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Reinventing Your Practice

Finish strongI trusted a hunch during my talk yesterday in Minneapolis and made the assertion that “...during the last four months, some of you in this room have actually contemplated what you could do other than practice chiropractic.”

After my talk was over, one of the chiropractors came up to me and asked, “How did you know?”

“Know what?” I asked having covered dozens of subjects during my talk.

“How did you know that some of us have considered alternatives to practicing chiropractic?”

“Just my intuition based on the vibe in the room. There seemed to be quite a few chiropractors who weren’t having fun. And if you’re not especially passionate about chiropractic, when circumstances get difficult it often prompts a look around for an easier way to make a living.”

“Well, that’s where I am,” he confessed. “Only trouble is, I’m stuck. There isn’t anything else I can do that would generate the income I used to make in chiropractic. And the problem is, even chiropractic isn’t producing the income I need to make, so I’m having to dip into savings.”

There. He had just said out loud what I suspected many chiropractors have been privately thinking.

I wasn’t sure how he was going to take my next observation, but I made it anyway.

“You can’t have your old practice back,” I said quietly.

“What do you mean,” he said nervously shifting his weight.

“What I mean is, the practice you had 10 or 15 years ago isn’t possible anymore. It’s not coming back. Your mission now is to reinvent your practice so it’s relevant for today. You’ll want to adapt, adjust and reinvent yourself, rather than trying to recover the good old days.”

I could tell that wasn’t what he wanted to hear. As he left the room and I turned my attention to another doctor’s question, I couldn’t help but notice that his posture and gait reminded me of someone who felt defeated, rather than someone energized to take on the challenging opportunity of rethinking his practice and creating something new and different.

It got me thinking on the flight home. What advice would I give a chiropractor who has a decade or two (or three) experience in private practice and finds things on a downward slope at the very time he or she thought these would be the “money years,” making the final push towards funding their retirement?

The overarching thing to be mindful of is to banish the ever-so-tempting feelings of entitlement and resentment. As in “I’ve paid my dues, I shouldn’t have to work this hard.” There will be no coasting to the finish line. There are too many alert, hungry and resourceful graduates in your area to permit that. Surrender to the fact that like any small business you must continually earn the right to serve your constituency.

With that as a backdrop, if you find yourself in this predicament, here are some suggestions for transforming you and your practice to finish strong:

Return to Practicing Chiropractic. Most chiropractors these days, especially if they have enjoyed several decades of insurance reimbursement, practice a form of chiropractic medicine. Which means patients think you treat their symptom or condition and that your adjustments are “pain relievers” whose dosage of three times a week controls the speed of their recovery. Instead, make sure every patient fully understands that all you’re doing is reviving their ability to self-heal, which will happen at a pace largely controlled by them, not you.

Establish an Internet Presence. I still meet chiropractors who think this www thing is a passing fad. They force their staff to print out their emails. The calcification reflected by an unwillingness to learn something new is actually emblematic of your current situation. This reflects the same mindset you accuse patients of having who won’t abandon their medicine cabinet or give up unhealthy habits. Learn how to operate your computer. Get a website. Join the rest of us in the twenty-first century. You can do it.

Train and Retrain Your Team. In the olden days (a decade ago) when everyone still had (by today’s standards) generous insurance coverage, your front desk CA was more of an order taker and appointment scheduler. No more. These days, prospective new patients have researched their condition on the Internet, ask far more difficult questions and know that a potentially more accommodating and responsive chiropractor is just a mouse click away. You’re actually losing new patients at the front desk while you’re in the back helping people. You simply must do a better job of staff training.

Wean Yourself Off Insurance Dependency. You must make your practice more attractive to those who value their health enough to pay cash. Turning your practice over to the whims and profit motives of stingy insurance companies will not produce the income you need or deserve. The days of juicy personal injury cases are largely gone (and not coming back) and the high deductibles and co-pays make it foolish to even be involved with filing claims, much less taking assignment!

Reinstate Things That Work. Ask chiropractors with huge practices before so-called “insurance equality,” and they’ll tell you two strategies that worked then and work now. The first is regular in-office spinal care classes. The second is regular patient newsletters. I know. You don’t want to work that hard. Sorry. But you absolutely must get back to the basics.

Refurbish Your Physical Plant. Many practitioners who are seeing their practices erode, are also working in a practice that still sports avocado green shag carpet, garish fluorescent light fixtures and heavy dark paneling. An out of date environment tells patients that you’re out of date, not keeping up and frankly, not optimistic about the future, which becomes a self-fulfilling prophecy and downward spiral to mediocrity.

Don’t Plan on Retiring. Actually, you probably shouldn’t plan on retiring. Besides the difficulty of finding a young whippersnapper with loads of cash to buy your practice outright, you’re more likely to have to carry the paper yourself. That places your retirement on the shoulders of someone you hardly know who may or may not have the chops to keep your legacy going while throwing off enough cash to make payments to you. Meanwhile, you’re at home annoying your spouse. Face it. We’re not wired to sit in a rocking chair on the porch or play golf every day or whatever hallucination you think retirement is. The fact is, retirement kills far too many people. Don’t fall for it. Even if you have to change techniques, I implore you not to withdraw your wisdom and experience in favor of something far less significant.

One of the things I learned and still remember from the first chiropractic seminar I attended in 1981 when I was researching what became known as the Peter Graves video is that the ability of an organism to adapt to its environment is a sign of intelligence. Same thing here. Times have changed. And while it’s aggravating that things didn’t turn out like you planned, at least you’re equipped with the intelligence to do something about it!

Comments (4)

Don Handly:

Reading your post was a nice breath of fresh air. As I have been working on my assignments for the up coming Conversation I have come to the conclusions that you discussed above. Changing the old way of think is a bit of a shock and I think some grieving process will go on, however it feels good to hear someone confirm what I have been feeling. Thanks Bill

Mark Croucher, DC:

Great post from Bill and Rick Nolting but I think it should be noted that chiropractors do deal with fear much like dentists do. Some patients are initially scared that we'll hurt them or even kill them with a chiropractic adjustment. With that said the great things about being a chiropractor is the trade. We get to build long term relationships with patients and care for them and they in turn support our practice.

Rick Nolting:

Reading your blog was interesting. I was watching the Chiropractors speak to you after the seminar. I think I could pick out who gave you the "How did you know?" comment. Two years ago in January I was at a local dental dinner/meeting. There were 14 of us at the table and I was the second oldest of the group. The discussion centered on job satisfaction. 11 of the 14 dentists said that if they could go back and do it over again, they would not choose Dentistry. I was shocked. I did not sleep well that night. I know of dentists here and there who would like to do something else but that number was a real wake up call.
I think that I have the best career in the world. Where else can you grow a practice where you treat great people for years, who support you , whom you get to know, and who continue to return and actually pay you to do the most fun work in the world?

I believe that a Chiropractic practice can provide exactly the same situation, and you don't even have to deal with the fear that patients have of you!

Have a great week!

Rick Nolting

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From April 29, 2012 10:07 AM

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