This article will not be a warm fuzzy pat-on-the-back to all the hard-working, difference-making chiropractors.
Instead, it will be something that needs to be said to great doctors who have not grasped an important principle: You are not merely a doctor; you are also a business owner.
If you are in private practice, being an absolutely awesome DC is not enough. It never will be. Until the business platform that underlies your professional care program is stable and durable, both your business and your practice are at risk. Failure happens every day and likely has happened to at least one doctor you know.
I knew this ophthalmologist . . .
Consider the following illustrations of the relationship between business and practice:
A group of dentists decided to retain an accounting firm so they could spend more time tending to patients. After they established the arrangement, the dentists assumed a hands-off attitude toward finances, planning, and basic marketing.
The accountant hired three stay- at-home mothers who were diligent, intelligent, discreet, and grateful for this part-time work that allowed them to stay financially sound (at least one was the daughter of a CPA). Twice monthly the dentists delivered to the accountant two or three shopping bags full of “accounting stuff,” such as checks (personal, family, and business), credit card statements (business and personal), and stacks of bills and receipts—household and business all comingled. The housewives would gather at the accountant’s office and spend two or three days sorting it out, making entries, and reconciling accounts.
When they were done, the accountant notified the dentists of critical matters they had overlooked, deposited the checks and cash into the appropriate banks, and printed checks for the dentists to sign before mailing them out.
This system worked for two reasons:
- The accountant and the housewives were scrupulously honest (plenty could have gone wrong if it were otherwise), and
- The dentists (or their spouses) had access to family resources and inheritances. It did not matter so much that they made money as it did that they could account for it, and could verify that they were living responsible and productive lives.
For the rest of us, the following situation more likely applies:
At the end of a long day, sitting in her office, a young ophthalmologist discloses that she had performed brilliantly through years of schooling. Upon striking out in the real world, she was overwhelmed by the complexity of setting up and maintaining an office, complying with government regulations, controlling her “in’s and out’s” (and seemingly paying taxes on both), setting appointments with her patients just to see them fall through, and coping with endless paperwork to get insurers to pay claims.
She longs to return to the friendly environment of the research hospital where she had interned, but she is stuck in deep student and practice debt. She feels trapped.
Who is to blame?
Any waste of healing talent is a shame. Good health is the thing most missed once it slips away, yet it seems that “the system” is determined to grind doctors down and drown them in trivia, forms, numbers, and financial bondage.
But looking for someone to blame for this iniquitous system is a dead-end journey. One can blame the colleges “not preparing” doctors properly; the government for endless regulations; the allopathic medical community for warning against the dangers of natural, non-pharmacological care; the state associations and boards; the insurance companies; even the economy. But at the end of the day, when you struck out on your own, you signed up for all of these challenges.
In more than one way, the buck stops here. The real issue in finding success is a matter of who has to do the work.
And the question that follows is, “What has to be done?” Business problems are not related to your desire to serve, or the good intentions of your heart. They are about properly running a business. When your spending is out of control, your ability to do good work in the world is compromised. You can’t do what you signed up for no matter how good a practitioner you may be.
According to Dean DiPice, DC, a chiropractic consultant, business problems are multifaceted, but their solutions are usually simple. Enacting them is essential.
“The first thing I do,” DiPice says, “is listen. I hear their pain. I sense their frustrations, I get a grasp of the doctor’s unique problems.” When he has a fuller understanding of the situation, he draws a line from top to bottom down a sheet of paper. On the left side, he lists the most urgent items to be addressed. Then, on the right side, he lists the long-term things that need to be fixed. The long-term items describe what needs to be done to prevent the practice from getting into trouble again.
“You can’t stop at Band-Aids. Most people get it that they have to do some drastic things to save the ship, but then they forget the little stuff, the day-to-day disciplines that will keep the business above water for the long term,” DePice says. “The stuff that might have prevented the mess in the first place.”
Chance favors the prepared mind
Business is not an easy game to play; most businesses fail. But many don’t, and the answer to a lot of problems
is more likely to be found in seeing what works more than carefully cultivating a list of reasons and people that explain why your challenges are unique.
Each year, Chiropractic Economics magazine researches the market for the chiropractic industry. Consider the findings shown in the table on the next page.
Notice that some of these doctors are earning healthy salaries. It is likely that several of the top earners went to the same school as you, had the same undergraduate training, came from the same socioeconomic background, etc. It is also likely that these practices all have patients who are in roughly the same demographic. What explains the differences in outcome?
Starting over, every day
“One of the hardest things I tell my clients is that they have to think like they are starting over,” DiPice says. “I tell them my ‘three-two-one’ plan. Each day, build your business for three hours. Don’t just type on Facebook, hit the streets. Then help patients for two hours. All the rest— figure out how to pack it into one hour. That is six hours, and you have time to eat lunch and run errands. It is a sustainable pace.”
He recommends doing this until it becomes second nature: “Paint chips and carpet samples can wait. Get customers, treat them, manage the books, and sweep up. You want to work a little longer, that’s fine, but make sure it is productive, not just putting in time to appear busy. You need your rest. Keep in balance. There are other people in your life; those relationships will last a lifetime, and they need your attention, too.”
But DePice notes there are two things you don’t want to do:
- Get distracted by shiny objects, and
- Sign things without thinking them through.
By “shiny objects,” he means investing in some gizmo that’s guaranteed to have customers lining up around the block if you commit to easy monthly payments. “Some of these devices are sold with all the assurance in the world that if conditions change for you, the company will work with you in every way possible,” DePice says. “But once you sign a business note that includes a promise to pay, the note itself can be sold and resold until someday, someone who bought it at deep discount is calling you at all hours demanding that you fulfill the terms, even if the device is long gone.”
By “signing things,” DePice refers to offers of help that include taking ownership of your practice, solving your problems, and offering you the chance to work free from the distractions of the business part of your business. “Remember, the kid who works at the pizza place around the corner can always just quit and walk away. Any agreement you make that involves your future performance may not provide you such freedom.”
It can get better
Financial problems don’t happen all at once. Neither do their solutions. But going back to the beginning and rebuilding—even if it is only your outlook and attitude because your business may still be viable, can often do a lot of good.
Creditors might be pacified with partial payments if they see you building your business and working. If you live in a small place where gossip travels, good news can too. Your apparent attitude can also be an advertisement.
Once your heart is in the right place, other options tend to appear. Carefully chosen business augmentations (such as nutritional supplements) might help—but you have to truly believe in the product and use it yourself. (Also, once you add retail sales to your mix, there are associated sales tax and accounting issues.)
Todd Singleton, DC, offers these guidelines to finding the right products, or product mix, to introduce into your practice. “First, avoid anything customers can buy for them- selves on Amazon or in a multilevel marketing system. If your patient finds online at a better price the same things that you sell, it may give them the wrong impression. This is an opportunity to locate products that only chiropractors can sell.”
Singleton also advises being aware of trends: “Right now, the digestive system is receiving a lot of attention. Gut health is big. And this aligns with the teachings of D.D. Palmer, who blamed the root cause of subluxations on ‘trauma, thoughts, and toxins.’ ”
New revenue streams
If you opt to discuss products with patients, be alert to timing and context. “There are a few golden moments with each patient when it is okay to make an indirect invitation,” Singleton says. “If a patient on your table could benefit from a little less body mass, you might say something like ‘Does anyone in your family have a problem controlling their weight?’ This can open the door to a brief discussion that can lead to an extra sale that will benefit your practice and your patient (or perhaps ‘their relative’).”
You can also build working relationships with practitioners you trust. Many DCs employ licensed massage therapists, which frees those providers from billing and scheduling, while creating a new revenue stream and more customers coming through the door. “There is also nothing wrong,” says DePice, “with structuring relationships with other doctors who are just starting out, or who want to get out of the burden of ownership. If your own business is working well, you may have a lot to teach someone who is struggling with the business side of things. I would think it a good goal to commit to training—maybe call it mentoring—four other doctors into financial success over the course of your own career.”
Develop your skills
It may seem as if this article is saying that the way to avoid problems and the way back out of them when they occur is the same—aggressive practice building and sound business management. And that is usually the case.
A high school district in Arizona, for example, took the bold move of consolidating all its vocational programs onto one campus, and busing students there for part of the day for training on real equipment and facilities. The culinary director encouraged his students to take all the business and accounting classes they could, including co-enrollment at a nearby community college with an excellent culinary program.
He then encouraged them while at the community college to continue taking business classes at a nearby university, and then to complete the business degree upon finishing the culinary program. If necessary, they were urged to get a part-time job in food service. The result, he said, would be students who had a job skill and also the business underpinnings to make a go of it on their own.
Should there not be at least this much care for doctors of chiropractic?
Rick Lehtinen has written about chiropractic issues for 15 years and was a content author at ChiroCode Institute in Spanish Fork, Utah. Lehtinen has written books, articles, and newsletters about HIPAA, ICD-10 coding, data centers, computer security, broadcast engineering, and organic gardening. He resides with his wife in Mesa, Arizona. He can be contacted at rick@ technicallyaccuratewords.com.
