In this interview, Dr. Marc Pietropaoli (Dr. P) discusses his 25‑year solo orthopedic practice in Skinny Atlas, New York, and the financial pressures of an insurance‑driven model. He explains how declining reimbursements and rising overhead made profitability impossible, prompting him to adopt orthobiologic treatments—PRP (since 2008) and BMAC (since 2009)—and later add cash‑pay services such as laser therapy, weight‑loss programs, and genetic‑based nutrition. During COVID, he began bundling these services into individualized programs, moving away from à‑la‑carte pricing. He details his pricing evolution from $750‑$800 per PRP injection to $1,900, and from low‑cost packages to average program fees of $11,000‑$12,000 (ranging $2,800 to $30,000+ for multi‑site procedures). Dr. P emphasizes that his patient base—high‑income village residents, farmers, and blue‑collar workers—are willing to pay for non‑surgical solutions. He contrasts the low margins of traditional surgeries (e.g., three knee replacements generating less revenue than a single bone‑marrow injection) with the higher profitability of orthobiologic programs. The shift has dramatically increased his job satisfaction, allowing him to see fewer patients while delivering higher‑value care. He credits a business coach/mentor (the interviewer's team) for guiding the transition and urges other physicians to seek similar support, stressing the importance of trust, listening, and taking action.
Chapters
All right, everyone.
We are here with the world famous Dr. P, otherwise really truly known as Dr. Pietropaoli. He is located in actually one of the most beautiful places we go to on a regular basis, and that's Skinny Atlas, New York. It's outside of Syracuse. But instead of me doing all the intros, Mark, why don't you tell everybody, wave hello to everybody, and why don't you tell everybody what you do and give a little bit of your background?
Yep, yep. My name is Dr. Mark Petropali. I've been in practice for 25 years. I did my college, medical school, and residency in Syracuse, so I do bleed orange. And then I trained my sports medicine fellowship with Dr. James Andrews in Birmingham, Alabama. He is the, obviously, the GOAT of all time in sports medicine. And yeah, it's great.
Awesome. So tell everybody, we've been working together I think 2 and a half years now. At that time, before we started working together, what were the biggest challenges that you were facing?
Yeah, well, I'm in solo practice. So I was in a group the first few years of practice and then I was going to join another guy who was leaving another group and he got out a year before I did. I had to honor my year, no compete type thing. And so he went into practice on his own. So basically I've been in business on my own as an orthopedic surgeon since 2001. And I built a business that was very successful. Basically our rule of thumb was one up the golden rule, just basically treat patients better than we would treat ourselves and The rest would take care of itself. And that's how a normal business should work, you know, great customer service, etc. But medicine is not a normal business. And there's a middleman named insurance in between. And over the years, that's gotten worse and worse and worse and worse. And so it really— the challenge was reimbursement was going down, and it's continued to go down. Yet we have great employees, as you know, and they deserve raises. They deserve Compensation for the great job that they do, and it's very difficult. So what we were finding was in order to bring in more revenue, your costs would go up, and they would always go up pretty much the same. So it was really difficult to make a profit. And then when we took a deep dive into looking at what we were actually getting paid and what our expenses were, I mean, you're either breaking even or losing money. I mean, I kind of knew this already, but I really realized how bad insurance-based practice was. I've been doing PRP, platelet-rich plasma, since 2008. I've been doing bone marrow aspirate cells, BMAC, since 2009. 2017, I had other self-pay cash pay services like MLS laser therapy, healing laser therapy. And so my staff was kind of, we were in a little bit of a transition and a little familiar with cash-based services and how to present them to patients and, and the value of them and get them to pay out of pocket stuff that wasn't covered on insurance. So I realized that was the future and that was the way to stay in business and stay afloat. The challenge was I started to package some of these services together on, on, And I, that was just my own idea. It came to me during COVID when I couldn't do knee replacements. And there were patients who just were like, what can we do? So I'm like, well, we have bone marrow cells. We have PRP, we have laser, we have strength and conditioning services. And they were like, well, when's, when are you going to be able to get my knee replacement? I'm like, I don't know. I mean, it could be 2, 3 years the way things are going. So we just packed things together and we found how great it was working. They work synergistically. And then that's when I'm like, I gotta get more into this. So I watched the Boston BioLife webinar. You were on it. Mm-hmm. And I realized I don't know squat about, uh, the business of orthobiologics. So I knew a bit about the science. So that's, yeah, that's when we met up. And my challenge was, how do I, I was kind of packaging these things, but I, you know, way underpricing.
What were you charging before, before we met? So what were your fees? What did you think that you could charge?
Well, I know I was charging $800 for a PRP, $750 or $800. I know that. And then when you looked at what the actual cost was and employees and keeping the lights on and rent and my time and the kit and just everything, losing money. So that's one of the—
Yeah. When you charge $800, you're gonna lose money, right? How would you describe Skinny Atlas and the people that live in your region, your client, your patient base?
It's a beautiful small town. It's about 7,000 people in the village and in the town. It's pretty much a high-income area right in the village of Skinny Atlas and some of the town. And so So you would think, oh, you know, there's these huge, beautiful houses, et cetera, et cetera. And it's gonna be no problem selling these things to people who are millionaires, et cetera. But really another thing you taught me was that it's, you never know who's gonna want services and you can't be afraid to offer those services to people. Don't have any preconceived notions. That's the biggest thing. You'd be surprised how much money farmers have and how hard they work and that they want to get better and they gotta get better fast and they don't want to have surgery. So we have a lot of farmers, we have a lot of blue collar people. And they've worked their whole life beating their bodies up and saving their money so that they can go on vacation and spend time with their wife and their kids and their grandkids. And they're willing to pay for services that are going to get them better without needing surgery.
Okay. So tell everybody just kind of the ballpark or what's your, what do you charge now? What are your fees like today?
Well, I mean, for instance, for PRP, it's probably underpriced too. It's not, it's $1,900 is what we charge for PRP right now. But we don't really do à la carte. We have everybody was individualized. And so we have so many different, we even have weight loss, laser weight loss, and we have a genetic-based nutrition. We come up with what we think is best for them. That's kind of our pillar of our culture. And we offer them what we think is best for them for what they want to reach their goals. So we don't even treat arthritis anymore per se. I treat the patient's goals. And that's another thing that I think that The questions and the way to interview people and spend more time with them that you've helped us with has really digs in deep to what they really want. Like, let's figure out what you really want. What are your goals?
Yeah.
Then we will come up with a program. So, I mean, I've had programs anywhere from like $2,800 for the whole program. And then we have people who need surgeries that aren't covered by insurance and procedures that aren't covered by insurance. Let's say on both knees. Or 2 shoulders and 2 ankles, and that can run $30,000, $40,000 sometimes. So there's a wide range, but the average is in the $10,000 to $15,000, I'd say, for— yeah, for people. Yeah.
So I want everybody to hear that his average price of what he charges is right in the $10,000 range. I think our last metric was like just shy of $10,000 or something like that.
It's probably— it's $11,000, $12,000, right around.
Oh, it's $11,000, $12,000. Okay, great. Yeah. So get this, $11,000, $12,000, Skinny Atlas New York. Blue-collar farmer. Did you ever think in a million years that you could charge $11,000, $12,000 to your client base? By the way, did you think I was nuts when I told you that? I'm just curious.
No, I really didn't. Because I honestly, your webinar was amazing and you're convincing, but you're right. I mean, you were right. So I knew you were right deep down inside. I just didn't know how to do it. So I didn't think you were crazy. I knew a knee replacement is $30,000 to the system. So I knew my services were Easily worth close to that or, you know, between $10,000 and $30,000, $5,000 and $30,000 for sure. So, I mean, if you look at what traditional services cost to the system, a lot of patients have to pay out of pocket, as you know, anyway. I mean, there's very rarely an insurance where someone doesn't have to pay a lot out of pocket anyway. So for services that are last century's technology.
That's a good point. It is last century's technology. Do you remember the text you sent when you were heading back from like a full day of surgery? And you were saying, "Wait a second! Yesterday I saw whatever it was. I think he sold two PRP patients, and I think it was one of those days you might have had like six surgeries or something like that. And you were like, "Wait a minute! I just made whatever it was four thousand dollars in surgery, of which I'll get almost nothing compared to." Do you remember kind of the gist of that text? Look, I know I'm putting you on the spot. Like no, I mean, it's really instructive for folks.
That may be one day, but that happens all the time. So like you know yesterday I had three surgeries, for instance. But That will bring in less than one bone marrow injection for, you know, a program. And that goes for the pre-op visit, the history and physical, the nursing staff, the PA. It goes to the billing department, billing for all their visits, the surgery. It goes to the front office scheduling all the visits, including the post-op visits. It goes for the surgery itself that day. I have a surgery scheduler, I have a surgery coordinator, and then it goes for 90 days after that. So, I mean, I'm preaching to the choir with any surgeon who knows that's crazy if you really look at your costs versus what you're getting, you're very rarely making money. That's why though you get the factory services where if you're gonna stick with— there's doctors who do tons of total knee replacements. They walk in the room for 10 minutes, not even. They look at the x-ray, they say you need surgery. They don't even touch the patient. 'Cause I have patients telling me this all the time. Then they own a surgery center, they own a total knee surgery center or a total hip surgery center, and they just crank 'em through like a factory, 20, 30 a day. And that's how they make their money.
Mm-hmm.
by massive volume, and about 30% of knee replacements are probably not necessary. There's studies that show that in the US and in other countries.
Yeah.
All right.
So what would you tell someone who's sitting in the audience that is thinking about working with us and our team and our organization?
I would say it's the real deal and, and trust and listen and just do it. Don't wait. Don't be afraid. I mean, what are you waiting for? My level of job satisfaction is tremendously higher and I see a lot less patients, but I get to spend half hour or I spend an hour with patients and we really figure out what's going on and they're very appreciative. And it's like getting back to the just real medicine. Job satisfaction is going to go up and you can see less patients and bring in the same amount. It's not easy. That's why you need help. You guys, I mean, it's not easy. I mean, you need help. You need a coach. You need someone to keep on you. You need someone with experience. And frankly, it's not just you. How about all the other docs? That I've met and other business owners. And we all have the same ideas and we really want to just treat patients great and get them better. And that makes us happy. Just like when, you know, knocking a 30-foot putt on the 18th hole, even if your day's been bad, you come back and play again. It's the same thing.
Well, Dr. P, thank you for taking the time and I appreciate you sharing your insights. And there you go. Thanks. Appreciate it, Mark.
