How Do You Want to Practice in These Interesting and Challenging Times?

I have been reading some of the articles I wrote 8 years ago on my thoughts about the right way to practice. They apply today as much as they did then and I want to share them with you.

How do you want to practice?

Blog post: Interesting Times 1/21/2010

When I watch the news on TV or listen to the radio, I am reminded of the old Chinese curse: “May you live in interesting times.”   Chiropractors and all other health care professionals are anxiously following the debate over “health care reform.”  We know that change is coming and that it will have a profound effect on our practice and the way we do business.

We will soon be faced with two choices:  Practice in accordance with the new health care reform and in effect become a government employee.  Or, declare your independence and practice privately.

The choice will be difficult for some, but easy for others.   Most people practicing today have depended heavily on one form or another of third party payment to provide them with a patient base.  For some it is a personal injury, or workman’s compensation practice.  For others it is as a participating provider in an HMO or PPO.   Doctors who have been accustomed to a primarily third party pay practice might not find the idea of working under a universal health care program to be offensive.  On the other hand, those of us who have had private practices will find the idea of government bureaucrats dictating how we run our practices and care for our patients to be unthinkable, and therefore the choice is easy.

The third group is made up of the doctors who do not like the prospect of practicing under a government administrated health care program, but question how they could have a viable private practice.

If you are in this third group, you are the one I want to talk to.

Having had a private practice for 42 years, this is something I know a little bit about.  My first 30 years of practice was in The Hamptons and now in the remote out islands of The Bahamas.  Two very different places, but the principles still apply.  I have often said that “unless your patients think enough of your services to write a check or pull cash out of their jeans, you don’t have the practice you think you have.”

It is really very simple.  People will pay for exceptional care.  They will not pay for the same generic care they can get for no out of pocket expense down the street or across town.

The way to build a private, cash practice in these difficult and challenging times is through what I call “THE PATIENT FOCUSED PRACTICE.”

“THE PATIENT FOCUSED PRACTICE” is the term I use to describe a philosophy of practice, the one I have found that best serves my patients and provides me with the most satisfying practice experience.

‘THE PATIENT FOCUSED PRACTICE’ is not a marketing term.  It is a philosophy of practice and an attitude that says the needs of the patient comes first.  There is no agenda other than to serve the needs of the patient.  No agenda to educate the patient about the chiropractic story, philosophy or the stages of subluxation degeneration.  There is no campaign to recruit new patients.  No lecture about the importance of lifetime care.  The patient never feels that he or she is the target of a sales pitch.

What the patient does experience is the feeling that they have been very well cared for.  That they have been carefully listened to and they know that we understand their condition, concerns and worries.  Whether new to chiropractic or an experienced chiropractic patient, they are invariably impressed by their examination and the obvious care that goes into my analysis and the details of their adjustment.  Most importantly, they leave our office knowing that something good has been done for them.  They have seen objective evidence of improvement and in the vast majority of cases, improvement in their symptoms.  They leave the office with confidence that they have come to the right doctor, one who can and will do all that is necessary to help them, as quickly and economically as possible.

You might find it curious that I am telling you not to do what all practice builders have been telling their clients to do for the last 40 years.  Am I just being contrarian?  Or maybe I have a better way.

The simple truth is that I learned long ago what worked for me and what didn’t.   It took me many years to realize that it was not my business to sell chiropractic.  It was far more important to sell myself.  I found that the best way to sell myself was not by telling people about me and what I do.  It was by showing them results.  I found that it wasn’t necessary that my patient believe in chiropractic as long as they believed in me and that I am the guy who can help them.  My job is to make sure that I am that guy and that I do everything possible to give them the results that they come to me for.

I attended the two most popular practice building seminars on a regular basis for years.  I got out of my comfort zone as recommended.  I did weekly patient lectures in my office.  I pressured my patients to attend.  I required all new patients to sit alone in my consultation room to watch chiropractic orientation videos on their first visit, then another video before their report of findings, and yet another prior to an interim report of

Findings, the point at which continued care or maintenance was to be recommended.  My patients resisted the pressure to attend lectures.  Others walked out on the videos never to return.

I followed these and other programs to the letter as recommended by the “experts.” I paid “big bucks” for a one year series of 6 seminars and private consultations with one of the “super star” management consultants who was one of the regular featured speakers at the big Texas based seminar program.’

I spent a day in his office, attended two of his seminars and had two private consultations.   I found his recommendations to be offensive.  There was no way I could subject my patients to his strong arm tactics.  There is no way that if I were the patient that I would put up with a doctor who practiced what he preached.   He blew his credibility with me when he told me that if I were spending more than 2 minutes with each patient, I was wasting time.  He even recommended that my assistant actually time my office visits with a stopwatch. He went on to warn me against asking my patients how they are doing, reasoning that they would waste my time telling me.

Is this kind of practice building advice obsolete?  Unfortunately, it isn’t.  Many management gurus are still preaching the same old messages to young chiropractors today.

A visit to the website of one of the self-proclaimed top dogs in chiropractic, gave these clues about his practice philosophy:

  • I never do anything that I can have one of my girls do.
  • I do not talk to my patients except for the 2-3 minutes that my hands are on them.
  • I have weekly staff motivational meetings to formulate new patient recruitment strategies, and what the y should do to improve patient compliance with his long term care recommendations.

The same doctor, who spends only 2-3 minutes with his patients, spends an extraordinary amount of time, money and effort advertising, doing mall shows and other promotions to drum up business.

I would suggest that if he spent more time on seeing to the care, needs and concerns of his patients, he wouldn’t have to be out beating the bush and having motivational meetings.

This approach to chiropractic practice building and patient management is still with us.  I do not think that it serves the best interests of the patient, doctor or profession.

No one can tell me that time spent taking excellent care of patients is ever wasted.  It pays dividends in the form of great results and patient satisfaction.  When your patients feel they are well cared for, their perception of the value of your service skyrockets.  That equals high level professional satisfaction and justified pride in a job well done on your part. It is the patient’s satisfaction and the confidence which you inspire that will make your patients happy and proud to refer their friends and family.  You won’t have to ask for their referrals, they will ask you if you could possibly fit in another new patient.

That is the way your practice can and should be.


IF you want to learn more about what I think is ChiroPractice Made Perfect, come to one of my Koch Seminars.  I would love to see you there.

Koch Protocols Seminar One March 23-25   and Seminar Two March 26-27

Other dates in June.




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