This original article was featured in the August 2021 issue of The American Chiropractor

This is not going to be a feel-good article. 

Confronting the reason(s) that you’re stressed out in practice, addressing why your revenue is low, and realizing that you’re constantly needing new patients are some things that you need to face head-on. And, the sooner that you realize this, the sooner you can make meaningful changes that will lead to the success that you desire.

I’ll address those challenges in just a moment but I want to share a bit about my story, as there are some lessons in there.

At the start of my career, I was a young naive guy that was fresh out of school and eager to open my own practice. My wife and new baby motivated me to succeed, as did my passion and desire to help more sick people get well with chiropractic care.  I wish that I could say it was an incredible journey to success right from the start…

But, I really struggled those first few years in practice. I had patients who were not enrolling in care despite my best efforts to educate them. I had patients that were dropping out of care as soon as the pain went away, even though I thought that they understood what chiropractic could do for them. I had patients leave because I didn’t accept their insurance.  I had heard every excuse there is!

The little voice that would creep into my thoughts would tell me, “You’re not charismatic enough to sell patients on care”. Or, “Maybe I should be an in-network provider with more insurance companies?”. Or the pathetic voice of, “Maybe this career isn’t the right choice for me”.

As time went on, I could no longer afford rent. In fact, my financial struggles got so dire that I had to move my family into my parent’s house. I felt like I had let my family down. I felt like I had failed.

I had named my practice The Chiropractic Wellness Center because I wanted to provide lifetime wellness care. Yet, upon deep reflection, it was apparent that the way I was communicating and treating patients was incongruent with that mission. 

As I analyzed what I could do differently that would be in alignment with my mission to provide lifetime wellness care, I discovered that I was unclear on my goals of care. Another way to say this is that I was unclear on the results the patient would get when they hired me. It was no wonder that patients stopped care when the pain went away!

Do your patients know what results they’re getting when they come to your office? If it’s unclear, they’ll think that you just help get them out of pain, and then they’ll leave when the pain goes away. 

Now, if your result is to get the patient out of pain and then you send them on their way– that’s no problem if that’s communicated to the patient when they hire you. 

However, if you’re a doctor like I am and you want to have a wellness-based practice, take a step back and reevaluate what you’re doing.  Be real with yourself and realize the issue is that maybe you don’t know what it is that you even deliver! 

Or maybe you know what it is you deliver, but you don’t feel confident measuring the results and adjusting your treatment plan when the patient isn’t making progress. 

Once I addressed this issue and became rock solid on the results that I deliver, things started to get easier for me. I was getting more patients starting and staying under care and it felt good. But as good as that felt, it wasn’t the complete answer because I was still not getting to where I needed to be.

I continued to reflect on the issues that plagued my practice and decided that I needed to learn the latest and greatest new techniques that other doctors seemed to be having success with. So, I learned how to do prepays. Some of my colleagues swore by this and I was convinced it was going to help me out of the rut that I was in.

After some studying and a seminar or two under my belt to learn how to do prepays, I applied it to my practice. With each patient who enrolled into care and pre-paid for their treatment plan, I was elated! I felt like this was going to be the answer to my prayers. 

Then, something big happened and I still remember the gut-wrenching feeling when getting the news.  I had two military families who had prepaid but they were getting transferred out of the state and had to stop care.  I had the unbelievable experience of writing out two refund checks for close to $10,000.   

It dawned on me– I was living on borrowed money! All of that prepay money wasn’t mine to begin with.  Right then and there, I decided that I never wanted to be in that situation again.

I picked myself up from the pits of despair and went to the beach to clear my head.  It became clear to me that I first had to start with my own mindset.  As I sat there on the beach, I poured my heart into how I was going to change myself and then my practice. 

I made it my mission to study and execute a new approach that I was going to apply in my life and in my practice. It was time to roll up my sleeves and go to work on the business. 

I came away from the beach with a desire to understand why some patients stayed while others didn’t.  Why some said yes to care, while others said no.  I started studying the topic of behavioral psychology in order to get a better understanding as to why people do the things they do.  I figured that if I could crack this code, I could use that knowledge to help my patients make the right decisions.

These questions continually swirled around and consumed my every thought. My practice was a great place to test different theories. With a lot of trial and error research, I was able to figure out the answers to many of these questions.

For example, I wanted to know what were the most effective payment options besides prepays?  Does patient education really matter?  We assume it does, right?  But, I had plenty of patients who were well educated on chiropractic and still dropped out of care.  While others, who never paid any attention to the patient education efforts, stuck like glue to the practice!  I had to ask myself– what the heck is going on?

I wanted to know the common characteristics of patients who became loyal to the practice.  With my desire to never live on borrowed money again, I decided to focus on trying different business models first.  I just knew that there had to be better options than selling prepays!

When it came to the way patients paid for their care plan, I had tried the pay-per-visit model, the quarterly payments model, having patients pay for blocks of care, and many more! 

I purposely tried lots of different ways in order to see what worked best.  It was like I was in a laboratory studying the impacts different business models had on patient loyalty.

One of my friends suggested that I try offering monthly payments instead of prepays.  I learned that over 90% of people preferred monthly payments.  This was eye-opening!  Looking back on it, that completely makes sense.  That’s really how most people decide what big purchases they can afford, i.e. cars and houses.  I realized all the other business models, including prepays, were working against what most people normally would do and want.

Now I say, “Monthly payments are the financial language most people use to make their purchase decisions”.  Once I learned this, I decided I need to start offering monthly payments. However, there is a small part of the population that prefers to prepay.    How do I know this?  For a period of time, I never offered the prepayment option, yet about 10% of new patients would ask for it.

In my earlier studies of learning what drove people’s decisions, I realized that if you give people a choice, it’s best to give patients three options.   For some reason, more or less options end up making it more difficult for people to decide. 

I already knew that prepays were one option, but now, monthly payments would be another.  So, I had to come up with a third option.  I thought, “It sure would be nice to just combine the two!”  I came up with the idea of offering the option of a larger down payment (kind of like a small prepay) and the rest would be monthly payments.  Thinking about that now, I laugh because there’s nothing revolutionary about that.  Again, that’s been around a long time for purchasing cars, houses, etc.

And there you have it!  I started offering three payment options that covered the treatment period:

1. Monthly payments
2. Down payment followed by smaller monthly payments
3. Prepayments
   

To my surprise, a large number of patients ended up choosing the second payment option.  They preferred to make a larger down payment to get smaller monthly payments.  

I loved that option because it was the best of both worlds.  When the patient had made a large down payment, they were committed to care, just like with prepays. More importantly, their monthly payment was now a part of their monthly household budget.  

This is where the monthly payment option blew the prepays out of the water. In my experience, one of the biggest challenges with prepays was the “re-sign”.  You know, that awkward conversation that happens when it’s time for patients to renew.  Turns out, the problem was they hadn’t spent money in the practice since they signed up.  They were now feeling better and they had to make a decision as to whether they wanted to start spending money again.

Most often, the decision they made was, “I’m feeling pretty good now.  I’ll let you know when I want to come back”.  Nearly every doctor that I consult with who does the prepay option suffers from the same problem– a terrible re-sign rate.

The monthly payment option made it so much easier to transition the patient to their wellness plan because they didn’t have a new purchase decision to make like they did if they had prepaid. I didn’t feel like I was having to ‘’sell’’ them again. And even better, my revenue was up…way up!

Now, I want to be clear. It’s not about just making more money.  I know that you became a chiropractor to serve your community.  I think we can agree that in order for us to serve them, they need to show up and follow through with the treatment plan that we outline.

As it turns out, getting patients to show up and follow through takes a lot more than just patient education.  The business model you employ in practice will have a tremendous impact on your patient’s ability to follow through with care.

After years of applying the knowledge that I gained on understanding what drove patients to make decisions, my patient retention had skyrocketed!  Not only did I now have patients completing the course of care, but I finally felt like I was delivering on the true promise of chiropractic. My patients were getting great results and I couldn’t be happier!

When I finally retired from practice in 2011 to devote myself to helping other chiropractors, I’m proud to say my average patient had been with me over 300 visits! That’s 24 times the national average of 12.  I left that practice with hundreds of families on regular active wellness care programs.

Doctor, I want you to be real with yourself when you answer the following questions.

If you saw an average of just 10 new patients per month and have been in practice for just 5 years, you would have had 600 new patients.  Now here’s the kicker– what percentage of your patients are still actively seeing you?  All 600?  300?  50?  

In my humble opinion, it’s not about how many visits you see per week or how many visits per day.  The true measure of whether you’re making a significant impact is how long each patient has been with you.  Let me put it another way.  Would you rather have 100 patients who only stay 10 visits?  Or would you prefer to have 10 patients who complete 100 visits?

And why do you prefer one versus the other?

Take a good hard look in the mirror and take responsibility. No one can change this except you. 

Reach out to your colleagues who are having success. Don’t be afraid to try new things. Push yourself out of your comfort zone and do it now. There are patients who need you, your family needs you, and in order for you to achieve the success that you desire, you need you.

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