Not all chiropractors understand the business aspect of health care. Four management consultants offer advice on how to achieve even greater success with tried-and-true practice management techniques.

The single most important detail doctors bypass is the business side to providing health care. Combining strong business acumen along with your clinical skills is the key to success.

You may broaden your possibilities and strengthen what you have already built by hiring a consultant. Here to offer a quick course on choosing consultants are four individuals who are currently in the field. They spoke with Chiropractic Products to educate, motivate, and debunk some of the myths surrounding consultants. The panel of experts include: Max Day, vice president of marketing for TNG Systems, Houston; Peter G. Fernandez, DC, president of Fernandez Consulting, Seminole, Fla; Mark Sanna, DC, the CEO of Breakthrough Coaching, Vernon, NJ; and David Singer, DC, founder of David Singer Enterprises Inc, Clearwater, Fla.

What are some aspects DCs should look for in choosing a management consultant for the “right fit?” Should practice philosophies enter into this decision?

Day: You should know what is being offered for the amount you are paying. What guarantees do you have that consultants will deliver what they promise? Can you visit and talk to their clients, see their books from one month to several years out? Does the consultant have a successful, ongoing practice?

Fernandez: DCs should know what they want and then hire a consultant who specializes in that area. Times, practice building opportunities, and laws change. Choose a consultant who is the most knowledgeable and up to date in those areas that affect or relate to the specific area of interest—choose a specialist. This is important to doctors who want to reach their goals as quickly and efficiently as possible.

Practice philosophy is also an important consideration in choosing a consultant. Whether mixer or straight, by choosing a consultant with the same philosophy, doctors are assured of getting the help and guidance best suited to their type of practice.

Sanna: Choose a consultant whose program is consistent with your belief system. When it comes to fees, choose a consultant who offers a flat rate and run from percentage agreements. Consultants who provide 1-day, one seminar or weekend consulting typically result in a short-term burst of enthusiasm that quickly fades. Look for a company that will provide personal consulting and a long-term relationship. Ask for the opportunity to attend consultants’ programs, free of charge, to meet their current members, and to determine whether the fit is right for you.

Singer: Find a consultant by first identifying your specific needs. Do you need new patients? Better patient management? Community outreach programs? Do you need help making your practice more efficient?

What do you think is the most successful marketing tool available to chiropractors?

Day: I have found an in-house marketing system operated by the chiropractor to be the most successful. These systems have put more patients—for less monthly cost—in the chiropractors’ office, than anything else out there. These systems are also guaranteed to work (if you follow the simple instructions) or you do not have to pay.

Fernandez: Professional, effective promotions, includes advertising in radio, television, Yellow Pages™, newspapers, personal networking, and personal contacts.

Sanna: Today, the most successful chiropractors regularly connect with their practice members and community through online technology. Fifty-three percent or 143 million Americans access the Internet. The best investment in new patient marketing technology is to invest time, energy, and effort in becoming Internet proficient.

Email offers frequency for free, which leads to a sense of community among your existing patients and ultimately, to the key ingredient in any robust, long-term relationship: trust. Keep in touch with your practice community through a weekly or semi-weekly inspirational, motivational, and informational electronic newsletter.

Recently, chiropractors across the country have been establishing themselves as editors of electronic “health magazines” for their communities. These content-driven websites provide existing and potential patients with updates on health information, items of local interest, and articles written by community-based health care providers who become excellent sources of referrals to your practice.

Singer: Going out into the community and delivering lectures on natural approaches to health, as well as basic education about chiropractic is the most successful way to market.

What effects do the increase in patients seeking alternative health care and the hormone replacement therapy (HRT) controversy have on the chiropractic profession?

Sanna: The chiropractic profession is situated at the pinnacle of the multi-billion dollar complementary and alternative medicine marketplace. More patients are seeking the trusted advice of their DCs in matters of nutritional supplementation and alternative health care since chiropractors receive more hours of education on these subjects than their traditional Western medicine colleagues. Chiropractors can capitalize on their knowledge and grow their practice by providing lectures to community clubs, organizations, and social groups.

There is a tremendous interest in wellness, longevity, anxiety, hormone replacement alternatives, and other alternative medicine topics. These topics provide an excellent springboard to deliver the chiropractic message to your community that health comes from within the body.

Singer: I would also suggest chiropractors deliver a lecture to enlighten women about the risks of HRT and educate them about how chiropractic, diet, and supplements can address hormone problems.

What are the most important benefits to attending management seminars rather than just individual consultations?

Fernandez: Education—the doctor must learn about insurance laws, HIPAA and other health care laws, doctor efficiency, effective practice building procedures, practice advertising and marketing, and proper business management techniques.

Another important benefit is that doctors will experience a motivating and rejuvenating mental “enema.” Unfortunately, life is full of negativity, which clutters our minds and hinders our success. Practice seminars will help you replace that with knowledge and confidence to strive toward higher goals and achieve them.

Sanna: I call the most important benefit of attending management seminars “achieving higher ground.” From which vantage point can you see the farther distance—from down in the valley or from high on the mountaintop? The higher you go, the farther you can see. Each day you work within the same four walls of your practice, and this becomes your vision. It is important for chiropractors and their practice team members to regularly receive a fresh perspective on practice.

The relationships with successful colleagues you develop during breaks and over meals are very valuable. For this reason, it is important to join with a consultant who works with clients across the country. A national client base of practices provides a consultant with the perspective to spot trends as they develop. This provides you and your staff with the advantage to strategizing your response rather than reacting to changing circumstances and events when it’s too late.

Singer: A hands-on seminar gives chiropractors the chance to watch a procedure done correctly so that they can learn how to use it most effectively in their practice.

What are the most direct competitors for DCs? What is the best way to compete?

Day: Health care products and massage therapy—the best way to compete is to offer these services, either direct, online, or through a referral program.

Fernandez: The most direct competitor for chiropractors are medical doctors. Today’s medical doctors are branching out in pain management and personal injury clinics. The best way to compete is to be the better practitioner and to educate people about health care services that chiropractors offer and medical doctors do not.

Sanna: Chiropractors are their own worst competition. The mindset that there are not enough new patients to go around limits growth and stifles opportunity. Eliminating the thought that medical physicians, physical therapists, massage therapists, or other alternative practitioners are your competition is the first step to unlimited new patients. Focus on polishing your patient communication skills so you can confidently express your message at every opportunity.

Singer: I would say that beyond other chiropractors in the immediate vicinity, it is the physical therapist. But with the right marketing and educational programs in place, the community will understand the unique benefits they can experience from chiropractic care and become regular patients.

What misconception about management consultants do a majority of chiropractors have?

Fernandez: The number one misconception is that consultants are too expensive. When chiropractors choose a consultant that fits their needs and goals and then diligently follows that consultant’s guidance and recommendations, chiropractors will soon realize that their consulting expenses are actually an investment with limitless return. The more DCs put into learning and following the consultant’s advice, the more DCs benefit in reaching goals and avoiding costly practice pitfalls.

Another common misconception is that consultants teach unethical procedures. This occasionally happens, but those consultants do not survive more than 2 to 3 years in the business. The longer consultants have been in practice, the more assured you can be of their ethics and expertise.

What adjunctive services, if offered, do you find the most beneficial for chiropractic practices?

Day: Health care products, massage therapy, and marketing services.

Fernandez: Though not really adjunct, but truly chiropractic, I would recommend that chiropractors increase their focus on providing those services for which they are more qualified than their closest competitors, such as postural correction, nutrition, rehabilitation, neck care classes, and back schools.

Sanna: In order to fully participate in the health care mainstream, chiropractors must become proficient in objectively assessing and documenting the functional outcomes of their care. It is extremely difficult, if not impossible, to track functional outcomes in a practice that operates in the passive care paradigm of the 1970s—in which patients come in, lay down, receive an adjustment, hot pack and muscle stimulation, visit after visit, for 40-plus visits.

The most successful chiropractors today include active care/rehabilitation in their treatment protocol. As patients progress through an active care protocol, their functional improvements can be easily documented. It’s also important to note that the CPT codes with the highest value are the active care codes: therapeutic exercises, kinetic activities, and neuromuscular rehabilitation. The reason these services receive such a high level of reimbursement is they produce a higher quality outcome. Patients who participate in rehabilitative exercise programs have a lower recurrence rate of their original conditions, which third-party payors recognize.

What mistakes in practice management do most DCs make?

Day: Allowing their assistants to handle their business, books, initial appointments, and personal life.

Fernandez: The most common mistake is they “don’t.” DCs go to great lengths and expense to master doctoring skills, but virtually ignore the business skills needed to open, build, and manage a successful practice. Most feel they can “wing it” by trying to copy what another DC is doing or by hiring an office manager. Quite simply, if you do not manage your practice, it will soon manage you.

Sanna: The single most effective habit you can develop to successfully manage your practice, after hiring a professional coach, is to establish regularly scheduled practice building hours. Every doctor has established regular hours for patient care; few have established similar hours for practice building.

Doctors need to set aside a minimum of 1 to 2 hours each week devoted entirely to practice building. This time should take place in your office and should be uninterrupted.

Singer: Sometimes chiropractors tend to blame the economy, their location, or insurance companies for their failures. Although these points may make their job harder, they need to focus on building their practices by using the right marketing and patient education systems for their practice.

What do you predict for the future growth of chiropractic practices (eg. more MD/DC practices, multiple locations, multiple DCs/partners, and gyms/spas)?

Day: The multidisciplinary concept with gym is a nice proven model for the future.

Sanna: Approximately 30% of medical physicians remain in private practice, and the day of the solo chiropractic practice is gone as well. The chiropractor of the future will be a member of a group practice. With student debt running at more than $100,000, the financial resources required to open a new practice from scratch are beyond the means of most new practitioners. The trend of the group practice—a senior physician with associate team members—is a win/win for both parties. The new practitioner benefits from the confidence, experience, and patient base of the seasoned doctor, and the senior physician benefits from the up-to-date knowledge, energy, and enthusiasm of the younger doctor. In addition, the group practice provides safety in numbers. Overhead costs can be shared, vacation coverage is assured, and most of the time two heads are better than one when it comes to strategic planning and decision-making.

The multidisciplinary practice is on the cutting-edge of the battleground of integrating chiropractic into the mainstream of health care. There is a clear scope of practice between traditional Western medicine and chiropractic, and multidisciplinary practices provide patients with the best of both disciplines. It is important to note that the paradigm of multidisciplinary practice is one fraught with many pitfalls, and doctors who are contemplating it should do so only at the advice of a consultant and legal counsel well-versed in the model.

Fernandez: With more people choosing chiropractic as their primary source of health care, chiropractic practices will have to expand in size and service in order to accommodate the demand. This expansion may result in more MD/DC practices, partnering of chiropractors, and an increase in the types of patient services provided.

Singer: I think that we are moving into a future with convenient symbiotic marketing taking place—for example, coffee shops inside of bookstores and banks inside of grocery stores. I envision a future with chiropractic offices inside of fitness clubs, health spas, and health food stores.

Julie Z. Lee is a contributing writer for Chiropractic Products.