Turn your practice from a failing business into a successful, thriving one

As a practice management columnist for Chiropractic Products, I receive many calls and emails requesting advice about the business of chiropractic. The following email from a frustrated chiropractor is one I come across all too frequently. My reply stresses what it takes to establish strong roots in a community by planning for your success.

Dear Dr Margolies:

I’ve read your Practice Sense column in Chiropractic Products magazine, and I wonder how I can also have a successful practice. I graduated in 1999 and opened my own office in 2001, closing it in 2003. I’m so frustrated that I’m thinking of not opening an office again.

I look forward to your reply and thank you for reading my confession.

I replied: Thanks for your email and question. I am saddened to read it, since  I have read many like yours before. Our profession allows us to be as flexible as we wish. We can either work with others or be on our own. Circumstances always play a role. But consider this, no matter where you practice or the amount of funds available, if one of our profession’s practice management consultants took over your practice and worked with the same resources, same budget and in the same location would things remain the same or would they seem to make lemonade from lemons? If you get my point, we are usually the stumbling blocks toward our own success.

I understand your dilemma and concern and hope you can salvage it.

First off, a chiropractic practice is a business just like others. Some of us have keen business sense and can make things work, while others are great followers and need to find competent and generous employers. There is no shame in this. Finding the right fit and an honorable doctor to work for is often difficult, but they are out there. So, prior to walking away from your years of training and potential years of helping others, I would not abandon the search.

I recommend taking a few steps back to clear your head and give thought to what you should do.

First, write down all the frustrations you felt while practicing, leaving nothing out. Where were the stumbling blocks that stopped practice growth and your ability to sustain and make a living?

This takes a lot of thought and honesty. Don’t be afraid to write the truth. That undoubtedly means you were probably fearful of going the extra mile, asking for or gathering additional practice building ideas, keeping a cash flow, or taking some extra risks.

Possibly, you were hasty in opening an office or had limited equipment, funds, money, and marketing knowledge. Maybe you felt insecure telling patients what they needed to hear (whether you were in insurance networks or not) or were unable to have them follow your recommendations. Whichever it is, there are other doctors in similar circumstances that have managed to survive and thrive, while many did not. Which end of the statistic do you want to be?

Now, decide what your next step will be. If you could wave that magic wand where do you see yourself in the next 6 to 12 months? What would you need (if you were able to gather it) to make it happen? What risks are necessary to create it? And what comfort zones will you need to break through to have it? These are important questions. Sense what you want and what you feel you need to get there as an objective observer, as if you were a consultant.

Chiropractic requires a bit of business sense and luck to create a practice from scratch. It hurts me to see a new restaurant materialize only to close within a month or so. This is all too common in the restaurant business and is becoming a concern within our profession.

Considering heavy student loans, the usual daily living expenses, and accumulated credit card debt, new graduates have little room for mistakes or miscues. Therefore, new practitioners or associates deciding on practicing alone must use careful planning and preparation.

While an instructor at Life University, my students were given guidance toward success. If they were awake during my class and used my textbook Smart Start, they at least had a head start on reducing mistakes and taking nothing for granted. Success is measured in many ways. For some, the barometer is money and material wealth, while for others family time and making a decent living is the ultimate sign that they have arrived. Therefore, the success of a practice is individually measured but the ingredients remain the same.

Stretching and warming up is critical to an athlete. The same holds true for the businessperson. Never take for granted preparation and training prior to opening an office. Prior to shopping for food, eat before venturing out or you may overbuy. It is also true for hungry doctors who need to open their offices as quickly as possible.

This burning desire and hunger creates rushed and emotional decisions rather than carefully thought out decisions. The clinic area may not be suitable or the space may be too large or small. The lessor may seem questionable but the price may be attractive, so you may make a rash decision or get in way over your head. Often, the mistake is not writing down the cost cost estimates, because you think a few extra dollars will sustain you for awhile. New doctors often forget or do not realize that utility and other business fees exceed private consumer costs and staff overhead and the cost of running a new business will quickly eat away at initial savings, therefore making a successful start crucial.

Preparation also comes in the form of study. Have you investigated the area both by day and night? Has a demographic profile been obtained either professionally or by driving around and asking the chamber of commerce? What is the age of the community? What new retail stores and sports venues have opened recently? Is the area busy during the day and a ghost down after 5 PM? Is there easy access to your potential office or are maps required? Are there marketing venues available for potential patients, such as a corporate employee base or municipal buildings? Are civic organizations within a 10- to 15-mile radius? How many religious institutions that have member clubs and activity groups are located in the area? Are there warehouses or large retail facilities with plenty of safety ergonomic programs, as well as areas available for screenings or wellness talks? Yes, you will need to work a bit for new patients, then expect to expand on your efforts once the practice takes hold. As you can see, careful planning and preparing for success starts with a careful review of the community way before you sign a lease.

An actor reads from a script mastering the lines and nuances necessary to play the role with each rehearsal. We are actors, playing to our patients and community. Our dialogue includes face-to-face or written interaction.

The average new doctor, fresh with a diploma and state license, is ready to make a move but usually not ready to move forward. Typical complaints of a slow start are either limited to finding new patients and the inability to maintain those you have. Again, it begins with planning.

Was time spent gathering new patient forms and educational literature prior to opening the doors? Have you practiced consultation and evaluation scripts or rehearsed with friends or colleagues various report-of-finding scenarios and financial obligation programs? Once you hire a chiropractic assistant will you be able to competently train them or will you need to have others do so? Have you investigated insurance protocols with the proper and ethical coding, assuring your compensation will be just and you are paid for your services rendered? Have you written letters of introduction to create professional alliances with allied health care providers or the legal profession, and are you prepared to step outside your comfort zone and either meet or call them on the phone?

The typical new doctor is too hurried to get their act together under the stress of business and debt survival. Consultation and report scripts are plenty within our profession and sold by practically all practice seminars and consultants in the form of written, audio, CD, DVD, and videotapes.

If you are new and plan to be an associate prior to stepping in the water of solo practice, I encourage you to prepare as well. Use the time working in another doctor’s office to establish successful patient management and open further dialogue within the community. As outlined above, use the office as a stepping stone to yours by gaining security and assurance that you can do it on your own. Market the area to bring new patients to the practice. Use quality patient time to stretch the patient base via referrals and internal public relations. Feel comfortable with services and billing procedures so you too can transfer this comfort to your own facility. Place a specific timeline to gather your strength and stretch your comfort zones to make the eventual proper move, unless you plan to work for others or remain an independent contractor.

Using the analogy of a farm, your soil preparation and choice of seeds and fertilizer helps assure a successful crop. Once established, maintenance is simple. Therefore, prepare prior to planting the seeds of success within your community.

If you need further support or encouragement check the mentors on my Web site for free advice.

A smart start begins each and every day. Constant practice, planning, and rehearsal means consistency. Educate your patients and staff and all else will follow.

Joel E. Margolies, DC, has been in practice for 25 years in Atlanta and is the author of four books: Smart Start, Workshop Workbook, Chiropractic Marketing and Public Relations, and Personal Injury Workbook. He sends a free weekly chiropractic e-newsletter concerning practice management, public relations, and philosophy to more than 10,000 DCs in 31 countries. Margolies can be reached via email: joel3639@aol.com,   or Web site: www.chirosmart.net.