You have been working in practice for years. You have been successful in building and maintaining your practice. The professional goals you set upon graduation have been far exceeded. Now you have ten, fifteen or twenty years before you complete your career. What are your opportunities to grow personally and professionally?
Turning one practice into multiple practices would drive the growth of many mid-career chiropractors. To be able to serve more of the community and in turn increase your passive income, reduce doctor/patient time and increase practice equity would further expand the definition of your success.
As a co-owner of six chiropractic practices, my experiences can clarify whether expanding multiple practices is a viable option for you to achieve higher professional satisfaction. When asked, most chiropractors would say they would love to own multiple practices and reap the benefits, but most chiropractors who try to expand fail.
A common business plan is to open a second office and work in it on your days off. Build up a small patient file and then an employee can take over the existing patent file. What invariably happens is that the profitability of the existing practice decreases, a small practice is built at the satellite practice, the overheads almost double, and the doctor works two extra days in addition to the regular work week, with no financial possibility to hire someone a business partner. The doctor now notices that he or she is bleeding until they bleed. The reality is that every hour they spend at the satellite office they lose money and enthusiasm.
This failed plan plays out over and over again. I have profited by buying many of my satellite practices from doctors in the bleeding phase. The doctors all believed that it is better to sell their practices at an undervalued price than to continue wasting money and energy. For them it was to sell the office or close it altogether.
The fundamental mistake these doctors made is that they worked in their practice, not their practice. This statement by Michael Gerber in the E-Myth must be fully understood before any expansion is attempted.
Doctors tell me all the time that they are working harder than ever before, spending time traveling from one practice to another, training new staff and seeing more people. They fail to achieve their multi-practice goal; they just do more of what they already do with a lot more overhead. They are at work in their practice.
The chiropractor whose goal is multiple practices should work less as a chiropractor and more as a visionary, administrator, and staff motivator. There needs to be a transformation from the practice of Chiropractic to the business of Chiropractic. A shift in thinking from “This is what I do, I will do more myself” to “I need to delegate responsibilities to grow” is a necessity for growth. Your interest will increase in other related areas such as computer technology for increased efficiency, human resources for quality hiring and training, and improvements in basic business mode of operation. Your responsibilities include researching the best purchasing option for printing, telephone, x-ray sales and service, malpractice and business liability insurance, and durable chiropractic supplies. The physician who puts his energy into implementing specific systems that can evaluate productivity and efficiency within his practice is working on his practice.
There are three interdependent properties that I have found that define the success of any project, but especially when expanding multiple offices; vision, motivation and system implementation. The vision you create will be the motivating force that develops quality systems that can be executed very well.
You, the chiropractor, must be the visionary; the leader who has a burning desire to climb this mountain. Your employees must understand, agree and follow this vision. Ideally, the chiropractor, staff and patients should all be aligned in the practice’s mission.
This vision should include satisfaction for all involved. Each person working with you should have both a common and a personal interest in achieving the goal. By serving the community, the practice and themselves professionally and financially, the entire organization solidifies with the vision.
No one can perform all the necessary tasks to build and maintain multiple practices; it is a real team effort. Acknowledging this statement illustrates the need to motivate your team. Not all employees are motivated by the same remuneration or by the same management style. My experience has shown that moving towards a well-defined company culture enables the leader to anticipate the needs of the team. A great diversity of employees leads to greater difficulty to motivate and manage. Similar personalities are motivated with similar and predictable ethics, expectations and rewards.
As the organization grows, the talent needed to manage and motivate must increase in equal measure. My basic theory of managing staff successfully is to clearly define what is expected of the employee, get them to agree to that level of competence, and then motivate and manage them to achieve that expected level.
“Success is in the system” and “the system is in the solution” are common expressions in my offices. We live through them and grow through them. The most famous illustration of the concept is McDonalds. With a three hundred percent turnover rate, they rely on systems to achieve a predictable standard of quality and service. Once the system was set up, replicating the service to over 25,000 locations worldwide was a thing of the past.
In many practices of a single physician with several employees, the chiropractor has the least knowledge of the systems within their practice; the office manager runs “the show”. This doctor is so dependent on that person that he is held hostage. The physician who peels away every important task within his practice and develops a system for outsourcing that task to others can grow into multiple practices. That doctor must first master the task, document the process or system, and then set it in stone for everyone to see. Every system should have a component that evaluates and monitors the effectiveness of that particular system for continuous improvement. This allows the doctor to delegate with the ability to check. The result of this process is growth; growth per organization, not per individual.
The hardest challenge is committing to multiple practices, both financially and emotionally. Be really committed, don’t go into the plan by saying “I’ll open a second office and see how I do”. Once committed, you become the architect and design the business plan using your talents. By drawing on your past experience, you will turn the concept into reality.
Personally, growing from one practice to six has been one of my most challenging and fulfilling professional experiences. I can relate it to mastering a video game. In a video game, every move you make first hits a landmine that almost kills you. As you begin to understand this new environment, you develop a plan or vision to win. It soon becomes apparent that a motivated workforce with a plan or system will overcome your opponent. Further repetition of the required tasks increases your ability to perform at a level of excellence. With all these forces behind you to gain intellectual strength, political influence and financial independence, you crush the opposition. Unfortunately, life doesn’t exactly imitate video games.