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And The Inside’s Bigger Than The Outside

And The Inside’s Bigger Than The Outside

How To Double Your Practice And Work Half As Hard

by Dr. Noel G. Lloyd

The title doesn’t really make sense, does it? How can the inside of anything be bigger than the outside? On the face of it, it’s hard to understand, maybe impossible, but nowhere near as hard to comprehend as the difference between Dr. X and Dr. Y.

Dr. X works like a dog every day, runs late for every patient, can never come to the phone during office hours, and never catches up. He leaves the clinic an hour late every night, exhausted, and as he looks for the energy to get out of the car once he’s home, he wonders how he can keep this up for another week, let alone another decade or two.

Dr. Y, on the other hand, sees his practice almost as recreation. He would tell you he works at it, but it’s more fun than work, seeing so many of his patients get better. He takes calls during the day, wonders where the time went at 6:00 PM, races and beats his last patient to his car. He has dinner with his family and enjoys life.

Now here’s the mystery: Dr. X sees 60 visits a week and Dr. Y sees 345 visits a week. The busy doctor who sees over 5 times the patients scarcely knows he’s working, while the doctor who sees fewer patients in a week than our busy doctor sees in a day struggles terribly.

At this point in the article, every management consultant is nodding, then shaking his head. Since consulting began, we’ve all run into these same 2 doctors. Dr. X is miserable and Dr. Y is having the time of his life. Ah, but it gets better and worse, depending on whose practice yours looks like. The patients in Dr. Y’s practice typically have more fun, refer more patients and are generally more satisfied with their care. That’s right, the one who works harder is appreciated less. Not fair, is it?

This mysterious contrast begs the question, “Why?” It even screams, “How can this be?” After all, a chiropractic practice is not a complex operation and, other than techniques that vary greatly, there isn’t much that can be so different from practice to practice as to explain this huge difference.

Dr. X may think that Dr. Y is a superhuman specimen or an unscrupulous villain running people through like cattle. Dr. Y being a villain may be preferable to thinking that Dr. Y is just that much better than Dr. X is. The fact is, none of these explanations are correct. The correct reason is painfully simple and well-illustrated with the following story.

My son Chris has a combination lock on his mountain bike. I don’t know the combination so I can’t open it to ride his bike. Chris, on the other hand, memorized the combination, can open it easily and rides to his heart’s content. Much like that, Dr. X doesn’t know the combination (the right action steps in sequence) to a smoothly running chiropractic practice and hasn’t been able to unlock his practice. Picture Dr. X carrying his locked mountain bike down the trail being passed by a coasting, and smiling, Dr. Y and you start to see what I mean.

I have seen some doctors who typically see smaller patient volume work vacation relief for a busy doctor and it may be like they are riding someone else’s bike. It can be quite a thrill! “Look at this thing go!” It can also be a trip over the handlebars if they don’t know what they’re doing, but as sure as I breathe, any doctor can learn to run a high volume, low stress practice almost as easily as you learn to use a combination lock.

Here’s another example: Picture the University of Washington Husky Marching Band. I live close to University Stadium and I’ve seen some excellent half-time shows. Every brightly uniformed member knows exactly where they should be, what dance step to be doing and what note to be playing at all times. It’s a study in precision. Of course, those shows just happen magically, just putting themselves together, right? Wrong. Living close to the stadium, I see the lights burning late, months ahead of the first football game and I hear the music, too. Boy, do I hear the music. The same songs over and over and over again, until everyone gets it right. It’s called practice.

Contrast the marching band halftime show with a South American soccer stadium stampede. Extreme example? Some practices I’ve seen have the same levels of panic and disorganization. What the Huskies have done is planned out a show and practiced it until they got it right, leaving nothing to chance. Uniforms, music, timing, positioning, the whole nine yards.

The examples are almost infinite. Take ballroom dancing, a Broadway musical or Tiger Woods. Tiger practices a combination of mental and physical steps to the point that when he swings the club, it’s not only automatic but close to perfect.

“All right,” you say. “My bike is locked up, my marching band needs help and I can’t hit the ball worth a damn. What do I do?”

First, get rid of the “Natural.” You know the guy or girl who has “the gift.” Most so called “Naturals” have explanations behind their success that I call “the rest of the story.” Remember, Mark McGwire, even with those arms, still spends hours in the batting cage with a great coach who watches his every move.

Second, visualize what you want. Maybe you want twice the volume at half the work; add to that an enjoyable practice day run on time with you home before dark. Don’t worry that it may seem impossible; it isn’t unless you believe it is. I actually saw 2000 visits in one week and I wasn’t even in the country, but that’s another story.

Go on to imagine and visualize that your patients understand your chiropractic purpose. Picture each patient knowing his or her job (yes, they do have job descriptions and patients, like staff, are happiest when they’re properly trained) and what a chiropractic adjustment is really all about. Imagine further that they know that the whole process of getting checked and adjusted is simple and sequential.

For some help in getting this into focus, visualize adjusting your spouse or significant other. Easy, isn’t it? And it takes less than 2 minutes. That’s what your entire day can be like. Interested? Some teach that visualization is all you need to do. You know it isn’t, so go on to the next principle.

There is a right way and a wrong way to do almost everything. “What the hell do you want?” is the wrong way to answer the phone. “Sound Chiropractic Center, Joy speaking. I can help you!” is at least one right way. The great news is that for everything that should be done in your practice, there’s at least one right way to do it. It’s hard to believe, but going from an awkward, slow practice to a smooth, fast practice is putting several dozen of these “best ways” end to end.

You improve on your practice this way already, but probably not as part of an overall plan. Let me illustrate. Have you ever heard something used for patient education that you thought was terribly clever? You remembered it, used it and your patients responded well. It lowered your stress, made practice easier and your patients liked it. That’s the “right way” that we are talking about. Principle number 2 is even better.

Someone wrote down the right way and will teach you. That’s what practice management consultants do. They develop effective, efficient and personal practice protocols and they teach chiropractors. It’s illustration time again. Remember adjusting your spouse? How would you like it if every patient was as low stress to adjust as your spouse? They put themselves back into treatment rooms. They’ve even marked their own charts for subjective improvement, positioned themselves on the table (just the way you wanted them to be) and waited to be adjusted. After their adjustment they quickly headed for the IST table, self-administrated their own therapy, then took themselves up to the front desk. I have trained thousands of my own patients to do just that. I’ve also trained over a thousand chiropractors to train their patients to do the same thing. Do you see it? Your practice is your marching band. Your assistants and patients need to be trained to work together with you to produce a great “show.” It is a thing of beauty to watch a wonderfully trained practice operate during a busy hour. It’s like a Swiss watch.

Does this become robotic? Not at all, once you make up your mind about what to do, train for it with a good coach and know it cold; you are free to be warm and personal while being very effective and efficient. A great actor never looks like he’s acting. Even though Shakespeare doesn’t change, a great actor makes it look spontaneous. The real fun for the actor is the interaction with a great script and that night’s audience. In a chiropractic practice, the real fun for the trained doctor and staff is the interaction with chiropractic and that day’s patients.

Your first assignment. Dust off your old consulting notes. If you don’t have a practice coach, get one. Then take a look at your New Patient Day One procedure. It’s usually the visit that produces the most work and is always the best place to start training the doctor, staff and patients.

Tell your staff that you will role play the first day for a new patient. Pass out the CA scripts for making the appointment, greeting and handling the patient. You take the doctor’s section on Day One. These are your scripts. Learn ’em! In a play you start rehearsal by just reading through the material. It’s even called a “read through.”

In the read through you’ll visualize how the individual parts fit together and how smooth and effortless it is. You can even have your spouse play the patient and you, as the director, watch the way they are handled on the phone and greeted. Make notes and give feedback to your CA. Typically your direction will be appreciated. Remember, one of the things that staff members appreciate most are training and feedback.

Now it’s time for your part. For best results, go through the doctor’s portion of the Day One scripts without changing a word of the presentation. Don’t mind that it doesn’t “feel like you.” It just feels a little foreign, like a new dance step. Practice it for a while and see how much easier things are. You will never experience the best effect your consultant can have if you change the scripts. Ask your staff and spouse to critique you after your part. As you improve over time, you will see how easy it is when you know what to say, how to say it and are prepared for each variation, because you have practiced it. As you progress, giving an hour a week to rehearsal, you move on to the report of findings appointment and re-examination and re-report appointments.

What you will see is a melting of the stress you used to feel. After you and your staff know the scripts cold, go for a shorter time. In my clinic system we regularly practice what we already know and do well, measuring for time and personal interaction.

Final thought: You’re going to be a chiropractor for at least another decade, maybe another four decades. Open the combination lock and ride!

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