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Dr. Brian Capra: Welcome everyone to UAC's Best Practices podcast. Our goal here today is to introduce you to a special guest, Dr. Ashley Torchio, and hopefully to share a best practice, a nugget that you can take, implement in your practice and see the results that another very successful doctor, actually husband and wife pair are getting in their practice. I'm here with my special partner in crime, Dr. Allen Miner. So, doc, why don't you take it away?
Dr. Allen Miner: Sounds like I come in on the short bus, Brian.
Dr. Allen Miner: Special partner. I have to laugh, Dr. Ashley.
Dr. Brian Capra: I can't get the word though.
Dr. Allen Miner: We all use the wired headphones. Nobody wants the EMF with the...
Dr. Ashley Torchio: No, never had them, never do them.
Dr. Allen Miner: Well, Dr. Ashley Campbell/Torchio and her husband, as Dr. Brian said, practice in Bend, Oregon. How long you guys had that practice for now, Ashley?
Dr. Ashley Torchio: We... This year will be 13 years in September. So, we just hit our 12-year mark.
Dr. Allen Miner: Way to go. And like many UAC members, you guys have built a successful clinic and now your kind of onto other acts as well, including... This isn't a best practice, but I just want to mention it, with what you guys have developed for patient education. Touch briefly on that. We'll come back to the practice with best practices. But tell everybody about what you guys have built and launched.
Dr. Ashley Torchio: Yeah, so it has been cool, when you kind of let go of the reins a little bit and just the adjusting part of it and you bring other people in to take your mission and kind of move it forward. So, we brought in multiple associates to start doing a lot of the patient care. And then my husband, Dr. Andrews, started a, it really is a, like a patient retention driver called PracticeOwl. So, he just launched that this year. And then on my front I, besides homeschooling kids and having babies and doing all that, I also do business coaching for service providers. I do one-on-one, I do group coaching. And then we're hoping to do, we want to launch something this year, my husband and I, because it's something we need to do together again. We did stuff together, went apart. We like it, but we like coming together and doing stuff again, so.
Dr. Allen Miner: I love it. Well, yeah. And for those of you who just probably never heard of PatientNow, google it, check it out. It's...
Dr. Ashley Torchio: PracticeOwl is cool. It is cool. It's like one-minute snippets in your patient's pocket. Like, it's cool.
Dr. Allen Miner: And from a very principled chiropractic education, increase retention, help people get the big vision why this makes sense not in the short term, but as a lifestyle for the family, so.
Dr. Ashley Torchio: Yep.
Dr. Allen Miner: With that said, though, let's talk about best practices. And we were talking before the podcast started, Ashley, and I love the concept. If you go a little deeper, you guys have, like many of us, I think, pressed marketing over the years in all its forms and all its ways. And you kind of took a different approach to it last year. Tell us about it.
Dr. Ashley Torchio: Yep. So last year, you always want growth, right? And so we had this number that we've been kind of striving for, and last year we let our marketer go. It wasn't going well. So part way through the year, we let her go and couldn't find the right person, I guess, to take over. So instead of continuing to try to drive in new patients, new patients, new patients, we're like, let's just take a beat and try to look at all of our retention factors that we have in our office to increase our PVA and keep the people that we have so we don't have to drive those new patients and just keep our in-office stuff working the way that it's working.
Dr. Allen Miner: Yeah. And so, what'd you find happened?
Dr. Ashley Torchio: So, during that time, we went a couple of different things. We rewrote some scripts and made sure that all of our docs were saying things on visit 1 through 13. And then after they had a re-sign, we actually went through the exact same scripts again. People had never heard it, did that again 1 through 13 at a re-sign. 1 through 13, just brought those same ideas back around and it was like they were brand new to people, which is fantastic. It just goes to show how many times you have to say the same thing.
Dr. Allen Miner: That's a nugget right there. I mean, you just... How many... I've heard it from my docs, like, well, we did that workshop or...
Dr. Ashley Torchio: I did that once.
Dr. Allen Miner: Right.
Dr. Allen Miner: Yeah, it's just, it's funny. I wonder sometimes when people, you know, we're so deep in the forest, sometimes you think of a patient who's never been to a chiropractor, they're processing so much. Who are these people? What's this like? This is such a different approach. What are they doing? I think very little of that sticks. And I think you're so smart to just not just double down once, but just to keep circling.
Dr. Brian Capra: Another thing is the opposite perspective is getting... They are getting bombarded with it every single day. Right?
Dr. Ashley Torchio: Yeah.
Dr. Brian Capra: And taking them the opposite direction. So sometimes if you... If you were to just say, hey, what's the 13 most important things that if a patient just got these things, they would be a patient for life kind of thing, right?
Dr. Ashley Torchio: Yep.
Dr. Brian Capra: And that's brilliant. And sometimes we try to over complicate it or, and like Alan said, just assume that they got it the first time, which they don't.
Dr. Ashley Torchio: Yeah, they heard it one time. They got this.
Dr. Brian Capra: Sometimes they do get it. They get it when you say it. Right? But they don't retain it. They're not telling other people.
Dr. Allen Miner: What were a couple of the key things that jumped out to you, Ashley, that you really doubled down on educating people and making sure they heard it over and over again?
Dr. Ashley Torchio: Yeah, I think... Well, I was saying about, Brian, I think the cool part about having associates is that we all communicate differently. So even if we have the same talking point, I'll be like, what were you just talking point? Like, what visit number was that? And they'll say it. I was like, oh, that's definitely not how I would say that. The first ones are pretty scripted, but then after that, it's kind of like, how would you take this idea and make it different through whatever? So that is kind of cool because you're right, Brian. Like, they might get it one way, but to hear it another way, to double down even on the idea was great.
Dr. Ashley Torchio: Okay, so some of the things that you talk about. Well, when it comes to chiropractic, I think all of us think, actually in my heart of hearts, I really believe that our philosophy is really everybody's philosophy. I think people actually believe in their heart of hearts that they were made to be healthy, that their body can heal itself, so I think that is real, but I just think they choose the contradiction on the regular only because they hear it so often, you know, like the analogy and all those different things. They know that their body is doing it for a reason, but they've been educated over and over and over again that it's troublesome rather than helpful. So, the crazy part is when you say it, they're like, oh yeah, of course. But you say of course, but yet you choose something else, so...
Dr. Brian Capra: So just doing that one thing alone, how much would you say your retention went up?
Dr. Ashley Torchio: Just education-wise?
Dr. Brian Capra: Yeah.
Dr. Ashley Torchio: So, I know our patient visit average, our PVA, I know how much that's gone up even over the last six months and we've increased it by about 15 visits just in the last 60 months. So, I took out of it, okay, what if we had the same amount of new patients? What does that... Like I've reworked all those numbers, so it's right around 15 visits by just strictly doing that and a couple other things that we did.
Dr. Allen Miner: What about, you alluded to it when we were talking earlier, podcast? Tell us a little bit about that. How often do you release it? Who's on it? What do you talk about? What have you found maybe works, doesn't work? How do you use it in the clinic, out of the clinic? Just give us all things podcast related that you found...
Dr. Ashley Torchio: Yeah, podcast-wise, we all do it. I have one doc that's pretty hesitant, but he does it and when he does it, he does great. He just is like a...
Dr. Allen Miner: So, it's like a group of you together?
Dr. Ashley Torchio: It's a group of us. Every single doc in the office does it. We haven't started inviting in guests yet, but that's our next hope is like we'll bring in people as we become hopefully the authority of health for our patients in our community. And we'll talk about our app in a little bit, but as long as we become the authority for them, I want to bring in other people that they can utilize as a resource. But right now, podcasting-wise, we only release every other week. I didn't want it to be daunting for my doctors. We're already doing workshops; we're already doing better results faster. We're already doing advanced wellness workshops, so I didn't want it to be more, I just wanted to take the information and recycle it a little differently.
Dr. Allen Miner: And how long is the podcast?
Dr. Ashley Torchio: 30 minutes. I try not to go longer than 30 minutes.
Dr. Allen Miner: And do you kind of have bullet points? Do you script it? How do you prepare it?
Dr. Ashley Torchio: Sometimes it's scripted. Sometimes one doc would interview the other, especially if they just taught a class. We'll use it more of like an interview format. And then sometimes if it's a topic where both are very well educated in that topic, we'll just go back and forth.
Dr. Allen Miner: That's great. What about...
Dr. Brian Capra: Do you have patients... Sorry, Allen.
Dr. Ashley Torchio: Yeah.
Dr. Brian Capra: You're publishing this, do you find that patients are coming in having seen it? Are they watching it? What kind of engagement are you seeing there from people that office?
Dr. Ashley Torchio: Yeah, the cool part is because we're archiving it and we have it available, the cool part is, you know, if you go into Genesis, when you go into your practice software and you type in conditions, the cool part is you can target your patients and be like, and the front will do it, they'll be like, hey, I know that you've been suffering with this. We talk about it when we're at the front. Dr. Andrew and Ashley just did this podcast. I think you should listen to it; I think it'd be super helpful. And so, it's cool because you can use it to target patients that are, you know they want to ask questions, but sometimes the timing and the pace, they feel like they can't. But I want them to know that we're available with other information.
Dr. Allen Miner: That's beautiful.
Dr. Ashley Torchio: Yeah.
Dr. Allen Miner: Any other internal facing things you did last year that you think helped with on the retention side of things that come to mind?
Dr. Ashley Torchio: Internal facing? So, we did launch PracticeOwl on our office. We were a beta office since Andrew developed it, so we were a beta office. But it was so cool. It's so cool to go and look at the metrics and see the patients and how many videos they watched and people that they get it after each adjustment. So, it was cool to see that people went in and watched them. Like, you wouldn't believe how many people watched 'em from beginning to end. It's crazy. There's like hundreds of videos. So, I mean, that was wild. And I think that was super helpful. And then we also did our app. And our app has all of our wellness workshops loaded, and didn't have a marketing person. I did hire someone that did AV and could do editing and all of that. And so the cool part is that they're done well.
Dr. Allen Miner: So instead of putting your workshops on maybe an office YouTube channel, you're having them live inside your app?
Dr. Ashley Torchio: Yeah.
Dr. Allen Miner: That's great.
Dr. Ashley Torchio: So, then our patients have access to our app and we're adding on things right now as we speak. So, I think eventually there'll be a paid section and there'll be a patient section. Maybe. That's my hope is thinking maybe go that direction.
Dr. Allen Miner: I mean, all those things point towards people staying longer. The education with Patient Now podcast, the app...
Dr. Ashley Torchio: 100%.
Dr. Allen Miner: The workshops. I mean, it's just 101, but as we've all learned, that social media, it's a hard path to bang out and attract people. And it is just common sense, if you can keep the people that are already there around longer, it's usually a lot more fun and easier road. And it's neat to hear you guys doubling down on that perspective.
Dr. Ashley Torchio: Agree. Yeah. That's good.
Dr. Allen Miner: Last question, Ashley. We ask everybody who comes on this podcast, UAC, what's been the benefits? How have you guys... How's it added? Why have you been a member for so long? Tell us about that.
Dr. Ashley Torchio: Yeah, UAC has been so cool, and this last year we've been absent for some things just because of the family growing.
Dr. Allen Miner: Life, yeah.
Dr. Ashley Torchio: Yeah.
Dr. Allen Miner: Ashley just had another, their third baby this last year.
Dr. Ashley Torchio: Yeah, I was like, you're right. Life, it just gets a little wild. But even with that being said, we did make multiple trips and have multiple connections with people in the group. So definitely the friendships have been awesome. We just got together with a family a couple weeks ago. We all went snowboarding together. They were in Bend. We're going to Florida in the end of January to meet with another family. So that's probably the coolest part is all the friendships.
Dr. Allen Miner: Yeah, we haven't released this data yet, but we did our annual metrics on UAC for 2024, and I could be off on this, but I think the average person in UAC said that they had created 11 relationships within UAC that they predict will be lifelong relationships. And so that's what that's about, is getting together and travelling. And so, awesome.
Dr. Ashley Torchio: I agree.
Dr. Allen Miner: Well, Dr. Ashley...
Dr. Brian Capra: Thanks so much.
Dr. Allen Miner: We love and appreciate you.
Dr. Ashley Torchio: Thanks guys.
Dr. Allen Miner: Say hi to Dr. Andrew for us and thanks for being on.
Dr. Ashley Torchio: I will. You're welcome. Thank you.
Dr. Allen Miner: Have an awesome one. We'll see you.
Dr. Brian Capra: See you soon.
Dr. Ashley Torchio: Bye.
Dr. Allen Miner: Bye-bye.
Dr. Brian Capra: Bye now.
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Dr. Allen Miner: Hey, Dr. Mark, how's it going?
Dr. Mark Mouw: Doing great. How about yourself, man?
Dr. Allen Miner: Doing good. I'll just start before we get into this master class. You're looking fit and trim. What you been doing?
Dr. Mark Mouw: Yeah. So, Lynne and I started a 90-day reset about 14 days ago. Eric and Shannon Kowalke had one last year. Just wasn't right timing for us, but we said I'm 50 this year and our daughter is a senior and she's going off to school so it's no better time than to get back to being healthy. So, we started 14 days ago on a crazy cleanse. It's been fairly easy for me to be honest but working in between that and then we go into a 75 day, what they call reset with macros and tracking and workouts. So, it's been good, but it has been really good.
Dr. Allen Miner: Cool. Right on. Good work, man. Well, what I want to talk about is I think very pertinent to a lot of UAC members in who are either wanting to go through this or have just come through it. But after 20 plus years in practice, you just stepped out from being the adjusting doc one, you have three other associates but you're still, you were very much to the heart of that practice and now you're no longer adjusting. And at Chiro Match Makers we see that work well, not very often. And I think you've done it expertly and I think maybe due to some of the other clinics we've gotten to watch inside of Chiro Match Makers and how they, how successful clinics handle this transition where a founder of a clinic who's adjusted for 20 something years. It's a big thousand-week clinic. How did, how you. That's what I want to talk about today. How did you find somebody? What was the process to successfully remove yourself, so the practice didn't take a dip. So now you bought back your time freedom. Working on the practice now, not in the practice. Although I think you love sales. I know. So, you're still doing a lot of the initial, you know, consult report stuff. But let's talk about that today. So, let's just start with how long have you been in practice? Give a little history on the practice and then how it transpired.
Dr. Mark Mouw: That'd be awesome. So, we just had our 20th anniversary January 5th. So, we had a big celebration in our office actually last week. So, it was fun. We had five days tons of energy giving out T shirts of 10, 15, 20 years of healthy adjusting to our patients. It was so fun to see that we gave out hundreds of those T shirts over the last couple of weeks. That's been great. Yeah. So, everybody, you know Lynne. Lynne's a chiropractor as well. We started as a mom-and-pop shop was her and I opened the doors, and we were just hoping to be successful enough to pay off our loans, make a great living. But we had a big goal of to build a beautiful practice. And within our first couple years, we brought our first associate in, opened a second office, sold that office to a couple of associates we have and had 14 associates over the last 20 years. We currently have three associates before I brought my replacement in.
Dr. Allen Miner: That was a separate. You had a separate clinic? Bought it, put some in it, sold that off. You've always had this original core practice.
Dr. Mark Mouw: Yes, that was our core practice for 20 years. We started another one from scratch 17 years ago, owned it for three years and had a sellout to our associates that were in it, which was what was planned from the beginning. I was never a person who wanted to have multiple practices. To me, it's always easier to manage one big practice. Being able to see it instead of 6, 7, 8, 9, 10 of them. I love the docs that are out there doing that. I know you've done that, Allen, and I can appreciate that. But I've never really wanted that inside of our practice. And I always thought it's really easy to have one overhead with multiple people instead of multiple overheads spread out. So, it's been good for us to have this one large, big practice. So Dr. Amber's been with us for 14 years. Dr. Andrew's been with us for 10 years. Lucky enough, my son went to chiropractic school. So, Dr. Jordan's been with us for seven years now, which is crazy. It's gone so fast. And then we got to the point we launched a second clinic within our clinic call the Nerve and Disc Centers of the Midwest.
Dr. Mark Mouw: And we did that two years ago with the intent to have more complicated cases that came into our office. So we add decompression, we added neuropathy. And it's been really good in growth to our practice. Been able to see some really awesome results, saving tons of people from surgeries and so forth. But at that point, for the last seven, eight years, I've only been adjusting and in my office on Mondays and Wednesdays because I work in Chiro Match Makers Tuesdays, Thursdays and Fridays. And also, was in the TRP coaching system as well, coaching clients. So, we were able to run a very successful practice. Lynne has an adjustment since our daughter was born, and she's almost 18, so she runs part of the front of the house for the last, you know, multiple years.
Dr. Mark Mouw: She's only there 10 hours a week. So, we do have a COO and an office manager. So, we've pulled Lynne really out of that over the last three years. I know, Allen, you've seen that. And the next iteration was to get me out of the adjustatorium. And believe me, I love adjusting patients. But that next iteration to grow the practice was to pull me out, let the practice run, and that was to bring in a fourth doctor to see the patients I was seeing and me to go into not only the CEO role, which I was already running, but also, I'm just. I'm doing day ones and day twos on Monday, Wednesdays, yet mostly day twos on our complicated cases and then handing off to our doctors. And it's been super successful, and it's been really fun to see that iteration in our practice.
Dr. Allen Miner: You mind sharing numbers? This stays inside of UAC. So, volume, collections, where's the practice going to be at this year? Like, what do you guys do on a weekly basis? And for annually, what are you projecting for this year?
Dr. Mark Mouw: So, we're anywhere between 925 and 1025 visits per week. Our annual projection for this year is to push 3 million. We were at about 2.6 last year. We grew this. You know, the chiropractic practice there. Nerve and Disc is a DBA because of Star Clause. It's inside of our clinic. So literally we have two front doors. We have a sign for each business over those doors. But I moved into that Nerve and Disc Centers because once again, as we all come out of school 20 years ago, we name it after ourselves. So, I named it Mouw Family Chiropractic. Right. So, all of a sudden, you know, with still the negative equity we have, we put Nerve and Disc Centers up as a DBA, but it really runs as a separate business in our office. Different colored files, all of our spreadsheets are calculated separately. We know exactly what our CVA is on both businesses. Expenses on both businesses. There’re two credit cards. You know, it really runs as two separate businesses even though it's under the same roof. So, our chiropractic practice last year was 2.2. And then our Nerve and Disc after two years was at 400,000. And I do believe that can push to around seven this year. Six is our projection. So, 2.4 in the chiropractic and then six inside of the Nerve and Disc Center.
Dr. Allen Miner: So, we've set the stage. You've built a successful clinic. You have unwound your wife. I mean, I've been in that position too. I've been on vacation with you, and you guys were having to answer phones because you didn't have the right people in place, which I think was what put you guys over the line. Like, we got to systemize this. So, I watched you put a leadership team in place. And so, then the last thing is you still are. We're adjusting. I think maybe the majority of people, or at least percentage wise, on Mondays.
Dr. Mark Mouw: I was seeing about 25. So, Monday, Wednesdays I was seeing 250, and we were at a thousand. So, my other docs were each seeing around 250. So, it was really split up evenly in there, which is good. So, I run more of a solid line model, which would mean that each one of my associates see and convert their own patients, so they have their own practice within my clinic, even though they're still an employee.
Dr. Allen Miner: So, then you decide, all right, I'm going to step out. So, talk about how you approached it and why it's been successful.
Dr. Mark Mouw: What's been. I think the knowledge behind what we've done in Chiro Match Makers had allowed me to do this the right way. And knowing that there's two types of associates. There are business builders and there are caregivers. And when we approach that process and understanding what's successful in our practice, what I needed is I didn't need somebody else doing a day one, day two closing care plans, because I already have three doctors doing that. I needed a doctor that would want to come in and just see patients because I'm still doing day ones and day twos. The next iteration is to free up Dr. Jordan because Dr. Jordan could go into that role. So that's the next two to three years. Just long-term play for where he'll be. He'll replace himself next. But inside of that process, what I wanted to do is I wanted to find a caregiver. And I knew the best place to do that was we went through Chiro Match Makers, obviously, is what we're going to use. And I was sent a doctor from over in Omaha who was in his mid-60s. And I interviewed him. 41 years of experience, heart of gold.
Dr. Mark Mouw: Was retired for six months. Worked in a pain practice the last time. Freaking hated it. Life grad way back when, was in the military, flies airplanes. I mean, just a really cool guy. Super in shape. Rose three times a week for an hour after seeing patients yet, which is so super cool. And he's like, doc, I just want to come in and work in a place. I'm bored out of my mind. My wife is still working part time. We don't need to, but I just love seeing patients. So, we brought him in, and that process was fun. And I can talk about that process, but it was...
Dr. Allen Miner: Yeah, let's. I want to break that down.
Dr. Mark Mouw: Finding the right person was important.
Dr. Allen Miner: But first let's just unpack. You know, we've got 70 open jobs with Chiro Match Makers. We placed over 200 associates last year. We see inside every different kind of practice, and we talk to owners all day. And one of the most common red flags we get is, oh, 60-year-old Doc, I don't want them. 40 years. You know, kind of old dog, old habits. We hear that a lot, you know, and there's kind of the other extreme is new students, they don't know anything. They have no skill set, no hands, no bedside manner. But you know, I've always had good success with the season docs myself as well. So just touch on that a little bit. Why? You know, opposite to maybe what most people. I bet when you said 60, some people watching immediately went, why? I don't want somebody that old. But what's your benefits of hiring somebody that seasoned?
Dr. Mark Mouw: Well, I'll start out by saying We've had 14 associates, and I'm split seven. Seven. Seven seasoned doctors and seven new doctors. And what, you pick your poison. Right. There are great things about both. The new doctor coming out of school, the new grad, they're potter's clay. The problem is they haven't had 10,000 laps. I said you need 10,000 adjustments before you know how to really take care of a person and get people adjusted. Right. So, it's going to take them whatever and how fast your practice is and how many patients the person can see, how many times, how many, how long is it going to take them to get 10,000 laps and can you afford to do that? On the other end of it, it's the seasoned doctor. Oh, they have bad habits. I need to break those. Yeah. You know what If a person wants to listen, they're a type of caregiver or a doc that really wants to... Maybe they've been roughed up. We usually see that in Chiro Match Makers. Right, Dr. Allen?
Dr. Mark Mouw: It's like that doctor has been out five or six years. They open their own practice, they close down, they maybe worked the joint, something like that. All of a sudden, that doctor comes in, and they're just like, man, they're just looking for a beautiful landing spot because they want to take care of people. And that's really what I found with Dr. Mike. He was successful. The interesting story was, is Chiro Match Makers actually sent him to an office about 25 minutes from me in Omaha. A young couple who I know, and we sent them in, and they were upset that we sent an old doctor into them. So, Adriana reached out to me. She's like, he doesn't have his Iowa license because I'm on the Iowa side of Omaha. Would you still be interested in talking to him? I'm like, yes, absolutely. So spoke to him, brought him in, job shadow. He adjusted me. I mean, hands are gold. And here was the iteration that was important to me is that every time I grew from myself to the next associate to the next associate, clipping from 300 to 600 to 900 to whatever it was, I could bring a young doctor in because I didn't have the patients there for them to take over.
Dr. Mark Mouw: But when I had patients that I had been adjusting for 20 years and I consider myself a good adjuster, I needed to bring somebody in that had hands to do it. And that's the iteration that there's no way I could have brought a doctor in to replace myself. That was less than two years of experience to see 250 people boom from day one, which there's a training process we can talk about. So, I needed somebody. I needed that old dog to come in to give people the benefit of understanding that, wow, I even break him up. He has more experience than me. He's better than I am. He's 41 years in practice. He's going to be awesome. So, my established patients knew I wouldn't be sticking them with somebody who was going to be learning on them, but they had the confidence that they could get well and stay well with him.
Dr. Allen Miner: Yeah, it's. There's a lot to unpack here, and I want to. Because you hit a key point. I just want to recap. And that is when you're a seasoned doc who's a really good adjuster, you can't just bring in somebody. You need an A player who matches your skill set, because your patients will smell that in a heartbeat. And I want to talk about that transition, because so often practices take a dip, people leave, they're not happy about the transition, and that is, I want to unpack. But first, let's talk salary a little bit. You know, we've seen. Just to give everybody an industry update at CMM, you know, the Bureau of Labor Statistics puts the average salary at 89,000 around the country. And we find that to be pretty average. But about second quarter last year, the joint bumped up to $100,000 base in most of their markets. And we saw that really quickly ripple through the profession. And you know, by our estimate, right now there's somewhere in the neighborhood of four to five openings for every one available associate. So, there's a supply problem. There are not enough associates. And now you got the joint paying $100,000.
Dr. Allen Miner: And so, we've seen that have an impact. You know, we. What's unique about us is we don't use job boards. We found all the D and F and C players are on job boards. Why do you go on a job board when you lost your job, or we find the job hoppers tend to be on there. So, we have had much better success. Our recruiters all day long are calling, talking to, you know, I think have the biggest database in the country. We know every state who's an associate, who's an owner. So, when we have a job in Iowa, we can pull up and see who all the associates are we've spoken with, and we start running our job in front of them. And the advantage to that is the A players aren't on a job board. They've been head down, bum up for three, five, seven years in a clinic. They're not really looking for a job. They're probably making that average salary of 89,000, maybe 95, maybe 75. So, we found right now, when we can come along with a price point that's north of a hundred, you'll get that A player's attention.
Dr. Allen Miner: So, it truly is head hunting. We're poaching. But there's this bubble in chiropractic right now because we have the resources and the access to these associates. If the job's good enough, we can pull them out, which is essentially what we did for you. Now the ROI on this, we found, needs to be a minimum of three. I prefer four to one. So, if you're paying somebody at 105, 110, 115, I pay my docs a 125 base. I just don't want to mess with it. You know, they need to bring back 4 or $500,000 on the income that they're generating. So how did. Do you mind talking? Where did you put the salary at? What are they Generating give some real-world experience to what I just said.
Dr. Mark Mouw: Yeah. So, he came in and what I did, I started at 95,000. And what he does is he has escalators for after he sees a certain number of visits per month and that is pretty easy to attain. He's seeing 225 to 250 a week. What was different from his schedule to mine is he is in Monday Wednesdays, which I have been for the last five or six, seven years. He's also in Thursday afternoon and Friday morning. So, he's only in really three days a week, what I would call six shifts or three days. He's making 95,000 at 800 visits per week. He then for every 200 visits over he gets a $500 bonus. So last year...
Dr. Allen Miner: A month, 800 a month.
Dr. Mark Mouw: Yeah, I'm sorry, yes. 800 visits a month. It's of 200 over thousand, 1200, 1400. So, there's a growth and push forward for him to grow and continue to see more patients which lies about most, you know, back on me as well as, you know, doing day ones and day twos because he's seeing most of those patients I'm converting. So, he made 103 or 104 last year and he should be on target to do 110 this year as they continue to grow. And he's ecstatic, ecstatic. And the reason why is because he has the stability and he's actually living in his best life because he's doing what he loves best, just adjusting and educating patients. He's a true teacher, caregiver, doctor.
Dr. Allen Miner: And a true. Something we got to point out is caregivers are motivated. Think engineer or accountant. These are the same profiles. They could have been an accountant in another life. They're detailed people, they're loyal, they're systematic, they're procedural and they like stability and predictability. So, these people like a solid salary. They're not motivated by high end bonuses like we are. You know, they want stability. We see about a four or five... We get four or five times the applicants on jobs with just a good base salary than any kind of combo commission bonus incentive program. So that's worth noting. Now here's another point let's talk about in the last couple minutes the transition because so often two things. I think you did it the right way. What's common is you get an owner; they're getting maxed out. So, they bring in the new doc and they have, they want to build up the new doc’s clinic next to the owner. And now that you're having to pay north of $100,000 to get a solid A player associate, that sucks. If you're seeing 300 people as the owner and you got an associate over here seeing 25, 50 people, you're trying to grow their clinic and you're paying them 105,000, yet you're still doing most of the work.
Dr. Allen Miner: That's where this gets upside down. What I'm a fan of is when you find a caregiver, I want to put the volume they're expected to be at right out of the gate because people tend to their thermostat resets. If they all of a sudden are sitting around only seeing 25, 50 people, they never really do seem to grow it as big as the owner grew it. So, I'm a fan of the owner taking all of the adjustments, putting them on the associate right out of the gate. So, he's starting at 250, 300 a week, she's starting at that level because that's all they know from day one. And now you just bought back your time freedom. But that transition is what's key. So how did you do that handoff so that people, you didn't get the complaints of, "I've gone to Dr. Mark for 15 years. You're not him." How'd you do that?
Dr. Mark Mouw: Yeah, and that's true. Like some calls like you and I have every day. It's the doctor's burnt out, they're overloaded. What they want to do is bring a doc in and either take off on vacation right away and do no training, or what they want to do is that I want them build up the other 300. And it doesn't work that way. You just don't see it ever work. And the reason why is that that doc is more of a supporting doc. That's what you want. The doctor who can just build up the next 300 is going to leave you in two to three years down the road and do their own thing anyway. They're going to leave high and dry. So, what I did is I brought him in. He actually started with me last February, so he'll be with me a year in February. He spent 90 days literally standing at the table next to me watching me adjust, educate patients, talking about how I was adjusting them and doing my notes. And he's 68 years old, just to let you know, in February last year. So, he's 69 now, but he's 68 years old, doing my notes, figuring out our systems, procedure and process of the floor.
Dr. Mark Mouw: I didn't do that for 90 days. At that point. He then started to see patients and we were sharing patients. If I was in a consult room doing an ROF, he'd jump in, see patients. And what I told patients is we were co carrying them. And this was in May. Well, then in June. I was gone for a couple weeks in June and July with vacations and national dance with my daughter. So, I'll let patients know, Dr. Mike's going to take great care of you. Before, when we didn't have that, I was gone. My docs, the other three, would have to absorb 250 visits the weeks I was gone. So, we couldn't grow because we had to block out their new patient time zones. Now what that did is that allowed them to keep all their new patient time zones open. Dr. Mike could just see my patients. So then when I ended up getting back at the end of July, I let most patients know that Dr. Mike was going to be their primary care provider. He was going to take great care of them. They had a great experience because they had been adjusted by him a couple times now.
Dr. Mark Mouw: And those things stabilize. What was nice I would say about 10% of patients saw Dr. Mike, but they had seen my other doctors over the years because when I was gone, they would. So, we didn't lose any patients, but I did have about 10% of my patients go to the other three associates, which was okay, they stayed inside the office, but they had seen them for 10 years when I was gone. So that wasn't a big deal. But he absorbed that, and it worked out great.
Dr. Allen Miner: Here's what we noticed, Mark, and what I think you applied is we started noticing Chiro Match Makers when an owner was pregnant or injured and brought in an associate. And they stayed there for about six to eight weeks. Just literally look like, look, I can't adjust you physically, but I brought somebody here and I'm going to walk them through everything I do. I'm going to, you know the listings. You're literally the docs calling out the listings. The adjustment, what to do. The patient, that confidence gets transferred. Instead of like just, all right, you're on your own, doc, go figure it out. That's what people didn't like. And so, and you weren't injured. So, you just told him, you know, he's helping me here. And so. But it's that if that's the part is that's key, is you staying there for about almost till you know you don't need to be, but you're still around. Patients don't feel abandoned. They feel like all of your knowledge, they've heard you transmit your knowledge to the associate oversee the work. So, they're confident in the associate. It lifts them up. And then the other key part in this, Mark, that you also touched on, I don't want to skip on, is I think there's just a trust innately that this doc had confidence that he'd practice longer than you.
Dr. Allen Miner: And so that's really where that transition works. And then the last thing is recognizing you're the special sauce in that practice. All these owners who've grown these clinics, that's a skill set that's harder to hire for. You can convert people. It's easier to find people to handle the workload. There's much fewer docs that can do the day one, day two. And so, you still maintain that. So, the practice keeps on growing. You're just not doing the physical work of it. And I think that's a key point that a lot of docs miss often, sometimes.
Dr. Mark Mouw: Well, what is great is we can, I mean, we don't. We can continue to do what we do is see the volume when I'm gone, because we just need the adjusting there. My other docs can absorb some of the ROFs, but if we want to turn down neuropathy when I'm gone for two or three weeks, my goal is to be off out of my office for three weeks, 30 days. This summer, Lila's graduating, she's going off to college, she's leaving the area. So, we went into that, and it's been a goal of mine for two years. And that was the iteration of going through the process. The way it was is I didn't want to hurt the mothership, but I also wanted the time, freedom to be able to step away and do that. And this is the process that I was given. And by the way, what I'll state is that there's a lot of great doctors. Dr. Bart Patzer, Dr. Kevin Priestley, I mean, they're awesome. They're in their adjustatorium. Jody Sura, he's one of my accountability partners that I'm on every other week. Yet he's 60 some years old and he's in his adjustment and he's in his glory and all these guys love doing it.
Dr. Mark Mouw: Stepping out and not adjusting isn't something you need to do to be successful. That's the really cool part. Inside of our own businesses, we get to choose what it looks like. You want to see patients five days a week? Knock your socks off. You don't want to be in your office at all and you want it run for you. Just put the right people in a position and that's possible. We see it. But have the goal, have the purpose, but do it correctly and hire the right team, have the right person, the right role, doing the right job. That's where you're actually going to see what your goals are, and your purpose are as you move forward.
Dr. Allen Miner: Absolutely. Well, I got to wrap it up. Last thing is Dr. Brian Dahmer had a question about what's the best retention tool for key staff when you're not in the practice every day. I still own four clinics: I'm not in them. Brian. It's a great leadership team and its weekly check ins and for us it's doing scorecards. So, we record their day ones and day twos and give them scorecards on that regularly, so everybody knows everybody's staying on track. And then finally, I think a great salary. Pay your people better than any other chiropractor is going to pay them in your community and they don't have anywhere to go. And the ROI on that should be five, tenfold very easily for a successful clinic. Just pay people well. It's amazing how far that goes. Do you have anything to add to that, Mark?
Dr. Mark Mouw: Yes, yes, yes and yes. And I would just add one thing is we track stick rates. So, we have our conversion stick rate, we have our 3-, 6- and 12-month strict rates of our patients because we're a wellness based practice. If things are going to go sideways, you're going to see your stick rates go down. That means people aren't doing their KPIs and their scorecards. So that's where you need to come back in over top and make sure your leadership team is making sure that transition going forward.
Dr. Allen Miner: Yeah. On a simple level, people want to know what's expected of them that A players, they want to be measured on that, so they know they're doing a good job. And when they have that feedback loop, you don't really have to motivate people. So, thank you Dr. Mark. I got to get over to sales call so appreciate the call. Thanks guys. Have a great one. See you.
Dr. Mark Mouw: Appreciate you guys. Bye-bye.
Dr. Allen Miner: Bye.
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Saknas det avsnitt?
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Dr. Brian Capra: Everyone, welcome back to the UAC Best Practices podcast. I'm Dr. Brian Capra from UAC. I'm here with my co-host, Dr. Allen Miner, and a very special guest, Dr. Olivia Joseph. The goal today is just to share best practice that you can take it, implement in your practice, and get great results like a successful husband and wife team like the Doctors Joseph are. Dr. Allen, want to take it away?
Dr. Allen Miner: Yeah, I'm trying to think back how long I've known you, Olivia and Brian, and I don't know, it seems like probably at least six, seven years.
Dr. Brian Capra: Long time.
Dr. Olivia Joseph: Say about a decade.
Dr. Allen Miner: Yeah, probably. So, you practice out of the St. Louis, the suburb of St. Louis. And you know, the first thing I'll touch on that I've just always been impressed is there's a lot of people in chiropractic who I think all chiropractors are trying to figure out how do I maximize healing potential for my clients and revenue within this profit center of my brick-and-mortar business. And I think that what you and Brian have done is best in class. You guys are in a number of verticals with traditional chiropractic care, but then you also offer decompression and then you offer, I believe how I always know you is kind of as a functional expert. So, then there's the functional side and then you guys have a nurse practitioner doing PRP and stem cells, and you really have that.
Dr. Allen Miner: There are all kinds of different terms these days. I'll let you name how you guys describe your clinic, but can you just maybe briefly talk about how you integrate all of that? Because I see so many doctors, really, they're challenged with, you know, when somebody comes in the door, where do you direct them? I see so many offices that they focus on one of these verticals and they lose sight of the other verticals and you guys’ shine. And I know I'm seeing the end product where you, it is probably perceived by us as a lot easier because you guys are so graceful, but there's probably been so much work and pain working out how you do it. So, can you just give a little insight maybe from where you're at now to back to how it started? You know, when somebody comes in, how do you direct them? What have been the benefits? And then we'll get into your best practice. But I just, I think you guys have such a fascinating practice model. I want to start there.
Dr. Olivia Joseph: So, I think initially we started out with just two simple offerings, chiropractic and nutrition. That was pretty much it. And what happened was they both grew and grew and grew big and strong enough where, like we said, we weren't robbing Peter to pay Paul. And there have been times in our practice where we integrated a new service or a treatment. There have also been times where we got rid of, like we got rid of our acupuncture department. And I can explain why, you know, in moments which was thriving, by the way. If you looked at it, it would have been called like a high-volume acupuncture practice to chiropractic. Right. Or to acupuncture. But we just had to, when we looked up the space, the time units, the dollar productivity. Like, I needed those rooms to hire another functional medicine practitioner, and it was going to be way more profitable, and it kind of hard to get rid of it because I knew what amazing clinical results we were getting. But at the same time, that was the first service that we had to let go because of COVID.
Dr. Allen Miner: Pause there Olivia. I just. That's brilliant. Because that is, you know, that's the analogy of is you willing to tear something good down for something great? And how many clinics would just. Even though it doesn't feel like a lack mentality, when you have something positive and cash flowing, there's a tendency to want to hold on to it. But for you to actually say no, time out, we can have a bigger impact, help more people in a bigger way, and make more revenue. That's fascinating. So, did you try to sell it? You just shut it down?
Dr. Olivia Joseph: Shut it down. Just shut it down. And I was the one running the department. I was the one, like, I started doing care plans and treatment plans. In acupuncture that kind of wasn't heard of, like, especially. So, we treat. I was doing care plans with nutrition and acupuncture combined based on the demographic I was seeing. And no, we just had to shut it down. And I hired another functional medicine practitioner and filled his schedule fast and then had to hire. So, I think what the moral of the story is we started out pretty much just two services, but they were both strong enough where they didn't pull from each other. When somebody comes in on my side just for functional medicine, that is not a chiropractic patient. Very easy to get them to chiropractic because they're already in functionally. The fee system's way different.
Dr. Olivia Joseph: Right. So, if somebody's used to coming for, you know, $2,000 worth of testing upfront, to send them to chiropractic is an easy referral. And then on the chiropractic side, it's such a large volume of people that they're seeing what's going on in our office and under our roof. And when a patient that's stubborn or even one that's like not responding well, stubborn as well, or not getting the best results or even just interested in those other services, they're already getting a good experience on the chiropractic side, they're getting good results. They already trust us to come into that higher dollar productive service. But to this day, we have people that come in just for functional medicine, just for chiropractic, just for, you know, one service or another.
Dr. Allen Miner: Do you, I'm curious about that. Do you market decompression separate than chiro, separate than functional? Do you, are they all kind of their own separate tributaries?
Dr. Olivia Joseph: Yeah.
Dr. Allen Miner: And so, when they come in, if they came in on a decompression ad, do you address that first and then refer over or how do you guys integrate all of that back and forth?
Dr. Olivia Joseph: So, if you come in for decompression, you're going to be getting chiropractic care too. It doesn't mean you're coming over to the functional medicine side at all. Same thing, if you come over to the functional medicine side. It's usually for you know, whatever a marketing campaign was, if it was thyroid, if it was diabetes, something of that. We're mostly referral though, honestly like, we're mostly still a referral-based practice. We do tailor our marketing specific to a department. Even like for injections. Like if we're doing specific, you know, marketing towards injections, then that's the report of findings and the treatment plan that they're going to get.
Dr. Allen Miner: I won't ask numbers, but I am curious, of the four departments, which one top line revenue does the most business?
Dr. Olivia Joseph: I would say chiropractic and functional medicine are about the same. They really are. The one that has the most potential is the injections, right? That's the one that's got the most potential. That's the one where we have the most capacity. And then again like if you're measuring your options, like am I going to keep acupuncture in my clinic or look how much this nurse practitioner can do in injections. It's kind of a no-brainer, right?
Dr. Allen Miner: Yeah. So how many staff members do you guys have?
Dr. Olivia Joseph: Oh gosh, we just hired like six more because it's been really challenging to find full-time. So, we've had to like we've retained our core people for so many years and years and years and years, we have very little turnover. We have, you know, staff turnover. But we've just brought in like six new hires because it's a struggle to get people full time. I should know this number. Brian would know. I'd say with practitioners, we've got 10 providers, and we've got probably 24 total.
Dr. Allen Miner: Okay, so then that leads me into the best practice question. 24 people working under your roof. How? What are you guys doing? Let's talk best practices. You know, what are you using with data, with strengths. Talk. Let's, let's. And I just say all this to build up. You've got a lot of credibility in this space because you've got a big team, a successful team. So, talk to us. What can somebody listening use, glean from what you guys are doing?
Dr. Olivia Joseph: So, I think one thing I figured out early on, so I've been in practice for 21 years, and in the last 18 years, we've been in this practice, this, like this bubble of, you know, functional medicine and chiropractic in a variety of capacities. And Brian, my husband, has from day zero, he's like a statistician. Like, he is using stats to drive almost every decision. I'm not saying sometimes there's no emotion because we're business partners, we're husband and wife. We're business partners with another husband-and-wife couple.
Dr. Olivia Joseph: So, there is emotion. We're all best friends and we were having babies, and we were doing all this, but really it came down to the numbers. And what I mean by that is like every year, over and over and over, Brian goes deeper and deeper and deeper into stats in many of the decisions that we make. And, well, like I said, getting rid of acupuncture, yeah, that was hard for me, but I really had to make it not an emotional decision. And look at what's the greater good of the clinic and the people that we can help and serve. So, what ended up happening, like stats. Just recently, even Brian did this whole evaluation on every one of our providers.
Dr. Olivia Joseph: Not by department, so not by department, by provider, to find out their dollar per visit average is, what their retention rate is. Just looking at everything, the report of findings, all that. And so. And he was talking to me, he goes, do you know who has the highest retention in the practice? And I said, I don't know. Who? It was me and the lead chiro. Right. And he's like, well, what does that say? He's like, we've got to use our strongest people to train the others on retention. Who has the highest per visit average? I do. The nurse practitioner has the most potential for that for sure.
Dr. Olivia Joseph: Who does the lion share of the production in that department. It's not me, I work three half days a week. That's it. But just kind of looking under the hood at the stats and I think it's also revealed people on our team not just practitioners, a lot of what their strengths are. Right now, we're doing this project to kick off the new year where we've split the office into teams. There's a loyalty team that's... And Brian came up with this concept too. There's a cash flow team, there's a appearance team with like aesthetics. So, we're broken into these teams where we have strengths and passions. Like, I don't want to be in the cash flow team. Actually. You know what he said to me when he came up with the teams? He was, "Do not sign up for the cash flow team."
[laughter]
Dr. Allen Miner: That's awesome. But that's your strengths. I mean, and that is when people are working in their God-given strengths, you don't have to motivate them. They have an energy in that area. They want to contribute to that area.
Dr. Olivia Joseph: You're totally right. And so, I signed up for team loyalty, and then I found I have one of the highest retention rates. You know, it's like stuff like that. So, I'd say we let the artists be artists in the clinic and the people that are really strong at marketing, business, statistics, let them be strong at that, which is what Brian is, you know. So, I think that that's probably what's allowed us to succeed.
Dr. Allen Miner: That's beautiful.
Dr. Brian Capra: Brilliant. Yep. Run up by the numbers.
Dr. Allen Miner: Yeah, it is.
Dr. Brian Capra: because it is... It can be so difficult to take your emotion out of something like that. Looks perfectly great, you know, on paper. By any means. Any other means? Yeah.
Dr. Olivia Joseph: Perfect example of that. So last month I was in my... We have a leadership meeting, right? And so, the leader of functional medicine team is there. Me, you know, whatever. So we've got six people in the boardroom and I say to my team, I said, "We have more cancels right now than we had a year ago. I don't know what's going on in the functional medicine department, but I'm like, our visits are down, and our collections are down." And Brian just looks at me and doesn't skip a beat. He goes, "Is that a fact?" I'm like, "Yeah." And he goes, "Did you pull up last year's numbers and compare them?" I'm like, "No." and he goes, "They're exactly the same." I'm like, "Dang it. Dang it." That's a perfect...
Dr. Brian Capra: Yeah. You can totally believe something is true without numbers.
Dr. Allen Miner: I'll say it again because you touched on it, but it is amazing when you have data how the emotion can just leave. And we found, especially with staff, it just... It's not about them. It's not to be taken personally. It really can transform things to where you're... That data is... It tells the truth without pointing the finger necessarily at somebody. And that I think...
Dr. Brian Capra: Yeah. It agonizes team too. Like, because, okay, our goal is to get better. Right? Let's talk about that. How do we get better?
Dr. Olivia Joseph: And I don't want to give the impression like Brian does all that, but I don't want to give the impression, like I'm a Pollyanna and I don't look at that. I have to run a department. I have two doctors who work for me in the functional medicine side. I'm month over month, I've got to know what my new patients are doing. My report of finding stats are. And then I'm looking at each doctor's individual production average in the sense... Well, man, he... This one recommends a lot more testing and supplements than this one. You know what I mean? So, it's kind of looking at things like that. So, I still look at it and understand it. I wouldn't say... And I say it's extremely important to be successful, especially if you have multiple services or multiple practitioners. That's... Yeah. So, the numbers matter. I'm not the, like I said, the statistician like my husband is. But I still have to look at that without emotion because I'm leading a team.
Dr. Allen Miner: Yeah, that's beautiful.
Dr. Brian Capra: Deeper more important, like you said, more complex, like we do at Genesis, because you can kind of... Even with chiropractic, you know, it's relatively straightforward. You know the numbers. And then you add one more service with what we have right now, for example, there's like 500 and something combinations of products. It's not 500 products, but there's co-tier... Once you get into tiers and all this stuff, and if you don't have the numbers, you're like completely lost. But if you do have the numbers, that benefit of having that platform of offerings is huge.
Dr. Olivia Joseph: Totally. And Allen, to justify what you said, there have been hiccups over 18 years when you...
Dr. Allen Miner: Of course.
Dr. Olivia Joseph: When a new patient call comes in, how do I know which service to direct them to? Do you know what I mean? And that takes good training. That takes good systems, you know, so that's part of the art, too.
Dr. Allen Miner: It's beautiful. Dr. Olivia, final question. You've been in UAC a long time. What's been the benefit? How's that contributed to you guys in your success?
Dr. Olivia Joseph: I think the benefit is the relationships. And we started really, really early on, and we haven't been able, just because of life... And we had a fourth kid five years ago, been able to participate as much as we did in the beginning. But I feel like, especially when we were really involved, that it was just kind of humble relationships in the sense where I spent an entire weekend side by side with Dan Pompa talking about nutrition and detox, and I didn't know who the heck he was, you know what I mean? So, like, kind of like that.
Dr. Olivia Joseph: And when I, when I do, you know, run into Mary Lee periodically at a, event, like, it's like, it's like you don't miss a beat, you know? Same thing with you guys. Same thing. I would say that, like, the relationship part for me has been the best. And then even, like the... There are just things you don't forget. Like, even remember Pat did the whole "Miles Davis you got to, like, burn down," right? Like, I was just reading a book last week that's talking about that, and I'm like, "Wow." Like, it was... That was such an amazing point and concept, and it circles back in your life. Like, greatness will circle back. Not always going to be great all the time, but if we put ourselves in places around greatness, like, it comes full circle.
Dr. Allen Miner: Well said. Beautiful. We're honored to...
Dr. Brian Capra: Awesome. Thank you.
Dr. Allen Miner: To be affiliated and associated and have you guys be part of the group. And thanks for sharing this. It's going to help a lot of docs.
Dr. Brian Capra: Thanks Olivia.
Dr. Allen Miner: Think bigger.
Dr. Olivia Joseph: It's great catching up.
Dr. Allen Miner: Thanks, Dr. Olivia. Have a great one. Take care.
Dr. Olivia Joseph: Thanks.
Dr. Brian Capra: Bye.
- Visa fler
