Twenty years of practice give the Cohens a growth spurt without the growing pains with three offices (and counting) in Northern Delaware

“Putting patients first” is the motto of First State Health & Wellness in Newark, Del. To live up to that credo, the 20-year-old chiropractic group has, among other things, rolled out a private-label collection of supplements, brought in an array of cutting-edge therapy equipment, widely expanded its scope of services, and built an 8,500-square-foot fitness center.

Costly efforts all, but plainly worth the price—First State, now with six doctors in four offices, stands as Delaware’s largest and perhaps best-known chiropractic practice.

Left to right: Lydia Cohen, DC; Doug Briggs, DC; Stacy Cohen, DC; Amanda Tobin, CA, rehabilitation; Tracy Smith, CA, front desk; and Kalina Frazer, CA; at the Hockessin location. The Cohen’s plan for the next 2 to 3 years is to open six fully staffed offices.

First State is the creation of Stacy Cohen, DC, and Lydia Cohen, DC, husband and wife who were students at New York Chiropractic College and still just dating when they initially laid plans to one day practice together. That day arrived in 1984. And, as it was back then, the majority of cases currently flowing into First State involve musculoskeletal problems. Although now, with the addition of acupuncture and nutrition services, there are an increasing number of encounters with patients seeking treatment of atrial fibrillation, asthma, hepatitis, obesity, tobacco addiction, pregnancy complications, low fertility, and other organic maladies.

“We try to incorporate whatever conservative measures are necessary to help our patients—chiropractic, acupuncture, nutritional counseling, spinal decompression therapy, and rehab exercise,” says Stacy Cohen, a past president of the Delaware Chiropractic Society and the state’s 1988 Chiropractor of the Year.

By Fair Means
For marketing, the Cohens find that their most effective means of getting the word out concerning the practice is simply to make sure patients are satisfied, the idea being that individuals who have experienced good results at First State make the most enthusiastic and persuasive promoters of the practice.

However, the couple is not content to rely solely on that kind of passive marketing. They also take their message directly to the community and do so in several ways. One is frequent participation in health fairs. “Health fairs represent great opportunities for us to meet people and be able to answer their questions,” says Stacy Cohen. “The [fairs] acquaint them with us, but they also dissipate the apprehensiveness many of them would otherwise have about making an initial appointment to come in and see us.”

Once a year, First State also helps raise funds for Ronald McDonald House, a nonprofit organization that provides a place for out-of-town parents to stay for little or no charge while their children undergo nearby hospitalization for treatment of life-threatening diseases.

“For a week straight at the end of October or early November, we deliver services free of charge to anyone who makes a donation to our local Ronald McDonald House,” says Stacy Cohen. “This has generated a lot of goodwill for the practice and opened many doors for us in the community. In fact, this coming April, the Ronald McDonald House has asked us to be the main sponsor of their 15th annual run/walkathon. That could be a very positive experience for us because it is an event that is usually covered extensively by the press and attracts lots of community participation.”

First State also has developed an Internet presence, which it is in the process of enhancing: Soon to debut alongside the existing brochure pages and educational content will be an e-commerce section where Web site visitors can purchase the recommended supplements.

“These are the same supplements available for purchase in our offices,” says Stacy Cohen. “In addition to those supplements, we are going to use the site to also sell special pillows and other musculoskeletal-related wares. Our goal is to increase the convenience for our patients, but we think it will also give us the ability to reach and work with more people outside our immediate market area.”

Fit to Be Tried
Possibly the most helpful practice-building tool for First State has been its fitness center. Operating under the name Delaware Health & Fitness, the facility opened in 1993 in space adjacent to one of the offices. So successful was it that it won recognition from the leading newspaper, the Delaware News Journal, as one of the state’s best fitness emporiums.

Approximately half of the center’s 1,000 dues-paying members are or once were First State patients.

“The fitness center started out as a place for rehab exercise only,” says Stacy Cohen. “Gradually, though, more and more patients found they enjoyed exercising and wanted to continue with some kind of fitness program even after treatment ended. So we expanded the center’s services to include fitness. When we did that, we began attracting a large clientele of people who weren’t specifically looking for chiropractic care. They were just people who wanted to be able to have a great workout in a state-of-the-art facility.”

In many instances, fitness-seekers coming to Delaware Health & Fitness are attracted by the equipment, much of which was developed by the same designer whose breakthrough exercise machines in the early 1970s helped propel the fitness-center industry to its current heights. “The equipment we’re using is about the easiest there is to use, yet it’s also equipment that is very sophisticated in terms of how it works on the body and the results it delivers,” says Stacy Cohen.

Briggs is a diplomate/advanced fellow of the International Academy of Medical Acupuncture, and therefore sees all First State patients whose treatment plan includes acupuncture.

While most other fitness centers in the local market emphasize body-shaping and beauty, Delaware Health & Fitness continues to stress the health benefits of exercise. “From experience, we know that large numbers of people will join our fitness center mainly to feel better and that trying to improve their appearance is lower down the list of motivations for taking out a membership,” says Stacy Cohen. “So at Delaware Health & Fitness, the staff has been trained to support members in the quest for greater health.”

The Cohens sold the fitness center earlier this year, believing “it needed to get to the next level of growth but wasn’t going to because of the constraints on our time and because of the way our business model is designed,” Stacy Cohen explains. However, since Delaware Health & Fitness and First State share the same building, the Cohens continue to send patients to the fitness center as part of the rehabilitation care process. At the same time, the Cohens have agreed to provide no-cost physical evaluations to fitness center members (thereby opening the door to the possibility of gaining new patients). “This gives us a chance to expose fitness-club members to our philosophy and approach to health care,” Stacy Cohen says.

All in a Day’s Work
Because the Cohens want to see their practice draw patients from a wider geographic area, First State plans to eventually open more offices (in addition to the Newark facility, locations in the cities of Hockessin and Glasgow are also operating). Stacy Cohen expects to have as many as six full-service, fully staffed sites up and running within the next 2 or 3 years.

“This will be possible because of steps we’ve taken to bolster the soundness of our business model,” he says. “We’ve centralized our billing and much of our organizational structure. The result is lower overhead, which we feel is the key to being able to add more offices.”

One of those forthcoming offices might be manned by Lydia Cohen’s nephew, a recent chiropractic college graduate from out of state, who is giving serious thought to moving to Delaware—just as Long Island, NY, native Lydia Cohen herself did when she and Stacy Cohen (another Long Islander) came to work as associates in the practice of her older brother (who sold them his Newark practice in 1987) just prior to starting First State.

If the Cohens do open additional offices, it is a sure bet Lydia Cohen will not be spending much time at them. As it is, she is working only 1 or 2 days a week at the office she already has.

“I’ve cut back my schedule and am seeing only my maintenance patients so that I can have enough time to raise our two boys,” she says. “Eventually, I might go back to more of a full-time practice. But for now, my attentions are on the kids and their schooling.”

Stacy Cohen, meanwhile, is busier than ever—and not just because he is taking up the slack. No, the reason is that Stacy Cohen has started a venture to develop medical office systems software. He is doing this in collaboration with a programmer who, for 15 years prior, wrote business software for First State’s own office computer.

According to Stacy Cohen, the debut product to emerge from this enterprise will allow medical and chiropractic offices to crunch statistical numbers in a way that yields insights into how healthy a practice actually is.

“Most software programs just do billing and bookkeeping,” he says. “The product we are developing will do that plus let them see the real workings of their practice so that they can make good, sound decisions—something they have enormous difficulty doing now because of the lack of easily available information.”

Because the product is targeted toward not just chiropractors, but also medical doctors (MDs), one hope for it is that it will give the Cohens another vehicle for establishing relationships with MDs to benefit chiropractic practices. “We already are on very good terms with physicians thanks to the timeliness and detail of our reporting to them and because of our willingness to employ approaches to getting their patients well that go beyond the purely chiropractic,” he says.

Having once wanted to be a medical doctor, Stacy Cohen has an unusually high degree of affinity with medicos, and that helps the practice in its efforts to attract referrals from them.

But regardless of how the demands on their time and talents tug at them, the Cohens insist they are not about to lose focus. “We’re doing what we love,” says Stacy Cohen.

And, clearly, the market loves what the Cohens love. Evidence? The practice has won awards, including the 2003 Delaware Torch Award from the Better Business Bureau for marketplace ethics (meaning high ethical standards of behavior toward customers, employees, and the communities in which they do business) and, over the last 3 years, a total of 16 News Journal Readers’ Choice awards. “That’s what happens when you put patients first,” Stacy Cohen notes.

In addition to the Cohens, Douglas R. Briggs DC, DiplAc (IAMA), who has been with the group since 1996, 1 year after graduating from Palmer College of Chiropractic and co-owner of the Hockessin office; Kevin Murray, DC, a 1997 Life University School of Chiropractic alumnus; John Mahoney, DC (another former Life University student); and Ronald P. Miller, DC, L.Ac, ND (the newest addition to the group and a 1985 graduate of New York Chiropractic College) also practice at First State. CP

Rich Smith is a contributing writer for Chiropractic Products.