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.
One of the fundamentally most important concepts you need to understand to succeed in practice 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 coaching 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 downside 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 hits home with you, let me suggest two final things:
For Current Business Owners
The chiropractic marketplace is ever changing. If you feel that you are working harder (than ever) and profiting too little, then it’s time for you to seriously sit down and strategize how to work smarter! Lots of DC’s like the idea, but few actually put the pencil to the paper and take time out to implement the steps that it takes to make that happen. The good news is — that’s what our Smarter Chiropractic seminars are all about! You might have missed the opportunity to attend live, but it’s not too late for you to get the recording and get to work growing your bottom line!! Click the link here to buy the Smarter Chiropractic recording and start creating smarter income today.
For Associates and Those Who WANT To Be Business Owners (Someday Sooner or Later)
Few chiropractors enter the profession to work for someone else, yet it is a legitimate step in the process for many. But if you are currently in an Associateship, make sure that it is serving you to reach your goals or find a new chiropractic job that will. Our Free Practice Match service will help you find a great job that meets your needs and interests (and/or chiropractic practices for sale).
And, if you feel that it’s time to become the business owner — or if you are uncertain where your next step should be — consider our Buy, Build or Break Up WEBINAR to help you make your next best move towards Buying a Chiropractic Practice, Starting one from scratch or getting a new chiropractic associate job.