Building a Patient-First Podiatry Practice with Dr. Adam Shapiro 9-28-25

Summary

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Episode Summary: Building a Patient-First Podiatry Practice with Dr. Adam Shapiro

Podcast: Becker Business (also Becker’s Healthcare Podcast)
Host: Scott Becker
Guest: Dr. Adam Shapiro, Podiatric Foot and Ankle Surgeon, Entrepreneur
Date: September 28, 2025

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Overview

This episode features Dr. Adam Shapiro, founder of the Carolinas’ largest independent podiatry practice. Dr. Shapiro shares the journey of building and scaling a patient-centered podiatry operation, his approach to culture and growth, strategies for physician and patient satisfaction, and his vision for a comprehensive lower extremity health platform. Key themes include patient-first philosophy, physician well-being, practice scaling, multidisciplinary integration, and adapting to healthcare trends.

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Key Discussion Points & Insights

1. Dr. Shapiro’s Background and Practice Philosophy

• Introduction: Dr. Shapiro traces his career from residency in Washington, D.C. to launching his Charlotte-based practice in 1999, now the largest independent podiatry practice in the Carolinas.
• Growth Approach: The practice’s expansion was “organic,” focusing consistently on patient experience as the core of its success.
  • “We’re proud to be the largest independent podiatry practice... we’re building out a multidisciplinary lower extremity health platform.” (B, 00:30)

2. Building a Patient-First Practice

• Guiding Principle: “Good medicine is good business.” The practice’s culture is fundamentally a patient-first approach.
• Patient Journey Focus: Every touchpoint is optimized—the initial phone call, the office environment, clinical protocols, and the checkout process.
• Cultural Standard: The “golden rule” is applied across all staff interactions.
  • “Our goal each and every day is to exceed patient expectations, and that's what fuels our growth.” (B, 01:43)
• Training Young Doctors: New physicians are taught not just clinical skills, but also the practice’s ethos and high-touch patient care model.
  • “We give them a masterclass in how to be successful... it’s not just throwing them in.” (B, 03:46)

3. Preserving Traditional Values in a Modern Environment

• Continuity of Care: Despite the evolution of healthcare, the “old school” patient-by-patient approach remains effective and sustainable.
• Recruitment and Onboarding: Young physicians are developed through an intensive onboarding process to align with the practice’s patient philosophy.
• Cultural Buy-in: Compare patient care to a superior service experience (e.g., Chick-fil-A vs. fast food).
  • “It’s important that everyone buys into that culture.” (B, 03:46)

4. Physician Well-being and Motivation

• Burnout Prevention: Structured schedules, promotion of autonomy, and attention to mental health are core strategies.
• Work-Life Balance: Three-year associateship leading to partnership, with increased vacation (up to six weeks) for mental health as tenure increases.
  • “It's not a sprint, it's a marathon, these careers.” (B, 05:47)
• Technology as a Tool: Adoption of AI transcription to reduce documentation burden and allow doctors to finish work at reasonable hours.
  • “AI transcription has been phenomenal in reducing... the burden on physicians.” (B, 07:09)

5. Collaboration Across Disciplines

• Cooperation vs. Competition: Dr. Shapiro describes a collegial relationship with orthopedic surgeons and other specialists, focusing on shared care.
  • “The pie is big enough for everyone.” (B, 07:49)

6. Innovation and Practice Growth

• Scaling Operations: The business is moving into a new phase of “de novo growth,” adding new specialties, service lines, and building out the C-suite team.
• Fall Risk Program: Focused initiative addressing hospitalizations due to falls—patients are screened during intake, and those at risk are referred to in-house physical therapists.
  • “Falls are the leading cause of hospitalizations in folks 60 and older... No one is addressing fall risk.” (B, 08:28)
• Integrated Services: Emphasis on creating a “one-stop-shop” for lower extremity health, integrating podiatry, physical therapy, and vascular specialists.
  • “The goal is... to be the leading lower extremity health platform.” (B, 09:42)

7. Sustaining Passion and Energy

• Purpose-Driven Practice: Passion and sense of purpose are key motivators.
  • “To become a physician, you have to have a certain sense of purpose, and with that purpose comes happiness.” (B, 10:23)
• Non-Surgical Focus: Podiatry’s strength lies in comprehensive non-surgical intervention.
  • “We really have a knack of getting folks better non-surgically... and that is what most people want.” (B, 10:23)
• Industry Outlook: High demand for podiatric services as population ages and the need for lower extremity care increases.

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Notable Quotes & Memorable Moments

• Dr. Shapiro:

  • “Good medicine is good business.” (B, 01:43)
  • “I always tell physicians, when you join our team… it’s not a sprint, it’s a marathon.” (B, 05:47)
  • “AI transcription has been phenomenal in reducing the burden on physicians and getting home at a reasonable hour.” (B, 07:09)
  • “Falls are the leading cause of hospitalizations in folks 60 and older. No one is addressing fall risk. Right. So we… refer to in-house physical therapists.” (B, 08:28)
  • “To become a physician, you have to have a certain sense of purpose... with that purpose comes happiness.” (B, 10:23)
  • “One of the greatest things about our specialty... it’s just such early innings.” (B, 10:23)
  • “The pie is big enough for everyone.” (B, 07:49)

• Scott Becker:

  • “You can’t see 40 patients a day and stay in a good headspace and love your patients how you want to love them.” (A, 05:47)
  • “Traditional practice never goes out of style in terms of actually taking care of patients well and building a great practice.” (A, 02:45)
  • “All of us live on our feet…” (A, 11:42)

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Timestamps for Important Segments

• 00:30 — Dr. Shapiro's background and practice history
• 01:43 — The patient-first philosophy and culture
• 03:46 — Training and onboarding young physicians
• 05:47 — Structuring physician schedules for longevity and well-being
• 07:09 — Embracing technology to prevent burnout
• 07:49 — Collaboration between podiatry and orthopedics
• 08:28 — New service lines: fall risk, multidisciplinary expansion
• 10:23 — Sustaining energy and passion in medicine; non-surgical focus
• 11:42 — The universal importance of lower extremity health

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Conclusion

Dr. Adam Shapiro’s practice growth is firmly rooted in patient-first values, physician well-being, and strategic innovation. His multidisciplinary vision aims to address gaps in lower extremity health, with a strong commitment to culture, collaboration, and adaptability in a changing healthcare environment. Dr. Shapiro’s message is clear: combining passion, purpose, and solid business practices creates not only better patient care, but also a thriving, resilient organization.

Transcript

[A]

This is Scott Becker with a special combined episode of the Becker Business Podcast and the Becker's Healthcare Podcast. I am thrilled today to be joined by somebody who's both a brilliant doctor and a brilliant entrepreneur. We're joined today by Dr. Adam Shapiro, and Adam's going to talk to us about the building of his practice, the trends he's watching currently. What he's most excited about in a lot more. Dr. Shapiro, can you take a moment? Adam, talk to us a little bit about what you do and your background.

[B]

Hey, Scott. First, thank you so much, you know, for having me. I'm, I'm truly honored. Hopefully I'm not bringing your listenership down by, you know, 25 to 50%, but I am a practicing podiatric foot and ankle surgeon, you know, as well as an entrepreneur. I started following my residency in Washington, D.C. down in the Charlotte region in about 1999. And we have just kind of grown our, our footprint, if you will, organically, you know, and we're proud to be the largest independent podiatry practice, you know, in the Carolinas. And we're currently working on building out a multidisciplinary lower extremity health platform.

[A]

I mean, it's amazing what you've done. I've watched your growth over the last 15 to 20 years. I'm always amazed at sort of the diligence, the entrepreneurship, the intelligence at which you've taken it. Taken. Taken with it. Give us a moment on when you look at building a practice, what advice would you give to others in building a practice? So what you've done in building a podiatric practice is similar to people building other types of practices. What have you seen? What works, what doesn't work? And tell us a little bit about how you look at that.

[B]

Yeah, no, that's a great question, Scott. So, I mean, I think fundamentally it's important to understand that, that good medicine is good business. And the core philosophy and what drives our culture is a patient first approach. So our goal each and every day is to exceed patient expectations, and that's what fuels our growth. And that involves everything. That involves not just the physicians, but it involves from the moment somebody has the first impression of the practice, when they call the office, there is a scripted response as to how that call is handled, to their physical impression of what the office spaces look like, to the protocols and practices that take place during that visit to the checkout procedure, all of which kind of globally, I think, exceeds the typical patient experience that the typical patient would have in the everyday practice. It's the golden rule, if you will.

[A]

Let me ask you a question, though, because how much you talk about is sort of the old school, traditional private practice, really patient by patient, really taking care of patients, great intake when they first call to the doctor, really being on board and really taking care of the patient to really the entire experience. And it's really what you've built your practice around. It seems like so much of the world is changing as the world has got information overload. It's so convoluted. There's such a shortage of doctors. Are there shortages of podiatrists as well, or what does that look like compared to the rest of the sort of the physician population? And then how hard is it to get people to practice how you've always grown your practice? Because that's sort of the traditional practice. And what happens is, I always say that kind of traditional practice never goes out of style in terms of actually taking care of patients well and building a great practice. But it seems like it's so different today in so many of the environments you see in practice.

[B]

Yeah, I mean, first is not to take any patient for granted. We value our patients. You have to have a true love for your patients. I think the entire team, both on the physician as well as on the ancillary staff side, kind of share sort of in that culture. And so I kind of equate it to the fast food experience, if you will. You can go to your Wendy's or your Burger King and have sort of an okay experience. But if you go to a Chick Fil a in the Southeast, you know, they tend to sort of exceed, you know, kind of the fast food experience for the average, you know, customer kind of coming in. And so it's, it's important that, you know, everyone kind of buys into that culture. So, you know, coming out of training, coming out of residency, you know, most of the young, you know, physicians really are a blank slate. And we do a great job, you know, within our environment in really, you know, bringing them up to speed. So, you know, everyone can kind of come out. Everyone knows how to do surgery, everyone knows how to, you know, do the basics of patient care. But it's really sort of kind of instilling in them that patient philosophy and also kind of the onboarding process. So what we're really unique at doing is, if you will, and we kind of give them the masterclass in how to be successful as a podiatric physician. And so there's a lot of. We don't just throwing them in there's kind of a lot of growth and education that occurs during that first year.

[A]

You've done a remarkable job of it over a prolonged period of time.

[B]

Time, yeah.

[A]

To be able to love your patients, there seems to be multiple pieces of that. You have to be in a good headspace yourself to stay motivated, to stay excited, to stay at it, stay physically mentally healthy. How do you sort of take care of yourself so that you can make sure you're taking care of patients well. And then you also can't see 40 patients a day and stay in a good headspace and love your patients how you want to love them. How do you sort of manage your self in your schedule to stay in that spot where you can love your patient?

[B]

Yeah, yeah, so, so that's, so that's an outstanding, that's an outstanding question, Scott. So, you know, first, you know, it comes down to the scheduling, so having a very templated type of schedule where the physicians, you know, will not get overwhelmed by classifying patients into certain categories. You know, the second is the physician schedules, you know, themselves and what's kind of built into their contracts. So, you know, I always tell physicians, you know, when you, when you join our team and we're looking for longevity, you know, we don't want physician churn, invest a lot in you, and we hope that you're going to be here for the long run. But it's not a sprint, it's a marathon, these careers. And so our sort of track, if you will, is a three year associateship track. And then there's a sort of a partnership track beyond three years. And once you're in that greater than three year partnership track, there is quite a bit of vacation time that you can use. So if after a certain number of years, if you actually need, you know, up to six weeks off for whatever, you know, reason in one particular year to help reset, you know, for mental health, you know, that's available to you. A lot of how the physicians are compensated is somewhat of a meritocracy. So, you know, obviously if you're taking more time off, you know, you may not, you know, earn as much in that particular, you know, window of time.

[A]

But you've got choices though. You live life, you want to win.

[B]

Exactly. Physicians need no autonomy. And at the end of the day, physicians have to be happy. I mean, there is a lot of physician burnout. We're also embracing technology. So, I mean, I think AI transcription has been phenomenal in reducing, you know, the, the burden on physicians and, and, and getting home at A reasonable hour, you know, obviously moderating, you know, how much they take on call, you know, so we're, we're very careful about, you know, how much hospital call we take and making sure we're not overburdened by that.

[A]

And how do I. A couple more questions. How does the podiatric community work with the orthopedic community? Is it, is it cooperation? Is it competition? Is it some of both?

[B]

Yeah, I think it's, at least in my environment, I think it's very collaborative. I'm, I'm friends with and colleagues with, you know, most of the orthopedics in my area and we share patients, you know, we'll have certain patients that, you know, I might want a second opinion of and let's, you know, get, get an orthopedic opinion on that, you know, and vice versa. There's a little bit of overlap, just like in, you know, ENT and oral maxillofacial surgery. But, you know, I'm a big believer in that. The pie is big enough for everyone.

[A]

I'm going to ask you two more questions, I promise. I would only ask you one more.

[B]

But I've got two more.

[A]

The first one is what are you most focused on and excited about this year and as you had in 2026?

[B]

Yeah. So I think we're really scaling, you know, at this point. I think that we have, we've got a platform, you know, if you will. We've kind of built out, you know, the C suite team and now we're kind of in de novo growth, you know, and so I think I'm really excited about that. We're also adding, you know, some other specialties, you know, into the mix and adding new service lines. So, for example, falls, you know, falls are the leading cause of hospitalizations in folks 60 and older. No one is addressing fall risk. Right. So we, you know, have questionnaires during patient intake and if you check certain boxes and we think at risk for a fall falling, your podiatric assessment, you may then see, you know, one of our in house physical therapists to, you know, work on mobility and balance issues. So I mean, I think we're making a real difference, you know, in that way. So physical therapy has been a great ancillary that works really well with, you know, how we can serve the patient better. It's sort of a one stop shop for all your lower extremity health needs. Yeah, we do a lot of diabetic limb salvage. We working with vascular right now. And so, you know, ultimately, you know, the Goal is to, you know, not be a podiatry platform, but we're planning to be, you know, the leading lower extremity health platform.

[A]

Well, you really are. And so yeah, this question because to do what you do and to do it not just taking care of patients, but to see the world around you, to see the lower extremity, to see health and wellness. I mean you've got a lot of diabetic patients. When you're dealing with foot and ankles like that, you've got a lot of sports industry, you've got a lot of everything. And you're obviously keep yourself well versed across the board and a lot of things, the energy to do that, to stay up and I mean I see so many on college to say, for example, that just seem overwhelmed. There's too much information overload. How do you keep the energy up to stay thinking, learning, growing, getting better at what you do? How do you maintain some of that energy?

[B]

It's a passion. I mean, honestly, it's a passion. You know, I, you know, I think to become a physician, you know, you have to have a certain sense of purpose, you know, and with that purpose comes happiness and you know, profits are one thing, but we also, we just take great pleasure in, you know, being to help people and make a difference in people's lives. And whether it's something simple or something complex, you know, when people can't walk, when they're not functional, it impacts everything from, you know, their cardiovascular health to their, you know, financial health. And one of the great things about podiatry in relation to orthopedics, because you did ask that question, is that we really have a knack of getting folks better non surgically. If you see my orthopedic colleagues, and they're great, they're typically going to recommend surgery for us. We're going to exhaust every non surgical option to get you back on your feet. And truthfully, that is what most people want and we just have a way of doing that. And there's a real void in the healthcare environment, you know, for that. And, and one of the greatest things about our specialty and where we are is it's just such early innings, you know, I feel like podiatry, you know, or large family health is sort of, you know, kind of overlooked by the big hospital systems. Right? Yeah. And so, and there's just tremendous demand, you know, for what we do and.

[A]

Also important because all of us live on our feet. Live.

[B]

Yeah.

[A]

And do what we're going to do.

[B]

Right.

[A]

And if our feet and lower extremities aren't working.

[B]

Absolutely.

[A]

We're just not able to do.

[B]

And especially as the baby boomers are getting older, you know, there's a greater, you know, emphasis on exercise and, and, and staying fit and staying healthy. And so, you know, we really see the gamut. We see children, we see seniors, we see diabetics.

[A]

And we'll ask you one more question, Adam.

[B]

Yeah.

[A]

Who are you calling a baby boomer? No, I'm just, yeah. Adam. Dr. Shapiro, I want to thank you so much for joining us. Dan. The Becker Business, Becker Private Equity podcast, Becker Healthcare Podcast. What a great pleasure. I've watched you grow your business, your practice over 20 years. I love what you do. I love how you do it. It just is phenomenal to watch. Thank you so much for joining us.

[B]

Yeah, thank you so much. It was a pleasure.

[A]

Absolutely.