January 2009

Six practice myths

by Dr. Dennis Nikitow

As you make decisions to improve your practice, it's important to be aware of certain myths before you embark on a change or strategy that could backfire on you. Be careful when looking at your peers and the strategies they've used because things aren't always as they appear to be. In fact, they could be just the opposite.

*** Myth 1: High volume means higher income. Over the years, I've seen doctors fall into the volume trap -- doing anything to pump up their volume, including treating people for free. Paradoxically, some of the highest volume practices proportionally make the least amount of money. This is because doctors buy into the myth that volume means status, credibility, and money.

I've talked to doctors who've been frustrated because they let people come for free, thinking that if the patient either didn't start or dropped care their volume would drop and they would suffer some sort of fictitious disgrace. Other doctors told me that by allowing patients to come for free, or dropping their fee to whatever the patient could pay, the patient would refer more patients. Yet, the reality is these patients either don't refer or they refer birds of a similar feather.

You can avoid this trap by having a solid system of communicating chiropractic to maximize perceived value, providing affordable payment plans based on fee for service not unlimited service for fixed fee, offering family plans, and most importantly, by not comparing yourself with others. Be humble and thankful for everything God gives you.

*** Myth 2: Associates will build your practice while giving you more time off. Your practice is successful because of you, not your associate. Your energy built it and is required to sustain it. Associates are there to learn, and then go out on their own. Their time should be limited to two years and they should be given incentives based on time and money. Lower salaries and higher bonus incentives are the best relationships.

This can keep your practice stable, but its growth cannot be dependant on associates. Your focus should be on teaching the associate to apply your practice strategies for success because if they're successful in your practice they will be successful in theirs. Delegate, then monitor your associate closely. If you take more time off, be prepared for your practice to drop, but weigh out what's more important. It can be a win, win, but just remember no one will ever be you.

*** Myth 3: Multiple clinics will increase your business and income. Owning multiple clinics is tricky. It's similar to having associates. The major difference is that overhead dramatically increases and your energy shifts from doctor to manager. Some doctors love this and others hate it. Doctors have often told me they work more, their main practice drops while they're trying to build the other, their income doesn't go up, but their stress does.

If you're a hands-on doctor who loves being with patients, but hates the business and paper work side of practice, don't think about multiple practices. Exercise your energy on one clinic and you'll build more success. Focused energy is much better than dispersed energy because it keeps your practice moving in the direction you want.

On the other hand, if you're set on multiple clinics, give an associate incentive to do a buyout after you get him or her started. You'll give up ownership after a while, but you'll make more money and be less stressed because the doctor will work harder knowing that he or she is building for the future.

*** Myth 4: CAs will build your practice. CAs are an integral part of every practice, and acquiring a CA with a purpose-driven heart will be a great asset to your practice. However, they will never be able to substitute for the doctor, and should not be relied upon to build your practice for you. Create a team approach based on a strong mission and purpose that includes your staff. Pay them well and give them bonus incentives for practice growth. But, never cede too much power to CAs, and cross-train them in case one leaves.

*** Myth 5: Therapies will make me more income. If you bill insurance, therapy can be billed and provide you more income. However, if insurance is limited, will you charge your patients the same for the therapies and use them as frequently? Therapies also promote a pain relief practice instead of a family wellness practice. If this is the kind of practice you want, then varied therapies could be used.

*** Myth 6: Different instrumentation could be used to monitor patients' progress instead of x-rays. There are several good instrumentation programs available, but their reliability is questionable. If chiropractors claim to correct spinal alignment, how could that be identified or monitored without x-ray? There are enough solid studies to provide evidence for spinal restoration and its relationship to function, yet there aren't enough to rely solely on the instrumentation that's currently available. Learn a technique for spinal correction that is evidenced by x-ray, and once an instrumentation program becomes available that is reliable, we will all have it.

If you familiarize yourself with some of these myths, you can make better choices for your practice and your future.

(To learn about the Certainty System, Certainty Practice Products and Dr. Dennis Nikitow's upcoming seminar schedule, call 800-544-3884. Outside the US, 303-721-6202.)