Master Your Practice
Your ultiimate guide to starting a practice and building success
By Dennis Perman, D.C.
If you are a new practitioner, there are some time-tested tools and techniques
you can use to create the practice and lifestyle you really want. But in addition
to having these tools you’ll need to be willing to invest the time, energy
and capital required to make your dream reality.
Here’s your primer to bridging the transition between student and doctor
and opening, managing and building your practice.
Visualize Success and Take Action
Dream practices don’t just fall out of the sky. They are the result of
clear vision, diligent effort and significant resiliency. You can win this game
if you are willing to pay the price—in establishing motivating, yet believable
outcomes, planning effectively and taking the necessary action big goals require.
No matter what style of practice you prefer, the first step is to envision your
ideal practice, so you have clarity regarding your intended outcome. Give your
mind a target to aim for, and fortify this vision with rich detail. This kind
of multi-sensory visualization is more than just embellishment—it motivates
you to pursue the objective and closes your mental gaps between student thinking
and doctor thinking. Seeing yourself working and managing your ideal practice
is empowering, stimulating and, according to most philosophy scholars, a source
of attraction that helps to manifest your goals. Whether you’ve had experience
with this phenomenon or not, setting your mind on what you want is a necessary
first step.
Use this vision as leverage to raise your personal and professional standards.
In order to have the practice you want, you’ll have to take action and
establish a certain identity to execute the tasks to create your dream. This
means taking on the behaviors of a successful D.C.—increase the perceived
value of timeliness, neatness and self-discipline. Work on yourself diligently,
and in time you’ll experience an increase in confidence, enthusiasm and
attention to detail. Be sure your grooming and physical appearance matches up
to the image you want to portray. Remember that before people buy your message,
they’ll have to be able to buy you as a messenger. You’re sculpting
an identity for yourself that people will evaluate before they have a chance
to get to know you. You can improve your chances by selecting an identity that
is consistent with the clientele you wish to serve. Self-development is a critical
inner secret to success, so don’t underestimate its power and value.
Tools that may come in handy include affirmation, visualization, exercise, prayer,
meditation, breathing, creative hobbies, communing with nature, anchoring, resource
building, reading books and listening to CDs and so on. Construct a morning
routine that sets aside 20 minutes to an hour to prepare yourself for your day
and focus on building your vision. Awaken with a smile, stretch, say an affirmation
filled with self esteem and positive expectancy, do some breathing, listen to
something motivational or spiritual, and you’ll be raring to go. And,
when you hit a speed bump along the way, you’ll have the momentum to get
through it.
Getting Started
Once your vision is crystallized and you’ve begun a routine of personal
growth and development, it’s time for you to get started. Write a description
of your ideal practice, based on how you see yourself as a chiropractor, the
image of other successful practices you’ve visited, and how you see your
best case scenario for a rewarding practice and a fulfilling career. Define
your practice philosophy, the way you express your identity through your practice.
What practice format will you start with? Are you entrepreneurial, and ready
to start your own practice solo? Or do you want a partner to share the work,
the expenses and the profits? Would you prefer to rent space in an established
office as an independent contractor, or do you feel you need more seasoning
as an associate doctor, employed by another doctor to help in an established
practice? Or would you be interested in becoming a coverage doctor for a while,
to gain experience in a variety of different practice settings, to solidify
your own thinking before you build your own practice? All have their merits,
and you’ll have to decide which configuration suits you best.
Begin to determine your location—do you want a city practice, a suburban
practice or a rural practice? What climate? What socio-economics? Define a 30-minute
radius around your preferred location, to narrow down the landscape.
Now, consider the type of building you’d like for your practice. Do you
want a storefront clinic, a home office, a suite in a professional building
or an office condo? Do you prefer a free standing building or being a part of
a larger structure? What rooms will you need in your office flow—reception
room, business area, adjusting rooms, examination and X-ray rooms, doctor’s
office, bathrooms, storage, educational areas, therapy, rehab or massage areas.
Don’t forget to consider the size of your practice. You’ll nee to
have an idea of how many patients you’ll be treating when configuring
your office layout and location.
Putting a professional team together early on is another little known secret
of success. While it may require a bit of an investment at a time when money
is tight, having advisors you trust will save you in the long run. You need
an accountant, an attorney, an insurance advisor, a financial advisor and a
practice consultant/coach. Based on the enormous investment you’ve made
in your education, and the one you will soon make in your office, you need to
have expert opinions to streamline the process and save valuable resources.
Consider the dynamics of profitability—you must earn and collect more
than it costs you to practice, enough so that your profit is at least sufficient
for you to prosper. To achieve this you need to attract the right number of
the right kind of new patients. These are clients that receive full value from
your services and you also get full value from them. You’ll also need
a fee structure and collections policy that is fair and reasonable for the patient,
and also compensates you appropriately. Therefore, you can increase your profitability
three ways—by getting more new patients, by increasing the value and cost
of your average office visit, or by increasing the number of visits the patient
makes, consistent with your model of patient compliance.
Opening a Practice
Make your final decisions on practice format, location, building type, office
flow, volume, professional team and the proposed dynamics of profitability—create
a project notebook or folder that contains all your collected information.
Let your advisors help you decide which business formulas are in your best interest—owning
or renting space? Percentage or flat rental for an independent contractor? What
salary should a new associate expect? Do you need to raise capital to get started,
or can you tap personal or family resources? Do you have a floor plan that encourages
the office flow you desire? Use your professional team and their referrals to
write your plan and prepare to take action.
If you’re associating, have a superb attitude of enthusiasm, coachability
and trustworthiness. If you are renting space as an independent contractor,
make a deal only after you’ve crunched the numbers. A flat rate rental
must be fair, perhaps ramping up from a lower number for the first few months
to a higher number later on. If it’s a percentage deal, in those states
that allow it (check your local laws), figure out your cost not only at smaller
volumes in the beginning, but at larger volumes months and years down the road.
If you’re opening your own practice, solo or partnership, you’ll
need to sign a lease or buy your office, buy or lease equipment and furniture,
start an inventory of office and clinical supplies, and hire and train your
staff. Your practice management consultant/coach will be instrumental in this
process, as will the rest of your professional team.
If you need to do construction in a rented space, as you usually will, you can
negotiate with the owner to pay for the build-out and include the expense as
additional rent—or, you can cut a deal on who pays for what, without affecting
the rent. Don’t rely on only the comments of interior decorators, who
understand design and aesthetics, but not necessarily office flow.
Consult a reputable firm to purchase or lease equipment and furniture. Ask the
salesperson explain all costs and details of delivery, so you have everything
you need when you’re ready to open. Choose your office computers and software
carefully, so you are prepared to run an efficient office.
Office Procedures and Policies
Plan your office procedures and policies in advance, so you can buy or print
the forms you need. Get a multi-column appointment book, leaving room not only
for office visit appointments, but for new patients, report of findings, and
re-examinations, so you can clearly see the structure of your office day. If
you plan on taking credit cards, as most of you should, shop around to get a
good deal on the equipment and the service from the bank.
It’s best for you to hire a chiropractic assistant from the day you open.
It’s more professional to have someone answering the phone, making appointments
and taking money, while you focus on things only you can do. Train your staff
not only on office procedure and policy, but in people skills, courtesy, neatness
and timeliness, and wellness principles, so they also represent good examples
of the chiropractic lifestyle. Plan to have your new CA become a patient, and
you are taking strides toward creating an agent and ally in the marketplace.
Often, it’s better to wait on your gala office opening until you have
built up a bit of public awareness and some clientele. Either way, plan to send
invitations to local officials, as well as your intended constituency in your
neighborhood, and use the media to invite people to your opening, with refreshments,
entertainment and health information to be distributed. Get a photographer to
memorialize the scene, and see if you can get your local paper to print a news
release and picture of your opening.
Running A Practice
Once your practice is open, you must learn to run it properly. In The “E-Myth”
series, Michael Gerber talks about the technician, the manager and the entrepreneur,
three roles the business owner must fill, either personally, as it usually starts
out, or by delegating some tasks to others. In the context of a chiropractic
practice, the technician performs the clinical duties, the manager handles the
administration of the business, and the entrepreneur sets the vision and the
course toward that vision. In many practices, the sole practitioner plays all
three roles, and when they are not in proper balance, that compromises the practice
and makes it more difficult to expand and grow.
So, you must prepare your practice for growth and success by implementing standardized
systems and empowering employees to work the systems effectively. Installing
procedures for new patient processing, patient education, money management,
marketing and new patient acquisition, and research and development are keys
to running a successful practice.
Establishing enforceable policies that guide your patients toward compliance
and minimize stress for all are desirable, so when you come across a situation
that you don’t have a system to handle, write it down and seek support
from your professional team.
Working With Your Staff
Delegate effectively to your staff—clearly define job descriptions and
create “position contracts” that hold you and your staff accountable
for certain tasks and territories. Think in terms of having some of the technician
tasks performed by someone other than you, even if you can’t do it right
away. You’ll do better if you clear your schedule to do the things only
you can do, but no chore in the office is beneath you—it all has to get
done, you just want to maneuver into position so you can spend more time as
an entrepreneur, with confidence in your team to handle the technician and managerial
responsibilities, with you overseeing and guiding. Once again, this often isn’t
possible in the beginning, but if you aim at it, and take the steps to move
in that direction you’ll get there.
To facilitate this process, get into the habit of having regular staff meetings—a
weekly meeting to discuss office business, pool resources, identify problems
and challenges, reconnect as a team and set goals. Hold a general meeting early
in the week, individual meetings with each team member for training, appreciation
and accountability, and a brief huddle before each shift, to get on the same
page and address your shift with enthusiasm, focus and love. Your team is an
extension of you, and they must feel empowered to carry out your procedures
and policies smoothly and professionally.
Fee Integrity
Create a fee structure that represents your sense of the value of your care.
Organize the services you choose to provide, and create your policies to fit
your style, whether direct pay, third party pay or a mixture. Fee integrity
is an essential ingredient of prosperity consciousness, so select a fee structure
that is fair to both your patients and yourself. Pick a fee that you can use
for both insurance and direct pay patients—ethically, your service is
worth a certain value, and whether or not the patient has insurance coverage,
that should be the fee. Don’t fall into the trap of over-billing third
parties and cutting your fee for cash patients—not only is it illegal
in many places, but it creates a vibration of lack and insincerity that will
only hurt your attraction.
Patient Compliance Systems
Create patient compliance systems that mold and shape your patients toward your
ideal. Your patient’s experience in your office falls into four stages—basic
training, where they learn the rules and policies of your office, helping them
to understand chiropractic care, case management beyond relief, and fourth,
that using chiropractic care as wellness care throughout their lives has additional
wellness benefits. Depending on your personal practice philosophy, you may or
may not apply all four of these phases, though most successful doctors have
at least some patients in each category.
There are four skills that help you guide your patients through these four phases.
To provide basic training you need a powerful and impressive entry procedure,
with the patient interactions with doctors and staff, the consultation/ history/exam
and especially the report of findings to set the stage for a patient to comply.
To communicate the message, then you need to implement effective patient education
procedures. To help the patient understand the value of continuing their care
past the point of symptom reduction, you need to have a consistent and intelligent
re-examination system with a report that reconnects the patient to his or her
purpose for being in your office; and finally, to build a lifetime patient,
which doesn’t mean a patient who comes in every week for life, it means
a patient who gets the value of chiropractic in their particular lifestyle,
you need a productive and well-orchestrated recall system, which services your
patients who are not under active care, but keeps them connected to you and
to chiropractic by updating their files and staying in their awareness.
The measure of patient compliance and retention is known as the Patient Visit
Average, or PVA, calculated by dividing the total office visits by the number
of new patients. This gives you an index of how many visits an average patient
sees you. There is no correct or incorrect PVA—it depends on your practice
philosophy. If your PVA is lower, it indicates that you have more of a condition-based
practice, where a higher percentage of your patients come primarily for relief
of symptoms. Higher PVA practices usually have a higher percentage or patients
who stay for wellness services beyond relief. These four skills, the entry procedure
and report of findings, your patient education process, your re-examination
mini-report and your recall system, are referred to as the PVA Skills, and you
can achieve the level of patient compliance you desire by using these skills
in the proper balance.
Troubleshooting Capacity Limitations
In running your practice, you must learn to troubleshoot the bottlenecks and
limitations that interfere with your growth. To help you understand how to do
this effectively, you can use the metaphor of the flat tire.
When I get a flat tire, I take it to the service station, and the repair guy
fills it with air until it’s full. Then, he plops it into a water basin,
and looks for bubbles—that’s how he finds the leaks. Notice that
he had to fill the tire to build the pressure to see the bubbles escaping—no
pressure, no bubbles and no way to track the leaks.
This shows you how to troubleshoot your practice for leaks and limitations—you
have to look for them at your busiest times, just when you don’t want
to, thinking you have to concentrate on patient care. You do, but you could
step away from the table for a minute and quickly tour your office—where
are the bottlenecks? If there are people backed up in the reception area, at
the front desk, at the payment counter, in the business office, it all tells
you something about your efficiency, and gives you ideas on how to streamline
your procedures to increase your capacity.
Periodically, at your peak hours, step away from the table and look for bubbles
escaping—they are the clues to your continued growth, and will lead to
you building the practice you really want.
Building A Practice
Once your practice is open and running, and you get the hang of it, you’re
going to want to build your volume until it matches or exceeds your original
vision. You’ll discover that as you grow, you’ll make distinctions
about different levels of practice, and as you reduce or eliminate the weaker
areas that hold you back, you’ll be able to build to a volume that satisfies
you. This is very personal, and each doctor will seek his or her own level,
but a word to the wise—aim high, show up big and expect a lot of yourself.
This is your career, and if you can’t get pumped up about it now, when
will you get excited about it? Pour energy and love into the practice, and make
things happen.
Write a statement of purpose and a mission statement. Your mission statement
is a declaration of the intention of your office (Our mission is to provide
outstanding chiropractic care to the citizens of Anytown...). Your statement
of purpose is broader, more about who you are, your highest values and beliefs
(My purpose is to be happy and help others be happy...). In other words, it’s
the “why” that makes your mission important to you. You’ll
have many missions revolving around your purpose, so define each, and let those
definitions mature over time.
Continually refine and sculpt your written description of your dream, and keep
working on yourself through reading, listening, seminars, coaching and consulting
and stretching yourself. If you are afraid to present workshops work your way
up until you have more experience and confidence. Start by presenting to an
empty room then work up to presenting to strangers. If you like to present,
aim for a bigger audience or a busier speaking schedule. As you continue to
grow yourself, you’ll be better equipped to generate the new patient flow
that will fuel your growth. The idea is to maintain or increase your PVA and
dollars per visit, while increasing the number of new patients, so you serve
more people and also become more profitable.
Target Your Ideal Patient
You can shape your practice toward your optimum blend of patients by targeting
your ideal patient with the following five simple steps. First, identify the
kinds of patients you like best—age, condition, interests, acute or wellness,
method of compensation, etc. Next, locate where those patients are likely to
be found. Third, increase your visibility in those locations, so a higher number
of ideal prospects notice you. Fourth, expose the benefits of becoming a patient
and the consequences of not becoming a patient, in terms of that type of patient’s
values. Finally, tailor your office procedures and policies to suit the needs
of that kind of patient.
Once you have completed these five steps, develop marketing plans that increase
your visibility and give you opportunities to close new patients. Each month,
set a new patient goal, and write your plan, the new patient generating activities
you believe will bring in the number of the kind of new patients you desire.
Keep track of each activity and the results, so you can refine your goal setting,
increasing activities that yield a good new patient flow and reducing or eliminating
activities that don’t produce as well.
Setting Meaningful Goals
Develop a financial master plan, by adding your monthly office expenses, your
monthly home expenses, and your average monthly income taxes, to get your monthly
overhead. Add a monthly savings of 10 percent or more, an additional payment
toward your debts, and an amount toward fun and entertainment. The sum of these
numbers is your target income, to be attained by seeing a certain number of
visits at a certain fee. To set these goals, divide your master plan income
by your average collections per visit, and you’ll know how many visits
you need—then simply divide this number of visits by your PVA to get the
number of new patients you need to hit this goal. Once you know how many visits
and new patients you need to hit your financial goals, you can use your new
patient machine to generate the desired flow of new patients.
Practice Fulfillment
As a new practitioner, you have a world of opportunity before you. There has
never been a better time to be a chiropractor, and by learning the game and
playing it well, you can do a tremendous good for the people of your community,
and create a delightful, prosperous lifestyle. There are patterns of business
and psychology to improve your chances of accomplishing your goals and building
that dream practice. Get the support of professionals who dedicate themselves
to serving doctors, helping them achieve their objectives with minimum stress
and maximum productivity.
Above all, be willing to learn and grow along the path, because who you are
determines how well what you do works. Success comes from you, not to you, so
keep working toward mastery, and you’ll find more in yourself than you
could have believed possible. The net effect is a happy, fulfilled, worthwhile
life and career, helping many neighbors and enjoying life to the fullest.
Dr. Dennis Perman is co-founder of The Masters Circle, with Drs. Larry Markson
and Bob Hoffman. A specialist in communication skills, personal growth
and self-development technology, Dr. Perman writes and lectures on all aspects
of practice building, practice management, patient education, prosperity consciousness
and leadership. Learn more about The Masters Circle by visiting www.themasterscircle.com
or calling 800-451-4514.
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