As is true with many doctors, Dr. Jeffrey Smith didn¹t give nutrition much thought when he first began providing chiropractic care. Not long after Smith found out what an important role nutrition can play, his patients started learning as well.
Smith opened his practice, Smith Family Chiropractic & Acupuncture in Bentonville, Ark., in 1998 after graduating from Cleveland Chiropractic College. Within a year, he was incorporating nutritional counseling and products into his practice. He made the move so quickly because he found out right away that patients’ nutrition, or lack thereof, was often a major factor in their physical well-being.
“I was already speaking to physicians about that and knew it was something I needed to work on,” Smith says. “…We want to provide as many services as we can, because we’re holistic practitioners.”
Something Smith quickly found out when assessing patients’ nutritional needs is that they sometimes were unintentionally hurting their overall health, while believing they were doing things to help themselves. Specifically, Smith found that many patients were coming up with their own supplementation plans, with little knowledge about nutrition. With more and more nutritional products becoming widely available, patients’ lack of information can sometimes work against them, when they are actually trying to establish a more healthful way of life.
For instance, a person may load up on a variety of vitamins, not realizing each one of them includes a certain amount of vitamin A. Although each of these doses of vitamin A may seem harmless enough on its own, the combination of multiple doses can lead to toxic levels. That’s where Smith says he and other chiropractors can help out. Education and information are important when it comes to nutrition, as well as any aspect of care provided by chiropractors, Smith says.
“People have been hoarding vitamins,” he says. “They’ve been taking 55 different pills every day. That’s a big problem nowadays.” Smith points out that even discount stores like Walmart now have huge departments that are filled with various types of nutritional products. When it comes to choosing which products should be taken, customers are on their own.
Even chiropractors who haven’t carved out a niche in nutrition may eventually find patients asking them questions about vitamins and supplements, as well as their diets. “You need to be very open and willing to learn,” Smith says. “There is a lot to learn with nutrition. People are beginning to ask a lot of these questions, and you better be prepared to answer them.”
Smith says he has found it is of particular importance to understand different nutritional products in terms of how certain products may interact with prescription medications patients might already be taking. The chiropractor is then obligated to consult with the prescribing MD or DO in order to coordinate the patient’s care in this area.
In addition, Smith consults with area nutritional specialist Marvin Shipman, ND, on certain cases. He recommends other chiropractors do the same. It’s not so much a better-safe-than-sorry approach, but part of an ongoing learning process. Smith says he plans in the near future to expand to a multi-discipline practice (he has already broken ground for a new facility) ‹ and a staff nutritionist is part of that plan. The expanded practice will move toward more holistic means of practice. “I’m really planning on doing a lot more with nutrition this year,” Smith says. “Speaking with medical doctors and physicians that are my friends, everybody is beginning to realize the importance of nutrition in overall healthy care.”
Of course this is nothing new. There is a level of common sense involved. But in the drive-through society in which we live, common sense is often shelved for the sake of convenience. Fruits and vegetables are forsaken for a burger, fries and a shake. That leaves for a lot of less-than-healthy bodies. “Nobody has time for proper meals,” Smith says. “We try to stress a balanced diet, as well.”
Smith introduces nutrition into his treatment plan during the patient’s second visit. He doesn’t specifically market the nutritional aspect of his practice, but he does sell more than $1,350 per month in nutritional products. This represented about 3% of his gross billings in 2000, and it’s a figure that could go much higher as more and more patients begin to see the benefits. It’s also a number that could be even greater than it is now, but Smith fancies himself a “soft salesman,” not wanting to “push” anything just for the sake of pushing.
“I like to be straightforward and honest,” he says. “A lot of people know what they need; they just like to hear it. That’s true of a lot of things. We present them with information and that makes the decision easy for them.”
Smith offers all new patients a booklet on chiropractic. The booklet includes a section on nutrition and how it pertains to chiropractic. He also presents a detailed report of findings, with any nutritional recommendations included.
“I find it important to make for a complete care package for patients, and to offer added services and bonuses to try to speed their recovery,” he says. “I give them my opinion, if not necessarily telling them what to do. I leave the ball in their court.”
Smith offers a variety of other ancillary products and services in addition to nutruition, including orthotics, knee braces and pillows. His main concerns are always efficacy and safety. “The first and foremost thing I look for is regulation,” he says. “There are so many products out there that are unregulated. I need to be well-assured that a product is safe, know what’s in it and know to what degree of efficiency a product works. In this day and age, research is the main thing.”
Smith has incorporated, and will continue to further incorporate, nutrition into a practice that has in about three years grown to a business with $450,000 annual in gross billings. He estimates that his practice will grow to $700,000 in gross billings this year. His methods are simple: offer as much as possible for a fair fee. It’s not as cut-and-dried as it sounds, but it’s close.
Smith employs five support staff other than his wife, Shelley ‹ but none full-time. He simply has two part-time people covering each full-time position. This helps cut overhead while ensuring that things run smoothly. “I like to have help,” he says. “If you have a full-time staff and one of them is out, it can create havoc. This way I make sure everything is covered. We’re very efficient and it’s a nice cost control for me.”
Smith’s budget otherwise is fairly limited. He spends approximately $6,000 per year on a Yellow Pages ad and placement in local coupon booklets. Attacking through direct mail via the coupon sellers has proven quite successful. “Almost everyone who has come through the door has had a coupon,” he says. “Either they’ve been given one or gotten one through the mail.” That, along with patient referrals, has seen his practice grow to more than 1,000 patient visits per month in the three years since he opened the doors.
Smith has done it all himself, too. He never enlisted the help of a professional, and he had no management experience. He doesn’t necessarily recommend this strategy, though. He did have a “secret weapon”: His wife, Shelley, who works for him now as a part-time office manager, worked as a chiropractic assistant before Smith opened his practice. She knew many tricks of the trade and has helped Smith from the get-go.
Smith says he knew as a seventh grader that he wanted to be a chiropractor and stayed on that path. He hopes the momentum he’s mustered will carry him throughout his long-term goal of being the head of a major multi-discipline practice.
For now, though, he’ll concentrate on doing what he does best: Helping patients through a variety of means. Nutrition will continue to be part of that focus. “There is a need for expanding the practice and offering more services,” Smith says. “I don’t push stuff on people. People become interested in things and if they do they will ask for it up front. People say they’ve heard about something I do, and I’ve shown results.”
Acupuncture: Another Aspect of Complementary Care
Sometimes patients are surprised when learning about Dr. Jeffrey Smith’s practice to find that nutrition and acupuncture can combine so well with chiropractic to form a complete care package. Smith of Bentonville, Ark., says chances are good that other chiropractors could find this triumvirate every bit as appealing as his patients ultimately do. The three disciplines seem to go hand-in-hand (and foot, and backŠ).
“I have an old saying,” Smith says. “I tell patients that chiropractic is 115 years old and Western medicine is a few hundred years old. But Chinese acupuncture is 5,000 years old. They’ve got a little more time on us.”
It’s with that historical perspective that Smith includes acupuncture in his practice. Once he began incorporating nutrition in general, he found it blended fairly well with this ancient art. “Where as chiropractically you deal with a lot of vitamins and minerals, with Chinese acupuncture you’ve got a lot of herbs,” Smith says. “We can work with anything from ginger for poor circulation to a bee complex for nerve problems.”
Acupuncture has drawn numerous patients to Smith’s practice and he finds himself treating more and more patients that way. “A lot of people don’t realize it’s for pain, he says. The fastest-growing group using acupuncture is not chiropractors, but general practice physicians and neurologists. “It’s just becoming more common,” Smith says.
Smith Family Chiropractic & Acupuncture
Dr. Jeffrey Smith
904 South Walton, Suite 2
Bentonville AR 72712
Shelley Smith, part-time office manager
Pat Short, chiropractic assistant and part-time office manager
Nicole Popejoy, chiropractic assistant and part-time office manager
Katie Herrington, massage therapist
Nicole DeVasiar, part-time insurance tracking
Marilyn Smith, part-time insurance tracking
M-W-F: 8 a.m.-6 p.m.
T-TH: 1 p.m.-6:30 p.m.
SAT: emergency only
Revenue by Payment Type:
Personal Injury: 15%
Workers’ Comp: 5%
2001 – Projected Collections:
Gross Billings: $700,000
Gross Collections: $525,000