A practice manager confided in me that it was easy to make a new practice grow, but much more difficult to help one that was already doing well become more successful. Perhaps it's because practice tends to be paradoxical. For example, working more hours a week increases volume at first, but eventually decreases it; charging more per visit increases net income, but in the end, decreases it; spending less time on routine visits increases volume to a point, but then ... you get the idea.
There are ideals or "sweet spots" for every practice. The best way to find the sweet spot is to investigate other modes of practice. The ideal policies and procedures may be different from what you imagine. Eventually, more becomes less, and discovering your "sweet spot" is everything. Here's some suggestions to help you along the way, recognizing that at first, you may bitterly resist what your practice (and you) desperately need.
Shorter Hours
When I started in practice, I had tons of energy and assumed the more hours I was open, the more people I could help. So, I worked from the early morning 'till late at night, on weekends, and even made house calls. I would even open my clinic at odd hours to accommodate emergencies.
A good friend urged me to cut my hours, pointing out there were practices much larger than mine open only three days a week. I couldn't believe it. It didn't make sense. Finally, I relented and cut back my hours – and the practice grew. I did it again and it expanded further. I was dumbfounded. How could this be? I could help more people working fewer hours – and help myself in the process?
As it so happens, it's true. Cutting practice hours allows you to rest so you can serve your patients better. They will feel your increased focus and energy because you're not worn out from standing around waiting for the next patient to arrive. Patients want you and your staff to be totally engaged and enthusiastically giving service. They want you at your very best.
Shorter hours can serve everyone better (to a certain point). Of course, if you're not open enough hours, or during the hours that are convenient for your demographic, your practice will suffer. You can't cut your hours to nothing and help patients.
Shorter Visits
If you're successful in practice, you've learned shorter visit times actually can help you provide better care. Taking less time to adjust increases focus, quality of care and results. Do you remember how long your first adjustment took? Mine was well over an hour! No one wants an hour-long adjustment. Up to a certain point, shorter regular visits are better and will increase your total volume.
A Fair Fee
Early on in practice, I charged $17 for an adjustment. I assumed if I charged a fee everyone could afford, I'd help more people. It turns out this is not true. Fees can be so far below the rest of the market, patients assume the quality of care is inferior. Charging a fair fee will increase the perceived value of your service. If you provide superior service, charge above-average fees to serve more people. However, if your fee is substantially above market values, your volume will drop.
New Patients Matter – But Only to a Point
At seminars, doctors will stand up in a roomful of their peers and brag about their statistics. As the weekend advances (and after a few beers), these numbers grow from impressive to unbelievable. Even if they are real, they come with a dramatic downside.
My colleague, who at one time helped 75 new patients in one week, admitted his regular patient volume dwindled because of the time and energy it took to help the new ones. He also told me few of the new ones became regular patients. Often, more becomes less.
Recommendations for Care: Find the Middle Ground
Reporting to patients can be difficult. Do you really want to confront them with how bad their condition is? Should you spoon-feed them their findings, rather than risk losing them as a patient by presenting a comprehensive care program they may not be ready to absorb or agree to?
For a while during the '90s, "confrontational tolerance" became a way of life for many doctors. It was commonly assumed that the more you stood your ground and confronted people with the reality of their situation, the bigger your practice would become. Of course this was effective, especially for doctors who had been watering down their recommendations for fear of being rejected. Patients appreciate strong leadership.
However, for doctors who were unafraid of confrontation and naturally persuasive, it made reports worse. Patients rejected what they perceived as an overbearing, self-serving style of practice, and would not begin care.
A growing number of doctors are serving more and more patients by giving them what they want. Some practice managers advise - "Just agree with them" - and you'll become more attractive; "Don't confront." How do you find the middle ground? How do you offer care patients need without overwhelming them or minimizing significant problems?
Finding the Sweet Spot: Open Your Mind
Business practices produce bell-shaped curves. Cutting hours increases volume to a point, then falls away as fewer available hours turn away potential patients. The same can be said of visit length, fees and recommended number of visits. That "sweet spot" is an ideal way of practicing ... but where is it? Where is the top of this bell-shaped curve for your practice? To find the top of the curve, search for where it starts to dramatically fall off.
To confidently assess where your personal "sweet spot" is, you will need to reach out and identify styles of practice that don't work for you. Go on a "mission" trip and help as many people as you can in a third-world country just to see what it's like. Spend a day observing a practice that's radically different from your own. Offer free care for one day and serve as many people as you can. Investigate extremes to find a style of practice that serves your patient demographic best. Open your mind to styles of practice different from your own experience. Discover what you're most attracted to by offering quality care in a style that best suits you and your patients' needs.
Each practice is as unique as the doctor and patients it serves. Where your "sweet spots" are is up to you to ferret out. You may have to explore new worlds before you come home to your ideal practice.
I heard of a doctor who for years practiced using the "box on the wall" fee structure. Patients were allowed to contribute whatever they wanted for the services they received. They left their payments in a box on the wall. To this doctor, it was the most ethical way to deliver care.
But after a certain amount of time, his idealism degenerated into cynicism and anger. As he served more and more, he was paid less and less. His patients took advantage of him. One day, his anger seized him and he ripped the box off the wall.
The moral to this story: You don't have to adopt a particular style of practice. Just investigate the different styles until you know which path will serve your patients best. Discover, evolve, change and grow! Challenge existing trends in practice, and even resolutely journey in an opposite direction. Visit extremes to know what's best for your patients and discover your unique "sweet spot."
Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
Some pundits say that the upcoming presidential and congressional races, and many local races, might be the most consequential in our country’s history. We do not have the choice of sitting on the sidelines and hoping our patients will carry our water. Unlike other medical professions such as physical therapists, podiatrists, nurses, etc., the health care class (AMA) will not protect us. We must be in the game.
The most common condition affecting the shoulder is rotator-cuff disease. From acute tears to chronic tendinopathy, it’s common and needs a thorough workup. In fact, even asymptomatic shoulders can have full-thickness rotator-cuff rears in up to 40% of instances. Let’s look at additional conditions that can present to the office with weakness, loss of motion and pain in the shoulder beyond rotator-cuff tears.
