UCM 020: How to Develop Systems to Improve Efficiency and Effectiveness of Your Upper Cervical Practice with Dr. Michael Lenarz




UCM 020: How to Develop Systems to Improve Efficiency and Effectiveness of Your Upper Cervical Practice with Dr. Michael Lenarz


How to Develop Systems to Improve Efficiency and Effectiveness of Your Upper Cervical Practice with Dr. Michael Lenarz

In this Upper Cervical Marketing Podcast interview we talked with Dr. Michael Lenarz of Health First Chiropractic who discussed the importance of developing systems that can be translated to multiple offices and multiple doctors.

Hello Upper Cervical Doctors and Students, it’s your host Dr. Bill Davis here. Welcome to the Upper Cervical Marketing Podcast. The UCM Podcast is released the 1st and 3rd Mondays of every month to grow you, your practice and upper cervical and the show notes for this episode can be found at uppercervicalmarketing.com/podcast.

We have an awesome interview today with Dr. Michael Lenarz about systems that you are going to get 8 one of useful and actionable information that will provide value for your practice immediately.

But before we get into the interview with Dr. Lenarz we wanted to highlight a new opportunity that a bunch of you have been taking advantage of at uppercervicalmarketing.com.

It’s the 2016 upper cervical practice survey. Our 2nd annual survey is designed to develop a better understanding of what works and what doesn’t for upper cervical practices. This best practice survey will help all upper cervical doctors focus their time on activities that produce results.

To take the survey if you have not already go to uppercervicalmarketing.com/2016survey immediately after you complete the entire 12 question survey you will be able to receive the current results.

The survey only takes about 3 minutes so feel free to pause this podcast and go to  right now and then come back for this awesome interview.

Now let’s get into our interview for today!

Dr. Davis: Welcome Dr. Lenarz.

Dr. Lenarz: Hello Dr. Davis!

Dr. Davis: Great to have you on, and previously we talked on the blog, and I interviewed you, and you shared some of your back story about how you got started in practice, and how really you went to a chiropractor, and he told you the story, and you were just blown away by the philosophy, and it really shaped and changed your life and moved you in the direction that you've gone, and all these years later, and we'll link to that interview, and in the show notes for this podcast. Doctors want to go back, and learn more about you, and your back story, and specifically in that interview we were talking about the chiropractic marketing life cycle as well, but for those of our listeners who hadn't read that interview, can you just share a little bit about you and your practices and what you're up to these days.

Dr. Lenarz: Sure. So, a little bit about myself, I've been in practice for 28 years. I opened my first practice in Sedro-Woolley, Washington, and I opened up seven additional practices. A number of them in Washington state, a couple of them in Michigan, and I opened those up with associates, and I've sold off five of those clinics over time to the doctors who were the associates, and now I currently run and own three clinics in Washington State. I've done a pretty significant amount of coaching over the years. I had chiropractic consulting firm for a number of years, that's a bit in hibernation right now. I'm just focusing on developing my own practices.

The Importance of Systems in Upper Cervical Practice

Dr. Davis: Very good. Yeah, absolutely and the topic I really wanted to focus on today, and I think it just be so much value for our listeners is the idea and the the topic of systems, and I know that you're a big proponent of systems, and as any successful doctor, especially one that has multiple clinics will tell you systems are crucial. So, can you talk about the importance of systems in your upper cervical practices specifically?

Dr. Lenarz: Yeah. So, there's a couple of things that I think are important about systems, but I want to maybe just step back from that and see how does that really fit into the broader framework of what we're doing. I think that anybody who's an upper cervical doctor understands systems from a clinical perspective. The work that we have historically done in our practices is Blair work. I've worked with a lot of NUCCA doctors, AO doctors, orthospinology doctors…

How do the upper cervical technique that you do, your learning systems, your learning procedures? How do you do this? How do you position the patient? How do you assess whether they need to be adjusted or whether they don't need to be adjusted? Those are all systems. Systems are very much embedded into our life. There's another whole aspect to practice development and professional development, which is the personal growth side of our being, which goes more into who we are being in our life as opposed to what we are doing, and it's really interesting because in our practices we've always held personal growth to be a core value.

All of the people involved in the clinic, in the health center, in the practice, and whether that's patients or doctors or team members, the idea is that personal growth is really critical, and one of the things that I've discovered recently is that, as much as I covet personal growth, and I try to create actually systems that support personal growth. Really my strength is systems and procedures and management. I like the nuts and bolts. So, just like we have systems for our clinical technique, it's really important for the smooth operation of any business, let alone a chiropractic practice, let alone an upper cervical chiropractic practice that you have systems, and systems are kind of like the grease that make the wheels turn smoothly in the practice. I'll give you some examples, as I really, if you consider yourself a really good chiropractor, like you do really good work, you do good clinical work, you have good communication skills, you have good if you will tableside manner. You're generating lots of new patients, you realize that in some ways one of the most stressful things that you do in some ways is to generate a new patient.

Well, why is that? Well, I know from my perspective when I start a new patient, there's all kinds of things that need to be done. We need to meet the patient. We need to get to know them. We need to know their health history. We need to take them through exam work. We need to go through all the clinical procedures. On the front end, the front desk has to handle all of the financial aspects of that relationship, putting together programs of care, putting together financial estimates whether you use cash practice or whether you do insurance.

So, I know that in our office as an example, we have a checklist. This is part of our systems, and on that checklist there's a whole column with about 35 things on it that the front desk or the CAs or the accounts area needs to make sure gets done, and on the other side of the paper is a column of things that need to be done on the clinical perspective, and have the measurements been taken on the x-rays, have the x-rays been taken, have we done the proper exam work, have we prepared well for going over the information with the patient. A lot of us put together packages for the report of findings, and has that been done well.

So, that's a lot of work that goes into generating a relationship with that patient on their first and on their second day, on their third day to set up the foundation for that relationship. So, again for us, we have systems. Someone comes in the office, the front desk CA knows what they're supposed to do. They give them a tour of the office before any paperwork is done. It make them feel welcome. They offer them coffee or tea or water, which we have available in the office.

We orient the patients two the office. Then, we have them if they haven't already brought it in with them. We have them fill out the paperwork, and all of this is according to the checklist. All of this is according to training. So, we take what could possibly be somewhat haphazard and complex amount of effort that means to be made, and we've systematized it and reduces the stress level. It makes it a much more pleasant experience for the patient, the practice member, much more pleasant experience for the CA, and a much more pleasant experience for the doctor.

It all happens smoothly. You don't have to reinvent the wheel every time a new patient walks in the door. I think that's a great example of how systems are one of the areas in which systems are really critical.

The Main Systems Needed by an Upper Cervical Doctor

Dr. Davis: Absolutely. You touched on it a little bit but talked about some of the main systems that you feel an upper cervical doctor needs to develop for their practice.

Dr. Lenarz: Okay. So, of course one of the systems which is critical, critical, critical is the initial workup on the patient. Do you have all of the aspects of your technique clearly learned and clearly implemented so that you're getting a good upper cervical listing? Right and the thing that I would recommend, I mean for new doctors especially. Don't reinvent the wheel. Like, really learn from the masters. Learn from the people. Learn from the seminars. Learn from what has already been established.

Dr. Davis: Right.

Dr. Lenarz: If you want to work on advancing the technique, wait until you get proficient.

Dr. Davis: Right.


Dr. Lenarz: That's one area of learning a system. Next system might be, as I mentioned, the procedures for day one, two and three. So, that's a whole area of, like a package of systems relative to processing new patients.

Another aspect to that is, we have systems which are communication systems, our education systems. So, we have scripting for day one, two and three. We have scripting that we call a pre-consultation statement. That's when the doctor first sits down with a practice member. What do we say how do we explain upper cervical to them? We have it scripted when we take the patient into x-ray, to be able to explain clearly what we're doing and why we're doing to reinforce the upper cervical precepts. We have a scripting for that we use while we are doing x-rays. On day two, when the patient comes back and we in the Blair work, we take two more x-rays usually on day two before we adjust them, and then we sit down with the patient and go through the reported findings. We have that scripted.

As a matter of fact after this call today, I'm going to meet with the three doctors that I'm currently having the training process. We're going to go over our day-to scripting. That's so, that we can clearly explain what we're doing. What I find is oftentimes when doctors first get out of school especially, their command of the language in terms of being able to explain this work clearly is clearly lacking, and oftentimes the patient kind of walks away bewildered, like what did you say? So, I think scripting is important.

Now, here's the thing about scripting. In some ways, scripting can be deleterious. We don't really want to have everything so tightly packaged that it doesn't allow for the personal expression of the doctor.

Dr. Davis: Right.

Dr. Lenarz: …but I've tried if you can learn good scripting on the front end. Learn how things that have been developed either by your coach or by other doctors who have developed these systems. I have mine and then Dr. Brooks has great systems that he teaches in terms of new patient communication. Other coaches have great scripting that they use.

Once you get that down and learn how to do it clearly and again that's part of a system. Right?

Dr. Davis: Right.

Dr. Lenarz: Then, over time you can make that your own once you learn how to do it clearly. I'll just have another example, built into the scripting is a system of education. So, oftentimes what we want to do is take a patient from a symptom-treatment paradigm to a chiropractic-philosophical paradigm.

This is how we generate referrals. This is how we generate long-term lifetime care is to really get the patient to clearly understand why we do what we do, and to move from the old medical paradigm to a newer chiropractic paradigm, and the scripting that we have on day one, two and three, and the procedures that we have are also part of an underlying system of patient education to help bring the patient to this new understanding.

So, those are some examples, and one last piece to that right in terms of long term retention for a new patient, we have systems in place for that. So, for instance we have a day three script, which we call retracing where we talk about the patient with making about retracing about symptoms and we don't make decisions based on symptoms. We have common communication pieces that we touch base with them on over the first few weeks that are part of that education system and retention system. At six weeks in our practices, we do a reexam. That's part of the retention system.

Dr. Davis: Right.

Dr. Lenarz: At 12 weeks we do another exam that's part of the retention system. So, there's another underlying system, which is geared towards retention. All of these systems are tied together, the more effective you are at the education underlying system supporting the long term retention underlying system, and the front-desk systems, and the clinical systems so that they're streamlined and effective. Does it mean you can't go outside of the system because one of the things I've learned with patients over the last 28 years there's not a single patient who's a textbook patient.

Everybody is unique. Every situation is unique but once you get the system's down, then if you have to step outside of the system to handle a unique situation, then you can step back into the system, and it allows for the smooth operation of the business. It allows for a much more pleasant experience for everybody involved.

You Will Generate Your Own Scripting

Dr. Davis: Absolutely, and you mentioned scripting and I think some doctors are a little nervous about scripts and scripting, and those types of things, and I think about it when it comes to systems, the systems I use in my business now or the systems I used in my practice and whatnot. I think about it like milestones, right? Or those checkpoints that I need to hit at certain points. It doesn't mean that I have to say the exact same words every single time with or my associates would or other people that work for me. I have to say exactly the same words, and that's why I think sometimes scripting gets a bad name is because people think that it has to be exactly the same. Right?

Dr. Lenarz: Right. Well, here's the thing to consider, once you've been in practice a while, let's say you’re a solo doctor, you're in practice common thing in chiropractic. What you'll find is after a year or two, if you haven't learned any scripting before, you will generate your own scripting.

Dr. Davis: Right.

Dr. Lenarz: Right. You'll generate how you have learned to say things clearly and 90 percent of the patients who walk through the door are walking and subluxated. They may have symptoms. They may have different symptoms. They may have no symptoms but you have learned how to clearly communicate the principles that you need to communicate, and whether you've written it down or whether you've memorized it or whether you've just created it over time as how you do things, a solo doctor will generate scripts. Right?

Dr. Davis: Absolutely.

Dr. Lenarz: You generate how you explain things and I think that if someone comes in as an associate or someone comes into a coaching program, those scripts can be certainly helpful, but as I mentioned, in the long run you have to make it your own. You have to learn how to adapt to the unique situation of every single patient, and every single interaction. The scripts just help to learn how to do it well.

Dr. Davis: Yes.

Dr. Lenarz: And then you can do variations on the theme.

Why More Doctors Don't Go From Solo Practice to a Multi-Doctor or Practice With Associates?

Dr. Davis: Absolutely, absolutely. So, you mentioned that the fact that there are a lot of doctors who are in solo practice, right? Who don't have associates in the office, and they're practicing by themselves and I mean our numbers it's probably, we think it's about 80 percent of doctors, right? Are in solo practice, and so my belief is that, that's too small the number. Only 20% of doctors out there have associates and so what can if you… I think that systems is probably a big factor. What are your opinion on that as far as why more doctors don't go from solo practice to a multi-doctor or practice with associates?

Dr. Lenarz: Well, it's a really good question. So, I have a lot of opinions around this. So, I'll share some of those.

Dr. Davis: Yeah.

Dr. Lenarz: …and like what's the framework for that.

Dr. Davis: Right.

Dr. Lenarz: Well, you see 50 years ago when I was but a lad, the doctor who delivered me. It was more than 50 years ago I was delivered. He was our doctor who delivered me. He was our family doctor. When I was seven I had my appendix out, he was the surgeon, and he was in solo practice. This was the nature of medicine. Most doctors 50 years ago were in solo practice. You don't see that today. As a matter of fact, it's super rare. You see a medical doctor in solo practice?

Dr. Davis: Yes.

Dr. Lenarz: Your large conglomerates which are mostly large partnerships or corporate medicine.

Dr. Davis: Right.

Dr. Lenarz: Why has that occurred? Well, specialties have occurred the forces within the marketplace have made that occur, and then especially in the last 10 years, the last five years. There's been a larger consolidation of practices in medicine. You're beginning to see the same thing happening now that happened in medicine 50 years ago, and I think that the value of being in larger practices over time is going to outweigh the value of being in a solo practice. As an example, having good vacation relief…

Dr. Davis: Yes.

Dr. Lenarz: …having the support within the office, not having it all dependent on one doctor. If you think about the security of that, if a doctor is in solo practice all by themselves, and they get ill or they get injured or something happens to them, all of a sudden the income stops.

Dr. Davis: Right.

Dr. Lenarz: And maybe…

Dr. Davis: You're preaching to the choir here, right doc?

Dr. Lenarz: You got it right. If you have a multi-doctor practice, then the practice can continue to generate income. There's all sorts of benefit to that. Also there's pressure on pricing. I think chiropractic is unique. One of chiropractic strengths is that, it does have all these little practices all over the place. So, it's kind of hard for the big money and the big corporations to kind of put their thumbs on chiropractic because we're just so large and varied. I think in some ways, it's a strength; but nonetheless, there is a momentum over time towards larger multi-doctor practice, and I think you're going to see that more and more in chiropractic.

One of the problems is that there are not very many people teaching or that understand the systems involved in a multi-doctor practice. So, oftentimes associates will step into an associate position with a doctor who thought they wanted an associate but actually didn't really know how to do an associate program, and it turns out being a bad situation for the associate and an unpleasant situation for the doctor.

Dr. Davis: Right.

Dr. Lenarz: So, anyways this has gotten a bit of a bad rap in chiropractic. So, that's another kind of piece to that puzzle, and the problem is that most doctors just hire associates really don't know what they're doing in terms of hiring associate. They don't know how to train them. They're not really know how to compensate them properly. They either pay them too much or they pay them too little. They don't know how to you systematize that. So, one of the things that's really critical is, if doctors want to do that is to learn what are the systems that are involved in actually having an associate. How do you make that work? How do you make it effective?

As an example, I'll be doing training this afternoon for two hours with my associates. That's part of the systems that we have in place for making the associate systems work in our offices.

When a System Doesn't Work

Dr. Davis: Right. Absolutely and that's I think you hit on so many things there that are a big part of the issue of why there are so few practices that are not multi-doctor and when it comes to associates… When it comes to systems I should say and you're building systems because I talk to doctors about this that when you're in that twenty thousand to thirty five thousand, forty thousand dollar level collections per month and solo practice, and you want to get to the next level where you can have associates, systems are our key, right? And getting that dialed in so that you can bring in someone else and plug them in to what you have been doing and what you've been successful with, and so talk about that the pitfalls or the things that sometimes break down or when a system doesn't work, what are some of the reasons behind that?

Dr. Lenarz: Great. So, oftentimes what happens with associates and the reason it doesn't work as you mentioned, is because there are no systems or they're not explicit systems or maybe implicit systems, like for instance… I'll give you an example. One of the things that happens and I think this happens in upper cervical practices a lot. I know that it doesn’t mind, and I think there's a little different flavor with each technique, but I'm not adjusting people based on how they feel, right?

Dr. Davis: Right.

Dr. Lenarz: And so… Now, there is some correlation between being in adjustment and feeling good or being out of adjustment and feeling bad, and especially when a new patient starts, right? The first few weeks, they maybe going through retracing. They may be going through some restructuring. They may be have a hard day at work and that's why we try to make our decision when to adjust and not to adjust objectively.

Dr. Davis: Right.

Dr. Lenarz: I find that oftentimes that piece is not clearly explained to patients, and so it creates a tension in the relationship between the doctor and the patient, and it hasn't been really fully explained in a way that's clear. So, as an example, I created this day three scripts, which I call a retracing script. This is an interesting thing about scripting and systems, right? So, where did I get the script? Well, it was simply what I learned to say to patients over a period of about 15 years, and I found that after a while, I kind of got down how I felt like it was really clearly explained to patients. I did that on day three, so they, one time, so they may come in on day six or seven or ten and say, ‘Hey! This is hurting,’ or that's happening. I think it may just be retracing.

Dr. Davis: Right.

Dr. Lenarz: …which was like music to your ears, right? ‘Right now I am hurting, you’re going to adjust me, right?’ So, I bring associate in, if I have and then so, I created that script. I just wrote down what I said and I gave it to the associate say, ‘Hey! Learn this.’

Dr. Davis: Right.

Wisdom Is Learning From Other People's Mistakes. It Accelerates Learning.

Dr. Lenarz: So, now when the associate comes in and they're kind of struggling, learning how to adjust, learning how to manage cases, learning how to generate a practice within the practice. All of a sudden they have patients who are disgruntled because they're going through retracing or having symptoms, and if the associate hasn't learned to communicate that clearly, now they're making the same mistake that I made 25 years ago that I figured out how to not make that mistake. This is what you call wisdom, right?

Dr. Davis: Right.

Dr. Lenarz: Wisdom is learning from other people's mistakes. It accelerates learning. So, systems can accelerate learning. They can help the doctor bypass all sorts of mistakes. You're going to have to learn to some degree on your own, but learning from wisdom allows us to grow faster both personally, financially and in practice. So, it's one of the things that a system does. If they're properly implemented and created, especially for new doctors coming into a system, it makes the learning process much quicker, and it helps to avoid breakdown in the patient-doctor relationship.

Dr. Davis: Absolutely. So, a lot of times then, if there's an issue with the patient, there was probably an issue with the way that the system either was in place or was not utilized. Would you agree with that?

Dr. Lenarz: Yes.

It's Important to Adapt Those Systems

Dr. Davis: Right, and so as systems are tested, right? And tried and whatnot, it's important to adapt those systems, right?

Dr. Lenarz: Absolutely. It's a really good point, really good point. They always need to be adapted. Systems are not static. Systems always need to be adapted over time, and that's like there's nothing set in stone here, right? And if you think about, there's basically two parallel systems here that are occurring in terms of patient management, and I'm not forgetting the whole business side of it. Just patient management.

Dr. Davis: Right.

Dr. Lenarz: There's clinical systems and there's communication systems. So, when a doctor is generating a successful clinical outcome, it has to do with one, how good are they at what they do clinically, and the other is how good their communication techniques are? How good are they at communicating? How good are they at explaining things to patients, in generating relationship with patients. You don't have to sit with a patient for an hour to generate a relationship with them. You can generate a relationship in 3 minutes. You can generate a relationship in a second, right? So, learning how to get good at that.

So, for instance for communication systems if you will, there's lots of great books on how to communicate effectively, right? So, reading books, doctors generating their own systems, even in solo practice. Learn how to communicate better. Learn how to run your business smoother. I mean, things like the e-myth revisited is a great book on systems in terms of business procedures, right? There's a book called Crucial Conversations, which is a great book on communication skills. So, you can generate kind of internal systems in terms of your ability to communicate and manage cases. Always learning, always learning is so critical, going to your technique seminars, going to other technique seminars, doing the upper cervical diplomate. Always advancing your communication skills. Always advancing your clinical skills.

I Want to Connect With the Patient. I Want to Be Present. Systems Don't Replace That …But They Can Support That.

One of the things that I found Bill that I think is really interesting that I've been thinking about recently, I've got all of these systems in place to run my practices and to work with doctors but here's the thing that I realized. I never want to be on automatic. Like, I want to be super present, present time consciousness. Each time that I’m with the patient, I don't want to go into automatic and just do my reading, do my tests, do the adjustment, don't do the adjustment. I want to connect with the patient. I want to make sure that I'm not missing anything. I want to be present. I want to be… but it's a need, that's how I want to live my life.

Dr. Davis: Sure.

Dr. Lenarz: So, systems don't replace that.

Dr. Davis: Right.

Dr. Lenarz: …but they can support that.

Dr. Davis: Absolutely, absolutely. Systems shouldn't make you robotic, right? Systems should free you up to be yourself in the best possible way with that patient.

Dr. Lenarz: Absolutely.

Dr. Davis: Right.

Dr. Lenarz: That's really a good point. Yeah, absolutely, those are systems that are well developed.

Dr. Davis: …and it's in a doctor that really understands the system and has fully embraced it and implemented it, that can be themselves within that system, right?

Dr. Lenarz: Absolutely, and this works really well in a solo practices or multi-doctor practices.

I've Just Started on the Diplomate Program.

Dr. Davis: Sure. Yeah, I mean you can't be a multi-doctor practice unless you're good at solo practice, right? And part of being good at solo practice is having systems in place that are consistent and effective, and so absolutely.

Well, this is a great conversation today doc. I think it's going to bring a lot of value. I want to give you an opportunity to share anything that whether it's how to get in contact with you and then we have some lots of students that listen to this, and so if you have associate positions or whatever you think you want to talk about and/or share about what's going on with you these days.

Dr. Lenarz: Yeah. I'll tell you, I have a lot of people who kind of reach out to me to see if I'm still doing coaching and I'm really not at this point. I'm happy to talk with anybody that wants to chat with me. I'm really kind of focused on a new model within my practices, and growing these practices that we've got now, and we're going to be developing more. So, I'm always definitely looking for associates, and not just Blair doctors. We want to have multiple upper cervical techniques that we have established in our clinics, and I think perhaps the thing that I'm really excited about right now is, I've just started on the diplomate program.

So, I'm taking the upper cervical diplomate. I didn't take it on the first round. I'm excited about taking it on this round. I truly believe that upper cervical has so much to offer the world, but I feel that in terms of technique groups whereas the technique groups have really served chiropractic well over the last number of decades, for us to move forward, I'm not saying we don't need technique groups but we have to go beyond technique groups.

So, I think that the upper cervical diplomate, which teaches all of the main upper cervical techniques, and goes back and really looks at upper cervical from the philosophical and a scientific and current scientific data. It's really exciting for the profession. I'm excited for myself, and I really encouraged a doctor who really wants to reach the top of their game in the upper cervical world of making a difference in your practice, making difference in your patients practice, making a difference in the upper cervical world. Consider, if you haven't done it yet on the next round, jump on in and take the upper cervical diplomate. I'm very passionate about that.

Dr. Davis: Awesome. Yeah, we talk a lot about that on this podcast as well. We've had Dr. Julie Meyer-Hunt, and if you're ever around her at any point, she will get you excited about the diplomate, right? And anybody else that has been through that, just has nothing but good things to say about it. So yeah, absolutely. I'm excited to hear that you're going through that Michael as well, and so thank you so much for being on today, and just bringing so much value to our audience.

Dr. Lenarz: Bill, I want to appreciate you for all you bring to the upper cervical world and for giving me this opportunity to share.

Dr. Davis: Awesome. Thank you so much.

Dr. Lenarz: Thanks Bill.

UCM 020: How to Develop Systems to Improve Efficiency and Effectiveness of Your Upper Cervical Practice with Dr. Michael Lenarz
UCM 020: How to Develop Systems to Improve Efficiency and Effectiveness of Your Upper Cervical Practice with Dr. Michael Lenarz
UCM 020: How to Develop Systems to Improve Efficiency and Effectiveness of Your Upper Cervical Practice with Dr. Michael Lenarz
About the Author: Dr. Bill Davis
Dr. Bill Davis is the Founder and CEO of uppercervicalmarketing.com. His goal is to spread the word about the best-kept secret in health through Upper Cervical Specific Business and Marketing Solutions.
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