Get Comfortable Being “Cringe”: AI Videos, Direct Primary Care, and Talking Cash Prices in Podiatry

Michele McGowan discusses why “cringe” often signals an uncomfortable but necessary skill, linking her experience using AI avatars and posting high-volume content across platforms with the need for physicians to talk openly about pricing and cash-pay options. She shares why she chose a direct primary care doctor despite paying $2,900/month for family insurance, valuing an hour-long visit, access, and participatory decision-making. After her brother questioned her AI videos, she realized visibility creates opportunities, including LinkedIn outreach from companies and potential podcast sponsors. McGowan argues patients pay for time, expertise, and choices, and that presenting appropriate options early is preparation, not sales. She describes seeing fewer patients while making more income by discussing value-based treatments ethically and consistently, emphasizing education, transparency, and patient choice.

00:00 Getting Comfortable With Cringe

00:33 Less Volume More Income

02:10 Why Pay Direct Primary Care

03:42 Time Access And Value

05:23 AI Avatars And Posting More

07:12 Cross Posting Past The Fear

08:37 Visibility Creates Opportunities

12:34 Purpose Behind The Content

13:50 Talking Money Without Selling

14:28 Present Options Early

17:33 Real Practice Revenue Example

20:35 Cringe Is Where Growth Happens

21:22 Ethics And Final Challenge

22:26 Closing And Share This

The Trick Nobody Tells You About Practice Value: Better Outcomes = Higher Profit (PRP, Shockwave, Laser)

Michele McGowan argues that in regenerative and energy-based medicine (PRP, allograft, shockwave, Class 4 laser), improving patient outcomes and increasing practice value are not competing goals but the same compounding track: proficiency leads to better results, reputation, and demand. She contrasts this with insurance-driven, high-volume models where revenue depends on speed and routine services like nail care don’t compound into differentiation or meaningful practice value. She advises choosing additions based on what you’re willing to get genuinely good at, since that benefits both patients and the bottom line. She also discusses building profitability to avoid selling to private equity, including streamlining operations by firing a billing company, reducing software costs by switching from AdvancedMD to Jane App with Claim.MD, and gradually leaving insurance contracts that create authorization and denial issues. 00:00 Practice Value Myth 01:03 Why Volume Warps Care 01:35 Proficiency Builds Value 02:42 Compounding Demand Loop 04:10 Routine Care Trap 04:52 One Question Filter 06:26 Selling And Profitability 07:20 Firing The Billing Company 09:09 Streamlining Tech Stack 10:18 Avoiding Private Equity Exit 12:04 Modernize Your Practice 12:56 Closing And Contact

The Dark Side of Implementation: Change Your Podiatry Practice Without Permission Michele McGowan explains why getting excited about new ideas, buying technology, or attending conferences is easy, but implementing change in a podiatry practice is hard because of fear, money conversations, and worry about peer judgment. She emphasizes doing homework on evidence and indications, communicating ethically without promising miracles, and getting comfortable discussing cash-pay options as informed decision-making. McGowan argues that true implementation requires elimination—removing low-value or undesired services and creating schedule space—because “implementation without elimination is just accumulation.” She shares how adding services like Shockwave, laser, PRP, and a MediPedi spa worked through trial and error, packaging, and staff workflows, ultimately transforming the practice one uncomfortable decision at a time. 00:00 Dark Side of Implementation 00:52 Fear After Buying In 01:59 Peer Judgment and Permission 02:49 Evidence Without Hype 04:09 Talking Money Confidently 05:53 Fail Upward to Improve 07:02 Eliminate to Implement 09:16 What Actually Pays 11:47 MediPedi Spa Case Study 15:20 Systems and Staying in Lane 19:17 Profit Ethics and Patient Demand 21:50 Practice Transformation Over Time 24:47 One Thing Add One Remove 26:23 Final Encouragement and Wrap

Stop Apologizing for Your Fees: How to Confidently Talk Cash-Pay Pricing in Podiatry Michele McGowan explains why many private practice podiatrists struggle to say the price for cash-pay and regenerative services, urging doctors to stop apologizing and confidently communicate value. She argues patients already spend money on outcomes (LASIK, Invisalign, Botox, concierge medicine) and want clear options, not doctors deciding their financial priorities. Using examples like plantar fasciitis, ingrown toenails, and an insertional Achilles tendinitis patient, she emphasizes presenting conservative, regenerative (laser, shockwave/Softwave, PRP), and surgical choices upfront, focusing on outcomes rather than the technology. McGowan shares her evolution with transparent website pricing, staff scripts, and packages (including $300/session or $1577 for six shockwave sessions), and challenges listeners to notice whether hesitation is about protecting patients or avoiding hearing “no.” 00:00 Stop Apologizing For Fees 01:13 Why Money Feels Awkward 01:54 Patients Already Pay Cash 04:49 Offer Options First Visit 08:42 Achilles Case And Pricing 12:43 Quit Counting Their Money 13:39 Sell Outcomes Not Devices 17:21 Confidence And Value Talk 19:29 Transparent Website Pricing 23:36 Scripts Staff And Mindset 28:38 Practice Growth And Ethics 33:34 Final Challenge And Wrap

Implement or Die: How I Pivoted My Podiatry Practice (Regenerative Care + MediPedi Spa) Michele McGowan argues independent podiatrists must keep implementing new services instead of staying comfortable in an insurance-dependent model where reimbursement declines and payment isn’t guaranteed. She shares how she pivoted after 20 years of surgery into regenerative, non-surgical care (Softwave TRT, class IV laser, custom orthotics, allografts), then launched an in-practice medical spa service line in two weeks. She describes building a luxury, waterless MediPedi room for about $1,200–$1,500, hiring a licensed nail tech paid hourly plus commission, creating tiered pedicure offerings, and integrating KeryFlex and laser nail fungus services with new bundles like a $1,577 six-visit package. McGowan explains pricing challenges, consent/compliance, training staff with scripts, promoting via social content and ads, and why podiatrists should capture aesthetic foot-care demand with strong processes and experience. 00:00 Introduction: Implement or Die 00:39 About Podiatry Unfiltered 02:54 From Surgery to Regenerative Medicine 05:11 Building the Spa: The Idea 15:51 Creating the Laser + Spa Bundle 18:38 Compliance & Legal Considerations 24:08 Where to Start: Actionable Framework

The Medi-Pedi Comeback: Foot Wellness, Athlete Recovery & the Private Practice Advantage Michele McGowan records from an RV trip to Myrtle Beach and Virginia Beach, reflecting on how private practice independence lets her build a schedule around family and avoid asking permission. She shares a decade-long lesson from opening a separate “Natural Nail Spa” in 2012, running it alongside her podiatry practice, then shutting it down in 2017 due to poor economics, time demands, and family health issues. In 2026 she revisits the idea by integrating a renovated treatment room into her existing practice—no separate company or insurance—launching a higher-value, waterless Medi-Pedi and laser-based neuropathy and fungal nail options. Early results included $150 medi-pedis, $300 laser pedicures, and conversions to an $877 package, showing that the foot relationship, medical expertise, pricing, and positioning—not a nail salon model—drive success, especially for unused rooms and athlete recovery services. 00:00 RV Trip Intro 00:32 Why Independence Matters 02:16 A Business Mistake Story 03:06 Launching Natural Nail Spa 04:04 Bad Economics And Burnout 04:57 Revisiting The Idea 05:53 Simpler Integration Strategy 06:54 Building The Medi Pedi Room 07:09 Week One Results 08:33 Laser Pedicure Upsell 10:39 Fungal Nail Conversion 12:01 The Real Business Lesson 12:37 Unused Space Opportunity 13:49 Athlete Recovery Pedicure 14:46 Closing Takeaways

Dr. Michele McGowan explains why small and independent podiatry practices should add in-house 3D printed custom orthotics as a profitable, patient-benefiting service with faster turnaround than traditional lab-made devices. She contrasts the old model—casting/scanning, paying labs $80–$150+ per pair, and waiting 4+ weeks—with her OLT-based workflow: a 2-minute iPhone scan, cloud prescription, quick file return, simple software setup, and printing (about 3–6 hours) with next-day delivery. She discusses pricing ($550 per pair; $275 for a second reprint), bundling orthotics with therapies like Softwave/laser (e.g., a “Heel Pain Blaster” package), and how this boosts outcomes and revenue without adding patient volume. She also advises students/residents to learn the workflow cheaply and use it to stand out, and she offers a paid course and limited coaching via [email protected]. 00:00 Why Orthotics Matter 00:43 From Skeptic to Believer 01:55 Student Side Hustle Idea 04:28 Traditional Lab Model Costs 05:54 3D Printing Workflow 08:29 Turnaround and Profit Math 12:23 Bundling With Therapies 13:36 Advice for Students Residents 15:51 Course and Coaching Offer 17:55 Protect Independent Practice #custom orthotics #podiatry 3D printing orthotics #foot orthotics #podiatrist t #custom foot orthotics #in-house orthotics #3D printed custom orthotics #private practice podiatry #podiatry business #independent podiatry practice #podiatry practice tips #podiatry income

I explains how I redesigned office staffing by hiring motivated gap year students (future med, PA, and NP applicants) for front office, back office, and billing roles to address rising costs while staying profitable. I share the uncomfortable reality of balancing being a good employer with financial sustainability, and compares her model to McDonald’s: young workers guided by one experienced manager. I detail my hiring funnel—an Indeed post written specifically for gap year applicants at $18/hour, Zoom pre-screens, then in-person interviews—and emphasizes the trade: students gain rare clinical and operational experience and strong letters of recommendation, while the practice gains fast-learning, tech-native staff. The approach works because of strong SOPs and training videos, accepts predictable turnover, and leverages part-time flexibility to match real clinic schedules and improve the P&L.

Podiatrist Michele McGowan reflects on how private practices across specialties are facing the same pressures—lower reimbursement, higher overhead, rising payroll and supply costs, growing administrative burden, private equity acquisitions, and hospital systems absorbing independent medicine—despite independent practices being profitable and valuable. She explains how she and her husband transformed their practice over the last four years by stepping away from low-paying insurance models, dropping certain insurances, implementing transparent cash pricing, and adding services not dependent on insurance approval, resulting in more time with patients, better outcomes, and less chaos. McGowan argues high-volume medicine harms care and shares that patients want present, unburned-out doctors who build long-term relationships. She introduces the Independent Doctors Network as a cross-specialty community to share strategies on cash services, AI/technology, sustainable operations, and practice-building resources via a webpage and Facebook group.

Why I Quit Podiatric Surgery After 20 Years (And My Practice Got Better)

Michele McGowan of Podiatry Unfiltered reflects on Muhammad Ali’s late-career fights to introduce the uncomfortable idea that quitting can be a win, then explains why she stopped doing surgery after 20 years in private practice. Trained in a strong surgical residency at West Penn Hospital, she built her own Florida practice and became board certified, with surgery once central to her identity. Over time, the realities of OR delays, lost time, and two decades of hospital call—weekend emergencies and missed family time—left her unfulfilled, and she wishes she’d changed sooner. Four years ago she stopped surgery entirely, found malpractice costs dropped, and discovered her practice and patient care improved. She now focuses on regenerative and conservative treatments (PRP, SoftWave, laser, orthotics) while referring surgical cases, emphasizing that doctors are allowed to change what no longer serves them.

00:00 Ali and Quitting

01:03 Why I Left Surgery

03:17 Training and Identity

04:42 Private Practice OR Reality

06:09 Call Burnout Turning Point

07:23 Stopping Cold Turkey

08:00 New Conservative Focus

09:23 Practice Got Better

10:41 Permission to Change

11:48 Closing Thoughts