Mini-Retirement Plan

Anthony Lombardi
January 31, 2013
Written by
“An American businessman was standing at the pier of a small coastal Mexican village when a small boat with just one fisherman docked. Inside the small boat were several large yellowfin tuna. The American complimented the Mexican on the quality of his fish.
“How long did it take you to catch them?” the American asked.
“Only a little while,” the Mexican replied.
“Why don’t you stay out longer and catch more fish?” the American then asked.
“I have enough to support my family’s immediate needs,” the Mexican said.
“But,” the American then asked, “what do you do with the rest of your time?”
The Mexican fisherman said, “I sleep late, fish a little, play with my children, take a siesta with my wife, Maria, stroll into the village each evening where I sip wine and play guitar with my amigos. I have a full and busy life, senor.”
The American scoffed, “I am a Harvard MBA and could help you. You should spend more time fishing and with the proceeds you could buy a bigger boat, and with the proceeds from the bigger boat you could buy several boats, eventually you would have a fleet of fishing boats.
“Instead of selling your catch to a middleman you would sell directly to the consumers, eventually opening your own canning factory. You would control the product, processing and distribution. You would need to leave this small coastal fishing village and move to Mexico City, then LA and eventually NYC where you will run your expanding enterprise.”
The Mexican fisherman asked, “But senor, how long will this all take?”
To which the American replied, “15-20 years.”
“But what then, senor?”
The American laughed and said, “That’s the best part. When the time is right you would announce an IPO (Initial Public Offering) and sell your company stock to the public and become very rich – you would make millions.”
“Millions, senor? Then what?”
The American said slowly, “Then you would retire. Move to a small coastal fishing village where you would sleep late, fish a little, play with your kids, take a siesta with your wife, stroll to the village in the evenings where you could sip wine and play your guitar with your amigos…”    
(adaptation from The 4-Hour Workweek by Timothy Ferris)

Money is not your primary reason for being successful. That will come in time. The patient is always the first reason for you to become a success. And, if you get patients better, they will come back, they will refer more, and your reputation will precede you. 

However, many feel that in order to live the life they really want, they must sacrifice 30 years of their time, working 50 hours per week, to accumulate the means to do so. Therefore, the first step to “working less and achieving more” is changing your mindset. First, we must change the conventional thinking, which is: “the more time I put in, the more successful I will be.” As chiropractors, we must realize that we are also, for the most part, business owners. As such, we must come to the realization that retirement, or at least “mini-retirement,” is a concept that is closer than we think. Second, we must create efficient systems in our practice that our fellow co-workers will embrace so that the operational business side of our practice is able to run without our constant presence. For example, in 2010, I worked 288 days in my practice. In 2011, after creating and implementing my systems I worked 183 days and was just as productive as the year before. 

CREATING EFFICIENT SYSTEMS
Remember that systems are designed to make things easier and more efficient, first, for the business and second, for you, the doctor.

The first step in creating an efficient system is to keep in mind your target audience. This will always be the patient. Your systems should ultimately make patient visits turn into experiences. When things happen easily and run smoothly, it creates a positive experience for the patient and indirectly helps your business.

START WITH THE BASICS
A business has four core elements: booking, billing, collecting, and a team concept. You need these four areas to run like clockwork in order to have a viable business.

Booking Patients
Making things easy for your patients is essential. Everyone likes options, so, one thing you can do to make things easier for your patients is to give them options when it comes to booking their appointments. These days, there are five ways a patient can request an appointment: online; by e-mail; via text message; through social media; or in the conventional way by telephone. When you give the patient these various options, it takes some of the pressure for bookings off your front-end staff and gives your patients a way to book appointments that works for them.

When it comes to rebooking patients, it is vital that there is smooth communication between you and your front desk staff. In order to keep the flow moving smoothly, you shouldn’t need to disrupt the process of going from one patient to the next by having to stop at the front desk. Routing slips or electronic messages make this exchange between you and your staff quick and easy.  A routing slip is a piece of paper inserted into the file at the end of each visit informing the front desk what treatment was done, the amount the patient owes, and when the doctor needs to see the patient again. Slipping one into the patient’s file will allow you to communicate with your staff without disrupting your own flow. Similarly, if you use a paperless filing system, sending an electronic message works in place of a routing slip. An iPad, BlackBerry or similar electronic device makes things even easier.

Billing Insurance Companies and Paying Your Bills
This area includes billing insurance companies for services rendered and also paying your bills and covering payroll. Bills are going out and bills are coming in. Managing this system is crucial.

For billing insurance companies, create a billing cycle that bills insurance companies daily. Ideally, two people need to be trained on this process because having a backup person is key. The sooner you bill, the sooner you get reimbursed.

For paying your bills and payroll, maximize what your bank and your bookkeeper have to offer you. Arrange, with your bank, to pay all of your bills online automatically every month. This includes credit card balances, utilities, and your salary. Your bookkeeper can arrange through your bank to pay your employees through direct deposit.

Collecting
I would like to revisit the idea that, although as chiropractors, our main focus is to take care of our patients, we are also business owners who want our businesses to succeed. Successful businesses should model themselves around grocery stores. You have to pay for your groceries before you leave the store. Providing services without payment is like taking milk from the shelf and walking out without paying. It wouldn’t be tolerated in a supermarket – and shouldn’t be allowed in your practice.

Creating a Team Environment
The greatest asset to support you in working less and being more productive is utilization of your co-workers so that whether you are present or absent, they look forward to doing their work while promoting your brand. For your staff to become passionate and interested in their work, three ingredients are essential. These are: autonomy, effort and reward. (See sidebar on page 9.)

PROMOTION IN YOUR CLINIC
Although I didn’t mention it earlier, some form of promotion must be occurring in your clinic in order to build and sustain it as a successful business. There are several ways you can promote your practice and how you do this will depend largely on the demographics of your patients, or target patients, as well as on your personal preferences as a chiropractor and the clinic owner. The sidebar below outlines some easy strategies for promotion available to you – you can use some or all of these.

WORKING FEWER HOURS IS BETTER FOR BUSINESS?
Believe it or not, the answer to this is a resounding yes! There are two reasons for this.

Working less gives you more time to focus on you and your practice. For example, working four days instead of five allows you to keep your mind and technique fresh. It can allow you to see patient problems more clearly and treat them better than if you are overworked and demotivated.

Secondly, when you work less, your time is in greater demand. Therefore you have the ability to make your fees more competitive.
* * *
Remember, you are the expert in chiropractic. This means you should not expect to also be an accountant, a bookkeeper, a magician and a fabulous writer. Know what you are good at, where your limits are, and when you need to step away.

Surround yourself with people who are experts in their own areas. This will naturally make you and your practice look good, while allowing you to be more productive.

The most exciting part of building a practice is using the resources around you to make your life more enjoyable. Many people view work as a job and use future vacations and time off as motivators to get them through the day. Simply by creating systems in our practice, we will be able to create the life we’ve always dreamed of – and maybe even retire, move to a small town where we can sleep late, fish a little, play with our kids, take a nap with our wives, go for long walks in the evenings, sip wine, and play guitar with your friends . . .

Three Easy Promotion Strategies
Social media
Have your patients promote for you. Social media outlets such as Twitter and Facebook allow patients to become part of your culture. Patients discussing your care will promote your practice to others while increasing the amount of online material relating to your practice – this raises your search engine optimization and makes it easier for prospective patients to find you online.

In-clinic promotion
Every one of your patients waits in your waiting room.

Use this time to make your patients more aware of what you and your clinic have to offer. Your reception and treatment rooms offer walls of space where you can post signage and screen educational videos. Employing these strategies should see you increase your clinic’s sales of goods and services.

Patient referrals
Use every visit as an opportunity to grow and expand your brand. You are building a relationship with the patient, so make it a habit to thank your patient in advance for their kind referrals, even if they haven’t yet referred anyone.

Three Ingredients for a Passionate Staff
  1. Autonomy: A self-directing freedom
    When you, as an employer, allow your co-workers autonomy, it speaks volumes about your faith in their ability – this promotes confidence and pride within those individuals. No one wants to be micro-managed by their employer, and in order to follow the “work less, make more” mantra, you yourself do not want to be a micro-manager. Have faith in your staff and fellow health professionals – they may make the occasional error but they will learn from it and become better for it.
  2. Effort: A conscious exertion of their power
    Allow your staff to become involved in work that is important to the clinic’s function and success. Train staff to bill insurance companies, collect funds from patients and process paperwork so you do not have to do it yourself. Educate your associate chiropractors to clinically assess using the system you use and help them to improve their treatment skills. Allowing your staff to become stimulated by meaningful work makes their job more gratifying to them, and they will, in turn, actually feel more important within your organization.
  3. Reward: A satisfying return, or result
    Rewarding good work is the final ingredient that creates a positive feedback loop of business operational success. Paying your staff well is only the first small step towards recognizing them for their work. You must create incentives and benefits within their position, in order to make yours a unique and valuable place of employment.
For example, I provide my associate chiropractors and therapists with annual education stipends. My clinic provides them with $500-$1,000 per year to spend on furthering their education and manual skills. To my support staff, I offer a set number of paid sick days per year. However, there is incentive to stay healthy and go to work because at the end of the year, they are paid for the number of sick days they did not use.

And lastly, do not let the accomplishments of your staff go unnoticed by their co-workers. Praise and recognize the good work of others at staff meetings or through company e-mail.


Dr. Anthony Lombardi is a private consultant to athletes in the NFL, CFL and NHL, and founder of Hamilton Back Clinic, a multidisciplinary clinic. He teaches his fundamental EXSTORE Assessment System and practice building workshops to various health professionals. For more information, visit www.exstore.ca .

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