EPISODE 495: Optimizing the Front Desk with Pablo Blanco
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.
Dr. Kevin Christie: [00:00:00] All right. Have Pablo Blanco on the interview here, otherwise known as Mr. P. Uh, welcome. It's not your first time nor your last on the show. You've done a lot for us, for my practice, for MCM, for our MCM members. Uh, we recently had you doing a webinar on Google Ads, uh, for our mastermind members, and, you know, you are co-founder of, of Avonmed, and you guys do a, a whole lot, and we're gonna dive into some of that today.
But before we do, uh, update us. What's new in your world?
Pablo Blanco: Oh, man. Thank you so much, and thanks for bringing me back, uh, Dr. Christie. It's, it's been an amazing ride. You know, back in the day, I used to say two, three years working together. Uh, we've surpassed a decade by now, so it- it's, it's really exciting to see all the new changes in the market, what you've gone through, and how you've been able to overcome these challenges.
Um, so yeah, AvanMed started in digital marketing, paid advertisement. We moved on to web development, so, [00:01:00] uh, all the digital presence that you need to have online in order to run successful ads and campaigns, uh, building your social media, right? Uh, and then in the last four years, we introduced our virtual agent services.
Dr. Kevin Christie: Yeah.
Pablo Blanco: Something, again, that, yeah, even you utilize with us, is, is extremely important. So how can we keep, um, you know, your operating cash flow thin and, and, or growing while reducing those costs and, and delivering that type of service, the quality service that we have, uh, for your practice. Uh, fast-forward to today, we're also, uh, involved now.
We have a development team building, uh, applications. We have the AvanMed CRM. We're now working with larger entities such as hospitals in building, uh, dedicated applications for their infrastructure with business intelligence. So a- as the market trends continue to evolve and expand, AvanMed continues to grow with them.
And, uh, that's where we are today.
Dr. Kevin Christie: Nice. Yeah, you know, last time I had you on, I, I [00:02:00] re-listened to it and, and got some notes on it, and we, you know, kind of tackled a lot of the virtual front desk, which we'll dive into again today, but from a different angle. Last time we talked about, you know, like, a practice that was a lone wolf practice, and what that would look like to have a virtual front desk, or a practice that needed a second front desk person and wanted the, you know, the main front desk person, the human, to be able to interact with the humans that are there in the office.
And then we also dove into kind of a hybrid there. And so we won't dive too much into that, but yeah, I'll share a story 'cause we've been using, uh, your virtual front desk, and we've had Sophia with us from the beginning in, I think, almost, like, two and a half years now, and it's been pretty cool. Like, one of the things that we were using, uh, the service part-time, and now we've been full-time for a while, but we went to full-time because our office manager/front desk, she went on her first maternity leave a couple years ago.
She's about to enter into another maternity leave, so it's been nice to, to, to really get the phones away from the [00:03:00] front desk and, and do all that. Um, and so it's been great, so I wanted to preamble that to give people some context. But first thing I wanna dive in, you were kind enough to kind of give me a, like, a deck of information of things that you guys have been doing a lot of research on and- And I wanted to kind of look through that.
And I wanted to start with the wages, right? So the payroll cost, which is everything from interviewing, hiring, training, technology, the, all, you know, the taxes, the insurance, the benefits. It's, it's qui- quite a bit, right? Like, a lot of times people say, "Okay, can I afford, you know, $15 an hour, or can I afford $20 an hour?"
And they, and they do the math, and they'll just be like, "Okay, $20 times 35 hours a week is this much, times four weeks in a month." And they think that's what it, what it costs. Uh, but they forget certain things like, uh, payroll taxes and FICA and, uh, unemployment taxes for your state and federal and, uh, all the [00:04:00] things, interviewing, hiring, training.
It's, it's quite substantial. Um, what are, what are you guys seeing between, like, smaller markets, maybe your typical suburban metro market versus your dense metro? Like, smaller market, let's call it, you know, Omaha, Nebraska. Typical suburban, let's, let's talk about, like, maybe a outside of, like a suburban outside of a Dallas.
And then a dense metro might be like your San Francisco or New York, right? Is, uh- Right ... what are you seeing on, on, like, the cost of a human being, like hiring someone for your practice?
Pablo Blanco: Right. So there, there's a few things where they're across the board equal. I mean, they all share the same pain points. Uh, like you said, whether you are, you're in, in a, in a small town or, or in dead smack middle of Manhattan, right?
Yeah. Uh, the pain points are, are, are across the board equal. You know, clients in, in [00:05:00] our case, and providers, uh, identify that it's difficult for them to, to find the right person, uh, and retain the right person. And, and we're not even talking by salary or wages, it's just retain- the retention is, is, is challenging.
Um, finding someone in your immediate area that has the, the knowledge or, or the history background, right? The experience that you can onboard and, and ideally say, "Well, hey, he or she's gonna start in a week, and then by the end of the month she's gonna be ready to, to go," right? Um, so finding people on the local market, having that retention, and then finding the time.
A, a lot of business owners are extremely busy. Uh, you can't devote, uh, an entire month to, like you mentioned, you know, interviewing and- Mm-hmm ... hiring and training and getting them set up and up to speed. And of course, there's gonna be mistakes that are gonna happen along the [00:06:00] way, so you have to absorb those costs- Yeah
those mistakes. Um, so that's what everyone shares in common. Now, what, what we've noticed in the market and what we've studied and seen is that in small town area, uh, the hourly cost per employee doesn't drop below $15 an hour, right? Um, and, and, and on top of that, as you mentioned, which, which gives you a base wage of about 30, $31,000.
Mm-hmm. Um, add to that your payroll taxes, federal, state, depending on the state in which you're at. Yeah. Workers' comp. Uh, if, if you're giving benefits to that employee or not. Mm-hmm. The cost of interviewing, training, hiring, onboarding, right? The technology, computers, licenses, emails, et cetera. Um, all that up, about an extra 10 to $15,000.
So your $15 an hour, uh, employee is running you about [00:07:00] $44,000 on an annual basis. Mm-hmm. Yeah. Um, when you're... and you're... on, on your paper, right, you're writing down, let's say 30, 31,000. Um, for a typical suburban metro area, we're looking at $20 an hour.
Dr. Kevin Christie: Mm-hmm.
Pablo Blanco: And then that cost instead of 44,000 goes up to like 55,000.
And then we have your San Francisco, Chicago, New Yorks where, um, you know, on average you would say $25 an hour. The last conversation I had with a client in Manhattan, and this was last month, um- Uh, he couldn't hire anyone under $50 an hour.
Dr. Kevin Christie: Yeah.
Pablo Blanco: Right? So it's well over $66,000 on a, on an annual basis. Uh, now the question is, can any provider, whether you're in a dense metro market area or in a small market area, uh, by the services that you're offering to your patients and what you're capturing from that, is it accessible to you as a provider and a business owner- Mm
to front $44,000 for upward 66 plus thousand [00:08:00] dollars for a person m- managing your front desk, right?
Dr. Kevin Christie: Yeah,
Pablo Blanco: exactly How do you justify
Dr. Kevin Christie: that? And, and that's the thing is, like, a lot of, uh ... I, I'm gonna bring it back here. Like, I was just doing another, uh ... I had an interview with someone that they do on-site, uh, or shouldn't say on-site.
They do, uh, healthcare for providers or, or for companies and everything, and we were talking about some of the costs you just don't see, like presenteeism and absenteeism that these companies measure, and these larger corporations do a good job of understanding what the true cost of something is, and that's what we're getting down to.
And yeah, like, you know, that $20 an hour person, if you ... or if they're full-time, the actual base wage would be about 41,000, but then you're gonna have about $3,100 in, in payroll taxes. If, you know, federal state unemployment might be another 700. Uh, and then, you know, you got other things. There's like, I know we do a 401match and a, and, and all that, and that, that adds to it.
And, and so these are all real costs that [00:09:00] happen. So someone you may thought that was a base wage of 41,000, it truly costs you about 55,000, and it just keeps on going up. And then what's happening with all of the inflation is people are needing and wanting more money, right? That the person that really was $20 an hour a few years ago wants 25.
If they were 25, they want 30, 35. As we see, like, you know, not to get on the politics side, but always the push for the $15 minimum wage. The, the struggle with that is, is like, again, if ... No offense to the burger flipper, but if they're, if they're now 15 an hour, which was, you know, flipping burgers in the 1970s and '80s was meant for, like, the high school kid as a part-time job, not a career and trying to live and pay it for a family doing that.
And so when we make $15 an hour the minimum wage, now you, you know, that means 16-year-olds are at $15 an hour, right? Living with their parents, 'cause it's minimum wage. [00:10:00] And now when that person's saying, "Oh, that 16-year-old that works at, you know, Publix is making 15 an hour, and I'm 34 years old and I'm really skilled at working the front desk, like, I should be worth double than that," right?
And so psychologically, people are saying, you know, 15 is, is the 16-year-old kid, not the skilled front desk person that's got a kid or two or a family and is 33 years old, right? Is that some of the stuff that you're seeing?
Pablo Blanco: A- absolutely. And there's something that's tied to it directly, which, um- E- e- everyone tuning into the podcast should, should, should be well aware of, and, and it's retention, right?
Yeah. What, what is the probability of an employee that you decide to not hire perhaps full time and think, "Well, you know what? I'm, I'm just... I'm gonna hire two part-timers and not have to front the benefits because they're both working 20 hours each." Uh, so two [00:11:00] things happen. One, the probability of that individual leaving, right?
Dr. Kevin Christie: Yep.
Pablo Blanco: Less than 12 months out is significantly higher than someone full-time with benefits. Yeah. A- and not closer to the minimum wage, right? Mm-hmm. Uh, two, it becomes an operational issue, especially if you're trying... And I don't wanna say this is cutting corners, but you say like, "Oh, I have a part-timer that comes in the morning, one that closes the shop- Yeah
uh, or the business." Um, but it's also that management, right? Yeah. Now you have two individuals, one transitioning to the other, so you're prone to making more mistakes, to dropping the ball- Mm-hmm ... uh, to, to having a different type of patient experience because that individual is not fully vested, uh, in your business, and the minute they get something with, with a higher wage and benefits, they're out the door.
So is it a viable option? Uh, I mean, on paper it looks great, but, uh, over the course of a year you end up having to either hire somebody new and then you go through the whole cycle again, right? Yep. [00:12:00] Uh, you know very well how long it takes to hire, train and retain someone. It doesn't happen overnight. Uh, what we see is- You know, if you, you spend one month of continuous training, the second month they're starting to get really used to the- Mm-hmm
the day-to-day work. And by month three, uh, you're almost kind of taking that deep breath and going like, "Okay."
Dr. Kevin Christie: Yeah. "
Pablo Blanco: Things are finally back on track," right? Um, if they're part-time and they get something else, between month four to six- Mm ... is when you have to repeat the process of hiring, training, and onboarding again.
Um, and if the salary is too close to that minimum wage, then you're looking at 12 months out, between 9 to 12 months before they start renegotiating-
Dr. Kevin Christie: Mm ...
Pablo Blanco: their base pay. And if you're asking for more work, right, they're also gonna be asking you for a higher hourly rate.
Dr. Kevin Christie: Yeah. And I, and I like this... You got this kind of broken down.
This is just something that we all forget, and I hear it a lot, is [00:13:00] the turnover. And, and it's very frustrating that people deal, especially with front desk and other positions, with the turnover. And, uh, the annual turnover for healthcare sector is 30 to 40%. And you mentioned here it can cost you 8 to $12,000 for replacement costs.
So every time you have to replace that front desk person, uh, it, it, it adds to the cost and it impacts the, the practice. And so, uh, I'm glad we're, like, diving into these numbers, 'cause I- I've been on a kick this year. Uh, I've been on a kick for a while of, like, really understanding practice finances, but I feel like this year I'm having, I'm having guests on where we're, like, really diving into some of the, the nitty-gritty of it that we don't think about, right?
I've had plenty of people on where we talk about, you know, profit and loss or OVA or this or that, new patient value and stuff. But when we get into this, this is stuff that we sometimes forget, and even, even I do. And so there is costs to, uh, to the, the turnover side. Um- Um ... [00:14:00] anything else you wanna say on that part of it?
Pablo Blanco: Um, well, I... So, so I, I would say in summary, the, the effective cost per worked hour that an employee is giving you once you look at all the numbers i- i- is not really 15 or 14 to $16 an hour. It's upwards 23, $25 an hour a- a- at, at minimum, right? At minimum. And, and there is that, um- That upfront cost, not financially, but you are either paying someone- Mm-hmm
a recruiter to find you the right person, or y- you have to devote and dedicate your time for it.
Dr. Kevin Christie: Yeah.
Pablo Blanco: Interviewing, and then the onboarding, training, so on and so forth. A- and that does take time from you doing the work that you should actually be doing, right? Uh, is it feasible, scalable? I- is it something that works long-term?
Um, as we've seen over time, and, and, and business owners know this really [00:15:00] well, is they, they, they can't be bothered anymore, right?
Dr. Kevin Christie: Yeah.
Pablo Blanco: They realize that the tasks that you are asking from an individual that you're paying upwards of 25-plus dollars an hour, uh, are, are, are so basic that i- in, in, in a way they don't really justify The cost per hourly rate, right?
Yeah. That, that you have to acquire that person for. Uh-
Dr. Kevin Christie: So, you know, you... Those are kind of like the hard and soft costs and expenses of, of front desk and, you know, the, the human also just the turnover and all the other things like that, and that- and that's, um, a big issue. We, uh, we're gonna segue a little bit here.
W- in our East Mastermind we had the Scheduling Institute come and talk to us, and, you know, they do a lot with front desk f- training. Like, not... They don't supply anybody or anything like that. They don't do virtual or anything. But they g- they kinda train people and, and they, they have a whole thing where they actually show [00:16:00] the costs of, like, not- the phones not being answered.
Uh, they have all these stats of the phones being answered inappropriately, and basically it's, it's a, it's a leaky bucket that a lot of clinics have. I mean, they even did, like, sample calls of our staff and, and just they, they have a lot of good, uh, information there a- and so do you on this. So I wanna kinda segue into the fact that, like, now we might run into issues.
Okay, we just talked about the expenses of a front desk, but what if we have a front desk but they're ineffectual, right? They're not that good at what they're doing, or your front d- you're closed on Tuesday, Fridays like we are, and no one's at the front. The phones aren't being answered. Uh, all these different things.
You got... You're, you're running marketing campaigns, but they answer the phone and don't really understand how to get them in- You know, like, there's a lot, like a lead conversion issue. So we're gonna kinda dive into, into some of that. [00:17:00] Uh, I wanna start out with, like, some of the most common leaks you find at the front desk, 'cause this is a problem where you might have a good, technically a good person there and, and whatever, but what are some of the leaks you're seeing?
Pablo Blanco: Right. So, so the- couple of things. One, and, and we pulled a sample from, from clients once we pair on systems, and, and sometimes they even request for an audit. They're like, "Hey, like how effective are we?" Currently in, in answering our phones and getting back to patients' opportunities, whether they're running paid advertisement or not.
I mean, this, this could be organic, this could be from word of mouth. Um, and it's anywhere between 27 to 35% of calls on average are missed. Now, I'm not saying or, and do not imply that all these calls are, are new patients.
Dr. Kevin Christie: Yeah.
Pablo Blanco: Every practice is gonna be different 'cause you have a different, you know, breakdown- Mm-hmm
of what those calls will be, new patients or [00:18:00] new opportunities. Uh, but I would say the question on that, and, and, and anyone can a- ask themselves and write it down and say, "Well, what's my lifetime value for acquiring a new patient, and how many of those live in that 25, 27 to 35%?" Right? Yeah. Uh, so it could be anywhere from one call where it's like, well, you just lost $1,500, right?
Yeah. Or it could be five calls and, and you start realizing, wow, I'm, I'm close to losing 10 grand on new business and opportunities as, as, as a result. Um, but yeah, missing those calls, uh, not being able to or not finding the time at the front desk to reactivate existing patients. Now, again, looking at it from the financial standpoint, and, and Dr.
Christy, you know this well, are you going to, A, decide to reactivate existing patients that you have not seen over the last year because you already have the staff to maybe place those calls, send those emails, send those messages, or do you wanna [00:19:00] invest in additional Google ad spend, right? Yeah. Mm-hmm. So yeah, recall and reactivation, that's a leak.
Most front desk agents are not capable of managing a list of patients and continuously, right, on a weekly and monthly basis, keeping that cadence, saying, "Kevin, every patient that we have not seen over the last six months has been reached out, and for X amount of patients that we called, we've been able to reactivate Y."
Right?
Dr. Kevin Christie: Yeah.
Pablo Blanco: Uh, the response time on, on... And again, front desk, and, and this, this varies by practice, but- The majority of individuals running their front desk are assigning their front desk, uh, their social media channels. So are you answering to my Instagram, my Facebook, my TikTok, uh, the DMs that are coming through those channels, right?
Are you responding to the website inquiries? Some of them have... Some websites have a chatbot, right? And you can submit questions through that chatbot. Who's [00:20:00] responding to them? A- and are we responding to them i- i- in a timely manner? Um- Mm ... when it comes to that, I would say those responses, especially on chatbots, uh, and DMs, should be anywhere between 8 to 12 minutes.
Yeah. Because that individual, if it's a new opportunity are shopping around, uh, they're looking for two, three different options. You're one- Mm-hmm ... of them, and at that point is whoever responds first and has the right tone of communication is gonna establish that cadence to book that appointment. Yeah.
Right?
Dr. Kevin Christie: Yeah, yeah. Um- No, it makes sense.
Pablo Blanco: Mm-hmm.
Dr. Kevin Christie: Uh- Uh,
Pablo Blanco: that, mm-hmm.
Dr. Kevin Christie: I just wanna, yeah, I wanna say one thing on there 'cause I, I agree with you. 'Cause you guys are kinda closing that loop and, and, and for us as well, and, and I always like to give credit where credit due. Again, with Scheduling Institute, one of the things that they've talked about, whereas a lot of times your front desk person is not either, like you said, well-versed or trained in it or they're really not [00:21:00] incentivized, uh, to really care about getting those leads in the door per se, right?
Like, um, and they're not, they're not trained or have a vested interest in doing that versus you guys have kind of put that all together where you got great virtual agents, front desk that are also trained in lead management and nurturing, and then you guys also do run the ads and stuff. I- and, and so it all kinda comes full circle there, and that's something that I think, uh, goes unnoticed in a lot of practices that are running marketing campaigns, but they've got that leaky bucket like you just said with the front desk.
Yeah,
Pablo Blanco: yeah. And, and, and again, the, by, by the numbers, it is, it is far more common to have a business, a, a chiropractic business established where, uh, the business owner needs to go after different resources to run marketing, to manage leads, to do this, [00:22:00] and, and very few of them are established where they have a marketing director, right?
Dr. Kevin Christie: Yeah.
Pablo Blanco: And they have a patient coordinator that has someone underneath their wing that is managing these leads on a, on a daily, uh, and weekly, monthly basis and, and they're really good at it, but they're very few, right?
Dr. Kevin Christie: Yeah.
Pablo Blanco: Uh, and if you also look at how much they're investing on a monthly basis to keep that operation thriving, it, it, it's a lot, right?
Yeah. It, it almost becomes a, a far-fetched dream for, for most, um-
Dr. Kevin Christie: Yeah, no, that's, that's awesome. And so, um, you know, obviously with our, with Sophia, we do a lot with confirmation and, and really making sure that patients are, are confirming their appointments and, and showing up and, and calling them appropriately.
We even have like a, a, you know, a kind of a, a tracking system with that, that she keeps, keeps up with. Uh, we do a lot with recalls and reactivations as well, and that's been really good because that can be always a struggle. We'll go back some months and, and just check in on patients and do all that. Uh, [00:23:00] we're not in-network with insurances, um, so we don't necessarily do the verification.
Um, but I know that you have a lot of, uh, clients that they are and the person- Yeah ... can do that. Because that's the one thing that kills me when I see practices. Like they're a busy practice, they're in-network with insurance, and they got one front desk person, which is fine, but they're on the phone so much and v- and sh- verifying insurances, it's insane.
Uh- Yeah ... and so that's a, a big one for sure. And then obviously you mentioned about kinda responding to, to web inquiries. But, uh, let's talk about, I wanna segue a little bit but similar Again, like, um, the, the fact that I just love... Like, we've been this summer doing a lot with the patient experience and trying to really hone in on that.
And I think if you're a practice that, um, can handle it, which there's a lot that can, that you got your human being at the front. Uh, and I've got some practices where they have a revolving front, [00:24:00] like who- you know, like whoever's available. They have interns or CAs and other doctors and, and so many things are already automated that they don't need someone sitting at the front per se, but they have someone there.
Uh, or I got practices where they do have a full-time person at the front and then have a, a... Like we do. We have a full-time person at the front and we also have interns, but then Sophia is virtually answering the phones all the time. Well, not necessarily all the time, but full time, and that really has been, been great for us as far as the patient experience side of it.
And I think sometimes that's a, a revenue spot that we don't think of, right?
Pablo Blanco: Right.
Dr. Kevin Christie: Have you seen some of that with some of the clients you've worked with?
Pablo Blanco: Oh, ab- absolutely. I mean, y- you just... You're example number one, right?
Dr. Kevin Christie: Yeah. A-
Pablo Blanco: as a business owner, you need to not just think of hiring an individual to work your front desk to do tasks, but they are the first point of contact for new business, and [00:25:00] in, in some cases, most cases, the last point of contact before they even capture payment and walk out the door.
And, and, and they set the tone, right? Uh, as you mentioned before, yeah, sometimes your staff can be overwhelmed with in-office tasks. I- I've seen it where, uh, the front desk might be pulled back just to like, "Hey, help me out with this real quick," you know, and then that's left unattended, and then there's two, three missed calls.
Or, uh, I mean, we could get distracted too, right? We take that- Yeah ... little coffee break. We're in the back room. We're talking about maybe, uh, uh, the doctor's talking to them about some changes that they wanna implement halfway through the day, plus that coffee break, plus a little distractor, right? Before you know it, 45 minutes go unattended and you're scratching your head thinking, "Well, why are we not following up on these things," right?
Dr. Kevin Christie: Yeah. Yeah.
Pablo Blanco: Um, and then they say they're overwhelmed, busy, and, or, and, and, and underpaid, so we go- Yeah ... back into that cycle of, oh, geez, how, how do, how do we address or fix this, right?
Dr. Kevin Christie: Yeah. [00:26:00] Um,
Pablo Blanco: what
Dr. Kevin Christie: I wanna do is have you give us in a second a, kind of a success story without, uh, mentioning clinic names. But some of the types of clinics I know you and I have talked about that really can benefit from this...
I mean, everybody really can, but, uh, there's a lot of examples of, uh, multiple locations, like trying to, you know, h- almost have like a call center. That's something that I've heard recommended. Right. Like, if you're really trying to scale to multiple locations, have the phones answered in one place, I know that's a-
Pablo Blanco: Right
Dr. Kevin Christie: a great situation for this. Obviously, like the solo managed practice or like that lone wolf where you're not ready to invest in a person, but this could be that bridge to it. Or if you're seeing just like a ton of turnover in your market, this can help solve that. Again, it's, uh, you know, getting... Even just not having to worry about the hiring, letting you guys worry about the hiring is great.
Uh, I think you hit the head on one earlier, uh, when you and I were talking before, uh, was just like small towns and not [00:27:00] having a great hiring market. Mm-hmm. I know there's a lot of chiropractors that fall into that where you're just like you don't trust the, the market in your area, the talent, and the...
You know, people are, um, maybe not inclined to work in a chiropractic practice. There's just not a lot of people there or whatever. Just- Right ... that happens in certain areas where you, you get to know your area, where it's, it's not, not great. Uh, and then yeah, there's, there's the other one is just like the cost savings of it, right?
Like if, if you have a, an in person and, and you're in a bigger market, it could cost you 60, $65,000 a year all in with all those costs that we talked about, and it's a- almost like half the co- close to half the cost to, to have a contracted agent through like what you guys do. So there's a lot of scenarios where this makes sense, but, um, that's my long-winded way of saying what, what's a, a success story that you guys have recently had?
Other than mine. I know- Yeah ... it's been a success. Um, I would... Let's not talk about mine anymore, but- Right ... uh, you know, again, without [00:28:00] naming any clinics, what is something that you've seen that has been
Pablo Blanco: pretty cool? Yeah. I, I, I, I, I, I would say that at this point I've, I've seen pretty much just everything.
Um, but, but I'll tackle a few. As, as you mentioned- Yeah ... you know, you, you, you brought up the, the lone wolf, and, and I would say that's really where, where it all starts for a lot of business owners. They, um, fresh out of school, uh, go work for someone, and then a few years later say, "You know what? I got this, and I'm gonna do this on my own, and here I am doing it," right?
Dr. Kevin Christie: Mm-hmm.
Pablo Blanco: Um, and, and this individual would start running their business at first with a handful of patients that they already have, maybe some, uh, referrals, right? And, and, and this lone wolf is really doing everything. Now, if you think about it, you're starting a business, um, you wanna keep that overhead cost as low as possible because you, your cash flow is just- Slim, thin-
Dr. Kevin Christie: Yeah
Pablo Blanco: right? You're taking a massive pay cut, huge risk, and, a- [00:29:00] and, and so we, we have individuals, it's not just one case, but we have had multiple individuals that, you know, nine months later, 14, 18 months later, are calling and saying, "All right, Pablo, so here's the deal, right? Here's the situation. Um, left my business, started on my own.
Things were tough at first. Things are going great now, but I'm about to yank all my hairs out of my head because I am picking up the phone-
Dr. Kevin Christie: Mm-hmm ... I'm
Pablo Blanco: scheduling the patient. Uh, sometimes they don't show up. When they do, I'm treating the patient. If I have time, I'll call and remind them, then I have to check out the patient."
And they start realizing, "Wait, like okay, how, how am I the person picking up the phone, treating the patient, and then I have to show my face again and actually charge the transaction, right- Yeah ... for, for my services? And, and I get it. I do this to start out, but I'm at a point where I, I, I just... One, I don't wanna do it anymore.
I'm starting to get really busy, and I'm [00:30:00] creating my own approach and get more business. I need help, right?"
Dr. Kevin Christie: Yeah. "
Pablo Blanco: Where do I start?" And, and that lone wolf, um, can look in their local market, but when you look at the cost of hiring a full-time agent, it again, it, it, it becomes an operating cash flow. Question is, can I afford to pay someone?
And, and do not make this mistake. Do not look at it as, "I'm hiring someone, and I'm gonna pay them 10 or $15 an hour, period." There's no period there.
Dr. Kevin Christie: Yeah.
Pablo Blanco: You need to make sure you're adding all the additional costs, including your time a- as a recruiter, interviewing, putting the posts up, right? For, for, for job opportunity, hiring, training, and everything else that follows.
So don't just say, "I'm paying $15 an hour," and that's it. What's your true cost? At the end of the year- Mm-hmm ... you're, when you close that cycle, you're gonna know what the true cost is. You should, right?
Dr. Kevin Christie: Yeah.
Pablo Blanco: Um, so that's, that's a good, a good example of an individual, the lone wolf, coming in and [00:31:00] saying, "Well, what's accessible?
What's feasible? What's cost-effective, right?" Yeah. A- and at this point, it's, it's, it could be a combination of cost, number one. Uh, but then you're a small business owner. Do you know how to train and, and, and bring someone up to speed on, on, on these mundane tasks? A- and, and maybe, maybe not. So i- i- uh, the output they're gonna give you is the input that you put to them and your skill set to bring them up to speed, right?
Um- Small towns. Small towns with no hiring markets. Yeah. That's another one. So what happens, you run your business, you're effective at it, you're growing, you're thriving, your front desk staff leaves. Maybe they- they're retiring, maybe they're moving out of state, they got married, have kids, don't wanna work anymore.
Who knows? But now you have to go back out on the market and you're putting your job listings on all platforms, and you're not getting any [00:32:00] hits. And the few that you get, you're just scratching your head thinking that this is not gonna work, right?
Dr. Kevin Christie: Yeah.
Pablo Blanco: 30 days go by, 45 w- days go by. You're almost 90 days in thinking, "WTF, what am I gonna do?"
Right? How difficult could it be to hire someone for my front desk? I started offering $10 an hour. I'm upwards $17 an hour. I still can't find the right person. In fact- Yeah ... I'm not finding anyone. So that's another, uh, scenario where, uh, a virtual front desk agent can go ahead and s- and start Overseeing a lot of these, these communication tasks with your patients, new patients returning, whether you're insurance or not, verifications, right, billing collections, all the tasks that really help your business thrive forward while you address some of the internal operations.
That... So a virtual agent's not gonna be able to open up your doors at 7:00 AM- Yeah ... and lock them at 5:00 PM, but they should be able to do the bulk of those operational tasks that, you know, cannot be left unattended, especially 30, 60 days out. [00:33:00]
Dr. Kevin Christie: Mm-hmm.
Pablo Blanco: Um, and then, and then last, if, if I still have some time, Kevin.
Yep. Um, we have, uh, clients that have multiple locations. Mm-hmm. And, and for them, it, it, it is not a, um, like, well, can I afford, uh, the, the hourly rate or full-time versus, versus part-time? They're looking at it for, for each location, what is my operating cash flow, and how can I, can I keep that high without having to hire?
Or if I were to hire a front desk person for each office, that three salaries, $120,000 for someone taking calls- Yeah ... how can I centralize my three locations and have maybe a team or an individual manage it for all of them, and I don't have to worry about the hiring, training, onboarding, and impacting that operating cash flow per location?
So they see it differently, right? Yeah. They're, they're just saying, "How can we reduce it and [00:34:00] maximize?" And, and what, what they do is centralize their operations, whether they are in network with insurance and they need that department, but have that department for three locations, they divide by three, right?
Operating cost by three. Yeah. A lot lower. The same thing for the front desk, for reactivations, and anything and everything that they're doing, uh, in, in that regard. I, I have clients that manage a large volume for PI cases- Mm-hmm ... uh, and you know the, the ticket value for that, but you also understand the type of infrastructure you need to have to communicate with attorneys, doctors, the hospital, the patient, your own provider, right?
Keeping track record of all of that. Um, so yeah, they can't find someone locally, and more importantly, as, uh, as this continues to scale in volume, the client's number one concern was, well, if even if I hired someone locally, I, I, I can't expect that person to hire somebody else and train them as we continue to grow.
So how do we solve that [00:35:00] problem? Mm-hmm. And, and that's when we came in and said, "All right, well, as you continue to grow, our department already has people that we are training and onboarding. You just need to kind of like ring the bell when, when, when you say, 'Hey, get the next person in.' Um, that way we can cover that demand."
Dr. Kevin Christie: I love it, man. That is, that is good info. Now, I think one of the things you s- you said a lot of good stuff there, but the one is just, oh, man, training front desk and, and, and that's just really hard to do, and that alone is worth its weight in gold. Um, what are some of the ways you guys train and kinda onboard these, these particular, uh, virtual front desk?
Pablo Blanco: Right. So, so there's, there's several things that take place be- behind the scenes. Um, and, and I do wanna bring, bring up that, uh, retention and turnover happens on, on both ends, right? It can happen- Yeah ... in, in your brick-and-mortar, at your place of business, as well as it [00:36:00] can happen even on our end, right?
Mm-hmm. Uh, what's important, and, and this is what you need to really understand, is what happens behind the scenes, because if it were to happen, when it happens, it's not like, "Oh, geez, well, someone left me virtually," like someone could have left me in office, right? And we're back to square one. A- and the answer is no, we're not back to square one because, uh, you as the business owner, you don't have to go out there and- But the job listing, interview, hire, trained, and onboard.
So what we do is, obviously, be- before we assign anyone, agents are already going through training.
Dr. Kevin Christie: Mm-hmm.
Pablo Blanco: Uh, we identify skillsets that they have, whether they are sales-focused, right? Uh, if you're, if you're not in network, almost every service that you're providing to your patients, it has to be approached kind of like in a sales format, right?
Dr. Kevin Christie: Yeah.
Pablo Blanco: Um, or if they're more on the insurance model [00:37:00] side where it's like you're a network, out of network, BPO, HMO, this is your deductible, copay, da, da, da, da, da, da, da, right? Um, or if they're doing something more executive, like we have clients where they're, we're, we do their bookkeeping and accounting for them.
So, uh, yeah, they go through that training, and then they also go through a separate training, uh, whether it be on sales-
Dr. Kevin Christie: Mm-hmm ...
Pablo Blanco: call handling, handling difficult patients or scenarios, um, handling, uh, perhaps multiple calls at once, and how can you basically leverage and, and prioritize your tasks. Uh, so we try to give them as many scenarios as possible so when they go out to the, to the real world, um, uh, they, they're, they're prepared.
Dr. Kevin Christie: Mm-hmm.
Pablo Blanco: Side note to that, uh, the vast majority, at least on our end for our agents, uh, they already work in the BPO industry, so they already worked, uh, managing an account in, in Guatemala- Mm-hmm ... which, which is where our call [00:38:00] center is. Uh, both Amazon, UnitedHealthcare, Royal Caribbean, Wix- Mm. Yeah
Squarespace, they all have their BPOs. That's their, their call centers in Guatemala.
Dr. Kevin Christie: Yeah.
Pablo Blanco: So, uh, I, I am fortunate enough to hire a lot of individuals that have worked in the industry, right-
Dr. Kevin Christie: Mm ...
Pablo Blanco: uh, virtually, like as a virtual agent managing accounts that, uh, you and I use on a day-to-day basis, right?
Dr. Kevin Christie: Yeah, yeah.
Pablo Blanco: Um, um, so that helps also, uh, become culturally inclined and, and understand- Mm-hmm The ways that we work and- Yeah ... communicate with, with individuals, and in this case, it would transition from maybe a client to what would be a patient, right? So that's where that additional training comes into play. It's, it's not so much can you do the work, it's like, all right, let's adapt you to healthcare specific-
Dr. Kevin Christie: Yeah
Pablo Blanco: you know, uh, culture.
Dr. Kevin Christie: Love it. Love it, man. Um, this has been great. Uh, if anybody's interested to reach out to you guys, how can they do that? Um, and anything else you wanna mention.
Pablo Blanco: [00:39:00] Absolutely. So what best way to reach us, uh, avalonmed.com. Uh, they, they could also email me, pablo@avalonmed.com. Uh, or if they reach you- And I'll put that in the show notes
and you can put us in, in contact, I'd be more than happy. It doesn't cost anyone anything to, to have a conversation. I'm always happy to hear and, and see what, what anyone is going through and also share, uh, some of our experiences as well.
Dr. Kevin Christie: Mm-hmm.
Pablo Blanco: And things that we're working on right now, as, as we mentioned at the beginning of the podcast, you know, Avalon Med did start in the digital marketing world.
Dr. Kevin Christie: Mm-hmm.
Pablo Blanco: Uh, and then the web development, uh, realizing that a lot of the opportunities that were coming through the door, uh, were not so much a marketing problem or- Mm-hmm ... issue, but a lot of these opportunities were being left at the front desk. Yeah. And then that's really where the front desk agents came about, is how can we Manage that for the client and, and very quickly realized, "Oh, wow, we could [00:40:00] actually do a lot more- Mm-hmm
and do it quite well." Um, and fast-forward to today, realizing that in order to do that the most effective way, because if, if you look at your marketing and all these channels of communication that your front desk is receiving, um, you have individuals reaching you via phone call, via email, via SMS, um, if you have a web chat on your Instagram page, on your Facebook, on your TikTok, right?
All these different channels-
Dr. Kevin Christie: Mm-hmm ...
Pablo Blanco: are extremely difficult to manage and, and, and not skip a beat. So what AvanMed created in 2026 is the AvanMed CRM, and as, as you've seen and, and, and have heard of many CRMs, um, you centralize all of that communication into a universal inbox. You can send email and drip campaigns depending on- Mm-hmm
each stage that you get an- Yeah ... individual coming through, and it helps your front desk, our agents, [00:41:00] anyone that's using the CRM, uh, be structured and organized so you don't let things fall through the crack. Mm-hmm. 'Cause every patient that falls through the crack, you just have to see it as $1,500 just went out the door.
Yeah. Or whatever the lifetime value of your patient is. Well,
Dr. Kevin Christie: yeah, we'll, we'll have to have a, a whole other episode where we dive into why a CRM is im- important for a chiropractic practice. I know that is, i- that's just huge, and I think a lot of people are missing the, the boat on that. So that's, uh, that's exciting.
They can definitely chat with you about that as well. Um- Absolutely ... and we'll probably have to do that. So, um, I do wanna appreciate your time today. I thank you for, for doing this, and I always love working with you guys and the stuff you do for my practice and for MCM.
Pablo Blanco: Likewise, and thank you so much for the opportunity, and for everyone out there, just keep it up.
Uh, I'm available if you have questions. Reach out. Like I said, it doesn't cost you anything other than a conversation, and, um, thank you so much.
Dr. Kevin Christie: Awesome.