Q: After 6 years as an associate with the same practice and getting fed up with them "hiding" money that were paid on my patients, I left and opened my own practice in a small town not far from where I was practicing. We did all the demographic studies, etc. Put together a great business plan and was approved for an SBA loan. There were no other Chiros in the area. The closes was 17 miles in either direction. Anyway, before I even opened my doors I got a call from a new graduate wanting a job. Of course I told him I hadn't even opened my doors yet and there was no way I could hire him. His response floored me. He said that he had been looking at the area and would be moving in and opening his own practice. The problem is, and I told him so, was that this town of just about 8,500 people, statistically, would not support 2 chiropractors. Statistics say one Chiro for every 8,000 people. Well, he can anyway about 3 weeks after I opened up. Now it has been 6 months, I've done all the advertising I could think of, i.e., mass mailing prior to opening, 2 newspapers, Chamber of Commerce and in their Relocation packs, TV on the local county channel, at the only area Golf Course, brochures in different businesses, 2 different coupon mailers, taken attorneys to lunch from Pensacola to Fort Walton Beach, spoke to the coaches at the local high school (one patient is a star athlete there), etc., etc., etc. All to no avail. I figured on our proposal that I would see an average of 120 patients per week. It takes me a MONTH to do that. I figured having lots of Ins. patients and PI, but have primarily CASH. And as you can imagine, you can't get them to commit to a treatment schedule. Most of them have come to me from other docs in the neighboring towns because I'm closer, and are already on maintenance. The other doc in town, from what I've heard is not doing that great either. He does have an advantage in that he lives here and I'm still trying to sell my house so I too can be in the community. My other disadvantage, in my opinion, is that I am subleasing a few rooms in an Urology clinic 4 1/2 days a week until a shopping center gets built. The problem is that they (the builders) have put me off on the completion date and the latest projection is Jan. 1999! Almost a year late. Currently I am 6 miles out of town, or on the edge of town. The new location will be in the heart of the so called town, really just a community. Like one of the letters on your page stated, not only am I frustrated, but the SBA loan is having to be revised because I was supposed to have used the money within 6 months. Therefore, if they pull the plug, I'll be broke! We all feel I will do much better in the new location, but as I stated, its start up date keeps getting put back and back. At this very moment, unless the loan gets extended, I'm frustrated, broke and totally dismayed at the lack of patient compliance I'm having. Oh, I have about 148 patients on file, but only see about 28+/- visits a week. I've read a lot about how great a CASH Practice is "suppose to be," but I'm not seeing it and no, I did not start out to have a cash practice. Being a basically military town, no health benefits. So, have any advise you could share? Oh, and yes, I've done the health fairs, screenings and have talked to people about speaking, again, not much luck there. I'm at my wits end. The other guy has family money supporting him, young and fresh out of school. Don't know anything about the limits of his finances, but mine are dwindling fast! I would appreciate any advise or help you can spare! A: I am deeply sorry you have to go through the troubles of making a living in chiropractic. Considering the degree of good we perform on a daily basis for millions across the world .. every soul should be a patient. Distance from your office .. insurance or not .. inner city location or in the boondocks .. there is never a reason good enough when either your mind is set to win or lose. You have been paying your dues .. the questions is .. and this isn't judgmental .. were your meetings with lawyers .. coaches .. folks around and about a learning session for them or a promotional session for you? Did you ever consider closing the sale? Consider this .. if you invite a Larry Markson or a David Singer in your office for two weeks .. they live in your house .. have access to your meager budget .. use your office with whatever there is .. what would they do to turn it around? Really .. what would they do? .. would they visit the same folks you did and make arrangements on the spot for specific care dates and fees (closing the sale) .. would they create educational workshops for professionals and community folks ..such as clubs .. library .. etc. Would they offer a Community Wellness Program such as a HMO where they offered a reduced fee for the employee and their immediate family member .. what would they do? Really .. this isn't a cope out answer for you .. this is where the metal meets the peddle .. when you are down and out you find the strength to see the solution. Okay .. with all that .. what can you do today. First of all .. review your last 50 to 100 new patients .. log them on a sheet of paper and determine how many visits they followed through with you .. was it 5 or less or ten or more? Did they drop out on their own .. were they given a schedule of any care .. maintenance or not .. were they told to attend a workshop and offered a survey to gather names of people and places you can meet and greet? If they are dropping out .. not referring .. what have you been doing to discourage or not encourage them to continue care .. give this some thought. The cash practice is built on long term contracts .. people maybe paying $50- $300 a month for a number or preset visits .. credit cards used on a regular basis to continue this care .. you have to lock people into a care plan .. Okay .. I know you mentioned you have tried and actually done a lot. If your area is dry .. you may need to farm somewhere else .. if you feel there is enough fertile soil to plant your seeds of success and sow them later .. then get down and dirty .. review what I wrote above. If you own my Smart Start Book .. or the CA's Marketing and PR book .. it's full of good ideas and scripts like above .. review it and begin to use it. Okay .. I have to go now .. but hang in there and don't be too discouraged .. wins at times come slow but once they come and you do they right things ..it keeps on keeping on Have a Great Day Dr. M