087 - Dr John Guiliana Clinical Benefits of Lower Patient Volumes

Dr John Guiliana has had a unique career path, moving from Pharmacy to Podiatry and eventually into Healthcare Management with NEMO Health.

Right now, during COVID-19, he has been assisting podiatry business owners across North America to move through the Fear, Learning and Growth Zones, and helping them understand how they can have lower patient volumes, yet still, enjoy improved profits.  

On this episode we discuss:

  • How a D+ student found his intellectual groove 
  • Why he decided to leave Pharmacy and become a Podiatrist
  • Nemo Health - A Practice Improvement Company 


Covid-19 has affected everybody, on both a business and personal perspective, and it has been global.

Fear, Learning & Growth Zones

During this pandemic, it's essential to get out of the Fear Zone, move through the Learning Zone, and eventually get into the Growth Zone

You need to learn how to maintain profitability in your business with lower patient volumes, and some podiatrists will come out of the pandemic in a better than when they went in. 

It's about learning to do more with less. 

Why is there is a low patient volume?

Patients are also going through the three zones of fear, learning and growth. 

There is also the Paradox of Thrift - which occurs when you have people that have been economically hurt, and because of this, they become more thrifty with where and when they spend their money. 

Cash flow is the key right now for every business. Getting paid faster and being more careful where you spend your money, only then can you work on profits. 

"The actions you take right now are going to help you with the long-term profitability of your business."

Action Steps with Lower Patient Volumes 

  • Spend time reinventing your practice:
    • Go through your policy and procedure manuals.
    • Engage and collaborate with your staff and be a leader, and remove those team members that will not change.
  • Look at your clinical protocols: You need to increase your PVR - Per visit Revenue.
    • This is why lower patient volume will help increase long-term revenue because of the more thorough patient and evidence-based protocols. 
    • These will well offset lower patient volumes.
    • Focus on what you enjoy doing. Get rid of the things they don't like to do. 
  • Looking beyond the chief complaint: What other treatment or service can you ethically provide.
    • Dentists have been doing this forever. They explain things you cannot see.
    • Does your patient with an ingrown toenail have bunions or chronic knee pain? Creating Care Plans results in better patient outcomes and a higher PVR. 

Final Tip

Search for lessons learned. And the #1 lesson learned from this pandemic is the importance of liquidity. You need to have six to nine months of cash reserves for the next economic crisis. 

If you have any questions after listening to this episode, please send me an email at email/tf)(tysonfranklin.com, or you can reach out to John at email/john)(nemohealth.com 

John Also has a podcast video series called Essential Adaptations. (Live Wednesday 8 pm EST)

Facebook Page & Group

Facebook Group: Podiatry Business Owners Club - This is for podiatry business owners and budding business owners, and is the group I now add my business and marketing videos. 

Facebook Page: Podiatry Legends Podcast - This is where I post each podcast episode and information regarding podiatry events around the world.

Podiatry Business Coaching & Mentoring

If you want to own and operate a Thriving Podiatry Business, you've got to work on four specific areas of your business. 

  • Marketing - You need to have a proper, well thought out strategy
  • Systems - You need systems that will support both your marketing and your team.
  • Team - You need to develop a culture that makes your life easier, not harder
  • Diary - This is the backbone. Your diary needs to be structured in a way that maximises patient number per day and in turn, will increase your daily profits. 

Thinking you can just work on one part or maybe two out of four areas and still do well is no longer good enough, you must develop all four pieces of the business puzzle.

If you want to join one of my upcoming Group Coaching Programs or discuss one-on-one Business Coaching & Mentoring, please email me at email/tf)(tysonfranklin.com, and we can set up a Zoom Call and have a quick chat and see where I can help.  

Newsletter & Events 

Please sign up for my NEWSLETTER if you'd like to know more about upcoming EVENTS, I promise not to spam you with daily emails telling you how great I am.

My Book

It's No Secret There's Money In Podiatry. In Australia, you can order directly from my website, but if you live overseas, I would suggest Amazon or the Book Depository.

Tell Your Podiatry Friends

If you enjoy listening to Podiatry Legends, please tell all your podiatry friends, and please feel free to leave a REVIEW on iTunes, or wherever you like to listen to podcasts. 

If you enjoyed this episode you might also enjoy:

Episode 40 - Dr Michael Graham The Entrepreneurial Podiatrist

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