EPISODE 490: From Vision to Scaling

Hey, chiropractors. We're ready for another Modern Chiropractic Mastery 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.

00:00:00] Welcome to another episode of Modern Chiropractic Mastery. Today, I am doing a solo episode for you, and we are talking about from vision to scale. Um, and, you know, a lot of talk around scaling, it's sometimes a buzzword, sometimes doesn't really, um, have the meaning that it should. Sometimes people think scaling just means growing revenue as quick as you can.

Um, sometimes you see in, like, the tech industry, they talk about scaling, and frankly, they're only surviving off of investors' money, and they haven't actually turned a profit, and that's actually not what scale is. And, you know, there's a lot of misconceptions around it. I think in the chiropractic profession, it may think it's, um, you know, scaling to a million dollars.

It may feel like it's scaling from one office to ten offices, uh, but it doesn't really have to be that way, and we're gonna touch base on that. Uh, but before we do, one of the things [00:01:00] with scaling is compliance as well, and, uh, that's why we brought on, uh, one of our MCM collaborators in our private practice, which is ChiroHealthUSA, because we offer...

For us, is we offer shockwave therapy, and, uh, certain carriers pay for it really well, and then we have a cash price that's different. And so we use ChiroHealthUSA to be compliant on that and avoid any dual fee schedule. So check them out at chirohealthusa.com. Highly recommend what they have going on and just making sure you're compliant if you need that type of situation or service, okay?

Um, so make sure you got your compliance. Uh, you know, it's just, uh, I wanted to kinda come out of the gates on the compliance thing. I know it's not the most fun topic in the world, but if you're gonna scale a clinic, you do have to be compliant, so make sure you have your bases covered in general, okay?

All right, so let's go in to, uh, the idea of from vision to scale because I think [00:02:00] that's the key. Because when-- A lot of times, if you go to other events or you read certain books or you do certain things or you hear people talk about scaling, it's, it's what their perceive, um, or their perception of scaling is, and it just means one thing, right?

Get, get revenue up, uh, or it may be you gotta have multiple locations, or you gotta have this, that, and the other thing, but it's gotta be really serving your vision. So we'll dive into that today. We're kinda doing a update show on this. We did, uh, back in, uh, July 14th, 2022, I did a solo episode, episode two seventy-five, called The Truth of Scaling Your Practice.

Uh, I knew I had done that, and I thought it was, like, last year, uh, but time's flying, so we're-- that was four years ago, uh, believe it or not. And we had also done a whole playbook on that, uh, also titled "The Truth of, of Scaling Your Practice." And in that particular [00:03:00] episode, I, I kinda read through that, um, and talked about certain things like the book called "The Voltage, Voltage Effect" by John List, which was good.

And really how we had def- how they defined it in that book, what we talked about with scalability is really the capacity to grow and expand in a robust and sustainable way, right? So only growing revenue or locations or office visits or those things may not be sustainable. And we see that a lot of times where scaling or the perception of scaling actually breaks your clinic or your business model.

And so with scalability, essentially boil it down is growing revenue without growing overhead equally, right? There's gonna be some overhead increase as you grow, but you wanna be able to grow the revenue and then also grow the profits, uh, substantially as well. And that's [00:04:00] really the, the, the, the down and dirty of what scaling is, right?

And, you know, some of the things that you get from scaling that I talked about in that episode were definitely improved profit margins, prevent professional burnout, function in your unique ability, which is a strategic coach thing, and I'll touch a little bit more on that. You charge what you're worth.

You get better patient outcomes, enhanced continuity of care for your patients, increased valuation of your practice if you go to sell it, and ultimately you get better team members from that. And those are some of the benefits of, of scaling your practice. Um, you know, we als- why we also did the 30K online course, um, I think that was a year and a half ago, was I feel like scaling to 30K a month average is really that first step of scale that allows you to start [00:05:00] to hire and bring on and reinvest into your business things to scale to the next level.

And so I did a blog on that. You can go to our website, modernchiropracticmastery.com, and check our blog section, and you can see the 30K blog. Uh, I don't have the course on there anymore. That's not available to purchase. We do, in our coaching program, we have... Everybody has access to the 30K course. They have access to the Cash Confident course.

They have all that stuff. But, um, you know, you can read the blog if you want to. And 'cause I felt like that was like the first level of, of scale was let's, let's get you to 30K, and then we can, you know, break through that ceiling of complexity and go to the, to the next one, right? So now let's talk about something that I ask a lot, and this is one of the foundational things that I learned from, uh, Strategic Coach, right?

And that's the R factor question. And whenever we get a, [00:06:00] a, a potential new client, we ask it. We ask this question whenever I'm doing a, a full-on three-year vision, uh, with one of our clients, I ask this. Um, we even ask this question to our patients and during our history and consultation. Now, it's not a three-year timeframe when we ask it.

It's at the end of the care plan is the timeframe that we ask it. But the R factor question is, and I'd love for you to y- if you get one thing from this episode today, would be for you to get clear on your vision. And so the question is, again, this is a Strategic Coach, um, question. The R factor question is, um, three years from today, what has to be the case in both your personal and professional life that you would be happy with your success, right?

So if you were to project out three years, so as I record this, we're in August of twenty twenty-six. So let's just say, you know, summer of twenty twenty-nine, what does it look like for you both personally and professionally? And just start writing that down, okay? And [00:07:00] get really clear on what that looks like because when you start with that R factor question, you start answering, that becomes your vision.

And when you get clear on what your vision is, then we can scale to that because what scaling looks like to one person doesn't look like the o- to the other, right? There could be a clinic that wants to have five associates and the owner doesn't wanna treat patients, and then they wanna open up a second location.

Awesome. And there could be another one who's like, "I wanna be a solo provider. I wanna work on a really healthy profit margin. I wanna, uh, get the clinic to $400,000 a year in revenue, and I wanna take home two hundred of it. That's what I wanna do." And that is fine also, right? So you gotta get clear on what your vision is, then the actual steps to scaling your practice can be, can be had, okay?

So go ahead and do that. And then, you know, um, [00:08:00] I'm gonna go just one last strategic coach concept, and I mentioned it in that previous episode I did on this, but that is the unique ability, right? I think to be able to scale, you need to function in your unique ability, and strategic coach defines that as doing, um, activities that fascinate and motivate you.

And then they, they ba- basically break down every activity that you could be doing, let's just say in your business life, in four categories. One being incompetent, which is the wor- worst level. You wanna delegate those off as, as quick as possible. Then the next level is competent, like you are competent in those activities, but you wanna get rid of those also.

Shouldn't be doing those for too long. The third is excellent activities. Those are things you're actually really good at, but they don't fascinate and motivate you anymore. Um, could be something like, you know what, you do so- you've done soft tissue, you do... You're certified in ART like I am, and you've done it for a long time, but it just, you know, and you're really good at it and excellent at it, but it doesn't fascinate and motivate you anymore, and so you could get that off your plate, right?

And then finally, the holy grail is things [00:09:00] that are your unique ability. Handful of things you do that you're fascinated and motivated by, and you spend, like, eighty percent of your working s- life in that. Now, I always take patient notes out of that equation. I'm hoping that AI becomes... And it is. I, I was, uh, fortunate enough to have, uh, Dr.

Brandon Steele speak to our West Mastermind group in Sonoma, uh, a couple weeks ago, and he talked about the patient experience, but then dive into, like, what's coming down the pike on their EHR, on AI, and how that's gonna help. But yeah, the notes aren't a unique ability, but it's like paying taxes. You have to do them.

So if you can essentially build a practice that is serving that three-year vision and long-term vision that we just talked about, and you start to whittle away at your unique ability, and you're doing mostly things that you're fascinated and motivated by in your practice, you can do that for a long time, and that is a big part of what [00:10:00] scaling is, okay?

So I'd really, really recommend working towards that, and it's a whole process. That's why I joined Strategic Coach. Uh, we help clients out with it as well. But they are the, um, the masters of that for sure. Um, now something that I kinda worked through, this was right before the West Mastermind. I kind of, you know...

It's been a summer, and I've talked about it on the podcast, it's been a summer of a lot of patient experience stuff, whether it was the London, uh, workshop I did with Chris Chippendale on the patient experience back in June, or in Maine, we had the Scheduling Institute come speak to our Mastermind, East Mastermind group on the sales component of the patient experience, but we dove into it as a group after they had left.

And then we talked about it in Sonoma, and I've done podcasts on it and coaching calls. It kinda like re- you know, there's been a lot more good information that I've been applying to it. Um, recently, this week on our coaching call, we just dove into [00:11:00] day one. Like, we put together a whole playbook framework really for day one and what that looks like.

But as I was preparing for the West Mastermind, I kinda sat down, I was like, you know, "What are the, what are the real true aspects of a thriving practice where if you hit, if you hit it well on these things, you are more than likely gonna have a really good practice?" And, uh, I came up with six things, and that was, that was actually taking out the clinical, right?

So clinical, you gotta be good. Table stakes, gotta be good clinically. I could probably make this seven instead of six and just put clinical in there, but, um, I, I'm gonna just put that out. You gotta be good clinically. And so the six aspects of a thriving practice that I think you need to be able to really dial in to scale is gonna be new patients, right?

Like, you gotta have new patients. And yeah, you're gonna s- there's gonna-- As I go through this list, you're gonna say, "Oh, well, what about this?" And it's like, yeah, we kinda did a group poll on this and did [00:12:00] everything, and a lot of times it will fall under that, right? So if, if you said, like, "What about, you know..."

'Cause I'm not gonna list marketing on here as, as a six aspects of a thriving practice and, and some would say that for sure. But I'm gonna say that's where it's, it's at, okay? Marketing would fall under new patients. It's also gonna fall under a couple other things I said here. So you gotta have a healthy amount of new patients, right?

Some people will call it that top of the funnel, but you need to have a healthy new patients. Uh, second is the patient experience. You need to optimize the patient experience. Everything from beginning to discharge and then even in, you know, act- inactive. Like, you really gotta dominate that patient experience, and that's also where the clinical falls into, right?

That's, uh, a lot of things fall into there, and that's what we've been harping on all summer is the patient experience. Third is care plan commitment. You have to have patients that commit to their treatment plan, an ethical and elegant treatment plan, and they need to be committed. When you have, [00:13:00] uh, patients that are not confident in you and not committed to the care plan and they fall right off, that's a problem.

So you need to have care plan commitment from the beginning And that leads me to the fourth one, which is almost like a cousin to it, but it's different, and that's optimal patient adherence. You do need patients to adhere to the treatment plan throughout the entire treatment plan un- until you actually discharge them, and that needs to be at, like, a 70, 80% clip of patients that adhere.

That means they are doctor discharged. That means they either finished care or you discharge them to a different provider for whatever reason versus self-discharge, where they just discharge themselves for various reasons. You need optimal patient adherence throughout that entire active care. Fifth, I see a lot of great practices who have a segue from acute care to performance care, [00:14:00] and that performance care can look different.

We've got clients, we got chiropractors we know that have the clinic gym model, and they get a good amount of people that get into fitness at their clinic or somewhere, um, or they do soft tissue or adjustments, part of performance care. But the person is getting bodywork and/or fitness, and hopefully, you know, they are in your practice.

If they decide to do it elsewhere, that's fine, but we need to get patients to, when they get rid of their injury or we get rid of their injury, they need to have some kinda level of performance care. And then six is you need a healthy amount of reactivations in your practice. And as your practice gets more mature, you will get more reactivations.

But you need to be doing certain marketing and things to cultivate reactivations in your practice. And when I see practices that get a healthy amount of new patients, they dominate the patient experience, they get patients to buy, you know, reasonable treatment packages or payment [00:15:00] plans, or they pay as they go, and they get the patient to schedule that entire treatment plan out for six or eight visits, whatever it may be, um, those...

You know, that's the care cam- the care plan commitment that I'm talking about, those kinda three things. When I see pa- practices that have really good patient adherence, when I see them do well with getting them from acute care to performance care that are re- that's reasonable, and they get a lot of reactivations, those are the clinics that can scale because they're, they're healthy.

They don't have holes in the bucket, and they're doing well with that. So make sure you're checking those off a- and you're working towards that in your practice, okay? Now, you know, there's, there's the financials of scale, right? And I'm not gonna dive a, a whole lot into it. I-- that's why I dove into that in the 30K course and the Cash Confident course, we talk about this.

But that's where I really like Greg Crabtree's work. I'm gonna give some overview with that. One of the things that you have to be able to do is scale [00:16:00] payroll, and he has the 2.0 number. I recommend his book called "Simple Number, Straight Talk, Big Profits." That's the name of the book, "Simple Number, Straight Talk, Big Profit-Profits."

And he-- you can dive into there. I mean, heck, you could probably AI it now if you want to, but his 2.0 number essentially is your overall labor cost should be half of your revenue. So if you do $500,000 in revenue in a year, about 250, give or take. He, he kinda gives you some wiggle room, like between 1.9 and 2.1 as that number, but essentially about 250K would go to labor costs.

And that's sometimes people run into scaling issues 'cause they're bloated on payroll. So if you can get real clear on that 2.0 number, you can scale the, the payroll The other thing he talks about is you need a healthy profit margin to scale, and so you need at least 15% profit. And that's... He talks about you paying yourself as the owner, [00:17:00] um, a competitive wage, right?

Not $40,000. If you do that, whatever, and you can work with your accountant and some of it may be distribution, but what would it take to, to hire a chiropractor to replace you? What's the, the full c-compensation of that? And that would be what you would count as your, uh, payroll, and then anything after that and all the other expenses, then it's 15%.

'Cause again, some people will... You'll hear say, "Oh, it's like my, my, uh, my overhead. I pay myself 50%, so my..." You know, or, "My profit's 50%," 'cause o-overhead is 50% to operate, but then they're, they're not counting what they're paying themselves as op- as overhead, so it's kinda bloating the profit margin. So a true profit margin includes you paying yourself a real wage, and he wants you to be at least 15% profitable, because what...

You know, reinvesting profits and being profitable is what can scale. And the third thing I'll say about Crabtree's work that helps with scaling is reinvesting profits back into the business for growth. And [00:18:00] so what he talks about is when you have profit, he has like a 40-30-30 model where let's just imagine you got $10,000 of profit, just for sake of argument.

Uh, 40% would go to the tax man, so $4,000. And again, depending on what state you're in, depending on what models you run, certain things, it could be lower than that. I, I don't do 40%, honestly. Um, but so you could call it a third, a third, a third. However, you know, I don't, I don't wanna mix up his, his framework, so it's 40-30-30.

So 40% to taxes, 30% would be a personal distribution to yourself, reward yourself for profit, and then 30% would be reinvested back into the business, uh, t- for growth. And that's how you can scale is by reinvesting back into the business. And you might decide, you know, like you're at a stage of your life where you're gonna reinvest more than 30% back into the business.

That's up to you, but that's what he recommends to, to be able to scale So a few book recommendations, and then I'm gonna dive a little bit into [00:19:00] one I just read. So book recommendations, I read Science of Scaling by Ben Hardy about two years ago when it came out, um And he has a whole thing called scaling.com.

Really, it's kind of expensive coaching, um, but "Science of Scaling" is a good book to get you thinking. Uh, Greg Crabtree's book I talked about, um, "Simple Numbers," uh, "Straight Talk, Big Profits." Uh, "The Voltage Effect" is really good as well, that I mentioned earlier. So that, uh, "The Voltage of-- Voltage Effect" by John List.

And then lastly, I'm gonna dive into this particular author's framework. Uh, she has a book. Her name is Alison Maslin, and, um, she wrote a book called "Scale or Fail: How to Build Your Dream Team, Explode Your Growth, and Let Your Business Soar" is the tagline. That was in 2018. And she has a scale-it method which kinda...

Like, I read it through, and it's like, it's, it's good, and it touches on a lot of stuff that I kind of worked on over the years from Strategic Coach. 'Cause [00:20:00] for me, Strategic Coach has been my kinda operating system for, for scaling and, you know, honestly, you know, developed the life I have. Um, uh, I'm very fortunate, but it's been a lot of work, and, and it's been scaling through a lot of the principles of Strategic Coach.

Um, and then this particular book had some similar things there. But her, uh, scale framework is, uh, f- start... First, you start off with a strategic vision, right? So you get radical clarity on your big picture vision, she calls it. So that's kinda like what I talked about with the R factor question. You, you just gotta start with vision, and not enough people do.

They start with other people's visions, or they s- they start with what the misconceptions or just, like, what the, what other people say and that they came out of school thinking, right? Second thing is you gotta have cash flow. I just talked about that with, uh, Crabtree's stuff, is you just gotta have cash flow.

You gotta get off the, the money roller coaster and build revenue and profits that can help you reinvest. [00:21:00] Um, and then the third is alliance of the team, so you need to really build a great team. I fully re- I fully, fully, fully recommend that. You gotta build an A team to be able to scale. Next is leadership, right?

Um, she talks about you have to personally grow faster than the business. Um, you have to develop as a leader, and if you don't, then it's gonna be hard to scale. So you gotta keep on getting better with leadership. I've talked a lot about that over the years. Um, I c- it's a continual journey for me.

Everybody's leadership looks different, but you have to grow as a leader if you're gonna grow a practice. And then lastly, execution, right? Turn strategy into consistent systems and results, treating mistakes and course corrections as assets rather than failures. I mean, this is probably one of the biggest things people fail on is, uh, is execution, right?

So you definitely, to be able to go from vision to scale, you need to have the vision [00:22:00] And you need to execute that vision, and you need to overcome obstacles. It's never gonna be linear, you know? Um, I've, I've had a vision for a while now, and it, it's been a rollercoaster, but I wouldn't trade it for the world, and it's ultimately been really effective for me, and then I'm in a good spot now, and, you know, there'll probably be bumps in the road down the-- coming, coming.

Uh, that's just life. And so you gotta be able to execute even when things start to not maybe go the way you thought they were. And I always love Dan Sullivan's, uh, quote or thought on, um, you know, wasting money or mistakes and things like that. He just calls it R&D, research and development. So it's gonna happen.

You learn from them, and you get even better. So that's some of my updated thoughts on scaling. Obviously, like, there's a whole process to make it happen. You gotta get clear on some of these things, and I think that's where, you know, coaching is so invaluable c- so you can actually start working on the things that's gonna get there because you...

Uh, I, I, [00:23:00] I s- s- stealing this from Kurt Kippenberger, and I'm sure he stole it from someone else. I forget where he stole it from, but I heard him say it at our mastermind back in Maine, was when you're insar- when you're inside the jar, it's hard to read the label. And when you're in the s- inside of your business, it's hard to read the label from the outside and get the proper guidance.

And, you know, frankly, AI can help a little bit, but it, it, it's not gonna be everything you need and all the nuances of your particular practice and hearing you out and stuff like that. So, um, that's my updated thoughts, again, four years after I first did a podcast episode on scaling, and, uh, I hope you found that interesting.

Have a great week