The big leagues
By Dawn Armstrong
Keys to building a successful multidiscipline practice
By Dawn Armstrong
For the people of the City of Nanaimo, the spirit of Christmas is a really big deal.
Each year, all of the community-minded businesses take part in a friendly competition for the coveted ‘Best Decorated’ award.
Right about now Dr. Stacey Scott is settling in to an annual ritual of her own. She is imagining, sketching and planning out the large-as-life designs for another one of her original Christmas decorations.
Soon, she will enlist the help of a trusted adviser (who knows everything there is to know about fancy carpentry and table saws) who’ll see to building it according to the plans – shaping and assembling the pieces.
Then, Scott will apply the finishing touches – a stunning paint job with fine details and intense colours that bring her characters to life. Two years ago it was Santa and Rudolph. Picture Santa Claus, lying prone on a chiropractic table outside his little northern house (10’ x 12’, complete with wooden shingles) with Rudolph the Reindeer standing over him, doing an adjustment. Rudolph looks as though he really cares and Santa, in his red and white striped boxer shorts, is obviously appreciating the attention.
In November, with the support of staff and a handful of loyal patients, she will spend two full days installing Santa and Rudolph and the entirety of her growing collection – the princesses and the elves, the minions and the superheroes will all be dressed in strands of twinkling lights. The clinic entranceway and the second storey balconies will become a showcase of beauty and joy that all can appreciate.
Every year, Dr. Scott presents this generous gift of goodwill to the people of her community, shining a light on her contributions to the wellbeing of the citizens of Nanaimo.
How much is your practice a part of your community? How much does your health-care business give back to your city or town? How visible are you?
For more than a century we have struggled to establish and defend our place as primary providers of safe, effective health care. However, we’ve mostly done it from the margins, the fringe; and we’ve done it all by ourselves.
Health-care facilities such as hospitals and nursing homes are an essential part of every community but almost none of us are salaried employees of a public institution. We are compelled to be players in the world of private health care and many of us are fiercely independent. More than a third of DCs are solo practitioners (Canadian Chiropractor, July/August 2016, “Survey Says”).
Most of us will build our practices from the ground up, just the way past generations of DCs did. In the world of the ‘old-fashioned’ chiropractor – and there are many of us who continue to practice this way – the first rule is to keep the overhead as low as you possibly can. You rent a second floor walkup or convert the lower level of your home or, like Dr. Kay MacDonald, a pioneer chiropractor who moved to the Yukon after WWII, you could (temporarily) run your practice out of a 5th wheel parked at the campground just outside of town.
Your spouse works the front desk, you do your own books and your cousin does the cleaning. You’re available pretty much seven days a week. It can take a long time to build a practice this way – sometimes a decade or more.
What if, after spending years building a loyal patient base, you have to move to a new community on the other side of the country?
Or, what if you’ve decided it’s time to change things up? Maybe you are a little lonely – it would be great to have some other professionals around to bounce ideas off of. Perhaps you are thinking about getting into a better place than you’re used to – something a little more upscale, more visible, more parking spots. It sounds suspiciously more expensive, but if you bring in some other health-care practitioners, you could afford it.
And then another thought pops into your head. “Go big or go home!” You could make it a multidisciplinary clinic, a wellness centre. What a great idea!
It is a great idea, but you should first ask yourself a very important question: “Am I a builder or am I a joiner?” Be honest, because not every hard-working, independent chiropractor is a builder. In fact, I now understand that the builders are a rare and special few.
Putting together a multidisciplinary/wellness centre could be the best decision you ever make – or not. If you fail to examine and discern your motives behind wanting to start something big, if you are not perfectly frank with yourself about who you are and what you really need in life, living by the ‘go big or go home’ mantra will not protect you from the very harsh realities of failure.
Do you want to enlist the help of other health-care professionals to help you build something of value in your community, to bring doctors of chiropractic from the margins into the mainstream? Or do you simply need them to help cover the costs of the rent and heat and lights? In other words, do your plans for a clinic qualify as an act of creation or an act borne out of necessity?
There are some important points to consider when thinking about building a multidisciplinary clinic. You’ve found the perfect location with all the right features, but remember that while the physical attributes of your practice matter, the people factor matters even more.
- Who will you team up with? Why them?
- How will you attract these people to your clinic?
- How do you plan to keep them there?
- What do you hope to accomplish with these other practitioners?
- Will you collaborate with them and integrate your services? On a practical level, what might that look like?
These questions all need to be answered before you sign that long-term lease you could never afford on your own.
You might be considering including MDs. If you are, be clear and upfront about your expectations.
- Do they need you?
- Do you need them?
- Are you anticipating that these doctors will be a source of new chiropractic patients?
- Will you share an electronic health records system?
- Even more importantly, do you expect them to pay you a lot of rent or any rent at all?
Perhaps you have already met the ‘perfect’ doctors to associate with, but it can only work out in the long run if everyone wins – and by “everyone”, I mean including your patients. Don’t hesitate to explore ways of working together with medical professionals – they just need to be the right people.
This applies equally to the allied and alternative health-care providers you choose to bring in to your wellness space. The first and most important question to ask is, will your patients benefit from their services? Make sure that you understand what these practitioners actually do.
Woodgrove Pines Wellness Clinic in Nanaimo, B.C., is a truly multidisciplinary institution, housed in a facility that can only be described as awesome and founded by Dr. Stacey Scott, one of our most hard-working, forward thinking and irrepressibly independent colleagues.
She began practicing in Nanaimo in 1994. Many years later, the Woodgrove Pines Clinic opened its doors. From where it is, to how it looks, and what it does, no detail is accidental. It is located on Metral Drive, close to two major roads. It is tucked away in a quiet neighbourhood, beautifully landscaped and right on a bus route. Nestled into the scenery to a greater degree than you might imagine an 18,000-square-foot edifice could be, the views from the top level luxury condos are spectacular.
The main, street-level entrance to the clinic is spacious and serene. There are two reception areas and eye-catching retail displays, along with an abundance of educational material. There are about 20 practitioners of various stripes and approximately 20 treatment rooms. It was difficult to keep track of the actual number of practice spaces – the way Dr. Scott so purposefully designed the layout with different professions in mind.
The physiotherapy department is one larger space, subdivided by curtains. The naturopathic doctors have the use of a small “surgical” suite for doing IV infusions. The chiropractic offices each come equipped with a high-end adjusting table; there are laser units, decompression and shock wave treatments for the difficult cases. The RMTs and acupuncturists have laundry facilities. I could go on, but we haven’t yet got to the lower floor, which is accessed from the parking lot at the back of the building. There is a 24-hour gym, a large studio for yoga/dance, showers and a rehab centre with a kinesiologist and some very cool, high-tech XBody suits for muscle stimulation during exercise.
There are 11 support staff (nine full-time), with three of them dedicated to billings and administration.
Scott descends from builders – her family has been in the construction industry for a long time. This may be why she comfortably takes on tasks like patching a ding in the drywall or fixing a broken adjusting table or clearing the snow from the walkways.
She never stops learning and expanding her horizons – from specializing in sports chiropractic to now focusing on concussion care. She provides bursaries for young athletes and does baseline screening in the community, firmly establishing her reputation as an expert.
While she has always made a point of understanding every aspect of running a clinic, she knows when to call in professional help. A specialist to manage the clinic’s digital and social media presence, a lawyer to draw up detailed contracts and a gardener to spruce up the property are all integral components of her team.
She started small (1,500 sq. ft.) but dreamt large. She tested the waters with a part-time acupuncturist and never looked back.
“It requires a lot of hard work and commitment with many sleepless nights,” Scott says. “However, in the end, when you are fortunate enough to attract a remarkable group of like-minded, dedicated and caring practitioners as well as loyal, hardworking, conscientious support staff, the results can be amazing.”
It’s probably just a coincidence, but rumour has it that the Christmas decoration she is working on right now is Superwoman. The people of Nanaimo may as well give her that award – again.
Dr. Dawn Armstrong is a graduate of CMCC and has been in practice for nearly 30 years. She is currently focused on promoting life-long learning and professional development and has created a continuing education course – Clinical Record Keeping: A Hands-On Approach. Learn more at www.auroraeducationservices.ca.