[INTERVIEW]
Ronda Nelson: Listen, if your patients are disappearing after two or three visits, there’s a reason, and it might not be your protocol or even your clinical skills. It might be your business model. Because when every supplement, every visit, every lab, and every follow-up feels like another charge, patients start doing mental math instead of focusing on getting better. Today, we’re gonna talk about doing it a different way and why this way could be a game-changer for your practice.
Welcome back to The Clinical Entrepreneur, where we are talking all things clinical and all things business, helping you grow your really successful practice and allowing you to serve more people. That is our topic for today is how to serve the people. We are going to dive into one of the biggest reasons I think that functional medicine practitioners are underpaid. They’re underpaid, they’re overworked, and super frustrated with the amount of work that goes into running a business. I mean, really, if you think about it, if someone told you how hard this was gonna be to run a business, would you have signed up? I mean, maybe all of you would’ve said yes. I guess if the alternative is you would be working for someone as an associate or, you know, something like that, maybe that’s not your jam. A lot of people, it’s okay. They just wanna take a paycheck and go home. But there is a different breed of us that love business. We love doing the thing in business, but the problem is, is that we don’t always know how to do it.
What we’re gonna talk about today is something I’ve talked about before, but I’m gonna give it to you in a little different way, because I know sometimes when you are met with a new idea, the first thing we do is resist it, and we make excuses. “Nope, that will never work. It’s never gonna work. I’m different. My practice is different. You don’t understand. It just won’t work that way for me.” And I smile and go, “Okay. Mm-hmm. Yeah. All right. Good.” And then you’ll hear me talk about it again, and then you’ll say, “Hmm. Well, maybe. Let’s see.” And pretty soon, here we are. We’re gonna talk about it again, and I’m hoping every time you might be thinking, “Well, this just might work.”
Here’s the thing. You are providing care for people that are naturally attracted to you in your practice. You are good at something. I don’t mean that in a disrespectful way, but you’re good at something, meaning there is probably one or two things that you are just like, ooh, it’s just your zone. Like every time you get a weight loss patient, you’re like, “Yes, I love it so much.” Or every time you get a digestive patient, you’re like, “Oh, I love this,” or, “I love SIBO,” or, “I love Hashimoto’s,” whatever it is. You just love, love, love it all the way around, and you’re good at it, and you could do it in your sleep. Those are your ideal people. The people that come in with a bag full of supplements, and they, you know, have been to all the practitioners, and no one’s been able to help them, and you’re like, “Oh, gosh, this is exactly what the problem is. Here we go. Let’s just go get it fixed,” and you get it fixed.
How do you do that? How do you have that structured? I would think that you have some kind of a plan, so to speak. I know everybody’s different, but like a plan. Like, first we start with X, then we’re gonna do Y, then we’re gonna do Z, and then we’re gonna reevaluate. Usually it goes something like that. Some people start with a liver cleanse. Some people start with mitochondrial health. Some people start with metabolic health. You do it your way. I’m not here to tell you what the right way is. There’s some certain things we have to cover the bases on, but you can do them in whatever order makes sense to you.
But those patients, what they’re not looking for is a one-off visit. What they’re not looking for is someone to just say, “Okay, well, come in. Here’s your first visit, and then let’s just see how you do, and let me know, and we’ll follow up in a couple months and see how it’s all going.” No, no, no. What they want is a structured clinical roadmap. Patients want to know, “Where am I going? What are we doing? How long is it going to take? What are the steps? What’s first? What’s next? How will I know when I have arrived? Are we going to be retesting? If so, when are those retests gonna be happening?” That’s what patients wanna know, and when we have a model, however you structure the model, that addresses that, the patients are far more likely to stay and pay. Paying is kind of important, wouldn’t you agree?
But when you have just a one-off fee for service model, then they start looking at it like a transaction. They’re looking at it as every time they come into your office, I always say it’s the ka-ching. They come in, ka-ching. They have to buy supplements, ka-ching. They have to order, do we have to do another test? We have to test your cholesterol again, ka-ching. We’re ka-chinging them all, walking them right out the door. Not everyone has ka-ching money. Not everyone can afford to pay for the ka-chinging, especially when you have a spouse that’s looking at a credit card bill going, “What? Wait a minute. You’ve spent how much on what this month, and you’re still not feeling well?” Do you see how that’s not gonna ever work?
Now, I’m being a bit stereotypical here, but let’s just say it’s a wife who’s coming in, which 80% of our practices are women anyway. But you’ve got a wife coming in, and the husband’s looking at the bill, and he’s like, “Uh, no, no. No, no. No. We’re not doing that program right now.” Because she can’t articulate what it is that she’s in for. She can’t articulate it. “Well, we’re working on my gut.” That’s all she has to say, and he’s like, “Well, I don’t give a rat’s rear end what you’re working on. This is costing too much money, and you’re done. That’s it. You can go once a month, but you only have $100 to spend.” Whatever their conversation is. But because those expectations were not set correctly right in the beginning, then they start going online. They’re looking for supplements cheaper, and then they just conveniently cancel their appointment or don’t come back in two weeks or four weeks when you tell them, and then it’s six weeks, and then it’s eight weeks ’cause they’re getting pressure at home. There’s all these things going on behind the scenes that you don’t know anything about. You’re just wondering, “Well, why did the patient not come back?”
It’s not that there’s a compliance problem. It’s often that there is a clarity problem. It’s clarity in the way that you’ve communicated it. Sometimes the patients will just drop off because they didn’t understand. They didn’t know the plan. They just were being told to ka-ching the next step, and the next appointment, and the next test, and the next set of supplements, and that just gets exhausting. But when you change that around and you say, “Here’s the structured plan that we’re gonna walk through,” that helps them commit to a process, not a one-off decision every single time.
So functional medicine, you know this, it’s a journey. It is a process. It’s not a one pill and we’re done. If you want that, there’s Western medicine all over the place, and you can go find it there, and that’s what that model is built for. Functional medicine is intentionally different from a traditional model because we’re not dealing with one system. We’re looking at all the body systems. So we ask questions like, “Why is the body doing this? Where’s the stress coming from? What systems are underperforming? What do we need to stabilize? What do we need to sequence?” In other words, what comes first? And it just takes time. But we don’t often explain that well to the patient, and this is where we get into trouble because there’s no plan, then the patient feels like, you know, “Come back in three weeks and we’ll see how you’re doing.” Yay. And they’re like, “Wait, wait, what, where’s the end? What’s the end goal?”
We have to determine and define the problem. First, you have to define the problem. You can’t just treat the patient. You have to articulate what the problem is. And the money comes when you can articulate the problem. The better able you are to articulate the outcome that you’re gonna provide, the problem, and then the outcome that you’re gonna provide, the more you can charge. I know, I know you’re rolling your eyes and you’re like, “Oh my gosh, here she goes again.” I’m telling you, I’ve seen it. I have seen it. I’ve seen it over and over and over again. You can’t talk me out of it. Like my experience is my experience. I’ve seen it hundreds and hundreds and hundreds and hundreds of times. The more able you are to articulate the problem that you solve, the more you can charge for what you do, and people will pay for it. You become a specialist, not a generalist.
Even if you have to start someone with just one supplement, and you put them in a very specific container, this structured clinical plan, I’ll say, it provides safety and security for the patient because they don’t wanna lose. They want to win, but they also don’t want to work inside of a loosey-goosey situation. When you can clearly say, “This is where we are, here’s where we’re going, here’s why it matters, this is what’s included, and here’s the timeline. And then here’s the investment,” they’re like, “What? What? I get all of that for that? Wait. Hold it. What? You mean no nickel and diming, no fee for service, no ka-ching ka-ching?” They are far more likely to say yes, because now this is not the hope and pray that they come back model at all. This is now the model that says, “You’re gonna come back and we’re gonna work until we get an outcome for you.”
Now, the conversation always comes up, and just recently, several weeks ago in the Facebook group, someone mentioned being upset about the fact that supplements from a certain vendor are available online and they’re sponsoring them, and the practitioner was really upset. I get it. I don’t like it either. I don’t like it either. But you have to adapt. We have to adapt. Every business has to adapt. You have to adapt to the environment, and right now the environment is an Amazon environment. We used to talk about like microwave, right? Everybody just wants a microwave solution. No one even refers to a microwave anymore. It’s like old. Now it’s Amazon. One-day delivery, same-day delivery, super fast, no shipping. It’s where we all go. I bet all of you have logged in, opened Amazon on your browser in the last week and probably ordered something. You would be an anomaly if you hadn’t. The whole world orders from Amazon, so why would your patients not get their supplements from Amazon? Unless you make it inconvenient for them.
And the way that you do that is, you’ve heard me talk about this before if you’ve been around for a bit, the way that you do that is you include it in your structured plan. You include a supplement credit. And when you do that, they’re not even gonna be tempted to go buy them on Amazon because they have a credit with you. “I’m gonna use my credit. I got a credit.” And I’m not saying you should rip anybody off, but I am saying that, you know, you make sure that your supplements are marked up appropriately so that you’ve got enough profit to keep the lights on in the business. It’s not free to run a business, as you well know. And so you can build in the retail on those products that you’re providing for the patient, but you just include it in your structured plan. So this clinical process that you’re giving them, “We’re starting here and this is what’s included. These are the tests. We’re gonna include them, not include them. Your call. You can do it however you want.” This is what I teach inside Clinical Business Academy, one of the things. But when you include those supplements, then they’re not tempted to go somewhere else.
The old fee for service model doesn’t work. If you are already well-established and you are just doing straight up chiropractic, maybe. But my question to you is, is your bank account full? Is your schedule full? Do you have a retirement set up? If you don’t, then you have a structure problem in your business. Full stop. Like you do. I know. I know. You don’t like me right now. I get it. I love you very much. I’m just being honest. You can’t say to me, like, “Oh, that won’t work for me.” Okay, fine. Keep your empty bank account. Keep on the struggle bus. Or you could maybe consider that there’s a different option, a different way to do it.
So when you give this supplement credit, it’s powerful because it makes them more compliant. They come back. It’s thoughtful. They’re grateful that they don’t have to ka-ching. They don’t have to listen to a husband that’s complaining every time they come in and have to order more supplements. And you still get to have boundaries. You can structure it however you want. It doesn’t have to be what I say. It has to be right for you. But when the supplements become part of your overall protocol with them over however many months, three months, four months, whatever it is, it’s not an afterthought, it’s an intentional addition.
So when we structure this clinical roadmap, it changes the whole conversation that you have with the patient because they know that certain appointments are already included, so they’re gonna make them because no one wants to not get what they paid for. So they will always come in for their scheduled follow-ups. None of this chasing people. I mean, how much time do you spend looking at your calendar wondering, “Where did that person go?” And, you know, maybe you don’t, maybe there’s not a lot of that in your practice. Good on you. But there’s some of it. So let’s make it super easy for the patient to be able to say, “Absolutely, I’m gonna schedule my next appointment, and I know I’ve got, you know, $380 worth of a supplement credit.” And so you just get to say to them, “All right, we’re gonna decide when you come back in, we’re gonna watch what improves, what changes, and then we’ll make those modifications when you come in the next time.” They’ll never miss, and it doesn’t feel salesy.
You’ve just given them a roadmap. You’ve just said, “You have Hashimoto’s. Here’s your roadmap.” That’s all. I have a roadmap. This is a roadmap. There’s four stages or four phases. There’s three phases, whatever it is. And you give that to them. You lay it out to them. It’s written out so they can see it. Phase one or stage one, whatever you wanna call it. You’re not pressuring them. You’re just showing them exactly the steps. People feel so much better, more confident when they know that there is a plan, because a confused patient doesn’t decide. A clear patient will say yes. The confused patient says, “Well, I need to think about it,” which is, you know, a clue for I’m not interested, or I don’t feel confident about this, or you haven’t convinced me. Not that your job is to convince, but you have to articulate it well enough that the patient says, “Yes, that’s exactly what I’m looking for.”
So what do you put? If you’re gonna do a clinical roadmap, a structured plan, a structured clinical roadmap, what would you include? Well, you would include a very clear outcome. I always use my hands like this. I always say, “Here is the outcome.” What’s the outcome? We start here. This is where we’re going. Here’s how you feel now. This is where we’re going right here. There’s also a very defined timeline, so it’s three months or four months or six weeks or four weeks. Whatever it is, there’s a very specific phased or stages. In other words, okay, for the first three weeks, there’s this. Then after that, the next three weeks, there’s this. And you stage it out like that so that they have something to look forward to. It’s kind of like going on a vacation. You know, you go on a vacation, you’re so excited about going on vacation. When the vacation’s over, you’re like, “Waa, waa, I need to plan something else ’cause I don’t have anywhere else to go.” So we plan out. Give them a plan, something that they can look forward to. They can put labs inside of a structured roadmap like this. You can put in, you know, phone calls. You can provide them with videos. You can provide them with all kinds of things, whatever it is that you think is gonna help them get results faster.
The most important part, though, yes, they’re paying for what’s included, but what they’re actually saying yes to is the outcome over here. That’s what they’re saying yes to. I mean, they’re saying yes to you, but they’re drafting off of your confidence, but what they want is what’s right here. It’s not just, “Okay, well, you get eight visits and this much of supplement credit and blah, blah, blah.” It’s more like, “Here is the framework and the support that you need over the next eight weeks to get you to where you are sleeping all night. We’re gonna help you regulate your stress, improve your energy, and get your sleep back stable again over the next eight weeks.” And that’s what she came in for. And she’s like, “Oh, thank you, Jesus, ’cause I need some help over here. I can’t find anybody to help me, and you’ve got the plan. It’s what you can do in your sleep. You’re really good at it.” That’s how you have that conversation with her.
But we often will just resist it because, well, what if they can’t afford it? And what if they think I’m being salesy? And well, I don’t know exactly what they need, so how can I create a roadmap if I don’t know what they need because everyone is different, you know? How is that gonna work? Well, what do I do if something changes and we hit a road bump or a speed bump, or we get, you know, something happens, and when I find out they didn’t tell me something, and then we have to go over here and adjust, and I can’t create a roadmap because it might change. Or what if I overpromise and I can’t deliver? What if they’re not happy with the outcome? What if they don’t get results? I know. I hear you. I get it. I had all of that stuff rolling around in my mind, too. I get it.
But all of that is irrelevant because what you’re providing for them is an outcome. Now certainly, they have to do the work, and every once in a while you get those patients that are like, “This is not working for me. It just didn’t work.” And you say, “Well, you know, did you take the supplements?” “Well, no, because I had to travel.” And then, you know, “I’m sorry. Well, let’s get you back on track. Let’s… What do we need to do to get you back on track?” It’s all possible in a conversation, but when you go in with all the reasons it won’t work, your brain will never come up with a reason why it can work.
So my challenge to you is, and you’re listening to this, ask yourself, “How could this work in my practice?” Instead of defaulting and saying, “It’ll never work,” let’s just look at it from a different angle. How could this work? How could I make this work? And then let your brain go to work. Ask yourself that question before you go to sleep at night, and let your brain go to work trying to figure out the solution. Because I know you don’t believe me, but it really does give you so much. The framework gives you flexibility. That’s the best way I can describe it. The framework, the roadmap gives you flexibility. You’re thinking, “Oh my gosh, what if something changes? What if I didn’t calculate the supplements right?” Well, that’s just a conversation. What happens if you find out that they have some crazy something going on and you have to abort what you’re doing and say, “We have to go over here and do this. I didn’t expect that, but we’re gonna keep going because this is just gonna take a while while we peel the layers of the onion back”? You just have a conversation with them. It’s not a failure. You just say, “Ooh, we need to readjust here.”
When you stay in this model, this old model of fee for service, the cost isn’t just financial. The cost, I think, is in the patient outcomes. They’re not getting the outcomes that they deserve because they leave too early. When you put it in a roadmap framework, then they’re not gonna leave early. They’re gonna finish it out because by golly, they’ve paid for it. They’ve paid for those supplements, and by golly, I’m gonna make sure I get every last penny I paid for. I’m gonna show up for every appointment, be 10 minutes early. That’s great for the patient. We make it about you and your excuses. We always have them, right? We always have them. We make it about us, but who are we not making it about? Them. They’re always having to resell themselves every time they check out. “Is this really worth it? I don’t know. Is this worth my husband telling me that this is stupid that I’m doing this? Is it worth it?” At some point, she’s gonna get decision fatigue, and she’s gonna say, “I can’t do this anymore.” It costs mental energy for them, fee for service, mental energy, emotional energy, maybe some strife at home, and they don’t get the results because they don’t stay and play with you.
So I would challenge you, start to look at who might be dropping off in your practice. Who haven’t you seen in a while? When do you feel like patients are dropping off? Maybe you don’t have this problem, in which case, if you’ve been a practitioner for forever and you’re doing a fee for service, you do that. I’m telling you right now what’s working is these types of frameworks, roadmaps. I have hesitated, if you’ve noticed, to say anything about a plan or a program because those are often misused and abused by others in our industry, and it kind of is a trigger word a little bit, and I don’t want you to get triggered. I want you to think about it differently, so I’m intentionally using different language. I want you to think about it like a roadmap or a framework, and a framework that helps them get what they want.
So instead of thinking, “How much should I charge for a visit? Do I need to raise my fees?” What if you created a framework and it just was all included? And then you can charge a little bit more for what you’re delivering because you’re kind of packaging it in a way that is far more beneficial for the patient. So if you can think about it differently, ask yourself, “How can I make this work in my practice? How can I make this roadmap, this framework concept work?” Rather than saying, “Well, I don’t wanna sell.” Don’t. Stop. Just stop. Just say instead, “How can I make this work? What would it look like if I did it this way?” Just be open. Be creative. What would this look like if I had someone and they came in and I was able to generate the revenue from the supplements rather than fighting with people about buying them online? That conversation’s now over. You don’t even have to worry about the people that are selling online, the vendors that are selling online. It doesn’t matter. Doesn’t even matter because you’re creating a framework and your people are coming in and getting the supplements from you.
So not only are you making the money from the clinical service that you’re providing, but then you’re also retaining that supplement income. Do you see how it’s more profitable for the business? And when the business is profitable, then you get paid for what you do. It’s not a you get paid, then the business gets paid. It’s the business has to have the money in order to pay you, and your job as the CEO of your business is to make sure that the business is profitable. That’s your job. So this is just one way that you can do that.
So it is one of the things that we work on inside Clinical Business Academy. We help practitioners take all of their clinical knowledge and turn it into these types of structured frameworks or roadmaps that the patients can understand, they can commit to, they can say yes to, and they get great results because the structure and the plan can’t just live in your head. You have to be able to get it out. Your brilliance is in a messy mind and maybe a messy intake and a messy follow-up. We need to structure and streamline some of those things so that the experience is better for the patient. That’s exactly what we do inside Clinical Business Academy.
[CLOSING]
Ronda Nelson: If you know that you’re ready for help, you want help in your business, you don’t wanna have to figure this out by yourself and stay on the struggle bus, schedule a call with me. Schedule a practice strategy call with me. I’d love to talk to you. We’ll talk about what’s stuck in your business, and then we’ll decide if Clinical Business Academy is the right fit for you and will help you be able to accomplish what your goals are. Because it’s about what you need in your business. It’s not about me putting my expectations on you. I really do want to help you. That’s why I’m here.
So if you wanna schedule a call with me, go to rondanelson.com/practicestrategy. Choose a time, get on my calendar, and let’s talk. I would really love to help you be able to transform what you’re doing in your practice now from being that fee for service where you’re putting that financial decision on them every single time to determine whether your care is worth it. And we take that and we flip it on its head, and we now create a roadmap that your patients can follow, and they’re gonna get so much better results. You’ll get paid better for what you do. Everybody wins in the end. All right, my friend, if you like this, subscribe, come back. I’ll see you next week on The Clinical Entrepreneur.