Chiropractic Marketing | Chiropractic Advertising | Chiropractic Ads

In the last post (Chiropractic Marketing Is A Changing) I began revealing the answers to a recent blog survey I conducted. I left the answer to the final question to be discussed in full today.

The question I asked my readers was:

5. What is the biggest challenge you see facing you as a chiropractor over the next year?

The answers I received were very surprising. Let me explain…

First, a bit of history. I asked a very similar question in a survey about a year and half ago. The most common answer at the time had to deal with getting new patients. This was no surprise, as that has always been the biggest struggle in running a chiropractic practice.

Chiropractors struggle with the problem of getting new patients for a couple of reasons.

Reason #1: The common misconception of chiropractic by the public.

Reason #2: Most chiropractors complete disregard for using effective marketing and measuring ROI.

Number 1 above we can do little about individually, other than keep making our practices successful so we can reach more people. But the second reason above is totally within your control.

Why do most chiropractors have a complete disregard for using effective marketing? There are various reasons I’ve heard from doctors over the years, ranging from the “marketing is not professional” to the “it just doesn’t work in my area”.

So it wasn’t a big surprise to me that this was the most common answer with my survey last week. 36% of people mentioned new patients or marketing as their biggest problem. It’s definitely still a problem chiropractors face, and will be until we all become better educated on real chiropractic marketing.

What was a surprise was the second place answer, coming in at 35% of respondents mentioning it in their write-in answers. This new category of answers had to deal with health care reform (Obamacare) and the issue of cash practice or cash patients!

Now you may think this has been around for awhile, so it’s not big deal to see that answer. But think about it for a minute. Almost as many people are concerned about how the insurance industry changes will affect their practice as are concerned about actually getting new patients. This is a big change in our profession.

Especially when you consider only 4-5% of people mentioned anything about insurance or cash patients 1.5 yrs ago in my survey.

Also, what I’m noticing is that chiropractors are looking at the cash practice as a better, less stressful business model because of these new health care laws. This is much different from 5-10 years ago, when most chiropractors were switching to cash practices for more philosophical reasons.

I’m curious as to what you think about all this?

Leave a comment below telling us what type of practice you have now (cash or insurance), and if you plan to change it in the future (and if so, why.) If you didn’t participate in the survey last week and you leave a comment below discussing this, I’ll send you the link to the bonus marketing audios I gave away. (I can see your email address when you leave a comment, so you don’t need to put it in the comment itself.)

As Bob Dylan once sang, ‘times they are are a changing’, and this is especially true in the profession of chiropractic.

Most of you can feel it, knowing that there is a wind of change blowing through our industry. Currently it may feel like a small breeze. But soon I fear it will be a strong, gale force wind.

But while some things are changing, still others remain the same. Which is good if it’s a rock solid marketing method, as I’ll soon show you below with the results of my recent survey.

Why are things changing? Two big reasons.

#1. A recent recession and still weak economy. This has caused some chiropractors to withdraw all marketing ( very dumb move if your marketing was previously working). Others had thought their low return-on-investment marketing would get them through the recession, but it didn’t. And still others sought after the magic pill that would save their practice, expecting a new marketing product would undo years of bad business management.

#2. Health care reform. (Also called Obamacare by some.) This is the biggest reason for change occurring in chiropractic. While there are still a lot of questions over this recent congressional bill, many chiropractors get the sense this bill is bad news for their practice. The ACA and ICA both seem to be convinced this is an “historic pro-chiropractic” bill, mostly because it will not allow insurers to discriminate against us. Of course some chiropractors have said to me they’d gladly take a little discrimination as opposed to an across-the-board-medicare-like system that has low payouts and excludes payment for exams, x-rays, therapies, etc.

Other chiropractors have taken a “wait-and-see” approach to this bill. After all, we have 4 years to figure things out, right? Well, if you are anything like me, being reactive is not something I like. Being proactive in growing my businesses has always been extremely successful, whereas being reactive to problems others throw at me ends in mediocrity at best.

Last week, I ran a quick survey to my list of blog readers. I limited the survey to 100 respondents and offered a package of marketing audios to those who answered every question of the survey. (Links to the audios will go out Wednesday to those who completed the survey. Thank you!)

Let’s look at some results of the survey. The first question I asked was:

Question 1. What area of marketing do you want the most help with right now

Now I expected a wide range of answers, which I certainly got. But I did not expect the answers to be strongly skewed toward what’s referred to today as “offline advertising”. Over 67% of the responders chose an answer in the offline group of marketing which contained newspaper advertising, internal referrals, MD referrals, attorney referrals and public lectures. Very few wanted help with their websites, pay per click, blogs, Facebook & Twitter. Is this because D.C.’s don’t fully understand these online methods yet? Or is it that the offline methods are continuing to outperform newer, online marketing strategies? (What do you think? Please leave a comment below.)

Question 2. What area do you currently spend most of your marketing budget on?

Big surprise here! A whopping 38% of respondents chose newspaper advertising compared to the second most popular answer (websites) being only 17%. This result was very telling of our profession for 2 reasons. First, there are many ‘salesmen’ shouting that newspaper ads are dead. If this was the case, why are so many chiropractors in June, 2010 still spending a large amount on them? And secondly, most businesses don’t continue to spend money where there is no return. Therefore, newspaper ads must be bringing in a decent ROI at least, compared to other advertising.

You may think this answer is not surprising, because after all I developed the Ultimate Chiropractic Ads, so of course the answers would be biased. But the interesting thing is, most of the people filling out the survey have never bought my newspaper ads.

So here is an example of one thing that hasn’t changed much, which is good because its working and continues to work well. Marketing that works well doesn’t need to change.

Question 3. Which form of marketing/advertising is currently most effective for you?

Here I gave the same choices as I had given in the previous 2 questions. No surprise here that the answer “internal referrals” won by a large margin. Everyone knows referrals are the easiest to convert to care and cost almost nothing to bring in. Taking 2nd place was public lectures and 3rd was newspaper advertising (which confirms the assumption I made about ROI above.)

Question 4. Which of these products, if any, would most interest you?

The answers to choose from were  weight loss, associate hiring /training, massage therapy and write in your own. This question brought a pretty broad range of answers. Write-in answers varied with 16 different answers typed in. Weight loss won, (but just barely) and all the other answers pretty much tied for 2nd place.

5. What is the biggest challenge you see facing you as a chiropractor over the next year?

This was a completely open ended question, with the ability to type in what you wanted here. This is where I saw the biggest change in our profession. Huge actually! But you’ll have to wait until Friday because I’m going to do a whole blog post just on this topic. I know, it’s annoying to wait, but sometimes it’s well worth the wait, right?

See ya Friday.

Are you happy with your income so far this year?

The June 3, 2010 issue of Chiropractic Economics magazine is entitled “DCs: Are You Back in Black?” The feature article in this issue is a their “13th Annual Salary & Expense Survey”.

This survey was taken from a good number of practicing chiropractors spread evenly throughout the U.S. Here are some major points that I got out of the 3-year comparison chart on pg. 33.

1. Franchises are declining. According to the percent of franchises in our profession from 2008 to 2010, the number is dropping significantly. The chart shows 3.9% of chiropractors surveyed in 2008 had a franchise, 1.4% in 2009, and only 1% in 2010.

Why are franchises declining? I’m uncertain. I have heard a few past franchisees say they didn’t get what they expected out of the deal. Perhaps the marketing didn’t live up to the franchisees expectations.

2. Associates are up, almost double from what they were in 2008 and 2009. 9.4% of those surveyed had an associate. This could be due to the recent recession, as more graduates are looking for a job, since they are unable to get a loan to start their own practice. Yet, this number is also telling of the owners who hire the associates. Are practices growing in 2010 to the point where they can hire more associates so quickly?

3. Salaries and DC compensations are still low. While definitely up from last year’s depressing numbers, the 2010 average salary of $87,538 has not returned to the level observed in 2008. The lower salary could be explained by the increase in associate doctors, but the overall DC total compensation is still low as well at $112,368.

4. The average chiropractor’s advertising expense is embarrassing. A general rule in business, one I heard even in chiropractic school, was that you should spend at least 10% of your monthly gross collections on marketing. I realize this will not always be the case. Some times you spend more, like when you open a new practice for example. Other times you spend a bit less.

According to the study, the average gross collections for chiropractors in 2010 will be $323,421. Yet the average spent on marketing is projected to be only $10,660. This isn’t anywhere close to 10%! The amount spent on marketing by the average chiropractor is only 3% of their collections. This is actually down from last year’s average of 4.6% spent on marketing and 2008′s 3.7% spent on marketing. This means chiropractors on average are cutting back this year on their marketing spend. It doesn’t make any sense to cut back now, as the economy is showing signs of recovery and many business are hitting a growth spurt right now.

What lessons can you learn from this?

If you don’t want to have just an average practice, increase your marketing spend immediately. What better time for your marketing to stand out than now, when everyone else is still cutting back.

Of course, you shouldn’t waste your money on useless marketing that doesn’t work. It’s best to use direct response marketing to bring in new patients every week of the year.

If you’re spend increases on productive marketing, your practice can only grow. And then you’ll be far ahead the “averages” mentioned above.

Here’s a list of tools & products I recommend for helping you get more new patients in over the summer. Some are mine and others are excellent products from friends of mine who’ve proven themselves in the field of chiropractic marketing.

Use these tools now to bring in more new patients. Don’t waste the whole summer, thinking “everyone is on vacation, no one will come in.” Cut the excuses and grow your practice to the level you always wanted it to be!

The Ultimate Chiropractic Ads

Decompression Marketing Elite

Internet Marketing for Chiropractors

Chiropractic Marketing Academy

PI Marketing

Internal Referral Marketing System

Neuropathy Doctor Marketing

There are 5 lies every chiropractor has been tempted to tell himself at one point or another. Some of us have only fallen prey to 1 or 2 of these lies. Others of us have succumbed to all 5 and felt the devastating effects on our practices.

Where do these lies come from?

Many of them come from chiropractic consultants, especially numbers 1 through 4. The 5th lie is one we usually come up with on our own during desperate times.

Which of these chiropractic marketing lies have you believed? Do you agree with these or disagree, post your comments below.

1. I’ll just cut back on my marketing expenses for awhile, since I’ve got so many referrals coming in.

This one gets a lot of chiropractors. Usually the doctor is looking for ways to cut costs or maybe is just tired of having to “market my practice.” It’s not that marketing has been a failure, as much as it takes a bit of work to measure return on investment (ROI) and keep track of what’s working. Plus, there’s the added task of trying something new occasionally. Why not just take a few months off and let the referrals keep coming in?

Of course the problem is that many of these referrals come from the “marketed to” new patients. For example, a new patient comes in from a chiropractic newspaper ad and after starting care refers their husband in to you. The husband refers a coworker. The coworker refers their spouse in. By this time, you may have forgotten where this process started. Don’t cut the referral generator off at the source.

2. Marketing isn’t professional.

Thankfully this lie isn’t believed near as much these days. During the Mercedes 80s, chiropractors could get new patients simply by putting a sign on the door and getting on the best insurance plans. Who needed marketing?

Chiropractic schools sometimes give off the aura that marketing is not professional. How many marketing classes did you get in school?

Times have changed. Insurance doesn’t pay what it used to, nor are you going to get flooded with new patients by joining the local networks. And everyone has to agree that chiropractic school does not prepare you 100% for the business of chiropractic. What profession doesn’t market themselves? Hospitals have billboards, newspaper ads, and more. Dentist advertise in the phone book, newspaper, TV, radio, etc. Attorneys, medical doctors, surgeons, orthodontists — if they are successful and growing, they advertise.

3. I want MD referrals, and MDs won’t refer to me if I advertise because it’s unprofessional.

I first heard this one from a prominent consulting group. They wanted me to pay them $40k to show me how to get more referrals from MDs. And of course I’d need to tone down my other marketing, since it wasn’t professional like MD marketing. Plus this consultant would show me how to get so many MD referrals that I would never need to spend money on marketing. A pipe dream for sure.

Back on planet earth, every business has to market their services. Certainly there are sleazy, hyped up ads, but not all marketing is like this. Marketing and advertising does not have to be unprofessional. Many MD’s and D.O.’s will refer to you because of your marketing. I ran newspaper ads for years, and never met the big medical practice down the street, yet I got referrals from them for years. Why? Only thing I can figure is they read my ads in the paper on the different conditions we help.

4. If a marketing strategy or tool is good, it will bring me 100′s of new patients per month.

We’ve all heard of the proverbial marketing “magic pill.” Problem is that it’s a fairy tale. Everyone knows this. But desperate times call for desperate measures, and doctors expect the next thing they buy will produce 100′s of new patients. What if you only get 10 new patients for $1000 spent?

Two different perspectives can occur here.

#1. One doctor says wow, one marketing tactic got me 10 new patients, that’s awesome!

#2. Another doctor says “man, I needed 20 new ones this month to remain profitable. This only brought in 10. Guess that strategy didn’t work well at all. Time to trash it and try another one.”

Some of you may be thinking #2 is a made-up doctor, no one with this thinking really exists. But trust me, I see it every week. See the blog post “Chiropractic Math and the Struggling Practice” for an in-depth example.

Now we mustn’t over do this and say all marketing is equal because there isn’t a magic pill. There is certainly a dividing line between effective marketing strategies and crappy, waste-of-money marketing strategies. There are tools which will bring you 20 new patients a month, but even then you should not focus 100% of your money and time on that one stratagy. One month you may only get 5 new patients instead of the normal 20, so make sure you have multiple streams of quality new patients coming in.

5. If money gets tight this month, I’ll cut the most expensive advertising out.

What’s wrong with this one?  After all, when things get tight you’ve got to cut something out, right?

That’s true. But it doesn’t follow that you base what your going to cut out simply on how much things cost. If it did, then you should cut out your rent first. And your payroll. Plus your salary.

You should determine what you’re going to cut out based on what’s effective. If an ad has been working in the newspaper, why would you stop running it because it’s the most expensive marketing cost you have? Better to cut out all the little things that don’t work, like maybe yellow page ads or poorly done static websites.

The cost of advertising tells you nothing about how many patients it brings in. For that you need to figure ROI and compare your returns across multiple marketing strategies.

Make sure not to cut the advertising that is actually keeping you alive. Cutting off the hand that feeds you will only result in a downward spiral that makes it very difficult to come out of.

Math has never been my favorite subject. It wasn’t in elementary, middle school, high school, or college. Especially those nasty algebra and calculus type classes.

But as a business owner, I quickly learned that it didn’t matter how much I liked math and numbers, they are a fact of life.

You’ve got to be able to figure your stats. Determine your prices. Set up a care plan with x number of visits per week, month, etc. You need to keep good business statistics and know what those stats tell you.

For example, early on in practice, I thought my care plans were great. Patients were prepaying for care and my volume was high. What could be better?

The problem was that no money was coming in. So, I sat down and figured my average collection per visit. It came to about $17. No wonder the business was broke. But, without knowing the simple formula of collections divided by visits, I would not have been able to out this huge blunder in my practice.

You might be thinking this is simple stuff, anyone can figure it out. Yet, you would be surprised at the chiropractors I speak with who either don’t know how to figure simple stats or if they know how, simply don’t keep any numbers for their practice.

Here’s the biggest “chiropractic math” problem I see…

Chiropractors don’t figure ROI (Return on Investment)!

Let’s do a basic math problem. Say I get 12 new patients in the door from a newspaper ad which cost me $1000. And let’s assume I’m new in practice, and my conversions are low, so I only convert 4 of those patients to a care plan. If my care plans are worth $1500 (which is a very conservative case value) what was my ROI?

It’s ok to use a calculator on this test. (I had to )

The answer is 6:1, or a 600% ROI. So for every dollar invested, I made $6 back.

Do you run the ad again or not? How low is the ROI going to be before you say this ad doesn’t work?

You bet I’m going to run that ad again! For me it’s got to bring in at least 2:1 ROI over time. Meaning, after all the money comes in from the patients care plans, the minimum ROI it can bring is 2:1. Occasionally a newspaper ad will be a 1:1 or negative ROI, and I’ll tweak something or run it in a better paper and it immediately becomes a huge winner!

But, some chiropractors think an ad is a failure if it doesn’t bring in a 20:1 ROI or higher. In other words, they are upset if their ROI is only 5:1. What other business owner would be upset that the $1 they spent brought back $5?   No one.

Unfortunately, it happens daily in chiropractic. Look, the days of spending $0 on marketing and bringing in $30…$40…$50k a month are over. The days of running a killer ad and getting 676 new patients is over. It’s not 1991 anymore.

It’s time to face the fact you’ve got to pay for some marketing. And you’ve got to be happy with a positive return on investment.  Now the only question which remains is which marketing gives the best return?

What billion dollar business gets better than a 5:1 ROI on their external marketing dollars? What small business get’s better than this?

Are all your eggs in one basket?

Man how I wish they had a class on ROI in chiropractic school. As simple as it sounds, a doctor in an emotional situation or someone who says “I’m just not good at the business side of chiropractic” does not run these numbers.

I was there. I came out of school and thought 1 magic marketing pill, one magic ad would solve all my problems. I’d run one ad, get 100 new patients, and within a short time I’d have a 100% referral practice.

Then I woke up one day and realized if there was a 1 magic ad that brought in 100 new patients, everyone would soon be using it, and it wouldn’t bring in 100 new patients anymore.

I realized I would have to use multiple marketing strategies to grow my practice. But which ones? And how should I proportion my marketing budget out?

Then it came to me. Measure the ROI, return on investment, of each strategy. Put more money into the ones with the highest ROI. If it shows a 6 or 12 month decline, readjust the money into other high ROI marketing. Simple really.

The best thing about this strategy, was that I wasn’t relying on just 1 thing to grow. If the newspaper ad didn’t bring in a 100:1 ROI for me, no sweat. I’ll take a 5:1 ROI because I’ve got 7 other streams of new patient generation methods.

In other words, I didn’t put all the success on my practice on one thing. Even if that one thing works, I’ll need other streams of new patients so I can pay the bills, right?

Are you measuring your ROI? Are you putting the full load of your practice success on 1 ad or marketing strategy, or are you spreading your marketing out evenly over many different ads and other strategies?

My last post on the new health care reform (entitled “Congress Has Done It, Now What?“), caused quite a few comments. Mostly the feedback was good. One lady called me a right wing nut and we gladly accommodated her request to be removed from the email list. I guess in today’s politically correct world, stating the obvious (that our taxes will go up and it will be more work on our practices) makes you a right wing nut.

A few concerned doctors emailed me trying to persuade me to see the “bright side of things”.  They argued things were not so bad, after all the ACA or ICA (depending on which one you ask) was responsible for getting anti-discriminatory language in the bill. While I commend both organizations for fighting hard for chiropractic, I’m not so sure the gain of anti-discrimination language will justify the huge stack of problems the bill will cause.

Of course if your patients are mostly Muslim, Amish, American Indian or a Christian Scientist you will likely continue on as if nothing has changed.

As for everyone else, this type of government action brings up the age old chiropractic question, “cash or insurance?”

First off, I must state I do not agree with the mentality that has been perpetuated for years by many chiropractic coaches: “we must do cash because all insurance is evil” . There are good reasons not to take insurance, some of which are philosophical, but this type of rhetoric mentioned above is usually just a cop-out for those are are scared and don’t know how to bill insurance. Trust me, I know because this was me for the first 2 years in practice!

So with that said, let’s look at a the biggest reasons some doctors abandon insurance for an all-cash practice.

What the Proponents of an All-Cash Practice Say:

1. Insurance is too restrictive of the services you provide.

Many chiros do away with insurance hassles because of the burden it puts on their practice. They do not like to be told what they can and can not do with their patients. If most of their insurance patients are carrying these types of restrictive plans, they will choose to convert to an all-cash practice. Do you think Obamacare will make insurance more restrictive or less for chiropractic? (Leave your comments below.)

One medical doctor sent a letter to her patients stating she will not comply to the new laws Obama has enacted.

Of course the doctor who takes insurance will rebut this argument when applied broadly to the whole United States. His reply would be that “just because there are some bad insurance pockets, or even whole states, does not justify saying all insurance is bad and only pays for 12 visits anyway, so we might as well go all-cash.”

2. Insurance is too much work.

Other doctors choose not to bill insurance because they say it is too much work. They have to submit reams and reams of paperwork just to make $30 on a visit. Exams and x-rays require even more notes and paperwork. They’ll have to hire another staff person just to figure out all the billing codes and how to do chiropractic insurance appeals.

What does the non-cash chiropractor say to this? He would likely reply that “while some insurance plans and contracts require an insane amount of work, this does not mean that all insurance plans do. I simply do not participate in the ones that are bad.” He would also argue that whether cash or insurance, we all must have documentation. He would likely also add that many cash practices give the patient a superbill, which is essentially doing everything an insurance practice would do, except fight denials.

3. They do not pay special services.

A few doctors choose not to bill insurance because their practice is very specialized and insurance in their area does not pay chiropractors for these services. These include spinal decompression, weight loss, nutrition, cold laser, deep tissue laser, etc.

On the other side, many chiropractors will still implement these uncovered services, but also continue to offer chiropractic adjustments and therapy. So they will bill insurance for those services that are covered and do cash for those services not covered like decompression treatments, etc.

So which side of the fence do I stand on?

Neither. At the current time (and this may change in the future), I do not paint with a broad brush when it comes to this subject. Some states and areas are great with insurance, with plans giving 80-100 visits per year. I’ve even seen a few that allow unlimited visits to chiropractors per year. Other areas are so bad you’d have to be crazy to bill insurance there.

In my Decompression Marketing Elite program, there is one client grossing a million per year as an all cash practice. Another client has a mostly insurance practice and is doing nearly the same amount. Other clients have more of a 50/50 mixture, doing cash for decompression plans and insurance for other services.

You see, whether you choose cash or insurance, you should choose wisely. And once you make that choice, it all comes down to one thing — marketing. Insurance companies won’t bring you many new patients, if they bring any at all. Simply switching your practice to all cash won’t make people flock to you either.

I think too many people sit around thinking the grass is greener on the other side, when in reality they are not reaching their potential because of poor marketing choices.

What do you think about all this? Leave your comments below.

Whether the American people wanted it or not, the U.S. Congress has passed President Obama’s long awaited healthcare bill. But what does it mean for us chiropractors? How will it affect our lives?

Many of these questions will take time to answer, since the bill is massive and it’s doubtful the word “chiropractor” is mentioned too often. But for those who take insurance, your office will have to spend more time and money to figure out the changes you’ll need to make.

Let’s look at 2 certainties that will come of this…

#1. If you are successful in your business, you’re taxes will go up.
To pay for this new plan, the payroll taxes of “the rich” will be raised. Guess who the rich are? Any bum who wants to make more than $200k per year.

Does your dream of a successful practice entail you making more than $200k per year? It should. Most of us did not go to chiropractic school and go into mountains of debt to make $50k or $60k per year.

#2. You’re going to spend a lot more time and money trying to figure out these new laws.
Do you think it’s going to be easier or more difficult to bill insurance after this plan takes affect? Is Medicare currently more or less trouble than other insurance billings?

Your staff is going to have to go through training seminars to get updated. You may even need to hire more staff to keep everything compliant. SOAP notes will have to be top notch (after all we got big brother watching over everything now.) And guess who is going to pay for all these “upgrades” your practice will have to make? The government? Congress? No, you are!

So let’s summarize what we are going to get out of this “historic” bill. Higher taxes and more work. Oh joy, everyone loves those two things, right?

Lest you think I’m all doom and gloom, let me say there is hope. In other countries chiropractic has survived fine without health insurance coverage. Our Australian brothers have been doing it for years. So chiropractic will not end as we know it.

But many chiropractors will suffer. Mainly because they waited too long to counteract the negative effects of this legislation.

“So going to an “all cash” practice is the way to go, right?”

No, an all cash practice is not going to work for everyone. If you’ve been around awhile and have some established marketing strategies that are working, you could make the switch. But there’s a little secret to running a cash practice none of the gurus ever mention. A cash practice requires a lot more new patient flow than an insurance practice.  And since most chiropractors are terrible at marketing…well, they are just not in a place to risk it all. (Of course being terrible at marketing is not an excuse to stay that way. Learn how to do it right, or pay others to do it right for you.)

Plus insurance is still good in some states and not much of a hassle to work with. So if you’re practice heavily relies on insurance, wait and see what’s going to happen. But it’s likely things will get worse in the future as the government gets their hands on more and more private industries.

So how do you overcome the government takeover of health insurance?

First you’ve got to make more than you did previously (and get a really good CPA). To make more money in your practice, you’ll need to grow it by getting more new patients. And doing so now, not in 2014 when this plan fully kicks in. If you wait until then, you’ll be completely behind the curve ball. And the “chiropractic recession of 2014″ will be much worse than the one you’ve been through these past 3 years.

Second, you’ll need to trim the fat. That means getting rid of old marketing tactics, like blindly spending money on “brand” marketing. You don’t need to “get your name out there”. You need to get more new patients. Now. Next month. The month after that, and so on.

Also, you’ve got to get rid of equipment that’s taking up space and isn’t making you money. Get more patients on your spinal decompression table now (see Decompression Marketing Elite) and stop letting it collect dust. If you aren’t going to market it properly, sell it and use the space for something else. Throw out the passive therapies and get some active rehab going.

Plus you should add other non-healthcare based services. Get a cash-only weight loss program going. Add massage therapy. Build up your PI practice. (Look for our new PI marketing course in the next few weeks.) Sell supplements and do nutritional consulting.

“Is there anything good about Obamacare?”

What, you don’t think the added expenses, higher taxes, more stress, more paperwork, more government control, and having to hire more employees is a good thing?

Well, I guess you could look on the bright side. At least more people will have health insurance since we are all now forced by law to carry it. But that may be like getting excited that Medicare covers x-rays, except not for chiropractors. Or getting excited about more high deductible insurance patients, except most of them don’t have the money saved to cover the high deductible.

But I digress. Let’s focus on what you need to do now.

Your 2010 Game Plan

In summary, here’s what you need to do:

Get more new patients now. Through newspaper ads, the internet, referrals, TV, radio, MD referrals, attorney referrals. Get one stream up and running now. Then start another. Then another.

Cut the fat. Run your practice lean and mean. Use the equipment or loose it. Have your staff do the work or cut them. Add more cash services to your practice.

Go now. What are you waiting for? Choose one of the above and do it now.

No matter where you are at in life or your practice, there is hope. While we can’t sit on our haunches and “believe” success into our practice, we can be inspired by others, which should cause us to then take action.

This guy is making the best of what he has. Are you?

This week, I read Jim Collins’ new book How The Mighty Fall: And How Some Companies Never Give In. I knew this book would have application to chiropractic offices as soon as I read the back cover in Barnes and Noble.

“Whether you prevail or fail, endure or die, depends more on what you do to yourself than on what the world does to you.” – Jim Collins

How true this statement is. Not in a mystical, ‘think and it will happen’ kind of way. Not in a flippant statement some consultants throw at their clients for a ‘pump-me-up’.

But simply a statement of truth.

The success of your practice depends on you! Not the economy. Not the size of your town. Not where you practice. Not the government’s attempts at screwing up healthcare. Not Obama’s spending that you’ll never see a dime of.

Sure, these things make practice a bit more difficult. No one would say they don’t have an affect. But they are not the determining factor in your success.

You would be amazed at the doctors who’ve simply given up marketing their practice the last couple of years. And paid dearly for it. Some haven’t done any outside marketing in 10 or 20 years, but now find themselves forced to due to a declining practice.

Granted, most marketing out there sucks at bringing in new patients. Yet there are proven methods and strategies that work.

And the simple fact is that if you’re not marketing your services to the public, it’s just a matter of time before you’re practice will decline.

Back to the book. Collins has taken various failed companies and studied them to determine what caused their decline. Based on this he has uncovered 5 stages of decline.

Below I list the 5 stages and show how they apply to a chiropractic office. I’ve chosen to give our imaginary chiropractor a name, Dr. Decline, so as not to insinuate that all chiropractors are declining. But it’s very likely many of my readers will be in one of these 5 stages, whether they know it or not.

Hey, I admit I went through stages 1-4 in my early days of practice. Most of us do at some point. But hopefully reading this will help you to recognize it better next time.

Are you in one of this 5 stages?

1. Hubris Born of Success

Hubris is a word from ancient Greece that means overbearing pride or presumption. It’s the thing in Greek mythology that always brought down the hero. It’s what Proverbs 16:18 says well “Pride goes before destruction, And a haughty spirit before a fall. ”

This is what Dr. Decline says at some point, “Things are going great right now. I’ve done well. Money is coming in. Why should I even pay for that ad in the newspaper anymore? I can cut back and just rely on referrals. After all, my patients refer because I’m the best doctor in town, not because of some words they read in my newspaper ad or website.”

2. Undisciplined Pursuit of More

Collins thought his data would show declining companies had become complacent and lazy, watching the world go by. But his data showed quite the opposite. He found “overreaching much better explains how the once-invincible self-destruct”

Here our doctor says to himself, “Maybe I’ll buy that new decompression table or new rehab equipment. What’s a big fat lease payment when I’m doing this well. We better hire some new staff too, to get ready for big growth. Things have been busy lately, after all. And I’ll have money because I’ve cut back on my marketing expenses too.”

3. Denial of Risk or Peril

This is when the effects of stage 1 and 2 are starting to set in. Money is still coming in, but signs of danger are starting to appear. There aren’t a lot of new patients on the books next month. The bills are starting to pile up. But the leaders deny the risk.

But our good doctor says, “Ah, it’s probably just the economy or the summer slump or insurance companies. Things will be fine. After all, I’ve been in practice over 10 years, and I’m still here, right?”

4. Grasping for Salvation

The risks of stage 3 have now become a reality, throwing the company into a sharp decline. Collins says this is a pivotal time and brings up the critical question of “how does its leadership respond?”

Does Dr. Decline grasp for a savior in the form of a charismatic chiropractic coach, a “bold but untested strategy” or any other number of magic pill solutions? What he does here is pivotal because once in stage 5 below, there is no coming back.

5. Capitulation to Irrelevance or Death

“The longer a company remains in stage 4, repeatedly grasping for silver bullets, the more likely it will spiral downward”, says Collins. The leaders abandon all hope and either sell out or liquidate assets.

This is a sad state for chiropractors when this happens. Let’s hope Dr. Decline never gets here. But the truth is some chiros do.

So how do you prevent the 5 stages of decline listed above?

It’s hard to say for your particular case. But a couple of general guidelines are “don’t ever stop using marketing that works” and cut, cut, cut your expenses.

Oh, and kill that awful sin we all struggle with: pride!