EPISODE 375: The 30 and 60 Minute DC Dilemma

Hey, chiropractors. We're ready for another Modern Chiropractic Marketing Show with Dr. Kevin Christie, where we discuss the latest in marketing strategies, contact marketing, direct response marketing, and business development with some of the leading experts in the industry.

[00:00:00] Welcome to another episode of Modern Chiropractic Mastery. This is your host. Dr. Kevin Christie. And today bringing you a little bit of a different episode. This is kind of like a public service announcement episode. And, uh, I've got Dr. Kirk Kippenberger, uh, joining me, not as a guest that I'm going to be interviewing, but more as a guest to dialogue with on this particular topic of the 30 and 60 minute, um, DC that's, uh, you know, you utilizing time as the, uh, as a Component as how they're trying to, uh, separate themselves.

And we talk a lot about the positives on the introduction. So I don't, this isn't a, um, a bash vest. It's more of just really trying to dive into all the nuances of it. And that was the angle we're coming at it from, because I do think the 30 and 60 minute DC is doing. good things, but I think there's some concerns to address.

Um, and in, in the conversation, we have a wine raging [00:01:00] conversation around it, but I just want to, you know, set a little more context in this introduction. And, um, you know, just, I want chiropractors to provide great care, but I also want them to thrive. I want them to grow. I want them to be able to delegate.

I want them to have a team around them. Part of why I love say the clinic gym hybrid model, the essence of that part of why I love. Motion palpation and active release technique, certain things, um, and the concept of maximizing your license. But, uh, I'm just, you know, I want to make sure that we have all the chips on the table and understand how to become a great chiropractor clinically, but also how to have a great life around that and preventing burnout.

And that's some of the things that we, uh, we talk about. And I do think there's a solution, right? I think Some of the options for the 30 and 60 minute DC, you know, if you're at 30 minutes, you, we, we've had episodes before, and we've talked about it. And one of the things [00:02:00] we coach our clients on is, is getting from 30 to 20.

So instead of seeing two an hour, you can see three, um, at the price point you're at, uh, or even raising the price point a little bit. And that can sometimes, um, help out with that hourly capacity. Um, if you, if you're going to be the, you know, if you want your patients in there for. the 60 minutes. Um, I really would, would consider a path and start the path now to where you're delegating some of that.

And you're not specifically spending 60 minutes, um, or, you know, consider the clinic gym hybrid. And we talk about why in this episode. So I'm just going to leave it kind of there as far as the paths that we've, we've worked with chiropractors or seen chiropractors do, um, to be able to. do this model, but do it effectively and thrive over the years.

And that's something that, uh, to consider, um, because, you know, if you're going to spend 60 minutes as the doctor with that patient, you have to, um, figure out that [00:03:00] hourly capacity that we talk about in this episode. And, and, and earning a certain amount per hour. Um, and really there, there is a way of doing that.

You know, we've, we've had, I've talked about it before we've had Dr. James Spencer, and we mentioned a few other chiropractors in this particular episode that, that have done that and charge quite a bit. Um, but we, in this episode talk about some of the. Other sides of what that looks like and how that can be very challenging.

And so if you are going that route, um, we have some good information in this episode, um, to help you out there. And, and you know, one of the things I want you to ponder as you listen to this too, is if you're, if you are going that route of charging a lot, um, You know, we kind of banged on the other side of the profession for the huge care plans, you know, six months of care, 5, 000.

Um, we've been, you know, we've banged on them for, for many years for that and trying to find a middle ground of, um, I love when doctors can charge. a premium. [00:04:00] I really do. And so I don't want it to come across like that. Um, but I, but there is a sweet spot where you're charging a premium, but it's still a reasonable and affordable for, for a good percentage of the patients that you can then have enough patients to, to, to make it work, you know, and, and a question I have on that, and we, we don't necessarily, um, dissect this part out, but we do dissect other aspects of if a patient is.

paying a lot of money. Um, you know, what happens if they don't get the results? What happens if they don't get better if they dished out three, four, five, six, 7, 000, um, for, for, you know, months care. So, uh, what happens when they don't? get better. And so just, you know, again, we all have to deal with the patients, get it not getting better.

I had Mark King on the episode back, I think in December of 2023 of addressing that. So we all have to face that. So it's just something that you'll have to also consider as well when there's been [00:05:00] an outlay of money like that, and if they don't get the results with it. And so we just, we, we dive in again, um, this conversation.

was really meant to just provide all of the angles and nuances of the 30 and 60 minute, uh, chiropractor and what to look at, know what you're getting into. If you do it, um, go, go full steam ahead. If you've checked all the boxes and you're comfortable with it, but just have, uh, have all the facts and also know there are.

uh, alternatives and solutions. Um, if, if when you do all your research on that, it isn't something that you want to go down for the next 30 years. Cause that's ultimately what the decision making process has to be is you have to have a path, not only for now, uh, but for the rest of your career and build the practice, uh, correctly, um, out of the gates, cause I do get a lot of chiropractors that come to me and they're my age and they didn't build it.

The [00:06:00] way they wanted to, and they kind of realize it now. And so we have to reverse engineer it and it's always a little bit harder, but definitely doable. And so let's do it the right way from the beginning. And here are just some of the nuances of the 30 and 60 minute DC. And my guest host on, or my cohost on this one, uh, is Dr.

Kurt Kippenberger.

Dr. Kevin Christie: All right. Thanks for joining me, Kurt. I appreciate your, uh, sounding board effect in my day to day life. And then on today's episode, as we, we dive into the, uh, 30 minute and 60 minute, uh, DC, how are things in your end?

Curt Kippenberger, DC: You know, really great. We are fresh off of our Q2 team training, even though it came a little late.

That's just how, how it worked and actually some of the topics I think that we'll hit today or something we addressed last Friday. And I think, yeah, I'm just excited to continue to talk about the, the models that you can practice within as an evidence informed DC.

Dr. Kevin Christie: I've had some [00:07:00] interviews recently.

Some of them will come out after this. Um, but it's been with, um, Chris Chippendale, Tony Katakis, uh, Bobby Mabee, Josh Satterley. Um, some of those haven't come out yet as this will come out, but we've had a lot of good conversations on, you know, the evidence based, evidence informed side of the profession.

So let's, let's put the other. Side of the professional way, but there's definitely, um, becoming a diverse crowd within our evidence based, um, chiropractic model and the other, you know, even I referenced back, um, a good interview I had with Dr. Alan Sokoloff, uh, he's been someone that's been a sports chiropractor for many, many years now.

Um, And in that episode, him and I talked about kind of those three phases of the sports chiropractor, right? Like the, he was phase one, uh, you know, someone like him, someone like Thomas Hyde, a lot of really good guys doing things that were, um, kind of at the, the [00:08:00] frontier of sports chiropractic back then.

And then I kind of put myself into that tier two. I came in at oh five and I had the ARTs and the grasslands and the TPIs. Uh, but I still was very heavy on palpation and manipulation. Um, and then there's been this phase three sports chiropractor that's, um, uh, doing different things. Um, and some of that is a time component, right?

And that's kind of, we're going to talk a little bit about today is the chiropractor that is spending 30 to or 60 minutes with patients with followup visits. So let's put the, new patient visit aside, but just each visit is 30 and or, uh, 60. And I want to start out by talking about the good of it. Cause we're not, this episode is, is not going to be, um, us, you know, saying like, Oh, this is bad care.

It's, you know, it's great care. Like there's, there's a lot of positives to it, right? There's, um, great leadership for that patient. It's just the same way as [00:09:00] like, I think when people hire personal trainers, it's phenomenal, obviously, given if the personal trainer is. is actually good. Um, but yeah, I think there's a lot of positives for a, that a chiropractor is doing when they are having a time component, right?

I'm, I'm not a huge fan of making time the, uh, the thing, right? Like, uh, I, I like it to be a results economy versus a time economy. That's kind of the first thing I want to touch on after we, we do dive into the, the good of it. Um, but yeah, what are some of your thoughts on the, on the positives of the 30 to 60 minute DC?

Curt Kippenberger, DC: Yeah, I love your intro on the elegance of very patient centered care. And I think so many of our profession and physical therapist. Truly believe that to have patient centered care, it has to be kind of as a direct delivery from that person. And there [00:10:00] are some very, very good things about having the continuity of care between one person only versus having a team of experts surrounding you.

But I also think there's some really great things about having a team behind you too. And we can get into that, uh, in our next little segue, but. You know, knowing the patient by name, knowing their, uh, their family, their dog's name, uh, what they do exercise well, what they don't exercise well. Yeah, I, I think all of that could be wrapped in some to say, if you're spending 30 to 60 minutes and you don't know those things about them, then you're doing something vastly wrong.

Right. Um, but I do think there are lots of limitations too. And I think, uh, the big thing is it's a very hard. Businesses scale, right? You can only see X amount of people a day.

Dr. Kevin Christie: Yeah. And I think, uh, you know, that's something to touch on because there is that component business is a [00:11:00] part of what we do. Uh, I know that the term scaling gets thrown around a lot, but, um, If you cannot make a thriving business out of it, and if there's not a product market fit, uh, it becomes a, a, a really big struggle.

And, um, I think that hourly capacity is, is important. I've, I've harped on that a lot. Like, um, you know, what's the hourly capacity that you have? And, and, and there's two components of this that, that, one of 'em I've talked a lot about. One, I've kind of just. Forgot to talk about or didn't realize I wasn't talking about it, but the hourly capacity would be is okay.

If you can see, uh, let's take the chiropractor that can see 4 people in 1 hour and let's say your office visit average is, um, 80. That's four times 80. That is now a 320 hourly capacity that you have that in, in above, uh, like those types of numbers, 300, 400, uh, you know, you're, that's where you're going [00:12:00] to have margin that's when you have profit margin, that's when you're going to have enough meat on the bone to where you can pay yourself.

professional wage, right? And you also can, you can hire, they can get out of that vicious cycle of, um, being more, you know, being lacking margin, lack, lacking profit margin. Uh, because what we do see in the 30 to 60 minute DC, a lot of times is, uh, let's say two patients an hour chart getting, getting, um, Let's even say 90 from that.

That's 180. That's typically not going to, uh, leave most chiropractors enough money to pay themselves a six figure pay, and then obviously start hiring folks. And that's a concern. But there's a second aspect to the, to the hourly capacity is okay. It's one is what's your hourly capacity? Is it good? Yes. Uh, let's say it's 400 an hour, but then are you actually filling up your [00:13:00] schedule?

Um, uh, or do you have so many holes in your schedule? You're not, you're not getting enough volume, you know, enough volume in the practice. So yeah, you're, you're, you could make 400 an hour, but you're just not growing your business to do that. So you're, you don't actually have enough revenue coming in. To, to sustain that business.

And, and that's where, uh, we see a lot of people run into issues with this hourly capacity aspect.

Curt Kippenberger, DC: Yeah, absolutely. Uh, I think Mark King said something at a seminar years ago, I was retaking a lower quarter dynamic and whatever your time block, whether that's 10 minutes or 20 minutes, or, you know, just assign your value, what can you do to change your patient's life in that timeframe?

And that resonated so well because. Even though that might be your piece of the puzzle, if you have high level extenders that are also helping you multiply that you do have a 30 minute or maybe even a 60 [00:14:00] minute model, they might just be seeing other people. And one of the things that I forgot to circle back about, you know, a few of the really great.

Aspects of spending time is it really respects some of the principles of the functional movement systems, resetting joints, reinforcing with good healthy habits and retraining and reloading. And so whether you're the 30 to 60 minute Cairo or you're the 20 minute, just having those strategies in place to make sure that you're delivering high quality evidence and form care or having Resources outside of your clinic that will provide those things that you can't, or maybe aren't able to yet provide for your patients.

Dr. Kevin Christie: Yeah, definitely. And obviously just for clarity sake is, you know, we're, when we say the 30 minute to 60 minute DC, this is the DC that's spending all the time with that patient, not, not delegating and we'll, we'll get to the delegation side of things soon. Um, but, but doing everything essentially. And, um, Uh, I think clinical efficiency is something [00:15:00] that pops up and we've seen this and I want to reference a great book and I think it's really a good concept, uh, for younger, uh, DCs in particular, uh, you don't have to go out and read the whole book.

You can, if you, if you want to, um, it's a, it's a thick read, but it's, it's called thinking slow and fast by Daniel Kahneman and in that book, he, he talks a lot about. System one and system two thinking and system one thinking is essentially automatic thinking, you know, what's two plus two or brain, no sweat, no calories burned.

Uh, system two is when you really have to think, you know, what's 25 times 36, right? You could probably figure it out, but you're gonna have to put that thinking cap on and really work through that. And when you're in clinical care, Um, early on, you're really burning through that system to thinking more than say you and I are because we've been doing it for quite a long time.

I would say that a lot of my patients that come in through a day, it's just system one thinking. And then, uh, yeah, then, then the hard case comes in and I turn on system two. [00:16:00] I hope it's not 5 30 p. m. I have to turn on the system to thinking, but. It's, uh, it's something to recognize. And as I, I usually tell that to young chiropractors, it makes sense to them.

And it makes them feel a little bit better that, uh, it's going to get better. Like they're not going to be burned out like they are. They're not going to, uh, they're going to get more clinically efficient. It's not going to take them as much time. And I think a great podcast episode to reference for our audience, if they haven't already.

Is the episode I did with Brett Winchester on clinical efficiency and even things he talked about on there where, um, there is a such thing as over treating. Right. Um, so there's a chance if you're not careful and you're spending too much time with a patient, you might be over treating them. And he talks about in that episode two where the, the value of a treatment plan is that you're gonna progress them through the treatment plan.

You don't have to throw the kitchen sink at them every visit. You're gonna progress them and regress them, and you're gonna learn them over a little bit of time, and you're gonna have that and you're gonna get more efficient. And I, [00:17:00] I think that's something that, uh, a lot of the younger dcs that are. Uh, feeling like they need 30 minutes with a patient or need 60, um, can take some Salicin and that it's going to get better.

If you get more, um, efficient, you'll, you'll continue to sharpen that saw and it'll be a lot easier for you and you won't be burning through that system to thinking all the time.

Curt Kippenberger, DC: Right. And I think Brett has so many good knowledge bombs that he drops in his seminars and through the podcast with the gestalt.

And, you know, one of them is his next treatment will be his best treatment. So that clinical acumen that you gain each visit in each visit out, you're just going to be that much more efficient. And when we were in Jupiter earlier this year for our mastermind, he introduced the phrase that I hadn't heard before.

I've heard him say it in different ways, but situational IQ. And that. That situational IQ grows every single time. And even though, you know, in the functional movement systems, we say never take shortcuts. Sometimes you do earn your right to [00:18:00] a shortcut because you've seen it 10, 000 times.

Dr. Kevin Christie: Yeah, I, that was, that was a great one.

I had a lot of great, uh, that was a great con just for our presentation. He gave our group was, was amazing to, to hear him on the business side of things. And then just the, the thinking he goes through, not just the clinical, which is good. And I, you know, I think I. I reference him a lot because, you know, he's someone we put up on the, on the hierarchy of clinical skills.

And obviously he's clinically minded, but, um, he also runs a very efficient, um, business that does well. And he's able to put a great team around him, which is allows him to, um, do other things and really maximize, uh, what he does do in the, in the clinic, which is important. I think that's what I want for chiropractors because one of the current concerns I have This is still a fairly new thing, right?

Um, where the DC is spending a lot of time with a patient outside of some outliers, right? Yeah. [00:19:00] Craig Liebenson has been doing that for a long time. Um, I've gotten to know over the years, um, people that have done it on a scale that's been really cool. Like Troy van Biesen, obviously with professional sports.

So I think sometimes we see though them doing that. And, and, and it looks great and it's amazing, but that's a different business model, right? Like I can tell you what Troy's running is a different business model than a private practice when he's working with the number one golfer in the world. Um, or, you know, on another podcast, I'll reference that I had was, was Dr.

James Spencer, who's about 40 minutes away from me here. And I've known him since he graduated and. And that episode, I think he said he charges 500 an hour, but, and I'm gonna have you speak to this part of it here in a second. Um, if you listen to that episode, you hear the evolution where he had to really get good at what he was doing, uh, from a, from a clinical standpoint, a rehab standpoint, he's dry needling and he does rehab and does a lot of different things.

But [00:20:00] he didn't start out charging that, like he built up a reputation over 10 plus years and it went from maybe, I don't know, 80 a session to 100, 120 to 200 to 250 to 500, like wherever it went. Um, but it was a slow build of a, of a extremely, extremely good positioning. And expertise and a skill set that he had, um, to be able to, to charge the, the high fee for that.

And so I think I want to talk about that a little bit right now is, is the clinical chops to be able to charge a high fee. And then we can talk about charging a high fee,

Curt Kippenberger, DC: right? You, you mentioned some of those Mount Rushmore chiropractors, like Brett and Troy and these guys, and, uh, Greg Rose is one of mine, you know?

Mm-Hmm. , the very first SFMA seminar that I took with him. He, he told us his story. He, he didn't own TPI from day one. He did not invent SFMA with gray [00:21:00] on day one. It was an evolution of his practice model. Of course, Greg coming from an engineering background, originally, he was really able to compartmentalize some of these things.

And maybe he got there faster than your average, but he still had to put his reps in and he had some great successes and he had even greater failures. And he habit stacked all of that to build the dynasty that is now TPI and SFMA, the functional movement systems. Uh, but you know, when we graduate and even in our first few years of practice, we're so low value and low exit.

Because we don't have the case manager. We don't have that situational IQ that we were just talking about with Brett. And. It's really, really hard to sell that to the public. It's hard to sell that to yourself in the mirror, to be honest with you. I mean, so many coach coaching clients that we have in an MCM breaking them out of that poverty complex is so hard, right?

They come out of school with two 50 K in debt. If they went and opened their own practice, they might have another 50 to 150 on top of that. It seems [00:22:00] like an insurmountable mountain. And. You can't take the elevator to success on that. You have to grind it out step by step at a time. There's just no fast pace to get there.

Dr. Kevin Christie: Yeah, it's true. And I think, um, you know, it's, I, I kind of was on a Facebook thread. I forget, I think it might've been in, in Bobby's group and FTCA, uh, which always has just really good, um, threads in there. And, um, one of them was about, about this, about sales and about, um, about costs for patients and things of that nature.

And I just talked about, you know, What's tricky about the 60 minute DC or even a 30 minute DC is that idea of the product market fit and there's a couple of things about that is one is that. Um, as a chiropractor, um, you know, the community, the, the, the, the people in your town, they [00:23:00] do put you into a certain category of what they expect.

Like the, the general public thinks of chiropractic and they think of a certain thing. Um, they may be a little bit more astute and they do think, Oh, well, the chiropractor is going to help out with maybe with some soft tissue as well. Maybe some rehab. They don't necessarily think of. Spending an hour, um, each time they go in with, with a chiropractor and what that looks like now, I'm not saying don't do that.

And what I do think can happen is actually really good marketing can overcome some of that, which is, which is really cool. And we see some. Some folks do that. And I, you know, I, I love good marketing and, and that's what's so important about good marketing is that you can educate the community and you can overcome a product market mismatch like that.

Um, and you can get them into the, into the door. Um, but then the second product market mismatch happens, and that is the [00:24:00] compensation model that is chiropractic. Uh, whether, you know, obviously on one side of the spectrum, you're gonna have insurance based model. Insurance model is just not gonna cover it.

Right? Um, you'd be very hard pressed to find an insurance model. That's going to compensate appropriately for the time you have to put in with that patient. So that that's out the window. Um, and so then you really have to be on the cash base aspect. And in there, whenever, whenever you're talking about a product market fit, Um, it has to be, you know, multiple things, but one of those is what the expected value is of the, uh, service that they're going to get and the, and the value.

And you kind of referenced a little bit, but I'm going to take a step back before we go further into that product, that second part of the product market fit for the cash paying patient. But there's the X, Godin thing I learned. Years ago, and, uh, basically you got your, you know, your X and your [00:25:00] Y axis and the upper right quadrant is going to be, uh, your, your high experts, uh, let's call it high value.

All right. Um, and, and so let's, let me rephrase that a little bit. Let's say your vertical axis is going to be on the top is going to be, is, is just world class, um, expert on the bottom is non expert. And then on the, um, horizontal axis on the left side is going to be, um, Affordable, cheap, right? And on the other side, it's going to be high value.

And what ends up happening is when you're young, and even if you're great, even if you're better than most in the eyes of the beholder, you have not built up that reputation you're talking about yet. And so just naturally, you fall on the non expert side of that axis. And what happens is if you're on that Side of it.

And you're in a non expert because you just haven't had the years under your belt, or you haven't gotten, you haven't broken into the market share of your community yet. Not enough people know about you, whatever, [00:26:00] not enough referrals yet. It takes time. That high, that value switches to too expensive.

Right. Where like, so if that person goes and sees Greg Rose, they see the value in paying the money. If they go and see the DC that's a few years out, um, or frankly could be 20 years out, but hasn't done enough to establish, establish expertise, which many chiropractors 20 years out still have not done. Um, that's going to flip from a high value to too expensive.

Right. And that's where a part of the product market. Mismatch happens when a, um, a younger DC that has not built up the expertise in positioning in the eyes of the beholder, which is your community. Uh, when that's happened, it's a product market mismatch. And so what you, what you have to do, cause like.

I'm a big proponent of like, you got to get that hourly capacity. I was like, yeah, you're worth 400 an hour. You're worth [00:27:00] 350 an hour. You're worth 500 an hour. Fuck you're worth a thousand dollars an hour in my mind. Right? Like, like you're worth it. Like I, I'm not saying you're not, you definitely are. But in the eyes of one patient, Are you worth spending 350 or 500 on?

And that's the tricky part. That's where the product market mismatch can happen. And then the only way you can really get over that, unless you've Again, built up the expertise over time and you become someone that's well sought after, which can happen, but let's assume you're not that at this point. The only way you can potentially get over that is if you get really good at hard sales, right?

Hard sales is needed. When you have a situation that you're not providing, it's not a perfect product market, miss a fit, [00:28:00] and they're not compelled to just write the check, right? Like, oh, it's 75 for this 10 minute visit. Boom. I'm in right. They see the value per potentially, uh, or you become Greg Rose or James Spencer or Troy van Beeson or Brett Winchester.

Yeah. I'll write that check. And that's what we see. And then that's when we see we have to have the hard sales to, to make this work because you better get to that hourly capacity of 400 or 300 or five or whatever it is. Like if you're in San Francisco, it's going to look different than Iowa, but you better get there.

And that cash based 30 to 60 minute DC is, is running into really only A couple options to make this work,

Curt Kippenberger, DC: right? You know, another thing while we're on the theme of X, Y axes, uh, and our last mastermind at Nashville vision spark was talking about your brand versus culture. X, Y axes. So people like [00:29:00] Hilton and Amex and Marriott, they don't have to do anything as far as marketing, they've got more, more patrons and they know what to do with, but again, like, Hilton didn't start that way.

Ritz Carlton did not start that way. They started very, very singularly focused on each person that walked through the hotel. And they figured out a way to scale that, right? Like I remember we had an opportunity to stay at the Ritz years ago at a seminar at an incredibly discounted rate. And before I got to the front desk, they knew who we were.

They knew our names. They knew They knew stuff about us that I was borderline creeped out about. I was like, what kind of mug did you plant in me when you took my bags? Uh, but no, they're, they're just, they're world class in every respect. They, they really want to serve their, their clientele at a high level.

That way they can maintain that high value, high, high cost model too.

Dr. Kevin Christie: Yeah, I think it's important. Um, it's all about the experience, right? So that's the [00:30:00] customer experience. And then obviously we use the language, the patient experience. And I think when a patient comes into a, uh, a busy practice, um, and they've, and there's a team, you know, there's a really, you know, Uh, happy front desk person and, uh, they're nice.

And then there's, uh, the doctor, maybe two doctors, there's the CA, maybe preceptors, maybe a massage therapist, whatever. Um, and that team can provide a phenomenal experience. It goes a long way for sure. Um, now not everybody can have a team out of, out of the gates, but you need to be building the foundation of a practice model that will allow you again.

I think every chiropractor has to design their business to offer phenomenal care, offer a great patient experience, a path for you to make a professional living and a path for you to make a professional living and pay team members well, and then ultimately, uh, hire an associate down the road. [00:31:00] And I think one of the things people don't realize is how much money it takes to a year in a clinic revenue to be able to really afford an associate, like to where you can actually, you know what, like, I can actually afford this associate.

I'm not trying to pigeonhole this into some shenanigans of compensation. Um, and, And it's not 200, 000 a year clinic revenue, you know, that's why I wrote that blog on why 30, 000 a month is so important. That's 360, 000 a year. That's when you can start thinking about it, right? Even in some, depending on your situation, even at three 50 a year revenue might not get you.

That, um, but 500 gets you that 400 gets you that, uh, 450 probably gets you that depending on how much you need to pay yourself, obviously, but you can have a delayed gratification, uh, a bit and hire an associate. And then obviously on board that show associate, they should be a profit center. This isn't volunteer work.

This isn't, [00:32:00] you know, you're not, you know, letting them just ride your coattails for nothing. Like you shouldn't. Obviously make profit off them and then that you can pay yourself more on there. That's the law of scale. And so it is important to build a model right out of the gates that is scalable, that can, that can bring on associates and provide great care.

Now, If you want your patients to come in and spend 30, like a lot of the patients come into my practice and they do spend 30 minutes in my practice. Um, some it's 10, some it's 15, some it's 30, depending on what they've got going on there. They're in our clinic. They're getting that. They're just getting it from a team.

And that's where. I think you and I, uh, you know, work, you know, coaching as many chiropractors we have. That's where we're trying to reframe this for chiropractors is that let's get this model correct. Let's make sure it's a product market fit. Let's make sure the patients are compelled when they come in and then that.[00:33:00]

Um, when they're, when they're in it, you don't have to have this like hard sales job to get them to commit to some kind of, um, cost that it's going to be for them. What is a good number for that patient to pay per visit and a good amount of time and efficiency you provide for them and gets them really good results.

And then maybe you have some really good ways. Like we use, uh, you know, a system to get them their exercises. You can even check out Jay Greensign's app, which has like the at home exercise where you can actually monitor them doing it. Like, it's pretty cool. You can do like, so there's some things they can do at home to, to help with the long term side of things.

But what, what can we do to build a model that's, um, long lasting, you know?

Curt Kippenberger, DC: Yeah. You know, the. Kind of speaking on the hard sales and you kind of skimmed over the insurance versus cash model. I think one of the things specifically within our mastermind group, but we've deployed this [00:34:00] also to our MCM clients is if you are in an insurance based economy.

And it's not paying you to get you to that threshold of a good labor ratio, a good working ratio of production per hour. What cash base add ons can you do to complement your services and even fill some gaps? I know Shockwave was a really big topic at our last mastermind and You know, if you're having trouble with chronic fasciosis with your skill set that you have with your hands, it's very elegant to scale your practice with a modality like shockwave or needling or radio frequency, whatever it is.

Uh, cause again, if you're not in a time based economy or an outcome based economy, what can you do to get that patient to the finish line faster? That's how you're going to build value over time. And I think that that, that kind of helps your scalability issues. It also goes back and talks about the hard sales.

And when, when we were doing our team training last week, that word came up. It's that dirty [00:35:00] word that none of us in the evidence based world like to talk about as sales, but let's be frank. I sold Krista on me 26 years ago. You sold Laura on you. And we have to sell ourselves every day because let's, let's face it.

We married up, right? Um, especially

Dr. Kevin Christie: you and me, anybody has, but definitely you and me,

Curt Kippenberger, DC: there might not be two better examples. With that though, if you can look a patient in the eye and you're using those monitoring systems like Jay's app or Cairo app or something like, Hey, you know what? We're going to Once upon a time, we got a 50 percent improvement in 30 days with plantar fasciitis.

Then we added shockwave to our practice. It went to 85%. When you're measuring that stuff, you're not selling anything. You're solving people's problems and they want that product faster. Like why do people take Tylenol? They don't want to deal with pain. Why do people take ibuprofen? They don't want to deal with the inflammation.

So give them something to help them solve their problems and they'll love you for a while. [00:36:00]

Dr. Kevin Christie: I love what you just said. And then a couple of things on that, um, I recently interviewed Josh Saturday on the topic. It'll come out after this does, but I want to, uh, reference in and also break it down a little bit.

So it's on this particular episode too, but, um, you know, that I interviewed him about the maximizing your license idea, and it's so important. And then obviously Josh is someone that that's built the clinic gym hybrid model, which I love. And you run that for your practice and actually Jordan, our other coach for MCM does.

And so we're not saying like rehab is amazing. Training's amazing. Fitness is amazing. Exercise is so important. Yes. Long term it's, I mean, we all know that. Um, but there are models out there that allow your patients to have that in your clinic, uh, without you having to particularly do it. So they're still getting that.

Um, and, and you're maximizing the license. And one of the things we talked about, Josh and I did on that, um, which I thought was, was, was, um, [00:37:00] a good way of looking at it, probably because I said it, but that's a different story. No, I'm just kidding. Um, was that, okay, let's say, you know, you have DNS and you've got Mackenzie and you got SFMA, you've got your ART, you got all that stuff.

Right. Alphabet soup.

Curt Kippenberger, DC: Right.

Dr. Kevin Christie: Yeah. You got it. Right. But the thing that's cool is that what, what we talked about with that episode with Josh was that, um, there's even a maximizing of the license within each of those. Right. So, uh, let's take McKenzie. Um, you could decide that you're only going to be doing some of the directional preferencing testing and some of the stuff like that, that McKenzie protocol, and maybe run them through a couple of things, but then have an extender, which.

Don't let me forget. I want to talk about that. The first time I ever heard that was from Ben Fergus. I want to give him credit and I do want to talk about it, but someone else is carrying out the actual repetitions of it, right? Or you're doing a DNS audit of the person, but then someone else is doing the [00:38:00] actual DNS positions and things of that nature.

You're doing the SFMA tiers and assessing it, but someone else is doing the correctives of it, right? So they're within each of those. certifications that you may have, there is a maximizing your license component of it. And then there's a non maximizing your license component of it potentially, right? And, and that's where I want to, like, I want to make sure that people listening to this is like, we're not saying don't do these things and don't have these things, or patients don't need exercise or they don't need this.

They need that stuff, but it can come from, uh, an extender, uh, in your practice. And can you, I know you know that a little bit more than I do. Uh, what Ben is referencing on that. Can you chat about that?

Curt Kippenberger, DC: Yeah, absolutely. I think maybe to also put an analogy to this. So, I mean, I had my ACL reconstructed in 2018 and I handpicked my surgeon.

That's, you know, one of the blessings of being integrated in the healthcare model in the community. But Dr. Sherman was not the guy [00:39:00] that gave me ADL advice. He didn't give me a home exercise prescription. He didn't do PT. He didn't shoot my images. He didn't do any of that stuff. He performed surgery. He's really good and gets paid best to perform surgery.

So to Josh's tout, you know, that idea of maximizing your license as DCs, we're really good at diagnosing musculoskeletal conditions, neuromusculoskeletal conditions, if we want to throw that in there. We're really great at treating those with our hands and with other tools that are at our fingertips, but you know something we teach in the clinic gym hybrid model with Josh is if you're that level of an expert, you should be able to train other people to be experts within those models and whether that's DNS, the functional movement systems model.

Sometimes even soft tissue delegation and rehab exercises. We can find these people as Ben Fergus calls them, the extenders, the extensions of our fingertips to become much more clinically [00:40:00] efficient. And quite honestly, one of the other big advantages of having a team. I was just talking to one of our MCM clients about this this morning.

When you have a team, patients are going to tell different people in your practice, different things. If you're a patient, if I'm a patient of yours, Kevin, I want you to succeed because if you succeed, I succeed. However, I'm also terrified to tell you if you're failing sometimes. And that's the, you know, it's a little psychosocial model thing, right?

But there sure is hell to tell the people that are taking their money. Well, yeah, I'm not feeling any better, or these exercises aren't working. And so adding another set of ears to empathetically listen to your patient population, I think really gives them a layer of comfort that most people seek after.

Dr. Kevin Christie: Yeah, I think this is so, so true. And I think that's one of the things that's been cool to work with the chiropractors we have been working with. And I know you've had a couple, uh, visit your office lately, which is awesome, but you know, we're, we're [00:41:00] trying to find that model of care. And I think we've found at MCM where whether you're in network with insurances or your cash, and you want to provide an evidence based model that does include a multi, a multimodal approach, that there is a business model for, for you to grow, um, and to get paid what you're worth.

But then also that works for the patient, right? And I, a question that I kind of been chewing on a lot, and I don't know what the answer is. But we, we throw around the, the term patient centered a lot in the evidence based crowd. And I love it, right? And we always bash the other side of the profession for being doctor centered.

But a question I just kind of been pondering a lot and I don't have the answer, but, but, uh, it's just something I've been chewing on is, you know, is it being patient centered? If you, as the doctor business owner can't figure out a, a business model that provides great [00:42:00] results for the patient at a reasonable cost to them, right?

And, and I'm, and I'm not saying that in network insurance is a reasonable reimbursement for chiropractors. Uh, I'm not going to go down the insurance model, but But can they find good results in your practice at a reasonable cost to them that, and you're still running a business that's thriving really well.

And I know a lot of chiropractors that have done that. Uh, we work with them. I've noticed some that are in our mastermind. We, and that's, that's what we're trying to get. Our chiropractors to, to do is find that beautiful spot where the, a very healthy percentage of their potential patients come in and, and say to themselves, yeah, I can, I can manage that financially.

And I'm also getting great results.

Curt Kippenberger, DC: I think the, uh, the idea of. Reaching more people, right? Like if, if you're spending more and more time, you're reaching less and less people. [00:43:00] And unless you're a level five leader, that's also developing other leaders to go out and have satellite facilities that are doing the exact same thing.

Your law of multiplicity is going to be very, very tiny. Meaning your common denominator is also going to be small. You're not going to be able to change the healthcare in your community. That's one of our clinical mission statements. And. I don't know, uh, changing the lives of a small subset of people in a meaningful way that that does give you some some wind in your philanthropic sales.

But what if you can multiply that by two or three or four, maybe not 100. But, you know, just ripple that through your community a little bit more and and quite honestly, like, things that we're doing through M. C. M. and what M. P. I. does inspiring other clinicians to do the same, I think, is is so elegant.

They. They want our profession to succeed. They want to do [00:44:00] it through an evidence informed lens, but they want to, they want to see that medium volume of people coming through their doors so they can make sure that the impact is actually lasting.

Dr. Kevin Christie: Yeah, absolutely. And to your point, um, you mentioned level five leadership, uh, recently, the episode with, uh, Dr.

Chris Chippendale, uh, we talked about optimism versus cynicism and it was really good. And we talked about some of the cynicism that is in our, in our side of the profession, evidence based, um, in, in the belief that delegating Uh, rehab is, is bad or not, not good for the patient, I think, is a, a cynical viewpoint, a little, you know, I think it's a little fixed mindset versus growth mindset.

It's borderline a

Curt Kippenberger, DC: fallacy, to be honest with you.

Dr. Kevin Christie: Yes, exactly. It's true. Um, and because what it does do, like what it does take, I should say, is it does take a level of leadership to be able to lead a team and train a team on how to, [00:45:00] Deliver care, um, within their scope, um, uh, at a very effective level. And I think sometimes maybe some people have a little bit of cynicism around the ability to do that.

It's like, oh, I'm never going to be able to train someone, uh, that's going to be able to do it, or, uh, I'm going to train them. They're going to leave me. Uh, you said something that, uh, it was in, I never, I'll never forget exactly where I was sitting and where it was, but it was our St. Augustine mastermind.

And you gave each one to each one on preceptors. And you were talking about your preceptor program and you, you said, I know you didn't come up with it. You stole from someone else like that probably stole from someone else, but it was, um, you know, the concern about training a team member and then leaving you.

And you said something in the back, it was like, I'd rather train a team member really good and then leave me or not train them well and then stay with me. And, uh, that just really resonated with me.

Curt Kippenberger, DC: I always said that this morning again to one of our clients and yeah, I think there's a big fear around [00:46:00] that is they're going to steal my intellectual property and they're going to do this like, well, guess what?

If they're doing that, then congratulations. You just multiplied your model. Like you scaled without even know you were scaling. Uh, I, I really firmly believe, I mean, one of my interns practices here in this town with, I mean, two miles from my practice, we didn't have a spot on the team for him. He's a great doc.

He's really empathetic. He has an, uh, that evidence informed lens, but you know what? I'm so happy when we have, uh, you know, a patient that needs in on a Friday that we can't get in, I can send them down the road to mall and I know they're going to get fantastic care. Starbucks did never intended to have just one, right?

Uh, so I don't think that we need to have again, thousands of practices under our one cloak, but to speak to those levels of leadership, I think, you know, many of us get to that level three and maybe level four leader when you're when you want to get to that economy of scale of like a Ray [00:47:00] Tuck, you really have to go to that fifth level of leadership because you can't run 11 clinics and be in the, in the trenches with them.

You know, we've had so many influences, whether they're in our mastermind in our MCM group or people that we've brought in to speak on behalf of that. That really truly show that pinnacle level of leadership. That's a long haul to get there, just like we entered our conversation today. Like you don't get that overnight.

You don't have the 5, 000 square foot practice with the clinic gym right out of the gates. You might have to start off in a small room. You might have to, You know, go into a corporate environment where you're learning that clinical case management. But I think it resonates again to just say those steps, that cynicism, the fallacy of belief that we can't delegate.

One of my favorite quotes, I say it probably weekly before it's your favorite place. It's a place you've never been. You have no clue if you've never delegated rehab out how rewarding it can actually be to teach somebody to [00:48:00] be great at it.

Dr. Kevin Christie: Yeah, that's awesome. Um, And I just want to touch on one last topic and, and that's the, the thought of burnout, right?

Um, I think I've been thinking about a lot about this cause I've, uh, I've been practicing for 19 years and I've done the burnout. I've done the burnout thing. I've faced it head on before and what I've, I've kind of thought about whether it's my own personal life or, uh, being fortunate enough to work with chiropractors is that, um, I feel like a chiropractor does really well.

When they are working hard, but they see the progress they're making and the progress is, um, yeah, financially they feel good about their progress. They're feeling good about, you know, I'm contributing to retirement. Um, you know, I'm on pace, you know, I'm 35 years old and I'm on pace doing good. Um, [00:49:00] and, and you can work hard when you feel like you're making progress and there's other aspects of progress other than money.

Um, and, and that's definitely, um, something that you have to be honest with yourself about, right? Like for me, I couldn't imagine talking to a patient for 60 minutes, uh, you know, all the time, I love my 10 to 15 minute conversations and in getting them to, uh, one of the extenders to, to do shockwave or rehab or whatever.

Um, but like, so for me, I get a lot of social engagement and I love it. Um, in the, in the, in the. And that timeframe. So there's a lot more to the burnout, but my concern is, and I see it, um, because it's one thing to, and I've said this before on a podcast, I'm not going to make it my, my slogan, but, um, it's cool when you're broke, when you're 28 and you're doing.

What you love, right? Like we, we've all been there. It's not as cool.

Curt Kippenberger, DC: I wanted to be a professional cyclist and they made about 12, 000 a year at that point in my career. [00:50:00] So yes,

Dr. Kevin Christie: yeah, it's, it's cool to be 28 and broke, even the chicks don't mind it. But, um, you know, when you're 38 and broke, it's, it's not as cool.

And you got family and you got kids and you got things you want to do and you want to make that progress. Um, and that's where I get chiropractors coming to me. Yeah. Where they're not seeing that progress and they're getting burned out because of that. And so I think it's just so important if you're starting out early on, or you're at that point where you're facing burnout because of it, um, to recognize that, um, it doesn't have to be that way.

Uh, there are, uh, really good evidence informed models of care that does offer, um, a multi modal approach. And is congruent with your level of care and your standard of care. Um, but that can also be financially rewarding for you so that you can feel like you're making progress and that your family feels like you're making progress and that your team members, you can afford and you can pay [00:51:00] them, um, well, right.

And, and you can grow and you can see that progress you're making. And, uh, and that's where I think, uh, burnout. Is, uh, can be avoided. Um, there's other things in life that can happen and I'm not an expert. We do have an expert coming to our Chicago mastermind, Dr. Manuel Estruck, and he's going to be talking about that because our mastermind has got a lot of high achievers pushing the envelope, but how do we do that without, um, burnout and that's what he's going to talk about.

Talk about more of, but just my own experience of working with chiropractors in my own personal life or professional life. Um, that's my thought on, on the burnout. And that's my concern for the 36 minute minute DC that it feels like they have to do everything. Um, I don't know what this looks like for that doctor.

15 years down the road because it's such a newer thing, right? Like, um, it's, it's a newer concept that I haven't, I don't know what it looks like when you're my age at [00:52:00] 44 doing everything. If you can't get out of that. And that's my concern, uh, for, for this sub, uh, sect of the, of the chiropractic model here.

Curt Kippenberger, DC: Yeah, I agree. And, um, you know, within the NPI model, I don't think anybody says it better than Corey Campbell. Their, their mantra, grit, grace, and gratitude is also really important to avoid burnout because it's not all going to be kitty cats and rainbows every single day of practice. I mean, that grit is so, so important and you have to give your grace or yourself grace to allow yourself that amount of time to take the steps to success versus the elevator.

And damn it. freaking grateful for it every step of the way. I've said recently, I don't necessarily owe this profession anything, but it has allowed me a lifestyle and a purpose to deliver something I think is meaningful. So maybe, you know, if I say it a different way, maybe I do owe the profession quite a bit.

I mean, it's a gateway to. Have this incredible opportunity to grow a [00:53:00] team within my community. I mean, you know, I won't, I won't dive into the weeds on this, but I went through some tough times, like a lot of people have in the last four years. And my team was one of the main reasons I portaged through that.

Cause I wrote a big, long thing on a FTCA and it was basically like, fuck it. I'm done. And, uh, my team was the people that brought me through it. My family, my team. You, Kevin, I mean, we, we've got a good people surrounding us, so we're so grateful for that.

Dr. Kevin Christie: Yeah. And, and, and no matter who you are, I mean, I've been through it.

I've, I've talked about my 2015 on the podcast before, um, you know, anybody that's successful or you think is like they have their own ups and downs for sure, but, you know, I want to give kudos to you because you, uh, you know, you're, you're at the ripe old age of 40, is it 41 now or 40?

Curt Kippenberger, DC: Forty wonderful.

Dr. Kevin Christie: Forty wonderful. But now, like how many hours a week are you treating patients now?

Curt Kippenberger, DC: Uh, 17 and a half.

Dr. Kevin Christie: Perfect. And then it's given you a freedom to where you've got a business that is [00:54:00] self managing, you provide the leadership. Um, and then it gives you the freedom to spend time with your family. You're able to coach for MCM.

You're able to go to the mastermind and really help me out there. I couldn't do without you. Um, you're able to teach with, with Josh a little bit and some SFMA stuff. And so that kind of fills your bucket to where that's the other part of that burnout is there, there might be some things that are ancillary aspects of your professional life that can help fill your bucket to stave off the burnout.

And if you can't find that freedom by the time you get to. Forty wonderful. Um, you start to get, you get to get a little enclosed, right? Like you feel like a little squeeze and like, where am I going with all this? But if you do it right, you build something that's bigger than yourself. Um, you will have that freedom.

It won't happen at 31, most likely. Um, but maybe at 41 and definitely by 51, if you do this right.

Curt Kippenberger, DC: Yeah. What was Mark King's earmark in his podcast? It's like he finally felt like he really had his [00:55:00] feet underneath him when he was 45. I think that was about

Dr. Kevin Christie: it. Yeah, exactly.

Curt Kippenberger, DC: And so to hear again, another Mount Rushmore chiropractor say that it really, it just puts proof in the pudding that there are no shortcuts to success.

Uh, I think inarguably. If anyone in our profession that was in an evidence informed model went and shadowed Mark and Donna's practice in Mount Lookout, Ohio, they would be blown away. But it's kind of like, you know, when the 16 year old gets the Mercedes for their first car, the likelihood of you having Mercedes practice out of the gates is pretty low, but you know, we've been fortunate.

You mentioned one of our shadows. So we had two MCM members, uh, that have shadowed our clinic in the last two weeks and they've been in practice. One of them, you know, one's a couple, they've been in practice for eight years, uh, up in Western Wisconsin. And then another one is just, you know, here a few months into practice and everybody has their own lens that they look through.

Another quote I love is when you're, um, [00:56:00] you can't see the entire picture when you're stuck inside the frame. And so occasionally getting out of your comfort zone and going to shadow and learn with clinics. And I say, learn with, I learned plenty. With Brianne, uh, Kellen last week and then Luke yesterday, we learned together and I, I highly encourage everybody to go out and shadow practices, big, small, in the middle, it doesn't matter, people that you respect and, and make sure that you're making some clinical choices for your patients, for your team and for yourself moving forward.

Dr. Kevin Christie: That's lovely. It's been a cool trend also with our mastermind. Now that we took it out of Florida, um, we have members that practice some, you know, near Nashville and I know a couple of people, you went to Jason Holmes and I think Andy went to Anthony Hussain's and I think when we got Chicago next, a couple of our members are in that area, people are going to shadow their clinics.

And so you, you can definitely get out [00:57:00] outside of your four walls and learn from other practices. guys.

Curt Kippenberger, DC: I think we're becoming roadies Kevin.

Dr. Kevin Christie: Yes, exactly. It's fun. It's fun. It's, it is fun. Well, Kurt, I appreciate your, uh, willingness to come up with this idea of helping me navigate the waters of this conversation.

Cause I didn't, I don't want it to attend, like we were bashing anybody or anything. I just wanted to put out kind of a, a comprehensive audio here. I was thinking about writing a lengthy blog, but finding the time to sit down and write like I used to is trickier with a two and a four year old. So thanks for helping me navigate the waters of this, because I think it's important and I just want.

I just want the chiropractor to have all the angles so that they can make an informed decision. And if they make the informed decision that works for them, and it's not along these lines that we talk about, that's fine. But at least, um, I think hearing this, no matter where you stand on your thoughts on [00:58:00] it is good to, to make an informed decision.

Cause if you don't, um, it's hard to make great decisions when you have some holes in your, in your knowledge base.

Curt Kippenberger, DC: Absolutely. Couldn't agree more.

Dr. Kevin Christie: Awesome, man. Well, uh, we'll have to do this again. This was nice.

Curt Kippenberger, DC: Yeah, it was fun. I think so, too.

Dr. Kevin Christie: All right. Well, you have a great rest of the

Curt Kippenberger, DC: weekend. Yeah. You do the same.

Chase that two and four year old around.