Dr. M,

I was just thinking about your topic yesterday and I definitely have 
not put together a built in system of re-evaluation. I have mentioned 
it to my CA's a couple times but never told them how to make sure I 
do re-exams every 12th visit and thus re-reports...that would help so 
much with their retention and results!

I have something important to ask you. But first I must give you 
some background. There's another DC working in my office on 
opposite days, conveniently opening the office for 6 days/wk. (I was 
only open MWF before he came in). Rather than messing with a 
contract and who adjusted how many patients... we decided to split 
the expenses. I didn't do much about it the first 2 months and then I 
gave them, he and his wife who is his CA, a list of expenses and
asked them to make a determination of how they would handle that. 
At the time it would have been half of $3,600/mo, their portion 
$1,800 and that didn't include any office supplies. I knew that was a 
lot for him since he still had hardly any patients. So when he slipped 
me a $400 check one day in the drawer when I wasn't there, I left 
him a thank you message. Each month they would leave $400 and on 
occasion he would buy supplies and his wife keeps the computers 
going and helps a lot at the office. Since we were both broke, I didn't 
argue. Plus we adjust each other and cover for each other when we 
can (my schedule is usually too busy to reciprocate).

However, then he started complaining that he is reaching a capacity 
block, not having a full time CA to help and seeing a lot of my 
patients on his days and he wants to get paid for them. He says he 
doesn't have time to see more of his own patients if he's busy seeing 
mine without pay. His wife bills out his HCFAs and if they have 
insurance, he gets paid insurance on my patients, which was not part 
of the agreement. So then he complains if my patients don't have 
insurance, he should get some of their monthly budgeted program if 
he adjusts them. I told him it would even out and when he builds his 
practice, I'll be adjusting some of his patients and it would be a 
wash, don't sweat the small stuff. He says, I've been checking and
almost none of my patients come to you. (Some do, but she only has a 
handful to begin with and a family of 5 just this week said they're 
schedule worked better on my days and asked if they could they come 
then). Not to mention, I adjust as though I have a high volume 
practice, no frills full spine , no fear chiropractic. He takes his time 
and gives them the blocks, the activator, the rack traction and strips 
the babies for pediatric adjusting and spends excessive time playing 
and socializing with them. He's sweet and lovable. It's great bedside 
manner but doesn't pay the bills.

Meanwhile he asked about my CA's working for him. I told him he'd 
have to ask them if they have the time, a mother and daughter. Last 
night the daughter says she wants to talk with me as we're leaving. 
She told me Dr. Ed's husband is switching to day shift and can't help 
him in the office anymore so she wants to switch to Ed's day, works 
better for her schedule as she's preparing for her wedding. I was 
floored since I spent time and money out of my pocket to train her 
and she's going to work for the other doctor? I asked her a couple 
weeks ago how she would handle working 5 full days and a
half if she also worked with the other DC? She said she was working 
on that. I guess so I've been tossing around a couple ideas and I'll 
present them to them at the staff meeting on Monday. First, I'll give 
them all sheets to take home and write out their goals over the 
weekend. The mother wants to work back desk insurance and 
accounting in early mornings and through lunch but she hasn't been 
because her daughter doesn't have a drivers license yet (at 21) so 
she drives her in during front desk hours. Perhaps the mother would 
do front desk MWF morns and back desk the rest of the time. And 
maybe the daughter would consider working afternoons or she and 
the other DC廣 wife can train their replacement in the afternoons. 
That might work well, especially if I get a top notch gal to come in. 
It would surely save on income expenses which has been too much to 
handle most pay periods. I still have no working capitol and we're 
going day-to-day paying bills and meeting payroll. Meanwhile, the 
mother hasn't billed out yet on our new accounting software,
except for her own as a dry run, since Feb 1st. There is such a cash 
flow problem to begin with I can't even fathom what is yet to come. 
I am mortified just thinking about it. We are keeping the doors open 
simply on patient payments and an occasional insurance check that 
floats in from last year or January. And yet, I know everything will 
work out fine. Am I a worrier?

I thought I'd give the other DC some options: 1) IC contract with 
specific goals for specific raises regardless of who the patient is 
and he'll adjust like me, treat all patients like it's high volume time, 
and I'll pay a CA (probably the new one) on his day (I really don't have 
the money to do that and he doesn't have the patients to make it fly 
after 9 months so maybe I shouldn't give him this option since it 
wasn't one to begin with), or 2) He pays half the previous month's 
expenses on the first of every month, including salary since the 
mother will be doing her billing too and he's on all the advertising
now, and we get paid on our own patients regardless of who adjusts 
who, and he will adjust like me to keep it uniform and to promote a 
high volume practice, or 3) He decides to leave and we go back to 
just me on MWF, or maybe I'll pick up another half day.

Quite frankly, if we don't have the same goals and technique, we 
won't be going in the same direction and patients will get confused 
and so will we and it will pull apart just like it has been. Of course 
the problem lies, too, in that we don't go out and market like we 
should. I would love to do more but other personal responsibilities 
keep me out straight, too, not to mention being a mom and a DC and a 
business owner and a wife. I just got approved for the Subluxation
Station (SEMG/Thermoscan/Inclinometer) also, so that's another 
huge expense coming but great to have for exams, especially since 
we don't take x-rays.

Anyway, What do you think? What now? Any suggestions as to how to 
straighten this out? Am I on the right path to recovery? What would 
you do? Thanks for your time, you are such a big help. I need help
and expert advice! That would be you!

Thanks again! You're Great!


A:

Thanks for the e-mail. One common rule in business is never mix 
business with pleasure. Some of the most heart wrenching 
situations is when friends become enemies or worse when families 
breakup due to business wrangling. Although the other DC is not 
family but a friend of sorts .. the mistake you possibly made and it 
may only get worse .. is not having a clear contract written and 
signed and most importantly followed. Creating a shoestring 
practice should be a temporary situations as it builds into a 
successful business .. oh .. what is successful ??? If it is creating 
wealth .. have you? .. if it is paying your debts and saving as well as 
living a moderate lifestyle from your business .. have you? Is it 
being happy and care less about financial rewards .. is that you? 
Success is a word that is different for different people. 

Okay .. this other DC .. as you describe the situation .. sounds more 
like he is taking over .. something like kudzu .. looks good but can 
become a problem. Decide what you want to do .. if he is an IC .. he 
literally rents your office space and pays a set fee per month .. say 
$1200 a month just for rent. You can leave it at that and he keeps all 
his earnings or you can charge him a percentage of what he takes it 
after .. say .. $5000 collections .. maybe 20% or so to be nice plus the 
$1200. Either way .. write it down and be firm about it. If he cannot 
pay you the fees you request per month .. he will owe it to you as he 
grows .. the carrot before the horse .. something has to drive him to 
build a clinic. Like any billing .. it is always hard to recover.

As far as who adjusts who .. there is no problem. You have set hours 
and your patients who wish to have you as their chiropractor comes 
during these times .. on exception only .. do they see anyone else. 
This would be different if the other DC was an associate of yours 
and was being paid a salary .. you then share the patients. But this 
other DC is literally an IC and rents space or should be doing so. 
When he sees your patients he must charge them for it and be done 
with it. To make it fair and equitable .. you can split it 50/50 but 
again this should be the exception both ways. Have this in writing if 
it is acceptable.

The CA issue looks interesting. If the younger girl is 21 and doesn廠 
drive it simply means her family cannot afford another car or the 
girl is not motivated .. most kids demand to have a license as least. I 
don廠 know her or the mother .. but what you hire is what you get .. 
poverty consciousness and all. Rather than being politically correct .. 
consider yourself as a consultant and providing advice to someone 
attempting to get their office off the ground and in order and 
actually wishing to make a living in this great profession .. what 
would you say?

Now .. addressing specific issues as I re-read your e-mail and go 
back and forth:

Splitting the expenses with the other DC makes him a partner of 
sorts. This is never a good idea .. he should pay a rental fee for your 
office space .. $1800 is okay is you feel this is okay and that廣 it. He 
keeps all his money that is made and you get help with the rent. 
When a business rents a location and signs a contract the landlord 
doesn廠 care if they have to loan the money to pay rent or not .. it is 
rent. Think this through as you will have many problems if this is 
not handled correctly. A $400 check here and there doesn廠 cut it and 
when he finally comes to you and mentions that you are not fair .. the 
game of suspicion and distrust begins. Get it clean and right and go 
from there .. even if you have to let him go. 

If you are both broke and have limited time to reciprocate working 
on his patients etc or worse can personally work only 3 days a week 
.. then you have to sit down quietly with your check book and either 
time manager yourself better or change your priorities .. that gets 
back to the success .. what is it. You are a civic officer and give of 
yourself unselfishly as a chiropractor so what else is there .. well .. 
maybe a few extra dollars for all your hard work would help. 

You mentioned that the other DC has reached his capacity and is 
unable to work with your patients. Also his wife bills your patient廣 
insurance .. well .. he did supply the service and a referral fee would 
be improper .. this is why it needs to be cleaned up .. if he adjusts 
your patients on a regular basis he should be paid .. if the patient is 
on a budgeted monthly or yearly plan and you prorate the visit by 
visit amount .. besides paying that fee to the other DC for the day廣 
service .. it may enlighten you to the fact that you are overly 
generous and that the payment plans may not be cost effective to 
you.

When I taught at Life .. I always told the students that hiring an 
associate with drastically different techniques will only confuse 
the patient and often may cause you to lose patients as the patient 
may wish the other DC.  This should not be a problem overall but this 
is a business and lost patients is lost income. 

Staff mutiny often is the forerunner of lost control. Whether you 
train them or not .. the CA has to have strong allegiance with their 
DC not the associate or IC .. the beginning of trouble usually begins 
here. If the younger CA finds it easier to work for the other DC then 
what I wrote before bears repeating .. the other DC is slowly taking 
over your office. This may be a bit of an exaggeration but maybe not.

Prior to your staff meeting on Monday and having them write their 
purpose statements etc. go over yours first. Set your immediate .. 
short and long term goals and fit in the staff and how they can 
assist YOU! Now ask them how they can help .. where they see a 
blockage .. what they can do to bolster the practice and their 
specific action steps to achieve their individual office goals. The 
condition within the office is not their problem it廣 yours. Make 
them part of the solution for YOU! The other DC fits in the picture 
but not part of your solution. As this stage of the game .. YOUR CA 
must be crossed trained in marketing .. creating a festive theme per 
month .. calling some professionals and working with your contacts 
to bolster your office. Possibly a small bonus as an incentive when 
reaching small goals

As far as business/practice management and billing .. don廠 make it 
too complicated. Set a specific day and time to update and send 
HCFA廣 and bills. New patient info should be placed in the computer 
shortly after they are in your office for the first time or soon if you 
are creating a new database. Set a specific time of the week to send 
HCFA forms out and if this becomes overwhelming the program you 
use is either too complicated or way too many buttons and whistles. 
Make the billing and business end of things easy .. it may be time 
consuming but should always be on a tight timeline. As far as 
catching up .. start this weekend on your own .. the DC must always 
know how to run the program .. never be a hostage to it or your CA. 

Cash flow problems is the result of a new office awaiting checks or 
patient payments or poor patient management. Again .. prior to any 
staff meeting and drastic changes .. I recommend that you find the 
time to go through every patient procedure from the first phone call 
to the report of findings and determine where the weak links are. 
There are DC廣 in poor hamlets or with very few people living in the 
immediate community that do quite well within the demographics of 
their town. They may not make the same financially as those that 
work in San Francisco but then again it doesn廠 cost that much to 
live there. You have to consolidate your forms .. your scripts .. your 
staff accountability and create strict timelines to follow with. This 
should be done now .. credit card imprints are taken without 
exception so billing is kept to a minimum .. cash plans are reviewed 
to determine if you have been too generous with a lesser fee rather 
than an equitable fee paid over a longer period. Think business with a 
compassionate edge. 

As far as your options for the other DC .. if you give him a set goal 
and stuff he becomes an associate or employee .. you then should pay 
him a set salary and bonuses depending on the volume he brings in. 
This may be the way to go. An IC as I said before rents space and 
pays you a set fee and/or percentage depending on the arrangement. 

If the other DC is an IC he should help with the marketing by 50% or 
he should be off the marketing. If you were getting a % of his 
collections after a specific collection number than there is an 
incentive for you to assist in his growth otherwise he pays you a set 
fee and he is on his own. You just have to clean up the who gets what 
and with who廣 patients. This is a mess. Personally .. I think he is 
invading on your turf and this is never good. If you cannot set a 
better agenda with strict guidelines then I would ask him to leave. If 
you sorely need him to assist with office rent then let him pay a set 
fee at the beginning of each month whether he has to borrow for it 
or what. This is business or he doesn廠 belong with you. If you 
consider him paying you every week a portion ending with the total 
at the end of the month this may work but once he gets behind it廣 
like any landlord tenant relationship it sours quickly. I don廠 have to 
tell you how difficult it is to find a good associate or partner in 
anything. But .. it also isn廠 right to have your world invaded or feel 
uncomfortable with what you created by anyone unless you want it 
to be. 

As far as reduced fee plans .. first concentrate on getting them in. 
EMG units etc. are great incentives to confirm objective findings and 
have patient visualization but the old fashion way still works and is 
cheaper .. that廣 just meeting people and touch and tell. Focus your 
marketing efforts with a strong purpose. Go to the events as a 
hunter goes to the field .. to catch a meal. Take no prisoners and with 
truth tell them about your work and their need and make the 
appointment .. education is great but your main purpose of a 
screening is to get new patients and make no mistake about it. So .. 
concentrate on the close statements and generate quick forms and 
get them evaluated and with value to your scripts make their 
appointments and all else will follow. If the other DC wants new 
patients he should also participate. 

Just have fun at work .. work on time management .. concentrate on a 
working relationship with your staff and the other DC .. it幢l take 
time but there is no time like the present

In conclusion:

It is very difficult to find a good CA .. you have two losers. If the 
mother wants to work doing insurance and has at this point been 
backed up and not sent claims or bills .. she is useless .. as far as the 
daughter .. you may wish to send her packing too.

Listen .. you went to some seminars and after listening to their 
consulting fee structure .. you and others may have walked out and 
said it was too expensive. But .. some folks need a coach .. not just a 
person to call here and there .. or a shoulder to cry on .. but someone 
that has the skills to kick a DC's behind and force them to make the 
right business decisions and bring their practice forward .. either by 
themselves or by using the proper IC or associates.

I am not recommending one consultant over another .. but you and 
every DC has to decide the purpose of your being a chiropractor .. is 
it to uphold a philosophy but have limited patients and therefore not 
being able to assist those that the philosophy was meant help .. or is 
it to build a successful and ethical business based on solid business 
practice procedures within the bounds of our great philosophy. You 
and every professional must decide correctly or you will be in 
business purgatory forever. 

You spent too many years in school and as such was brainwashed into 
whatever they wished you to be. There are some great mixer DC's 
that give the best adjustments as there are lousy straight DC's that 
are as unethical as can be and can't adjust worth a flip .. this is not 
a philosophical situation you are having .. it is purely business. When 
you are ready to get down to business there are many out there that 
can help. 

Have a Great Day

Dr. M

Have a Great Day

Dr. M