Died and Gone to Heaven, or Just Plain Dead?

Two signs in the window: "Family Chiropractic Center" and "Now For Lease: Call Ace Commercial Real Estate Brokerage." Just a quick look in the window: great colors; new carpet; fresh paint; interesting design detail in the front desk CA station; efficient central hall design; and a stack of letters on the floor under the mail slot, many with "FINAL NOTICE" stamped on the front. A failed chiropractic business.

Notice I didn't say failed chiropractic practice. I would guess that the few patients the doctor saw were thrilled with the care. That's the way it is with chiropractic practices. Chiropractic works miracles, even for ordinary chiropractors. But it's the business of chiropractic that needs to prosper for the practice to survive. If you are a chiropractic student, go back and read the previous sentence two more times and remember it. If you have been in practice for a year or more, you can't forget that principle.

This doctor's misfortune illustrates the main point of this article all too clearly and painfully. The science, art and philosophy of chiropractic fails if the business of chiropractic fails. These three cherished components vanish from that office, that part of the community, that practice (the patients in care) and, in some cases, from the doctor.

Try on these shoes: After spending $150,000 on your chiropractic education and practice set-up, tell your spouse and family that the money is gone, you can't pay your bills, and you're looking for work as a construction worker. Would that test your faith? "Yeah, chiropractic's great, it's just me." Ouch.

I'm so compelled by sympathy for chiropractors who are too close to the same fate that I have to say emphatically that it doesn't have to be that way. I have coached many clients who have turned to me for help in the eleventh hour and have been able to pull the nose up just before a disastrous practice crash. They have gone on to make a soaring success of their chiropractic business and practice. They found out that the difference between "died and gone to heaven" and "just plain dead" is knowing how to run a chiropractic business and running it well.

In our capitalist economy the vast majority of health care is provided by private businesses. These private businesses, or practices, have to make a profit to survive. In chiropractic that is even more true.

For most chiropractic practices, like every other business, there is the initial struggle to get, then keep, a safe distance between total receipts and expenses, the difference being your net profit. If there is enough profit in your chiropractic practice, you can afford to provide service again next month, next year and the year after that. In fact, if there is enough profit in your practice, your business model may be worthy of reproduction, but that's another article. Since we are talking about profit, let's talk about the dreams those profits fund: the wonderful house, nice cars, vacations, college for the kids and a comfortable transition from full-time practice to part time. More of an "end game" point here, but the happiest senior chiropractors I know still have their hands in the practice one to two days a week. You spend decades building these skills and patient relationships, and now you're going to watch the dog while your wife shops? Hand me the razor! That's right, a whole other article there, too. Back to business.

An interesting fact about the purity of business evolution: "Only the strong survive" is true in spades in the U.S., where four of five nonformatted businesses (we'll discuss formatted vs. nonformatted) die within five years. Lack of profit is always on the death certificate, and that's right, 80 percent die.

What did the 20 percent do to succeed? Some don't know or can't tell you. That group can't take the credit; it's either dumb luck or natural talent. I've seen a lot of both, and neither can be replicated. They aren't the teachers. The teachers are those who didn't know, have learned, and are kicking ass. Here's what they teach:

• Before you even start, vow to do whatever is necessary to succeed. The only constraints on what you will do are good ethics, and those guidelines are in the golden rule. Here's a great ethics assessment for selecting your future action steps: Would you want a chiropractor to use those action steps to acquire and treat your parents as patients?

• Never give up. After honesty, determination is worth 10 times any other attribute you can name.

• Embrace that your practice is a start-up business. Do whatever is needed to learn and excel at the fundamentals of the business of chiropractic. They are the following:

Marketing: Everything else can be wrong, but if you are producing lots of new patients, you will make it. Conversely, everything else can be right, but if you are producing too few new patients, you will fail. This is hard for some, but chiropractic is sales and chiropractors are salespeople. Every business is sales and everyone on the planet is a salesperson. Husbands sell to wives; wives to husbands; professors sell to students and students to professors. You get it. Anyone who has an opinion is a salesperson. Decide to like it and be very good at it. The sale doesn't end when someone becomes a patient or chooses lifetime care. The sale simply never ends. If at this point you're saying to yourself that you didn't get into chiropractic to be a salesperson and that you are a doctor, not a salesperson, let me set you straight. You have a self-image problem. Trying to hide behind a title or degree is fear of rejection. If you can get over that you will succeed. If you can't, that may be your office I discussed in the first paragraph.

Management: You have three management challenges:

1. Let's discuss the toughest first - you. Your management challenge is to get you to do whatever is needed to make your practice flourish. I'm not talking about slave driving yourself through distasteful drudgery, but to artfully help yourself build a love for doing what you need to do to build the practice of your dreams. It is the most challenging, rewarding and worthy of all endeavors.

    

2. Your staff. You may not have any staff at first, but you will. This will be the easiest of the three groups and therefore is usually neglected. Few people invest proper time, effort and money in developing staff. CAs, properly trained and cared for, are the most consistent good in any chiropractic practice, and that includes the chiropractor.

    

3. Chiropractic patients. Your patient management objective is being of value to and staying in a relationship with your patients for the rest of their lives. There isn't one person on the planet who doesn't need to have access to a chiropractor and know and understand why they should see their personal chiropractor. The short course on patient management is, "Do unto others as you would have them do unto you." For me, it boils down to this: If some other chiropractor were responsible for my family, I would want him or her to bring my wife and two boys through any relief, correction and strengthening care and then into a lifetime chiropractic care program that included at least monthly check-ups. Now, how to do this for as many people as you care to and can serve is another lifetime challenge. The good news is that just a few hours a week can make this a living reality.

Operations: This is the mechanics of your business/practice. You know, the office and how it operates. Operations get so little attention, and that neglect produces so much stress. An interesting study in operations is the University of Washington Huskies' marching band. They do a great halftime show. Ever wonder how that show got so great? It's practice, the essence of operations. However, less than one percent of chiropractors actually practice their practice off the "playing field." Ask Tiger Woods and Mark McGwire about practice.

Finance: Again, the short course. Don't spend it until you have it. I know it's a little like locking the door after the horse has been stolen if you're $100,000 in debt to school loans, but be frugal. Start your practice with used furniture, used equipment and a small office. Maybe you will rent space with an established DC who has all that already. Patients don't choose and stay with a chiropractor because of the new office chairs. After you start making money, get out of debt as fast as you can, especially before you buy that boat.

You've gotten the wake-up call. What now? Three things: 1) Believe that you can not only survive and succeed, but that you can have a blast doing it. It's like golf: the better your game gets, the more fun it becomes. 2) Get some help. Where did this Marlboro Man, Frank Sinatra style, "I Did It My Way" thing come from? Pros get help; rookies are too proud/scared/dumb (your pick). There are more out-of-business chiropractors because of this than anything else. Stop and ask for directions. 3) Hang in there. It's a journey, and some are further away from the goal than others, but "died and gone to heaven" often starts just a few steps past the point when you think you're "just plain dead."