One DC finds success with a boutique-style practice in the heart of Union Square

Some felt she was taking a risk setting up shop in such a place. Too big a risk, in fact. The address: 450 Sutter St—a glorious, art deco-style medical office complex that held a citywide reputation as home to San Francisco’s most elite health care providers. If you were a well-heeled Golden Gater and needed the absolute finest in care, you could do no better than to be seen by someone at 450 Sutter.

It was precisely because of this building’s stellar reputation that Jacalyn G. Buettner, DC, not long out of Palmer College of Chiropractic, decided to occupy a suite there, even though the price of square footage was extremely high.

But Buettner (pronounced “BIT-ner”) was determined to situate herself at that location. And, once ensconced there, it quickly became apparent that she had made a shrewd move.

“I knew that this building, by virtue of its reputation as the place where you find only the top doctors, would act as a powerful form of advertising for my practice,” says Buettner, who was able to pass around business cards bearing the Sutter address beginning in 1989. “It was worth every penny of what it cost being here because it gave my young practice instant credibility and cachet. I did not become an overnight success, but the location did help ensure that I at least made money my first year.”

Buettner was able to financially swing this deal by arranging to share space with another chiropractor who was using that site as a satellite office. Since he was only there 2 days a week, this other doctor was open to the idea of having someone utilize that office the other 3 days to help defray costs.

However, a few months after moving in, Buettner decided to seek a space of her own in order to see patients on a 5-day weekly schedule. Negotiating good terms with the building’s managers, she then moved to an 8th floor, 860-square-foot suite overlooking the city. She has been in that office ever since.

Boutique Opportunity
Buettner has positioned her Union Square Chiropractic as a boutique practice—meaning it is cozy, intimate, personable, and service-driven. Her practice choice reflects, she says, a desire to attract as patients the city’s most affluent and health care-sophisticated adults—individuals with a reflexive distaste for care delivered in impersonal, assembly-line fashion.

Yet while she has purposely pursued affluent white-collar and, as she terms them, gold-collar patients, Buettner does not have a cash-based practice. “Cash and personal injury add up to only about 10% of my payor mix,” she says. “The largest piece is PPO, which accounts for 40% of my income. That’s followed by workers’ comp, 30%. HMOs are now down to around 20%. I have exactly two patients on Medicare, so that’s not even a statistically significant piece.”

Earlier in her career, it was managed care that towered above the rest of Buettner’s income sources. In fact, Buettner used to joke that she was San Francisco’s chiropractic Queen of Managed Care. “I had more HMO billings than anything,” she remembers. “It started when I joined the American Specialty Health Plan (ASHP) and at least one other HMO back in 1991. Participating was a hassle, their policies and procedures were difficult to understand. I felt like a slave because of all the paperwork.”

She was paid only $26 per patient visit, but Buettner decided to stick with it. Good thing she did, as it turned out. “A major local employer, one of my biggest sources of patients, was signed up with ASHP. I did not drop the plan because many of the people who were using this insurance were that employer’s clerical workers. They were not earning the kind of money where you could realistically expect them to pay $40, $50, $60 in cash out-of-pocket.

“So from that perspective, I came to understand that by participating in managed care, I was making it affordable for people to have access to chiropractic care. I was getting them acquainted with chiropractic and getting them turned on to it.”

That proved entirely worthwhile when the employer later dumped its HMO in favor of a PPO plan. As a result of that switch, Buettner’s reimbursement on those particular patients doubled. And because she hung in there with them during the time they were covered by the poorly paying HMO, Buettner gained the loyalty of the employer’s workforce. Her reward was a huge, almost overnight upsurge in practice income.

Buettner was able to endure those years of HMO-induced hardship by streamlining her office operations. Increased administrative efficiency meant that the documentation demands of managed care would be less burdensome. To achieve that extra efficiency, Buettner acquired top-notch practice-management software for her office computer.

“I did a lot of research on this before I made the purchase,” she says. “I even went around to other doctors’ offices and solicited the honest opinions of their staff to see which systems received the highest marks from actual users.”

Women's Lit Women have played a vital role in shaping chiropractic, right from the profession’s beginning. However, their role today is largely being overlooked, asserts Jacalyn G. Buettner, DC, who says she intends to do something about that. San Francisco-based Buettner is writing what she hopes will be the definitive book about modern women in chiropractic. So far, she has interviewed 38 of the field’s female movers-and-shakers. “Ultimately, I’d like to have profiles of 50 contemporary women doctors,” Buettner offers. “Some of those I’m including are very well known, and others are not. But the point is that they all are important contributors to the profession.” Her inspiration for writing this book was an awareness that the modern history of women in chiropractic had not been committed to paper in any accessible or authoritative way. “There are a few pieces, like the story of Sylva Ashworth, a pioneering chiropractor from the last part of the 19th century,” she explains. “But apart from those small pieces, there’s not much information on the women who’ve done so much over the years to advance the profession. The problem is especially pronounced for the women chiropractors of today who are out there on the forefront—their stories just aren’t being captured for posterity.” The women being profiled by Buettner are in many instances dramatically different from one another in terms of personality, interests, clinical style, and thinking. But the one thread that ties them together is that their initial encounter with chiropractic represented, as Buettner characterizes it, “an ‘aha!’ moment in their lives. It changed them forever.” The book is expected to be released in August. Buettner is considering publishing it herself and offering it online at www.drjack ieb.com.

The Road to Chiropractic
San Francisco is a great market for chiropractic, but it is a world apart from the small Ohio town of Delphos where Buettner was born and raised. Her first taste of city living came in 1976 when she moved to Lima, Ohio, and landed a job as a secretary. The money was good (she was at one point employed by Ford Motor Co). But she was deeply dissatisfied and unfulfilled. So she decided to attend college in preparation for a career change to the field of communications.

Buettner had just started classes in 1980 and was working nights as a waitress in a Toledo restaurant. One evening, a chiropractor and his wife were seated at Buettner’s table. As Buettner approached to take their orders, the doctor matter-of-factly told her he believed she had a back problem. Intrigued, Buettner inquired as to how he could possibly know that. “‘By the way you walk,’” she recalls him saying. “So, he handed me his card and invited me to come see him at his office.”

Buettner had no idea what to expect when she made the appointment, since chiropractic was a term unfamiliar to her. She had been plagued by back pain since she was 12 when her brother accidentally injured her while rough-housing on a folding exercise platform. “I was lying on the exerciser, stomach down, and my brother tried to fold me up inside it. As he did, I heard my back pop. But, being young kids, we were scared to tell our mom,” she recounts.

Buettner suffered in silence with the pain and, for the first couple of years, learned to function despite it by developing a pronounced forward slouch. Later, she sought relief from physicians who prescribed physical therapy. Those interventions proved ineffective.

Things worked out differently when she went to see the chiropractor she had met at the restaurant. He x-rayed her spine and reported that the third lumbar showed signs of fracture. Additionally, he uncovered classic indications of scoliosis. “No one else in all those years had noticed this,” says Buettner. “The fact that he did put him at the top of my chart.”

Following a month of chiropractic treatment, Buettner was pain-free. Her happy experience led her to think about becoming a chiropractor. After contacting the admissions office at Palmer in Davenport, Iowa, for information on enrollment prerequisites, she switched her undergraduate course focus from communications to the biologic sciences. Upon fulfilling those entrance requirements, she transferred to Palmer in 1982 and graduated in 1985.

Buettner then moved to California. She lived there briefly in 1979 before returning to Ohio, but in that short span Buettner fell in love with the state and vowed to someday make it her permanent home. After arriving in California the second time, Buettner became an associate in a chiropractic office about 50 miles east of Los Angeles. From there, she joined the practice of a chiropractor in the San Francisco area, Leigh Beekman, DC.

Beekman’s office was among the state’s most viable, and Buettner learned much during the time she was with him. “He was my mentor,” she says. “He taught me the basics of how to run a successful practice.”

On Speaking Terms
Running a successful practice entails much more than business acumen. It also requires the delivery of good results for patients. Buettner believes she achieves her best outcomes by relying on the diversified technique and making extensive use of flexion-distraction tables. “I love this combination because it’s so very good at relaxing the muscles,” she explains. “Here in this hectic metropolitan environment, people tend to be more stressed and tense than out in the suburbs, so muscle tension is something I really have to address. Once I get their muscles relaxed, adjusting is much easier and holds better.”

The busy time for Buettner is the lunch hour. Many of her patients work in the nearby financial district, and that 12-to-2 segment of the day is the only opportunity many of them have to drop by her office. Periodically, Buettner travels to the offices of those patients, but not to treat them. She goes there to deliver talks about health, which proves to be one of the more profitable avenues of outreach for her.

“These talks—I give them to employees gathered in groups—give me a chance to meet many potential new patients,” she says. “I frequently address the topic of body mechanics because what I’ve found is that employees are very eager to understand what they need to do in the course of their daily activities, sitting at their desk and hunched over a computer all day, in order to be able to work pain-free, injury-free,” she reveals.

Buettner sometimes lands the initial invitation to speak by being inquisitive during patient encounters. For example, while she is working with a patient, Buettner typically tries to get to know him or her better by asking questions about career, schooling, travel experiences, and personal interests.

“If I find out the patient is in a position of some authority at a company that I’ve not yet spoken at, I’m not bashful about offering to come by and make a presentation to the coworkers about health and safety issues,” she says.

Other times it is the patient who broaches the idea of lining up Buettner as a guest speaker. But whether initiated by Buettner or a patient, these speaking engagements seldom are one-time affairs. Buettner usually finds herself invited back again and again thanks to her outgoing, enthusiastic persona.

“I know how to keep up the energy level during a presentation, which is essential for a speech to be well received,” she says. “And the more speaking engagements I do, the more invitations I receive. Accepting as many opportunities to speak as possible results in high visibility, which prompts people to seek me out with offers for further speaking.”

The Midas Touch
Buettner’s skill as a presenter of information even has led to a role as a media spokeswoman for the chiropractic profession. “Early in my career, I joined the California Chiropractic Association, the American Chiropractic Association (ACA), and the International Chiropractic Association and became an activist on behalf of those bodies,” she says. “So, when ABC Television’s Good Morning America show wanted to do a segment on alternative health care, they went to the ACA and asked for a chiropractor in San Francisco who they could have as a guest. Because the association was so familiar with me and knew I was a good speaker who could represent chiropractic well, they immediately suggested me to the show’s producers.”

Her contribution to Good Morning America went so well that the ACA tapped her to appear at a later date in a story aired on World News Tonight With Peter Jennings.

Buettner also made the rounds of local and regional talk shows and other media just a few months back to deliver the chiropractic response to a concern about stroke risks.

Where does Buettner go from here? “I’m headed,” she promises, “to a lifetime of success.”

Actually, an argument can be made that she has already arrived there. Indeed, practically everything she touches nowadays turns to gold. For instance, when Buettner not long ago decided to take off Fridays, her practice volume rose 33% in response. “Taking that day off forced me to become even more efficient, which had the effect of allowing me to do more in the time I had available,” she says.

A factor, too, no doubt was how she chose to spend that day off. Mainly, she devoted herself to helping out at the school where her two sons, A.J., 9, and Dan, 7, are enrolled (Buettner has been raising the boys on her own since her husband died of cancer a few years back). While at the school, Buettner has found and made opportunities galore to interact with teachers, administrators, parents, and outside supporters, touting chiropractic whenever possible. New patients have been born of those interactions.

But do not look for Buettner to attempt growing her practice through satelliting. She is content with one office. “If I open additional offices, I’m going to lose the boutique aspect of my practice,” she confides. “That would completely change its identity, which would hurt business more than help. I’ve always believed that a key to success is to be who you are. And who I am is a practitioner who delivers very personalized care in a friendly, relaxed setting.” CP

Rich Smith is a contributing writer for Chiropractic Products.