Practice Management

5 Warning Signs that You're Not Developing Your Staff
Practice Management
Written by Tom Owen III, and Todd Osborne, D.C.   
Sunday, 25 April 2010 00:00

One of the areas in business management that is consistently overlooked is staff development. Most chiropractors dislike the management side of running a chiropractic business because their hearts are dedicated to serving their patients. The reason why so many doctors continue to improve their clinical skills and techniques long after graduation is that they are designed by nature to be passionate healers. However, they are not necessarily inwardly driven to improve their business skills or knowledge in practice management and, as a result, the business side of their practice usually has room for improvement.. development should be a priority for every practicing chiropractor. There will never be a practice that will outgrow the development of the people who work within it. Many chiropractors are ignoring the most valuable commodity they have, their staff.

Development of yourself and others is one of the most rewarding privileges that business ownership provides. Staff should feel they are developing daily or they will become disengaged and bored or, even worse, treat their positions like a job rather than a career.

Does this sound like your practice environment? Here are five warning signs of staff under development.

1. High staff turnover

2. Your greatest source of internal referrals is not your staff

3. Your patients would score higher than your staff on chiropractic knowledge

4. Your services/collection ratios average less than 90% per month

5. You would rather have a root canal than an office staff meeting

Simply put, you are not leading anyone if you are not developing someone. If you are only known as the "check signer," that makes you the boss, not the leader. Once a doctor has taken an active role in leadership and mentoring his staff, the production or revenue in that office increases. In fact, you will never reach stress-free production levels without good staff, and that only comes from staff development.

People are starving for leadership. Nobody wants a dead end job. However, in environments where there is a lack of leadership, this is exactly the result. If you make an effort to become a leader within your practice and require accountability from your staff, you will be surprised with the results. Regularly we hear, once a doctor has taken an active role in leadership and mentoring his staff, the production in that office has a substantial increase.

We realize there are many chiropractic doctors struggling to pay their bills and keep their practices afloat. With those valid concerns on their mind, leadership skills may be the last thing they care about right now. Nevertheless, taking an interest in developing staff and their leadership skills may be the very thing that provides the growth that practice so desperately needs.

Doctors, you owe it to your staff and your practice to take charge. In fact, your practice will never reach its full potential without staff development.

Find someone who can mentor you and provide some leadership skills in practice management. Once you gain some confidence, you will find there is a motivating, self-confident and worthwhile leader lying dormant within you who is ready and able to share this skill with other members on your team.

Give me a great doctor and a poorly developed staff and you will get mediocre results. Give me a mediocre doctor with a highly developed staff and the practice will flourish! You may be surprised to know that it’s not you that determines the outcome of your production, it’s your staff. An investment in your staff is an investment in your practice. Help them develop personally and professionally. With your help they can thrive and, when they thrive, so does your practice!


Tom Owen III, President of AMC, lectures extensively from coast-to-coast to thousands of chiropractors and students annually. He is the author of Chiropractic from a Business Man’s Perspective, and has spent the last 25 years in the day-to-day trenches of the chiropractic profession. He lives by his quote that "In the end, all that is left are the lives we’ve touched and to what extent they were changed."

Dr. Osborne, a 1989 graduate of Palmer College, ran a successful high volume multiple doctor practice, and is currently Vice President of AMC, Inc., as well as an author and lecturer. Visit or call (877) AMC-7117 for more information.

The Future of Chiropractic: Personality-Driven Practice or Process-Driven Business
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Practice Management
Written by Gerard Hinley, D.C.   
Sunday, 25 April 2010 00:00

As chiropractors, we all strive to accomplish bigger and better things throughout our careers. One of the dilemmas is how can I best grow the practice?

To answer this, many DC’s think the only way to accomplish this is to emulate other successful doctors in the field. We study what they say, their mannerisms, personalities and simply try to "be them." Unfortunately, being someone else 8-hours a day, year-after-year can create internal strife, foster unhappiness and, potentially, lead to feelings of living a lie.

Personality-driven practices, solely based upon your mission or acting out what others say, lead to patients gravitating toward the personality in the practice versus the power, process and principle behind the chiropractic adjustment in a true business setting. A personality-driven practice may build income, but it will not build equity. day, after 19 years of practice, I looked out on a roomful of patients waiting for their adjustments and realized if I was not the doctor there that particular day, they may not be there either. This may be a great feeling for one’s ego, but not a great approach to growing a practice.

If the delivery of chiropractic in your office is based on external emotion only, you have based the success on your mood, energy level and your attention to the practice or your feelings that particular day. This is the main reason why some practitioners fail to achieve consistent and sustainable growth.

Each year, on review with my accountant, I am told that my practice is worth 3-6 times the last year’s net. I always wonder to myself, Is it really?

There will be a time when I will walk away from active practice. I want to think that what I have worked for made a difference in thousands of my patients’ lives and that my practice is actually worth something sellable and on-going for the next generation.

Take a look at your practice now and ask yourself, What is it really worth when you are not there delivering the care on a day-to-day basis?

Personalities, your own driving the practice or your imitation of another, also make sustainability and reproducibility a major problem for our profession. A practice that simply produces when you produce can also lead to lives that tip out of balance. If balance is an issue, move toward proper process. Find work-life balance by examining equal parts: Family-Faith-and Fulfillment.

Faith means growing into a person of assured ethics and unwavering honesty in order to connect with your purpose. Family balance only happens when we grow to value the important relationships in our lives and this only happens when our spouse, family and loved ones never fall second in line to our practice. Fulfillment is attained when we reach our greatest potential, provide for our loved ones, caring for our patients and enjoying the rewards of a work-life balance.

This morning, I experienced, first-hand, the importance of a self-sustaining practice. As I arrived at the office, I fell on the ice and immobilized my shoulder. After a few adjustments, the pain intensified and I shifted my role to Administrator, as my Associate Doctors kicked in without missing a beat.

A self-sustaining practice allows us all the freedom of never "falling" (no pun intended!) out of balance and, at the same time, builds equity in the business. By having a process in place for sustainability, you create a practice based on delivering the power and principle of chiropractic to be valuable and bullet proof from any variable. As well, proper delegation, through a well documented training process and a curriculum, is how to turnkey your employees to produce regardless of personality, emotions or economic variables.

To transition to a business model, from merely a practice, one must first examine the following:

1) exactly what you want;

2) how you intend to proceed;

3) what is important to you;

4) what you want the practice to be; and

5) how you want to get there.1

A battle between Doctor as owner vs. employee must be determined to get you working through solid processes ON the practice—not just IN the practice.2 Resolve the conflict by determining the most effective way to do the job you are doing and then document that job. Once you have documented the job, create a strategy for replacing yourself with someone else (another Doctor or paraprofessional) who will then use the documented system exactly as you do.3 Use your new employees to manage the newly delegated system. Improve the system by quantifying its effectiveness over time and repeat with any process where you are acting as employee rather than owner.4

In addition to these recommendations, I encourage the most repetitious and time consuming procedures be replaced by blue-ray video. By doing so, you pre-frame value and education into the patient process as patients will find videos cutting-edge, more authoritative, and factual than most doctor-driven processes. This type of educational process, tied in with solid care plan options and financial recommendations, produces exceptional outcomes in a process-driven chiropractic business.

The chiropractic families that we see now are amazed, excited, and in awe with superior service and clinical outcomes. They refer friends and family because the systematic process anchors them to the principle of chiropractic and not just the practice owner.


Dr. Gerard Hinley is a 20-year practitioner and co-owner of Infiniti Group, LLC, a company created to cultivate the power in chiropractors’ lives, by building purpose-driven, profitable, reproducible, self-sustaining businesses that enrich and balance the doctors’ lives, as well as those they serve. Dr. Hinley is co-creator of the Care Plan Calculator, which simplifies care plan options and financials for the chiropractic office. He may be reached at or to master financial care plans at


1. The E-MYTH Physician, Gerber, Michael E., page 113

2. The E-MYTH Physician, Gerber, Michael E., page 28

3. The E-MYTH Physician, Gerber, Michael E., page 28, 29

4. The E-MYTH Physician, Gerber, Michael E., page 29

You Don't Know What You Don't Know
Practice Management
Written by Tom Owen III, and Todd Osborne, D.C.   
Thursday, 25 March 2010 00:00

We’ve never met a chiropractor who came out of Chiropractic College with the business wisdom that they needed. The average chiropractor or chiropractic student has spent anywhere from $150,000 to $200,000 to be educated in the philosophy, science, and art of chiropractic but, upon graduation, they still come out with little to no business education or experience. It’s not that a chiropractic education isn’t worth that amount of money, it certainly is; it’s just that our colleges don’t teach complex business principles.

From the initial decision to go to chiropractic school through the entire education and degree process to the licensing and board review process, most chiropractors never thought about the fact that they had to be a businessman or businesswoman once they graduated and started their career. The average mindset of the new graduate is, "If I open my doors, they will come;" and once they figure out that it doesn’t work that way, they become disengaged with the prospect of running the business, because they simply want to love and treat the patients, not run the day to day operations of a self-employed business.

In the chiropractic world today, the CCE requirements and restraints that the universities are put under make it nearly impossible for our schools to teach the business principles necessary to succeed as a practicing chiropractor. Let me take this opportunity to say that most universities do a great job at preparing students in the philosophy, science and art of chiropractic but, because of the lack of business education, we find our profession in a state of disillusionment about what it takes to operate a chiropractic practice. Statistics show that 82 percent of our practicing chiropractors nationwide struggle to pay their bills or don’t pay them.

Over all the years that we have been around chiropractic, we have gone to many graduations at various chiropractic schools. As we sit there and watch the graduates walk across the stage, we always ask ourselves, "Which two out of each ten graduates are actually going to be successful?" Of actual graduates, 50 percent of them fail, and nearly 20 percent of them never even use the diploma, itself.

We believe that this failure rate is due to the lack of business training. The principles that a businessman utilizes to make his or her business flourish are so foreign to the chiropractic profession. Over the years we have seen that most chiropractors have a tendency, regardless of their background, to envision the operation of their practice completely differently than how the business world would approach such an endeavor. Most doctors, upon graduation, think they know how to pick markets and locations, how to manage the practice, staff it, equip it, market it, etc. But, once they get out and start practicing, they realize that knowing how to run an efficient, proficient, productive, and profitable chiropractic practice is not as simple as they thought.

Obviously, we can’t address all the nuts and bolts of running a practice in one magazine column, but we can tell you that, if you’ll remember these three things, it can help put you on the road to being successful as a chiropractor. If you get these three things right, it’s hard to fail. If you make a mess of any one of these three factors, you’re going to have hard times. It’s like a three-legged stool. Leave one of those legs off and you’ll probably end up on your tail.

What are the three things to remember? Get the right LAND, use the right PLAN, and be the right MAN (or WOMAN). With that formula, it is hard to fail.

What happens nine times out of ten in today’s world is the chiropractors are picking the wrong land. They’re choosing the wrong markets for the wrong reasons. They’re picking the wrong locations for the wrong reasons. They have no idea what goes into choosing a good market for a chiropractic practice.

To add to those mistakes, the doctor doesn’t have the right plan. Many doctors don’t utilize any type of business system at all. In today’s world, overhead is too high; marketing is too expensive; you can’t afford to shoot from the hip any longer. You have to have a genuine system from A to Z that answers how to run a successful chiropractic practice.

And, even if the right concepts and procedures are in place, the doctor still has to exemplify the right attitude, be willing to put action behind the right attitude, and be committed to being a life-long learner. When you’ve decided you know it all, you’re on the wrong road! Be willing to learn and grow as a person.

You don’t know what you don’t know. Commit to finding out what it is that you don’t know, commit to learning, and change your situation. Remember the definition of insanity? Doing the same thing over and over and expecting different results.

Get educated on the business of chiropractic and let 2010 be the year that you help more people with the power of chiropractic than ever before.


Tom Owen III, President of AMC, lectures extensively from coast-to-coast to thousands of chiropractors and students annually. He is the author of Chiropractic from a Business Man’s Perspective, and has spent the last 25 years in the day-to-day trenches of the chiropractic profession. He lives by his quote that "In the end, all that is left are the lives we’ve touched and to what extent they were changed."

Dr. Osborne, a 1989 graduate of Palmer College, ran a successful high volume multiple doctor practice, and is currently Vice President of AMC, Inc., as well as an author and lecturer. Visit or call (877) AMC-7117 for more information.

The Key to Opening Any Practice
Practice Management
Written by Dr. Miles Bodzin, D.C.   
Thursday, 25 March 2010 00:00

I was watching some professional baseball players warm-up before a game and it dawned on me. They’re doing the exact same thing I see the local little league players do. They were practicing the basics. I am sure every one of those players knew how to do the basics. But there they were, practicing them anyway.

My question for you is, are you a professional? If you are, are you practicing the basics? Are you mastering the basics?

Why is mastering the basics the single-most important topic? Because it will keep you focused on patient retention. By the end of your first year in practice, if all you did was focus on new patients (which are important) and you put little emphasis on mastering the basics, you will end up with a practice that is symptom based; one that will always need a constant source of new patients. You see, patient retention is the key to profitability. At the end of the day, you need to be profitable to stay in business. What do you think is the #1 reason businesses close? Failure to be profitable.

So let’s review the things you need to master so the new patients you work hard to get, stay with you for years to come.

Basic #1: Always start with the end in mind. You need to develop an attitude of knowing what you are trying to accomplish with everything you do. This is especially true for your office procedures & systems. So, keeping this in mind, let’s review the rest of the basics.

Basic #2: Mastering the Consultation & Exam. Not only do you need to get the clinical data to help the patient, but you need to also find out what to accomplish in the consultation & exam. You need to make sure you let the patient know what you are looking for so you can then report back to them in the clinical report of findings, if you find it. Are you looking for subluxations? Posture? What? Then, in the exam, let them know if what you are observing is indicating evidence of subluxations. "Mary, your posture shows your head is 2 inches forward. This indicates…." Another thing that should occur is an invitation of the patient’s spouse to attend the report of finding. Having the spouse at the report of findings is very important.

Basic #3: Mastering the Clinical Report of Finding (ROF) & Care Recommendations. The clinical report of findings is probably the most important part of the process to master. The spouse should be there. Let me cut right to the chase. The only thing that needs to be done in the ROF is to give the patient enough information for them to justify hiring you to help them. That’s it. This is not the time to teach them everything about chiropractic. This is not the time to scare them into care. This is the time to act as if you could care less. Not to say you do care less. But you can’t come off sounding like you need them more than they need you. The topic of the clinical ROF is a very large topic that cannot be fully explored here; but make sure you spend the time you need in mastering it.

Part of the ROF will be recommending care. The bottom line with recommending care is - Just do it! Don’t be wishy-washy. Don’t say, "We’ll see you for a while and then I’ll let you know what we need to do." Patients expect you to know approximately how long it will take to get them well. So tell them the truth.

Basic #4: Mastering the Financial Presentation: Once master Basic #3, this becomes super easy. You see, when a patient is armed with the information they need to justify hiring you, presenting finances is not a challenge. By the end of the clinical report, you should be hearing the patient confirm that they want to get started with care. The next natural step is to review the financial plan you offer for them to pay for the services you’re recommending. Once the patient gives you the go ahead to discuss finances, the key here is to have a comprehensive financial plan that covers your entire treatment plan. You need to master creating a good payment plan.

Basic #5: Mastering Re-Evaluations: Doing re-evaluations is important for a variety of reasons. Of course, there’s the significance of monitoring the clinical changes your patient is making. However, that’s only part of their importance. Patients need to know that you know they’re making progress. Using an objective tool to measure their changes is crucial. Have you ever heard, "You go to a chiropractor, you go for the rest of your life," said in a negative way? Where do you think that comes from? It doesn’t come from the docs who show their patients why they need care and then show them the progress their making. It comes from the doc who rarely does re-evals and starts care by saying, "Let’s see you for a while and see how you do." You see, if a patient does not know how they are progressing, they will make their own assumptions. "I guess the doc just wants me to keep coming back." Patients have no problem committing and sticking to long-term programs of care, if they are monitored on a regular basis and shown that progress is occurring.

Basic #6: Transitioning to Wellness Care: The point when a patient has completed their initial corrective care program and is ready to transition to wellness care is one of the most common times a good patient will be lost. Why? Simply because you’re asking them to make a decision if they want to continue with care or not. It’s not that they don’t want to continue with wellness care. It’s that they have to make a purchase decision. They ask themselves, "Do I want to buy again?" This is especially true for offices where they primarily have patients pre-pay for 12-months of care at a time. Using an automated system with monthly payments nearly eliminates patients from dropping out at this time. (Consult state laws to verify pre-paying is an option for you).

Master these basics. Then make sure you practice them throughout your career. There will, no doubt, be times in your career where you just feel like things aren’t going as well as you wanted. Whenever I felt that way, I went back to reviewing and practicing these basics. They’ve never failed to get me back on track and they should do the same for you.


Dr. Miles Bodzin is the Founder & CEO of Cash Practice Inc., a web-based service company providing the Cash Plan Calculator®, Auto-Debit System® and Drip-Education® Email Marketing System. To learn more about how the Cash Practice® Systems can help your practice, visit where you can get our Free Cash Practice® Mini-Course to learn even more. Dr. Bodzin can be reached at This e-mail address is being protected from spambots. You need JavaScript enabled to view it or 1-877-343-8950.

DC's Aligned for $1 Billion Department of Transportation (DOT) Market
Practice Management
Written by Michael Megehee, D.C.   
Thursday, 25 March 2010 00:00

Chiropractic Physicians have an insurmountable competitive advantage over other health care professions to draw substantial new income into their practices. Nowhere else is the opportunity greater; all that is needed is for Chiropractic Physicians to "align" their practices to include driver physicals, alcohol and drug testing for the transportation industry.

The "adjustment" of where $1 Billion is spent annually is imminent, due to the upcoming mandatory training and testing of those that perform the DOT Medical Exam for truck drivers. Until now, any DC, MD, DO, ANP or PA could perform the exam with minimal preparation. That is due to change early this Fall, when the Final Rule is published for the National Registry of Certified Medical Examiners (NRCME).

No physician wants to be forced to take a training course, or even worse, to take a certification test. However, as a profession, this is one time when we should embrace inconvenience. Because few chiropractic offices offer this procedure, nearly all of the annual 4+ million driver exams are provided by the other professions. However, when faced with the new requirements, the number of these providers is expected to drop dramatically. As the trucking industry scrambles to find a new provider, the door swings open for chiropractic and those that prepare now will reap the benefits.

Cost has and will be an important factor in who gets the business. This is where chiropractic’s low overhead serves best. Chiropractic costs for rent, malpractice insurance, and employees are hard to beat. The result is that, when it comes to pricing, chiropractors can out-compete just about everyone, except another chiropractor. The significance of this can not be overstated.

Reimbursement will be a major deterrent for many clinics. Most chiropractors charge between $45 and $100 for a driver exam. This amount is frequently greater than that for chiropractic adjustments and/or therapy. In a medicine oriented office, however, this represents a relatively low reimbursement compared to what services could be billed. This deters medicine based clinics, and attracts the chiropractic physician. An added bonus is that there is no insurance to contend with and no waiting to get paid.

Motor Carriers frown when paying drivers to sit in an office waiting for an exam, or if an appointment is not available for several days or weeks in some clinics. Many self employed drivers are paid by the mile and time off the road is money lost. To add to the urgency, many drivers inadvertently allow their current exams to expire. It’s no surprise they’re looking for a same-day appointment, as they are either off the road, or subject to a substantial fine if caught driving. It’s been an unfortunate fact that many chiropractic offices are underutilized. However, chiropractic offices can often provide same-day appointments. For many drivers and motor carriers, this is "the" determining factor in physician choice. chiropractic offices also underutilize their staff. Since drug and alcohol testing can and should be performed by your staff, income from these services comes nearly cost free. The clinic gains an ability to generate income, even if the physician is absent. Companies prefer a one-stop shop which also offers the alcohol and drug testing. There is a nationwide shortage of clinics offering the alcohol test for truck drivers. This is a strong selling point to companies that struggle to find clinics with all three services. Once an office is providing the DOT drug and alcohol testing, there’s no reason not to provide drug testing for non-DOT regulated employers. The Non-DOT drug testing market is estimated as being 7X larger than the DOT drug/alcohol market. Opening a satellite clinic in a truck stop, or providing services at the client’s facility are options few clinics have the desire or ability to consider, but they are effective marketing strategies.

FMCSA estimates that 40,000 trained medical examiners will be needed within 2-3 years. As these services are federally mandated, they tend to be independent of the state of the economy. Even those ready for retirement may find this an appropriate avenue to continue at a reduced pace and a reduced physical stress to themselves.

Starting now deters other clinics from competing with you later, increases your visibility when trucking companies are looking for a provider, and firmly establishes your office with the client for years to come.

Training is available from chiropractic colleges, nationwide physician networks and third parties. Although training is not required to perform the driver medical exam, the physician should download and review the exam form and instructions from the FMCSA website. Training is required to perform the DOT drug collection and alcohol test. DOT alcohol testing many times requires purchase of a breath alcohol tester that is approved by the DOT. This is part of the reason why clinics that perform alcohol testing are in such short supply. If the physician will attend a "Train the Trainer" course for alcohol and drug testing, he is able to train his own staff which greatly reduces his costs.

For those looking to build their chiropractic visits, every driver exam, alcohol test and drug collection represents a potential chiropractic patient. What other marketing strategy pays to have a potential patient come to your office? Incorporating these services into a practice will not be for every chiropractor, but every chiropractor should investigate this opportunity to out compete the competition while the door remains open.

Michael Megehee, DC, is a FMCSA designated Subject Matter Expert and President of TeamCME, a nationwide network of physicians that provide services to the trucking industry. Dr. Megehee is a member of the FMCSA Team that developed the NRCME physician training course. For free information on how to get started performing driver medical exams, go to


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