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"A lady just called me today. Her husband just lost his license because the state board took it away. She's in tears and doesn't know what to do."

[ILLUSTRATION OMITTED]

Robert DeBiasse often gets up at 4:00 A.M. in the morning to deal with issues like this. He is the voice behind the phone at Medical Mavin, Ltd. in Downington, PA.

"I often give advice people don't want to hear. But often it is the solution to their problems." Bob DeBiasse's unvarnished, raspy voice is hardly what you'd expect to be the salvation for the podiatrist's wife who is about to see her husband through a glass window. He has seen it all, or almost all of it.

DeBiasse didn't start out in podiatry or anything even close. For years he operated his own autorepair business and still knows the inside of a motor as well as the inside of podiatry. His gruff exterior successfully hides a soft spot for people who are in real trouble and have no place else to turn. His solutions are creative and reflect the long experience he has had with both life itself and podiatry.

If it is true that politics creates strange bedfellows, it is certainly true that podiatry does too. Like the smoke-filled rooms of political yesteryear, when it comes to finding a solution that "works," it makes sense to go to somebody who understands the best and worst that this profession has to offer. That crown falls on the "Mavin."

How on Earth Did He Get That Name?

DeBiasse's Italian approach to business is like a Jewish mother. "Actually there is no difference" says DeBiasse, "except the language." "Anybody raised by an Italian mother is as Jewish as a person who was told to finish dinner because the people in Palermo are starving." For those unfamiliar with the Yiddish word, it means: "self-proclaimed expert."

"I spoke with an Irish attorney who liked the name, but we decided to "misspell" it." (According to Webster's either spelling is correct). As it turns out, the name is about perfect. You find that out when you work with him. In a business where it is easy to collect disgruntled survivors, his reputation for honesty, reliability and trustworthiness is surgically clean. That's no small achievement even after you've negotiated a simple practice sale.

"There is no such thing," counters the Mavin. All practice purchases and sales are complex, require hand-holding and a great deal of time to put together and complete. "The seller wants to get the most possible, but he/she has to understand that the practice itself has to sustain the buyer. Often the buyer is inexperienced handling a practice. We offer a total package of mentoring and monitoring to those who want it. "We have experts in coding, charting, business practice, you name it."

Survival in Podiatry

DeBiasse feels that the schools and graduate programs dropped the ball: "These are really talented people, but they don't know the first thing about business or what it takes to survive." But keeping them afloat is a challenge the Mavin can handle. He does this with a group of practice program sales formats that include everything from buy/sell to various copyrighted hybrid purchase and associateship programs. His favorite is the Independent Doctor [c] (ID) Program.

Independent Doctor puts new graduates and in-experienced podiatrists into a "pay your school loan back now" status. This will put them far ahead of those not paying their student loans from the get go, as soon as they are finished with their training. "There is no substitute for avoiding negative amortization no matter how much you go into debt to pay off a purchased practice. A steady flow of income from the start solves almost every personal problem a podiatrist has."

The Independent Doctor[c] Program fits that description because it is a hybrid of a practice sale that allows a podiatrist to start seeing and getting paid for patients immediately without placing a huge investment in an office with furniture and supplies. "Many of the details are protected by copyright," retorts DeBiasse, who spent many thousands of dollars with attorneys and CPA's to create it.

"A good business plan is not an accident. It takes experience and knowledge that beginning podiatrists are not even close to having. Best of all, with the ID program, you are protected from predatory practice and associate agreements."

In The Trenches

"My style is different. I was raised in the trenches. If there's any piece of advice I'd give to starting-off doctors, it's get into a situation where you can start paying off your college loans, and be willing to listen to advice from people who know what they're talking about." That advice can come from The Mavin, from Podiatry Management magazine, from other experts like Dr. Jon Hultman, or even your local practice management study group.

There are many solutions to basic problems that The Mavin has to offer. Recently he instituted a $2,000 signing bonus and possible relocation benefits for selected situations.

Often engineers, lawyers and people with marketable degrees get these benefits, but for podiatry it has never happened, until now.

A Day With the Mavin

DeBiasse's wife Jean has been with him through the thick and thin of their businesses and works at his side, often on weekends and early rising. They have a son-in-law who is a podiatrist, who was the genesis of his business. Medical Mavin is a full-fledged family business.

"There was a hole to be filled. Nobody was doing this when I started over 18 years ago." If you want to work for The Mavin, you'd better be prepared to work long hours and listen to the slings and arrows of outrageous suffering from podiatrists, as well as their unreasoned, inexperienced lack of trust.

"We hear everything," says The Mavin. "The worst thing we hear is when people just don't understand what we're trying to do. Sometimes I just have to give up on some of them."

This situation erupts when new podiatrists don't understand that the "business model" for podiatry is very limited. Mostly it's a private practice model. Even those who are embarking on an employee route with a large group practice or HMO should consider their options openly. This happened to a highly experienced podiatrist I know who decided to "part company" with his large group practice for financial reasons well into his career: "They weren't paying me enough and expected me to do all of the difficult procedures like compartment releases and ankle trauma, stay up late, get up early and also run a fellowship program without additional pay. It was too much."

DeBiasse understands. He has dealt with and helped people who left the "perfect mold" of a cushy job with an HMO after they found that the HMO expected far too much and that the internal politics were murder. "There's no free ride."

Just as this is true with the podiatrist in the trenches, it is also true for the Mavin. It takes many hours to put together a deal and create a solution to difficult problems and the glitches that inevitable occur. "We earn every penny of our fees, just like you do."

Mentoring and Monitoring

Mentoring and monitoring is an important part of the process. "A practice sale/purchase does not begin and end in a day. It goes on for months or even years after the signings occur." Naturally, some practices are just bought and sold, without mentoring.

Mentoring and monitoring gradually grew over a period of years to protect the financial sources of DeBiasse's deals. "If I had practice sales fail over the years, it would eventually destroy my ability to achieve funding. This would even occur in the case of government-backed loans."

So mentoring and monitoring grew naturally from that need to protect funding sources. That's what started DeBiasse on the road to learning and understanding podiatry practice from the sole upwards. "There was no choice. I have consultants and am constantly looking for people who understand practice management and new technologies that offer podiatrists opportunities to improve coding and collections."

That is one of the main reasons why Medical Mavin advertises and believes in Podiatry Management Magazine. "This publication understands that doctors must pay their bills and survive before anything else. There's no substitute for survival. Almost every page of PM has an idea that provides basic usefulness."

Mavin's mentoring and monitoring programs involve detailed reports from the practices he works with, including daily, monthly and yearly financial features and day-to-day patient contact.