For young people, platforms like Facebook and MySpace may be regularly used for social networking.  They are a way to keep up with old and new friends, classmates and family members and to kill some time on a not-so-busy day.

At present, I use a Facebook account for personal use.  Like most others, my account allows me to see pictures of my new niece or email some high school classmates or out-of-state family members.  I have seen chiropractic colleagues post pictures of their new offices or even develop pages for their business. 

It has prompted me to ask, do applications like Facebook and MySpace have a place in marketing chiropractic?

According to Michael Greene, research analyst at Jupiter Research, social networks such as Facebook and MySpace can be powerful marketing platforms.  He notes that the key for companies planning to use these sites to market their products and services is not only to use ads to “push” messages to consumers but also to create engaging social environments that enable communication and self-expression. 

An account can allow viewers access to your office website, photos, videos, and contact information for key employees.  Lee Aase manager of Syndication and Social Media at the Mayo Clinic says, “It’s like a supercharged, multimedia Yellow Pages Ad, but it’s in a global directory, and it’s free.”

With all the potential for business networking online, here are some recommendations for using these applications:

• Only display on your profile what you would put on your desk
  Don’t add anything to your profile that you wouldn’t display for your supervisors, co-workers or clients to see in your actual office.
• Look for old and current connections
  This may let them know what you’re doing in your office without being intrusive.
• Add friends selectively
  Consider creating a limited profile for those people you are “on the fence” about whether to include.  Give careful consideration to exactly who sees your profile, what they see, and when. 
• Use your privacy settings wisely to prevent inappropriate viewings or postings on your site.
  Join groups related to your business interests

There are quite a few Facebook groups that can provide useful information and professional connections.  If you’re into sport chiropractic, look for groups on Kinesiotaping, ART, Graston or other applicable techniques. 

As a provider interested in pre-natal care I have joined groups and posted articles related to chiropractic in pregnancy, breast feeding, and wellness care.  These groups can provide resources for potential patients and also let your current patients know where your interests lie.

Do some good
You can use your business account to be philanthropic and look good to your friends while doing it!  You can add various applications showing your support for charity organizations in your area.  Are you participating in a walk for MS?  Provide a link for others to donate. You can support a group that stands for actions you believe in without having to be pushy about it!

So do applications like MySpace and Facebook have a place in chiropractic?  Generations of potential patients are now wired-up and these applications provide a platform from which to reach them. 

It appears that taking advantage of a free service to market your practice - and using it wisely - can certainly do some good. 

Have you used any social networking sites to help build your practice? Leave a comment below and share your thoughts.

During these economic times, it seems everyone is looking for ways to cut costs.  Insurance is an area where most people could save some money, but they don't expend the effort to review their policies and make cost-saving changes.

In many cases, you can reduce premiums by making a few changes.  In other cases, the best policy coverage may not be the cheapest, but may be the best value. 

A few tips you may find helpful as either a practice owner or consumer:

• Shop around.
  Prices vary from company to company.  The easiest way to do this is to work with an independent agent who has access to a variety of carriers.  Make sure you work with someone who understands your practice.  It is important to pick a company that is financially stable, so check the financial heal of your potential insurer with rating companies such as AM Best or Standard & Poor's.
• Look at group rates.
  Purchasing your insurance through a business or professional organization can save you money.  The savings typically outweigh any member dues.  General business organizations, such as your local Chamber of Commerce and the Better Business Bureau also offer business insurance discounts.
• Choose a higher deductible.
  Deductibles represent the amount of money you pay before your insurance policy kicks in. The higher the deductible, the less you pay in premiums.
• Consider a package policy.
  A Business Owners Policy (BOP) is often significantly less expensive than a self-designed plan.  BOPs include property insurance, business interruption insurance and liability protection.  Often it is cheaper to buy the bundled product rather than buying the coverage individually.
• Work with your agent.
  Your agent is responsible for helping you identify your risks and providing the products to manage those risks.  A good agent will sit down with you to review everything you have and where coverage enhancements are needed and where cost savings may be acheived.

Remember, the policy you purchased in the past may not be the best policy for you now.  Call your agent to schedule a review and see if you can enhance your coverage and save some money!

While most of us believe we're invincible, estate planning is something we should all do regardless of station in practice or life. Often we focus on paying off educational loans, saving for a child's education or a second home.

While all of these are important, deciding what happens to your money and estate at your demise is crucial to the well being of your heirs. Otherwise, others will decide what happens to your assets and as some have said, "If you don't do it.... someone will do it for you."

Regardless of the size or complexity, a few key elements to consider as you establish your estate planning include:

WILLS:  A must for all but particularly those who are married or have children. A will can clarify who takes care of children in case of a parent's death. Otherwise the state will chose, based on family as opposed to who is best equipped and without consideration of a parent's wishes. Simple or complex wills can be drawn by attorneys or several on line websites are available to guide you through the process at little or no expense.

LIVING WILLS: These should also be considered by all. Not too long ago, most of the country was bombarded by the media concerning the Terry Schiavo case. Family members argued and speculated over her wishes of whether to continue life support or remove artificial methods being used. With the use of a living will or medical directive statement, these issues can be clarified and implemented fairly easily. Once again, these instruments can be drawn by an attorney and can also be found on the Internet, but don't forget.... the devil is in the details.

SPECIAL NEEDS TRUSTS: While we all have concerns for the welfare of our kids, parents with children who have special needs [mental or physical] often have specific considerations, particularly how a parent's  death would effect those with these challenges. The establishment of a special needs trust can supplement the benefits a child might receive from the government if his or her parents were deceased. Again, planning is imperative and while not difficult to establish, the special needs trust can address funding, whether through life insurance, securities or cash and also address who will serve as trustee, guiding the needs of the beneficiary.

ESTATE TAXES: Currently [2009] a husband and wife can pass $7 million to their children tax free. If dealing with larger amounts, appropriate planning can reduce the tax liability to loved ones. Planning and reviewing the plan periodically is important particularly as life milestones and families change.

Wills, trusts, and estate plans are no longer just for the rich and famous. They are a method by which each of us is able to protect our hard earned assets...and don't forget to periodically review the documents as life circumstances [baby, divorce, lottery winner, etc.] change over time.

Happy Days!

When asked to share some very basic but valuable thoughts to those of you about to graduate I immediately thought of a simple rule ... the rule of 1-2-3.  I have taught this rule to hundreds of new doctors planning their first office and to almost every staff person they've hired.

What's the rule of 1-2-3?

Make everything you design, concept and execute usable in THREE formats. Not only is it effective, it saves time and money.

Need a couple of examples? 

Your business cards

Well, the first is branding 101.  Once you have developed a logo for your office (and please, let's be contemporary about this one!) you will probably place it first on your business cards. 

Apply the 1-2-3 rule to that card!  How can you use the same, simple card in three different ways? 

1. First is the standard professional card. 
2. Second - print a place for appointments on the back
3. Third - print it again with a message to draw people to you...how about your website address with a catch phrase like "have questions about my services/chiropractic?  Visit my website at www.ABCChiropractic.com.  Of course this is now assuming that you have a website, or plan on one and if you do, be sure again you 1-2-3 the site (read on). 

Your website

1. First - design it and get it up and running ... no matter how simple.  You can continue to build the site over time. 
2. Second - have a Q&A section (you will have to write it, with commonly asked questions and answers).
3. Third - invite people who visit your site to provide their email address for you to send them monthly articles (there's another 1-2-3!)
4. Bonus ... create a way for potential patients to make an appointment and/or download your intake forms to complete at home.

So, back to those business cards...establish a business relationship with a local printer.

Yes, it may be easier to send away to a catalog or print your own, but relationships aren't built that way (more in another blog).  Price breaks on all printed items come in bulk ordering.  Tell the printer that you may want to print a large quantity of cards -- some plain, some with different messages on the back.

The printer will give you some ideas regarding costs and price breaks.  I NEVER print anything with only one purpose in mind. And if I only have one right now, I still print in bulk with the understanding that when I want something else done with that supply it can be done.

Dare I give you another one?

Letterhead and envelopes

1. Print standard letterhead on high quality paper with matching envelopes.  This "good stuff" is kept for the most important communications. 
2. Print on a regular quality with a regular quality envelope for billing, mass mailings, messages, etc. (The ink is on the press...so all the printer does is change the paper).
3. Ask if it can be printed with a border around the page...perfect for a one-page newsletter. Yes, there are plenty of people without email and who actually LIKE to get snail mail!  And how are you going to get their email if you don't send them something to drive them to your site?

I'm on a roll...so here is one more.

1. If you have a logo or black and white sketch of your office or logo have it put on heavy stock with a matching envelope in a size like a personal fold-over note. 
2. They can be left unfolded and printed on the inside when you have an open house or office event, left blank for handwritten personal notes to anyone you wish for any occasion,
3. And the best one yet ... one doctor's spouse "enhanced" a black and white picture of their home office with a bit of white snow glitter and made them into Christmas cards!  

So, my challenge and advice to you is to never look at anything as a "one time wonder." Instead, create a 1-2-3 and before you know it, it will be 4-5-6 too!

Experience tells me that the more you plan the more efficiently and quickly you will achieve the goal.  Time management experts state that for "every minute spent in planning you can save as much as 10 minutes in execution." 

So, if you spend 10 minutes planning you save nearly two hours in time and wasted effort!

Many doctors ignore the importance of planning tools like the simple "to do" list.  You can increase your productivity by more than 25% the first day you begin working consistently from a list.  The ideal list system includes:

1. A Master List that contains everything you want to accomplish sometime in the future.  Write down every thought that arises.  Keep a separate list for your personal and professional thoughts.
2. A Monthly List that you create at the end of each month in preparation for the upcoming month.  The list may come from some of the items on the Master List.
3. A Weekly List that plans out the week. The list should be under constant construction and reconstruction as you move throughout the current week.  
4. A Daily List that includes specific items associated with the monthly/weekly lists.  

For those of you who have "given up paper" and function with a computer or Blackberry, lists can be created and logged using Microsoft Outlook.

Don't throw out your completed or outdated lists! Archive these on your computer or file in a folder for future reference.  Every quarter, review the old lists to see how for you have (or have not) come.

The road to a fully actualized practice requires planning,focus and execution.  These simple steps can and will provide a road map for your professional career.

And, oh yes, plan for an occasional "detour."  But with good planning habits, you will be back on the expressway with a minimum of inconvenience.  

I recently went through a reorganization of my real estate business.  It was a learning process.  One thing I learned is that my insurance may have covered me, but not my corporation.  I needed to contact my insurance agent and make some changes to the policies.

That got me thinking about malpractice insurance for the chiropractors served by NCMIC. 

If your practice is a corporation, you must let NCMIC know so we can ensure you have the proper coverage in place.  When your corporation is added to the policy, you and the corporation share the limits of liability on the policy. 

For example, if you and your corporation are named in a malpractice action, and you have limits of $1 million per occurrence and $3 million aggregate, you and your corporation will share the $1 million for the claim.

You can also add separate limits for your corporation for an additional premium of 20%.  In the example above, you would have $1 million and your corporation would have an additional $1 million for the claim.  You essentially are doubling your coverage for 20% of your premium.

Issues like this really hit home the importance of working closely with your insurance advisors.  NCMIC's client representatives are available to help you identify and manage your malpractice risks, including any resulting from the incorporation of your practice.

Following are some questions recently posed through "Ask the Expert" on this site. You'll see the answers posted to each section. I hope this helps all our new D.C.s.

I’ve heard that a successful practice can be measured by (1) new patients, (2) case average/dollar amount and (3) patient visit average. I understand the first two but am perplexed about the third. In all I have studied, there is a huge range of recommendations for care. I've seen ranges from 3-7 visits over a few weeks to 50-100 visits over a year. 

These are not the successful numbers.  New patients definitely are the lifeblood of any practice - new or established.  So getting NEW patients is critical at any time in the practice cycle.

There is no case average. The case average is not established before you start seeing patients but rather after you have been in practice for some time and understand the “case mix” of  your practice, the demographics, the practice style you have opted for, and a host of other factors such as size of facility, number of treatment rooms, staff, etc.

So the average after your first year and second year will be determined by your practice and not some outside number.

The Patient visit average….is simply bogus practice management guru talk. The patient visit average is whatever will get the patient to a functioning state.  Nothing more. Nothing less.
 
It is this very absurd number of 50 to 100 that has gotten this profession in trouble over the years.  There are very few cases which will ever require that kind of number of visits, much less to call it an “average.”

What do you find most docs do for recommendations for care? Do they follow certain guidelines or protocols or documents?

You should be thankful that your college taught “ethical” management of patients and the recommendation for care is what you can justify and document coupled with demonstrable evidence of improved outcomes.  The care is individualized and not based on any average but on each individual who walks into your office.  We are not dealing with widgets … but with people who are scared, suffering and vulnerable. They need to be treated as such.
 
From the outdated Mercy Document to the AHCPR Document to the more recent Council  on Chiropractic Guidelines and Practice Parameters (CCGPP) which have just recently been published … these will provide the most evidence-based protocols and guidelines available. 

Is there a case for "maintenance care" or "supportive care"?   If so, how do we get that across to our patients and get them on board? 

Certainly there is a case for maintenance and/or supportive care – but these are two very different items.  Maintenance is care that the patient selects without any health condition and is paid for by the patient out of pocket. There are no insurance company plans that pay for maintenance care. It is desirable and when the patients self-select this kind of care they are excellent patients and very compliant and health conscious.  Supportive care is care that is therapeutically necessary because the patient will not be able to sustain maximum therapeutic benefit when care is withdrawn. If you are able to documented it, then it should be reimbursed.

I also would like some numbers. If someone comes in with back pain or neck pain, what would the average chiro recommend for treatment in visits and time (weeks)? What would he/she do once the patient is out of pain? Drop them from care?   Continue to treat them until the treatment plan is done? Is there justification for treatment beyond pain? Who or where would you recommend I turn to for more mentoring on this subject?

Easy ...  take the time to educate them.  And recognize early on that not every patient will buy into that model.  Accept it, covet those patients and take time to develop the kind of practice you want.
 
Examine the patient, determine the history, do a physical, conduct appropriate testing, put the patient on a two-week minimum of care and re-evaluate. The rule of thumb is if a patient is not demonstrating some improvement in a two week period, it should raise red flags with you because something is wrong. If you work in two week intervals, there is always time to reevaluate your options based upon the patient results and there is no long-term commitment, the commitment is based upon patient outcome and doctor patient relationship (the best kind).
 
Physician know thyself …you are already on the right road by not adopting the nonsense that has been touted in the chiropractic press. You obviously are uneasy with long-term care with numbers that are picked from the air.  Deal with each patient as an individual and you will not have problems being successful and getting your patients, better quicker and less expensive which is the very thing that made chiropractic great.
 

"But I don't have time for that!" I hear it often from friends and colleagues and I've even said it myself.  When did we get so busy that helping a stranger 'just because' was beneath us?  

I am part of an organization that has begun a reading program at the local elementary school. Although reluctant due to time constraints, I did it anyway. Who knew the outcome that would follow.

I'd like to share my thoughts and their consequences over the past few months, because 'I didn't really have time for this...'

Last fall, I was invited by a friend to be a part of this group, an education foundation.  They raise money to give back to the school system to pay for things outside the school budget. 

"Ok, here we go...another group that will suck up my time like a 7-Eleven Slurpie."

He and his wife became new patients the following week.

My friend asked me to head up the committee to organize a tutoring program at the elementary school. "Please order lapel pins and design some fliers. Oh yeah, and could you meet with the principal and school counselor?"

"Ah, geez...now I'm held accountable."

Three of the four committee members referred a spouse or friend.  

As committee chair I, of course, had to sign up for this reading program and now I carve time out of my already busy day to read with a little boy struggling in class.   

The school secretary I check in with upon arrival is now a patient.

"Hmm...I see a trend here."

I ran into the little boy in the grocery store with his Dad, who upon meeting me, said"Aren't you the chiropractor lady"? 

His wife, and his co-worker are now both patients. 

The little boy's teacher told me his reading scores have improved.  He is now excited to go to the library when I show up for our session! 

By the way, the teacher is now a patient.

And I thought "I didn't have time" to spend 30 minutes reading with a child.

I won't complain about the new patient flow, but the smile on that kid's face is worth more than I'll ever collect from the patients "he referred."

Sometimes it's the stuff we don't have time for that proves to be more effective at practice building than expensive yellow book ads.

Please share your inspiring ideas of Important Stuff that turned out to be free marketing.

I am sitting here writing this article with an albatross around my neck.  There is a woman that works at NCMIC who probably has a voodoo doll of me and is sticking it with needles.  I feel like I have let her down.  I was supposed to have this post done two weeks ago, and here I am sitting today finally getting around to my responsibilities.

Why do I do this to myself? 

Why do I wait until the last minute and then let things go by without getting them done?  I can give you all the excuses in the world - but the fact of the matter is that I committed to doing this and I am failing at that duty. 

This got me thinking about how easily we tend to self-sabotage in our professional lives.  I'm going to list a few examples here.

1. Not getting your continuing education credits done.  I dislike these seminars as much as the next man.  I would rather have root canal without anesthesia than listen to some of these programs.  Yet if I don't get them done... there goes my practice.  How many of us wait until the last few months before we get it done.  The consequences are so grave, and the price is minimal... just a weekend here or there.
2. Taking good notes. Let's be real.  We all know that, as a profession, our notes could use some help.  Why don't we take the time to build our profession and show the world how effective we are through the prowess of our notes?  Every court depostion, every records request by insurers could prove our power.  Yet we still bring forth these simplistic notes that don't do justice to our work.  We all mean to do it, we just don't get around to it.  That extra few seconds could do wonders for our profession and save you a lot of money.
3. Staff evaluations.  It is a simple process. You take a few minutes with your staff to discuss positives, negatives and you create a plan for the future.  Having this process is essential to staff development and growth, yet we push it off... why?  I actually heard one doc explain his inaction this way.  He was never evaluated and was still motivated... why can't he expect the same from his staff.  Let me know if you want me to delve further into this.

There are so many more areas that I could address:  patient education marketing process networking updating your literature updating your office changing the magazines, etc.

We all have our reasons for not getting these things done, but the tragic aspect of it is we all know we could be doing better.

I have no answer to get over these procrastinations, and this blog was more of a rambling thought process than a cogent thesis statement. But I do feel that awareness is an important step to evaluating what needs to be done with it.

Thank you for your time.

I have been speaking with numerous healthcare professionals who have been affected by the economic times and some are responding by shortening their hours or closing the office on slow days to reduce overhead. 

Personally, I think this is not only a bad move but a negative knee jerk reaction.

What business ... besides McDonalds... has not been affected by the economy?  In my practice, more than ever, the patients coming into the office are acute cases who have waited as long as they could before calling for help. 

This is human nature when difficult financial decisions need to be made.  So is this the time to cut back on office hours or should you make yourself more available?

Now is the time to evaluate your practice and /or put in the extra effort to maintain a successful practice - which in my mind is keeping the office hours that you have so you are there when that new patient really needs you. 

A patient-centered practice that spends the necessary time educating patients and exceeding expectations is more important now than ever.   

I hope that no one reading this is experiencing a reduction in patient visits but if you are, hold true to what made your practice successful. Now is the time to do more ... not less! 

Do you think McDonald's will stop serving 24/7 because of the financial times?