Six changes to a cash-based chiropractic business model

But as I had talked to a friend about why we want to have someone on, I'm like, because I want to have a team, you know, like I want them to feel like they're compensated appropriately, but I want a team. Like I feel like we can do a really good job. I feel like we can get people really good care and I want to make a team effort with it. Like I know a lot of clinics will do like the whole, you know, this is your patient, that's my patient. Like I don't know how to not do that. I just want the boat to be full, like raising water raises all ships, right? If there's, I want more than enough to go around where no one fights about that. And I want it to be a team approach. I want us to feel good that we're on the same team. You're listening to the Restoring Human Movement podcast, where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery. And now your host, Dr. Sebastian Gonzales.

Hey everyone, it's Dr. Sebastian Gonzales, your host with the Restoring Human Movement podcast. Thanks for joining the movement, movement. This is your first time. Welcome. It's about a 45 minute to an hour long format where we cover lots of fun things for young clinicians, young DCs, PTs, athletic trainers, and people who just want to help people feel better. Now in the past, this podcast used to be a little bit more patient friendly, but I think at the beginning of each podcast now in the coming future, I'm going to be, I'll be designating whether it's actually more patient friendly or more clinician friendly or vice versa, or maybe both, I guess I'd be. Mainly because I think some of the, some of the topics have been more very targeted at clinicians because it's just stuff that I'm interested in at the moment. I thought I would share. So this is still going to be common communication between everybody. So if we're all having a beer, I decided to get a Pacifico because I want to keep it real light today. And also it's sunny and you got a, you went on my tie, a my tie today. And I think the other person, you know, the, uh, that I get spitzer water, you had too much drink last week. So we're all having that common communication, uh, that we could have at a bar. And so everybody's getting along and still having a good time, but it's might not be always tips and tricks of how patients can help themselves.

So just let that everyone be aware of that. They might be migrating a little bit because I think as we go, as I'm going through different, um, evolutions of this podcast, I'm finding that it's very hard to talk about just only cases because there's other things going on that you guys want to hear about that the clinicians want to hear about so we can help other clinicians, uh, or so we can help patients get better. Sorry, I'm a rambling this morning. Uh, anyways, if this is your first time in the podcast, go back in the archives and just listen to all the other great stuff we have. It's been about two years or so running. And I think there's some very valuable information in the archives, especially in December of 2019. Please go through there. You're not going to want to miss out. Now in every podcast, I start with, um, staring a little, sharing a little bit of a short story about my life. So you guys understand where your host is coming from and who I am. And hopefully you like me and follow the podcast a little bit more. So we'll get into that one second today. I'm going to share some of my, uh, business changes that I'm doing in 2020. Um, I had mainly cash-based business in the past. And so I'm going to show you some evolutions. I think I'm going to make just to help. Um, I already use the word evolutionary, so I'm going to evolve. Hopefully I'm going to evolve.

So, um, that's the goal with that. And so we'll get into some really cool stuff that maybe you guys can think about in your practice, um, over the next year or so. So let's get into this short story and then we'll get right into the show today. Now, if you guys have not been involved in a scam before, uh, there has been scams going on. I'm sure that you've had grandmothers or sisters or brothers who have been kind of dealt with this thing. There was one that actually I thought, I thought it was ridiculous, but, um, it almost got us a couple of times. And so at one point there was one where they called as in our area, the major electrical company called Southern California Edison.

And so they'll call and they'll say, look, you're about three months behind on your, um, electric bill. We're going to shut all your electricity off in about an hour or so if you don't go pay it. And so my front office staff comes running up to me. She's like, Hey, Edison called. They're going to turn electricity off because you didn't pay the bill. I'm like, number one, I don't pay that bill. It's our landlord. Okay. Let's call him back and just see what's going on. And so she called him back and she said, okay, so they have an area where you can actually pay it. And I said, okay, where's that Edison? They said, no, no, no. They're going to check. And so she's like, uh, she's like, where do we pay this bill? And so she's like, uh, they're like, okay, here, let me check. And so it was silent on there for a little bit. And then they came back and like, okay, there's a few locations. The closest one to you, what's your zip code by the way? And they check your zip code and so on.

And they're like, close to one of you is a pavilions. And they're like, here's what we need to do. We need you to go inside and buy gift cards. And we're like, whoa, you want us to pay our Edison bill, our electric bill by paying, but with gift cards. Apparently they have you scratch the backside off and they, that's their way of scamming people for money. So anyways, don't let that happen to you. I've heard this happening to multiple people actually for different various reasons, but they'll typically ask you for gift cards. That's BS. Don't do that stuff. And plus Edison, when I called them later, they said they won't call from that type of number.

They'll call from, I think, uh, 800 or something like that. So make sure you know what number your electric company is calling from. Anyways, let's get back onto the show. So the things that I thought we'd cover in 2020, at least in my business is there's been a couple of things. I'll, I'll, I'll, I'll laundry list the topics at first, just to kind of give you an eyeball of what we might cover today. Um, cash versus insurance. What should we do? Or what might I do? What's my approach going to be? Uh, exam rates. The third is going to be solo, uh, practice versus in a verse having an associate or making a group practice. Um, finding new patients versus retention of old ones. Uh, the, let's see, one, two, three, four, fifth point is going to be pain versus wellness model. And then the sixth one is going to be, uh, cold versus warm leads. Let's start off first, first with cash versus insurance. Now I've, I went to the Sam Collins workshop last year and I did have Sam Collins from HJ Ross on recently. And I think it was very valuable information and very insightful into the idea of diversification. And so in the past years, I'll tell you my evolution of you, at least using cash versus insurance for, for patient services. And, um, in the, I'd say in the very first year of practice, probably the only reason I was able to make it or at least feel comfortable was because I had a couple insurance clients and it, I, I didn't know that they would pay well. And so that was 10, 10 years ago or so. So it paid pretty well. I was able to help somebody. Uh, they were able to refer more people.

And so I got some more heads in the office that weren't insurance based because I treated one insurance person. Now I guess it's probably important to, to realize that there's people, insurance versus not insurance. They're still good people. Okay. I know it sounds stupid to have to identify, but it's, it's the people we want to help. And so the insurance or the lack of insurance or the lack of cash is just something in the way. We still want to help these people. And so if our goal, if my goal is to help more people than I ever thought possible, I need to get them to be able to come. I need to negotiate a little bit with them or meet them part way. And so sometimes cash is not an option for people. Sometimes it is an option, but they don't feel it's an option because it's not very important to them. That takes a whole nother discussion. Uh, but sometimes there is, there is legitimate insurance coverage that can be helpful to, to, um, getting them to have the care that they want. Now in the past, I have been part of, I think the first year I was part of Blue Shield, California. Um, that was before they made some of the changes of the percentage base.

I think it's, what is it? 75%, 50%, 25%, 10%. It was before that whole era. And it was, it worked out okay for a year or so. And then after that, I just decided I didn't want to get into it. Um, some of my interns have asked me, how come you operate with the model that you do with cash? Um, and only some in select insurances and so on. I'm like, honestly, it's because the guy that I did my internship with, he did that and it worked well for him. He was seeing like, um, I mean, he was seeing like 30, 35 people a day, three days a week. He only worked three days a week and, um, people would pay cash. Most of them, more than half of them would pay cash.

And so they were very willing to pay cash because they knew the results were there. And so it was, I observed this for years. I worked there for five, six years. And so it worked very well for him, but it'd be stupid to not include the amount of people that he saw that were also insurance based because they also had great insurance. He saw people that had insurance that would, would pay a bit. He was out of network. He wasn't in network with anybody. I did see him take some workers comp. I did see him take some personal injury and I did see him take, uh, more private insurances out of network. And so those people were very happy. They got better.

They referred friends and family. And so that's how his practice grew is all word of mouth. And also too, probably as a side note, um, as I had told, um, someone the other day is that, um, we, we've been trying to improve our referrals from, from medical offices, MDs, general practitioners and so on because we, people go there primarily for their back pain, hip pain. So that's where they go. A lot of times is the first stop shop and just to see what to do. And so we, I've not spent time over the years nurturing these relationships, which I probably could have done a lot more of. It was just very menacing to me. It's, um, challenging. It's, I don't tend to follow up as much as I could and it just makes it so the experience ends up. It's, it's just kind of uneventful when I do it. However, with, with the new blood in the office, uh, it's been, it's been, I tell them to do it and then I'm like, shit, I got to do it too.

And so what we've kind of found is that some of these, a lot of these practitioners will, they say, well, what insurance networks are you in? And we make our, we make our referrals, um, based upon what's easiest on the person with their network. And so I was kind of thinking, you guys don't make referrals always based upon need or competency is what I'm, or maybe they don't know me, you know? And so I think back of what the, we were doing when I was an intern. And so I remember there was an orthopedic and there was a general practitioner who was, he was an HMO practitioner. And so I, we fully know that, that my, the doctor that I was working with or for, he was not in that network. And so he had two people referring that were just, I remember I saw one had a, one, a couple people had papers when they came in. And so there was a couple of providers on the page. And so this guy just happened to be one of them and it was circled. And he said, he basically said, go there. And so like kind of the, the referral was like, okay, you've tried this, you've tried that. It hasn't worked, right? No, it hasn't worked. Okay. Here's your options.

All right. So here's what I want you to do. I want you to go to this guy. He's good. It's not covered. Here, what's the price? You just got to call him, but it's not covered. It's worth it. Do it. People will come in. All right. And I think it's the strength of the referral and how real it is, honestly. And so these two practitioners in particular made it so, I mean, I answered the phone there. We had about probably three, two, three, four calls a week just from these people referring in and they didn't even work every day. So they must have been referring multiple times a day. Um, just for, I mean, it was random types of cases. It wasn't even just like only back. It was like shoulder, neck, hip, foot, ankle. It was everything, right? I mean, the, the surgeon mainly did backs because he was a spine orthopedic, but the general practitioner would refer in for a lot of things. And so he was so passionate about this guy's business, um, or passionate about this guy's treatment style that he would come in and shadow him. So the MD would shadow the DC.

And so I met him a bunch of times. He's the nicest guy. He just cared a lot about his patients. And at the time we're doing, um, it was mainly an active release practice. And so active release helped people. And so that general practitioner actually went to go learn active release because he wanted to do some in his office for his patients because he saw it work so well. And so if you think about this, it's very different experience that we've had so far, but I'm not saying that we won't get there. And I think that's our goal is to get to the point where it's a go to my guy type of referral versus just, you know, he's in your network, but, but we're willing to take steps is the point. So this next year, what we've done is I've opted into, uh, you guys probably heard me talking about it before, but now, now I'm in tri-west so we can take the VA, VA spine based care, uh, spine based problems, uh, with veterans that are non-active duty veterans. And so this really opens the door with people who have signed up for their, um, signed up for their VA benefits, but don't really want to go to the VA for care. And so it's called the, uh, PC3, uh, community care network. And so we've signed up into that, which, um, has been very good. So we've gotten, we've gotten a couple of vets. It pays, it pays well, it pays fair. And the cool thing is the vet doesn't have to pay anything. And so that barrier right there is, um, one that's been broken down already. However, remember that the patients that come in from this is they possibly can reform or reform more people.

And so one of the vets, he's like, dude, this rehab has been so much different than the other places I've been to. It's great. I love it. You know? And so we're able to challenge him with some weights. And the cool thing is, is, is the, uh, um, with this program in particular, they encourage active care. They want us to get to the patient to a, um, independence. And so it's encouraged. And so, um, it's been really fun to see, um, the difference that he's experienced through these other clinics that he's been to before for this type of problem versus this one. He seems to really enjoy this. So, um, he even talked about referring in, uh, one of his friends and so on and asked about if we take their insurance and so on, which is a whole different story. Do we take their insurance or not? I have no idea, which I can talk about in a little bit, but the, um, overall, we started to take that one. And so I think that's been a helpful one. The second one is since I'm in, um, Huntington beach area, we started to take the longshoreman insurance, which I remember when I first started practice years ago, it didn't matter if you're in or out of network, it just worked like longshoremen are known to have one of the better insurances out there. Um, they, they don't really have to pay for much at all. I don't think they really have a copay or co or deductible at all. And so, uh, at a period of time, I think it was about five years ago or so they changed that you had to be in network to do it. So there was negotiated rates. And so, um, I opted into that recently. And so that was been good. And so we've had a couple calls just, um, from, um, longshoremen or longshoremen's family who's covered in, and that just works. And so these ones are easy ones where if you get on the phone, it's like, yes, come in. Like, I know that covers, um, I know we're going to be covered. Let's just do it. Let me examine you. Let me help you. So those ones are good, I think to build the base of the practice and also improve the amount of exposure that we're going to get. We're also too going to sign into, um, Medicare. And so I've been a little bit more opposed to this over the years. And I think about the, the reasons why it's because that they only pay for one thing and it only pays for an adjustment. And so it was kind of a turnoff to me, but, uh, they encourage you if you have other services that you have, um, that you think that that patient will benefit from, then you can, you go through Medicare and then you can build a patient for non-covered services. And so as you can probably tell from, from the practice style that I have, I, I feel like active care and patient empowerment is a really important thing. And if a barrier to helping some of these people to some independence is whether I'm in the Medicare network or not is it's a gamble I'm willing to take. And so there, there's going to be people probably who come in that don't, they're not probably not going to agree with what I'm going to tell them. And so I, just like I said in one of the other podcasts that I, I don't want to force people into what I think, uh, what I think is right and what they are severely in disagreement with, or it makes them worse. But in my experience, movement is medicine.

And so we just have to get them to move and build a little bit of core endurance. And I think they should feel fine with whatever we're, we're dealing with there. And so what we're, what I'm intending on doing is, is having them come in and hopefully getting them to, uh, agree to try a little bit of, um, floor based program, core work, um, you know, body weight movements. And I mean, you think about like, it was on PBS years ago, there was that, um, exercise program where people were just following someone who was sitting and squatting and using a chair for their exercise program. I mean, that helps. It helps, but a lot of people don't do it if they don't know what to do.

So my intention with that is that like, well, we'll sign into the program, but I think the only way it's going to be, I don't want to say it's not sustainable for us, but it's, it's in, I believe in giving the care that is needed and giving only the best care. I don't want to be part of the, the ongoing, I don't want to say problem, but the, like, I don't want to be one of those other clinics that, that someone leaves and says, oh, it didn't work because this is all we did. Um, so I'm willing to take the gamble and see if this works, works well or not, but I'm, I'm really going to encourage these people that is, if this is not only, if the adjustment's not the only thing working, we need to do more and this is what I suggest. And so at that point, those people are actually going to, um, I think do much better. Hopefully they're going to refer their friends and family. And so as we know with like people like of that age too, they're just friendly. A lot of them are just friendly. They are very creatures of habits and they'll probably come back in for workouts, which is what I want. I want them to come in just for some type of weekly sustainable movement flow or, um, little weight training program. All right. It doesn't have to take a lot, but I'm hoping just that small touch point is something that I can make an impact in their life. And so they can, um, sit, they can sit longer so they can get on the toilet, off the toilet and so on. Um, and so I know my grandfather, he, after he sustained a hip problem, he stopped walking his dog. And after that, like he, he ended up having a lot more problems, you know, by the way, um, it's important to note that the Medicare age is not what you guys probably think of is that like say my grandfather has, he, he ended, he did end up in a, in a retirement home, but I mean, my mother's Medicare age, you know, she's completely independent. My father is too.

Like there's a lot of patients that I have that are like about to age up to Medicare. I'm like, man, you are like, you're just beast, you know? And so those people are still going to be in that boat there. So I'm in full recognition. There's maybe a lot of, there's a lot of, um, there's, there's still just like with people under the age of 30. Um, there's an age range that is the age range is one thing, but the activity level in the mindset is a different story. So I don't pretend to, to blend well with everybody. And to my treatment style, I don't pretend for it to blend well with everybody. So I might have to just let them know that this is, this is the style that we do here a little bit. Is that something that you're open to without forcing it upon them? But if they're only looking for one thing and one thing only, and maybe that's not, maybe we're not the clinic for them. We'll just refer them to another clinic. They'll take their, uh, take their insurance. Um, probably another thing with this is, um, gosh, now I lost my train of thought. Um, but anyways, those are the three things I might come back to that again in a second is that number one, we're going to like, we're in a longshoreman network. Number two is we're in the VA community care network. And number three, we're trying to get into Medicare. And those are probably the only three I'm going to do. Um, we're going to start taking some out of, out of network insurance a little bit more. And so this has been something that I've not done for years, uh, really in regards to calling policies, but not until recently that I realized availability.com was available for a lot of the blue plans, anthems in blue, um, um, out of network blue, blue cross, blue shield, blue shield, and so on. And so it's been a lot easier. You can actually see it right there. You don't have to be on the phone for 30 minutes, then get hung up on. And so we've started to explore those a little bit.

And so I'm taking my interns through the process of just, um, learning how to navigate that and figuring out number one, if they do go there, do their practice on their own, like, is this something they're going to want to do? And they've had experience with it. I remember being on the phone for hours at a time, checking people's policies back in the day. Um, and again, just getting hung up on, it was just a big, not always a big waste of time because there was people who came from that because I verified their policy. And so we're starting to offer insurance fabrications, um, for we're saying all insurance right now. I might change that a little bit though, because as we're finding the signals are hard to call, we haven't called United recently. Um, but I want to make sure that if we see a pattern developed that maybe all those Cigna people would be people that we're not going to be able to, uh, see in an insurance basis. And those just are going to be cash-based patients.

Um, but, um, for the moment in time, it's nice to go and look through and just see, we're just exploring using the experience of calling and, um, going through availability to check insurances, just to see what is out there and give people their options of what they, um, just making talking points of what they can and can't do for their care. Um, there's a great book. It's called F insurance that, um, I read that it was a very easy read. It was, um, uh, I think it was Danny, Danny Mata was, is a PT that kind of helps navigate that insurance conversation with people about what their options are. So that's something I do suggest you guys listen to. Um, so anyways, we're not going to go fully insurance, but there are, I want to make sure that there's a one more barrier knocked down. If I had to guess, we're going to try to keep around 50, 60% cash, um, keep PI and workers comp very low because those ones are a little bit more challenging for me.

Um, and there's going to be, uh, some, we're hopefully, hopefully some VA and, um, longshoremen in there to cover like another 25% bulk Medicare, as well as, uh, private insurances hopefully should cover their remainders. So we're still not dropping the idea of shooting for ideal patients, um, who want to pay cash and that way we're not chasing them, chasing them down for money like a drug dealer would. Um, I like to sleep well at night just knowing that people don't really owe me money and I don't have to track people down. I like things checked off my list. So I just want to make sure that, um, uh, I am diversified is the idea. So sorry, long conversation in that. The second topic is going to be, uh, exam rates. So, uh, I talked about this, uh, probably about a year or so ago is that I, I changed my exam time to longer.

I actually made, I made it an hour and a half, then I made an hour and 15, I scaled it down, but it was around $300. I dropped it a little bit to 275 just cause I'm, I believe in AB testing just to figure out what, um, what people are willing to pay and if what the barrier is. And so, um, after figuring out that some people are not willing to pay that in, they just want, they just want their quote unquote quick adjustment or a little tissue work and they're not really sold on the, their pain points, not really big enough for them to want to pay that much. We've started making levels of an exam. So the most comprehensive exam, this is how the conversation will kind of go is, so if they want the best of best care, the, the best care I can give them on day one, it's going to be about an hour. It's going to take, uh, $275. And this is where people who have complex conditions or they really want honestly the best care. They want me to spend more time with them and they want me to be able to take them through some exercises to do at home, uh, what they should do if their pain increases, um, and just rule out any other thing they possibly think it could be and make sure that we have a good communication in the process too.

That's number one. And so if they balk at that, we'll say, well, there's another one. And so there's, there's one that's 45 minutes. It's $175. It covers, um, not quite as much as the top, top one because we can't get through as much, but we'll certainly rule everything out. And we believe that we'll do a really good job. Even if you have a stubborn case, what we're hoping for is, is, is a dramatic improvement within about a week and a half or so. And you just take those exercises, one or two exercises we do in that exam and, um, or on that date and just, uh, you do it at home and you'll be good. If you need soft tissue work, we'll do it. If you need adjusting, we'll do it. And so on.

That way they know things are included and they're still like, Hmm, well, I don't know. This is still a little too much. And so we do have one more exam price, which is 140. This is all brand new stuff, by the way. So when I started to talk to people about this, the last person I spoke with, I said, look, there is a 140 exam. I'm not gonna lie though. It's quick. It's 30 minutes. We, we do do some treatment or some suggestions in there. However, if you have any questions whatsoever, we will not be able to answer them in detail how we would in the 45 minute or the hour long one. This is for people who don't really want to ask any questions. They just want to know what to do and that's it. And they have a very simple problem. One single area. If you say like, well, I got a knee one and you know, my foot a little bit and sometimes my shoulder, this is not for you or your choices that we only address one because that's all that you're, you're paying for a very accelerated exam. And it's a very short block of time where we're doing the work that we would usually do in 45 minutes to an hour and 30. So I'll let you make the choice. However, just know that if there's a lot of questions asked that we will not get through what you want to get through. And so last guy I talked to, he's like, hmm, so it sounds like the 175 or the 275 are the better for me. I said, yeah, you know? And so I let them make the choice with that. And so when I, again, the, the insurance conversation, the cash conversation, the scaled exams, um, I'm trying to give them the choice and the empowerment to make, um, make a decision and then feel good about it so they can come in and start care. Because, um, I think as, as I tend to realize with this is the one for the 140 exam, the light exam is not what I'm looking for, but maybe it's what they're looking for. And so I might just have, it might take just a little longer with this person in regards to getting them better over the long haul because they're, they're not allowing me to do my entire job and that's okay. All right.

The next thing we can address is, uh, solo versus associate. And so this year I am hiring an associate doctor out of my intern group. And so I never thought I would do this, but, um, as I've started to realize, especially through my Instagram experience recently over the last year is surprisingly, there's a lot of people that follow me that are in New York and New Jersey. I don't know why. And so I'm like, look, okay, there's a guy out there. He interned with me. His name is Jeremy Dinkin. He does a great job. Just go out to see him. I fully trust him. He'll do good work. And so people have gone to see him. And so he does good work. People feel good. I see his reviews.

I'm like, man, you're my boy, Jeremy. I like that. So Jeremy does a good job. And so Jeremy's like, oh man, you should start a P2 West or sorry, P2 East. And I'm like, why would I do that? And he's like, so I can see more people. I'm like, you're seeing them anyways. Like I'm already sending them to you. And so I was thinking about it here. If I feel so confident in referring to someone like an old intern like Jeremy, why not see if we can help build one of their practice here under the roof or the system that's already working. And so that's what I'm trying to do. Here's the trouble that people tend to realize once they get out of school. If they're, if they're out their first year, all of a sudden all these things that you never thought you'd have to do, like get a business license, figure out, um, fee schedules, figure out billing software, figure out email systems.

Uh, you know, how do you do this? How do you do that? Like, how do I, um, like, so it's basically system development and, um, in business practices. And so I like to think of it like this, like I already have a, I already have a system that's working here. It's not perfect, but it's working. Maybe we just use that system to help build up somebody else. And then just part of the money that they don't get for treating people is going to be kind of like an admin fee. I would call it, you know, like we're using that, um, we're using the system here to help them get off the, get off the ground a little quicker. And so it'll be still under the same roof umbrella. I know that some people do associates or employees versus employees versus, um, um, contractors and so on.

We're just going to do employee, um, make it real quick and quick and dirty. And I think that, um, I talked to some other, um, past associates, not of my own, but of other people's that have left that office. And I said, why? And they said, because the doctor never came in, they just left. And I was like, Oh, okay. So what, how'd that make you feel? And they feel that I feel like I was like, whose practice is this? You know, like I'm here doing all the work and you just leave for two weeks. And so I think I'm on the right track with this anyways. And I thought, Oh, it's good verification. But as I had talked to a friend about why I, why we want to have someone on, I'm like, cause I want to have a team, you know, like I, I, I want them to feel like they're compensated appropriately, but I want a team. Like, I feel like we can do a really good job. I feel like we can get people really good care and I want to make a team effort with it. Like I know, um, a lot of clinics will do like the whole, you know, this is your patient. That's my patient. Like, I don't know how to not do that. I just want the boat to be full. Like raising water raises all ships, right? If there's, I want more than enough to go around where no one fights about that.

And, and I want it to be a team approach. I want us to feel good that we're on the same team. Um, and so I don't plan on leaving the office in this situation. I plan on building with her. So I'm, I'm getting into the trenches as well. I'm going in there and doing networking and, um, conversations with people that I usually would not have. Uh, and I'm doing work on, on days off that I usually wouldn't do, which has actually been one of the challenges with keeping the podcast going as I thought about going once every two weeks, because I'm like, I could spend this extra hour, uh, building the team. And so that might, that might be something that comes in the near future. I'm not sure, but at this point I feel like I can handle it because I love doing this. Um, but also at the same time, I want that to happen desperately. So we have some targets in play, but again, the reason why I want to explore this is, is that, uh, I see there's a good safety net and having someone else in the office. It's lonely too, as you guys kind of know, if you're a solo practitioner, it's lonely in the office, you know? So it's, it's nice to have other people around. Um, and it's nice to have other people, uh, getting your back and keeping you accountable. And so that's hoping what that's hoping that's, I'm hoping that's what we get out of this. Um, and we'll still have interns and so on, but, um, I would, I would love for her to stay, uh, forever. And I told her you can, you can die here. Like that's perfect. Like that's, that's what I want to happen. Uh, I don't want to, uh, I don't, I don't want to do the whole chiropractic eating their young thing. I want it just to be like, like I got your back. You got my back. Let's just build this thing together. Let's build a Patriot team. Now probably a dreaded mid-session break that you guys don't look forward to. I hope you look forward to my mid-session break. So let's try to make them unique most of the time anyways, but I do get lazy anyways. So, uh, as we probably heard in the last couple of sessions is I'm trying to promote a couple of workshops and put together. All right. I, last year we had a couple of them. It went really well. Uh, the turnout was great, especially for one of them. The other one got a little slow, but actually it was, it was better than I thought it'd be. And actually the response was better than I thought it'd be. So I'm going to, I'm going to tell you the dates right now and I'm going to tell you what we're going to learn at it. So there's a student's one.

There's a doctor's one. May 30th is one day only. You will get fed. Come to my garage or we'll cook some tomahawk steaks, probably some sweet potatoes as well, and probably beer, wine, and so on. Have a good time. Last time we were just brewing down by the garage until about 10 o'clock at night. Man, it was great. Especially the ones where all my, all my classmates came. So that is the second one. That's the doctor's ones in California. Doctors, especially that's April, 18th and 19th. Students are not encouraged to come to this one because we're starting in a different point. But that's when we just hung out there. It was like, it was like class reunions getting down. It was great. So what we're going to learn is we're going to go through dynamic testing of the, um, uh, ball and socket joints as well as the spine. Stuff that we covered in December of last year in the podcast. There's also audio or sorry, there's video and, um, text versions of all of this. If you want to investigate what it is first, I'll show you in person.

I'll show you how to use it. I'll show you how to categorize people as a criteria of do they need rehab or they need, do they need passive therapy? And I'll show you even the rehab that I use into loaded movements. So it's all inclusive. I'm going to help you guys get there with these people. So hopefully you guys will attend. Please contact me on Instagram. That's at performance HB or just email me. Seb, S E B at P two sports care.com. Spread the word. I'd love to have a packed house and just get down with everybody back to the show. Okay. So that's the third thing. Again, that was just something I never thought I would do. Um, but I'm willing to explore it and take the gamble. Um, now finding new patients worth, uh, versus retaining old ones. This is something that, uh, as I've started to go through all my career, I started noticing that people tend to have flare ups of certain things. And some people who stay around a little bit, at least in regards to doing some corrective exercise or some very responsible strength training. Um, I don't even do a lot of maintenance work with people. Like I don't do a lot of maintenance adjusting or traction or tissue work.

And I do it sometimes. Um, but they tend to feel better. They tend, they tend to not have as many problems if I degeneralize. And so finding new patients is challenging. I think we all know that. And it's like the last thing I want is on my last day of practice or my last year of practice is still looking for the next patient. I want to, I want to help people get better, but I don't want to just partially help a bunch of people get better. I want to help a handful of people get really better and feel empowered and, um, strong throughout their life. And so with that being said, I know that we've done, I've talked in the past about the sustainability training. And so I think that's what I want to do.

The Dan John model, um, the use of kettlebells, not necessarily barbells, probably kettlebells, do a little Pavel stuff and use that as like creation of what I would call quote unquote, a base of the practice. I know that probably in a, in a great business model for a chiropractic office is to have people coming in for wellness care and because they come in monthly every couple of weeks, whatever it might be, and they do their one thing. And then they like, so you don't have, you don't have a situation where like you're, you, you, you, you got 10 patients and then you got nine better. And then one stays. And the only reason your practice is still going is because you have a chronic case. Like that's not what I want. I want people to, um, I want people to keep learning the things that I think are be helpful. Again, in the past, I've done a bad job sometimes of getting people to do things that it was not helpful to them. But I really do. I think for majority of people, just general strength, uh, sustainable strength training movements and supplying some challenge to their bones and their muscles and nervous system is going to be helpful. So what I think we're going to attempt to do is then we're going to try to get people a little bit more out of their injury care sooner, and then get them into weight training, um, at least bare bones a little sooner. And, um, during that process, there's going to be an offer where they have, they can do 15 minutes or 30 minutes of like a sustainable training program once every month, once every couple of weeks, whatever they, whatever they deem is necessary. And they just do that program at home. Um, as long as they feel competent with it, I say, then do it at home. And so that would be more of a base of practice in my opinion. And so we wouldn't have to worry about finding more and more new patients because we still have a little bit of old kind of, um, uh, Oh, I guess base or, you know, people still coming in, uh, paying much less, but they're actually just asking for weight training, resistance training. Now, if we had somebody who's actually a collegiate athlete or a high school athlete, who's trying to actually do X, Y, Z for sport, this is not for them. I understand this is general public. Okay. This is recreational athlete. This is a weekend warrior. This is people who, who like, like my friends who just need a little bit of guidance and just need to know what to do. And so I think there's a lot of those in this world. And I don't think I've been, um, I've, I've, I've been open about, I don't want to treat professional athletes. I want to treat general population people. Um, it's funny going through symposiums. They say, here's how we treat our athletes. I'm like, I don't care about that. I care about how you treat normal people, people who majority of the people we see. We all don't see professional athletes. I don't see professional athletes. I don't want to because it's a little bit more work, a little bit more thinking. I want to just do some basic stuff, be savagely good at the basics as, um, who, who, who said that? Uh, uh, Jeff, Jeff, you said that. Um, so Jeff was, Jeff is a listener and a strength coach. He's like, I want to be savagely good at the basics. And so I dig that. So just the basics, just be good at it. So that's the idea of keeping a little bit more retention model versus always searching for new patients and just nurturing those relationships. The fifth point, let's see, one, two, three, four, fifth point is going to be, uh, again, pain versus wellness model. Again, this kind of piggybacks on the last one is that I'm, I don't, I love troubleshooting people in pain.

All right. I love it because it's fun. It's like a Sudoku game for me. It's, it's great. And, um, but at the same time, there's a lot of, um, I don't, I don't have a lot of chronic pain patients. Number one, if you have chronic pain patients, they might weigh in your mind a little bit more. Um, and this is actually the reason why I've decided over the last year to try not to take two complex cases. Like I want to help them, but at the same time, it, it weighs a lot of my mind. I don't sleep well at night. I think about how I could have done better. I troubleshoot, I troubleshoot them at nighttime when I sleep and I, I, I doesn't leave me fresh for anything else the rest day, the rest of the next day. So I want to make sure that I only do cases that I feel comfortable with. Now working with people in pain overall, it's a lot of concerns. It's a lot of, um, I don't want to say complaining. Let's just say complaining though. Like they're, they're, they have problems.

They're, they're worried. They have questions, you know? And so it's very different than like, hey, feel good today. Yeah, I feel good. Cool. Let's just get at it. Right. They're, they're different things. And so I want to make sure that my practice is a part of both. And so having that base of wellness patients, so the retention of the old patient doing some strength training or some, just some, just some easy strength stuff, you know? Um, that's, that's, I think it would way better on my mind than just only dealing with people with pain or helping people in pain. Um, I know that everybody has a different tolerance for their stress in their life. Um, I, I do pretty well with stress.

I think I do pretty well with a high workload. Um, as you can see with all this production with podcasts and keeping busy with patients and I had four interns last term and, um, I, I do okay with it. However, there is, uh, everybody has different stress, uh, tolerance. So I, the stress I don't do well under is, is, um, people who need a lot of attention. And so when I get that, then that's when I tend to fall apart a little bit from the seams. Um, and it affects my sleep. I cannot have it affect my sleep. So I need to make sure that I'm staying fresh. And so just for my own personal wellbeing, I'm choosing to only, uh, work with certain types of cases. And that's why earlier in the, in the, in the conversation we talked about, uh, being selective about, you know, let's just say Medicare age people that like, if I, if I have people who are, um, say they're, they're at the point where they have dementia and they have, um, all these other, let's call them comorbidities or, or issues. I just wouldn't do well with them. I really don't think I'll do well with them.

And so I need to get them somewhere where they will have the help they need, but also too, there's a lot of people in that category that I think I can help very well. I'll resonate well with, we'll bro down, they'll feel good. I'll feel good. And so you can't help anybody if you're hurting yourself. And so I just want to make sure that I'm being more selective and making sure that if I am actually not as selective as I want to be that I, that there's people in between that will help me find that mental clarity and relax a little bit throughout the day, rather than just over and over again, having people always in mental turmoil because they were a sponge. I believe we're a sponge and people will dump on you and is it's the right for rightly. So they're paying to come in their pain you to solve their problem. But if you soak up too much throughout the day, it doesn't always work well. So that's just my thought with that anyways. Pain versus wellness model. I would rather have a good 50-50 split if that were to be the case. However, I'm okay with not having a 50-50 split just as long as the people in pain are not intensely in pain and it's not a lot of mental turmoil for me. And it's more of like the, I don't want to say lower level, but like groin is, groin's not a, it's not a life or death situation. It's just frustrating. All right. Low back, a little bit more of mental turmoil because they can't do a lot of stuff. But I mean, there's, there's certain conditions that I think are much more, people are more mentally in control and they know it's nothing in the world. They just, they just want some help. Now the last thing, the third thing, or sorry, this is the sixth thing is warm versus cold leads. So I don't believe that we, at least in my, my practice, I don't want to force myself upon people. Um, when they call, I know it takes a lot within them to call or email, to contact us, to say they want some help. All right. That is a big step. And that's where people, uh, I think are very, um, primed to make a decision. However, I don't want to force them. I don't want to like, if the price is too much or if the drive is too far or whatever, I don't want to force them, but I do want to keep in contact with them, but I can't possibly keep in contact with all these people who have not really committed to me either. I believe in it like a relationship, you know, like if I said, Hey, let's go steady. I would expect you to say, let's go steady as well. You wouldn't say, well, we can keep, we can keep seeing each other, but I'm deciding to casually date you. Like you can't do it. Like you have to be in communication about that. You know, I'm going to marry you, but you know what? You just date me. Like that doesn't work. So with this, the warm leads, uh, I'm trying to get people into a warm lead versus a cold lead. Actually, I take that back. They're there. Let's go hot versus warm. They called their, their warm leads. They called, they experienced me somewhere. They, they saw the reviews. They saw an Instagram post. They saw a YouTube video, whatever they saw or heard. They, they liked it. And so they're warm, they're warm to me, but they might not be ready. And so I've started creating some audio and some things to email them, um, uh, access to if they want it. And so these ones are email opt-ins. All right. And so I want to make sure that I'm clear with everybody on this because you can't just put somebody in an email campaign. You gotta, they gotta opt into it. And so I just tell them, look, you got two options with this. Let's just say with shoulder blade pain, which is something that, uh, we address, on, uh, the first of the year this year. And so that audio is available. It's not available on my website. You have to put your email in for it. So you have two choices. I see that you're not ready. You're not ready to actually come in for the shoulder thing yet because the price is too much and so on. But you know what? Um, I have some really good, um, information on the website, which it goes over some of the stuff we do in here and some covers some case studies. It covers some of the myths. There's an audio actually that covers some myths about why people don't get better after they tried a bunch of the stretching and massage that you did because that's the story.

Not there's anything against that. It just didn't work for this person. So are you interested in that? Yeah. Yeah. Cool. Which one do you want? You want the article or you want the audio? And they'll be like, well, how about both? Okay. You can have both. So what's your email? And so I email, we email them the links. We don't opt them in. And so we say, here's this, here's that. We strongly suggest the audio. The audio will take them into an email campaign, which is not a salesy one. It's just informational based. And so it's not aggressive either. It just, there's a 45 minute audio in there, which covers some of the major conversation points that we end up having with patients on day one or the questions they have on the phone. You know, I tried stretching. How come stretching's not working? Well, because of X, Y, and Z. Well, I tried adjusting. That's not working. Why is that not working? Well, because of X, Y, and Z. Do you think I'll ever get better? Sure. But blah, blah, blah.

Right. And so it covers a lot of that stuff. And I've created one for shoulder blade pain. I've created one for piriformis syndrome, groin pain, low back pain, and foot and ankle problems. I know they're a little bit different, but those are the most common things that we get contacted about. I didn't have shoulder blade pain until recently in the audio series because it just wasn't something that I was interested in, in seeing people for, but we kept getting phone calls and emails about it. So I put it in there. And so after that, they'll get into an email campaign where they'll see some of the things that we do, or they'll get more information about how, um, how things can get better or how maybe let's just say a piriformis syndrome. Did you know that sitting on your wallet can increase piriformis syndrome? Well, take it out. You know, whether you believe or not that the wallet's the problem, I personally believe it's the lean, it's the lean into the side. So it's a little bit of IVF closure. Either way, the person's like, holy shit, that worked. This guy knows something.

I need to go there. That's not the response I'm hoping for. And so whatever, whatever experience they had of me or my content to get, get, get them to the phone call. Hopefully we're going to have the same experience that will get them to booking after that. And so I need to curate this experience, which is why the email campaigns there. I can't expect Instagram or Facebook to show all of this stuff in the right order for this one person specifically for this problem. It's just not going to happen. I know that you guys probably too, when you look at Instagram, it's like, Hey, I got a thousand followers. Why did only 26 people see my post today? Well, it's because they don't see everybody doesn't see everything. And that's why I repurpose content, honestly. And a lot of the content I've created via Instagram or on YouTube is in this email series.

Like I don't expect people to see it the first time in those social media platforms. I expect them to see it when I present it to them. So I know in the past I've said creation of content is king. It's the starting point. This is why I couldn't, I couldn't create this email campaign if I did not have parts to put into it. So the things I'm going to focus on this year is number one, we're going to do a little bit more of a diversification of cash versus insurance and so on just to make sure that we're protected against the ups and downs of economics and so on. The second is that we're allowing people to, we're meeting people where they're at in regards to their tolerance or their, their, their, their exposure to their wallet, their, their pocketbook in the exam in the beginning. I know my dad said years ago, don't diagnose someone's pocketbook. So just give them a choice. All right. I think iPod and Zoom did this years ago and it worked out well for iPod.

The third is that solo versus associate. It's just mainly again, just to create a, um, I'm gonna say better, not, not versions of me, but, um, Jeremy does a great job over there. I'm so glad he's around. I'm so glad he's there and I'm so glad he's helping people. Why not have one more in the office here? And that's what I'm hoping for, but we're still going to keep, I'm still going to keep taking interns because I want to keep having that, that experience. And I'm, I'm really thankful to have him as well as Nathan Nether, Sara Van Dyke and Kyle Hemsley. Um, Dawne Costantino, uh, Dawne Costantino is, is the associate who's going to come on here, but, um, I'm thankful to have all of them. I think, uh, I think my teaching has gotten better over the years and so I think they'll do very well with their, with their practice and they're going to help a lot of people. Uh, the fourth was, um, again, new patients versus old, um, just building a base for the practice. So you don't have to keep searching, searching, searching. Fifth was pain versus wellness model or sustainable training was my idea of it. And the sixth was warm versus hot leads. So those are the major talking points for today. Um, so you guys have questions on this stuff. Um, you can always reach out to me if you'd like.

As always, I don't pretend to know everything with this stuff. I'm just relaying stuff as I go. And, um, if you like this podcast, please share this with another chiropractor, PT, DC, MD, um, uh, who else do we got? Strength coach. We got a bunch of people in there. So I think we're all, we're all movement professionals and we want the best for our clients. So please share it with one of them. Um, if you, this, if this podcast isn't the right one for them or this episode isn't the right one for them, just share a different one. All right. There's lots of different ones in there. Uh, obviously I have to keep, uh, narrowing the focus of what we talk about in these podcasts.

Cause I, I, I, if I'm talking to generally anybody, then no one's going to really relate to it. So it seems like a lot of people are relating to it now. Um, again, you heard the thing in the middle. Um, I have workshops coming, please attend the workshops. Cause if you guys ask me, what are the most important things I should be doing? Uh, how do you do X, Y, and Z, I'm going to show it on the workshop. And I, it's something I want to develop over the, over the years to continually just to have a handful of people in. Um, again, I don't pretend to know everything, but I do see that as I've taught the, this intern group, as well as the last intern group, um, there's a lot of missing parts in just putting things together. I want to put things together for people. I know that, uh, in my practice in about probably about five years in, I was missing a huge chunk of stuff and just no one told me cause I was isolated on an Island and I didn't ask cause I thought I knew everything. And so I'm hoping that we just hit a couple aha moments, which I think we did with some of the people who came to my last workshop. So, um, um, my friend Alicia went, uh, ended up, ended up going to neurodynamics with Michael Shacklock, which is she's, she just, her, her text to me was just, it was the emoji, which was the mind blown. Okay. And so she was not going to be able to, to get there unless she had already come to my workshops cause we had talked about some of the implementations and so on. So please attend the workshops and share this podcast with a friend. I'll see you guys next week.