by William D. Esteb
My very first job was selling hand-picked blackberries door to door to those wanting to bake pies but avoid the thorns and hot sun. My second job was mowing lawns in my neighborhood using my Dad's old rotary lawn mower. Paper routes. Washing dishes at a local restaurant. Shelving books at the public library. Each of us has an early job history that has probably never shown up on a resume but affects the way we each work today. Which is why so many student doctors become indentured servants to established doctors.
Many students came to chiropractic because they saw it as a chance to make a lot of money, especially in the rollicking days of the 1980s. All too many chiropractic college professors lament about the number of students who didn't receive their first chiropractic adjustment until after arriving at school. "We've got an entire generation of students who got involved in chiropractic for the wrong reason," they sigh, looking wistfully upward.
Is this where the chiropractic poverty complex gets rooted, by chiropractic college teachers who scorn money and its implications? Teachers who find the real world unfamiliar and their skills ignored by paying customers often retreat to the institution that bred them, infecting others. Students who find they must withstand the entrepreneurial pressures of those who conduct management seminars for the optimism and leadership they crave. A profession that seeks acceptance and has such a low self-image looks to insurance companies, HMOs, hospitals and the federal government for validation. New graduates who have paid tuition fees based upon a different time in chiropractic leave with a choice-crippling millstone around their necks. It seems the only solution is to prostrate themselves in front of field doctors and beg for the opportunity to conduct exams, process X-rays and wash the doctor's car.
As a cruel test, all too many states schedule their board examinations a week or two before the graduation dates of most chiropractic colleges. Insecure doctors living in a zero-sum mentality (your success diminishes my success) or who have adopted a scarcity outlook (there are only so many patients and I want my share), have become examination board members and have created this barrier in the hopes of discouraging new doctors from considering their particular state or locality.
Having an experienced practitioner as a mentor is a good thing. But there are other things you can do while waiting to get your license that could be even more profitable and help you successfully launch your new practice. If I was cooling my heels after enduring a long commencement exercise and storing my cap and gown, here are some things I'd do:
1. Tour lots of practices. Some say imitation is the sincerest form of flattery. I agree. Just as it is impossible to pull water from an empty well, to create your own practice, it's valuable to see what works in other practices. You'll still make some mistakes but you'll avoid a lot of them, too.
Work with your alumni association, technique club or through a few of the "movers and shakers" in the chiropractic association or society of the state in which you want to practice. Get the names of those who use a similar technique or went to the same college and ask to spend a day touring their practice and going on rounds. Explain your situation. Buy them lunch and pick their brains. "What would you do if you were just starting practice today?" "How did you get your first 10 patients?" "What's the most important aspect of the doctor/patient relationship?" "How do you handle skeptical patients?"
As long as you ask questions, keep your own opinions to yourself and try to honestly see the wisdom of their point of view, you'll learn a lot. This will be information you won't find in a book, a tape or a seminar.
2. Conduct patient focus groups. Maybe in conjunction with your office tours you can earn a few bucks by volunteering to conduct a patient focus group for the field doctor.
Arrange to meet five or six patients for lunch at a nearby restaurant. Ask them questions about what they like and don't like about the practice, the procedures, the staff, the parking; that sort of thing. Explain to the patients that you'll keep their names confidential, but your job is to uncover ways the office can offer better service to its patients.
The information you uncover for the doctor will be invaluable. Besides picking up some cash on top of the expense of the meals you'll be learning incredible insights about how today's real live patients think and act. You'll see chiropractic practice entirely different, and I can guarantee your own practice will be more relevant, more attractive and more successful.
3. Seek public speaking opportunities. It is said that those who can't, teach. Since you can't practice--yet, you might as well teach! That's what I do.
Since the caliber of your communication skills are an accurate indicator of your success as a chiropractor, confront your fears. Put your understanding of chiropractic to the test by speaking to any group looking for a speaker. Check with your chamber of commerce, toastmaster group or the editor of the suburban weekly newspapers. Find out who needs a speaker.
If this suggestion makes you uncomfortable you're the perfect candidate for this exercise. Your ability to articulate your philosophy, your treatment style and describe the mythical practice of your dreams can help assure it becoming a reality. Perhaps only without a practice of your own can you most effectively "sell" chiropractic without worrying about the perception that you're out soliciting patients.
4. Become a patient education specialist. This is what I want to do someday! Find a busy field doctor who recognizes the value of educated patients but doesn't have the time or systems to make it happen. Become the "new patient advocate." Design and implement a comprehensive patient education strategy.
Prepare patients for every office function and be the new patient's liaison in the office. Lay the groundwork for the patient's report of findings. Clean up and organize the admitting paperwork, patient policy handouts and other documents. Conduct patient lectures, seminars and workshops. Experiment with different metaphors and communication devices to help convey chiropractic.
You want to get paid for doing this? Remind the treating doctor that there is a CPT code for patient education. Perhaps you can split this fee with the office and maybe pick up an additional fee based upon your ability to increase the patient visit average or case fee average. Be creative. It may be minimum wage but you'll be in an office acquiring a skill that may be one of the most important aspects of practice.
5. Conduct neighborhood surveys. I had to throw this one in because I've heard how effective it can be if done properly. It's a twist on the focus group idea mentioned earlier. Tour the area in which you are intending to open your practice and go door to door asking questions.
Remember, while your practice may be nine months away, most patients wait even longer before garnering the courage to consult a chiropractic office. So don't be afraid of planting "seeds" when you have no practice with which to harvest them.
Ask questions about the practicalities of opening an office in the area, such as traffic patterns, parking problems or other practical matters. Ask about their experiences with chiropractors in the past. What are some of the qualities they'd look for in a chiropractor. That sort of thing. Take notes! Buy a mailing list and use it to code who you've talked to and their openness to your survey. Send them a follow-up "thank you" card! Later invite them to your open house. Get the picture?
Will there be people who will slam their door in your face? Of course. Will there be dogs waiting to chew on your leg? Probably. Will there be people with a negative chiropractic experience and choose you to do a little venting? Sure. Mark Victor Hanson has the perfect antidote. You simply say to yourself, "Next!" and move on.
Starting a practice is not easy. Much of the difficulty arises from one's expectations not meeting reality. Add to this the fear of rejection and you have a formula that paralyzes many new graduates. Welcome. You've just taken the first pop quiz at the School of Hard Knocks!
Originally published in 1996
Not a reader? Bill reads his favorite chapters
from all 10 books on Bill's Best.