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Practice Management


How to Avoid Associate Lockdown
Practice Management
Written by Bart Anderson, DC   
Sunday, 25 August 2013 19:10
I
t’s no secret that only a small percentage of new grads opt for the challenge of chasing their dream and building a practice right out of school. In fact, as the leader for a company specializing in practice start-ups, I see it every day. The sad reality is that there are far more new doctors out there who are capable than those that actually attempt the endeavor. But for those that do buckle down and dig in, the end result can be very rewarding.
 
jobhireFor that reason alone, I’m very outspoken about new graduates seizing the opportunity of launching their own practice. However, it’s my unfortunate observation that many new grads “default” to taking an Associate position due to some common fears, frustrations, and uncertainties. Some of those are justified, but many are certainly not. I use the term “default”, because, in a high percentage of the situations, it is simply not the preferred choice or original planned path.
 
It is clear to anyone in our profession (who actually pauses to assess it) that this common re-active approach results in many unhealthy and poorly orchestrated Associate D.C. employment scenarios. An otherwise excited, passionate and well-educated D.C. winds up in what we call “Associate Jail”. What’s that? It’s the endless cases you have probably heard of (or been in) when a doctor is captive to their circumstances … stuck in a place difficult to get out of. Not learning. Not earning. It can be very tough to endure and causes undue stress, loads of frustration, costly financial challenges, and perhaps worst of all, significant delays in your professional growth and achievements.
 
Even with all this said, I do suggest some consider an Associate position. Business ownership is not for all. For the sake of this article, let’s say you have considered your options, put aside the inaccurate fears instilled by supposed “experts”, and still ultimately chose to inquire into the idea of an Associate position. A thorough pursuit of establishing such a role that will be mutually beneficial for you (employee) and the owner doctor (employer) is a must.
 
Too many new grads jump on the first “job opportunity” that comes along. This proves detrimental in a high percent of cases, and seems to be the “norm” for Associate positions in our profession. In this article, I want to share some questions I suggest you ask as you explore the path of an Associate position.

Too many new grads jump on the first “job opportunity” that comes along.

 
First, why does the owner D.C. even want an Associate? Do they really “need” one to see a higher volume of patients, cover more hours, or deliver better care? Is there some other plan? Or do they just “want” someone who will handle some of the work they prefer not to do? There is no “wrong” answer, but it would sure be nice to know this from the start.
 
That question leads to the next point: get clarity about your potential role. Don’t assume that, because you are a doctor, you will do just “doctor things.” The term “associate” means different things in different offices. Will you be seeing patients, and if so, in what capacity? Will that include doing consults and exams? Or covering for the employer when he/she is out of office? Will you have your own patients and do everything? Or will you only be a marketing D.C. responsible for bringing in new patients?  Maybe you will simply serve as a therapy assistant or “glorified C.A.” I’ve seen each of these scenarios, and as you might expect many of them leave the Associate very unhappy and frustrated.
 
I’d like to have you ask this: Was the employer ever an Associate? If so, what was their experience? This might give you an idea of their personality type, and establish whether or not they will be sensitive to your position in your working relationship.
 
Next, you may know what you want out of an Associate position, but ask them about their expected outcome. Where is this working relationship going? What does it look like after a year, or two years, or further down the road depending on your desires.
 
Establish your potential employer’s experience in the role you are counting on them to fulfill – mentor, trainer, etc. After all, you are probably banking on them teaching you a bunch, right? You want someone who will lead you and prove to be a great example. So, ask how many Associates they have had. Are you going to be an experiment? Do they have a training plan or agenda set, and can you see it? This will indicate “if” they really plan to make time for that teaching aspect.
 
Along with that, ask if the potential employer has an office manual. This will demonstrate if the office has systems in place. Is there an ongoing coaching plan? So often there is a barrage of half-organized training when the Associate arrives in order to hand-off what the employer doesn’t want to do. Then, the training stops before any leadership, management, marketing or other business sense is really taught.

The majority of the colleges are making a good attempt to deliver more and more business acumen to their students.

  
Find out how much they value growth. Ask them who their coach is. What sort of continuing education or training do they do for themselves? This can be a telling factor about their work ethic and desire to create something bigger and better with you there. What is their vision for the future of the practice? And, how does an Associate (you) fit into that?
 
Finally, make NO assumptions about how you will be compensated. As in so many relationships, money is often the “nail in the coffin” for a frustrated Associate D.C. Inquire about the total “compensation package.” Don’t just ask about the salary. What about bonus opportunities? How about malpractice insurance? Can you write a check for such a payment (sometimes quite large) before you ever see a patient? Who will handle that? Other things that may be discussed or negotiated include continuing education, practice building seminars and coaching, benefits, and retirement.
 
The list goes on and on, but you will never know for sure … unless you ASK! When you are bold enough to ask these questions up front, you will likely realize that many potential employers are simply not ready for that role … at least not up to your standards. If that’s the case, move on! Just say “next!”
 
As a result of being part of the business curriculum at a couple of chiropractic colleges and speaking at several others, I have made an encouraging observation. The majority of the colleges are making a good attempt to deliver more and more business acumen to their students. They realize more students need more business to succeed in practice. As this happens, we expect more and more new grads will choose to go into business on their own right from the start.
 
So, don’t be one to “assume” you have to take 2-3 years to fill an Associate position. It’s not all it’s cracked up to be. However, if you do feel that is best for you, ask questions like those above. Interview the potential employer as much as they interview you. After all, you have worked hard for that D.C. behind your name. Don’t settle for anything less than high potential, positivity and prosperity!

Dr. Bart Anderson of HealthSource Launch U (HSLU), a specialized training & coaching program for D.C.s working to start, build, and succeed quickly in a practice they own. To date, HSLU has been involved in the launching and/or owning of over 100 combined practices. Dr. Bart speaks at numerous chiropractic colleges on a regular basis. To learn more about Launch U go to www.healthsourcelaunchu.com. Or call 888-550-3816 or e-mail him directly at This e-mail address is being protected from spambots. You need JavaScript enabled to view it
 
 
Five Ways to Manage Clinics that Have Several Employees
Practice Management
Written by Tom Owen III   
Thursday, 25 July 2013 18:57
I
t is important to be proactive rather than reactive when addressing potential problems within your practice that occur when more than two or three people work in your clinic.
 
staffThe greatest asset in a chiropractic practice is the staff. Unlike other assets, staffing is a dynamic resource in terms of productivity. The need to create the right operating environment for high productivity should be a top priority for all doctors; unfortunately, many end up losing the potency of their staffs and do not prioritize developing their staffs. These are not necessarily bad intentions or motivations, but they should be sanctioned as actual business goals. Management is obliged to integrate this with the staff in an inclusive and developmental approach to unify your practice.
 
Here are a few ways to establish a growing and motivational environment with your staff:
 
Inclusive Decisions and Directives
A common model in a chiropractic practice is a doctor-directed environment where only the needs of the patient direct the reaction among the staff. This creates a passive approach among the staff where decisions are held back until the doctor approves or disproves the action. To avert this negative approach, any development in skill, treatment methods, and patient management should be made with the staff’s full participation. This does not strip the managerial team of their authoritative rights, and it empowers them to focus on strategy while mid-level decisions are conducted according to business management goals.
 
Communication and Team Effort
The diversity of skill among your staff is the very reason why there is measurable success. In human resourcing, division of labor accounts for the largest degree in efficiency, the ability for all to work in a team. The passive presumption that skill diversity is categorized in levels of importance reduces the ability to communicate within the team. For instance, the most critical staff members are the doctors. Critical staff members may be at a high level of importance, but they are only effective with supporting staff for administration of the treatment, documentation, and accounting among other skill diversities. A better approach would be to regard each member as critical to the overall success of the establishment.
 
Transparency in Operations
Staff attitude is governed by the attitude of the doctor or management staff. This is predicated by privileged access to business operations and performance. Informing the staff with current business performance information is one way of establishing a positive attitude. This gives each staff member the confidence to respond toward the success of the business; for instance, transforming the staff into marketing agents or rewarding staff members for bringing in the greatest numbers of referrals because they believe in chiropractic to deliver results.
 
Unifying Purpose
Everyone needs to play their roles in the establishment of the business objective and goals, and the doctor and/or management need to connect the dots for all of the staff in regards to participation toward the business’s goals. This gives each of them purpose—a drive for the intent of establishing the success of the business. Human beings are purpose-centric, so the drive of most doctors is to relieve patients of suffering and enhance the quality of their life experiences. Should this be a unifying purpose for the business, then all the staff must relate to it, no duty should be routine or be labeled as mundane, and it must connect to the organizational goal.
 
Incentives
Benefits rewarded for remarkable performance is a good incentive towards an effective and efficient team. These benefits could include medical insurance, dental insurance, bonuses, gift cards, or paid holidays or personal days. This would appear as a great cost, but if one believes in the staff, which is the recommended approach, then one would not hesitate to invest in them as part of the business success.
 
Summary
Admittedly, managing multiple staff members requires a unique model of operation, but it should not be at the cost of large staff turnover, reducing performance rate, non-inclusive routine tasking, poor communication, or other causes springing from a lack of staff development and building. The purpose remains for the patient, but the quality of service administration lies with the staff members, who, without deliberate efforts by the doctor to grow and develop them, will inadvertently lead to poor patient administration and care.
 
 
How to Develop an Entrepreneurial Mindset
Practice Management
Written by Tom Owen III   
Tuesday, 25 June 2013 19:09
W
hen you first envisioned yourself as a chiropractor, you were probably focused on the opportunity to help people who were suffering from pain. However, most chiropractors realize quickly that the lessons they learned in school aren't enough to gain success in the real world. Chiropractors also need business knowledge and entrepreneurial spirit if they hope to run their own practices.
 
dreambigOf course, an entrepreneurial spirit isn't simply born overnight. That's why it's so important to start developing your skills as soon as you've finished school. With training, passion and commitment to the field, you can develop an entrepreneurial mindset that will help you achieve success. Use the five following strategies to train yourself to think like an entrepreneur.
 
Shift Your Thinking
First, it's important to recognize that you're not actually trying to start a chiropractic practice. You're attempting to open and run a small business. Before you can begin seeing patients, you need to complete tasks like finding an office, setting prices, hiring staff and assistants, marketing your services and working out terms with insurance companies. Whether or not you're interested in the business side of your operation, you can't avoid the logistical half of the job. Until you can think of your practice as a business, you'll have a tough time turning a profit.
 
Consider Unique Marketing Approaches
As a chiropractor, you'll be working closely with your patients. Your success will hinge largely on the quality of the relationships you can build. Fortunately, many of the latest trends in marketing focus on the importance of personal connections. Instead of relying on traditional advertising methods like mailers or television commercials, think outside the box. Use new media like social networking or a blog to spread the word about your practice. These approaches help you reach new customers while also helping you to hone your entrepreneurial skills.
 
Set Yourself Apart
Entrepreneurs know how to set themselves apart from the crowd, so you should focus on finding something that makes you unique. Whether your practice specializes in a particular healing method or whether you offer a follow-up care package, it's essential to find a way to differentiate yourself from the competition. As you begin to think about your practice as a business, consider how you want others to think of you. These qualities and impressions can help you solidify a brand for your practice.
 
Manage and Delegate
Business owners understand that they can't operate alone. Similarly, you'll need to work with other people to create a successful chiropractic practice. Many inexperienced chiropractors suffer from an inability to delegate tasks to other people. Because they are used to relying on their own skills and knowledge, it can be tough to allow others to get involved with the practice. However, you can reduce substantial waste in your practice by hiring a small staff and delegating particular duties to each person. Best of all, you'll free up a significant portion of your own time so that you can focus on your patients and the other most important parts of your practice.
 
Dream Big
Finally, remember that no dream is too large for a true entrepreneur. The entrepreneurial mindset is marked by passion, hope and big goals. Set targets for yourself and reward yourself for the small successes you achieve on the way toward your larger dreams. In school, most people learn how to fit their dreams into traditional archetypes. As you set out to build your own practice, you'll have to train yourself to think in a less restrictive way if you hope to achieve true success as a chiropractor.
 
Pay Now or Pay Later...Expanding into Three Clinics and the Cost!
Practice Management
Written by Tim Gober, DC   
Monday, 25 March 2013 21:02
growthaheadsign
G
ood staff will do. Imagine you were planning on building a health care empire.  Would you have time to be so picky about hiring new staff that you would delay months just to find that perfect staff member?  Would you have time to constantly turn over your staff? This process is costly, decreases morale, and ultimately slows you down from achieving your goal.  Hire people who have the basic qualities that any employee should possess.  Beyond that, it is your responsibility to see to it that they are trained properly to serve their purpose.  Great companies tend to create a noticeable culture amongst their employees, and the company's expectations and standards are built into that culture.  A new employee working with such a company should quickly understand what is expected of them regarding work ethic, punctuality, detail, and customer service.  Once these basics are in place, training on their job specifics is simply a function of planning and time.  Be patient, have fun with them, encourage and guide them, and redirect when necessary.  Remember, you are building an empire and you don't have time to lose them and start the process over.  A word of caution:  If your hiring standards are too high, and so few will do in order for your company to be successful, you should reconsider your practice model.  Subway was recently named the most profitable fast food chain, with locations in 85 countries, 150,000 employees, and total annual sales of 9 billion dollars 1.  The simplicity of Subway's business model has been the key to their success.  If they relied on only hiring that one-in-a-million staff member, they never would have grown to the top so quickly.
 
Slow down to speed up.  Commit early to training an associate D.C. as a future clinic director.  Most clinic owners resist this step, since it usually decreases profits in the short term.  Of course the associate D.C. isn't as good as the owner, and they make more errors.  However, if you are patient and dedicated to the training process, the return is substantial because it allows you to replace yourself in the business.  It frees you up to spend the bulk of your time working on the business, not in the business.  Is it more important that you perform the hands-on care yourself, or would you rather be responsible for exponentially more patients receiving care because of the practice you have created?  Not only are extra patients receiving care, expansion also creates more jobs, and more opportunities for advancement within your company.  You win, your employees win, and the patients win.  Have you ever heard that learning how to play golf and tennis is a good idea, since both sports can be played into your elder years?  Well, learning how to train and manage another doctor to run your clinic successfully follows the same concept.  The sooner you learn this vital skill set, the sooner you will be positioned to expand more successfully.  Pay for this experience now, and not later.  Who knows what can happen later.  You have the opportunity to do it now, so get started. 
 

Quick response ads and spinal screenings are nothing but short-term solutions.

Branding works, and prostituting does not.  Many D.C.s that fancy themselves as marketing savvy will tell you that long-term branding is ineffective and a waste of money.  This couldn't be further from the truth.  Quick response ads and spinal screenings are nothing but short-term solutions.  They will not positively contribute to your company's reputation.  Think about it:  You are sending the message that you need patients, and are willing to give away or discount services in order to get them.  Instead, focus on developing the qualities that make your business different.  Determine the best platform to send that message.  Then, begin establishing relationships with as many community members as possible.  Start with the most obvious sources, and go from there.  Once you have reached a critical level of branding, multiple sources of referrals will consistently show up.  Everything gets easier.  Just as more patients attract more patients, more professional referrals attract more professional referrals.  How we did it: Our branding started with informational television commercials, none of which offered discounted or free services. In addition, we began building relationships with the primary care providers and specialists in our community.  As our frequency of calls increased, we had to form a separate call center which allowed all incoming calls to be funneled to a separate location.  Next, we began tracking the calls, and the information that process gave us was priceless.  We discovered that many patients were coming from other towns, and when it was time to open a second clinic we already had supporting data to decide on which location made the most sense.
 
The two step satellite process:  We subleased the space of our second clinic, and began a part-time schedule there. We shared staff between the two clinics in order to minimize the transition costs.  After maximizing our part-time schedule with services, we then moved to step two:  Expanding into our own space within the same building, and offering a full-time schedule.  This two-step plan for a satellite clinic allows you to test a new area before committing to a long-term lease, and the expenses that come with staffing and supplying a full-time clinic.  
 
Make a strategic plan.  Start with a practice model that allows for a large profit margin.  For us, it was the integrated health model.  Determine the best fit for you.  
 
References: 
  1. The Editors of Publications International, Ltd.  How Stuff Works [Internet].  [2007 Sep 15; cited 2013 Feb 7]. Available from: http://money.howstuffworks.com/9-most-successful-fast-food-chains.htm
Tim Gober, D.C. is the President and CEO of The Integration Group, a consulting company specializing in multidisciplinary integration for D.C.s. He is also the owner and founder of The Baltimore Pain Relief Centers. Dr. Gober can be contacted at This e-mail address is being protected from spambots. You need JavaScript enabled to view it
 
Small Business Strategy: 4 Vital Tips for Success
Practice Management
Written by Tom Owen III   
Monday, 24 December 2012 04:59
M
uch hard work goes into beginning a new business, and we all know that blood, sweat, and tears are the primary ingredients for success.  However, it takes much more than that to establish a thriving business. In building your chiropractic business, many other factors also come into play. After many years of running a chiropractic business, my partners and I have come to understand that there are a few elements that are absolutely critical to becoming successful. The following four tips should help you fine-tune your chiropractic business and have your message reaching the masses in no time.
  
Choose your Name Carefully
chessboardFirst of all, your business will need a name.  And not just any name, but something people will remember.  A clever, descriptive name is actually a smart business strategy.  The name of your business is key.  Although it is difficult to come up with a name that is descriptive, yet one of kind, many people have had success with this.  For example, Coca-Cola's name comes from the coca leaves and kola nuts used as flavorings in the original drink.  And Google derived its name from the fact that you can find a "Googol" of information from an Internet search engine (a “Googol” is the number “1” followed by 100 zeros.)  Put much thought into your name—it is imperative that people can remember it and recommend it to others via the best kind of free marketing: word-of-mouth. 
 
Promote your Practice
Once you have a name, you will need to advertise and market your business.  Marketing is of utmost importance. Without it, there will be limited or no growth. Marketing your chiropractic business is necessary from the very beginning, and needs to be a continuing part of your overall business strategy. 
 
Direct mail is one of the oldest and most effective ways to reach your market. You can rent or purchase a mailing list and then mail postcards to announce or promote your practice.  Your mailings will go out to areas in the vicinity of your practice.  Your postcard can educate the public on various treatments and services while also advertising your name and location. 
 
In addition to postcards and mailings, the Internet is another great way to draw attention to your business.  These days, people are constantly online, so having a website for your chiropractic business is essential. The website can be simple and does not need to be fancy or expensive. But even a basic website should look professional, should contain a short bio for each doctor or provider, and should list your services, address, and contact information, including email.
 
It’s important to remember that marketing does not stop once you have a steady flow of patients.  To maintain your clients and continue to grow, you must continue to market your business from within your business.  You may consider setting up a monthly theme in your office or a birthday board with patient’s birthdays posted. Periodically emailing your clients with newsletters, updates, and special discounts is another good idea.  Offering occasional promotions, discounts or free screenings is a great way to attract new business and show existing patients that you care. The business strategy here is to encourage patients to strike up conversations about your business.  Again, the best marketing is word-of-mouth, and it’s free!
 
Manage your Business
Regardless of how well you advertise your business, you will only be as successful as your management practices allow.  Before you ever delve into a new business, consider the cost.  Literally sit down and make a basic spreadsheet to consider the upfront cost of beginning your business.  Consider your operational costs, marketing costs, and the costs of your supplies.  Make certain that you have enough capital before you start.
 
Next, consider your cash flow. You need a steady cash flow to continue to thrive each month until your business is steady.  If you need more capital or cash, consider these options: 1) Partnership. A partner can share the cost, but will also share the potential profits. Your partner also needs to be someone with whom you share mutual trust and with whom you get along well. Weigh this option if necessary.  2) Cost cutting. To cut back on initial costs, find employees--perhaps friends or family--who are willing to work for deferred salaries in the beginning.  And postpone any and all purchases as long as possible. 
 
Pamper your Patients
Most importantly, your customers, your patients, are your most valuable assets. Without them, your business is nothing. Once you have a client, you must work hard to keep him by exceeding his expectations. It's much cheaper to keep a client than to attract a new one, so keep clients happy and keep them coming back. Your customers are also your greatest and least expensive mode of marketing. Call them on occasion, just to check on their wellbeing. Get to know them and develop a relationship with them through dialogue in the office. Treat them well and they will spread the word for you.
 
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