“Shut Up and Build a Huge Practice – Part 2”


It’s been almost 2 years since I wrote “Shut and Build a Huge Practice – Part 1” in consultation #34 and so much has changed over the last 2 years, while so much has also stayed the same. Over the last few weeks, this topic has been coming up over and over with doctors nationally who have already read the first part. It appears that most of you understand the words, but don’t grasp the practical application of the concept.


Last night, I lectured to a group of lawyers and the sponsor was an MRI owner who is also a chiropractor. This chiropractor, Glen, had previously worked for me 20 years ago, out of school, as an associate doctor. He anecdotally reminded me of how I trained my associate doctors; I would give them 4 minutes to enter a room to adjust the patient after the initial visit, knowing that this was a simple, straightforward case and needed nothing else, as the person wanted to get “in and out.” I kept an egg timer in the hallway and if the associate doctor couldn’t get in and out in 4 minutes, I would let the doctor go (fire him/her) unless he/she had a really good excuse. That was how Glen came to work in my office. The doctor he replaced went “ding” on the egg timer and was fired because I was not tolerant of chit-chatting with the patients when all they wanted was to get adjusted and get out. There was an entirely different population of patients who needed more time with therapies and rehabilitations and we scheduled them accordingly, but this population wanted in and out.


When we questioned those “quickie patients,” they all felt as if they were with the doctor for 8-10 minutes, they were extremely satisfied because they could “pop in,” get adjusted and get on with their lives. Glen understood that most patients wanted out as quickly as possible and really didn’t care about anything we had to say unless it was related to their care. He took this philosophy and cared for over 1000 patients weekly, in Virginia, for years until he retired from active practice.


One of the doctors I lectured for last night stated that he uses the time with each patient to educate them and getting them out quicker would be counterproductive to getting new patients. My answer to that statement is, “Oy vey!!!” That is what a report of findings is for. I asked the doctor, “Do you show a DVD? Do you do a written report of findings? Do you schedule special time for your patients to review their x-rays and findings?” The answer was, “I show them their x-rays and explain what is wrong with them.” This doctor has a PVA of 28 and is constantly looking for his next new patient to survive.


If the patient was educated properly, this doctor wouldn’t have to try to “sell chiropractic” on every visit. If he taught subluxation care, in either a pain, reconstruction or wellness model, then patients would understand why they were there. If he used a 3rd party through a DVD to validate his explanations, more patients would accept his reconstruction recommendations and his PVA would be higher. He could shut up and focus on treating his patients' subluxations or subluxation-related issues and see more patients. The time to talk more is in the report of findings, not during each visit. It is that time that educates patients and will empower them to refer others. Most of you have that upside down. Get chatty in the report of findings room and shut the hell up in the treatment rooms. (I apologize to all the people I have or will offend in this consult and every other consult.)



  1. Do not care about you
  2. Only care about themselves
  3. Hate having to come to you
  4. Hate coming to you frequently
  5. Want to get out of your office quickly
  6. Do not want your jokes
  7. Do not want your problems to deal with
  8. Want you to respect their time
  9. Will quit very quickly if you do not heed the above advice
  10. Will not tell you why they stop coming for care


The message is clear; chat it up in the report of findings room, use 3rd party validation with a DVD (I recommend Back Talk Systems 8 minute explanation), give the patient the choice between pain, reconstruction and wellness care (you will get a cross section of all of them) and when caring for them, get them in and out as quickly as possible. Practice “touch and tell,” as explained in another consultation. Be respectful of their time.


Another observation is that Glen, who treated 1000 patients per week, could also get on the phone with me to chat for 5 seconds if I said it was important. The other doctors in the audience last night, who average less than 200 per week, can never get on the phone with me because they have empowered their staffs with the decision making of who they will talk to. A given doctor's staff member always says, “The doctor cannot talk. He/she is with a patient.” The doctor, in turn, has 10-15 calls to return by the end of the day and cannot get to all of them.  If he/she took 30 seconds in between patients to talk on the phone by having the staff member ask the person calling to stay on hold for a few minutes, he/she would be able to communicate in a timely manner with everyone. Try blowing off a lawyer and not returning his/her calls...You will be a one-and-done.


The problem with these doctors is they abdicate the decision making process to their staffs and do not have control through delegating and maintaining control to make the decisions. Patient time is critical and needs to be guarded, but do not put blinders on. Colleagues of mine who are neurosurgeons, cancer surgeons, oncologists, etc., are all available in non-critical times during their surgical or treatment days to take calls and return calls.


In consultation #34, I shared with you the cycle of talking too much where you chat with patients during their treatment and it takes time. Let’s look at it differently by doing the math. If you treat 150 patients per week and you waste 5 minutes chatting with each patient about nonsense, that equates to 16.6 hours of wasted time that you could be using to treat other patients. If you average 15 minutes per patient, that equates to 67 additional patient visits per week. At $60 per visit collected on average (more in most states with PI), that equates to $174,200 per year for wasting your time on bullcrap! If you are in a good PI state that pays $150.00 per visit, that equates to $468,000 per year. Am I starting to make sense now? Do I have your attention?


SHUT UP AND BUILD A HUGE PRACTICE...Your patients will appreciate it.