Alterman & Johnson Family Chiropractors, PA
423 N. Third St.
Jacksonville Beach, FL 32250
904-247-3933 · Fax: 904-247-1001
Alterman & Johnson Family Chiropractors, PA,
is a subluxation-based practice, established in October 1994. It is located in a 1,700-square-foot office, with two adjusting rooms, one massage therapy room, one open adjusting room and an exam/X-ray room.
Franca Alterman, DC, graduated from Life College in Georgia in 1984. Originally from Colombia, South America, Alterman practiced in Michigan and South Florida before relocating to Jacksonville Beach in 1986. She is the mother of a 13-year-old daughter.
Diane Johnson, DC, graduated from Life College in 1986. She worked as an associate in Georgia for a year. After researching ideal office locations in Florida, she decided on Jacksonville Beach in 1989. She is the mother of three children: a 10-year-old son, a 3-year-old daughter, and a 9-month-old son.
Claudia Rusnak, full-time front desk CA.
Sharon Piantadosi, insurance coordinator and front desk back-up.
Also, the practice has three massage therapists who cover the same hours as the doctors: Anne Barefoot, Rebecca Nitsch, and Bootsie Haas.
Monday, Wednesday and Friday:
9 a.m. to noon and 2 p.m. to 6 p.m.
Tuesday and Saturday: 10 a.m. to 1 p.m.
Staff Meeting Every Wednesday, 1 p.m. to 2 p.m.
Health-Care Class Every Wednesday, 6 p.m. to 7 p.m.
Johnson: Monday, Tuesday and Friday mornings; Wednesdays; and every other Saturday.
Alterman: Monday and Friday afternoons; Wednesdays; and every other Saturday.
The doctors’ schedules overlap on Wednesdays. They each see patients for half a day, and the rest of the day is used for “catch up” – time for reports, calls, consults with each other, etc.
Each doctor takes nine weeks of vacation per year. They each take six weeks of vacation in the summer; one week in December, either during Christmas or New Year’s week (alternating weeks, rotating every year); one week during their children’s spring break vacations (the schools’ time off occurs during different weeks); and one additional week each during the rest of the year.
Note: Prior to August 1999, both doctors worked approximately 25 hours per week.
From August 1999 through March 2000, Johnson was on maternity leave. When Johnson returned from her leave, both doctors began working 15 to 17 hours each per week. The doctors have made a more focused use of their time and are carrying the same patient load as they did before.
When dealing with choices concerning the tricky balance between professional and personal satisfaction, does one aspect of your life have to suffer in order for another to succeed?
Drs. Franca Alterman and Diane Johnson say absolutely not.
By thinking outside the box, these doctors have found the secret to enjoying the best of both worlds at their thriving practice in Jacksonville Beach, Fla. Nearly six years ago, Alterman and Johnson made a decision to form a unique practice in which they share patients and work shorter hours, which allows them to have flexibility and time for their personal lives.
They have made deliberate choices in terms of staffing, patient demographics and scheduling that have enabled them to form a successful practice with a family focus. This unique arrangement, similar to “job sharing” found in corporate America, has thrived – thanks to their ability to be flexible, and because of a deep level of trust between the partners.
After graduating from Life College and practicing in Michigan and South Florida, Alterman moved to Jacksonville Beach in 1986. That same year, she became a mother, while remaining a full-time chiropractor in a partnership practice. By 1991, she was a solo practitioner, burning out, and, as she puts it, feeling “trapped.” While she was doing well financially, there was no flexibility in her schedule. “I wanted to do something, but I just didn’t know what to do. Finally, I realized I needed a partner,” Alterman says.
An acquaintance from Life College, Johnson, was in a similar situation. After practicing in Georgia following graduation, Johnson established a solo practice in Jacksonville Beach in 1989 and had her first child in 1990. After five years in practice, she was working full time and had taken a total of one week of vacation, which created havoc at the practice. “I was very stressed trying to juggle my practice and my family, and carrying a fairly high overhead,” Johnson says. “I knew a partner would help ease the load in many ways.”
Fast forward to 1994, when both doctors found themselves at a crossroads in their lives – personally and professionally. The two would get together occasionally to talk and adjust each other. The topic of going into a partnership would come up from time to time, but hadn’t materialized. “We kept hitting the same snag: where to locate,” Alterman says. “We were both hesitant to leave our current locations, even though they were only one mile apart.”
Finally, it took outside advice, from Dr. Guy Riekeman, to help determine what was really important to them (see related article, page 40). In the end, the question of where to locate was left up to chance: The doctors asked their respective landlords for lower rent, and decided beforehand that they would let economics settle the issue.
As fate – and economics – would have it, Alterman & Johnson Family Chiropractors set up practice in Johnson’s office in October 1994. From day one, they enjoyed the savings of splitting the practice overhead between two doctors. The proximity of their practices meant a seamless transition for patients. The two combined their staffs and added a “new-patient advocate” position, for a total of five employees.
In the beginning, the bookkeeping arrangement called for each of the doctors to keep their patients from their solo practices. New patients were assigned to each partner on an alternating basis. Both doctors saw all patients, but for accounting purposes, they were assigned individual patients.
After one year, they evaluated this time-consuming record keeping and determined that the division of revenue generated between the two was 49%/51%. Realizing that it would be simpler and more cost-effective, they eliminated this tedious process and now simply split profits down the middle.
Achieving Their Goals
Alterman and Johnson agreed from the beginning that their ultimate goals were to have a subluxation-based practice with an emphasis on children and families. Due to changes in managed care, they also decided to move toward a cash-based practice. Over the past five years, Alterman and Johnson have been steadily converting their practice to achieve these goals. They have increased the number of children in the practice from 15% of their patient base to 27%. The doctors have also been able to increase their cash revenue from 20% in 1995 to 55% in 1999.
These substantive changes, aimed at long-term growth and professional fulfillment, have brought some decreases in revenue and the number of patient visits and new patients. However, with a purposeful, focused decrease in overhead costs, Alterman and Johnson have been able to maintain a constant personal income level.
They have achieved a significant reduction in overhead, dropping it from 51% of collected revenue in 1995 to just 42% in 1999. They do not include their salaries or bonuses in overhead expenses.
Alterman says they took a hard look at their overhead costs for two reasons. “First, we realized we had people doing jobs we could be doing, such as exams and X-rays. Second, our patient volume had changed and we needed to cut costs accordingly.”
In the process of lowering their overhead, Alterman and Johnson also looked at ways they could staff the practice more efficiently. On the average, they were both putting in 25-hour work weeks, with a large support staff, and “down” time on their hands. Today, the doctors work 15- to 17-hour weeks and have two full-time CAs. One is the insurance coordinator, who also backs up the CA in charge of the front desk. In addition, one of three massage therapists is always scheduled during regular office hours.
Working smarter has meant Alterman and Johnson’s incomes have remained steady. While these doctors work less than half the hours of the average chiropractor, they enjoy comfortable annual incomes of approximately $100,000. Both draw an annual base salary of $40,000. Monthly, after covering expenses, any excess is divided in half and paid out as a bonus. That amount averages $60,000 each per year. Planning for the future, both contribute 15% annually to their individual retirement funds.
Getting Better, Not Bigger
A major component contributing to the financial success of Alterman and Johnson’s practice is their collection rate. On average, since 1995, their collection rate has been more than 91%.
Interestingly, patient visits in 1999 were about 82% of what they were in 1996, but collected revenue in 1999 was 102% of 1996’s amount. In 1997, collected revenue was 113% of 1996’s level, while patient visits declined by 8%. In 1998, there was less than a 2% increase in both collected revenue and patient visits, and in 1999, patient visits declined by 13%, while collected revenue declined by a slightly lower 11%.
Alterman and Johnson say their arrangement works for them for a number of reasons. One of the principal reasons is their ability to be flexible. For instance, Johnson recently returned from a six-month maternity leave, after having her third child. During that time, Alterman worked the full schedule, and she now has six months of time she can draw from. There were no changes in the financial arrangements during Johnson’s leave.
“No matter who is working, our arrangement is to split profits 50/50,” Alterman says. Both doctors include trust and an ability to relinquish control to the other as the other key elements in making their practice work successfully. As partners, they say, both of them have a lot invested in making the practice successful.
The name Alterman & Johnson Family Chiropractors says exactly what this practice focuses on – caring for families. Their statement of purpose is, “Dedicated to spreading health and wellness throughout our community beginning with children.” The doctors – who emphasize staff participation in the decision-making process – say the statement of purpose was developed through a series of very focused after-hours staff meetings.
The practice had a pretty standard demographic make-up when Alterman and Johnson first got together, treating men and women, who would occasionally bring in a child. Today, it is a different story. Children are a primary focus, and they account for a substantial 27% of the patient base, followed by 47% women and 26% men.
Johnson acknowledges that, in the beginning, they had to develop a compatible style of working. “Both doctors care for all patients, so everything – from our adjusting technique to examinations to how we explain things to patients – had to be standardized,” she says. “With procedures in place, we ensure that our patients receive consistent, quality care.”
The doctors offer quarterly wellness workshops that were inspired by Dr. Eric Plasker of Atlanta and began as “Mother’s Morning Out.” Now, the talks are scheduled in the evenings to also accommodate working parents. Many of the topics are baby- and child-related, dealing with pressing issues such as Attention Deficit Disorder (ADD), ear infections, antibiotics and colic.
Because patient referral is by far the practice’s number-one source of new patients, consistent office procedures and education are integral to patient recruitment and retention. Plus, the doctors use high-profile activities, such as patient appreciation events, to keep their practice in their patients’ hearts and minds.
What Alterman and Johnson have done to obtain balance in all areas of their lives while maintaining a sizable income and operating an efficient practice may be applied in other partnerships, regardless of the partners’ family situations or personal priorities.
“Forming the partnership was the best decision I could have made for my practice and for myself,” says Johnson, who had two of her three children while in partnership with Alterman. “It has allowed me to step away from the practice and spend more time being a mom. For instance, I’m there nearly every day when my kids come home from school, and that’s important to me. At the same time, I’m able to give more focused energy to the practice.”
She adds: “My life is no longer defined by my practice. Now my practice is one wonderful piece of my life.”
Alterman says the arrangement allows more time not only for family, but for other personal pursuits. “I enjoy my schedule, because it allows me time for my daughter and time for myself,” she says. “Before, work consumed my life; now work is just one part of my life.”
In her spare time, Alterman is taking university courses in philosophy and religion, and she is able to pursue other interests, such as her love for travel. “… I look forward to a long professional career,” she says. “Perhaps the fact that I’m taking less abuse physically by working limited hours will enable me to do this at 75!”