Not long ago I watched a movie starring Channing Tatum as Tyler, a roughneck with soul, and Jenna Dewan, as Nora,  an aspiring ballerina from a wealthy family. They both learn lessons about dancing and life in this teen drama. One of the biggest lessons they learned was that you've got to shed old habits (and maybe even old friends) to succeed.

You can't be afraid to ask for help and can't be discouraged if someone tells you "NO." 

In other words, you've got to "step up" to the challenges facing you right now as you get ready or have just opened your practice!  

When Mike, Dan, Anna and I conduct Starting into Practice and Risk Management programs at the colleges, we are all delighted when we meet the students who "step up" to ask questions. It's amazing how that works.

In fact, I'm just back from a college program. In the classes I teach I often ask the students, "Where do you plan on practicing?" A young woman in the back of the class answered, "I'm planning on going to Orlando. Do you know any doctors there that might be willing to tell me what it's like to practice there?"

It took me by surprise, as most students (and unfortunately I mean "most") don't think they need anyone's help. I told her, "Yes. See me after class." We had a nice conversation and I was able to refer her to a very reputable D.C. in Orlando who I know will be delighted to answer her questions.

That's what good doctors do.

So before you strike out on your own, or maybe even after, and you find yourself wondering "Where do I turn next?" try sending your questions to "Ask the Expert" or ask one of us, or your favorite professor, or a successful business person to help you with advice, give you encouragement or suggest a referral.

You may walk away with just what you needed!

You can't do it alone so it's time for you to "Step Up" and ask for a little help!

Can you share with us anyone who made a difference in your school life or your business success when you "stepped up" to ask for help?

Intrepid blogger Ginger Marcinkowski and I had the opportunity to have a long, frank disucssion with an associate doctor who has been practicing for about three months.  Let's refer to him as Dr. Z.  We will be posting a series of blogs to pass on some of the insights this young DC had to share.

I was first curious as to what Dr. Z had learned during the first three months.

First area of growth for the doc was with case management.  Dr. Z felt he was seriously lacking in getting all facts during the initial examination and preparing the report of findings. 

He struggled with managing patient expectations and communicating what results can be expected after treatment. 

"Telling the patient, in some cases, that they may only have a 50/50 chance of benefiting from my care was a statement that never crossed my mind in college."  Dr. Z found that offering the patient a trial period of care and allowing him to decide if it has been beneficial made the patient feel he had been dealt with honestly, fairly, and was receiving quality care for their money.  "I found it instills immediate trust in the doctor," says Dr. Z.

The other area of growth for Dr. Z has been learning how to properly treat various cases.  The variety of patients is far greater than what was his experience in the college setting.  Observing and treating acute injuries, how to correctly apply therapies, and the correlation between patient complaints and the amount of time between maintenance visits were all areas of learning during the first three months.

"Initially, I did not realize just how little I knew about case management and I now realize I still have much more to learn"

Well said, Dr. Z.!

There are some very simple and easy steps you can do to ease your ability to get hired.  These are just a few:

1.   Credential with insurance companies

Ask any field doc, and they are likely to tell you how annoying it can be to go through the credentialing process with a new doc.  When you have determined where you would like to get set up, start contacting the appropriate insurance companies.  In many cases you can get enrolled in the programs before you are hired.  There is often a small credentialing fee, but it will really make things easier for your other doc.

2.   Create a marketing plan

Too often I see new docs who are planning on associating eschew their responsibility in creating a business plan.  While this is an issue unto itself, I am going to focus on the marketing plan.  Do a demographic study of the desired areas where you want to work.  Who do you want to take care of?  How are you going to meet them and bring them into the office?  It will truly put you way ahead of the game if you have a plan for this as you are talking with field docs.  I have yet to run across someone who is that prepared.  

3.   Get involved in the community

As you are looking into an area, look for organizations, etc. that you have an interest in getting involved in.  As a field doc, seeing an intent to dig into the community will give a strong signal that you are serious about this.  The last thing I want to do is invest time and energy into someone, and have them take off for someplace they would rather be.  

4.   Go where you want to live

This item probably should have preceded the last one.  Make sure you are looking for jobs in places you want to live.  A rough statistic suggests 80% of docs stay within 20 miles of where they associate.  If you don't have a desire to live someplace, it can really show in your interviews.  Most docs like where they live, and an earnest interest in the area will create a connection between the two of you.

I hope these suggestions have helped.  For details on how to write a marketing plan, please refer to the content on our website.

Very soon, doctors will be graduating from chiropractic colleges throughout the United States.  It is truly an exciting time in your career. But if you do not proceed with caution, it could ruin your chances for a successful start.

The contract is a legally binding contract between you and another party.  That other party may be an employer, a business partner, a practice management company or an insurance company as in the case of a PPO.  Whichever it may be, it is your responsibility to thoroughly read the contracts, ask questions and in most cases, seek guidance from family, peers and/or legal counsel.

Recently, a soon-to-be-graduate, asked me about an associate contract. The pay was not bad, but I noticed that the contract had a 50-mile non-compete clause. 

Isn't that too excessive? 

Maybe not in the tundra of Alaska, but in a metro area, it may not hold up in court.  Time to talk to an attorney.

Are you going to be an independent contractor?  You must make yourself aware of the IRS rules as an independent contractor.  Are your hours being set?   Will the other party involved schedule patients for you?  Will they collect for you?  Will they provide equipment for you?  If you answered yes to any of these questions, then you most probably will be deemed an employee and not an independent contractor.

When getting into a Preferred Provider Organization (PPO)  you must carefully read the contract.  Once you sign the contract, you are legally bound to follow all the PPO rules and regulations. 

The reimbursement rates are not the only criteria to consider.  As an example, some Blue Cross PPO plans also control what services are billable and, as in the case of physical therapy codes, who can perform the services.  One recent case with a Blue Cross Federal PPO plan stipulated that trigger point therapy had to be done by the chiropractor and could not be delegated to staff, such as a massage therapist.  Since the doctor had several massage therapists performing this service on his orders, it led to a demand of repayment by Blue Cross of several hundred thousands of dollars.

You made an informed decision when you decided to become a chiropractic physician.  Using that same investigative attitude may pay off huge in future dividends, a successful career and multitudes of patients benefiting from your care. 

Since I'm a movie buff, I've had a heightened awareness of Facebook and, more specifically, the story of how it came to be.

"The Social Network" has created a lot of buzz in moviedom.  Is it accurate?  Does the movie accurately depict the dynamics between this small group of young people who ended up changing the world?

So, I was interested to read commentary by Eduardo Saverin.  Of course, I read it hoping for additional insights into the story behind the movie.  But what I got was a perspective on entrepreneurship from someone who has lived it.

Thought I'd pass it along.

Young D.C.s seeking associateships are eager to begin working on their new career.  Often times, the fine print is not read, the due diligence is not done and the care is not evident in “careful” and the experience which started out as a dream becomes a nightmare. 

What do you do?

When your relationship turns sour for whatever reason, first read the fine print in the contract (if there is one).  You will be surprised at what you will read and learn because some of the fine print is very, very difficult to extract yourself. 

However, there are usually clauses which require you to give notice. Pay attention to those requirements and if you did not consult an attorney initially, now may be a good time to do so.  Honor the contract, which is a key responsibility you have and also one which will be a lasting teachable moment in your life. 

Following your review of the contract, give notice, begin to plan for your exit and then - as Kenny Rogers says "fold 'em" and move on. 

If there is no contract, do the right thing. Give several weeks notice and extract yourself like a bad tooth from the jaws of an unpleasant, unethical or unfulfilling experience immediately.  Better to be searching for another associateship without the stress than trying to continue in a mental state of dysfunction. 

Is it easy ... hell, no.  But often the right decisions are not!

Lots of good associate relationships are available - the key is to find them. 

How to do that is a lot like the story of the drunkard looking for his wallet under a lamppost to no avail.  A passerby asked him where he lost his wallet, he said half a block down the street.  He asked why he was looking here, and the response –“because the light is better!” 

Ask yourself where you want to be - location is a critical factor to your overall satisfaction.  If you have a spouse or significant other, the decision should be mutual because nothing wears a relationship thin than half the partnership being unhappy. 

Once you have determined the location, do your “sole searching” and that is not finding yourself … that is hitting the street walking from door to door and meeting all your colleagues in a 30-mile radius.

You will be surprised at the positive reception you will find.  By the way, ask these colleagues about the next local meeting of your colleagues and then attend. Ask the chairman if you could say a few words at the meeting. Then have a short bio available for the D.C.s who attend and seek their help in finding a position. 

Your energy and determination will go a long way in creating an image that your colleagues will be impressed with.

Know when to hold 'em … and professionally engage your trump cards.

The college door swings close behind you. Panic begins to settle in. No more classes. No more tests. No more loan money to live on. Just a wide open world ready for you to claim!

What now? 

Your student loans will be due in six months! You haven't even decided where you're headed yet! Help!

Sound familiar? 

Not to worry, because you are still in a  position to succeed! The economy and luck are on your side. Never has there been a better time to walk into a chiropractic office in a town you might want to practice in.  ASK for an opportunity to associate with a possible chance of buying the doctor out at the end of a year or two!

Here are some reasons this could be your ticket to financial success!

1. Baby boomers are ready to retire
2. Very few baby boomers have exit strategies
3. Upcoming Medicare rules will require electronic billing
4. Baby boomers may want to walk away rather than learn electronic billing
5. Baby boomers want more time to relax
6. You'll have a turn-key opportunity if you create that exit strategy for the doctor

So, what's required of you?

• Find the place you want to practice
• Visit doctor's offices in that area
• ASK if you can associate with them for a year with the thought process that if you have a good fit, you'd like to buy the practice!
• Arm yourself with knowledge of their practice and expect a few no's before you find the right fit!

Some doctors might never have thought about hiring an associate, but if you're well prepared with a great attitude, a personal budget and a marketing plan to show them your value you can offer them a chance to take more time off, update their computer systems and/or buy them out. 

You both might be winners!

Compensation - a.k.a. your salary.  It's a very broad category when you really think about it.  If negotiated carefully, both parties can come to an agreement that leaves everyone satisfied. 

Let's face it, you should not start a job bitter about your salary, nor should the hiring D.C. feel he/she is "giving" you too much.  Here are a few things to consider when navigating this tricky topic.  Much of the following has been learned via trial and error by myself or former classmates.

I frequently attend post-graduate seminars at a nearby chiropractic college and shortly after students find out I'm a "field doc" they start firing questions about contracts, jobs, etc. 

I even met one intelligent young man who had a 10-year plan mapped out to the finest of details like where he'd grocery shop to save money!  I couldn't help but wonder what would happen if his life didn't go 'according to plan'.  What would he do if that particular store chain closed?  Could he adapt to the inevitable changes ahead of him? 

I heard a great piece of advice from a professor once:  "failure to plan is planning to fail" and I couldn't agree more. 

However, failure to be flexible is a recipe for disappointment. 

Sit back and look at what has happened to the economy in the last 24 months.  Do you think anyone, even the nations' top financial advisors saw "it" all coming? 

Doubtful. 

Do you think the 70-year old-man who spent years dumping funds into a 401k thought the bottom would fall out months before he attended his own retirement party? 

Not likely. 

Let me be the first to tell you, and anyone who knows me will agree, this "field doc" never in a hundred years would have believed I'd be practicing how, with who, or where I'm at now.  But guess what, I wouldn't change a thing now, but it took adapting to change to make it possible. 

Embrace change.  It's inevitable.  Life is colorful ... become your own chameleon!