Course Corrections

by William D. Esteb

Doctors who ate the rich foods of personal injury cases and the fattening desserts of low insurance deductibles are finding that their dietary habits have produced hyperlordotic lumbar curves from carrying extra weight around their waists. In retrospect, enjoying these tasty morsels is understandable. The buffet table was continually replenished and virtually every seminar and practice management program taught how to exploit the opportunity presented. After all, everyone was doing it.

But times have changed. Some hope that 1986 will return. Others have simply become even more resourceful in ferreting out the increasingly rare cases that have the financial rewards of the past. Still others are misguided into thinking that hospital privileges or acceptance in a sufficient number of managed care organizations is the key to survival. Fortunately, many can read the handwriting on the wall and are professing to repent, embracing the notion of a family-based cash practice. And not a minute too late!

I once worked with a doctor who, besides having a million dollars in tax-free municipal bonds, used a very dictatorial, authoritarian management style with his four associate-run clinics. Associate doctors and staff members lived in constant fear of losing their jobs. Information about the health and direction of the business was kept secret. Surprise visits, and new instructions barked over brief phone calls, interrupted the care of patients. As I saw staff emotionally disengaged and doctors contributing the barest minimum to keep their jobs, I decided my mission was to change the management style of this self-made millionaire.

I might as well have wanted to single-handedly clear up the national debt or bring permanent peace to the Middle East!

Like the alcoholic who must first hit bottom before being available for, and acting on, the suggestion of sobriety, same with this doctor. While his practices weren't what they could be, they were "successful" in the traditional sense, so why change?

That's not the problem with the many doctors who recognize the game has changed. They quickly admit that they should've, could've, would've (educated their patients, saved more of their money, etc.) and freely admit they "blew it." Now, they want to respond to the changes and have the cash-based wellness practice of their dreams. And they want it now!

Talk to the captains who pilot the big super oil tankers or the navigators who push heavy barges up the Mississippi River. These massive chunks of real estate are sluggish. Making course corrections requires taking action many miles in advance. The momentum of these crafts make it difficult to stop quickly or make quick turns to avoid hazards--not unlike the predicament a doctor faces when a change in their practice style is required.

The first strategy is to tap the trophy case of inactive work comp and personal injury patient files. Because these patients, while grateful for the symptomatic results you produced, don't understand chiropractic (and someone else paid for their care), your attempts at reactivation fall short of your hopes. Because these patients see wellness care as a needless luxury, they are not inclined to revisit your office until they slip and fall or get rear-ended again. The fact is, you had a promotion, not a practice; an acute care center, not a health care facility; you were treating a policy, not a patient.

The sad truth is, you're starting over.

Like the new graduate looking for the first new patients, countless doctors with established practices and ten years or more of excellent clinical results, are waking up to find their practices have vanished. Either by a sudden limitation on PIP coverage, insurance "reform" or the installation of gatekeepers in the work comp structure. The health of many practices changed overnight. It is only from this vantage point that the carrot dangled by managed care organizations must seem palatable. Clinging to the scraps of flotsam and jetsam from the 1990s with a clammy death grip, all too many doctors are going from the frying pan into the fire. Remember, managed care is about management, not about care!

While doctors who find themselves in this predicament resent the obvious solutions and would rather avoid expending the energy required to restart their practices, here are some ways to jump-start a plateaued practice:

1. Public speaking. This is probably the most sophisticated and effective way to restart a practice. Sure, the instant gratification of coupons and mailings is missing, but it's a great way to reveal your values, personality and experience. Right this very minute, the program directors for countless civic groups and organizations are pulling their hair, wondering who they can get next month to entertain the "troops" over a rubber chicken lunch. Solve their problem! Outreach programs, in which you get to share your unique view of health and human physiology, pay off by trusting the audience to do the right thing when they feel it is appropriate.

2. Influence the influencers. Make a list of the small businesses in your immediate area that see lots of people every day. At the top of your list make sure you include the beauticians, dry cleaners, travel agents and similar businesses that tend to influence the behavior of others. Target these businesses with a regular appearance to drop off your latest newsletter. Start frequenting them, even if that means spreading your dry cleaning around among three establishments! Give the cosmetologists, bank tellers and waitresses in your vicinity something to talk about: you!

3. Conduct patient focus groups. 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. Your job is to uncover ways the office can offer better service to the kinds of patients you'd especially enjoy serving.

4. Identify your ideal patient. Again, it sounds so unproductive at a time when you need spines warmer than room temperature in the practice, but if you don't, it's easy to wake up years from now, trapped in a practice with patients you don't like. Can you and your staff recognize the types of patients you want to rebuild your practice with? How do they think? Where do they live? What kind of car do they drive? Do they have children?

5. Work out. You probably need to get back down to fighting weight after enjoying all that high cholesterol diet from the insurance era. Plan to give yourself 20 to 30 minutes of vigorous physical exercise every day. Get ready to handle the demand for your unique and highly-effective approach to health care.

6. Read non-chiropractic books. Since you've got chiropractic figured out now, the remaining uncharted territory is how to think like the types of patients you want to attract to your practice. Read some books outside of chiropractic! My favorites are The E-Myth by Michael Gerber, How to Win Customers and Keep Them For Life by Michael LeBoeuf, Ph.D., Customers For Life by Carl Sewell, Marketing Without Advertising by Michael Phillips and Salli Rasberry, and Positively Outrageous Service by T. Scott Gross.

"But Bill, I need new patients now!" Remember how you tell patients that they've had the problem for awhile and it's going to take time to see improvement? Same thing here. In fact, remember the alcoholic who has to hit bottom before seeking help and making change? Same thing here.

Excerpted from
Chiropractic Patientology
Originally published in 1996
240 Pages
US $24.95

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