Practice Management

Self Esteem, the Missing Link in Practice Success and Satisfaction
Practice Management
Written by Dennis Perman, D.C.   
Wednesday, 29 February 2012 14:43
he most important things in life come from inside out – happiness is inside-out, love is inside-out, health is inside-out, and indeed, success in chiropractic practice is also inside-out.

selfesteemSo, what do you need inside you to experience the level of success and satisfaction in practice that you desire? There are many qualities that figure into this equation – discipline, creativity, presence, healing consciousness, willingness to do whatever it takes, decisiveness, confidence, technical skill, motivation, passion – to varying degrees, such characteristics seem to be predictors of practice growth and development.

But there is a single attribute that seems to drive all the others, and that is self esteem. You cannot develop or demonstrate any of these other traits unless you believe yourself to be worthy of so doing. Self esteem is the foundation of all positive movement, professionally and personally, so it will help you to understand and appreciate the importance of self esteem, and the ways to evaluate your own self-image to make the most of yourself and your practice.

Dr. Nathaniel Branden, author of The Six Pillars of Self Esteem, says that self esteem is feeling “competent to cope with the basic challenges of life” and  “worthy of happiness.” He goes on to say, “It is confidence in the efficacy of our mind, in our ability to think… our ability to learn, make appropriate choices and decisions, and respond effectively to change. It is also the experience that success, achievement, fulfillment — happiness — are right and natural for us.”

Notice the impact of self esteem on your evolution as a professional and as a healer – you’ll have to see yourself as being competent to deal with challenges and being worthy of happiness to generate any personal or professional progress. Why would you work at improving yourself if you didn’t feel competent and worthy? These are the precursors to optimal performance, and an invitation to achieve at the highest level possible.

And that’s why it’s so important for the doctor of chiropractic to understand the role self esteem will play in his or her practice success and satisfaction. Let’s compare those with sufficient self esteem and those without, and note the distinctions between them, so you can identify where you are in this continuum and take the necessary next steps.

Doctors with high self esteem feel good about themselves and their work. They are proud and confident, inspired to share their ideas, and driven to provide an outstanding service. These doctors invest in themselves, through seminars, reading, online courses, coaching, masterminding, and otherwise enriching their internal maps, imprinting new ideas, constantly learning, and sharing with patients and other doctors.

Doctors with high self esteem have fair policies and effective, enforceable procedures. They are comfortable discussing finances with patients, and confront gently and professionally to guide patients toward compliance. They are neat, timely and organized, and they lead their teams with integrity, while caring attentively for their patients. They are reliable and service-oriented.

Doctors with poor self esteem, on the other hand, may feel insecure, indecisive, and weak. They resist change, are defensive, and underachieve for lack of drive to succeed, since they don’t feel competent or worthy of success.

The same thing happens when you get squeezed – what comes out is what’s inside.

You can build self esteem by reinforcing positive habits and behavior patterns, and by establishing a constructive inner environment, so you perceive the world optimistically and respond accordingly. You can use affirmation, visualization, empowering self-talk and goal-setting to shift your self-concept, among other self-development tools and techniques. Self esteem influences every aspect of a chiropractic practice.

It encourages confrontational tolerance in asking for referrals, addressing delinquent payment or re-delegating staff responsibilities. It turbocharges your patient compliance, because patients will automatically gravitate toward and follow the recommendations of a doctor who is certain and authoritative without being unpleasant about it. And finances are managed more efficiently because the doctor and staff with good self esteem expect to be properly compensated for their excellent work, and won’t settle for less, since it would be out of balance any other way.

Like Wayne Dyer says, when you squeeze an orange, what comes out is orange juice, because that’s what’s inside. The same thing happens when you get squeezed – what comes out is what’s inside. In practice, every day you’ll need to perform professionally, charismatically, and compassionately. You’ll also have to deal with patients or staff who may need extra guidance to stay on course, families who struggle to afford the care they need, and people’s very real health challenges.

For those reasons and many more, you must feel good about yourself as a person and as a doctor to effectively handle modern-day practice. Who you are determines how well what you do works – success comes from you, not to you.  Show up as a better version of you and your patients will be better served, and  your overall practice experience will be more fulfilling.

Dennis Perman DC is co-founder of The Masters Circle, a leadership coaching, practice building and personal development company for chiropractors. The author of numerous CD albums and books, and the executive producer of TMCtv, the world’s largest online video success library for chiropractors, he has published “The Column” every week for over thirteen years. Contact him at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

Murphy’s Law (1) When Starting a Practice
Practice Management
Written by Dr. Peter G. Fernandez   
Wednesday, 29 February 2012 11:45

“Murphy's Law” is an old adage that is typically stated as: "Anything that can go wrong will go wrong". When you start a new practice you’ll experience many examples of Murphy’s law. I’ve opened over 3,000 new practices. Just when I think I’ve heard them all, a new twist on Murphy’s Law comes along. Here are a few of my favorites. I offer them with the hope that they just might help you avoid getting “Murphied”.

Everything takes twice as long as you think it will – then double it.


ook at your projections … then double the length of time you’ll need to open your new practice. You’ll find that whenever you set out to do a task, something else must be done first. And if you think you don’t have time to do something right, you’ll always find time to do it over again. I’ve had many clients who tried to rush into practice. The day they arrived in town they put up their “open” sign. Unfortunately, the city noticed that they didn’t purchase their city and county licenses and closed them down. Then when they solved this problem they rushed into practice… forgetting to apply to and sign up with Medicare, HMOs & PPOs. Therefore they didn’t get paid. All that work and stress resulted in extremely little income and more stress. Trying to speed up the process doesn’t work. Unfortunately, you’ll find that out when you skip a step, it will take longer because every shortcut breeds new problems. This results in the saying, “A shortcut is the longest distance between two points”.

Don’t try to establish an opening date for your practice. You’ll never open on that date. Your opening date will occur when everything that needs to be done is completed…not until then. Remember, everything takes twice as long as you anticipate. And if you pressure yourself to open on a certain date, all you’ll accomplish is greatly increasing your stress…unnecessarily.

Nothing is as easy as it looks... nothing. EVER!

The best made plans usually go from bad to worse. Most of the time when you apply for a remodeling permit the city won’t approve it. When they do approve it they will usually change their mind. When you are ready to sign your office lease, the landlord will lease your office space to someone else. That’s Murphy’s Law.

When you cheat… you’ll get caught… KARMA

When a doctor tries to remodel his/her office without a permit, he/she will usuallly get caught. Too many times a doctor will try to save money by not paying for an architect to design his/her office to city specifications, not paying for building permits, etc. He/she is trying to outsmart the system. This doesn’t work. City codes are made to protect you and your patients. The city building inspectors and fire inspectors will notice construction going on at your office site and close your office. At this point the city will be furious at you and will make you tear out your drywall to make you re-do the electrical, plumbing, spacing of studs and fire protection. I’ve actually seen cities make doctors tear out all the walls and re-do the process (i.e.: architect, permits, inspections, etc.). Because the city is furious at the doctor for cheating, they will be twice as stringent on their codes and inspections… and take their time approving anything the doctor does. I’ve seen cities take 1 ½ years to approve the remodeling. Imagine the loss of income you’ll suffer by delaying your opening by 1 ½ years, e.g.: $250,000 – $400,000 all because you cheated. Cheaters get caught. Every shortcut breeds new problems.

Anything that can go wrong… will go wrong.

ifitcanitwillgowrongIf there is a possibility of several things going wrong, the one that will cause the most damage will be the first one to go wrong. And, if there is a worst time for something to go wrong, that’s when it will happen. It’s amazing how contractors, subcontractors and suppliers can screw up your plans (e.g.: they will have a $3,000 X-ray tube protecting a 10 cent fuse… the x-ray tube will blow first).

If your X-ray equipment is to be installed on a certain date, it will be late. If it is on time, the floor will be uneven. If it is delivered on time and the floor is even, they will forget the lead for the walls. If it arrives on time and the floor is even and they have the lead for the walls, then the electrician has installed the wrong wiring. Does it sound like I’m being cynical? I’m not. One of my clients purchased her used X-ray machine against my advice. She had it installed and then had a contractor build the walls around it. You guessed it. The machine didn’t work and it couldn’t be fixed or disassembled in order to be removed from the room. Therefore the doctor had to have her contractor tear out the door and the walls to remove the old unit, and then place a new X-ray in the room and then replace the walls. By trying to save a few thousand dollars on a used X-ray machine, it cost her over $20,000 for the contractor to tear out and reconstruct the room. And, she still had to purchase a new X-ray unit.

Lastly, all equipment you purchase will break down after the last payment or when the warranty expires… whichever comes first.

Everything will cost you twice as much as you think it will – then double it.

Trying to save money will usually cost you more money. You’ll find that the few pennies you save will not be worth very much… considering the money you’ll lose trying to save a few pennies.

Unfortunately, the temporary joy of a lower price will soon be replaced by the sorrow of poor quality. I’ve always instructed my Practice Starters® Program clients on the brands of equipment they should buy… or should not buy. Naturally some of my clients didn’t like my advice and bought equipment that was of inferior quality, or had a history of breaking down. I remember being berated by a doctor because I told him not to buy a certain brand of adjusting table… he bought three. After a few years, I asked him how his tables were working. He got red in the face and said all three of his tables had broken down… and the company had gone out of business.

Lastly, no matter how good of a deal you get on your equipment, it will be put on sale later. Count on it.

Did you encounter a different Murphy’s Law when starting your practice? If so, I’d like to hear about it. Send it my way at This e-mail address is being protected from spambots. You need JavaScript enabled to view it . I’ll see that it gets published along with your name. For more information on starting a new practice go to

Dr. Peter G. Fernandez is the world’s leading authority on starting a practice. He has 30 years’ experience in starting new practices, has written four books and over 100 articles on the subject, and has consulted in the opening of over 3,000 new practices. Please contact Dr. Fernandez at 10733 57th Avenue North, Seminole, Florida, 33772; 1-800-882-4476; This e-mail address is being protected from spambots. You need JavaScript enabled to view it , or visit

Going Paperless in 2012? Great Tips on How to Choose Your New System
Practice Management
Written by Claude Cote   
Saturday, 28 January 2012 06:04


o the benefit of chiropractors, there are more and more full automated paperless systems available for their practice. This rapid growth in the chiropractic software industry is due to the high demand of the product, which is great for chiropractors because it keeps prices down.  With all these choices of software systems, how can you make sure you choose the best fit for you and the way you practice?    How can you make sure you choose the provider who will meet the service level you need?  Choosing the right software system and the right provider to suit your needs is very important.  This important choice will reduce your stress and will turn your money into an investment instead of an expense.  Here are a few good tips that will help you to make this important decision.

Online demo

With Internet, it is very easy to shop software systems with online demos.  An online demo can be a good start for your shopping and should be a step during your decision process, but should definitely not be your one and only step.  Software vendors will demonstrate your online demo using small databases, showing you great speed, while in reality, with eight or ten thousand patients in the system, the speed can be very different.  Since a full automated E.H.R. system includes complete patient flow management, it is just impossible to show you that aspect.

Online demos can only show you a few screens here and there but you miss the most important aspect of the system, the patient flow management.  Ask for online demos from a few vendors you are interested in and do not make any decisions at this point.  Don' t make up your mind yet and stay neutral as much as possible.

Visit a practice close to yours

Ask vendors if you can visit a practice close to yours that uses their system so you can see the system in action.  The software provider will arrange this visit for you.  If they have a good service and a good product, users and doctors are very happy to help their colleagues and show their system.

During  this visit, the users will give you some great tips on how to maximize the system based on their own experience.  By far, this live visit will give you a totally different  perspective of these systems.  Good chances are you will see happy patients coming in, swiping their Chiropractic Health Card in an arrival station, being called and being directed to a treatment room automatically.  The doctor will show you how he sees all X-rays on the screen, how he enters his accurate SOAP notes in the system and so much more.

Try before you buy

At this point, you had an online demo and you visited an office that is using the system.  You saw the system live and you really liked it.  Your decision is made.   But wait!  Seeing it and using it are different, much different.  Maybe your chiropractic technique is different from the doctor you visited.  Your office may be designed differently and your patient flow may also be different.  Don' t take any chances to lose your money or sign a contract for a system that may disappoint you.  Try before you buy.  Software providers who stand behind their product and service will give you this option.  A minimum of six months to a year of free trial will give you enough time to use the system and make sure it works as expected.  Not only will you try the product, but you will make sure you will be receiving the service and live training you need.  Worst case scenario, if the system does not work as promised or if the service is deficient, you leave and you do not have to spend any money for the software.

This is a very simple and effective plan to shop for a software system.  You can't miss and you will be assured you will be using the best automated software system for you.  This buying process can be the difference between a nightmare and the greatest investment you have ever made for your practice and for yourself.


Claude Cote  is an expert in EHR systems, insurance billing and chiropractic clinic management for 22 years.  He has installed EHR system in 18 countries over 5 continents and nationwide in USA.  He is the President and Founder of Platinum System C.R. Corp (  For comments or questions, please email to This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Building The Sports Chiropractic Practice – A Recipe for Success
Practice Management
Written by Jay S. Greenstein, DC, CCSP, CGFI-L1, CKTP   
Saturday, 28 January 2012 03:31

hroughout my travels I have had the opportunity to meet lots of great people in our profession. Many have been in practice for years, but some are in school, getting ready to graduate or just getting started. I’m often asked by these folks what it takes to build a sports chiropractic practice. The answer essentially revolves around three key ingredients. They are (1) education and training; (2) building strong internal and external relationships; and (3) hard work.   So let’s jump right in and discuss each of these ingredients in detail.

Education and Training 

sportschiropracticWhen I graduated National, I decided I was going to do whatever it took to work for a great sports chiropractor. I was fortunate enough to be hired by Dr. Jan Corwin, who was the official US Olympic Team Chiropractor in Seoul in 1988. I spent a year with Jan learning each day about what a high quality sports chiropractic practice looked like and the importance of having great relationships with people both inside and outside the profession – more on that later. When I decided to return home to my roots in Washington, DC and start my own practice, I realized I had a lot more to learn – clinically. Immediately I enrolled in my CCSP course. In that course, I was trained by some of the world’s best sports chiropractors – Drs. Marianne Gengenbach, Tom Hyde, Bill Moreau and more. Once you begin to go down the road of postgraduate training, my advice would be to never get off. Continuous education to pursue a Diplomate, an ICSSD, a masters in sports, and/or certifications in great programs such as Functional Movement Screen®, Active Release Technique®, Graston Technique®, Kinesiology taping, FAKTR®, and more, can be extremely beneficial. These degrees and certifications are not about the letters after your name – they’re about tools in the toolbox. The more tools you have the more you can correctly apply those tools to the athlete you are treating and their goals and needs. Dr. Tom Hyde, DC, DACBSP, co-founder of Functional and Kinetic Treatment with Rehabilitation, Provocation and Motion (, and one of the world’s preeminent sports chiropractors, emphasizes never stop learning, saying, “It’s amazing how far sports chiropractic has come in the last two decades. Dedication to learning has turned into a process whereby now we are teaching some of the most advanced techniques in managing the athletic chiropractic patient.  Continuous focus on education and evidence-based practice will propel the sports chiropractor to new levels in the future.” Further attending interdisciplinary conferences can be extremely beneficial. Dr. Angela Salcedo, Past President of the International Sports Chiropractic Association and now a member of Federation of International Chiropractic Sport, states, "Attending other sports medicine conferences outside of chiropractic has afforded me the opportunity to build multi-disciplinary relationships. Over the years, these relationships in turn have given me additional opportunities to build my sports chiropractic practice as the team sports chiropractor for the British Virgin Islands Olympic Committee and Track and Field team and support my leadership role in the International Sports Chiropractic Association and the Federation of International Chiropractic Sport."

Thus, investment and commitment to education and training will pay off in spades when it comes to… 

Building Strong Internal and External Relationships 

This second ingredient is not necessarily a “second step”. Building strong relationships can happen congruently as you build your sports chiropractic skill set. I always recommend that any doctor wanting to be a great sports chiropractor join the American Chiropractic Association Council on Sports Injuries and Physical Fitness (ACASC).  Dr. Corwin took me to my first ACASC convention in Santa Barbara, California. Dr. Corwin emphasizes the importance of intra-professional meetings… “Having a network of other DCs around the country to share your trials and tribulations with, knowing they are also involved in sports chiropractic can be extremely beneficial because the knowledge sharing is so strong.” Certainly for my first ACASC convention, it became abundantly clear that not only was I surrounded by phenomenal sports chiropractors, I was surrounded by phenomenal people. Every person I met was (and still is) completely engaged and committed to bringing chiropractic to the forefront of sports. Not only that, they were, and still are, committed to helping others grow sports chiropractic. I met Dr. Hyde for the first time at this convention and he literally changed my life.  He took me under his wing and helped me, and continues to help me to this day, increase my involvement in sports chiropractic. The lesson to be learned here is that had I never gone to our national association’s convention, I would have never met these people who have had such an impact on my life. And, as great as the professional opportunities that came about because of building these internal-to-chiropractic relationships, it’s actually the personal connections that I’ve made with these great folks that are the most rewarding. In addition, being part of the national association provides tremendous resources to the budding sports chiropractor. Local, regional and national events that require staffing, educational meetings and vendor resources are just a few of the many reasons to join.

The message that was reiterated over and over again in speaking with the world’s best sports chiropractors was that in order to be successful as a sports chiropractor, you had to be humble. Even though we leave school with a passion to literally change the world with our hands, we have to be respectful of the other healthcare providers on the healthcare team. I remember hearing stories of Dr. Phil Santiago, who was the official chiropractor for the 1992 US Olympic team in Barcelona, Spain, cleaning up the training room because there were no patients that day and he wanted to do something to begin to make a contribution. Those sports chiropractors who think cleaning, or helping in any way, is below them will find the road to gaining acceptance long and hard. Those sports chiropractors who are willing to roll up their sleeves and do whatever it takes to make a positive contribution, listen and respect others, and clearly communicate how they can be an integral part of the healthcare team in a manner that is humble, but confident, will excel. Dr. Alan Sokoloff, Chiropractor for the Baltimore Ravens, adds, “Most chiropractors do well to get involved with sports teams, but many of their struggles come with staying involved.  I have found good communication to be the key.  1. Communication with your team supervisor (Physician, athletic trainer, etc.) about what you recommend for the player. 2. Communication with the player and making sure your message is consistent with that of the rest of the medical staff.  3. Communication with your office and family, so they know your time commitments. The goal is to not just get involved, it’s to stay involved.”

What’s the best way to go about building these relationships? If you are already in practice, have inquisitive conversations with your existing patients about themselves, their kids, their friends and family that are participating in sports and offer your services – in your office, on the field, and/or in the company lunchroom for a lecture.  Do they know coaches and athletic directors? Do they know of community groups that are bound by a particular sport – running, skiing, bowling??? For those of you who are starting a brand new sports chiropractic practice and don’t have a patient base to leverage, use my favorite tool…Google…think about the sports you want to serve, and Google “youth football league, your town” and see what comes up. Also spend some time out of the office introducing yourself to local coaches, trainers and owners of health clubs. Dr. Peter Garbutt, President of Sports Chiropractic Australia, states, “I would say that one of the things that I found most beneficial with building relationships with other professionals was to join a sports medicine association and participate in the interests of the organization, not yourself and not chiropractic. Throughout our training and general socialization we tend to become a part of the chiropractic community automatically. We don't have that luxury within the sports medicine community, so we have to show that we are a part of that community and not an opportunist or pariah in their organization.”

There are infinite possibilities…Of course, if you’re going to be a great sports chiropractor and you’re going to have all these potential opportunities, you better get used to…

Hard work

We’re all tasked with working hard to have successful practices. But the great sports chiropractors take hard work to another level. Working in their practices during the week and then working on the weekends doing community sports events, treating patients on the sidelines or on the court, providing sports injury treatment and prevention lectures, are all critical elements to building your brand as a top sports chiropractor. It takes hard work to raise your level of education, it takes hard work to spend time building new relationships with the outside sports world – coaches, athletic trainers, parents, personal trainers, other physicians.

Most highly successful sports chiropractors work a lot more hours, and they do it not because it’s going to get them another new patient, but for the love of service. They know they can help that athlete recover from an injury faster, prevent an injury and/or provide information and feedback that will change the game in the positive direction for the athlete. It’s that commitment to service that shines through, and when intent is altruistic, great things happen.


Dr. Greenstein is the CEO of the Sport and Spine Companies, a multi-location, multi-disciplinary, evidenced-based practice in the Washington DC Metro region. He is also the President and Founder of the Sport and Spine Rehab Clinical Research Foundation, a non-profit dedicated to high quality, clinical research. He is a member of the scientific advisory board for Thera-band®. He serves on the CCGPP as the Vice Chair and represents CCGPP on the Chiropractic Summit and the Government Relations Committee.

How to Control Your Appointment Book
Practice Management
Written by Tom Owen III   
Sunday, 18 December 2011 00:32
ne subject that tends to get overlooked when it comes to the overall management of a chiropractic practice is simple appointment book control. A lot of doctors haven’t learned that there needs to be a certain rhyme and reason to every minute that is controlled by the appointment book for the practice. Because really, when it boils down to it, there’s only so much time in a day. If that time is not managed properly then it’s going to lead to frustration, distress, and ultimately, failure.
appointmentbookDon’t allow patients to come and go as they please. Schedule them. When you allow the patients to control your schedule, you’ll have a day like this: You’ve got four regular people that show up for their regular care, and then a new patient shows up and waits for an hour and a half to be processed because you weren’t expecting two of the four regular patients, and both the new patient, the regular patients, and the doctor just end up being stressed and frustrated. It just leads to a big break down in efficiency and stress that doesn’t need to occur.
One way to fix that would be something as simple as cluster booking. Cluster booking is essentially blocking time throughout the day where the CA, the chiropractic assistant, and/or the staff know they can’t book any new patients. That two and a half hours or hour and a half or whatever it may be is only to see patient visits for regular care.
Then there will be blocks of time where you’re only going to see report of findings. So if you need to fit in your report of findings, it helps you get into a groove. Also, you’re not bouncing around. You’re able to focus on the patients at hand. It really helps with the efficiency and the effectiveness of what you’re trying to communicate to the patients.
Here’s another point that’s often overlooked. This helps reduce missed appointments. If someone calls and cancels, are they rescheduled for the appointment that was missed? In other words, if they were on some type of care plan where they were scheduled to be seen three times that week but they call on Monday and cancel do you just say, “Okay, we’ll see you on Wednesday.” If so, you’ve just missed that appointment that was originally scheduled in the care plan. So that’s not a rescheduled, that’s just a missed appointment.
A lot of doctors think, well, I had 25 visits scheduled today and 24 of them showed, so we did pretty good. Well, if that was the case, in most chiropractic offices that’s not too bad. However, if they have 25 scheduled, had four missed appointments, and had five drop-ins there is a good indication that there is a problem with appointment book control.
Just on the missed appointments, forget the drop-ins for a moment, just on the missed appointments alone, do you know that if you have one missed appointment a day and you do that for a year’s time that’s over $10,000 you’ve lost? So when the appointment book is mismanaged, and even down to one missed appointment a day, that’s going to lead to dramatic loss of profits and productivity.

When I ask doctors how many additional patient visits they would like to be able to see in a day, effectively and efficiently, with low stress, most doctors will say somewhere around 20 more patients a day.
However, if it takes you 20 minutes to see a patient visit, 30 minutes to do a report of findings, a full hour to process a new patient, then you’re taking up the time in that day that you could be seeing additional patients. There is only so much time in a day, and if you keep running your practice in an inefficient manner, how are you ever going to squeeze 20 more people into your schedule?
Until you can better manage your schedule, the day that you’re going to squeeze 20 more people in is never going to come. Because that’s a stress point. And you cannot outgrow a stress point. It can’t be done until you address it. All of those inefficiencies lead to a “friendship practice” that so many doctors have. Friendship practices are those that allow the patients to come and go when they what to. Patients dictate the care, not the doctor. There’s no respect.
Until you learn to manage the business that you already have, you’re going to be constantly looking for new business. Think about that for a second. If we’re losing business, the very business that we’ve already spent a certain amount of money and time to get into our office, if we mismanage that, then we’re going to be seeking out new business before we really need it. Pay attention to the appointment book and determine to become more effective and efficient in your practice.

by Tom Owen III, and Todd Osborne, D.C.

Page 5 of 37
TAC Cover
TCA Cover
BL Cover
Buyers Guide

Click on image above
to view the
Digital Edition






TAC Publications

The American Chiropractor Magazine: Digital Issues | Past Issues | Buyer's Guide


More Information

TAC Editorial: About | Circulation | Contact

Sales: Advertising | Subscriptions | Media Kit