Using growth and communication strategies not introduced yet in Chiropractic, PPFS members see increase in their practice with far less energy and expense.
Dr. Josh brought extremely high value in this interview that I know will help you immediately in your consultations and report of findings. This is not theory. But real world nuts and bolts teaching to help you help more people in your upper cervical practice. Enjoy!
Dr. Bill Davis: Dr. Josh great to talk with you today.
Dr. Josh Wagner: Good to be here, thanks for having me on Dr. Bill. Thanks for all you do with getting more awareness for upper cervical chiropractic and getting more patients in the office.
Dr. Bill: Absolutely. Well I would like to find out first Dr. Josh what got you into chiropractic. Why are you a chiropractor today? What drew you to do this work.
Dr. Josh: Great question. I was absolutely lost as a 21-year old and undergrad and somehow, I could only remember the exact moment walking into dorm room as a sophomore in college and chiropractic popped into my head. And I never met one, just my brother and mother had been for traditional chiropractic complaint of back stuff.
But it was enough for me, I have always been very holistic in nature and I thought, “I can help people with their back pain and I don't give drugs or surgery and I'm on my own Boss. I make my own hours and have a nice revenue.”
I started digging into online. I went and visited some chiropractors and the chiropractors seemed to love what they were doing.
I and did internship over summer. And that’s when I started realizing the neurological connection, the philosophy of chiropractic. I started listening to hours and hours of Dr. Sid Williams and all the greats. My mentors told me to go to Life First. That’s the place to go.
I went down to Life. And before going to Life, I didn’t even know what upper cervical was and a portion of having to go down there was being opened up to some different techniques and I now have the utmost respect for upper cervical. That’s the only type of care I get myself.
I actually practice torque release technique. I took upper cervical from that work. It’s really what I received. So I have the utmost respect from some of best mentors and lessons I learned along the way have been from upper cervical docs.
Dr. Bill: So you went down to Life and did your chiropractic training there and then moved out to practice in Manhattan. Is that correct Manhattan, New York?
Dr. Josh: I practice in Manhattan, New York City. That is close to where I grew up. I grew up in the southern part of it. I did not anticipate practicing here. Actually, I had to take some time off between grad school and starting because my head was in a funk and I thought I wanted to practice one way.
And then, when reality hit I realized that's not what I wanted to do. I also saw that the demographic, everything changing with chiropractic, with insurance shifting, public awareness and I realized how I thought I wanted to practice which was super high volume, save the world through my clinic. It wasn’t necessarily the type of practice I wanted to cultivate.
I also planned on not being in New York. Life has its way of guiding us where we’re supposed to be. And now I’m in Manhattan, created a great practice from scratch with hardly any money in my pocket when I first started it. And I couldn’t imagine being anywhere else.
That’s a brief history from past to present.
Dr. Bill: Awesome. I understand you built a really nice practice there in Manhattan. Can you tell us more about your practice and how you have been able to build such a good practice in a relatively short amount of time?
Dr. Josh: Right. I started with no patients like many chiropractors, hardly any money, found through my due diligence of research some practice basics where I can start with a low overhead. And part of my struggles of starting immediately after school was because I had what I consider the old paradigm of chiropractic so ingrained in me which was trying to convert every new patient, every lay person to a lifetime chiropractic wellness patient from day one and day two.
Which, what I noticed, back in the old days when insurance were abundant and patient didn’t really have to pay much out of pocket; that was a much easier sell. That was a much easier conversation. And even if only 20% of patients follow that suit, there was often times an abundance and endless line of patients coming in because there’s very little barrier to care.
I didn’t graduate that many years ago and that's in changing New York especially. Insurance is few and far between – I mean I'm out of network only about 20% of people I’ve seen maybe have coverage. I had to go out in search of business and marketing strategies and communication strategies for people to pay me what I feel I’m worth from the value of my care continuously and to refer others.
I started devouring material outside of our profession, put it into my practice and seen really great results, before I knew it I was knocking out my student loans pretty quickly and not having any business debt and just as importantly, not being stressed in practice and not having to work hard whether that’s marketing on the weekend, etc.
Not to say I didn’t do that, but not nearly as hard as I thought I was going to for the consultations, appearances, drop off, lack of referrals, all those issues that speaks to chiropractic all the time now. I know there’s problems in the field and a lot of it is, what I want to share on this call, is how we can communicate to patients in a way that often causes this and how we market our practice and how we practice what we’re doing.
And a lot of that can be stemmed and a lot of that needs to be stemmed now that more patients are more responsible for their monetary investments now. It’s more crucial more than ever to practice with the best resources as possible.
Dr. Bill: So talk more about that. You mentioned about the old paradigm and versus what you’ve been successful with. Talk more about some of the communication strategy and the types of things that you found to be the most important work for your practice.
Dr. Josh: Definitely. I think that’s how we got connected; I have an online training program for chiropractors sharing this strategy. And one of my members in San Francisco uses your services and that’s how we got connected.
And one of the quotes he sent me a few months into using the communication strategies in this upper cervical doctor loves taking care of children and having a family practice and he said – he wrote to me and said, “Dr Wagner. I've had more patients ask in the last three weeks,” something like that, three weeks, if they can bring their entire family in than in the last nine years of practice total.”
So that’s a shocking stat. I'm going to get into different communication strategies, different mindsets because that’s more important than anything else. And what comes out of your mouth is a function of what you're thinking inside. And when you're in a conversation with a person, people will feel what you’re feeling inside. If you have hesitancy of what you are about to say, if you’re unsure or if you're nervous, it can come off weak and you don’t even realize.
Even the tone of your voice, how you hold your head and your posture. These aren’t things you can script or plan. Whatever you’re feeling usually you can’t control that and your body gets affected by it and people feel it. The last thing you want to do is have the patient feel anything but complete optimism and enthusiasm for you helping them and to what they’re going to get and the care that needs to get there.
The biggest factor, your certainty and your confidence is the biggest factor in people trusting you, wanting to refer to you and wanting to accept your care and trusting, believing that you are the answer to their problem.
One thing I love about upper cervical is because of the science of upper cervical, what leads a chiropractor to go that route, you usually already have above and beyond than normal level of certainty and confidence because you're choosing to deliver this type care which is not obvious, which is not necessarily the norm. You have to come to your own conclusion through experience or research as to why this makes more sense.
And that is often above and beyond chiropractors who may just take the grab bag tactic from school and go practice which is fine. There’s so much more that you've chosen to master when you choose a more specific technique and you get credit for that and that already puts you ahead.
You’ve got to come off with that air of absolute certainty and confidence that that person, that patient is in the right office and you are going to get them the result that they’re hoping for and expected and they’re having nothing less. Even if you don't – listen, this is chiropractic we don't know 100% exactly how that person is going to respond whether it’s fibromyalgia, a neck sprain, chronic migraine, scoliosis, we don’t know. But we got to have that certainty and confidence because that's what people feel and that’s what people want when they go into a doctor's office.
They want to be led. They don't want to have to make the decision. They don't want to have to be the one deciding. They want to be able to take – you take them by the hand and this is how we're going to do it and everything's going to turn out just fine. That's what people want.
They’re coming in. They’re coming in vulnerable. They’re coming in anxious and you got to cater to that mentality.
Now, chiropractors sometimes misinterpret that because of the age old paradigm of, “We're taking care of subluxation,” compared to, “We're just treating symptoms.”
I absolutely agree. You're taking care of what you know clinically to take care of that’s in the best interest of the patient. Do not sacrifice that and that’s why you’re a chiropractor.
In terms of the communication, that's where our entire profession goes awry but upper cervical doctors just as much. Patients don't need to know very much, especially in the beginning, even the analytical patient. When someone’s coming in, they’re most likely in pain. They don't know how to get rid of it themselves. They are coming to you acknowledging, “I can't fix this on my own. Can you help me?”
And even the most analytical or driver personality, you got to cater to both the moment they're in right now, the personality that they’re in right now when they’re in your office. I’m telling you, how you communicate with them is far more important than diagnosing their problem and showing them graphs or charts or statistic for an analytical person, let’s just say.
I’m one of the most analytical people I know and when it comes down to decision making, it’s all emotional. Do I like the person that’s giving me that choice? Do I feel comfortable? Do I fell inspired way above and beyond? Do the numbers work out? Is this the most logical way to go forward or did I do even my due diligence?
So consider patients coming to your office, it’s all about the emotion.
But you’re catering to everything to the end results that they want and not just the symptomatic relief. Yes, the person with chronic headache wants their headaches gone. But what's the difference that's going to make in their life both the immediate difference and the long term difference? You got to dig for that.
So when you're in your consult, you find out, yes they want their headaches to go away because they're painful and agonizing. But what’s that going to change immediately? Are they going to be able to go to sleep through the night? Are they going to be able spend more time with their children? Are they going to be better at work? If that’s happening, then what's happening because of that?
Will they finally be able to get back to the gym and lose that 15 pounds they said they want to for the summer? Or they’ll be spending more time with their children? Their relationships are going to get better with their husband or wife because they're not chronically agonizing with this pain and having to be in a dark room with her head into the pillow or just more – they're on edge all the time because of the pain so they snap at their spouse.
It’s all that digging in and finding what the end result those patient wants and catering more so why you’re delivering the care; why you’re recommending the care that you do to those end results to the patients, rather than trying to get people to understand why upper cervical works or chiropractic works in those first couple visits which is a logical educational conversation which you can have and you can start doing on later visits and all of that once they’re under care, once they don’t have to make the decision anymore.
The more we try to explain and justify why we're doing what we're doing, as it’s the right thing to do, the more it’s come off to a patient as either salesy or less confident on the doctor’s part because, “Why does he have to justify this? Why does he have to explain so much,” rather than, “I’m the answer for you. Based on my experience I've seen and this is the best way to get there for XYZ,” and it’s all catered to those results that they want.
Dr. Bill: There’s a concept that I learned a long time ago in practice and that’s “The need behind the need.” It's never the headache; it's never the back pain; it's never the fibromyalgia. It's how that person’s quality of life, how does it affect their relationship with their spouse, with their kid, the things they want to do especially a lot of times, especially the things they want to do.
Is it affecting their golf game? Is it affecting their ability to play basketball with their friends on the weekend? Whatever is exciting to them and helps their life be more meaningful is a lot of what you have to get to, like you were saying to really connect with them on and emotional level not just on a logical and analytical level.
Dr. Josh: Absolutely and there’s ways in the initial consult because you can't assume everyone has pain and wants an end result that they want affecting their life. So there's a way to gently and professionally get all that information out of them so they feel open to telling you. I call that the three essentials and that’s being able to listen so well in a consult, to listen to what they’re telling you.
There’s certain words that they are using, that you got to tap into how they're feeling. Because when you let a patient know that you understand how they feel, that creates such a rapport and connection that most doctors don't have with their patient and just another level of trust and authority of whether some are saying, “Yes, can you start right now?” Or that woman went home and convincing her husband that, “You know it doesn’t matter what you say. I want to see Dr. Smith.”
And it doesn't matter what your care recommendations, your fees, that you know a woman whether it’s in the best interest of herself or her children, she overrides the husband if it comes to the proverbial conversation, “I need to speak with my spouse,” which a lot of chiropractors get at the end of giving the recommendations.
The words, the emotion and then how to tap into the end result of the person’s wants. And one of those mindsets that you have to have in this first visit or two with a new patient is the "I want what you want" mentality. And again, it’s not going against chiropractic. It’s not going against your value. It’s not just meaning you’re a symptoms treater. But in your communication with the patient, the whole feeling, the whole filter has to be through that paradigm.
When you start communicating in that way that everything you do, why you’re doing the exams, why you’re recommending the care, the end results you’re expecting to get is because you want what they want. That's what you're doing internally, that's what you’re doing on the table for your care. That’s your intention.
But if you’re trying to communicate with your patient, it is like speaking another language to them, rather you’ll see people – their shoulders drop, their face relaxed and say, “Wow. You listened to me. You understand what I want.”
When you start catering everything that you're communicated in terms of “I want what you want” mentality and dig into those real deep, the reason behind the reason and results that they're looking for.
I have a webinar that I do every week on my website www.PerfectPatientfunnel.com. You can get it so I'm not going to go to through all here. Let me talk about other stuff.
Dr. Bill: Excellent. Yeah, I love that. Getting into that team atmosphere, “I’m on your team. I’m here leading you to where you want to go. I want what you want.” I love that.
Dr. Josh: So one way I use to show chiropractors, again, what I considered that old paradigm, old chiropractic is over the past 35 years when Insurance became abundant, that’s when so much of the communication strategy, practice management really started in our field.
There’s a lot of that. That’s helped a lot to grow practices. A lot of doctors I noticed, they often times they feel that they say or do things that they don't want to do whether that’s in a proverbial report of findings or whether that’s screening every weekend or having to constantly get talks.
One thing I share is over the past 35 years, we have the best time in history of chiropractic to increase public awareness and acceptance and unfortunately we haven’t. The people who have an access to chiropractors have not increased our market share and our credibility.
Even more so, this may have happened because of what's going on in the past 30-35 years is any of the stats you see is it’s at the bottom of the health care credibility totem pole. That’s not a good way to position yourself in the market, whether you're upper cervical or not a new patient comes in, it usually doesn’t make a difference.
What I love about the strategy I share with chiropractors whether it’s from the marketing end, the communication end, anything I share is you can show your spouse, you can show your patients, you can show your local media and you would have no hesitation doing that because I know I've been through a lot of different programs and a lot of different scripts that you would not want to show your parents you’re using or the local media. That would be the worst part of our profession.
That’s something that also makes the big difference with chiropractors is when you are able to be fully be yourself and share what you know what's true and don’t feel like you’re trying to be robot or be someone else. There's another level of – again this what you can’t even control. But when you’re being authentic, yourself and pure, patients take off on that. Patients again become more connected to you and trust you and want to tell other people about you rather than if – people know if you’re scripted. People know if you are saying something you're kind of unsure about.
I just wanted to address that because sometimes chiropractors don’t realize that's what sabotaging their practice even if they feel like they have the perfectly memorized script after 15 years and all the procedures are perfect. That gets in the way.
Another mindset is when I talked about “I want what you want”, the second one un-neediness, meaning you don’t need that patient. Again, this comes so much with chiropractic that the patients get the feeling that chiropractor needs the patient more than the patient needs the chiropractor which should never ever be the case in their mind even if it's true. Even if you need to grow your practice, even if you’re new in practice; that’s fine but that can’t ever come up.
So I'll share with you great way when you're giving your recommendations to completely flip that. So even if you do have that internal needy dialogue in your head, that really helps to quiet that down and dispel it for the patient to feel that. Because that’s a big reason why patients disappear after that first visit and you never meet them again; they don’t reschedule; or just don't accept your recommendation. They feel the doctor, the chiropractor needs them more than they need the chiropractor.
I experienced this myself. One of my biggest lessons was one of those first visit only patients who I guess was nice enough to tell me why and email me. A 21-year old guy with fibromyalgia who completely needed my care; I mean this guy – you know fibromyalgia patients, his life was a symptomatic mess.
And he literally e-mailed me days later after he didn’t reschedule or missed a second appointment and he said exactly that. This was years ago. He said, “Dr. Wagner. It felt like you needed me more than I needed you.” As horrible as it was to read that, it was one of the greatest things I've ever gotten because it made me change my ways.
Think about how when you're going over your recommendations or your consults, in what ways you may you come off with that energy, with that mentality that you need the patient more than they need you.
What I used to do, one little thing, I used to give a patient recommendations once they started care. Meaning these are things that you can do outside of the office to help your body heal, to keep and hold your adjustment, all of that. And it is very simple stuff like increasing their water and being aware of their body posture. Especially in New York City a lot of people are on computers for long hours of the day, or how they sleep or reducing caffeine and other stresses in the body.
So when I hand those recommendations with a sheet in my folder that I give to people, I'm sure 90% of people never looked at it. If they did read it, it went in one ear and out the other, never really thought of it.
So what I did, I changed that from my recommendations that I will mention and hand them the handout and I changed to what I call a ‘care commitment list’. It’s a conversation I have with the person after I go through a very well structured what I call the ‘fixed question’ during a consult, re-frame those statements when I'm going over the recommendations.
Before I give them my initial recommendations with frequency and all that, I let them know that if they're not going to do their part, which is these care commitments, then I value the care I deliver so much that it’s not even worth starting because I don't want to jeopardize me delivering this care and you accidentally going off and messing it up or not getting the results I’m expecting outside of here.
I show them this care commitment list. And this is the same thing that I would have recommended but now the conversation is, “If you can't do these very simple things,” it’s very important how you structure this because it’s not upsell and it’s not really tough stuff like, “You got to drastically change your diet or you got a hire a trainer three times a week or you got to run three miles a day,” nothing like that. Increasing your water, decreasing caffeine, how you’re sleeping, how you're sitting at your desk, very simple things no one should have an issue with not complying with.
But the underlying tone is literally, “Mary, if you can't even do these simple things which I’m not even profiting from, then I'm not even willing to take your money for care.” I mean I don’t say that but that’s literally the tone and it completely and easily giving off that on un-needy energy. What it does is it draws the person is even closer to you because they know they’re responsible now and they know you’re not just taking anyone, and they know that they got skin in the game too, and you’re not just willing to accept anyone with a heartbeat and a wallet.
It’s a very, very important part and quick as 30 seconds for going over your list looking up and saying, “When you're ready, you can sign at the bottom that you are committing to these and we can move forward.” And that’s another level of connection of that person is really, “Okay, you’re the one. I’m signing this. We’ll move forward,” even before I get to the recommendations.
Again, it sets the foundation for commitment and for that un-neediness which must be there in that initial first visit when someone’s starting to choose your care or not.
Dr. Bill: Absolutely. So the first one was “I want what you want” and the second was un-neediness.
Dr. Josh: Well, before number one is your certainty and confidence. I’m preaching to a crowd that has already usually have a great deal of this but where can you off it? Where can you increase this? Where can you fake it until you make it without saying anything? But where can you come off as you know that you know that you know that you know and they are in the best hands that they can ever be?
And again feeling that inside you, you will stand in certain ways; you will speak in certain ways. I'm not talking arrogant. I’m not talking conceitedness. I’m talking being the greatest person of what you do in your area the person is so lucky to have found you and owning that.
The more you think like that, the more you own that. The more you think like that and act like that, the more people will be looking at you and respond to you like that and then it's just a snow ball effect that will grow inside of you.
That’s the first one. Set the mindset and three essentials which I say you can get it on my website. Go there to get that. That’s an amazing way to start your first and second visit to dramatically increase care acceptance, compliance, retention and people wanting to tell other people about you.
The reason anyone refers is not the results that you’re getting with them. People accept the result. If you get them, you met the status quo. It’s not because you're asking for referral.
Think about a movie or a restaurant you tell people about. It has nothing to do with anyone there asking you to tell other people about it. You're telling them because you had such a good experience that you want them to have that experience too and then get credited for it.
Same thing in your office, the number one reason people refer is because the experience is so good that they want to tell other people about it especially visit the doctor's office, you're referring people in usually who are in a vulnerable state or in a nervous or anxious, scared state. The experience is even more important.
And that experience is fairly is shaped by the conversation they have with you. Do they feel you’re scripted or did they feel you’re being yourself? Did they feel you’re certain and confident or did they feel that you need them more than they need you?
All of these components caters to the person right in front of you, trusting and accepting your care far quicker and easier, it makes a huge difference with the amount of referrals you get without having to work any harder, without having to constantly ask or thinking of your results.
Dr. Bill: Absolutely. This has been a great talk, doc. I really appreciated the value you brought today and I know this is going to be something that our readers are really going to enjoy. To learn more about you, the best place to go to is www.perfectpatientfunnel.com?
Dr. Josh: Yes, that’s the easiest place to go. There's tons of freebies, sources, videos, webinars to get on. You can get on my email list which gives you practice building tips and the easiest way to find more information.
Dr. Bill: Before we wrap up today, is there anything else you would you like to share with our audience, we have lots of students and doctors out there.
Dr. Josh: The main thing is really thanking and acknowledging everyone that’s listening to this or reading this. At any point whether you’re about to graduate, whether you’re 30 years in practice; it’s not getting any easier out there in practice. I’m the last person to say that this is the best time to be chiropractic.
That doesn’t mean you don’t have an amazing gift that you are giving to people and it doesn’t mean that you can’t be as successful as you want to. It’s all about doing if you’re doing the same things right now, that you were doing last year, five years ago and your results are declining or staying the same, it’s that ego principle. You keep doing the same stuff you’re going to get the same result no different than you may say on occasion.
Really check in. You've gotten an amazing service that people are lucky to find you. Dr. Bill has a great service for that. But once when they find you, you've got to be prepared to really create that relationship where they want what you have and they want to tell other people that what you have.
And if what you're doing right now isn't giving you the results that you want, realize there is other ways to go about it. You don't have to be stuck and locked into how you've always done it. It’s about changing for the better, being congruent to everything you say and in what you deliver and having fun doing it and just doing it smarter and harder.
So thank you for listening. You’re obviously listening to this or reading this because you want to grow and constantly improve and I thank you for that. I thank you for the care you’re giving for your patients and just to your overall success.