afternoon.
A forecast with a fourth quarter shaped like orthotics
Most extended-health plans reset with the calendar year, so casting bunches in the fall as patients spend remaining coverage, and January opens quiet with December's lab bills still arriving. A rolling 13-week cash forecast built around that shape, plus the nursing-home payment lag, shows which season can pay for the new chair, the marketing push or the next hire, and which season only looks like it can. The quiet months earn their keep in the same view: January is when an equipment install or staff training costs the least chair time, provided the autumn's cash was planned to fund it.
Growth where clinicians are the constraint
Ontario has registered no new podiatrists since 1993, so retiring podiatrists' practices come to market while new capacity enters the profession only as chiropodists, and the fastest growth available is often buying a book of patients rather than advertising for one. That is a financing story: what the practice is worth on its real margins, what the bank needs to see, and whether the purchase debt services itself from the cash the book actually throws off. Our Fractional CFO engagement builds that case, and because founder Walla Assaf spent years on the lending side, the package answers a banker's questions before they are asked, with Business Financing Advisory carrying the application and Business Plans documenting it when a lender wants the full story. The cadence stays light: one morning a month on the numbers, the decisions they point to, and who owns each one.
