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From the outdated Mercy Document to the AHCPR Document to the more recent Council  on Chiropractic Guidelines and Practice Parameters (CCGPP) which have just recently been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.