Twenty-six years ago, I opened my practice. Growth was slow at first. Painfully slow. I knew I had something to offer the world. More than just offering a temporary assuage from people’s ills, I could offer a genuine ability to enhance quality of life. Knowing this, I did not just sit idly in my office, waiting for my practice to build itself. I was proactive.

I gave lectures, attended seminars, and lived and breathed chiropractic. All of my time and effort was focused on expanding knowledge of chiropractic and of people. I sought out the successful individuals in my field, not so that I could mimic them, but so that I could understand their confidence, know their methods, and be able to create my own.

Building Rapport
My practice began in a 600-square-foot office. There was a big desk, and miniscule adjusting rooms. I could have devoted hours to each individual patient. (I had that kind of time on my hands.) Instead, I spent less than 5 hours in the office. I spent the  rest of my workday observing colleagues and introducing myself to the community at large, establishing myself as a recognizable local figure, and creating ties and building rapport with local businesses. As the business owners got to know me, I became a trusted part of their network of health providers. Business neighbors began introducing me as their chiropractor to their families, associates, and clients.

Learning to build rapport was key to the growth of my practice. And it is a worthwhile study unto itself. Knowing people enables you to communicate effectively and find the most efficient and valuable way to get your message across. As soon as people meet me, they know I am a chiropractor. I listen to what they have to say and find a way to introduce chiropractic in a way that complements whatever they are talking about.

Get Systems In Place
It was some time after the dismissal of my third untrained assistant that I had a breakthrough. I realized that growth not only depended on my ability to adjust and communicate, but it was at least equally reliant upon my staff’s ability to exemplify and verbalize the same message. Although I was out in the community seeing and educating patients at their homes, traveling out of state to treat patients 2 days per week, and getting great results, I did not reap great rewards. Patients were happy, but they were not filling my office with dozens of referrals.

To facilitate growth, I realized that I needed to have systems in place run by someone who appreciated what chiropractic (and specifically, my office) had to offer. I needed someone who could manage the paperwork and would inspire patient confidence. It would be someone who could make their own connections that would help the practice grow. I was a green doctor when it came to running a practice, and I had tried to make it work with green assistants.

I hired a woman with five brothers, all of whom had their own private health care practices. Each practice was making more than $1 million in 1984. She expected us to grow. She expected patients to show up, pay, and refer. She set up in-office lectures and came with me to seminars. We set goals, wrote a mission statement, and stayed focused. As a result, my practice grew from 100 patients per week to 300.

The space became restrictive. Our continued growth necessitated a change in office space. So we moved. With more room—2,000 square feet—we could offer more services. We brought in massage therapy and a separate room for adjunctive rehab. These additions necessitated more staff. This new staff had to be educated. They had to learn the big picture of chiropractic health care. These people often spend more time and have more contact with the patients then the doctors do, so they had better have the message straight. My CAs became so indoctrinated into the chiropractic life that many of them left the practice to attend chiropractic school.

Education and Growth
The practice continued to grow, as health care classes reached attendance of 40 patients or more. I maxed out the capacity of that office and decided to relocate to an office that was substantially larger—4,000 square feet. This is my current office. But it is not without its problems. The larger office was perfect (in theory) for accommodating the steadily growing numbers, but just as the new doors opened, the practice seemed to reach a plateau. This created a great dilemma for me, because my overhead had increased substantially with this relocation. As a solution, I decided to improve the quality and consistency of my patient-education programs. This was an effort to make patients more involved in their health care. The belief behind this was if patients are more informed, they will be more willing to invest in lifetime health care instead of only being treated for acute issues.

To evolve my office into an education center as well as a treatment center, I added many informative systems and even added other forms of health care—acupuncture, massage, and physical therapy— so that my office would be a total wellness center. Each adjusting room, as well as the reception area, features a televised slide show of the services available in my office (including exercise, nutrition, and posture analysis) along with continuous chiropractic education.

For Love or Money
Deciding how to grow often became a question of love or money, and even more often, a compromise of the two. The practice grew, seeing 100, 200, 300, and more patients per week, and the thrill of helping and treating more was intoxicating. It was the thrill of victory that athletes and warriors feel—the pure adrenaline rush of success. The more patients I saw, the more energy I had at the end of the day. It was the opposite experience of most of my friends and patients. Exhaustion came with the slow days in which there was too much time to think. As with all success, there were complications. Volume brought logistical conundrums. Adding more staff forced me to learn financial responsibilities, including profit sharing and insurance coverage. But there were benefits as well, such as allowing my office to become bilingual and more fully serve our diverse community. More staff is a mixed blessing. It created the financial burden of providing benefits and added to overhead in many unforeseen ways, while stimulating the practice with more sources of ideas, referrals, and diversity.

Practices change, as does everything else in life. In reviewing my past 25 years, I have come to realize that I do not adapt to growth; growth adapts to me.

Wendy S. Coren, DC, practices in Norwalk, Conn. Contact her at docwoc@sprynet.com