Academy of Chiropractic Personal Injury & Primary Spine Care Program

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From the Desk of Dr. Mark Studin
Academy of Chiropractic

Preamble: Many of the issues I bring to you are very small, yet each issue is just that, an issue. If you take care of the small issues, then you will be able to build and more importantly, focus on the bigger issues...a larger practice and more family time. -Mark Studin 2006

"Should I open a second office vs Building the one I am in"


Dr Studin: The question of the day is, should you open up a second office? so let's just dig into some numbers. Your average collection, you said is $175 a visit, you're seeing about 150 visits a week, 70% as PI on your primary office with a part time associate, Tuesdays and Thursdays, the 70% net you 955 and then the other 30% next year may be about 200,000 because he get crap managed care and Medicare and all that other crap, so really only focusing on personal injury. How far away is the second location?

Guest Doctor: 25 minutes.

Dr Studin: How many miles?

Guest Doctor: 30 miles, it's shorter, but there's a lot of traffic. So I'm saying probably 18 miles, 20 miles.

Dr Studin: I've heard this everywhere from LA to Chicago to New York City to Miami, all the big cities, not really the suburbs. And you're in suburban area. I have a lawyer, he could fill my the office, have an MD and he can fill my office, everyone can fill my office, not once has that occurred and I know you can probably be the first, but I can tell you he the last 30 people who told me that zero were successful letting something else fill in their office. So, unless you have connections there and you're willing to work the region, do not expect it to fill your office. Number two, you're going to have to leave your primary office, only expect to be in the other office at most two days a week because you're in the primary office three days a week and it's going to split your attention away and that's going to drop just there. With that being said, you're not a trauma team member and you need to be, you need to take the 11 courses out that makes you just trauma qualified, and there's not a whole lot of docs in your state who are trauma qualified, that matters more than you can imagine. I just wrote a consult this morning that doctors are now referring in our program or exclusively to only doctors on that list. That's number one. And number two, lawyers are starting to put lists up on the wall now in your region I lectured in your region to lawyers maybe five, six years ago. In the city close to you, I've lectured a dozen times. So, there's a lot of people looking for you and you're not there. So, the first thing you need to do finish the trauma qualification. Number two, you need to do another lawyer seminar and I will come there physically you're better off doing a virtual one where on the big silver screen because when the screen goes off, I'm gone, you’re last man standing and that matters. But if you're going to open up another location, you want to open that other location and organize a lawyer seminar, the week you open that office and then you create another one three months after that. And do two different topics. You want to try to get the push to go into that immediately because I don't trust your other sources for referral, no matter who tells you. So, the only person I trust to build your practice is you, however you've got to finish up, I won't lecture a few, unless you're trauma qualified. Now with that being said, the other thing is I would prefer, If we could get you to 175 visits a week at $175, 52 weeks a year, you're collecting $1,000,006. It's really about the money, not about capturing people in different locations. So the question is, what's a clear path to 1,000,006, is that a second location or is it getting you to 175 PI visits? And I know you well, you've already got a reputation in the community. You've got the connections, but you're in a suburb. You can only get, there were only so many accidents in your community. So the question is, can we work with you in the local hospitals to infiltrate the local hospitals? We can't do anything unless you're credential. That's just bottom line. Here's the next issue is you have a hard time getting associates. As you know, we've credited a fellowship program when you need to be in New York, It's October 18th, 2019. We've created a fellowship program. You're aware of that?

Guest Doctor: Yes.

Dr Studin: And after you do all your classroom work and you become trauma qualified, then it's a two year program in your clinical rotations through pain management, orthopedic surgery, neurosurgery, and on, you confirmed as a fellow, and it's recognized for medical, academic, chiropractic, etc. But here's the thing that's missing in Chiropractic is we don't have residency programs. We don't have for a residency like in orthopedics and neurology in our surgery, there is nothing like that exists in chiropractic. There is a true residency program and some of the VA hospitals, but that's it. So we wanted to create that residency type program, but we didn't want to have to have the level of oversight. So we created somebody called a fellowship in associate practice, meaning that instead of a residence, some kid out of school is going to do a two year stint in your office. And during those two years, the first year they have to learn where the bathroom is, you'll teach them how to adjust and then I will put them through all of our academics. The second year they've done work with Dr. Owens and he's going to put them through the fellowship program they may confront a fellow and they're going to be working in your office and working in hospitals and medical specialist's office and urgent care centers and making all those relationships and then referring in. But during those two years are also your full-time associates. Now, after the first year that's a junior fellow associates, they become a senior fellow associates. You can then bring in another junior to work underneath them so you can perpetually have two associates and we feed them into your office on a perpetual basis. There is no limitation of how many associates we'll put into your office. We'll actually supply you. You then pay them an associate fee. In other words, trying to $50,000 a year plus health insurance and the cell phone and malpractice insurance, whatever it comes down to. But we are training them how to function in your office. You're going give them a little bit of guidance and after the second year, beginning of the third year, there's a company that goes in and then opens an office for them somewhere in the country. It could be in your locale which you also have an opportunity to get a piece of. So we're not quite sure of the rest of that, but this is what we're doing, which will perpetually allow you to open up office two, office three ,office four and have a lot of people work with you so you don't have to take the hit financially. I mean just think about how this can grow exponentially and you could take over your half of the state.

Guest Doctor: I mean absolutely.

Dr Studin: And this resolves that problem, but it all starts with you getting into academics. You can't even come to the table yet. So, we could resolve that problem. The goal is 1/6 you get to keep if is your only your primary office, you get to keep 1/3. That's before taxes. You can open a second office, but it's going to take away from what you're doing now or work growing what you do and working with hospitals, urgent cares because you've really maximize a lot of your relationships even though you can make more, but the next step is urgent cares and emergency rooms. That's the next step in your local area. You have to make those decisions, but mark my words, you open a second office, it's going to drop your volume and drop your rank up because you don't have the support to open that up.

Guest Doctor: That's why I've been kind of stolen on pulling the trigger on the second location.

Dr Studin: and if you get an associate, you're going to get a stupid kid who can't make it on their own. They're not trained. Which is why when we do it, I'm going to hold their hand for a year and then Dr. Rollins is going to hold their hands for a year. We're going to train them. You're going to get someone who is fully trained. That's what you need. And I know your capacity and it's all chiropractic. No medical. Just pure, exam, X-ray, adjust therapies, Rehab. So number one, make a decision. Academics is non-negotiable either way, cause you're really losing by not doing that. Then number two, do you want to grow which You are, or do you want to go someplace else but understand you're going to take a hit for a period of time.

Guest Doctor: Now let me ask you this. A cash practices?

Dr Studin: cash practice is fine.

Guest Doctor: But in the same token, now you going to get high volume. And I don't want to be a salesman. I don't want to be three times a week the rest your life. because I truly don't believe in that.

Dr Studin: Then the other issue is, I believe in the rest of your life, but not three times a week.

Guest Doctor: Exactly. I don't want to have to sell chiropractic. I want to go to educate and then, you know.

Dr Studin: You're going to have to, and then when you get into selling packages, now you have legal issues because you're acting as an insurance company without being an insurance company. There's a lot of laws and hoops you going to jump through. So, you have to be careful.

Guest Doctor: And well, that kind of helps. it all comes down to pulling the trigger. And I've been delaying.

Dr Studin: it all comes down to what you want to do and then realize you're going to take a hit in your primary office with the hope, but you'll do better elsewhere. And at the end of the day you'll met more. Or do you want to stick with door number one? If it was made, I would stick with door number one. You haven't maximized your community, work on urgent cares and hospitals. That's what I would do, but it is less stress, more time with your family and doing what you need to do.

Guest Doctor: I've got every other Friday and my associate, so I've got a four-day weekend for the summer, so every other week.

Dr Studin: I wouldn't consider open up anything until even like the middle of August to start about it. Or maybe even September. This where you can enjoy your kids, enjoy your family, cause you're going to have mayhem and you're going to take a hit, and we've been together for a long time and you've taken some hits in the past and I don't want you to have to take another hit. 

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