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“My first practice in Midwest City, Oklahoma, grew from 70 patients a day to 140 by adapting my practice to be efficient in time, space and energy. After three consecutive years at that pace I could have retired, instead I chose to start over in Tulsa. Here are my five keys to achieving these numbers with a solo practice.”
I’ve been in practice for about 20 years. After graduating from Logan College of Chiropractic in 1973, I developed a large solo practice in Midwest City, Oklahoma. My past has been good to meI was consistently seeing 21,000 patients a year and could have retired at that point, but I decided I wanted to live in Tulsa. I sold my practice, moved my family and started over. Now I have two C.A.’s and we see between 40 and 50 patients a day. We’ll again grow to 100 patients daily. Starting a practice in the ’90s is a challenge, but my overhead is really nice. It’s less than 25% and I can grow my new practice gradually but steadily.
Did you have contacts in Tulsa?
Dr. Jack Sibley has been practicing about 19 years and has steadiness in his practice. We both philosophically practice the same and we’re within a mile of each other. We’re also close friends and mentors. When you are a Doctor of Chiropractic, you are “chiropractic” to that patient. When they are happy with you and your service, they will continue to come to you and refer to you; so there is no competition amongst chiropractors. There is a friendship when you want to go out and reach the other 90% who are unaware of chiropractic. Together, Dr. Sibley and I have formed Power Management along with a team of prosperous chiropractors who teach these success principles across the nation.
How has your practice changed?
In Midwest City, I was seeing 60-70 patients every day, just running from room to room. You think you get too busy, but you really just get too inefficient to see the patients. You become tired because you are working so hardthe rewards are not better than the work you put out, therefore you get burnt out. Or you have nothing to show for it in your career over a period of 15-25 years towards the lifestyle that you look forward to because the profit margin was not there during those years.
I have since adapted my practices to be more efficient with time, space and energy. Instead of walking from room to room, we have the patient come to a hot seat area outside our adjusting rooms and have no visual barriers in the office from the front desk back to the treating area where the C.A.s become of vital importance in the practice’s growth. We train our C.A.s in all areas of the practice including insurance, examination of patients, patient treatment and promoting the practice outside the office. My first practice grew from 70 patients a day to 140 a day under this system.
How does the system work?
In a solo practice this system drives the overhead down and the profit is very high. It creates a referral practice because you average over 100 patients a day, every day, as I did for three years. I see people who have multiple clinics and bigger is not always better. My partner, Dr. Jack Sibley has taken this system to very successful chiropractors where their overhead has decreased from more than 80% to 20% because they’ve dropped a number of staff people due to the interactive office design we’ve developed. This also allows more energy for the doctor who is not walking from room to room. The staff is now career-oriented, not clerically oriented. They are part of the educational process and part of the treating process with the doctor’s supervision, but also they have an vested interest in their career. As the business grows, instead of paying for an associate, the C.A.’s salary becomes very, very rewarding as well.
What is a typical practice’s overhead?
We have two doctors in our clinic, but we do not stress having multiple clinics because of the overhead involved. The national overhead for every chiropractor is 55% on average and I’ve seen some as high as 100% to start. On the other hand, we’ve seen new doctors in offices of 1,000 square feet or less with one C.A. capable of handling 25-35 patients a day comfortably. They are able to add staff members as their practices need it, are always in control of their overhead, able to stay afloat, and able to help more people per day, therefore their overhead goes down and their discretionary income goes up.
It comes down to your hands on a patient’s back to adjust their spine. Everything else is overhead. We make sure our office’s therapies are effective and we don’t go for the bells and whistles, but if there is something that will benefit our patients we make sure the therapeuatic value has been tested. It’s nice because you can stay fresh in practice and you have patients come to your hands instead of your hands going to the patient. That saves a lot of enery because there is time and energy in those steps, which will wear out even the best of doctors.
How else does this system help a solo practice?
We teach the staff to “zone” in peak hours. The insurance person will come back and be a treating C.A. and the front desk person will help out and file our insurance in the off hours. We play as a team in our office where there’s an overlapping of responsibilities. The excitement exists amongst the staff because they know that in keeping overhead down, their salaries will be rewarded properly.
What’s your breakdown of patients?
Basically, commercial insurance is about 37%, personal injury 33%, cash patients about 20% and worker’s comp is probably 20%.
Do you think the future is a mixed group?
Yes, definitely. You want to be as diversified as possible because each patient has different employment, different sources of revenue, different changing systemsemployment changes, benefits change, so the patient who has insurance today may possibly not have that same insurance two years from now, but they know where to go to get the care in that community. If you have a program that is equitable to all patients, then you have to be diverse. To zone in on one aspect in today’s market is very riskysuch as going totally managed care or totally PI. A strictly cash practice does not allow you the diversity in the marketplace for those patients who are paying for insurance benefits. Become part of those programs as long as you can live by the contracts and work with them. You need to be diverse in these times for the future.
What are your thoughts on all cash?
I was told a long time ago: people will follow the dollar. They will go for the bargain. If it is cheaper using the co-pay for the patient, they will try that as the initial approach. For a managed care program, the same person told me the fact is when your product is considered a commodity, the price is an issue. When they consider the value of the product, price is not an issue. So people’s first approach is, “What’s the cheapest way for me to deal with this?” However, if they feel they are not being treated properly and are unhappy with the service, it will increase the value of the service to pay for it elsewhere. Initally, people will follow the dollar.
What advantages does being involved in managed care bring?
With managed care you have a sphere of influence with other doctors in managed care such as medical practices. As you build your relationships, you will see more patients because their practices will refer to yours where you could not previously get to those patients or enrollees. If you include yourself in MCO’s, there are other situations that occur with the enrollees, such as personal injury. When accidents happen to those people, you are able to participate because you are in that sphere of managed care enrollees. There are some spin-offs because people have other health care needs not directly related to managed care needs such as personal injury, workers’ comp or other things. Plus, they have spouses who may not be enrolled in the same program. If you see them for a co-payment of your $10+ contractual agreement and you take care of them properly, the spouse, who may have other insurance or no insurancea cash situationwill be happy with the care you’ve given and come in themselves. I believe these programs are important. There’s nothing wrong with having a cash practice. I just think that you can have bothyou can have more.
Do you market products?
Only if crisis care necessitates it, then we do on an as-needed basis. We believe in whatever will enhance the well-being of a patient. I do have nutritional and orthotic products. However, they are considered supportive patient care versus a regimen of care.
Is most of your marketing done through referrals?
I do spinal care classes and I think that’s a very good educational tool for the patient and doctor. My staff does spinal care classes, which is very exciting because they can give the same caliber and get the message and referrals to the patients. We occasionally do spinal screenings for the community because I want to train my staff how to evaluate the conditions; they can then speak on my behalf. It returns higher referral rates when the staff is well educated. We also work with industrya very big market right now with stress management and protecting your back. We are also working with professional “MDs without walls,” getting into hospitals as a department of chiropractic as well as working with various institutions. That’s where health care is headed for the consumer, who is going to want chiropractic in these institutions. The aggressive chiropractor, by example, is showing these professionals what they are capable of doing by working confidently with them and understanding the protocol for treatment. Networking between professionals is getting friendly for “doctors without walls.” We have a good referral system with MDs, neurologists, surgeons, internists and so forth who are all very busy doctors. They refer to our office and we refer to theirs. It’s just a matter of a phone call from staff to staff.
Please contact Dr. Frank Ungerland at 3322 East 51st Street, Tulsa, OK 74135-3512 or call 918-749-8682. E-mail: firstname.lastname@example.org.
What are your keys to success?
1. Successful people are committed to their purpose.
Overcome distractions in your life and practice. Stay focused. When at work be at work. Heighten the moment by practicing present time consciousness. Treat each moment preciously, you will never see it again. Give it your best. Do not succumb to adversity. Some people will approve of your efforts, some will not. As long as you do your best, so what!
2. Develop mentorships with other successful professionals.
The likeness of minds creates a power that is unexplainable, yet it is very powerful. All successful people have had role models to emulate and could confide in. To walk through life and share ideas, dreams, and activities with others who love doing the same things you like to do, is a precious treasure.
3. Have an efficient office system.
Your office system should emphasize high volume and low overhead, and an office procedure that will conserve energy of both doctor and staff.
4. Be capable of handling every patient under every situation that arises.
To be prepared for the unexpected is service; to do things for a patient before they ask is ultimate service. In a sense, it is practicing slightly ahead of time. This type of service is an art form and will create a wondrous professional reputation for your practice.
5. Keep the excitement in your life and your practice.
Reward yourself and those around you for a job well done. The more peoples’ lives change for the better, your personal and professional life should reflect the same abundance in life.
6. The best investment in chiropractic will always be your practice.
The things you do today and the people you help today will pay dividends if you are able to help them tomorrow or when they need your help next. I’ve lived that and I’m living it again. I believe it’s not how many people you know, but how many people know you in practice. That is generated by the good works chiropractic is able to do. It’s just nice to know that your good works are creating dividends down the road.
TIPS AND TRICKS
When is your clinic open?
From 8:30-1:00 and then 3:00-6:00 Monday-Thursday and 8:30-12:00 on Friday. That’s 38 hours a week. No Saturdays. I used to work that way before and I would advise a new practitioner to be available for patients six days a week. The key is if you keep regular hours patients will understand your hours, but you cannot be erratic, there must be consistency. Saturdays are mostly for patients in acute care or a patient who couldn’t get in during the week. I help my patients. I give them my home phone number and it’s never been abusedI can’t remember the last time I was called in on an emergency. The idea is the doctor stays fresh and consistent with approximately 40 hours a week. If the doctor does things consistently well with overhead, he or she can enjoy a very good livelihood.