Second- and third-year learning curves…

I meant to do a follow-up last year on the previous posts that discuss what we learned during our first year of practice, but as I recall, we were knee-deep in staffing issues and upcoming travel plans, and unfortunately, this blog took a back seat.  Before I realized it, Years 2 and 3 have slipped by, so I think I’ll take this opportunity to play catch-up, because we learned a few more things that might help someone else, and if they have that potential, they’re worth sharing.

It seems that the first several years in practice are spent figuring out 10,000 ways NOT to do something.  (Yes, this is normal; you’re not alone!)  My philosophy, though, is that you only actually FAIL when you stop trying; everything else is a stepping stone to eventual success.  I thought I’d share more of those stepping stones.  OK, here goes…

The first thing that comes to mind is, have a treatment/care plan written out for the patient, whether it’s for chiropractic, acupuncture, nutritional counseling, or other.  Having these things in writing solidifies the goals, needs, and expectations of the patient, giving them a written game-plan.  It gives them something tangible to work toward, and it helps them if they have something they can refer to whenever they need to.  It also helps keep you, the doctor, on track.  It’s also a handy document that can be easily photocopied and put in their file, reducing the need to type/write out notes by hand.  Patients are more likely to stick to this plan than they are to something verbal.

Next thing – when a patient has more than a simple 5-minute question, it’s important to schedule an office visit.  Many chiropractic doctors are hesitant to schedule an appointment for a patient that does not involve a chiropractic treatment, but if this encounter is going to take any length of time, it should be reserved on the schedule.  It goes without saying that it’s a good idea if this appointment is paid for; it is taking your time and expertise, after all, which is the bulk of what most of us have to sell.  (Yes, you also have your adjusting skills, if you are an adjusting doctor, but let’s face it; many different types of people will “crack” someone’s back–massage therapists, friends/family members who think they know how to do so, etc… it’s your expertise and formal training–and indeed, your license–that set you apart.)  Do respect your own time and collect payment for such an appointment.

On the subject of appointments – do not get too lax on no-shows.  If a patient was due in at 10:00 am and it is now 10:05, get on the phone (or have your front desk make the call) and find out where that patient is.  Don’t be too quick to place blame on the patient; after all, the front desk CA might’ve scheduled the appointment for the wrong day or time.  But do start out by informing the patient that your system indicates they had an appointment scheduled for “x” time today, and you’re just checking up to see where the ball dropped.  If the patient forgot, we give them one; after all, life happens and humans are human.  They forget things.  They get hurried or preoccupied with something else in life.  An emergency pops up; a kid or pet is sick.  Or maybe they’re actually on the way, but there was an unexpected delay due to construction, an accident, etc.  The list goes on.  Sometimes, they plum forgot.  Give them one, let them know you’re making an exception, politely reiterate the cancellation policy (if you don’t have a cancellation policy, enact one….yesterday), and reschedule them (not “would you like to reschedule this appointment?” but rather, “which day works better for you this week?”).  Then be done with it.

One theme I noticed as I reviewed all the now-dormant files from our first and second years in practice, and all the personal journal entries from that time period, is the fact that I.  Got.  Shit.  On.  A lot.  Sorry for the language; in fact, it isn’t nearly strong enough to describe what I went through.  I made the mistake of trying to be their friend as well as their doctor.  It’s not that I hung out with them socially outside of the clinic or anything, but I was way too informal in my communication with them, way too lax on my expectations of them.  I wasn’t entirely confident and although I tried to keep up appearances, I’m sure it showed anyway.  I must’ve been way too apologetic, trying too hard to justify my recommendations, most likely due to the price tag these recommendations would cost.  I must’ve felt strange asking for the sums that I was.

It took a long time to move past that.  Finally, I evolved into the mental framework of, I’m not skimping on your care.  I’m going to be thorough, give you all of my recommended options, then tell you what I would do in your shoes.  My goal is to give you good care and tell you what you need; finances are secondary and they are up to you.  Good care costs, and here are the costs…  It feels much better now, and I get much more respect.  This evolution was a painfully gradual process; it did not happen overnight.  I had to be patient with myself.

If you practice any kind of nutritional counseling or Functional Medicine that requires that the patient follow some strict guidelines, be strict.  Do not waiver, or you’ll send the unintended message that it’s not all that important.  If they have a serious condition, you need to meet that with a serious care plan.  Allow for some dietary/supplemental liberties where you can, but be strict on the absolutes.  If it’s something the patient needs to do in order for this care plan to work effectively, they need to know that.

Staffing – during our second and third year of practice, we had staffing issues.  These took several forms, and we learned a lot.  First, we learned to NOT ever hire friends of current staff.  While this might work for some offices, it can be a double-edged sword.  We had a situation in which our front desk person was friends with one of our massage therapists.  They resorted to less-than-honest tactics to protect each other.  We had a total of two massage therapists, each of whom covered certain days.  The front desk would lie to patients about massage therapy availability to maximize the number of patients scheduled for her friend, edging out the other therapist.  Also, if the front desk receptionist and massage therapist friend wanted a day off together, they would schedule massages around the desired day off and then approach us with, “can we have Friday off?  There’s nothing scheduled anyway…”  When that front desk person eventually departed (mutually–we would’ve fired her but she was planning to leave anyway), the therapist friend (who had been an excellent long-term contractor up until then) left soon after, and we ended up losing both.

We had another issue in which a different front desk person connected on a social media website with another one of our therapists.  When the front desk person was finally fired for her attitude and tardiness, that caused an awkward situation between us and the therapist she was “friends” with.  That therapist drifted away, and in that situation, too, we lost two people for the price of one.

We found ourselves having a lot of conversations last summer about staff members; when you find yourself thinking a lot about a staff member’s shortcomings and asking yourself if it’s time to let them go, then it is.  While it’s important to remember that your staff–contractors and employees–are people, it’s also important to keep in mind that business is business, and that letting someone go is not personal, but simply the cost of doing business, especially if that person was bad for business.  The front desk person with the bad attitude no doubt did a lot of damage before we booted her; she drove away several patients, some of whom have not yet returned, even a year later.  She flirted with several male patients; we learned about this through the patients themselves.

In terms of patient feedback, we learned that if even one or two patients makes a comment (especially if it’s constructive criticism) about any aspect of your practice – your lobby, front desk person, massage therapist or other practitioner, aesthetics of the office, etc, it’s important to know that only a small percentage of patients will speak up about something; many others will keep quiet.  Thus, if one person says something, you can bet that many others are thinking it, but don’t want to say anything.  It takes courage to speak up, so if even one patient makes that effort, pay close attention to what they say, and (depending on the patient), be inclined to believe it.

We also learned miscellaneous things…

  • Don’t reserve supplements too long if a patient has not come to pick them up.
  • Don’t keep an iffy appointment on the schedule if you’re not fairly confident that it’s going to happen.
  • Don’t let a less-than-reliable patient schedule too far in advance.
  • Don’t allow your clientele to leave without settling that day’s balance in full!
  • Communicate all aspects of care plans.  If you don’t know the answer to something, be honest, and then research the answer to their question as you can.
  • Follow up on anything you say you’ll do; you want to be trustworthy.
  • Don’t advertise something you’re not sure you can deliver.
  • Be picky when selecting staff, especially front desk staff – they represent you in your place, speaking for you, and they are often a patient’s first impression.  That first impression is only as good as your front desk staff.
  • When it comes to front desk pay structure, consider more of an emphasis on clinic-performance-based bonuses, rather than set salary.  Yes, you pay them a set hourly wage, but since that’s the wage someone gets just for warming a seat, lower that wage and set higher bonuses for various benchmarks met; this gives them an incentive to work FOR you.

Here’s to another year!

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