"I've always dreamed of seeing 300 patient visits a week, but it seems like we can't get beyond 150-170. I thought I would be further along by now. What advice do you have?"

It's a common refrain. Seems the 150-visit range is a common "set point" for many chiropractors. They often imagine that seeing twice as many would finally grant them access to the promised land. However, when I review these six elements below there is often resistance.

If you're unwilling to rethink one or more of these six variables, then stop torturing yourself about the notion of doubling your practice. Instead, resolve to lower your personal overhead, live beneath your means and enjoy the ride.

1. Shorten Adjusting Times

Many chiropractors who find themselves with little to do at 10:30 in the morning or 3:00 in the afternoon imagine that their practice could easily double in size by simply filling those off-peak slots. And while that's theoretically possible, it requires marketing to Medicare patients, stay-at-home moms and cultivating others who have flexible schedules. Which may not be possible based upon your practice location or interest.

However, there's a more pressing concern. It's the time it takes you to adjust a patient at 5:30 PM. For most practices, how well you choreograph the hour or two when everyone wants to see you, offers the greatest promise of helping more people.

"How long does it take you to adjust your spouse?" I'll often ask.

When I raise this issue, I'm reminded that while it only takes a minute or two, they don't have the documentation obligation and their spouse already "gets" chiropractic.

Yet, a hidden camera in an adjusting room would reveal that most of the time with a paying customer is rarely consumed with documentation or patient teaching. Instead, it is often characterized by adjusting too many segments, meaningless chit-chat or other time-wasters.

You may need to make several changes if there is any hope in doubling the size of your practice:

1. Make sure patients understand they are buying your talent, not your time. If they have other issues to discuss, a special appointment can be arranged. Or a phone call can be arranged during nonclinical hours. They may not drone on about their husband's ankle pain when the reception room is backing up.

2. Use a faster assessment and adjusting technique. If this is nonnegotiable, then you have placed a cap on the number of people you can help. Other chiropractors are getting great results spending 30-seconds checking and adjusting a single vertebra. Squandering 10-minutes (or longer) may be an expensive luxury if you want to help more people.

Granted, making such changes with existing patients may prompt disappointment or even defection. To avoid putting your practice into shock, start any new routine with your new patients. And if modifying your adjusting time is too scary or too high a price to pay for a larger practice, stop torturing yourself and enjoy what you have.

2. Clarify Your Identity

It's hard to see a way forward to the goal of helping more people if you have a distorted notion of who you are and what you're doing. Combine this with patients who are even more unclear about what you're doing (and not doing), and you'll remain trapped in an underperforming practice.

Before you can expect patients to fully participate and become partners in their care, it's essential that you have clear intentions and well-formed boundaries. That means constantly reminding yourself (and patients) that…

• You offer chiropractic care, not medical treatment
• You're interested in the whole person, not their problem
• You're first and foremost a nerve doctor, not a bone doctor
• You do not and will not be treating their symptom(s)
• You'll be relying on reviving their self-healing capacity
• You'll be assisting their body to function as designed
• You do not and cannot control the speed of their recovery

You must own these simple truths before a patient ever will. And even then, there's no guarantee. But it must begin with you and be properly communicated. Which means not relying solely on the spoken word. (Hint: put it in poster form on your walls.)

Related, is an all-too common block to helping more people that is the metaphorical "wetting of your finger" to test a patient's ongoing commitment and satisfaction with their care. I can assure you that chiropractors in larger practices don't have the time to micro-manage patients, conduct loyalty tests or fish for compliments.

In other words, you must care—but not too much. You simply cannot afford the luxury of being emotionally invested in their decisions. You are not their parent or guardian. You are not their conscience. The choices they make are NOT a reflection of you.

3. Streamline Your Procedures

There's a popular story about a family ham recipe, passed down from generation to generation. When shared with the newest family member, the newlywed wanted to know why the first instruction was to cut 2" off the end of the ham.

The mother-in-law was consulted. She didn't know. The grandmother was asked. She couldn't remember. Finally, the great grandmother was questioned about the odd instruction. After a moment she smiled, "I had to cut 2" off so it would fit in my pan."

Similarly, many chiropractors are using office procedures based some obsolete belief, irrelevant preference, legacy technology or merely out of habit. Procedures that can accommodate 150 patient visits a week simply won't permit 300 visits a week.

Streamlining your procedures begins with rethinking the patient experience, identifying bottlenecks, reducing redundancies and questioning every step in the process. Ultimately, this must be codified in a procedure manual.

"Oh sure, we have a procedure manual."

But it's an expensive artifact from a stint with a practice management company or an out of date three-ring binder that is rarely, if ever, consulted.

"Since I've never worked in a chiropractic practice, could I read your manual and perform front desk duties?" I'll often ask.

Long pause.

Practitioners stuck at 150 like the luxury of calling audibles—modifying procedures on the fly based on their mood, the number of patients waiting, whether they know the new patient socially and countless other reasons. They create a wake of uncertainty as team members scramble to maintain order and reverse engineer the doctor's intent.

Rather than a constraint, an airtight procedure manual frees everyone to perform at their best. No guessing. No double or triple handling of documents. Nothing falls through the cracks. It permits everyone to focus on creating the optimum patient experience. Your procedure manual codifies your unique "system" for delivering chiropractic care. Such as…

• The new patient marketing system
• The new patient onboarding system
• The staff training system
• The first visit system
• The second visit system
• The routine visit system
• The report of findings system
• The patient education system
• The progress exam system
• The reactivation system

And so it goes. Creating and executing systems is what separates boutique practices from enterprises that can grow and profoundly make a difference. When there are snafus or service failures, individuals or personalities aren't blamed, the procedure manual is consulted and the system is revised. The result is not only a well-oiled machine, but if desired, something that permits adding associates, multiple locations and value that far exceeds what a personality-based practice can produce.

If this sounds like too much work or you don't believe that consistent procedures produce freedom, stop torturing yourself about doubling the size of your practice.

4. Practice Space and Location

You can't put 12 ounces of fluid in a 10-ounce container. Physical constraints may be a reason why you can temporarily push your numbers up with a great deal of self-effort, but within 4-6 weeks your practice volume returns to its original "set point."

There can be countless friction points in your physical plant that interfere with patient flow too numerous to list here. But if you're serious about growing your practice, you'll want to conduct a time and motion study. This should identify how patients interact with your physical environment. Become mindful of the time it takes you to open adjusting room doors. The steps it takes to get to the next adjusting table. Privacy concerns. Hallway congestion. Lack of parking. The list is endless. A second here, six seconds there—it adds up. Remember, time is your most valuable inventory.

If your office layout and patient flow is restricting practice growth you have a couple of choices. Remodel your space to accommodate greater patient throughput or move to a space that will.

If neither is an option, you may need to rethink your practice hours. And if that's not an option, stop torturing yourself—at least until you're closer to the end of your lease.

5. Your Business Acumen

Make no mistake, you have a small business. It may be called a practice and your customers patients, but it's a small business. All the principles of profit and loss, overhead, cost of sales, taxes, salaries, marketing and other metrics apply. If running a business is uninteresting or distasteful obligation, you won't be very good at it.

The childlike belief that simply having great hands and producing delighted patients is all it takes to grow a practice is a common limiting factor to sustainable practice growth.

This belief may be acquired in chiropractic college where only perfunctory attention is given to practice management—lest it be seen as a mere trade school. Or perhaps the business aspect of practice is considered "dirty" or only necessary if you must compensate for poor clinical skills. Either way, countless chiropractors are disgorged from chiropractic colleges with an almost anti-business attitude.

Becoming a smart businessperson is a decision. Virtually all the critical skills are learnable. Your local community college probably offers classes that can help you decipher a P & L. Most bookstores have an entire section devoted to running a business and essential marketing strategies. Plus, the most successful chiropractors are quite generous with their knowledge if you express an interest. If practice promotion is unpleasant, it will be a long and difficult slog.

Where things often breakdown is when you add a staff member. Even if it's your spouse (which is convenient but more difficult), you must address boundaries, communication, expectations, decision-making and all the rest.

If you hate staff management, or have been burned, embezzled from or expect those whom you pay to have mind-reading skills, you've placed a cap on the number of people you can help. Granted, there are efficiencies by being a one-man band, but it limits possibilities. There's no shame in not wanting the leadership obligations that come with employees. But stop torturing yourself if the prospect of finding, training and mentoring a support team is unappealing.

6. Your Personality

This is a catch-all element that includes some of the more important aspects of you as a person. While there are exceptions to each of these, here some of the more pressing issues that can thwart the long-term sustainable growth of a practice:

Introversion/extroversion – Each has its advantages and disadvantages. Extroverts may have a slight advantage because of their people skills but may be challenged by some of the finer details. Introverts may need to compensate by surrounding themselves with team members who can better create emotional connections with patients.

Relationship with risk – Doubling the size of your practice means greater obligations, more taxes, larger payroll, being a bigger target and other issues that may be stressful. Your tolerance for risk, your willingness to seek professional advice and take responsibility for failures come with the territory.

Discipline – How good are you at managing your emotional state? Are you willing to hold yourself to a higher standard? Do you walk your talk? Can you be trusted?

Motivation – How badly do you want this larger practice? Is it your dream, or some else's? Is it your spouse who is waiting for a doctor's salary? Did someone you respect observe that if you're not seeing 300 a week, you're a sorry excuse for a chiropractor? Why do you want to see more? Because none of these reasons will be enough to keep you going when the going gets tough.

Boundaries – Do you have clear boundaries so you don't find yourself emotionally invested in the decisions patients make about their health? If you're thin-skinned or care too much about what others think, you can be easily seduced off course.

Delayed gratification – Remember the marshmallow test? Are you inclined to take the sure thing (one marshmallow), or willing to wait for two?

Margin – Can you afford missteps and mistakes? Are you betting the farm, or do you have enough margin to suffer some losses? If you're drowning in credit card debt or living hand to mouth, sustainable, long-term practice growth is more difficult. Thinking that growing the practice will produce the income needed to extricate yourself from financial pain rarely works. Until you can be trusted with little (by living beneath your means), you will not be trusted with much.

Vision casting – If you wish to help more people, you'll need to enroll others in your dream—including your team. Are you effective in creating the hope of a better tomorrow and the communication skills to help others see it?

In Conclusion

All this assumes that you're handy around an adjusting table, deliver excellent care, take adequate notes and generally deliver the goods.

Whether these observations discourage you from putting the peddle to the metal or inspires you to grow your practice, then mission accomplished. But one thing is certain, if you want to help more people you'll need to think and do things differently than you are now. You're the lynch pin. Which is good news. Because it's not the medical mindset of your town, the weather, the economy or the other convenient culprits. It's you. And you can change you. In fact, that's the only thing you can change. If you're not up for it, stop torturing yourself.

Thanks for the question!

Ask Bill your question.

« Previous   Next »