The Future Adjustment Podcast Episode 22: Building a million dollar clinic

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 James Fedich, DC, who’s notable for his tremendous success in the field. Since launching his practice upon his graduation in 2003, he has grown year on year in scope and in 2015 published a book titled, “Secrets of a Million Dollar Clinic.” Today, he employs two chiropractors, two physical therapists, an acupuncturist, a nutritionist and an MD. He coaches other DC’s who want to model his path to prosperity, while remaining active in daily practice.

Doctor Fedich, welcome to our podcast.

James: Thanks for having me on Dan, I appreciate the time to come on the show.

Daniel: All right, you’re somebody I’ve wanted to talk to for a long time. Can you tell me how you came to start your practice, actually securing office space even before you obtained your diploma?

James: Yeah, it wasn’t the most well thought out plan, now I look back on it 14-years later. But I graduated from NYCC in December, 2003, and signed a lease on a 700-square foot space before I got my board scores back so, if I failed my boards I’d be in big trouble because I already signed a lease. It wasn’t a well thought out plan but it ended up working out really well. A space came up and somebody knew this place and thought it was a good spot to practice and I jumped in probably not knowing as much as I should. If I knew what I knew now I might have not done it but it worked out for the best. I just jumped right in and had very little money in the bank, and just made it work by hustle, sweat. I worked 2-days a week in somebody else’s clinic on the weekend and 5-days a week in my own clinic, you know, 12 hour days and slowly built it on up to where we are now.

Daniel: Wow. How long did it take you to reach profitability in your first clinic?

James: Yeah, I mean it’s tough. It takes some time, you know, people see it now. The first couple years were tough, I was living with my parents for a year or two and commuting on the weekends to another clinic. And barely every dollar really went back to the business for the first couple years and then there was a point where I got myself in trouble using credit cards trying to fund office expenses when we had some slow months. And, so there were quite a few years where it was kinda tough in there and I was floating it on credit cards, all those things you hear about. So you know, it’s a good couple years but it really just you know, grew [inaudible 00:02:24] the first year you do $100,000 and then you grow 20% every year. I just have really grown 15-20% year after year until we really get to the numbers where we’re at today. So, it’s just been a slow steady growth for the first year, yeah, the first four years is pretty tough.

Daniel: That’s what I’ve heard. Normally it takes three to five years before you really start moving into the green and you know, new docs need to be aware of that if they’re going to try to follow your model and launch their own practice as opposed to being an associate, And, it’s interesting that you actually kinda did a hybrid model where you were doing a little work for another practice as well as getting your own off the ground. Hey, you’ve written for “Chiropractic Economics” before and you’ve described something that you call the Practice roller coaster. What is that and how can a D.C. get off of it?

James: Yeah, that’s what most docs do when they’re marketing their practice and we’ve all heard of some of the promotions. A patient appreciation day is a good example that has been around for 100 years. You know, we do a patient appreciation day. You get this flood of patients, the practice jumps up 25 to 50 visits a week and you’re processing new patients and you’re so busy treating all these people, we don’t do any marketing in our office for 6 or 8 weeks and you know, that big rush of patients dies down and we end up back at the same number of visits we were seeing seeing before, you know, this rush of new people. So, instead of consistently promoting and growing month over month, you know, we do a promotion, we ride that wave and then it comes back down as we you know, process those patients and then we weren’t marketing in those six to eight weeks that we were treating all those people. So that’s what a whole lot of docs do, they promote, they have a bunch of clients and they treat and then they don’t promote again until things slow down, they have another promotion and then it picks back up again. But, you know, year after year we never get anywhere going up and down that way.

Daniel: That’s right. I have definitely heard that before and I’ve heard that, especially in the newer years of your career, you probably want to do more marketing and regular marketing. And then, you can kinda taper off after you’re, you know, well established and you have more of the referral traffic coming your way. In addition to your book, “The Secrets of a Million Dollar Clinic,” you also lecture on that topic. Can you share a few of those secrets with us?

James: Yes, I’ve lectured on several different topics and one of the things I’ve talked a lot about is internet marketing over the years. But, you know, everybody talks about that as well so we also teach direct mail and we do do all that kind of stuff. But, you know, I’ve done a lot of Facebook ads, and YouTube, and Google, I’ve thought a lot about that ways. But, one of the key things we’ve talked about is getting the marketing calendar just like with a roller coaster, just consistently marketing the practice, and having, you know, an internal event going on all the time and an external event. Like you said, when you’ve been in practice awhile you get more referrals. And I just had a new client, he’s seeing 15-visits a day and he wanted some help bringing on an associate. And I just had a little internal thing and he saw this big jump in patients. Even though he didn’t need it, it was just a small internal thing. So, just always keeping an internal marketing going and external, every single month. And those could be things like direct mail or internet marketing as well as internal events. You’ve gotta kinda do it on both ends is my thoughts.

Daniel: Definitely, and you mentioned direct mail, you know, it kinda sounds old school but there’s a reason why it has traditionally been highly effective and it remains so today. And that’s that certain kinds of marketing, like let’s say, Facebook or other kinds of internet driven campaigns are reaching a potentially wide audience but most chiropractors are probably interested in that area of about 15-square miles around, in a radius around their practice and direct mail allows you to target that demographic with surgical precision, if you will. And, it tends to have a pretty high rate of response as well. I know that e-mail campaigns can be considered effective if you’re getting a 3-5% response rate, that’s great. And, normally you can beat that with direct mail.

James: Yeah, absolutely. I was just reading an article about this. And yeah, the direct mail rates are going up, the percentage of responders, because there’s less mail in the mailbox, your odds are going up of people reading your message and getting the message. And, we all know what’s going on with Facebook, you know kinda, everything about, who’s watching your ads and all that stuff. So yeah, direct mail is still good, I mean, we just did an every-door direct mail, it’s a great program for chiropractors. You get low cost, you can get your whole neighborhood and you can also buy a list, it’s real targeted. We just did a senior mailing where we bought a list of just people, you know, over a certain age, to market to seniors.

Dan: Sure.

James: So yeah, direct mail is still good. I don’t care about the medium, I tell doctors, “Whatever works. If it brings people in, it gets your message out, that’s all that’s important. Whether it’s new or old isn’t important, just get them in the door.”

Daniel: Yeah. Hey, one of the consulting services that you offer is something called a Remote-Practice Assessment, wherein a doc will send you like 3-months worth of statistics on their practice and then you analyze them. What kind of things do you look at and why?

James: Yeah, that’s a great thing. Really, with the practice, statistics never lie. You can really always tell what’s going on with the practice if they show you the numbers. You know, everybody’s got different issues whether it’s not enough new patients, or they’re retention, they’re not keeping people enough not or not collecting enough per visit. If you look those, they’re really new patients, collections, patient retention, office visit average, case visit average, all those metrics. But, if you get all those, you can really see what the problem is of the practice from afar. Those numbers really don’t ever lie, what’s the issue, whether it’s new patients. And, a lot of times docs think they may need more new patients. They add the new patients, but they’re not keeping them long enough or something else. But yeah, the numbers really never lie. You can always figure out what’s going on with the practice. I’m always astonished when doctors do that and they don’t even know their numbers, that’s usually step one is finding out all these numbers and then step two, analyzing them.

Daniel: Yeah, if you’re not measuring it you can’t fix it, is something that I’ve heard before as well. Okay, and you know, just to kinda switch gears, there was something kind of interesting I saw in your story is that, well you know, topical analgesics and chiropractic have been you know, hand-in-hand for 50-years or more because topical therapy is clinically effective, and it’s also a good profit center. And, I understand that you developed your own topical line of products for patients, how did you do that?

James: Yeah, we actually found a laboratory that’ll private label for people without like, a huge order. So, I looked around and saw you know, we were promoting brands that are available in other stories or every chiropractor has them. To, look for something different so I looked all over the country for a years to find a lab that would do them and most of them wanted to provide 10,000 bottles of them. But, we found a lab that, you know, they have a formula and they private label it for you and I think you can order as few as 48-jars or maybe even less than that, 24-jars. So yeah, it’s a company that does it and they private label it for us and some of our clients. But, and this way it, you know, has your logo, your phone number, it’s in their medicine cabinet, people never really throw it away. So, it’s good marketing, and it’s a good formula, you know, similar to a lot of the stuff, Pharmaca and Menthol and all the stuff that most of them have in there but it’s got your name on it instead of promoting another company.

Daniel: Yeah, private labeling, where the D.C. can get their name on supplements, on topicals, that just seems to be good marketing, in general. You know, like publishing a book with your name on it as well. These things just, I think kind of, increase your authority and your legitimacy in the eyes of your clientele. And, I just thought that was just a really clever idea. And, it probably improves your bottom line as well.

James: Yeah, absolutely. And you know, they can’t, if they liked it, they can’t go to the CVS or Walmart and buy it because it’s your name on it. They don’t know what formula it is. You know, so, they can only get it from you and we send it in like a new patient welcome box to everybody. So, it’s in their house, it’s in their door. So it’s already in their house. Everybody gets a free jar so, you know, my name’s in their medicine cabinet for, you know, probably years I would think, for most people unless they use it up and then they come buy more.

Daniel: Got it. Hey, before I let you go, do you have any new initiatives or things you’re working on, symposiums coming up? Any new…

James: Yeah, we’ve always got…

Daniel: Yeah, go ahead.

James: We’ve always got new stuff going on, I mean, obviously the podcast is out. We have two new episodes a week. I just did an interview with Doctor John Demartini, who is obviously well known in our profession.

Daniel: Oh, yeah.

James: There’s always free tips and tricks on our podcast, you know, we have like 50-60 episodes, we do 2 a week, there’s always something going on there. We talked a little bit before now, we have a free audio program on, “Ways to get New Patients,” available on our website at drjamesfedich.com. That’s F-E-D-I-C-H. You can download a free audio of, “The Top 10-Ways to Get New Patients in 2018.” Yeah, I do some speaking here and there and we’re always around at chiropractic conventions, but a whole lot of it we do remotely because I’m still in practice. But, there’s always stuff available and the podcast has always got some new great tips for you.

Daniel: Okay, well, you’re a thought leader and you definitely have your finger on the pulse of the profession. So, we’ll try to get you back in the magazine as fast as we can and…

James: Thanks Dan, I appreciate it.

Daniel: All right, well hey, Dr. Fedich, thank you so much for spending this time with us. It has been highly informative and you’ve given us a million dollar look at the “Future Adjustment.” I’m Daniel Sosnoski, we’ll see you next time.