James W. Gudgel, DC, RPT, offers his advice and shares his secrets to success on how being the master of one technique can be the best policy.
By Wendy Bautista
For nearly three decades, James W. Gudgel, DC, RPT, has held the same idea for his practice: Learn one technique extremely well — become a master of one — rather than a jack of trade of several.
“By learning one technique extremely well and focusing on that, and knowing that you know it, you can then deliver the adjustment with confidence — and your patient will also know you found it, you fixed it, and it’s time to go on,” says Gudgel. “And that’s the way it’s always been in this office.”
His clinic, which sees 500 patients a week, was always, and still is, a high-volume clinic offering instrument adjusting only — no modalities. He attended one Activator Methods course in 1980 while attending Logan College of Chiropractic and was hooked on instrument adjusting — eventually teaching Activator Methods along with physical therapy at Logan until he graduated in 1982.
Upon graduation, he accepted an offer to become the clinic director of the LeeFuhr Chiropractic Clinic in Redwood Falls, Minn. — the birthplace of Activator Methods. He began as the director in January 1983 and, today, still practices in the same building, but changed the name when he bought the practice in the early ’90s. He instructed for Activator Methods all over the United States, Canada, and Australia until 2005, when he began teaching for Neuromechanical Innovations in 2006 — where he is currently the lead technique instructor.
While he also holds a B.S. in physical therapy from the University of Oklahoma and practiced physical therapy until 1979, he currently only uses that knowledge to provide specialized exercises to certain patients for their specific condition.
“As a physical therapist, I do instruct patients in the one or two most important rehab exercises for their condition,” says Gudgel. “I have found, and the literature agrees, that most patients will not do the rehab exercises if they are given too many exercises or exercises that require assistance or external devices or machines. Therefore, I keep it simple and ‘doable.’”
Do what you do best
His practice philosophy is to administer the best spinal and extremity instrument adjustments possible, supplement with appropriate exercise if indicated, and let the body heal itself. An average treatment session in his practice is less than five minutes, usually around three minutes, which allows them to be able to see a large volume of patients each week.
“I believe too many of today’s chiropractors spend way too much time in the treatment room. Part of this is their uncertainty of when an adjustment is done.’ They feel the need to do more to the patient,” says Gudgel. “Further, much of what they do above and beyond the adjustment is never charged for. Many chiropractors are struggling because they cannot reduce their treatment time enough to see the volume that must be seen to make a decent profit.”
In his many years of teaching instrument adjusting, Gudgel says a lot of what he’s seen when doctors attend the classes is they’re confused. “They get to the table during the practical session and when I show them what we are teaching, they ask, ‘what about this, and what about that,’” continues Gudgel. “What I garner from this is they are throwing in a basketful of different procedures and that, of course, increases the amount of time in the treatment room, but in essence what they are saying is they’re not sure they are done.”
But Gudgel feels that once you found the area on the patient that needs to be adjusted and you’ve done your adjustment, what more is there to do? One main point he tries to make is there are essentially three codes primarily that chiropractors get paid on, which are based on regions of the body, not time.
“So I tell them if I can see a person in three minutes and accomplish what I’m after with an instrument adjustment and it takes you 20 minutes with a manual adjustment, who’s going to see more people in an hour, in a week, in a month, and who’s liable to make more income, employ more people, pay the bills, improve the building, and reach more people?”
He says often times attendees will still ask about increasing treatment time and he has to go back to the original thing: Learn one technique only. He brings up examples of the original masters of the profession such as Gonstead, where they did one thing and one thing exceedingly well. They didn’t dabble with four or five other things.
Working for you and your practice
Gudgel says one of the biggest reasons most people don’t go to chiropractors is because they’re scared. But with instrument adjusting, the patient lies prone, doesn’t move, and the adjustment is administered in a neutral posture with a very relative light force — therefore it opens up the range of patients you can treat.
Not only does instrument adjusting increase the range of people you can see, but it tends to bring in cases that may be a little bit more difficult for the average chiropractor because some people cannot withstand the higher velocity, higher force procedure — either they’re too sore, too old, or too scared.
“I have performed an instrument adjustment because of the low-force nature of the adjustment on a one-day-old baby on the way home from the hospital to a 105-year-old geriatric patient with osteoporosis that most manual adjusters wouldn’t touch for fear of fracturing her bones,” says Gudgel.
He says instrument adjusting has also helped him treat patients with extremity issues, as most patients have at least one extremity problem. He has had patients walk in with heel pain not knowing if they were in the right place and he has been able to help, tying it in to then treat their whole spine along with the mechanics of their pelvis, back, and heel.
And extremity issues are not just with the patients. When he teaches, Gudgel says there are many chiropractors who now have a back problem or a shoulder problem and can’t do what they used to do, so they’re there to learn a new technique that is easier on them, which instrument adjusting is.
Gudgel says instrument adjusting can also extend your longevity and it doesn’t drain you. “At 8 a.m. when I apply an adjustment with the instrument and again at 8 p.m., it’s the same quality because the instrument doesn’t get tired,” he says. “Whereas at 8 a.m. if you’re a manual adjuster, you might be a little more tired by 5 p.m. and the quality of your treatment might not be quite as good because fatigue sets in,” says Gudgel. “But with the instrument, you get the same quality all the time. It’s comfortable and it’s effective and I can treat people in all stages of their condition when other types of techniques might not be able to because the patient can’t tolerate it.”
Gudgel says another way instrument adjusting can help your practice is to have everyone on the same page. His philosophy is that the patient lying prone on the treatment table should not be able to tell which doctor is treating them because they all do the exact same thing. He says the goal is for that patient on that table to not be able to tell who’s treating him or her; it should be the same analysis and the same application.
“I have two associates, my son Wayne Gudgel, DC, and Clark Phillips, DC. We all three do exactly the same procedures. None of us performs any type of chiropractic
adjustments other than the Impulse Technique.”
He says this way a patient will still come in for care even if his or her primary doctor is out of the office. “If you are an owner and are going to hire an associate, train them to do what you do best so it’s a duplicate or shadow of you. That is our philosophy here — the exact same procedure and nothing different.”
When asked for any parting advice, Gudgel offers, “Don’t go in to big debt. Just do what you do best as a chiropractor, and that’s adjusting. Get started, get a name for yourself as to what you do, and then when you start to succeed and make money and you want to add some ancillary things, that’s fine — just make sure they don’t interfere with your number one job, which is administering a good chiropractic adjustment.”
He truly believes in learning something and learning it well, and focusing on that patient in that room. He recommends, “Don’t get distracted by talking about current events or whatnot. Teach them as you are treating them, and then their mind is so occupied by what you are saying and what you’re doing, they don’t equate the time or the length of the treatment with the quality of the treatment.
“Some people think if you don’t spend enough time with them you didn’t do a good job — and that’s not good,” says Gudgel. “People’s time is short and they all want it quick — they want it now and they want good service in a short amount of time. So I encourage them to learn how to process patients quickly and to keep that flow going.”
Wendy Bautista is editor of Chiropractic Economics. She can be reached at 9045671539, firstname.lastname@example.org, or through www.ChiroEco.com.
**If you would like to attend one of Dr. Gudgel’s training seminars, contact Neuromechanical Innovations at 8882944750
or through www.neuromechanical.com.
James W. Gudgel, DC, RPT, married his wife, Kathryn, in 1967, and together they have two children and now four grandchildren. Both children went on to become
chiropractors, but his daughter is currently a stay-at-home mom who keeps her license current. His son, Wayne, works with him in the clinic. Gudgel’s wife is the office manager and gets to travel with him when he teaches because she runs the registration tables. The rest of the staff is like family. His associate, Clark Phillips, DC, has been at the practice for about as long as he has. He also has one full-time insurance CA and three part-time front desk CAs — with very little to almost no turnover.
He believes if it’s a “family-run” operation you have better control of the staff and your finances because embezzlement is another problem that happens when you hire employees that maybe aren’t attached to you. “Granted, there are other problems, of course, with having family in the office, but if you can get it to work, it’s a good deal,” says Gudgel. “Then everyone knows what’s going on and there’s people double-checking here and there, so it reduces fraud and embezzlement and everybody’s on the same page.”
Because they want to be available to the patients, they try to make themselves very accessible. The practice is open six days a week, Monday through Saturday. It sees about 500 patients a week, with Saturday mornings seeing about 70 to 80. They are open 8 a.m. to 8 p.m. Monday through Friday and from 9 a.m. to noon on Saturday. They pride themselves on being very accessible with their hours and very quick. “You can call from your car to say you are on your way, and we will get you in because our procedures are so proficient,” says Gudgel.