The Strategic Chiropractor Blog

Reading time: 9 – 14 minutes

I’ve been thinking yet again about what it means to be in practice, talking with several successful entrepreneurs who have built multi-million dollar businesses (in chiropractic, dentistry, construction, real estate and – believe it or not – vending machines) and who have gone through the cycle of starting up new businesses (some several times over). This “extra” thinking may be due to the fact that I have noticed a disturbing trend in the docs who have inquired about my consulting services. Regardless of how long they have been in practice, they are (still) struggling with making a decent living in chiropractic.

Before you get too judgmental, these DC’s are not slow minded, spendthrifts, or hacks who couldn’t adjust their way out of a paper bag. On the contrary, I have been impressed at the results these docs are getting from their myriad of techniques.  Because of their diversity, I can’t necessarily pinpoint the reason for their clinical success, but I can tell you one common bond they all do share:  their income is less than stellar.

So the question of the hour is:

Why start a chiropractic practice in the first place?

Regardless of whether you are a chiropractor, dentist, inventor, or any other person crazy enough to choose to be self-employed, there are two important reasons to start a business – any business. They are (1) Control and (2) Profit

For years,  I was first a subscriber to Reason #1 for many years: to have control. Call it what you want it – vision, independence, being free of “The Man”, having meaningful work, controlling my own destiny, changing the world (or at least your corner of it), being your own boss – it all means the same thing.  You want creative control over the means of your income.

For me, that means that I choose the patients with whom I work in my practice and the clients whom I help in my consulting business. I steer my career toward a life I enjoy. Note how “profit” isn’t mentioned in this definition.

And certainly, control is necessary.  Specifically, your guiding sense of control – your vision – is the roadmap you need to start with and should certainly be present in your business from beginning to end and every point in between.

Without vision, you will either be a sad success or a dabbling failure. You will find yourself running a financially lucrative practice and longing to get away from the monster you have created.  Or you will look like some crazed Dr. Seuss character fed on green eggs and crack.  You will bounce from one idea to the next, buy all the latest gadgets and drive your staff, spouse and self crazy as you haphazardly hope for one of your ideas to hit home and create instant success.

So, yes, control – specifically, the control necessary to harness your own vision – is a necessary element of business success.

Unfortunately, most chiropractors stop there.  If they even get that far.  Worse, important reason numero uno is the smaller piece of the puzzle.

Case in point: look at the slop most chiropractic gurus pass off as marketing or practice management advice. It’s often very “visionary” and lofty sounding. But here are a few questions I’d like the yogi to answer:

Sure, you can see 100 NPs per month, but when you generate $1200 after all the free exams, x-rays, family discounts and other goodies you gave away, is this a profitable method of growing your practice (not to mention, is it even legal)?

Or perhaps that new device that you just purchased IS just the cat’s meow, but when you have to spend $5000 per month to advertise it because no insurance company this side of Pluto covers the service, is THAT profitable? Or have you even calculated your break even point?

Certainly, the “stressless” cash practice is a fine idea and a star in the distance many practices hope to reach one day. But if your office is currently 80% insurance based, does it make sense to try and gear every possible service or protocol you deliver towards the cash patient who only represents a small segment of your patient base?  Instead, why not see how you can appeal to the 80% of the rest of your practice and make them happy to be in your clinic and profitable for you at the same time?

The Yogi often is silent at this point.  Here’s why:

Once you have a good idea of your vision (as it is meaningful to you), it’s time to focus on the mechanics of profit. This requires good planning, thorough analysis, willingness to change and steer toward or away from ideas that don’t work, and maintaining discipline, which may be the most difficult part of it all.  None of this is fancy enough to put in a brochure so the gurus don’t like to tell you that it is necessary for success.  Plus, you can’t craft a catchy logo with it.

Without spending time “under the hood” of your idea, you are simply a mad scientist at best: Mr. Chitty Chitty Bang Bang awaiting for the world to discover his whistling candy or floating car and write his meal ticket.  Sadly, there are many inventors whose brilliant ideas will never see the light of day, because there is not a practical – i.e. profitable – motive behind them.

On the contrary, all successful businesspeople (regardless of industry) cultivate the discipline required to run a profitable business – whether it’s from the start or they acquire it from the “school of hard knocks” as they go.

So, the important insight regarding Reason #2 is that if you’re not thinking of how to make a profit, you’re not going to make it at all. Many a brilliant chiropractor has failed because he or she couldn’t master the business. Just look at your chiropractic schooling – many of them were your professors.  Profit, therefore, is a fundamentally the more practical guideline. Sure it’s not as exciting as the “build it and they will come” type mantra, but this type of ballyhoo sells seminar seats, not services.

Your business decisions are ultimately bound by the rule of profit – like it or not.

In this way, Control and Profit are two stars by which you can steer your rowboat. Generally, I’ve found that “Control” is pitched by creative people who have clawed their way out of the rat race and made it work. “Profit” is pitched by entrepreneurs and business people who see work as a means to an end – not an end in itself.  The ironic part is that this is the very thing that motivated many of the creative types to go into business in the first place.

In Secrets of the $1,250 Per Hour Chiropractic Practice I talk in detail about one of the fundamentally most important concepts you need to understand to succeed in practice.  It is simply this:

Let how you practice be dictated by your passion and let how you profit be by design.

In this respect, my goal as a consultant is not to replace my client’s style of practice with mine. Instead, I seek to help you identify areas of missed opportunity for more income, strategies to increase revenue and aid in increasing the overall profitability of your practice.

I see part of my job is making sure that your company is working smarter, not harder by helping you learn how to run an efficient practice. Sometimes that involves just small “tweaks” here and there to produce excellent results. At other times, it may mean, taking a step back, and overhauling an unprofitable business model with which you have been operating.

Is this something you can do on your own?  Certainly. In fact, I would encourage you to dedicate a significant amount of time each week into strategic planning on how you can improve your business and its profits.

However, because most chiropractors have a strong sense of conviction about what we are doing and feel compelled to spread the chiropractic story everywhere, we sometimes let our hearts get in the way of our heads and make emotional decisions about our business. And we do this daily. We give services away because we don’t know how to properly code, bill or document them or because we’re not sure why we are doing them in the first place.  We don’t charge what we should because we either don’t know what that is exactly or we don’t quite know the specific requirements for the exams or procedures we are performing.  We’d like to do more X, sell more Y or have some Z in the mix, but we have no concrete plans or protocols or systems to put this in place.

This is where an outside opinion, an objective extra set of eyes comes in handy. And sometimes a whip to goad you along. (Just kidding. Well not really.  OK, maybe a little kidding, a little serious…).  I periodically have to remind my clients that practice is, after all, a business designed to produce income and support yourself, your family and your lifestyle. If your business fails to produce enough income, your personal life will suffer and you may need to supplement your income in other ways.  At the very least, if your business ceases to produce meaningful income, the IRS will declare it a hobby.

The nice thing about being able to exercise creative control in a business means that you can essentially practice however you would like — and as long as you are operating from a profitable business model — you are very likely to succeed!

The down side about this is that there is not just one thing that will make your practice improve, no”magic pill” that will cure all your practice ailments. There are many little things, some of which seem insignificant alone, but compound to make major changes.

Without knowing your specific situation from the vantage point of this article, I can at least say this.  All businesses, no matter how big or small, financially successful or flailing, have room for improvement.  My suggestion is for you to set aside the time it takes to identify areas that you can improve in your practice, analyze profitability and get to working on the business of your business.

If this e-mail hit home with you, let me suggest two final things:

1)      Pick up a copy of Secrets of the $1,250 Per Hour Chiropractic Practice and read it through (also now on Audio CD).  The concept is just about what we are talking in this email – setting your business up to be highly profitable, based on your passion, and the premises in the book will help you get started into thinking more conceptually about how to design your business to be more financially rewarding.

2)    Download  my Practice Analysis Questionnaire, complete and fax it in.  I will contact you afterward to discuss my analysis. There is no charge for this and you are under no obligation to utilize my services.

I hope you enjoyed this extra long reminder/wake-up/inspirational message and look forward to talking to you soon!

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Reading time: 6 – 10 minutes

From the emails I have been receiving lately, it would appear that the current events in our country, the economy and the uncertainty of the healthcare marketplace have more than a few chiropractors seriously worried about their future. Rather than dwell on circumstances that are largely beyond our control, here are some strategies for transforming negativity and unpredictability into opportunities for practice growth, progress, and achievement.

1. Futurize, Supersize and Minimize
Unfortunately, many leaders dwell on the past and what went wrong. If you must talk about the past, learn from it, don’t dwell on it – minimize it and move on! Instead Futurize – communicate your vision and communicate it often. And while you’re at it –supersize it! Make your goals big and well known to yourself and your staff.

2. Give Mediocrity the Boot
When we are stressed and focused on external problems, we tend to let things slide and accept mediocrity. Now is the time to tighten the reigns, pick up the slack and get rid of sloppy habits. If you need a kick in the pants in this department, I suggest you pick up a copy of George’s Cloutier’s Profits Aren’t Everything, They’re the Only Thing. Though I certainly don’t agree with all his ideas, and he is sure to offend many, the book is a worthwhile read as no-nonsense guide to running your business more effectively.

3. Problem Focused Spinning
Focusing on helping your patients transform their negatives into positives. The more you contribute in this fashion, the less you will need to worry about your own situation. You will become a source of confidence for everyone else. You will inspire patients to use time wisely to regain their health and place even more value in your care. Tell patients simply and directly: “You can’t afford to have this problem. We need to get you fixed up quickly so that you don’t lose work time and so that you keep your job.” They will agree wholeheartedly and accept your care plan.

4. Go Deeper
There is a massive refining process underway right before our eyes, thanks to the present economy. Into the fire go the lazy, unmotivated, uncommitted, and other parasites that had a free ride for far too long. Witness the mass exodus in professions such as real estate where agents were quick to take their 150 hour exam, get their license and unload $500,000 houses at 6% or 7% commission as quickly as possible, no effort needed, no talent or skill required. Now monster.com and every other job board is glutted with the fallouts of many of these industries. While that may sound harsh, there are survivors and the best have learned to go deeper into their well of resources to sharpen or develop new skills.
The quickest way to achieve this? Read! There is nothing new under the sun and certainly you can discover how others are succeeding around you even in what appears to be new fields or technology. Don’t like to read? You are fortunate to be living in the best time ever for illiterates. Podcasts, YouTube and a host of other internet gadgets can now enable you to get massive quantities of information without laying a single finger on a book or even opening your eyelids. If reading is not your style, you no longer have an excuse – develop yourself!

5. Fail Quickly, Mitigate Risk
Put away two myths: first, you have to be good at everything and second, that successful business people are wild risk takers whose daring proposition somehow panned out. Get over failures quickly and become self-directed, self-managed, and self-motivated. Resolve to accentuate your strengths and focus even more on what you are good at.
Because, when analyze it closely, business generally rewards the specialist. It is more advantageous to become an “expert” in a few things than to be acceptable at many. Once you find your expertise, there are no daredevil methods required to harness it. Mitigate risk and make small moves towards mining that expertise for profit. For an eye-opening look at how others did this (some of whom are perhaps more famous than you – i.e. Bill Gates) get Rick Smith’s quick read The Leap and see how you can make simple changes to propel your career.

6. Forget What’s Missing, Borrow Brilliance
Too often I hear DC’s who are focused, even obsessed, on what is missing in chiropractic. They moan about how insurance isn’t what it used to be, taxes are up, patients don’t want to pay, competition is fierce, and on and on and on. Forget about what is missing in chiropractic. No, the healthcare marketplace is not perfect, but focus on what IS available!
One sure-fire way to do this is to get out of your chiropractic bubble! Read business related books by those outside the profession and apply their ideas to your own practice. Talk with successful dentists, dry cleaners or dog sitters and glean gems of wisdom from their experience. In the words of another book for your reading list, “Borrowing Brilliance” (title of same name, author David Kord Murray) can be the best way to harness someone else’s creativity for your own benefit.

7. Skip the Complaints
Ever spend time in a grocery line behind a whining toddler who constantly assaulted his mom with begging and pleading for candy? Annoying right? What’s even more exasperating is when the two year old finally wins. Mom gives in and gets the little booger his candy.
You are a grown adult and are certainly old enough and capable enough to buy your own candy, make priority decisions for yourself and your business and achieve all of this without whining like a poorly trained toddler. So don’t grumble and complain to your patients about the economy, your slow schedule or your thinning bank account as if, by some magical, parental force, they can give you your “candy” and make all your problems go away.

Instead, be thankful. Very thankful, in fact, that these good people have taken their hard-earned money and shared it with you by supporting your business.
A while back, I had the opportunity to observe myself from a distance by a chiropractic student who had shadowed me for a week or so. A month later, I received a copy of his evaluation of his time spent in my clinic. What surprised me was that, of all the things he learned, he brought to my attention something that I have done for years without even thinking about it. He wrote:

“In some small way, you communicate to each and every patient that they are special and that you are thankful they are in your clinic. Sometimes you simply say “Thank you.” Other times you say “I’m glad you were here today.” Still with others, your greeting and smile says “It’s great to see you” even though you didn’t voice those words.
If there is one thing I learned from this experience (and there were many), there is tremendous power in politeness. You treat your patients like friends, with respect and genuinely act pleased to see them. In response, they listen to you intently, follow your recommendations and trust you immensely.

Give Gratitude Freely
I share this with you not to toot my own horn, but because I believe it is something so simple, something so rewarding and something so powerful that each and every doctor ought to be communicating their constant gratitude toward their patients.
If you attempt no other items listed on this email, please be genuinely, sincerely thankful. It feels good to acknowledge others. It will help build goodwill in your practice, in times when goodwill is hard to find.

At the very least, gratitude builds a bridge of friendship toward your practice, one step at a time. And gratitude is the one powerful, pleasant and pleasing practice builder that you can give freely (and literally for free) that every patient is sure to enjoy!

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