A Better Way To Practice
"I never want to retire." And other stupid things chiropractors say.
I started my first business at 11 years old. A lawn care company, using my father’s gas lawnmower. I cut the neighbors' lawn for $10 during summer vacation and made around $40 a week. Comic books and candy were in abundant supply that summer.
As it happens, the kid across the street started a similar company with his father’s lawnmower, charging only $5 a lawn without bagging or trimming. His lawnmower was electric so he would plug in and the customer would pay the power bill.
I was envious of my friend: He charged less, had lower overhead, worked less, and had more free time. However, his system, while not the best quality, was more efficient, and I realized he would overtake my inefficient business unless we combined efforts.
Eventually we would merge and our newly minted Lawncare Co. would dominate the Oak St. lawn market. However, the partnership was short-lived as I learned my “friend” took jobs on the side without me. The partnership dissolved but we remained friends almost 50 years later.
Believe it or not, many of the lessons from the rise and fall of Lawncare Co. became relevant to my chiropractic practice. I learned about competition, associates leaving, and dissolving partnerships.
Chiropractors are wannabe entrepreneurs. They graduate, open a solo practice or a partnership, and may hire an associate. With new manpower, they may expand their business with a satellite practice a few days a week or take on a partner to share costs.
These options are good, but most offices can't sustain profits or grow without the main chiropractor's physical presence.
Want to take a vacation? Anything longer than 2 weeks and your practice will tank. Staff quits? You're staying late to train the new hires. Roof leaks? You have to climb the ladder. Unfortunately, most chiropractic businesses (even large ones) are not scalable.
In a traditional business, you may transition from a sole proprietorship where the owner or partners do most of the work, to hiring staff and delegating tasks. As the business grows and more employees are hired, managers oversee the new employees, and the original owners transition out of day-to-day activities in favor of a talented CEO.
However, chiropractic practices aren't inherently scalable. Entire books, like The E-Myth series and The E-Myth for Chiropractors, have explored this. However, I can summarize their teachings in one sentence:
If you have to physically go to work everyday to make a living, you have a job, not a business.
Sure, you might be able to go on vacation for a week or two. You might hire a locum to cover your practice and take a month off a year. But I bet your practice did not grow in your absence. In fact, I bet it slipped.
A real business should run AND grow without the owners' physical presence, allowing them to expand, pursue new ventures, or do nothing if they choose.
When providing a hands-on service like chiropractic, scaling personal efforts into a self-sustaining business can be difficult. In this respect, chiropractors, lawyers, medical doctors, and dentists have more in common with restaurant servers, electricians, and hairdressers than with CEOs or real estate investors.
In a service business, your future success depends on your physical presence on Monday. This concept has kept me up at night more than I would like to admit.
We need a better way, and I have an idea...
Ask a chiropractor their favorite part of practice and they'll say it's adjusting patients. They prefer adjusting over exams, charting, marketing, or anything else. If they grow enough to hire an associate, they delegate unwanted tasks to focus on adjusting hundreds of times a day.
Fellow chiropractors have told me with pride “they never plan to retire,” they just want to “keep adjusting until they die.”
Ugh. Can’t imagine a worse fate.
First, the adjustment isn't the only service you're selling and its not the most valuable. You're selling a lifestyle, an idea, a community, and a result. In the long term, those will create more growth and profit for your business than your amazing adjustment. Why focus so much on your least valuable service?
Consider everything you do to run a practice as a product or SKU:
Adjustments
exams
Marketing
Education
Outreach
hiring and firing
referrals
etc.
Which "SKUs” helped you grow your practice the most? Hint: It's not adjustments.
Second, if chiropractors spent as much effort on new patient consultations, education, and retention communications as they do on adjustments, their clinics would easily double and triple. These are the highest value services with the most impact on sustainable growth. Why would any chiropractor delegate those important duties to a new grad or associate?
Imagine a practice where your only duties were to create rapport with a new patients during the consult, check in on them periodically in person or via email, ask for referrals, give lunch and learn talks, and take your time hiring great staff so support your mission?
Imagine the practice you could have, if you let go of the desire to adjust all day and become the best communicator and leader for your team. Your schedule might be just be a few hours a day. Need a day off? Ok, no new patients scheduled. Easy.
Eventually, with enough experience, you could train an associate to master the new patient consult and client retention. They could grow your practice while you're at home. Extended summer vacation here we come! If they’re good enough, maybe you could finance a satellite office for them to run?
Is that starting to look like a real business yet?
Henry Ford didn’t build cars and Steve Jobs didn’t assemble MacBook Pros. They had the knowledge and expertise to do it, but this wasn't the best use of their talents. Real entrepreneurs know scale and focus on what really matters. Chiropractors need to move from the factory floor to the board room for real business growth.