One Florida DC finds the recipe for success by combining chiropractic, physical therapy, urgent care, and cookies, of course
How the cookie crumbles matters to Robert Lupo, DC. The sweet morsels offered in the waiting room of his plush, 4,500-square-foot Tampa, Fla, office assure that he can soon expect more referrals to push past the waiting room’s French doors.
Lupo has built a thriving practice in part by daily setting out for patients steaming platters of fresh-baked chocolate-chip cookies. “The cookies serve the purpose of making patients feel comfortable about coming to see a doctor,” says Lupo, who is convinced a reason many chiropractors have trouble attracting patients is due to a reflexive dislike most people have toward clinical settings.
The heavenly aroma of cookies hot out of the oven fills his office, which causes patients to forget they are even in a clinical environment, Lupo explains. Meanwhile, the consumption of those warm-and-gooey cookies—the very definition of a comfort food—helps alleviate anxiety and preexamination jitters.
Robert Lupo, DC, (R) stands next to Joseph A. Sassano, DO, medical director, in the multidisciplinary center’s laboratory.
“I haven’t mentioned the cookies in any kind of formal advertising campaign,” he says. “Right now, the word is getting out about them just by patients talking to family and friends. And believe me, the cookies get talked about a lot. It’s remarkable how many new patients I’m getting who’ve heard about the cookies and say that’s one of the reasons why they decided to choose me over someone else.”
Not surprisingly, cookies tend to disappear quickly in Lupo’s office, so they are made up often—one of the clerical staffers has this baking responsibility as an actual part of her job description. But it is not as tough a task as it sounds—the cookies are not made from scratch; they are produced with ready-to-bake dough that is cut from a refrigerated roll.
Lupo, whose practice is called First Care Injury Centers (formerly Physical Medicine Center), borrowed the idea of baking cookies from real estate professionals who often counsel homesellers to make sure good-smelling, ecstacy-inducing dessert foods are warming in the oven when prospective buyers stop by to look things over.
“Sure, some of my colleagues will think it’s a bad idea to feed chocolate-chip cookies to patients when one of the cornerstones of care is good nutrition,” says Lupo. “I think, though, that there are times when exceptions have to be made—and trying to help patients feel more at home in the doctor’s office is one of them.”
A Column for the Community Chocolate-chip cookies as a marketing tool can take a practice only so far. One that can carry it longer distances on the growth track is writing columns. Robert Lupo, DC, does just that—once a month he authors a health-related column for a local city magazine distributed free to every household and business in the New Tampa, Fla, area. “The idea is to provide education about various health concerns and injury prevention, but overall, it has been a very effective way to bring attention to my practice,” he says. Lupo landed the column-writing gig through the magazine’s editor, who happened to also be his patient. Noticing that her publication carried pieces written by various local movers and shakers, he asked her one day in his office if she would be interested in accepting an article from him on matters of health. She told him she would be happy to consider such a piece. “The feedback I received on what I submitted was very positive. I was asked to write a second article, and that led to doing a monthly column,” he explains. Lupo says it no doubt helped that he was already known by the editor, but he believes too that his first article would have been accepted for publication regardless of the relationship because of the magazine’s need for submissions to fill its pages and because it was an interesting, informative, and compelling contribution. Writing a monthly column can, however, be a particularly stressful process for authors who do not dabble in prose for a living. To make things go smoother for himself, Lupo develops months in advance a list of topics to write about for upcoming issues of the magazine. That way he is not thrown into a panic having to scramble at the last minute for an idea. Most of the material he imparts to readers is drawn from his own experiences in the clinic and from researching published scientific literature. He occasionally consults with his professional colleagues in the group for input, sometimes letting one of them pen the entire column (in that case, it is the colleague who receives byline credit, not Lupo). When Lupo finishes hammering out the 500 or so words that constitute a column, he does not immediately send his work to the magazine. First, he passes it by his wife to check for readability and understandability. If it fails on either point, Lupo knows he has got some polishing still to do to the story before it can be submitted. “The tendency of doctors who write for a lay audience is to use all kinds of clinical terms and in the driest ways imaginable,” says Lupo. “The worst thing you can do is write over the audience’s head.” |
Urgent Call for Care
Two other reasons Lupo’s practice is doing well are that he presides over a multidisciplinary care team and has morphed his originally chiropractic-only enterprise into a bonafide urgent care center, replete with an extensive physical rehabilitation department operating 7 days a week.
Lupo waits while the adjustment and treatment hi-lo table eases his patient to a standing position.
Lupo opened his practice in 1987. It shifted toward a multidisciplinary model beginning in 1994. Today, his team consists of two other chiropractors, one physical therapist, four massage therapists, an osteopathic (DO) physician, and a medical physician (MD). The DO and MD are both board-certified in family medicine and have been trained in occupational and pain medicine and emergency care; they are employees of First Care Injury Centers.
Recalling the process by which he recruited the medicos, Lupo confesses to being taken aback by how amenable they were to the prospect of working with—and for—a chiropractor. “There were only a few I interviewed who, in the end, couldn’t get beyond their preconceived notions of what chiropractic was all about,” he says. “Mostly, though, the doctors I met with were enthusiastic about becoming part of my team.”
The physicians who hoped to partner with Lupo were motivated to do so by a keen awareness of market realities, he explains. “In today’s health care model, physicians are under tremendous pressure,” says Lupo. “They’re forced to see tons of patients every day. That gives them just a few minutes to see each patient before having to run off to see the next one. As a result of that, they lose the ability to do much in the way of one-on-one interaction. But in my group, they’re empowered to practice medicine in a more one-on-one way.”
First Care Injury Centers sees patients of all ages, with the 35-to-55 age bracket dominating. Slightly under 10% of the group’s mix are Medicare patients. Fifteen percent of cases are work-related injury; 25% are a blend of cash and PPO insurance. The balance—50%—are auto-related injuries, meaning payment from indemnity insurance disbursements or settlements.
Then there is the urgent care center. It launched in 2000. “This was a type of service we had been providing on an informal basis for several years by the time we decided to make it an actual facet of the practice,” says Lupo. “We started offering the stitches and the medications and the other things associated with urgent care in response to patient demand. Patients who were satisfied with the chiropractic care and medical attention they received here on an everyday basis began showing up when they had more serious problems that required immediate attention but obviously not so serious as to merit a trip to the hospital emergency room. We took care of them, and they told their relatives and friends that this was the place to come for urgent care. Eventually, it got to the point where we decided we should formalize this aspect of the practice so that, among other things, we could at last be able to capitalize on it in our marketing.”
As would be expected, the urgent care center treats an abundance of flu cases, minor lacerations, and sundry internal-medicine conditions outside the scope of chiropractic care. However, plenty of other types of problems show up that are tailor-made for DC intervention. “We get a lot of cases that have musculoskeletal involvement, such as back pain, neck strain, and leg sprains,” says Lupo. “Some of those injuries require medical attention; in those instances, we chiropractors are able to assist the physicians and to provide follow-up and rehabilitation care.”
Formalizing the urgent care center entailed tackling an assortment of organizational challenges, such as hiring additional staff and providing everyone already onboard with extra training. “We also had to bring in some extra equipment, like EKG, spirometry, suture materials, injectables, splinting, things to allow us to handle any kind of minor emergency or urgent situation that comes through,” Lupo offers.
More significantly, the group found it necessary to move to a new location a few miles away in the northeastern corner of Tampa. The old site, in a retail strip center, was simply inadequate for operating a full-blown urgent care center, Lupo indicates. “It took about a year of searching to find this new site,” he says. “It fronts a side street but is plainly visible to cars passing in either direction along the busy, intersecting boulevard about 100 feet away.”
The site is a medical plaza with several highly compatible types of providers occupying the other tenant-owned, condo-style suites. It affords easy access and boasts abundant free parking.
The Road to Chiropractic
Originally from Fort Lauderdale, Fla, Lupo arrived in Tampa as a freshman at the University of South Florida during the late 1970s. His plan was to obtain a degree in science and then advance to medical school to fulfill his boyhood dream of becoming a physician. “Helping others get well and stay that way was always something I wanted to do,” he says.
Catherine M. Lupo, office manager, performs an ultrasound treatment on a patient in the therapy suite. Lupo and Shawn Edwards, DC, a staff chiropractor, review the patient’s records.
While at USF, Lupo obtained a part-time job in one of the local hospitals. This enabled him to freely interact with a number of physicians on staff and gain insights to their work. However, he noticed that many of those same MDs seemed dissatisfied with their career choice. Lupo, not eager to share such unhappiness, gradually cooled to the notion of going to medical school. A period of soul-searching followed, and that led Lupo to explore other fields. One of them was chiropractic. It did not escape his attention that the chiropractors he encountered appeared well satisfied by their work. Lupo soon decided that chiropractic best suited his ambitions and yearnings. He enrolled at Life Chiropractic College in Atlanta as soon as he completed his undergraduate studies in 1982. He received his DC in 1985.
From there, Lupo joined a Tampa chiropractic practice as an associate. He spent close to 2 years with that practice before venturing off on his own. “As a place to practice, Tampa was a very attractive choice,” he says. “It was a city with a young population, still true to this day. It wasn’t like having to break into a market where you have long-standing, deeply entrenched competition.”
Tampa of late has been growing like gangbusters. That has prompted Lupo to consider opening one or more satellites elsewhere in the market. “I’m anticipating a new set of challenges in attempting to expand out like that, but I think they will be manageable and, in the long-run, be well worth the time and effort.”
Of course, there will remain plenty of old challenges in need of addressing, one of them being to make sure sufficient ingredients for baking cookies are always on hand. Because, as Lupo can readily attest, it takes dough to make dough. CP
Rich Smith is a contributing writer for Chiropractic Products.
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