The Foster Brothers of New Jersey find success with six offices—and growing

David Foster, DC, PA, co-owns with his brother a sextet of northern New Jersey chiropractic offices; however, at some point soon, Foster hopes to expand to seven offices. Then eight. He might stop adding offices when the number reaches 80, but who knows? The way he set things up, he could just as easily take the tally to even 800.

The Family Chiropractic Center team members: (from left) Elliot P. Foster, DC; Pilar Mecadon, DC; David G. Foster, DC, PA; and Lucretia Cropsey, office manager.

“My offices run on the same concept that’s at the heart of the McDonald’s fast-food chain,” Foster says. “What that concept is really all about is utilizing a well-thought-out system of operation that delivers predictable, replicable success.”

Foster, whose practice goes by the name of Family Chiropractic Center, wants to build his empire by emulating the Golden Arches’ model not just for self-interest reasons. He believes a highly visible, impossible-to-ignore, geographically widespread penetration of Family Chiropractic Centers will help promote broader acceptance of chiropractic in general among consumers of health care services, and might even increase the profession’s political muscle in its dealings with other types of health care entities—payors in particular.

“I see only good things from growth to this degree,” he proffers.

Economies of Scale
As is true of chain eateries, Family Chiropractic Center provides product that is the same at each location. To abet that uniformity, the floor plan and equipment deployment at the sites are similar, one to the next.

“We want the offices to be as close to identical as possible,” says Foster, whose flagship is in the city of East Rutherford, NJ. “Conceptually, this is called ‘Office in a Box.’ From office to office, you find everything the same—right down to the type of paper clips we use and in which desk drawer they’re kept.”

The master floor plan calls for two adjusting rooms, one state-of-the-art x-ray room, a doctor’s office, a front desk and a waiting room, all tucked into a 1,000-sq-ft space per location.

Since the multiple offices of Family Chiropractic Center are appointed and outfitted in matching form, many items can be purchased in sufficient quantity to qualify for volume discounts.

“McDonald’s has the advantage of economies of scale working in its favor, and so do we,” Foster says. “It helps to be able to get things at a discount. That leaves us more capital to invest in other activities, such as the development of additional locations.”

Central data processing is another McDonald’s-esque feature of the practice. Effectively, all patient billing information and supporting documentation generated at the individual locations are funneled into the East Rutherford office, where they are reviewed for quality before being submitted to insurance companies. “Our claims are very clean because of the centralized QA process,” Foster says. “We have fewer claims rejected as a result.”

As to clinical services, the offices are across-the-board focused on delivering wellness care. “Our goal is to attract the long-term, wellness-minded patient,” even though the practice depends mainly on major medical plans for its income, Foster reports, noting that only about 15% of the mix is cash, 10% personal injury. “Our philosophy of chiropractic is strictly old school, which is to say an emphasis on wellness. It’s a common-sense approach to health care; once we teach it to patients, we find they’re eager to participate in it.”

Bond Memories
Foster asserts that the most important aspect of practice, right after clinical capability, is marketing. “You could be the greatest chiropractor of all time, but without patients you’re just not going to be successful,” he says. “And marketing is how you attract those patients to your practice.”

David Foster, DC, PA, reviews a patient file with Maria Rehrig, CA.

Foster’s understanding of the importance of marketing stems not just from his experience as the owner of chiropractic offices, but from his education and early employment history. Prior to becoming a DC, the Wayne, NJ, native and 1981 Boston University graduate was an advertising consultant and, later, a bond broker—fields he admits left him feeling dissatisfied.

“The bond industry in particular was a disappointment,” he says. “Things there weren’t as bad as Hollywood made them out to be in the movie ‘The Boiler Room,’ but it was nonetheless very cutthroat. I didn’t feel like I was serving my clients’ interests at all.”

At that time, Foster was sharing a home with his chiropractor brother, Elliot Foster, DC. This living arrangement allowed Foster to witness his sibling’s daily ups and downs, in the course of which there seemed vastly more of the former than of the latter.

“Things were going great for Elliot, professionally,” Foster recalls. “I looked at where I was—unhappy with my job, not really being of much help to people—and I decided to look into becoming a chiropractor myself.”

So Foster enrolled at Life Chiropractic College. He was 28 when he went in, 32 when he came out. Upon receiving his sheepskin in 1991 from the Marietta, Ga, school, his brother invited him to join the practice. “It was nothing formal; Elliot just suggested I hang out with him a while to see how things would go.” (Thirteen year later, it’s evident that things went exceptionally well for them both.)

Significantly, though, Foster brought to the party some decidedly big ideas for growing the practice. “You could almost say I was a businessman disguised in a chiropractor suit,” he muses.    First, there was health club-based satellite, which the Fosters entrusted to an associate they had hired.

“This provided the impetus for us to develop a system of billing that would allow us to easily move information about the activities of the satellite over to our main office, and this system became the basis for the one we now have in place at all our offices,” he says.

A while later, Foster became involved in the brokering of chiropractic offices for sale as a sort of adjunct to his clinical endeavors. Among the listings was a perfectly viable practice that for some reason was not attractive to buyers. When nobody snatched it up, Foster and his brother bought it for themselves. They kept adding offices from there. At one point, as a result of the growth, they were providing care to nearly 1,400 patients a week.

Today, the Brothers Foster share the main office, but each conducts clinical services on different days of the week. “I care for patients on Tuesdays and Thursdays; Elliot cares for patients on Mondays, Wednesdays, and Fridays,” Foster says. “On the days when I’m not seeing patients, I attend to all the financial and marketing tasks—I look at leases, buy equipment, and evaluate service contracts.”

The other five offices are occupied by associates, all of whom are employees except for one who is a part-owner of the office in which he works.

Chiropractors who become associates in the practice are recruited through a variety of avenues. These, says Foster, include the Internet, personal networking, and tapping into the preceptor programs offered by Palmer College and New York Chiropractic College. He looks for an outgoing personality in his candidates, and he wants to see signs that the prospective associate loves to teach.

“The person I consider has to be on fire for chiropractic,” he says. “I’ll supply the administrative support; the associate has to supply the energy. You put those two together, and you’ve got an unbeatable formula for success.”

Hiring decisions are made by the Foster brothers along with aide-de-camp Pilar Mecadon, DC (who functions as the go-to person for implementing improvements to existing processes), and office manager Lucretia Cropsey. “We each have one vote,” Foster reveals. “But, almost without exception, we don’t hire anybody unless it’s unanimous.”

Foster refers to the training he puts new associates through as “Everything I Never Learned in Chiropractic School,” a play on the title of a book about things not taught to Harvard Business School students but learned instead on the job.

“We don’t teach them anything about how to adjust; what we do is teach them how to be a chiropractor,” he says. “By that I mean we teach them how to be magnetic. How to communicate powerfully to the patient. How to develop a practice, and how to market it. We give them the vision to be successful, then teach them the system to make the vision a reality.”

As key as vision and systems are to success, Foster cautions his acolytes that both are useless without the support of solid teamwork. “You can’t make a go of practice by yourself anymore; that’s passé,” he says he informs them. “You must have the support of an excellent team,” which includes clinical and clerical assistants but also ancillary services providers, referral sources, and even the patients themselves.

Growth Factor
Foster does not lend much credence to experts who advise slow growth for businesses. “That’s not how chiropractic offices grow,” he argues. “Usually, they jump. And they jump down as routinely as they jump up.”

Foster recently bought a commercial building and is in the process of moving his administrative operations into it. That new building is large enough to also serve as home to a pair of separate Foster ventures, Optimum Management Corp and Axis Billing and Collections.

“I’m once again consulting and helping doctors with the buying and selling of their practices, but now I’m also helping them with their billings and collections,” Foster says in explaining the functions of the two companies. “I’m not actively trying to expand Optimum Management Corp or Axis Billing and Collections. That’s just sort of happening on it own. It’s happening because there’s a demand for it.”

Where the real growth will come is in the form of more Family Chiropractic Center locations. “As long as there’s opportunity, I’ll definitely purchase or build more offices or both,” Foster announces. “The reason is that the increased amount of work required to oversee seven offices instead of six is minimal. That being the case, why not have seven? Or eight?” Or, for that matter 80, 800, or 8,000? CP

Rich Smith is a contributing writer for Chiropractic Products.