Building Versus Growing

by William D. Esteb

The ads in the professional newspapers simultaneously excite and depress me. At one end of the spectrum you'll find the wild abandon resembling the untamed western frontier. At the other end is the crass double-your-income ads that suggest that making money is the highest calling in chiropractic. And while I don't advocate a life of ashes and sack cloth, seeing the ads pandering to the lowest common denominator alarms me. What if patients saw these publications!

Of special interest to me has been the ads from practice management firms that offer practice building techniques at their seminars and pricey telephone consulting sessions. I've always been intrigued as to how these organizations could continue to exist, and what prompted practitioners to sign up for these expensive, dependency-creating arrangements. Lack of self-esteem? Isolation? Low confidence? As I've met more and more doctors who have admitted to, and enjoyed their practice management relationship, my attitudes have become more tolerant.

What I've learned is that most practice management firms have an honest interest in helping doctors attain the success and fulfillment they deserve. Yet, as a non-D.C., the ploys used to get doctors to "reenlist" and make doctors seemingly dependent upon the consultant seem self-serving. Instead of being a mentor and facilitator, all too many consultants become an expensive habit, fueled by self-doubt and an inferiority complex.

The key is to look for a consultant who is more interested in helping you "grow" your practice rather than someone interested in helping you "build" your practice. The distinction deserves some further explanation.

When contractors "build" a building they orchestrate a symphony of building materials, laborers, and time schedules to create something that wasn't there before. Contractors and subcontractors take dissimilar materials and create something new--usually the vision of an architect or planner. Lots of diesel fuel, electricity, talent and muscle power are needed to fashion these various raw materials into a usable structure. While the final result may not perfectly reflect the intended vision of the architect, it's important to note that whatever building emerges when the final cleaning crew leaves, it is the result of a new combination of materials that do not normally arrange themselves in this new way by the forces of nature. Not that we should scorn any structure other than caves and other natural shelter formations, but that the act of "building" invites, or most often requires, the flaws of an educated intelligence to design and assemble the parts. The result may be elegant or pedestrian.

Growth, on the other hand, as in growing a practice, is much more likely to offer more satisfying qualities. While buildings don't "grow," a practice can. One of the fundamentals of anything that can grow is that it is alive and in good health (100% function).

A practice does not grow when the doctor is not healthy. A practice does not grow (for long) if the staff is not healthy. A practice does not grow when the office is not healthy (procedures, relationships, communications, etc.). Plants, animals, and practices flourish when they are healthy.

Do you have a healthy practice? If it's not growing, better check its vital signs. When a practice is healthy there are ample supplies of new patients, staff members enjoy their careers, and there are frequent "pinching sessions" as you squeeze accessible areas of your body to make sure you're not dreaming!

Is your practice healthy? According to Dorland's Medical Dictionary, health is defined as "optimum physical, mental, and social well-being and not merely the absence of disease or infirmity." What does that mean when applied to a chiropractic office?

Physical

What does your office look like to an anxious, apprehensive new patient? Is it organized? Does it function properly? Can it adapt to a changing environment or is it stuck with policies and procedures that served you five years ago? Is it efficient? Are patients walking down hallways in examination gowns? Is the doctor putting in 15 miles walking between a half dozen adjusting rooms and wasting valuable time? Do patients have to climb steps? Do patients have to apologize to friends about the outdated office colors? Is the office in a good location? Can patients find adequate parking? Form follows function and without the proper form, your office cannot function (health) properly.

Mental

This is the key. Like health, that is an inside job, your mental condition controls your practice. Your practice will never outgrow your self-esteem or clinical self-confidence. When you explore the upper reaches of professional sports, even the most physical (weight lifting for example), you discover it is primarily a mental game. Ever watch the expressions on the faces of Olympic athletes moments before their competition? It's a brain game. Whoever can harness their brain best is most likely to win.

Still blaming insurance companies, patients, weather, geography, or your college chemistry instructor? You're wasting time. It's in your head. If there's cluttered closets in your brain, there's clutter closets in your practice. If you don't have high standards and an attention to detail in your own thinking, than you probably don't expect much of your staff or patients. It's you. You are your practice. And it all starts inside the most powerful organ of your body. Is the practice healthy? Just examine the mental condition of the doctor. The rest follows.

Social

In a chiropractic setting, social well-being addresses the relationships between staff, doctor, and patients. When working with chiropractic assistants in an in-office consulting situation it is quite revealing how they refer to their relationship with the doctor. Staff members who work "with" Dr. SoAndSo find the relationship more satisfying than staff members who work "for" the doctor. This subtle difference speaks volumes. "With" reflects a growth/mentor relationship that is participative and properly harnesses staff members' desires to invest themselves in their career. "For" connotes a building/servitude relationship in which being a chiropractic assistant is merely a time clock-watching job. Big difference. When talking with your staff do you refer to "my" practice or "our" practice? Careful, your leadership skills are showing!

The other critical social relationship that affects the health of the practice is the doctor/patient relationship. Here, the doctor's communication skills shape the health of the social (and clinical) relationship with patients. Doctors who neglect to over-communicate and over-explain suffer from poor compliance and a lack of referrals.

Besides explaining the nature and severity of their problem, one of the primary purposes of over-communication is to make sure patients know it's their problem, not yours. Because of your training and first hand clinical experience it's easy to forget that patients don't automatically appreciate the significance of their aberrant spinal biomechanics. Or more frustrating, that patients don't value their health as much as you do. Relentless communications and singleness of purpose are essential for defining the social contract you have with your patients. Something difficult to do if you're distracted by peddling water purifiers, pillows, vitamins, heel lifts, weight loss programs, and mattresses. These products can interfere, or at least change, the relationship you have with patients. Only when patients "own" their problem and appreciate its significance are they likely to make better decisions about their care in your office.

Fees, personality, grooming habits, scheduling, waiting time, and bedside manner are other factors that shape the social dimension of a healthy practice. Overlooking any of these complex social dynamics can result in a variety of practice pathologies. Bringing in an outsider to "build" your practice is not likely to help until interferences to the natural growth process are removed. If your practice has plateaued (not merely the absence of disease or infirmity) the natural growth process has been shunted. A vital, healthy practice grows until some barrier or limiting force is encountered. It is the role of an ethical consultant to help diagnose this limiting force and set free the natural growth process.

While growing your practice may take longer then building your practice, the results are more lasting. What if the dreamy promises practice "builders" came true? What would you do if 20 new patients were milling around your front door next Monday morning when you drove up? Chances are your current procedures would make more than half of them angry from waiting too long. The rushed (or nonexistent) report of findings would sabotage the relationship for still others who wouldn't understand the what, how, and why of chiropractic.

Building a bigger practice could be toxic. Growing a practice allows for assimilation, evolution, and adaptation. Building is short term. Growing is long term. Building is mechanistic. Growing is vitalistic--like chiropractic.

Buy the book
My Report of Findings
Originally published in 1993
240 Pages
US $24.95

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