Practice Management

Powerful Positioning
Practice Management
Written by Marc Swerdlick, D.C.   
Thursday, 08 November 2007 16:23

Your practice is just that—YOUR PRACTICE. as straightforward and simplistic as that statement may be, many chiropractors promote their practice in a rather generic, almost "vanillalike" manner. Their outdoor sign just above their clinic reads CHIROPRACTOR, their walls are covered with posters that include photographs of a family holding hands while walking down the beach, and their brochures basically convey a general message of "Chiropractic is good for you." The doctors’ intentions are commendable; yet, they really don’t tell the prospective patient anything more than "I’m a chiropractor—just like the other guys down the street."

You are a doctor and, whether you like it or not, you’re also a businessperson. Your obligation to your business is to market your clinic, not everyone else’s clinic. What we’re talking about goes well beyond concepts like brand marketing and, no, this isn’t about stepping on the toes of other DC’s in your area. Rather, what we’re talking about is positioning your practice so that it stands out, and then giving that positioning a swift kick in the rear (the drive).

Most doctors are familiar with terms like USP (unique selling proposition) and target marketing. That’s all well and good; however, our concern for the moment is raising as many aspects of your practice as possible up on a pedestal so that they are visible. What do I mean? Well, for starters, it would be in your best interest to let prospective patients know what it is that you do in your clinic. Yes, I know that you are a chiropractor, and I realize that all techniques have something to offer. But, tell me, what do YOU offer under the heading of chiropractic? To put it another way, what exactly is chiropractic in YOUR CLINIC?

Some clinics consider disc decompression to be their definition of chiropractic, while other clinics consider chiropractic to involve the elimination of thought-based subluxations. Both clinics are chiropractic, yet very different in their approach in treating their patients. Why leave it up to the patient to figure out what it is that you do in your practice? Tell your prospective patients that you are a chiropractor, but then proceed to tell them HOW you define chiropractic in your office.

Regardless of what you’ve been taught in the past, uniqueness and positioning are not one and the same. Having an old firehouse as a location for your practice is a unique quality. If you offer your patients homemade cookies at each visit, that is also something that makes you unique.

Unique qualities and characteristics serve as attractors, but are not nearly as powerful as a positioning strategy that is built around building value.

Positioning involves a strategy that broadcasts the aspects of your practice that are clearly different from other doctors in your community. Notice that I did not say that these aspects were better, just different. Perhaps your focus is structural correction or the correction of Anterior Head Syndrome? If that were the case, then it would be in your best interest to let prospective patients know that, yes, you are a chiropractor; however, you are a chiropractor who focuses (not specializes) on a certain area of chiropractic.

Does your practice focus on pediatrics? Just the idea that a chiropractor focuses on pediatrics, in and of itself, suggests that there are pediatric health issues that can be addressed by doctors of chiropractic.

Are you an upper cervical doctor? Great! The recent study that came out that links upper cervical adjustments to a reduction in blood pressure is pure gold, and all the more reason for you to position your practice in such a way that prospective patients understand that there are different options when seeking out chiropractic care.

If you are someone who has gone through the effort of getting a diplomate in a certain area of chiropractic, why should you be quiet about it? Yes, I understand that there are chiropractors that are threatened by other doctors who stand up and say, "I do something a little different," or "I may have a little more experience in this area," but their issues are not your issues.

Should not having a certificate on your wall, yet still having experience in a certain area of chiropractic, preclude you from actually positioning your practice and making strides in that branch of chiropractic? Of course not! Without diplomate status, it stands to reason that suggesting that you are board certified is a big no-no. But, as an example, if you have years of experience working with athletes (and athletic injuries), you certainly have every right to position your practice in such a way that is suggestive of a sports injury oriented practice. All the power to you!

As we discussed earlier, unique qualities of a practice are not synonymous with positioning. However, multiple unique qualities that share a common denominator can be used in conjunction with a power positioning strategy.

For example, let’s say that your practice is big on being green (environmentally friendly). You use only 100 percent recycled paper, you recycle all office waste, you use environmentally friendly lighting, and have switched over to using digital ra diography in an effort to eliminate the use of hazardous chemicals. Do you think that, on top of other qualities that establish a difference when compared to other doctors, the fact that you are environmentally concerned could be the tipping point in attracting some of your new patients? Absolutely!

Powerful positioning is not about claiming superiority; rather, it’s about letting people know that some doctors have areas of interest that are different from others. Instead of being vanilla, be proud of your accomplishments and let people know what it is that you do.

Dr. Marc Swerdlick is a 1998 graduate of Palmer College of Chiropractic and is the president of S Group Inc., and—Chicago-based companies that offer marketing strategies and systems to health and wellness professionals, as well as to businesses outside the health and wellness arena. Dr. Swerdlick offers his Pre-Sale Strategy, New Patient Acquisition, and Patient Reinforcement Seminars for chiropractors in conjunction with Integrity Strategies LLC. For more detailed information on these seminars, contact Integrity Strategies by going to or by calling 1-608-865-0466.

Desire and Direction
Practice Management
Written by Marc Swerdlick, D.C.   
Monday, 08 October 2007 16:02

Who doesn’t want to do better? regardless of whom you talk to, most people want to be in a better place than they are today. As you may have guessed, for many folks, enhancing their financial status is their number one concern. But, for other people, improving their health and improving their relationship with their spouse/family is what’s most important.

On the business side of the chiropractic profession, there is an enormous amount of focus on self-improvement. Some practice management consulting companies contend that most of the doctor’s "challenges" in practice are a result of issues that reside between their ears. In other words, it is the doctors’ lack of self-esteem, self-confidence and goals, as well as a poverty mentality that act like a gigantic anchor holding back their ability to achieve more in life, and more in their practices.

I completely agree that headspace issues are not only a legitimate concern, but must be addressed in order for anyone, in any walk of life, to move forward. Obviously, this is not just a chiropractic issue. Having said that, I also believe that there is more to the puzzle than simply addressing the doctor’s personal issues. Once the doctor feels better about him- or herself, has the self-confidence to move forward, and has a list of goals that have been carefully outlined and prioritized, the next step is laying out the road map to get from where you are now to where you want to be in the future.

There are plenty of ways to make this discussion more complicated, but that’s just not my style. The point here is that we can all attend seminars that have us exiting the venue with a "YES—I can do anything" attitude. We can all read books that help us to attract positive energy. We can all listen to audio programs that show us how to become more goal-oriented. All of these action steps are a move in the right direction. However, what is often left out is direction and implementation.

Now I’m not suggesting for one moment that some practice management consulting organizations are not providing some amount of direction. What I am suggesting is that, more often than not, the direction is too vague. Imagine yourself attending a seminar where seventy-five percent of the weekend was spent making you feel better about yourself (a very worthwhile investment). On the last afternoon of the last day of the seminar, the focus switches from the headspace phase to the implementation phase—the point where you are shown how to get your wheels spinning and make things happen. Now that you are feeling better about who you are and where you want to go, the practice management consultant tells you to go out and tell anyone and everyone about chiropractic and, of course, about your practice. That’s great until you realize that you are uncertain about what to say, how to say it, how to position what you say, how to distinguish and differentiate your practice, etc.

You quickly realize that the "Just Do It™" mentality isn’t enough. Sure, it’s a great starting point, but building your practice requires more than just desire. You have the "Just Do It™" fire burning deep inside, but you are not sure about the "How to do it" that seems to be missing. You’ve been given some direction so that you have a USP (unique selling proposition) that is reminiscent of "Chiropractic turns on the power," but, beyond that, you are really only a vague ambassador for chiropractic instead of what you should be, an ambassador for YOUR chiropractic clinic.

To achieve your goals, you must have direction. To put it another way, you must have specific steps mapped out to get you from where you are to where you want to be. Telling a doctor to go join the chamber of commerce in his or her town is not a specific step. Telling the doctor exactly how to make the most of their membership (specifics) in the chamber of commerce is more in line with a direction-oriented train of thought.

To achieve your goals, you must understand how to implement the strategies that will lead you to your pot of gold at the end of the rainbow. Again, the "Just Do It™" mind-set isn’t enough. What is needed is more specific information on how to do it, when to do it, and where to do it. Lack of direction and lack of a strategy for implementation often result in frustration and, eventually, damage to one’s self-esteem and self-confidence. In the end, many doctors find themselves right back at the beginning of their journey with their goals now appearing even farther beyond their grasp.

We’ve all heard the expression, "To achieve, you’ve got to believe." That expression is valid and represents an excellent beginning. Like a person who has a vision of their dream home, they start with a mental image and eventually create a blueprint. In between the blueprint and the day you cross the threshold of your new home is the construction process. In essence, in your practice, you must learn how to become your own general contractor (instead of relying on someone else or some organization which tries to make you dependent on them) so that you are able to travel through life with the ability to turn a blueprint into reality.


Dr. Marc Swerdlick is a 1998 graduate of Palmer College of Chiropractic and is the president of S Group Inc. and—Chicago-based companies that offer marketing strategies and systems to health and wellness professionals, as well as to businesses outside the health and wellness arena. Dr. Swerdlick offers his Pre-Sale Strategy, New Patient Acquisition, and Patient Reinforcement Seminars for chiropractors in conjunction with Integrity Strategies LLC. For more detailed information on these seminars, contact Integrity Strategies at or by calling 1-608-865-0466.


History and Research of the National Upper Cervical Chiropractic Association
Practice Management
Written by Marshall Dickholtz, Sr., D.C.   
Monday, 08 October 2007 11:57

Practically all authorities agree that a subluxated vertebra, by definition, includes movement of the vertebra from its proper position in several planes and directions. The reduction of the subluxation, the adjustment, must be a predetermined and pre-directed process of correction.

Direction is a measurable factor in a subluxation; force is an inherent element of the adjustment. Force, however, has the characteristic of direction—it is going somewhere—so it must be controlled and calculated. Each subluxation requires its own mathematically pre-determined directional path for its successful and efficient reduction. The subluxation and its correction is a procedure that can be tested in the light of scientifically acceptable principles, so far, at least, as the misalignment factors are concerned.

The National Upper Cervical Chiropractic association, Inc., was formed April 16, 1966, as a non-profit corporation, with Mr. Donald A. Miller of Detroit retained as general counsel. The official publication of the corporation. The NUCCA Monograph, originally titled NUCCA NEWS for a few years following the formation of NUCCA, contains articles of a technical nature as a service to the membership and scientific community. Membership in NUCCA is open to any graduate from a chartered chiropractic college who is of good moral character.

The NUCCA Directive Board has adopted a policy statement to the effect that chiropractic is predicated on the restoration principle, inclusive of all methods that reduce the subluxation misalignment factors, and which are based upon specific and acceptable principles of subluxation reduction. The adoption of this policy statement gives direction to the corporation, and forms the basis upon which any technique will receive attention and approval from NUCCA.


The subluxation and its removal is the basic tool of chiropractic. NUCCA invites all chiropractors to join with them in the furtherance of the restoration principle, and in the belief that, as chiropractors, their duty to the patient is concerned with this principle.


The late Dr. Ralph Gregory of Monroe, Michigan, in his organizing of the National Upper Cervical Chiropractic Association in 1966, envisioned a non-profit organization dedicated to a mechanical science that is apodictic to what chiropractic should be. Since dealing, in part, with solid structures, the laws of physics and mathematics must form the significant basis of spinal care.

Mathematical formulas can be derived from properly taken cervical radiographs. These formulas tell the doctor how to place the patient on the side-posture adjusting table. In addition, after analyzing these radiographs, the doctor knows the direction the atlas has misaligned in relationship to the condyles and the lower cervical vertebrae.


With this knowledge, the proper adjustment—direction and torque—can be delivered to the atlas transverse to align the head and neck to the vertical axis of the body. The pisiform of the wrist is used to contact the patient’s atlas transverse process, which is used as a lever to move the head and neck. With the proper balancing and control of the doctor’s body and arms, an adjustment can then be delivered with very little depth to the patient. A reflex takes place that unlocks the atlas subluxation. There is a force behind the adjustment of up to 23 lbs., but with very little depth; the patient does not feel the adjustment.


The high blood pressure research project, recently published in the May 2007 issue of the Journal of Human Hypertension, demonstrated, in a medically instigated and scientifically controlled research project with a subject group of 50 patients (all adjusting done by this author), that there is a science to chiropractic.

A brief review of the results reveals the following:


1. The systolic readings dropped seventeen points.

2. Eighty five percent of the patients only needed one [NUCCA] National Upper Cervical Chiropractic procedure adjustment. Their one adjustment lasted at least two months. When the neck and head relationship is balanced by the reduction of the atlas subluxation complex [ASC] there is no need of additional adjusting.

3. Pre to Post Cervical radiographic1 analysis in these cases demonstrated: an average atlas misalignment of 2.17 degrees off the central skull line in the frontal plane reduced by adjustment to .22 degrees; atlas rotation in the transverse plane was an average of 1.29 degrees, and reduced to .19 degrees; the seventh cervical was off the patient’s vertical axis when standing, and was reduced to zero.

4. When the patient was standing in a posture constant, the pelvic tilt averaged 3.7 degrees in the frontal plane, reducing to zero post adjustment, and pelvic torque showed a two degree rotation in the transverse plane before the NUCCA adjustment, reducing to .3 degrees post adjustment.

Another part of the standing patient examination that was not covered entirely in the published article was that the shoulders were also leveled, and the torque differential between the shoulder girdle and the pelvic girdle was reduced. They had a perfectly balanced spine. This was determined, during the research project, with the use of the new Dickholtz laser light spinal analyzer.2 This torque could be the first indication the patient has an atlas subluxation complex syndrome, or the last indicator that there is still part of the subluxation present.

Until the stressor at the brain stem level is removed, the spine will be distorted. A partial reason for this has long been known3—the facilitators and inhibitors of the muscles of the body lie within the central reticular formation of the brain stem. If there is a stressor at the brain stem, the muscle will be contracted more on one side of the body than the other. The pelvic girdle is then distorted in three planes.

Serious discussions in the field of chiropractic have been engaged in about pinched nerves and dentate ligaments, which have possibly overshadowed the importance of numerous other sensors of different types, especially in the cervical region. It is this author’s opinion that the sensors are more to be considered than the former. This is why the chiropractor must realize that he works with very small details.


In one third of the cases there is only three quarters to one degree laterality of the atlas. With precisely aligned X-ray equipment and very sharp radiographs these small subluxations can be measured. Knowing the correct misalignment factors is paramount to having the proper direction of forces with which to reduce the atlas subluxation. This takes into account the atlas laterality, the tilt of the head, the twist of the atlas in the transverse plane, and the lower cervical vertebrae as they relate to the vertical axis of the body.

The atlas is the only vertebra you can move with relative independence, there being no boney interlocking mechanism. This is used as a lever system to move the head and neck to the patient’s vertical axis, and to reduce the twisting of vertebrae in the transverse plane.

There is one more test that was not mentioned in the research paper, which was recorded in this project, namely, the supine leg check. All fifty subjects in the research had hip distortion, with leg length inequality (LLI) when in the supine position. All adjusted subjects were post-measured with even leg lengths (no LLI) in each of the succeeding seven visits over the two months duration. On the other hand, all the placebo group subjects had contracted ilium, and LLI, upon examination during each of the first eight visits. After the conclusion of the main study, the placebo group members were adjusted and, upon examination, each subject presented with balanced spines, and even leg lengths [no LLI] in the supine position.

While we are discussing LLI (leg length inequality) it should be mentioned that there is a simple test to determine the presence of stress to the brain stem. Try the following: Lay the patient down on a fairly hard surface with a small pillow under the head, and wearing a pair of solid shoes. Push on the bottom of the shoes with about five pounds pressure, having the same angle on both shoes which are aligned to the patient’s ears. Then have the patient rotate the head each direction. If there is a stressor at the brain stem level, there will be a movement in the relative length of the legs. With one direction the head is turned, the stressor at the brain stem is reduced and, as it turns the other way, the stress increases. As the stress is decreased, the legs become more even. Once again, this demonstrates a relationship between the upper cervical mechanism and the brain stem’s control of the muscle balance of the whole body.

The central nervous system is not the only nervous system that is affected by an atlas subluxation. In a previous research project by this author on chronic fatigue syndrome, a board certified psychiatrist stated that the correction we gave was affecting brain chemicals. He correlated the subject’s positive changes in brain chemicals, which gave rise to the positive changes in their symptom pictures. The Rand 36 questionnaire was used in that study, demonstrating improved health in all eight categories, including mental. This will be published as a pilot study.

The whole point here is: an atlas subluxation complex (ASC) syndrome is very, very, encompassing. The National Upper Cervical Chiropractic Association (NUCCA) holds two large seminar conventions each year, in the Spring and the Fall, inviting all to attend who wish to begin study of this specialty, or to increase their knowledge and skills in this demanding field. The NUCCA website is a wealth of reading, audio and visual information, found at In addition, the research arm of NUCCA, the National Upper Cervical Research Association (NUCCRA), the research board tasked with protocols and research, maintains a research site for funding purposes and study, at or

Dr. Marshall Dickholtz Sr. can be contacted at 3420 W. Peterson Ave., Chicago, Illinois 60659. Email This e-mail address is being protected from spambots. You need JavaScript enabled to view it , or visit


1. Dr. Ralph Gregory: The first concern in the problem of motion in the subluxation system concerns the forces that the vertebrae exert on each other—internal forces. Given the forces, we seek to know the manner in which the vertebrae move under the action of the forces. This is the subject matter of mechanics proper and, incidentally, one of the reasons why we post X-ray every case immediately after the first adjustment to learn how the vertebra that were displaced, as seen in the pre X-rays, moved under the external force of the adjustment.

2. This was invented by Mrs. Mary Ann Dickholtz.

3. Magoun, H.W. 1968 Brain Stem, Encyclopedia Brittanica Vol. 4; Steindler, A 1955 Kinesiology of the Human Body. Chas.C; Well, K. 1955 Kinesiology, 2nd Edition W. B. Saunders Company.


The Power of Priorities
Practice Management
Written by Eric Kaplan, D.C., N.D.   
Monday, 08 October 2007 11:55

Time is money and money is time. you can always get more money in life, but time spent, is spent. Economize your time to be successful in practice. People often ask how did I see two hundred patients in a day. My comical response is, "Quickly." The truth is we had a great staff and utilized and maximized time. My patients never felt rushed and I never rushed a patient. Sounds difficult? It was. My staff knew every person counted in the treatment of any given patient. To maximize your practice, maximize your time with patients.

The very worst use of your time is to do well what need not be done at all. The Pareto Principle is the 80/ 20 principle of time. It says that 20 percent of your activities will account for 80 percent of the value of your activities. This means that, if you have a list of ten items to accomplish, two of those items will be worth more than the other eight items altogether. Following that same formula, 20 percent of your patients will cause 80 percent of your headaches.

To achieve great things, you must always be concentrating on the small number of activities that contribute the greatest value to your life and your practice.

Conquer the Consequences

The value of anything in your order of priorities can be measured by assessing the potential consequences of doing it or not doing it. Every action will have an equal or opposite reaction. B.J. Palmer said, "Everything you think, say, or do today, will affect the lives of millions of people tomorrow. What are you thinking, saying, doing?"

Something that is important to you will have significant consequences on your life and your practice. Something that is unimportant has few or no consequences of significance to your life or career. The mark of the superior thinker is your ability to consider possible consequences before you begin. It’s the chess game of life, so to speak. What will the patients think? How do they see you, or your office. William Esteb conquered this formula, and made a business out of looking to see the patient’s response. A simple concept, yet not many masters.

The Key Question

Continually ask yourself, "What is the most valuable use of my time, right now?" And whatever it is, work on that. Your ability to discipline yourself to work on those few tasks that can make the greatest difference in your life is the key quality that makes everything else possible for you. Develop to do lists and do it!

If you can, work on your highest priority items every minute of the day. How would that change your behavior? What would you do differently?

Think about your future.

Do you know where you are GOING?

Time will always have enemies; we call these distractions.

"Adversity? When you come to a roadblock, take a detour." ~ Mary Kay Ash

Is Your Paperwork a Dammed Up River or a Fast Flowing Rapid?

In today’s world of managed care, many of us are bottled, drowned by paperwork. It is inevitable, yet most offices and doctors I visit with are behind. There are four simple ways to handle the flow of paperwork and they are:

• Act on it.

• Delegate it.

• Schedule it.

• Recycle it!

Make your desk a river, not a reservoir.

Today’s Priority..

1. Which of your paperwork items need to be handled today?

2. Which of your current paperwork items are low priority?

3. To whom can you delegate some of your paperwork today?

"If at first you don’t succeed; you are running about average."

Paperwork (a.k.a. EOB’s,letters, faxes, e-mails, forms, bills, newsletters, invoices, travel receipts, memos, contracts, proposals, patient files, budgets, reports, taxes—all that stuff that you have to deal with—has to be completed. It has a purpose and a benefit. So organize it once and conquer it! Create a system. Sign it, send it on, file it or do whatever is needed to complete it productively with the least time and effort on your part.

"Yesterdays don’t matter…."

You are 100 percent correct. What was good enough to get you by last year doesn’t have a snow-ball’s chance this year. You have to do things differently—just to keep pace with the competition, the industry. Are insurance companies paying the same as last year or less? Never or rarely in today’s marketplace do they pay more. Yet everything takes more time.

In the normal course of a day, life appears to be one continuous stream of actions, reactions, situations and conditions. It’s all a blur. In this state of overwhelm, it’s impossible to see exactly what you need to do differently to improve your productivity, or change your circumstances. Prioritize your time. Develop systems and stick with them.

The sad truth is that opportunity doesn’t knock twice

Living in Florida, we get to read a lot of Gloria Estefan. She is more then a singer; she is a successful business person. Brittany Spears is a successful singer. Is she a successful business person? Both have utilized their time differently.

Time out of the office is not time off. "The sad truth is that opportunity doesn’t knock twice. You can put things off until tomorrow, but tomorrow may never come. Where will you be a few years down the line? Will it be everything you dreamed of?

"We seal our fate with the choices we make, but don’t give a second thought to the chances we take."~ Gloria Estefan

Opportunity abounds. Always has...always will. Will you be prepared to take advantage? Will you have the time—especially in tough times; especially now in this world marred by managed care?

Opportunity NEVER knocks twice. Biotechnology, like decompression, is filling offices with cash-paying new patients. Will it last forever? The time to act is now. In fact, most of the time, opportunity doesn’t knock at all. It NEVER makes a sound. Opportunity is something you SEE...something you FEEL...something you SENSE.

I have built my entire career around seizing ever-growing opportunities. I have gone from one office to five, to Wall Street. I have written two books and been in two feature movies. I have yet to hear even ONE knock on my door—maybe once, it whacked me upside my head. Opportunities behave quite differently from what we have been trained to expect. You must have POWERFUL LENSES with which to see and sense them.

Take this as gospel from a man who has MISSED a phenomenal number of HUGE opportunities over the last thirty years. The good news is that I have also seen (and seized) a fair number of at least moderately world-changing opportunities...which has given me the power to see even more!

You see, it is IMPOSSIBLE to even SEE the ever-present opportunities surrounding you unless you have sufficient VISION. It is IMPOSSIBLE to SEIZE these opportunities unless you have sufficient Priorities.

The bottom line is that seeing and seizing opportunities—everyday you are alive—requires real Priorities...what we call The Power of Priorities.

There are no exceptions to the truth...

"The key to true and lasting success is High Priorities, High Expectations" ~ Brilliant Execution.

Learn to SEE the opportunities in YOUR life—and transform them into crystal-clear goals and plans—and you will earn the RIGHT to EXPECT that they will happen. However, to MAKE THEM HAPPEN, you must execute beyond Expectations. You must prioritize.

In the end, it is the ratio between what you have given yourself the right to expect over your power to execute that will determine how many of the opportunities you see are turned into tangible results.

I have found, from years of experience, that VISION, OPPORTUNITY and SUCCESS are inextricably linked. For most people, each is just outside their line of sight.

So, get more powerful glasses!

If you lack vision, opportunity and success, it means that you need a more POWERFUL LENS with which to SEE the future. "If you see the invisible you can do the impossible" Prioritize what it takes to reach your potential, see yourself as the success you deserve to be, and then do it!

See you in Panama, at chiropractic ’08

Dr. Eric S. Kaplan, is CEO of Multidisciplinary Business Applications, Inc. (MBA), a comprehensive coaching firm with a successful, documented history of creating profitable multidisciplinary practices nationwide. For more information, call 1-561-626-3004.


Moving from an Insurance or Cash Practice to a CASH-Like Practice
Practice Management
Written by Bruce Parker, D.C.   
Saturday, 08 September 2007 11:04

If you have heard, “I can't afford it,” more than a few times from a patient, you may have, as a knee-jerk reaction, actually believed what you heard and begun to adopt financial policies in your practice to meet everybody’s limited financial status—like let’s make a deal, or unlimited care for a fixed fee, you pay and all your family is free, kids are free! I don’t remember the time I agreed to operate a charity or applied for non-profit status! Do you?

 The cash-like practice is a practice that emphasizes the benefit of care first, and how your patients are going to pay only as a way to receive the care they have decide they need.

It is never the money, or lack thereof; this is the richest country on the planet and people do have money, they just don’t have a priority for spending it on health care. Because of the lack of understanding regarding chiropractic, and not knowing how it will ultimately benefit the person, it is my opinion that people don’t want to pay for care because they don’t believe they will get well anyway. After all, if you review the statistics for medical care, the chances are slim they will get better. So why would someone want to part with their hard earned cash and still not get better? It seems the financial risk is less if a third party springs for it.

I want you to adopt a new policy right now! If someone ever tells you, “I can’t afford it,” rather than believing this excuse, interpret their saying, “I don’t see the value in what you are offering, and how will I benefit from spending my hard earned money for that service”. Then adopt procedures which clearly outline the benefits and value from your service.

Insurance is a crutch and will cause you to practice in ways you may not want to. While chiropractic boasts that we look for the cause not the symptom, insurance is a total symptomatic pain relief model—the exact model we campaign as a profession against. But, in times of our own financial need, it is easy to succumb to the thought that, if the patient had insurance, then they could afford the care and we wouldn’t have to take the time to “sell” the care to them. So we change our model to an insurance-based practice and advise the patient not to worry about anything financial.

You now have a patient that is coming to you with no worry of money, so the visits you recommend are of no other consequence than time. It all seems very good! Two months into care, the first EOB’s return paying ten cents on the dollar, and the next day you receive a request for reports and chart notes stating you will not receive any more of the drastically reduced reimbursements if you don’t comply! (This is not fun!) Additionally, if a patient’s insurance quits or changes, so does the patient. Need and desire for care is based on a third party’s willingness to pay. The patient sees no value and you are now practicing at the whims of someone else’s willingness to pay.


So, you scream, “I hate insurance!!!!!! I am just going to go cash.” This, again, is knee-jerk reaction, and an adoption of yet another emotionally made decision.


There is no place for Emotion in your business decisions.

Emotions are for your personal life and are appropriate in a loving relationship. In business, decisions made from emotion are not appropriate and will almost always end up poorly.


Decisions are made from facts and analysis!

Analyzing facts may take the zest out of your love life, yet it’s critical in your business life. If you are a chiropractor operating a practice, you are in business. Run your business from emotions and you will suffer every up and down associated with the ebb and flow of life. You will become almost manic, as you judge how you feel each day by how many new patients you received, who accepted care, and how many checks arrived in the mail! This is the fast lane to burn out!

The solution is to focus on the “Benefit” you provide your patients, and the consequence to your patients of NOT receiving your service! Financial arrangements are NOT the secret to your success!

A cash practice is a metaphor for the state of mind one must have as a doctor in not only recommending care to a patient, but for the entire package. It's about how you present yourself, how you educate and motivate a patient, how you demonstrate “Why Chiropractic,” as separate from any other health care discipline, and non-duplicate-able by any other health discipline (i.e., physical therapy is not the same!). These are all small factors which build up to an overall I’m-in-the-right-place or Get-me-out-of-here perspective for those you potentially serve.

With the above well in order, your recommendations must be focused specifi cally on how your service will ultimately benefit the prospective patient. With zero attention on fees, and all attention to benefits of service and consequences of NOT having the service, your personal certainty of your recommendations will be what dictate your case acceptance…not the “deal” you offer.

My favorite phrase is, “Change your thinking; change your life.” So you may find it very helpful to think of all new patients in these terms. A prospective patient enters your office with a real complaint that has been affecting their ability to have a normal life. They had consulted others or even tried other procedures which failed, and now they arrive in your offi ce. What they are looking for is a solution to get their life back…not a deal! I recommend you adopt this mindset; you will then understand how benefit trumps deal every time!

The cash-like practice is a practice that emphasizes the benefit of care first, and how your patients are going to pay only as a way to receive the care they have decided they need. If they have insurance, we will help them and bill the portion that an insurance company will pay. The important thing is that this reimbursement is not payment in full; it is payment toward the recommendation, and the patient will pay the difference. Our fees are our fees, and we will assist them in receiving money from any source to do their part, but we do not change the recommendation by judging their financial means. If they truly need charity, we do a few charity cases a month by case importance, as long as they attest to their total lack of funds.

Now, ask yourself, if a person really had a life altering problem and totally believed you were the solution, do you think—in a society where people rely on labels for status, set goals for more and more adult toys, take lavish vacations, and spend $260 a pair for blue jeans—a little money would actually stop them from doing whatever they believed would get their life back, and increase their health and vitality?

Not on their life!

Dr. Bruce Parker was a pioneer in practice, establishing five offices in his first six years of practice. He has now personally owned thirteen clinics. Through this experience, he developed what he now calls “The Practice Freedom System.” He feels his strongest attribute is communicating the need for lifetime care; his history of patient retention would validate that fact. Dr Parker, president of Bruce Parker Consulting, teaches his “Practice Freedom System.” For more information, visit


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