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Welcome to Business School for the Rehab Chiropractor where we coach you on how to run the practice and business of your dreams. Your host is Justin Rabinowitz - a multiple Rehab Chiropractic practice business owner and investor. In addition to running his own locations, Justin works with Rehab Chiropractors across the US talking about everything from sales to marketing, and creating the business systems necessary to succeed.
Tyler Brookings:
I'm not going to deal with what felt like a situation where I had no power and I wanted to take it back.
Justin Rabinowitz:
Tyler Brooking was a struggling locum who finally took the leap to create his own practice. Things were going well until, like a lot of practitioners, he hit a wall with unreliable insurance payments. Tyler realized he needed to take a risk to protect his business long term. And that risk-taking instinct is why he's on the podcast today. In today's episode, we'll talk through what to look for when you're opening up a new practice for the first time, what kind of questions to ask before signing a lease for a new space, and why those decisions can make a massive difference for your practice.
If you're new to the podcast, every episode, we share the stories of chiros who are learning how to build their businesses, and along the way, learning the lessons they won't teach you in chiro school. If you want the kind of help I give out on the podcast today, click the link in the show notes to book a call with our team. It's a simple, no pressure, no obligation conversation to help you figure out the next right steps. And if anything you hear today is useful to your practice, please like and follow wherever you get your podcasts, or leave a review. We'd love to hear from you. I'm Dr. Justin Rabinowitz. And this is Business School for the Rehab Chiropractor.
It's great to have you here. I want to start with giving the audience some basics. So just when did you graduate chiropractic school? Where did you go? And where do you practice now?
Tyler Brookings:
I graduated 2022 from Western States out here in Portland, Oregon. I've been in practice for three years next week. That's when I officially opened my doors. I opened up right away.
Justin Rabinowitz:
And so with that, you graduate in 2022 and you started doing some locum work basically the moment you got your license while hunting for a place to open your clinic.
Tyler Brookings:
Yeah.
Justin Rabinowitz:
What did that look like for you during that time? It sounds chaotic.
Tyler Brookings:
It was a little chaotic. Finished up December, officially got my license early January. And then I had met, actually, a guy while I was a CA during that time. So I was in school, was doing CA to make some cash actually on the side knowing I was going to go and open up my own practice. And then he told me about locum work. I didn't really know it was a thing whatsoever. And so while studying for boards, I was a CA, and then got my license early January, and moved as soon as I could to finding options for locum. So he let me know a couple options when he was there. And he was super gracious to provide me some numbers, so I gave those guys a call. And then from there, it expanded. So I was doing once a week, maybe twice a week for locum. And then I'd have a call three, four, five days a week. And I was just busy. And so it was pretty fantastic just to build that cash reserve knowing that I'd be needing it when I opened my shop.
Justin Rabinowitz:
And so when you started the locum work, it was always something ... It was a means to an end, like you were going to start with that and then go full-time. I guess the question really is, did you always have the vision of doing your own thing?
Tyler Brookings:
I'd worked for people my entire life. This is my third career, technically. And I always knew I wanted to open up my own shop as soon as I started school. And the locum was a means to an end, for sure. It was just a way to really put cash in the reserves. And honestly, in the background too, it was a way to see clinics, see if I liked them, how they ran, and then take what I liked and left what I didn't.
Justin Rabinowitz:
What was the moment where you finally decided, "I'm out of the locum thing, and I'm going all in, betting on myself"?
Tyler Brookings:
It was a relatively slow buildup, but there was a time towards the end where I think I first had my first $2,500, $3,000 day. And I was thinking, "I worked half the time at my clinic to make that money, whereas I'm working a full eight-hour day at this locum." And that was it. Those were the moments. I had a couple of those days. I'm like, "All right. 100%. They may be fewer, farther between, but that's where I want to go." And it was pretty awesome to think, like, "Oh, man," just to watch that come into the checking account. And it was my patients that I had worked with, built up, helped, and it wasn't work for somebody else.
Justin Rabinowitz:
Once Tyler decides to bet on himself, the next problem isn't about mindset anymore, it's about execution. For practitioners, where you open and what you can afford can make or break your practice.
So you started practicing in 2022. How long until ... When was this date? Give us a timeline of when you're like, "All right. I'm going to go do it on my own."
Tyler Brookings:
Yeah. So 2022, finished up, graduated, got my license early 2023. And I went ... Essentially, as soon as I got my license, I started the hunt for my space. And I got connected with a realtor a few months in. It took a little while, until October of that year, of 2023, to really find this space. We'd bounced around to a bunch of them. There's a few areas around here that are sort of higher end where I was looking to be, right where I wanted to be, but everything there, as far as the lease space, was four, five, six grand. And I'm like, "I don't want that overhead as soon as I get out of school. There's no way." And then it was all triple net, these places too. And so the last thing I wanted to do was take out a massive loan. This realtor, Colleen, she's phenomenal. She's from Gresham, where I practice now. And she said, "I have this opportunity for you. Let's go look at it. It's essentially just a rectangle. It's empty rectangle." I was like, "All right. Let's go check it out."
Didn't want to be there. Gresham has a relatively bad reputation out here. And I'd actually never even been. I'd been in Portland for three and a half years, never even been 15 minutes away. And so I said, "Let's go do it, check it out." Show up. It's this beautiful main street right downtown, kind of like classic Americana. And you roll up. And they had just redone this whole building. I did a ton of research before I even committed, but I knew that felt like the spot. So I looked at what does the five year out look like for median income? What's the current median income? As far as business plan goes, what's out here? Right? Who is actually working out here? And who would come to see me? I really like working with outdoor sportsmen and women. It's kind of the gateway to the east, right? Mount Hood is 35, 40 minutes away. And that's what drew me in.
Justin Rabinowitz:
When you did your research, you reached out to people. I think this is an important point. When you actually talked to them, what questions did you ask? And what parameters were you looking for when you were connecting?
Tyler Brookings:
Yeah. First things first was talking to realtors and talking to that. What'd it look like? What's the demographics? All those things. Those are the main questions. And then it was, who comes downtown? What's it been like? We're coming off COVID, right? Homelessness is a issue here in Portland and Oregon and Gresham in general. And is it safe? It really was just kind of all over the place. And it was also talking about industry, like who's out here? And so there's a few industries out here. There's massive factories, like places like Grainger out here, Subaru factories, there's a semiconductor manufacturer, there's a lab-grown diamond, those kind of industries out here, but also down the road, there's a massive Boeing plant and a Honda. And so these are working people that you're connecting with. And that's exactly who I wanted to connect with and work with. And growing up in my relatively small hometown, you know that the flashiness does not always equal money.
Can kind of back up a little bit of who's out here, right? These people are hardworking. Yeah, they work in a factory, but you have no idea what their bank account looks like compared to the guy driving the super nice brand new Range Rover, right? And so those are the questions that I connected with, asked, and it made all the difference.
Justin Rabinowitz:
When it comes to choosing the right location for your practice, the thing that I would think about is, number one, where do I want to be long-term? Now, it might not be in that actual location, but in the general area where you can see yourself being long-term is massive. When I opened my practice, I shared an office space with someone else. I knew I wasn't going to be there forever, but I knew, within a five-mile radius, that was going to be the long-term setup for myself. And so when we finally did get our own space, we were within a mile or two from that location and it was an easy transition. One day to the next, we were just in a different facility. So many chiropractors I see, they open where it's convenient or they haven't really thought about where they're going to be long-term.
And the problem they face is they go to build the big space next or get another lease somewhere else, and they almost have to start the practice over. So we definitely don't want to do that. At the live event in May, something we're focusing on now with all of our new guests that are coming is how to open up their practice, where their location should be. And depending on what they need from us, we're going to sit down with them one-on-one to make sure they get the information required so they can get going and get going fast. So wherever you are in your practice, whether you're just starting out or you're stuck at a revenue level, we can sit down with you and build a customized plan specifically for you.
Tyler went about it the right way. He knew who he wanted to serve and what kind of area he needed to focus on. But choosing the right place is only one part of this journey. You still need to focus on growing your own skills.
Tyler Brookings:
I started my first coaching group January 2025, basically when I started doing locum. That was a mindset shift. My little baby girl was three months old at that point. I need to ... Life changes. You know. With kids, life changes real quick. Your mindset shifts. It's the most beautiful thing in the world. And so I connected with a coach that I had known of out here, again, through just contacts and mentors. And it was great at first. It was motivational. To be around people that want to be successful is next level. Changes your mindset. But what I started to realize was, "All right. This isn't the direction ..." Most people in the group are typically adjustment-only style. Not everybody, but most of them, but it's a little bit more sort of straight chiropractic focused, and it wasn't necessarily the model I wanted to. And I felt like something was just missing week in, week out where I needed a little bit more connection or I needed it explained to me differently because the options were there, right?
But I was like, "I need something more. This isn't hitting right inside my head." And that was a big move because it was tough because I really enjoyed my first coach and he's a great mentor and a colleague and friend and we still talk. But I remember calling him and just being like, "Hey, this isn't quite hitting for me just right. And I need to go about it a different way to feel more successful." And then talking to Jared as well. We were talking to each other weekly, monthly, like, "How's it going? What's going on?" And he was talking to me about how well he was going, what he was looking at, how he was getting help from you. I was like, "This is kind of where I want to be." And then just that, the longer visit style, the sales approach, the marketing approach was like, "All right. I need help with those things. I'm not too proud to admit it. I've been doing well, but I need to do better. And how does this happen?"
Justin Rabinowitz:
What was it about the sales approach, from your perspective, of, call it, old way, new way that changed for you from before to now?
Tyler Brookings:
It was sort of the classic day one, day two, right? Which in this, we still sort of have that with discovery call, discovery visit. It's similar, but it's not what I felt was real old school, too salesy sometimes, not how I wanted to approach things. I didn't have the tools or the language that I really felt was like ... This is me conveying to you that yes, this is how much it costs, but I know it's going to help you.
Justin Rabinowitz:
When you said it felt almost salesy, obviously that's a big thing. And I don't think anyone wants to feel salesy, specifically in healthcare. And I think a lot of people are scared of learning any process at all because of the intent of being salesy. So can you go kind of deeper into the weeds a little bit for us and talk through maybe a couple examples of how learning a "good sales process" isn't salesy?
Tyler Brookings:
Some of the best advice I got from one of my mentors was, ultimately, people are going to come see you, right? And so you are the product, right? Yes, the knowledge that you have, the treatments, X, Y, Z is phenomenal, but they're going to come to see you, right? And that, in my head, turns into how do I sell myself? How do I be authentic? When you get too salesy, how I feel, is like let me get as deep as I can, start bending the truth a little bit or outright lies or no actual rationale for why you're giving them the total amount of time you're giving them.
Justin Rabinowitz:
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So, guys, when Jane reached out to me to become an ambassador for them, it was a no-brainer. In my community Slack channel, we have 140 chiros, PTs, US, Canada, and all over the world. And this is the one piece of equipment software that consistently gets a 10 out of 10 rating. They talk about it all the time. They absolutely love it. And so when Jane reached out to me to help them and be an ambassador for their brand, it was a absolute no-brainer. And I am so excited to be able to work with them. To learn more about Jane, how they could support you and your patients, head to jane.app/demo. And then one last thing. If you're ready to get started with Jane, you can use my code RehabChiro1MO for a one-month grace period on your new account.
Tyler realized that working with an insurance company was going to hold him back. And he did what we always talk about here at Rehab Chiro. He took action, he took a risk. He didn't let his practice and revenue stream drift away from him.
Up until recently, what insurance panels were you on? And then we'll get into the Blue Cross thing that I know happened recently.
Tyler Brookings:
Yeah. So actually, I was only on Blue Cross Blue Shield. That was it. I always knew I wanted to be mostly cash or all cash. Out here in Oregon, PIP or MBAs, it's a great opportunity to work with people, make some really good cash, consistent cash. And so Blue Cross Blue Shield, that was probably mid-2023, so I've been on it for about two and a half years. And I had just started, so even 40 bucks felt like a win. But same time, I was like, "That's not even close to enough to what I need," but I was getting paid. It's like, "All right. Come on." It's like, "Come on in and help me get some patients." You could say, "Yes, I take your insurance." You have people reach out. Every now and then, I get an email from the insurance gods saying, "Here. You're so welcome. Here's a patient that we're giving you." And half the time, they wouldn't show up, wouldn't hear from them. It was just kind of like, "All right. This person reached out and connected, or they weren't the consistent patients."
And over time, you start to see the reimbursements just drop. Or last week, they paid for X, Y, Z. This week, they didn't. And then you have to spend an hour chasing down 15 bucks or 10 bucks. And so I'd looked at do I hire a billing assistant, a billing company, or is it worth it? And ultimately, it wasn't to me because I wasn't billing all that much insurance, but it was still losing thousands of dollars, I felt like, every six months to a year. And all right. How do I figure this out? And it kind of was just this consistent buildup of, "All right. I just don't want to do this anymore. I don't want to deal with insurance panels," because reimbursements keep going down. They can change their mind anytime they want. And really, the patient base is just sort of there just to use their insurance. I have phenomenal patients who are on Blue Cross Blue Shield, for sure. Most of them, though, are there to just use the benefit and not necessarily take the time to get themselves better, nor does insurance allow it.
Justin Rabinowitz:
Was there one instant or moment that made you say, "I'm done"?
Tyler Brookings:
Late summer, early fall, they just stopped paying for any physical therapy codes or PT codes, so 97 codes. So I've been doing all my own billing this whole time, right? So you get pretty intimate and pretty familiar with it. Same thing. Literally, one week, they're paying this. The next, it's not there. And that is ... It can be half the cost of the visit. And so you go on all the forums and they're like, "Hey, is everyone else experiencing not getting paid for 97 codes?" And everyone's, "Yes, yes, yes, yes." And then there's this one comment, like, "Oh, if you look at this August issue of this magazine in this paragraph, you'll see that they mentioned this." And you go and find it. It is the most vague sentence ever. It's basically just like, "Some changes are coming to the insurance panels in November 1st, 2021, 2025."
I don't even think it said that. And so then all of a sudden, you're like, "Wow." It starts blowing up. And so I'm part of the Oregon Chiropractic Association, so you see these in all the forums again. And everyone's talking like, "All right. There's no way this is legal," which ultimately was not, right? And maybe they overturned that. But just the power that the insurance panels have, that was the moment of, "Oh, all right. So I was billing this last week and I can't bill it this week, and that's half the revenue of a visit." And a lot of clinics around me take most insurance panels, and Blue Cross is a massive one. And I was thinking, "Oh my God, what are these people going to do?" Myself, thankfully, again, it wasn't a massive hit, but still it was ... yeah. I'm not going to deal with what felt like a situation where I had no power and I wanted to take it back.
So that was this fall. After all the research I could, how do I get out of this insurance panel? And figuring it out and then realizing they also have a ton of power on the back end of getting out of an insurance panel. I put my official termination letter in, and then here we are. So I'm actually still waiting to officially get out of Blue Cross Blue Shield. Some of it is make sure there's no patient abandonment. Totally get that. But it's 60 to 120 days that they keep you in it.
Justin Rabinowitz:
Tyler's situation with insurance happened to me. When I opened my practice in 2015, there was some out of network insurance providers here in the state of New Jersey that paid two to $300 per session. And on January 1st of the next year, that same two to $300 payment went to $24.50. And the first thing I did was probably cry, to be honest with you. How would you expect if your paycheck that was decreased by that much? And honestly, I didn't know what to do. The problem, at the time, for me, was that I didn't really have the skills to be able to withstand it. And that's really one of the main reasons why I'm so bullish on helping people have the marketing and sales skills to overcome something that's out of their control. Yeah. So at a wider lens, if we look at the entire insurance industry, it's just inevitable that in order for them to make more money and profit as a profitable business, they are going to continue to squeeze the providers.
And it just makes sense for them. Their costs are going up, they're hiring, and their business needs to be profitable. So if they can't decrease their payments or decrease their reimbursement, something has to give. But just think about their business in general. They're going to increase the cost of the premium and they're going to decrease the amount of reimbursement. And when they do that, they can make a profit. And so the little man, the small practice, where realistically, that doesn't matter for them, those are the ones they're going to go after first. I'm curious. Now that you mentioned your patients and you told them that you're getting out, what's been the response from them?
Tyler Brookings:
It's been good. I mean, I've certainly had people say, "Oh, shoot. I can't keep coming," right? And you have those conversations of, "All right. I'm here for you. Here's what it looks like. Let's talk about it. Is it okay if I connect with you?" But really, it was well received and nobody was angry. And that is kind of a worry, like, "Oh, man. This person's going to write a terrible review of all of a sudden, their ... It was going great, and then they just left me." It didn't happen, thankfully. And those are those worries that you just got to shove out of your head. You just can't exist in that world. And so it's been really nice to be able to get that out there, well received, have people move to cash pay. We did a big Black Friday sale at our current rate, and so that was a really big jump.
And then after that, I've had people booking in for the DV, discovery call, discovery visits, booking treatment plans. And ultimately, it's been a phenomenal decision. And so I still am in contact with emailing people every week, just connecting with my Blue Cross patients. And a few people will check in, open it up, "Let me see if I can book this." And yeah.
Justin Rabinowitz:
What Tyler's saying reminds me of one of the biggest traps clinicians fall into. I call it selling out of your own pocket. So you have to understand the world that you live in. You are probably younger, you are probably healthy, and you have a knowledge, an intimate knowledge about the human body. But when you graduate chiro school, for the first five, 10 years, you're building a business yourself, you're not going to have that much money, and you're going to be relatively healthy, but you live a certain place in the world. When you deal with a patient who's 50, 60, 70 years old, who may have a different financial situation than you and certainly has a different knowledge level than you and probably has a different life experience from a health standpoint, that person will value different things than you will. And so if you just think, "Oh, they can't afford it, or that's really expensive," you're espousing your own value on them.
And so that is the biggest issue I see with the chiropractors that I work with who are all between 28 and 40 years old. And those people, what is expensive to them and what is or isn't valuable is categorically not the same thing as their perfect patient. Tyler made a big change in his business. If you're out there and looking to make a big change in your business, the first thing I want you to understand is do not use the everybody, nobody. As an example, if, let's say, you drop insurance, like Tyler's doing, well, nobody's going to pay. It's like categorically, that's not going to be true. Here's how I would think about it. I would think about it like a 10/80/10 rule. There's going to be 10% of the people that as soon as you drop insurance, they're out. It doesn't matter if I sell to them, if I give you the perfect script. It doesn't matter if you smile. Nothing's going to matter.
They're going to be gone. The only reason they were there was because you took their insurance. And then on the other end, there's going to be a 10% that no matter what you do, what insurance you take, what you don't take, the price you charge, they're just going to say yes. The reason why we want to talk about this and have a plan around it and have a system and a process and a script and all of that is for the 80% in the middle. I've always said you're going to build your business, your life, your legacy on the 80% in the middle because those are the people that if you do the right thing with, if you talk to them in the right way, if you have the right script and have the right offer and display empathy and don't sell out of your own pocket, those people are the ones that you can influence and those are the ones that are going to build your practice long term.
If you're listening to this and you're looking to navigate big changes in your practice, go to the link in the show notes and talk to our team. We also have a massive community of people just like you who have taken their practice to the next level, so send us a message if you're interested in doing that. We have a live show coming up in early May called Rehab Chiro Mastermind Live, and we still have tickets available. We'll be talking about how to deal with unreliable insurance and all of the other setbacks you'll run into in your practice. The links and the details for all of that are in the show notes. I'm Dr. Justin Rabinowitz. And this has been Business School for the Rehab Chiropractor. Like, subscribe, and click follow wherever you get your podcasts.