Stop Letting Routine Nail Care Cap Your Income (Here’s a Simpler Model)

READ TIME – 2 MINUTES

I was coaching a doc recently who’s doing about $600k as a solo provider, seeing 20–24 patients a day, mostly from 8–4. Sound familiar?

Here was the big issue: Roughly 50% of her day was routine care—nails, corns, calluses—and she was trying to grow to $1M without changing how those visits were structured or billed.

You can’t hit $1M doing low-value work in prime time.

1. Stop Scattering Routine Care All Over Your Schedule

What she was doing (and what I used to do):

• Routine nail care sprinkled throughout the day
• Mixed in with plantar fasciitis, Shockwave, higher-value visits
• Always running behind when someone said “Can we start Shockwave today?”

What we do now:

• All routine care is clustered on one half-day per week (some call it “Toenail Tuesday”)
• Those visits are double-booked in shorter slots
• This opens up the rest of the week for higher-value care

Just doing this removes chaos from your schedule and creates capacity without seeing “more” patients.

2. Make Routine Care Profitable and Ethical

Here’s the elephant in the room: If you’re billing E&Ms for simple routine nail care every 2–3 months, you may be wandering into risky territory.

My approach:

• Nail trimming that isn’t covered
• “Mrs. Jones, this isn’t covered under your policy. It’s $75. I know your previous doctor may have done it differently, but I’m trying to stay on the right side of the rules.”
• Callus care that isn’t covered
• Same conversation: insurance doesn’t cover everything that’s helpful.
• Medically necessary care (diabetics, neuropathy, PVD, RA, etc.)
• Billed correctly under their policy when criteria are met.
• Once a year, around their birthday:
  • Comprehensive diabetic foot exam
  • ABIs
  • Diabetic shoes if appropriate

You’re not “nickel and diming” patients—you’re stopping giving away work for free and being honest about what insurance does and doesn’t cover.

3. The Hard Truth: Money Conversations Start Small

If it feels hard to say, “It’s $75 for nail care,” it will feel impossible to say, “It’s $1,500 for Shockwave” later.

So think of this as training: Get comfortable charging fairly for routine care now so you can confidently present higher-value services later.

Key Takeaways

• Cluster routine nail/callus care into one dedicated session (e.g., Toenail Tuesday).
• Use that day to do annual exams, ABIs, and other covered services to increase value.
• Stop relying on questionable E&Ms for routine care; bill what you actually do.
• Learn to calmly state your cash price—this is the foundation for future cash-pay services.