Kats Chiropractic Consultants CHIROpulse

201 Are You Focused on Chiropractic Practice Profitability?

• Marisa Mateja

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Welcome to the KC CHIROpulse Podcast.  

This week’s topic:   Are You Focused on Chiropractic Practice Profitability?

The KC CHIROpulse Podcast is designed for Chiropractic professionals ready to elevate their practice to new heights, and is hosted by Kats Consultants coaches Dr Michael Perusich and Dr Troy Fos.  Michael and Troy are both seasoned experts in Chiropractic business development.  This podcast provides invaluable insights and actionable strategies to help you create a flourishing and sustainable Chiropractic business.

In this episode, we discuss:

  • The lack of focus sometimes seen in practices and it impacts profitability
  • What are the common factors on which we need to focus on
  • What are some of the strategies for increasing our profitability
  • We’ll banter through several jewels of practice success
  • …and so much more…

In each episode of KC CHIROpulse, we delve into crucial aspects of building a successful Chiropractic practice, covering topics such as establishing a strong foundation, adopting a patient-centric approach, mastering marketing techniques, achieving financial fitness, fostering effective team building and leadership, integrating technology and innovation, and navigating common challenges in the field.

Whether you're a seasoned chiropractor or just starting your practice, the KC CHIROpulse Podcast offers a wealth of knowledge and personalized practical advice to help you navigate the intricate world of Chiropractic business. Join us on this journey as we explore proven strategies, share success stories, and connect with industry experts to empower you in your pursuit of building a thriving Chiropractic practice.

Don't miss out on the latest insights and expert guidance. Subscribe now and unlock the secrets to taking your Chiropractic practice to the next level. Your success is our priority at Kats Chiropractic Business Advisors.

DISCLAIMER:  The information presented in this broadcast is for educational purposes only and is not intended to offer legal, investment, accounting, or medical advice, and represents the opinions of the speakers.  Seek the consultation of a professional for advice in those areas. And remember…your results using this information may be different than described.

Be sure to SUBSCRIBE to the Kats Consultants CHIROPulse Podcast
When you are ready we can help.


KC CHIROpulse Podcast. Helping Chiropractors keep their pulse on success. Thanks for listening.



Dr. Michael Perusich:

Doctors, are you focused on profit? Hi everybody. Welcome to the KC Chiro Pulse podcast brought to you by Kats consultants and Chiro health USA. I'm your host, Dr. Michael Perusich. I'm joined by my cohost, Dr. Troy Fox. Hello, Dr. Fox. It says Bridget. You don't look like Bridget.

Dr. Troy Fox:

No, she's better looking than I am. So I will attest to that. Yes. I'm just here in her place today because maybe I have a little technical knowledge on how to completely screw up focusing on profit. And creating a loss for yourself by doing stupid stuff. I've been there, done that. That's why I'm an expert at it.

Dr. Michael Perusich:

Whatever you don't touch Bridget's computer.

Dr. Troy Fox:

Oh, I already touched in a minute ago. I screwed it up. Yeah. I tried to change my name on here, but I'm not smart enough to do that. So hands off. Yeah, that's right.

Dr. Michael Perusich:

Yeah, I wanted to talk a little bit today, here at the beginning of the year about focusing on profit and, there's a reason why when we pull up our P and L report, there's a reason why the P comes before the L because profit is the most important part. Our law are your losses, which are really your expenses. Is that side of the ledger important? Yes, absolutely. It is. But here's the thing it's present time consciousness. If you're so focused on your expenses, guess what? You're going to create losses. You're just going to ride that pony right on down that trail. And I think our profession has a tendency. Sorry, I'm trying to change my volume here. I think our profession has just this little bit of a tendency to focus too much on the law side, on the expense side, and we forget about the profit side. And maybe that's because we don't really know where profitability comes from. And I, when I say that everybody out there is thinking I know where profitability comes from. You see some patients, they pay in money goes in the bank, right? There's a little bit more to it than that. a true business standpoint. So I thought it'd be good if we just kick this soccer ball down the field a little bit today and talk about profitability and how we get profit.

Dr. Troy Fox:

I think you came across an important point right at the very beginning, we see people sometimes so focused and paralyzed by their expenses. That's one side of the spectrum. They're so focused or so, so paralyzed by their expenses. They don't upgrade their practices. They don't do anything to really make their practice attractive to people so they can generate profit. I don't know how, I don't know how many times I've walked into a practice and I go, Oh my. I'm here. I don't, I've done it a few times and say, maybe an optometrist office or a dentist office or a medical doctor's office. There are some outdated offices out there. I was in my dentist's office the other day. And sometimes how we tell people to go out in your front room and just sit and see what I was looking at his chairs because that's what I'm trained to do. And I looked at him and went. Time for a new set of front waiting room furniture. But I think sometimes we get really hung up on, Oh my gosh, I'm spending so much money. The only way that I'm going to be profitable is to tighten the purse strings and not spend any money. And I think sometimes that really it really causes your con your practice to move like you're walking through concrete. I almost wasn't able to say that I was trying, but that's what it feels like. Sometimes you're walking and your knee deep in, in wet concrete and you just can't figure out your way out of it. So that's one side of the equation that we see. And unfortunately, when the general public sees that side, when you're in that rut, it really. Creates a bad light on your practice as well. Yeah. And I really don't like seeing that one, but the converse side. Is wildly spending without any kind of imagination whatsoever. What really creates profit and loss other than I see patients, I put money in the back, right? Yeah, exactly. And it's scary sometimes what we see people do.

Dr. Michael Perusich:

And there's this happy medium. There's the sweet spot in practice really, where, your equipment. And your physical plant has to look good. It doesn't have to be the Taj Mahal. You don't have to have gold plated walls and restoration hardware, furniture, restoration hardware.

Dr. Troy Fox:

I like that place.

Dr. Michael Perusich:

I know, but we don't, Oh, we

Dr. Troy Fox:

don't have to have it. So we can go to Hobby Lobby or Walmart and get some furniture.

Dr. Michael Perusich:

Yeah. Or, it make it look nice. And then as it ages, don't hold it together with duct tape and those kinds of things. You got to let the practice evolve. It's got to grow. It's got to, it's got to be refreshing at times, but we don't have to spend a ton of money on those things. So I think it's really important for doctors to understand where profitability comes from. And you mentioned. Sometimes we see offices and docs out there, we see a lot of offices. We can tell you some crazy stories, but anyway we see a lot of offices, they'll buy equipment and they'll buy equipment, like it's going out of style. And they think I'm going to buy this shockwave. I'm going to buy this laser. I'm going to buy this decompression table or, whatever it might be thinking, Oh, it's going to generate all kinds of revenue. And what happens? It sits in the corner and never gets used

Dr. Troy Fox:

and they go deeper into debt, but you're absolutely right. They buy it for a noble purpose. They're like, Hey, I want to make my practice better. I want this a shiny or fishing lure for people to be attracted to more products, more services. But the problem is if you're not ready to implement that product, it becomes a lead weight really quick. Really quick.

Dr. Michael Perusich:

And if it's, if you're buying the hook, that's going to catch a Marlin, but you're fishing in a pond for blue gill, it ain't going to work. So you have to know your lane too. So when it comes to equipment, if you're going to buy a piece of equipment and thinking it's going to be a profit center, you can really think it through. What do you have to think about? Okay. Who of my patients will this be good for? How will I build this into my treatment plans? How will I price it so that I can pay it off quick enough? How many patients can actually utilize it? How am I going to communicate the value? To patients for this, am I going to need to spend money to market it? Am I going to need to train staff? Can I train staff to manage that piece of equipment and free my capacity up? So I can see more adjustments. There's a whole bunch of things you have to think about.

Dr. Troy Fox:

Hey, let me ask you a question real quick. So there are going to be people that are listening right now. They're going to ask the question immediately. If I buy a piece of equipment, how long should I break even or start to get a return on investment?

Dr. Michael Perusich:

Oh, I love that question.

Dr. Troy Fox:

So talk about that a little bit, because that's important. Cause there are some people that we've talked to that their timeline might be 10 years. And other people have an expectation that they're going to pay it off in three months, which is fantastic, but what do you think is a reasonable timeline for a moderately priced piece of equipment for return on let's say, let's just go 20, 000. That's not because there are pieces of equipment out there right now. I won't name any names, but there are things you can buy for 60 to a hundred thousand easy, right? And they all say, here's your plan on return for an investment, right? This is what you charge. This is how many patients you need to get in. So let me ask you on a 20, 000 piece of equipment. If I were to buy one today, what would you tell me? How long do I have to get a return on my investment?

Dr. Michael Perusich:

I'm going to do a little teaser here.

Dr. Troy Fox:

All right. I'm going to push

Dr. Michael Perusich:

this to a break and we're going to come back and we're going to talk about that. Let's do it. That is the perfect question for what we're talking about. So we're talking about generating profit and how to really manage your practice by your profit loss. Troy asked a question that we're going to talk about on regarding ROI. When we come back. We'll be right back.

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Dr. Michael Perusich:

All right, everybody. Welcome back to the KC ChiroPulse podcast. We are talking about managing your practice via your profit loss. Really managing the profit side of your practice and being focused on your expenses, but not so focused that it's just taking you down a negative path. And we were talking about Before the break, we were talking about buying a new piece of equipment. You asked the great question of if I buy a 20, 000 piece of equipment, how long should I take to pay it off? Should I pay it off in 10 years or should I pay it off in 10 minutes? Yeah, exactly. You didn't say that. And

Dr. Troy Fox:

that's a question. A lot of people ask. Yeah, it

Dr. Michael Perusich:

is. Yeah. And it truly is a great question. And I appreciate the fact that I think most of us. Think about that when we buy a piece of equipment, but we really need to nail down how long it's going to take. My general rule of thumb for most pieces of equipment of 20, 000 and under is what's it going to take to pay that off in six months. Now, it doesn't mean you will, it doesn't mean you should and we can talk about the proper use of third party money, like a loan or something. That's probably another podcast, but yeah, but that's my general rule of thumb. What's it going to take to pay this piece of equipment off in six months? Okay. So if we take, I've got my trusty calculator here. If we take that 20, 000 just in principle and we divide it by six. Okay. Yep. That's 3, 333 a month. Now, if we take that 20, 000 we'll go even further. And this is where some of you might need some financial help, which is one of the things we do here at Kats consultants. So if we actually put that in the calculator and put interest to it,

Dr. Troy Fox:

so

Dr. Michael Perusich:

to pay it off in six months, we'd have to generate about, I'm going to round it up 3, 410 per month.

Dr. Troy Fox:

Okay,

Dr. Michael Perusich:

reasonable. However, if we're going to charge patients 9 a visit, it's going to take us a while. It's going to take 378 patient visits.

Dr. Troy Fox:

If, because you set the value folks, you set the value. So if you have a poverty complex or now I'm going to say this, is this is sometimes the case you can be in an economically depressed area where it just doesn't warrant. You may want to charge 175 a treatment with this 20, 000 piece of equipment. And not one person would come in. So it's supply and demand. We have to remember that as well. We work in an economic. Environment where supply and demand rule. So if you only want to see three patients a month and charge them a thousand dollars a piece, you could try that. Or you can sweeten the pot a little bit and find what I would call that sweet spot, that middle ground where, and you can have focus group. People respond to what they think a reasonable amount is as well, or even your staff, and a lot of cases, your staff will be like. That's too low. We need to charge more than that for that. I'm sure my, my staff's very intuitive about that, but that's one thing we have to look at.

Dr. Michael Perusich:

It absolutely is. So you have to know your market. Okay. So at 9, it was what, 378 patients or something. And if you don't see 378 patients a month, you're never going to make it at 9. And number one, not every patient is going to be utilizing that service. You may recommend it to everybody you won't, but you may, but not everybody's going to do it. Not everybody's going to need it. And they

Dr. Troy Fox:

may not be a fit for it. It's, it really is a situation where you can probably look at any given technology that you bring into your office. And I'm going to say that a good round, just guesstimate numbers, usually about 25 percent of your patient base are going to eventually. Use it at that time. And it'll continue down the road to be about 25%. It's not, you get some things like a roller table or some stem or something, somebody really likes her on Aqua bed. Oh my gosh, people love that thing. And a lot of people are going to lay on it, but let's say you buy a shockwave unit or a decompression table. Is that, are you going to put a 12 year old kid on a decompression table in most cases, or. Are you going to do shockwave on them? Probably not likely at 12 years old, unless something really crazy is going on. And I don't even know that would be warranted, just somebody with a bad knee. How many bad knees do you have in your practice? Probably about 25 percent of your patient base, right? Somewhere in there.

Dr. Michael Perusich:

Yeah, there might be a few things where you might be able to get a higher volume of patients was probably never going to be over about 40 percent ops, right? Now if we take that same scenario and we charge 79 per patient, then we need 43 patients to utilize that a month or about 11 per week. Okay. Yeah. Does that seem a little more easy to attain? It does. But then the follow up question is, this goes back to what you said a minute ago. Know your community. Will people pay 79? So these are the balances you really have to look at. And I can give you a couple. We always like to give a little nuggets. Here's a couple of nuggets. Okay. Number one, in your first six months, don't expect more than 10 to 15 percent of your patients to utilize that service. Yes. Okay. Now you might be really good at communicating. And I know everybody hates this word, but you might be really good at selling that service. And that's great. You might be able to get that number up a little bit higher. But let's set the expectation ourselves. The goal. Let's figure out if only 10 percent of the practice utilizes it. Then we've got a buffer there. So if we charge 79, for example, and we expect 10 percent of the patients to use it and we need 43 to pay for it for the month, then you need to be seeing at least 430 patient visits per month.

Dr. Troy Fox:

And you know how you get that number up and here's the thing. Most of you won't do this. I'm not even good at this. Here's the thing. You don't have time to go out and sell, right? You're busy with patients all day, right? You're busy with patient care. Or you hope to be how, yeah. How do you get your practice to adopt a new treatment and especially one that maybe nobody's ever heard of before, or they've vaguely heard of it and. And you're starting to teach them. You better have a pretty good social media presence because as I got told the other day, this is interesting. I met with review wave. Because they now support my software. Guess what? The one thing they said is, wow, you have really great reviews, but they're inconsistent. So inconsistency is a killer in your practice. And I'd suffer from it as well. Do am I constantly asking for reviews from patients? No, I go in waves. That's why they call it review waiver now. Aloha. But it goes in waves because sometimes I don't, it depends on my mood and what I'm thinking. And the staff's the same way they get busy. So if you're going to market a new tool to get more than 10%, you better have a really focused marketing campaign put together. And I've actually just been thinking about this over the last month, because we're going to unveil a new piece of equipment probably here in two to three weeks, somewhere in that neighborhood. And I'm working on the marketing campaign right now, because I'm going to create an automated marketing campaign because I know. That I don't have time to sell it. So I'm going to see if I can get more than 10%.

Dr. Michael Perusich:

Yeah. And you might be able to,

Dr. Troy Fox:

maybe,

Dr. Michael Perusich:

I had a couple of profit centers. We didn't start at 10%, but I did get probably about 55 to 60 percent of the practice using it. You can get there. You just have to be really good at how you do it. And the problem most of us have is it's hard to keep your foot on the gas. Yeah, it was something especially if you are not 100 percent of belief of it. And what do when I say that if you're the kind of person that the first time somebody says, oh, that's a piece of junk, I don't want to do it. And you take it personal, guess what? You won't recommend it anymore. Now that brand new shiny laser becomes some, someplace where you hang your laundry

Dr. Troy Fox:

and we've all been beat down that way. Our equipment sucks. We suck. We are a very hands on profession that get evaluated, not by the volume of our adjustments over our career or the volume of treatments that we've given patients with our modalities, but they base it on the very last one. And yeah, so it's a hard climb, but I love the way that you approach it. Because what you've done now is you've broken it down by the week. Can I, and my staff now goal set? Absolutely. We can goal set now. So I love the way you approached it because that return on investment doesn't seem, when you said 3000 and something, some people are like, Oh God, really. But when you break it down, do you have to take a leap of faith to buy any equipment? Yeah, absolutely. Because you never know unless you are just an absolute pied Piper, you never know that it's going to be successful, but from a standpoint of looking at the investment and breaking it down by the week, all of a sudden it's in manageable bites and break it down even further to the day.

Dr. Michael Perusich:

Yeah. Or even the day part. So what do I mean by day part? Oh yeah. A morning and an afternoon. That's two day parts, morning, afternoon, break it down, so if you break it down to a standard four day week, You need three patients per day on that service at 79.

Dr. Troy Fox:

So that's one in the morning, one in the afternoon, and you cut the other one in half.

Dr. Michael Perusich:

Exactly.

Dr. Troy Fox:

Okay, gotcha.

Dr. Michael Perusich:

So the whole goal then would be, okay, let's identify two patients in the morning and two patients every afternoon. And. Let's get this thing going because now what are we done? We need one and a half, but we're shaft two. So now we're already building what profitability into the whole process. We're not just paying it off. Now we're starting to think profitability. So when you look at profitability, what we have a tendency to do is focus so much on the expense side that we see everything as an expense. Okay. People do this with coaching. They think, Oh, that, that's just an expense. They forget that membership fee to your coaching or consulting program is actually helping you generate way more, probably 10 to 20 times more than what that membership fee is. So we have to look at everything on the expense side of the P& L. Okay. How is that helping me generate revenue? I've got this loan on this brand or lease, whatever it might be on this brand new piece of equipment. Okay. How do we look at that? Is it just an expense? It's an expensive for not creating revenue. But if we look at that and go, okay that 3, 000 a month that I want to pay. So I paid off soon. We'll just use that number. I've got to look at that as, okay, that 3, 000 could help me generate 6, 000 or 9, 000. What do I need to do? How do I break that down? So I'm generating more than what it's costing me. That's how you have to look at everything. And that's what your P& L does. It puts it All in black and white right in front of you and let you look at it. Now, some of you out there probably going, I didn't even know I had a P& L. Where's my P& L? You have one. I promise. If you have an accountant, your accountant's probably using QuickBooks online. You should have access to it. If you don't know how to read it, ask your accountant. How do I read this? How do I utilize this? How can this benefit me by reviewing it? If you have a business coach, We do this all the time with doctors, we help them understand what does that P and L mean and how can I take those expenses and not just look at them as expenses. How can we turn those expenses into profit? Now, there are some expenses you can't do a whole lot about but Troy, you brought up marketing. Okay. You're putting together a marketing program. We want marketing to have an impact, not just an expense. So you might be putting, make up a number, 1, 500 a month into your marketing. Number one, is that the right number? Are you generating enough revenue? This is something else we do for right. We help them understand how much you have available to spend on marketing, but that's a side note. But if you're spending 1500. It's an expense if you only generate a thousand, but if we look at that and go, okay, I'm spending 1500. How do I generate 3000? What do I need to do? How many new patients do I need to get in the door utilizing this service to generate 3000 because we should utilize. All of our expenses to help us parlay that into higher profits.

Dr. Troy Fox:

Yeah, it scares me to see sometimes the way people handle development and launching of products. And I'm going to give you a couple of real quick tips on this. And then let's talk about high expense marketing. So here's how you launch a new product docs, know everything you can about it. Learn as much as you can figure out what other people are doing. Marketing wise, know your market, what it costs. Next step. You got to train your staff. So you need to get them excited about it to let them know why you're excited about it. They're going to be excited. That's step number two. So we get our staff trained on as well. You notice I haven't said one word about talking to patients yet. I get my marketing plan together. I get ready to go. And literally when the first patient walks through the door, we've already rehearsed this. We've already used the product. We've trained on it. We're ready to rock just like it's been in our practice for 10 years. Now, here's the problem. I see the problem I see is. That one, we'll buy a piece of equipment because you couldn't swing a dead cat in your town where

Dr. Michael Perusich:

you're going with that

Dr. Troy Fox:

without hitting somebody else that already has that piece of equipment. So you have to do some heavy marketing. You're killing me. You got to do some heavy marketing just to get a few patients in the door and your return on investment on your marketing sucks, or. You've got such a high priced item and other words, supply and demand, right? You have the supply, but there's not a very high demand for it because you got it and people go, I'd pay 69. 95 for that, but I wouldn't pay one 89. 95. You're not even close. So if you're not even close on price, you can advertise all you want. And we see this sometimes with some of these high volume advertisements for like decompression centers, right? To where sometimes people are just pound in the marketing because they can't get people through the door for some of these big packages and you return on vet. If you get a bunch of people in the door and people get well and they're telling other people, then you're going to get retention and it makes it worth it. But if you just have people coming through the door and pouring right out the backside and your practice stay static, you really are losing money by doing that because you're not investing in anything that lasts.

Dr. Michael Perusich:

Oh, you just opened Pandora's Box. I

Dr. Troy Fox:

did. There's

Dr. Michael Perusich:

you did 10 more podcasts. I love this. I love this. Yeah. We, I'm gonna do this again. I'm gonna tease this segment a little bit. So we're talking about managing your p and l. We need to take a quick break, but we're talking about managing your p and l and you just stepped off into a well of information that we need to talk about. When we come back, we're going to dive into this just a little bit more. And I think we're going to have to do part two and

Dr. Troy Fox:

part two. Yeah, for sure.

Dr. Michael Perusich:

Yeah. All right. So hang on everybody. We'll be right back.

Kats Consultants:

Kats Chiropractic Consultants your partner in chiropractic success. We are dedicated with one on one guidance to bring you all your practice management needs. Let's supercharge your practice. Give us a call today.

Dr. Michael Perusich:

All right, everybody. Welcome back to the KC Chiro Pulse podcast. We are talking about some deep stuff today. We're talking about creating, basically talking about creating profitability in your practice. And Troy, you were talking about marketing and you hit the R word. My favorite thing, retention, this is so important when we're talking about profitability. We have to realize that every new patient that comes in our door probably takes three to four, maybe five visits before they're truly profitable in your practice. Now, the most common dropout point. With a new patient is visit three. It's the day they could have started becoming profitable and somehow we let them fall through the cracks. And because of that, those marketing dollars, and you can do the same scenario with your marketing dollars that I did with. With bringing in a profit center is divided down to, what's every patient costing me. And if that patient's costing you 500, do you collect 500 on day one? No, our day one services are so undervalued, but it's what the market will bear and what the market has come to realize with day one. So we've got to get them to that point where, on what visit are we hitting that 500 mark? So we're at least breaking even I'm telling you busted out. It's the. Third, fourth, or fifth visit for most of us before we get there,

Dr. Troy Fox:

it's a little scary when you look at it for a lot of people, because if you've never looked at it before, I think you realize that your marketing budget in a lot of cases probably needs to be smaller. Now, there are some of you. Your marketing needs to go up and here's the deal. Some of you can just do some boosting on Facebook, to a target specific area and do fairly well with that. Just get the word out, especially like a new product. Like we're getting ready to bring into our practice and our price point that product will be at. That's all I got to do. Quite frankly, my marketing campaign could be that easy. Now, what we're going to do is we're going to drive. People to our website with that as well. So it's a twofold marketing plan, but I don't have to spend a ton of money to do this. I don't have to pour a bunch and I'm not going to. Make every post that I do be general or be driven by revenue. In other words, I'm not going to boost every post and we're just going to boost a few of them and we're going to start bringing people in and then it'll organically grow, which that's another secret to that.

Dr. Michael Perusich:

And you're managing it exactly what the way we're talking about. You're minimizing the expense down to the point where we're not overspending, hitting that sweet spot where we're maximizing. The number of new patients that we're getting, which is allowing us then to reach profitability that much quicker. And so these are important things you have to think about in your practice. We can't just willy nilly spend money and we can't just willy nilly set our fees. Thinking that we're going to be profitable. And I see this happen a lot. I see doctors misusing, it's probably not the right word not setting their fee strategy correctly. It's random. That's the word I was looking for. They're just randomly setting their fees up and their fees typically aren't high enough to cover the expense load. So now that forces them to just look at expenses. And we've got to figure out what the fee strategy is. And you can't look at just the market. You can't look at Dr. Bill down the street and go, Oh he's charging 29 for an adjustment. I probably should charge 28. That's just a race to the bottom. You need to charge what your practice needs you to charge. So you turn a profit. That's hugely important. And everybody, I'm going to, I'm going to cut on our profession here just a little bit. And keep in mind, people, I love this profession. So when I do this, it's just a frustration of mine because I see a better way. We have a tendency to always want to undervalue our services. We have a tendency to be random about how we run our businesses. And then we wonder why We're not turning a profit and we institute strategies in our practice. And here's the best one I can think of on top of my head. We raise our fees. We go out on that limb. We haven't raised fees in five years. We're scared to death. And so what do we do? We raised our fees, but we stopped recommending services that patients could utilize and need because we're afraid of the number they're going to hear. So what have we done? Sure. We raised our fees, but we decreased our collections. Because now we're not doing enough

Dr. Troy Fox:

services. Sometimes you even see them go down when that happens. It's crazy. Instead of you being where you're at, you raised your fees and then you quit putting therapy on patients or something. Oh gosh. And now all of a sudden we look at your numbers three months later and you're trending down dollar wise. It's what in the world? The other big thing that I see and you guys know this is happening. It's called that front end load and you talked about it a minute ago about patients leaving after three visits. We focus so heavily on getting new patients in the door. We don't have any procedure in place to make sure that patients are successful with their care. They're happy with their care. They're giving it, maybe they're doing, maybe they're not we're not checking to see if. They have any suggestions for our office. I love doing those questionnaires. I think those are all important factors because that client now, or that patient feels included in the process. And there, there are groups out there that'll help you put that together if that's something that, that you can't do on your own or don't want to do on your own. But I think it's an important part. And I think instead what we do is go, I'll put out a 29 ad. I'll drive as many patients through the doors I can, and then I have no plan. And then they all, it's like a boat with holes in it. You can bail as much water as you want, and it keeps filling up with water. And you're trying, you're sitting there going, why is my practice still sinking? Why is it still filling up with water? You're right on your front end loaded. So where are your long term patients that are getting wellness care? Where are your patients that believe in chiropractic like you believe in chiropractic? So that all ties all the way back into profit and loss, because if you can't keep Patients under care that get chiropractic, you need to stay, take a step back to start with. That's where you have to start.

Dr. Michael Perusich:

You can't build a practice long term on the front end. Now I understand if you're first two, three years in practice, I get it. So we need new patients. That's how we get going, but if you're five years or longer in practice and you're. You think you're still dependent on new patients, you may be looking at your practice wrong. And so if you're just constantly trying to drive more new patients, my first question is, what's your new patient capacity? And you're going to look at me and go, I don't even know what that is. Because you've never looked at how many new patients can my practice actually handle? We just keep shoving them in the door, right? That increases your dropout rate. I'm here to tell you, I don't even have to look at your stats to know that's increasing your dropout rate. We have to look at not the front end of patients for a profitability standpoint. Our profitability comes from creating lifetime patients. I'm creating long term patients, Walmart didn't get big because they're constantly looking for new clientele. They bring in new clientele, but it's because they keep people. McDonald's sells so many hamburgers because they keep people coming back. Nordstrom's has a great business model because they keep people coming back. So that they have

Dr. Troy Fox:

the same model that we have in chiropractic. If you didn't realize people that pay stay. And refer their friends in, oh man, when Walmart first started, it's oh my gosh, you got to go to Walmart. Things huge. They got one of everything in there. Literally when Walmart's first started, some of you guys are young enough, you don't remember when Walmart started, but I remember back in the days of TG and why, and they had some, I remember back in the days of JC Penny and they had some stuff, but then you'd get a Wichita to Nordstrom's and there's a guy playing piano in there. Yeah. I'm like, what's cool. So guess what I did paid, stayed and referred my friends in there. Yeah. Pay, stay and refer. It's the same thing in chiropractic. And unfortunately we often want to say, I don't like to do sales. I like profit and I'm running a business. So here's the thing. I got a great product. The only reason that you don't want to do sales is because you don't believe in your product.

Dr. Michael Perusich:

So you believe in your product. You don't, it's not. It's not really selling,

Dr. Troy Fox:

at least it doesn't feel like it because who am I, Dr. Paroosh, I am the philosophy guy. I am. So I've made some people mad because of things I've said philosophy wise to them and called people on the carpet that are chiropractors, because if you don't have a belief in what you do, and I say belief, like it's a belief system, but you know what I'm saying. If you don't understand the philosophy of chiropractic and you don't understand the science behind it, and you think it's just a back popping, Hey, I feel better kind of experience like a lot of our patients do, you're going to struggle to be profitable in practice. So I got to go all the way back to philosophy. We could, we got so many. Loose threads going on this podcast today, but there are so many directions that we could go with this, but that's one I look at often is where are you at? I hear chiropractors that tell me how often do you get adjusted? It's been a while because there's nobody that, is off work at the same time as me, or I got to get home to my kids or whatever, and it's you're not getting adjusted. So how in the world would you be able to recommend care to your patients if you're not even getting care? It didn't make any sense to me because last time I checked, I'm looking at chiropractic as a wellness profession, not as a sickness profession.

Dr. Michael Perusich:

Okay. You just made me think of something. Here we go. There's probably another tangent. Yeah. One of the things that drives me crazy is when people are on maintenance care, if we're recommending maintenance care,

Dr. Troy Fox:

and

Dr. Michael Perusich:

we say things like just come back when you need or come back in four weeks or six weeks. Mhm. We'll just put you out that far. Yeah. And then I turn to the doctor and say, how often do you get adjusted? Oh, I, at least once a week. Why do we let our patients not have Access to care like, shouldn't they at least have the opportunity out of your poverty, complex mindset you're killing your profitability. Again, I'm bringing it back to profitability here. You're killing your opportunity for profitability. You're so focused on the new patient that we forget that it's the lifetime patient, the maintenance patient, the long term care patient, whatever you want to call it. That's the patient that builds your practice.

Dr. Troy Fox:

And if you move a patient to wellness, who then asked you, can I come in a week earlier than that? I don't really want to go out three weeks or four weeks. Could I be seen in three weeks or how could I be seen every two weeks? You missed a huge opportunity. Now it's there because they just gave it back to you. They threw the ball back to you. So you got a huge gift from your patient because they said, I want to get adjusted more often than that, but here is one way that you can approach this. You make a blanket recommendation. Let's look at the cadence of care that we're going to put you on. Michael, as I start to work with you and your treatment plan is over. So what I'm going to recommend at this point, and I'll just tell you, a lot of patients ask me, how often do you get adjusted? I get adjusted weekly. I have for 30 years, I've got adjusted weekly. I'm going to make a recommendation for you now. Hey, by all means I typically don't offer or I don't recommend a lot of folks. Get adjusted once a week, because I just think of time restraints. Sure. A lot of people, it's just sometimes a struggle, but if you want to get adjusted every week, by all means. So what I've done is I've thrown in a negative there. So now I can throw my positive and you may disagree with me on this. I want to see how you respond to this. Now I say, but what I'm going to do is I'm going to recommend that you be seen every two to three weeks. And I leave it at that. So what did I just do? I gave an option number one, which I assume they'll discount because they're going to pick the one in the middle. And then I gave two and three. So I gave one, two, three, and it without fail, they go up front and schedule for two weeks. Because that's what I really wanted them to do anyway, because that's what they need.

Dr. Michael Perusich:

That's pretty much what I did too. Yeah. The town that I practiced in the mindset was monthly. When I got there monthly mindset and I slowly started changing it and I would tell, I started with, okay, I want to see in three to four. And a lot of them would ask me how often do you get adjusted? I get adjusted every week. Oh, okay. I'll try three is what a lot of them would say. Then after a while I start telling them, all right, I'll see you back in two to three weeks. Now you have to have your staff keyed in on this too. Yeah. Dr. wants to see you back in two to three weeks and they have to start with two weeks looking at the schedule. And I'm going to tell you guys, we did this big, huge experiment in our practice. And when you get people to three weeks, no more than three weeks, they remember what the adjustment feels like. And now they want to start coming in sooner. And that's when Trey, you mentioned it. That's when they start asking you the doctor how often do you get adjusted? And I, so I learned to just lead with that. Okay, here's the deal. You're ready for maintenance. Now I get adjusted every week. Marissa up there at the front desk, she gets adjusted like two or three times a week. And so you set that perception. Oh, okay. You guys look healthy. You guys get adjusted often. Maybe I need to be too. Yeah.

Dr. Troy Fox:

Now here's what's crazy on a national level. And we're starting to see this with places like new spine and the joint and some of the chiropractic offices that have become franchised and do more of a monthly plan. What we're seeing on a national level. Is a lot more people asking for every two weeks care than they are monthly care. It's mind blowing to me that we as chiropractors think once a month and the public had been somewhat ingrained into once a month, but when people are spending money and have a reasonable value, a lot of times they're saying, you know what, I have a really busy schedule and I'm under a lot of stress, I'd really like to get adjusted once every two weeks. Okay. So we're not offering that to our patients and you just tell them a month, they're going to do a month. So you really need to offer up what the options are. And I have some patients that have been weekly patients of mine for quite a while. And they are, I'll tell you what, those weekly patients are adamant they're going to get their adjustment like today. At the time of us recording this podcast, I'm snowed into my house. And so I have patients I didn't get it. Yeah, that did. Yeah. Daytona probably is that area is probably a little nicer today, but I have those patients that are freaking out right now. That are going to get adjusted this week. It's amazing how committed they are to getting their care. Yeah. Somebody that's at somebody that's a month, they get we'll just push it out another week or even worse. I'll just wait until next month. Cause I'm really busy right now. Anyway, I don't have time to reschedule. Yeah. Those are the kinds of things that you hear when people aren't really feeling the full benefit of care. So again, that goes back to profit. We're going to end up having to break this podcast in half for sure, because it goes back to profit when we look at that, you're leaving profit on the table. When we start talking about profit loss with the same amount of patients in your practice, if you could double the revenue with even 25 percent of your patients, you're good. Yeah. That's pretty darn good.

Dr. Michael Perusich:

So I'm telling you, if you've been in practice five years or longer, you're sitting on a gold mine. If your practice isn't profitable, give us a call, jump, jump on my schedule. Let's just have a 30 minute session and talk about your practice. And I can point out some things probably over the phone or immediately where you probably have some holes. And you may have picked up on some of those in today's podcast because we gave you a ton of jewels today. Oh my gosh. I love it. But go to our website to Kats consultants. com Kats with a K. Go check it out. We've got some free downloads on there. I don't know if this is still up there or not, but we have one about increasing your practice by 130, 000 or more a year just by doing like it. I can't remember seven or 10 little things in your practice. And it's amazing. We've talked about some of those today. It's amazing how quick your profitability, your revenue and things would go up. And gosh, guys and gals here at the beginning of the year, wouldn't it be nice to have a more profitable 2025 than 2024 and you may have been super. Profitable in 2024. Let's not take our foot off the gas.'cause guess what? The world gets more expensive as time goes by and we want to keep up with that. So our profitability has to keep ticking up and up. Troy, anything to add? I know there's so much to talk about

Dr. Troy Fox:

here. Just about coaching in general. I think, a lot of times we get, it's kinda like a guy that goes on YouTube to, or a gal that goes on YouTube to figure out how to play golf based off of YouTube, right? There's a lot of really good tips out there. But how do you integrate those into your swing? How do you integrate the tips that we're giving you into your practice? Some of them are easy. Some of the things we're giving you are just nuggets that you can take back immediately, but you know what we see with clients all the time? And I was the same way as a client. What I would do is I would juggle eight balls at once and I do it really well. As long as somebody was right on top of me, Hey, how's this going? How's that going? Let's take a look at your numbers and accountability. And the second that I'd get off my calls, which I know crazy, right? But even I did that back in the day, I wouldn't end up on my calls and you know what, I'd start dropping balls. And then when I'd get back on my calls, now I got work to do again, because I had somebody look at my practice from the outside that could identify the key areas. Cause they do it all day, every day. That's why coach is important. It's yeah, you can get tips on here from us. So we're going to give you everything we can, but it isn't going to solve all the world's problems. Even the best players in the NFL need coaching. Although I didn't see Andy Reed doing a whole lot of coaching yesterday.

Dr. Michael Perusich:

I don't think he needed to.

Dr. Troy Fox:

I don't, I think he just sat there.

Dr. Michael Perusich:

That it's the accountability factor. So go check us out, go to katsconsultants.com, jump on our schedule. Happy to do a conversation with you. We do those for free. People ask me all the time. Why do you guys do that? Because we love this profession and we believe everybody has a shot at running a very profitable practice because chiropractic is being sought out by people. In today's world. All right. On behalf of all of us here at Kats consultants, thank you for tuning in. Make sure you subscribe. Tell everybody about the podcast. We're growing because of you. So we'll see you next time. Have a good one.