As some of you might know I began practice a short time ago.  I bought an established practice and everything stayed including the front desk manager. 

Over the past 8 months, some changes and a lot of updating occurred but the front desk operations stayed relatively the same. 

I knew the time would come when the front desk manager would want to enjoy retirement with her husband and move on with life.  Upon recent discussions we decided the time was sooner than anticipated.

The hiring process will be a first for me and will be very interesting.  I know offices hire often, probably more than they would like, but it is part of the business side of healthcare and I will soon venture into it. 

I am lucky to have great mentors and people to talk to about tackling this situation.  I see them take the task of hiring and do it gracefully, without any practice disruption.  My goal will be to do just that, transition the new front desk person into the big role of practice manager. 

Although right now I'm overwhelmed thinking about it, but it will get done.

One thing on my side is that I have some time, which is good - I'm going to need it! I anticipate that it will take about 30-60 days to find a reliable/trustworthy replacement.  Which I think is more than enough time. 

From my undersanding, it is difficult to find qualified and competent help.  If any of you have suggestions - please don't hesistate to post a comment.  At this time I only have a tentative plan, but in the next week a plan will be made and set into place.  

In my next blog, I will share my plan and how things turned out.

For now, I would like to thank Mrs. C for all her knowledge, time, and energy she has given me and my practice. 

Until next time ...

It seems Facebook is everywhere these days.  When you meet someone new or reconnect with someone you haven't seen for a while, the inevitable question seems to always come up:  "Are you on Facebook?"

I have to admit I'm getting old.  I was reluctant to get started on something that seemed to be a drag on my time and of little use.  This appeared at first as something for the kids.  But I also have to admit that I'm enjoying it.

I have reconnected with a kid I grew up with who lived down the street.  I actually found him through his kid sister.  I have been "friended" by classmates from grade school, middle school, high school and college. 

Sometimes I don't really want to be found, but you gotta take the good with the bad, right?

This experience has made me realize the double-edged sword of Facebook.  By participating in this new must-have application, I have given up a piece of privacy.  I am putting myself out there for anyone to see.  Anyone.

Not only can Becky, my grade school best friend's little sister, find me, so can colleagues, clients, current and prospective employers...the list is endless. 

And for doctors the list includes patients.

So what face do I put out there on Facebook?  My profile represents me and I want that representation to be accurate and up-to-date, but I also want it to be professional and nothing I'd be embarrased about.

A doctor I know who recently "friended" me sent me this link to switched.com which has some great tips on how to effectively use Facebook.  I thought this might be useful for students and new docs. 

You are transitioning from student to professional.  Facebook can be a powerful networking tool, but it can also damage your professionalism.

I'm curious.  What are you using for social networking?  Is Facebook the end-all or are there other tools out there you are using? 

Let me know.  You can post a comment here or send me a friend request on Facebook. 

I'm out there for all to see!

I had lunch yesterday with a very influential business person in our community. It's part of my New Year's resolutions to meet at least one new contact for lunch each week this year.

Our conversation focused on many topics including the new Obama administration, football and recruiting, kids and schools, and our businesses.

I have been in the community longer than he, but over the past three or four years we've crossed paths but had not gotten to know each other well. During our discussion, we shared information about our educational backgrounds, and he told me of his experiences and student life, while at the U.S. Naval Academy.

He commented on both the mental and physical hazing (which has since been reduced) associated with being a cadet. Limited conversation and communication, marching drills, shining shoes and multiple menial tasks were all part of the training to prepare future leaders and soldiers.

He strongly believed that these exercises assisted him and his classmates with their organizational abilities, critical in battleground settings and future occupations. Important to the cadets were the "Seven P's of Preparation."

We've all been in meetings or settings where things are "out of sorts." Whether it's an office which is unprepared for a new patient, a meeting where an agenda has not been established, or participants of a group who are ill prepared.

Most successful businesses have clear-cut and well-defined systems and procedures as a part of their organization, Each of us, as professionals should be well-prepared, whether treating patients, serving as an expert witness or on a civic committee.

Your reputation depends on your knowledge and preparation. And  much can be gleaned from the cadets and their "Seven P's" of......

Proper Prior Planning Prevents Piss Poor Performance.  Happy Days!

I recently visited the Boston Globe blog site regarding the Boston-area medical community.  One blog that caught my eye was related to the worry and perceived intrusion of electronic medical records into the doctor-patient relationship. 

The comments from doctors, particularly new doctors, indicate that while they appreciated the accessibility and efficiency that digital records can bring, they worried about the possible "damage" to the doctor's office visit and patient interaction.

This was supported by medical students and interns from Stanford University who lamented that they spend more time "marooned" in the computer room entering and reviewing electronic records than they do visiting the patients who occupy beds in the hospital.

A leading senior resident commented "The body is a text, a text that is changing and must be frequently inspected, palpated and percussed.  The scent of the room, a comment by a family member that contradicts that of the patient, a multitude of inputs help us understand the patient ... the technology in medicine is tremendously valuable, but it tends to draw us away from the patient."

Doctors of ALL specialties, including chiropractic, will continue to struggle to figure out how to take advantage of electronic medical record information while preserving what is good about hands-on care. 

As a "new breed" of clinicians, you will be entering this world of electronic record exchange. If it hasn't happened yet, it will. In the explosion of all this technology, never forget your patient!  Chiropractic patients historically comment about how their doctor cares, listens and touches ... let's not lose high touch because of high tech!

Year end is a perfect time to gather data from your practice.  The data will reveal the current state of the business side of practice - the strengths and weaknesses - and it will give you substantial direction for building a plan of action for the year to come.

Gather the following for each month of 2008:

• Number of new patients
• Patient's age/sex
• Referral source
• Employer
• Primary entry complaint
• Diagnosis
• Number of completed office visits
• Clinical outcome:  Good/Fair/Poor/Did not return
• Services rendered (dollar value)
• Collected income
• Adjustment to charges
• Number of speaking engagements/in-service for other health care providers completed

Gathering data may require some extra effort, but the return on investment of time and energy can be significant.  Data analysis is a management tool that should not be ignored. 

Be sure to read my next blog:  Data, What Does it Mean?

Here's a question I received from a recent graduate. I'm sure this idea has occurred to several of you.

Hello Dr. Fucinari, I'm currently looking for an office space to work out of.  I already have a couple of people who want to be seen, so is it possible to see someone in your living room and stay within HIPAA guidelines?   

 

I know it’s somewhat less than professional, but until I get a good deal, I'd like to start building a reputation.  I was curious about the legalities of seeing someone in your home?  I’m assuming it would be like a house call?  Since I haven’t formed a business, would that default to a sole proprietorship regarding liability?

There are several things to consider in this situation.

Since you are in your own home, it may not be such a big deal for HIPAA.  You are not a covered entity unless you file claims or check other information electronically.  All files have to be protected from unauthorized disclosure, theft and fire. 

The BIG problem comes with liability. 

Let’s have others weigh in from NCMIC as to liability.  You have a huge liability in case someone falls at your home. 

You should check with your homeowner's (or renter's) policy to see what coverage you have. 

There are dozens of articles within Starting Into Practice about networking with other professionals and outlets to filter patients through our doors.

But what about networking with our peers?

The popularity of chiropractic is expanding exponentially, and our graduation rates send many (some may argue too many) DCs out into the world. 

As Dr. Braxton Pulley pointed out in a recent blog, this creates a tendency to "eat our young."  I see another trend: forget the veterans; new grads are feasting on each other! 

You can read through any chiropractic publication or attend any seminar and find undertones of the unfortunate trend of DCs circling their wagons and firing inward.  We argue over technique, philosophy, whose alma mater is 'better,' scope of practice, and the list goes on.  Enough already!

I decided to break this trend, even if for just one day, and accepted a recent invitation. 

I joined forces with another chiropractor and set up a joint booth at a local health fair.  Yes...my competition and I worked together for a whole day!  

We made the agreement that until every person in the county was seeing one of us, we were not competitors. 

• We split the cost of a banner promoting chiropractic, not his practice or mine.  
• We did posture screenings, blood pressure checks, etc. 
• We passed out spine charts and literature with neither of our names on it. 
• We each left a stack of business cards on the table, but it wasn't about that. It was about educating the public of what CHIROPRACT-I-C has to offer!  There are plenty of patients to go around, many just don't know what we have to offer!  

Take it one step further! 

Another friend of mine in a larger city formed a Community Chiropractic Collaborative.  They meet monthly to create chiropractic awareness events all over town.  As a group, they sponsor 5K's, blood drives, little league, and more. 

Consider the possibility of 20 like-minded individuals working together and sharing expenses to promote the profession in a concentrated area!  He reports to me that they are all seeing increased office flow along with welcomed camaraderie!

Ok, so maybe this is too far out there for you, but it starts with small steps. Start with a good ole' fashioned Attitude Adjustment. Pun Intended. 

Do you sneer at another DC's ad in the newspaper or do you smile because maybe just one person read that ad today and finally got the Big Idea?

Your brainstorming ideas are always welcome.  Any other ideas on joining forces?

Ahhh, the winter season is in full swing and the back pain from snow shoveling or slipping on the ice is bringing patients in that I have not seen in a while. There are also many new patients. 

Now, I do not want to take advantage of a situation but let's face it ... we are the portal of entry for these conditions. Very few of these aches and pains are an emergency room case and people do not want to wait 4 days to see the family doctor. 

With that said, during this season, I find that my office needs to be accessible more than ever.  I realize that not everyone is in an area where it snows but this is applicable to any acute pain situation.

So what do I do?

I make sure that the front desk makes every effort to accomodate these patients.  As I wrote in a previous post "what makes your time more important than mine", if they are unsure of where to place a patient, they can always come back and ask me. 

If a new patient is calling to make an appointment, then your marketing has worked. And now is the time to follow through with the plan by getting them in ASAP before they decide to go elswhere.

Along with getting these acute cases in to the office, it is also a great time for some patient education in terms of icing, heating, stretching, exercising and dietary advice as I find my patients tend to be lazy and less healthy during the winter months.

On a personal note, (and this goes along with Dr. Palmer's last blog "Are you beating your head against the wall?") jamming the idea of supportive/wellness care at this time may not be a wise move.  Chances are that a large percentage of new patients have not been to a chiropractor before for one of many reasons.  

But I have found that the notion of having to go back for the rest of your life is the most popular...and most frustrating to me!  

Many conditions may require supportive/wellness care but trying to force this treatment plan on them without the time to form a relationship and educate them may end up pushing them away.  In my practice, I resolve the condition of a new patient and discharge them from care and have them call me when they need me. 

Inevitably, they will call and I will continue to resolve their problems.  Over time, a large percentage will realize how much better they can feel with periodic evaluatons and they will choose a wellness program.

I realize that this is against every "wellness" concept that we are taught by the marketing guru's. As you can see, I believe in wellness but have a different method of getting it across to my patients.  Am I wrong and philosophically weak?  Give me your thoughts and post a comment here.

I just returned from Parker Las Vegas where I had the opportunity to observe the mood of both new and established DC's. Truthfully, I was expecting to hear how everyone's business was down and how the poor economy was affecting business.

What I heard was quite the opposite!

DC's from across the nation were saying that business was good! I heard speakers telling the crowd that NOW was a wonderful time for chiropractic, especially because of the economy.

DC's were excited that for the first time in a long time, people were seeking chiropractic care which offered them HOPE. No longer willing to pay high prices or settle for medication that often masked physical issues, patients are looking toward more natural alternatives where doctors care about them.

You can take advantage of this situation as a new DC. YOU have a chance to spread the word throughout the area where you live. Here's how:

• Offer your speaking services to your community
• Write news articles on health care
• Local radio stations love interviewing doctors who have a passion for what they do. Find a patient who has benefited from chiropractic care and invite them along to share their story!
• Contact local companies and offer 30-minute lunch programs. Tout your education and statistics that prove your expertise and knowledge.

Remember, chiropractic is offering patients HOPE without surgery or high costs. So in this new year, with a new president, take up the gauntlet and realize the opportunities you have in this economic downturn!

Get out there and make a difference in chiropractic!

That's what we've always been told.  Practice makes perfect.  It applies to sports, music, public speaking and chiropractic.

It also applies to interviews. 

I have a friend who is job hunting.  She has an interview today.  So last night she came over to my house and we did mock interviews.

Sure, it seems silly at first.  Me asking a friend whom I've known for close to 20 years to tell me about herself.  But once we got past the initial giggles, it became a useful tool for her.

Here are areas where it helped:

• Delivery of the answers in a smooth, well-thought out manner.
• She identified areas she was weak and how to deal with it during an interview.
• She identified her strengths and how to play them up.
• She now knows better what to expect. 
• She hasn't interview for a long time and some of the anxiety has been relieved

I think the most important benefit is that she is now more comfortable going into the interview process.  After we inteviewed for a while, she was much more relaxed and her personality was able to shine through along with a heck of a sales job.

Before you go on that interview with a hiring doctor, grab a friend or two and do some mock interviewing.  I think you will find it some of the best preparation you can do.