How to Eliminate the Five Most Destructive Practice Stresses

Dr. Dave loves chiropractic, has a great personal chiropractic story and used to love going to the office. Recently, he told colleagues – half jokingly – "I love chiropractic, it's the practice I hate." I asked him why he felt that way. "It's too stressful" was his answer.

Stress can put a knot in your stomach, a frown on your face, and leave you exhausted and sick. And for too many chiropractors, their practice is a major source of stress. What can be decades of delight becomes a source of mental anguish. Stress can pile up quickly and take away the enjoyment of practice. Instead of looking forward to taking care of people, you slog through another day, another year, secretly counting down the time to retirement and just seconds from yet another heavy sigh.

The good news is, it doesn't have to be that way. You can eliminate the stress in your practice and enjoy being a chiropractor again – or keep on enjoying it. All while helping more people, having more fun and making more money.

If you want to keep loving chiropractic and enjoy your practice for a lifetime (OK, until you retire), we need to identify the stressors and deal with them – the earlier, the better. So, let's discuss the five most common practice stresses that can leave you grinding your teeth at night, and brainstorm solid, practical strategies and solutions to get rid of the stress and love your practice again.

#1 Stressor: Not Enough New Patients

Low numbers of new patients will produce a host of problems including a feeling of failed purpose, small practice volume, low energy and poor collections. The lack of new patients is the biggest practice stressor for most chiropractors by a 10:1 ratio.

Solution: The concept is simple and results can be dramatic. First, quit complaining about the need to market chiropractic and yourself – just get good at it. Every industry markets and the medical profession has a $1 trillion industry shilling for it. We don't, so just embrace it and do it yourself. Start by hanging a marketing calendar in your back office. Then fill it up with three internal and three external new-patient programs. Spend 3-7 hours a week telling the chiropractic story and offering help.

Hot Tip: Learn how to manage a marketing CA who will go into the community, do screenings, lunch and learns, and massage events. The marketing CA brings back new patients while you stay in the office taking care of established patients. Never be without a great marketing CA. This is the most logical next hire in all of chiropractic.

#2 Stressor: Your Team Doesn't Perform to Your Standards

Your day starts off stressfully if the staff arrives late, poorly dressed and won't take care of you or your patients the way you'd like. This stress distracts you from patient care because you know the phone work, patient scheduling, billing, etc., are all in bad repair. It seems no matter what you do, you can't get the performance you're looking for from your team. The growing frustration invites the dangerous thought, I can hardly wait to get out of here!

Solution: First, you want your team to anticipate your every need and care for your patients like honored guests. Here's what to do. For just a moment, think of your practice as a halftime show – you and your staff are the marching band. You want your performance to be precise, energetic and impress the fans. How can you ensure that's the case?

For major colleges, the process starts months before football season. The band takes to the field late at night in an empty stadium to practice each and every song, all the dance moves and every formation – again and again and again.

In the chiropractic office, it's much the same. Train staff to your standard on phones, day one and two, and how to handle every possible situation – again and again and again.Hot Tip: You might say this: "Next Tuesday, we're running through New Patient Day 1 – start to finish. I want everyone to have the scripts memorized. Amy will play the part of the new patient. Here are the scripts. Any questions?" Consistent training over time is the key. Take the time to train properly and you (and your practice) will reap the rewards.

#3 Stressor: Demanding, Spoiled, Ungrateful Patients

Some patients are so demanding. You end up in debates over whether you're adjusting them correctly. "Don't think you got it, doc, try again" or "I want you to do this one for free. The last one didn't work." The fact is, you created the problem – and you can also fix it.

Solution: From the very beginning, you need to frame the relationship. A positive statement that installs you as the leader and them as the follower who happily agrees is essential. I start this way: "Before we get started, let me tell you how we do things." This announces you have a proven, trusted process. Then take control by doing a strong day one and two where you explain the best path to their goal of wellness and extract commitments.

Be authoritative. Patients respect you when you're convinced you know what you're doing. If they don't, maybe they're in the wrong office.

Hot Tip: Have you ever "fired" a patient before? It's an empowering feeling. Frequently staff will thank you and everyone feels better. Ask your CAs who the worst patient is and find them another DC. Sound harsh? Trust me, they (and you) will be better off.

Stressor #4: Too Much Month, Not Enough Money (Poor Collections)

Granted, the low-cash stress goes away when you market, but I've seen busy successful practices leave more than $100,000 a year rotting in their AR and later write most of it off as bad debt. That hard-earned cash could have gone home with you.

Solution: Collect 96 percent after MCO write-offs. Here's how: First, standardize all patient payment plans, giving them four options – prepay, health care financing, auto-debit and pay as you go. That will fix the money going into the AR.

Now for getting the money out: Each week, meet with your CA over a fresh paper copy of an aged AR. Identify the worst 12 troubled accounts, starting with large balances, bad pay histories and poor security. Then make specific assignments, such as audit, rebill, call insurance, call patient, call attorney or send a collection letter.

Hot Tip: Require a 60-second daily check-in from the biller on the assigned work. When 2-3 accounts resolve, add 2-3 more, have another weekly AR meeting and repeat the process. In no time, you'll be hard pressed to find 12 troubled accounts and you'll have tons of extra cash in your pocket.

Stressor #5: You're a Prisoner of Your Own Success

You have a busy practice, wonderful patients, delightful staff and a great income. But you have a dirty little secret: You're working at close to capacity and can't take time away without damaging (or even crashing) the practice. Two weeks off could cost up to $50,000.

Solution: You'd like to have 4-6 weeks off a year while the practice purrs like a kitten in your absence? Here's how: Hire an associate with compatible goals and formulate a well-laid-out plan for a win-win relationship. Lead and manage your associate based on replicating your success in them.

Hot Tip: When the associate is fully trained, let them handle the practice solo on a Friday – then check their performance and make corrections. Some time later, let them cover your four-day weekend. Eventually, you take a full week off – then several times a year.