Resource Centers:(News, information, and tools to support your practice)
March 2010
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What do DCs do now?
15 industry insiders answer questions on new issues you may be facing in this tumultuous economic time and offer advice on what you can do to still be profitable.
By Wendy Bautista
Bailouts. Layoffs. Unemployment. Recession. Financial upheaval. Downturned economy. Stock market crash.
These latest economic buzzwords have much of the population convinced things are bad — but are they really?
Chiropractic has been around for more than 100 years and has grown as a profession regardless of what was happening in the economy, but what do industry insiders think about the current economy status and how it will affect their practice in the foreseeable future?
Chiropractic Economics asked industry insiders to answer a few questions about:
• What they feel are some new issues you are facing;
• What you can do to still be profitable; and
• How this economic time will or will not affect the future of chiropractic.
When asked about current economic times and some of the new issues chiropractors are facing because of them, many said it’s the patients who are scared and wrought with many emotions. “You are facing a group of patients who are going to place a higher priority on their financial health than their personal health — even the most dedicated of wellness patients,” said Julie Weaver.
Weaver added that this economy presents similar stumbling blocks and hurdles that chiropractic already has been facing, but she believes that chiropractic is the “most equipped healthcare profession to calm people’s fears, and provide a voice that people can trust.”
Freddie Ulan, DC, agreed these problems are not really new, but are “amplified due to the ‘noise’ in the public mind.”
“Patients have always had a concern for where they spend their money, but have historically had a far greater concern for their health and the health of their family,” he stated.
“It is an erroneous belief that during these times people are not willing to pay fair fees for quality care,” said Daniel T. Drubin, DC. “The tougher the economy becomes the more stress people experience, and the more they need chiropractic care.”
“Patients do not have time, distance, or money challenges — they always have challenges based on their priorities,” said Bob Hoffman, DC. “You must properly explain and demonstrate why chiropractic is not a luxury and why it is a necessity.”
“Don’t see what you do as superfluous, unnecessary, a frivolity, or a luxury,” agreed Dr. Ogi, DC. “That thinking needs to change. Chiropractic is not a luxury; it is an absolute necessity. And that is the perspective you need to have and totally own.”
Stanley B. Greenfield, RHU, added that “many people are afraid to spend any money unless they feel it is absolutely necessary,” so you need to remind patients why it is so important to follow your treatment plan.
Another problem chiropractors are facing is the change in insurance. Barbara Sturm, DC, believes the present economic condition brings the reality and stress of high overhead practices front and center. “I grieve for my colleagues who just assumed the insurance gravy train would keep coming back around, dumping off piles of cash at their door step.”
Mark Sanna, DC, ACRB Level II, FICC, feels that diminishing third-party reimbursements is a new problem chiropractors are facing. These economic times have made “collecting cash for the services you deliver a requirement, which means you must build a high-perceived value for your services in the eyes of your patients.”
“We need to adjust our ’80s view of insurance,” stated Keith Maule, “I think the biggest change we are facing is the way we see insurance and the way it is seen in the office. The majority of policies now have very high deductibles. It is more of a ‘collection’ department than an ‘insurance’ department.”
Other experts felt it was a combination of issues that they were facing. “A lack of confidence is by far the biggest challenge facing chiropractors in this economy today,” said CJ Mertz, DC. He believes chiropractors are “lacking the day-to-day confidence needed to grow their practice.” He said it’s easy to grow in a healthy economy, “but champions separate themselves by growing through a challenged economy.”
Eric Plasker, DC, believes that one problem is that the DC’s “practice model is exclusively based on third-party reimbursement or one type of condition, and they don’t educate patients about the benefits of lifetime chiropractic care.”
Peter G. Fernandez, DC, and Bradley K. Chapman, DC agreed it was a financial situation that was affecting chiropractors the most. Fernandez said it will become almost impossible to finance a new practice without a great co-signer, and that bank financing or lease financing for new equipment will be very difficult to get. Chapman said the tightening of the credit markets will make it more difficult for the small business owner to obtain ready credit for expansion and growth.
Dealing with the economy
But there are ways to deal with the economy and still be profitable in your practice. “There are two ways to grow a practice; first is increase new patients and second is patient retention,” said [BOLD]David Singer, DC. [/BOLD] “Cars stop moving forward when you take your foot off the gas. The gas that pushes a practice forward is marketing.
“Marketing is nothing more than having people in our community find out who you are and what you do. The most traditional methods to achieve this are asking for referrals; in-office workshops for patients, friends, and families; outside lectures; screenings,” said Singer.
Larry Markson, DC, said chiropractors need to change their thinking so practice success becomes their self-fulfilling prophesy.
“My broad suggestion is that they turn fear into power by turning their fear into faith,” said Markson. He went on to add that to accomplish this, DCs need to “put a smile on their faces, become ministers of encouragement, and teach their patients that all this stress bombards the nervous system creating the very nerve interference that we have been trained to correct. You should ask your patients how worry and fear helps alleviate their financial situation.”
“This is the time for DCs to step up to their greatness,” said Hoffman, “be proud to be doctors of chiropractic, constantly work on becoming better versions of yourself, and be more clinically competent than ever.”
Fernandez believes the better a doctor is with insurance, personal injury, and cash procedures, the more successful he or she will be in financially hard times. “I also tell my clients to curtail personal spending on purchases that don’t improve their practice’s bottom line.”
“DCs need to not only tighten up their belts, but tighten up their procedures,” said Ulan. “There are tried and true fundamentals that never change, despite ‘the weather.’ Yes, it takes some discipline and the knowledge of what these basics are, but the basics are the ‘rock’ as far as stability of growth.”
Mertz and Drubin believe one way chiropractors can deal with the economy and still be profitable is to step up their level of communication. According to Drubin, “Ultimately, the more effective the communicator, the less resistance they will face to patients accepting their programs of care.” He goes on to add that you must clearly distinguish between “elective” care and “essential” care, and the focus must be on patient education and the value and benefits of care.
Sanna and Plasker believe you must diversify your business model. “Adopt a business model based upon delivering wellness services along with the traditional chiropractic services of examination and adjustment,” said Sanna.
“It’s all about ‘the transition,’” said Plasker. “This way they can keep their insurance practice base, while adding a much bigger, stronger, and more stable base of cash paying lifetime patients. This eliminates the fear that doctors have from making the inevitable changes that they are going to have to make in order to survive and thrive in these rapidly changing times.”
Just don’t panic, said Chapman, “the market will cycle back, and you must be patient. Every doctor must be putting away money for retirement, and must be in a fully diversified portfolio to ‘weather the storm.’”
Surviving the hype
“It is more important than ever not to buy into the hype that we live in a world of scarcity and lack,” said Sanna. “Remember, everything you say and think is an affirmation. Be aware of your words and your thoughts — keep them positive.”
Sanna advised that to attract more abundance into your life, don’t disregard what you already have. “Every day set a small amount of time aside to think about and be grateful for things you already have in your life. By focusing on the good things, you will attract even more into your life.”
Weaver added her thoughts by saying, “Be fair with yourself and you’ll find that there’s a lot to be thankful for.” She also advised that instead of asking patients how they are today; ask them to tell you about one good thing that’s happened to them that day. “Lead your patients to looking for the positives in their day, too,” she said.
Sturm agreed that you need to limit your exposure to the negativity, but offered an alternative. “Creatively reposition conversations about the economy so objections get transformed into positive promotions for higher retention.”
She said rehearsing these conversations and masterfully overcoming the objections can put you in even greater positions of leadership and prosperity within your community. She added, “Practice leads to competence and confidence.”
On the subject of leadership, Hoffman added, “Leadership teaches us that in times of crisis, it is essential to remain calm and confident and to become more aggressive in the things that matter the most.”
One more note on staying positive, Mertz feels you should “Only listen, read, and watch programs that leave you stronger, more inspired, and more focused as a result.”
“Running a successful practice is a ‘state of mind’ — in any economy,” said Fernandez. “If you are a pessimist and think there is little chance a practice can thrive in a downturned economy, you are right. If you are an optimist and think a downturned economy presents unique strategic opportunities for a practice to prosper, you are also right.”
He commented that DCs are either prepared to fail or prepared to prosper, and the choice is theirs. “Like attaining any goal, preparation and strategy are everything,” he said. “If you want to prosper, prepare your practice and arm yourself by learning the latest information on practice matters, such as insurance, personal injury, cash procedures, marketing, advertising, public relations, community relations, and networking.”
Plasker agreed that having office procedures, systems, and marketing in place makes this a great time to grow your practice because the demand for your services are higher than ever.
But, according to Ulan, in order to grow your practice you must ensure you have your own act together first. “There is a huge difference between the fact of economic duress and the reason for the practice numbers going down," said Ulan.
He said that while there is a hue and cry about the economy, there will be holes
One hole in practice procedures is people simply don’t understand what you do. They say they quit your care to “save money” — but it is really because they don’t know what you do. According to Dr. Ogi, you have somehow failed to explain to your patients and impress them with what you do that they don’t find your care an absolute necessity.
“You see, when it comes to their health, it really doesn’t matter what the economy dictates. What matters is that people want to rid themselves of this ‘thing’ they have been battling with,” said Dr. Ogi.
He recommended you offer your patients something of substance, something they can get their teeth into and touch and feel — something that is real. “If you do, people will line up to see you, be fighting to get on your waiting list, fly from vast distances to meet you, refer all their loved ones and their children to you, and your fees and insurance would never be an issue. Money would not be a problem — ever — no matter what the economy dictates.”
When economic times are bad, Maule believes you need to work harder. “To shrink back in tough times is to guarantee decline and make it even much greater if there is going to be decline,” he said. “Be strong and do [ITAL]more[/ITAL] in down times — not less.”
“To survive a downtrend, said Singer, “all you need to do is create a plan to meet twice as many people each week and tell them how you get sick people well. The more people who know you the more people will go to you.”
Greenfield and Drubin agreed that you need to do more, but more in the form of marketing. Greenfield’s advice is to continue to market and educate the public about the importance of chiropractic care — now more so than ever.
Drubin believes “marketing drives businesses and the more internal and external marketing projects the better. All business is a matter of percentages. And, the doctor that works to tip the percentages in his or her favor will always do the best.”
Impact of a downturn
Markson does not think this “temporary” economic downturn will have any impact upon the chiropractic profession — positive or negative. “In every walk of life, in every business, and in every profession,” said Markson, “20 percent thrive, 60 percent struggle for varying degrees of success or mediocrity, and 20 percent fail regardless of anything or everything.”
Weaver believes it is up to you to decide how you choose to look at things. “John F. Kennedy had a great way of looking at what some people would perceive to be a dire situation. He said, ‘When written in Chinese, the word crisis is composed of two characters. One represents danger and the other represents opportunity.’”
“Tough times are good times for tough people,” stated Singer. “How tough you are will decide your future … you may discover that while an economic downturn is for economies, it is not necessarily for individuals.”
“The strong will survive,” said Plasker. “The doctors who are willing to adapt and change will become the chiropractic upper class. Change is inevitable and the urgency to change is now.”
Hoffman felt “that the middle class of the chiropractic profession is diminishing. Those with the best practices are having record-breaking years and those with borderline practices are more challenged then ever.”
Mertz agreed with Plasker and Hoffman by saying, “Today’s economy is merely a snapshot in the eternal winds of change.” Mertz felt that perhaps what comes to the profession the most in the next three to five years is a return of focus to what matters most.
“The fundamentals never go out of style. The principles never fade. But in time of difficulty, we have a way of rethinking our lives (and our work) and putting our time and energy to their greatest use,” said Mertz. “Chiropractic over the next 30 to 40 years will be leading the wellness movement globally. So now is the time to realign ourselves to true north in chiropractic because what is ‘fringe’ will fall away by itself.”
Drubin expects the profession to thrive regardless of economic times. “Winners always find a way; losers always find an excuse,” said Drubin. “Choose to win and be prepared to experience greatness in all that you do. The very best times for chiropractic have yet to occur.”
Sturm believes that “through effective communication where we share on levels members can relate to, we will take our rightful place as the leaders of the healthcare industry!”
Wendy Bautista is the associate editor of Chiropractic Economics. She can be reached at 904-567-1539, wbautista@chiroeco.com, or through www.ChiroEco.com.
**For more tips from 15 industry insiders on surviving the current economic times go to www.ChiroEco.com/survival.
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Meet the panel
The panel who contributed to this article include (listed in alphabetical order by last name):
• Bradley K. Chapman, DC, senior management consultant and physician with Chapman Management Corporation (www.chapmanmanagementcorp.com);
• Daniel T. Drubin, DC, managing partner of ProPractice Partners LLC (www.propracticepartners.com);
• Peter G. Fernandez, DC, founder of DrFernandez.com (www.DrFernandez.com);
• Stanley B. Greenfield, RHU, (www.stanleygreenfield.com);
• Bob Hoffman, DC, president and CEO of The Masters Circle (www.themasterscircle.com);
• Larry Markson, DC, president of LTM Consulting Inc. & The Cabin Experience (www.thecabinexperience.com);
• Keith Maule, CEO and president of Integrity Management (www.integritymanagement.com);
• CJ Mertz,DC, president and founder of The Waiting List Practice (www.teamwlp.com);
• Eric Plasker, DC, president and CEO of The Family Practice (www.thefamilypractice.net);
• Ogi “Dr. Ogi” Ressel, DC, coach for The Practice Evolution Program (www.practiceevolution.com)
• Mark Sanna, DC, ACRB Level II, FICC, president and CEO of Breakthrough Coaching (www.mybreakthrough.com);
• Barbara Sturm, DC, coach for elite chiropractors with Simple Solutions for Chiropractic Success (www.drbarbarasturm.com);
• Freddie Ulan, DC, founder of Ulan Nutritional Systems Inc. (www.unsinc.info); and
• Julie Weaver, co-founder of VIP Experts (www.VIPExperts.com).
Survey of DCs on the economy
DCs are handling economic turmoil better than their patients
In an attempt to get an overall national perspective on how the current economic turmoil troubling the Untied States and Canada is affecting chiropractic practices, we sent a four question survey to doctors of chiropractic while we were on deadline for this current issue of Chiropractic Economics in order to provide you the most up-to-date information.
Within less than 24 hours, we received 442 responses from DCs throughout the country and parts of Canada.
What is apparent is chiropractic patients are responding to the economic conditions more adversely than DCs.
In our accompanying cover story dealing with the economy, “What can DCs do now?,” Julie Weaver, a practice management consultant with VIP Experts LLC, based in Tampa, Fla., summed up the general response of DCs who answered to our survey. “You are facing a group of patients,” she said, “who are going to place a higher priority on their financial health than their personal health — even the most dedicated of wellness patients.”
But those involved in healing, both physically and mentally, may be used to handling momentary erratic behavior of people undergoing pain. Or that is what the survey seems to indicate.
On the opening question of the survey — Have the number of new patients fallen off — 55 percent answered in the affirmative, 45 percent said no.
On our follow-up question — If yes, what is the estimated percentage of drop-off? — some 30 percent said more than 20 percent have fallen off; 18 percent are experiencing a 10 percent decline; 18 percent are experiencing a 15 percent decline; and 20 percent are experiencing a 28 percent decline.
Our second question — Are your existing patients returning less frequently? — revealed that 63 percent of respondents are seeing regular patients less frequently, while 37 percent said their existing patients are still coming in regularly.
Our third question dealt with cash flow — the lifeline of any practice. Are you having trouble with collections? revealed that only 37 percent answered in the affirmative, while 63 percent said no. Our general coverage of practice management over the years tends to indicate that this problem of collections is just slightly more than normal.
Some 61 percent of the DCs experiencing problems with collections indicated that receivables are in arrears only 60 days or less — also not too out of the ordinary.
Our last question — Will you cancel intended purchases for November? — concerned purchases. What should be encouraging is that 55 percent of the DCs who responded said no — they planned to continue buying in November to maintain their practice.
Survey results can be found on www.chiroeco.com.
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