An Associateship That Works

associateshipthatworksThe tandem associateship: 2 doctors successfully treating the same patients.

In the previous article of this, “How to Start a Practice” series, I discussed the “Associateships from Hell.”  Unfortunately, most starting doctors get trapped in bad associate arrangements like these. However, this article describes an associateship structure that’s very successful, an associateship in which both the established doctor and the associate doctor benefit.  It’s called a “tandem associateship,” an arrangement where two doctors treat the same patients.

In a “tandem associateship,” the established doctor’s practice is so full that he finds himself skipping procedures, turning away new patients, prematurely stretching out the care of existing patients, etc., because he quite simply has more patients than any one doctor can handle. To alleviate this problem, he hires an extra set of hands (an associate) to take care of all the patients he can’t get to. By doing so, the established doctor can grow his practice larger. This type of associateship works well for both doctors.

“Tandem associateship” criteria

In this type of relationship, the established doctor, being very successful, is willing to teach the associate doctor everything he knows. The associate doctor, in a “tandem” relationship, must be an extremely willing student and learn everything the established doctor has to teach. The associate doctor must swallow his ego in order to welcome and accept constructive criticism. How else is he going to learn? The associate doctor must totally agree with this concept, otherwise the tandem associateship will not work.

The “tandem associateship” is a teacher-student relationship. All good teachers want their students to learn everything they have to teach. All good students want to learn everything the teacher has to teach. When this symbiosis occurs, the associate relationship will become successful.

The associate doctor must understand that he’ll have to work hard, go the extra mile and work more hours than the established doctor; however, the associate will still be working fewer hours than if he owned his own practice.

Financial arrangements for a tandem associate practice

In a “Tandem” associateship, the associate usually receives a guaranteed weekly or monthly compensation amount, which is a draw against commission. The commission is usually a percentage of the services or collections the associate doctor renders.

The associate doctor should expect to make 25% of collections on his services. An associate who feels he should make 50% or more is totally unrealistic. The average chiropractic practice has a 50% to 60% overhead, which leaves an average net profit of 40%. The established doctor must earn compensation for the time he dedicates to training his associate and for the patients he turns over to his associate. The established doctor can only share the net of his practice, and it’s fair that he make 15% for his efforts, while the associate makes 25%.

Non-competition agreements

There is always a genuine and legitimate concern on the part of the established doctor that, after he provides an associate with valuable training, experience and patients, the associate will leave him and open a practice next door. If this happens, it will rob the established doctor of patients and income, while at the same time his overhead will not decrease, thereby forcing the established doctor into an unfavorable financial situation. To keep this from happening, the established doctor will require a non-competition agreement from his associate.

Believe it or not…non-competition agreements are in the best interest of both the established and the associate doctor. This type of agreement will help eliminate any hesitation the established doctor may have in turning over a large volume of his patients to the associate doctor. After all, the entire purpose of the “tandem” associate arrangement is for the established doctor to increase and improve his practice by using his associate’s skills while, at the same time, the associate wants to be filled with patients, learn correct and successful practice habits, including how to run a large practice, and earn a respectable living in the process. The only way all of this can happen is if the associate doctor signs a non-competition agreement.

More information on becoming an associate is available online at www.practicestarters.com.

When you’re through being an associate and are ready to start your own practice, hire a consultant who specializes in starting practices to guide you.  Don’t think that you now have the experience necessary to start and build a new practice…. You don’t!  Yes, you’ve gained the experience of caring for patients and learned some good office procedures, but that’s not enough knowledge to start a successful new practice.  You still have to learn how to find a great office location, effective bank negotiating strategies, cost-cutting remodeling negotiations, how to market a new practice, etc.  It’s the lack of this specialized knowledge that dooms new practices, not the lack of knowledge regarding patient care.

 

Dr. Peter G. Fernandez is the world’s authority on starting a practice.  He has 30 years’ experience in starting new practices, has written four books and numerous articles on the subject, and has consulted in the opening of over 3,000 new practices.  Please contact Dr. Fernandez at 10733 57th Avenue North, Seminole, Florida, 33772; 1-800-882-4476; [email protected] or visit www.drfernandez.com

Practice Equity

 

smilingmedicalstaff:dropcap_open:M:dropcap_close:ark Cuban, owner of the Dallas Mavericks, once said about his basketball franchise, “Everyone has thousands of entertainment choices and we don’t want to create any excuses for them to go and spend their money somewhere else.” This is the way every chiropractor must think in a 21st century, service oriented, practice.

 

Consumers have more choices for which they can choose to spend their money, today, than ever before in our society. These opportunities range any where from flat screen televisions, to new cars, to plastic surgery.  The chiropractor down the street is no longer your biggest competitor.  Every retail store and service provider is now competing with you for the discretionary income of your patients. You need to make it a priority to have the best customer service, the best staff, and the best results, to make sure there is no excuse for anyone to walk out your door and never return.

Of course, the attrition of some patients due to death or relocation is to be expected, but losing patients because of less than stellar service is unacceptable. Your patients have money they are going to spend somewhere and, if they’re your patients, that means, at some point in time, they were willing to spend it with you. Don’t give them an easy reason to change their mind and go somewhere else.

Most chiropractors realize that, if they are to be profitable, retention rates must be kept at a high level. In order to do that, doctors must have loyal patients. What many chiropractors fail to realize is that those patients need to be highly regarded as an integral part of the practice. Returning patients don’t just add value to your practice; those patients are the most valuable asset you have!

We see many chiropractors that are more worried about where the next patient will come from and when the next dollar is going to come through the door; all the while, ignoring the dollars that have already walked in and out of their door several times.

As chiropractors reflect on the worth of their practice, most likely they think of items that are listed on a balance sheet, or a profit and loss statement. However, the most valuable pieces to any practice aren’t “pieces” at all, they are patients.  Every other piece of equipment in your office can be replaced but, if you lose the patients, none of it really matters.

Think of this as patient equity. The amount of investment in time and quality work you put into that patient is considered an investment in your patient equity. Like a house, having more equity in your patient base leads to a more successful practice. Also, like a house, your patient base can truly be considered an asset.  When you look at returning patients as an asset that add equity to your practice, it is easier to understand why they should be valued and every effort should be made to keep them coming back.  Following are a few ways to do that:

Ensure that you are maintaining the patient/doctor relationship. Protect yourself from losing your patients to the many other products and services vying for their money.

Another way to protect that equity is being mindful of quality in customer service (both on the phone and in person) and in the service you provide them with─chiropractic care. If you think there is a problem with an established patient, it may be forgivable, but with a new patient, it may lead to a rocky future or no future at all.

Also, find ways to keep your current patients involved and lock in patient loyalty when they aren’t physically in the practice. Social media is one such method that excels in this area. The more you can entwine your practice into their life, the harder it will be for them to go anywhere else. 

Never underestimate the value your patient base adds to your practice. It is one of the most important assets you have. Understanding this concept will enable you to continue to invest in your patient equity which, in turn, will make your practice more successful.

 

Dr. Todd Osborne, a 1989 graduate of Palmer College, ran a successful high volume multiple doctor practice, and is currently Vice President of AMC, Inc., as well as an author and lecturer. Visit www.amcfamily.com or call (877) AMC-7117 for more information.

“The Associateships from Hell”

The 5 types of associateships to avoid…and why.

Becoming an associate doctor is not a demeaning career move.  Trying to open a new practice when you or your finances are not ready…is.  Being an associate should be an honorable, rewarding and learning experience. You will hit net profit your first week in practice (your paycheck), you will work fewer hours, and you will have much less responsibility and stress than if you had your own practice.  For example, an associate’s main functions are to diagnose, adjust and occasionally do some paperwork. These tasks are the easiest part of any doctor’s workday.  Being an associate is easier and it’s profitable.associateshipfromhell2

I’m sure you have heard stories about “Associateships from Hell,” associates who were taken advantage of, paid “slave wages,” etc.  While these types of associateships occur, they can be avoided. This article will explain what you should look for in an associateship, what you should accept and what you should reject.  I was an associate for three years and had a great boss and mentor. I owe the majority of my success to him. Just as I was able to find an “Associateship from Heaven,” the next article in this series will show you how to find yours.

Should you become an associate?

An associateship is appropriate:

»  If you are insecure and unsure of your skills in finding and reducing subluxations.

»  If you’ve declared bankruptcy, have a terrible credit rating and no alternate way of getting the money needed to start a practice.  Continue in an associate position until you have corrected your credit problems and saved enough money to start your practice.

»  If you’re looking for specialized knowledge, i.e., if you want to learn the flexion distraction technique and have the opportunity to practice with Dr. James Cox, the originator of the technique, you’d be wise to do so. You’ll learn ten times more about the technique by working for him than you ever would by attending seminars.

If your motive to become an associate is not supported by any of these three criteria, you are better advised to hire an experienced a consultant to teach you how to successfully start and run your own practice.

There Are 5 types of associateships

The word “associate” is defined many different ways by chiropractic professionals.  It can mean employment, sharing another doctor’s overhead, or starting your own practice in someone else’s facility.  The following scenarios are brief descriptions of some of the various types of “associateships. 

Salaried Employee

This type of associateship occurs when an established doctor pays a junior doctor $1,500-$2,000 a month to do as he is told.  The junior doctor is not given any opportunity or incentive to increase his salary.  The junior doctor is basically a “gofer” or a “flunky”.  Of course, this type of relationship fails quickly.  If you are offered an associateship like this, pass on it.

:dropcap_open:Starting a practice in someone else’s office is a pseudo-partnership, and pseudo-partnerships do not work.:quoteleft_close:

Time-sharing

Sometimes, an established doctor practices Monday, Wednesday and Friday and wants a junior doctor to practice Tuesday, Thursday and Saturday. Or, the established doctor practices in the mornings and wants a junior doctor to practice in the afternoons.  Most time-sharing relationships blow up due to the following reasons:

»  The doctors are in competition with each other.  When you are in competition with your partner (this is a pseudo-partnership) the partnership won’t last.

»  Time restraints restrict practice growth.  When the junior doctor’s practice fills up, he will attempt to encroach on his pseudo-partner’s time or, if the established doctor’s practice grows and he needs the extra practice time, he’ll encroach on the junior doctor’s time.  Either way, the junior doctor will be thrown out.

»  There’s no managerial strength in a time-sharing practice. Managerial strength is what builds large practices.  In a time-sharing scenario, you’ve got two doctors with a 50-50 vote, no tie-breakers. It can’t work.

Income-splitting

In this practice, two doctors practice together—place all their money in one pool—and share income and overhead 50-50.  Unfortunately, there are no two doctors with the very same goals and levels of ambition regarding overhead, hours to be worked, marketing, number of patients to be seen, etc.   Inevitably, one doctor will be more ambitious and work harder than the other doctor, but the income will still be split 50-50.  The partner that does most of the work will eventually call an end to this cash-splitting relationship.

Expense-sharing

This arrangement occurs when an established doctor brings in a second DC to help him pay his overhead expenses.  Think about it.  If the established doctor’s location and practice is not good enough to support one DC, how is it going to support two?

This type of practice is also doomed by the competition it creates between the two doctors.  Competition between two partners destroys a practice…and a friendship.  In addition, there’s no managerial strength in an expense sharing relationship.  And, without managerial strength, a practice flounders and soon dies.

There is an exception to this rule:  This type of relationship can work when family members practice together.  However, even a family practice will fail if the senior doctor is so set in his ways that he refuses to consider any changes suggested by the junior doctors, i.e., modernizing equipment or instituting new and improved office procedures.  The senior doctor who does not acknowledge and respect his children’s learned and professional abilities soon kills the family-run practice.forrent

Renting space

Beware of this type of arrangement. When an established doctor rents space to another doctor, it’s usually because he has a very small practice that leaves him with unused space that he rents out to help him cover his expenses.

If the practice location is not good enough to fill up one doctor, why would you think it would fill up two? It won’t.

This arrangement is similar to the “time-sharing” associateships described in a previous article, except that both doctors can schedule patients seven days a week. This type of relationship usually fails because the office’s location can only support one DC, there is competition between the two doctors, and there is no managerial strength.

If you decide to rent space in an established DC’s office, make sure that you do not sign a non-competition agreement. Eventually these relationships break up and you want to be able to move your practice with no restraints. Also, immediately start saving money. When this pseudo-partnership breaks up (as it most certainly will), you’ll need money to build-out an office space, etc.

(This is similar to the “Independent Contractor” style of practice, which I will discuss in a future article.) 

Caution: All of the previously described methods of practice, while being called associateships, are not true associateships.  Starting a practice in someone else’s office is a pseudo-partnership, and pseudo-partnerships do not work.  If you choose to enter into practice utilizing a relationship of this type, immediately start saving your money.  You will either be evicted or will walk out and need money to remodel another facility.

If you choose any of these unfavorable types of practice relationships, you need to make sure you are not restricted by a non-competition agreement.  If you are evicted (chances are you will be), you’ll need to quickly relocate nearby.  If you have to relocate outside of a non-competition radius, your patients will transfer to the established doctor.  In addition, in choosing one of these relationships it is important that you make sure you can put up your own outdoor sign.  If any of these criteria are not met, don’t practice there.

“Associateships from Hell” not only don’t work, but will trap and hurt you.  In the next issue I will tell you how and where to find a successful associate relationship.

More information on becoming an associate is available online at www.practicestarters.com.

 

Dr. Peter G. Fernandez is the world’s authority on starting a practice.  He has 30 years’ experience in starting new practices, has written four books and numerous articles on the subject, and has consulted in the opening of over 3,000 new practices.  Please contact Dr. Fernandez at 10733 57th Avenue North, Seminole, Florida, 33772; 1-800-882-4476; [email protected] or visit www.drfernandez.com

To Be or Not to Be…An Associate Doctor

decidingThese 8 questions will help you decide if you should become an associate or start your own practice.

    1. Are you inexperienced, but don’t want outside help?

    2. Is your ego too big to pay for – and listen to expert advice?

    3. Can you raise the money?

    4. Are you willing to work 70 hours a week?

    5. Are you too scared to open a practice?

    6. Do you lack self-motivation?

    7. Are you a passive person?

    8. Is your spouse going to be supportive?

Every DC has a vision of starting their own practice, becoming extremely successful and enjoying the riches of life.  Reads like a fairy tale, doesn’t it?  Realistically, this scenario is a fantasy to the many DC’s who aren’t destined to start and operate their own practice.  How do you know if you have what it takes to start a new practice—or if you’d be happier as an associate? Your personal answers to the following questions will tell you.

1. Are you inexperienced in starting a practice, but don’t want outside help?

Do you know how to find, hire and train the best person for a chiropractic assistant (CA) position?  The American Management Association tells us that it costs over $12,000 to hire and train a good CA.  Frequently having to replace CA’s can sink a new practice.  Unfortunately, the average new DC goes through three CA’s his first year in practice.

Most DCs who fail in practice have violated some major practice-starting principles such as starting their practices with inadequate financing, not effectively or adequately promoting, or not finding and properly training the right staff.  These doctors will offer a thousand and one excuses for their failures. The truth is most of them did not know how to efficiently and successfully start a new practice and were not willing to get the practice-starting education they needed.

2. Is your ego too big to pay for and listen to expert advice?

A major reason why DC’s fail when starting a new practice is ego.  Yes, ego!  You’ll hear them say, “I’ll show them how,” or “They haven’t seen anything yet.”   This is the attitude displayed by the egocentric DC as he dashes headlong into failure.

I’ve never understood how a DC with no experience in starting a practice, no knowledge of what works and what doesn’t work, no knowledge of the intricacies of insurance, marketing, patient processing, overhead control, etc., has the audacity to think that he can successfully perform these tasks without the advice of an experienced consultant.  Audacity … no, delusional would be a better description.

Would a prospector find gold wherever he chose to look?  Most didn’t.  Now, let’s assume there is a consultant who knows where gold is buried and has drawn a map of how to find it.  Wouldn’t it be wise for the prospector to pay for that consultant’s map (advice)?  Wouldn’t you hire a consultant who can show you the most direct route to a financially successful practice?  Sure you would, unless you are one of those who allow themselves to be deluded by an over-inflated ego.

Wayne State University, the University that specializes in starting new businesses, reports that, “There is only a 4% chance of failing, if the start-up person seeks out and gets the correct answers (“a map of how to get what they want”).

3. Can you raise enough money to adequately start and finance a new practice?

The number one reason for new practice failure is the doctor didn’t have enough money (or enough borrowing power) to last until his practice hit net profit. If you don’t have the money to start and succeed in your new practice, do you have the ability to motivate people (bankers, loan companies, parents, in-laws, etc.) to lend you the money?  Do you have this ability?  If you don’t, perhaps an associateship is going to be the better choice for you.

If you have a terrible credit rating or a bankruptcy in your background, an associate position is recommended until you can clean up your credit history and save enough money to finance a new practice.

:dropcap_open:How do you know if you have what it takes to start a new practice—or if you’d be happier as an associate?:quoteleft_close:

4.  Are you willing to work 60 – 70 hours a week?

Are you lazy?  Heck no!  Who is going to admit to being lazy? However, you must be willing to work 60 to 70 hours a week for five years to establish your practice.  No, I’m not kidding about working 60 to 70 hours a week.

The Journal of the American Chiropractic Association (JACA) reported that the average established practitioner works 46 hours a week; the Wall Street Journal reported an average of 50 hours per week.  A doctor starting a new practice must be willing to work 20 or more hours per week more than the established practitioner.  This additional time is needed for the new doctor to participate in activities that will attract the number of new patients needed to build a successful practice.  If you are not able or willing to work these hours, become an associate – you’ll work fewer hours.

5. Are you too scared to open a new practice?

It’s normal to be scared when attempting to do something you’ve never done before. Considering today’s statistics from the Small Business Administration (SBA) that only 20% of new businesses will still be there in five years, it’s natural for you to be scared. However, being “too scared” means you do not have the self-confidence you’ll need to overcome the usual apprehensions and challenges of starting a new practice.

6. Do you lack self-motivation?

Do you wake up in the morning slowly and proceed at that same pace for the rest of the day?  Are you a chronic procrastinator?  If so, starting and owning a practice is not for you.

7. Are you a passive person?

All successful new DC’s are highly competitive, goal-driven individuals. They are determined fighters. They know most HMOS and managed care plans will not welcome them and they are willing to fight for the remaining non-HMO/managed care patients.  If you are passive in nature, become an associate—let your employer do the fighting for you.

8. Will your spouse be supportive?

Does he or she understand the stress you will be under while arranging construction loans, building-out your office, negotiating equipment leases, talking to bankers, etc.?  Is he or she going to be supportive of you when you practice 40 hours a week in your office, plus spend another 20 hours as a member of the Jaycees, the Chamber of Commerce, the Lions, The Rotary, etc.? If not, you should become an associate, not the owner of a practice.

How to Evaluate Your Answers

The reason I wrote this article was not to deflate your hopes and dreams of having your own practice, but to motivate you to seriously evaluate whether or not you are ready to be an entrepreneur (start a new practice).  If you answered yes to any of the questions posed in this article … don’t go against the odds, become an associate.  In time, you may develop the self-confidence and financial resources it takes to make it in your own practice or you may find yourself content and fulfilled as a career associate.

There are two other compelling reasons why you may choose to be an associate.  If you feel unsure about finding and reducing subluxations, or if you want to gain some specialized knowledge, becoming an associate is appropriate.  However, only associate with a highly successful doctor who will teach and mentor you.  How to find this type of doctor and how to avoid being trapped in “An Associateship From Hell” are topics of the next two articles in this series.

More information on becoming an associate is available online at www.practicestarters.com.

 

Dr. Peter G. Fernandez is the world’s authority on starting a practice.  He has 30 years’ experience in starting new practices, has written four books and numerous articles on the subject, and has consulted in the opening of over 3,000 new practices.  Contact Dr. Fernandez at 10733 57th Avenue North, Seminole, Florida, 33772; 1-800-882-4476; [email protected] or visit www.drfernandez.com.

Tips for Finding the Right Business Management Company

busmanagementco:dropcap_open:W:dropcap_close:hile most chiropractic colleges do an outstanding job of preparing students in the art, philosophy, and science of chiropractic, unfortunately they fall short in preparing their graduates on the business side of running a chiropractic practice. As a result, many chiropractors turn to management companies to help them run their practices. You may be considering hiring one in the future, so we wanted to pass along some tips to aid you in your search for the right company for you. There are many management companies out there and it’s important that you know what to look for to ensure it will be a good experience for you and your staff.

You should hire a company which will change the focus of how your practice communicates your most important job—changing your patients’ lives through the healing art of chiropractic. This is very difficult to accomplish unless your learn how to effectively communicate with your patients about how their bodies are functioning, what is causing their pain, and what chiropractic can do to restore their ailing bodies to health.

If the focus isn’t about the quality of your life, more money won’t change what ails the practice. It’s important to choose a company that cares about YOU and not just increasing the bottom line of your practice. If they really get to know the doctors whom they are helping, they will understand that “change” doesn’t come easily and it takes awhile to change from the inside out before excellence is processed as the norm.

Research each company you are considering very carefully, but don’t allow a small amount of negative feedback to unduly influence you. Many chiropractors talk about wanting change, but a much smaller number are actually willing to embrace it. There are many companies in the chiropractic management business and, if you dig deep enough, you can find someone who has something negative to say about each one of them. Have you ever looked on the Internet at the many “message boards” out there devoted to chiropractic?  There are many hurting doctors who are posting on those sites. Differentiate between those who may be bitter because success was going to “cost” them more than they were willing to pay (and we’re not talking about money here) and those who really did receive sub-par service. (And, keep in mind, busy doctors who run successful practices don’t have time to post on message boards on the Internet….)

Another way to research a company is to schedule a telephone conference with a representative of each company you are considering. There should never be a charge for this type of consultation. You should expect to speak with someone who is knowledgeable about the company, but also takes time to listen to you and the circumstances of your practice. If they don’t have time for you in that initial conversation, they’re not going to have time for you when you become a client. However, if you feel you’ve connected with the “heart” of the company and sense their genuine love for chiropractic and concern for those who practice in this fine profession, then you should further consider adding them to your team. This initial conversation can help you decide if this is a company that helps you achieve goals you have for your practice and are not just focused on cookie-cutter results.

:dropcap_open:You should hire a company which will change the focus of how your practice communicates your most important job:quoteleft_close:

Another way to determine if this is the company for you is by asking for at least three or four references that are current clients. Every consulting company will tell you that their best compliment is a referral, and satisfied clients are more than happy to tell you about their success with a particular company. Taking the time to speak with these doctors will help you determine if the company is a good fit for your practice. It also is an opportunity to hear a client’s perspective about working with the company. They can familiarize you with the company philosophy and make sure they’re compatible with you and your team.

Look for a company that teaches you how to track. Crunching numbers helps you know where you’re doing well and where you’re doing poorly, and how to make adjustments accordingly. Certain consulting companies teach you and your team how to appropriately monitor the practice week to week. Tracking gives you more answers and allows you to tackle the problem before it escalates. Remember—knowing the “why” is part of finding the solution.

Look for a company which has been around awhile. Older usually does mean wiser in this business. If they have been helping chiropractors 20 years or longer, there is a high probability they have worked with a practice similar to yours and have taken them to where you’d like to go. If they did it for them, they can do it for you, too.

Shopping for a management company to assist you in running your chiropractic office can be an overwhelming decision. Partnering with a consultant is a major investment and should not be made without careful deliberation. Finding and hiring the right company can and will change the quality of your life. We hope these tips will assist you and help lead you to the company that is right for you.

 

Tom Owen III, President of AMC, lectures extensively from coast-to-coast to thousands of chiropractors and students annually. He is the author of Chiropractic from a Business Man’s Perspective, and has spent the last 25 years in the day-to-day trenches of the chiropractic profession. He lives by his quote that “In the end, all that is left are the lives we’ve touched and to what extent they were changed.”

Dr. Todd Osborne, a 1989 graduate of Palmer College, ran a successful high volume multiple doctor practice, and is currently Vice President of AMC, Inc., as well as an author and lecturer. Visit www.amcfamily.com or call (877) AMC-7117 for more information.

I Am Not a Salesman!

:dropcap_open:D:dropcap_close:octors of chiropractic generally are attracted to the profession from a desire to heal others. The majority of DCs we come into contact with say they were attracted to chiropractic because they saw it as a way to “make a difference” in the world and truly “heal” people. There are all different kinds of DCs – with varying philosophies – but the majority see themselves as healers.

That is why some DCs have a problem with selling products in their practice. We often hear, “But I am a healer, not  a salesman.” “Salesman” are the guys down at the corner at the car lot. They “sell” people. DCs are there to heal and make us feel better, in less pain. Many do not feel it is their job to “hawk” products. It makes them feel cheap and uncomfortable.

How many of us are not “in sales?”salesmanmay

Many of us do not have the title of a salesman, but does that really mean we are not in sales, at all? Fact is, almost every one of us is in sales in same shape or form.  No? How about these jobs?

CEO. Not in sales? Don’t bet on it. CEO’s have to instill confidence in their teammates that they have a good plan. No one can dive into their work if they don’t believe in the master plan. A CEO has to see him or herself and know that they know what they are doing. They must SELL themselves and their game plan.

Manager. Same as above. If the employees under the manager don’t believe their boss knows what he is doing, then they will be uninspired and the opposite of – what all employees want – which is in the mindset of “taking initiative.”

Artist. This may seem like a stretch, but, at the end of the day, they must influence people to feel their work is worth paying for. (Unfortunately, people often come around to valuing their work after the artist has passed away. Not much “selling” from them at that point, other than the work they already did.) But if you have attended viewings at art galas you will often notice the artists themselves, out in front of their work, and, yes – in their own way – selling the value for their paintings or what not.

MD. Whether it be a case of a general MD or a surgeon, these docs do indeed sell. If the patients doesn’t feel confident a surgeon knows what they are doing, will they go on with the surgery? How about the general MD; what are they selling? How about drugs? They confidently write out the “sale” on a prescription pad, but they are selling, none the less.

Mom. Yes, I wrote “mom.” Does she not have to sell her agenda to the kids and the dad? She may not always get her way 100% of the time (depending on the relationship), but she has an opinion on how the household should be run, how the kids should be raised, schooled, what sports they should be allowed to do, etc. Is it time for a new car, a vacation, house project or stashing away some money for the kids college tuition? Mom will sell which direction she feels the family should go (and dad too, sometimes.)

Your patients come to you for your expertise!

This is what you do. Your patients rely on your professional opinion for their health, including directing them to the best products, whether it be the right pillow or nutritional supplements. They could go to Wal-Mart and buy the cheapest memory foam pillow they have, or they could listen to your expert advice on the best pillow for their condition, size, etc. Who exactly benefits from you not suggesting the best options for your patients? Them? No. You? No. No only are you keeping yourself from some extra revenue buy keeping mum, but you are also depriving your patients the best possible wellness level and losing an opportunity for that people to create more business by, A.) Reminding your patient, on a daily basis, where they got that pillow that changed their life, and, B.) The opportunity for your patient to tell their friends about their love for their new pillow, which obvious leads to them also telling them where they got it. And, whammo, just like that, you might have some new patients walking through your door.

:dropcap_open:Many of us do not have the title of a salesman, but does that really mean we are not in sales, at all?:quoteleft_close:

I’m still not a salesman

OK, you’ve read the above and still feel like you can’t muster up mentioning various products for your patients to buy, even though you know they would improve your patients’ conditions and lives? That’s all right. You don’t have to become Zig Ziglar or Ron Popeil overnight. There are some procedures that assist those who may be a bit shy about suggesting products for purchase.

1.)Hand out literature at patient sign in. This will cause the patient to ask you or the CA about the product.

2.)Have signage and kiosk information visible. This will also create an environment where they ask you about the products.

3.)Create a environment where the staff can offer first- or second-hand stories about the product helped them or family members. Nothing is more effective than the CA telling a patient about how their support pillow made their mom’s beck pain go away and delivered her restless nights of sleep, etc.

4.)Use your own version of prescription pad. Matter-of-factly write down what you suggest a patient should purchase for their particular condition. If MDs can confidently write our prescription for drugs, with no hesitation, why can’t a DC write out their suggestion for non-allopathic products, that don’t possess any risky side effects?

Summary

Bottom line, DCs should feel no aversion towards suggesting products to help patients. Not only is it “OK” to do so, but some would say it is your duty to do so – to offer all the advise you can to make your patients as healthy as possible. Just being armed with that mindset is half the battle. But if you still feel uncomfortable with suggesting products to purchase, there are several things at your disposal to help make it over the hump and giving all the expertise your patients deserve, including in-home rehab products and the like. Do it with confidence, knowing you are doing the right thing for everyone. If you make a couple of bucks in the process, all the better. Last time I checked we still lived in a country operating in a capitalistic system, and if you don’t make profit, you go away. The guy down at the car shop wasn’t offering to fix my car for free last I checked.

Phil Mattison is president of Core Products International where the company’s motto is “Make Your Life More Comfortable.” In 1988 Mattison launched Core as a company making support pillows, including their flagship “Tri-Core pillow” which is widely recommended by chiropractors. They have since expanded beyond pillows to offer support and therapy products for people suffering from all kinds of aches and pains. To view their entire collection of pillows, supports, braces or hot and cold therapies visit www.coreproducts.com or call (877) 249-1251.

The Financial Report of Findings: Say It and They Will Pay It!

:dropcap_open:O:dropcap_close:ne of the most overlooked areas of practice management, meaning the management of your practice, is in the area of finances. For whatever reason, doctors of chiropractic have struggled with this area due to lack of knowledge, lack of the ability to confront the situation or lack of effective team members to assist in this important area. The most important concept when asking for payment from a patient is that of perceived value.  The patient must assess a value either at or greater than what they are being charged in order to be on board with the cost of the service.  It’s equally, if not more important, for the staff member dealing with the finances to understand the perceived value of the service for themselves. As the saying goes, it’s difficult to sell what you don’t own. I have consulted with many offices where the primary staff member whose job it is to collect payment, has confided to me that she just can’t ask these poor people to pay for what she couldn’t afford.

billsMy favorite chide to doctors:  “Stay out of the patient’s pocketbook, because you don’t know what they can or can’t afford.” Do not prejudge what a patient can or can’t do financially.  How many times have you had a patient who complains the most about money drive up to an appointment in a very expensive car?  Or a patient who you never would believe can afford your care write a check for a large sum of money?  It all centers on the value that a patient places on the care.  I wish I could tell you how many times in my career I have had a patient tell me they couldn’t afford the care recommended to them, then, a week later, I ran into them coming out of the nail salon.  This is a patient who did not have perceived value instilled upon them by the doctor. Our job is to tell the patient what they need to hear, and then let them make their own financial decisions.I believe that the “why” is easy to figure out. More important is the “how.”  First, let’s look at some ways to maximize your results when asking for payment from a patient or describing their financial responsibility.

  • Assume you will get what you ask for! If you assume you can’t, you’ve already lost.
  • Be prepared! The Boy Scouts know what they are talking about! Have the doctor’s treatment plan, the insurance verification information, and everything else you will need to formulate an appropriate financial plan with the patient.
  • Know when NOT to talk!  Don’t try to fill the silence while we wait for the reply from the patient. Be clear about your request, and then wait.  For example, say, “Mrs. Jones that will be $45 for today.”
  • Have an array of options. If a patient can’t pay for a visit’s charges, be prepared to offer alternatives, such as a pre-addressed envelope they can mail back with the payment as soon as they reach home.
  • NO! is not the end of the world: Remember that the most important technique of all is to know you can get what you want by asking and, if it doesn’t happen, be prepared to say, “Next!”

The following are some helpful scripts that you can use in your financial report of findings to help increase your odds of getting to Yes!

:dropcap_open:Know when NOT to talk!  Don’t try to fill the silence while we wait for the reply from the patient.:quoteleft_close:

Objection #1: The patient wants to wait till next visit to decide. Our problem is that we expected to put both the balance of yesterday’s visit and ongoing care into a plan for them.

“It’s not a problem, Mrs. Jones, if you need to speak to your husband. I know that I wouldn’t want to make a decision like this without my husband present, either. That is why we hoped he would be able to attend this visit, so that he could better understand what’s going on with your care. Let’s go ahead and take care of your balance to date, so we can start with a clean slate on the next visit. After you’ve had a chance to visit with Mr. Jones, we will be able to recalculate a payment plan that will work well in your budget. Today’s charges added to yesterday’s balance will be $150.”

Objection #2:  The patient wants to make a further decision about care beyond insurance coverage  once insurance visits are used.

“Mr. Smith, I understand what you may be thinking. However, if we were to only recommend the amount of care covered by your insurance, this would be a tremendous disservice to you. Your third-party coverage was never meant to cover all of your care. That’s the reason  we’ve joined companies like ChiroHealthUSA, to be able to extend to you a contracted discounted rate for the portion of your care that needs to come out of pocket. I would much rather look at how we can spread this across more time and work with your monthly payment, than have you consider not taking all of Dr. Jones’s recommendations. The 15 visits covered by your insurance will only be the acute phase of your care. As Dr. Jones explains, to stop your care at that point would be like taking your braces off after just a couple of months of treatment. Again, that’s the reason why we try to make this affordable.”

Objection #3: The patient feels the total amount for care is too far out of their budget.

“Yes, Mary, I understand that this amount may be outside your budget. We have already been able to discount your fees considerably by discussing ChiroHealthUSA, and my concern is that, if we go visit by visit, you will find that it gets out of hand. My experience is, patients tend to get out of pain and then think they can do it on their own. What can I do to help you make this more affordable so that you can commit to the full treatment plan recommended by Dr. Jones?”

In closing, remember that he who asks the question controls the conversation.  Not only is it our duty to ask for and collect payments from patients, it is a part of the healing process.  That patient who pays will stay and get better quicker.  Asking for anything increases the odds of getting it by 200%.  Once you master this skill, exercise the asking muscle often, and you’ll be surprised at how effective it is.

 

Kathy Mills Chang is the President and CEO of KMC University, a consulting and training company in the areas of Medicare, collections, documentation, coding, billing, patient finances, and audit protection. Kathy is also a sought-after speaker, and can be found delivering seminars at the most important events in the chiropractic field around the country. She can be reached at [email protected] or through www.kmcuniversity.com.

The Multidisciplined Approach to Growing Your Practice

:dropcap_open:S:dropcap_close:o I bet you’re getting all the clients you can handle and don’t want any more right? Let’s be honest, we could all benefit by having at least a few morepuzzle people walk through the door.

But where do you start?

To get more information, I caught up with Dr. Mark Steenerson of Minnesota. A few years ago, he was asking himself the same question. He found his answer. In the last year, Dr. Steenerson’s practice grew by 48%. In fact, he made around $10,000 in just two hours by implementing a simple change. Dr. Steenerson’s practice became multi-disciplined.

When I speak to the most successful doctors, they say that the key is getting people in the door and proving that you can create a lasting positive impact in their lives. Many people do not understand what chiropractic is and how it can benefit them, so, in order to be successful “chiropractors must educate communities about the benefits of chiropractic care.” (Bureau of Labor Statistics 2010-2011 Handbook). This realization by the community changes a chiropractic practice forever. Referrals grow, income finally reaches desired levels and the doctors are able to build a name for themselves as local health experts.

The United States Department of Labor says that success prospects are best for chiropractors who operate within a multi-disciplined practice, because it allows patients to stay in house for their most pressing needs. A multi-disciplined practice simply means that the practice offers more than one service, such as weight loss, laser hair removal, nutritional services, acupuncture or massage. The other benefit of a multi-disciplined practice for chiropractors is that it gives them the ability to attract people who do not understand or would not otherwise pursue chiropractic care. If a chiropractor successfully demonstrates their value to a patient, that patient will be far more likely to evaluate, understand and purchase the needed chiropractic care regimen.

So, how do you decide on additional services to provide?

Well, a good business is always built around an unfilled need or opportunity. In order to decide which service will benefit your practice most, you need to figure out which service will benefit your community and current patients. What are their greatest needs?

For those of you who are still wondering, Dr. Steenerson chose weight loss. “I was having major problems getting people in the door for chiropractic, but when they come for weight loss and get great results, you better believe they are willing to listen.” (Dr. Mark Steenerson)

Dr. Steenerson uses his weight loss program to attract patients who are interested in losing weight. Once he helps them do so, they are easily converted to chiropractic patients in order to address further imbalances within their bodies. Dr. Steenerson kicked off his weight loss practice by putting on a two-hour “Weight Loss Information Night.” This event was open to the public and generated more than $10,000 in cash revenue. This number, however, is trivial when compared to the chiropractic and referral business that is still coming in the door. To make the event a success, he placed professional advertisements in two local papers, which yielded around 70 attendees. A year later, he is still reaping the benefits of this event and will be for a long time to come.

So, why weight loss?

With two in three Americans overweight and all of the highly publicized health risks, the weight loss industry is booming. I guarantee that hoards of people in your community and even your own clients are spending significant amounts of money on weight loss right now. To make matters worse, most of them are spending it on unhealthy, unsustainable programs with miniscule long term success rates.

:dropcap_open:With two in three Americans overweight and all of the highly publicized health risks, the weight loss industry is booming.:quoteleft_close:

Weight loss is the perfect example of an effective, cash based service with ongoing profit potential; but just bringing a strong program into your practice is not enough. Jim Allchin, a former executive at Microsoft once said, “We’re obviously going to spend a lot in marketing, because we think the product sells itself.”

Just because you now have this high quality, in-demand product doesn’t mean people know about it. You need to make marketing a priority and do it effectively. In addition, explore opportunities to position yourself as an expert within the community by doing talks at local health food stores, churches and other health professional’s offices. Get creative!

Once people are coming in the door, develop and test a system for moving patients between the various services you offer to provide highest value to them and highest revenue to you. Remember, if you do not offer it to them, chances are they will get it elsewhere. Finally, be sure to leverage referrals. You can simply ask or research ways to get a little more creative. The key is to find something that works and stick with it.

 

Susan Blackard, R.N., N.D.c, M.H.A., F.N.P.c, is an expert on obesity, weight loss and detoxification at the Rejuvenation Weight Loss. For more information, visit www.dc-weightloss.com or call 866.95.ANEWYOU.


Sources:

Bureau of Labor Statistics. Department of Labor. Occupational Outlook Handbook. 2010-11 Edition. http://www.bls.gov/oco/ocos071.htm

Know Your Numbers

knowyournumbers:dropcap_open:O:dropcap_close:ften times we have the misconception that success is something we enjoy only after we master difficult concepts and complicated theories. However, it may surprise you to know that you learned some of the necessary skills required for a successful chiropractic office when you were in Kindergarten.

Do you know your numbers?  If you don’t, then reading this article and implementing its message can turn your practice around.  It’s really as simple as One, Two, Three!

The failure to keep proper statistics is a weak area among most chiropractors for two reasons. The first reason is because there are plenty of other details in the practice that keep the doctor too busy to focus on their numbers. Secondly, if doctors do not know how to analyze their statistics, they fail to understand how important it is to know them in the first place.

Knowing your numbers will increase production and profit without having to increase any aspect of budget or overhead. Read that last sentence again. Keeping detailed monthly statistics in your practice does this by allowing you to correct mistakes (or avoid them altogether). It helps determine how much you should charge for services, if more staff training is needed, and guides you to an exact dollar amount that you should spend on marketing.

If you’re not keeping proper statistics, our guess is you are losing a ton of money. Doctors tell us all the time that they know what is going on in their office because they’re always there. However, once they start “learning their numbers,” they see a completely different situation than what they originally thought.

Here’s a million dollar formula on patient visit statistics that won’t cost you dime! To determine patient visit statistics, take your monthly overhead and divide that number by the number of patient visits you’ve had that month. The result is the amount that each office visits costs you. (Yes, YOU! Every time a patient walks through your doors, you’re paying something; don’t you want to know how much?)

:dropcap_open:If you know your numbers, you know it’s about practicing smarter, not harder.:quoteleft_close:

Compare the resulting number to the amount you’ve collected per visit that month in your office and see if each visit is profitable. For example, we recently visited with a doctor whose overhead is about $5,000 a month. During the month of December, he had 200 patient visits. That means each patient visit cost him $25.  (We’ve shown thousands of doctors how to do this and the surprised expression on their faces when they see the results tells us that they’re stunned to see how little their actual profit per visit results in actual profit.) One had a very insurance dependent practice and would get as little as $10 from the insurance for adjustments. He was actually paying the patient $15 to come to his practice!

Listen, if you want to take care of patients out of the goodness of your heart and pay them to receive your services, that’s fine; but you’re not going to make a living that way!

If you know your numbers, you know it’s about practicing smarter, not harder. We’re not impressed with collections until we know these statistics. We can’t tell you how many doctors we’ve worked with that were paying patients to visit their clinics!  Don’t confuse motion with progress. Profitability comes down to what you’re really making after overhead is figured in and, if you’re not keeping monthly stats in your practice, then you don’t know what that number is. Just because you’re seeing high numbers of patient visits doesn’t mean that your overhead is low enough to net you some profit. If you don’t know your numbers, you’re not going to know how low your overhead should be, or what you should charge, or whether or not to spend money on marketing, etc. You have to know your stats, so you’ll know how to proceed.

To revise a statement coined by former President Bill Clinton’s campaign strategist, James Carville, It’s the profitability, stupid!

Use the skills you learned in Kindergarten. Know your numbers, then you’ll better know what decisions to make in every other area of your practice. Don’t continue to make weighty financial decisions based on faulty thought patterns, rather than factual statistics. What is it they say about insanity? Don’t do the same thing over and over and expect different results. Making a small change in your practice today can add up to BIG results (and profits) tomorrow!

 

by Tom Owen III, and Todd Osborne, D.C.

Dr. Todd Osborne, a 1989 graduate of Palmer College, ran a successful high volume multiple doctor practice, and is currently Vice President of AMC, Inc., as well as an author and lecturer. Visit www.amcfamily.com or call (877) AMC-7117 for more information.

Choose Your Space Wisely

classifiedsmarch:dropcap_open:W:dropcap_close:hen opening a new practice, selecting a facility that best suits your needs begins with a solid foundation. Now, more than ever, countless chiropractors are being misled by representations from their landlord or realtor that, if not carefully understood, could cost you tens of thousands of dollars.  Start with good questions and learn their language.

A Different Language

Landlords and Realtors have developed a language of their own, developed to slant negotiations greatly in their favor. The art of negotiations is a game that everyone has to play, but it goes much deeper than cost per square foot and triple net leases.

An Informed Shopper

As you shop different locations and view different size facilities, the first details discussed by your realtor are cost, either per square foot or by the month, as well as CAM or triple net expenses. There may even be offerings of “TI”, Tenant Improvement money. This is money that they are willing to offer you to improve the facility. In this economy, this could amount to as much as $20-$30 per square foot. In a deal for 1,600 square feet, this adds up significantly but, before you jump up and down with joy that they are willing to pay to build out your office, it is important to understand the starting point for this expenditure.

Facilities are offered in many different ways, such as: “As Built,”  “Vanilla Shell,” and “Grey Shell,” to name a few. “As Built” means that you take it as it is and you are responsible for any changes and improvements needed. You get to save any walls that you feel you can still use; however, you are typically left with old and outdated infrastructure that will take more than just paint and carpet to fix. Old HVAC units may or may not function efficiently or at a level acceptable to you, and restrooms may not meet code. With the recent changes to federal building and accessibility guidelines, once you do any form of construction, you will probably be required to bring everything up to CURRENT codes. Just because a rest room has handicapped access bars on the walls does not make it ADA compliant.  What you typically find is that “Grey Shell” offices come with higher TI offerings. This is because a grey shell is incomplete. You are responsible for the HVAC, Rest Rooms, and even electric service and ceilings. Essentially, TI money is used to fix, repair, upgrade or complete their facility.  Nine times out of ten, the TI money won’t even get close to paying for the basic necessities and mechanicals, let alone anything you need to transform these bare bones into a chiropractic practice. A facility offered in a “Vanilla Shell” is the best way to control costs and avoid hidden nightmares.

Leasable vs. Usable

:quoteright_open:Facilities are offered in many different ways, such as: “As Built,”  “Vanilla Shell,” and “Grey Shell,” to name a few.:quoteright_close:

When looking for space, you will always be offered “rentable” square footage. While they never disclose this, the difference between rentable and usable can be significant. When comparing one site to another, all that matters to you is what is USABLE. Usable is the amount of space you can transform into a chiropractic  practice. Rentable starts with the same, but also includes the thickness of the walls, any exterior overhangs, your portion of the common areas, such as lobbies, elevators and mechanical rooms. Offices in High Rise buildings can have a difference between the two of as much as 35%. You pay for 3,000 square feet and can only use 2,000. In strip stores and free standing buildings, it is common to have this loss factor in the 5-10%. Professional buildings may be in the 10-15% range. When comparing facilities, divide the monthly cost by the usable space and then compare. All that matters to you is usable. 

Less Is More

If you are starting a new practice or spinning off a satellite clinic or franchise, use the old adage that less is more. New graduates starting their career have had years of philosophy that says more is better. Seeing 450 or even 600 weekly visits is wonderful when thinking about improving the health of the planet, but be sure to match the growth of your practice to duration of the lease and, therefore, the size of your building. Balance your growth curve to the length of your lease. Think of your practice as an evolution, not a snapshot of your goals. Shorter leases are better when starting.

Scaling back in size does not mean scaling back volume. It is possible to see 2-300 or more weekly visits in 6-700 square feet (depending upon your clinical services offered). Leasing 1100 square feet instead of a 1600 square foot office can save you almost $70,000! Why pay someone else’s mortgage when you can keep this hard earned money in your pocket. This lowers your stress and financial burden, allowing you to focus on building a practice instead of how to pay your bills. Furthermore, your utility bills and staff payroll can also be lowered. Leasing 800 square feet instead of 1,200 will net you over $50,000 without having to do anything! Try to find that return in any financial institution!

Purchase or Lease

In starting a new practice, we disagree with most financial advisors’ suggestions to pay your own mortgage by owning instead of renting. Unless you have a 5-7 year business record that allows you to project your growth in volume and services, no chiropractor should purchase their own facility. Proof has shown us that doctors either over purchase and have huge overhead that they have to struggle to meet, or under purchase and grow out of their facilities long before their principal payments have made a dent in what they still owe.

Ask

Mark Victor Hansen always said that you never get anything unless you ask, ask, ask, ask, ask. We are seeing deals like never before, so be sure to ask for a better deal. You will be surprised at what you get.

So, when starting a practice, understand the foundations of negotiating, play the game better than they do, balance your growth, rent less than you think and purchase only when you are certain, design properly and, most importantly, ask!

 

Glen David has designed and outfitted over 4,700 chiropractic offices worldwide. More information on the evolution of your office environment as well as the efficiency and productivity concepts discussed can be found at www.DavlenDesign.com.  Glen and his team can be contacted at [email protected] or at 1-631-924-8686 .