12 Ways to Revive an Eroding Practice

Posted by Bill Esteb on Apr 30th 2017

12 Strategies For Those Who Want to Thrive


As the practice environment transforms from the “good old days” of just five or six years ago, some chiropractors are finding their practices eroding beneath them.

This wasn’t supposed to happen—not with the home stretch of retirement within sight.

Worse, pushing the reactivation button, turning up the referral dial and pulling the free spinal exam lever don’t produce the results they used to. This is a new, never-before-experienced predicament. “Do I need to add nutrition? Should I get a laser? How do I get my numbers back up?”

Scan the pages of the least objectionable (and increasingly thin) chiropractic publications, and you might be seduced by the shrill headlines touting hidden profits, untapped patient demand or the “free money” generated by some new revolutionary gadget or “clinically formulated” product. Yet the only people making money from these overtures are those selling them to desperate chiropractors.

You knew that. Nonetheless, it might be kind of exciting to add something new to the mix, right? Anything to distract you from addressing the real problem.

Is Chiropractic Enough?

Behind much of this is the unhelpful belief that chiropractic has somehow lost its touch—that it’s no longer effective, that patients expect something more and must be pleased.

While these are tempting beliefs, the fact is, patients heal the same way today that they always have, whether they understand it or not: from the inside out. The problem starts by allowing patients on their first visit to believe that you’re consenting to treat their symptoms. When you let such a belief stand—or worse, believe it yourself—you become responsible for something out of your control. This is not a position of strength, nor does it give you the certainty that patients find attractive.

Start by alerting your next new patient that you won’t be treating their symptoms—this is the practice of medicine, for which you are not licensed or insured. Because if all they want is for their symptoms to diminish, you might recommend seeking medical help, since pain relievers are faster, cheaper and more convenient.

They will not get up in a huff and storm out the door! 

But you will certainly have their attention, making now the perfect time to remind them that your intent is to reduce nervous system interferences (usually along the spine) that impair their body’s function and ability to self-heal. Only as the integrity of their nervous system is restored will their body stop using annoying symptoms to get its owner’s attention. That’s far different from agreeing to use cervical adjustments to relieve their headaches or lumbar adjustments to reduce low back pain.

Granted, it’s far easier to go along to get along and let patients believe you’re treating their symptoms, but eventually it catches up with you, destroying their confidence, and worse, yours. You cannot and will not enjoy the peace and prosperity you deserve until you return to the fundamentals and stop practicing a perverted form of physical medicine.

Financial Fragility

There’s another issue that combines with the first to create a perfect storm: the increasing lack of financial margin that more and more people are experiencing these days. Turns out, half of all Americans are unable to come up with $2,000 to deal with an unplanned emergency. With little or no savings and their credit cards to the limit, they find covering the deductible for an unexpected bout of back pain to be painful, both physically and financially.

While there’s little you can do about their financial habits, there are three things you should consider implementing:

1. Add CareCredit to your payment options. You’re not a bank. Avoid the temptation of being seduced into financing a patient’s episode of care (and the associated collections headache) and let someone else assume the risk.

2. Add ChiroHealthUSA to your payment options. Consider the flexibility of being able to offer a “discount medical plan” (that’s what they’re called) so you can legally offer cash patients more affordable fees.

3. Reduce your practice and personal overhead. Granted, you can’t conserve your way to practice success, but if you haven’t already done so, this would be a good time to reduce your expenses, be they premium cable channels, club memberships, cleaning services or any other inappropriate luxuries. In other words, stop spending like it’s 1999.

Back to the Basics

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If you’ve seen an erosion in your practice, turning it around will require time and a constellation of new attitudes and action steps. There isn’t a single silver bullet, but the list below is a place to start. Choose half a dozen of them and get busy.

Caution. There’s nothing new or sexy on the list. You’re already familiar with each item. But the barrier to success is often attitudinal, as in, “After 16 years in the trenches, I shouldn’t have to (fill in the blank).” Or, “I tried that it and didn’t work.” Or, “That’s way too much work.” Or finally, “What else do you have?”

Like patients who want a pill to effortlessly restore their health or expect to be pain-free after one adjustment, countless chiropractors are stopped before they start by their need for instant gratification, have an entitlement mentality or have become, dare I say, lazy.

That should only sting if it’s true.

I meet countless chiropractors with only five or ten years of experience who still have a fire in their belly and are ready to take names and make a ruckus. Rarely do I see more mature chiropractors with a similar drive or determination. That’s often because they’ve switched from playing offense to defense. They’re trying to keep what they have rather than claim new territory. Practice decline is the common result.

Here’s an action list of the basics that go-getters are doing to thrive:

  1. Extraordinary adjustments: If you’re a sloppy adjuster, lack confidence or simply adjust every articulation to fool patients into thinking they’re getting their money’s worth, start here. Get to a technique seminar and brush up. Oh, and how can you tell if your adjustments are extraordinary? Count how many other chiropractors want you to adjust them.
  2. Profound listening: If things are a little slow around your shop, it’s time to stop talking and start listening. Patients are voting with their feet. Find out if there’s anything you or your team is doing (or not doing) that they perceive as off-putting. Maybe conduct a patient focus group or two.
  3. Educate like crazy: Almost without exception, when pressed, practitioners who find their numbers down admit that they neglect to give formal reports, no longer send patient newsletters and haven’t handed out a brochure in years. It’s a classic small business mistake to cut your marketing investment when finances get tight. Instead, this is a time to redouble your efforts.
  4. Calling patients: Ringing a patient after their first adjustment is another fundamental that struggling chiropractors will often admit they’ve stopped doing. There are three important reasons to resume. First, patients perceive it as proof that you really care; second, it provides feedback about their first visit experience; and third, it gives you the opportunity to address any questions, misgivings or fears new patients may have.
  5. Spinal care classes: Hold monthly or quarterly in-office seminars (regardless of what you call them). Granted, only a fraction of your patients will show up (be sure they bring a guest), but it’s from this core that you can grow a thriving practice of people who actually value their health rather than just being pain-free. Oh, and remember, these lectures are more for your benefit than theirs.
  6. External events: I’m not talking about chasing patients down the mall with a plastic spine. Look for opportunities to give health talks at schools, provide ergonomic programs over the lunch hour at a local business and search out civic groups and service organizations to share your worldview. This isn’t about harvesting new patients—it’s about sharing the chiropractic perspective, becoming familiar and engendering trust. The patients manifest months later.
  7. Community participation: Become involved in your community by contributing, volunteering and investing your time and talent. It’s difficult to grow a practice if you’re not continually meeting new people, and even more difficult if you don’t even live in the community you’re trying to serve.
  8. Lose some friends: It’s likely you need to defriend some folks. Take an inventory of your five closest chiropractic friends. If someone is constantly expressing a cynical attitude, negativity or pessimism, it’s time to cut them loose. Create a monthly mentoring group or regularly take a high-performing chiropractor to lunch and pick his or her brain. Hang with winners.
  9. Stop all media: Disengage from the media. All media. Even social media. Especially social media. Commercial media is mostly fear mongering to attract eyeballs to sell to advertisers. Social media is mostly about gossip, boasting and fake news, and it encourages comparing ourselves to others. If your practice has eroded, you can’t afford the luxury of a single negative thought, image or headline entering your consciousness.
  10. Up your physical fitness: If your numbers are down, I’m almost positive you’ve gained some weight, aren’t exercising as you should and aren’t getting regularly adjusted. You must have the discipline to walk the talk. And if you’re suffering the lethargic symptoms of burnout, end the inappropriate attachments you’ve formed to things you can’t control and identify and extinguish the underlying source of your anger.
  11. Take a field trip: Tour some practices that are busier than yours. Watch, listen and take notes. Observe his or her actions, but become a student of the underlying operating system producing them. Debrief the chiropractor after patient hours. What does he or she believe about patients, new patients, reactivations, staff hiring and training, presence, intention, etc.?
  12. Lose the Plan B: This is the time for 100% commitment. You’re “going to the mattresses” and need to be fully invested, boots and all. Stop looking for what else you could do. And if you’re working nights with Uber or selling shoes at the mall, stop the self-sabotage. You’re far more valuable to your family and community when you’re helping others actualize their full potential by reducing nervous system interferences.

Take Your Own Advice

Your mission is to attract your tribe of patients who resonate with your philosophy, values and worldview. Keeping your deepest beliefs on the down-low hoping not to offend, that showing up safe, neutral and beige is the way to practice success, is instead the road to obscurity. Give patients something to anchor to.

Success is largely a shedding process. What can you eliminate from your practice to reduce friction? What can you jettison that is irrelevant or off-purpose? How can you tell your truth more memorably and consistently? What advice would give yourself if you were a patient consulting you? Take it and act on it.

(Need some help getting your head back into the game? Consider a one-hour phone consultation.)