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The term “pig in a poke” comes from the old days, when someone would buy from someone else, and not see what he or she was getting.  The item being bought was not shown to the buyer before the money was paid.  Would you buy a pig in a poke?

I wouldn’t.  I would want to see what I’m getting before I shell out my hard-earned money.  But too many young chiropractors do just that.  They buy a practice, or they sign up with a practice management company, or they become an associate before getting all the facts.  Due diligence is the process of getting all the facts.  It is a complete 360 degree analysis of a business opportunity, with disclosure of all material (important) facts.

For example, if you were doing due diligence on a practice purchase, you would want to know if there were any outstanding debts that the practice had not paid.  There are lots of other items to check in a practice purchase.  A comprehensive list is included in my e-book Buying a Practice (scroll down the page to find this booklet).

If you’re looking at a practice management company, check them out at the Better Business Bureau or Ripoff.com, or go to the office of the Attorney General in your state and see if the company has complaints against it.

In any case, doing your due diligence can mean the difference between a bad transaction and one that works out well.  Get what you’re paying for – do your due diligence.

As usual, there’s no “rule” about this.  I’ve seen it both ways.  At one extreme, I have seen contracts in which the hiring doctor required the employee (associate) to have X amount of coverage, with Y malpractice carrier before starting work.  That’s pretty restrictive.  It’s also a reduction in the base pay (assuming there is a base pay), so the take-home pay is less. 

On the other end of the scale, I have seen hiring doctors pay the malpractice insurance for the employee.  That’s great, but what happens when you leave?  If it were my (personal opinion here), I’d choose to pay my own malpractice, and with the company I choose, so I can take it with me when I leave.  The insurance is very cheap for the first couple of years anyway. 

What do you think?  Would you rather pay your own and take it with you or have your employer pay? 

One final comment:  Remember that EVERYTHING IS NEGOTIABLE.  If your hiring doctor demands that you get insurance with his/her malpractice carrier, politely say you’d rather get it from your own company and then be prepared to give up something else, if necessary, to get this concession. 

A new grad just sent me information on this great tool and I wanted to share it with you.  It’s called Google Sketchup and it’s free (unless you want to upgrade).  You can use it to create a 2-D or 3-D model of your practice.  As he said, you can be as creative as you want.

He said he created a 3-D plan for his office and he’s going to do more when he has time. 

I’m a little afraid to try it – I get addicted to this stuff and I forget my work.  But for you, it would be for real. 

I’ll let you know more as I try it.  Let me know what you think of it.

1.  Don’t get involved in patient billing or collections.  That is the job of the billing person (what?! You don’t have a billing person?  Get one, now!).  You don’t see medical doctors or dentists talking to their patients about “why didn’t you pay your bill last month?” or “Medicare won’t pay, so you have to.”  Discussing financial issues with patients damage the doctor-patient relationship, which should focus on health care.  If you talk about financial issues with a patient, it sends a mixed message:  “I want to provide you with excellent care, but I’m really more interested in making sure I get paid.”

2.  Don’t discuss appointments, missed appointments, late  appointments, walk-ins with patients.  Let your front desk person do it.  Figure out your policies, communicate them to the front desk person, then stay out of the way.  If you get involved in discussions about “I am too busy to see you now, but come back at the end of the day,” you destroy the credibility of the front desk person (no one will pay any attention to him/her because they know you’ll break the rules).  And don’t contradict the front desk person in front of a patient:  “It’s ok, Jennifer. I’ll see Mrs. Smith, just this once.”  Bad idea.

3.  Finally, don’t get involved in patient/employee, employee/employee disagreements.  In these cases, you will always lose.  Let people work things out on their own.  If the communication breaks down completely:

a.  In the case of a patient vs. an employee, you must support the employee.  If you don’t, you won’t have any employees left.  Set policies, stick to them (see #2 above), and support your employees as they deal with these policies.  If the policy is bad, change it, but don’t do it in front of a patient.

b.  In the case of employee/employee, you will never win trying to arbitrate.  If they feel you’re taking sides, both will resent you.  If they aren’t speaking to one another, tell them you’ll fire them both unless they agree to get along.  You’d be surprised how fast they can “make up.”

In all three of these situations, the presence of a policy/procedure before there is need for one (i.e., before the crisis happens) is vital.  Sit down before you start your practice and set out a policy manual, an employee benefits/office rules manual, and procedures for dealing with patient.  I have an ebook clled “The Practice Manual” on my website  that you can download, along with a template to fill in.

How would you handle these types of situations?

A new (2008) book titled The One Minute Entrepreneur by Ken Blanchard, Don Hutson, and Ethan Willis  (Doubleday) includes a link to a website for the book.  On the website is a test you can take to see if you have what it takes to be an entrepreneur.  The link is www.estrengths.com.

Now, when I took the test, I found the questions pretty silly.  For example (answers are on a scale of “never” to “always”:

11. I marshall additional resources when overwhelmed with work rather than turn it away.

15. Competition does not disturb me because it helps me understand what I need to do better.

See what I mean?  How would you answer these questions?  “Never?”  Particularly if you have never been in a business before, seems to me you would have no idea how you would perform in these situations.  I suggest you take it to get an idea of what characteristics would be necessary for success in practice. In other words, don’t take it too seriously.

Let me know what you think of the test and how you did.

Fear of speaking is the #1 fear in the U.S.; more people are afraid of speaking in public than of dying. I figure it’s because you don’t want people to laugh at you, and you don’t care about that if you’re dead.  As a health care professional, you’ll need to be out in public talking about chiropractic.  It’s the best way to get new patients and get yourself respected and noticed in the community.

The best way to overcome your fear of speaking is to join TOASTMASTERS.  I have been a part of the Toastmasters Club at Palmer for several years, and I’ve seen dramatic improvements by students in ability to feel comfortable in front of an audience.  Form a club on your campus or find a local club right away.  Any city of any size will certainly have a Toastmasters Club. 

To overcome learn more about shyness and how to overcome it, here is a great article with tips from Think Simple Now.  The faster you overcome this fear, the sooner you’ll be able to relate to people and get them through Know-Like-Trust – absolutely essential for building a chiropractic practice.

I hope you have heard about the E-Myth – why businesses fail and what to do about it.

The C-Myth is the chiropractic myth.  It is the myth that all you have to do is be a great chiropractor with a cool technique and you will make a million dollars.

To be a successful chiropractor, any way you slice it, you MUST have 3 things:

1.  A great technique that gives pain relief to people.

2.  Business knowledge to keep your practice running smoothly.

3.  People skills/ability to communicate with others.

You have the technique;  you know how to adjust people.  Check that one off.

And you can get or hire the business skills.  Check that one off.

So do  you have the people skills?  You can’t hire that skill.  Get busy figuring out how to talk to people and get them to know you, like you, and trust you.  You have to have all three of these things, and the sooner you get them, the sooner you’ll have a successful practice.  And you’ll avoid the C-Myth.

I just heard of a young DC who graduated a few years ago.  He was in a terrible accident and sustained major injuries.  He may not be able to practice – ever.  He has no health insurance and no disability insurance.

If you are starting your practice and you think, “I’ll wait to buy health insurance and disability insurance until I can afford it,” THINK AGAIN.

You may be young and health and “well-adjusted,” but you never know what might happen.  Please, for the sake of your family, get health insurance and disability insurance.  If you think you can’t afford it, sacrifice something else (like that fancy couch in the reception area) and buy it.  At your age, it won’t be terribly expensive.

For health insurance, try Ehealthinsurance.com .  I’ll get back to you on where to get disability insurance.

This is an unusual website for a chiropractic practice.  It has been running for several years, and I used to use it as an example of what NOT to do in a website, because it took several clicks to get into the site and I didn’t like the sound (personal preference – I don’t like sounds/music on websites).

I recently saw on a group discussion that the chiropractors who saw this site loved it.

My question is this:  Pretend you are NOT a chiropractor.  Would you like this site?  Would you go through the trouble to click to get to the “real” home page?  I know it’s difficult to imagine yourself without a chiropractic background, but as a web user, I’m sure you can look at it like any other site.   Ask family and friends.

Here is the link:  Shephard Chiropractic

Post a comment and let me know what you think of this as a website.  Compare it to other websites you see and like, not just to other chiropractic websites.

Here are a couple of Chiropractic Economics articles on this subject:

Get caught in the Web! 4 Strategies…

Three Secrets to Profiting From Internet Marketing

There are many situations that may cause a new practice or an existing practice to have trouble paying its bills:

• Like many practices in the Midwest this spring, your business may have been hit by a storm or been flooded out
• You may have had a personal tragedy that caused you to neglect your practice
• You may have been a victim of theft or embezzlement
• You may have been served with a malpractice lawsuit or other legal action

In any of these situations, as well as the difficulties of practice startup, you may find yourself in the position of not being able to pay your business bills. 

SCORE (the Service Corps of Retired Executives – an SBA partner) has a new booklet that might help you with these bills.  Their brochure is titled Pay Business Debts You Can’t Afford. It’s worth a look.

The booklet takes you through the steps in debt restructuring, from categorizing creditors setting a monthly budget, sending out hardship letters and working with each creditor, and implementing your monthly budget.