Q: A DC wrote this concerning why she feels her practice declined First, the practice declined has a multitude of reasons, I changed the long standing name for a new name (i.e. lost name recognition) I dropped my display ad in the yellow pages- went to just line listing I moved my clinic to location off a major road to a road with no exposure and little signage I dropped out of the managed care plans Reimbursement amounts cut by major insurance providers I've heard the advice before that location doesn't matter, however, my experience has been that the mentality of a specific local community can be less conducive to wellness. A: Managed care stinks .. but in some areas if you are not in you on the way out. Managed care works both ways .. it can manage the number of visits and money provided but it further challenges us to manage our patients beyond the HMO dictates and into corrective or longer term cash care. I see the HMO's as another marketing tool .. sending people to me and allowing me to tell another person the chiropractic story. Yes many DC's get complacent and accept what they get from these HMO's and therefore their income declines appreciably .. but that choice has always been the doctors .. not the HMO. Office name change .. you may be right .. it could have had recognition value. Moving the office a few blocks had to have some sane reason behind it .. I'm sure. I don't think there are too many Yellow Page shoppers .. and it does get expensive .. this advice may have been either okay or too radical .. remains to be seen. Nonetheless .. this is water over the bridge. My opinion before rendering any advice about a move (purely an objective opinion .. the end choice must be yours) is this .. With the finacial resources you have and can get .. do you think you can jumpstart your present practice or are you burned out there and are looking for a radical change? If you feel you can make a new go of it where you presently are .. then I would plan out a 3-6 month marketing campaign and give it another shot. Remember .. where you would be going will require no less of your time. If you want a change than be sure that you are assured of the financial benefits of this change. How much are you expected to make per patient or per month. Is this as much or potentially can be made to where you are presently? Is there a time frame when you can be making as much if not more than you are doing today .. that would justify a radical move? Do you have a set buyout clause if you feel all your hard work is paying too much to the owner DC .. this hopefully will happen. Location does matter .. would you want to work in a crime ridden area .. a poor neighborhood .. a trailer park? Everyone needs chiropractic area .. not everyone has to come to you. I agree there is a set mentality that is often hard to break. Not impossible just much harder. These are the questions you must overcome and feel good about. Have a Great Day Dr. M