MY NAME IS DR. MARK RADERMACHER, I AM THE CHIROPRACTIC MENTOR FOR THE QUIETLY SUCCESSFUL PRACTICES, AND WELCOME TO YOUR TPMI FUNCTIONAL PHILOSOPHY TOPIC.
The topic today is The Maintenance Backdoor. When you hear this topic, you might be thinking, “what in the world is a maintenance backdoor? What is it when compared to a maintenance front door?” You may be thinking, “I’ve never heard of that. Never heard of the maintenance backdoor.” Well, you’re about to. Because as your chiropractic mentor, if you start thinking in your history, let’s say you’ve been in practice for five short years, and let’s say in that amount of time, you have seen an average of 20 new patients a month just for that entire five-year time frame. How many new patients is that?
BASIC REVEALING MATH
Well, 20 new patients per month, times 12, is really close to around 240. And you start doing the numbers and you get about 1,200 new patients in a five-year period. That’s a lot of, new patients, isn’t it? Now ask yourself, how many of those 1,200 new patients, are still coming in for maintenance care? It’s simple math, as your chiropractic mentor I can tell you, if all of them were, and maintenance care was defined as a one visit every two weeks, then guess what would happen? You would currently be seeing 600 visits a week because every other week, half of the 1,200 would be getting care. Do you have 600 visits a week right now? And are they all maintenance?
KNOW YOUR STATISTICS
Say you have 20 new patients a month and you’re five years into practice and you’ve had 1,200 new patients and only half of them got into maintenance care. So, what does that mean? Again, as your chiropractic mentor, I can tell you you’re looking then at around about 600. And if they come in every two weeks for a maintenance or wellness adjustment, you’d have pretty close to 300 visits a week. So, stop everything, think about your statistics in the last few months. Are you seeing around 300 visits a week? And are they all maintenance?
WHERE HAVE ALL THE NEW PATIENTS GONE
Look around, they are gone, and as your chiropractic mentor its clear for you to see where this is going. Where have all these people gone? Where are all the new patients who turned into maintenance visit patients, gone? You see, most doctors will say “I’ve got patients who have been coming in for care since I opened up my practice.” Well, those are the five or ten people you can name. And then what about the other 1,190? Don’t answer statistical questions with emotion. And, as your chiropractic mentor talking you should remember, numbers don’t lie, sometimes people do. Don’t lie to yourself about what isn’t working in practice. Just think about all those people, where have they gone?
IT’S ALL ABOUT THE SCIENCE
In reality, many of those 1,200 probably made it far enough to get into what is called backdoor maintenance. As your chiropractic mentor, the backdoor maintenance is simply defined as: a patient getting into maintenance care before there’s any objective reasoning to place them in maintenance care. In other words, it could sound like this, a patient comes in for care in their third week in care, you ask them how their low back is feeling, better, same or worse, and they say “it’s feeling better, doc.” By the fifth week of care, it’s still feeling better, and they say to you, “doc, I think I think we’ll just try and maintain this now. I think we’ll just hold off.” You see the double stop signs there? Hold off for a while on this care “I” chose and let’s just back off and just try and maintain this now.
JUST BE HONEST
At that moment, first of all, you have to realize you haven’t taught them very well. Secondly, you better say something pretty smart to respond to their request. But you know what most chiropractors do? And, if you’re the doctor who’s had 1,200 new patients in five years and you’re not seeing even half of them in maintenance now, 300 a week, all maintenance every week…you accepted their idea. A lot of doctors do that because out of fear they mistakenly think…“if I say no, they could quit.” Yet, if the patient knew more, they could stay. And whose care, is it? You see, as your chiropractic mentor, it’s clear that you, the doctor, will be there in either instance. Therefore, maybe you should just tell them the truth so that they do whatever they do and you keep chalking up wins, as you’re supposed to simply because you are being complete and honest in your communications with them.
THE CLEVER FOOL
You can control what you do and what you say. Therefore, if the patient comes up with the idea and you agree, don’t blame them. Now flip the coin over, you might sense that they’re a little less interested in coming in for care. They’ve missed two appointments in the last, nine days, and it’s the fifth week, same patient, three weeks they were out of pain, fifth week, they’re just sort of drifting a little bit. They haven’t said anything. They’re a bit distant. Missed those two appointments and so on. So, you think, clever, I’m going to be clever. I am going to tell the patient a surprise today, I’m going to tell them, “Mr. Smith, you’re probably ready for backdoor maintenance.” You don’t actually call it Backdoor maintenance care but you might say “Mr. Smith, you’re probably ready for maintenance care.” And the patient looks at you and says “really, Doc?” Yes. “Well, because I was really thinking I didn’t know where we were going anymore.” Yeah, no kidding, because your doctor hasn’t told you. As your chiropractic mentor, your best position to take is a professional one, not a clever one.
ALL YOU NEED TO DO IS TEACH
This is basic chiropractic mentor coaching, you miss these points in teaching, Doc, and the patients can begin to drift. Alright, so now you can see the two scenarios. It’s their brilliant idea. It’s your brilliant idea. Both ideas being really stupid. And they get into backdoor maintenance, meaning, remember, by definition, they should not, yet, be in maintenance at all.
GUESS AGAIN
Now here’s what happens. Weeks can go by, perhaps, a few months. And this patient, who was placed in backdoor maintenance care, begins to drift, fade, minimize, and quit. And it gets worse. You might think to yourself, well, “what’s worse than quitting?” As your chiropractic mentor, you need to understand this next point: another few weeks or few months, go by after they quit, and they start hurting again. And you would think, as much as they learned, as well as they had responded to care, they’ll just pick up the phone and make the call to come back to the office. Incorrect! Over 80 percent of those patients, based on statistics, will not call, not because they’re embarrassed, but because they honestly believe, “I put all this time and money and effort into chiropractic care, here I am hurting again, I need to find a ‘real’ doctor now.” Well, they got into maintenance care through the back door. They weren’t ready. And the problem that needed much more care at probably three times a week, reestablished itself to the point, even during maintenance care, whereby soon after quitting perhaps the eight or ten maintenance visits they got in the first place, they end up hurting again.
CARE MUST HAVE FAILED
You see, when they start thinking that this care failed. What they’re focusing on is how they feel at that moment in time. And, they’re focusing and over imagining all the time they spent in care. The many, many, many months they imagined they were under care; which was, in reality, maybe five weeks of three times a week, and maybe three months of twice a month (while they missed a few visits a month they’d rather not remember). Time has no meaning here. As your chiropractic mentor, I have to blast this point loud and clear!: the amount of care was not sufficient. So, they quit, and then, they don’t come back. Again, look back five years ago; for some of you, it’s 10, 15, 20, 30 years ago, and the new patient numbers are into the thousands.
REALITY
Do you know what really happens in most chiropractic practices? Around the 5th, 6th, or 7th year, that practice, gets to about 12, 15, 18 percent maintenance visits. And it never grows beyond. This has been statistically proven by your chiropractic mentor. You might see more volume, but the percentage of maintenance visits making up that entire volume stays right around 12, 15, 18 percent. Meaning, more and more patients are wasted. Why? Because far too many of them go into the maintenance back door far too soon, and, unfortunately experience the storyline that was discussed.
UNDERSTAND THE PAST, FIX THE FUTURE
This is simply the truth. That’s what happens with most of these people, and then they never, ever come back. As your chiropractic mentor, I challenge you to think about it like this: you have a decision to make; you might have five years left in practice, you might have 50 years left in practice, but you have the opportunity; actually, you have the obligation to identify this “backdoor to maintenance” in your practice and lock it, hire a welder, and have it welded shut…permanently.
THE CORRECT TIME FOR MAINTENANCE CARE
Then, have patients go into maintenance care when they’re actually ready for maintenance care. And if they quit, they quit; but you’re doing the right thing from a chiropractic point of view. By waiting and teaching, you’re giving their bodies enough time first to get to the point where they’re actually ready to attempt to maintain. And on that thought, doctor, as your chiropractic mentor I can enlighten you to the fact that you can change this tomorrow. You can stop the back door nonsense by tomorrow. Do you have the intestinal fortitude to do that? Your patients are counting on you. They don’t even know they’re counting on you, but they are. Think this through, doctor, and have a good day.
