From "Ask the Expert"...

Negotiations can be a stressful, daunting process.  Especially when purchasing a practice.

Put yourself in the sellers shoes for a moment.  The doctor has bled for the practice through the years and is now ready to pass it on to a new doctor.  Of course they have opinions about the practice's worth.

However, their opinion does not necessarily correlate with the actual value of the practice.

Consider the following factors:

• There needs to be an appraisal done by a qualified appraiser.  The seller customarily has this done and pays for it.
• Have an accountant review the appraisal and tax returns from the past three years.
• Have your own representation throughout the transaction by your own attorney.
• Assess the reputation of the practice within the community.
• Consider the payor profile....where do the revenues from this practice come from?  Insurance, cash, work comp, personal injury, etc.?
• The practice stats regarding new patients, office visits, collections vs. services rendered, from the past three years.
• Practice growth (or shrinkage) and potential for growth based on demographic data from the area.

This is one of the biggest decisions and transactions you will face.  There are many advantages of buying a practice vs. starting up your own, but it is not without pitfalls.  Do your homework and enlist the help of your attorney and accountant.

Reese Witherspoon and Ryan Phillipe, Denise Richards and Charlie Sheen, Whitney and Bobby (but, then, who didn't see that one coming).  There are even rumors that Brangelina are on the rocks.

When these stellar couples began their highly publicized unions, it was all smiles and happiness.  But somewhere along the way, something went wrong and the bliss is over.

Imagine a breakup, but it is with a business partner.  It can get uglier than Britney Spears and Kevin Federline in court.

And a good deal of the heartache can be avoided by having clarity in your partnership agreement.

• Be clear on responsibilities of each party
• Outline how the profits are distributed
• Insure your partners to fund buy/sell agreements in the event of their death
• Outline how the partnership will end, if it comes to that

It's always a good idea to have legal representation when drawing up these agreements. 

By dealing with these issues up front, you can avoid potential trouble down the road.

And who wants to end up like Brit and K-Fed?

I recently heard Donald Trump being interviewed. "The Donald" indicated that some of the worst real estate deals he ever made... were those properties he did not buy. He noted that regardless of price...the value of property almost always goes up.

That being said, and with low interest rates... it's a great time to buy an office site.

Many communities over the past few years have been overbuilt. Economic concerns surrounding sub prime mortgages and the possible dreaded "R" word have caused the Federal Reserve to cut lending rates significantly... making for a terrific buyer's market.

While we've all heard that your home may be your greatest asset... the same can be true of an office location. Rather than paying rent, those same tax deductible dollars, can be spent on the purchase of a property, which over time should appreciate.

Additionally, a practice which has been in the same location for years, will be more valuable than one which has moved about and is subject to tenancy.

Don't forget the 3 keys to real estate... location, location, location... and it's a great time to buy!!!

Somewhere in the last months of school, (buried in some business class you'd rather sleep through because upcoming board exams seem more important) you learn about a very small, yet crucial piece of cardstock...the business card.

Now, the purpose of this post is not about what to or to not put on your business card.  It's merely to point out an oversight I've come across on numerous occasions, and twice this past weekend!

If you are handing our your business card, it's most likely in attempt to provide your contact information, right? 

At a recent seminar I ran into two former classmates who have settled far from where I practice.  Because I'm all about networking, I like to keep a well-stocked Rolodex of people, specifically chiropractors, that I'd feel comfortable referring too. 

Not one, but both of these doctors handed me a card without an email address or telephone area code! 

Now how in the world am I (more importantly a patient) supposed to contact them?  Yes, I can Google the area code, but then what is the point of having his/her card?

My message is short and sweet...put all necessary information of that little piece of cardstock!

Before you place an order, ask yourself  "can I be reached solely on what's available here? " I know it seems like such a simple concept, but evidently, it's worth mentioning.

Self discovery is a great thing.  I know from my own experience that I have strengths and I have weaknesses.  I chose to expand on my strengths but always be aware of my weaknesses.

Whether you start your own practice or become an associate, you need to know what you bring to the table!

If your interpersonal communication skills are lacking, you will experience problems in communicating with your patients, other professionals and the community in general.  Now is the time to take a hard look at how you communicate and find ways to improve.  Toast Masters is a great way to interact with people who have bridged this fear and to hone your speaking skills.

It's all about relationship strategies..watch for my blogs in this regard. 

One-on-one communication is fine, so is communicating to groups large or small.  As a health care practitioner you have a story to tell.  Don't be afraid to tell it!  Let me know about your successes and share your failures...we can all learn from each other.

That's what my husband remarked after an emergency visit to a chiropractor who was located near the hotel we were staying at in Hawaii.

"I wanted to run," he continued, "but the pain made me stay. He's lucky I was hurting so bad." 

I was with him and knew what he was saying. Sure, when we opened to the door to the doctor's beachside office, it WAS beautiful, decorated in soft colors with a soothing fish tank as large as a boat centered in the open adjusting area.

The tiny wind chimes announced our entrance, bringing us to the attention of a man in his early 30's who had been sitting at a desk behind the aquarium. As he rounded the fish tank, we were both taken aback by his appearance.

He was not a big man, but well built and very tan. He wore a pair of white gauze pants and a tank shirt showing off his athletic body...and no shoes.

His smile was kind and wide and he extended his hand in greeting. I cautiously asked, "Is the doctor in?"  He smiled and said, "You're talking to him."

I think he could read the disappointment on my face.I found myself asking the doctor before he even touched my husband if he had malpractice insurance with NCMIC. Had he said no, I would have jerked my husband right off that table and found someone else.

Okay...so we might be in our 50's and on vacation, but it is true - clothes DO say a lot about the person in our eyes.

In our lifetime we cannot  let go of the fact that the very word "doctor" denotes an upscale, white jacket or shirt and tie kind of vision that gives us confidence in the doctor's competence. We can't get over it even though we have a grown son that has only worn cargo pants and golf shirts to work.

With that said, think about what your clients might be thinking as they arrive at your office and see you for the first time.

You might not even get a chance to show them what a great doctor you are if they consider you unprofessional or incompetent. It is not what YOU are thinking that matters. It is what the customer perceives.

You've heard that "You only have one chance to make a first impression." What will it be?

By the way, our Hawaiian DC was fabulous!

I have heard this soooo many times from new docs who are looking for space.  They are often tempted by the real estate agent to take space because the "price is right".  But I challenge you...is the "space right" for the image you want to portray in the community?

My favorite story, and some of you probably heard this from the podium at an SIP program, is the new grad who took me to look at an empty office space. 

It was in a small strip mall between a bar room and a pizza joint and next to a nail salon. 

Now don't get me wrong...I'm Italian and I love pizza and a cold (lite) beer, and I get my nails done regularly....but please!

To add to the problem, the space was double what he needed (over 2000 sq.ft) and he kept telling me it was a "bargain" at half the cost of everything else he had looked at!  Right. "And you get what you pay for" was my response. 

When we did a walk through I immediately called his attention to the fact that this was RAW 2000 sq. ft. and he happily told me that was great because the landlord would build it out to suit his needs and even dress up the front with an awning.  Obviously somewhere in the conversation he missed the part about build-out costs.

But my bigger concern was the fact that we had talked extensively about the kind of practice he wanted.  He planned on interfacing with a small, local hospital, the OB/GYN practice in the area and the local Physician Assistants that supported the physician in the catchment area.  And to boot, the space we were looking at was across a 4 lane highway from the providers he wanted to service in the catchment area.

After finally getting my point across that this site just did NOT match his objectives (would HE go there for care?) we looked at smaller space at a bit higher sq. ft rate and we found just want he wanted, with no build out required. 

So beware, the price isn't ALWAYS right.

You've been getting out and meeting people.

You've joined several community groups. 

People are just starting to get to know you and then it happens. 

Someone casually asks if you would be willing to do a presentation for their group.

"Hey Dr. So and so, we have a meeting in a few weeks, and we were wondering if you would b available to give us a presentation?" 

Or, perhaps it has come about from a different matter.  Perhaps you have been pushing for such a talk.  So what do you talk about?  What is going to help you the most?

Here is the secret.  It really doesn't matter what you talk about. 

I'm just being honest with you.  Chances are that an hour after your speech, you will be lucky if they remember 2 main points that you make.  Think about the last speech you were at... what do you remember?

The key with your presentation is to

• be professional
• be knowledgeable
• communicate well

Also, bring your business cards to pass out so people will remember your name. 

To work on the "communicate well: part, join Toastmasters. Enuf said. 

For the other parts, use your good sense.  If you represent well, people will be impressed and it will help develop a higher level of respect which directly goes to your credibility and reputation.

Talk about something that you are passionate about, people will see and sense that passion and associate you with it.  It is all about the fact that you are up there and talking.  That is the key way to make a presentation successful in my opinion. 

We will talk about some higher level strategies later on.

If you are about to graduate with your chiropractic degree, you are eager to get going, treat patients and pay off your school loans. 

Where to start? 

School has prepared you to take care of patients, but what about setting up practice. 

The steps you take before graduation day will help to make the transition to practice smoother. 

You will find that the puzzle pieces have to fall in a sequential order.  Many times, one piece of the puzzle needs to be completed, before you can apply for the next. 

The first step, prior to receiving your diploma,is to inquire with the state licensing board for the state you will be practicing in, to see what the requirements are for licensure. 

Many times, you can apply for the license before graduation and once processed, they will hold your application until they receive the copy of your diploma.  By “pre-registering,” you can often save three to four weeks processing time for your license.

Once you receive your license, you can then apply for your malpractice insurance at NCMIC and your NPI number. 

The NPI number is a 10-digit number that will stay with you wherever you may practice in your career.  It is the number that will identify you for billing, no matter where you practice.

Second - and very important of course - is to get your diploma.  Once you get the actual diploma, many doctors or their families want to rush out and get the diploma framed and hung on the wall – any wall! 

Before getting your diploma framed, make multiple copies of the diploma; you will need them for applications to the state, NCMIC, Medicare and for your NPI number.

Third, apply to Medicare for your provider number and any other Preferred Provider Organizations (PPOs) that you wish to get into. This may take up to five months. 

You can still see Medicare patients in the meantime, but hold off sending in any claims until you get approval.  Also, make sure to remember to read the PPO contracts!  Some PPOs are not worth getting involved, for any price.

Your Action Plan:

1. Three weeks before graduation, apply for state license.
2. Make multiple (20) copies of your diploma.
3. Once you have your license number, apply for malpractice at NCMIC.
4. Apply on-line for your NPI number.
5. Apply for Medicare and PPO approval.

There you are at church.  You are sitting in a pew listening to your pastor/preacher discussing the nature of God and the pathway to him/her.  Is this a good opportunity to discuss work? 

Should I be networking while in church? 

The answer is very clear... absolutely!

Networking is a specialized form of marketing.  It is not about selling, or deals, or things of that nature.  It is relationship building.  Any time that you can establish a link with another business person, go for it!  Think of networking as building a friendship, a business friendship.  The thought process is this: friends help each other in times of need. 

Business friends have a similar philosophy.

From this point of view, focus on your similarities. 

• Ask questions. 
• Develop small conversations during the social period of church. 
• If an interest is sparked, suggest taking them out for coffee later that week. 

Once a date is set, relax.  If they want to keep talking go for it.  If they are looking to mingle some more, let them go. 

Be sure to follow up the appointment with an email or a friendly phone call to ensure the time and convenience. 

Boom.  You have just networked at church! 

Just remember, networking is not just about what they can do for you, it is also about what you can do for them!