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Welcome to The Health & Wellness Practitioners Podcast! Dr. Danielle and other guest experts talk about everything from getting your practice started, developing your clinical skills, growing your practice YOUR way, and dealing with the real stuff life burnout and work/life balance. Whether you’ve been practicing for decades or just started your journey, you’ll find something here for you!
DR. DANIELLE: So I have with me today, Dr. Alex Pankoke, she's been on the podcast before. But today we're going to talk about a couple of things, boutique practices because this is your expertise, your specialty, and then also setting our fees, and I think I'll leave it at that for now and we'll just dive in. I'll let you introduce yourself first.
MEET DR. ALEX PANKOKE
DR. ALEX: Hi guys. My name is Dr. Alex Pankoke as Dr. Danielle just mentioned, I am a chiropractor in the Dallas, Texas area, and I am a wife, I'm a mom, I have two little boys and I have two boutique practices that I've built in the last three years. And I'm just super excited to be here. My goal really is to help practice owners see other possibilities for creating a practice even if you don't have one yet, but if you have one that you've been thinking and dreaming, you're like, I want to have a practice, I want to be a mom, I want to do this, I want to do that, but I don't want to devote my entire life to it, and I also don't want to see thousands of people or hundreds of people, and I want to be extremely profitable - perhaps what you do takes more time or you want to give more time to your patients. And so it's totally doable, and I want to show people that the conventional way of practicing isn't the only way.
DR. DANIELLE: So how did you come about this? I mean, I know your story because I’ve been along there with you throughout the journey, but for people that don't know you, how did you come to I guess even the belief system or the belief that practice could be different than what we're told that it should be?
DR. ALEX: Yeah. I think it's just been an amalgamation of different experiences. I would say starting in chiropractic school, I shadowed for my first trimester a doc here in Dallas and Dr. Camille Reagan, she's a phenomenal sports chiropractor. And she created a practice that works for her and the way she wants to practice, like she started in a small room as a personal trainer, turned it into her practice and she allowed it to grow over time to what she wanted it to be. But she saw patience and created systems in a way that I've never seen in a practice before, and quite frankly, haven't really seen often since, but allows her practice to look like and feel like you are a NFL superstar every time you walk in. And she works with superstars, she works with professional athletes all the time, all over the world. And she created a practice that makes everybody feel that way.
And I was like, that is so cool, such a cool concept. I thought I wanted to be a sports chiropractor and found out that I just loved her the way she did things, but not necessarily that I wanted to be a sports chiropractor over time. And then fast forward to getting out of chiropractic school and I went into an associate position that I thought was going to be amazing. And the team that I worked with was actually amazing, but it just really didn't work for me as a mom. And it was hard for me to really reconcile recommending things for moms that I couldn't participate in and do myself. Like I didn't have time for myself, I didn't have money, I wasn't making anything, pretty much paying childcare and that was about it. Like I was rushed between my shifts and getting my kids, because I couldn't find childcare during the shifts. I was seeing people or supposed to be seeing people. And it was very frustrating and stressful and I lost it a good, like not even 90 days where it's like, this makes no sense. I can't tell a mom she needs to do these things and say this is really important, and I'm not going to do that for myself, like my structure's not allowing for that.
So I parted ways there, went and worked at a, I call it the fast food chiropractic place. We all know what we're talking about for a while I kind of figured things out and my husband and I said, well, you know what? We had a friend who had a suite of rooms for wellness practitioners. We said, let's just grab one of those rooms. It's a really low overhead and let's keep the overhead low and start seeing people and growing. And at the time I had no idea what that was going to look like. I was a personal trainer before I was a chiropractor, and I didn't realize that the soft skills that I thought for some reason I would get in chiropractic school that would allow me to become a business owner we didn't quite get in chiropractic school. So I was like, man, this is just as hard as trying to grow a personal training business. Actually, it's probably harder because now there's so much more liability and responsibility. And I was like, man, I feel so lost. Like I thought becoming a chiropractor and specifically going to the school that was marketed as the Harvard of chiropractic that was going to teach me all this business acumen, I thought I was going to be able to step out and like have a low volume practice that exploded.
And it just, it didn't happen. I was very stressed. And then that's when I reached out to Dr. Danielle and she had an amazing program at the time that showed women how to build practices that are in alignment with your own values as a person and keeping you first. And so that's where I started doing the work and the work when you become a business owner I think is not the actual work itself. It's the work on yourself, and starting to learn more about, why do I want to practice this way? What do I really, really want? Not what do I see other practices doing. I had this vision before I got clear of some other practices here in Dallas where like their kids are running in and out of the room.
And often the chiropractors, they seem to just like float on clouds and they have like this perfect spotlight, like angels and they've got flowy dresses and they're just like this big love, like community like crunchy atmosphere. And I realized like when I started trying to do that, I was like, I don't want this. I'm so stressed out with my kids in the room. And I also started to really get to know those other docs as well. And they were just as stressed out as anybody else, you know, while they were on and while people were in the office, you know, it was Insta-perfect most of the time. But then like once things shut down and for the day, like they were real people too and struggling with a lot of different things.
I was like, that's not what I want. Like I want healthy relationships beyond relationships with my practice members beyond all the things. I want to have a really healthy life in general. And I don't want to feel like my practice is like the only baby in my life or like a primary baby in my life. So I started doing the work, started doing some different things, had a baby somewhere in between, then closed my practice for a while.
My first one out the gate was successful, but not as successful as I would like it to be. I made a profit, not a huge profit. I think it was in the mindset of you have to spend three years in practice to pay yourself well, and then COVID hit, my office was shut down; I didn't have anywhere to practice because Dallas shut my office or the location I was in down. And so I decided I'm going to open in my house and then I'm going to create a satellite office and a birth center in June of 2020. And my husband at the time lost one of his jobs and they cut, for whatever reason, his associateship decided to cut their bonus structure. So we lost like $4,000 a month or so in our house in like a really short period of time. And so I was like, well, I gotta go do something. We gotta do something. And I decided to open this practice and I said, I don't have time, I cannot wait three years for this practice to not pay me like the doctor that I am. I just don't have time. And I decided it wasn't an option.
So I went in I feel like guns ablazing with the things that I learned. And then I was being coached by the amazing Dr. Danielle at the time and decided to just figure it out. And that there really shouldn't be any reason that my practice shouldn't be successful. If I can see a personal trainer, a colleague, friends of mine who have been training and they're charging $100, $200, $300, $400 an hour with a kinesiology degree and they've positioned themselves really well, why as a chiropractor, should I not be earning that much?
DR. DANIELLE: Well that opens a whole can of worms, doesn't it? Because it's not even just chiropractors, but I think a lot of different kinds of health and wellness practitioners in general, energy healers especially I'm looking at you right now. The people that are really energy sensitive which most chiropractors are even if they don't use those words to identify with per se. We get so wrapped up in the “it's not about the money” story. We just want to help people, and ultimately that's actually hurting us more far more than it's helping us. That belief system that, you know, it's not about the money, I just want to help people - it shows a lot about what we believe about money already. That like we're demonizing it and making it mean something bad if we have more of it. Ultimately, my hope is for people to let go of that so that they can see that they can view money as a resource instead of a method of oppression.
DR. ALEX: Exactly. If it wasn't about the money, chiropractic school wouldn't be $200,000.
DR. DANIELLE: Well, yeah. But that's also why, you know, what you're doing this is in my opinion, of course, so smart because we chiropractors do take on a tremendous amount of debt in most cases to finance our education to be able to do what we do. And then we just struggle to make ends meet because that's what most people do, but we need to have people like you out there showing, being the evidence that we can choose a different way. We don't have to let what has existed already be the way forward.
KNOWING THE VALUE OF YOUR WORK
DR. ALEX: Yeah. And I think sometimes we don't really see, we talked a little bit earlier about like seeing our services as valuable, but I think it's not just that we are valuable, but the transformation that we offer is extremely valuable regardless of what it is that the modality that you're using, the changes that we're making in people's lives are extremely valuable. And I think when we don't see that or don't understand that we not only undervalue what we offer, we undervalue the people that we're offering it to and their ability to thrive and, and be as whole as they can possibly be because they may not be engaging with us for that very reason. Like it doesn't make sense to them. And on the same end of the token or the opposite end of the token rather, there's practitioners and providers out there more offering all kinds of things in more of the allopathic realm that they 100% believe in. I may not agree with, we may not agree with, but they see that they feel like they are changing the world and they have no problem charging for it. And I was in a mastermind with it was primarily for allopathic providers who wanted to go into offering one on one or not one on one, but concierge care things, very similar type of like high ticket high sales is what it was called, but offering this high level of service to people and some of the services that they offered when I like got to learn more about them, it would just blow my mind because I was like, I don't feel like you're really adding health and wellness to people's lives.
I can give you one example of a, this was one that it just, it really like struck a cord with me - a gentleman who was providing hair replacement, hormone therapy for men. And he was like, I'm changing these guys' lives because it's helping them improve their self-esteem. Like he was looking at the mental health side of the self-esteem of not having hair. And so from a mental health side, part of me really had a problem with like, I don't agree with that either. So I'm like, I know tons of bald men who are happy and successful and I don't know that hair really makes that big of a difference. I think it's more of an inner inner thing that needs to be worked on there personally. But then like the actual chemical side of it completely changing somebody's hormones and their body and their system to grow hair and it wasn't to support the normal physiological function in trying to figure out why they weren't growing hair. It was just like here, let's just throw these potions in here and, and kind of, you know, potentially throw off your whole system for hair. And he was charging thousands of dollars for this and he 100%, I never had a conversation with him in detail, but he 100% thought he was changing the world.
And like that's where his value system was, is like he is helping, you know, we talk about plastic surgery and, and you know, other things that I personally don't put a whole lot of value in depending on, you know, the, the reason and, and what we are doing, that's just me personally. But like there's doctors and providers who provide things that people want and they have no problem charging for it. And so I said, why don't we do that?
DR. DANIELLE: Do you remember when you came to me in the coaching session? Gosh, it was probably, I want to say it was 2020, but maybe 2021. I don't remember and forgive me that I don't remember the, the, the year even much less a month, but you had told me you're going to change your fees from this to this. And I was like, whoa.
DR. ALEX: I doubled them in one month.
DR. DANIELLE: I'm all about raising fees. And in fact, even in the sustainable practice, I have a challenge that people work through to increase their fees. And I give them all the mathematical equations and everything to help them figure out things. But you were just like, I just decided my fees are going to be this now. And I was like, who charges that much? Are you sure that you can do this? Are you sure? I mean, on the inside I knew that you could. But on the outside, like the initial surface stuff that came up, I was kind of like, oh boy, let's see how this is going to work out.
DR. ALEX: Yeah. It was a crazy experience. And the cool thing is that it continues and continued to be validated over and over again. So I like doubled my fees pretty much in one month and I was nervous. I was like, I'm going to lose some patients. I'm going to lose some clientele.
DR. DANIELLE: Can you hold on? Can you say that again? I think we need to emphasize that a bit more. You didn't just go up by $5 a visit. You doubled your fees
DR. ALEX: Yes. In one month. And this was part of that experience. I was in that mastermind in that race, in that timeframe. And then I also was really thinking and looking back and saying, Hey, when I was a personal trainer and I had my bachelor's, my master's degree in extra was nicem, and I thought I was the shit. And I was like, man, I've got all these certifications and blah, blah, blah, blah, blah. And then I'd go to chiropractic school and realize like, I don't know my ass from my elbow. And I was like, but gyms were paying me with my experience more than what I'm charging. And I'm charging more than a lot of chiropractors are charging in Dallas. Like I was still, I was already like $20, $10, $15, $20 more than a lot of people. And I was like, man, like, like I'm charging. Like this is awesome.
And then I was like, wait a minute. Like this, it just something in me broke. I think when I was in that mastermind and started hearing all these conversations and I was like, why, why this makes no sense to me whatsoever. Like the transformation that I could have provided as a personal trainer. Yes, I had, I helped people reach different health goals, but the reason I became a chiropractor is because I was sitting in front of them and I was like, I don't know how to help you anymore than this. I can obviously see something is off, there's something here, go see a chiropractor because my limitations are X, Y, and Z. And I would send people to chiropractors and PTs all the time. And I finally decided, Hey, I want to do that. I'm tired of sending my clients to help to people who have more experience and, and have more capacity to take them to the next level than I do. I want to take people to that next level. And so I was like, why all of a sudden I'm doing something at a completely higher level.
Why am I charging less? Like this doesn't make sense to me. And I think something in that like there's broke and I said, screw it. I'm going to charge. And I'm going to charge. And if people like it, if great, if they don't, they don't. And I was so afraid I was going to lose clients. But then at the same time, I'm like, well, if I double, if I lose one client and keep one, I mean, I'm not losing money. So if I lose half of my clientele over this, then I'm, I'm still going to be where I was. And honestly, the coolest thing was I didn't lose that many people. A lot of, I lost a few clients and, and it was the clients. I honestly didn't mind losing that were like, Hey, like yeah, no, we're not going to do that. And then I had other clients who were like, finally, like we were waiting for you to wake up and realize we are happy to pay youthis, like you deserve every penny of it.
And then I had, and not just that, I deserve every penny of it that like, we feel like this, we are getting this much value from your services. And then I started bringing new people in and I had experience after experience, one I can remember off the top of my head, a couple came in, mom was pregnant, dad had played football collegiate football, some professional football. And they came in and I was telling them, going through my report of findings and the recommendations for care. And it's one of the biggest packages I had ever recommended for the rest of her pregnancy. And then through her fourth trimester and her husband is like cross armed and sitting here and like guarded. And when we get to the financial section, I'm like, okay, let's go. We're just going to do this and see how it goes. And I get through it. And he says, that's it, that's all you're going to charge. And I was like, yeah, that's all it's. And he was like, you mean to tell me that we're going to see X, Y, and Z. Like, these are the goals we're working towards X, Y, and Z. And that's it. And he is like, and we're going to see you this often. And we are going to do all of these different things and that's it?
And I'm like, yeah. He's like, so I'm paying the OB who we may not even see at the birth. And we are seeing like maybe seven or eight times through the pregnancy triple that they're cash cash, their business owners paying cash for their healthcare and getting this. They were like, we wanted to choose who we work with. And so we have no problem paying, but you know, obviously anyway, so that's it. And he was like, so I'm paying the OB $15,000 and I've seen him like three times. I don't even know if we're going to see him at the labor. And really we're paying him to not do anything. That’s the intention is for him to not really do anything, but just to be there just in case, and you're only charging this and you're going to see us every single week, we're going to be doing some childbirth education. We're going to be doing some exercises at home. You're going to be coaching, guiding us through all of this. And, and that's all you're going to charge him. I was like, yes.
He's like, I never thought chiropractic was so inexpensive. I would've been coming in earlier. He said, I've been receiving chiropractic care through my collegiate and professional football career for free. Or like, I don't, I never saw the bill for it. And so I figured you guys started like $500 an adjustment. Like that was the value of it to him, to him. Like that's the value he saw. He never saw an invoice. He never saw a fee. So he figured that's what it was worth to him. And he said, because you're taking care of not just my pregnant wife, but my baby, like, this is such a precious thing. And it like, like, it almost teared me up talking to him about it and hearing it like saying it now, like, this is the most precious thing to me. And like, that's all you're going to charge like that doesn't he didn't even make sense to him. And so,
DR. DANIELLE: But I want to reiterate for people that are paying attention, that as he's talking about how he thought your fees would be more expensive, your fees at that time were already well ahead, higher than the vast majority.
DR. ALEX: It was already double what most perinatal chiropractors are charging in Dallas. And he was like, that's it? He was like, you know, I thought for an athlete, it would be like $500, but you were talking about my unborn child. Like, this is going to be like a thousand dollars. I don't know what he was thinking, but he's thinking it's going to be really expensive. Every single work. I didn't even like saying that, but way more, every single visit. And at the end of it, he was like, well, can I get started? He was like, when can I make an appointment? Because he was planning on dropping some serious cash. And he was like, I was planning on dropping like twice, three times as much. And so like, as soon as we finished the conversation, his arms dropped and he was like, put me down for an appointment.
And I didn't even have to talk about newborn care. Like they were like, when is it time to get my newborn as soon as they're born, let's bring him in. Like, wasn't even a question. And some of that came with their, you know, they had precon pre experience with chiropractic care. They were already planning to pay for their own healthcare. They had a value system that, you know, we take care of ourselves. And so that was part of it. But there are so many people already out there. And I think we can get in our heads and think that people aren't going to see the value of what we offer. But I was looking at a stat the other day, I did a post on this, Americans spend over 800 billion a year on health and wellness.
CLIENTS ARE WILLING TO PAY
DR. DANIELLE: I'm so glad that you're bringing this up, because it came up on mine earlier. I saw that, I think it was a reel this morning. I don't think you posted it today, but I saw it today. And I wanted to make sure that we talked about that statistic. It was very eye opening.
DR. ALEX: Yeah. Because we spent 800 billion on health and wellness between nutrition, supplements, fitness, personal trainers, As Seen On TV, all this random stuff to try to improve our health and wellness. This is beyond what pharmaceutical companies are paying and insurance is paying, this is what we're paying out of our own wallet. So why would we think that people are not willing to invest in their health?
Like it's very obvious. It's very clear that Americans are willing to invest in their own health. I think more and more Americans are seeing that the healthcare system that we have is not designed to support our health. And so people are like, Hey, like I need to take my life, my help into my own hands. So why would they not be willing to invest in their health with our services when we can truly help them to do that in the first place? And so when we say, Hey, it's only going to cost $49 to come in and do an exam and an adjustment and we're going to change your life.
DR. DANIELLE: Everything included for $49.
DR. ALEX: Yeah. And we're going to completely rock your world and change your life. And it's only going to cost like $69 a visit or less like some people are charging not even half that, it doesn't make sense. It sounds like an As Seen On TV, snake oil - it confuses people.
DR. DANIELLE: So I just did the math, which I hadn't done before because $838 billion sounds incomprehensible, especially if we're only talking about the US. So I just did the rough math of 838 billion divided by 330 million people in the us. Do you know what that number is? Per person per year? It's $2,539 per person per year. Now of course not every single of the 330 million people in the US are spending $2,500 on their health out of pocket every year. But that's the average.
DR. ALEX: And I think about it like this, like I have a certain shake that I like, I won't mention it on here, but a certain brand of protein shake that I really like that’s vegan. It's clean, it's all the things. And I tell people all about it all the time. People who are clients poor, not clients, people I just talk to on the street and they're like, man, what do you drink? I'm like, this is like my favorite thing. And it's not a company. I have any investment in. It's just something can buy online. And I tell people that all the time and people buy it all the time and it is not cheap. Like you could go to Walmart and get a protein shake, any protein shake for like a quarter of the price. But I have friends who are like, man, I tried it. It's awesome. They drop like $300 a month.
So we start adding that up. Like what are all the little pieces that people put together to try to sustain their health and their longevity every single month? And why can we not be a part of that pie and potentially not just a part of it, but really helping people navigate it? Like I talk to so many people who come in and I'm sure a lot of us see this. We have these conversations with people across the table and taking their health history and like all the things that they're doing and they're just like random advice from Instagram and they're like just putting it all together and like seeing what sticks and they really do need a coach. They need guidance. And that's what we're here for. That's what we can provide an offer more than just the physical service. If that's what you want to do, you can say, Hey, like I'm here to be your life, coach your, do your doula for this transition in your healthcare if you will, of going from where you're trying to be into where you want to go. And that's one of the things that in a boutique practice, what that allows us to do, because we don't see hundreds of people I see at most 40 people. And that's like, if I've got a lot of people in labor are about to be in labor.
And that allows me to be able to say, Hey, like let's sit down and talk about all of the pieces and be your coach through this transition from where you're trying to get from where you're at, to where you're trying to get beyond the physical service that I offer. Whether it's like to be a resource for somebody. So I've got a ton of resources. If you're in the birth, if you're pregnant, all the things like it may literally just be helping you connect the dots of the other pieces that you need and may be something that I can offer. It may be saying, Hey, like let's bring this other person into the conversation, a functional medicine specialist. Like I see that there's holes here and this is not my specialty, but let's make sure that we are really addressing you as an individual, not just your pain, not just the one thing that you potentially came in for and help people really to transform their overall health and wellness. And that's our goal. And that's what having low volume allows us to really do and have those conversations and take the time to, to be what the person needs in the moment.
DR. DANIELLE: So there are a lot of facets to this conversation. I mean, for chiropractors specifically, one of those is, well, you're doing a lot of things or not chiropractic. And I think honestly at this point, I'm not speaking for you, I'm only speaking for myself - if that's the conversation that you want to have, if, you know, if you want to just say like a chiropractic adjustment only takes five minutes. Why would you spend any longer than that with one person? I don't know that this conversation is really for you. Because that's one way of practicing. And I would also just come back to what I had kind of mentioned before, which is that we have to really start to get real and honest with ourselves about has the way that we've been taught to build a successful business, really helping us, or is it not? And sure it works for some people.
There's one person I know who is about two and a half hours from where I practice, who has an almost one and a half million practice. And there are like six chiropractors and they see hundreds of office visits every week. They're also breaking even. So is that the model of success that you want to create for yourself? And for those of us, like you like me who want a different way, we need to give ourselves permission for it to be okay. So I'm just going to put down that facet of the conversation, because like I said, I mean, if that's where you are in your perspective, you know, it has to be done this way, this conversation doesn't really fit for you necessarily.
Another aspect of this, of course, whenever I talk about, and you've probably experienced this many times too, increasing your fees, not participating in insurance, then it brings up the question of, well, how do we serve underprivileged families, right? How do we serve people of color? How do we serve people that are low income? How do we serve people that don't have health insurance to pay for their care? How do we serve people that do have medical insurance that want to be able to utilize the medical insurance and can afford care out of pocket if your fees are premium fees? So I think it is worthy for us to talk about that if you're game for it.
PROVIDING CARE TO UNDERSERVED POPULATIONS
DR. ALEX: I think that's really the biggest objection I hear when I talk to people about fees and I'm like, I don't want this just to be my care to just be for the elite. And there's two pieces to that. There's one is that, first of all, we're presuming that somebody of a certain economic status is not willing to rearrange their finances or get another job, or do what it takes to get into care. And that's not fair to them because there are people all the time that surprise me when I say these are my fees and they're like, I can make that work. Like I'll cut these things or I'll move these things around. Or I have no problem working a few extra hours or doing this to, you know, to make it work.
When I was in chiropractic school, one of the best lessons I had learned, I went to go to a chiro here in Dallas, high volume, complete opposite practice of what I have now, and I learned so much from what I don't want to do there. But when I, what he was really good at was explaining the transformation and the value of that transformation. And that's one of the things that it got were being a practice member there. And I said, Hey, like, I'd be happy to come work for you to try to trade for care, whatever. And he was like, you're not going to make mistakes on my dollar. If you really want this care and you really see the value in your health and a transformation, you'll figure it out. You're young, you're a student, you have time. And I was like, I don't have time, and he was like, you'll figure it out. What did I do? I went and got a job and I figured it out and paid for it. And I realized I had so much more capacity because I was really driven to do that.
Now, if you're saying, Hey, like, well, what if this person's already working like 80 hours a week? Oh, blah blah. And they don't, they literally like their situation does not allow for that. I understand. I see where there's a big gaping hole here. And I think as chiropractors, as healthcare providers, by offering premium services and having healthy, strong practices, we then have the ability and the resources to offer something to people who don't have those resources, whether it would be like scholarshipping patients in your practice. Or one thing I have this big wild dream of creating like a health share. I don't know what you would call it, but where chiropractors healthcare providers can put money into an account that when they have a client comes in, who really wants the care, who really needs the care, who really needs financial assistance. And doesn't want to take out a loan and have interest in all these different things that they can apply to have access to that money. So that way the doctor can be paid for their services. They don't have to necessarily give them away, especially if you're a new doctor or a doc working in an underprivileged community, essentially a non-for-profit organization that pays for the bills of clients who really need that help and that support to get them through that place of healing and restoration and transformation. So they can then take that next step in their health and their life that can get them potentially beyond the financial situation that they're in.
Because if somebody is stressed out, they're exhausted and all of the things, and they don't have the financial resources, it's unfair to expect them to have the capacity to then change their financial future in a place of extreme deficit, physically, emotionally, nutritionally, all of the things. And so that's one of my visions, my big goals, and the only way we're going to be able to do that, the only way we're going to be able to serve the underserved well is for us to have the resources to do that. And by staying broke, we can't get broke enough to help another broke person. It doesn't make sense.
DR. DANIELLE: Well, yes. I said something similar last week to one of my clients. She is a woman of color, new in practice. She is just starting her own business for the first time. And she is like avoiding collecting fees and just kind of like adjusting people and then not asking for payments and, and then sometimes also giving a discount. And I was like, that all has to stop because you don't have the financial resources to support yourself right now. And when you are giving those discounts, you're giving something you don't have to give. Yeah. And she was okay, thank you. And I said, let's focus on getting you resource so that you have what you want to give to other people.
DR. ALEX: Yeah. And I think we can also like another Dr. - I have no idea what this looks like. Never done it. So if anybody is listening to this and asking me how to do it, I'm not the person, but I really hope somebody steps up and decides to take this on - but I think that so many practices are operating as non-profit businesses without being classified as a non-profit business. And there's no reason for that.
The company that I worked for that I said is like a fast food of chiropractic, their vision and mission is to bring chiropractic to the underserved. Yet you never see one of their offices in an underserved population. They have these super low fees. There's like 40 of them here in DFW. And they're all in areas where people should, you would think based on the location, be able to afford full price for services. They shouldn't necessarily need to have super low fees, but you never actually see them in the healthcare deserts, in the food deserts, in the place where people really do need that and may not have the transformation or transportation to get to one of their clinics that really aggravates me to have that mission.
But I think that it would be amazing if a chiropractor who has experience or somebody who has experience in creating non-for-profit healthcare practices, created something that taught us how to do that. Because if you want to serve in an underprivileged community, there really shouldn't be any reason that you shouldn't be able to classify yourself as a non-for-profit practice. And there's like I said, so many practices, they're just breaking even they're not making a profit. And I think that speaks to another issue is there's some people who are like, oh, you have a million dollar practice. I'm like, yeah, but how much you pay yourself? Like your overhead is so high. Like I can pay myself more in my practice that is not hit that mark yet than, than you are. And not that we're like, you know, it's not a competition or anything, but like let's get realistic about it.
And so I think I would love for someone, I know there's a doc here in Dallas, if you're watching this or hearing this later, you know, I'm talking to you. She has an amazing non-for-profit practice that she's created. And it's just beautiful. And I would love for her or somebody who has something like that to, you know, take that mission on and create something for docs providers to, to actually create something similar in their location. So that way we can solve this problem from multiple angles versus the one angle that I use, which is let me make money so then I can give money, let me make some resources to give some resources.
And I think that's a great way to do it. I learned that from a midwife, she works here in Dallas. She works in or serves the uptown area. If you're from Dallas, you know, that's like where a lot of moms have a lot of money. The bougie moms is what she calls them. She says, I serve bougie moms. So that way I can use the excess funds or the profit to then serve moms who can't afford my services. And so that's a very similar model. Not that I would call my clients bougie by any means, but serving people who have the means to pay full price for their care so that way we can redistribute those funds to people who cannot.
DR. DANIELLE: Yes. Yeah. I think that we could have a whole other conversation about what is required of you as the practice owner to have premium fees and for it to work. So maybe that's something that we could talk more about talking about on another day, because it's kind of coming to my mind, like people are going to be asking there's a lot of people commenting by the way on this video, as we're talking - people are going to be thinking and, and wondering, okay, well how do I make that work? Because they're so used to just like what I call in my free training, the desperate destiny approach, which I've done as well. I'm not like shaming anyone for doing this, which is like just trying to get everybody through the door as many people as possible. And we've been taught that in order to do that, we need to be cheap and affordable and available to as many people as possible. Well, and then again, like look where that's gotten us. So to change from that model to this model is a big change.
It seemed to me as I have watched you go through the journey that you, you just made decisions and you just decided like this is going to work or it's not, if it doesn't, then I'm not doing this. Like this is how it's going to be and that's that. And then it did. But I think that there are also some tactical things or strategic things that you've done along the way too that you could share.
Someone mentioned in the comments that, well first Dr. Shara says, “It's unfortunate this conversation hasn't been had more often by coaches. This is exactly the opposite of what my coach coached me to do.” That's why we're here. I mean this conversation, that's why, I mean, both Alex and I like, we want to talk more about this topic because we've both lived it and seen the results.
Dr. Julia said, “I really feel like the value of services gets disordered in school when you can get adjusted for free, basically whenever you want and your friends can adjust you whenever.” And I think there's a lot of truth. Yeah. There's a lot of truth in that. And also once we are out in the real world and we're growing our own businesses, we have to also think about what we're modeling for the future generations. And what's been modeled for us so far is much different than what we're talking about right now. But we each get to make a choice. Like what do you want to model? Do you want to model being cheap and affordable and available all the time? And you'll just get a lot of people in here and work really hard? And one day your shoulder will get out and you won't be able to practice anymore? Don't worry about that right now. You'll figure that out when you get there or do you want to model something different.
PAYING FOR CARE EVEN WHEN ALL YOUR FRIENDS ARE CHIROPRACTORS
DR. ALEX: Yeah. And I think that's something that like the first step in doing that is if you're a chiropractor or a doc and you're getting, hopefully you're getting care. So that's the first thing, like, do you live in alignment with what you're recommending and when you create recommendations, are you making them best based on the best outcome that you can help people achieve? Are you making it based on what you think they can afford or what you're like potentially willing to ask for? Like, if you have a money story about how much you can actually charge, that's a part of it, but then are you not only receiving care yourself, but are you paying for that care?
So I am married to a chiropractor, my husband, Dr. Paul, and we adjust each other right now most of the time, but there have been times and one of the exercises that we have intentionally done is when we start to feel like our money stories are weird for us, and we talked about this last week, like we have like different levels that we have to like clear out as we get through, as we work on ourselves. One of the things that we do is instead of seeing each other, we go pay for care from somebody else and remind ourselves of the value of what it is that we're receiving. Because it can be really easy when it's, especially when it's your spouse. I'm like, Hey, get my shoulder real quick. You know? And you start to forget the value of, of what it is, but then, you know, taking the time to say, Hey, you know what, I need to be really intentional about my health. It can't just be, you know, can you just hit my shoulder real quick? That's a really weird way to say it.
But really being intentional, just like we're really intentional about our relationship and our love life. And like, I don't want to get too deep into that, but like, we're going to be relational about our intentional about our health and saying, Hey, you know what? I want to be under care from somebody who's treating me the same way they're treating any other client and any other patient. And as spouses, it can be really easy for us to forget that. Because we're around each other all the time. We've got tables around us, in our house and in here and there. And sometimes we forget to see each other as people that really need that higher level of care. So if I start a notice that my care is not like we haven't been given ourselves the space and time to receive the care that we need to receive, we'll go see somebody else. And not because we don't think that we can't provide care for each other, but we just need a break to realign ourselves with why we're doing what we're doing. And then we also need to, if we have like weird things with our money, we need to go pay for it and remind ourselves the amazing value of what it is that we offer.
Just a couple weeks ago, I started to realize, like, I thought that maybe I had like mastered this money story because I was like, yeah, I doubled my prices and my fees or da, da, blah. And I thought, I was like, I'm like good when it comes to my charging for my services. And then I spoke with my accountant and he looked at everything and he's a patient. And he sends his team to see us as an employee benefit and pays for their care with us. And he sat down for our quarterly meeting and helped us go through some stuff. And he was like you need to raise your fees. And I was like, so it's one thing that's coming from your account. It's another thing that he's paying for services for himself and his employees. And he's telling us to raise our fees. And I was like, really? was taken back. I was like you realize, like I charged double everybody else in Dallas, if not more than that in some cases. And he was like, well, it just doesn't make financial sense where your fees are at right now. Like this, this is not, you know, you're doing all right. And you've had amazing growth in all the things, but 2022 is kicking our ass with inflation and you need to raise your fees. Yeah. And I was like, like, including yours. And he was like, yeah, I'm raising mine on you.
And like, we started having this conversation and I told him, I said, I told him, you know, this is what I coach people on. This is what, you know, the industry is like. And he was like, I have no idea how your industry is going to survive. If that's the real out, like if you're not making this up, I have no idea how your industry is going to survive. And I was like, when you think about it, that's so true. And I had to challenge myself. I was like, I felt uncomfortable. I was like, I felt in me like, okay, can my fees? Like I had that feeling that a lot of people have, like, can I raise my fees anymore? Like really, can I do that? I'm starting to have people coming in who are struggling to pay for their services or they want to get started, but the fees are already at a level, but it's not well within, you know, within their budget.
And so I was like, you know what? It's not that I've mastered this money thing. It's that I just had a higher ceiling, I guess, than a lot of people. And so I've been working through that and, and devising ways. I just had a mama yesterday who she, you know, I felt so I felt for her. And I said, the best way I can help her is to raise my fees. So that way I can offer her something that works for her to get her the care that she needs because she needs the care and it's for her and her baby. Like, this is why I need to raise my fees because this person on the other end of the table, this, on the other end of the desk here, she needs me to be able to do that or not just her specifically, but our people that we serve need us to be able to have the resources to support them.
And I have a scholarship in my practice that I allow so many people into. And I was like, I don't have any more spaces for what I've been wanting to do to bring her in without, you know, stepping on my own boundaries. I'm like, this is why I need to raise my fees because I want to be able to help more people. And so I've been working through that little ceiling. So know that I'm not just this person that's crazy. I just, I don't know, maybe have a higher tolerance versus comfort when it comes to money and charging.
FAILING FAST TO BE SUCCESSFUL
DR. DANIELLE: I hear what you're saying, but I think there's also - I don't want to pedestalize you, but you also have just had a knack at growing a business and like I don't know that you necessarily came out of the womb that way, but you've grown quickly and, and you make leaps and bounds in growth, right? You don't just like inch your way up, you go big. The growth that you experience is big, way bigger than the average person. So I'm not going to let you like downplay or success.
DR. ALEX: Well, I appreciate that, but I will say that this is my, I actually sat down and thought about it a couple of months ago. This is my sixth or seventh business at this point.
DR. DANIELLE: And by the way, can we, can we just like normalize that? There’s so much discourse, I guess around, oh, this person, you know, wasn't successful the first two or three or however many times, but they kept going and they tried again and that's what leads to success.
DR. ALEX: Yeah. It's like you have to keep failing and failing and failing to be successful. The faster you fail, the faster you can be successful. And I've had a lot of practice at this. So while I've only been a chiropractor for three years, I started with network marketing businesses almost 15 years ago. And I tried and I tried, I tried like seven or eight of them when I realized, I know I want to be an entrepreneur, but not this way. This is not how I want to do it. But those soft skills of, of learning how to, to do that made a difference. And as a per I was a personal trainer, I had a personal training business in Florida and that didn't ever take off. And I created a personal training business before I became a chiropractor here in Dallas, and that really didn't take off.
And then I was doing all these different types of businesses and trying to, you know, figure it out. I was becoming an entrepreneur for the past 15 years and I've been practicing that. So it's not like I just graduated chiropractic school and was like, oh, I'm going to do my first business. I'm going to take off. That's not at all what happened. It was a lot of trial and error and I'm still in trial and error and learning how to grow and expand. So if you're someone who's like, man, like this is just way harder and you're only a year or two or three, and this, this is your first business, don't give up, like, the light is there. It's just, you might take a little more time to dig. Yeah. And I think that's the same with practice.
Just, the other day, like if anything, my clinical acumen is where I have the least amount of confidence I would say, but that doesn't stop my business growth. And so one of the, you know, areas that I really work on is really understanding and realizing that I am bringing more to the table than I think about clinically. And so I keep advisors, I keep people who have more experience in my back pocket to reach out to, and to continue to learn and grow. But giving myself grace, I've only been a chiropractor for three years. Yes, I've had personal training experience. I've been looking at the body, I've been looking at movement patterns for seven or eight, but like, there are people who have 30 years of experience and I can't expect to be at their level today.
And it's just going to take practice and it's going to take referring out clients that I'm not sure how to help and, or co-managing with another chiropractor who's willing to teach me and willing to work through things and allow me to grow. But also being really honest about it. I think too lot. There's a lot of imposter syndrome when we start a practice, especially if you're new, it's like, I don't know if I can help people. Well, if you have a case or a client or somebody that comes in, you don't know what to do, that's okay. You can take that opportunity and do what's best for the person and refer them to somebody else who can help them and see if in the process that person is willing to show you what how you can grow or invest in, in coaching and mentoring and in, in the clinical thingee. That's so professional. So how to learn with that case, but don't let - I think that's another big thing I had to do is don't let the clinical side of things if you don't know how to help someone do what's best for that person and then learn how to help them, but don't let that stop you from growing your practice, because they're going to be, if you graduating, you got a license, I'm sure you can help somebody. Like there's no, yeah. Reason to think you can't.
DR. DANIELLE: Yes, and if continuing education is what you need, then your business needs to be supporting the ability for you to get that continuing education. It's a business expense if you want to think of it that way. So if that means that I think for some people they would be thinking, well, I'll increase my fees when I'm more confident in my clinical skills, but that's not what a business owner would do. A business owner would say, we need to have this much revenue so that we can train this person to improve the delivery of the service. And how do we do that? We are the person delivering the service and the business owners. We have to be able to wear both hats and be in both roles when it's appropriate to be in one or the other.
So I wanted to wrap up on something that I was thinking about as you were talking. I don't remember now what it was. Maybe it's not meant for this conversation, maybe a different day. Do you have any final thoughts or things that you want to share with people before we wrap up?
CONTINUING EDUCATION AS A BUSINESS INVESTMENT
DR. ALEX: Yeah. I think one last thing that has been on my heart to chat and discuss, and it doesn't have to be very long, but really, like you said, looking at your continuing education as an investment into your business, but looking at our, at schooling, like our, our student loans, whatever it may be that you invested in yourself as an investment into your business. Now, legally tax wise, you can't write off your student loans, but it was an investment for you to be able to have your business. And so it's, I think a mindset shift to realize in order for my business, to me, I've decided in order for my business, for me to consider my business profitable, my business should also be able to support the education that it took for me to get here in the first place. And so I need to be able to pay myself enough to pay my student loans at the level that I've decided I want to do. I decided before I went into chiropractic school, I said, Hey, I'm going to pay this off in 10 years. I'm making the adult decision to take these student loans out and agree to this, and I'm going to stick to that commitment.
And so I just decided like a lot of other things that that's what's going to happen. And so as I'm growing my business, realizing that in order to do that, I have to pay myself enough to do that, because nobody's going to pay them for me. As far as I can tell, I'm really not expecting to because I chose to make that adult decision to do that. And so I know a lot of us have different experiences when it came to our student loans, but at some point we do have to just own up to the fact we took them out and pay them in whatever fashion that you decide is right for you.
So I think that's a conversation that we could potentially get into deeper another time. But I do think that as providers, we really should be looking at our education as an investment, as a liability versus a debt, which they're two completely different things. Like we shouldn't let that debt weigh us down. It was the, it gave us the opportunity. And so instead of I used to grip about my student loans all the time, instead of griping out, be thankful that I had the ability to participate in this process program, whatever, by, by the comp country to allow me to do the thing, like I didn't have the money to go to chiropractic school. So they gave me an opportunity.
DR. DANIELLE: I certainly didn't either. Yeah. I wouldn't be able to go to chiropractic school if I had had to pay for it out of pocket somehow. Working full time, I don't think I could have even earned enough in the qualifications and skillset that I had at that time to be able to finance my chiropractic education and also my living expenses. I don't know that there were, there would've been any other way besides to go into student loan debt.
DR. ALEX: Yeah. So I'm so grateful. I've started to affirm how grateful I am for my student loans, for the ability to pay them off I'm also grateful for the ability to start paying them off and to hit the goal that I decided.
DR. DANIELLE: Oh my gosh, we're going to make this a mantra. Like I am so grateful for my student loans and oh, I like everyone that's watching or listening to this. Just say it out loud and see what comes up in your body. As you say it out loud. Like how do you feel when you say that? Oh man. Okay. This you're on to something really good there.
For people that want to learn more about your practice and or how you help other practitioners start and grow a boutique practice, where should they go?
DR. ALEX: Yes. My website is BoutiquePractices.com. So it's pretty simple. Boutique's kind of easy or hard to spell, but it’s BoutiquePractices.com. On that website you'll have the ability to engage in a free mini course that I've created that's three days long. And as well as other resources that are available there. So you can check out that free mini course on what a boutique practice looks like, how to build one in 90 days, I think is what I created it, or like create the structure to build a boutique practice in 90 days. I think that's a great place to get started. And then obviously on Instagram, I'm on the grams. I'm actually like literally today, yesterday changing my Instagram. If you find me it's @boutique.practices on Instagram.
DR. DANIELLE: Thanks for being here and sharing your wonderful self and just being able to chat about all these things very transparently. We're going to do it again I think. Oh, I had promised that I would let people know what your first episode was on the podcast and it was episode number 182. So in that episode we talked more specifically about having a low volume practice. Thank you again. And I look forward to doing this with you again soon.