Think about the premise: “The inside is bigger than the outside.” It doesn’t really make sense, does it? How can that be possible? On the surface, that’s a difficult statement to understand — but nowhere near as hard to comprehend as the difference between Dr. X and Dr. Y. Let’s take a look at what’s going on inside these doctors’ practices, not just on the outside.
Dr. X works like a dog every day, runs late for every patient, can never come to the phone during office hours, and never catches up. He leaves the clinic an hour late every night, exhausted, and as he looks for the energy to get out of the car once he’s home, he wonders how he can keep this up for another week, let alone another couple of decades or more.
Dr. Y, on the other hand, sees his practice almost as recreation. He would tell you he works at it, but it’s more fun than work. He enjoys seeing so many of his patients get better. He takes calls during the day, wonders where the time went at 6 p.m., and races and beats his last patient to his car. He has dinner with his family and enjoys life.
Now here’s the most puzzling part of this scenario: Dr. X sees 60 patient visits a week, and Dr. Y sees 345. The busy doctor who sees more than five times the patients scarcely knows he’s working, while the doctor who sees fewer patients in a week than the busy doctor sees in a day struggles terribly.
Dr. X and Dr. Y aren’t as unusual as you may think. They represent prototypes of doctors found across the country. Dr. X is miserable, and Dr. Y is having the time of his life. And, it gets better and worse, depending on whose practice yours looks like. The patients in Dr. Y’s practice typically have more fun, refer more patients and are generally more satisfied with their care. That’s right, the one who works harder is appreciated less. Not fair, is it?
This mysterious contrast begs the question “Why?” It even screams, “How can this be?” After all, other than techniques, which may vary greatly, there isn’t much that can be so different from practice to practice that would easily explain this huge difference.
Dr. X may think that Dr. Y is a superhuman specimen or an unscrupulous villain running people through like cattle. Regarding Dr. Y as a villain may be preferable to assuming that Dr. Y is simply better at what he does. The fact is, none of these explanations are correct. The real reason is painfully simple and well-illustrated with the following story.
The Right Combination
My son Chris has a combination lock on his mountain bike. I don’t know the combination so I can’t open it to ride his bike. Chris, on the other hand, memorized the combination, can open it easily and rides to his heart’s content.
In much the same way, Dr. X doesn’t know the combination (the right action steps in sequence) to a smoothly running chiropractic office and hasn’t been able to “unlock” the secret to practice success. Picture Dr. X carrying his locked mountain bike down the trail, while a smiling Dr. Y coasts past him — and you start to see what I mean.
Occasionally, you’ll see a doctor who typically sees smaller patient volume work vacation relief for a busy doctor, and it may be like the relief doctor is riding someone else’s bike. It can be quite a thrill! “Look at this thing go!” It can also be a trip over the handlebars if the relief doctor doesn’t know exactly what to do. Luckily, any doctor can learn to run a high-volume, lower-stress practice almost as easily as you learn to use a combination lock.
Here’s another visual. Picture the half-time show put on by the best marching band you’ve seen. Every brightly uniformed member knows exactly where he or she should be, what step to be taking, and what note to be playing at all times. It’s a study in precision. Those shows may look so flawless that they seem to happen almost magically. But they get that way from one thing: practice.
Contrast the marching band halftime show with a South American soccer stadium stampede. Extreme example? Some practices have levels of panic and disorganization that almost conjure up that type of image. The parallel examples are almost infinite. Take ballroom dancing, a Broadway musical or Tiger Woods. Woods practices a combination of mental and physical steps to the point that when he swings the club, it’s not only automatic, but close to perfect. “All right,” you say. “My bike is locked up, my marching band needs help, and I can’t hit the ball worth a darn. What do I do?”
Steps You Need To Take
First, get rid of your perceptions about the “Natural.” You know, the man or woman who has “the gift.” Most so called “Naturals” have explanations behind their success that I call the rest of the story. Remember, Mark McGwire, even with those arms, still spends hours in the batting cage with a great coach who watches his every move.
Next, visualize what you want. Maybe you want twice the volume at half the work; an enjoyable practice day, to run on time; and you want to be home every night before dark. Don’t worry that it may seem impossible; it isn’t unless you believe it is.
Go on to imagine and visualize that your patients understand your chiropractic purpose. Picture each patient knowing his or her job (yes, they do have job descriptions, and patients, like staff, are happiest when they’re properly trained). Patients should also be taught what a chiropractic adjustment is really all about. Imagine further that your patients know the whole process of getting checked and adjusted is simple and sequential.
Right Way, Wrong Way
There is a right way and a wrong way to do almost everything. “What the heck do you want?” is obviously the wrong way for your CAs to answer the phone. “Chiropractic Wellness Center, Joy speaking. I can help you!” is at least one right way. The great news is that for everything that should be done in your practice, there’s at least one right way to do it. It’s hard to believe, but going from an awkward, slow practice to a smooth, fast practice is really about putting several dozen of these “best ways” end to end.
It’s likely you already make improvements like this to your practice here and there, but maybe not as part of an overall plan. Let me illustrate. Have you ever heard something used for patient education that you thought was terribly clever? You remembered it, used it and your patients responded well. It lowered your stress, made practice easier and your patients liked it. That’s one means of doing things the “right way.”
Practice management consultants take things a step further. They develop effective, efficient and personal practice protocols and they teach chiropractors. How would you like it if every patient interaction was as low-stress as possible? They put themselves back into treatment rooms. They’ve even marked their own charts for subjective improvement, positioned themselves on the table (just the way you wanted them to be) and waited to be adjusted. After their adjustment, they quickly head for the IST table, self-administer their therapy, then walk themselves up to the front desk. This is not an impossible scenario. You can do it, too, with the right guidance and some practice.
Your practice is your marching band. Your assistants and patients need to be trained to work together with you to produce a great “show.” It is a thing of beauty to watch a wonderfully trained practice operate during a busy hour. It’s like a Swiss watch.
Does this become robotic? Not at all, once you make up your mind about what to do, train for it with a good coach and know it cold; you are free to be warm and personal while being very effective and efficient. A great actor never looks like he or she is acting. Even though Shakespeare doesn’t change, a great actor makes it look spontaneous. The real fun for the actor is the interaction with a great script and that night’s audience. In a chiropractic practice, the real fun for the trained doctor and staff is the interaction with chiropractic and that day’s patients.
Scripting It Out
Your first assignment. Dust off your old consulting notes. Decide if you need a practice management consultant. Then take a look at your procedures for a new patient visit. It’s usually the visit that produces the most work, and is always the best place to start when re-evaluating the responsibilities of the doctor, staff and patients.
Tell your staff that you will role-play the first day for a new patient. Pass out “scripts” to your CAs for making the appointment, greeting and handling the patient. You too, should follow a “day one” script.
When you and your staff do your first “read-through,” you’ll all be able to visualize how the individual parts fit together and how smooth and effortless it is. You can even have someone play the patient, and you, as the director, can watch the way the person is handled on the phone and greeted. Make notes and give feedback to your CAs. Typically your direction will be appreciated. Remember, two of the things that staff members appreciate most are training and constructive feedback.
Now it’s time for your part. Go through the doctor’s portion of the day one scripts . It might feel a little foreign at first to follow a script, like a new dance step. Once you practice it for awhile, you will see how much easier things are. With practice, you will communicate the information in a natural way, and your patients will thank you. Ask your staff to critique you after your part. As you improve over time, you will see how easy it is when you know what to say, how to say it and are prepared for each variation, because you have practiced it. As you progress, giving an hour a week to rehearsal, you move on to the report of findings appointment and re-examination and re-report appointments.
What you will eventually experience is a melting of the stress you used to feel. After you and your staff know the scripts cold, go for a shorter time and more personal interaction.
Final thought: Chances are, you’re going to be a chiropractor for at least another decade — maybe another four decades. Open the combination lock and ride!
