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February, 2014

Achieving Excellence and Establishing the Perfect Practice

By Drew Stevens, PhD

Theresa called my office the other day very concerned that her practice was not growing the way she desired. She had been practicing for so many years but not earning the money she wanted to. After a brief conversation, I uncovered that her practice never grew more than 25 patients per week and her collections were in excess of $75,000. She owed four months back rent, her marriage was strained and she was so stressed she was suffering digestive issues. Currently, she is thinking of taking a part-time job to help with expenses.

This is no different from many other people. Each time I speak at a university, there is a sense of not only innocence but also arrogance in first timers thinking they will create a multi-million dollar empire in less than three years. While I always encourage reaching for the stars, it is financially prudent to think more practically about the world at your feet.

excellent - Copyright – Stock Photo / Register Mark What Theresa and many of her colleagues fail to realize is that when you decide to fly solo or integrate as an Independent Contractor or Associate, you operate a business. The idea was introduced during your last trimesters but you were either not ready to listen to the lecture, or were more focused about passing the exam. However, you need to be attentive to the fact that operating a practice requires patience, financial prudence, patient attentiveness and empathy, as well as relationship building. Without any of these you will find your condition similar to Theresa.

So, what is a chiropractor or aspiring chiropractor to do to help ensure the practice maximizes patient volume and revenue? I often suggest it comes down to four major principles:

  • Modeling – the only way to operate a sustainable practice is with a strategic model.
  • Marketing – chiropractors must create activities that build community.
  • Money Management – the notion of operating a business requires financial acumen.
  • Maintaining Focus – the entire practice must focus on acquisition and retention.


Once one matriculates from university, there is the idea that the doctor should develop a practice that uses chiropractic obviously, but also acupuncture and possibly massage. On the surface, this might appear as a good idea however, there is a clear lack of differentiation from the doctor down the street and little value to your patient demographic. You cannot build it and they will come, but you must develop a practice based on patient need and your value.

As you read this, you may have particular passions about health and wellness. This might include obesity, certain diseases, sports therapies, etc. With this in mind, you need to develop the practice based on your passion not just the job. Who do you want to help and why do you want to help them should be questions requiring an answer.

Secondly, there exist today several issues in health care that include, but are not limited to age, obesity, job related injury and stress, as well as overall health and wellness. Simply put, individuals are aging and undeniably desire their youth. Additionally, age brings about more aches, pains and other related stresses. With insurance companies becoming more scrupulous about whom they treat and what is treatable, the chiropractor of tomorrow (depending on state laws and certifications) can become a general practitioner in consulting with the patient on internal health stresses of the body. Through the use of nutritional counseling, the chiropractor of tomorrow can provide more than just adjustments. He/she can provide nutritional and wellness counseling, as well as other therapies.

The model of tomorrow requires providing ancillary services and not just straight chiropractic. Providing new technologies and approaches provides for supplemental income, passive income and better differentiation amongst competitors.


The chiropractic field today is more crowded then ever before. With so many students matriculating and settling within proximity of their universities, as well as the use of the Internet by patients, the field today is narrowing.

To that end, chiropractors must be more active in their local communities. They must emulate the local politicians that know all their constituents and whom one sees always kissing babies and shaking hands. Chiropractors cannot afford to live in obscurity but rather "live large" so that all in the community know their existence. What chiropractors need to understand is that their name is their brand, and the brand only grows with visibility and recognition.

This requires constant attention to positioning, the right message to the right demographic, comprehension of your value and activity. It is imperative you conduct the proper research that finds a demographic that fits your need. I always say you want to ensure that your patients fall under the F3 model in that they have the right fit. In other words, their conditions and issues fit the therapies and science that you desire to focus and heal. Patients should be fun to work with. They should enjoy your therapies and desire for you to find additional remedies for total health. Finally, they should financially afford your services.

Once you determine the proper demographic, then you must engage in daily activities that manifest the brand. These include, but are not limited to: lectures, website, community relations, alliances, marketing promotions, referrals from existing patients and many more. The more active, the more volume. The less active, the more sparse the waiting room.

Money Management

Operating a practice is wonderful when it is making money. In fact, it is great to begin billing patients so you can see the fruit of your labor. However, just like any plant, farming and cultivation are the keys to success. Well in chiropractic, financial acumen must be the seed you plant.

Being fiscally prudent denotes acknowledging your expenses and building your practice around your expenses. This means not buying every "shiny nickel" you see, but rather saving for a rainy day to ensure for personal and professional growth, emergencies and succession.

What is necessary with ensuring success is using tools such as balance sheets, and profit and loss statements and obtaining the services of a good accountant to ensure you save more than you spend. You cannot spend more than you reap and you cannot reap anything if you do not have it. Sure, making money is fun as long as you do not owe the landlord, vendors and suppliers and have nothing left at the end of the month to eat. Financial acumen begins and ends with you. Do not entrust staff, do not entrust the spouse, but make it incumbent on you.

Maintaining Focus

Ron is a chiropractor who, after eight years, built a practice of approximately 100 people per week. Currently, he is only seeing 22. After some mystery shopping, it was discovered patient service is not top of mind. In fact, it is patient service that has dropped his volume by more than 80%. The reason why practices fail is the front desk, the operations and even the doctor. If you want your practice to fail, then simply fail to provide proper patient service.

No matter what, patient service has got to be the pinnacle part of every practice. Patient services must be acculturated into the entire practice. This begins with hiring the right people, as well as having a doctor that is concerned with total patient care from the inside and out.

Therefore, telephones must be answered on the second ring, e-mails must be answered within six hours and staff understands that patients are not an interruption of the practice, but the purpose of it! If patient service is not part of the culture, the practice will fail. Additional recommendations include websites that have proper contact information and speak of results and outcomes for the patient. Also included are testimonials and case studies from former patients. Further, confirmation of appointments, handling of insurance claims and ensuring all paperwork is submitted timely is all part of the patient experience. To help with patient service think of this, you expect that when patients visit, you expect to cure their symptom. However, the question to actually address, "what do your patients expect when they visit you?" Ask!

No one said it was easy and no one said it was not work. Yet, operating a practice that sustains competitive forces and environmental issues can become extremely rewarding. What becomes necessary is sticking to the fundamentals. Ask any coach, athletic or business, it is always about fundamentals. While others are reaching for the "silver bullet" as long as you reach and retain fundamental business skills, you will thrive and survive. Using the principles for the perfect practice, you will enrich you life, enrich your practice and live your vision.

Drew Stevens, PhD, is known as "The Revenue Doctor." He helps chiropractors develop strategies that exponentially grow revenue and returns personal time. He is the author of eight books including the widely acclaimed "Practice Acceleration" by Greenbranch publishing. He can be reached through his website at

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