How to Choose a “Hot Town” in Which to Practice: Starting a New Practice IX

In the last article, “How to Choose a ‘Hot State’ in Which to Practice,” I advised you, the start-up doctor, to drive the country with your spouse looking for the climate, geography and type of people you prefer in choosing a place to live. Having found your ideal area of the country, I recommended that you find a “hot state” in which to practice. A “hot state” has better insurance and practice laws; therefore, the doctor can practice more easily and more profitably than in a “cold state.”

Now that you have determined the state in which you would like to practice, I recommend that you and your spouse drive around it looking at all the towns that are the size in which you would like to practice. If you were raised in a town of 100,000 and you would like to live in that size town, look at every town in your chosen state that has a population of 100,000. If you prefer to be on the water, look at every town of 100,000 on the water, etc. Give yourself a chance to fall in love with two or three towns, then determine if they’re “hot” or “cold.”

A “hot town” is one that can provide an additional 150 new patients a year to your practice (150 new patients at $1,000 per patient equals $150,000 in additional income per year). If one of the towns you like is “hot” and two of them are “cold,” and you’re equally in love with all three, your choice is easy, isn’t it? Choose the “hot town”!

A “cold town” is one that doesn’t need or want a chiropractor. If you choose to practice in a “cold town,” you’ll have to work four times harder to earn the same income as you would in a “hot town.”

Let me relate a story that happened to me. I was practicing in Georgia but decided to return to my home state, Florida, to practice. I was raised in Fort Lauderdale, one of the most beautiful towns in Florida, with wide streets, clean air, beautiful beaches, inland waterways, etc. When you are raised in heaven, why go elsewhere? I was madly in love with my hometown, just like a lot of start-up doctors love the town in which they lived.

At the same time, I had a friend in St. Petersburg, Florida, who insisted that I visit him. For your information, when you’re raised anywhere else in Florida, the last place you want to visit is St. Petersburg. Everyone’s heard of St. Petersburg. Comedians call it “God’s Waiting Room,” “Wrinkle City,” etc. It’s the retirement center of Florida. Who wants to practice in a retirement center? I sure didn’t.

But, he was my friend so I went to visit him, confidant that I would be happy to get back to Fort Lauderdale. Wow, was I surprised! It was a beautiful city with wide streets, clean town, fresh air, beach waterfront on three sides, inland waterways, etc. My next thought was, “Is this a ‘hot town’ or a ‘cold town’?” The demographic and psychographic studies revealed St. Petersburg was a “hot town.” I moved to St. Pete and was a very successful practitioner for over thirty years. I’ve loved every minute of my life in St. Petersburg and wouldn’t want to live anywhere else.

Isn’t it amazing? I was madly in love with one town—until I saw another. That’s my message to you. Drive your chosen state, look at all the towns of the size you prefer, and allow your spouse and yourself to fall in love with three or four. Then, ask a consultant who specializes in starting a practice to help you do the demographics and psychographics studies to determine which of the towns are “hot” and which are “cold.” You are making a costly mistake if you don’t have a consultant to advise you on how to start your practice. The following are some basic guidelines, which should help you.


Study demographic information available from the town’s libraries, Chamber of Commerce, real estate companies, etc. Learn everything you can about the people of the town. Some of the demographics I use to determine “hot towns” and “cold towns” are:

• The average household income;

• The percentage of the population over sixty-five;

• The population’s aging trend;

• The number of families with children—young children or teenagers;

• The DC-to-population ratio;

• The insurance coverage of most of the townspeople;

• The number of major industries in the town;

• The economic and population projections for the next five years;

• Are property prices declining, stable, or increasing?

• Is the crime rate above average, increasing, or decreasing?


Whether a town is “hot” or “cold” sometimes has little to do with demographics, and more to do with the perceptions of the people who live there. Psychographics is the study of the trends of the people in a city. Examples of psychographics are:

1. McDonald’s restaurants use psychographics very successfully. They use nighttime NASSA satellite data and photo imagery to track vehicle traffic patterns to determine where they will build new restaurants. They build at an intersection of town, if analysis of the photos shows a heavy pattern of vehicle traffic between the hours of six and ten at night (dinner time).

2. Does the chiropractic profession have a bad reputation in that town? You might wonder how could the people of a town have a bad impression of chiropractic. I know of a town in which a chiropractor’s method of treatment killed a man on the adjusting table. The negative newspaper, radio and television publicity severely hurt every DC’s practice in that town. A DC in another town was charged with paralyzing a patient. The DC fought the charges valiantly in court and won. But, he was “convicted” in the press. Most of the people in the town, believed the chiropractor paralyzed the patient, because the negative press was so convincing. The townspeople’s negative opinion of chiropractors took years to change.

Every possible source of competition in your prospective town should be noted. Evaluating your potential competitors is an intelligent element of any business plan.

Demographics vs. Psychographics

The facts, figures and ratios revealed by studying demographics are very valuable when properly analyzed. However, even the most favorable demographics can’t compensate for a psychographic study that comes up negative. Sometimes demographics give the wrong impression. For example: Everyone knows that statistics reveal that every third child born on this planet is oriental. This author has seven children, none of them oriental.

The key to getting the most from your demographic and psychographic studies is the proper analysis of what you find. Just one example is the doctor who decided to open his practice in a town with an excellent DC to population ratio of 1:8000 (the usual in his state was 1:2000). He failed to consider the psychographics, which would have told him the town’s main employer had an HMO insurance that didn’t cover chiropractic. The doctor’s analysis was incomplete causing him to pick a “very cold town”…and he failed.

In this article I have discussed the use of demographic and psychographic studies to determine a “hot town.” The next issue of this, “How to Start a Practice” series will concentrate on finding a “hot location” within your chosen town.

Dr. Peter G. Fernandez is a world authority on starting a practice. He has thirty year 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; Phone: 727-392-0822, 1-800-882-4476; Fax 727-392-0489; or visit

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