Hi!  This is Carla Vincent.  I am a consultant and work with the SIP team.  Although I currently don't go "on the road" with NCMIC Starting into Practice, I do answer the business management Q&As posted to the site. 

I have managed a chiropractic practice, worked for a managed care chiropractic carve-out and helped transition a merger of 5 managed care companies.   

I currently work as Director of Operations for a national company that trains interdisciplinary providers in soft-tissue management.

In my spare time I also serve as Chair of my condominium association, enjoy going to the beach (summer and winter) and I forgot to tell you...I'm from BOSTON so that tells you "the rest of my story" as far as baseball goes.

Blogging is a "whole new world" for me and I look forward to posting ideas that can hopefully help you as you face entering practice.  So, what do you need to know?   

I'll never forget Friday August 13, 2004.  The media had  warned all week about the possibility of a hurricane. As Central Florida had not had one in 100 years, I was  skeptical, or as my wife says, "in denial."

All over town,  people began "boarding up" and making provisions. We kept our office fully staffed as patients canceled appointments, and the storm got closer. At about 1:30pm, the sky turned black and the winds picked up dramatically.

My wife Ellen called and said, "Are you crazy? Let the staff go and get home quickly. I've got work for you to do!" We did get lots of rain that afternoon, but by 5 o'clock the weather had cleared.

A few hours later the winds began to howl and the electricity went out. The sky turned a shade I had never seen before. For 30 minutes we heard chilling noises and were quite frightened... but then, the storm was over.

The following day, travel was restricted  and we had no electricity.

As the roads were cleared and  curfews  lifted, I ventured to my office. There, I also had no electricity. There was also water and varmint intrusion. It remained that way, both at home and at the office, for the next week. While many in the community  were getting back to a normal routine, my office was still shut down and without  phone service for those patients who attempted to call.

As patients could not reach us, many came by to see our dilemma and damage. Each day we prayed that the electric company would fix our problem. One week after the storm, our power was restored, we were able to clean up and reopen on the following Monday. WHAT A RELIEF!!!!

In spite of being closed for ten days, I obviously had  ongoing financial obligations including staff  payroll.  While believing that I was "fully insured," I never expected that so many exclusions could exist in an insurance policy. Many storm victims like me, have "learned"  since Katrina, Charley, Ivan, Frances and other storms that some insurance carriers attempt to differentiate between "wind" and "flood" damage in efforts to avoid liability.

We feel blessed that we were not physically injured by "Charley" or the three subsequent storms that hit our area that year. My fingers remain crossed that 2007 will be storm free....   But  we have learned a valuable lesson!

I would STRONGLY urge that you review your insurance policies and consider a "Business Interruption" provision as accidents and storms do occur.

For a free no obligation review of insurance coverages, please click on STARTING IN PRACTICE .

I readily admit that I'm a pop-culture junkie.  And I watched Britney Spears implode at the VMA's like everyone else, with a strange mix of horror, disgust and fascination.

Where did this pop icon go astray?

Well , after extensive research I've pieced together what happened and realized it could happen to anyone in business.

• Brit didn't plan
• She didn't listen to her advisors.

She showed up late for rehearsals, she was "allegedly" inebriated, and she didn't do what was needed to deliver a great performance. 

Furthermore, she ignored her stylists and managers and made ill-advised decisions resulting in disaster.

Same's true with my business and yours.  Without proper planning, organization, budgeting and staying a step ahead, failure is much more likely.

We also need to recognize we are not experts on taxes, banking, contracts and the slough of other technicalities involved with running a business.  So we rely on advisors...and we should listen to them.

And, look in the mirror before you go to work.

I love it when something I've been preaching for years is validated in the press.  It just feels good to read something that says "You've been right all along!"

In the September 7th issue of Medical Economics, there is an excellent article on writing business plans.  A few points I alway make to students are prominent in the article:

• Developing a business plan will force you to raise and address hard questions
• The business plan should be continually revised and revisited to provide reality checks and reflect the current situation
• Business plan software and templates are not necessary and may be dangerous if a reader recognizes it and realized you didn't build the plan from the ground up

This is a good article that gives a few different approaches to writing a business plan and some good resources to get started.  No two plans are alike and the different approaches may give you a better comfort level with writing your plan.

I've run my business as recommended in the article.  It's worked for me, so I wanted to pass it on.  But most of all, I love reading that I'm right!

You've narrowed down the city you want to live and practice in. It's time now to begin "digging".

You'll have to find out several things before you make this "your" perfect place.

Start by asking a few questions that can make or break you in this new town.

• Who are the major employers and do they offer chiropractic care in their insurance packages?  It is great to move to an area that may have a lot of large employers, but if you find none of them offer chiropractic care to their employees, can you be as successful as you hope to be? Contact the companies directly and ask if they cover chiropractic care for their employees.
• What has the growth rate been? Check with www.census.gov and look at the ten year growth rates for the counties and/or cities you wish to practice in. Watch for growth trends and declines that may indicate success.                       
• Check the archives of the local newspapers. Type "chiropractor" in the search box and any article concerning chiropractic, good or bad, will pop up. This may give you an indication as to how chiropractic has been viewed in the community you want to become part of.

These few simple tips will give you a big leg up in establishing your first practice! For more information on demographics visit www.startingintopractice.com/pages/starting/location/choose-location/index.asp

You can see the end of the road coming at school.

You know you need to make some decisions concerning where you want to set up your practice.

How can you be sure you'll land in the right place?

For starters, let's look at a simple process that might get you thinking about where "your" perfect place is.

• Write down three places you have considered or want to live. They can be realistic or maybe just a place you have always dreamed of.
• Now write down three reasons for considering those places. It might be family support, weather, sports interest, population, etc.
• Then list three reasons why you shouldn't practice there. These reasons could be as diverse as "Press about chiropractors was negative", "I hate the winter", or the cost of living is too high.

In this short exercise, you may already be able to pinpoint the community you might be drawn to. In the next article, "Digging Up Dirt," we'll touch on where to gather the demographic information that will be critical for your move.

Okay, so you've got almost everything in place and you are ready to open the door to your new practice.
How do you get those first patients through the door? And how to you do it without breaking the bank?

Try taking tips from not-for-profit agencies whose budgets allow for little paid advertising.

• Write your own press release and submit it to local and nearby city newspapers. Create a story that has human interest to it, such as  "Local Chiropractor Returns from Mexican Mission.".
• Attend community functions that interest you. But be real. Everyone can tell if you are serious about the event or just trying to drum up business.   
• Write an article when someone tries to sell you an ad. You get a byline and exposure for your business and the community gets great tips on back care.
• Co-op. This can save you money. Call your local American Red Cross and become part of their "Back Talk" program. They will co-op on ads and provide your training that will get your foot in the door to corporations that need health programs for their employees.
• For more Marketing ideas visit www.startingintopractice.com/pages/starting/marketing

   Whatever you do, remember that your advertising and marketing techniques affect the whole profession. So be honest and ethical and you will be successful!

We are about to enter into a whole new era of communication in the chiropractic profession.  It is hard to understand that tremendous opportunities that a business blog can create for my fellow chiropractors that are recently graduating, as well as those professionals that have found themselves in a rut and need advice and/or support.

I have two main goals that I want to accomplish with this blog.

  1.   Provide an alternative source of information for recent grads to build and polish their practices.

  2.   Build a support network for the chiropractic profession.

With the resources available at NCMIC, I truly feel that these goals will be realized.

I have to pay property taxes this month.  As part of my rental property management business, property taxes are the twice-yearly nemesis that rocks my world each spring and fall.

Each time the tax man comes calling, it is a significant expense.  I have to write a check for on-time payment or face penalties, fines, fees and anything else the county can throw at me.

But....I will survive!  Two reasons I can pay this exorbitant bill every six months:

1. Planning
2. Budgeting

I have a budget in my business plan which I update periodically to ensure it accurately reflects my current income and expenses from the properties.

Even though the property taxes are paid every six months, I plan for this in my monthly budget and set the money aside. 

And here's the deal...I know myself.  If I didn't set the money aside, I'd spend it...it would be gone.  Money has a way of doing that.

But, thanks to my budgets and planning processes, I'll make it through the next six months and still be here to greet the tax man in the spring.

Once you have your practice in place and have employees and patients, it is easy to forget about some of the simpler everyday tasks associated with running a successful practice.

I will begin with discussing a very important and often forgotten employee policy and will share more over the coming months.

Employee policies and procedures

• Employees are not to date my patients
• Employees are not to borrow money from my patients

How would you like to be the doctor who comes to work one morning and has a conversation with an elderly male patient who is concerned because “Suzie” at the front desk has not paid back any of the $5,000 she has borrowed from him over the past year? 

What are you going to do with this information? 

This is an especially hard reality if you have never told your employee that this is unacceptable behavior and grounds for immediate dismissal.

Another bad scenario would be the employee who is intimately involved with one or more of your patients.  You can begin to see the dilemmas and hopefully how easily you can manage the outcomes if there were employee policies in place.