Practicing in his hometown of Williamston, SC, helps build this DC’s office into an 8,000-square-foot health care facility
The staff of Palmetto Family Medical Group PC: (front row L–R)) Kristy Newman, insurance clerk; Sharon Johnson, front desk; R. Mack Durham, DC, president; Patrice Shongo, MD; Beth Durham, DC, LMT; (back row L–R) Debbie Williams, office manager; Amber D. Fowler, front desk/therapy assistant; Crystal McDaniel, medical assistant; and Amanda Owens, therapy assistant. Not pictured: Sharon Durham, vice president, and Lee Day, therapy assistant.
While some South Carolinians are out shopping for a chiropractor, R. Mack Durham, DC, is busy shopping for a physician. But don’t jump to conclusions. Durham, of Williamston, SC, does not intend to place himself under the care of a medico; he merely wants to hire one—or two or three, maybe—in order to give his already-healthy practice a further shot in the arm.
It is Durham’s belief that having physicians on his team creates instant credibility in the eyes of the approximately 95% of health care consumers in the Williamston market who have never before visited a chiropractor. And he has seen plenty of evidence that this is so. Since 2000, Durham has opened his office twice a week to a local physician.
That relationship, operated under the terms of an independent contractor arrangement, is in the process of coming to a close, as the physician makes plans to move on to pursue other goals. However, it was a relationship that brought so much value to Durham’s Palmetto Family Medical Group PC, that the 43-year-old solo chiropractor now seeks to expand upon it with the hiring of one or more full-time, salaried physicians.
“I want to develop my practice into a larger business,” says Durham. “To accomplish this, I know I need to focus on growing the medical side of my office. I’m in negotiations now with a family practitioner from Mississippi as a possible full-time hire, and I’m also talking to a doctor here locally who is already coming in a couple of days a week.”
By summer, Durham’s practice will have moved from its 2,000-square-foot space into one four times as large a couple of blocks away. The new location will be big enough to accommodate not only Durham and his sister who also practices with him, but as many as four other physicians, a full-time staffed physical therapy department, and massage services as well.
“We’ll have the combined expertise to deliver truly excellent care,” he says. “At the same time, it will give me the freedom to be able to concentrate on what I love most, which is figuring out the chiropractic and neuromuscular and skeletal problems.”
| Take the Town by Storm When R. Mack Durham, DC, launched his solo practice in 1991, he took up space totaling 1,200 square feet in a Williamston, SC, strip-mall storefront . At first, the room was adequate—he was, after all, seeing only a few patients a week and ran the office by himself. But before long, his sister joined the practice and those quarters grew cramped as he added staff and equipment to handle the week-long crush of as many as 250 patients.  Durham therefore found it necessary to reconfigure his office space at least a half-dozen times during the 8 years he occupied that particular address in Williamston.
Those alterations could have been costlier than they were had it not been for Durham’s decision to start the build-out of the 20-by-60-foot space with the carpeting. “That’s the reverse of how you’re supposed to do it,” he says. “Customarily, you make wall partitions first, then you lay down the carpet and install the ceiling, which are cut to the dimensions of each partitioned room. “But by carpeting first instead, we were able to avoid the need to buy and cut new floor covering and ceiling tiles every time the partition locations changed. There was just one continuous carpet and ceiling across the entire space of the shell. All we had to do was put the partitions. So the carpet and ceiling we started with was able to see us through many reconfigurations.” In 1999, Durham moved his office to a better demographic location a short distance from his original location in Williamston, the same town where he was born and raised. “I chose to practice in Williamston because I figured this was where I’d have the best reception, since so many people here already knew me,” he explains. Interestingly, Durham’s decision to become a chiropractor was influenced in no small part by a medical doctor who lived just down the street from the house where Durham and his four siblings grew up. “His name was Dr Smith, and all the kids in my family loved to visit him,” Durham remembers. “It seemed like we were always at his house and going with him to his office. It got me thinking that maybe that’s something I’d like to do when I grew up, become a doctor.” The luster of the idea of following in Smith’s footsteps eventually dimmed, and young Durham settled on another career choice, mechanical engineering. And when he enrolled at Greenville Technical College in nearby Greenville, SC, Durham listed that as his major. Meanwhile, Durham’s younger brother decided to become a chiropractor. Before long, as the brother shared his knowledge about good health with the family, Durham realized he too might enjoy the field of chiropractic. Durham finished up his undergraduate work in 1987, then enrolled at Atlanta’s Life College of Chiropractic. He completed the program in 1991 and directly entered private practice. |
Doctor in the House
Durham recruited his first MD by cold-calling physicians assigned to emergency rooms in area hospitals. He figured those doctors more than any other would be open to the idea of teaming up with a chiropractor since it could mean practicing medicine at a comparatively slower pace while being able to forge deep, long-term relationships with patients.
“I called maybe a dozen or so of these doctors and just point-blank asked them if they would like to come work for me,” Durham recalls.
Russell Ross, MD, was the first one to say yes.
“When Dr Ross joined my practice, he continued working the emergency room, which allowed him just about 2 days a week with me,” says Durham, adding that Ross declined a subsequent invitation to work full-time at Palmetto Family Medical Group. “His interests were that he wanted to remain with an urgent or emergency care setting. Part-time with me turned out to be the best for both of us.”
Shongo examines Alexis Monet Marter’s sore throat. The synergy of different health care professionals has helped increase Palmetto Family Medical Group’s patient base.
After Ross announced plans to move on, Durham turned to a employment agency to find a replacement. The agency scouted candidates from across the South and came up with several who expressed willingness to put in a 5-day week as an employee of the practice.
“Joining an office with a balance between traditional and physical medicine holds appeal to physicians who are concerned about getting the best results for their patients and about offering them maximum convenience.”
Pivotal to achieving those great results, says Durham, “is to use what works.” And what works in the highest number of chiropractic cases at Palmetto Family Medical Group is the low-force activator technique.
“I like the activator technique because it has an accurate analysis and stabilizes patients much faster, and we can get them better with between 33% and 50% fewer visits,” Durham conveys. “Patients are very accepting of it, even those who come to a chiropractor expecting to have their neck popped in the course of a manual adjustment.”
Big-City Services
Of course, in Williamston, there are not many other chiropractors around to adjust those necks in the first place. The town, a largely blue-collar community in the heart of textile country, has a population of only about 5,000. Until Palmetto in its current form came along, residents of Williamston and environs who wanted comprehensive physical health services had to make a 30-minute drive to either the industrial city of Greenville or, in the opposite direction, the city of Anderson.
However, just having available the same types of services in Williamston as in the two nearby cities is insufficient to keep townsfolk from traveling to Greenville and Anderson, Durham notes. What is also required is the same level of quality care as that found in those small metropolises.
“We have to provide service comparable to what is available in Greenville or Anderson,” he says. “So that means we have to be more upscale and sophisticated in the services we offer and in h'ow we go about delivering them.”
A busy practice in motion: Amber Fowler encourages patient Alvin Lee Day as he performs spinal extensions to tone and train extensor muscles, while Amanda Owens assists her patient during a therapy session.
That means also having a support staff with sophisticated skills. Normally, such personnel would gravitate to jobs in Anderson and Greenville where the pay is better. Accordingly, counteracting that lure obliges Durham to offer salary-and-benefits packages matching those available in the cities.
“We could try to hire people from Greenville and Anderson, but the odds are against finding anyone who will be a long-term employee with us,” he explains. “That 30-minute drive from there to here isn’t a killer, but after a while it can become enough of a grind that a Greenville or Anderson resident will start looking for a job closer to home—and will be able to find one. For that reason, we prefer to hire from right here or in the near-vicinity of Williamston. By paying competitive wages, that employee will be more likely to stay with us for a long time. Our staff is an essential part of our success. We understand and appreciate that having a low turnover of staff is crucial formaintaining office efficiency, controlling our costs, and delivering a superior service.”
The Personal Touch
Though Williamston is small, the patient catchment area for Durham’s office extends out about 10 miles and takes in a population of roughly 50,000. That makes for a viable business base, he contends.
Most of the patients coming to Palmetto Family Medical Group for chiropractic care are women in their 30s, 40s, and 50s, presenting with almost every type of musculoskeletal problem under the sun. “We also treat our fair share of men, children, and the elderly,” Durham emphasizes.
Patients pay for services primarily through group medical insurance. To a lesser extent, practice income is derived from Medicare reimbursements, out-of-pocket cash, and personal injury awards or settlements.
Durham says he wants to boost the practice’s personal injury volume this year. He will accomplish that by stepping up promotion of Palmetto Family Medical to attorneys in the area. Promotion, which, like other campaigns Durham has waged in the past, will entail minimal formalized marketing.
“Other than a bold listing in the white pages of the phone book and a plain listing in the Yellow Pages, we don’t utilize media advertising,” he says. “Where we see the best results is in going out into the community and building relationships. The impersonal approach—newspaper ads, direct-mailers and the like—just doesn’t cut it here.
“Besides, people are inundated with offers. They’re drowning in marketing messages. They respond by tuning it out. So, those approaches have gotten very ineffective. I’d much rather just shake hands with someone and ask them how I can be of help.”
As such, Durham rarely turns down opportunities to get involved with local businesses, civic organizations, schools and health-oriented entities. “If a teacher wants me to come do a career day, I’ll be there,” he says. “If one of the local plants is going to have a health fair, I’m going to do everything I can to help out. When they do a fund-raiser here, such as a charity golf tournament, we’re going to play in it or sponsor a team.”
In Durham’s view, the biggest marketing challenge for a chiropractor is not just getting his name out; it is getting people to understand chiropractic and how it can help them.
Medical doctors play a role in that process, Durham points out—and thus his eagerness to team with them. “The vast majority of people in any market are conditioned to still think that it is a medical doctor you go see any time you have an ache or pain,” he says. “So, by bringing a medical doctor into your chiropractic office, you’re establishing a very workable way to educate people about chiropractic. It’s certainly been very workable for me.” CP
Rich Smith is a contributing writer for Chiropractic Products.
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