Practice Management


How to Raise Your Practice Expectations
Practice Management
Written by Tom Owen III   
Saturday, 02 June 2012 00:17

S
urprisingly, many chiropractors do not know that the success or failure of their practice first starts in the mind. Even before a dollar is collected, a chiropractor that has limited himself in the goals he has set for his practice has also limited the amount of success his practice will receive. There is an old adage that states, "Aim for the moon, even if you miss it, you will still land among the stars." There is indeed a lot of truth in this, and it is something that all chiropractors should consider when thinking about how successful they would like their practice to be. If you set high expectations for your chiropractic practice, even if you just come close to the goal, it is better than limiting what you are capable of making.

 
Think Big
groupplanningsessionMost analysts that work with overachievers and other highly successful people admit that they all have one thing in common - they think big. As Steve Jobs from Apple, Inc. once said, "Dream bigger." This is not about living in fairy tale land, but rather sitting down and developing a solid plan for your practice to increase in all areas. More patients, more revenue and a better level of service should all be part of your "Think Big" plan. It is all about increasing the performance of your practice to meet your expectations.

This is a good time to pause and think about your chiropractic practice. Do you really have expectations for it? Do you have small expectations that are limiting your ability to succeed? Are you just merely hoping your practice survives from year to year, or would you like to see a significant increase in revenue? Do you have an exact financial goal ($) you are working toward?

Have Clear Expectations
Your plan should be clear and concise, and this is why you are encouraged to write it down. Not only should a chiropractor have clear and well-thought expectations for a practice, he should also let his staff know what these expectations are. Employees perform better when they are given clear and realistic goals. You should continually talk about your monthly goals and your overall annual goals. In this way, your staff will know what is expected of them, and what they will need to do to help meet these expectations.

You should continually talk about your monthly goals and your overall annual goals.


Some chiropractors prefer to have vague expectations or goals, so they will not be disappointed when their practice is not successful. Setting vague goals is no way to run a business. By doing so, these chiropractors fail to realize that their lack of definite goals and expectations is potentially contributing to the limited success or failure of their practice. At the end of the financial year, when their practice does poorly, or has a limited amount of success, they feel justified in having set vague expectations or goals initially. However, they fail to see that a vague expectation or goal is like a moving target. Think how hard it would be to hit a moving target.
 
Celebrate
Celebrate when your practice reaches its monthly and annual goals. The way you choose to reward your staff can vary each month, but there should be a party at the end of the year when the practice expectations are achieved or even surpassed. Rewards have been shown as the best way to incorporate a new behavior. Rewards also give your employees something to work toward and show that you appreciate all they did. Therefore, by celebrating and rewarding the hard work and achievements of everyone that contributed to the success, your practice can set even higher goals and expectations for the following year.
 
Can the Chiropractic Profession Be Saved?
Practice Management
Written by Rick Sapio   
Friday, 25 May 2012 00:00
C
an the profession be saved? The jury is still out. One of the fundamental problems with the chiropractic profession (thankfully with a showskeletoncorresponding fundamental solution) is that DCs spend the vast majority of their non-patient business time reacting to issues related to employees, marketing, insurance, practice management, etc. These and other “urgent” tasks, issues, disturbances, and time-wasters consume their business days. This vicious reactionary cycle de-leverages their time and energy, and diminishes their ability to achieve their full potential. Since less than 3% (or even less) of the population regularly sees a chiropractor, I believe that the profession can be saved, if and only if the individual chiropractor can be saved FIRST.

It seems that most DCs think that practice management, marketing, and patient communication IS business, when in fact it is only a component of business, and actually a small component, when you consider what creates business value over the long haul. We have all witnessed chiropractors who are hitting the ball out of the park on their marketing, while in parallel their practice management processes are nearly flawless, and yet they are still struggling with stress and chaos, and sometimes bankruptcy. You see, your marketing and practice management skills/procedures are NOT in themselves business, they in fact sit on TOP of what I call “the foundational principles of business.” The same that is true for a downtown office building is also true for the entire chiropractic profession. If the foundation is cracked, broken, or non-existent, then what sits on top of that very same foundation will have serious flaws.

Once your foundation of business principles and processes is firmly set and practiced, then you have a much greater chance of successfully orchestrating all of the business tasks and objectives that sit up top. Examples that sit up top are things like launching a marketing campaign, or hiring the perfect long-term-oriented CA, or launching a new patient initiative that doubles the size of your practice. It is very similar to the principles of health. Your ‘health management procedures’ may be that you get regular adjustments, exercise a certain way, eat certain foods, etc. However, the reason you have those “health procedures,” and run them the way you do, is because you have a firm understanding and grounding in “the foundational principles of health.” You obviously know that health care is not sick care, inside-out healing, 3-dimensions of stress, or ‘the power that made the body heals the body,’ etc. True health care is much deeper and more principled.

When a new patient comes to you and says, “I heard you’re a great adjustor. I’d like to come once a week for the next 3 months!” you know in your heart that this person won’t be integrally healthy in 90 days. Just as you know that you won’t create a long-term, sustainable, thriving practice, with a very healthy balance sheet and several lucrative exit opportunities at your retirement, just because you instituted the latest blinky-shiny marketing technique, or software package, or gadget. I believe that you, as a DC, must realize at a deep level that you are in business, and because of that you must strive to become a “principle-centered” business person.

trianglefoundationMy wife and I know that we’re not going to guarantee that we’ll be celebrating our 50-year wedding anniversary in four decades, just because we learned a new way of communicating in a book. What goes for health, goes for marriage, and also goes for business… If you have a firm grasp through knowledge, deep understanding, and practice of the foundational principles of ANYTHING, you radically increase your long-term opportunities, value-creation, and satisfaction. And the most satisfying thing for a chiropractic office is a thriving patient community, a thriving staff, and a thriving bank account, with several opportunities to grow the business – or sell the business for that matter – when the time is right. Since you’re putting in the time and effort every minute of every day, of every week, why wouldn’t you like to have more certainty about how to increase the probability of your ultimate business success and value?

You must understand that this problem is NOT YOUR FAULT. How can you possibly know the foundational principles of business when you were never exposed to them in college, graduate school, or at any level in your chiropractic training? The interesting thing is that the chiropractic colleges that have begun training their students in business are also making the same glaring mistakes: They are teaching students to “go out in the world and conquer” yet they are focusing completely on teaching things that sit on top of the foundation, not, ironically, the foundation itself. So, it shouldn’t come as a surprise to anyone that the chiropractic profession is sick, from a business perspective. You were never trained in the foundational principles of business. The reality is that the serious issues that pervade most chiropractic offices, and that cap the growth of even the most successful practices, is that DCs never learned real business. After school they are thrown to the “business wolves” with a complete lack of training. Is it really any wonder that the profession is stuck at less than 3% of the population regularly seeing a chiropractor?

A long-term, sustainable company is supposed to keep growing, even after the founder leaves.

When one examines long-term-oriented, sustainable, growing companies, you notice that they have certain traits. However, when one examines a 20-year-old chiropractic office, many times you see one or two ‘Super DCs’ holding the entire operation together, as if all roads lead to Superman or Superwoman. I call this The Superman (or Superwoman) Syndrome. If you are Superman, you’re doing the OPPOSITE of what is required to create a long-term-oriented, sustainable, growing enterprise. You’re potentially wreaking havoc on your own well-being, your employees’ satisfaction, your patients' success, and on your family. And you have no chance of an exit strategy. Some people say, “Well, I never want to retire!” Everybody retires one way or another.

You can work for sure till your dying day and that is great. But still, the greatest asset you have in your estate, which gets left to your loved ones, is your business. Don’t you want it to have marketable value? A long-term, sustainable company is supposed to keep growing, even after the founder leaves. Look at Apple. After Steve Jobs’ leave of absence due to cancer several years ago, and his eventual death, the company never missed a beat, yet in the typical chiropractic office, if the boss is out (even for a few hours), the business begins to limp along.

It is my belief that in order to radically increase the probability of long-term business success for a chiropractic office, while at the same time leveraging the talent and skills of the DC and his or her staff, one must adopt a very straightforward model. This model has been proven with several hundred DCs over the past year and a half and the experience has been very revealing. The good news is that there is a lot of ‘low hanging fruit’ for the majority of practices. Business principles are easier to understand than health principles. So when a DC gets hold of them, they are transformative. profitparadigm

I believe that there are 12 Foundational Principles of Business. Here are some examples of some very basic ones, that when executed are transformative to your practice. Values–Based-Decision–Making says that when all decisions in your practice, from whom you hire, to whom you put your hands on, to where you locate your offices, are made from the same common set of long-term enforced values, you substantially increase your business’s viability, while eliminating the vast majority of business-debilitating mistakes. I’ve seen businesses double in size by effectively implementing only this one basic principle.

Next, we’ll consider the age-old principle of Management-by-Objectives. Many times, small businesses stall because they are trying to do TOO MUCH. They falter due to indigestion from trying to digest too many opportunities. Imagine that your practice only focuses on FIVE objectives during the next quarter. Imagine that all of your staff members are fully informed of exactly what those five objectives are, and that they are all bonused on the successful achievement of those FIVE.

Want to take your staff members to the next level of production, and supercharge your practice? After you’ve communicated your FIVE practice objectives, then meet with each staff person individually, and assign them each their own FIVE quarterly objectives that fully align with your office’s FIVE objectives. Then pay them a bonus upon achieving these. This very simple practice adds simplicity, success-probability, and full employee engagement/alignment to your practice.

Now let’s examine the next principle, The New Profit Paradigm. The P4 in the formula represents the four Ps that every business needs to clarify and understand: Profit (where do profit dollars really come from), People (customers, employees, stakeholders, etc.), Purpose (why does your business exist in the first place?), and Planet (which is about understanding your practice’s place in your community and the world at large). The right side of the equation is about Revenue, and the R2 symbolizes the fact that your practice MUST have recurring revenue systems baked into all aspects of your top-line revenue and growth. On the bottom of the equation, you see EV.

This represents expenses. Expenses can kill businesses, especially when they get out of hand, or when they are monthly and long term, or when they are not variable, which is what the V represents. Growing, thriving businesses understand how to make their expenses variable. For example, rather than spending $25,000 on a new marketing campaign, why not make that expense variable, i.e. pay the marketing company a fixed amount - say $150 - for every new patient who signs up? By doing this, you create WIN-WIN-WIN situations, i.e. your company, the aligned marketing company, and your ultimate customer can all win.

Can the chiropractic profession be saved? The answer of course is YES.

The arrows going up and down represent the fact that you must examine your business decisions by asking one simple question: Will executing on this decision increase my revenues or decrease my expenses/expense ratio? If the answer is NO, then don’t do it. The only exception to this rule is education. Warren Buffet, arguably the most successful business person who ever lived, has more than 100,000 employees, yet he reads and educates himself for a reported 9 hours of each and every day. He clearly puts an emphasis on business education, and I believe you should do the same.

So, to answer the title question: Can the chiropractic profession be saved? The answer of course is YES. It can not only be saved, it can thrive, but only if it sits firmly on top of a foundation of strong business principles, and if individual chiropractors make foundational business education and training a very important part of their overall education.

Rick Sapio has been involved in more than 75 companies, as either a founder, investor, owner, or operator, over the past 35 years. He has learned much more from his failures than from his successes. He has realized that putting all business decisions through the lens of simplicity, probability and leverage, while at the same time using a principle-centered business approach, radically increases the success of virtually any business. For the past two decades, he has been CEO of a financial services/healthcare holding company.

Two years ago, he partnered with Dr. Patrick Gentempo to launch ChiroFinishingSchool.com, in order to teach business principles to chiropractors.

 
Keys to a Successful Paperless Practice
Practice Management
Written by Dr. Michael Failla, D.C.   
Sunday, 01 April 2012 00:00
T
he benefits of a paperless office are numerous, but for many this goal has been elusive. Instead, the computer age has generated more paper than ever before. But with the right approach, it is possible to build a successful paperless chiropractic office and eliminate the paper piles.
 
Why Switch to a Paperless Office?

Here are a few of the many benefits reaped from eliminating paper and switching entirely to a digital electronic office:
  • Greater efficiency in retrieving and sharing information – The old paper office required painstaking sorting through paper folders and files. The electronic office allows workers to quickly query and retrieve multiple documents. These documents can be shared instantly and effortlessly with multiple users.
  • Cost reduction – The paperless office saves you a great amount of space, as you will not need whole rooms dedicated to file storage. This results in fewer file cabinets, folders, printers, toner, and other office supplies.
  • Greater security and ease of access– Electronic files are easy to secure using modern encryption and authentication systems. Files can be protected at different levels with password systems, yet one can still easily share medical records with medical facilities located anywhere in the world. Paperless files can be accessed from any location through an internet connection or a direct communication line.
  • Easy document editing – Older printed documents are often difficult to edit, but with electronic documents there is no problem quickly changing text and images.
  • Scalability – One of the great things about electronic systems is the ease with which they can be scaled up to handle growth in one’s company. Scaling up electronic resources takes up much less space as compared to the old paper office.
How to Build a Paperless Office

paperlessoffice5The first thing that needs to be done when building a paperless office is to convert all one’s existing paper documents into electronic format. There are a variety of chiropractic software programs that can help you with this conversion. All documents are scanned into digital files for use in record keeping applications like chiropractic soap notes systems.
 
Optical character recognition (OCR) software is able to recognize characters in scanned documents so that they can be converted into editable chiropractic EMR documents. Once in electronic form it is easy to convert such documents to highly portable formats like PDF files, which can be shared widely with anyone that has a computer or mobile device.
 
In order to successfully convert your paper documents, you will need both good scanning hardware and the right OCR software. Fortunately, many chiropractic software solutions come with the software applications in the same package. Thus, all you will need is a suitable scanner with an automatic document feeder to help speed up the process.
 
Electronic files can be organized in the same way that the paper files were organized in terms of folders and directories. By using tags to describe each document, folder and directory, you can easily call up files that you will need in the future. It is also much easier to rearrange electronic file systems as compared to a bulky file cabinet system. With most software, you can simply drag and drop the icons from one location to another.
 
When converting files, be sure to scan all documents at sufficient resolution for your needs. Check to make sure medical records, x-rays, tax documents, and the like have sufficient quality for them to be read and studied just as their paper counterparts would have been. Usually a scanning resolution of about 300 dpi is sufficient for most documents and it also produces reasonably fast scanning speeds. 
 
For documents of poor quality or for images that require high quality, you many need a higher scanning resolution. Note that OCR software generally will not be able to read handwritten documents, so such documents will be a bit more difficult to edit in the future, as the handwriting will most likely be converted into images.

Data Redundancy

All chiropractic documentation should be backed up to protect against data loss. In the old days, it was usually recommended to make at least one “hard copy” or paper copy of all documents, but today’s easy electronic storage options make this unnecessary.
 
Files that can take up a whole basement can now be easily saved on a single portable flash drive that you can drop into your pocket. There is also the option of remote storage that allows you to easily and economically store your data in locations other than your office. Thus, unlike the old days when a fire could cause catastrophic records damage, it is relatively easy to protect against such dangers today.
 
However, one should take care in noting the shelf life of the media – CDs, DVDs, tapes, etc. – that one is using to back up data. Transfer all files to new media well before the shelf life expires and make multiple backups, which is not expensive given the availability of cheap storage options.
 
Make sure that any data backup operation has been completed successfully. Oftentimes, offices will back up data but fail to check to make sure that no errors occurred during the process. Later on when they need the data they discover that some or all of their files are missing! While you do not need to check every file, a thorough random check is recommended. You can quickly scan to make sure that all the directories have been saved properly. Then randomly check files to make sure that they can be called up without any problem.
 
Chiropractic software will also take care of insurance and medical billing. All forms and documentation for insurance claims are handled automatically and can be filed remotely. Offices can save much time and energy in this area that would otherwise be spent handling mountains of paperwork.
 
The most important element in creating a successful paperless office is to make sure that you have the right software and hardware solutions to handle the job. With well-designed chiropractic software, many offices can make the full switch with little or no outside help. Once they have converted to the paperless office, they will immediately begin reaping the benefits of the digital age.
 
 
 
Murphy’s Law (3) When Starting a Practice
Practice Management
Written by Peter G. Fernandez, D.C.   
Sunday, 01 April 2012 00:00
Doing your own remodeling… will cost you more.

M
urphy'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 laws.  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”. 
 
newpracticeThere is no way you can do your own construction and save money. Imagine painting your own office. You’ll have to purchase ladders, drop cloths, rollers, paint brushes, paint, paint thinner, etc… then you’ll have to spend hours doing the work... and then cleaning up. Can you paint your space cheaper than a professional painter? Heck no! Remember, the professional painter already owns his ladders, rollers, paint brushes, drop cloths, etc… he won’t have to purchase them and he’ll know how to cover twice as much wall space with less paint. And he’ll finish your paint job in 2 days vs. you doing so in one week.  
 
I’ll tell you about an experience of mine.  I was going to hire a subcontractor to pour the front steps of my new house. His bid was $1,500. When I told my contractor about the bid he said, “The H with the $1,500 – I’ll get it done for $150”… and he did. You can’t beat a pro at his own game. When you do something that is outside your expertise (chiropractic), it will cost you twice as much. Hire someone that has the expertise.
 
Don’t listen to your friends or relatives… they’re wrong.

Beware. When you rely on your friends’ or relatives’ advice … it will cost you more. Nothing is impossible for people who don’t have to do the work. Every one of your friends and relatives will have ideas on how you should become successful that don’t work.

There is an exception to this rule. If your friends and relatives are entrepreneurs (e.g.: started and are running a business) their advice can possibly help you. However, if they work for a salary, and have never started a business, they won’t have the foggiest idea on what you are going through. Their advice will usually be totally wrong.
 
To illustrate the point, I’ll relate a personal experience. A few months after I opened my practice, my mother visited. She immediately expressed her concern that I was spending too much money on my work attire. I was wearing dress pants, white shirts and ties, and dress shoes. Nothing special. My mother said, “Your brother and brother-in-law are both professionals and they go to work in khaki pants, tee shirt and tennis shoes.” Every time she visited me, I heard the same story… over and over again.

Well, at the next family reunion I cornered my brother and brother-in-law.  I said, “Which one of you goes to work in khaki pants, tee shirt and tennis shoes?” They looked at me with disbelief and said, “Mom told us you did!”
 
As it turned out mom was wrong. Both of these professionals dressed for work like the professionals they were. They wore “professional attire” - dress pants, white shirts, ties, and dress shoes.  
 
Don’t depend upon friends and relatives to do your remodeling. 

Friends are friends. Relatives are relatives. Some are dependable… most aren’t. Some are knowledgeable about construction… most aren’t. Usually, when a doctor has friends and relatives help with office remodeling, it will take twice as long to complete because the doctor can’t get them to show up to do the construction. And every month delay in completing your remodeling costs you $15,000 to $20,000. You can’t afford this loss when opening a practice. Also, when friends and relatives do your remodeling for you, they usually do so without city permits. This will backfire on you. The city will require you to tear out your remodeling and redo it according to city code, greatly increasing your delay. Remodeling without city permits will also increase your liability, because when something goes wrong - because you intentionally didn’t follow city building codes or have them inspected by the city - and a patient gets hurt… you are guilty of neglect of patient welfare.
 
The day your equipment is supposed to arrive… it won’t.

We’ve all heard the old saying “When something goes wrong… blame someone else.” It’s an old saying because people do it all the time. I consulted in the opening of a new practice in California. My client doctor received a view box that was broken. He called me to complain that his view box arrived broken. I called his equipment company, raised “H” with them, and they sent him a new view box. When the new view box arrived, it too was broken. Now the doctor was really furious. He called me to complain, saying he felt I was to blame. I pointed out that the equipment company was not to blame. I wasn’t to blame. I asked him if he “really thought that I found out when his view box was due to arrive, got on a plane and traveled 1,500 miles to his practice door, and then jumped on his view box until it was broken?” I also asked him if he thought the equipment company broke their own view box before they had it delivered. It was, in fact, the delivery company that was to blame. Two lessons can be drawn from this example. First, find out where the problem really is - and then fix it. Misplacing blame doesn’t really solve anything. Second, sometimes your new equipment will arrive as scheduled… but won’t work. Murphy’s Law!
 
If everything seems to be going well, you obviously don’t know what the hell is going on.

If everything seems to be going well, obviously you have overlooked something. Watch out, Murphy is coming!  
 
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.
 
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 numerous 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 www.practicestarters.com
 
Your Practice in 2012: A Blueprint for Constant Change and Growth
Practice Management
Written by Chris Tomshack, D.C.   
Sunday, 01 April 2012 00:00
blueprint
W
ay back in 1997, I realized my wildly successful practice was, in fact, broken. And it all began with a simple question posed to me by a former high school classmate.
 
“Chris, where’ve you been?”

At the time, I had no answer. All day I had been busy. I saw a ton of patients, and each of their lives were improved because of the care my team and I were administering. I was feeling great about the direction my practice was going. Life was good…or so I thought.

It was summertime, which meant the sun was still shining when I left my office and drove to my daughter’s softball game around 7:30 p.m. A neighbor of mine, whose daughter was a teammate of my daughter’s, stopped me as I approached the diamond.

“Where’ve you been?” he asked. Still energized from my day, I didn’t notice his accusatory tone. I rambled on about how many patients I saw, how great I felt that I was changing lives, and how tired I was after a long, busy day.

“No,” he said. “Where’ve you been? The game’s almost over.”

I shot a glance at the scoreboard and my heart sank. It was the bottom of the last inning. The last batter was at the plate. I had missed it…again. 

It was that moment…that horrible feeling…that made me realize I needed a change. I needed to build a better practice. The problem was I didn’t know where to start.
 
Sound familiar?
 
Regardless of where you’re at in your career, whether you’re like I was and you want to transform your clinic or you’re just starting out, building a practice is a scary proposition, and it’s never been more difficult than in 2012.
 
And why wouldn’t it be? You went to school to become a chiropractor, not a business professional. Sure, you probably thought you’d pick it up on the fly, but the reality is neither time, nor the banks, will wait for you to figure it out.
 
The majority of your work has been focused on becoming an expert in chiropractic techniques, not marketing, managing a staff, and running a real business. 
 
Even if you give it your best, it might not be enough, because you likely don’t have all the answers…all the input.
 

An article from October of last year in The American Chiropractor reported that some 82 percent of practicing chiropractors nationwide struggle to pay their bills or don’t even pay them!

An article from October of last year in The American Chiropractor reported that some 82 percent of practicing chiropractors nationwide struggle to pay their bills or don’t even pay them! You’ve probably heard that out of all chiropractic graduates, 50 percent fail and nearly 20 percent never even use the diploma, which many spend anywhere from $150,000 to $200,000 acquiring. That’s a large debt load to service.

Now that’s just plain stupid. How is our profession supposed to achieve the level of utilization it should have with numbers like that? 
 
Today’s chiropractor can’t just be a skilled practitioner with an enviable bedside manner. Today’s chiropractor must always remember: you are no longer just a doctor… you’re a small business owner whose business should be delivering superior patient care.
 
That’s key, because the majority of your day is going to be spent running your practice, and not necessarily seeing patients. 
 
Business never stops, and neither should your education
 
graduationhatdiplomaI have a list of success secrets taped to my bathroom mirror. I committed them to memory long ago, but I still enjoy the gentle reminder each and every morning. In fact, I keep the same list in my pocket, so that I’m always able to reflect when I need to, and pass on to others some of the principles that continue to resonate with me. I learned this habit from one of my mentors.
 
While each secret inspires me in different ways, #4 on the list may be the one that continues to impact my life on a daily basis: “Never Stop Learning.”
 
To maintain success you have to constantly change and grow. Sure, becoming a doctor of chiropractic is one heck of an achievement, but unless you’re setting your sights on the next accomplishment—maybe it’s growing your clinic and your impact on your community, or maybe it’s simply providing the best care possible to your patients—complacency always leads to mediocrity. Want to become a better doctor, a better person? Become a fountain of knowledge—always keep learning. Sharpen your tools.
 
Read books, take some classes, do whatever you have to so you can learn how to manage a staff, market your clinic, run systems analysis and everything else that keeps your practice moving forward. 
 
And please don’t forget: If you practice today the way you did last year, your skills are already deteriorating. Improvements are constantly being made in how we can deliver exceptional care to our patients. Let’s keep our feet out of concrete and strive to be current, to be the best. Your patients deserve it!
 
Oh, and while you’re in education mode, pick up some books about leadership. One that I really like is Be Great by Peter Thomas. The bottom line is you’ve got to walk the talk. Once you start improving yourself, your ability to motivate your staff will improve, and that’s crucial to your success. You’ll need to train and motivate your team EVERY DAY so that your patients always have a 100 percent positive experience. 
 
Here’s a real life example of how important this is: A colleague recently emailed me about having to replace a front desk team member who made it clear daily they did not want to be there. Negativity can become infectious real quick, and that’s exactly what happened. This employee’s attitude infected everyone. The replacement was the exact opposite, and her presence benefited the practice immediately. For starters, the numbers started climbing and future appointments shot up after her hire!
 
alarmclockThis new team member not only brought an exciting new energy, she never forgot that serving the patients was the reason she was there. She believed in the systems that were in place and truly wanted to be there because she knew she was improving the lives of the people who walked through those doors.
 
That’s how big a difference having the right people on the bus can make, and it’ll be your job to not only find them, but keep them in the proper frame of mind. Always remember to train your team to ask the simple question, “What’s best for patients?” Then do it.
 
Some other ways to strengthen your business sense:
 
If you want to become a master at spotting short-term negative trends before they become financial quagmires, you’ll need to become familiar with tracking EVERYTHING. You’d be surprised how much a solid metrics analysis system can bolster the efforts of you and your team. 
 
Also, research other successful businesses and adopt the same techniques to make your practice run effectively and efficiently. This will likely lead you down the path to systemization—it’s no secret I’m a firm believer in an office that runs on autopilot, an office with systems.
 
Most chiropractic clinics are personality dependent, which means if the lead doc takes a two-week vacation, patients won’t schedule their appointments until he or she returns. You need your patients to feel comfortable no matter who they interact with, and you’ll do that by having effective systems in place -  systems for incredible care and systems to allow you to unplug while the office runs at peak performance.
 
Money: Why Can’t It Grow On Trees?
 
Starting a clinic is going to be expensive. Equipment. Staff salaries. Utility bills. Lease or mortgage payments. Plus a marketing budget to let people know what great services you offer.
 
You’ll need at least six months of capital to get you going. The worst thing that can happen is your business starts to pick up steam, but then you run out of money because you didn’t fund it properly. 
 
For most docs this means pulling out bank loans, and that isn’t as easy as it used to be. Before the Great Recession struck, getting a loan was as easy as having a pulse. Not any more, and especially not for those with poor credit.

You’ll need at least six months of capital to get you going.

 
Making yourself attractive to banks is more about what you don’t do than what you do. Don’t, for example, rack up a bunch of credit card debt while you’re in school. You’re a student, live like it. Also, it’s a good idea to have money saved up. Having at least 20 percent down will not only make those monthly payments easier to handle, but will make you look like you have the discipline not to default on the loan.
 
You don’t have to go it alone
 
A few months ago I sat down with a young man who had just graduated chiropractic school. He told me his plan was to open his own practice somewhere close to where he grew up in Columbus, Ohio. 
 
It had been his dream to start his chiropractic career by opening his own practice, rather than work as an associate, and he wanted it sooner rather than later. The problem is he didn’t have the cash, and after I told him all that went in to owning a clinic, he was perplexed. He had no idea. The key is to have mentorship readily available when opening a new practice. 
 
Owning your own practice is great. It gives you the freedom to treat patients the way you want to, and you always leave your office feeling good that you changed lives.
 
And there’s nothing wrong with spending a few years under the wing of an established chiropractor. Find someone whom you admire, someone who already has success in the field, and ask them to mentor you. Most docs will jump at the chance to share their knowledge. We all get into this field for the same reason: To make the lives of our patients better!
 
Improve yourself
 
You want to be successful? Here’s a little trick I’ve learned: Wake up early. Michael Masterson, in his book Automatic Wealth, talks at great lengths about this.
 
What does this mean to a practicing doc, busy all day with patients? It means this: Set your alarm clock an hour earlier than you would normally wake up. If you want to be successful and do what successful docs do, instead of watching the news, you’ll jump out of bed early enough to attack the day. First, read your goals and affirmations. Do some quality reading. Start the day by programming your mind for success. Skip the news entirely.

You want to be successful? Here’s a little trick I’ve learned: Wake up early.

 
Morning is also a great time to exercise. If I don’t work out right in the morning, it just doesn’t get done, and this is such an important step. You must maintain your health if you want to preach to others about theirs. While you’re working out, listen to audio books so that you’re feeding your mind while improving your body. 
 
Remember: successful doctors do what unsuccessful doctors refuse to do. It costs you nothing to wake up an hour earlier, and before you know it, 30 days later, it becomes part of your routine. Be diligent.
 
Steve Prefontaine, an Olympic runner from back in the 70s, had an awesome quote, which was "to give anything less than your best is to sacrifice the gift." Let’s not sacrifice the gift. Live to your full potential.
 
Building a practice in 2012 can be a struggle, but if you understand first what you must do to reach that point, it will be a whole lot easier. Even if you’ve got a successful practice now, make sure you hold on to that success by continuing to change and grow. It took me feeling like I let my daughter down to evolve my thinking and actions. Don’t let it get to that point for you. Now get to work!
 
Chris Tomshack, D.C., is CEO of HealthSource Chiropractic and Progressive Rehab® and currently oversees 346 offices throughout the nation. By supplying its doctors with a comprehensive set of systems, HealthSource positions its clinics to provide a singularly unique health care experience to patients, while focusing on community outreach and educational programs. HealthSource Chiropractic can be reached by calling 440-934-5858. For more information on HealthSource go to www.HealthSourceChiro.com
 
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