Bootstrapping the Struggling Practice

by William D. Esteb

Optimism fuels every new business or practice. With high hopes, planning and a little bit of luck, the new venture is launched. Keenly aware of the high failure statistics of new businesses in their first year (80%), with half of those remaining going “belly up” in the following two years, the dream of controlling one’s own future propels the entrepreneur forward.

But dwindling cash reserves prompt concern. Instead of visions of giddy success, the new business owner sees the end. Unless the overly optimistic projections become a reality, and in a hurry, the business’s days are numbered.

While at the beginning you could confidently see months into the future, the months have been reduced to weeks, maybe days. There is an increasing urgency to generate patients and cash. First in passing, and then more seriously, alternative sources of income are explored. Optimism is replaced with anger. Fear. Sleepless nights.

The dream has become a nightmare.

In addition to the shame and guilt that failure and borderline failure often produce, many practitioners, even in their fifth, 10th and 20th year of practice, still haven’t escaped. Chronically undercapitalized and lacking cushioning reserves, they practice from week to week, living, if you want to call it that, from hand to mouth.

These practices have an egocentric focus (my practice, my “girls” at the front desk, my patients, my income, my needs) and an unattractive scarcity that dampens referrals and sabotages patient retention. Distracting worries about cash flow and phone calls from collection agencies cripple the struggling doctor’s healing consciousness. The future becomes harder to imagine. The goal is mere survival. It’s the only goal the doctor seems able to manifest.

The number of practices suffering this tragic and unattractive form of chiropractic is alarming and unfortunately, increasing. If you find the future closing in like the walls of the giant trash compactor in Star Wars, it’s time to end the charade and become a more attractive and successful example of chiropractic.

1. Decide. It’s a simple idea, but many chiropractors haven’t yet decided who they are, who they want to be, what they do and what they want to do. They are essentially “beige.” Their circumstances have blinded them to the importance of having a point of view. Their chameleon-like existence (I’ll be anything and do anything if you’ll just show up and like me) is unattractive and off-putting. It attracts the least discerning and most irresponsible patients.

“Decide” comes from the Latin word meaning “to cut off from.” By opting not to totally commit to chiropractic; by depending on a spouse for too long to supplant the household income; by holding a second job; by hedging your bets, you have the luxury of dabbling in practice. Decide right now to give 100% commitment to the practice. In effect, burn your boats. Eliminate the escape hatch. Cut all other alternatives and choices. Failure is not an option. Decide!

2. Stay healthier than your patients. So you’re already giving your practice 110% and are truly committed to making it work. Great. Are you healthier than your patients?

Most chiropractors, consumed with health, think that their regular adjustments, Spartan diet and daily workouts are enough to be an attractive example to their patients. And they are, on a physical plane. But health is more than proper physical functioning!

Even Dorland’s Medical Dictionary defines health as “optimum physical, mental and social well-being, not merely the absence of disease or infirmity.” Focus on the physical—spinal biomechanics and proper weight—but don’t stop there. Make sure you maintain a positive attitude, remain optimistic, avoid the negativity of television, read inspiring books, listen to motivational tapes and face your fears (mental). And of course you’re working to improve your listening skills, public speaking proficiency and other communication skills, and encountering as many strangers as possible so you can share the chiropractic story (social).

Avoid the “healthier than thou” approach and simply become a walking, talking example of good health. If you already have a physical fitness program, raise the bar. Increase your ability to tolerate and withstand stress by physically stressing your body. In the process you increase your capacity and strengthen your resolve. But just as important is to enhance your mental and social well-being!

3. Admit you are wrong. It’s isn’t any surprise that those who are struggling believe they are right. That their vision, their procedures, their technique, their way of practice is the “correct” way. Being right seems so important. The more right answers on your test and you got a higher “better” grade. Being right is sooo important.

This is pride in its most unattractive state. Yes, “pride goes before destruction, a haughty spirit before a fall.” Resisting what is, ignoring reality and misreading circumstances are common symptoms among those at the helm of a struggling business. They so desperately want to take credit for what they are doing, that they are unwilling to accept the wisdom of others or to be corrected by the instruction of experienced experts. The most prideful must be humbled before they will admit to being incorrect. Instead, the successful are open. They ask questions, and more importantly, they listen and act on the answers. To them, being right isn’t as important as being an effective servant. Which means…

4. Ask for help. What is so ironic about the predicament that many struggling chiropractors face is that virtually every successful chiropractor I’ve met has shown tremendous interest in helping others. They don’t hoard their success and keep their approaches secret! They share freely. Because they don’t live in a zero sum world (my success depends on someone else’s failure) and see abundance, not scarcity (there are plenty of new patients to go around), they are happy to offer their help and guidance—if you’ll ask.

Those who are struggling find it difficult to ask for help. The tragic result is they often feel isolated and abandoned. But what’s worse, they remove the opportunity of the helper to enjoy the blessings of helping someone else. Asking for help is an essential. Interestingly, this isn’t really about asking, it’s about receiving! If you feel unworthy to receive the blessing of advice and guidance, or are afraid you’ll be beholden to those who offer their assistance, shake it off! These emotional “subluxations” are your doing. You can blame the economy, your location, your landlord, your parking, your town, your college, the HMOs or the “stupid” public, but the offices that are thriving don’t.

When you turn on your computer, a bootstrapping process takes place. Encoded into the hardware are specific instructions to “boot up” the computer. These instructions tell the computer how to spin up your hard drive, what memory address to access to find the operating system and the essential programs to load to enable your computer to be useful.

As CCE requirements increasingly force chiropractic colleges to focus on irrelevant board examinations at the expense of teaching students how to exchange their valuable healing skills in a successful business, more students are destined to struggle, fail and abandon their dreams. Not only is it needlessly painful for new graduates, it will become a crisis for the profession in the years ahead. Worse, a hurting public is denied chiropractic care.

Failure is not an option.

Excerpted from
What a Patient Wants
Originally published in 2002
240 Pages
US $24.95

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