Taking the Leap Expert Secrets on Launching a Successful Practice

BUILDINGBETTERPRACTICES

Taking the Leap Expert secrets on launching a successful practice

PEDIATRIC ADJUSTING TECHNIQUE

CONSULTANT-HIRING KNOW-HOW

THE PREGNANCY DISCRIMINATION ACT AND YOU PLUS Colleges & Insurance Buyers Guide

ISSUE #11: JULY 12, 2016 CHIROECO.COM

VOLUME 62, ISSUE 11

INFOCUS PERSONALGROWTH 15 Moving in the right direction 41 Take care of your The sports practice of Robert other customers Silverman, DC. You have to manage and motivate BY CHIROPRACTIC ECONOMICS STAFF more than your patients. BY KELLEY PENDLETON, DC

CLINICALCONCERNS 19 Light touch MONEYMANAGEMENT Safety is paramount 47 To your credit in pediatric adjusting. Recent tax-saving extensions offer BY ARLAN W. FUHR, DC you a mix of credits and write-offs. BY MARK E. BATTERSBY

RESEARCHRESULTS 23 Immune boost LEGALEASE Consider low level laser as a 53 Expecting better Taking the leap treatment option for shingles. Understand your obligations under 34 BY CHRISTOPHER CARRAWAY, DC the Family and Medical Leave Act. A successful practice BY STUART J. OBERMAN, ESQ. launch isn’t easy, but PRACTICECENTRAL you can do it. 27 The power of the 3 Ps By Michele Wojciechowski Your practice is made up of three elements: people, processes, and products. BY MARC LAMANTIA, DC 30 Oh, what they can see Why you should be working INEVERYISSUE with a consultant. 8 Editor’s Note BY MONICA WOFFORD, CSP 10 News Flash 56 StudentDC.com 58 Datebook 60 Ad Index BUYERSGUIDE 61 Product Showcase 44 Colleges & Insurance 62 Marketplace 63 Classifieds

Chiropractic Economics (ISSN 1087-1985) (USPS 019-178) is published monthly except semi-monthly (twice a month) in January, February, April, May, June, August, September, and October; 20 issues annually. Address: Chiropractic Economics Inc., 820 A1A N, Suite W18, Ponte Vedra Beach, FL 32082. Phone: 904-285-6020; Fax: 904-285-9944. Website: www.chiroeco.com. (A Florida Corporation) Postmaster: Please send form #3579 to Chiropractic Economics, PO Box 3521, Northbrook, IL 60065-9955. Periodicals class postage paid at Ponte Vedra, Florida and at additional mailing offices. GST #131868416. Subscription Rates: U.S. and possessions, $39.95 one year, Canadian subscribers add $35 per year shipping and handling; overseas subscribers add $60 per year shipping and handling. Students, $19.95, Single copy, $4. Statement: While encouraging the free expression of opinion by contributors to this publication, Chiropractic Economics and members of its staff do not necessarily agree with/or endorse the statements made in the advertisements or contributed articles. Chiropractic Economics is owned by Chiropractic Economics, Inc. a Florida Corporation, Joseph D. Doyle, President and CEO and Daniel Sosnoski, Editor. Authorization for the use of photographs and/or illustrations is the responsibility of the author(s). All materials submitted for publication shall remain the property of this magazine until published. Change of Address: Six to eight weeks prior to moving, please clip the mailing label from the most recent issue and send it along with your new address (including zip code) to the Chiropractic Economics circulation Department, PO Box 3521, Northbrook, IL 60065-9955. For a faster change, go to www.ChiroEco.com and click on “Magazine.”

4 CHIROPRACTICECONOMICS• JULY 12, 2016 CHIROECO.COM

THEMOSTCOMPREHENSIVEWEBSITEFORTHECHIROPRACTICPROFESSION What’s New Online Plus Resource Centers

More from the Web Expert Insights Tables Benefits of cryotherapy. Read more at ChiroEco.com/blogs ChiroEco.com/tables ChiroEco.com/cryotherapy Blogs by Anthony Lombardi, Mark Signs you need a new table Using CBD topicals. Learn more at Sanna, Drew Stevens, Josh Wagner, Buying the right accessories ChiroEco.com/cbd Daron Stegall, Perry Chinn, Shawne Duperon, Bill Esteb, and the Chiropractic Practice Management Software Economics editorial staff. The Tuesday Webinar Series ChiroEco.com/practice-management- Chiropractic Economics webinars are My Breakthrough software Who are you blaming? always available to download and Avoiding burnout view at your convenience. Mark Sanna, DC chiroeco.com/sanna Using paper and electronic records “5 Deadly Online Marketing Mistakes.” together Presenter Mike Garcia discusses how to improve your online traffic. What Are You Nutritional Supplements Broadcasting? Download any of our webinars at Preaching vs. Teaching ChiroEco.com/nutritional- ChiroEco.com/webinars. Shawne Duperon supplements chiroeco.com/sanna Benefits of African mango EHR Guru Best supplements for patients in their What’s in a SOAP note? 20s and 30s Alex Niswander Buyers Guide and Directory Our buyers guide and directory is now available online at ChiroEco.com/business-directory. Social Media Shout-Outs Job Board Neat Tweets Facebook Favorites Visit ChiroEco.com/jobs for Follow us on Twitter at Like us on Facebook at employment opportunity listings for: ChiroEco.com/twitter. ChiroEco.com/facebook. Associates Justin Trosclair | @cajunchiro Our most-shared post: Billing Jordan Spieth wins with sports Spieth, 2015 Masters winner,publicly Chiropractic Assistants chiropractic - Chiropractic Economics thanks his chiropractor for helping Doctors of Chiropractic via @chiroecomag him reach his peak performance. Faculty FCAChiro | @FCAChiro Front Office/Reception/Scheduling Medicare Access and CHIP Independent Contractors Reauthorization Act (MACRA) Marketing implemented the new coding requirements @ChiroEcoMag Massage Therapists Multidisciplinary Practice Opportunities Higgins Chiropractic | HigginsChiro Office Management Interesting read! Chiropractic care Temporary Positions can help with #foot and #bunion issues! ...and more

6 CHIROPRACTICECONOMICS• JULY 12, 2016 CHIROECO.COM

EDITOR’SNOTE

Green shoots You want to get off on the right foot. VolUME 62, NUMBER 11 EDItoR-IN-ChIEF Daniel Sosnoski VERYONE LOVES NEW BEGINNINGS.THE FUTURE MAY BE [email protected]

UNKNOWN, BUT THE POSSIBILITIES ARE ENDLESS.THIS ASSoCIAtE EDItoR Casey Nighbor Eapplies to planting a new garden, buying a new car, or [email protected] moving into a new home. There’s something else that most ARt DIRECtoR Christine Wojton large-projects and major purchases have in common, too— [email protected]

the need for research and planning. GRAPhIC DESIGNER Kelley lucas This makes sense, because some endeavors can be [email protected]

tremendously costly if you make a mistake right out of the WEBMAStER Aaron Belchamber gate. One of the best examples of this is a new [email protected]

practice launch. Accordingly, for this issue of ACCoUNtANt Jared Smith Chiropractic Economics, we gathered together a [email protected] group of experts who know what it takes to get a practice off the ground. DIRECtoR oF SAlES Susan Nevins We know this issue will be of tremendous 904-567-1554 interest to students, all of whom have to make a [email protected]

number of difficult choices following graduation NAtIoNAl ACCoUNt Jeﬀ Pruitt Let me know what’s and licensure. However, if you are an established ExECUtIVES 904-567-1542 on your mind: [email protected] 904-567-1539 DC with your student days long in your past, Fax: 904-285-9944 you’ll find a lot to like in our feature story, too. Janice Ruddiman long [email protected] For example, what’s involved in launching your 904-567-1541 [email protected] first practice applies to opening your second. You might be Donnell Curley pondering a satellite office, perhaps you’re moving, or you 904-567-1549 might be coming out of retirement because you miss the [email protected] profession. In all of these cases, the tips and advice here will ADMINIStRAtIVE AND lorie J. McKown guide you in the right direction. SAlES CooRINAtoR 904-567-1545 A major factor in setting up a winning practice is, [email protected] naturally enough, location. That’s common to virtually any BUSINESS & EDItoRIAl oFFICES business dependent on walk-in traffic. But so also is 820 A1A N, Suite W18 differentiation. If you offer something desirable that your Ponte Vedra Beach, Fl 32082 competitors don’t, people will travel farther to see you. And Phone: 904-285-6020 you’ll have access to a population the other guys can’t attract. Fax: 904-285-9944 This issue also presents several unique modalities you can chiroeco.com

consider adding, and a look at pediatric adjusting, high- FoUNDED 1954 lighting the opportunities afforded by special populations. William l. luckey and helen C. luckey Find the right locale, offer the right treatment mix, and let people know about your value proposition—the rest should take care of itself. To your success,

BPA Worldwide Chiropractic Economics’ subscriptions are now audited by BPA Worldwide, Daniel Sosnoski, editor-in-chief the most dominant global media auditing company for B2B publications in the world. BPA certifies that Chiropractic Economics has the highest number of requested readers in the profession. More doctors of chiropractic choose to read Chiropractic Economics than any other BPA-audited publication serving chiropractic.

8 CHIROPRACTICECONOMICS• JULY 12, 2016 CHIROECO.COM

CHIROECONEWSﬂash.com

T THE CHIROPRACTIC PULSE BY THE NUMBERS Ultra-distance runner’s trek to fight cancer stretches over 130 miles In June, ultra-marathoner Roy Wiegand faced a unique challenge to help alleviate the struggles of others. Wiegand tackled his third “Roy’s Run for Christopher” to benefit children’s cancer research, and Spenco Medical Company was supporting him every step of the way. On June 3, Wiegand kicked off a 131-mile course starting at the Burbank Tennis Center in Burbank, California. Spenco sponsors Wiegand’s efforts by providing him with the company’s ultra- 3 supportive insoles, recovery shoes, and other products. The number of months of smog “Roy plans to run the equivalent of five marathons in 29 hours, and we want to help make his journey as comfortable as possible,” said Jeff Antonioli, Spenco’s vice exposure that is linked to higher president of sales and marketing. “As he tests his physical limits, we’re proud to sponsor him as a cholesterol levels, according to a member of Team Spenco.” new study. to read more, visit ChiroEco.com/roy Source: HealthDay News Source: Spenco, spenco.com Chiropractic Summit unanimously supports national Medicare reform initiative to eliminate discrimination The Chiropractic Summit, an umbrella leadership group of chiropractic organizations and prominent business partners, met on April 28, 2016, in Phoenix, Ariz., and unanimously voted to support the national Medicare reform initiative. They also stated that they want to see Summit partners help grow public support to eliminate discrimination faced by chiropractic doctors in Medicare. To help build public support for the initiative, the American Chiropractic Association has 23 developed the National Medicare Equality Petition, a grassroots effort to eliminate a blatantly anti- The percentage of people who have competitive provision of Medicare law that arbitrarily limits reimbursement for medically necessary suffered concussions in the U.S., services delivered by DCs. showing how common mild brain “I am proud that the organizations representing the Chiropractic Summit came together and unanimously agreed on this very positive and powerful initiative,” said Lewis Bazakos, DC, the injuries are, according to a new poll. Summit chairman. Source: NPR to read more, visit ChiroEco.com/summit Source: American Chiropractic Association, acatoday.org Patterson Medical to acquire Performance Health Patterson Medical, a leading distributor of rehabilitation, sports medicine, and assistive patient products, announced today that it has signed a definitive agreement to acquire Performance Health, a leading manufacturer and supplier of consumer branded health, wellness, and self-care products. The highly complementary combination is expected to create a market-leading, multi-channel 1 branded supplier to global rehabilitation, recovery, and sports medicine customers. Through a broader supply and distribution platform, enhanced capabilities, and expanded offerings, over time the two The number of ounces that companies expect to produce numerous benefits for customers, employees, and suppliers. Patterson dermatologists consider the proper Medical, backed by majority shareholder Madison Dearborn Partners (MDP), is acquiring amount of sunscreen to apply Performance Health from Gridiron Capital (Gridiron). before sun exposure. to read more, visit ChiroEco.com/pattersonmedical Source: American Academy of Dermatology Source: Business Wire, businesswire.com

10 CHIROPRACTICECONOMICS• JULY 12, 2016 CHIROECO.COM

CHIROECONEWSﬂash.com

T THE LEARNING CURVE

Parker University appoints Life University student Guy F. Riekeman presented new president receives $2,500 scholarship with the New Beginnings The Board of Trustees of Parker University is from Standard Process Inc. Chiropractic Lifetime pleased to announce the appointment of their Each year, Standard Process Inc. awards over Achievement Award new president, William E. Morgan, DC. This $90,000 in scholarships to students studying At the New Beginnings Chiropractic Philosophy appointment comes after an extensive complementary medicine. Allison Outerbridge is Weekend, held May 19-21, 2016, Life University nationwide search conducted by the Board of this year’s Life University winner of a $2,500 President Guy F. Riekeman, DC, was presented Trustees, which is headed by Oliver “Bud” Smith, scholarship from Standard Process. She accepted with the New Beginnings Chiropractic Lifetime DC, chair of the board. her award on May 18, 2016, at the university’s Achievement Award. This weekend was In 1998, Morgan was chosen to establish the Student Leadership Awards ceremony. especially significant for New Beginnings, as first chiropractic clinic at the National Naval Outerbridge is approaching her last quarter at they were celebrating their 25th anniversary. Medical Center in Bethesda, Maryland, which later Life University in Marietta, Georgia, where she is “Dr. Guy Riekeman is by far the strongest became Walter Reed National Military Medical pursuing a graduate degree in medical nutrition. leader that chiropractic has today, bar none,” Center. In 2015, Walter Reed recognized Morgan “This is something that wouldn’t have been said James Dubel, DC, New Beginnings founder. with its highest honor for clinical excellence, the possible without financial assistance. I am “There is no one more on-purpose and on- Master Clinician’s Award. During the last 18 grateful for the opportunity to have received the principle for the profession than Dr. Riekeman, years at the military’s most prestigious medical scholarship,” said Outerbridge. “This has been an and when it was brought before the 14-member centers, he practiced in an integrative setting awesome journey, and I look forward to what is New Beginnings Executive Board, it was a providing chiropractic care to injured troops to come after graduation.” unanimous decision that he would receive our returning from the wars in Iraq and Afghanistan. to read more, visit ChiroEco.com/lifeu lifetime achievement award.” to read more, visit ChiroEco.com/morgan Source: Standard Process. Inc, to read more, visit ChiroEco.com/riekeman Source: Parker University, parker.edu standardprocess.com Source: Life University, life.edu

T WHAT’S HAPPENING IN HEALTH? Obesity rates rising among women, says CDC More American women than ever are obese, while the number of men carrying around far too many pounds has held steady, new research shows. And a second study finds U.S. teens are another group that continues to struggle with obesity. "Obesity remains a public health concern," said Cynthia Ogden, an epidemiologist at the U.S. Centers for Disease Control and Prevention's National Center for Health Statistics. She worked on both reports. The statistics are sobering. Forty percent of American women and 35 percent of men were obese in 2013- 2014, reflecting an increase among women but not among men, the report found. Among children, 17 percent were obese in 2011-2014, while nearly 6 percent were extremely obese. The prevalence of obesity seesawed among young children, but increased slightly among teens, researchers found. to read more, visit ChiroEco.com/obesity Source: HealthDay News, healthday.com

12 CHIROPRACTICECONOMICS• JULY 12, 2016 CHIROECO.COM

INFOCUS

Moving in the right direction

BYCHIROPRACTICECONOMICSSTAFF

S WE REPORTED IN OCTOBER LAST YEAR, AT THE AMERICAN AChiropractic Association Sports Council’s (ACASC) annual symposium, Robert Silverman, DC, DACBN, was selected as the ACA’s Sports Chiropractor of the Year. We caught up with him recently to find out more about how he gained this recognition and how other DCs might position themselves to achieve the same distinction.

Long in the making Like many chiropractors, Silverman’s road began with a personal health issue—congenital muscular torticollis, which occurs when the sternocleido- mastoid muscle is shortened and pulls the head downward. When surgery and standard medical treatment failed to resolve the problem, he tried chiropractic at age 21 and it completely changed his life. “It was my Mark Twain moment,” he says, referring to the author’s observation that the two most crucial days of your life are “the day you are born, and the day you find out why.” Because it was at that moment he decided to be a chiropractor himself. Over the following 30 years, he increasingly came to specialize in treating athletes and practicing sports chiropractic. “Sports, for me, were a natural fit, and a lot of DCs are athletes themselves,” Silverman says. “The him to start small. “First, I looked to are more challenging to work with reason athletes gravitate toward us is treat younger students at the local than others. Silverman finds that that we can help them on game day, level, Pee Wee league, grade school, collision sports tend to create difficult after game day, and our treatments are and high school students. I had to hone cases, with injuries that are more effective.” my skills and get my name out there.” complicated and advanced. “I’m a big Today, he gives other DCs the same proponent of using low-level cold laser Getting started advice, to start small and grow a niche to heal the body from the inside out, Even though he knew from the time of practice from there. “The Olympic and healing at the cellular level.” his graduation from chiropractic pro sports opportunities come along He finds the speed and efficacy from college that a sports-focused practice later in your career.” this modality to be exceptionally useful was his objective, his advisors urged It’s worth noting that some athletes for treating tendon and ligament

CHIROECO.COM JULY 12, 2016 • CHIROPRACTICECONOMICS 15 INFOCUS

injuries, and he’ll add nutrition, propri- and five TV programs, he’s appeared in oceptive training, and physical therapy Millennium and Shape magazines, and as needed for a course of care. in numerous blogs. He’s also appeared on Fox and Friends to discuss the “text Expectations and outcomes neck” phenomenon and prevention When you’re working with athletes, it’s strategies. His work in the media has vital to give them an understanding of led more people to see chiropractic in what you’re doing and why. “First, the a positive light. “My message to DCs is DC should do a functional assessment. that we have to define who we are,” he I like to see how the patient moves,” says. “Otherwise, other people will do Silverman says. “You want to do a that and they won’t do a positive job.” full evaluation, on the joints and the Another point is that the diversity in shoulders—the whole body puts strain the topics Silverman is speaking and on them. We all know how to adjust, writing about demonstrates that DCs but you want to use qualified soft are increasingly being seen as health- tissue treatments, other modalities, care experts and doctors in their own Working with athletes and treating sports injuries is likely to be a growing field.

laser, proprioceptive exercise, taping, right. “Our profession is not a technique. and exercise rehab.” And of course We have some limitations on our your assessment and diagnosis will be scope of practice, but we can certainly key to a successful game plan. “When I present health-related information.” incorporate nutrition, I’m ensuring complete healing from the inside out,” A winning game plan he says. To those DCs who would like to Working with athletes and treating transition their practice into this area, sports injuries is likely to be a growing Silverman advises getting involved with field. Silverman sees a bright future for local sports teams, such as those in those who pursue it: “There are so many school and church leagues, and making people who need us. Just tapping into sure all of your family members, sports performance, ACL injuries, church groups, and even library staff concussion, and prevention—you can know what you do. build a practice off that.” He adds that “And, No. 2, join the ACASC, the athletes often have parents who chiropractic organization that’s most become referral patients, too. involved in sports, then the CCSP, and look to gain a sports diplomate after Unexpected recognition that. If you donate your time to It would be natural to wonder whether address audiences, you can build your Silverman was surprised to be chosen reputation and visibility in your as the ACASC’s Sports Chiropractor of community. Later, when people come the Year. “I was in total shock and to your office, you have billable astonishment,” he says. “There’s nothing services,” Silverman advises. more moving than being awarded that In addition to his media work, he’s from my peers. I’ll always hold it in preparing to release a book on his the highest regard.” approach to healing from the inside Part of the reason for the award is out. “I want to be a voice for chiro- that he’s done so many different things practic and help take it to the next in the sports chiropractic arena. He’s level. I wake up every day thinking this been on more than 20 radio broadcasts is want I want to do.”

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CLINICALCONCERNS KEITH BROFSKY/THINKSTOCK Light touch Safety is paramount in pediatric adjusting.

BYARLANW.FUHR,DC

URÉLIE M.MARCHAND,DC, IN At Activator Methods, we have been amount of force transmitted into the PRIVATE PRACTICE IN ITALY, measuring the force parameters patient. This is especially important Apublished in the Journal of produced by our instruments for years. when treating the pediatric population. Manipulative and Physiological And, more recently, we have been able Another thrust parameter Liebschner Therapeutics in November 2015 what to produce an even more accurate measured was the depth of thrust (also may be the first preliminary model of testing apparatus. called thrust amplitude) on each setting care for adjusting infants and children.1 Michael Liebschner, PhD, at the Bio- of our instruments. Considering how Her paper brought attention to the Innovations Laboratory at Baylor lax the ligaments of an infant’s cervical amount of force that may be safe for College of Medicine, built a test setup spine are, this parameter is just as clinicians to use in children starting at that is able to precisely measure how important as the Newtons (N) of force birth to age 18. much force an adjusting instrument delivered by an adjustment. The depth Marchand’s efforts are laudable transmits into the patient.2 Prior to of thrust of our instruments ranges because the extent of force safe to use this, biomechanical engineers weren’t from 0.5 to 3 mm. when adjusting children—especially able to take the flexibility of biological As a practical overview, consider infants—is extremely important. To tissue into consideration. Marchand’s proposal and my own 50- really be safe, however, one must We now not only know the amount plus years of adjusting infants and precisely measure the amount of peak of force our instruments produce but children with no adverse events. It’s force used when delivering an also understand how the flexibility of evident that both the amount of force adjustment. tissue makes a big difference in the and the depth of thrust matter, which

CHIROECO.COM JULY 12, 2016 • CHIROPRACTICECONOMICS 19 CLINICALCONCERNS

The extent of force safe to use when adjusting Keeping the depth of thrust as low as possible is important, which is why an children—especially infants—is extremely adjusting instrument is preferred for important. young infants. Marchand goes on to propose that from 3 months to 2 years of age, 50 N is why instrument-assisted adjustments months (neonates). During that (approx. 11 lbs.) of force is safe. From are often preferred by many chiro- period, Marchand proposes that 20 N 3 to 8 years of age, 85 N (approx. 20 practors for pediatric patients. (approx. 5 lbs.) of force is likely to be lbs.) of force is safe. From 8 to 18 years The age you need to be the most safe (and I agree, especially if you are of age, 135 N (approx. 30 lbs.) of force careful with are those from 0 to 3 using your hands to manually adjust). is safe. She concludes her paper by noting that “more research will be needed to confirm the proposed model; thus, this research should be considered preliminary.” Another consideration is that for pediatric patients, you want an instrument designed so that the lowest setting does not exceed 50 N, as that may cause bradycardia in infants aged 0 to 3 months. In neonates, for added safety, the doctor should dampen the force by putting a thumb between the instrument and the atlas. If you are using your hands on neonates, there is a technique called “touch and hold.” The doctor palpates the cervical spine and touches and holds the area that is considered subluxated. This will not cause bradycardia in infants, newborn to 3 months. I hope this gives you more confi- dence when adjusting the pediatric population, and consider using an instrument so you can know the force you are using.

ARLAN W. FUHR, DC, is the co- founder and CEO of Activator Methods International. A practitioner and researcher for more than 40 years, Fuhr is widely acknowledged for bringing instrument adjusting to the chiropractic profession.

References 1 Marchand AM. A Proposed Model With Possible Implications for Safety and Technique Adaptations for Chiropractic Spinal Manipulative Therapy for Infants and Children. J Manipulative Physiol Ther. 2015;38(9):713-26. 2 In Vitro Biomechanical Evaluation of Single Impulse and Repetitive Mechanical Shockwave Devices Utilized for Spinal Manipulative Therapy. Ann Biomed Eng. 2014;42(12):2524- 2536.

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RESEARCHRESULTS

MONKEY BUSINESS IMAGES/STOCKBROKER/THINKSTOCK Immune boost Consider low level laser as a treatment option for shingles.

BYCHRISTOPHERCARRAWAY,DC

HINGLES IS A VIRAL INFECTION year. As people age, their vulnerability shingles disappear.6 THAT CAUSES A PAINFUL RASH. of contracting this disease increases, Shingles vaccine has been used since SMedically speaking, it is an acute with about half of all shingles cases 2006, and Zostavax is the only vaccine viral inflammation of the sensory occurring in people aged 60 or older.4 currently approved in U.S. This vaccine ganglia of the spinal and cranial nerves Given the ubiquity of this malady, reduces the risk of developing shingles that is associated with vesicular erup- alternative methods have been by slightly more than 50 percent and tions and neuralgic pain caused by developed to alleviate the painful PHN by almost 70 percent. It is reactivation of the herpes virus causing effects of shingles and some of these administered in one dose as a shot, varicella (chicken pox)—also called are of interest to the chiropractor. and can be given in a doctor’s office or herpes zoster, zoster.1 pharmacy.2 Studies show that more than 99 Standard treatments Standard biomedical treatments for percent of Americans aged 40 and Pharmaceutical advertisements herpes zoster include analgesics for older have had chickenpox, even if promote a shingles vaccination. Who pain, soothing lotions, wet compresses, they don’t remember getting the should get the vaccine? The Centers and steroids. Taken at the first sign of disease. Most people who get shingles for Disease Control and Prevention an outbreak, acyclovir may lessen the will have it only once. Each year, about (CDC) recommends that people aged severity of the attack.7 96 shingles-related deaths occur in the 60 and older get the shingles vaccine United States.2,3 to prevent an outbreak, as postherpetic A noninvasive approach Approximately one out of three neuralgia (PHN) is a complication of Photobiomodulation, also known as people in America will develop shingles.5 PHN affects nerve fibers and low level laser therapy (LLLT), offers a shingles during his or her lifetime. skin, causing burning pain that lasts noninvasive and effective treatment for That is nearly one million people each long after the rash and blisters of shingles. There are multiple research

CHIROECO.COM JULY 12, 2016 • CHIROPRACTICECONOMICS 23 RESEARCHRESULTS

papers demonstrating the effectiveness This author has been in private of LLLT for treating both acute and practice for 30 years, and has seen an Etymology of shingles chronic shingles.8-12 increase in the number of shingles From Middle English schingles, late Craig Hales, MD, a physician and cases treated in the last five years. 14C, from Medieval Latin cingulus, epidemiologist at the CDC, states, LLLT has proven to be an effective from Latin cingulum girdle: an “Herpes zoster rates among adults have treatment for shingles pain and can anatomical band or encircling ridge. been slowly rising over time in the U.S. result in resolution of the outbreak.8-12 Another Latin term for herpes zoster and other countries. In the U.S., herpes For example: With a patient who translates to English as “the fires of 5 zoster rates have increased by 39 had suffered from PHN for 18 years, a hell.” percent from 1992 to 2010 among few sessions of LLLT reduced her pain adults older than 65 years of age.”3 by 80 percent. This LLLT treatment Patients often attest to pain relief with super-pulsed laser (SPL) was a while still on the treatment table after non-contact laser application (the laser the first treatment. The classic rash and 11 emitter did not contact the patient’s vesicular eruptions associated with HZ ■ Zoster 10 ■ PHN skin).13 should show marked reduction after 9 8 A typical protocol, when treating follow-up treatment 24 hours later. 7 HZ patients, is to hold the SPL emitter Prior to treatment, have the patient 6 0.5 to 1 cm above the affected area. touch the painful area and make a 5 The patient should feel nothing during mental note of the severity of the pain 4 3 the treatment. After three to four and then have them touch the same 2 minutes into the session, patients may area post-treatment. The relief they 1 describe a cooling sensation in the experience assures them they are on 0 20 30 40 50 60 70 ≥80 painful area. The pain will continue to the right treatment path. Age (yrs) abate as the session continues. Pain relief with LLLT is well-estab-

24 CHIROPRACTICECONOMICS• JULY 12, 2016 CHIROECO.COM lished in scientific literature. At the References Neuralgia Using VAS and Modified McGill Pain National Institutes of Health (nih.gov) 1 “Shingles.” Merriam-Webster.com, 2015. Questionnaire. J Clin Laser Med Surg. http://www.merriam-webster.com/dictionary/ 1991;9(2):121-126. or PubMed (ncbi.nlm.nih.gov/pubmed) shingles. (May 2016). 9 Moore KC, Hira N, Kumar PS, Jayakumar CS, websites, you can search for LLLT, 2 Centers for Disease Control and Prevention. Ohshiro T. A double blind crossover trial of low photobiomodulation, phototherapy, “Vaccines and Immunizations.” level laser therapy in the treatment of postherpetic http://www.cdc.gov/vaccines/vpd-vac/shingles/ neuralgia. Laser Therapy. 1989;1(1):7-9. and laser therapy papers. You will find vacc-need-know.htm. Published Sept. 2011. 10 Ohtsuka H, Kemmotsu O, Dozaki S, Imai M. extensive peer-reviewed research on Accessed Dec 2015. Low reactive-level laser therapy near the the effects of LLLT and SPL on pain 3 Centers for Disease Control and Prevention. stellate ganglion for postherpetic facial “Morbidity and Mortality Weekly Report.” neuralgia. Masui. 1992;41(11):1809-13. abatement. The science is overwhelm- http://www.cdc.gov/mmwr/preview/mmwrhtml/rr 11 Kemmotsu O, Sato K, Furumido H, et al. ingly in favor of using this modality for 5705a1.htm. Published May 2006. Accessed May Efficacy of low reactive-level laser therapy for pain of all types and there are no 2016. pain attenuation of postherpetic neuralgia. 4 Laser Therapy. 1991;3(2):71-75. reported contraindications. Insinga RP, Itzler RF, Pellissier JM, Saddier P, Nikas AA. The incidence of herpes zoster in a 12 Numazawa R, Kemmotsu O, Otsuka H, et al. United States administrative database. J Gen The rôle of laser therapy in intensive pain CHRISTOPHER CARRAWAY, Intern Med. 2005;20(8):748-753. management of postherpetic neuralgia. Laser DC, DIBCN, CLS, is a board- 5 “shingles.” Merriam-Webster.com, 2015. Therapy. 1996;8(2):143-148. 13 certified chiropractic neurologist http://www.merriam-webster.com/dictionary/ Carraway C. “905 nm Super Pulsed Laser shingles. (May 2016). Therapy for the Treatment of Shingles (Herpes with the International Academy of 6 Mayo Clinic Staff. 2014. “Disease and Zoster).” A presentation at the North American Chiropractic Neurology and a Condition - Shingles.” Dec 11. Association for Laser Therapy 2013 conference charter member of the National Institute of http://www.mayoclinic.org/ diseases- at Palm Beach Gardens Jan 31-Feb 2. Chiropractic Research. He is a clinical advisor conditions/shingles/basics/definition/ con- https://www.youtube.com/watch?v=RtC5CT5X 20019574 uAw. Published Feb 2013. Accessed May 2016. to Laser Therapy U, and was awarded a 7 Gaeddert A. How Do You Treat Shingles? fellowship with the International Board of Acupuncture Today. 2004;05(02). Clinical Neurology. He is the senior medical 8 lijima K, Shimoyama N, Shimoyama M, advisor for Multi Radiance Medical. He can Mizuguchi T. Evaluation of Analgesic Effect of be contacted through lasertherapyu.org. Low-Power He: Ne Laser on Postherpetic

CHIROECO.COM JULY 12, 2016 • CHIROPRACTICECONOMICS 25

PRACTICECENTRAL WAVEBREAKMEDIA LTD/THINKSTOCK The power of the 3 Ps Your practice is made up of three elements: people, processes, and products.

BYMARCLAMANTIA,DC

HIROPRACTIC OFFERS MORE on and enhanced the work of the afforded by specialized services, you OPPORTUNITY TO ENGAGE pioneers who came before them. Each can start to work together clinically Cpatients than at any other time of them—among others—has estab- with other professionals in a way that in history. The profession’s diversity of lished a niche practice in a specialized was more difficult to do in the past. training and its philosophy of wellness field. What they share is the chiropractic This may be one reason you are have sparked a revolution in care. But philosophy of natural healing. For these witnessing a shift away from solo now you must fight to maintain your doctors, it’s less about their adjusting practices to multi-practitioner offices; place at the table. technique, and more about educating not necessarily multi-credentialed, but As with other medical professionals, the public about what they do. multidisciplinary nonetheless. The DCs are evolving to change the way Increasingly, chiropractors are prevailing trend is for successful offices their unique healthcare services are specializing in a multitude of sub- to co-manage cases within the walls of delivered. After all, chiropractors started disciplines. Now, patients are visiting their own facilities, with chiropractors out as outlaws, with many of the early DCs for conditions such as vertigo, who have unique subspecialties. practitioners being jailed and publicly scoliosis, metabolic disorders, and For example: In my New York City humiliated. concussions. office, we have six chiropractors who Today, innovative DCs such as Scott This is part of why Americans have have different practice niches. We each Rosa who founded the Trauma Imaging shifted their views on natural healing attract certain types of patients because Foundation, Datis Kharrazian who versus allopathic approaches, and in of our specialties, but often find that our works in endocrinology and the response you have an opportunity to patients tend to have multiple issues immune system, and Robert Melillo shift how you deliver chiropractic in and they are happy to find experts in with his work in neurology, have built the future. Through the opportunities natural healing under one roof.

CHIROECO.COM JULY 12, 2016 • CHIROPRACTICECONOMICS 27 PRACTICECENTRAL

Chiropractors are evolving to offer subspecialties that focus on distinct fields of study.

This is not to suggest that all DCs understanding your demographic and should form group practices, although setting prices. there are benefits in doing that. The If your ideal demographic is adults lesson is that chiropractic co-manage- aged 45 to 65, marketing on Instagram ment is simply better for the patient, and and Snapchat may not be ideal. Your likewise it’s better for the profession. materials and wording should be As my practice is focused on treating geared toward persons in that age scoliosis, and my main interventions group. are spinal orthotics and postural rehab, If properly developed, marketing I routinely co-manage many of my cases can better target your advertising to with either an upper cervical chiro- your audience. The colors, logos, and practor or a chiropractic neurologist. designs you choose are all elements My advice is to consider what your you can also align with your target niche is (or should be) and how you audience’s interests. plan to let everyone know about it. The Keep in mind that advertising has following are a few steps you can take. changed dramatically over the past decade. It is now done almost Identify the three Ps exclusively online. Local newspapers, Every practice is made up of three radio, and TV spots have their place, elements: people, processes, and but it is your internet presence that is products. Your uniqueness may lie in currently king. one or all of these areas. The first P— people—is you. Co-manage cases Identify your unique qualities and Chiropractors are evolving to offer market them. If you’re great with kids, subspecialties that focus on distinct or if you’re an athlete, let people know. fields of study. Identify your niche and Patients will be attracted to your let your colleagues know by being practice and other professionals are active in your state association and more likely to refer you if they know local business groups. your background. Find out what makes your colleagues The next P—processes—are the unique and be an advocate for their procedures that set you apart. Whether practices as well. Be generous in in regard to how you process a new referring to them; they’ll love you for patient or the unique chiropractic it, and they’ll return the favor. It’s a analyses you offer, the process is part win-win situation. of your identity. And the last P—products—is for MARCLAMANTIA, DC, is an your chiropractic care and lifestyle expert in nonsurgical scoliosis care. In 2006, he earned a instruction. This might also include diplomate in chiropractic supplement lines, your technique, or neurology, and in 2008 graduated orthotic services. with a Master’s Degree in Neuropsychology Rehabilitation. Lamantia is the science advisor Market and advertise your niche for the non-profit Scoliosis Care Foundation, You might think marketing and adver- and is a certified Schroth Method practitioner and Spinecor bracing specialist. He is a co- tising are the same but they are different founder of Scoliosis Systems LLP, a leader in things. Marketing is the process of nonsurgical scoliosis treatment. He can be preparing your product for the contacted at [email protected] or marketplace. It includes things such as through scoliosissystems.com.

PRACTICECENTRAL ANDREYPOPOV/THINKSTOCK Oh, what they can see Why you should be working with a consultant.

BYMONICAWOFFORD,CSP

ARENTSOFTENEXPERIENCETHIS the practice. The combined insights of or simply been caught by a stroke of WITHTHEIRCHILDREN:THECHILD those you lead and the fresh perspec- bad luck, may endeavor to put out a Pwill ask a question, but doubt tives of someone from outside the team shingle and claim to be a consultant. the correctness of the parent’s answer. can together lead to incredible results, But when you’re hiring a consultant, The child will then go ask the same which is what you want when you hire you don’t want to be his or her first question of a neighbor or other trusted a consultant. rodeo. Unless you’re receiving a sharply adult and believe them instead. Even But before jumping all in and reduced rate for being the beta though the answers are the same, the marveling at the freshness of a customer, check the background and child doesn’t see it that way. The consultant’s vision, consider the history of the consultants you’re looking difference is in the credibility of the following questions when you’re to hire. Who have they worked with source. looking for the right source of before? What were their results? Ask In business, you’ll see the same guidance for your practice and them to tell you about a time when dynamic. An employee comes up with your team. they worked with a client whose needs a good idea, but it fails to gain traction. were similar to yours. Then a consultant comes from afar, What is their track record? Certainly, hiring a consultant for makes the same proposal, and it is Anytime there is a spike in unemploy- your practice may be the beginning of promptly accepted. Still those from ment, the consulting profession sees an a successful consulting business journey, outside your business sometimes often increase in its ranks. Those who have and working with a consultant who is do have more clarity. They are not as gained wisdom in their role, but not new in the field is not always a bad close to the issues and daily routine of necessarily excelled in performance— idea. But knowing their history in the

30 CHIROPRACTICECONOMICS• JULY 12, 2016 CHIROECO.COM

PRACTICECENTRAL

business and determining how much looking for, and experience in the be done and will be willing to work you value past experience will help you second will just make your conversa- with you to make it happen. make a more valuable decision. tions shorter. Consulting is a profession in which What is their knowledge base? What do they see? the provider and the client work jointly When hiring a consultant for your One of the initial benefits of hiring to achieve the desired results. Unlike practice to improve your business or someone new to your team is gaining coaches, consultants gather data, address assess your team, it is tempting to hire insight from all the things they can see issues, and create solutions they help to one with similar experience in your that no one else can. You and your implement. industry. Tempting as it may be, this is team are often unable to see the forest If you or the members of your not always best nor necessary. for the trees. practice are looking to hire a consultant, One benefit of working with someone The same is true in consulting. investigate their history of work who consults professionally could be Those first visits to your practice are performance and determine the value of that person’s multi-industry back- invaluable because a consultant can see their history in one or more industries. ground. Perhaps an approach from a things that have become invisible to Then, schedule a meeting and ask them hospital client could provide you with everyone else who works there. to tell you what they see relevant to an innovative chiropractic standard. The consultant can spot daily habits your needs. These three pieces of data Perhaps a model from the retail world and even the stacks of paper nobody will help you make a confident, sound, could resolve an issue that no other notices anymore. They won’t make and reasonable decision when it comes chiropractor has thought of or brought excuses for this patient or that one, to hiring your ideal consultant. to market. and they won’t overlook problems with

Consultants assess, address, and try the waiting-room furniture. Because MONICAWOFFORD, CSP, is a to resolve problems. Often it is best to everything they view is new to their leadership development coach, uncover their grasp of the genuine eyes, they see it in the same way a new consultant, and professional issue at hand, versus being skeptical of patient does. They can also see things speaker. As CEO of training firm, their work in other industries. Confirm the way a new employee does (but Contagious Companies, Inc., she and her the consultant’s view of the issue before might be afraid to point out). A team work with chiropractic practices, insisting he or she hve intimate experi- consultant might also see what you’re healthcare, retail, hospitality and government ence in your industry and understand missing that’s keeping your business industry leaders to develop their leadership all the terminology. Experience in the from growing. And if you’ve hired the skills. She can be contacted at 866-382-0121, first might get you the result you’re right one, they’ll know what needs to or through contagiouscompanies.com.

32 CHIROPRACTICECONOMICS• JULY 12, 2016 CHIROECO.COM

Taking the leap A successful practice launch isn't easy, but you can do it.

BYMICHELEWOJCIECHOWSKI

ou’ve finished your advantages and disadvantages with geared to get a practice up and running classes, you’ve either option. Kirk Parge, DC, PsyD, in 90 days. His firm’s practice start-up graduated, and all the says that associates won’t make the manual lists more than 50 steps to take congratulations and same amount of money as they would before opening your practice doors. Yparties are over. You’re a new if they had their own practices, they If new practitioners want to do the doctor of chiropractic. will have to answer to someone else, work themselves, Brubaker says they Now what? and they can be always be fired. can do much of the planning for their Nevertheless, for some this would businesses in the last few quarters of Go solo or partner? be the better choice. school, shortening the time needed for New practitioners, once they’ve been opening after graduation. licensed, mainly have two choices: they But suppose you want to establish Working with a mentor, hiring a can open their own business or go to your own business. Where do you start? company that can advise you on how work for someone else. “In the past, a to set up your practice, or following a high percentage of students did come Be prepared proven system that walks you through out of school to start their own Launching your own practice can feel establishing your business are key practices,” says Jeremy Brubaker, DC. overwhelming, so it’s important that strategies. If you don’t know what Recently, he says, as student loans have you’re prepared. “The first thing new you’re doing—and you don’t seek the increased, there has been a trend for practitioners need to do is get help proper help—you could be out of new grads to gain experience as associ- from those who have done it success- business in no time. ates or independent contractors until fully in the past and are still very they feel comfortable in the field and successful,” Brubaker says. “Starting Location, location, location generate enough capital to establish any business, especially a chiropractic Finding the right location for your their own practices. practice, without a sound system for practice is crucial for many reasons— “Doctors coming out of chiropractic operating a business, managing staff, you need patients and you need to school, if they are not confident in marketing, and proper patient proce- make sure that you can live within themselves or their chiropractic dures is a recipe for disaster, as most commuting distance in an area that abilities just yet, should definitely new practitioners have a limited skill you like. Chandler George, DC, suggests associate,” says Pamela Johnson. “We set in these areas.” new practitioners use the internet to see two types of associates—temporary “The chiropractor who has no busi- research their ideal patients and where and career. Some doctors really just ness savvy will be swinging for the they’re located. “This is very impor- want to treat and heal people and fences at night with no lights on,” tant,” he says. would rather not be business owners. Parge says. “New chiropractors really “They need to decide where they That is great—the profession needs have one chance to get this right. It is want to practice first,” Johnson says. them. They would be career associates. like a high-hurdler running a 110-yard “Doing in-depth demographics and Others want to gain some experience dash; if they trip and fall on the first having a coach or mentor assist in adjusting and diagnosing or need to be hurdle, there is not a good chance of dissecting those demographics is financially more stable before starting a them winning the race.” essential. However, even poor demo- practice, so they are more a temporary Setting up your own business can graphics can be overcome with hard two-to-three-year associate.” take anywhere from four months to a work and a system.” As with any career choice, there are year. Parge says that his program is Brubaker advises new DCs to set

34 CHIROPRACTICECONOMICS• JULY 12, 2016 CHIROECO.COM PIXLAND/THINKSTOCKINKSTOCK

CHIROECO.COM JULY 12, 2016 • CHIROPRACTICECONOMICS 35 mends that you hire a lawyer who plans—including malpractice. “Doctors Meet the experts understands contract law regarding will use an attorney or an accountant to Jeremy Brubaker, DC, is a building leases. He also says not to set up their corporations—we generally director at Advanced overextend yourself regarding the size recommend an LLC/PLLC—and then Management for of your practice. You can always expand have an attorney review the lease Chiropractors (AMC) in into more space down the road. agreement and an accountant to assist Chattanooga, Tennessee. with quarterly and annual taxes,” amcfamily.com Get down to business ... plans Johnson says. Before you head to a bank or other The health insurance billing process Pamela Johnson is director of lending institution to seek financing, can be overwhelming for a new coaching at Integrity Doctors in Lakewood Ranch, Florida. you will need a business plan. If you’ve graduate just opening a practice. integritydoctors.com never written one before, get help. In “We have very clear and specific addition to books that cover how to steps to getting in-network and then Kirk Parge, DC, PsyD, ABCO, write business plans, there are tons of understanding how to bill and collect,” CME, CAc, is president of websites that can help as well. George Johnson says. “A new grad won’t be Chirognostics LLC in Boise, recommends using Live Plan able to start the process until they are Idaho. (liveplan.com) or something similar. licensed and have a location. So under- chiropracticesuccess.com Coaches, mentors, and practice standing that you will likely open as an Chandler George, DC, is guidance companies can also help you out-of-network provider for the first president of Catchfire write a thorough business plan. few months is important.” Coaching in Roanoke, Texas. Brubaker says that your business chandlergeorge.com plan should include everything from Office space the equipment you will buy or lease to Once you have a location, unless you projections about what your location are purchasing a previous chiropractic emotions aside and find a location that and operating expenses will be. practice, you will need to have the makes good business sense, as opposed space redesigned. Johnson suggests to just finding somewhere they want Show me the money getting contractor bids and timeframes to live. Once you’ve gathered the required for a build-out. Remember, she says, Once you’ve determined the area information, it’s time to approach a that some cities can take four to eight where you want to open your practice, bank or other lending institution. weeks just to issue permits. check out specific building locations. Remember, you are meeting with a “In setting up offices, creativity How much room you can afford will banking professional, not a college comes into play. It is all about flow,” initially depend on price and the professor, Johnson says. Don’t offer a Parge explains. “Arrange the rooms location you choose. business plan that you wrote in school. such that maximum patient visits can “Some doctors will find that in their “It needs to be specific and clear,” she be attained with minimal movement— area, they can only afford 800 square says. “This means that ‘more’ isn’t all with the idea of providing the best feet, while in another area, a space of always better.” services. The most effective treatments 2,400 square feet is the same price,” Brubaker says you’ll have to present with the least movement and confusion Johnson says. “The average recom- solid projections. “One of the biggest are ideal. Then, temper the office with mendation for a one-doctor office with mistakes in any business is to open the five sensing techniques—sight, a three-year lease would be 1,200 to underfinanced without adequate smell, sound, touch, and comfort. 1,500 square feet. This allows for plenty working capital to allow the business What experiences will the patient of growth when the floorplan is set up to hit black ink. I am all about keeping come away with aesthetically?” correctly.” expenses and overhead at a minimum,” As for equipment, really think about Brubaker agrees that 1,200 square he says. “There is no magic number what you need versus what you want. feet can be adequate for a solo practi- for opening an office as markets and Then decide what you want to lease or tioner with staff. market pricing can dictate that.” buy. “Start with a clean and profes- But don’t rush to sign a lease until sional look, and expand as the business you’ve written out a business plan and Bring in the pros flourishes,” Brubaker advises. secured financing. “Remember, a lease The next steps in the process are to set is a liability that you can’t get out of. Be up your business structure and apply for Get the word out careful,” George cautions. He recom- licenses and the necessary insurance You should start marketing your

36 CHIROPRACTICECONOMICS• JULY 12, 2016 CHIROECO.COM

The chiropractor who has no business savvy best results for new patients comes will be swinging for the fences at night with from face-to-face marketing and ‘lunch and learns’ that are specific to chiro- no lights on. practic,” she says. “Doing a class on things outside of chiropractic will not practice three or four months before websites that target your marketing increase your new patients.” you open. If you don’t have patients, area can bring people to your business. Be smart with your marketing you don’t have a practice. Johnson says that while these are all money. Johnson says that most new Having a website and a presence on important, they will not make your practitioners don’t have a ton of money social media, and even taking ads out practice. “It’s important for the doctor for marketing, public relations, etc. But on Google, in local publications, or to be out in the community. By far, the some creative approaches to marketing are remarkably cost-effective. George suggests that new DCs send out a press release about their new practice three months ahead of the planned opening, and then again with one month to go. After launch, send out another. In the first year, plan on sending out between six and 10 press releases about your practice. Consider doing a video press release, too, which is less expensive and will help you be found online, George says. You can also set up a YouTube channel with videos that promote your business page.

Recruiting your team This is one of the most critical steps in setting up your practice. “Remember, the first exposure the patient has with your office is the person answering your phone or sitting at the front desk,” Parge says. He suggests you look for people who are competent, people-oriented, team players, and willing to start part- time and grow with your business. It’s crucial to open with some kind of staffing. Johnson says it looks more professional and it’s important to protect yourself; it is best to have another person around when you’re treating patients. Having staff doesn’t let you off the hook, though. Parge says you need to know all aspects of your practice— including billing programs, scheduling, and collections—because if a staff member gets sick or leaves without notice, and you don’t know how to run that part of your business, it could have disastrous results.

38 CHIROPRACTICECONOMICS• JULY 12, 2016 CHIROECO.COM Buying your first that you can find. “Despite what new success in what you’re looking to do.” or opening another DCs might hear from naysayers, the Take heart in that if you successfully If you’re thinking about buying an chiropractic profession is a great place establish one practice, you’ll have the existing practice instead of opening a to be right now. They can often pay keys in hand to repeat the process new one, keep in mind that there is a lot student loans off, and do it in less than when you think the time is right. involved with purchasing a business. “I five years,” Johnson says. “But doctors beg any doctor looking to buy a practice need to know what to do, and when and MICHELEWOJCIECHOWSKI is to contact someone who has experi- how to do it. The profession is ever- an award-winning journalist, humorist, and author of the book ence and a proven track record in changing, and it is imperative to keep Next Time I Move, They’ll Carry Me analyzing and dealing with purchases,” up. Get a coach, get a mentor—but Out in a Box. For more information Johnson says. “This is not an accountant make sure it is someone who has proven and to contact her, visit wojosworld.com. or a seller’s broker, if they have one. There are specific things that need to be assessed when buying a chiropractic clinic—that accountants, attorneys, and mentors won’t know how to analyze.” You’ll want a specialized consultant who knows what to watch for. If you’re an established chiropractor looking to open a second office, George suggests that you only do so if your first location is maxed out. “Most have not,” he says, and admits he learned this lesson the hard way himself. In most cases, one large busy clinic is better than a few smaller ones. Be sure that your main location is financially secure before getting a second practice, Johnson says. “And realize the true cost if it isn’t. If you are not going to have an associate run the second practice, then what ends up happening is you’re diverting time and energy from one to the other, and you’ll have two struggling practices.” Brubaker agrees: “No matter how experienced the DC, starting something from nothing takes loads of energy, focus, and determination.” You don’t want to have double the overhead with a second location and then split your time in between them, only to generate the same revenue. “Staffing is key to multiple locations, as most practicing DCs know staff can make or break a practice—and that includes associates and partners,” he says.

You can do it Although opening a new practice can seem overwhelming, it is doable. But you’ll need the best guidance and help

CHIROECO.COM JULY 12, 2016 • CHIROPRACTICECONOMICS 39

PERSONALGROWTH MONKEYBUSINESSIMAGES/THINKSTOCK Take care of your other customers You have to manage and motivate more than your patients.

BYKELLEYPENDLETON,DC

ERTAIN PATTERNS SEEM TO ARISE Jeff’s story: Jeff has had a successful your practice and all that you’ve worked IN CHIROPRACTIC PRACTICES 20-year career and currently operates so hard to accomplish. The following Crepeatedly. Consider the two practices. But he can’t seem to hire tips can help avoid that outcome. following two accounts of doctors who or retain good staff. His history is filled are struggling: with lawsuits involving past associates Make a mental adjustment and employees who stayed less than six How do you think about hiring and Sarah’s story: Sarah has been in practice months and left on bad terms. Jeff is managing your staff? Is it a burden or for 12 years. Her office manager, Margo, bitter and defensive. He’s finding it a privilege? Do you dread interactions has been with her for the last six. increasingly difficult to stay positive with your team, or do they fill you with During the first two years of her and focused on his practice. energy and creativity? Are you resentful employment, Margo was energetic, of time spent in training and meetings, happy, and full of suggestions— Do either of these scenarios sound or do you relish the opportunity to seemingly able to read Sarah’s mind. familiar? Unfortunately, situations such continually enhance the skills of your But since then, Margo has become as these are all too common in the team? apathetic, complacent, and careless. profession. You spent years acquiring Whatever your thoughts and Sarah has tried talking with Margo, but skills to take care of people, not feelings are about being an employer, they always get interrupted and never learning to manage a staff. And an where do they come from? You are the finish the conversation. inability to manage your staff can kill foundation of your practice. If there’s an

CHIROECO.COM JULY 12, 2016 • CHIROPRACTICECONOMICS 41 PERSONALGROWTH

The more specifically you define your needs, have written procedures in place, then create a systematized and structured the more likely you’ll be to find employees who process. Ask a mentor or trusted match them. colleague for guidance, hire a consultant or coach, or look into practice management systems if you don’t have the issue in any area, evaluate the situation Go back to square one time or skills to develop your employ- with brutal honesty. If you need to Imagine you’re a brand-new employee ment procedures. change your mindset, look at managing in your practice. What processes and The result should be written job your staff as a way of serving your procedures are in place to recruit, hire, descriptions, policy and employment patients. onboard, and train you? If you don’t manuals, and practice processes. The more specifically you define your needs, the more likely you’ll be to find employees who match them.

Train and train some more You didn’t become a proficient and skilled adjuster after taking one class. It took patience, repetition, and years of practice. Likewise, your staff may need extensive training and practice to become a rock-star team. Be patient. Give them the tools they need to succeed. Provide regular training so they can run your practice exactly the way you want. If training isn’t your forte, outsource it. Hold monthly, quarterly, and annual training on a variety of topics including office policies and procedures, operating office equipment, answering frequently asked questions, personal growth, customer service, and job-related skills such as billing, coding, and software use.

Jeff’s story: Jeff never seems to have time to train his staff. He figures new employees can pick up skills as they go along, or be trained by the existing staff. Really, how hard is it to answer the phone or take a payment? He has no job descriptions, no employee manuals, and no training systems in place. Sometimes he holds training sessions during staff meetings, but these are usually the result of a recent mistake. His staff are stressed out and defensive, an attitude that bleeds into their patient interactions.

Encourage honest communication Typically, frontline employees are the

42 CHIROPRACTICECONOMICS• JULY 12, 2016 CHIROECO.COM first to know when something isn’t business. If you’ve hired and trained structure for his team. He has been working in any business. Their feedback them well, they’ll return your able to weed out those who aren’t a can be invaluable for the growth and investment many times over. When good fit in his new interviewing process, development of your practice, if you’ll they go above and beyond, come in and his new scheduled trainings are listen to them. Can your staff approach early or stay late, run a personal errand bringing his employees to a higher you and talk to you about anything, or for you, or make it through a tough level of effectiveness. do they have to tip-toe around you? day, express genuine appreciation in a way that’s meaningful to them. As a practice owner, you have two Sarah’s story: Margot is unhappy with sets of customers: your patients, and the way the practice is expanding. In Sarah’s story: Sarah scheduled a time your staff. If you spend as much care the early days, she felt like part of a to meet with Margot for an uninter- and consideration taking care of your close-knit team with a mission. But the rupted conversation. She was amazed team as you do with your patients, practice takes on more staff, there are at the insight and feedback Margot was they’ll take care of you and your inconsistencies in training and able to provide. As a result, she has practice for years to come. processes. And whenever Margo tries changed several things in the practice to express her thoughts to Sarah, to get it back on track. Margot has KELLEYPENDLETON, DC, is a something else takes priority. Margo been thrilled with the changes, feels healthcare marketing consultant, has resigned herself to accept that her valued and respected, and is becoming professional speaker, and the author of Community Connections! once noble mission is gone. her normal, happy self again. Relationship Marketing for Healthcare Professionals. She uses her expertise to help Appreciate your team often Jeff’s story: Jeff stopped making excuses other healthcare professionals build the Your team is the first and last and blaming previous employees. He practices—and lives—of their dreams. She can impression people have of your hired a practice management company be contacted through drkelleypendleton.com practice. They can make or break your to provide a comprehensive employment or through [email protected].

CHIROECO.COM JULY 12, 2016 • CHIROPRACTICECONOMICS 43 BUYERSGUIDE

Colleges & Insurance Chiropractic Economics is pleased to present the profession’s most comprehensive Colleges & Insurance directories. The information in the resource guide was obtained from questionnaires completed by the listed companies. Companies highlighted in RED have an advertisement in this issue.

Canadian Memorial Chiropractic College Parker University 416-482-2340 972-438-6932 cmcc.ca parker.edu President: David J. Wickes, DC, MA President: William E. Morgan, DC Cleveland University-Kansas City Sherman College of Chiropractic 913-234-0600 800-849-8771 cleveland.edu sherman.edu President: Carl S. Cleveland lll, DC President: Edwin Cordero, DC D'Youville College Southern California University 716-829-8000 of Health Sciences dyc.edu 562-947-8755 President: Sister Denise A. Roche, GNSh, PhD scuhs.edu Life Chiropractic College West President: John Scaringe, DC, EdD 800-788-4476 Texas Chiropractic College lifewest.edu 281-487-1170 President: Brian Kelly, DC txchiro.edu Life University larry C. Johnson, Interim President 800-543-3202 University of Bridgeport life.edu 888-822-4476 President: Guy Riekeman, DC bridgeport.edu/chiro Logan University President: Neil Albert Salonen 800-782-3344 University of Western States logan.edu 800-641-5641 President: Clay McDonald, DC, MBA, JD uws.edu National University of Health Sciences President: Joseph E. Brimhall, DC, FICC 800-826-6285 nuhs.edu INSURANCE SERVICES President: Joseph Stiefel, MS, EdD, DC Advantage Insurance Group New York Chiropractic College 386-615-3353 800-234-6922 advantageinsgroup.com nycc.edu President: Frank Nicchi, BA, DC, MS Arthur J. Gallagher & Co. Northwestern Health Sciences University 800-952-5557 952-888-4777 ajg.com/chiropractors nwhealth.edu Chiropractic Benefit Services President: Christopher Cassirer, ScD, MPh 866-851-4636 Palmer College of Chiropractic, cbsmalpractice.com Davenport , Iowa 800-722-3648 ChiroSecure palmer.edu 866-802-4476 Campus Provost: Dan Weinert, DC, PhD chirosecure.com Palmer College of Chiropractic, National Chiropractic Council Port Orange, Fla. 800-622-6869 866-585-9677 chiropracticcouncil.com palmer.edu Campus President: Peter Martin, DC NCMIC Insurance Company 800-769-2000 Palmer College of Chiropractic, ncmic.com San Jose, Calif. 866-303-7939 OUM Chiropractor Program palmer.edu 800-423-1504 Campus President: William Meeker, DC, MPh oumchiropractor.com

The information in the buyers guide was obtained from questionnaires completed by the listed companies. Company listings highlighted in RED have an advertisement in this issue. For the complete listing of services these companies provide, and to view our complete online directory, visit ChiroEco.com/directory.

44 CHIROPRACTICECONOMICS• JULY 12, 2016 CHIROECO.COM

MONEYMANAGEMENT

Toyour credit Recent tax-saving extensions offer you a mix of credits and write-offs.

BYMARKE.BATTERSBY JIRSAK/THINKSTOCK

NCE AGAIN, LAWMAKERS WAITED filed returns. A bonus write-off UNTIL LATE IN THE YEAR TO PASS However, the big deal for many Originally created as a short-term Oanother “extenders” bill. The chiropractors will be the permanent stimulus measure, bonus depreciation new Protecting Americans from Tax extension of the Section 179 small is back (albeit phased out over a five- Hikes (PATH) Act of 2015 retroac- business expensing deduction. year period). Bonus depreciation, which tively extended the 50 or so temporary permits the immediate deduction of tax provisions that have been routinely First-year write-offs any equipment expenses rather than a extended on a one- or two-year basis. The Section 179 deduction allows a depreciated tax benefit over time, has What has been termed the “Cadillac practice an up-front expense deduction been extended at the former 50 tax” on the type of high-cost health for the entire cost of equipment ranging percent rate for the 2015–2017 tax insurance plans that many chiropractors from computers and furniture to years, phased down to 40 percent in provide themselves and their key fixtures, vehicles, and medical devices. 2018 and 30 percent in 2019. employees with will be delayed from The amount allowed as a write-off in Making it even semi-permanent 2018 to 2020. The PATH legislation also the first year (instead of slowly allows practices that spend heavily on suspends the 2.3 percent excise tax on deducting or depreciating over several equipment, machinery, and other medical devices through 2017. A levy on years), is now permanently fixed at property to reap large up-front tax health insurers would stop for one year. $500,000 per year (phased out dollar- breaks. Overall, tax savings are predicted And, beginning with the forms W-2, for-dollar as expenditures begin to to be $281 billion over a 10-year period. W-3, and returns for reporting non- exceed $2 million a year). Many practices will find the bonus employee compensation (e.g., Form In an unusual move, lawmakers depreciation break to be more valuable 1099-MISC) filed for the 2016 tax year treated air conditioning and heating than the Section 179 deduction because and later, PATH will require them to units placed in service after 2015 as the latter is limited to the taxable be filed on or before January 31. They eligible for expensing. PATH also will income of the practice with any excess will no longer be eligible for the allow these amounts to be permanently carried forward. Naturally, losses extended filing date for electronically adjusted for inflation beginning in 2016. generated by the 50 percent bonus

CHIROECO.COM JULY 12, 2016 • CHIROPRACTICECONOMICS 47 MONEYMANAGEMENT

depreciation can offset other income. improvements to leased property may and retail establishments—and to They can also be carried back for two benefit from PATH’s new accelerated leased property. Without this unique years, thereby generating a refund depreciation rules. write-off, many improvements would from Uncle Sam. Under now-permanent special write- be depreciated over the much longer offs for qualified leasehold improve- 39-year period associated with the Writing off leasehold ments and qualified restaurant and building itself. improvements retail improvement property may Although few chiropractors operate qualify for shorter 15-year recovery Increased research expense credit from what our lawmakers label “retail periods. That’s right, PATH makes Overlooked and misunderstood by buildings,” or fall into the category of permanent a 15-year depreciable life many chiropractors, the biggest restaurants, many practices making for improvements made to restaurants provision in PATH is the research and experimentation tax credit. According to many, it’s the granddaddy of all extenders, dating back to 1981. PATH now makes permanent the Section 41 much-maligned credit for increased research expenses—a direct reduction of the practice’s tax bill rather than a deduction that merely reduces the income on which the tax bill is computed (for qualified research expenses). While market research and product testing do not qualify, all research in the laboratory or for experimental purposes does. In addition to becoming a permanent fixture, the research credit has been modified so eligible practices and businesses with $50 million or less in gross receipts can claim the credit against their alternative minimum tax (AMT) liability. Also, some small businesses and professional practices can claim the credit against their payroll tax liability.

Energy efficient commercial buildings A provision in PATH extends through the 2016 tax year: The above-the-line deduction for the cost of energy- efficient improvements made to commercial buildings. A practice can get tax deductions for new or renovated buildings that save 50 percent or more of projected annual energy costs for heating, cooling, and lighting compared to model national standards, and partial deductions for efficiency improvements to individual lighting, HVAC, and water heating or envelope systems. The tax deduction is up to $1.80 per

48 CHIROPRACTICECONOMICS• JULY 12, 2016 CHIROECO.COM square foot and available to owners or unemployment occurred relative to the WOTC also applies to employers who tenants (or designers, in the case of WOTC-eligible hiring date. hire qualified long-term unemployed government-owned buildings) of new The WOTC provision for employing individuals (i.e., those who have been or existing commercial buildings that veterans permanently extends the 20 unemployed for 27 weeks or more) are constructed or reconstructed to percent employer wage credit for who begin work after December 31, save at least 50 percent of the heating, employees called to active military 2015. The credit with such long-term cooling, ventilation, water heating, and duty. Beginning in 2016, the provision unemployed individuals is 40 percent interior lighting energy costs. modifies the credit to apply to of the first $6,000 of wages. A partial deduction of $0.60 per employers of any size, rather than square foot can be taken for improve- employers with 50 or fewer employees, The built-in gains of S corporations ments made to one of three building as under the current rules. As the economy improves, many systems: the building envelope, lighting or heating, and the cooling system. The partial building improvement must reduce total heating, cooling, ventilation, water heating, and interior lighting energy use by 16.66 percent (the 50 percent goal of the three systems spread equally over the three systems). On a related note, the American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE) standards required for the energy- efficient commercial building deduction have been updated in PATH. The provision modifies the deduction by updating the energy-efficiency standards to reflect the new ASHRAE standards beginning in 2016.

The work opportunity tax credit PATH retroactively extended and expanded the Work Opportunity Tax Credit (WOTC) through the 2019 tax year. The WOTC allows employers who hire members of certain targeted groups to get a credit against income tax of a percentage of first-year wages up to $6,000 per employee. In situations where the employee is a long- term family assistance (LTFA) recipient, the WOTC is a percentage of first and second year wages, up to $10,000 per employee. While the maximum WOTC for a practice hiring a qualifying veteran is generally also $6,000, it can be between $12,000–$24,000, depending on such factors as whether the veteran has a service-connected disability, the period of his or her unemployment before being hired, and when that period of

CHIROECO.COM JULY 12, 2016 • CHIROPRACTICECONOMICS 49 MONEYMANAGEMENT

Built-in capital gains of a corporation that has included as part of PATH. In other legislation, the Trade Facilitation and become an S corporation must be held for five Trade Enforcement Act of 2015 years to avoid a capital gains tax. included a provision that increased the penalties for failure to file certain tax returns. chiropractors are replacing equipment In other words, the built-in capital The complexity, the fact that many and other business assets. Unfortunately, gains of a corporation that has become of its provisions apply to transactions many are just discovering a corporate- an S corporation must be held for five occurring in 2015, and the uneven level tax is being imposed at the years to avoid a conversion capital gains expiration date for many of these tax highest marginal rate (currently 35 tax. Permanently reducing the S corpo- benefits makes professional assistance percent) on the built-in gains of a ration recognition period for the built- almost mandatory—at least if practices chiropractic practice operating as an S in gains tax will make it easier for hope to reap their share of the $622 corporation. incorporated practices to become S billion in tax savings available. These are usually gains realized corporations and more fluidly change prior to the practice’s conversion from the status of their practice entity to MARK E. BATTERSBY is a tax a regular C corporation to an S corpo- respond to changing market conditions. and financial adviser, freelance ration, and taxed when assets are sold. writer, lecturer, and author located More extended deductions in Philadelphia. He can be reached PATH retroactively and permanently at 610-789-2480. provides that, for determining the net There are, of course, quite a few more recognized built-in gain, the recognition tax-saving provisions, many of them Disclaimer: The author is not engaged in period is five years—the same period quite narrow in scope such as those for rendering tax, legal, or accounting advice. that applied to tax years beginning in film producers, NASCAR racetrack Please consult your professional adviser about 2014. owners, and racehorse owners, all issues related to your practice.

50 CHIROPRACTICECONOMICS• JULY 12, 2016 CHIROECO.COM

LEGALEASE MONKEYBUSINESSIMAGES/THINKSTOCK Expecting better Understand your obligations under the Family and Medical Leave Act.

BYSTUARTJ.OBERMAN,ESQ.

UE TO THE VAST NUMBER OF employees for the following reasons: because of her pregnancy. The act also FEMALE EMPLOYEES IN THE birth and care of the employee’s mandates that employers allow pregnant Dchiropractic field, the subject newborn child; care for a child after women to continue their work as long of employee pregnancy arises frequently. adoption or foster care placement; care as they are able to perform their job- Many chiropractors fail to abide by for the employee’s spouse, child, or related tasks. federal law in their dealings with parent with a serious health condition; In addition, employers must hold pregnant employees because they aren’t or for a serious health condition that the pregnant employee’s job open familiar with the legislation protecting affects the employee’s ability to work. during her maternity leave for the a pregnant employee: The Family and This federal law also addresses hiring, same amount of time that jobs are held Medical Leave Act (FMLA) and the maternity leave, health insurance, and open for employees on disability leave. Pregnancy Discrimination Act (PDA). fringe benefits for pregnant employees. The federal law also states that health But a lack of knowledge regarding The Family and Medical Leave Act insurance provided by an employer these laws can be costly and lead provides that women affected by must cover expenses for pregnancy- noncompliant chiropractors straight pregnancy, childbirth, or related medical related conditions. into disputes with labor boards. conditions shall be treated the same for Finally, the same benefits that are The FMLA was added to Title VII all employment-related purposes, provided to workers on disability leave of the Civil Rights Act of 1964 on including receipt of benefits, as other should be given to employees on October 31, 1978, and it applies to persons not so affected but similar in maternity leave. This includes temporary employers with 50 or more employees. their ability or inability to work. disability benefits, accrual and crediting Covered employers must provide up to Employers are prohibited from refusing of seniority, pay increases, and vacation 12 weeks of unpaid leave to eligible to hire someone who is pregnant calculation.

CHIROECO.COM JULY 12, 2016 • CHIROPRACTICECONOMICS 53 LEGALEASE

The Pregnancy Discrimination Act functions, employers are not required adhere to certain guidelines. If the (PDA), which applies to employers with to provide accommodations. pregnant employee refuses or is unable 15 or more employees, also prohibits Furthermore, most states have to perform certain tasks, such as lifting discrimination against pregnant women. enacted their own pregnancy discrim- heavy equipment or taking patients’ X- The PDA guarantees that pregnant ination laws. Many states have also rays, then the employer must determine women are provided with the same lowered the covered-employer threshold what accommodations may be needed. opportunities and benefits as non- to those employers with fewer than 15 For example: The employer may pregnant employees who are similarly employees. shorten the employee’s workweek or limited in their ability to perform their When federal or state pregnancy eliminate certain tasks such as lifting, job responsibilities. But if a pregnant laws apply to your chiropractic office, taking X-rays, or working around employee is unable to fulfill her job it is important to be aware of and to hazardous materials. If the accommodation would cause an undue hardship and require significant difficulty or expense for the employer (taking into consideration the number of employees in the practice, the expense of the accommodation, the financial resources of the practice, and the impact of the accommodation on the practice), then the employer may deny any accommodation. If the employee is unable to perform job-related tasks and the employer is unable to provide accommodations, then the employer must determine whether the tasks are essential to her job and, if so, whether another employee may take over those tasks. If another employee is unable to perform those job-related tasks, then it may be prudent to provide an unpaid maternity leave. In addition, when federal or state laws apply to a chiropractic practice, the chiropractor must remember that it is illegal to deny employment or promotions, or to fire a female employee because she is pregnant. Employers should also be aware that pregnancy leave is generally extended without pay. The employee may use any paid vacation or sick time accrued, however, as part of her pregnancy leave. Typically, pregnancy leave is four to six weeks, but it may be extended up to 12 weeks if the pregnancy involves complications. Finally, employees returning from a pregnancy leave are entitled to return to their former or a similar position at the same work schedule and pay, unless there is a legitimate business reason as to why that job is no longer available.

54 CHIROPRACTICECONOMICS• JULY 12, 2016 CHIROECO.COM If federal or state pregnancy laws do she accepts all responsibility for not apply to your office but you wish protecting herself and her child from Quick Tip to provide pregnancy leave either to exposure to all risks associated with retain a good employee or to be her job. competitive with other practices, you Women are a protected class, and if Sitting and liver disease must establish a leave policy and ensure an employee’s pregnancy is handled A study conducted in Seoul, Korea, it is administered in a consistent and inappropriately, her employer could found that people who spend much nondiscriminatory way. end up in court, incurring costly fees, of their time sitting may have an To be safe, whether or not federal or and time away from the practice. increased risk of developing non- state laws apply to your practice, you Therefore, it is important that employers alcoholic fatty liver disease (NAFLD). should take certain actions upon familiarize themselves with the laws The subjects were 139,056 men and discovering that an employee is that apply to such employees. women who had undergone physical pregnant. Sit down with the employee examinations and answered surveys and inquire about her plans for STUARTJ.OBERMAN, Esq., is about their diets and activity levels. returning to work after delivery. founder and president of It would be a good idea to ask the Oberman Law Firm, a midsize The scientists found that those who employee about her estimated delivery practice in the Atlanta area. reported sitting more than five date and whether she will have any Practicing law for more than 23 hours a day had a 9 percent higher years, he handles a range of legal issues for health restrictions that would limit her risk of being diagnosed with NAFLD chiropractors, including employment law, than did their peers who reported ability to adequately perform her job cybersecurity, practice sales, real estate sitting less. functions. In addition, the employee transactions, lease agreements, OSHA should sign a release that states that compliance, chiropractic board complaints, — The Baseline of Health Foundation she has been informed of the risks that and professional corporations. He can be JonBarron.org her job poses to her health and that contacted through obermanlaw.com.

CHIROECO.COM JULY 12, 2016 • CHIROPRACTICECONOMICS 55 STUDENTDC Click it!

Home Colleges CareerDevelopment FinancialPreparation JobSearch PracticeStartup Checklists Resources The online resource for future doctors of chiropractic.

Graduation gridlock

BYDREWSTEVENS,PHD

OLLOWING THE WARMTH OF THE cacies of running a practice. These purchases because you have an FRESH AIR AND BLOOMING FLOWERS include reimbursement, staffing issues, obligation to repay—and it should be Fof spring, the wonder of summer marketing, procedures, EHR, and a priority. To that end, establish two is upon us. With the change of season note taking. Launching a solo practice important daily goals: networking comes excitement; excitement about is beyond risky if you don’t under- aggressively to develop relationships advancement and, most importantly, stand the foundational processes. that get you known in the commu- the thrill of graduation. Across the One of the hidden secrets about nity, and diagnosing patients while U.S., some 2,000-plus individuals have chiropractic is that you will operate a getting referrals from them. The taken their boards and are now moving business after graduation. Some more you sow, the more you eat. The into their post-graduation careers. It’s colleges offer practice management more you earn, the sooner your debt an exhilarating yet scary time. and business courses. If your school will diminish. As the euphoria of graduation settles, doesn’t, seek out an education in Avoid the allure of products, supple- many questions arise such as getting business management, putting ments, get-rich-quick schemes, and started, finding patients, making money, emphasis on staffing, marketing, and other distractions that take your focus and the most pressing issue: When is financial operations. Learning these away from building community and the first installment of that hefty skills will make you a better owner. marketing your practice. There is no financial loan due? To that end, Many community colleges and magic bullet that generates business consider the following checklist of professional study programs offer and directs big profits your way— items to review once your certificate is public business courses. there is only hard work. You need to in hand. Whether you work as an intern, think like a golfer: Put your head There are a fair number of graduates associate, or solo practitioner, you are down and focus on where you want that settle within 30 miles of their in the relationship business. Any to go. chiropractic college. One of the first person you know or meet is a areas of research is determining what potential patient. Therefore, when Graduation is exciting. The time is the demographic of your competitors you lift your head off the pillow each now to take your vision of the perfect will be. Settling in an overpopulated morning, acknowledge that your daily practice and make it a reality. Do not area such as Miami, New York City, mission is meeting people. Each new get caught in a gridlock of speculation or Saint Louis may harm your future connection you make can introduce and serendipity. As a new chiropractic income. Look for areas where patient you to other relationships. The more graduate, be proud of your experi- volume and need can support your community you create, the greater ences, your investment, and your making a living. the number of chances for your future. Now make it all happen. After selecting a location, you’ll want waiting room to flourish. to discover if any of your school’s A major stress upon graduation is DREWSTEVENS, PhD, is a alumni or peers in the chiropractic repaying what is most likely a practice management expert who works with struggling profession are nearby, as they can substantial student loan. Don’t waste chiropractors and revives the support and guide you. Getting the time and instead start finding work practice into one that thrives. He help of a mentor you can shadow for to help you immediately settle your can be reached at 877-391-6821 or through a few years can teach you the intri- debt. Hold off on extravagant drewschiropracticmarketing.com.

56 CHIROPRACTICECONOMICS• JULY 12, 2016 CHIROECO.COM

DATEBOOK

DAtE EVENt WhERE SPoNSoR PhoNE July 16-17 low level laser Education Indianapolis Erchonia 888-242-0571 July 16-17 low level laser Education Scottsdale, AZ Erchonia 888-242-0571 July 21-24 Cox Seminar - Certification Course Parts I and II Fort Wayne, IN Cox Technic 260-637-6609 July 23-24 Documentation for Motor Vehicle Injuries Phoenix American Academy of Motor Vehicle Injuries 480-664-6644 July 23-24 RtP Course Knee and hip level 1 Toronto, ON Trigenics Institute 416-481-1936 July 28 how to Attract high School Athletes to Your Practice Webinar Online Foot Levelers 800-553-4860 Aug. 6-7 Kinesio taping Fundamentals and Advanced Anchorage, AK Kinesio Taping Association 888-320-8273 Aug. 11 Chronic Pain Syndrome: What Can Chiropractic Do to help Webinar Online Foot Levelers 800-553-4860 Aug. 12-14 American Functional Neurology Institute (AFNI) level 4 Tupelo, MS Trigenics Institute 416-481-1936 Aug. 20-21 Extremity Exam for Motor Vehicle Injuries Phoenix American Academy of Motor Vehicle Injuries 480-664-6644 Aug. 24-25 CEAS II: Expanded Ergonomics Assessment Skills Certification Los Angeles Back School of Atlanta 800-783-7536 Aug. 25 Caring for the Student Athlete Webinar Online Foot Levelers 800-553-4860 Aug. 25-26 CEAS I: Ergonomics Assessment Certification Workshop Denver Back School of Atlanta 800-783-7536 Aug. 25-28 live Posture Specialist training Orlando, FL BodyZone LLC 770-922-0700 Sept. 8 Plantar Fasiitis - to Stretch or Not to Stretch Webinar Online Foot Levelers 800-553-4860 Sept. 9-11 Koren Specific technique Indianapolis Koren Specific Technique 800-537-3001 Sept. 9-11 Full Body Master Plus RtP Exam Course Toronto, ON Trigenics Institute 416-481-1936 Sept. 10-11 Shoulder Assessment and treatment level 1 Toronto, ON Trigenics Institute 416-481-1936 Sept. 10-11 Posture, Balance, and Motion Portland, OR BodyZone LLC 770-922-0700 Sept. 10-11 Case Management for Motor Vehicle Injuries Phoenix American Academy of Motor Vehicle Injuries 480-664-6644 Sept. 17-18 Cox Seminar - Cervical Spine Certification Course Chicago Cox Technic 260-637-6609 Sept. 22 the Secrets of Shin Splints Webinar Online Foot Levelers 800-553-4860

58 CHIROPRACTICECONOMICS• JULY 12, 2016 CHIROECO.COM DAtE EVENt WhERE SPoNSoR PhoNE Sept. 23 Kt4: Specialty Pediatric Concepts Mason, MI Kinesio Taping Association 888-320-8273 Sept. 23-25 Balanced Structures, Emotions, and Nutritional Chemistry Chicago CRA Wellness 616-669-5534 Sept. 24-25 Posture, Balance, and Motion Greensboro, NC BodyZone LLC 770-922-0700 Sept. 28-30 CEAS I Ergonomics: Practical Applications Certification Practicum St. Augustine, FL Back School of Atlanta 800-783-7536 Oct. 1-2 Posture, Balance, and Motion Atlanta BodyZone LLC 770-922-0700 Oct. 6 the Feet and Arches Webinar Online Foot Levelers 800-553-4860 Oct. 7-9 Strengthening Posture for Rehab, Wellness, and Active Aging Anchorage, AK BodyZone LLC 770-922-0700 Oct. 7-9 Chiro-x-travaganza Ledyard, CT Connecticut Chiropractic Council 203-483-0084 Oct. 8-9 Kt1 and Kt2: Kinesio taping Fundamentals and Advanced Langhorne, PA Kinesio Taping 855-488-8273 Oct. 15-16 Concussions and Cranial Nerve Exam for Motor Vehicle Injuries Phoenix American Academy of Motor Vehicle Injuries 480-664-6644 Oct. 20 the Acute, Chronic, and Never Before Injured high School Athlete Online Foot Levelers 800-553-4860 Oct. 20-21 CEAS II: Expanded Ergonomics Assessment Skills Certification Atlanta Back School of Atlanta 800-783-7536 Oct. 20-23 Cox Seminar - Certification Course Parts I and II Fort Wayne, IN Cox Technic 260-637-6609 Oct. 21 Stand taller, live longer Seattle BodyZone LLC 770-922-0700 Oct. 22-23 RtP Course Knee and hip level 1 Toronto, ON Trigenics Institute 416-481-1936 Oct. 27-28 CEAS I: Ergonomics Assessment Certification Workshop Irvine, CA Back School of Atlanta 800-783-7536 Oct. 29-30 Posture, Balance, and Motion Bloomington, MN BodyZone LLC 770-922-0700 Nov. 3 Chronic Pain Syndrome: What Can Chiropractic Do to help Webinar Online Foot Levelers 800-553-4860 Nov. 4-5 CEAS I: Ergonomics Assessment Certification Workshop Orlando, FL Back School of Atlanta 800-783-7536 Nov. 4-6 Koren Specific technique Seminar Philadelphia Tedd Koren Seminars 800-537-3001

For a searchable list of more seminars and show dates or to submit your event, visit ChiroEco.com/datebook.

CHIROECO.COM JULY 12, 2016 • CHIROPRACTICECONOMICS 59 ADINDEX

ACOMSolutionsInc...... 38 Activator Methods Inc...... 28-29 Advanced Medical Integration ...... 62 Anabolic Laboratories ...... 20 Battle Creek Equipment ...... 63 BintzCompany...... 49 BIOTONE ...... 26 Breakthrough Coaching ...... 44 ChiroMatrix ...... 60 ChiroPlanet...... 40 Chiropractic Business Academy ...... 62 ChiroSecure...... 32 Chirowealth Learning Systems ...... 42 Concierge Contact Center ...... 63 CuttingEdgeLasers...... 11 DaVinciLabs ...... 18 Dee Cee Laboratories Inc...... 7 ECLIPSE Software Systems ...... 13 EmersonEcologics ...... 62 Erchonia...... 5,33 Florida Chiropractic Association ...... Cover Tip, 52 FootLevelersInc...... 9,68 Foundation For Chiropractic Progress ...... 51 Functional Medicine Masters ...... 62 HealthAtlast ...... 50 Hill Laboratories Co...... 64-67 ImpacInc...... 24-25 Inborne Technology - Now MD ...... 22 LiteCure...... 39 Medical Billing Professionals ...... 63 Michael’s Chiropractic Equipment ...... 54 NCMIC...... 17 Nutri-Spec ...... 14 Nutri-West...... 31 Omax3 Professional Strength ...... 48 PadoUSA ...... 55 ParkerSeminars ...... 45 PerformanceHealth ...... 37 Pulsed Energy Technologies ...... 21 S.A.M...... 63 SingletonSystems ...... 59 Solutions4...... 43 StandardProcess ...... 2-3 Sunlighten ...... 63 tgisoftware ...... 57 Ward Photonic Systems LLC ...... 46 WorkForceU ...... 16 World Federation of Chiropractic ...... 58

60 CHIROPRACTICECONOMICS• JULY 12, 2016 CHIROECO.COM PRODUCTSHOWCASE

Rehab tool Marketing book Motion Guidance is a visual feedback James Fedich spent over a decade building a product intended to enhance your patient's practice that collects well over a million dollars a proprioceptive skills and positional year. He was constantly being asked for advice awareness, while allowing them to visualize from other doctors, but couldn't spend time their progress. Research has supported helping them all. Tired of hearing consultants "joint positional awareness" deficit in patients with neck pain as who haven't practiced in decades, Fedich wrote well as back pain. Current research also supports external cues over this tell-all book. Available for purchase on Amazon. internal cues in the rehabilitation process. 908-813-8200 • milliondollarclinic.com 843-469-2627 • motionguidance.com

Scooter Cervical device Stars N Stripes Scooters provides high- The Functional Cervical quality, dependable, easy-to-use, and Support helps relieve elegant power-driven vehicles that help muscular tension in the cervical region and is effective in treating people of all ages get the most out of life. patients suffering from cervical headaches. The Functional Cervical These luxury scooters have already proven Support provides gentle stretches which contribute to traction along their superiority in Europe, where they the entire spinal column. The FCS can be used and bought as a quickly reached the top market position. Now Stars N Stripes stand-alone product or as a part of the Detensor Traction System. Scooters has enhanced and improved this already best-selling 844-692-2252 • avazo.com product line, elevating it for the standards of our American clientele. 800-767-9377 • snsscooters.com

Immune support Enzyme Process has combined Olive Leaf’s Probiotic natural immune boosting properties with Patient One Flora Maintenance is a multistrain, oregano’s natural respiratory support. We added identity-confirmed probiotic with a potency of 25 elderberry flowers, standardized echinacea billion live bacteria per serving at encapsulation, purpurea extract, slippery elm bark, fenugreek for 15 billion CFU at expiration based on proper seed, and eucalyptus leaf. Includes an active storage. Ten compatible, well-researched strains enzyme blend that may help increase absorption.* (seven found in the small intestine and three 800-521-8669 • enzymeprocess.com found in the large intestine) are combined with a fructo- oligosaccharide (FOS, a prebiotic). The combination of a prebiotic and a probiotic has been clinically proven to promote enhanced effectiveness.* Electrotherapy 877-723-0777 • patientoneformulas.com The Pulsed Energy Replenisher 2000 is lightweight and portable, allowing chiropractors to easily move it around their office or use in the field or at community events. Because it is easy to use and Wellness drops requires minimal training to operate, more staff Liquid Serenity supports a normal healthy members will be able to use the Pulsed Energy nervous system and emotional balance. Has Replenisher 2000, helping your practice run St. John's wort, California poppy, eleuthero, smoothly. If you’re interested in holistic, healing oat, chamomile, schisandra, skullcap, orange essential treatments that can aid patients of all ages and stages in life, the oil, and lavender essential oil in a base of organic PER 2000 can provide enhanced outcomes and patient satisfaction. alcohol, spring water, vegetable glycerin, and honey.* 818-982-2021 • pulsedenergytech.com 800-532-5219 • wisewomanherbals.com

*These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.

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62 CHIROPRACTICECONOMICS• JULY 12, 2016 CHIROECO.COM CLASSIFIEDMARKETPLACE TO PLACE AN AD CALL 904-285-6020

BUILDINGFORSALE PRIME 2500+ SQFT OFFICE LOCATED IN THE HEART OF THE LEHIGH VALLEY. Accommodating features throughout. Easy access for patients. 10+ examining rooms, large conference-reception area. RE/MAX Real Estate 610-770-9000. Howard Schaeffer 610-554-7759.

EQUIPMENTFORSALE INFRARED COLD LASERS $575 New Infrared Cold Lasers. Priced thousands below cold lasers with similar specs. Three 808nm diodes/200mW (combined output). Recharge- able. Animal Use Only. Quickly treat joints, wounds, muscles, and pain. Lots of extras. Acupuncture red laser (650nm/5mW), Dr. Daniel Kamen, D.C.’s animal chiropractic technique DVDs (horse and dog). Professional carrying case, user manual, charts, points, and treatment formulas. Call 800-742-8433. www.vetrolaser.com. We also sell Class IV vet- erinary lasers. Cost: $3495. www.vetrolaser4.com

PRACTICEFORSALE STARTUP OFFICE FOR DC IN NORTH GEORGIA. I am retiring after 32 yrs. All furniture, equipment and software, about 2300 patient files. No rental contract with shopping center. Low overhead. Contact me at [email protected] for more info and pic- tures. $10,000 total for everything. Dr. Ron Clark PRICE REDUCED Dallas, TX. Looking for an outstanding purchase opportunity? Well established, diversified practice specializing in Active Release Technique for sale in the upscale Park Cities area of Dallas, TX. Located in a high income, chiropractic friendly area for 15 years, Doctor is selling his practice, goodwill, customer list, equipment and office furniture. The thriving practice collected $347,630 in 2015. Doctor take home pay before taxes is $229,807 (66%). Doctor sees, on average, 20 patients per day. Interested Parties contact Michael Paulson at (469)766-2238. PRACTICES FOR SALE in CA, FL, GA, IL, MO, MI, MS, NM, NY,OH, OR, PA, TN, TX. I have new doctors who want to buy your practice $300.00 for Practice Analysis. For more info Contact Dr. Tom Morgan, [email protected], 770-748- 6084, www.VolumePractice.com WHY Advertise Here? Because it Works! Every ad that runs here, also runs on our website: ChiroEco.com

CHIROECO.COM JULY 12, 2016 • CHIROPRACTICECONOMICS 63