The goal in any business is client retention which is no different for our chiropractic practices. Retaining patients costs us less in the long run – new patient establishment always takes more time and money on our end. The more efficient we can be with our time, the more of our collections we can keep. This high profit side effect is one of the pillars of running and operating a Micropractice.
One way we can measure the retention in our chiropractic practices is by determining the practices Patient Visit Average or PVA. Currently, the average PVA in chiropractic practices in the US is 12. That means the number of total visits a chiropractor sees a specific patient is 12 times in their lifetime. Boy…that is a low number.
What if we could help increase this number for your practice? What would that look like for you? First off, your practice would be spending less time needing to acquire new patients and more time building the relationships with established patients. Getting to know more about your patients creates a long lasting bond with them. Throughout their lives, these patients then become natural cheerleaders for you – easily recommending patients your way. Sounds great, right?
More importantly, with a higher PVA, you will make and keep more money. If you broke down your earnings per minute of services rendered, we make more per minute with established patients versus new patients. Of course, new patients are the lifeblood – we need them in our practice. But to truly build a business that is as high profit as possible, we must retain these patients.
One of THE BEST ways to retain patients is to fine tune your communication in your practice. This means more than what you say to patients. But rather what do patients learn about you, chiropractic, your practice style? Whether they are speaking to a patient, reading reviews online, or checking out your website and social media channels…are people fully aware of what they are to expect when they become a patient in your practice? Without solid, consistent communication strategies, your messaging will be lost in translation.
Who Are You? How To Best Define Your Chiropractic Practice
Retaining patients is the goal. But what if we took this concept to the next level? Retaining patients YOU LOVE to work with? Sounds amazing, right? The key to making this a reality in your practice is attracting those patients you love to work with by defining your practice. This is best accomplished by defining your niche specialty, your practice values, and unique characteristics.
First, let’s start with defining your niche specialty – what sets you apart from other chiropractors? What are some cases or specialties you love working with? In my practice, for example, I enjoy seeing pregnant women and children (and other adults too!). That’s what I am known for in my community. Take some time to think about what you think sets yourself apart from other chiropractors. It’s important to have a good grasp of this niche because when you can easily define who you are, your ideal patient will have an easier time finding you.
Now that you know the types of cases you like to see, who is your ideal patient for your practice? Start with the end in mind – what are you great at working with in practice and then, who fits this profile best? What is their approximate age, gender, hobbies, interest, etc.? Having this well thought out and defined is so important for any business – but especially a chiropractic office. You can start to see your practice through the eyes of your ideal patient and make decisions that are best for this group. Just know, getting to the true definition of your ideal patient can take some time. Be patient…write out some ideas and come back to them multiple times to make sure they still work well.
Now that your niche specialty and ideal patient have been detailed, what are your practice values? This means, what can a patient expect from you as a business? For example, my practice values include honesty, thoroughness, and collaboration. When a patient is in my practice, I take an upfront approach to their healthcare and my recommendations. We work together with their specific goals, but ultimately, my recommendations are based on my experience and the thorough intake I do with each new patient. Your practice/business values are a feeling patients have when they are in your practice.
Finally, what about your practice’s unique characteristics? Now how is this different from the niche and values? Unique characteristics are something that make your practice different from other chiropractic offices – but more in a practice management category versus clinical specialty.
In my practice, the unique characteristics include after hours support and no-wait policy. This means patients can contact me via text outside of my practice hours. Not all providers love this option for themselves. But, in my experience, questions/concerns and emergencies rarely happen during office hours. My patients have always valued knowing they have me on their sides when they need help most. And do patients abuse this privilege and contact me in the middle of the night? Never.
Having a no wait policy let’s patients know their time will be valued in my practice. But, it also sets the tone for what to expect if they are tardy to their appointments. Because I schedule patients per appointment and do not double book, I can not guarantee I will be able to take you if you are late for your appointment. The far majority of the time, I can make it work and most patients are flexible. In the event that a patient is running really late, they will know that I am tied to this policy and won’t use up another patient’s time for them.
I find the unique characteristics of a practice really help a potential new patient truly know what to expect. In my experience, these are also characteristics patients appreciate because they had the opposite experience in other chiropractic practices.
By defining yourself in practice and who you most want to work with, your communication to future patients will be clear, and therefore truly ideal new patients will come pouring into your practice.
Customizing Chiropractic Communication With Patients
In chiropractic college, we soaked up everything there was to learn about chiropractic. Each time something new and exciting came across to us, we ran to our families and began to tell them all about this great career we were embarking on. They would smile, nod their heads, and listen to the waterfall of information being poured at them.
This process would repeat itself over and over again, until we began to interact with patients in student clinic or as practicing chiropractors. Now, these patients are no longer nodding their heads like our parents did…but instead meet us with confused looks. Why? Because we were terrible communicators. We would have all the built up excitement , knowledge, and passion for chiropractic, but had very little experience in effectively communicating to others. We quickly had to learn how to communicate and what to say and when to say it.
“What’s the big deal? I’m good at explaining chiropractic to patients and they totally get it!” Probably true. But as a micropractice owner, there isn’t a lot of extra time in your day to speak to patients about chiropractic. So not only do you need to communicate and educate, but it must be done on their terms and their understanding. Which means, it’s time to customize the communication to help streamline your practice even more. If you are just giving the same spiel to everyone, you are missing the mark. The best way to customize your communication is by asking questions, listen and repeat, and then ask for permission.
The Socratic Method of Teaching is one we have all heard about. Asking questions will always give you a better understanding of what a person knows about a given topic which then allows you to best guide them along. In my practice, I like to start with the following questions:
- Have you ever had a personal experience with chiropractic?
- What have you heard about chiropractic?
These few questions begin to paint the picture of what a patient knows and what holes you need to fill in. In some cases, it’s important to handle objections or concerns patients have shared with you (we will get to this part in a little bit).
Even if you are totally on board with what the patient has just shared, it’s important to repeat the information back to them. This accomplished two things – confirms what you have heard and shows the patient you truly care (because you are listening!) I consider myself a pretty good communicator and listener. But, every so often, I will repeat something back to a patient and realize I heard incorrectly. So even seasoned veterans make sure to listen and repeat.
The last strategy for efficient communication strategies is to ask for permission. Why would you waste your time on speaking to someone on a topic they don’t want to hear about? Or something they are just not ready for?
Typically, when a patient is in the office and you are first discussing what chiropractic is, they are all on board for learning as much as they can about what they are about to embark on. But I still ask patients just to confirm they are truly the right fit for my practice. Here’s an example of what I mean:
Doctor: “Mrs. Jones, I understand you have been to a chiropractor before. But in my experience, we all practice a bit differently. Would it be ok with you if I take just a couple of minutes to explain chiropractic and how it relates to your health concerns?”
If you have a new patient sitting in your office that says no to this question, they are not the right fit for your practice.
Another moment in the patient journey that is important for getting permission to proceed is regarding patient finances. By the time you have made it to the financial ROF, the patient has been through the following steps with your practice:
- NP Phone Call
- NP Online Paperwork
- NP Day #1
a. Welcome to the office tour
c. Chiro Education/Communication
e. Close and send out for xrays
- NP Day #2
a. Clinical ROF
b. Clinical Treatment Plan
c. Financial ROF
For the average person, all of the steps above financial ROF is a lot of new information to absorb. If you have done an amazing job at each of these steps, the patient is ready for the long term commitment to their care. The FROF is now asking them to now make a significant financial commitment to their health and you. Here’s how I handle this part in my practice:
DOCTOR: “Mrs. Jones, we had just reviewed a lot of new information regarding your health and how chiropractic can help. The last piece of information to review is the financial portion of your care and I have the plan ready to review with you. But if you prefer to review this portion on our next visit, we can absolutely wait.”
90% of the time, patients say yes – let’s review the FROF now. For the 10% who want to wait, here is how I finish off the discussion:
DOCTOR: “That sounds great – i will add a few extra minutes to your next appointment to review the finances with you. For today, I am ready to adjust you and will charge you my full fee for the adjustment. Later on, I can apply this as a credit to whichever financial care plan you choose.”
It may seem like an overkill, but in my experience, the patients who truly prefer to digest all of the information really appreciate your patience with them versus moving them along too quickly.
As we have reviewed, it’s critical to determine what a patient may know about chiropractic in order to customize their journey in your practice. Learning the above mentioned strategies and practicing them will not only boost your confidence but significantly improve your practice’s efficiency.
Effective Communication Strategies
Now that you’ve learned the strategies to determine where a patient is with their chiropractic understanding, it’s time to help further strengthen their knowledge on their level. Regardless of what a person may know, patients should all come to the understanding of the basic premise of chiropractic:
“The central nervous system controls every aspect of the human body and determines how healthy a person will be. Chiropractic care aims to detect any areas of the spine that may interfere with complete nerve function. These are called subluxations and our job is to detect and correct subluxations with a chiropractic adjustment. From there, the body will heal and adapt on its own.”
By truly understanding this, patients will have an easier time knowing and understanding what chiropractic can do for their health and wellness.
Coaching Versus Lecturing The Patient
If you are speaking with someone, isn’t it always nicer to have a conversation together versus just a one-sided lecture? Absolutely. This concept also applies when educating a patient on chiropractic care. Yes…some aspects of the education will be you lecturing more. But can you start to see where in the educational process you can engage the patients? My hope is the content up to this point has begun opening your eyes more.
I find patients will fall into one of three categories on their chiropractic knowledge:
- Patients who know nothing
- Patients who know a little bit
- Patients who are very well knowledged
What’s interesting to me is there should be another category between 2 and 3 – patients with medium knowledge. In my experience, it really doesn’t exist – either patients know a little or A LOT. Regardless of their category, it’s our job as the educator to help coach them into what chiropractic truly is. Compare this to a soccer coach of young children. They may have a team of kids with various understanding of soccer skills and it’s up to that coach to figure out what kids know what and who needs to learn more. Perhaps the children are divided into groups of kids who know how to kick a ball and ones that don’t – the coach will focus on different aspects of the game with one group versus the other but with the understanding that they will all eventually know how to kick the ball.
How can we coach these different patient categories?
The patients who know nothing are the easiest category to coach. You have a blank canvas and get to paint their full understanding of chiropractic care. Know that with this category, you’ll have to work slowly through the educational spectrum with them. If you speak too soon and too fast on a topic, you will lose them.
The category of knowing a bit about chiropractic is the hardest to coach. Some of these patients have negative experiences or thoughts about chiropractic. Some have learned bits and pieces from social media or the internet. Some may have been to another chiropractor who did little to no education. These patients typically attribute chiropractic adjustments to symptom relief only. Regardless, helping these patients understand fully the impact of chiropractic will be a critical point in their journey with you. You’ll have to take a few more minutes to determine specifically what they know/have heard and fill in the gaps. With this category, it’s important to listen and repeat often.
The patients with a heavy knowledge of chiropractic are typically pretty easy to coach as well. You will more support and encourage what they already know – their chiropractic cheerleader! It’s still important to ask questions and listen but for the most part, your communication will be affirming what they already know.
One aspect of this communication process that is super important to handle are patient objections. Most patients coming into your office for their first visit won’t necessarily object to your care. But rather, it’s the objections they have heard about chiropractic in the past or experiences they personally have had. Handling any and all objections at the beginning of the relationship is important. By missing this step, the patient will have these thoughts looming in their minds which is never a great way to build trust and rapport. Let’s take a look at a few of the most common objections and how I’ve handled them:
PATIENT: “Chiropractic care hurt me” (or someone they know)
After I adjust every new patient in my practice, I let them know what to expect post adjustment. They may notice improvements in their symptoms/health, they may notice no change, or they may experience some soreness. In my experience, most chiropractors don’t offer this information. In addition, the chiropractors also don’t follow up with their new patients post adjustment. When I text my new patients the day after their first adjustment, it’s mainly to handle the very small percentage that is sore afterward. Why? To reaffirm it’s a totally normal reaction and response. So here is how I handle this objection with most patients:
DOCTOR: “Mrs. Jones, I’m so sorry to hear you felt pain after your previous adjustments. I don’t know the exact circumstance with your previous chiropractic care but I can share with you my experience that may be related to you. In some cases, after a person gets adjusted, they can feel more sore. The soreness is typically a completely normal response to the adjustment and in fact, it’s showing us the body is willing to change. The soreness is usually related to the body wanting to be back in the incorrect position it had been in for years or decades.”
Something along these lines will work well. It’s important to come to an understanding with the patient so they are comfortable proceeding.
PATIENT: “I’ve heard once you start going to a chiropractor you will always have to go”
DOCTOR: “That’s all based on a number of factors in my practice. I will always recommend the absolute best treatment plan for each patient. I base these recommendations on three factors – the patient’s current state of health, the patient’s health and wellness goals, and my experience with patients who carry similar health backgrounds. For some patients, this does equate to lifelong chiropractic care.”
There are many many more objections we can discuss here but for now, these are the two most common.
Now that we have worked through detailed aspects of the patient’s communication journey, it’s now time to put it all together and communicate to educate the patient on chiropractic care and its impact on their health and wellness.
Think of the multiple layers of an onion – the top layers first need the inside layers to hold their shape. The same can be applied to educating your patients. Each time you move to another layer of education, it’s important they are still understanding what you have already taught them.
The best time to apply this is during the first couple of visits a patient has with you. If you have introduced the topic of subluxation during Day 1, it’s great to affirm what they remembered on Day 2 by asking questions. Encourage what they absorbed and retained, clarify anything that needs it, and support/cheerlead the items they correctly answered.
If you want to take your educational communication to the next level, consider how you are delivering the information – either verbally or visually. The more times a patient sees/hears a bit of information, they will retain it much more. Once a patient can teach someone else the information, they have fully absorbed what you have presented.
Verbally, I communicate one on one with patients during their visits with me. Verbal education is heavy at the beginning of their care and slowly will taper down. Re-examinations are great times to revisit chiropractic concepts with patients one on one again.
When verbal communication is low, visual communication increases. Examples of visual education are posters in your office, email campaigns and social media channels. Another visual tool I LOVE is my dry spine from chiropractic college. I am constantly referring to my dry spine throughout my days – with new and established patients.
What your patients learn about chiropractic is completely up to you as the provider. It’s our job to effectively communicate chiropractic to anyone and everyone, plus put together an action plan with systems to ensure no patient is left behind. This will create an office of thoughtful conversation and patients who truly understand what they are getting in your office.
Leaving A Lasting Impression
Leaving a lasting impression
- Consistent messaging
- Refer to others
- Just say no
Many Micropractic owners are cash-based practices which means it’s important to focus on the complete patient experience and how you can leave the greatest impression with them. Even with people who don’t become your patients (gasp!). By providing amazing value with clear communication strategies, we uphold efficiency in our practice because we will ultimately work with those patients we love to have in our practice.
One way to leave a great lasting impression with patients is to avoid confusion by creating and maintaining consistent messaging. This means any place a person hears about you and your practice, the message should be the same. On your website, social media, google reviews, from current patients…the same concepts on what chiropractic is and what they can expect in your office should shine through. By ensuring this information is always clear, you will attract those patients you truly love working with that you know you’ll get the best results with.
You will also leave a great impression when you actively refer people to others. Now, let’s first focus on this concept for your patients. When I establish a patient’s health and wellness goals, I ask them to add anything and everything they want for their lives. Even items I may not be the expert in helping them with. Weight loss is a common example here. I don’t have a weight loss program in my practice and can offer only minimal advice. But, I want my patients to see me as a resource in their health journey and know they can trust me to send them to the appropriate providers when needed.
By establishing this type of relationship with the patient, you create more stickiness with them. Having a sticky business means patients will stick with you for years and years versus drop out of care. For example, my patients know of me as the local resource for helping raise healthy families and they trust me by asking for referrals for supportive pediatricians. This personal is being lost in health care – so many providers are going into these very sterile/bland types of practices and if you ask for a recommendation, they typically don’t know anyone.
I’ve taken this aspect of my patient relationships to the next level but creating a page on my website called “Resources”. This is the place I send patients to when they ask for anything and everything. Having this page has been a huge time saver in practice – no longer am I writing down names and numbers, or looking through business cards, or sending follow up emails. Instead, I send my patients to the Resources Tab on my website and they can find who I recommend for their needs.
A final way to leave a great impression is by saying “no” to patients (in a very loving way). This is a concept I use with both my current patients and those wanting to become patients. Establishing and maintaining boundaries with patients is important – you continue to build the practice you love and feel respected and valued by people in the community.
With established patients, I’m creating boundaries all the time. I keep a very tight schedule in my practice and my patients know they are scheduled with me by appointment. I don’t accept walk-ins b/c personally, I don’t like walk-ins. I prefer knowing who is coming into the office in advance to avoid surprises or confusion. Does it mean I never allow a patient to come in on the day of? Of course not. But that is the exception and not the rule in my practice and my patients understand and respect my policy.
I also avoid answering too many texts from patients. I am totally available for text messages if patients have questions or concerns and I will eventually respond to their messages – either texting back or in person. At the beginning of care, I explain to the patients that they can reach me via text but I will respond when I can (and not right away). I also avoid responding to messages over weekends (unless they are emergencies). Once I’m in the office on Monday morning, I will run through the texts and handle any messages or rescheduling appointments.
With potential new patients, I will sometimes refer them to other chiropractors instead of me. I prefer speaking to potential new patients on the phone versus them scheduling themselves online. This allows me the time to learn a little bit more about them and what they are hoping to achieve in my practice.
I will also explain the new patient procedures and expectations. Prior to the first visit, the patient will need to fill out their intake information online…their first visit will last about an hour…I can’t always adjust on the first visit…I collect payment directly from patients and do not bill insurance. If there are any issues with any of these expectations, I’ll investigate further and refer to another chiropractic when appropriate. People are actually quite happy to get referred elsewhere – if something on your criteria doesn’t fit their criteria, everyone is just wasting time. By being clear and upfront, everyone wins – your practice has room for patients you love working with and the new patient is placed with a chiropractor better suited for them.
As you can see, communicating is more than just holding up a spine and pointing out a subluxation. There are so many different layers of communication throughout a patient’s experience with you, that it is important to stay clear, consistent, and organized with patient communication. By clearly defining who you are as a chiropractor, then using effective and customizable communication strategies, you will leave the most lasting impression with patients thus filling your practice with those you truly love working with. It makes practicing not only much easier, but so much more fun!