The Future Adjustment Podcast Episode 13: Building a wellness practice

Daniel: Welcome to The Future Adjustment, Chiropractic Economics podcast series on what’s new and notable in the world of chiropractic. I’m Daniel Sosnoski, the editor-in-chief of Chiropractic Economics. And our guest today is Alan Smith, DC. Dr. Alan, as he’s known by patients, is a 2001 graduate of Parker University. After launching a multidisciplinary chiropractic practice in Colorado, he began to envision a comprehensive wellness center that could offer a more tailored style of chiropractic which led to his development of the Axiom Wellness Center in Jacksonville, Florida. Axiom Wellness offers chiropractic, acupuncture, nutrition, corrective exercise, laser therapy, and even infrared sauna. We’ve asked Dr. Alan to join us today to describe how he developed this type of wellness practice and the lessons he’s learned along the way.

Welcome to the Future Adjustment, Dr. Alan, and thanks for joining me in person at the offices of Chiropractic Economics. To start off, it sounds like your first practice was a complex effort in taking right out of school. How did you envision this type of practice, and what happened as a result?

Dr. Alan: Well, first off, thank you for having me here. And it was a growing process, it truly was. When I graduated, I was under the model that it was subluxation only, you know, atlas was all that I would correct. I even… The first time I ever had an injured atlas. So it wasn’t until I literally was struggling, because I went to this town and I didn’t know anybody. I literally just threw a dart in the map and moved to Colorado which I was very blessed in that aspect as it evolved. But it took learning to take all the tools that I knew and evolve to be able to actually help the patient. Not just what I thought was the only right way to do it, of only atlas and or only the subluxation because not everybody was ready to hear that. I literally had someone come in one day from skiing. They’ve rotated her ankle and it made no sense for me to turn them away. And then ever since that day that I adjusted that person’s ankle, my practice, myself, has been working, growing that sort.

Daniel: You know, there’s that old saying, “If all you have is a hammer, everything looks like a nail.” If you’re restricted to one modality, then you’re tempted to kind of force everybody into that…

Dr. Alan: Into that mindset.

Daniel: Yeah.

Dr. Alan: Correct. I totally agree with you on that.

Daniel: So it makes sense that you would kind of vary the modalities such you would wanna be able to offer under one roof. And during that time, you tend to formulate a healthcare philosophy that you refer to as the five axioms of health. Would you like to walk us through those and what they are?

Dr. Alan: Of course, of course. To tie into where the practice before this, I started off as a sole practitioner like I said, that we struggled and then we evolved into truly doing a multidisciplinary practice. We had medical, we had massage, we had yoga, yoga therapy, we had physical therapy. You name it, we had the whole gamut. And it was wonderful in that regard. But what I learned was in order to keep patients focused, you had to bring them back as to why they were coming or what services you offer or how you could actually have them truly express wellness.

And wellness from being in Colorado especially close to Boulder, I wasn’t in Boulder, but close to it, has different definitions for different people. It might be CoolSculpting, it can be counseling, it can be health in the aspect that we understand in the chiropractic and expression of life. So I wanted to be able to bring people to understand that we were subluxation centered and then our spokes with those five axioms of chiropractic, exercise, nutrition, how’s the mental attitude, and then exercise. So that they can… Those spokes all revolve in the wheel of congruency centered on the subluxation that they understood that as chiropractors is what we do, how we evolve, and what true wellness is. Because that’s where our philosophies has always been. It’s true real wellness.

Daniel: Uh-huh. Yeah. I’ve noticed that not just in chiropractic, but in other healthcare modalities including the allopathic medicine, psychology, physical therapy, that traditionally there was a mentality that the patient had the role of being the patient and the doctor was in the role of the healer. And this was a kind of a one-way street. And things have been changing. And just this recently, it’s about five years ago where we’re seeing a shift, a paradigm change where the patient is being encouraged to become a more active participant in the journey towards health and wellness. Is that how you see it yourself?

Dr. Alan: Without a doubt, at least with the patients that we attract in the office. Most people know that they have to embrace their health, you know, and that they have to truly take it under their wing if they’re gonna get the results that they wanna get. And people are frustrated with what was happening before because they weren’t getting results or it was a sick, broken model. And people are paying more for organic food, they’re paying more for healthy water, they’re paying a kind of pocket for these things. So people are already doing that, they’re embracing this movement. And we as chiropractors should be the ones to actually voice that this is truly what we are and how we’re about it so that we attract the patients that are already looking for that just to realize that we were the ones that actually had been preaching this for the past hundred years.

Daniel: I see. Okay. Well, so to achieve a healthcare delivery model that fulfills and incorporates these ideas and ideals, you formed the Axiom Wellness Center. Do you provide all the services yourself or do you use other healthcare providers?

Dr. Alan: We have a few other practitioners that we actually work with and… But I am the, I guess the head and director to make sure that everything is congruent in that manner. In my previous practice, we had multiple practitioners. And here in Florida…excuse me. I wanted to keep it more streamlined and more focused so we can actually care for the patient, be more centered in that aspect. So it’s been working out very well, but obviously being here for the period of time that I have which is short, but still the evolution of the practice has been very blessed in that regard, and we’re constantly growing. So this conversation could change in a couple of years.

Daniel: Of course. You’re located in a very good part of the city that’s gentrifying at a rapid rate. And so, the demographics I think are very good for the kind of services that you offer. Speaking of providing services, I understand that you’re operating under a cash only model. A lot of docs just dream about doing that. That’s kind of a holy grail of practice. You can get rid of the insurance companies and credit card. How have you managed to make that work where so many other doctors have tried and failed?

Dr. Alan: Well, it’s the only thing that I truly know. So in that aspect it’s my truth. And what I learned a long time ago was you have to be comfortable with the number that you’re asking somebody for. I don’t care if it’s with insurance, it’s with the individual, but you have to look at that person and say, “This amount of time that I’m spending with you is worth this.” It may be an adjustment, it may be manual therapy or whatever it is you do. That’s not my judgment in that aspect. But it’s…you have to look at someone and say, “Hey, these 8 to 12 minutes that took me to work on you, I value my time at this much.” Because I’m gonna be seeing these many people to figure it out. Because you have a life, you have everything you need to pay for, and to be profitable in that as well. You’ve gotten in the business not just to help people, but to actually have a successful business for you and your life. So it’s really just knowing what you value yourself as, and that’s it. And not having to worry about taking advantage in any other way of insurance.

I don’t mean that in a negative way, but, you know, the energy changes when you have one person and all they do is call and bill. And then have to call back and get your money back again because you’re not getting paid or you didn’t put one number right for coding. And my overhead is drastically lower because I don’t have to employ all these people to have to deal with that and we just focus on you, the individual. And I will tell you this, when you as a patient give your hard-earned money over to somebody else because you want to get better or you’re searching for an answer, you get better a lot quicker because you are, that trade is happening, and that is very powerful. I’ve learned without a doubt even with someone that we’re gonna be doing trade if there’s a hardship for an individual, I still make them even give me a dollar because that process means something in that aspect.

Daniel: Yeah. The coding specialist, a Kathy Mills Chang, she has an anecdote about working with a practice where they were dealing with a hardship case and the woman wanted to pay $5 every visit just because it did mean something to her, and she wanted to let them know that that was important to her as well. So it’s nice that you can kinda reinforce that. Just one more thing on that, on this topic, do you offer any kind of payment plans or a credit, something of that nature for people who need to maybe space out the payments?

Dr. Alan: You know, I don’t. And I found out that I seem to be not the norm in that aspect. But I personally do not believe in year plans because I think they evolve and they change. And I know that there are some gray areas in that aspect where you have people pay for certain amount of time or in a limit or… And I don’t wanna operate in the gray. And I also…this may sound little rash, but I may not like the individual into three months. It may seem like way more work than it is reward. So, I don’t wanna get in a long-term thing with somebody. We take it easy. I have one package, that’s it. And everyone knows it, the numbers are set and done, and I don’t have an issue with people reupping it. I never have an issue. And I really…my patient average visit is about, I think I did the numbers the other day for this, was 63.

Daniel: That’s pretty good.

Dr. Alan: So I don’t lose people, you know, it’s… I’m very blessed in that regard. So I don’t do the year plans because I also have an issue why someone is paying obscene amount from the beginning to the end when they’re only coming in, you know, less in that aspect if that’s the way it evolves. So for me, it wasn’t a truth. And part of having a cash-based practice is you have to operate on your truth and be congruent. And that’s how we operate.

Daniel: You have patients who come, I mean, obviously, probably the core group of patients that you’re dealing with are chiropractic patients. Do you have some who come in for…exclusively for one or more of the other modalities, like they’re just coming in for help with nutrition or they want laser therapy or…?

Dr. Alan: Yes, I do. I have people that I have never touched chiropractically. And they know what I do, and they know how, and it’s… And they were referred in typically by someone, you know, chiropractically and just we got into conversations or found me and… But yeah, I have many. Actually nutrition is my first degree. I have my first degree in nutrition so I’ve been helping, doing that for a very long time. So I’ve been having people coming just for that forever. And then with the laser, the people, again I refer us from many practitioners, surgeons, post-op, you name it, podiatrist like crazy, and we just do the laser. And I never touched them chiropractically. Nobody talked about it in how I could improve it. They never stopped talking about… True that I’m a chiropractor and here’s how the benefit you’d get, but you know, I can’t force them into doing what they don’t wanna do.

Daniel: So, and you’re dealing with maybe the elbows, spondylitis, and the plantar fasciitis, and seeing those kind of patients.

Dr. Alan: Correct.

Daniel: Fantastic. Well, for anybody in the audience who’s thinking, “This really sounds like maybe the way I’d like to practice,” or it sounds like, “I’d love to move my practice in this direction,” do you have any other key words of advice or lessons learned along the way?

Dr. Alan: I do and there’s a few things. Number one, don’t be scared of the word “pain.” Not everybody is ready for wellness at the beginning like that we understand it. In school, philosophically like, “Oh, I don’t wanna address pain. I’m only a chiropractor, and the true chiropractic is practicing a subluxation. We don’t diagnose any of that.” And some people aren’t ready to hear that. And you know what, as long as your message is congruent, consistently saying, “This is really what I do and how I go about it. Well, let me get you out of pain first and we’re gonna revisit this later.” And then they’re ready to listen because they already have your trust. And if you work in group, everything in my office, everybody knows that I would either take personally or get to my family, and there’s no doubt. So it’s not selling. I’m educating them on why we have what we have, why they need what they need, and why I’d be using it on my own. So in that aspect, the congruency is so clear that people appreciate that and that trust is there. And you just need to be comfortable with yourself to be able to apply to the individual, and they will be receptive.

Daniel: If I could just put that in slightly other terms just to make sure that I’m following you, so it is in the matter of, “I’m a chiropractor and hey, I think I just wanna add on acupuncture because I’ve heard that that’s something…” You’re saying, build the kind of practice that reflects your philosophy of care, and that’s how it will start to build around you perhaps in the form of what it was.

Dr. Alan: Of course. Yes.

Daniel: Gotcha. Yeah. That makes a lot of sense. Hey, are there any changes or new developments that you have planned for the future, some new areas you think you might be branching out into?

Dr. Alan: You know, things are evolving. I believe next year, I’m gonna actually start speaking for a certain company. And I’m very blessed with, and I would have never thought that I would have been doing that when I first started out. The company is Foot Levelers, so I feel very blessed in that aspect because they’re asking about a cash practice and how can it be applied easily in today’s environment. And so, we’ll see where everything takes us because this is something that anyone would feel very blessed to be able to do that and grateful.

Daniel: Well, I know that they’re launching sort of these new training programs and kind of education. So you’re gonna kinda join their speakers group?

Dr. Alan: I am. I mean, they’re a really big foundation in chiropractic. There always have been. So, to be able to help that and help other chiropractors, by all means, I mean I feel truly honored to be able to do that.

Daniel: Well, that’s a powerful development. I’m very happy for you there. Okay. Well, I’d like to thank you very much for visiting us today, Dr. Alan. This has been extremely informative and you’ve given us an axiomatic work at the Future Adjustment. I’m Daniel Sosnoski and we’ll see you next time. Thank you.