Dear Bill | Feeling Stuck

Posted by Bill Esteb on Dec 24th 2020

Dear Bill,

I've been practicing for over 30 years. Back in the day I earned in the top 10%. But in the last 10 years it's probably towards the bottom 25%. Today my practice is dying a slow death. I can't afford to retire. I've lost my mojo and I'm feeling stuck. Any suggestions?



That isn't much to go on, but here are some observations to consider.

Testosterone Poisoning

After three decades in practice, it's unlikely that the lynchpin is a procedure, communication strategy or clinical shortcoming. More likely it's some type of headspace issue. This seems more common among male chiropractors who attempt to compartmentalize their life, trying to separate their practice from some drama going on in their personal life.

Some of these personal issues that can account for a practice to trend downward include:

  • Separation or divorce
  • Birth of child
  • House purchase
  • Death of a loved one
  • Financial stress

These and many other real-world challenges can prompt a chiropractor to switch from playing offense to playing defense. It's a subtle shift. Instead of boldly taking names and making a ruckus, they pull back, play it safe and abandon the winning strategy they used before the crisis. Trying to keep what you have, rather than seeking to conquer new territory eventually shows up in lost vitality.

If the home front isn't the issue, then there are obvious practice events that can similarly serve to either distract or undermine a chiropractor's confidence:

  • Lawsuit or malpractice case
  • Insurance or Medicare audit
  • Loss of a key employee
  • Associate leaving and taking patients
  • Personal health crisis

The energy suck comes from trying to defend oneself. Or an unwillingness to accept what is so. Or a desire to return things to the way they used to be. And quite often, needing to be "right."

Those of us who suffer from testosterone poisoning are often inclined to suppress the fear, anger or injustice. Or simply try to hide it. Pushing it down. Suppressing it. Denying it as it forms a cancerous tumor.

Of course, this doesn't work.

The way out is to confess. Apologize. Forgive. Accept. To humble oneself. Naturally, until you can heal your own life and become whole, there aren't many patients willing to pay you as you try to hold your own life together and soldier on.

Just as the body heals from the inside out, so too does a practice. Which always starts with the "physical, mental and social well-being" of the chiropractor. Which may necessitate learning some new skills. Trying some new approaches. Becoming a student again. Making mistakes. Seeking help. Being coachable. Curious.

Fall In Love Again

It's alarming how many chiropractors with decades of practice under their belts, have mismanaged their finances to such a degree that they're still living hand to mouth.

Wanting to practice morphs into having to practice. It's a difference that makes all the difference in the world.

Wanting to practice – When you're in a state of flow and fully present, the days fly by. You achieve a healing consciousness and practice seems almost effortless. You prefer Mondays over Fridays. This apparent ease means you've successfully become a servant to the moment, any disharmony in your personal life becomes irrelevant. You never find yourself doing math (estimating the day's services) while adjusting patients. You're fully engaged and can't believe they pay you to do this.

Having to practice – Practice becomes obligatory. You feel trapped. The joy is gone and the practice doesn't produce the emotional reward it used to. Your calling and career have become a job. Patient relationships become  transactional rather than transformational; problems rather than opportunities. Practitioners imprisoned in this way can rarely fake their way out of it as their moodiness sends subtle signals to staff ("practice is a burden") and patients ("leave me alone"). Will someone please put me out of my misery?!?

The result? Patients vote with their feet, choosing not to participate in your pity party. Staff members either leave or become similarly emotionally detached. The result is a downward spiral as everyone waits for resolution in either one of two ways.

In one, the practice either closes with a whimper or is sold at a fire sale price to a practitioner who has the energy and vision that the selling doctor used to have.

If one can be found.

The other, is when circumstances force the practitioner to take a deep breath and summon the fortitude to press in and turn the practice around. Ostensibly this is usually to get the numbers up so as to garner a better sales price.

Which rarely produces the necessary motivation. It's merely a different flavor of have to.

Instead, the way forward is to fall in love with practice.

Like the overreaction to your spouse leaving the toothpaste cap off, the irritants of practice may be many. But choose to embrace them. Because it's a decision.

And, if you dislike playing footsy with insurance carriers, convert to a cash practice. Others have.

If you loath the obligations of running a small business, look for opportunities to become an associate. Others have.

If you have an aversion to certain types of patients, refer them elsewhere. Others do.

The point is, reinvent your practice. Rekindle the original vision that prompted you to begin this journey in the first place. There are other chiropractors who became similarly disenchanted and courageously reconfigured their practice into something they now enjoy.

This will necessitate learning some new skills. Trying some new approaches. Becoming a student again. Making mistakes. Seeking help. Being coachable. Curious.

Remember, dwindling numbers is an effect. As is the reverse, a bigger paycheck. As are the emotional rewards of collaborating with patients to recover their health. While it's tempting to treat the symptoms, the cause is almost always the condition of your heart and the willingness to be of service.

Purpose of Equal or Greater Value

You are correct. You can't afford to retire. But probably not for the reason you think.

Retirement is a relatively new word that emerged in the 17th century as the industrial age was taking hold. Its original French meaning captured the idea of retreating and a "withdrawal from an occupation or business." Like a piece of worn machinery, as age took its toll on the physical productivity of employees, they were retired. Pushed out. Replaced.

With the wisdom and experience you've acquired, withdrawing it seems, well, almost selfish.

I'm reminded that Job, Moses, Aaron, Joseph and other patriarchs of the Bible were active and vital up to the very end. In fact, I can't find a single reference to the concept of retirement anywhere in scripture.

Now, if you're physically "worn out" and instrument adjusting is simply abhorrent, then withdrawing from practice may be the best option. But only on the condition that you can replace it with a meaningful purpose of equal or greater value.

Playing golf five days a week won't.

Puttering around the house won't.

Restoring that 1967 Volkswagen won't cut it, either.

Finding something big enough and significant enough to replace the emotional and spiritual affirmation that your ministrations in practice have produced over the years will be quite a challenge. Especially since your very identity is intertwined with being a doctor.

That's why I always appreciated Greg Stanley's turn of phrase of retiring in practice. In other words, remain engaged and purposeful, but without the obligations and responsibilities of practice ownership.

If that doesn't include adjusting a few favorite patients a day or two a week, then maybe it includes mentoring. Or consulting. Or writing. Or teaching. Or ways to inspire the next generation of chiropractors. Today, with access to the internet and a desire to serve, your influence can be significant.

Oh, but it will likely necessitate learning some new skills. Trying some new approaches. Becoming a student, yourself. Making mistakes. Seeking help. Being coachable. Curious.

Which, in case you haven't noticed, is a recurring theme— if you want to get unstuck.

Thanks for the question!

Email Bill with your question.

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