Climbing the chiropractic mountain: The first seven year of practice

Journal of the American Chiropractic Association, Oct 1999

Dr. Hodges agrees. "Take care of your patients, and they will take care of you. New doctors sometimes hook up with people who get them to do things that may help in the short term. In the long run, however, these things damage a reputation beyond repair. A practice is a marathon. It's not a sprint. It's hard work to get the practice up and growing-five days a week and Saturdays. New doctors think when they get out of school, it's going to be easy. No, school is a cocoon. But by sticking to what they know is right and best for the patient, they'll be all right. As they establish their reputation and image in the community, patients, fellow chiropractors, and other health care professionals will begin referring patients."

In the early years, most doctors will use what Perusich calls high-energy, low-cost marketing, such as spinal screenings, special events, and speaking engagements. Later on, as income increases, they may switch to high-cost, low-energy marketing, such as Value-Pak coupons and newspaper ads. Whatever the approach, she advises doctors to follow the results carefully. "If you place an ad in the paper, track it," she says. "Is it cost effective? If you're doing spinal screenings, track how many patients you get from that. Narrow down what works in your community."

And keep an overall marketing plan in mind. Seminars may focus on one issue or one portion of the practice, but according to Annie Schmitt, consultant for Practice Success at the Palmer Institute for Professional Advancement, it can be dangerous for people to pay too much attention to only one area of their practice. "We often see doctors jumping from issue to issue in their practice," Ms. Schmitt says. "They get their new patient issues under control, but they've lost three staff members in the past two weeks. Or they are having to continually get new patients because they're not educating them. Then the pendulum swings over to patient education, but they neglect new patients. We try to get them to see the big picture, to take the whole practice into consideration."

Reimbursements

In an ideal world, everyone is playing by the same ground rules. Not so in the world of insurance, says Dr. Sherwood. "There are ways to get reimbursed within a reasonable period, but insurance companies don't tell the doctors what the rules are or how to go about it."

Dr. Sherwood recommends making your relationship with a health care organization personal. If possible, meet with the physician recruiter, talk about who reviews the claims, and try to meet that person. "If people know you and your capabilities, if they trust your diagnoses and treatment, they are apt to be more accepting of what comes across their desk from you," he adds.

As the practice grows, and a fairly consistent patient base is achieved, doctors may want to expand into areas such as nutritional supplements; rehabilitation with strengthtraining machines and exercise areas; acupuncture; radiology; neurology; and diagnostic testing, such as nerve conduction velocity studies, thermograms, or electromyographic studies. Doctors can also expand their practices by offering their services to other practitioners in the area, such as orthopedic surgeons and fellow chiropractors, or by hiring an associate.