Have you ever thought about how vulnerable your Upper Cervical Practice is?
If you are in solo practice which according to our 2015 survey about 80% of you are, you are only one injury away from losing the majority of your practice.
I can speak to this from my own experience.
I’m Dr. Bill Davis and in 2011 I had a thriving all-cash upper cervical practice that was collecting around $30,000 per month after being in solo practice for only 3 years.
One day while I was mountain biking with some friends I broke my neck and was paralyzed. The paralysis has left me unable to stand or walk, use my left hand and half of my right hand. I also don’t have any core muscles control and my major organs are affected.
After 3 months in the hospital I had lost 80% my practice.
As a result of my injuries I was unable to practice and eventually my practice closed.
What would prevent this from happening to you?
How can you protect yourself, your family, your team and your patients from an injury like this?
There are steps you can take to make your practice more secure and give you the freedom to be able to take a vacation.
We have found the majority of upper cervical practices are collecting between $20,000 and $40,000 per month.
According to associate developing expert Dr. Noel Lloyd a practice needs to be collecting between $35,000 and $40,000 per month consistently and have about a 50% profit margin in order to bring on an associate.
So we are going to focus on the steps you can take if you’re collecting between $20,000 and $35,000 per month. If you are consistently collecting more than $35,000 per month and you are still in solo practice I highly recommend you learn how to do associate relationships well from Dr. Noel Lloyd or Dr. Jeff Scholten or someone else and get yourself an associate as soon as possible. It will be worth it in the security and the freedom that you will be able to have.
But now let’s focus on those of you or collecting between $20,000 and $35,000 per month.
When you’re collecting between $20,000 and $35,000 per month it is easy to become complacent. You are likely paying your bills and living a nice lifestyle depending on your location. But as I said this is exactly where I was when I was injured and 80% my practice was gone in 3 months.
Why did that happen?
Because everything depended on me.
I didn’t have an associate yet and I wasn’t quite ready to have one either based on my collections.
So if you’re in this position what can you do?
You do everything you can to get your practice to the level where you can afford an associate. If not your practice will always be as vulnerable as mine was and you will also never have the freedom that you would if you were in a multi-doctor practice.
So let’s focus on the 3 things to do to get your practice to the level where you can bring on an associate doctor.
The first thing you want to do is to make sure that you have the systems in place that from an operations perspective everything could run without you.
This means having your consultation systematized, your examination systematized, the report of findings systematized, your daily visits systematized, your progress exam systematized, your healthcare class systematized and so on.
You need to be able to develop systems that you can plug another doctor into and train on the systems.
Unless you really understand system development you might need a consultant or coach to help you to develop solid systems that could be reproducible.
If you already have solid systems or you have developed them the next step is to make sure that your retention is good.
The chiropractic industry average PVA (Patient Visit Average) is about 15. Most upper cervical doctors have a PVA slightly higher. Let’s say 23. This literally means that the average Upper Cervical Doc is having to look for another new patient to replace the one that left 23 visits ago. If you succeed in replacing the ones that leave, the practice will remain where it is.
On the other hand, a practice with a PVA of 23 will require a great amount of time, energy and money spent on attracting new ones if it to experience growth.
Patient Visit Average (PVA) is the average number of visits your patients are coming in to see you. You get this number by adding up all your Patient Visits for at least 8 weeks and then dividing the total Patient Visits by the total New Patients.
For 8 weeks the number of Patient Visits was 88, 92, 86, 93, 98, 104, 95 & 105. If you add those up you get 761. During the same 8 weeks your new patients were 3, 4, 3, 5, 6, 3, 4 & 5. The total New Patients would be 33. Patient Visits divided by New Patients is 761 divided by 33 equals 23.1 which can be averaged to 23.
That means your patients are coming to see you an average of 23 times.
Some see you once and some see you their entire life, but the average is 23 times.
PVA tells you how well you are doing on patient education and retention.
The better you get at it, the higher your PVA will rise.
Retention is a crucial part of growing the practice of your dreams and is an art that can definitely be mastered. Here is one of the easiest techniques you can use in order to improve your retention: Future Pacing!
Dr. Clayton Roach discusses future pacing below.
Future pacing is the art of always letting your patients know what to expect and what is coming.
A great way to use future pacing is to let patients know about their upcoming progress exam.
"Mary, I know this is only your 4th visit, but remember I told you we are going to re-examine you on your 12th visit. Progress exams are exciting visits for our patients as they get to see and realize their amazing results. I can't wait to see yours!"
Another opportune time to use future pacing is when discussing wellness care.
"Peter, you may already be wondering how you are going to maintain your results after we are done with the structural component of your care. Don't worry, at that point we will talk about a wellness plan that will have you coming in for maintenance visits that we will schedule according to your needs. We want to sustain these results for a lifetime!"
Feel free to use this technique whenever you feel appropriate. At times, you may get the feeling that patients are already looking for the exit sign because they feel so much better.
Here is another beauty:
"Jim, you have been doing well with your care and it is evident you are feeling much better. Remember that pain is just the tip of the iceberg and the cause we need to correct is the bigger part of the iceberg that lies below the surface. This is why we do objective progress exams so you don't have to judge your health by how you feel. Yours is coming up in 10 visits! I can't wait to see your results."
By future pacing your patients, you take control of their destiny and indirectly their results. We all know the miracle stories happen after the pain is gone, so higher retention means more amazing stories, more referrals and a booming practice. Remember that patients need to be led. Always dangle that carrot in front of their nose and future pace them to wellness care.
Once you have systems and you are addressing your retention problems the next step is you need to have more new patients.
As in the example above if you are seeing 95 patient visits per week and have an office visit average of $60 then you are collecting around $25,000 per month.
Also you need to know your office visit average (OVA).
OVA is the average amount you are collecting for each visit. You get this number by adding up all your Collections for at least 8 weeks and all your Patient Visits for the same number of weeks and then dividing the total Collections by the total Patient Visits.
To go from $25,000 per month to $38,000 per month you will need to increase your office visit average, your patient visits or both.
For instance if you were able to increase your office visit average from the $60 per visit to $92 per visit while still seeing 95 patient visits per week your average collections would increase from approximately $25,000 per month to $38,000 per month.
Or if your office visit average stayed at $60 per visit and average patient visits per week increase to 150 you would also be collecting about $38,000 per month.
So depending on if you want to work on increasing your prices, see more patients or both will depend on you and your market.
Either way you’re going to need more new patients in order to reach the level where you can bring on an associate who can do what you do and give you a level of security and freedom that is impossible to have in a solo practice.
If you want to see 150 Patient Visits you can figure out how many New Patients you need by dividing 150 by your PVA. If it is 23, you need to average 6.5 new patients per week to make your Patient Visits rise to 150.
This is where we come in.
Most doctors are relying on referrals alone to maintain or grow their practice.
This is usually NOT a good strategy.
Online marketing is one of the most effective ways to increase your new patient numbers and your retention.
Because when you have pre-educated new patients that are excited about upper cervical care they tend to stick around a lot longer.
In the past 12 months we have helped our doctors see over 4000 new patients from the Internet!
Increasing your new patients and your PVA will increase your patient visits and collections and put you in a place where you can bring on an associate who will give you the security and freedom you need in business.
To talk with us about your practice and market schedule a consultation with our team.