[INTERVIEW]
Ronda Nelson: What if I told you that having a fully booked practice might actually be hiding some pretty significant business problems? You might be able to see patients all day long, work your tail off, and still barely make any money. And the worst part, because you’re so busy, you don’t even realize what’s wrong.
We’re gonna talk about why a fully booked practice could be a bigger problem than you think. Let’s go.
Well, hello. Welcome back. I’m so glad that you’re here today. We’re gonna talk about this whole myth about being fully booked, and obviously that is kind of what we want, right? We wanna be booked, fully booked, lots of people on the calendar, and no room to do anything else except for take care of the people that you love.
However, this can be hiding a pretty significant business problem that you may not be aware of. And so we sometimes will equate then being booked with being successful.
But I want you to imagine. Let’s just think for a minute. Imagine that there are two practitioners, okay? Both of them are seeing, uh, roughly, and these are functional medicine patients. They’re seeing about 25 functional medicine patients per week. Their fees are roughly similar, and it generates about the same amount of revenue in both practices, give or take $500, $800.
One of them works four days a week, is able to take vacations and take a paycheck whether they’re working or not, and even has money left over to reinvest in the business. The other one works six days a week, same revenue, same time, same number of people, but they’re catching up on their charting over the weekend, they can’t cover expenses, and haven’t taken a proper vacation in a really long time. So they have the same volume, they have the same revenue, but their outcomes are different.
And I can hear you. You’re probably saying, “Well, yeah, because one of them has more expenses and one of them has, like less time or more time.” Okay, those things very likely true. There are gonna be some variations, but how you manage the calendar and how you manage each one of those patients is gonna determine what you have left over at the end of the day.
It’s not about working more hours, it’s about being fully booked and broken, and having your business be broken, and you’re thinking, “Why in the world am I working so dang hard? I’m working hard and I’m not getting ahead.” So let’s talk about working more hours than what you’re charging for.
I see this all the time in the consults that I do with practitioners all over the country as well. I see it, CBA doctors talk about it. And what happens is that we are working more hours because we’re not accounting for the other time that it takes to work with a patient.
So let’s just say that you have a 60-minute appointment, okay? But you’re charging for what you think a 60-minute appointment would be worth. And maybe you’ve even done some research. You’ve called and checked and snooped around on a few other websites and figured out what everybody else is charging. It doesn’t matter what everyone else is charging. Doesn’t matter. It matters what you’re worth. What is the transformation that you’re providing? How much are you worth?
But back to the story. You have a 60-minute appointment, but you don’t include the time in the fee that you charge for the amount of time, maybe it’s 30 minutes, that you’re gonna take ahead of that new patient appointment to go over their history. You’re looking at their lab results, you’re re- researching protocols, you’re checking to see some random condition that they have, you have to look it up online ’cause you haven’t heard it since you were in, you know, school.
There’s time that it takes, and when you price for your appointment without taking into consideration all of that extra time, then what happens is you end up working for, you know, $50 an hour. So you might charge $200 for a one-hour appointment, okay? There are practitioners that charge low like that, but let’s just say you can do that, $200, and you spend an extra hour to hour and 15 minutes outside that time, that face-to-face time with a patient. You end up working for less than $100 an hour, and I don’t think that’s what you signed up for.
In fact, you’re probably gonna end up being closer to about $75 an hour. That’s before you pay your rent, before you pay your software, before you buy office expenses and pay taxes and all the other things, and that’s not even expecting or thinking that you may have some extraneous expenses that you don’t need to be paying. There’s student loans in there, you got a car to pay, all of that, because we’re not charging correctly for the time that we’re spending.
So I argue that in most cases, if you’re listening, and if you’re not in Clinical Business Academy, you’re probably undercharging. The CBA doctors all are charging what they’re worth, but so many other practitioners don’t do that.
Number two, I want to talk about why your appointment structure might be costing you money. Sometimes we have, uh, the patient that comes in, and I mean, we love this. We’re all about, like, we wanna connect, we wanna build relationship. But here’s the patient who comes in for a follow-up, and they’ve been working on them with their digestive issues and some energy stuff. And, you know, you have a 30-minute appointment, and you don’t really have anyone behind them.
You know where I’m going with this, right? There’s no one behind them. You don’t have another paying patient for another hour. So you just kinda sit and chat it up and, you know, pretty soon you’re talking about her husband’s cholesterol and their new puppy and the grandma that went to the hospital with a UTI and how she got crazy.
And I mean, we’ve all done this. And you just, you know, build relationship, but it starts to leak into that time that you’re actually giving away. And I mean, full disclosure, I do this all the time. I shouldn’t say all the time. I really try and be good about it, but I genuinely love connecting with people and practitioners and patients.
And so it’s real easy. I think, “Oh, it’s 30 minutes. I’ve booked out 30 minutes,” and then I’ll go 45, and I don’t charge anybody for it. I just, ’cause I’m enjoying the conversation. But what happens is I then took that 15 minutes that I could be doing something else, like reading a chart note, writing chart notes, or looking through new patient paperwork, or working on the business. I’m stealing that time, I’m giving it away for free, and I’m not doing what I need to do to protect my time.
So we have, you know, appointment fee, what you’re charging. We have the time. This is where busyness doesn’t translate to profitability.
The third thing I want you to consider is that your fees have to reflect the economy of your practice. And I mentioned it earlier, but you can’t base your fees on what everyone else in your area is charging. Because what if your specialty is SIBO? Let’s just say you are flipping good at it. You can fix it in your sleep. You have a very structured protocol. You put people through for three months. You do this diet in the first two weeks, and then the next two weeks, and then you have supplements that you do.
You’ve perfected this, and it’s not very often that it stumps you. You really do well at this. Your price should probably be one and a half times, maybe two times what everyone else is, because you’ve specialized in something that everyone else kind of dances around and they throw supplements at. Like, “Oh, well, try this, you know, let’s see if we can get your bloating down,” or, “Stop eating all that fermentable carbohydrate.”
And you, though, as the specialist, you know exactly how to fix it, and that, my friend, is worth something. It’s worth you getting paid for, because this is what I hear back when I have this conversation. Practitioners will say, “Well, you know, I’m just like, I don’t know. I just, I don’t feel like I can charge that much.”
But let me ask you a question. Are you okay working 50 hours a week and barely paying yourself? Is that okay? Are you okay working that many hours and not getting paid for the work that you’re doing? Like, let’s just think about this. I really want you to consider that.
You give your time away. You give your services away and don’t charge enough for them, but what you’re getting in return is a hit on your own personal wellbeing and your own time. So you’re missing time with your family because you’re constantly catching up on work, and then what happens is down the road, you end up resenting your business. You resent your practice.
I have had this conversation with so many practitioners. They’re like, “I don’t wanna do this anymore. I don’t wanna do chiropractic anymore. I don’t wanna put needles in people anymore. I don’t wanna talk to people anymore.” But you know why? Because you’re working hard and you’re not getting paid, and that’s the truth.
Now there may be, if you’re a chiropractor, your body might hurt. That is a case. I mean, your shoulders or your wrists or something, and that’s fine, I understand that. But when we don’t get compensated for the work we do, we don’t wanna do the work. It’s an emotional drain. It becomes taxing mentally to show up, do the work, and I don’t have any more in my bank account. I’m still struggling. I’m still waiting for people to start paying, and we make all these excuses. “Well, they can’t afford it,” and, “Everything’s just so expensive,” and so, “Well, you know, I just, I don’t know. I just don’t wanna charge.”
Baloney. Come on. You have to charge what you’re worth. You are providing a service. You are providing an area of expertise. You are helping them solve a problem that no one else is solving. You cannot keep subsidizing patient care with your own unpaid time and have a financially healthy business. It just doesn’t work.
And even if your fees are perfect, you still could be dealing with another kind of money leak, I’ll call it, and that is in your overhead. How, when was the last time that you looked at your overhead? When was the last time that you looked at actually how much it costs you to run your business every month?
So I say this all the time. If you’ve heard me, I’m gonna say it again. There are only two dials you can turn in your business when it comes to money. You have a revenue dial, and you have an expense dial, and these are like dials on an old TV or on a radio in your car. Like two dials. You have volume and station, that’s all.
And if you have revenue, and you have expenses, if you can either turn up your revenue or turn down your expenses, and if you can figure out how to do both, now we’re gonna start getting you paid.
Because your business, the business itself, not you, right? You are the employee of the business. You are the practitioner, you’re the clinician, you are the employee of the business. You just happen to be running the business. But it’s two separate roles.
As the provider in the business, you just show up and generate the revenue. As the employee or the owner of the business, the CEO, the manager, the executive, has to be thinking about rent and software and merchant fees and the cost of supplements and selling through Fullscript versus having inventory on hand, operating costs, loans, fees, credit cards, student loans, all that stuff.
And those expenses start to quietly consume a bigger chunk of your revenue. And then, I call it subscription creep, and it’s when you have like a $29 app here, and you’re paying $11.99 to Apple for something, and you have a $35 subscription to Google, and there’s a $59 membership or whatever it is. And you paid it annual maybe, and then it just renews, and you’re not looking at your credit card. You see the charges come through and you think, “Wait, what? Wait a minute. What’s that? I haven’t used that.”
I just had that happen not very long ago. I looked at my credit card statement, I went, “What is that?” And it was an annual subscription. I’m not gonna say the name because you will know it, but it’s a very popular, I’ll call it a health research platform. And it was like $299 or something for the year, and the charge came through, and I thought, “What? Wait, why? I didn’t buy anything. What is this?”
So I logged in, and I looked, and it was on an auto-renew, and I just wasn’t paying attention. And then I emailed them and they said, “Oh, sorry, there’s no refunds once we’ve processed it.” So I turned it off, and I didn’t get my money back, so I paid for it for another year. But the worst part was, I looked back and I saw that I had paid them for three years and I hadn’t even logged in.
So I just missed it when I was looking at my credit card statement, or maybe that month I didn’t look at all. But this is how these fees and your overhead start getting out of control. It’s because we’re not watching.
So you might have, like, a seminar, maybe there’s a seminar that you wanna go to, or some kind of an online training, or you wanna go overseas or some specialty thing you wanna do. And your response is, “I really need to go to that training, but I just can’t afford it. And that $59 would be really great and I know that it would help me, but I just can’t afford it.”
Listen, if you need help in your office, you need, like, a virtual assistant or a front desk person or somebody to help you clean the office or, you know, 10 hours a week to unpack inventory and do whatever back office stuff, and your words are, “I can’t afford it,” we have a problem. We got a problem.
I’m not asking you to go buy a Mercedes. We’re not talking about a huge, big expenditure. We’re talking about paying someone to come in and help you in the office. It’s not that much of an expense. But it’s like sometimes it’s a mindset, but also, I would argue, where is the revenue leaking? Where are the expenses too high? What do we need to do to the dials to make the business a little bit more profitable? Where is your money going? That’s your question. Where is it going?
Why are you working so hard with this really full schedule and you’re just like that, on the hamster wheel, go, go, go, go, go, all the time, all the time, all the time. And all you’re just really doing is spinning your wheels, and you are exhausted at the end of the day and you think, “Oh my gosh, I am not having a good time. I am not enjoying this. This is not fun. This is not my idea of a good time.” We have to get that fixed.
There’s another thing that you can think about too, and that is that you’re spending so much time on that hamster wheel working in the business, that you can’t manage the business. And I have always said you need at least three or four hours a week, if it’s a Saturday morning, listen, that’s just a business penalty tax. Not in a bad way, but that’s just what it takes. If you spend three to four hours a week and you do nothing but work on the business, for instance, work on your systems.
One of the things that I’m working on right now, I’ll pull the curtain back for you. Maybe I’ll record a show soon about it. But like most of you, I don’t wanna put you all in this category ’cause that would not be fair, but like most of you, I’m gonna say we. Is that okay? Can I just say we? ’Cause I’ll feel better if I say we. We tend to be a bit disorganized. Can I get an amen? We tend to be a little bit disorganized.
Not everyone, but by nature, practitioners are not real organized, and we just have things everywhere. We have, like, the back of an envelope that we’ve written something on. Like, right here on my computer, I’m recording this, I have, like, a yellow sticky note that says, “Water,” that one of my staff gave me and said, “Don’t forget to order water.” So now I’m walking around with this yellow sticky note on my computer until I take the minute to go order the water.
But, like, we’re just disorganized. We just have a paper calendar. We have a digital calendar, and we got sticky notes, and we have an envelope, and maybe I’m trying an app, and maybe using Siri. “Siri, remind me to blah, blah, blah.” We tend to be disorganized.
What I’m working on right now is how to streamline that. Where does everything live? Where does everything live? Is it in a notebook? Is it online? Is it in an app? Is it in Asana? I love Asana. Where does my everything live? Because I can’t have it living everywhere.
This is part of, like, managing a business. I’m kind of managing myself, but I’m managing myself as the manager of the business. Did that make sense? I’m putting myself in a situation, looking at, like, what is making me least effective when I’m running a business, running my life. I’ve got two businesses, very active businesses.
And so, what is keeping me, where are things dropping through the cracks? Well, I know it’s because I have, like, it’s the envelope phenomenon, right? I’ve got a piece of paper everywhere. Where did I write that down? Where did I save that? I can’t remember. So I am now, right now, my task or my challenge to myself is to figure out how I can streamline this whole process because it’s not working.
So my question to you is, what is it that’s not working in your business? What is it that’s not working? If you could pick one thing in your business that’s not working, that’s keeping you in this state of, like, “Well, I’m just so busy. I have all these people to take care of. I’ve got a full busy schedule. But my business, I’m not making any money, and I’m tired, and I don’t wanna do this anymore.” What’s happening?
And even if you’re not busy, you wanna be busier, you still have room. There’s still a sticking point. You still have room to work on the business. So what is it? What is that one thing? Just think about it.
If you could wave a magic wand, I love that question, and say, “This is the one thing that I would love to fix more than anything. I would love to fix this,” what would that one thing be? In your business. Then that’s what you spend that three or four hours on a Saturday or a Sunday or an evening, whatever you, whenever you do it, that’s what you work on fixing.
When was the last time you looked at your financials? Probably never, because we hate it, and in CBA, we just did a deep dive on financials, and so my CBA doctors are doing really good at this, or they’re learning how to do well at it. But it’s the thing that we avoid. When was the last time you actually looked at your credit card statement to see what came through on the charges?
What is it that you need to work on in the business, not just be the clinician or the practitioner in the business? And then, what if, just the last hypothetical question, what if you really didn’t need any more new patients? Everybody always says that like, “I just need more new people. I just need better marketing. I need to be on social media. I need, I need, I need.”
What if you didn’t need any more patients? What if your revenue is enough, but instead of adding like five new patients to your schedule with some intentional changes, what if you decreased your appointment time by 15 minutes but charged the same so you could get a few more people in?
What if you adjusted your fees a little bit that reflected better the kind of care that you’re giving? What if you increased your new patient fee? What if you took out the things that were draining your time, like an unlimited inbox? We’re gonna talk about that, I think, next week. But having people having access to you, what are the things that are draining you?
Are you the one that’s unpacking supplements? Are you the one that’s invoicing? Are you actually balancing your bank statement? Did you know you can find someone to do that for you and it doesn’t cost that much? But that frees up your time so that the illusion of, “I’m just fully booked. I’m so busy. I have all these people that wanna see me,” or, “I’m on the hamster wheel. I’m on the treadmill. I’m on the busy, busy go, go, go, go, go,” that you don’t work in the business. You don’t step back to expose what really could be going on in your business, in your practice.
You know, we call it a practice. “Yeah, I have a practice. I have a chiropractic practice. I have a chiropractic business.” Well, you are a CEO. You are a CEO first. You own a business. You own a business. You just happen to be the key employee in your business. But you have as much of a responsibility to take care of the business as you do to provide the service as a practitioner. It’s just two very different hats.
So I just want you, in this next week, I just want you to look at your schedule. Just look at it and think, “Okay, where could I tighten this up a little bit? Where can I work more efficiently? Are there places that I need to do less and give less, maybe less time, maybe not spend so much time researching?”
I worked with a doctor one time, and every single new patient, she took three to four hours per new patient to go investigate every single supplement that she thought was gonna be great, and she would write it out, and she would, like, it was like a one-page document that she would write out all the benefits of this one supplement, what it is, why it is, how it was formed, what the ingredients are, what each of the ingredients means. She was spending hours.
I about fell off my chair. I said, “Girlfriend, nobody needs to be doing that. The patient’s never gonna read it. It’s just overwhelming for them.”
So I want you to look this next week. It’s your homework. And just say, “Okay, I’m not gonna think about the economy. I don’t want you to think about the economy. I don’t want you to think. Just leave all of that aside, ’cause that could just be a really great excuse for you to never, ever take action, because people are still sick.” In fact, I would argue they’re sicker now than they’ve ever been before, which means they need you and me. So I don’t want you to even think about the economy. That is a bad mindset. You gotta stop that, because people pay for what they value, and when you can come in and say, “Here’s what I know how to do. I’m gonna care about you. I’m gonna care about what’s going on, and this is what it’s gonna cost,” and you can do that with confidence, then you may not need to see the same number of people.
You may be able to see fewer people, make more money, and have more time for yourself. Because it’s not about, at the end of the day, it’s really not about the money that they spend, you know, in their mind. It’s really about the value that they perceive that you’re gonna give them. That’s what it is, and having a healthy practice just means that you’re taking care of your patients, but you’re also taking care of you, and you have a life outside of work. That is your goal.
I don’t want you to keep on that treadmill of just go, go, go, go, go, go, go, go, go, and then you, at the end of the day, just fall over completely exhausted. That is not a good plan.
[CLOSING]
Ronda Nelson: So this week, just think about it. That’s all I want you to do, and then come back next week and we’re gonna keep having this conversation, but we’re gonna talk about it a little differently. All right, guys, have an amazing week. I’ll see you next week on the show.
[END]