Q: Dear Dr. Margolies, I have almost completed reading through your book, Smart Start, and have gained lots of insights and good info for starting my own practice. I just graduated this past August and will be opening my own office in January/February of 2000. I was wondering if you had a list of all the recommended equipment and office supplies for a startup office. I have a good idea but did not want to miss anything. Any assistance you can give will be deeply appreciated. A: Thanks for your e-mail. Answering your question is difficult without knowing how you intend to practice ..what equipment you feel you need to get started and how much space will you be able to get by with. Typically .. you need a quality adjusting table .. whether with drops .. distraction or straight bench. Spend some extra money getting your bread and butter table as you like it. I have some straight benches for side posture work and working with smaller children. By the way .. I adjust out of one room .. a patient at a time. Some DC¼s have open adjusting areas .. I never felt comfortable with this but it works. I also recommedn a few roller type tables .. like a spinalator. These should all be the same type and color as I mention in the book. I own Haberer tables .. they last forever and if anything goes wrong it is a few screws you remove and then send the motor back .. probably will never happen. The tables cost about $700 or so a piece. I have five but two or three if sapace allows works well. Again .. since patient sremain there for 8-10 minutes at a time it is important you own more than one. I also have a hydrocollater .. heat. For ice .. you can buy instant ice packs. I use the heat with the rolla table .. insurance covers these. If interested in these table ..here are two numbers of similar type. These will get you by without the added expense of heavy duty tables. Start frugally and go from there. Haberer Tables - 770-445-5947 or Kyroflex tables- 1-817-336-1319. Both can ship very easily. An x-ray machine is necessary .. you probably can find a good quality used one if you ask around .. especially the x-ray techs around. Diagnostic equipment is dependent again on what you feel you need. Some DC's feel it important to have computer generated stuff .. SEMG and the like. If you feel you need it then get it .. but I always taught my students that these were second tier purchases unless you felt it part of your initial protocol. As far as general info .. a cheap 13 inch TV/VCR combo works well for patient education and/or general info for waiting room or selected room use. Enough chairs should be available for patients to feel comfortable while they wait as well as reading material. You can stick with chiropractic or health oriented stuff .. but some general magazines will also be okay. This doesn't have to be the brainwashing hour .. they come quite often and should feel at home. I recommend you reply to me with your list and if there are items you question let me know why you question them or why you feel you do or possibly do not need it and we can go over that. In the meantime .. plan your next few weeks as if you are planting send in your new location. More important than the chairs and tables is getting the patients. The second half of every chapter in Smart Start concerns marketing. It was setup this way as what I would do with a lead time of 8 weeks prior to turning the key to open a new office. Plan the days correctly to build a marketing farm use the components of retail .. residential .. clerical and labor. If you are able to get into my webpage: http://www.mindspring.com/~chirosmart .. check under Practice Tips and scroll down for start up ideas. In the bottom of the area I call cyberconsulting is a place called class notes .. my handouts that went along with each chapter of the book .. print these and follow along. There may be an area there that describes my last lecture on exactly the steps to start a new office. Gather your thoughts and keep in touch we can work your successful start together. Smart Start Note: There are many of you who will be successful just by the nature of your karma and being. If you have the touch .. not stifle it with educated methods to suppress this gift .. Go with the flow. For the majority of you, it will be imperative to create the office you wish, and more important, maintain a constant flow of patients to carry on. The most important buzz word is Retention. An office based on constant advertising is a drain on you and your profits. AÝpractice that has patient¼s returning for supportive care; referring their friends and family; as well as being a constant source of on going income, is what you are after. The numbers you are looking for are Patient Visit Average. PVA¼s are the average time a patient spends in your office. This number is found by dividing your new patients into the total weekly visits. A healthy practice has a number of 30 and above. If you have patient s coming for acute care only, and they leave between 1-10 visits, you have no choice but to „pump¾ your practice up all the time. An office with clear patient communications and education will reduce overall stress as patient¼s will return for the correct reason .. subluxation management and wellness. You¼ve made it this far as a student because you have seen the potential of chiropractic .. share it with others. Therefore: Read the material handed to you during the last few weeks. As with everything else, there are ideas you feel comfortable implementing and others you have to gag to even read. Don¼t throw the baby out with the bath water. Use what you can and keep the others for some later date when you feel it may be useful. That said, let¼s recap what would be helpful to get started: Two months prior to opening your own office do the following: Final Word of Advice Right From The Start Purpose: Ä Define your Professional Goals Ä Define your Personal Goals Ä Write clear month by month Action Steps Ä Clean up your act -- Plan your success -- reduce emotional stress Commitment: Ä Tap into Chiropractic Spizzerentum Ä Tap into Chiropractic Philosophy Ä Understand the Predicament of the Species Ä Determine where is Chiropractic in your Community Ä Know who your enemies are: Community Ignorance Confidence: Ä Review and sharpen your skills Adjustment (primary and one-two secondary) Examinations (perform quickly and with authority) Communications (consultation, report of findings, follow up) Office Procedures (insurance, fast efficient paperwork) Finances (replace poverty consciousness with purpose) Public Relations (meet the public -- professionals and civic) Go For It!: Select area and pick location Work your Farm and create business logas Purchase business cards and hand them out Start a telephone and mailing campaign for workshops Create a newsletter and hand deliver them to businesses Drop newsletters in mailboxes, laundry rooms of apartments, etc. Ask to do screenings in local spas, clubhouses, and health food stores Send direct mailing to community -- offer complimentary exams Lectures and workshops -- offices, homes, churches, clubs Take professionals to lunch Provide a dinner workshop at a local steak or fish restaurant Have „pack them in¾ times. Schedule many people at the same time Be sure to have your new patients excited within the first 5-7 visits Don¼t be afraid to tell the patients what they need Never recommend care based on a patient¼s pocket book Don¼t overspend to impress ---- Impress then spend Attend management seminars when ready -- return to DE Never stop dreaming -- always go for it If you get down and out -- get down and dirty and fight your way out Remember -- Profitability and Accumulation -- that¼s the ticket Good Luck -- You Have What It Takes -- Now Go For It! Ä Drive the area and gather a demographic and farm approach to what¼s there Ä Gather a list of companies, either from the phone book, Hanes directory, etc. Ä Call these companies and use the handout scripts to reach the proper person Ä Send letters concerning workshops and meetings (it will take time for this) Ä Send material to local attorney¼s via names gathered in the phone book Ä Set up meetings with attorney¼s and have your material ready Ä Canvas your farm with a newsletter about your „to be¾ office and you Ä Give out your business card to anyone you have contact with and get their card Ä Look in the phone book for local clubs, unions, church groups and see their interest Ä Write your own purpose and policy statements and adhere to these Ä Prepare a front desk manual and have all the forms prepared in advance Ä Train a staff member and do not cheat on time, you¼ll be molding them Ä When patients first come in, cluster book them if practical Ä Be firm with your policy and give patient classes even for that one person Ä Be cautious of spending too much time with the first patients .. capacity is key Ä Even though it may be hard .. save 5-10% each week in a money market account Ä Resist spending on „things¾ until you¼re rolling .. a few months or more Ä Ask your patient¼s for referrals -- don¼t seem desperate -- only concerned to help Ä Ask your patient¼s, via a survey, where they work, your workshops, etc. Ä If you had been writing newsletters, you should send them out to your community Communications and Avoid Burn-Out Even though you are just getting started, it is very easy to get burned out. Burn out is a state of mind, but when it hits ...... it can be very dangerous. The momentum and energy of the practice is directly proportional to your level of energy. If you get down .. the practice is down. If the staff is sloppy, it¼s because your procedures are sloppy as well. To avoid burn out it is important to avoid office and personal stress. Easy said than done, but it can be accompolished by active communications with everyone you have to work with. This includes your patients. Following your office and personal policies to maintain your purpose, will by the nature of this close checking, keep you from being burned out. Burn out can also be due to lost interest .. losing the excitment levels that kept you going .. this is especially true when you have to deal with insurance companies and the lack of respect from the general public. Keep your spirits high with continued belief in what your goals are, as well as tapping into positive influences such as DE or Parker.