Thinking of opening multiple chiropractic practices?

You have been in practice for many years. You have successfully established and maintained your practice. The professional goals you set for yourself with your degree have been far exceeded. Now you have ten, fifteen or twenty years until you retire. What opportunities do you have to grow personally and professionally?

The conversion of one practice into multiple practices would define the growth of many mid-career chiropractors. Being able to serve more of the community and in turn increase your residual income, decrease doctor/patient time and increase practice equity would further broaden the definition of your success.

As a co-owner of six chiropractic practices, my experience can clarify whether multiple practice expansions are a viable option for you to achieve greater job satisfaction. If asked, most chiropractors would say they would love to own multiple practices and reap the rewards, but most chiropractors that try to expand fail.

A common business plan is to open a second office and work in it on days off. Build a small patient base and then an associate can take over the existing patent base. What always happens is that the profitability of the existing practice drops, a small practice is built in the satellite practice, the overhead costs are almost double, and the doctor works two extra days on top of the regular work week without being financially able to hire an employee. The doctor now notes that he or she bleeds until they bleed. The reality is that they are losing money and enthusiasm for every hour they spend in the field office.

This failed plan plays out over and over again. I have benefited from buying many of my satellite practices from doctors in the bleeding stage. The doctors all agreed that selling their practices at an undervalued price was better than continuing to lose money and energy. For them it meant selling the office or closing it entirely.

The basic mistake these doctors made is that they worked in their office, not in their office. This statement by Michael Gerber in the E-Myth must be fully understood before attempting an extension.

Doctors tell me all the time that they are working harder than ever, spending time traveling from office to office, training new staff, and seeing more people. They don’t reach their goal of multiple practices; They’re just doing more of what they’re already doing with a lot more overhead. They work in their practice.

The chiropractor whose goal is multiple practices needs to work less as a chiropractor and more as a visionary, administrator, and motivator of employees. There needs to be a transformation from the practice of chiropractic to the business of chiropractic. A shift in thinking from “This is what I do, I’ll do more of it myself” to “I have to delegate responsibility in order to grow” is a necessity for growth. Your interest will grow in other related areas such as computer technology for greater efficiency, human resources for quality recruitment and training, and improvements in fundamental business operations. Your responsibilities will include identifying the best place to shop for printing, telephone, x-ray sales and service, malpractice and commercial liability insurance, and durable chiropractic supplies. The doctor who invests his energy in implementing specific systems that can evaluate the productivity and efficiency in his practice works on his practice.

There are three interdependent qualities that I have found that define success in any project, but definitely in multi-office expansion; Vision, motivation and system implementation. The vision you create will be the motivating force that develops quality systems that can be executed to a high standard.

You, the chiropractor, must be the visionary; the leader who has a burning desire to climb this mountain. Your employees must understand, agree with and follow this vision. Ideally, the chiropractor, staff, and patients should all be aligned with the practices’ mission.

This vision must include the satisfaction of all parties involved. Each person who works with you must have both a common and a personal interest in achieving the goal. By serving the community, the practice, and oneself professionally and financially, the entire organization solidifies the vision.

No one can perform all the tasks required to build and maintain multiple practices; It’s a real team effort. Acknowledging this statement highlights the need to motivate your team. Not all employees are motivated by the same compensation or leadership style. My experience has shown that developing into a well-defined organizational culture allows the leader to anticipate the needs of the team. A high level of employee diversity leads to increased motivation and leadership difficulties. Similar personalities are motivated by similar and predictable ethics, expectations, and rewards.

As the organization grows, the talents required to lead and motivate must likewise increase. My basic theory for leading employees successfully is to clearly define what is expected of the employee, have them agree to that level of competency, and then motivate and lead them to achieve that expected level.

“Success lies in the system” and “The system lies in the solution” are common phrases in my office. We live from them and grow from them. The most famous example of the concept is McDonalds. With a three hundred percent staff turnover, they rely on systems to deliver a predictable standard of quality and service. Once the system was in place, replication of the service to over 25,000 locations worldwide was history.

In many multi-staff, single-physician practices, the chiropractor has the least knowledge of the systems in their practice; the office manager runs “the show”. This doctor depends on this person until he is held hostage. The physician who detaches every important task in his practice and develops a system to have that task done by others will be able to grow into multiple practices. This doctor must first master the task, document the process or system and then make it usable for everyone. Every system must have a component that evaluates and monitors the effectiveness of that specific system in order to constantly improve it. This allows the doctor to delegate with the ability to oversee. The result of this process is growth; Growth through organization, not through individuals.

The hardest challenge is getting financially and emotionally committed to multiple practices. Really commit yourself, don’t go into the plan by saying, “I’m going to open a second office and see how I do it”. Once committed, you become the architect and use your talents to design the business plan. Based on your previous experiences, you will turn the concept into reality.

Personally, growing from one to six practices has been one of my most challenging and rewarding professional experiences. I can relate it to mastering a video game. In a video game, the first thing you do when you move is a land mine that will bring you close to death. As you begin to understand this new environment, develop a plan or vision to win. It quickly becomes apparent that a motivated workforce with a plan or system will defeat your opponent. Further repetition of the required tasks will increase your performance at the highest level. With all these forces behind you to gain intellectual strength, political influence and financial independence, you crush the opposition. Unfortunately, life doesn’t exactly mimic video games.