Recently I met with a couple who were nearing graduation and contemplating their future plans. They were both very bright, highly motivated and eager to share their opinions on great places to practice.

The female had grown up in a large metropolitan area and was a proponent for this type of setting. She had a few cities in mind, believing that they offered much... including dynamic growth, job opportunities, high tech industries, a future "medical city" and multiple health facilities. She was also enamored by the cultural characteristics of the area which included professional sports teams, world renowned museums, and the infrastructure to accommodate mass transit and future residents.

Her husband - and soon to be business partner - advocated for a small community. He liked the idea of a short automobile commute traveling through tasteful and well manicured residential areas. He enjoyed the small town atmosphere of his family's hometown, including the weekly farmers market, open green space and parks, minor league baseball in the summer, as well as the historic downtown area.

Neither had considered the tax structures of their possible future homes, but they knew that both areas had great public schools which were a strong attraction.

Each partner presented great "arguments" and thoughtful rationale on why their individual choice for their "shangrila" made sense as a future home and place to build a practice and raise a family.

Following our meeting, I felt like I had been through an interesting debate and found myself... agreeing with both Julie and Jim.

Whether we choose to practice in a small town, mid-sized metropolitan area, or one of the great cities of the world, each and every setting offers both personal and professional opportunities to be successful.

My advice ... work hard, become active in your community, live a balanced life and Happy Days!

All start-up doctors know the standard ways to meet people -- Rotary, Kiwanis, church groups, social networking -- and all these are valuable places to make yourself known.  I happen to believe there is huge value in meeting everyday people as well.  People who may have a more immediate need for your services.

This thought came to mind the other day when I was at Staples. 

Over several years I have made a good number of friends there ... all of them work in the store.  One in particular is a guy named Marty.  In fact, he is my "main go-to" person when I have a problem, a question or a return!  He knows what I do for a living (sort of) and is always willing to help (more about Marty in another blog).  In fact, most times I go to the store when I know Marty is working. 

So what does Marty have to do with building your practice? 

How many "everyday people" do you come in contact with who don't know who you are or what you do? 

 What about the guy at the gas station (ok, you pump your own, but if you need a windshield wiper, your oil checked etc. there is someone there you know).  What about the lady at the window at Starbucks?  Are you just a casual "hello thank you for choosing Starbucks" or does she know you are a new chiropractor in town? 

How difficult is it to say that ... and your name ... and hand her your business card (the one with your website on the back)?  How do you know she may not hand it to someone else who is looking for a doctor?

I think we have become so mechanized as a society (bank machines, drive ups, ordering on line) that we forget or don't even see the humans we come in contact with!  I have watched chiropractors who are committed and interested in meeting people hand out cards with ease ... and don't forget to ask for a card in return (mailing list fodder!). 

How about every time you had your credit card to someone you hand a card too? 

I assure you this isn't a 1-2-3 deal ... unless of course your "weekly to do list" includes handing out THREE cards a day!

It's everyday people who build practices...people who know you, like you and remember you when they have a need. 

Don't think so?  I challenge you to reply to this blog and ask the SIP experts about this fact....and start with Dr. Sportelli ... there isn't anyone in Palmerton, PA who doesn't know him! 

In the 1990s, comedian Flip Wilson would put on a wig and a mini dressand transform into Geraldine ... a truly outrageous character.  Geraldine's screeching byline was "Honey, what you see is what you get!" 

Using that as a reference, I would suggest that what the public sees in all matters that relate to you, is the perception of you ... and remember, perception is the viewer's reality. 

• What does your personal demeanor say about you?  
• Do you demonstrate the qualities of a professional in terms of grooming, choice of clothing, communication skills (both verbal and non-verbal)?
• How have you branded yourself in all things representative of you:  letterhead, business cards, website and collateral?
• How strong are your interpersonal and intrapersonal communication skills? 
• How confident are you in intraprofessional dialog essential to the new health care paradigm?

Does your reflection in that mirror need a little "buffing up"?  Take a good look in that mirror and if there are blemishes, get to work on them ... NOW!

Remember, "what your community sees is what it gets!"

In March I wrote about a prospective opportunity I have to join a local M.D. in his new satellite office.  This new clinic will be in a community we both draw a significant amount of patients from.  His goal is to provide primary care via himself or a P.A. daily, and have a rotation of specialists throughout the week.  

Let me first thank those of you who responded with excellent advice and "thumbs up" responses! 

From that valuable insight, I thought I'd compose a working to-do list for those of you considering a similar situation. I'll update this as new ideas are presented.

1. Investigate the background of all individuals you'll now be associated with.  The 'owner' of the clinic as well as other rotating individuals.  Your reputations, good or bad, will soon become one.
2. Make sure all parties are clear as to their expectations of the working relationship.  More importantly, make sure all efforts are patient-centric.
3. Call your malpractice and insurance providers to notify them of the secondary location.  Complete any necessary updates to your file. 
4. Clarify billing.  Who will do it and how is it done?  For example, a DC cannot bill under an MD's NPI to increase the rate of reimbursement.
5. How will you be classified? Employee or an Independent Contractor renting space?  If the latter, be sure to check out the law binding specifications for IC's with the IRS.  
6. Be familiar with Stark Laws and Anti-Kickback Statutes that regulate reimbursements.  
7. Establish an in-office referral procedure with the MD to make sure he/she is not 'rubber stamping' your treatment plans and re-evaluations.   
8. Last, but certainly not least, make sure you have a qualified attorney review all documents, contracts and agreements.  This attorney should be independent from the MD.    

I'll report back when there is more progress on my situation, but I hope this list helps get you started. 

Best of luck in your current endeavors and as always, your comments are welcome!

Because I practice in a blue collar town, most of the population and prospective patients rely on their insurance coverage.  There is an ironic aspect to their "coverage" but we will get to that later.

When they ask if we take their insurance, the majority of the time we can tell from the insurance card. But in most cases, we need to call the insurance company and verify the coverage as every policy is different. 

When we call the company and finally get in touch with an actual person (which can take a while of being on hold and listening to music) it is important to get the necessary information. To ensure nothing is forgotten, my office has a checklist of questions that should be asked.

• Do they have chiropractic coverage?
• What are the specific procedures covered? Be sure to have the specific CPT codes to ask about.
• Do they require a referral?
• Are diagnostic procedures covered and if so, do they require pre-authorization?
• How many visits does the patient have and is a treatment plan required?
• Does the patient have a deductable and if so what is it and has it been met?
• Get the name of the person that you spoke with.

Granted, there may be more but this should give you the general idea.  I find it very important that the patient understand what their coverage entails so they understand their financial responsibilities when deciding to become a patient.  Surprises tend to result in an unpleasant patient experience!

If you are not a provider, find out how to become one.  I

n some cases, it is not a matter of you not "becoming" a provider but rather you "not being qualified to become a provider."  If the latter is the case, be sure to find out why so that you can explain to the patient that it is not up to you and give them the specific reasons. 

Now for the ironic part. 

I find that the majority of coverages have a huge deductible and co-pays that are as much as my office visit. So even though I am a provider...they are in essence a CASH PATIENT even if I "take their insurance!"

Next time I will tell you how I became a provider for an insurance company that did not want me.

At a recent Starting into Practice seminar, I had a student share her concerns about coming to the end of her educational process.

She is convinced that she may not want to open an office or for that matter even practice as a chiropractor.

Like many, she fears failure, the risk and the paperwork that lies ahead. She didn’t feel like low reimbursement and high oversight from the health care system was what she bargained for when she entered chiropractic college.

Once patient centered, she feels she may have to become money centered just to survive. Yet, with all of the debt she has incurred she feels she may have no other career path.

Let me assure you, all is not lost.

In today’s health conscious world, there are a myriad of careers open to chiropractors. For instance here are just a few ideas. 

• Professor - teaching health care and anatomy or other muscular-skeletal classes
• Public Speaker - Many reputable companies hire D.C.s  full-time to speak for them on various subjects or represent them at college events
• Research - the need is now for evidence-based research
• Association Leader - every state and national organization needs imaginative leaders at the helm to promote and move chiropractic to the forefront of the health field
• Lobbyist - relationship building is key to this pivotal political position
• Writing - health related articles for medical journals, newspapers and mainstream magazines can provide a revenue stream

With our economic times, look around for other opportunities where your education can and will make a difference. Don’t take your eyes off practicing what you love or a viable health care choice for an ever needy population.

Let the choice you make carry the torch of passion for patient centered care. In the end, whether you choose to associate, buy and own a practice or try some other avenue that will utilize the skills you have acquired, do it because you want to shine the best light you have on the chiropractic health care field.

Do you know a D.C. who is currently doing something outside of practicing chiropractic? Would you share that with us?