How to Enjoy Practice Again

By: Dennis Perman, DC

If you’re like many Chiropractors who have been working harder recently and enjoying it less, there is a way for you to regain the passion and enthusiasm you may feel you’ve lost, and to reshape your practice so you feel great about going to the office every day.

There are five specific components that combine to determine exactly how happy and satisfied you are in your practice. If your practice seems less than ideal to you, it is because one or more of these factors is out of balance, and requires attention.

Figure 1

Look at the diagram in Figure 1. Notice that there are five components contributing to your practice fulfillment – your identity, who you are, your beliefs, values, behavior patterns, and how you apply these things in your practice; your philosophy of practice, which will create the specific matrix in which your practice is formed; your new patient flow, measured in new patients per month, which determines how quickly your practice reaches and pushes your capacity; your patient compliance, measured as your patient visit average, or PVA, which is the best measure of efficiency and stresslessness, and getting and giving maximum value through your service; and your money management, measured by your office visit average and collections ratio, which reflects the effectiveness of your policies and determines the profitability and equity of your practice. The intersection of these five areas will determine your Practice Fulfillment Quotient – in other words, the place where all these components come together, to define the ideal practice for you.

A practice that is fulfilling for you will have the right blend of these factors, and the only practice development strategies that make sense for you are actions that take you in the direction of your particular dream. So, let’s explore these five areas, and decide which of them may be out of balance for you.

The Mechanics of Your Ideal Practice

Let’s look at the three inner components first. New patient flow doesn’t only refer to the number of new patients each month, but the type of patient as well. If you want to attract twenty new patients per month, there’s a big difference between attracting twenty Medicare patients and attracting five families of four. Neither is necessarily better or worse than the other – they’re just different. If you prefer to cater to seniors, the twenty Medicare patients works just fine. But if you want to see families, the twenty Medicare patients would make you more successful, but not more fulfilled. Fulfillment comes from a good match between what you want and what you’re getting.

Likewise, your patient compliance plays a major role in your level of satisfaction in practice. If you focus on wellness, then you prefer a practice with a higher patient visit average, or PVA. PVA is calculated by dividing your total office visits by your number of new patients; so if a patient in your ideal model would come in for regular wellness care throughout his or her lifetime, that would mean more visits per patient, or a higher PVA. If you prefer acute care, a lower PVA suits your needs, since you would see patients fewer times on average. Once again, neither is in and of itself good or bad; it’s just a matter of what fits your preference.

Then, your money management and financial policies must reflect the way you choose to be compensated. If you prefer a direct, cash-based relationship with your patients, you won’t be happy working with third party payors. On the other hand, if you enjoy personal injury or workers compensation patients, you’ll only be happy if you learn the skills of managing those types of cases.

These three practice management parameter—your new patient flow, your patient compliance, and your money management—will form the mechanics of your practice development. If you want twenty new patients (20 NP) to come in forty times each on average (40 PVA) and pay thirty-five dollars for each visit ($35 OVA), you would see 800 visits per month, earning $28,000 per month. Your collections ratio, calculated by dividing your income by your services rendered, would determine how much of that $28K you would collect. At 100% collections, you get all of it. At 75% collections, you get only $21K.

Only you can decide what practice statistics would be satisfying for you. If you desire a wellness practice, but your PVA is too low, you need to work on your PVA skills, like your Report of Findings or your Patient Education. If your new patient flow is too low, you need to work on your marketing. If your money management isn’t what you want, look at your fees or your collections procedures.

This covers the mechanics of your practice – but how can you change these factors, when you’ve already been trying your best to attract new patients, get them to comply with your recommendations, and have them follow your financial policies?

Building Your Practice from the Inside Out

That’s where the outer part of the diagram comes into play – your identity and your practice philosophy. This is one of the most important breakthroughs of this Practice Fulfillment Quotient model—that it clearly defines not only the things you need to DO to create your ideal practice, but also who you have to BE.

A certain kind of Chiropractor would design a practice like the one you want, with the right number of the right kind of new patients, complying as you desire by coming in the number of visits you believe they need, and cooperating throughout their time with you in a way that enhances their response and reduces your stress, and paying you at the rate and in the way you prefer. There is a certain version of you that could pull that off, with certain belief structure, certain values, certain resources available, and certain behaviors and habit patterns. If you expect to be able to create that dream practice, you’d better begin by transforming yourself into the person who could make that dream come true.

For example, if you believe that to create your ideal practice, you’d have to be confident, motivated, focused, and determined, and you’d have to become a great communicator, an excellent adjustor, and a skillful time manager, this would contribute to the identity profile you would aim for. Belief structures like “I can definitely build this practice” and “It’s worth it for me to do whatever it takes” might also be helpful. Recognizing your values hierarchy, realizing why you do what you do, will also be useful – is educating the public about health important to you, or reaching financial independence, or being acknowledged as an expert in your field? Knowing your priorities will help you shape yourself into the kind of person who could indeed design and achieve this ideal practice.

Once you compose your identity profile, notice where you are already like this person, and where you are not. Those distinctions will direct your attention to the weaker areas, the places where you are not yet like the version of you that would build this dream practice. In an Identity-Basedä process, the sequence of manifestation is BE-DO-HAVE, so you’ll need to work on refining your identity if you expect to be able to execute the mechanics of building this practice.

The factor that brings your identity and your practice mechanics together is your practice philosophy, the way that your identity is expressed in your practice. If you run a subluxation-based wellness practice, it establishes a different matrix in which to grow your practice than if you have a neuromusculoskeletal approach. Get clarity on the philosophy of your desired practice, and compose a statement that demonstrates your practice philosophy. This focus will help you eliminate contradictions – for example, if your philosophy statement revolves around providing subluxation-based wellness care to families in your community, you wouldn’t call your office the “Anytown Back and Neck Pain Relief Center” – that name wouldn’t be congruent with your philosophy.

Your Practice Fulfillment Quotient

When your identity is well-defined, and your philosophy and purpose are clear, you can focus the three inner elements of the diagram, to have the intersection of them be as wide-open as possible. As you bring your new patients, your patient compliance, and your money management into the proper balance for your taste, your practice becomes maximally fulfilling – the right number of the right kind of new patients, complying so they and you have the best experience possible, managing your money so they get the fairest deal possible and you have optimal profitability.

By working on your identity and the clear representation and enactment of your practice philosophy (BEING), and by balancing the new patient flow, patient compliance and money management (DOING), you can refine your practice, sculpting and reshaping it until it matches your ideal (HAVING). If your practice is not as fulfilling as you desire, look into the five components of your Practice Fulfillment Quotient, and you’ll be able to figure out how to enjoy practice again.