Died and Gone to Heaven, Or Just Plain Dead?
By Dr. Noel G. Lloyd
Two signs in the window, the first read “Family Chiropractic Center” and the second, “Now For Lease: Call Ace Commercial Real Estate Brokerage.” Just a quick look in the window told the story: great colors, nice new carpet, fresh paint, interesting design detail in the front desk C.A. 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 it.
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 that doctor him/herself.
Try on these shoes: After spending $150K 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 that sucks.” Ouch.
I’m so compelled by sympathy for chiropractors who are too close to the same fate that I have to say, and 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, then made 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 the capitalist economy we have in the US, the vast majority of health care is provided by private businesses. These private businesses, or practices, have to make a profit in order to survive. In chiropractic that is even more so.
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 that profits fund.
You know, 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 hand 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: the principle “only the strong survive” is true in spades in the US where 4 of 5 non-formatted businesses (we’ll discuss formatted vs. non-formatted) die within five years. Lack of profit is always on the death certificate, and that’s right, 80% die.
What did the 20% do to succeed, you ask? 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:
1. 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?
2. Never give up. After honesty, determination is worth 10 times any other attribute you can name.
3. 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:
A. Marketing: Everything else can be wrong and if you are producing lots of new patients, you will make it. Everything else can be right and if you are producing too few new patients, you will fail. This is hard for some, but chiropractic is sales and chiropractors are salespeople. The facts are that every business is sales and everyone on the planet is a salesperson. Husbands sell to wives, wives to husbands. Professors sell to students, students to professors.
You get it. Anyone who has an opinion is a salesperson. Decide to like it and to be very good at it. The sale doesn’t end when someone becomes a patient, or when they choose 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; fear of rejection trying to hide behind a title or degree. If you can get over that you will succeed. If you can’t, that may be your office in the first paragraph.
B. Management: You have three management challenges. Let’s discuss the toughest first: it’s 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. Second, 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; however, C.A.s, properly trained and cared for, are the most consistent good in any chiropractic practice, and that includes the chiropractor. Third, 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, 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 2 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. Some good news: just a few hours a week can make this a living reality.
C. 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? Practice, practice, practice. The essence of operations. However, less than 1% of all chiropractors actually practice their practice off the “playing field.” Ask Tiger Woods and Mark McGwire about practice./
D. 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 $100K in debt to school loans, but be frugal. Start your practice with used furniture, used equipment and small office space. Maybe you will rent space with an established D.C. who has all that already. Remember that no one ever chose and stayed with a chiropractor because of the new office chairs. After you start making money, get out of debt as fast as you can and especially before you buy that boat.
All right, you got the wake up call. What do we do now, you ask? Three things: first, believe. 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. Second, 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. Third, 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.”