Can the profession be saved? The jury is still out. One of the fundamental problems with the chiropractic profession (thankfully with a corresponding fundamental solution) is that DCs spend the vast majority of their non-patient business time reacting to issues related to employees, marketing, insurance, practice management, etc. These and other “urgent” tasks, issues, disturbances, and time-wasters consume their business days. This vicious reactionary cycle de-leverages their time and energy, and diminishes their ability to achieve their full potential. Since less than 3% (or even less) of the population regularly sees a chiropractor, I believe that the profession can be saved, if and only if the individual chiropractor can be saved FIRST.
It seems that most DCs think that practice management, marketing, and patient communication IS business, when in fact it is only a component of business, and actually a small component, when you consider what creates business value over the long haul.
We have all witnessed chiropractors who are hitting the ball out of the park on their marketing, while in parallel their practice management processes are nearly flawless, and yet they are still struggling with stress and chaos, and sometimes bankruptcy. You see, your marketing and practice management skills/procedures are NOT in themselves business, they in fact sit on TOP of what I call “the foundational principles of business.” The same that is true for a downtown office building is also true for the entire chiropractic profession. If the foundation is cracked, broken, or non-existent, then what sits on top of that very same foundation will have serious flaws. Once your foundation of business principles and processes is firmly set and practiced, then you have a much greater chance of successfully orchestrating all of the business tasks and objectives that sit up top.
Examples that sit up top are things like launching a marketing campaign, or hiring the perfect long-term-oriented CA, or launching a new patient initiative that doubles the size of your practice. It is very similar to the principles of health. Your ‘health management procedures’ may be that you get regular adjustments, exercise a certain way, eat certain foods, etc. However, the reason you have those “health procedures,” and run them the way you do, is because you have a firm understanding and grounding in “the foundational principles of health.” You obviously know that health care is not sick care, inside-out healing, 3-dimensions of stress, or ‘the power that made the body heals the body,’ etc. True health care is much deeper and more principled. When a new patient comes to you and says, “I heard you’re a great adjustor. I’d like to come once a week for the next 3 months!” you know in your heart that this person won’t be integrally healthy in 90 days. Just as you know that you won’t create a long-term, sustainable, thriving practice, with a very healthy balance sheet and several lucrative exit opportunities at your retirement, just because you instituted the latest blinky-shiny marketing technique, or software package, or gadget. I believe that you, as a DC, must realize at a deep level that you are in business, and because of that you must strive to become a “principle-centered” business person.
My wife and I know that we’re not going to guarantee that we’ll be celebrating our 50-year wedding anniversary in four decades, just because we learned a new way of communicating in a book. What goes for health, goes for marriage, and also goes for business… If you have a firm grasp through knowledge, deep understanding, and practice of the foundational principles of ANYTHING, you radically increase your long-term opportunities, value-creation, and satisfaction. And the most satisfying thing for a chiropractic office is a thriving patient community, a thriving staff, and a thriving bank account, with several opportunities to grow the business – or sell the business for that matter – when the time is right. Since you’re putting in the time and effort every minute of every day, of every week, why wouldn’t you like to have more certainty about how to increase the probability of your ultimate business success and value? You must understand that this problem is NOT YOUR FAULT. How can you possibly know the foundational principles of business when you were never exposed to them in college, graduate school, or at any level in your chiropractic training? The interesting thing is that the chiropractic colleges that have begun training their students in business are also making the same glaring mistakes: They are teaching students to “go out in the world and conquer” yet they are focusing completely on teaching things that sit on top of the foundation, not, ironically, the foundation itself. So, it shouldn’t come as a surprise to anyone that the chiropractic profession is sick, from a business perspective. You were never trained in the foundational principles of business.
The reality is that the serious issues that pervade most chiropractic offices, and that cap the growth of even the most successful practices, is that DCs never learned real business. After school they are thrown to the “business wolves” with a complete lack of training. Is it really any wonder that the profession is stuck at less than 3% of the population regularly seeing a chiropractor?
When one examines long-term-oriented, sustainable, growing companies, you notice that they have certain traits. However, when one examines a 20-year-old chiropractic office, many times you see one or two ‘Super DCs’ holding the entire operation together, as if all roads lead to Superman or Superwoman. I call this The Superman (or Superwoman) Syndrome.
[quote_center]If you are Superman, you’re doing the OPPOSITE of what is required to create a long-term-oriented, sustainable, growing enterprise.[/quote_center] You’re potentially wreaking havoc on your own well-being, your employees’ satisfaction, your patients’ success, and on your family. And you have no chance of an exit strategy. Some people say, “Well, I never want to retire!” Everybody retires one way or another. You can work for sure till your dying day and that is great. But still, the greatest asset you have in your estate, which gets left to your loved ones, is your business. Don’t you want it to have marketable value? A long-term, sustainable company is supposed to keep growing, even after the founder leaves. Look at Apple. After Steve Jobs’ leave of absence due to cancer several years ago, and his eventual death, the company never missed a beat, yet in the typical chiropractic office, if the boss is out (even for a few hours), the business begins to limp along. It is my belief that in order to radically increase the probability of long-term business success for a chiropractic office, while at the same time leveraging the talent and skills of the DC and his or her staff, one must adopt a very straightforward model.
This model has been proven with several hundred DCs over the past year and a half and the experience has been very revealing. The good news is that there is a lot of ‘low hanging fruit’ for the majority of practices. Business principles are easier to understand than health principles. So when a DC gets hold of them, they are transformative.
I believe that there are 12 Foundational Principles of Business. Here are some examples of some very basic ones, that when executed are trans-formative to your practice. Values Based-Decision Making says that when all decisions in your practice, from whom you hire, to whom you put your hands on, to where you locate your offices, are made from the same common set of long-term enforced values, you substantially increase your business’s viability, while eliminating the vast majority of business-debilitating mistakes. I’ve seen businesses double in size by effectively implementing only this one basic principle.
Next, we’ll consider the age-old principle of Management-by-Objectives.
Many times, small businesses stall because they are trying to do TOO MUCH. They falter due to indigestion from trying to digest too many opportunities. Imagine that your practice only focuses on FIVE objectives during the next quarter. Imagine that all of your staff members are fully informed of exactly what those five objectives are, and that they are all bonused on the successful achievement of those FIVE. Want to take your staff members to the next level of production, and supercharge your practice? After you’ve communicated your FIVE practice objectives, then meet with each staff person individually, and assign them each their own FIVE quarterly objectives that fully align with your office’s FIVE objectives. Then pay them a bonus upon achieving these. This very simple practice adds simplicity, success-probability, and full employee engagement/alignment to your practice.
Now let’s examine the next principle, The New Profit Paradigm.
The P4 in the formula represents the four Ps that every business needs to clarify and understand: Profit (where do profit dollars really come from), People (customers, employees, stakeholders, etc.), Purpose (why does your business exist in the first place?), and Planet (which is about understanding your practice’s place in your community and the world at large). The right side of the equation is about Revenue, and the R2 symbolizes the fact that your practice MUST have recurring revenue systems baked into all aspects of your top-line revenue and growth. On the bottom of the equation, you see EV. This represents expenses. Expenses can kill businesses, especially when they get out of hand, or when they are monthly and long term, or when they are not variable, which is what the V represents.
Growing, thriving businesses understand how to make their expenses variable. For example, rather than spending $25,000 on a new marketing campaign, why not make that expense variable, i.e. pay the marketing company a fixed amount – say $150 – for every new patient who signs up?
By doing this, you create WIN-WIN-WIN situations, i.e. your company, the aligned marketing company, and your ultimate customer can all win.
The arrows going up and down represent the fact that you must examine your business decisions by asking one simple question: Will executing on this decision increase my revenues or decrease my expenses/expense ratio? If the answer is NO, then don’t do it. The only exception to this rule is education. Warren Buffet, arguably the most successful business person who ever lived, has more than 100,000 employees, yet he reads and educates himself for a reported 9 hours of each and every day. He clearly puts an emphasis on business education, and I believe you should do the same.
So, to answer the title question: Can the chiropractic profession be saved? The answer of course is YES. It can not only be saved, it can thrive, but only if it sits firmly on top of a foundation of strong business principles, and if individual chiropractors make foundational business education and training a very important part of their overall education.
Rick Sapio has been involved in more than 75 companies, as either a founder, investor, owner, or operator, over the past 35 years. He has learned much more from his failures than from his successes. He has realized that putting all business decisions through the lens of simplicity, probability and leverage, while at the same time using a principle centered business approach, radically increases the success of virtually any business. For the past two decades, he has been CEO of a financial services/healthcare holding company. He is the CEO of BusinessFinishingSchool.com, in order to teach business principles to entrepreneurs.