Q: Can too much change be bad for a new practice? In the 30 months that I have been open I have changed my hours, 1st visit fees, care recommendations, exam frequency, health class, new patient acceptance, adjust on 1st visit, to not adjust on 1st visit, practice management assistance, technique, financial plans, and overall attitude. Before I made most of the above changes I had managed to grow this practice by myself to $12,000/month in collections in 10 months. I then purchased an EMG, hired a coach, joined the velocity program in the hopes of growing even more. I then made most of the above changes and now my practice is down to 5300 in collections and barely making it. I am in a small town that is very unforgiving to people especially outsiders. I have tried screenings, free exams, radio ads, newspaper ads, outside talks and nothing has worked to bring the numbers back up. I feel that I may have burned too many bridges. I have lost the desire to keep it growing enough to be worth buying. My vision of a wellness practice in a small town is not the vision that this town has. I have tried to give them what they want and it is not me. Even the health food store closed down. I had hoped to have sold my practice by now and have moved back to California with some money in the bank. How do I support my wife and 2 kids with all of this happening? A: Thanks for the e-mail. You have a number of questions in your e-mail. First .. change is good and only if you feel it is too much .. it is. Everything you said you changed seems in order .. but if the prices and demands of patients were so high and too much too soon .. it would stifle an existing practice but not necessarily for the long term. Question and Answer #1: Why a coach .. why an EMG .. why the velocity program? Was it to make more money (nothing wrong with this) or provide an improved service? The reason I ask is simple .. if the perception of the patient was that you were desperate for more money and more patients .. then your office tone changed and the existing patients didnžt. In this case .. change possibly came about too much and too soon. If you did all these things to improve services and as a healthy side effect .. existing patients would refer and remain with you for the correct reasons .. and money came as a result .. then you probably would have had a different e-mail to me. I realize that you got into all these things to improve services and make a few extra dollars as well .. okay ..but often as we struggle to pay the bills for all these consultants and new equipment we place a great deal of new and increased stress that shows itself as survivalist and therefore desperation. Just give this some thought. As far as the practice going down and fear of being in a small community .. remember .. even in a small town .. you are like a twig on a mountain top. Every car that drives by is a potential new patient. Every teacher, police officer, librarian, waitress, etc. is a potential new patient. Is there a church with that has a social director, a womenžs club that has a program chairman, a library that has a meeting room, a municipality building with civil servants? If yes .. you have potential new patients. Let me ask you something .. of all these areas I mentioned above .. do you think that some if not all of the existing patients that may have dropped out recently .. spoke to everyone of these potential new patients about you? I doubt it!!!! Therefore .. renewal is the game rather than retreat. I appreciate you have done to date .. life is a game of revolution and evolution .. we have to keep churning the water and doing things over and over again .. especially if they were wins .. the losers we have to sharpen and tweak a little. Also .. Ižm not sure what you mean by your small town wellness concept is not what you have envisioned .. can you explain that to me as wellness is not dictated by city size. In other words .. I am giving you a dose of tough love and also an understanding ear. I appreciate what you have written and hope to salvage what you have created to date. If you are already burnt out with your town and there is nothing to salvage .. then so be it ... get out of Dodge. Hope this helps Have a Great Day Dr. M Follow up e-mail reply: Dr. M. thanks for the sound advice. I am a purist-I am 100% cash, no PI No WC. I believe in wellness only, I don't treat patients. I even had a low overhead. My goal in life is to know my family, have a large family practice and never have to worry about money. I was up to 100/week, $12,000 in collections, had money in the bank, taxes paid and was lessening my debt before I hired any one. I just felt that it was not enough, that I needed to see more people. I was told that those numbers and my PVA was too low, that I was not seeing enough kids in the practice, that I needed to prove that I was correcting the subluxation and therefore I was a pain doctor. It had nothing to do with the fact that I had not even been open for 9 months. I was sold a bill of goods that was supposed to make life easier for everyone. Before I changed my fee I averaged $185 a first visit but was not seeing enough families. My consultant suggested a flat fee of $95.00 to lessen the up front cost to allow more people to come in. I then saw less new patients. My re-exam fee was $55.00 and I lowered it to $25.00 when I got the EMG-Their suggestion. I changed my office hours to Monday-Thursday and worked only 20 hours a week-their suggestion. I stopped adjusting on the first visit for seven months because they said it was giving a wrong impression. I did what was supposed to be the the Chiropractic way. I even went to a small town because that is where chiropractors are needed. I love what I do, I just don't know what is the right thing to do. How do I get out of Dodge when I Have 2 Kids and now have no money? My family keeps saying wait and sell it. Don't do anything drastic. My bottom line is that I have to feed my family and to practice where I want to live. I have passed my license for California I just don't know where just yet. Thanks for the help A: Thanks for the e-mail .. you sent me a classic reply. You know .. I've been in practice for 21 years and never had what is known as a high volume clinic .. I saw many kids .. families etc .. and I adjusted, but I also accumulated a good deal of money, spent over $275,000 putting three kids through private school, sent my wife and kids overseas each yaer and saved a good deal for my retirement. Labels always meant nothing to me .. but I'd watch at DE's and other meetings the few that manipulated the many with what they considered "chiropractic." A „puristū .. what's that. Do you have to starve to be pure .. do you have to listen to people that question your ethics and ability and for a fee advise you to go against your inner instincts that worked? Listen .. you created something comfortable in the past .. it still remains there. Changing fees and adding services is not the reason your practice is down .. and it's too coy to say it was you either. There is a balance here .. start from the beginning. Review the last 50-100 new patients that were examined in your office .. determine when they dropped out and if you could remember why. See if you can plug the leaks. Start the following day with a new attitude .. if not to keep your practice than to kick start it again for the sale. A renewed vigor and enthusiasm is what will revive your practice and there is no doubt about it. Look at your team .. your CA .. have you surveyed your patients to determine if they can invite others for workshops? Have you asked for referrals and made each visit a valuable lesson in Health and Wellness? Seriously .. this isn't patent BS .. this is real. You need to sit down with your wife and determine what and where your future will be. Choices have to be made and once made .. Go For It! If it's here then put your heart and mind into it .. if it's in Mass .. then liquidate and get out and start it all over again. But .. the grass may not as green there as you think .. why .. because you're bringing yourself with you. If you were brand new .. didn't have some successful months .. weren't able to feed the family and felt uncomfortable growing a healthy practice .. then I'd say you either need help or cut loose. But .. from what I read about your early .. pre-coach days .. you were on your way. Yes .. we all want more .. but with whose play book. I still contend that you should have a heart to heart talk with yourself .. close your eyes and remember the real early days in your town .. what brought you there .. who you met and travel the same path again. By the way .. loosen up .. take some insurance .. auto accident cases definetly need chiropractic care .. practice chiropractic for everyone. If you still are under contract with these consultants .. bug them .. get your money worth. Whatever you do .. do it! Have a Great Day Dr. M