With a new year ahead, don't be surprised if you are hit up early in the year for "donations" of every kind. Every Cub Scout, high school sports team, charity and advertising magazine will be looking to their community to help support very worthwhile causes.

Being new to both a community and business, your budget may not be able to sustain the requests, but you also cannot afford to give to everyone. This is where you must remember that "charity begins at home." 

Here are a few tips for balancing the delicate task of giving.

First, set a manageble marketing budget. (for example, $1,000 per year)

When the budget is gone, offer your expertise to:

• Write an article instead of placing an ad

• Volunteer to assist a sports team as a coach or at a one-time-event

• Host a special one-time meeting for a club

• Donate something that costs just a little (cookies for a bake sale, a toy, a gift you have made.)

• Offer to print posters on your office printer

Giving is a wonderful thing and adds to your contribution to be recognized as a community citizen!

Use your imagination to give what you can, but remember as a new business, costs need to be kept in check for your future to be successful.

My mother had a tradition.  It happened every New Year's Day.  After the tree was taken down and the ornaments wrapped and stored she started - like clockwork - to clean out every drawer and closet in the house.

With a basket in hand (this was way before super-sized, extra strength trash bags) she started in the kitchen and purged everything that was over a year old.  If it hadn't been used, or was outdated, it was tossed. 

Every closet was cleaned, old clothing examined, missing buttons replaced and the rest either sent to Goodwill or put back in the closet.  The desk was cleaned and reorganized.  On and on it went until the job was complete.  Somehow I inherited this "gene" and although I try, something comes over me on January 1 and the clean out begins. 

My daughter, who has her own home, called me a few years ago to state that the phenomenon has been passed on to her, too.  Not a BAD thing!

I encourage you to do this in your office.  

Years ago the computer gurus claimed that computers would do away with paper.  NOT!  I find that we continue to print just about everything that comes our way. Some offices still use paper ledgers AND a computer ledger system!

I confess ... I even print these monthly blogs and have them in a nice 3-ring binder.  Some habits don't change.  I still have seven file cabinets in the basement that are going to be the 2009 clean-out project. 

In approaching this or any clean-out project, I am reminded of something Dr. Sportelli told me years ago when he was cleaning out his archives.  He asked himself "if I ever need this article again, would I know where to find it?"  If the answer was yes, he disposed of the papers.  If the answer was no, he kept it. With today's Internet access I suspect he, too, is disposing of more.  

Earlier this year, Dr. Erin Palmer commented at one of our teleconferences that her generation "didn't buy textbooks or keep manuals." If she needed it, she knew where to find it on the web.

Technology has changed us.  Let's get rid of the old paper once and for all. 

I, for one, promise to print less and save a few trees next year. How do you plan to clean out in 2009?

There seems to be a resurgence of "old time chiropractic ads" in newspapers. These are the ones that might include a $10 initial fee or some similar offer that reminds me of what D.C.s did back in the '50s and '60s to get new patients.

But do they work? And is that the image you want to portray?

These ads may bring in a few patients - but is that how you want to spend your advertising dollars?

If you're getting some "cheap advertising" by purchasing already made ads and placing them in your free or local newspaper, maybe it's time to evaluate if your advertising dollars are working effectively for you.

There is a direct correlation between mass advertising cost and effectiveness. In other words, you get what you pay for.

If you want to get the most out of your advertising dollars, ask yourself these questions:

• who do I want to target (people in a certain demographic, a certain area, etc.)?
• how can I reach them best?

You'll find some good advertising ideas on the Starting Into Practice website. What have you learned about advertising? Comment here and share your tips with others.

Tough economic times have hit the United States and, really, the world.  Some businesses such as Wal-Mart are prospering, while others are closing their doors, declaring bankruptcy or asking for a bailout. 

In order to survive, you must be a visionary. 

You have to realize what your customer – the patient – is looking to buy.  Their dollars will be spent for necessities and services which they deem to be indispensible.

A visionary doctor has to realize that he or she is a people person.  People come to your office because they want relief of their pain.  However, they rarely choose a doctor for their prices or the amount of initials after their name.

That means you must sell yourself! 

In the ‘70s, there was a commercial where a woman recommends a shampoo to her friend, and then “She told two friends, who told two friends and on and on and on.” 

This is word-of-mouth marketing. It shows the power of the personal recommendation.  I still find that this works best to get referrals, even in the toughest of times.  While most of us will tune out the daily barrage of messages that are thrown at us on a daily basis, we will still listen and trust our friends’ and families’ word-of-mouth recommendation.  People will come to you, because they feel they know you.

As the New Year arrives, people will naturally set their goals for the coming year. 

This may be the year where they want to take care of themselves by exercising right and eating right.  Volunteer your time at weight loss group sessions, civic groups, chamber of commerce meetings or church groups. 

Your goal should be to meet three people per day.  I don’t mean just to say hello, I mean to get their first and last name and their address.  Give them one of your business cards and get one back. 

Once you have met your three people for the day, go back to the office and write them a quick “Thank you” note.  Tell them it was a pleasure meeting them and invite them to give you a try to help with their pain or for ways to live a healthy life in an unhealthy world. 

Include two business cards in the letter; one for them and one for their friend.

A true killer for any practice is sitting around waiting for the telephone to ring.  Get out and meet people, who will in turn become a future patient in your office.  It may stretch your comfort zone, but successful people will do what unsuccessful ones won’t!

Routine is inevitable, but in the day-to-day operation of your practice, be careful not to let complacency slip in the back door and get comfortable. 

It can seem like you say the same things over and over - "you have a reversed cervical curve" or "the cause of your pain is a subluxation located in the lumbar spine."  Sound familiar?  

Catching yourself in this pattern is tricky, but important if you want to talk with your patients, instead of at them. 

Ask yourself:  

1. Do your staff members leave the room during patient consultations because they've heard it all before?
2. Do you remember your patients by their names and faces or by their x-ray listings? 
3. Do your patients nod and smile during your canned, generic ROF until you've finished telling them all you know? 
4. Do you fail to allow time in your schedule for questions because they shouldn't have any after your knowledgable mini-seminar?  

Laugh at yourself.  It's oK. We've all done it. 

You've learned so much and you know exactly what to do and you can't wait to get your hands on their spine to save the world, right?  We all have our methods of getting The Big Idea across, but do you preach from the chiropractic pulpit or discuss conditions and concerns with your patients?  

No two patients respond the same to a diagnosis, adjustment, treatment plan, or patient education protocol.  You already know this.  Your patients are people first, consumers second.  

They expect you to be different than other providers, so give them what they came for....individualized healthcare!    

When there's an allegation of malpractice, I think every doctor would agree they want one thing when it comes to legal representation. 

They want the best.

Your reputation is on the line. This is definitely one area where the bargain basement attorney may not be the best value.

In the event a claim is filed against you, your malpractice insurance company is responsible for providing you with a defense and paying the cost of your defense.  But this is an area where there is a huge difference.

You want to make sure the attorney representing you is the best.

• Has the attorney ever defended a chiropractor before? 
• Are they well familiar with the chiropractic profession? 
• Does the insurance company provide defense counsel that has chiropractic specific training and resources? 

Beyond your attorney, another person you want on your side through this process is your claims representative.  This is the insurance company employee who works with the doctor and the attorney throughout the claim.  Same issues apply. 

• Are they familar with chiropractors? 
• Have they worked on chiropractic claims before or are they part of a medical malpractice company that only works on chiropractic claims infrequently? 
• What kind of chiropractic specific training and resources have they recieved? 

All these issues will have a big impact on you throughout the entire process of the claim.  So again, when shopping for a malpractice insurance policy, ask questions.  Ask about the company's experience with chiropractors.  Ask about the number of chiropractors they represent. 

In short, look for the best value with your coverage.

I am a firm believer in education and that we, as doctors, must educate our patients as to their diagnosis and any diagnostic reports. 

I find that when time is taken on that initial visit to explain the following points, it can put their mind at ease, help with patient compliance and make them an active participant in their health care:

• Explain the anatomy! One thing we can all agree on regardless of the school you graduated from is that anatomy has not and does not change and no other specialist knows their anatomy like a DC!  You will be surprised how many people are unaware of basic anatomy.
• Discuss test results. I am shocked how many people are told they have a herniated disc but have no idea what a disc is!  I describe the disc as a round thick slice of an onion with the center few rings taken out and filled with jelly or a grape. Who has not seen an onion slice?
• Use pictures.  I use my Netters more now than I did in the anatomy lab to show patients what their anatomy looks like ... please do not use the same one from lab.  Also, I keep a 16x22 inch dry eraser board with erasable markers in my initial consultation room and often draw pictures or flow charts to help patients get a visual of what I am saying.

Perhaps the easiest thing to "impress" them is to interpret the terms of their diagnosis and test results. Words that you take for granted (spondylosis, degenerative disc disease, facet hypertrophy, scoliosis, etc.) can scare the heck out of your patients.

Put their minds to ease by teaching them. I have 80-year-old patients asking if I think they have arthritis........like it is something they can avoid and to have it is life threatening!

Make your office visit stand out from any other experience they have ever had with any other doctor by taking the time on that initial consultation to teach them what they need to know so they can be an active participant in their treatment. 

Well, here we are in December ,,, the month of no-shows and cancellations. With all the "holiday stress" there is a high possibility that the first thing to be skipped is the regularly scheduled appointment.

That means that now is a great time to encourage your staff to take extra time to confirm appointments ... in person as well as by phone and email!

Communication experts say that in order for a message to lock into the brain it needs to be heard three times. Challenge staff to repeat the appointment three times with every patient.

Call the patient two days before to confirm their appointment. Hand the patient a reminder card with the date(s) and time of their upcoming appointment.

This one is short and sweet ... no shows and cancellations compromise the patient's care. Stress creates more need for care, not less.

Over the years, I have tried every realistic form of advertising and marketing out there:

• Mailers
• Newspaper ads
• Newspaper inserts
• Networking
• Public speaking
• Radio ads
• Sponsorships
• Newsletters
• Gift certificates
• Patient education
• TV ads
• Spinal screenings
• and so on. 

I have been very successful, but it can get difficult sometimes to come up with new ideas.  In fact, sometimes things tend to get down right stale.  Unfortunately, when I feel it is getting stale it is reflected in my approach and my business suffers for it. 

I have found that I am not unique in this aspect. 

My friend in Maine has an interesting dilemma.  He finds that his business increases significantly when he stresses patient education more.  Seems simple enough, but it is hard work to maintain positive energy when not everyone is getting the message.  At times he feels down right defeated and gets bored with it because he is always saying the same darn thing.

And, like me, when he gets bored with it, his business slows down during that time.  This is a lot of pressure to put on a practitioner and can lead to some pretty significant burnout.

This all changed for my office about a month ago. 

We were having a staff meeting and I had asked them prior to the meeting to come with two marketing ideas that we could try out.  As we got started, there were some good and some not so good ideas floated around.  To me it seemed like the same old, same old. 

It was my wife who broke through with a really fun idea.  She had been noticing that each month tends to be designated numerous times as a special for month for this or that.  I forget which month is which, but for example, lets say September is national Stress Awareness Month.  That's what I am talking about. 

I became very excited as she started bringing up this idea and my mind went on fire.  The game was afoot! 

Now, instead of saying the same things all the time, we can rally all of our marketing each month around the focus of that month!  Obviously the goal will be the same, but now we are excited about figuring ways to match our ideas with the theme of the month.

It seems like a simple concept - and it is. But it has re-invigorated our creativity to tell the story of our office in new and different ways. With the theme changing each month, I have found that it is getting harder to be bored!

What are your thoughts?

In August 2008, I bought an existing practice. My goal was to get acclimated and sustain the previous Doc's patient volume. 

In the beginning, I used local newspapers to let people and patients in the area know that Doc Cavallo was retiring and that I would be taking over his practice.

In addition, I volunteered at local events and had an open house (I will blog about that experience another time).  My advertising was inexpensive - but it was meant to achieve one goal: sustaining business and having a smooth transition. 

This took some time and a lot of effort, but after looking at numbers over the past months my goal was achieved. 

Now coming into 2009, my goals have changed to increasing volume at a suitable rate (trying to be careful of not growing to fast or losing what I have sustained). 

I am in the process of working on an advertising plan for '09.  My plan consists of:

• marketing in newspapers
• website design
• bi-monthly lecture series
• and other creative ways to get my name out in the community in a positive way. 

I realize with this type of plan that expense will be an issue. I will set aside 5-10 percent of my office's monthly income for advertising.  To me this seems pretty aggressive, but I will monitor my efforts along the way for a period of 6 months. 

If I find my plan has not been successful, I will reassess and adjust my plan. 

If there are any suggestions you have, feel free to comment here and I will consider them for my '09 marketing plan.