Subscribe
Share
Share
Embed
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.
Dr. Ben Stevens:
You owe it to your patients to be really, really good at business, because as soon as you lock into a certain level of success and flow in business, your clinical game gets 10 times better.
When you don't feel desperate ever helping a patient, when you don't feel like any one patient needs to do a certain thing for you to feel validated or for your business to be successful, you become even more ethical in business, you become significantly better at what you do.
Dr. Justin Rabinowitz:
That is Dr. Ben Stevens. He's a clinician, an educator who spent years helping chiros and PTs in the US and Canada improve their skills. This is the second part of our conversation we started last week. There, we spoke about how to improve your patient communication and how to include AI in your practice. So, jump back in and listen to that if you haven't had a chance.
This week, we pick up where we left off and drill down even deeper about how poor communication with your patients is holding your practice back. By the way, Ben's also doing an exclusive Mastermind with my community. So if you get a lot of value out of this conversation, head over to the show notes to find out more about how Ben can help take your practice to the next level. I'm Justin Rabinowitz and this is Business School for the Rehab Chiropractor.
We spoke about this a lot on the chronic pain side. Where do you think clinicians really struggle with chronic pain patients specifically? 'Cause it is a tough bunch of people to treat, and it's hard.
Dr. Ben Stevens:
Yeah. I mean, to be fair, asking Dmitri about this or Annie O'Connor about this would be a much more meaningful answer than mine, but I can tell you what I see because people bring up chronic pain in every single seminar. No matter what the topic is of the seminar, people being up chronic pain. And I think one of the things that I see as the main difficulty a lot of people have is trying to fix them.
And I know that seems like a strange thing to say, but trying to take the operator mentality of like, "I am the person or the clinician," or, "I have the tool that is going to fix you, you just haven't found your way to it yet," is really naive when it comes to dealing with chronic pain.
When people actually have chronic pain, and they have all the comorbidities and all the environment around that, it's so much more complex. A lot of the time, it's not about, "Here's the tool, here's the thing that you just haven't seen yet." It is about becoming more of the collaborator than the operator is a big, big part of it. Education is also very, very important.
And trying to fix them is something that I think a lot of people get frustrated with, where when they have a chronic pain patient come in, there's so many other things that you can do besides fix the problem that will be doing a massive service to that patient.
And that's something I think most of us are used to. A patient comes in and they go like, "Oh, I got [inaudible 00:02:53]," whatever. And we go, "Oh, they got a rib thing," or, "Oh, they got a facet thing," or, "Oh, they got a disc thing." And we kind of guide them through the process of that getting fixed, for lack of better phrase, or feeling better.
And with chronic pain, a lot of the time we'll do an exam or we'll take a history and we'll go like, "Man, I don't even know where to start with this thing or where to go." And if you stay in that fix them mentality, you're just going to do them a huge disservice.
And you might even, I'm not going to say make them worse, 'cause they don't physically make them worse, but you might actually add to the pile of distrust that they have that they're ever going to get better, that they're ever going to feel better.
And so I think the main struggle people have is taking what they do with, say, a young, healthy athlete and applying it to someone who's 50 and has fibromyalgia and smokes. They're just not the same thing.
Dr. Justin Rabinowitz:
I get this question a lot, and I'm curious your take on it. So if someone comes to you and said, "Yeah, the patient came in. It was a great interaction. Everything went really well. I put together a plan for them, but then I never heard from them again." What do I do? What do you tell someone in that situation?
Dr. Ben Stevens:
I mean, I'm just going to say it again, it's a communication thing most of the time. With that being said, humans are humans. You can't pretend that you're going to get the same outcome 100% of the time because that's just not how it works. It's a communication thing.
So, I think the most uncomfortable and most meaningful thing that the vast, vast majority of clinicians could do is they could go study what they've already done. And it's very almost heartbreaking a lot of the time. Most clinicians don't know their numbers.
Most clinicians don't know anything about their practice outside of the number of new patients, the number of visits they have on their schedule in a week, and the amount of dollars coming and going, even if they know that.
But one of the things I would highly, highly recommend people do is go back and look at the last 50 or 100 new patients and then see how commonly they actually stuck around for the full care plan, and just knock off the outliers.
You'll have the people who they just fall in love with you, and they want to be there all the time, so they're constantly booking you even though they don't need to. And then you'll have the people who you were never going to help or you just referred out on day one. So it can't be purely numbers. You can knock off the outliers.
But one of the things that you'll probably find if you're running into that problem over and over again, is if you go and look at the last 50 patients, if 20 of them only came in for 0 visits after the initial, or 2 visits or 3 visits and then they kind of disappeared, you would probably notice some commonalities between all those patients.
You'd probably notice a commonality in how they made you feel. There's a really good chance, in my mind that, you would look at all those and go, "Yeah, almost every single one of those I kind of felt like I saw it coming. I kind of felt like I knew they weren't really going to come back."
Because it's very weird if you get this sense of like, "Man, I knocked it out of the park and we did absolutely phenomenal," and then they didn't come back and you're absolutely confused. And I kind of have systems around how I like to study these things, and they involve a lot of vulnerability.
And so, if I were doing that now, I would say, "Go look at your last 50 patients, go look at all the ones that you don't think came in to the full extent of what they needed to get better, call all of them." It's a really unfortunate feeling to call all of them and to... You don't have to put them in a hot seat, but you need to, in one or two questions, figure out what happened.
Did they actually feel phenomenally better? If so, great. Did they feel enough better but are kind of giving you the vibe that they weren't sure it was the right thing? Great, that's information. And I would go through and just do the last 50 to 100 patients that you don't feel actually did what you wanted or didn't do what you thought was best for them, call them, communicate with them, and then codify the whole thing.
Once you codify that whole thing, you're going to have this very obvious trend of just like, "Holy shit, I am really bad at this thing," or, "I never mentioned this thing," or, "I didn't educate this way," or, "I am putting across this vibe when I don't want to put across that vibe."
There's a lot of ways to kind of come at this, but I think the most obvious way is if someone asks me that question and they just go, "This happens all the time." My immediate answer is going to be, "Go back to the last 50 patients that happened with, call them. They'll give you an indication as to why, and then it's your job to fix it."
Dr. Justin Rabinowitz:
So, what do I make a Ben's suggestion to call the last 50 patients that didn't sign on for a treatment plan? This is going to be very uncomfortable for a lot of people, and unfortunately for many people listening to this podcast, they're going to resonate with everything I'm about to say.
So the problem that most of us have in our life is that, to be honest, we've been very successful in everything we've tried. If you're listening to this and you're out of chiropractic school, it means that you've graduated college, it means that you've passed your boards in chiro school, you've got a chiro degree, you've opened a business.
Objectively, you're in the top, top, top percentage of people in the world. It means that things that you've tried, you've been successful. We now get into business, and in this specific case, people that said no to you, rejection, and this is hard.
And I wish there was an easier way. I wish I could just tell you to go find other people that are only going to say yes, but unfortunately the hard path forward is the only path forward. And so, most of the time, we don't want to reach out to these people because we're afraid they're going to tell us something we don't want to hear, and I understand, and I felt the same way, and oftentimes I do.
The best way to learn what needs to happen and what needs to be done differently is to go in unbelievably and passionately curious. It isn't about trying to convince someone to come back. It's oftentimes about being curious enough to ask the question, "Hey, how are you feeling? Have you found a solution to your problem? Curious, what was it that you might have needed to see in order for you to say yes, because I really thought we could help you? I would love to have that conversation with you."
And I think for some of us, our ego, or potentially not being humble enough to go in and put our tail between our legs and ask that question, is really, really hard. Let's get back to my conversation with Ben. I want to find out why he thinks so many chiros and PTs struggle with the business side of their practice.
Dr. Ben Stevens:
Maybe up to 80% of chiros out there that are really, really good at their job are struggling in business. I think it is the majority more so than the exception that are actually struggling in business. And one of the things I wish more people would do is just have a huge mindset shift. Most people absolutely love the idea of having a certification, of having a qualification, of having a tool, of having a technique, and they think that is going to be the thing. And to me, it's very important to have a level of excellence in what you deliver clinically. That needs to be the foundation of a good business. But for some strange reason, as soon as you switch into anything that is not anatomical, physiological, chiropractic, whatever it is, whether it's patient communication, whether it's business, whatever it is, for some reason people think they're just going to vibe their way through it.
People think that they're just going to read a book or they're going to do one thing and that's it. It's really just a mindset shift. I was so fortunate that when I started chiro school, I was shadowing chiro's left, right and center. And one of the people that I liked the most, that I went, "I want to emulate this guy because he seems happy, seems like he's making money, seems like he's practicing ethically and he's treating the kind of patients I want," he said, "Here's what I want you to do if you never talk to me again." First quarter, soon as you buy those textbooks, for every textbook you buy, buy a business book."
And I did it for 13 quarters, straight through. And I mean, you can probably see it behind me, I still have a ton of them up here. I read so much. I still read twice a day. And I don't think you need to read twice a day to be successful in practice by any means, but I think having this constant mindset of, "For everything that I do to get better as a clinician, I need to match that one-to-one with something I'm doing to get better as a business owner," whether you're an associate or a business owner. It's really that simple. Because I think as a clinician, even in your first five years, you have all these tools, you're trying to fill your toolbox, so to speak, and you have all these different things. And over time, you kind of create your own, whether on purpose or accidentally, your own kind of cohesive system of what you do in clinical practice.
And then yet in business, for some reason, we do the same thing, and we kind of create our habits, we create our systems and practice, but we do it with almost no influence, with almost no input. We don't hire coaches, we don't read the books, we don't shadow, we don't ask hard questions, we just ignore so much of it. And there are a million things that people could be doing outside of learning more clinically in order to become extremely excellent. And on this note, the last thing that I'm going to say, you owe it to your patients to be really, really good at business, because as soon as you lock into a certain level of success and flow in business, your clinical game gets 10 times better.
When you don't feel desperate ever helping a patient, when you don't feel like any one patient needs to do a certain thing for you to feel validated, or for your business to be successful, you become even more ethical in business, you become significantly better at what you do, you remove a lot of bias, and you just become so good as a clinician. They have to go hand in hand, but for some reason it's almost uncouth for us to focus heavily on being a clinician and focus heavily on being good at business, and it's just a mindset shift.
Dr. Justin Rabinowitz:
This episode is brought to you by Jane, a practice management software and EMR built to support you in the day-to-day work of running your business. If you're a health or wellness practitioner, you already know the care you provide starts well before your patient arrives and extends far beyond the treatment room. Jane is here to support every part of that experience.
With online booking, your clients can book at a time that works for them, and with features like wait-list notifications, they'll even be able to grab last minute openings when they pop up. It's an easy way to keep your schedule full while getting your patients the care they need.
During your appointment, Jane's AI-powered documentation feature can help you thoughtfully take notes so you can stay present with the person in front of you. And after appointments, you can end your time together on a healing note, not a transactional one by charging the card on file.
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 like 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 an 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 one last thing, if you're ready to get started with Jane, you can use my code, REHABCHIRO1MO, for a on month grace period on your new account.
I had an intern years ago who is now very successful in practice, has a really good business, and he was one of my first Mastermind members, but when he came as an intern, I said, "What's your big goal when you graduate?" He's like, "I want to open my own practice." And I said, "Okay, what's going to hold you back from doing it?"
And he's like, "Well, I need to learn social media, and I need to learn marketing, and [inaudible 00:14:16], all of that." And I said, "All right, open your backpack." And he's like, "Why?" I was like, "Open it up." And I said, "Pull the books out." And it was Stu McGill Low Back, and it was another one. I'm like, "These are great, by the way. I've read them. However, you just told me these are your goals, but they don't match what you're actually studying." So I mean, 100% that's a massive thing where there's a level of frustration, but we're not actually doing the work to improve at that.
One more tactical thing there, you've expressed your frustration with people that you want to be able to help, and it's always like, "I would, but I don't have any money," which is always a symptom of 99% of the time that clinicians are undercharging for their services, specifically in our profession.
What do you think that someone, again, going... The clinician that you work with gets good outcomes and you look at them, "You're the best in your town. I know you are, yet you charge half of what they should be charging, or you spend more time with people and charge what the person spending two minutes with is"? What conversations have you heard or seen or had with people that have come into your world?
Dr. Ben Stevens:
Yeah. So, people come pre-defeated a lot of the time. They come to these things being like, "Oh, this doesn't work because it's the..." 'Cause I'm Canadian, and so they go, "This doesn't work in the Canadian system." And I go, "Okay, great. Sure. I pretty well guarantee it does, but sure."
And I'm not a business coach, so I'm not in your seat of making sure people understand that they can and should charge more, but I do hear it constantly, that people go, "Oh, we have our fees set for us. Oh, blah, blah, blah insurance. We're competing with physio or whatever it might be. These people have better coverage," and so on and so forth.
And the vast majority of the time, it just again comes down to a communication thing. You're not really good at communicating your value and then bringing that value.
Dr. Justin Rabinowitz:
So, what business books would I recommend to clinicians? If you are a rehab chiro, if you are a chiropractor, my first book, Business School for the Rehab Chiropractor is literally the book built on this. Obviously, there are so many other books depending on what you're looking for. Whenever someone asks me about business books, the answer I always give them is not the answer they're looking to hear.
It is I ask them another question, and the question always is, "What problem are you trying to solve?" Someone says, "What book should I read on business?" "Tell me specifically what problem are you trying to solve? Is it a leadership book? Is it a sales and communication book? Is it a marketing problem? Is it a mindset problem? What is it specifically? And then I can give you specific answers. But just throwing out random books to solve random problems might not be the specific problem you have."
Being better at business leads to being a better clinician because a good business leader can take emotion out of decision making. And what I've always talked to my clinicians, of my doctors, the people in my program about, is many times we need to treat their business more like they treat their patients.
And what I mean by that is let's say a patient walks in and you really, really, really want to be able to help them, but you do your exam on them and objectively they shouldn't be in your office. Maybe they show some sinister signs, maybe they have some things there that you're uncomfortable with. Even though you really want to help them objectively without emotion, you refer them out to get an x-ray, to get an MRI, to their specialist, you refer them out.
That is a decision matrix that you've made independent of how you feel about it. Of course, you would love to save it and be the one who can fix their back, but if you think there's a chance that something else is going on, objectively you have to have a clinical decision-making process that puts them in the right position.
Business is very much the same. So many times it's we feel like it isn't working. We don't love being rejected, but if we can think about it unemotionally, we know that the most important thing is that we make the right decision with all of the right information, independent of how we think and feel about it. And so, very much the best business owners take that clinical mindset and put it into their business.
Dr. Ben Stevens:
There's two things that I think really commonly people should be doing that they're not. For one, I think people should be focusing more in one single treatment. So in one treatment block, whether it's 15 minutes, 20 minutes, 10 minutes, whatever it is, people should be focusing more. Again, we want so badly to not be the guy that just spends 90 seconds with someone that we're doing the opposite.
We are doing education, we're doing nutrition, we're adjusting them, we're doing soft tissue, we're doing some exercise, and we're trying to be their best friend all in 20 minutes. And then we're trying to give as much value as possible in 20 minutes, and then we're doing the opposite in the long run, where we're only seeing people for two or three visits. And we're not actually giving ourselves the opportunity to really make a big impact because we're not doing a good job of communicating the value of all the things that we're going to do along the line, and the process of how we're going to get there.
And so, what I see is people trying to deliver absolutely everything on day one, and communicating as such, and doing way, way too much per visit. Guilty, by the way. I'm not saying this because I think everyone else is doing it and I'm not. Super guilty. I will get into people-pleasing mode over and over and over again, but really good communication and conviction around what you have to offer, and why you're so good compared to the guy down the street or compared to whatever you want, should come out in the way that you communicate.
So they're trying to do too much in one visit and they're not asking for enough visits in the long run to actually get them better. And I'm not saying you have to say, "Hey, we're going to see each other for six months." If you're in practice that you're doing ACL rehab, you probably should be saying at least that, you should be communicating that.
But if someone comes in very injured and you're just like, "Well, we're going to see how it goes. We'll see you a few times," and communicating in that way rather than going, "Listen, this is going to take a while. We need to kind of settle in and understand that this is going to be an ongoing process," and however you want to explain it at that point.
And so doing too much in one visit, not enough in the long run, I think is probably the big thing that happens a lot of the time, because yeah, in the Canadian system, you can charge more per visit if you want. It's just when literally everyone in town is charging the exact same, it'll be a little harder for you.
So I sympathize with that, but one of the things you can get better at is going, "Yeah, we do rehab. We do all these other things," focusing on the communication around those and setting it up so it's not like, "Oh, we're going to adjust you three times a week for six months."
But it might be something closer to, "In order to really change this, in order to change whatever objective measures you have, this takes some time, and this is how we're going to do it. This is how we're going to communicate it." You give yourself the opportunity to help them by communicating that this is going to take however long it's actually going to take. We don't exaggerate these things.
Dr. Justin Rabinowitz:
I think one of the downsides, and I remember this as a clinician, but specifically in your business, is the downsides of what you do is that people get so much knowledge and they become almost too smart, in that they have so much knowledge, and then the challenge becomes how do they actually communicate that and get to a level that the patient can actually understand.
Where do you see the biggest disconnect between somebody that has all the things and can actually utilize them in practice, and knows when to utilize the tools that they've been given through a lot of the programs that you've done? But then, to actually go back to, I call it being a caveman, and explaining to a patient that they leave there and actually understand, "Where do you see the disconnect between the high-level clinician that's got all the skills but the communication that needs to happen in the practice?"
Dr. Ben Stevens:
Yeah. I mean, I think that's a little person-dependent because I think people all have their natural communication styles, and their natural ability to communicate in a way that people like or don't like. I shouldn't say like or don't like, the way that gains trust or doesn't gain trust. And some of us have it naturally, and some of us don't.
I think one thing I can speak from my experience and from what I've seen from shadowing a lot of docs, is I still go in shadow docs. I still go and hang out at people's clinics actually relatively often. I'm literally doing it today, in a couple of hours.
A lot of the time, people, when what they're trying to do is educate, they end up patronizing, or they end up... What they are trying to do is to to help. What they end up doing is sounding salesy, and they don't really have a good system in which to do it.
And to me, I always erred on the side of asking questions as a means to enter the conversation I want to have, and that's something I think that is very natural for most people. So for instance, someone comes in, I saw a lot of non-spine stuff. I was just a sports practitioner, kind of full top to bottom, everything. Someone comes in with a knee injury, I do some kind of assessment.
One of the things I will do is throughout that assessment, after I take a thorough history and I make sure it's been a great kind of intake, is every single exam that I'm doing, I'll tell them while I'm doing it. And so, say I'm doing like a valgus test in some way, and I'm aiming in some way to figure out whether or not their MCL is involved. I'll just say that.
I'll say, "Have you heard the word MCL?" And they go, "Yeah." I go, "That's actually ligament that's right here on the inside of your knee," and I'll touch right there. I go, "Pretty close to where your pain is. Right?" And they go, "Yeah." I go, "When I'm doing this on your knee, it's to figure out if it's going to strain that MCL. It's just to figure out if that's one of the problems."
And then if I go do it and they have pain, they go, "Oh." I go, "Oh, well, look at that. We might have an MCL problem, but there's other things in the area. We're going to test those." Do that with a few tests. I come to the end and I go, "Okay, it looks like you got an MCL issue and you got a little bit of meniscus tear. I'm not entirely sure exactly whatever it might be. Okay, I think you know what an MCL is. Right?"
And they go, "Yeah." And I go, "Do you know what a meniscus is? "And they go, "No." And I go, "Okay, hold on a second." And I'll draw it on the board and I go, "This is an MCL, this is a meniscus. They're actually attached to the joint line here," or whatever it might be. I'll explain it to them.
And I'll go, "Okay, this one is made primarily of connective tissue, like tendons, and it's a ligament. This one's made a cartilage that kind of heal in different timelines. This is why we're going to do this sort of thing. These are the techniques that we're going to do because these techniques do this sort of thing. But at the end of the day, this is a lot about guided exercise and movement, and I'm going to guide you through that as we go at every stage to get you back to whatever it might be," proceed to talk about care plan or whatever it might be.
And so, to me, the clinician has to know the reasoning, anatomically, physiologically behind every assessment that they're doing and every intervention that they might be suggesting, because if you treat the patient as stupid, you're going to get stupid outcomes. And so, what I want is to treat the patient as intelligent, trusting that they're going to know I'm intelligent as a result, and then we're going to go. That's something that has always served me very, very well.
Every single time someone has something that I can explain to them, I will literally draw it on a whiteboard. I will explain it anatomically. I will poke them and I go, "This thing, it's here, this is what it does. This is how it seems like you've caused it. This is what we're going to do to get it better. Do you understand?" It's really that simple, a lot of the time.
One of the problems comes when people get into really obscure things that they don't understand that well, and then they try to implement them in practice, and they really just suck at communicating about it, because then the patient kind of goes, "Okay, I feel better, but what? How does that work?"
It's one of the reasons that the old school chiro has a significantly easier job. They can be like, "You have a subluxation. Boop, you don't have a subluxation. Ta-da, problem fixed. You have foot on hose, you have spinal curvature, you have whatever it is." It's so easy to sell. It's so easy to communicate on.
So, our job as evidence-based or rehab-based chiros is to know our shit inside and out, have a great amount of humility, a great amount of understanding, be great at communicating that, because you don't need significantly more than that, because honestly, that's just the most ethical thing to do.
They now understand how they got into your office, what the problem is, what they're going to do to get to the end, and how you're going to collaborate to get to that end goal. It really can be that simple, as long as you're kind of good at communicating and structuring it.
Dr. Justin Rabinowitz:
Last question. I think it's a great place to wrap up. From everything that you've seen, the experience you've had as a clinician and working in your business now, what do you think separates the clinicians who actually succeed in practice versus the ones who are stuck?
Dr. Ben Stevens:
Yeah, communication. It's a redundant answer at this point, but it is communication. The people who are great at almost everything, they're really good communicators. Second to that, I would say that communication has to come inside of good systems, clinically and business-wise. It has to be built in repeatable, predictable systems. One of the things I've always done is, I mean, I've hired... I've spent probably 20 grand US this year already, and we're in April, on coaching, on some kind of business coach or some other kind of coach.
One of the things I constantly do is I go and I learn in depth from these coaches and then I take their system, and rather than just kind of blindly apply it, I go, "Here are all the things that I love. I'm going to apply those. They're great. What doesn't sit right with me? What doesn't fit perfectly in my practice?" And then I'm going to either talk to that coach or I'm going to alter it myself, or I'm going to get a different coach. And I'm just constantly evolving through that.
Because I think there's a way for almost every style of practice to have really, really good systems, and for every kind of clinician to have really, really good communication. And as soon as you have those two things, honestly, I don't even know if it matters necessarily the specifics of what you do, whether you're adjusting only or you're doing nothing but DNS. I think if you're really, really good at communicating it and you're really good at getting outcomes, just communicate well and get systems and I think you should be good to go. But a lot of people are afraid of working on those things, so they just rely on what they do naturally.
Dr. Justin Rabinowitz:
So if you're a PT or a chiro in the US and Canada and you want to take your business and career to the next level, head over to the link in the show notes. We've got a team of people that would be happy to help you. Also, don't forget to follow the podcast, leave a rating or a review, and comment wherever you get your podcasts.
And if you're interested in hearing the talk that Ben's doing for Mastermind on June 4th, click the link in the show notes to find out more. I'm Dr. Justin Rabinowitz, and this has been Business School for the Rehab Chiropractor. Thanks for listening.