With 12 offices throughout Southern California, BKP Chiropractic and Rehabilitation never misses an opportunity for growth

Brian K. Padveen, DC, FAICC, QME, is a firm believer in opportunities — whether by chance or creation, they should never be missed. Padveen has grown his practice from a small office in Northridge, Calif, to BKP Chiropractic and Rehabilitation, a thriving practice with 12 offices in the greater Los Angeles area of Southern California. Padveen says he owes his success to taking and making opportunities.

Opportunity first came knocking while an undergraduate student at California State University, Northridge. Padveen majored in biology with a pre-dentistry intent. However, he found that he did not have a passion for the field, nor was he comfortable with surgical procedures and risks. His friends, who were about to start chiropractic school, suggested he join them. It sounded like an opportunity well suited to his goals, and Padveen found himself enrolling in Cleveland Chiropractic College, Los Angeles.

Baptism by Fire
Padveen began his practice as a doctor of chiropractic in August 1984 “when the medical community considered chiropractic to be a voodoo profession,” he says. But opportunity knocked again in the form of two Los Angeles firefighters who became his patients. At the time, the Los Angeles Fire Department (LAFD) was looking to offer chiropractic to its members. Padveen’s two LAFD member patients referred him, and he began treating fire department members and their families.

Brian K. Padveen, DC, FAICC, QME, discusses practice management of the 12 locations with his office manager, Beverly Geffen, who has worked for him since Padveen first began expanding.

But the financial reward was small. “At that time, the LAFD benefit only paid $400 per year per family member,” notes Padveen. “It was a challenge to spread that amount throughout the year. Many visits were $20. But I had patients.”

In fact, he had so many patients that he outgrew his office space. Another local chiropractor, whose business had not fared well, offered to sell Padveen his practice. The deal provided Padveen with twice the office space and an office manager, Bev Geffon, who has been with him ever since. Padveen brought in his sister, renamed the practice BKP Chiropractic and continued to grow, opening a second office in the San Fernando Valley in 1990.

That same year, Ron Cappi, DC, CCSP, DABCO, came aboard. Padveen had just hired a colleague whom he had met through his health club when several of his patients suggested he talk to a chiropractor they knew who had just graduated from Padveen’s alma mater. Padveen agreed to meet him, expecting little.

Instead, he was immediately won over, and hired Cappi in place of the other doctor. Padveen recalls, “In that first meeting, we spoke about two of my passions: rock and roll and hockey. We also discussed our chiropractic philosophies and found them well aligned. It seemed like a great fit.”

Joining Forces
Their philosophies have influenced the path of the practice. Padveen had been frustrated with monthly readjustments as a program of treatment. “I felt a need to deal with all the levels of rehabilitation as opposed to just an immediate fix. I was there for patients whenever they needed me, but I wanted to give them as many tools as necessary so they could help themselves,” he says. Home stretches and exercises were added to treatment programs containing chiropractic manipulative therapy and flexion distraction therapy.

In 1992, Padveen underwent surgery on his left knee and was beginning physical therapy. “I felt the exercises could be integrated into our practice,” he says. Cappi, at the time, was completing a certified chiropractic sports practitioners (CCSP) program, in which he learned rehabilitation exercises. He used this information to develop treatment programs for the practice, which was renamed BKP Chiropractic and Rehabilitation.

“The first rehabilitation office began in a 10x10 ft space in our Northridge office. The rehabilitation center, at that time, was a European wall system, two rehab benches and a treadmill. We began to integrate weights, continuation of home exercises, and therapy balls,” says Padveen. His philosophy evolved again. “I had had a maintenance practice that was taught by every practice builder out there. I found that with rehabilitation exercises, home stretches, and patient education, I did not think chiropractic maintenance was necessary any more.”

He applied the philosophy to all of his patients, including workers’ compensation. Padveen has become an expert in evaluating and treating this group, and continues to handle all of the QME and AME evaluations. The referrals caused his practice to soar again. Additional offices were opened in Valencia, Lancaster, and Lomita. Selected locations were a combination of opportunity and strategy: Padveen expanded into areas he felt were underserved, and local contacts helped him build his business.

Multiple geographic options were also beneficial for patients. “It’s important to promote the different locations. We may be near a patient’s home as well as his or her workplace, allowing continuous care rather than switching doctors,” Padveen says.

A Pillar of Communication
The practice has worked out a system for overseeing the multiple offices. “We’ve developed an excellent communication system between the various branches,” he says. It also helps that many of his employees have been with him for years. “BKP has a lot of stability owing to low turnover,” says Padveen. “Chiropractic is generally accused of devouring its young, providing them with low pay and long hours after graduation.” Padveen, however, believes in paying his people well, and rewarding them for bringing in new business. He offers a profit sharing plan, benefits, and continuing education. “It’s important that chiropractic doctors keep learning so we bring in doctors, physical therapists, and other professionals for lectures,” he says.

Padveen admits that he is not the easiest person to work for, but his employees know what is expected of them. “I practice honesty and integrity, and people respect that,” says Padveen. In addition, he recognizes his own strengths and weaknesses, and allows others to do the same. “I tend to handle the concepts, and others make it work,” he says. Particularly Cappi, who Padveen describes as the “nuts and bolts of the operation.” “If Cappi thinks one of my ideas is a go, he’ll develop the procedure and I’ll fine-tune,” says Padveen.

It is a philosophy Padveen espouses to younger doctors. “I tell new doctors not to try to be me, but rather to build their practice around their strengths. It’s sincerity that works with people, not a specific style,” advises Padveen.

Early promotional efforts focused on the patient. “Being nice to people goes a long way. We sent thank you cards for both visits and referrals, and we held patient appreciation days, where we offered free services and food all day,” says Padveen.

Working Well With Others
As his practice grew with workers’ compensation patients, he visited orthopedic groups to inquire whether they would be interested in receiving and referring patients. Some said no, others, yes. “At first, the orthopedists would be doubtful about our abilities, particularly in regard to rehab. But as they saw the positive benefits, their attitudes changed. They began to refer more patients with a wider range of diagnoses,” says Padveen. Patients with postsurgical shoulders, wrists, hands, knees, ankles, and other areas not related to the spine were treated with physical therapy modalities and rehabilitation exercises.

The team at BKP Chiropractic and Rehabilitation, all of whom work and communicate effectively for success: (clockwise from bottom right) Rand Tucker, acupuncturist; Heidi Chapnick, DC; Beverly Geffon, office manager; Janet Norraik, front office assistant; Donna Schwartz, ATC; Michael Gitter, MD; Charles Kunz, ATC, head athletic trainer; Dawn Taillon, massage therapist; Larissa Roberts, therapy assistant; and Padveen (center).

“We became the team chiropractor for the Los Angeles Valley College and began to integrate our practice with the athletic community. One of the advantages of this role was that as the primary treating physician, we could refer patients to the orthopedic community. Sometimes this was the only way an orthopedic surgeon could see the quality work of our practice,” says Padveen. Many of these doctors became referring physicians.

Padveen believes that some chiropractors are reluctant to refer patients to orthopedists, fearing they’ll be stolen away. “I may have lost a few patients, but the successes have far outweighed the risks. Currently, roughly 50% of our patients are referred from orthopedists,” says Padveen.

As patients improved, insurance companies joined the medical community in reevaluating the use of chiropractic. “At first, the insurance companies were hesitant to approve treatment, but with the quality of care and results, they began to authorize treatment for postsurgical and nonspinal care,” says Padveen. They even began to send him patients, particularly those with industrial injuries.

With referrals coming in from orthopedists and insurance companies, Padveen’s practice continued to grow. Attorneys also began referring patients to the group, utilizing chiropractors as primary care physicians. BKP opened offices in the San Gabriel Valley, Beverly Hills, Thousand Oaks, and the Antelope Valley.

With the larger practice, Padveen’s marketing efforts expanded to include networking, attending golf tournaments (some of which he sponsored), breakfasts, and conventions. “Any chance I had to talk about chiropractic and my philosophies, I took,” says Padveen.

Padveen performs a basic upper extremity examination as part of the post-therapy treatment on patient Shawn Peden.

Now he networks with attorneys, insurance companies, and the medical and political communities, providing copies of reports to illustrate the effectiveness of chiropractic and make them aware of the discipline’s capabilities. “Chiropractors have broad, general knowledge and can be experts in treatment for areas other than the spine, such as fibromyalgia, chronic pain syndrome, and general medical conditions. Many referrals recommend us as primary care physicians.

“The key to being successful in chiropractic today is to understand your limits, know when to refer to specialists, and utilize diagnostic studies when appropriate to do so,” advises Padveen. In truth, he does not think there are a great number of limitations placed on chiropractic doctors, but if he has patients who do not respond to care, he refers them to another discipline. “I wouldn’t treat an acute compression fracture, for example, nor do we treat difficult postsurgical tendon grafts. If manipulative medicine cannot be integrated into the treatment program, I will refer the patient to another specialist, but there isn’t much we can’t treat successfully,” says Padveen.

In addition, he continues to expand the tools in his arsenal, recently bringing in acupuncture. “It adds another dimension to treatment. I’ve seen acupuncturists do some amazing things,” says Padveen. “If I had the resources, I’d bring in aquatic therapy as well. I’ve seen tremendous benefits with this method. However, there are financial limitations,” says Padveen, alluding to the costs of installing and insuring such a program.

Chiropractic has evolved quite a bit since Padveen first started practicing, and he sees that evolution continuing in the next millennium. “The medical community needs to work together, recognizing that each discipline has a place in a patient’s treatment plan. Chiropractic has a place in that plan. As the medical community learns more about our results, they utilize our expertise, and treatment becomes more integrated. To be a success, you should have confidence in your abilities and grab an opportunity when you see it. You never know where it will take you.”

Renee DiIulio is a contributing writer for Chiropractic Products.