Hi Doc, I was hoping you would take a moment out of your busy schedule to guide me in the right direction. As you know, I am another greenhorn DC who is experiencing some wonderful successes with my patients. I would like these patients to give me testimonials for a Practice Member Scrapbook like "Our Patient Speaks" and to acknowledge the Practice Member of the Month. I wondered what questions you ask them for their testimonials and what kind of parameters do you use to determine your patient of the month. Also, what kind of internal referral programs do you use to boost referrals from existing satisfied practice members. And what do you do to prevent patient drop out? I know these last 2 are loaded questions and I'll understand if you don't have the time to answer. I don't have a CA yet, but I am getting too busy to keep it going myself and having a good CA will plug up the holes in office protocol and patient management. I haven't been keeping up with paperwork like I should, even though most of it is cash. Am I just being lazy or should I feel guilty for not wanting to be the CA too, (I was an experienced CA)? This month I have done alot of spinal screenings and now I am experiencing more new patients and higher volume and already feel overwhelmed, I can't keep up with it all. I have a new patient that can't afford care and has offered to help me catch up with paperwork, thankfully, but that won't help me keep up. Money is starting to come in now, but I'm worried that it won't be consistent enough to support an employee's salary. Do you suppose a CA will be exactly what I need to ensure that I can handle all the new patients and keep them and the income coming? It's hard to break out of the poverty mentality after sooooooooo many years. Shame on me. Any suggestions? Thanks for any time and thots you can share with me. I love & appreciate all you do for me and the profession. A: Thanks for the e-mail. This is basic practice building question 101 .. what to do when three people enter the office at the same time. The problem is called Capacity. Some DC¼s can handle many hats and chores with no problem including answering the phone .. taking x- rays .. doing an exam and providing adjustments while taking money, etc. Capacity is all dependent on the individual and the environment. If you feel overwhelmed and find that catch up has begun then you need help. As I discussed in my class today .. possibly hire a part time person .. afternoons or mornings to help with the paperwork or PR. First try to streamline your paperwork .. see if you can block visits and chores during the same time .. so catch up and paper time is standard and adhered to. Also .. if you plan to grow and grow with the object to profit and accumulate .. you must decide now how you plan to do it. Once seeds of growth are planted .. the seedlings will begin to rise (screenings equal new people). To nurture these seedlings you must cultivate the land and the land surrounding it. To nurture a new practice (which by the way is practically re-newed or made new daily) the same is true .. cultivate. Farmers need help .. either to plant or to harvest. Screenings (PR) are the planting .. taking care and requesting referrals and other internal practice promotions is the harvest. What happens when the land is not harvested correctly .. it has fruits and vegetables dying on the vine. In one breath it is a waste for us .. but on the other hand it is healthy mulch and life for the future harvest. Nothing goes wasted .. just opportunities. So .. after all that .. what am I trying to say? Take a moment .. close your eyes .. forget the present financial restraints and visualize a full office .. people coming and going .. staff doing what needs to be done .. patients laughing having a grand time and telling others about your office. Can you see an x-ray machine (if yes .. what is it doing there .. why is there none now). Can you see additional staff busy creating more capacity (if yes .. what is it doing there.. why are there none now). Can you see a full waiting room with people scheduled for extended periods of care and means to pay the fees you need to sustain you and your family .. this should be the goal .. this will only begin when you make it happen .. by deciding this is where you plan to plant your garden .. nurture the soil and harvest the crops. Farmers .. unless they were in the 1700¼s .. usually don¼t pitch a tent and plow the land by themselves. They have a home .. equipment .. plant on time and with all the material they need and then they hope .. are you doing this now .. or have you decided the tent will suffice for awhile longer? Testimonials and Referrals can be found in my Smart Start Book pages 107, 59, 146-7, 150. It may be time to read this book again. Have a Great Day Dr. M