Education and skills development begin the day you decide to be a chiropractor and the process never stops — there is always more to learn, and there are more resources available than ever.

By Sam BruceLearningEarning

As a chiropractor, your most important job is the treatment and care of your patients, but effectively providing this valuable service requires knowledge and adaptation amid constantly changing business and market environments.

Fortunately, innovative new educational resources are constantly evolving to assist you in establishing and maintaining a profitable and sustainable business model for your practice. Perhaps the best way to think of education is as being an investment.

Investing in your staff

Consider the following specific educational resources that can help you address the weak spots in your business model and increase your practice’s efficiency and profitability.

One of the most important factors in the success of your practice is a well-trained and motivated staff. Brandi MacDonald of True Concepts Inc. specializes in chiropractic-specific leadership and staff training.

“I follow the model that Starbucks follows,” MacDonald says. “Your best marketing investment is in your staff, which allows you to focus on what you are great at — educating and adjusting patients. All else in the practice is delegated to a well-trained, self-directed team. When staff members know their roles, and the team is empowered to run the office, the office grows in numbers and patients stay longer.”

MacDonald provides four types of training to help optimize staff performance. The first is provided by a series of CDs designed to train chiropractic assistants, ranging from the philosophy of chiropractic to the procedures and systems for running a cash-based, wellness-focused practice.

The second type of training is leadership coaching for doctors, with the goal of increasing retention of CAs. This can include looking at training issues, recruitment practices, job descriptions, performance reviews, bonus structures, and other factors. This individualized program is designed with input from the DC or owners.

For an even more customized training experience, MacDonald can visit a practice, observe the staff, and then run a team-training session based on her findings. Desired outcomes are individually designed after talking to the DCs. MacDonald also offers all-day “team boot camp” seminars.

How can leadership and staff training benefit your bottom line? An effective, self-directed team in your office can result in increased collections, as your staff is better able to keep patients on plans and collect money confidently. When your staff learns to internally and externally market your practice, you can gain more new patients and higher patient-visit averages.

MacDonald says, “We know that a well-trained staff is an overhead cost-cutting factor in itself, as constant turnover and recruitment is highly expensive not only in dollars, but also in time and energy away from the practice and patients. I am about spectacular customer service and increased exposure of chiropractic first — increased profit is a byproduct of this model. Investment in the team is key.”

Invest in marketing yourself

The need for effective marketing is obvious — you can’t build your patient base if people have never heard of your practice. MacDonald asserts that your staff is your best marketing resource, and marketing consultant Judy Munroe of Consistent Marketing Inc. (CMI) agrees.

“Too often,” Munroe says, “chiropractors simply leave marketing concerns to the front desk, which leaves the business in a vulnerable position. If a key employee leaves the practice, marketing can simply collapse.”

Well-run practices employ dozens of marketing techniques every day, and Munroe stresses that successful marketing is a complex system of tasks that includes planning, positioning, implementation, and tracking. Putting this system in place requires training and the involvement of your whole team, but once effectively implemented it is self-sustaining and can survive the challenge of staffing changes or disruptions.

CMI develops internal marketing systems for an individual practice in five steps. First is a visit to the office to develop an evaluation of current marketing and customer service efforts. The second step is to design a marketing plan and calendar, with critical due dates for marketing projects that will ensure a consistent marketing effort in line with goals.

The third step is an important one: identifying and promoting the practice’s “wow” factor. Chiropractic is first and foremost a personality-based business, Munroe says, and although it’s important to provide your patients with a unique experience, it’s equally important for you and your staff to communicate your office’s “special story.”

What is different and exciting about your approach or office environment? Learning how to communicate your practice’s unique “brand” to your patients effectively turns doctors, staff, and patients into a highly effective marketing team, an approach Munroe calls “marketing from the inside out.”

The fourth step concerns direct marketing services, including ads, welcome books, patient letters (from referrals to reactivations), newsletters, patient appreciation days, and PR campaigns. Again, keeping it personal and unique is the goal.

Munroe often sees marketing email that incorporates flashy design and fancy templates. “Those are the first to be deleted,” she says. In this case, less is more — a simpler design can create a more personal feel and tends to be more attractive to potential patients.

The fifth step is measuring the results. Expect a measurable return on your investment. If you discover that one method out-performs another, update and retool your marketing plan immediately.

When it comes to marketing a practice, Munroe stresses the need for effective communication. It is easy to focus on a patient’s pain and relief, and then move on to the next patient.

“Treat and heal,” Munroe advises, “but then keep in touch!”

Anytime, anywhere

As you strengthen your practice’s business foundations, another educational option to consider is webinars (from “Web” and “seminar”). These innovative online tools are popular in many professions for their efficiency and convenience, and they can be accessed from the comfort of your home or practice.

A look at one such program specifically designed for chiropractors shows the kind of training available. The On the Level Webinar Series, co-sponsored by Foot Levelers and New York Chiropractic College (NYCC), covers a broad range of topics in the business of chiropractic as well as treatment.

In the business arena, topics include post-payment audits, which arise from government agencies or insurance companies and can be a huge hit on a practice’s profitability. If an auditor determines that case notes do not support the coding under which claims have been paid, for example, a practice can be required to return the payments.

A major post-payment audit can cost hundreds of thousands of dollars, so familiarity with how they work and how they can be avoided can make a major difference to your success.

The webinar offers a detailed look at what post-payment audits are, why there has been a rise in the number of post-payment audits, some of the most common causes, and what you can do to defend your practice.

As with health, prevention is the best approach to such audits, proper coding of medical documentation is key. Another webinar in the series, How to Code the Proper Level of E/M Services, illustrates simple, accurate ways to properly code for evaluation and management services.

Without up-to-date knowledge, coding can quickly turn into a nightmare — not only does improper coding raise the possibility of future audits, it can alternately result in billing shortages, leaving unclaimed money on the table. Coding webinars can be an effective solution for you and your team.

Not only are webinars convenient, most are free to attend. Check to see if CEU credits are available.

Hilary Kelly of Foot Levelers says, however, “Webinars should be supplemental to the weekend seminars in your area. Networking with colleagues and face-to-face interactions with the presenters are not aspects that can be replaced. The valuable techniques that are shown in these personal interactions, along with practice insights from peers, are things that are not as effectively experienced online.”

Whether you avail yourself of consultations, seminars, webinars, or other training opportunities, take the time to reevaluate your practice’s business model.

Do you have a system in place that ensures the crucial tasks of staffing, management, billing, and marketing practically take care of themselves? This should be the goal, as it allows you to concentrate on what you do best — treating your patients and keeping them healthy and pain-free.

A model program

Kevin Cunningham, DC, PhD, and vice chancellor for student success at Palmer College of Chiropractic, Davenport campus, stresses the importance of taking an informed and multifaceted approach to today’s business environment for both chiropractic students and practicing DCs.

“One of our main concerns for our students,” he says, “is with their successful transition after graduation into the business environment and a profitable practice.

“Think of it in terms of the proverbial half-full glass. The contents are the certainties — the things covered in our core curriculum, for example — but from the top of the liquid to the top of the glass are the uncertainties of the marketplace. Minimizing that uncertainty for our students as well as our alumni is the goal.”

To address this concern, the college launched the Palmer Center for Business Development in 2008, a three-year co-curricular program that works in tandem with the core curriculum to ensure students gain the business acumen necessary for success in the field.

The initiative is organized into three groups of “business modules,” which start with the basics of entering a practice and gradually progress to complex concepts such as financing, marketing, and insurance compliance. Backing up these modules, taught by local practitioners and industry experts in three-hour sessions on weekends and evenings, are a series of business-oriented services provided by the school’s career center.

As an example of how the program works, consider the first year’s module, which introduces core concepts such as networking, mentorships, and starting a practice. These concepts are not only taught in class, but are immediately backed up with practical experience through two online ancillary services, Locus and Palmer Connect.

Students are challenged to begin a business-oriented self-assessment from the start of the program. As they begin to explore communities in which they might want to set up practice, they can access the Locus software online and enter prospective zip codes to see how many chiropractors are currently in practice in that area as well as typical rates in the region.

The searcher can also find out whether Palmer alumni are in the area for mentor relationships. Locus is backed up by another online resource, Palmer Connect, a Facebook-like recruiting website for both students and industry professionals to set up profiles that allow for productive “matches” between graduates and prospective employers or mentors.

Palmer Connect is also used by Palmer to determine placement rates for their graduates and to monitor the crucial benchmarks at years three, five, and seven of practice — widely recognized barometers of small business success or failure.

The second year’s business module at Palmer offers education in marketing, selecting appropriate software for a practice, office design and flow, and selecting additional sources of income. Also stressed are the development of an optimal curriculum vitae and interview skills, with the latter strengthened and honed by mock interviews videotaped for review.

The third year also explores advanced business concepts such as commercial real estate, financial and business planning, business structure, legal documents, insurance compliance, healthcare networks, and hiring and managing staff. The student’s experience is deepened by both group and individual coaching opportunities from faculty and experts from the profession on targeted areas of concern to the chiropractic entrepreneur.

A valuable resource for students and alumni, the program at the Palmer Center for Business Development also stands as a useful business paradigm for even the most experienced practitioner, and a review and mastery of its concepts would form a sound foundation for the profitability and growth of any practice.

Sam Bruce is a freelance writer and editor based in Austin, Texas. He can be contacted at


Meet the experts

Kevin Cunningham, DC, PhD

Practicing chiropractor, vice chancellor for student success at Palmer College of Chiropractic

Brandi MacDonald

Founder and owner of True Concepts Inc., coach, author, and international speaker for chiropractors and staff

Judy Munroe

Founder and owner of Consistent Marketing Inc., providing marketing education and consulting to chiropractors and other healthcare professionals for 20 years

Hilary Kelley

Public relations manager at Foot Levelers Inc., a leading provider of custom-made Spinal Pelvic Stabilizers and other healthcare products