The Business of Chiropractic

Breaking Through Practice Plateaus

Dr. John was frustrated with his practice. In his opinion it was “Good, but not great.” He made a decent amount of money, at least compared to some of his friends. He enjoyed his patients. But he wanted more. This isn’t the practice that he dreamed of. And yet when asked about what was keeping him stuck, he claimed he had no idea. He felt like he gave good care to his patients, had a decent team on board. He was involved in the community and did a few trade show events every year. And yet month after month remained the same. Sometimes a little better. Sometimes a little worse.

Dr. John is just a representative of so many doctors that worked so hard to get through school, to get a practice started, and yet it isn’t what they had imagined it to be. They aren’t really sure what to do next, so they do relatively nothing different. Ultimately leading to burnout.

The problem is that Dr. John doesn’t think strategically. He’s not strategic in his analysis of what’s going on in his practice which makes it impossible for him to plan strategically how to fix the problem and get back to growing again. He doesn’t even know where to start.

The solution isn’t that difficult. It really comes down to determining a Key Strategic Objective to focus on. Unfortunately when most doctors are asked what that would be the answer is “I want to make more money.”

Of course! But that’s not specific enough.

There are a variety of ways to make more money in a chiropractic clinic. The good news is there is a finite number of options and it’s a fairly simple math problem:

Patient Visits x Average Visit Income = Revenue – Expenses = Owner Benefit/Profit

Seems simple enough! We basically have three areas we can focus on to find our Key Strategic Objective:

  1. Decrease clinic expenses
  2. Increase patient visits
  3. Increase the average income from the same number of patient visits

Those are not Strategic Objectives themselves, because they aren’t specific enough.  There are lots of ways to achieve each of those.  By determining which has the highest potential impact, we can determine our Key Strategic Objective.

Decrease Clinic Expenses

Without a doubt, this part of the formula is straightforward enough.  Look at your profit/loss and determine if there are line items that aren’t necessary.  Unfortunately, in chiropractic business there is not a lot of areas to cut.  Payroll … reducing payroll may increase your profit slightly in the short term, it will ultimately limit your overall potential for growth.  If you’re overstaffed, find ways to GROW into it, not reduce it.  Marketing… very few chiropractic clinics spend TOO MUCH on marketing.  The common mistake they make is not utilizing their software to track the results of their marketing efforts to make sure it’s being spent in the right place.  Supplements and Supports … this should never be an area that is being reduced as an expense but we should be tracking the expense as a comparison to the revenue generated to make sure that we are in fact selling the inventory we have at a profit versus having hundreds of dollars of inventory that eventually expires and gets tossed.

Overall, decreasing clinic expenses is typically the LAST area to look when wanting to increase clinic profits.  So lets look at patient visits and average visit income from those visits.

Increase Patient Visits

This one seems simple enough.  Too often, doctors overlook the fact that this is also the result of a math equation and instead of figuring out which part of the equation to focus on they try to WILL their way to increase patient visits and ultimately nothing really changes.

New Patients x Patient Visit Average = Patient Visits

Basically three ways we can impact our patient visit numbers:

  1. Increase the number of new patients each month, while keeping the treatment plans and the percentage of patients continuing on to a wellness/maintenance plan the same.
  2. Increase the size of active treatment plans, while keeping the number of new patients and the percentage of patients continuing on to a wellness/maintenance plan the same.
  3. Improve retention to recommended treatment plans, while keeping NP’s and treatment plan recommendations the same, as well as the number
  4. Improve conversion of patients to wellness plans, while keeping the number of new patients and the active treatment plans the same.

All three of those can increase your overall patient visits.  Obviously, #1 and #2 will have a quicker impact on PV, but #3 can be equally impactful over a longer period of time.

Increase Average Visit Income

Average Visit Income can increase in a variety of ways as well:

  1. Increase the fee schedule being utilized on the current patient volume.
  2. Increase the services provided to existing patients to improve patient outcomes and also increase revenue
  3. Increase the product sales provided to current patient volume
  4. Improve billing practices to increase the collection percentage without changing Average Visit Services at all.

It All Begins with Knowing Your Numbers

It’s impossible to build your practice with intention if you don’t know your numbers to start with.  By evaluating your current analytics, you can determine where the biggest opportunity for change exists.  Commit to ONE of them as your Key Strategic Objective and focus on activities that will directly affect that statistics (while also making sure you aren’t dropping the ball on something else.) The best way to determine activities that can change or be improved is by having a Bottlenecks meeting with your team. Read about that HERE in another post.

Team Approach to Crushing the Bottlenecks in Your Business

In “Not Your Ordinary Business…or Is It?”, we talked about the importance of developing a more focused approach to growing a practice or getting unstuck. That started with developing a Key Strategic Objective. If you haven’t done that or didn’t read that article, click HERE and make sure you know what that Key Strategic Objective is. Without knowing that and being committed to focusing on it, your efforts will tend to be distracted, inconsistent, and ultimately ineffective.

Assuming you know your Key Strategic Objective, and feel confident that is the most important change you can make in your practice, it’s time to engage your team. You can’t do this alone. Your team has perspectives you don’t have and will never have. Unfortunately, sometimes our leadership style has squashed their ability or desire to share those thoughts openly.

Preparing for the Bottlenecks Meeting

The amount of prepping you need to do for this meeting will be largely dependent on the structure of your previous team meetings. If team meetings are typically led by you as the owner and doctor, and you do most of the talking, you will need to spend more time prepping. You will need to find ways to engage the team. You will need to strategic plan your communication to encourage open communication and brainstorming.

And you will need to be prepared for the sound of crickets when you initially ask for their input because they may not feel comfortable sharing, or they’ve somewhat turned off their creative side because it hasn’t been used or welcomed in the past.

1. Evaluate your ability to allow for the team lead a meeting and get them to openly share ideas.
2. Plan for your opening introduction that may take accountability for not allowing them to express their ideas as much as you could have in the past and how necessary it is to hear all their ideas today to get the most from this meeting
3. The week before the meeting, notify the team when this meeting will take place, letting them know that it’s going to be a very open meeting with a great deal of brainstorming. Share the Key Strategic Objective and ask them to think of all of the potential bottlenecks in the office, and give some examples. Make some of the examples very system driven and some very personal so they know to be thinking about all of the possibilities.
4. Based on your Key Strategic Objectives, come up with your own list of bottlenecks that could be affecting that result. Include in this list any personal distractions that you can be transparent about that may have caused you to lose focus, be negative, or otherwise affect the results. By sharing openly, you will encourage your team to openly share their own personal challenges as well.


Executing the Bottlenecks Meeting

1. Introduction

  • Tell them the importance of the meeting and how it relates to the mission of the office in serving more people
  • Acknowledge any previous role you’ve had as the leader in shutting down their creative ideas and assure them this will be different.
  • Let them know that anyone is able to bring the meeting back to focus if a discussion goes too far where it is no longer focused on the goal.

2. Sharing of ideas

  • Have a whiteboard or flipchart with the Strategic Objective written on the top.
  • Ask if someone wants to start with sharing one of the top items on their list, and if no one volunteers then share one of yours.
  • Allow any conversations to take natural tangents as long as it is still accomplishing the goal of making a positive change to the Strategic Objective.
  • Continue to encourage sharing of ideas around the room until all ideas are on the board.

3. Creating a plan

  • Ask the team to agree on the number one item on the list that will positively move the business toward that objective
  • Continue to rank the items until you have a fully prioritized list.
  • Agree on how many of those items are feasible to tackle at one time.
  • Create an action plan that details the specific items that are going to be implemented and change immediately

4. Reset the Key Strategic Objective

  1. Ask the team, based on all the of possible changes that can be made if this objective is realistic. Too high? Too low?
  2. Get total team “buy-in” on the the new objective (or the current one)
  3. What gets tracked gets changed!
  4. Find the most visible way to track and communicate the progress toward the objective where it is top of mind consciousness for everyone on the team

5. Close the meeting

  • Thank the team for their input and congratulate them for having one of the most open and engaging team meetings yet.
  • End the meeting with encouragement and excitement for the changes that are about to occur and how that will affect the ability of the clinic to impact the community.

Now, you have key actions steps, team buy-in, and excitement towards where the clinic is going. It’s up to you, as the leader, to not lose sight of this objective. It needs to be talked about consistently in every meeting. Changes may need to be made to the action plan but you must stay committed to achieving the objective!

Not Your Ordinary Business … Or is it?

I can’t count the number of times I’ve heard chiropractors say “yeah, but my business is different.” In fact, I think as a profession a majority of clinic owners believe that chiropractic is a different business than most others.

But is that really true?

Is it the business that’s different or is it CHIROPRACTORS that are different?

We are an odd bunch! Consistently, doctors try to run their business with no specific marketing strategy and hope patients will just walk in the door. They have no office systems to ensure a consistent patient experience. And they manage their business by how much is in the checking account when it comes time to pay bills. It’s crazy!

As much as many doctors truly believe that their business is different, ultimately it is an excuse not to change.

A Business is a Business

Businesses are all relatively the same, INCLUDING Chiropractic. There are core components that apply to all businesses whether its a Subway, a car dealership, or a chiropractic clinic.

* Leadership
* Marketing
* Lead Generation
* Lead Conversion
* Client Fulfillment / Success
* Financial Management

If any of those systems break down (or don’t exist at all), your business is going to underperform and not serve the number of people that you would like to serve and ultimately you won’t reap the benefits of owning the business that you should.

Once we determine that a chiropractic clinic, like any other business can, and should, operate like a machine with a series of interconnected systems that all create a consistent result, the next step is creating those systems.

Sounds overwhelming, right?

All of the various moving parts that happen from day to day and week to week and now we are talking about creating a system for each! For certain personality types, that probably sounds exciting. For most, it seems like an insurmountable task that just causes the brain to spin.

Too many books and courses take a very linear approach to systematizing a business. Start with one particular aspect that they suggest and move through them all progressively one at a time.

There’s a better way! To maintain momentum in this process, like anything else, it’s important that we see some results of your hard work or you will lose interest and it will be another one of those projects you told your team you were all excited about and 30 days later its no longer spoken of.

Begin With the End in Mind

The key is to begin with the desired change you intend to create. What would you like to improve about your business? People own businesses for two reasons; to make an impact by solving a problem for other people and to make money that provides for the lifestyle for their family that they desire. If you’re wanting to try to improve some aspect of your business, it likely is not where you want it to be in one of those two areas, or both.

You may have a goal for your practice that you are trying to reach. Let’s call this a Strategic Objective. Some Strategic Objectives for your practice could include any of the following:
* Increase average monthly collections to $60,000/mo for Q4 of this year
* Increase patient visits to 1200/mo for Q4
* Improve percentage of patients reaching their first progress evaluation to 75%
* Reduce Cancellation / No Show percentage to under 6%
* Increase Future Appointments per Active Case to 9

But there are lots of ways to achieve the same goal.  Breaking those goals down into the various parts that contribute to their achievement is going to be necessary so you can focus on one Key Strategic Objective.  We discuss that in Breaking Through Practice Plateaus.   Click HERE to read that post.