Why High-Volume Chiropractic Clinics Feel Chaotic (and How to Fix It with Patient Training Systems)

 Welcome back to the Deep Dive, and today we are zooming in on a really specific, I mean a high stakes world. Mm-hmm. The world of the high volume chiropractic clinic.

It’s a unique ecosystem, isn’t it? Yeah. It has its own, like its own physics. Its own pressures. It really does. Mm-hmm. And to frame this up, we’re calling this the Chiropractic Deep Dive. It’s a dedicated segment of the Successful Chiro Podcast. So if you’re a clinic owner or an associate grinding it out, or a ca running the front desk Exactly.

This is, uh, built specifically for you. And we should mention, we’re exploring this with a specific guide. This deep dive is brought to you by Five Star Management, right? And if you’ve been in the profession for what, more than five minutes, you know that name? Oh yeah. They’re the premier consulting firm for chiropractors.

So you know, as we go through this, we’re looking at it from that insider perspective. We’re not on the outside looking in. We’re part of the Five Star family, which is really the only way to understand the source material we have today. Right. We’re not looking at a book or some article. No. We are analyzing a private Zoom mastermind call, and it was led by the founder of Five Star himself, Dr.

Noel Lloyd, and that’s what makes this so fascinating to me. Masterminds are, they’re behind closed doors. That’s where the real talk happens. Yeah. You don’t get the polished PR version. You get the, okay, here’s what’s actually broken and here’s how we fix it. Precisely. And the room, this virtual room, it was filled with high performing doctors, their teams.

But um, even with all that success. The topic was one that just plagues everyone. Chaos. Chaos. Uhhuh caused by what Dr. Lloyd says is a very specific variable. The patient, or more accurately the untrained patient. Oh, okay. The core idea he lays out is that in so many practices, the patients are basically running the asylum, they’re running the show.

They dictate the flow, the timing, and because of that. The doctor is constantly fighting this losing battle against, uh, friction. That just sounds exhausting. I mean, it sounds like a recipe for hating your job. It leads to burnout. 100%. Yeah. So our mission today is to unpack the system. Dr. Lloyd teaches to flip that whole dynamic, okay.

How do you take that chaotic, stressful environment where you’re always running behind and turn it into what he calls a silky smooth operation? Silky smooth. I like that. That’s the goal. Okay, so let’s get into this Mastermind call. How does he kick it off? Because he doesn’t just jump into the problem. He starts with mindset.

He does, and this is I think, a huge differentiator for five star clinics. He starts with wins, wins. He asks the participants, the doctors, the cas to share their victories. And I don’t mean, you know, I found a great parking spot. I mean hard irrefutable metrics. I was looking at the numbers in our notes. I mean, they’re staggering.

They really are. One practice shared a record collection month. We’re talking over $75,000 for a single doctor. Yeah, in one month. In one month. Yeah. Another one shared a volume record. 394 adjustments in a single week, nearly 400. Wow. I mean, just the math on that. Yeah. The efficiency you need to handle that kind of volume without burning out is just immense.

Well, that’s the point. You can’t do that if you’re arguing with people about taking their coats off, you absolutely cannot hit those numbers. If you have chaos, but Dr. Lloyd, he uses these wins to anchor a specific philosophy. He drops this quote right at the top. What’s the quote? If what you think makes no difference in what you do, it makes no difference what you think.

Okay. That’s a bit of a brain twister. Break that down. It’s all about the gap between theory and what you actually do. You can know all the practice management theory in the world, but if that knowledge doesn’t translate into action, into what you do with your hands, your words in the clinic, it’s worthless.

It’s just noise. So it’s the difference between reading a book on how to play tennis and actually, you know, hitting the ball. That is the exact analogy Dr. Lloyd uses. He talks about pro tennis players. When a pro is on the court, ball’s coming at ’em a hundred miles an hour. They’re not thinking, okay, feet shoulder width apart, rotate my hips.

No way. If you have to think about it, the ball’s already passed you. You lost. Exactly. They drill that movement until it’s subconscious. It’s just muscle memory. And Dr. Lloyd argues that a chiropractor needs to template and format their office procedures the same way. So when a patient does something, the response isn’t, it’s not a creative writing exercise every time.

It should be a reflex, which makes sense for efficiency, but it also just sounds like it saves a ton of mental energy. Decision fatigue is a real thing. It’s huge. And you know, one of the participants on the call, they pointed out another benefit to this. Templating idea. They said their biggest win was just getting everything in writing.

Why was that the biggest win? Well, think about it. Personnel risk. If you have one rockstar ca, we’ll call her Sarah and Sarah knows everything, but it’s all in her head. What happens when Sarah moves away? The practice falls into a crater. It just grinds to a halt. It implodes. But if the system is written down, if it’s templated, the system survives the person.

It protects the asset. Okay, so we have the mindset: template everything. Drill it like a tennis pro. Now let’s get to the villain of our story. The untrained patient, Dr. Lloyd paints this picture that I think is gonna trigger some PTSD for our listener. Oh, it’s a scene every doctor knows. You walk into the adjustment room, you’re ready to go, you’re on schedule, but the patient is not.

Describe the scene. The patient is still standing up. They’ve got their heavy winter coat on a hat. Maybe they’re uh, digging through their purse or worse on their phone, scrolling on their phone, completely oblivious that you even walked in, and the doctor’s just standing there watching the clock tick. It’s a disaster for flow.

Dr. Lloyd points out if you have to wait 90 seconds for every patient to get ready. And you see, say 40 or 50 patients a day. You just lost an hour of your life. You lost an hour. But is it just about time? Because I can hear people saying, well, I wanna be patient centered. Right. Is there a clinical issue here too?

That’s the deeper layer, and he hits this hard. A patient who is checking email or standing in heavy coat is not ready to be adjusted. Their muscles are cold. Their nervous system is probably in a sympathetic state fight or flight. So you’re basically trying to adjust. A brick wall. You got it. Yep. You cannot deliver a quality adjustment to a tense, distracted spine.

So the directive is to reframe that relationship. Dr. Lloyd says you have to view the patient almost like a new employee. You have to onboard them. I love that term. Onboard them. Yeah. It implies they have a job to do. They do. Their job is to be a good patient. Yes. And if they don’t know how to do it, it’s not their fault.

It’s the doctor’s fault for not training them. Okay, so what does this training curriculum look like? Because the Mastermind went into a lot of detail. It’s not just bucking orders on day one. No, no. That would be totally off-putting. It breaks down into two distinct phases. Phase one is the guest phase. The guest phase, days one and two, right? Days, one and two.

And you treat them like royalty, like a guest in your home. You don’t ask a guest to find the bathroom. You show them. You do everything for them. You’re building that rapport, showing them it’s a safe, caring place. Exactly. You’re making deposits into the emotional bank account. Yeah, because on day three you’re gonna make a withdrawal.

Day three, the pivot point in the five star system, this is the routing visit. This was the training wheels come off. The staff explicitly teaches the patient how to fish for themselves. How do they do that without it feeling jarring? Like, okay, fun time’s over, get to work. It’s all about clear communication.

And one of those effective tactics they shared on the call was the use of visual aids, specifically this thing called the purple card. Just a purple card. Okay. Tell me about this. It is brilliant in its simplicity. Mm. So one clinic. Hangs a laminated purple card in every single treatment room. Okay, on day three, the staff just tells the patient, from now on when you come into this room, your job is to read the purple card and follow the instructions before the doctor arrives.

Huh? It outsources the authority to the card. It’s not the staff nagging. It’s just the procedure. What’s on the list? So what’s on the list? It’s a readiness checklist. Yeah. Number one, empty your pockets. And one participant had a great script for this. They don’t just say empty pockets, they say remove anything that will poke or break.

That’s smart. Nobody wants a key fob jamming into them during an adjustment. Exactly. Or a smartphone screen cracking. Take off the belt. Take off glasses. There’s a really specific one that came up that, uh, made me laugh, but it’s a real issue. Stilettos. Oh, the footwear. Yes. Dr. Lloyd told a story a period when stiletto heels came back in fashion.

Within one month, he had three distinct puncture holes in his vinyl adjustment tables. Wow. That is an expensive fashion statement. It is. Unless you tell ’em. They just don’t know. They’re not trying to destroy your equipment. They’re just untrained. Okay, so the purple card handles clothing. What about positioning?

That’s the most important item on the card. Lie face down immediately. Immediately. Not when you hear the doctor knock. Right, and this goes back to the physiology. Dr. Lloyd explains that when a patient lies face down for just two or three minutes. Gravity starts to do the work. The muscles relax. The patient transitions outta that rush, rush mentality.

So by the time your hands touch their spine, the tissue is actually receptive precisely. It makes the adjustment easier on the doctor, more effective for the patient win-win. But to get them to do that, you have to eliminate the biggest competitor for their attention. Let me guess, the smartphone. A glowing rectangle of distraction.

This is a huge topic. The phone is the enemy of the silky smooth practice. It’s almost an addiction, isn’t it? People can’t stand three minutes of just waiting and one clinic shared a strategy for this that I thought was just a hilarious, but also kind of genius, the wifi strategy. I’m listening. They simply do not give out the wifi password to patients.

Access. Denied. Denied, and if the cell reception just happens to be bad in the building. All the better. It forces the patient to disconnect. It stops them from lingering, it keeps the flow moving. Sometimes the best tech solution is no tech. Okay, so we’ve got the patient prepped, they’ve read the purple card.

Now the doctor walks in right now we move to the interaction, and Dr. Lloyd is very clear. You can’t just be a robot. You have to explain the why, the what’s in it for me. Exactly. You don’t just say lie down, you say, I need you to lie down so your muscles can relax. This helps me give you a better adjustment.

You link their compliance to their benefit. That makes perfect sense. What about the adjustment itself? I mean, for a new patient that pop can be surprising. Yeah. So the group shared some fantastic scripts for framing that you normalize it before it happens. One participant used the phrase, I’m gonna go dancing with you.

That’s nice. It implies partnership movement takes the clinical edge off. Another one uses a great analogy for any soreness. Afterward they say it’s like cleaning out a cut. It might sting a little at first, but that means we’re cleaning it out so it can heal properly, which manages expectations beautifully so they don’t call the next day freaking out.

But my absolute favorite script was a tool for, uh, what I call verbal crowd control. The chatterbox patients. The chatterbox, yes. Mm. They wanna talk about the weather, their grandkids, their vacation. And meanwhile, you’ve got three other rooms waiting and the schedule is just slipping away. Right? You don’t wanna be rude.

So Dr. Lloyd suggests this line, it’s polite, but firm. You put your hands on the patient and you say, I wanna concentrate as I adjust you. Oh, that is good. You can’t argue with that. If you keep talking, you’re basically saying, I don’t want you to concentrate on my health. It shuts down the cheddar instantly.

Yeah, but it makes the patient feel special. Oh, the doctor’s focusing really hard on me. It’s brilliant. And then when the adjustment’s done, you seal it. You always, always say. Great adjustment. You validate the experience. It’s landing the plane. Okay, so there’s one more piece of communication I wanna touch on, and that’s the long-term view.

How do we keep patients on board for the whole plan? Right? This is the four phases of care, conversation, relief, correction, strengthening and maintenance. And the group talked about how vital it is to educate the patient that pain relief is just the first stop. It’s not the destination. There was a script for the chronic pain patient, the person with a bad back for 10 years that I thought was so powerful.

The last episode script. Yes. How does that go? You just look that patient right in the eye and you say, we want to make this episode your last episode. That’s a total game changer. It moves the goalpost from make it stop hurting for now to let’s fix this problem for good and that justifies the whole plan the time.

The money. It’s a masterclass in communication. Okay. So we have the systems, we have the purple card, the scripts, but we’re dealing with human beings and humans are notoriously resistant to rules. Exactly. Even with the best onboarding, people slide back into bad habits. So what happens when a patient falls off the wagon?

The group had a systematic answer for this too. It’s called recoding. Sounds like computer programming. It basically is you go into their file in the computer. And you change their status back to day three. You’re rebooting the patient, you reboot them. The next time they check in, the system alerts the staff, and the staff treats them exactly like it’s their routing visit all over again.

So it’s a gentle corrective nudge. Mm-hmm. Not personal, just procedure, but any, sometimes gentle doesn’t work. And then Dr. Lloyd shared a story about what I’d call the nuclear option. For the patient who really isn’t getting it. This was the story about the teenager, right? The 16-year-old girl. Yeah. So Dr.

Lloyd walks into the room. This young patient is supposed to be face down doing her warmup exercises. Instead, she’s sitting up on the table, legs swinging. Playing on her phone classic, right. Now, most doctors would get annoyed. They might snap, Hey, put the phone away. But that just creates a power struggle, and you never wanna get into a power struggle with a teenager.

You will lose. You’ll lose every time. So, Dr. Lloyd didn’t say a word about the phone. He just stopped, looked at her and said, oh, I see you aren’t ready yet. I’ll come back. And then what? He walked out, closed the door, went to see other patients. He just left her there. That takes some guts. It does. A few minutes later he came back.

She still wasn’t ready. She’s sitting there maybe thought he was loving. He just opened the door, oh, take your time and left again. Wow. So he really committed. He did. The third time he came back. She was face down phone in the bag doing the exercises, no yelling required. No yelling, no lecture. It’s what one participant called My Way or the highway, but delivered with absolute grace.

It establishes who the captain of the ship is, and really that’s the theme of this whole deep dive being the captain. Yes, Dr. Lloyd summarizes the whole call with this. The doctor has to listen with owner ears. You cannot let patients run the practice. If you do, you get chaos if you lead them, if you onboard them.

You get that silky smooth flow, it all comes back to that opening idea. If you don’t have a system, the default is chaos. Entropy is real. And in a high volume office, chaos isn’t just annoying, it’s the enemy of healing. It is. And honestly, it’s the enemy of the doctor’s longevity in the profession. So what does this all mean for our listener if they’re driving to the clinic right now, maybe gripping the wheel a little tight, thinking about their day.

What’s the big takeaway? I think the provocative thought to leave with is a question about energy. If you are feeling exhausted at the end of your day, you need to audit that exhaustion. Okay? Ask yourself, are you exhausted because you performed a high volume of necessary work, or are you exhausted because you were mentally fighting your patients the whole time?

Oof. That’s a real question. Are you worn out from the adjustments or from the friction of untrained people in your space? ’cause the volume. The volume isn’t what kills you, it’s the resistance. If every patient is a tiny battle, you will burn out. But if they’re trained to flow, you can see 80 people and feel energized.

That is a huge insight. If you’re fighting for every single adjustment, you are just doing it the hard way, the absolute hard way. Well, this has been an incredible look into the systems of a top tier practice. It’s not just about, you know, being bossy. It’s about creating an environment where healing can actually happen efficiently.

Yeah. And consistently. Now, as we sit at the top, this wisdom comes straight from the source. And if you’re listening to this and thinking, I need this kind of structure in my practice, we have a direct line for you. We do Dr. Noel Lloyd and his whole team at Five Star Management.

They’re the best in the business at fixing these kinds of problems. They have the templates, they have the scripts. They’ve done it a thousand times. So in the show notes, we have a link to book a free call with Dr. George Birnbach.

And Dr. Birnbach is a legend in this space. If you get a chance to speak with him, you should take it. He can diagnose your practice flow in about 10 minutes flat. Absolutely. So click that link book the free call. It could change the whole trajectory of your year, but we’ve got one more major opportunity, specifically if new patients is your bottleneck.

This is the big one. Five Star Management is hosting a live two day event. It’s in Chicago, Illinois, and it’s called Too Many New Patients. The title says it all, doesn’t it? It’s all about the marketing and the conversion systems to get a flood of new patients in the door, fast. So if your problem isn’t flow, but it’s empty tables, this is where you need to be Uhhuh.

The link for that event is also right there in the show notes. Chicago two days be there. It is so worth the trip. I mean, the networking alone with other high performing docs is worth the ticket. Absolutely. And finally, if you enjoy this specific deep dive, this look behind the curtain of practice management and you want more insider tips, please hit that subscribe button.

We have plenty more coming your way. Always more to learn. Thanks for listening, everyone. Go template those procedures. Get your purple cards ready, and we will see you on the next deep dive. See you then.