Upon graduating from New York Chiropractic College, I decided to venture out into practice on my own, but not without a lot of guidance, planning, and achievable goals.  Due diligence is a buzzword I heard throughout my planning, and I recommend to anyone venturing out on their own to do just that - research and research. 

But first, students should know their options and decide early in their schooling which option might be the best to pursue.  My list of options, like most others, was:

• associating
• independent contracting
• opening a new practice
• buying an existing practice

I opted with buying an existing practice for many reasons.  The main reasons for this included my long-time dream of owning my own practice and it also made the most sense economically. 

In making my decision, I initially decided to talk to as many people as possible.  It didn’t matter what type of business they were in or how successful, I just wanted different perspectives of business ownership.  After all, business is business. 

Later, I focused my energy on getting perspectives from chiropractors.  Again, it didn’t matter if they were new, old, or even retired as long as they had clinical experience treating patients I was calling or meeting them. 

This type of networking provided me with very practical and useful information.  Not to mention, this is how I learned about the office I would later purchase.  I would advise you to talk to as many people as possible, but be cautious.  You may find that the more people you talk to, the more information you will have from which to determine what is good and bad, which sometimes is not easy.

I suggest talking to people who are where you want to be in the future.  I once read, “If you want to climb Mt. Everest it is in your best interest to talk to people who have already climbed it.” 

They can and will give you pertinent information on where you are going, their positive and negative experiences, and pitfalls to watch for along the way.  Don’t forget to have fun along the trail. 

The peak is not as far as you think - approximately 29,029 feet.

I live in Iowa and have all my life.  I've been in Des Moines for close to 20 years.  In 1993, we had a 500-year flood.  It devastated the town, wiping out our water supply, shutting down commerce for weeks.  It was a reminder to us to respect Mother Nature and prepare for the worst.

Over the past few weeks, we have been experiencing another 500 year flood.  Actually, this year the river waters swelled to new heights, again threatening people and property across the state.

While eastern Iowa was hit much harder this time around than Des Moines, we did evacuate areas in the flood plain.  And the water kept rising.

But it was different this time.  Des Moines was prepared.  At no time were we in danger of losing our water.  The downtown business district did not shut down.  We did not lose power.  Overall, we came through this very well because of lessons learned in 1993 and preparations in place for something that was not supposed to happen for another 485 years.

How prepared are you?  Whether you are new to practice or have been open for a while, how prepared are you for an unexpected event that could have a catastrophic impact on your practice? 

• What contingency plans do you have in place? 
• Are they written down in your office manual?

Disaster recovery is not something we like to think about, but it is sometimes it turns out to be something we are glad we did address.

And I think they need to rename the "500-year" flood.

Just like Baskin-Robbins has 31 flavors of ice cream, financial companies also offer a wide array of ways to invest - some which are more cost effective and have lower fees than others.

Over the years, I've tried multiple strategies to enhance my investment returns. I attempted market timing, trading specific stocks which had "hot products" and I'll certainly never forget my "wagers" on penny stocks.

Chasing returns was never particularly successful for me, and some time ago, I adopted the "KISS" (keep it simple Sherlock) principle. While still considering asset allocation relative to my percentage of stocks, bonds, cash and  market sectors, I now avoid emotional investing, particularly as I am often unable to explain, much less control the rise and fall of stock prices.

I now purchase a few indexed funds which provide great diversity in various market sectors. Best of all, the costs/fees associated with  them is minimal. Fees on some investments can vary significantly over time and can greatly alter your total return.

On a monthly basis, I invest in each, these being a part of my retirement account. With the power of compounding, and the ability of these funds to grow in a tax-deferred setting until retirement and redemption, they should add up to be a "pretty penny."

As you contemplate your financial future, keep these things in mind:

• Start early
• Save regularly in a tax-deferred vehicle
• Utilize low-cost funds

Last, but not least, find a good financial advisor who can help you make the most of your hard-earned dollars.

A recent article in the Boston Globe reports that the Internet search giant Google has rolled out its long-awaited Google Health product which will enable users to upload and store medical records from many sources.  Boston Hospitals such as Beth Israel, Deaconess Medical Center and even CVS Caremark in Rhode Island are early participators. 

Google says that users can enter their personal medical records on a site with individual password protection which gives them a way to view information from any geographical location.  This access will be especially useful if a patient becomes ill or is injured far from his/her primary care physician.  It is Beth Israel's vision that patients will be able to electronically upload their diagnosis lists, medication lists and allergy lists in Google Health accounts to enable sharing with health care providers.

The health care industry considers electronic medical records critical to reducing costs in health care and eliminating medical errors.  This is only the beginning.

Why do I share this?  As a start-up doctor (or a seasoned practitioner), it is important to be part of the future and not stuck in the past.  Electronic medical records are here to stay. Be sure to factor this technology into your business plan!

Another travel episode gives rise for this blog. 

The flight was late arriving.  Pressed for time and late for an engagement, I decided to rent a car to get to my destination.  I hopped on the first rental car van that came by - Enterprise, not my usual choice of agencies, but time was of the essence. 

The van headed to the rental pick up area.  Once we reach the lot, I grabbed my carry-on and as I stepped off the van, I was greeted by an attendant who insisted on taking my bag and escorting me to check in. 

I was greeted by another staff person who said "Welcome!" and then offered me some bottled water and took me to the counter for an expedited check in.  Within moments, I received my rental documents and was waiting for my rental to be delivered to the door. 

At this point, Enterprise's service exceeded a 5-star level. 

Up came a Dodge Van.  I made a quick inspection and discovered that the front license plate had obviously been crumpled in an accident and was loosely attached by one screw.  I pointed it out to the attendant, got in the car and hurried on my way.

For whatever the reasons were, a crumpled license plate, held on by one screw negated the whole beyond 5-star experience!

How often do patients encounter a 5-star experience in the doctor's office only to have it negated by a less than clean treatment table, an overflowing trash basket, a moment of non-patient focus and a sundry of other things that can take place during the day?

Whether it is the rental of a car or the experience of a patient encounter, it is FOCUS and ATTENTION TO DETAIL that moves the experience from ordinary to extraordinary or 5-star service.

I bought a scooter this week.

Now, I am no daredevil and typically prefer a few tons of Detroit steel around me when cruising down the road.  But gas is $4.00 a gallon and my car is not the most fuel efficient.

So I started cutting back.  If I had a scooter, I thought, I can get 90 mpg going back and forth to work, I can save a little money.  And maybe my household budget won't be too out of wack.

Which brings me to my topic.  Budgets are not something you develop and never look at again.  They are living, breathing documents that change as your reality changes. 

They also help keep you on track.  As with the price of gas, when the cost of something changes, your budget has to change to reflect it.  Whether you cut back on the item that has increased, shop around, or cut back on something else, everything must remain in balance or your practice and personal finances will suffer.

There are some great forms on this website and tons of information for free on the web to help with this process.

When times change we adapt.  I bought a scooter to adapt. 

Unfortunately, there are aspects of society that we, as health professionals, have to consider.  One of these is child abuse. 

Every doctor should have a staff meeting with all the staff and establish policy for reporting child abuse.  Hopefully, no one will have to deal with this subject, but you and your staff should be aware that you are all a point of contact for reporting abuse.

In most, if not all, states the doctor and staff are a "point of contact" for reporting child and elder abuse.  What this means is that all you have to do is suspect abuse and it must be reported.  If abuse is suspected, it should be reported to the Department of Child and Family Services (DCFS).  You never have to investigate the matter.  This is up to DCFS.  The number for DCFS should be available for the office staff and an office policy should be established in your office. 

Remember that when you report the matter to DCFS, the records of the child are now off limits to the parents.  Parents typically have the right to the minor's medical records, except in the case of suspected child abuse.

Be aware of the clues for suspected abuse:

• Inconsistent or lack of history
• History of multiple doctors or hospitals
• Unusually shy or evasive behavior by the child
• Findings of cuts, bruises, welts or bite marks
• Cigarette burns
• Radiographic evidence of healed fractures

When in doubt, err on the side of child safety.  It will probably be rare that you come across this type of case, however one is too many.  If missed, the consequences to the doctor may be serious including loss of license.  Preparation is the best policy.

In preparation to write this post, I did a little homework.  I figured who better to provide quality advice than those who've been around for awhile.  That's right...I contacted a few 'veteran' DC's I know. 

I asked them simply "What specific financial issue keeps you up at night?"  Every single one of them - six in all - replied with concerns about retirement! 

So, where does that leave the rest of us?  Yea, I get it....I'm a 'newbie' myself and retirement seems like a long lost dream after student loans, equipment leases, living expenses, etc. are paid. 

Assuming the majority of us don't have a keen understanding of investing, there are overwhelming issues in front of you.

• How much do you need? 
• When will you need it? 
• How will you be able to put it aside?

Planning for your financial future is easier than you might think!  Here are the first baby steps...

1. Outsource it - Consult with a trusted financial professional. Speak to a few different ones until you find a good fit.  This should be someone who guides you, yet listens to your concerns and wishes.  After all, it's YOUR money. Consider established groups like Edward Jones, Prudential, Schwab or any number of the quality companies out there.  Many banks even offer these services to accountholders.
2. Set goals - Once you've selected your financial advisor, discuss goals.  My advisor recommended I set up three types of accounts: one for immediate savings (for life's little emergencies), one for short-term goals (such as a new home) and one for the long-term (to include retirement).

Obviously, goals vary among individuals, but the time is NOW to start saving!  In my next post I will share a few specific, yet simple ways to get started.  It's time to dust off that piggy bank!   

Getting started in business isn't all that easy. We've all run into the same situations, questions, problems. That's why I am going to list off a number of thoughts on how to get a network up and running that can help you out.

1. Focus on your existing friends and family.  These individuals can be a tremendous asset to your company if utilized effectively.  They can provide you with feedback on your approach as well as potential leads for either your business directly or for furthering your network.  The biggest mistake I see people make is simply not engaging them.  Failure to ask for help from your network is a common problem on all levels, but especially for family.  There is a caveat to that though: don't overdo it.  It is not the job of your family and friends to build your practice, it is yours.  I met a doc that had been out for 6 months, and still hadn't seen patients beyond the family. 
2. As you open your company, you should be developing a professional support team.  This is your next group to add to your network.  You should have a good attorney, a good insurance person, an accountant, a banker, and a commercial real estate agent.  Again, these people already know you and are working with you.  They want to see you succeed. 
3. What interests you?  Is it biking?  Church?  Politics?  Charity work?  Find something you enjoy to do and get to know the people there.  As you build friendships there will be a general desire to see each other do well.  Again, they are in your network now, utilize them.  Cautionary note... don't join a group if you aren't interested in their purpose.  It is insulting to their beliefs, and you will not walk away with any help.
4. Get to know your neighbors at your business.  Very rarely will you find an office out in the middle of nowhere.  Go and introduce yourself to your fellow business people.  Bring a gift, but don't cheapen what you do by giving them a free exam, please.  Bring a fruit basket or something of use to start the relationship on the right foot.  Build that network.

So boom, right out of the shoot you should have a minimum of 20 to 30 people in your network.  Let it blossom from there.

With Great Respect,

Braxton 

There are always cases where the patient will want to give you a call when they need you.  I personally have no problem with patients calling for an appointment but, to avoid potential problems, I deal with them in two ways.

The first case scenario deals with the patients who you think need the follow-up but they promise to call later.

I respond by saying,"You may not need the appointment, but if you wait to call we may not be able to accommodate you. So why don't you make the appointment and then cancel if you feel fine." 

I would rather have a few moments to do some paperwork (if they cancel) rather than squeezing in a patient (who calls at the last minute).  Besides, the "will call" patient usually wants the appointment when it is a good time for them no matter how inconvenient it may be for you and your office.

The second case involves patients who really do not need a follow-up and should call if they need me. 

For this group, I designed a "will call appointment card."  It is similar to the regular appointment cards but it says: My last appointment was _________  and I decided to call if I required further care. Then, there's a space where the patient writes in their appointment date and time after they've called the office.

This way they have an appointment card and they also are able to see how long it has been since they were treated. They also leave with a sheet that has my office hours so they do not call at a time when we are not there.

There is no need to discourage the "will call" patient and this helps my office manage them better. 

Next time, I'll talk about identifying the "will call" patients who really need to make regular appointments and may require supportive care.