Maximize income potential by offering health care products in your office.

Has your income met your expectations over the past few years? Or do you see a disparity between your efforts and the dwindling cash flow? The most recent American Chiropractic Association (ACA) Statistical Survey reveals the median gross chiropractic income reported in 2000 was $220,000, with median practice expenses at $120,000, and an individual net income of $81,500.¹ This is disturbing news for chiropractors who are practicing full time.

Many in the chiropractic profession believe the way to increase income is to add staff members (increase overhead) and work longer hours. Juggling a patient load with the challenges of operating a business leaves many chiropractors feeling as if they are not getting a good return on their hard work and investment. But the truth is they have not yet reached their earning potential.

Path of Passive Assistance
How do you increase income without adding employees or working longer hours? Passive income. There are two types of income—active and passive. Active income requires direct participation of the doctor in patient care, which includes activities such as performing examinations, reading x-rays, and providing adjustments. Passive income represents all other situations where revenue is generated without the provider’s direct involvement.

To underscore the difference between active and passive income generation, consider a standard visit to the dentist. During the visit, you will likely have a set of radiographs taken, a thorough cleaning, and a quick examination and consultation with the dentist. But in the 1 to 1 ½ hours spent in the office, how much time do you spend face-to-face with the dentist? Probably not more than 5 minutes. During the remainder of the visit, the staff will perform the time-intensive tasks (passive income generation) that leaves the provider’s time free for drilling and filling (active income generation).

Although spending more time with patients means seeing fewer patients or expanding your workday hours, this does not always equal increased quality care. Long appointments generally result from patients losing focus on the treatment plan or discussing interesting but non-crucial topics. Before deciding to hire new employees to offset an increased patient load and additional services, or becoming a workaholic to accommodate longer hours in hopes of generating more income, consider this: it is far easier to add revenue by offering additional products and services that do not require additional hours or employees.

Stock in Trade
A significant and necessary aspect for generating passive income is to offer products to your patients. For some reason, chiropractic professionals are often hesitant about selling products to their patients. But, by offering products that will enhance their health and quality of care, then you are providing products patients will probably buy anyway—it may as well be from you.

Simply displaying products will generate patient inquires. A hard sell is not even necessary. Providers also have an advantage because patients perceive providers as authorities whom they already entrust with their health, so they will assume products displayed are efficacious than if found at other retail outlets.

For example, Robert Hamric, DMD, developed a simple product center where he displayed every product he would suggest to patients—from toothbrushes, floss, fluoride, and toothpaste to prescription medications, such as fluoride gels and rinses.² If you want your patients to be successful, provide the tools they need for success.

Veterinarians have been dispensing for years. Remember the last time you took your puppy in for a visit? I bet you came away with all kinds of goodies and you were charged accordingly.

At Their Convenience
There are many products you may want to provide to improve patient care, some of which include nutritional analysis and supplements, orthotics, pillows and back supports, and topical creams and ointments (Table 1). Why send patients across town for products they can purchase from you? Your patients will appreciate the convenience as you will reap the additional earnings.

For example, if 12 out of 15 patients benefit from nutritional supplements, and a bottle costs $15; and you offer it for $30, then you have just added $180 to your income for the day simply by having the products available for your patients.

Until recently, nutritional assessments were considered too time-consuming and costly. Today, the work is outsourced to companies that specialize in nutritional analysis while doctors make a reasonable profit. Additionally, nutritional assessments reveal why a patient should take a vitamin/mineral supplement, which will also add to your income.

Orthotics are also effective in generating passive income without being an an orthotic expert. If you sell 150 pairs of orthotics per year with $150 net profit per orthotic, this yields a total profit of $22,500³ without spending extra time in the office.

Referral cards are another way of increasing income without directly involving the provider. Make use of the time patients spend waiting for their examination after the initial visit by giving them a referral card, which should be small, no larger than the size of an envelope, but large enough to attract attention. A card that is too large can appear to be time-consuming or require too much effort to read. For example, the card could read, Do you feel better? Do you know somebody else who may benefit from a good night’s sleep (or other benefits resulting from quality chiropractic care)?

To give patients incentive to pass on the referral cards to their families and friends, offer a discount on their next visit or give them a special rate for vitamins and other adjunct products. You may also want to extend the discount to new patients referred by existing ones, such as a $15 discount on the initial visit.

Patients are more likely to refer others if they believe in chiropractic—in other words, get your patients to buy into chiropractic. The best way to ensure this is to educate them about the benefits of chiropractic for complete health and wellness, but this does not mean pulling staff away from their routine activities to conduct educational seminars.

Hand out books about chiropractic to new patients. These books explain the benefits and importance of chiropractic in easy-to-understand terms. You may even choose books with testimonials or case study results.

Take advantage of the convenience of technology by sending email about product announcements to your patients every month. Request email addresses on new patient information forms. The emails can be sent as weekly or monthly newsletters with important health information. They can also contain product information and special discounts. Many people access email at work, so your messages can prompt patients to bring up chiropractic in casual conversations with coworkers and friends. For every email sent, you could possibly reach 10 additional people.

These are only a few examples of how to maximize your earning potential. By aggressively implementing a few passive revenue options, you can concentrate on doing what you do best—ensuring quality chiropractic care for your patients. CP

Jeffrey D. Olsen, DC, is in private practice in Roanoke, Va, with his two brothers/partners. He is also a frequent lecturer and author. Olsen can be reached at olsen_jeffrey@hotmail.com.

References
1. Jackson P. Summary of the 2000 ACA professional survey on chiropractic practice. Dynamic Chiropractic. 2001;19(6):1,50–51.
2. Hamric R. Exclusive! Stop giving it away! Dental Economics [Dental Economics web exclusive January 31, 2002]. Available at: http://de.pennet.com/articles/article_display. Accessed February 5, 2002.
3. Austin WM. Profitable shoe-in. Chiropractic Products. 2002;17(3):46.
4. Seaman D. Challenge: how can you and your patients profit from nutrition? Chiropractic Economics. 1998;40(6):72.