StudentDC Interactive

This is a sad story I saw about a new DC in Wichita, Kansas .  Reading between the lines, it sounds like he got in too far with a lease commitment, then he couldn’t get patients in the door fast enough (or he couldn’t get them to pay) to meet his commitments.  If he had borrowed a little more and spent a little les on startup, he might have had enough money to pay his bills while he was building his patient base.

This is a classic example of “lack of capital.”  It can happen any time, but is most common in the beginning.  How do you overcome it?  A wise chiropractor told me “DSATM - Don’t Spend All the Money.”  In other words, dole out your loan proceeds very carefully, not spending on all your “wants” but focusing on the minimal needs you have in startup and the requirments to pay back your loans and make required payments (like the lease, utilities, etc.).  Then you’ll (hopefully) have enough money to pay your bills while you work to build up a good patient base.

This young doctor sounds optimistic.  I would encourage him to try again.  What do you think?

I’m on my soapbox here, so feel free to disagree.  I see a lot of grads coming out of school with high expectations and even higher  startup costs, because of the technique they have chosen.  These techniques require you to spend tons of money on x-ray and other specialized equipment and tables.  And startup is the time when you need to keep your expenses low.

Now, I’m fully in favor of using the latest technological stuff, and I agree that using evidence from x-rays helps the profession and brings an additional element to your practice. But… you’re paying a premium for this stuff. 

What if you could start out with $50,000, including used equipment and furniture and something left over for working capital, rather than $150,000?  Starting smaller would

• Give you a better chance of getting a loan, even if you don’t have a lot of collateral, and
• Would relieve you of a high monthly overhead.

Think of it this way:  Wouldn’t you rather have a practice with $4,000 a month overhead than $9,000 a month overhead?  (By ‘overhead’ I mean all the money you must pay for fixed expenses, like rent and your payments on loans and on financing for equipment.)  This lower overhead requirement would mean you would be able to pay your bills with fewer patients each month.  You could save the difference and put it towards that fancy new equipment you want.  AND you would be able to sleep at night, your marriage and family would still be there. 

Do you REALLY need all that fancy equipment and x-ray?  I thought chiropractors worked with their hands.  Just a thought….

A grad emailed me the other day and said she is having difficulty getting bank financing and she wondered if she should finance her startup with credit cards.  My answer would be, “Only as a last resort and keep it to a minimum.”  Here is what I’d suggest:

• Get vendor financing for big items like tables and x-ray equipment.  This financing is more expensive than a loan, but it will keep your credit card balance lower.
• Try to get a 0% introductory rate card with the lowest post-introductory rate.  Make sure the 0% also applies to ATM withdrawals.  Then WATCH to see when the intro rate stops and try to pay off the card before this happens.  Pay this card off FIRST if possible.
• Go minimal, and I mean MINIMAL.  Buy only what you absolutely need.  Don’t get carried away with sales.  Have someone go with you when you are buying, if you have trouble with this.  You must keep your credit card balance as low as possible. 
• Look for used equipment and furniture.  If possible, use your credit card for this stuff.  You may have to use the ATM if it’s a direct purchase from an individual; that’s why you need the 0% on the ATM withdrawals too.
• After you start, use the card for working capital.  Work out a bill payment schedule.  Pay the rent and utilities first.  And be sure to pay the minimum on the credit card each month.
• Live simply.  Take out as little as possible for living expenses.  You did it for three plus years while you were in school; you can do it for a little longer.
• Show positive cash flow as soon as possible.  Work to get to a position where you are consistently bringing in more in income than you are paying, every single month. 

After six months or a year, re-work your cash flow statement and take it to the bank to show them that you are consistently bringing in more money than you’re spending.  See if you can get them to give you a loan before your 0% introductory rate stops. 

If you can discipline yourself in the short term with this method, you’ll be in great shape in the long term, because you won’t have a huge amount of bank debt to pay back, and you can take your profits and plow them back into new furniture and other neat stuff as you go. 

Entrepreneur Magazine has a good article with some additional advice on this subject.  Here is the link:  http://www.entrepreneur.com/money/financing/financingcolumnistdavidnewton/article41520.html

I talked to a recent grad who said he had met with 4 banks.  All told him, “Your student loan debt is too high.”  That’s interesting.  I’d like to know if these banks would say the same thing to a medical school or dental school grad.  I am sure they wouldn’t.  Banks recognize that a health care provider is a low risk because they have spent the time learning their practice.   But… here is the difference:

THEY DON’T KNOW CHIROPRACTIC.  They don’t know these important figures about chiropractor income and compensation:

• Mean collections for chiropractic offices:  $294,909
• Mean net practice annual income: $134,832
• Mean DC annual salary: $94,116
• Total annual DC compensation: $118,709

These are very respectable figures, and they probably would surprise a skeptical banker.

***ALWAYS REMEMBER WHAT A BANKER IS CONCERNED ABOUT - GETTING THE LOAN PAID BACK. ***

Your job is to convince the banker that you can pay back the loan.  Use these figures and others from the  Chiropractic Economics Salary and Expense Survey to make your case.  Print out a copy and take it along when you make a presentation to a bank.

A soon-to-be grad brought me an interesting dilemma the other day.  Here is the choice he was given:

Pay Package #1.  Base plus 35 percent incentive on the monthly collections of the entire office.

Pay Package #2.  Base plus 50 percent incentive on his collections each month.

In other words, is it better to get a greater incentive based on your own work or a lower incentive, but based on the work of the entire office?

After quite a bit of thought, I figured out that it is a classic investment dilemma:  Are you willing to take more of risk for a higher reward or less risk for les of an award?  Another way to state it is:  Would you rather take the sure thing (getting paid based on the office as a whole), or take a chance (what if you can’t produce enough to get the incentive each month?)?

The risk, of course, is in what you think you can do to bring in patients on your own.  If you can bring in a lot of patients every month, you can do really well.  But if one month you are sick, or have a family issue that takes you away from the office or prevents you from marketing, you will only receive your base. 

There may be other considerations I am missing.  I would like to know what  you think - which would you take?  I will tell you what this doctor decided and why, in a later post.

It is a great time to be a chiropractor!  Not only are you in the position to lead patients to better health, but you can make a profit doing so.
Forbes Magazine has named chiropractors and other “alternative” health care providers as one of the 10 most profitable types of business.  Chiropractic (and the other related professions) came in as #5 with a 17.5 percent average pretax margin. 

Here is the article:  The Most Profitable Businesses to Start

It is not surprising to me that chiropractors are listed as more profitable than dentists.  As you look at the top businesses on the list, you’ll notice that most are professional firms (accountants and lawyers top the list) and many are in the health care field (doctor’s offices, dentists, medical services).  Having the professional background and business expertise to run a successful chiropractice practice is a path to success.

The answer is:  probably, but you will have to pay more to do this.  (In interest, I mean.)Here are some suggestions to work on to increase your credit rating: 

50 tips

Ways to increase your credit score

I was asked if putting your student loans into deferment or forbearance would have a negative effect on your credit rating.  As usual, I have to say “it depends.”  In this case, it seems to depend upon the lender, and the credit rating service. 

First, you will need to understand the difference between deferment and forbearance.

Deferment is a time when you can suspend payments on student loans.  This is the more common situation, and you can get a deferment for such reasons as being in school, graduate studies, and economic hardship.

Forbearance is another way to get your loan payments suspended, and it is usually reserved for situations when deferment cannot be granted.  Here is a good website which explains both situations in more detail:  http://studentloan.citibank.com/slcsite/repay/defer/1a6b.asp 

Be aware that, in both cases,  interest will continue to accrue on your loan, and it will need to be paid at some point.  So the amount of your loan will continue to increase, even if you are not making payments for a time.

If the credit bureau (Experian, Equifax, or TransUnion) sees that you are not making monthly payments on a loan, they may consider this a negative.  You would have to write the credit bureau and explain.  If you otherwise have good credit, it probably won’t affect it much.  If your credit score (FICO) is low, it would be another thing that would lower your score even more. 

Here is a good article from eHow with some suggestions:   http://www.ehow.com/how_2002591_avoid-loan-deferment.html

I wondered when several students talked to me about the “new” transition loans for health care proviers.  So I talked with someone at Wells Fargo.  Here is the deal:

These are nothing more than “unsecured” (no collateral) personal loans or lines of credit.  The “hidden” cost is the interest rates - depending on a lot of factors, including your credit rating, the rate is over 11 percent.  Yikes! 

Think carefully about adding another loan to your credit rating just before you go to the bank.  Instead of taking on more high-interest debt, cut back on your expectations, borrow less money, live frugally for a couple of years. 

If it seems too good to be true, it probably is!

I am not sure where this loan started, or who is funding it, but it’s a great idea.

Students have been telling me they can get a “transition” loan of up to $15,000 from NELNA or Key Bank.  The loan is a variable rate, right now at 11.5%, with a 20-year term.

I will keep you posted as I find out more information.