Lawyers PI Program
From the Desk of:
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
“Little and Big Issues That Will Destroy Your Practice”
Consultation #34 was entitled, “Shut Up and Build a Huge Practice.” Too many of you either haven’t read it, do not understand it, or do not believe it to be gospel…It is and as a result, you are preventing the multitudes from getting the care they need. When you tell me that you can’t talk on the phone during the day, as you are too busy, and I ask you or your staff how many patients you are seeing in a week and am told 75-80, I cringe!
As I have previously shared with you, my mentor treated 300 patients per day and rendered quality care. On my busiest day in practice, I treated 165 patients and I was very proud of my accomplishment. In fact, I was so proud of my accomplishment that my head could hardly fit through the door of my office, so I decided to call my mentor to share (brag). He had just adjusted 300 patients that day and when I called him at 9 PM that evening, his response to me was, “When you get busy, call me back,” and he hung up! There are certain moments in your life when humility is thrust upon you and for me one of those moments occurred just then. It was a defining moment when I realized that I am here to serve, not be served, and those patients weren’t my accomplishment, they were a gift given to me, and unless I embraced that gift, it would be taken away for a lifetime.
The most important lesson my mentor taught me in building a huge practice was to focus on what I offered the patient that was unique - chiropractic. The patient could get emotional help elsewhere, but nowhere else could they get unsubluxated. As a result, my entire encounter with the patient was on one topic, the detection and correction of subluxation and the effects thereof.
Consultation #34 says in part (please re-read it :)
Many of you have the same problem that I had for years; I wanted to be liked. I wanted to be everyone’s friend and I liked the gossip. In fact, I fed off my patient’s gossip. All of these issues prevented me from having a bigger practice than I did.
My mentor, who constantly reminded me in many ways that I was not really busy, would rarely, if ever, talk to his patients about any topic other than their care and subluxation. By the way, he saw 300 patients per day and every patient was thrilled with their care and the results.
When you chat with patients about their personal lives and issues, it takes time away from caring for more people. The issue goes well beyond the time needed to care for more patients. What are you going to do with those patients you now act as a therapist or psychologist for when you don’t have the time to talk to them?
Understand “prime time” in an office. Prime time is when everyone wants to come for care: lunchtime and just after work. Therefore, everyone will want to get care between 11:30 AM & 1 PM and 5 & 7 PM. If you can care for 30-40% more patients during those hours, your practice will grow. How do you get busier during those times?…“Shut up.”
This now creates another problem; if your patients are conditioned for you to act as their therapist, psychologist or gossip monger, when you stop listening or don’t give them the same time listening to their issues, they feel that you are not giving them the care they have been getting. Those patients expect you to be their therapists and now that you aren’t giving them the emotional therapy you were previously giving them, many will stop seeking your care because they are not getting what they are used to. Worse, they will think that you no longer like them and emotionally that will short circuit their relationship with you as a doctor.
By simply engaging with the patients on that emotional level, you prevent yourself from creating a large practice. You can’t gain minutes once used for emotional issues. In other words, use your time to the greatest benefit for your patients. Talk and deliver chiropractic care.
When I stopped talking about their personal lives and started talking about their health, the patients were more compliant and happier that I was focused on the immediate problems they were seeking care for. The biggest bonus, the patients were in and out of my office much more quickly and guess who was the happiest? The patients! They had lives and they didn’t want to spend them in my office. Everyone wins!
So…shut up about the gossip, do not be a therapist or psychologist, and practice chiropractic. Touch and tell about the areas you are adjusting and if your patients have personal issues, ask them to see you before or after hours. There are patients that do need to talk to you regarding personal issues. Ask them to make an appointment either before or after patient hours. Most will understand.
The next complaint I hear from most of you regarding the volume of patients is the “paperwork.” The biggest question is how you handle all the paperwork at that level of practice, or the next level? The answer is simple: A very tight paper system or automation through technology. I have given you a very simple SOAP note that should take 40-60 seconds once you get the feel for the paper.
Your staff, if you document solely on paper, should add the next SOAP note in your chart so that when you are in front of the patient, all you need to do is look at the previous treatment below the top blank sheet to understand what you did last. All that is left is to fill out the top sheet and give the chart back to the patient to bring to the front desk. It is a very bad habit to let your charts pile up until the end of the day.
I worked with a doctor 2 months ago that was in a terrible cash flow crisis and about 10 seconds after dissecting his practice, I got the answer to one of my first questions which had been, “How far behind are you in your notes?” The answer was, “Weeks.” The doctor felt that his paperwork was overwhelming. He first tried to keep up and then catch up. He couldn’t!
Here is a hard rule: If you can’t keep up, then you will have a very difficult time catching up because it isn’t the volume or the requirements, it’s your system. If you do electronic notes, the key is to create enough macros that you have enough pre-done choices to meet your specific needs. NEVER, EVER, NEVER GO ON TO THE NEXT PATIENT WITHOUT FINISHING THE PATIENT THAT IS IN FRONT OF YOU. It is a formula for failure if you do!
When you complete your forms or create macros, make sure you have findings or symptoms in the areas you are treating and that you have documented every area you have treated. In addition, make sure there is a diagnosis for every area being treated. Most law suits and retrospective reviews are a result of billing for services not performed and/or treating areas not diagnosed.
This compliance moment might save your life savings…It is also a reminder to call Dr. Schonfeld at 516-695-7732, if you haven’t already, for a compliance review. Do not be stupid and put your head in the sand…It will cost you!
The next area is to look carefully at is your PVA. A pain practice is in the 20-30’s, a corrective practice in the 40-50’s, and a wellness practice is above the 50’s. It doesn’t matter where you practice, as you get to choose the practice you want. What does matter is the number. It HAS TO BE 35 or above, as a practice with a PVA below 35 is headed for trouble financially. All it takes is 1-2 bad weeks with no new patients and you are now in crisis, as this type of practice cannot tolerate a bad week or two. This is where educating your patients comes into play.
A junior high school friend reached out to me yesterday after 40 years of not speaking to her and we chatted for an hour. She went on to say that she has a teenager and goes to a chiropractor occasionally. She then asked me if chiropractic could really help his asthma and I responded that I have never had an asthmatic that didn’t respond favorably to care in 28 years of practice. She said she heard that chiropractic helps, but didn’t want to take her son for care 3 times a week, as it sounded excessive. I proceeded to spend 3-4 minutes explaining chiropractic care and the necessity for repeat visits to re-train the muscles to hold the correction, as drugs cannot take the bone off the nerve. Once I explained it to her, she replied, “Why didn’t my chiropractor explain that to me? I would have had my son there regularly over the last few years instead of only for urgent care and he wouldn’t have suffered and taken unnecessary medication.” I told her she needed to ask her chiropractor that question.
She is a typical patient. Make sure you educate, educate, educate. It also must be in writing utilizing a multimedia platform, as I have explained in Consultations #19-#21. Please re-read.
Take the challenge and double your practice within the next 60 days. It’s easier than you think. To double your practice, you do not need to double the people you know; you need to double the people who know you. The more who know who you are and what you do, the more patients they will send to you. Bashful?…Too bad! If you do not tell your story, than who will? The answer is very few!!! Start talking about you and your practice; tell every shopkeeper in your community, every business owner and every patient to share you with their friends. Give out cards and send thank you letters to everyone who you re-introduce yourself to, as it is purely a numbers game.
When I practiced in the 80’s, it was much harder in my community because 99% of the medical community went out of their way to leverage their patients not to seek chiropractic care. It was a battle. Today you are part of the accepted medical community and you should embrace that.
In addition, lawyers welcome you and will work with you if you are the best-of-the-best and your work is admissible. How do I know? 35,000 lawyers nationally have told me that they need you. Not the entire chiropractic profession, only the best, and that means you because you have made the commitment to be the best.
*Double the people you know
*Do whatever it takes to be the best