TORs Do (Some) Things Right - Mike Stanley DC

Forward from Dr. Maybee:

FTCA Blog features guest articles from FTCA members.  They of course are not completely the sanctioned opinions of the FTCA, but are editorial in nature.  And hopefully educational, or thought inspiring, and fresh, and and and...  A new perspective as we catapult this profession into a future leaning trajectory.  

With that in mind, it is however important to reflect upon the past.  It would be wasteful to take what has worked well in the past, and toss it merely because it is attached to "old thinking".  We don't want to throw the baby out with the bath water so to speak.  And we don't, if we are to be critical of the "straight" or "vitalistic" part of the profession, want to dismiss everything they have done as worthless or unimportant.  In fact, there are many things we can learn from that corner of the profession that could make our practices better.  There are things they do really, REALLY well.  

It would be advantageous for us, as progressive chiropractors, to recognize those things and re-engineer them into our evidence based practices.  As we move forward, it is important to define who and what we are as the chiropractors of the future, and dwell on or center our language on what we are NOT.  Dr. Mike Stanley understands this, and he expands upon it in the following blog entry.

Bobby Maybee DC

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TORs Do (Some) Things Right

Ah, the TORs. If you've been a member of the FTCA for more than...

*Checks watch*

24 hours...you have seen the disdain that we progressive chiropractors have for "The TORs." It's all too common to see Billy D freaking out about planes flying over California or yet another person that we've seen conned into a 3-year treatment plan, paid up front, for the bargain deal of $8,000. All you must do is attend 10 mandatory workshops, bring all your friends, shave your heads, drink this, put on these Nikes, and don't ask any questions.

There are plenty of TORs out there who are taking advantage of people for their own personal benefit out of nothing more than greed. Of course, there also are some TORs out there who have bought in and they think that they are doing a disservice to their patients by NOT signing them up for years of care because "If I don't check them for silent killers then WHO THE HELL WILL?!?!"

The TORs and the Progressives will likely never see eye to eye on chiropractic philosophy. The philosophical gap between the two is too great, and odds are that you have either bought in or you have not. However, I do believe that there are many things that we progressives can learn from the TORs when you look at the attitude they bring to practice and how they engage their patients and potential patients. They do a lot of things well, and I think that it is worth our time to recognize what those things are and apply them in our own lives and practice. Now before, you pluck the chickens and warm up the tar, hear me out.

TORs have certainty in the adjustment.

Certainty is a buzzword in chiropractic. It has gained a bad connotation due to its vague usage, but it is something that even we progressives should have when it comes to our best form of treatment, the chiropractic adjustment. I see too many progressives doubting their own training and treatment, and often over-complicating the issue. Let's be real, if you're not being dumb, you're not going to hurt anyone with an adjustment. In the absence of red flags, move the damn bone. The adjustment, a spinal manipulation, or whatever the hell you want to call it, is a powerful treatment. Don't be afraid to use it.

TORs aren't afraid to hustle.

Spinal screenings, health fairs, bridal shows, the mall. Many of us laugh when we see these poor saps wasting their weekends out there. We would never be caught dead doing such a thing! We chuckle that someone would stoop to that level, and then we sit back in our office and wonder where our patients are. Meanwhile, the doc you were just laughing at will see 15 new patients in the next week. Now, I'm not saying that we all need to do screenings at the mall, and God knows you shouldn’t lure people in with a bait and switch, but we also need to not be ashamed to get out and do some legwork. You may be a great doctor, but if no one knows who you are, they're going to go to the doc they know. And guess what? The general public doesn't care what the specific details of a chiropractor’s treatment philosophy are if they get results, and we all know you will get results in most cases by adjusting alone.

TORs don't care what other people think.

To be a TOR, you have to be someone who is comfortable challenging the status quo. TORs do not fall in line. They do not fit the mold. They do what they want when they want, and most don't care that we are hiding in our groups and laughing at them. They have defined their purpose, regardless of how much we

may disagree with it, and they are not afraid to go for it. We need more of this in the progressive world. Too often it seems like we are looking out the window and laughing at the TOR across the street when we don't even have our own office in order. Find how you want to treat and what chiropractic means to you and go for it. Stop worrying about what anyone else thinks. They aren't treating your patients and they aren't paying your bills.

TORs have passion.

Spend some time with some TORs. Their passion is infectious. They really do have a passion for helping people and they believe that chiropractic is the best way to do that. They get that twinkle in their eye when they talk about it. They get pumped up about chiropractic, and you cannot help but do the same when you are around them. Passion is what attracts people to anyone. Period. A person who is passionately speaking on a subject (even if it isn't one we agree with) will draw the crowd from the person who is robotically reading off today's newest research every time. Why? Because passion engages people on an emotional level. We need more passion in the progressive realm of chiropractic, and I'm not talking about passionately hating on the TORs. You'll win more people over when you passionately promote something rather than being critical regardless of how right you may be.

TORs don't think the grass is always greener.

Every now and then, the topic of bailing out of the profession comes up in the FTCA. I understand that for some people, this profession is not the right fit. If you got into chiropractic and you don't enjoy it or if you feel like you are being led elsewhere, best of luck to you and best wishes. However, if you want to make a good living in chiropractic, you must decide whether you're going to go all-in or whether you're going to fold. The chiropractic profession is not a profession that you can half-ass. No one, and I mean no one, does well in this profession by accident. You cannot succeed in chiropractic if you have one foot out of the door. The grass always looks greener, but every profession has the drama that the chiropractic profession has, it just is not at the forefront of your consciousness.

Being a successful chiropractor is hard. It's damn hard. However, this profession can provide you a great income and a great quality of life if you prove yourself worthy. It also cannot be denied that we have some hurdles to jump that no other profession has. Philosophically, the two camps in chiropractic could not be more divided, however, I do believe that we all have the same goal: to help as many people as we can live better lives through chiropractic care. While the two sides will likely never agree philosophically, I do believe that there are things that we can learn from one another to be successful and to help move the profession forward.

Be certain in your training and treatment, and if there's no reason not to, don't be afraid to adjust someone. Sometimes it can make the difference. Don't be afraid to get out and put in the legwork to build your practice. Stop caring what people think about you or how you treat your patients, and in that same vein, we could stand to stop picking apart everyone who doesn't practice identically to us on social media. One of the great things about chiropractic is you can practice how you want. As long as people are being ethical and getting results, give them a break. Finally, identify your passion within this profession and go all-in on it. This profession is not one for the lukewarm. The lukewarm will be chewed up and spit out.

The tides are turning in chiropractic. We are slowly seeing this ship turning around and that is due in large part to progressive chiropractors regaining public trust and integrating with other healthcare professionals in a patient-centered approach, but we still have to reach more people. While we may only see 10% of the population currently, the optimist in me means that we have a 90% untapped market. I think that if we take a step back we can learn to apply some techniques from our more vitalistic colleagues to reach the 90%, educate them on how we can help, and help the world to see how we are the answer when it comes to evaluating and treating the cause of pain without the use of drugs or surgery. 

Mike Stanley DC

A Marketing and Media Crash Course with Dr. Kevin Christie

This informative webinar was produced by Kevin Christie DC of Health-Fit Chiropractic & Sports Medicine.  Dr. Christie also administrates the Modern Chiropractic Marketing Facebook Group, which I highly recommend.

Check this video out and use it as a great launching pad for your content creation ideas and marketing strategy.  Don't just use your website as a digital business card...  CONTENT IS KING!!

Our Hybrid Model of Healthcare

Guest post by Dr. Josh Satterlee

I am a chiropractor, and I own my own clinic.

I am a strength coach, and I own my own gym.

I am a business owner, and I recognize the limits of each of those practices. And, in all three of those capacities, I am a witness to the changing landscape in healthcare, which is being reshaped due to changes in law, repayments and consumer desires.

But out of this chaos I think I’ve come up with a hybrid healthcare idea that makes perfect sense for me and my clients, and I think it can make sense for you, too.

Origin of the Idea

Quick history: I graduated from chiropractic college in 2006 and then opened a small office in Henderson, Nevada, with a partner. I was “Full-Body” certified in ART, and we worked the local race circuit to build up our clientele. So we had a pretty active client base. I fell in love with the SFMA, FMS and TPI in 2011. In 2012, we started seeing a significant decline in repayments from insurance. At the same time, I had been going to a CrossFit gym for about four years and treated many of my fellow box-goers. And then we got inspired to more fully combine our work with our passion—our sweat with our smarts—and we opened a hybrid facility in February 2013.

The idea basically came from two core convictions.

The first was teaching patients to move better. This is THE most important aspect of healthcare. See, doctors know that people need to exercise to keep their hearts healthy, keep the weight off, and keep their joints moving. However, if it hurts to move, most people will NOT move enough. So moving pain-free is a “first-principle” matter in healthcare. The idea also stemmed from an inherent limit within the current style of chiropractic: The better you are, the fewer visits you’ll see from each patient. It always bothered me that to make a decent, TESLA-driving living within chiropractic, I felt that you had to
sell your soul to the devil and push six-month care plans. We kept stats on every patient, and I was only averaging 4.7 visits per injury with my patients—and that included teaching home therapy as well. So the “customer value” was less than $1,000. And that was at a cash price of $85 per follow-up. In fact, I was seeing five to 14 new patients per week, and my schedule still had room. I ran that by my “straight chiro” friend, and he said that was a big number.

I also was seeing the huge influx of boutique gyms popping up—CrossFit boxes, Orange Theory, small yoga/pilates places. Although their average sale was small, it was recurring monthly revenue.

So we threw our hat in the ring.

Current Business Model

We ended up moving into a 5,000-square-foot office—more than triple the size of our old place. Along one side is our clinic with three large treatment rooms, and the doors of the treatment rooms open out to the gym. We want to empower our clients to get right back to training. The gym is an open-concept training space like a CrossFit gym, with a large, multipurpose rack as the centerpiece. We keep the place very clean and everything (save for the rack) is on wheels and can be moved. We change the floor plan every six weeks to keep it interesting and let our clients know we care.

We still have clients who are “treatment only” and have never used the gym other than for rehab. We also have a few gym members who have never been patients. And we have a large portion of people who get treatments and use the gym.

Most clients are looking for recommendations for what to do post-injury. And if you are trained in the FMS/SFMA model, you are probably performing a lot of rehab that looks similar to exercise. We use kettlebells extensively in rehab, and most of our lowback patients will work in some deadlifting before they leave. So, our thinking goes, why not keep them around by extending the exercise piece to them? That way, with our highly trained coaches, we can closely monitor their progress and correct their mistakes as they work their way back to good, functional health.

This develops the sweet spot for the business: gym memberships. It cures that part I don’t like about treating people as a chiropractor—when it goes on forever—and yet also encourages the doctor-client relationship to last as long as possible. As a business owner, it’s also reassuring to know that you have recurring monthly cashflow. Done correctly, this can become greater than 60 percent of your monthly revenue.

In our model, we try to perform a “discharge” FMS/YBT on each patient. This is included in their care plan, and it’s actually run by one of our trainers. It empowers the coaches and sets up a great conversation about the next step. Clients are invited to work out in the gym, and based on their FMS, we recommend Group, Small Group (4:1 ratio) or Individual (1:1) training. If they are a perfect fit, this sale is easy. One caveat, though, is a lot of patients were referred to us by another gym or another trainer. We work hard to send these people back to their gym with our training recommendations. As much as we’d love to have them join our gym, it would be bad karma and bad business to try and “poach” these people.

They often note our advantages over their old gyms, though. A big one is the quality, caring and attentiveness offered by our coaching staff.

In our model, the “traditional” CA role is boring and out of date. Our trainers function as CA’s. We find motivated, smart, hungry personal trainers and train them in the FMS and SFMA. They understand the system and know where they can help, but they don’t ever perform something beyond their scope. Instead of applying hot packs and EStim for the 18th time in a day, they are an active part of the patient’s case. They help reapply tape, teach home exercises, and offer some soft-tissue solutions. Thee trainers love it, the patients love the trainers, and this frees up the doctor to do what only he can do: diagnose and adjust.

One more bit of advice: Get every member of your team operating at the highest possible legal level of their training. Empower, don’t stifle. It has worked great for me.

For example, our head coach is Brian Chandler. He’s a licensed massage therapist and spent years in a big-box gym as a personal trainer. He is now trained in the SFMA, and he is able to help a lot of our clients through the transition from treatment to rehab to training. While doing this, he absolutely loves the challenge of getting our clients moving better. They perceive him as an expert, he works his butt off, and when the client needs to be manipulated, he refers them to me. This helps build the relationship AND it positions our facility as something special. Who else offers that? Chandler is also used to spending one hour with clients, which is perfect in his model. No one expects that a personal trainer will bill their insurance, either.

So the trainers in our clinic are treated as high-level players. The patients and clients positively respond to that “air of excellence,” and we can all help bounce ideas, exercises, and outcomes off each other because we are all using the same operating system. It’s the Functional Movement System, and it works great.

Recommendations

Looking back, we had a bumpy start to our gym. The main bump turned out to be time. You are only one person, and you may be asked to coach, treat, bill and manage. For a while, my Monday-Wednesday-Friday involved coaching classes at 5:30 a.m. and 5:30 p.m., then treating patients all day between. Most lunches were meetings to grow the business. I also cold-called 18 doctor’s offices to pitch my concept. On many Saturdays I would do presentation at local gyms or travel to teach with SFMA. It was crazy, but somehow I made it through. Here are some of the lessons I learned along the way: First, develop a system to “selling” at your clinic. I don’t mean a hard-style close in the ROF, but a systematic approach to how each patient gets processed and goes through care. You should work to make this so smooth that it runs even when you’re not there. This way your clinic revenue won’t take a dip while you get distracted by this new venture (ask me how I know). Second, develop early traction in the world of exercise. Host workshops for patients about mobility or shoulder care that are focused on a very active population. They have to perceive you (or your head trainer) as an expert in the field. And see if you can start your gym in someone else’s. We started an early class in a local CrossFit gym that let us use its space for free. Actually, we traded care (and the owner went to the finals at the 2012 CrossFit Games), so it was just a time investment.

Recap

I believe this is the model of the future. With the changes in healthcare and repayments declining, it becomes battle of value versus time. By leveraging our knowledge of movement, we can better help our clients. When your trainers can help with rehab, it establishes them as experts in the eyes of your patients. Then the lead in to the gym is easier. Plus, if you are able to capture just 10 percent of your chiropractic clients into a recurring revenue membership, you will have a highly successful gym. And you’d probably worry less about repayments and be more present with your patients. It works out for everyone.
By the way, we are looking to add a couple more clinicians to our team in the next year. If you are interested in joining us, please contact me. And if you have any questions about this model or need some help, I’m happy to share with you what I’ve learned. If nothing else, I can point you to someone who can help.

Resources

Here are some resources that have been helpful to us:
Gym Business Consultant: Thom Plummer. (http://www.thenfba.com/)
I met Thom through TPI, and he was incredibly instrumental in getting our systems up and running. Plus, he is quite inspirational and an all-around good guy.

Injury Risk Measurement: Move 2 Perform (www.move2perform.com)
The Move 2 Perform software prints out a report for each client, categorizing them into a risk bracket. This is the single best tool for client retention. Once you run the client through the test and print a report, the client essentially sells themselves on training with you. I can say that this tool also single handedly helped us land a 12-week,$14,000 contract to train the local fire department.

Equipment: Perform Better (www.performbetter.com)
The crew at Perform Better will hook you up with the right equipment. Plus, I would HIGHLY recommend their 3-Day Training Summits. It’s the best three days you can spend, and I would HIGHLY encourage you to take your trainers.

Functional Movement Systems (www.functionalmovement.com)
The FMS and SFMA are the single greatest tool in our arsenal. It’s not just the diagnostics (which are fantastic); it’s that the clinicians and the trainers are all communicating the same way. A DN for Hip IR, moving to a 2:3 makes sense to our crew, and the patients feel confident.

Dr. Jason Hulme, DC, Active Spine and Joint Center (http://www.activesjc.com/)
I met Jason at the Functional Movement Summit at Duke University a few years back. More than anyone else I know, he has developed an incredible system to implement the Functional Movement Systems into clinical practice. His consultation fee is money well spent to systematize and communicate your office systems.

NPE/Net Profit Explosion (www.netprofitexplosion.com)
I took NPE’s online-training course and it helped us get over the hurdle of not having great sales systems in our gym. Once we started running their systems, our gym revenues quickly beat our clinic revenues, which was awesome. Looking back, I wished we would have found them sooner. I can’t recommend them enough! I would talk to Ric Isaac there, and he can get you set up.

Custom Foot Orthoses

Chiropractic doctors see a variety of patients and complaints in daily practice and we offer highly beneficial treatment and care to the patients who seek our services. The majority of that care is focused on the spine, although we encounter a good deal of extremity complaints as well. The foot and ankle are an often overlooked etiology of many common complaints and training in this area and especially custom foot orthoses, is entirely lacking.

Corporate Spotlight: David Wedemeyer and Solelutions Orthotic Lab

Corporate Spotlight: David Wedemeyer and Solelutions Orthotic Lab

We are extremely excited about this post because it's our first ever Corporate Spotlight!

Dr. David Wedemeyer of Wedemeyer Chiropractic and Orthotics AND Solelutions Orthotic Lab has become the first corporate sponsor of the Forward Thinking Chiropractic Alliance.  Dr. Wedemeyer is located in Costa Mesa, California and is a Cleveland Chiropractic College - Los Angeles graduate.  To learn more about his view, experience, and sponsorship, keep reading!

Ego - A Rant

We have members who have been “in the field” for decades.  We have researchers who have worked on the newest and best methods known to chiropractic practice.  We have business owners who operate million dollar clinics.  We have students who have learned the best methods, as refined over years of practice.  We have new doctors who are learning new methods as you read this.

Member Spotlight: Ailsa Patterson

In March 2000 Ailsa Patterson B.Sc M.Chiro, became the owner and principal Chiropractor at City Centre Chiropractic, in Brisbane. Her qualifications include 1996 Bachelor of Science from The University of Queensland and a 1998 Master of Chiropractic from Macquarie University in Sydney. She has previously worked in clinics in Perth and South East Queensland, before settling in Brisbane City. 

The Science and Application of Human Anatomy Series

Welcome to the first post of the series related to clinical anatomy.  Throughout this series we will be reviewing anatomical structures as well as their clinical significance.  Since this is the first of the series, I wanted to provide a foundation for the future posts that will focus on more specific regions of the human body.  Generally, this series will concentrate on regional anatomy as opposed to systemic anatomy which will allow us to integrate biomechanics and physiology into the anatomy being presented.

Member Spotlight: Gitte Tønner

 

Gitte Tønner is a 2004 University of Southern Denmark graduate who has been keeping herself busy since entering the profession. Within two months of graduation, Gitte was moved and starting practice in the Netherlands. 

Gitte believes in the use of any modality she can rationally justify to get her patients better in the short term and healthier in the long run. She endeavors to run an ethical practice. To her, this means informing people in what she does, meaning working with their GPs or specialist when deemed necessary and that if her patients wish to work towards longer term results, she'll then talk posture, exercise, diet and supplementation.


Member Spotlight: Joshua Lederman DC, MS, ART, NRCME

Dr. Joshua Lederman is a Board Certified Chiropractic Physician in Illinois, has a Masters of Science in Sports Science and Rehabilitation degree, is Full Body Certified in Active Release Techniques (ART®), is an IronMan® Proud Partner, is a National Registry Certified Medical Examiner, and as if that wasn't enough is certified in Selective Functional Movement Assessment - Level 1.  His mission is to provide the highest quality, patient-centered, outcomes-based healthcare.