116: Chiropractic Excuses

All right, here we go. All right, stop making excuses. Welcome everybody to the KC CHIROpulse podcast, brought to you by Kats Consultants. I'm Dr. Michael Perusich, and I am joined in the studio today with my good friend and co-host, Dr. Troy Fox. 

 

Troy, I know you get all the emails with the questions from our listeners.

 

Um, what'd you get 

 

this? So this was, uh, this was kind of a two or three part email. The individual emailed me to begin with to ask a question that they were curious about us answering on the show. And I responded with a few more questions because I wanted a little more information about this individual's practice.

 

And what I got back was a laundry list of why they couldn't be successful in practice. Yeah. And it was painful too. I'll be honest. It was, and we're not gonna name this individual today. I don't, I don't think that that's the appropriate way to do this, but I do think that we've, we've got a major problem in practice.

 

We don't want to take responsibility for our own actions in some cases because it's, well, my town won't support this, or My practice won't support this, or My patients won't put up with this, or they want this or that, or they're not gonna pay for that. We've heard it. , you know, and I, I get, if you're charging $1,500 for a one to two region adjustment with no therapy and you're not, and, and the rule is you can't, the patient can't speak to you while they're getting adjusted.

 

your practice probably won't survive that way. I, I get that one. So that one, I agree with you. You probably can't do that in your town. Well, when it comes to normal chiropractic practice.  and it comes to patient education and it comes to short treatment schedules for patients to alleviate pain, moving patients into wellness models.

 

Those are things that happen all over the United States. And your town is not the only town in the United States that won't support that. Correct. Um, I think part of that, and, and we can talk a little more, I'm gonna let you step in, but I'm gonna say that a lot of this is an education issue with your patients.

 

Correct. Blank. Correct. 

 

We will stop. And, and I, I think that's a great point and I think, I think it's also a headspace issue for doctors. Yep. And. , which I get, and you and I talk about this all the time. You know, you're going 90 to nothing as a chiropractor mm-hmm. In your practice. And then all of a sudden you gotta put the brakes on and toss the chiropractic hat off and put on the entrepreneur hat and mm-hmm.

 

y you know, there, there's a lot of things happening to try to keep your brain around and it gets frustrating at times. And you know, when frustration sets in, we get down. When we get down, what do we do? We make excuses. Yeah. Well, I, I want to tell everybody listening out there that your town is not unique.

 

It may be beautiful, it may be gorgeous, it may be prettier than where I live, but it's not unique when it comes to chiropractic care. Your patients aren't unique when it comes to chiropractic care. If it was, we wouldn't hear the same excuses from doctors all over the country. So all of a sudden everybody's in a, in a unique town and you're not.

 

So we just have to get our head around. , how to manage our practice so we can find success, so, mm-hmm. , you were sharing this with me earlier today, that you got this email, so, mm-hmm. . Yeah. I thought it would be, I thought it would be interesting for us to just kind of talk about some of the excuses that we hear, what they mean and how do we kind of get our head space around 'em and get past them.

 

Mm-hmm.  Sometimes, you know, like one of the big ones that we hear often is when people say, well, , I'm barely surviving in practice and I can't meet my bills. And we will delve into numbers and look at your numbers. And you're seeing 12 patients a day, right? And you tell us that you can't see any more patients than that, that your patients expect a certain level of care from you, um, and that you're gonna spend, say, an hour and a half with each.

 

That's one of the big things that we hear. And what happens is, if there's a disproportionate amount of work being done that's not being billed. And that's something that we look at often in that maybe you're billing just for an adjustment, but yet you're doing an hour's worth of soft tissue work.

 

And that may be, that may be a a, a big, but we've actually heard that before. We've actually seen folks that Yeah, that want to practice that way. , there's a disconnect between practicing that way and actually getting paid enough to survive. 

 

Well, that's absolutely right. You know, we have to think about simple economics.

 

Mm-hmm. And mm-hmm. , that's kind of, in a lot of ways, that's all business really is. It's just simple economics, supply and demand, you know, so if your supply is low,  and your demand is high, you should be getting high prices and there are practices out there that are, you know, getting 15 to $20,000 for a treatment plan cuz they're a high niche type practice.

 

Mm-hmm. . Mm-hmm . But if you're wanting to do some soft tissue work and an adjustment on everybody and spend 30 minutes with people, and I'm not saying there's anything wrong with this. No. , but if that's the case, you better be charging appropriately for it. So I personally think it's easiest to just stop and think, what do I need to make?

 

What do I want to make out of my practice? Mm-hmm.  and the need part's easy. Sit down and create a budget. Create a budget. Bring it down to a monthly basis. How much do you need per month to cover your. . Mm-hmm. . And then bring it down to a weekly basis. How much do I need to make per week? And then how much do I need to make per day?

 

Break it down to how much do I need to make per hour? And we, we oftentimes in business, we don't think like this. We don't, we don't think, how much should I get paid hourly because we're the owner of the clinic. We don't get paid hourly. . Mm-hmm. . Yeah, you do. Yeah, you do. Yeah. And I want you to think that way just because it's super simple and just as a general rule of thumb, and I'll probably get some emails about this, which is fine.

 

Mm-hmm. , but just generally, just as a general rule of thumb, you should be collecting at least $400 an hour. . Okay. 

 

Yeah. So break that down real quick so that way we understand how easy that is to do. Yeah. So 

 

if you're seeing 10 patient visits an hour and you're charging $40 mm-hmm.  and, and you're, uh, we'll use a cash practice as an example just cuz it's easier.

 

I don't have to think about the write offs and all that, but you charge $40 for an adjustment, you see 10 patients an hour, boom, you hit your $400. Mm-hmm.  as opposed to. , the practice you were talking about at the beginning, if you're seeing one or two patients an hour and charging $40 mm-hmm. , you're making 80 bucks.

 

Yeah. Well that isn't gonna cut it. So, you know, if you're only gonna see two, then you need to charge $200 per patient. So just mm-hmm. . It's not a hard and fast rule. It's just my, my number gauge, if you will, that I think is just a good goal for every. 

 

Well, and I, I think to shoot your, yeah, I think your good goal is great because here's what happens in 99% of cases, when we see somebody that's in that situation, what happens is, is they're, they're staunchly defending the fact that they're not billing for services.

 

They provide. They're giving, they're giving away services. They're billing for an adjustment, they're doing a bunch of soft tissue work, which they're not getting paid for. Right? And, and that's, that's what I really, I, I really hate to see for docs, because you guys are putting in the work and you're fantastic at what you do.

 

We just wanna see you get paid for what you do. So, you do certainly need to get paid for what you do. . Yeah. And a lot of times you're making excuses going, well, our town, you know, financially can't support that. I'll tell you what, that patient that came in that can't afford that soft tissue that you just did with them, drove up in a brand new car and they just got their nails done yesterday.

 

Yep. Yep. And they, and they paid full retail for it when they did. And kids, then all of the sudden they came and they kids in. . Yeah. And they, but they can't pay for chiropractic care. So I think I, I think that we come to that realization in a lot of cases, but I think as doctors, two things happen. We get super busy and it becomes real easy to actually write off services because we're, we're too busy to even.

 

Tell our staff up front, Hey, I did a therapy on this patient today. I'll just charge him for the adjustment. It's already on the books that way, you know? Or you get a patient that comes in and you're already playing. Let's make a deal with them, and they never even said they needed a deal. , you know? Right, right.

 

It's like, it's like when you, when you go to a jeweler and you look at jewelry, they typically, and I get that there's sales all the time at most retail stores, but let's use this for an example. You know that you go to a small town jeweler, they're gonna give you a price on something, right? Mm-hmm. , right?

 

And then, and then let's say there's no sale going on that day. And then you say, Hey, you know, what's your best. Okay. Now there may be a little discount associated with that, but they typically don't come through the door and go, Hey, guess what? We've got this at 400% of what, what, what our cost is on this item.

 

So how about I just charge you $3 over what our cost is?  and you haven't even pulled, they haven't even pulled it outta the case yet. That's sometimes how we react as chiropractors is we automatically go into this poverty complex. So that's how we get to making excuses is because we make excuses for our patients and then all of a sudden we're making excuses for our practices.

 

and that's one of those big excuses we hear all the time. Oh, my patients won't pay for that, so I just give it to 'em, okay? Mm-hmm. , number one, they're not paying for it because you haven't told them the value of it. So if you feel like right, as a doctor you need to recommend a service, pick something out.

 

Laser therapy. Yeah. Don't give it away. Tell the patient why they need it and, and I think, yeah, I think that's a big thing that a lot of doctors miss. Sitting down, educate with a patient, educating them on why you're making the recommendations that you're making. Mm-hmm. , when you make them in a, in a value-based statement.

 

Yeah. The patients are gonna pay for it all day 

 

long, and don't be afraid to tell 'em, because you, you need to tell 'em anyway legally. So there's two steps here. Number one, don't give it away, because in certain instances that's considered enticement.  and you run into legal problems. Yep. Here's the other end of the equation, and here's a great, here's a great statement, Mike.

 

I know that your knee's been giving you some trouble and we've been talking about that. We've adjusted that a couple of times. I really think that some laser therapy might be helpful for this. It's gonna help reduce inflammation and initiate some healing processes within the knee itself.  and I just want you to know, I would recommend that for you today, you can, you can do what you want with that, whether you decide you want to do it or not, but I wanna let you know it's $23 if we do the laser.

 

Is that something you'd be interested in? Absolutely. It's a real quick conversation. I'm adjusting them while I'm doing that because I already know that I think they need laser that day. So it's a real simple conversation. But I want to get the patient's acknowledgement that that's okay as well. I'm not gonna just say, Hey, I think you need to get laser, and I send them back.

 

That's a really good way to irritate someone as well. So if you're gonna do it, do it the right way, but don't give it away, because like I said, well, two, two things. One, it's bad for you and sometimes it's really bad for you because you run into federal entitlement issues with certain individuals. Yeah.

 

You, you have to be careful and mm-hmm. , I always go back to, you know me, I always ask the, the question. . Yeah. And a doctor says to me, you know, my patients won't pay for it. My question is always, why? Yeah. Why won't they mine? Did yours do? Mm-hmm. , why won't yours? Yeah. Your patients aren't any different than mine.

 

And what if I could come into your clinic and talk to your patients, your same patients that you think won't pay for it? What if I could come in and talk to them and they would mm-hmm. , how would you feel? Yeah, hopefully a little sheepish because yeah, you, you've gotta realize that it's between the ears that's holding you backs, you're running the business, not, it's not your patients that are holding you back.

 

It's between your ears and, and here's part of that story. Part of that story is, and this is another excuse. My staff isn't engaged enough to talk to my patients about money. Mm-hmm. , or they're not engaged enough to talk to my patients about scheduling. You know, we hear that all the time. Yeah. Are your patients scheduling the whole treatment plan?

 

Oh no. We just schedule one visit at a time. Why? It's too much work on my staff. Stop the excuses. Stop the excuses. Your patients should understand why you recommended that 18 visit treatment plan or whatever it might be. Right. And they should schedule the, they should be excited to get the entire thing scheduled.

 

Yeah. So they get the days and times they want, and they're on your schedule in a manner that allows them to have the time with you that they need. It's a win-win. Why wouldn't they schedule? Yeah, it's because we didn't spend the. To train our staff. Yeah, get everybody in the same head space and learn the communication strategy to make it happen.

 

This is where I go on my side rant, where I do the, I do the pyramid thing. I think I just have one . Yeah. Well, you had one and I have one as well, and my side rant is this, that you are not the foundation of your practice docs. I know you think you are. Your staff is the foundation of your practice. Well, what if you're, what if you are the staff and the doctor?

 

Well, you're the foundation and you're the pinnacle at the peak. Yeah. Most of the time the doctors up. , the foundation is below you that makes the whole machine run every day. So absolutely. Your staff needs to be well trained. And that's something that we talk to a lot of clients about. We have a full library of information for not only our clients, but staff, and then on top of that with our, with our higher tier program.

 

For our clients, we also offer CA certification where they actually go through classes, they learn all the things that we're talking about so they can kind of crack the whip and, and, and keep you in shape docs. And they have their own coach. And they have their own coach. And so it's not you coaching 'em, it's not you teaching 'em what they need to do in the practice.

 

I like that a lot. And, and sometimes that gets rid of a lot of excuses cuz guess what Doc? If you have a poverty complex, but yet you've got your fees set and your front desk doesn't, they'll handle it for. You don't need to worry about it. Just keep your mouth shut. Do what you do. Tell 'em it's an additional $23 for laser, and staff will handle it up front.

 

Yep. That way you can stay out of it because what you do is you, doctor. That's right. You're not an accountant. Doctors don't talk about money. Nope, you shouldn't be. You can tell 'em what it costs, but then that's it. We don't need to, that's it. We don't need to have a financial hardship discussion while I'm adjusting you.

 

You know what, you know what's funny about that? I would've, patients ask me all the time, you know, what's, what's the laser cost or what's the supplement cost? My pat answer was, I don't know. Ask the girls up front. I have no idea. Yeah.  and I do it a 

 

I do it a little bit differently because I do know what a couple, three of the, the major therapies, but sometimes like there might be an exam charge and they're like, what is that?

 

And I'm like, I'm not sure how much that is. Let's ask the girls up front. But when it comes to like some of the minor therapies, I'm like, yeah, I know exactly what this costs. So, but yeah, most of the time it is better to let the staff handle it up. , right. So 

 

yeah, and, and caveat there. We both called 'em girls.

 

We're not trying to be sexist. It's just born outta habit. And most of us have female staff. 

 

Well, yeah. Yeah. And, and I say that in the most endearing way before we get ourselves in trouble, but I don't have any males, so there are no guys, it's just girls that work for me, and they do a fantastic job.

 

They're the li they are the lifeblood of the practice. So, you know, don't make excuses too.  put 'em into a position where they're just assigned tasks to do every day. Mm-hmm. , get them engaged. Get them trained, have those conversations on a constant basis so that everybody continues to learn. And training is one of those invaluable investments that you can make in your practice.

 

Mm-hmm. . And they see so many doctors coming up with so many excuses of why they can't do it. Oh, we don't have time. We, it, it doesn't work. Stop making excuses. I can't say that. 

 

Yeah, absolutely. So as we wrap this thing up today, we've learned a couple things. Number one, we need to educate our staff. We need to educate our patients, and we need to sit down and have a.

 

Really, uh, deep in-depth, talk with ourselves about kind of where we're at so far as, uh, you know, let's be honest with ourselves. Are you making excuses about your practice right now? If you are, let's figure out how you can get away from it. And if you're not and you really have a major obstacle you're trying to cross, get some help.

 

Yeah. So that's where we come in. In either case, we can help your head space or we can help you remove that obstacle either. . Yeah. 

 

So here's what I want you to do right now. Go to Kats Consultants. It's Kats with a Katsconsultants.com. We've been around a long time. We've been doing this a long time.

 

We understand where you're at because we're chiropractors too. Yeah, so jump on our website. If you want, you can make, you can schedule a breakthrough call. Let's talk about your practice. We do that for free, just because we like talking to docs and we like giving back to the profession. So we're here to help. So go check us out and make sure to download some of the things that we have in the resource center on the website as well.

 

We've got some great blogs and downloads, some things in there for you. Alright. Thanks everybody for listening to the KC CHIROpulse podcast, brought to you by Kats Consultants, helping doctors keep their pulses on success. So from all of us here, we'll see you next time. See ya.