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?

 A tip I received from a student:

He suggested not using your personal name for your practice name.  While we all want to see our “names up in lights,” this may not be the best idea in some circumstances.  If you grew up in the town and you were a rowdy teenager, you might not want everyone in town associating  your practice with your past exploits in  high school.  On the other hand, if you were a model citizen, it might be great for you to tell everyone you’re back in town as a professional.
The biggest reason for not using your own name for your practice is in case you want to sell the practice.  It’s much easier to sell “Perfection Chiropractic” than to sell “Cosgrove Chiropractic.”  The student is looking at buying a practice, but he feels it will be difficult to make the transition from the old practice name, which is the owner’s name, to the name he wants.  One way to transition is to hyphenate the names.  For example, Cosgrove Chiropractic could transition to Cosgrove-Sutlow Chiropractic, then a year or so later the “Cosgrove” could be dropped.   

Choosing your practice name is one of the most difficult and important decisions you’ll make when you start out.  See this article in StudentDC for more tips for choosing a practice name

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….

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.

“With the economic situation right now, is this a bad time to start or buy a chiropractic practice?” If you are graduating from chiropractic school right now, you’re probably wondering if you are graduating at the wrong time. Sure, gas prices are high and going higher, and people in some areas of the country are having trouble paying for their homes. But health care is a pretty “recession-proof” business. People will always need health care, and if people understand the value of chiropractic care, they will keep coming back. Sure, you may lose a few people who have to drive a long distance to get to your office, but you may pick up others who don’t.

This might be a good time to consider buying an existing practice rather than starting a new practice. Why? You will have a built-in patient base and employees who know how to run the practice. You may also have an easier time getting a loan for an existing practice, since it has a track record that a bank can rely on.

The answer to that question is:  You can’t!  I know you are very eager/anxious to get going.  You have lots of student loan debt to repay, and you’ve found a great location, and you are chomping at the bit.  But you can’t commit to anything until you have your license IN YOUR HANDS! 

I talked to a couple the other day who wanted to commit to a lease.  They are graduating in October.  Give a month or so to process their license (assuming they have already passed all their boards) and they will be lucky if they can get their licenses by December 1.  I suggested they put a contingency in their lease that said they didn’t have to make a final commitment until they have their licenses.  This probably means the property owner won’t start build-out until then. 

It is far better to be patient for a few months while waiting for your license than to take a chance and have to start paying rent and paying back bank loans without a license to practice and no way to generate income to pay these bills. 

Be patient.  I promise it will all happen in due time.

I was talking with a grad today who was considering an associate contract. He said, “If the doctor won’t bend on this issue (it happened to be on a non-compete), that’s a deal breaker for me.”
I’m always pleased when I hear grads talk about “deal breakers” because it shows that they have thought through the process (whether it’s an associate contract or a practice purchase or something else) and that they know what is acceptable and what isn’t…for them.

Too many young DC’s are afraid to set limits and they are too timid to say, “This is unacceptable to me.” You get what you put up with, so if you don’t set limits on your agreements, you will get walked on, taken advantage of, treated badly.

Decide what your “deal breakers” are and stick to them. Let me know what you think a “deal breaker” is for you.

Sure. I know of several people who started out of their homes or by going to people’s homes with a portable table. This is an excellent way to build a patient base before you commit to paying rent.

Here are some things to consider:
1. Working from Home. If you have a house you want to use as an office, you will need to check with the city where you live, to see what their zoning requirements are. They may have restrictions on how much of the home you can use, and parking restrictions. Many cities require you to poll the neighbors to see if someone objects, and then you must show up at a city council meeting to present your case. If no one objects, and you have met all the restrictions, you may be able to work from home. If you are in an apartment, you will also have to get permission from the landlord.
2. Traveling Office. If you want to work by going to people’s homes, all you need is a telephone and a portable table. This is a good way to get started in a small town, where you can build a patient base quickly. Be careful about going into homes of people you don’t know, especially in the city. You may want to schedule a brief first visit to talk to the family before you decide you want to continue going to this home. You may still need a license from the city, in addition to your chiropractic license, so check their requirements.

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

Here is an online workshop from SCORE that walks you through questions relating to starting your practice.  Here are some thoughts on what I saw as I took the workshop:

1.  You will have to log in before you can access the workshop.

2.  Skip the home business example.

3.  Use the retail business example and modify it for a chiropractic practice.

4.  Note that the working capital example asks you first to estimate PERSONAL expenses, then you will be asked to estimate BUSINESS expenses.  Don’t confuse the two.  The personal expenses are what you will need to live on while you’re starting your practice. 

5.  The workshop takes you through startup expenses first, then working capital.  Read the information working capital; this is an important concept for startups.

Here is the website:  SCORE Online Workshop