Paying bill after bill in what was a $500,000 practice back in the early 1990s was stressing out Dr. Mark Cymerint more than he cares to remember. By cutting overhead, Cymerint cut stress. Now vastly successful with incredibly low overhead, Cymerint preaches the low-overhead style of practice, and he can’t seem to stress it enough. Cymerint, who practices in Mission Viejo, Calif., was 30 years old in 1993 when he blew a disc in his neck.
Five-and-a-half hours of surgery — and six months — later, he needed to find a way to minimize most of the $300,000 in annual overhead that was bogging him down. It wasn’t too long ago that becoming a chiropractor wasn’t even in the cards for Dr. Neil Schwartz. Halfway through undergraduate school, he wasn’t even interested in the medical profession. Between a little reading and his experience as a college athlete, a career was born.
Now a “All of a sudden I couldn’t work at all,” Cymerint recalls. “For the first two weeks, I couldn’t find anyone to run my practice.” When he did find someone, the relief doctor broke his leg the day before he was going to start. “For six months I didn’t work,” Cymerint says. “I didn’t have any income. I had to pay for things out of my savings account. It almost devastated me financially.”
Cymerint, after recovering from his injury with the help of chiropractic care, eventually began practicing again. However, things did not go as smoothly as he had planned. He was down from 345 patient visits per week to less than 40, and he had an associate doctor and support staff on the payroll. Feeling physically and financially stressed, Cymerint knew he needed to make some serious changes. He ultimately sold his office equipment for $35,000 in June 1995. “I basically gave away my practice and all my patient files for free,” he says.
Suddenly Cymerint was faced with the rest of his professional life in front of him, along with the question of exactly what he was going to do with it. Only one thing was certain: He was sure he didn’t want to go back to a high-overhead, high-stress practice again. He took a three-month sabbatical and worked on some professional projects.
It was October of 1995 when Cymerint re-opened shop. Sort of. He rented space in a Laguna Hills, Calif., health club for $400 a month. His “office” consisted of a utility closet big enough to hold a bench, a small desk, filing cabinet and a phone. Cymerint says that was fine with him. After everything he’d been through, he had no delusions of grandeur. His original plan was to adjust a limited clientele while working on building a seminar business.
However, business was better than Cymerint anticipated, and by April of 1997, he had opened a new 750-square- foot practice in Mission Viejo, Calif. By this time, Cymerint was physically stronger after further rehabilitation with trainers at the health club where he had been practicing. Things were finally getting back to normal. But today, “normal” life has a whole different look than it did back in 1993 when Cymerint was running a high-volume, high-overhead, high-stress practice.
First off, Cymerint’s billings are down to about $200,000. His patient visits per week are steady at 125, and his overhead is as lean as possible, at an average of less than $1,200 per month. The reduction in outgoing cash, along with $150,000 in annual collections, translates into a better income than when his billings were significantly higher. Whereas Cymerint was netting a little more than $100,000 when his practice was grossing five times that much, he now nets approximately $135,000 of his $200,000 gross.
Practicing what he preaches in his low-overhead seminars, Cymerint now gets by on about $1,169 a month, give or take a few bucks. That outrageously low number includes rent, utilities, supplies, office cleaning, a credit card machine and a website. A few miscellaneous expenses, such as printing and business cards, bump the number a bit higher from time to time, but Cymerint says he has vowed to never again let his overhead get out of control.
One area in which Cymerint has cut back is on payroll. He has neither full-time office help, nor associate doctors. If the phone rings, he answers it. If there’s a knock at the door, he opens it. Trash needs emptied? He’s got it covered.
Wearing so many hats isn’t always easy, but the pay-off is worth it, Cymerint says. “It’s hard, and it’s hard work at some points,” he says. “But I know that everything always gets done. I never have to worry about the stress of changing staff members and training people, or people’s personal problems when they come to work. It’s always consistent.”
Cymerint’s only office help consists of students who occasionally do filing work for $5 an hour. He uses Advanced Chiropractic Management, a company based in Aliso Viejo, Calif., for his billing. ACM also handles his insurance verification and follow-up on collections. The trade-off is ACM gets a percentage of the collections, usually between 7% and 10%. “I’m very happy with it,” Cymerint says. “It cuts all my paperwork down to one piece of paper per day.”
Cymerint says the service has been a lifesaver for his low-overhead practice. “I didn’t have a complete understanding of insurance codes,” he says. “I was backlogged in paperwork. I could never get reports in a timely fashion.” All told, Cymerint’s collection rate stands at about 70%-75%, a number he says he’s comfortable with. “In this market of managed care and insurance companies and the way they pay, that’s good,” he says.
About 70% of Cymerint’s practice revenue comes from cash. He does not belong to any HMOs. Cymerint started making a conscious effort to add more cash-based business about three and a half years ago. “What I started doing was getting out of managed-care networks,” he says. “I was sick of paying for it. My overhead was so low I could actually do it. I tried to do it three different times in the early ’90s, unsuccessfully because the overhead was high.” Cymerint requests payment at the time of the visit, offering a discount to patients who pre-pay for 10 visits.
For X-rays, Cymerint has an agreement with another chiropractor in the area. He simply sends his patients across the way to the other doctor’s office, where they receive diagnostic X-rays. The two split the X-ray fee in half. The obvious financial benefit to Cymerint is that he doesn’t have to pay for the equipment, film, processing and space needed for X-rays.
Cymerint also refers his patients out for massage therapy. Leslie Hogbin, an independent massage therapist, handles the hands-on therapy.
Cymerint sticks to the bare bones when it comes to office amenities. His only equipment, outside of two adjusting areas, a bench with drop pieces, are two devices he invented. One is a posture-balancing instrument, and the other is a trigger-point therapy stimulator. He markets both products to other chiropractors. Beyond that, he simply sticks to ice. “I’m basically a straight practitioner,” he says.
Despite his low overhead, Cymerint says he hasn’t made sacrifices when it comes to the level of care he offers his patients. His colleagues agree. “One thing that’s important about what Mark is doing is, it’s a high-tech, low-cost way of doing things,” says Dr. Harold McCoy of Kirkland, Wash., who has closely studied Cymerint’s methods. “Everyone knows they need to lower overhead, and they can do it without having to live in shoebox. Mark has been able to maintain a high-tech practice and maintain the value of service so that people want to pay cash.”
Cymerint’s low-overhead philosophy includes the elimination of virtually all marketing and advertising. He relies heavily on patient referrals by word-of-mouth. He also spends a few bucks here and there advertising in local publications, such as high school football team programs or yearbooks. “They have to be in my community,” he says. His other promotion includes a creative business card, which doubles as playing cards, with the inscription, “Don’t gamble with your health; Chiropractic, the drugless alternative.” The decks are printed for $3.50 each, with $150 worth lasting a year.
Before making the segue to a low-overhead practice, Cymerint says he spent more than $25,000 a year on marketing and advertising. That included money for coupon books, Yellow Page ads, ads on park benches, signs at car washes, newsletters and direct mailings. That, along with referrals, translated into 15 new patient visits per week. Now, based primarily on patient referrals alone, Cymerint sees between six and eight new patients every week.
Nonetheless, Cymerint knows marketing is necessary and still sees its merits. He spends several thousands of dollars a year marketing his now-blossoming seminar business, which teaches other doctors how to operate low-overhead practices. The majority of the marketing budget is spent on direct-mail and fax campaigns. Cymerint offers about two dozen of his 12-hour seminars throughout the year, mostly in California, but occasionally elsewhere. He has also offered them on the East Coast, in Las Vegas and Reno, Nev., and is looking into Michigan, Arizona and New York, among other states. Down the road, he even hopes to take the seminars overseas.
Cymerint’s successful low-cost practice and devotion to the seminar circuit helped him earn Chiropractor of the Year honors from the International Chiropractic Association of California earlier this year. “I was totally shocked,” he says of the honor. “I didn’t expect it.” A member of the ICAC board, Cymerint spends much of his free time working with the organization to educate politicians about the benefits of chiropractic.
Cymerint says it’s unlikely his professional life would have headed in the direction it did if he had maintained his original practice schedule and the hours it demanded. In the end, his forced “down time” in the early ’90s ended up being time well-spent. While recovering from his injury, Cymerint planned his seminars. He also mapped out a life that would mean less stress, fewer demands, more professional diversity, and more income.
The lack of overhead has meant fewer hours at the practice. Cymerint’s office is open just 221/2 hours per week. This flexibility has allowed him to get back to a more relaxed way of life. “I may have been waiting for a stroke or heart attack at age 40,” he says now. “I have no stress today. Other than the birth of my kids, this might be the best thing that’s ever happened to me in my life.”