EPISODE 443: Capacity Block Breakthrough: Clinical Capacity

Hey, chiropractors. We're ready for another Modern Chiropractic Marketing Show with Dr. Kevin Christie, where we discuss the latest in marketing strategies, contact marketing, direct response marketing, and business development with some of the leading experts in the industry. 

Dr. Kevin Christie: [00:00:00] Hey doc. Welcome to another episode of Modern Chiropractic Mastery. Today I have a solo episode. For you. One of the things we do with our coaching clients is work them through the capacity block breakthrough. We're gonna go over that today of blocks that we see in practice growth, and in today we're gonna dive into clinical capacity block where you're just.

It kind of hits your max of patient visits you can see in a week or a day or a month, and we're gonna dive into that today. But before we do though, I do wanna make mention we, we have a new offering in our coaching program aspect, and that is an associate training program. So if you are an owner, doctor, and you have an associate, whether it's uh, fresh outta school or started with you recently or just needs.

Some, some training. I think one of the things that we've realized with coaching so many chiropractors and practices is that there's really four stages of having an A team. And that, whether [00:01:00] that's front desk, office manager, associates yourself, but essentially, you know, you need to have a talent acquisition plan that is step one.

Step two is you need to have a great hiring process. Step three is a really strategic onboarding process, and then four is continued training. And one of the things we see oftentimes is you may hire. A good associate, uh, but the onboarding and the training wasn't really there, and that's something we've earmarked with a lot of our clients.

And so we developed a, a coaching program. Again, it's gonna be for the associate to attend and for the owner to sign up for and pay, but it's a great investment, uh, in your practice and, and in your associate. And the details are, are simple. It's a, it's a six month program. It's two training calls per month with different coaches of ours.

We have 12 lessons that we work that associate through to make sure that [00:02:00] they are doing everything appropriately from treatment planning to report of findings, to community outreach, to overall communication, to market content marketing. I mean, you know, we, we really sat down and thought of like what would be the.

Ideal training program and skillset for an associate to have and developed a training program around that. And it's only seven $49 per month. It's a six month commitment, and after that, there's no further commitment. You may choose to continue with our traditional marketing and coaching program for yourself or your for your clinic, but this is just a six month um, process.

So just go to our website, modern chiropractic marketing.com. Just, uh, there's a contact form. Reach out to us and just say you're interested in the associate training program. We are only taking seven practices to start out with this and so, 'cause the bandwidth of the, of the different, you know, I'm gonna be doing some of the calls.

Kurt Berger's gonna be doing some of the calls. [00:03:00] Dr. Ashley Jordan's gonna be doing some of the calls and Gage Winkle's gonna be doing some of the calls. So we've got a team of people that are gonna, you know, really specialize in particular, call for your associate. Alright, so, uh, let's dive into today's topic again.

We developed a tool, we have a handful of tools. We work our coaching clients through to make sure they're optimizing their themselves and their practice. And the capacity block breakthrough has been well received and it's a, a whole document where we get clear on maybe our biggest capacity block.

Some of the ones that a practice may have are. Uh, you know, support team members, you're lacking that maybe, maybe you're lacking clinical duplication, which is just another word that I heard from the Scheduling Institute, uh, which would say your associate doctor being able to have duplication of clinical services.

Space could be a block equipment, lack of equipment could be a block. Marketing is definitely a block for many. It could be your [00:04:00] mindset. If you don't think you have any blocks, it probably is your mindset. Uh, time could be a block. Profit, cash, profit margin, cash flow. That could be a block and a delegation could be one of those as well.

And a lot of times we'll get clear with the client like, what do you think is your biggest block right now? And they'll, they'll pick one. And then what we'll realize is that. There's a lot of kind of sub issues from that one block, right? And, and so if you have a block in, um, you know, your c clinical capacity, you can only see so many people right now and you've maxed yourself out and, and, and you're struggling to break through that, um, there could be like five things going on there.

And one of the, the common issues we're seeing, unfortunately a lot with the younger dcs. That are running into this clinical block is I'll get on the phone with them. And they're busy, right? They've got their, they can't really fit anybody in for the [00:05:00] week. Um, but they're really not all that profitable and they're not paying themselves what they would like to, uh, and we're seeing it, uh, chronically in the chiropractors that are.

Um, putting a value on time in, in their clinic. The, you know, the one hour DC or even sometimes the 30 minute one, they can run into it as well. The one hour ones are really running into it and what's happening there, and, and again, even our 10 and 15 minute dcs are running into it as well. But what's happening with the one hour DC is that they're filling their schedule.

Um, but there's just not enough revenue and definitely not enough profit margin so that then they're not able to see more people, they're not able to pay themselves what they would like, let alone hire some help to then free them up to see more people because they're, they're in a finite business. Uh, kind of like a massage therapist runs into that, right?

Like part of the problem with massage therapy is it's a, it's a, a time-based economy, not a [00:06:00] results-based economy. And people pay for, I want an hour massage. I want a 90 minute massage. But people are only gonna pay so much for a massage. And even if you're great at massage, like are you gonna, are you gonna pay, you know, $400 for a hour massage?

Probably not, uh, unless you're at like, maybe a Ritz Carlton in Paris. Uh, and that's a shitty massage, but. You get the point, like there's only so much the market can handle paying for an hour massage. And we're seeing the same thing with our chiropractors that are spending an hour with a patient themselves, is that, uh, even though you're great, you're doing amazing things with rehab.

I love rehab, I love all the things that are, that you're doing. But the reality of it is, is that you can only see so many people in a, in a. In a week if you're spending an hour with a patient and then you can only charge so much, right? [00:07:00] Like people, the market is gonna say, yeah, like I, I like spending. An hour with Dr.

Smith, but can I handle, you know, $400, $500 for that session? Uh, and, and some people can pull that off, right? Like there are some people, I had a great episode with Dr. James Spencer a few years ago, who's pulled it off. But if you listen to that episode, which I recommend you do, if you are a one hour dc this isn't an episode today that's bashing him just.

Given the realities of it and then some things we gotta consider to work through that. But go back and listen to that episode. He didn't start out with that. Like he, over, over years built up to that it built a level of expertise and in, in the eyes of enough people to where it, it has worked out for him.

What I'm seeing too much. Is the only outlet valve for the one hour DC when they hit this clinical capacity is that to raise their rates substantially to try to get the [00:08:00] profit, the revenue, and the profit in there. And they're still only gonna get to a certain level. Uh, and, and, and ultimately there's a, a high sales component to that.

There's a select few. That can pull it off and then too many are trying to pull it off early in their career when they have not built up any level of expertise in the community. That would, people would see the perceived value of spending $400 in an hour to to get treatment. Right. And so we're seeing, um, that, and that's one of the ways why, you know, it's not that it's not completely akin to the massage therapist, but it's the same animal that a massage therapist runs into and why they have a hard time really building a thriving business that pays them a professional living and able to hire people.

And the best, most sustained practices that I've worked with, whether we've coached them or they've been in our masterminds, are the one that can you [00:09:00] know, increase revenues, um, ethically, and then be able to hire teams and be able to hire associates and they don't burn out. I just don't know how many of the, uh, you know, hour long visit dcs, uh, are gonna have associates down the road that are going, they're gonna be able to also pay the associate a professional wage.

And so you're gonna. Either never hire an associate or you're gonna burn through associates 'cause you can't really compensate them effectively or they're not gonna be able to keep up your model of care effectively. And so it runs into a, a problem. And so we see a big clinical capacity block in those folks, but again, we see it, uh, with others as well.

We definitely do and we have a lot of solutions for all types of. Chiropractors to work through that. But as we dig deeper onto why someone would have a clinical capacity block, so again, this is the doctor who is maxed out [00:10:00] on their schedule or pretty close to it and having a hard time breaking through that ceiling complexity.

One of the, one of the other blocks we see is they don't have enough support team members. Right. They have, uh, they, they don't, um. Have that person to help with all the other things so that the doctor can focus on, uh, what they can focus on and maximize their license. So, uh, you gotta look at do, if you had a support team member, a ca, a rehab ca, a front desk person, uh, a preceptor program, would that help you break through that clinical capacity?

Right. If you're only able to see. You know, 75 in a week and you feel like you're maxed out. How do we get you to a hundred a week and not feel maxed out? The next is gonna be clinical duplication. It's obviously that associate, um, if you. The ideal situation is you've maxed out your schedule and you got plenty of profit margin, and you say, yeah, I've got cash on hand.

I've got cashflow confidence. [00:11:00] I can afford an associate because I'm maxed out. The worst scenario is when you're maxed out with visits and you can't afford a. An associate, that's when you don't have enough profit margin and too many practices are not designing themselves early on to provide great care, but also enough profit margin to where when you are maxed out, you can afford an associate.

And so when you do hire, when you do this right, and this is what we try to get chiropractors to do when you, when you do this right and you have enough people being able to afford your care, and I'm not saying. Be cheap, but be to where enough people can afford it. Um, and you can grow your practice and have meat on the bone to hire an associate.

That's a healthy practice, that's a healthy business model. And so oftentimes, uh, practices hit this clinical capacity issue and they can't afford an associate, so they're spinning their wheels or. They can afford an associate, they're just having a hard time finding the right associate. And so those are two different [00:12:00] pathways we gotta solve.

And we often work with practices and and owners to solve that, whichever path they're down. Right. Um, next is space. We definitely run into scenarios where a practice is at a capacity and they just don't have the space. They're like, I'd like to. Hire an associate doctor, but I don't have enough rooms for them and we gotta solve that space.

So we might say, okay, let's figure out what the space. Resolution is may, and maybe that's not gonna happen for some time, but we could have a plan for it. Let's work that out. And then once we solve the space, then we can go hire the associates. So you might be saying, I, I got a clinical capacity issue and it's because I need an associate.

But the real root of the causes, you just don't have enough space for the associate. So space is a common block for clinical, uh, clinical capacity.

The nex is mindset. Um, that one we could probably spend a an hour on itself, but certain things I see there, people [00:13:00] are reluctant to hire associates. People are reluctant to increase overhead even though they've got enough meat on the bone. People are reluctant to pay fairly. People are reluctant. They're worried to hire an associate because they might leave them or take their patients.

Uh, people are reluctant to. Um, go from spending an hour to 30 minutes with a patient or go from 30 minutes to 20 minutes with a patient and have a, a rehab ca do the rehab. People are reluctant in many ways. Um, when they hit this clinical capacity, they don't want to complicate their business anymore. A lot of things happen there, and we have to dive into that with folks as well.

So. Mindset. I think probably mindset is probably at the root of a lot of blocks we have. Next is lastly is profit and cash flow. I kind of touched on it already, right? It's just we gotta build a business that has profit, profit margin, ano, you know, and it's not a profit percentage only, right? So we've got.

A couple [00:14:00] scenarios that we can see happen here is, uh, I'll get a chiropractor that keeps the overhead super low. They're really happy about things. And, and they'll, and they'll brag about the profit percentage, but you look at it and they're, they're maxed out and their revenue is $200,000 for the clinic for the year, and they're paying themselves 50%, uh, so a hundred thousand a year, which is fine on the surface of it.

But now they've hit that block and they can't break through that, um, because there's not enough. So maybe they got a high percentage of. Profit in that practice. 'cause overhead is super low and maybe they're not reinvesting money into it versus a practice that's like a million dollar practice and has a less profit margin.

Uh, maybe they're, they're, maybe they're only 25%. Profit, uh, which isn't only, it's a good profit again, if you're, if the owners paying themselves a full salary, uh, reference Greg Crabtree's work, [00:15:00] but, uh, 25% is 250,000 a year. And, and that's a professional living for a chiropractor, right? And so the. The profit percentage might be lower, but the absolute amount of money being taken home by the owner doctor is obviously way higher.

Uh, I think we all would trade in a hundred k uh, salary for 250 k, uh, but it takes work to get there in building that up. And so profit is important. Cash flow is important. Cash on hand is important. If you have that, you can typically, uh, break through a lot of the, the blocks you have. And like Dan Sullivan of Strategic Coach says is if you have the money to solve a problem, you don't have a problem.

Right? And a lot of us as chiropractors have problems and as part of it's, we don't have enough profit and cash flow to solve that. Problem. And so that could be the root of where your clinical capacity block is there. So we, and we have more to this tool, we really try to break down. Well, like what's the big domino we gotta tackle?

Then go to the next and go to the [00:16:00] next and really help you break through that, uh, ceiling of complexity that is in your practice so that you can grow. And then ultimately, yeah, like pay yourself a professional living. Get it. I'd love for you to pay, be paying yourself 200,000 a year and then have an associate that's making a hundred thousand a year and a few years of hard work and now you're making two 50 in the associates.

Making a buck 15 or whatever, you know, in year two or three. And then you're all, you're both growing from there and you got a great situation. I'm just not seeing that enough. And a lot of the root causes, 'cause the owner doctor is running into blocks and they're not. Uh, working to solve that or maybe just don't have the, the know-how and that nothing wrong with that.

The first step is to admitting what you're missing and, and that's where we're here to help you out, uh, no matter what type of practice you are. Um, if you want to go from an hour and work on how to. Increase your capacity block without, [00:17:00] um, having to, um, you know, charge a, a, a ton of money that very few people can, can afford, and you're just not quite there yet.

And the ability to do that, and maybe you will someday down the road as you build up your expertise like James Spencer has, again, watch that show. Just Google search. James Spencer, modern Chiropractic. Um, mastery Podcast and it'll pop, pop up. I think it's a great timeline if you're going to go that route to do it, but in the meantime, there's some other solutions for you to get there.

Or maybe you just, you know, you're spending uh, 15 minutes with a patient, but your OVA is super low and you don't have enough profit margin there. We work with a lot of chiropractors to increase that OVA office visit, average dollar amount per visit. There. So I hope this was helpful. We'll be doing, uh, on some of these solo calls to finish up this year.

I'll be breaking down some of these other blocks that we have and try to help you out and growing your practice and not being busy and broke.