From the Ground Up

By Gwyn Herbein

For chiropractic students, thinking about how to build a practice takes up a substantial amount of time. With classes devoted to the planning and implementation process, students have to consider questions such as what city to work in, whether to be a cash- or insurance-based practice, how many employees to hire and whether or not to have an X-ray machine, among other issues. Once new DCs leave the halls of academia and set out on their own, however, they often find that one of the more challenging aspects of setting up a practice is finding the right building. If the perfect physical space does not immediately present itself, some DCs take matters into their own hands … literally. Meet three DCs whose concept of building a practice took on new meaning and gave them a greater sense of purpose in the process.


Robert Steele, D.C.

Montgomery, Ala., native Robert Steele, D.C., did not set out to get into the construction business. His father was a chiropractor who practiced in Georgia, but when Steele graduated from Palmer in 1970, he returned to Montgomery in the hopes of setting up his own practice. He practiced in Montgomery for about a year before he decided that the city had changed too much during the time he had been away at school. “I was looking for a smaller town to move to,” he says. After visiting and talking with people who lived in Lineville, Ala., Steele and his family decided to make the move.


Steele found space in a building also occupied by an insurance company. As the years passed and both businesses grew, they needed more space. When the owner of the insurance company offered to move, Steele took over the rest of the building, which has been altered and expanded as needed. For Steele, finding another building was simply out of the question. “I live in a town of 2,000 people, and buildings are very limited,” he says with a laugh, so “you have to build it yourself.” In addition to the limitations of his location, Steele enjoyed being able to customize his space. “I have a daughter who is a massage therapist,” he explains. “We needed more room, so we went behind the office and doubled the space.” The practice expanded further when Steele’s son-in-law, also a DC, came on board.


While Steele hired contractors to do the build-outs, he says he put together the designs based on his observations of the practice’s needs. “We did things that were necessary for us,” he says, “but I’m not sure if it would be suitable for someone else.” Steele acknowledges that experience in the day-to-day running of a practice often makes it necessary for DCs to shift the vision they have for their practices. “You have a concept of what you think you want when you’re in school, but when you get out and practice, that theory goes out the window,” he says. “You build the way you need to, so the practice runs smoothly. It needs to have a flow to it.” He also notes that one of the many benefits of having hands-on experience with one’s practice space is that you know everything about it, why it is the way it is, how it got that way and where things are. Most importantly, he says, you have to be willing to learn from your mistakes. At the end of the day, says Steele, “You just do what you have to do” for the good of the practice.


Victor Dees, D.C.

For Victor Dees, D.C., Chiropractic seemed a natural career choice given his life trajectory. A native of Queens, N.Y., Dees served in the United States Marine Corps and with the Charlotte Mecklenburg Police Department. He also spent several years as a professional wrestler. “Chiropractic seemed like the logical career path for me since I spent my entire adult life helping others and living the life of a competitive bodybuilder,” he says. “I wanted to be a part of the health care field, but did not like the direction traditional medicine was taking.” After graduating from Life University, Dees set out to do nothing less than change the lives of those in his community. 


With his practice philosophy fully fleshed out (“My practice utilizes a Total Optimal Wellness philosophy where we combine traditional chiropractic wellness paradigms, modern food sensitivity/intolerance testing, weight loss management, nutritional management and fitness management,” says Dees), all that was left was finding the perfect space. He had specific building criteria in mind, such as one that was either stand-alone or a noticeably separate space within another building; was clearly visible from the roadway with plenty of foot and drive-by traffic; had clear outdoor signage; an attentive landlord; and at least 1,500 square feet of space. 


After several months of searching, he found a facility in Roswell, Ga., that met his needs. “The practice was previously a 2,400-square-foot dental office, so I had to redesign the office to meet the needs of a chiropractic office,” he explains. He liked the layout but still had to move the plumbing, gas and water lines. Once that work was done, he was able to personalize the office. “It was necessary to repaint, carpet and tile the entire space to my personal likes,” he says. “I just chose a three-color, vibrant earth tone palette to mimic a sense of natural vitality. I want my practice partners to feel like they are a part of the space and not just in a doctor’s office.” Dees Family Chiropractic opened its doors on Jan. 1.


While he had no formal training in design or construction, Dees found inspiration in offices he had visited and worked in. He credits his vision and a good construction team with the success of the project. “If I can do it, almost anyone with drive and passion can as well,” he says. Of course, like any business, Dees admits he faced challenges around deadlines and budgets during the construction process. He also struggled with some of the logistical aspects of building out his office. “The biggest issue I ran into was the city business rules,” he says. “For example, I didn’t realize that not only do you need a business license, but you need sign permits, fire inspections, occupancy permits, business taxes, etc. These sort of caught me off guard because it varies from city to city.”


Now that the practice is up and running, Dees feels a sense of accomplishment that his vision has come to life. “Even though the growth of a practice is a slow and humbling experience, it makes me feel that I have really accomplished something important and that I am a part of the community,” he says. “[Caring for] patients is an amazing feeling of purpose, but [doing so] in your own space is a higher level of that amazing feeling of purpose. I could literally live in my practice and [care for] people all day and all night if I had to.”


Tim Milano, D.C.

DCs Tim and Kelly Milano have been dreaming about their practice since early in their chiropractic education at Life University. “I wanted to hit the road running when we got out of school,” says Tim Milano. “Especially with all the debt we had incurred, it didn’t seem feasible to work for someone else as an associate.” He got a head start on the process before his 2012 graduation by setting up an LLC, getting a business line of credit and scouting locations with real estate agents in his native Michigan. “We hadn’t even decided what city to live in,” he remembers, but he found a shopping plaza in Howell, Mich., with several available storefronts. “We negotiated a deal where [the building owner] did the build-out, which worked well because they had their own in-house guy,” Milano says.


Milano designed the space using software he found online and gave it to the building’s architects. Much of his inspiration came from offices he had visited, and he also knew he needed an open floorplan in the 2,600-square-foot space. While the Milanos had planned to be open for business in October 2012, once construction was underway, the date had to be pushed. “If I’d found an office that didn’t require build-out, we could have opened in August,” he notes, but Milano describes himself as vision-oriented and passionate, so he knew he was doing the right thing by taking on the project. Restored Life Health Center, PLLC, opened its doors in January 2013.


Despite the challenges, the space is exactly what the Milanos needed to help their vision become reality. “There’s a great sense of pride because I designed this, it has a floorplan that matches my needs and it’s big enough that I have a lot of room for growth,” he says. The open floorplan allows patients to see what is going on around them and to connect with one another as well as with the practitioners. It also has space for lay lectures and community events, another aspect of the practice that the Milanos feel passionate about. For example, they are hosting a local networking group that helps educate people about alternative health practices and in April they will participate in the Great Cloth Diaper Change, an opportunity to set a new Guinness World Record for the most cloth diapers changed in a single day.


Milano admits the learning curve is pretty steep when it comes to operating a practice and dealing with the administrative minutia for which even the best education cannot prepare you—like dealing with insurance companies and handling billing for various vendors—but he and his wife are taking it all in stride. “We know we’re in this for the long run; you have to juggle all the plates,” he says. “You’re always going to have challenges.” The Milanos are sure that having the right space in which to practice will keep them moving forward for years to come.