While we are all concerned about the quality of the care we offer, there is a mitigating factor involved in our practice decisions. It is called the bottom line! The truth of the matter is that we have to show a profit at the end of the day. This bottom line is more like an edge than a line as it involves service rendered, income generated and overhead expenses. Each of these factors need to be considered to develop the perfect practice.
Actually, this is the easy one – in fact for Chiropractors, it is too easy. Why? Chiropractic adjustments get results! The vast majority of Chiropractors practice some level of a diversified technique as they have discovered that while all techniques work, one technique doesn’t fit every patient’s needs. This is a key issue regarding the service you render. The better you can fit your care to the patient’s needs, the better will be the results. While this may sound simplistic, the fact that chiropractic adjustments get such good results, most Chiropractors miss the need for the specific application of adjusting toward a specific patient need. The guidelines for care have focused on frequency and duration plans and missed a critical step called “Intensity of care”. A patient with an over-aroused nervous system and sympathetic responses in high gear does not need further over stimulation with a high level of sensory input such as frequent visits, multiple areas adjusted and high intensity input. What they need is less input, fewer visits but a longer duration of care. This plan has a dramatic effect on outcomes and patient visit average (PVA). Increased PVA means increased income and practice stability. My experience in practice with PVAs of 12 and then up to 180 as I changed my approach in practice, means that I can write with authority about the effects of making these types of changes in your practice. Yes, the practice was very busy with the 180 PVA foundation but it was what I thought Chiropractic practice was to be while at college. My bank account enjoyed it as well.
After over 50 years of being involved with Chiropractic, I’ve seen just about every practice management approach, gimmicks, additional sales attached to the practice, and the dilution of the value of the adjustment. I experienced the shift from straight Chiropractic, to posture analysis, to joint manipulation, to joint mechanics and pain relief in defining the profession. Today we see even more confusion in the mind of the public as to what the profession of Chiropractic has to offer. We see “Stop Smoking” and “Weight Loss” clinics calling themselves Chiropractic. While these generate income and are part of what I call a healthy Chiropractic lifestyle, they don’t reflect the real value of Chiropractic. They do however restrict the scope of practice of Chiropractic and this is another critical factor in income generation. If your practice only focuses on weight loss or pain reduction, once these goals are accomplished you will need to replace that patient. This is where those practice management groups are so willing to charge you a ton of money to attract new patients. Anyone in business soon learns that repeat business is the key to business success. That is the difference between practice with a PVA of 12 and one with 180, where the appointment book fills up 6 months out and you will start to see patients booking their time a year in advance.
Today there is great news for the Chiropractic profession! The research over the last 15 years now has established that the reason the Chiropractic Adjustment gets great results is as a result of its direct effect on the Brain and its function. No longer are we tied to the vertebral subluxation and the nerve root pressure relief theory to support Chiropractic results and with this research comes a shift in the intent of chiropractic care. This new knowledge moves Chiropractic out of the structure correction model and into the improved neurological function at the central nervous system model. This also means that we don’t address signs and symptoms as our basis for either care plans or results of care. The question now becomes, “How efficient do you want your nervous system to function?” When patients recognize this is the real value of Chiropractic, their level of participation soars. Income is now a result of you giving your patients something of greater value.
The art of running a business tends to be in short supply when it comes to many chiros. It seems to start with the huge amount of debt students generate with the education loans now available. Hindsight has little value in these cases. The problem is that the huge loan debt cripples many new graduates and we see them dropping out of the profession within a few short years. Many will start as associates and find that their loan payments absorb 90% of their income. The realization of being in their own practice becomes more of a dream than a reality. While many of the new graduates are in tune with the new neurological intent of care, the senior DC is not and they have to practice in the style of the associate office.
The expense of office rent, equipment, staff, electrical, water, marketing, and advertising are issues that require an office budget. DON’T forget the TAX man!!! Then you get to pay yourself! That is right – the Doctor needs to be put him/herself on salary as well! I do have a formula for staff and Doctor salaries. Most DCs tend to pass out when they see what their salary should be. There is another factor in expenses that most DCs miss completely! Every successful business has an expense column to cover reinvestment in the business. The standard is 10% of the gross. DCs tend to be very short-sighted about this concept.
The new approach of Neurologically Based Chiropractic has created a shift from straight spines, pain reduction, and spinal care. This means that much of the old analysis instruments in use are no longer of value to determine the care needed. The need for every Chiropractor to buy an expensive X-Ray machine is no longer in place. Most Radiography Clinics will take the films for DCs. This reduces the debt load for the business. New equipment such as the NeuroInfiniti now fits the new direction of the profession with its ability to show abnormal CNS patterns and responses. This step alone matches the new intent of Chiropractic care. The NeuroInfiniti also brings in a new income center in the form of bio and neurofeedback within the Chiropractic office to help reestablish better neurological patterns.
What we now have:
- By recognizing that income is generated not by the number of new patients, but by the quality of patients, and their higher participation in Chiropractic care.
- In shifting the intent of care from pain relief or weight loss etc. to improved brain function, we open the scope of practice. This means a broader patient base.
- By developing the good business practice of budgeting and reinvestment, you can continue to offer the highest quality of care for your community
Neurologically Based Chiropractic is a reality and the equipment and training are available for you to move your practice to a new level of income and excitement. You deserve to open this possibility! I recommend that at the very least, you call some of the DCs enjoying this experience. Just call DeDe at 1-877-391-9662 and ask for a referral to speak with about how their practices have changed for the better.