The Reality of Cash-Based Podiatry: Balancing Freedom and Friction

In today’s unpredictable healthcare system, many of us are asking: Is cash-based podiatry really the answer? As someone practicing podiatry outside of insurance constraints, I’ve seen both sides — the freedom to care and the friction that comes with it.

I didn’t choose this path lightly. But when the system no longer allowed me to show up for patients the way they deserved, I stopped asking for permission and started creating something better.

The Realities Behind “Infected Toenails”

I once told a patient, "You do not need to walk around with a throbbing, infected toenail, like, it was interesting." And I meant it. Podiatry isn’t just about feet — it’s about helping people walk through life with less pain and more dignity.

But here’s the reality: in a cash-based model, patients sometimes pause. Will they be seen without insurance? Can they afford it? These are valid concerns. And it’s up to us, as physicians, to meet that hesitation with education, transparency, and compassion.

Sondema Said It Best

My podcast co-host, Dr. Sondema Tarr, put it perfectly:"None of us thought, when we dreamed of becoming doctors, that we’d be practicing in this kind of climate."

And yet — here we are. A system where double-booking is the norm, insurance dictates care, and physicians burn out trying to do more with less. When patients ask, "Why am I waiting over two hours?" — the answer isn't incompetence. It's survival in a system that demands volume over value.

Dignity Isn’t Optional

For me, dignity is non-negotiable. Whether you’re a dancer with a torn toenail or a grandmother struggling to walk, I want you to feel seen — as a whole person, not a diagnosis code.

This is what direct care is about: slowing down to listen, being available when it matters, and building care plans that reflect reality — yours and mine.

Where We Go from Here

Cash-based care isn’t easy. It’s not a magic solution. But it is a chance — a chance to return to a system where humanity isn’t buried under paperwork and doctors don’t have to ask permission to do what’s right.

As we keep redefining what it means to practice medicine today, one thing is clear:We must never lose sight of the patient’s dignity — or our own.