THIS IS DR. MARK RADERMACHER, AND WELCOME TO YOUR CHIROPRACTIC TRAINING TPMI WEEKLY HOT TOPIC.
The hot topic this week is called the relationship between time and retention, in your clinic. Here’s how this works. There are doctors who are looking to try and enhance the care that they are rendering to patients. Sometimes, they’re going beyond the adjustment and they’re bringing some other service or services into the clinic.
CHIROPRACTIC VERSUS THE EXTRAS
Here’s what you need to understand in chiropractic training and loud and clear. If you study the retention in many clinics, and this has been done on an ongoing basis for years and years now. Typically, the clinics with the highest retention are adjusting patients only. Nothing else. And then on the other end of the spectrum, there are clinics that are offering many additional therapies, tractions, what have you, beyond the adjustment. These offices have the lowest patient retention. This is not a discussion of the clinical ramifications of adjusting only versus adjusting plus all the rest of what could be added, but think about this chiropractic training question before really diving into the topic. If you are doing more than adjusting in your clinic, what are you doing? Do you have one additional offering? You know, a therapy, or one traction only. Or do you have two? Or three, you have four machines for this, and PT for that, and traction, and traction, and traction, and exercises, and stretches, and so on and so forth. Why do you only have six? And in your chiropractic training, why weren’t you taught to have 10 or why stop at just 10 additional things to offer after the adjustment…more, is always better, or is it.
IS IT YOUR PHYSICAL FOOT PRINT
Is it because you ran out of physical space in the clinic? Because just go get a bigger space. There’s always a solution, right? Or you might be thinking, I don’t have enough staff team to administer any more than what I’m offering now. I’ve got six different things I’m offering beyond the adjustment; if I went to seven, I’d have to hire another staff team member.
BUILD A MONSTER BUILDING
Well, get a bigger space and hire two more staff team members. How’s that for chiropractic training idiocy? Why stop at 10 or 12 or 15? You know, if you looked, you could buy and bring in 50, 60, 70 additional services in your clinic for a patient to receive in addition to getting adjusted. Why did you stop at just two or three or five?
ENOUGH IS ENOUGH
Why don’t you have 50? I mean, if they need these three, why don’t they need 47 more? There are always other doctors who are arguing patients need three or four different additional services that you aren’t offering. So why not offer everything you could ever find…anything that’s ever, been invented?
IT’S ABOUT THE CLOCK
Here’s why. Innately. Yeah, that’s a word. Innately. A lot of chiropractors, never learned this in their chiropractic training and have never thought this through, realize there’s only so much that you can bring in to a clinic and offer to a patient. And you want to know why? Because there’s this relationship between time and retention. And this is what the new patient tracking forms have proven for years and years.
INVERSE PROPORTION
In other words, it’s a teeter totter. What happens is, the more time a patient spends in an average visit, the lower their retention. The more minutes they spend in an average visit, the less they stay for chiropractic care. Basic chiropractic training 101. So, you’ve got this situation whereby clinically, you’re trying to do more and more for a potential better outcome for the patient.
IS IT ABOUT THE MONEY
Well, of course, you probably get paid for all of that as well. Some chiropractic training focuses only on the money. Some of you might not. You’re just doing all the extras to try and create more of a beneficial outcome for the patient. But the more the minutes go up, the more the retention goes down. It can be dramatic. For example, a patient comes in to a clinic that is adjusting only, now let’s say they charge $60 for a visit, which is not outlandish; it’s in the middle of what many chiropractors are charging. They come in; they check in at the front desk. They go to a brilliant open adjusting area where they can sit, watch, listen, and learn.
THE SHORT VERSUS THE LONG VISIT
But, they sign in at the front desk, go into the open adjusting and get adjusted within a few minutes. And then checkout. Their entire check in to checkout, in other words, door to door time might be all of eight minutes, nine minutes. This is what precision chiropractic training is all about. But interestingly, it’s those offices that will see retention in the 80, 100, 170 visit range. There are doctors who have retention well over 200 visits. But you flip that over and you’ve got a patient checking in and then going to wait, maybe they’re going to wait in the fish tank magazine room (where was the fish tank and magazine selection in your chiropractic training?) where they are entertained by fish, if they’re still alive, and magazines that are maybe old, maybe new, but none of them talk or teach about chiropractic or health. They don’t teach anything about health. So, they’re in the fish magazine tank room, maybe five, 10 minutes, 12 minutes. Then they go into a closed little cubby hole where the walls just keep coming tighter and tighter toward the table.
HOW MUCH OF THEIR TIME CAN YOU WASTE
And they sit down there, and they read another old magazine. No fish. They can still smell them, but they don’t get to look at any fish. And they go through this magazine and flip through it back and forth, and it’s meaningless. Another four or five or six minutes then… the doctor comes in. Oh, let’s shake hands and talk, and “how was the weekend,” and “how was the weather,” and how was the you know, “this event,” or “the vacation,” or “the upcoming planning for a trip,” or all worthless nonsense communications that could be 2, 3, 4, 5 minutes. Then they get adjusted, maybe rub-a-dubbed, as well. Then they go into the next phase. They walk to another room, a little room, and a staff team member comes in and this is done, and that is done. And then this is done, and that is done. And perhaps 35 minutes, 45 minutes later, they check out.
WHY DO PATIENTS CANCEL THE MARATHON VISIT
The retention in that clinic is far lower than the first clinic described because the minutes just kept stacking up. Think of it this way. A patient is slightly backed up in traffic. They’ve got a four o’clock in the afternoon appointment. It’s five to four. They know they’re not going to get there till 4:15. They don’t even bother calling; in this instance, and this happens a lot, because they believe the front desk might try and talk them into still coming in. They know that if they’re going to have to get there at 4:15 and then it’s going to take 30, 35 minutes. In some clinics 45, 50 minutes to get from front door to front door, they’re looking at their watch thinking “I’m already going to be 15 minutes late. I don’t have another 35, 40 minutes. I’ve got to do this and I’ve got to pick up, a child or I’ve got to drop something off. I can’t. I can’t.” So, they just miss. Or maybe they call in and say, can’t make it, no way, today’s not going to work. That kind of patient is less likely to ever make up that missed appointment. You should know this from your chiropractic training.
PAIN ONLY GOES SO FAR
Why? Because they just don’t have that kind of time. Realize, in the beginning, when there’s enough pain, the greatest motivator on the planet, they’ll find the time. The patient will just make the time. They’ll even ask if you come in on Saturday. Crazy. There are some chiropractors that’ll go in on Saturday to see a patient. Maybe even a Sunday every once in a while. But when the pain’s gone, or mostly gone, and the clock is ticking, the retention is sliced and diced you’ve learned this from your on-the-job chiropractic training. So, if you’re really thinking Model 3, and your office statistics are showing your retention is Model 1, and if you’re confused, about the difference between the 3 models in practice, that means you didn’t dive into the TPMI website far enough yet. You need to do that. You need to learn about the three models, and the fact that you must choose the model in your clinic that makes the greatest sense. But if in your mind you are model 3, high retention type of clinic, and the statistics prove that you’re really only experiencing a model 1, low retention practice, that dichotomy will tear you to pieces.
FAIRY TALE LAND
And the problem might be you’ve got way too many services requiring way too many minutes for the average visit, and the retention is impossible to be able to build. So, final thought for your chiropractic training, somewhere in the middle, you know, if this were a perfect world, and patients could spend an hour and a half getting all of the rest of the care beyond the adjustment that might benefit them, it would be great, wouldn’t it?
IN THE REAL WORLD
This is an imperfect world, and you can’t find many patients who can or will do that sort of time on a three time a week visit basis. So, considering this is not a perfect world, maybe you should be thinking somewhere in between, maybe somewhere toward the shorter minutes end of things is going to be the best for the patient. Because if they’re really coming in mostly to get adjusted, then you do whatever you can do to raise the retention for them. Just decent chiropractic training dictates this to be done. Because adjusting is the unique component that you, only you, the chiropractor, offers, remember? Nobody else offers adjusting, but many other healthcare professionals offer a lot of the extras and not trashing the extras, just saying in reality, you might consider trying to bring the visit time down to the essence of what you really believe the patient needs. But if you lose the patient and they lose their opportunity, who cares? Moot point. So, more doctors are bringing the amount of care rendered, down, so that fewer minutes are involved in the typical visit. For starters, at least get rid of your holding tank waiting room!
CATAPULT TO A MODERN CHIROPRACTIC CLINIC
Don’t waste their time in a closed room waiting for you. Let them watch and listen and learn in an open setting. Don’t waste their time talking about nonsense elevator talk. Every second counts. And every minute that they get the care they really need, if it’s lower minutes in total, will provide more potential retention, more chiropractic adjustments. One of the chiropractic training tenets.
JUST THINK
Some doctors will say, “well that’s a really hard clinical pill to swallow.” Well, how fun is it to see people quit? Swallow that every day and see how much sense that makes for the patient and the growth of your clinic. Be smart, think, deliver what’s essential, but keep the minutes in a visit at a minimum. And typically, then, if you communicate well enough, and use your chiropractic training, watch your retention rise. Give that some very serious thought, enjoy thinking about it, and until next time, do use that information to your and to your patient’s advantage. Good day.
