EPISODE 389: Strategically Delegating Rehab in Your Practice with Taylor Premer DC

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.

Dr. Kevin Christie: [00:00:00] Welcome to my interview with Dr. Taylor Priemer. And we're going to dive into a topic that, um, I, you know, it's, it's important to me. And that is the delegation of rehab. And I think a lot of chiropractors feel like they have to do the rehab. And you may, if you're listening to this and you decide you want to do all the rehab, and that is, uh, that fills your cup and you feel like that is where you're, unique ability is, um, I'm not here to, to try to change your mind completely, but there's a lot of chiropractors out there that are currently doing all the rehab and would, um, we either like to, to delegate it, know they want to delegate it, or they're kind of on the fence of it.

And I wanted to bring Taylor on here to chat about that because he's, uh, kind of run the gamut with that. Um, at Winchester spine and sports, we dive into what it has looked like in the progression of his early career, um, to be doing the rehab and then to be delegating the rehab and some of his [00:01:00] insights, uh, on that.

And, uh, I thought he'd be a great guest for that because he's, uh, lived it and breathed it and has some really good insights on, um, delegating the rehab and what the patient experience has actually been. when they do delegate it. So we will dive into that topic. Something I want to mention too, as we, towards the end of the conversation, discuss shortly after this release of the MPI Adjustathon will be going on in Kansas City, Overland Park.

And I'll be there. I'm excited to be there. First Adjustathon, uh, surprising. I've been to all the MPI seminars. I've been to a bunch of them, but I have not been to an Adjustathon yet, but excited to be there. So hopefully you will join us there. So just go to motionpalpation. org to check it out. There's going to be a.

just great amount of chiropractors. There's going to be a student track at DC only track. So if you are a licensed DC, um, you will have a, your own separate track to learn some advanced palpations and manipulations. And so check that out. All right. Without further ado, here's my interview with [00:02:00] Dr.

Taylor Premer.

All right. Welcome to the show, Taylor. I really appreciate you coming on and hopping on a topic that I'm excited to dive further into. And actually here's someone that's definitely run the gamut of delegation as it pertains to rehab and clinical care. But before we dive into that topic, tell us a little bit about yourself personally, professionally, and some updates.

Taylor Premer, DC: Yeah, man. So thanks for having me on. Obviously, Kevin, I've been a long time listener, so it's exciting to be on for sure. But my name is Taylor Premer. So I'm a, I'm a chiropractor here at Winchester spine and sport in Troy, Missouri. Um, and so I have a specialty in sports medicine. And so that's kind of my, my, uh, my love.

We'll put it that way. I love seeing high school patients and high school athletes. And, uh, I, Volunteer some time at two local high schools. And so, uh, that's really what gets me up in the morning is, is getting kids back on the field and, uh, you know, I've been lucky enough to treat a bunch of professional athletes, but, uh, high school athletes are really the, what really brings me joy and gets, gets me going so, uh, that, and then, uh, [00:03:00] along with Brett Winchester, uh, we own Gestalt Education, which is a continued education company, and we also have a podcast called the Gestalt Education Show.

And so, uh, if I'm not in here treating patients, uh, we're out usually traveling to teach or to host podcasts. And then, uh, I have a wife. Her name is also Taylor, ironically.

So, uh, anyway, uh, yeah, that's, that's kind of my life. I, I'm, uh, from Nebraska originally, a little tiny town. And Somehow found my way to train Missouri and the rest is history. So, uh, I absolutely love what I do. And I know that you echo it to Kevin, that there is no better time to be a chiropractor. And, uh, I think the topic today is an exciting one because, uh, you know, early on in my career, I really didn't know what the hell chiropractic was to be completely honest with you and, and kind of having my eyes opened up to the possibilities and how you can.

Um, kind of be in two places at once is, is something that kind of excites me as, as someone that almost thrives on chaos. I love the idea of a little bit more chaos in my life. And so, uh, anyway, I'm, I'm excited to kind of dive into this topic.

Dr. Kevin Christie: Yeah, no, absolutely. Um, you know, it's been kind of something [00:04:00] that, you know, we're seeing, I think a little bit more and more is chiropractors that, um, do, you know, multimodal approach of care, which is great.

And, you know, I'm, I'm at the age now, you Where, uh, when I talk about when I used to be young, you know, um, I actually used to do a lot of rehab exercises. You know, I'm, I'm, I'm certified in the TPI stuff. I certified in the, uh, the SFMA back from the beginning part. And I was learning from great cook and read up all on the Craig Liebman's and stuff.

So I, I was, I was in the thick of it on doing the rehab and, and, and actually physically doing it with the patients and showing them how to do it. So I, I did live that life a little bit. Um, and now that I'm in my mid forties and have built up a practice built and sold another practice, I realized, you know, um, at some point there is a, uh, a growth strategy you need to have for your, for your clinical delegation so that you could have [00:05:00] longevity in, in this career we call chiropractic and also.

Build a thriving practice around it. So I wanted to bring you on to kind of talk about the process that you went through, and then also the current process that the clinic has of, of really starting to understand how to effectively delegate the, the rehab component of that. So, um, my, my first question after that long preamble there is, um, tell us about, you, you got to, to Winchester's place there as a, as a preceptor, correct?

Yeah. And then what was it like to be on the end of it to where you were learning that and learning how to delegate from another doctor, the doctors prescribing and you have to obviously, um, you know, render those services on the rehab side of things.

Taylor Premer, DC: Yeah, so I have kind of a unique, uh, start to it on honestly.

So when I first got here, uh, the, the internship program wasn't what [00:06:00] it is now. We'll put it that way. And so I honestly didn't do a ton of personalized rehab for Brad. It's some passive stuff and some rehab here and there, but it wasn't structured by any means. And so. Yeah, the majority of time I was just shadowing him, taking notes, um, helping patients get them out of rooms, maybe taking them out of decompression, doing laser, pulling needles, uh, doing some rehab here and there, but it wasn't really structured.

And so, you know, early on, I, I loved it. I mean, what an amazing experience. I spent basically six months in a room with Brett Winchester all day, every day. I mean, I am literally the luckiest human being alive for that. And so, you Um, however, I could start to see that there were some holes in the growth opportunities like we talked about kind of in the intro, you know, uh, Brett is an absolute savant when it comes to treating patients.

I mean, uh, I don't think anybody would, I would put them up against anybody in the world and don't tell him I said that. I hope he doesn't listen to this, but, um, with that being said, uh, Brett. You know, he would be an hour and a half behind at certain points. And, you know, there [00:07:00] was just some, some interesting things.

And so as I started to transition into more of a position, uh, that's when him and I started to have more conversations about what we're talking about today, uh, you know, we had a, we had a rehab tech, Danielle, that's been with Brett for a long time. And, and she would do a lot of this stuff for him, meaning.

You know, uh, we're, I'm a DNS geek. And so nobody in the world can teach respiration and internal pressure probably better than Danielle, because she's done it every year for the last almost 10 years. And so that was really the only delegation, uh, we had three doctors at the time and they were all using Danielle and it was just like, it was a lot for her to handle.

And at the time, you know, it was, we, we would basically, he would have one, maybe two interns at a time. And it wasn't very, uh, structured, like I said. And so, uh, throughout the first year and a half of my, of actually being in practice here, we started to have conversations about creating more of an intern program and creating more of that longevity conversation on what it actually looks like to delegate and what it actually looks like to.

like fully immerse students [00:08:00] into this world that we live in, you know, uh, Brett being an educator himself, he's used to having people with them. And, you know, there's not a day goes by that we don't have some sort of shadow or intern in with us, but again, there was no structure. And so, you know, within the first year, we started to have conversations about actually structuring them.

Number one. And then number two, actually like starting to reach out to more schools and get more people into our web. And That actually wanted to be here. And so, you know, early on it was just kinda like a, well, they, you know, people from, from Palmer or from Florida or from Western states, they're not gonna come to Troy because I don't know where are they gonna stay?

What are they gonna do? Like our people really wanting to do that. And, uh, we kind of jumped right into the deep end and found out that people were actually like craving to be here. Mm-Hmm. . And so that kind of evolved and it forced us really quickly to be able to kind of build a structural, uh, program and, and to where it's evolved now.

Uh, now. You know, interns are integrated into the care every single day. So today I have a new patient, uh, I think at three 30, so at three 30, an intern, whoever's turn it is just in the [00:09:00] rotation, we'll get assigned to that patient with, so they will be with me every step of the way through the entire care plan, through that patient's lifespan, whether they're here longer or the interns are longer.

And so, uh, what it forces us to do is number one, us as physicians, we have to have. You know, very pointed reasons for what we're doing, meaning every single time that I am doing something in the treatment room, whether that's an assessment, whether that's sending for imaging for lab work, a rehab exercise, I have someone that's going to be asking me why we're doing that, number one.

And then number two. It forces us to kind of think about the lifespan of that patient. I mean, what does this case look like in two weeks? What does that look like in three weeks? And so that's kind of where it's evolved to now where interns are extremely valuable to our practice. Uh, not only to, to kind of delegate the rehab process off to you, but also it kind of forces us to get.

Kind of pull back the curtains and, you know, full holes barred, like discuss cases that aren't working well, discuss cases that are going really well and kind of decide [00:10:00] on what, what needs to happen from there. And so that's kind of been the evolution, honestly. And there were some hard times, but I had some hard, hard discussions.

And, uh, if you know, Brett and I, we liked, did you have each other a little bit, there was some, there was some. I don't know some, a little bit of back and forth on what that actually looked like. And now I think it's probably, uh, it is an invaluable experience to be here for the interns and seeing them progress from students to doctors has been really cool.

I mean, the, the amount of growth that we can get kids to, to feel in the first, uh, you know, couple of months is pretty extraordinary. And I think that, uh, you know, similar to in med school where you're integrated into the hospital or into this, you know, network, we're doing the same thing here with, with our internships.

And so that's really how it's evolved. And we're, we're super proud of it.

Dr. Kevin Christie: That's great. Yeah. And I want to, I want a couple of questions on that. I'm going to go back to your rehab tech. Um, what are her credentials before I was saying when she started working for you

Taylor Premer, DC: guys? Ironically, Brett knew her family and she was working checkout at Walmart.[00:11:00]

And so Brett, yeah. And so Brett fell in love with her, uh, Her personality and her ability to connect with people and said, I will teach you everything you need. You need to know. And I think it's a good point to bring up to Kevin, because I think we get so caught up in people having training credentials, personal training credentials and all these different things, because we feel like.

It's so difficult to learn these things. You need to have some sort of background. And the reality is you really don't. It just takes effort and it takes time, uh, to, to really teach them how you want things to be conceived or how you want it to, the patient to view this or how you want it to be kind of, uh, settled out.

So yeah, she was just check out at Walmart.

Dr. Kevin Christie: Yeah. You want to find the person that has a good personality and has a high capacity to learn, obviously eager to learn. It doesn't have to have the alphabet behind their name to get that for this rehab tech position, which is, which is really awesome. So that's why I wanted to ask that.

Cause I kind of knew the answer. Um, and also

Taylor Premer, DC: too, Kevin, I mean, like talking about overhead, like nobody knows more about overhead than you. Uh, being able to. [00:12:00] Maybe not pay them quite as much as that athletic trainer or, you know, the, the personal training background. It just allows you to do more things in the practice.

You have more to the community, bring in more people, uh, have more marketing and do more things in the community. And it doesn't devalue her at all. I mean, she makes a great living doing this, but it just opens up many more doors in your practice to be able to do things. Yeah.

Dr. Kevin Christie: And what's cool about it. And we've talked about this on a previous episode is we're, we're through MCM and we're working with our clients.

We're, we're talking a lot about this idea of a Swiss army CA where, you know, maybe you hire for that rehab tech, but they also can back up the front desk or even be part of the front. They can also help out with other things when the clinic, and it's just really having that right hand person to, to help the doctor out, kind of like how you mentioned the interns shadow you for the case.

And, uh, and that's really good. And that leads me to my second question is. You talked about, about structure, and I think one of the things I'd love to hear you talk about, because this is, in my [00:13:00] opinion, a key ingredient to this whole thing, whether you have a rehab tech or you have an influx of interns is, is a training program to, to learn this stuff.

What is, what does that look like in your clinic? And then, uh, some things that you'd recommend as far as training consistently for that person.

Taylor Premer, DC: Yeah, so every Wednesday we have a meeting. So the first hour of our schedule is blocked off every single Wednesday. The first Wednesday of every month is a full staff meeting.

And that's where Brett usually will either bring someone into the community that's, you know, doing really exceptional things to kind of talk about. Uh, how they grow their business and, and, uh, things like that, or if it's just us as a staff talking about ways that we can improve the practice or, you know, uh, we do a one on one reports.

And so each one of us has our own little, um, thing that we're responsible, responsible for in the practice. For me, it's the high schools and external marketing. And so every, every first Wednesday of the month, I know that I'm going to be called on to basically give a report on. Hey, this is what the status of the high schools is.

This is the sports we have coming up. This is what to [00:14:00] expect with injuries. Uh, this is what we need to have sports, physicals, and then also like, Hey, this is where the community golf tournaments are and things like that. Uh, but then all the other Wednesdays are doctors meetings and interns meetings and, and it's, uh, per topic.

And so usually how we do it is we just kind of work our way through the body, whether that's foot and ankle, knee, hip, uh, or like an MDT day or a DNS day and things like that. And so it's very, you Um, you know, one of each of us doctors is usually giving input or we have like a responsibility on, okay, we're talking about DNS today.

Okay, you're going to talk about respiration. You're going to talk about three months prone and then Brett will maybe interject into like a couple of cases that he's had lately on what that actually looks like. Uh, so that's, that's part of it. And then I have Tuesday mornings off and so Tuesday mornings are my day off at the practice.

And so usually, if not every Tuesday, every other Tuesday, we'll do it just a quick in service with the patient or with the interns where it's just me and them. Uh, you know, whatever they're struggling with, or if us doctors notice that, hey, this isn't quite right as far as the rehab or the laser needling or whatever it might be taping, then I'll, I'll just take them through [00:15:00] those, those little things.

And, um, so that's kind of how it's structured. And then, honestly, it's just like, uh, every single day at the end of the day, we usually. We have seltzers, we drink a little tequila, do something like that. And then it opens up the floor for the interns to actually ask questions about cases. Hey, when you were doing this, can you show me what exactly that looked like?

And so it's just kind of like an ongoing conversation. We have structured days, Tuesday mornings and Wednesdays that are kind of like for education, for teaching, but then every single day it usually culminates into conversations about other things or, Hey, I noticed, uh, I've been having a hard time doing this.

I noticed you did it really well. Do you mind if next Tuesday we talk about that? And then that just gets kind of added into the education. So I say structured, it's pretty structured. We're getting better at actually getting like a curriculum set out. Uh, but honestly it's, it's, it, what makes it fun is that each intern has just a different set of skills, a different set of challenges, a different set of, uh, you know, ideas on what they want to learn.

And so that just kind of helps evolve the curriculum as we go through their internship. And that's, that's kind [00:16:00] of how we evolve it.

Dr. Kevin Christie: Yeah. And I think, you know, the, the training is a huge part of it. And, and, uh, you know, we have that. And I, what's good about it is when you put it together, um, and you get, if you start getting interns, obviously if you have a rehab tech, it might take a little bit longer.

You get a good chiropractic intern. They're going to have a, probably a higher capacity, probably, uh, obviously a lot more education, uh, than someone that doesn't have gone through four years of chiropractic school plus four years of undergrad. Uh, but. Either your onboarding for your interns still needs to happen.

It might just be quicker, which is cool. Cause I think I want to dispel the myth because I hear sometimes from chiropractors that, you know, I don't want to really deal with the internship program schools because it's like, I might get one for four months. I might get one for eight. I might have a gap.

They're worried about the consistency of it because obviously it's a little easier for your clinic and probably my clinic to get a steady influx of interns than maybe, uh, other clinics. So that's just a reality. And, um, my, my argument of that is, is, [00:17:00] is, is. Is just put together a really good training program on board the preceptor.

Try to get as many as you can, when you can like get, you know, get proactive with that, uh, but any just insights on onboarding more of a chiropractic intern versus say a rehab tech.

Taylor Premer, DC: Yeah, I think you're, you bring up some good points. I mean, it's something that we've struggled with too. I mean, you just never know, you know, we're pretty picky on our interns.

We want them to have certain skills and certain, uh, You know, seminars they've taken and things like that, just because one, it helps her onboarding process feel a bit quicker, but also to, uh, we're, we're trusting them with a lot of things. And so we want them to be proactive, but honestly, like personality trumps all like that literally trumps everything.

And so I think if you have a good personality and you have someone that's willing to learn, like we talked about earlier, then, you know, the onboarding is pretty damn quick, but I think, uh, Having just time set away, I think that is the most difficult thing. It's very easy to just cram as many patients into a week as you can, but You know, then now you haven't taken the time aside to [00:18:00] try to educate.

Then you're, you're forced to try to educate while you're treating and you're trying to educate between patients and things like that. And that is just, that's a recipe for disaster. Uh, one, it's going to just overwhelm you to the patient experience. It goes out the door because now you're, you're not connecting with them.

You're connecting with the person that's in the room with you. And so I think that is my biggest tip is just literally have time set aside where it's, Hey, this is the time. It doesn't matter how many patients, how, if I'm leaving for the weekend, Uh, this is the time. We can't add more patients to this time.

This is it. Like this time is set aside. The staff knows it. The interns knows it. The docs know it. Time is set aside and stick to it and just be very diligent in that time set aside and don't, don't, uh, you know, come off of that time.

Dr. Kevin Christie: Okay. And then I want to just switch gears a little bit. Cause I get it.

There's, you know, some of the docs listening here that are, are rehab heavy. You know, rehab can get very complicated, like I get it, you know, if you're some chiropractors are doing post surgical rehab, uh, you start adding things like DNS and neurodynamics and the Liebenson stuff [00:19:00] and all they get, I, I get it, like some of these chiropractors are Spending 30 to 60 minutes with patients doing rehab and it gets very intricate and understanding the, the patient's bodies and progressions and regressions.

Like I, I get the, how, how in depth they can get. So I don't want to, uh, discount that. So I do understand it. And then when, before we hit record, you were kind of talking about how even you were reluctant at one point to, um, delegate. The, the rehab side of things. Can you talk about that, uh, kind of progression for yourself?

Taylor Premer, DC: Yeah, I mean, honestly, like the hard truth and the thing that I kind of had to reconcile is early on, this was really crappy at assessment, to be completely honest with you. And so I think that that was a little bit difficult because I was just trying so many things because my assessment wasn't very good.

I was having to do so many things just to try. get anything to change. And so, um, it took me kind of looking in the mirror [00:20:00] and, and really getting a little bit more specific on my assessments in order to feel comfortable delegating because I didn't want to pull back the curtain all the way, you know, and I didn't want to show that maybe I didn't have everything figured out.

And so once I kind of let down my guard on those times, it was, it became a lot easier and I mean, honestly, like, you know, I was the, I was the fifth chiropractor at the time, brought it in. And so my patient wasn't very busy. I had the time. And so I said, screw it. I'm just going to go all in. I'm going to, I'm just going to, you know, ramrod this, and I will spend those 30 and 45 minutes with these patients.

But then when I started to realize really quickly is one, uh, you can't make very much money when you see people for 45 minutes and take insurance, that's just the reality. And then two, my results really weren't that much better than people that were seeing patients for 15 minutes. You know, just because you see people for an hour doesn't mean that your results are that much better.

And so, uh, I came to those realizations and then I just started getting better at my assessment and actually taking the time to get good with assessing, paying attention, uh, having a little bit [00:21:00] more of like a playbook or a strategy that, uh, kind of strategically look through the body. And that way I can be more specific in my assessment.

I would still have time to then manipulate, do my manual therapy, maybe do a couple of rehab, but then have more of like a specific, Hey, I need you to work on this thing specifically. This is what I would suggest for the rehab. But then, you know, as you start to trust the interns more in the CA, then. You can kind of give them more of a, Hey, this is what I need to work on.

I don't care how you do it, but this is what I need to change. And this is why, you know, this is the assessment that I found it in. This is why it's affecting their case. And so, you know, you can kind of have a little bit of gray areas there as far as, uh, progressing, regressing, uh, because I knew that it was, you know, anything in that area is going to be really good.

And so that was kind of my experience in the first year. It was just a lot of me. Like I, I spent a lot of time trying to figure out myself, trying to figure out what it looked like in these four walls in the treatment room and, and. You know, I learned so much, but I also learned that it was okay to [00:22:00] delegate number one, as long as you're paying attention, as long as your assessments are very clean.

Uh, and then, you know, whatever, if you send it back to an intern or CA and it doesn't go perfectly, you still got time for them to come back. But, you know, that kind of brings us in, hopefully Mark will appreciate, Mark King will talk about this, but having a plan together for the patient. That's integrated together.

You know, if you have a plan that looks like twice a week for 3 weeks or whatever that looks like, then, you know, you do your assessment. You make a clinical leap of faith. You go down that route. You have the intern go down that route. They come back and things are not going well. Well, okay, no problem.

Then go back to my assessment, reassess, re look at things. Maybe I missed this little piece here, or maybe we do need to change things up on the rehab side. Then it's a point of education for myself. It's a point of education for the intern. And then things go really well. And honestly, the patients feel very taken care of, you know, in a world of medicine where, uh, you know, doors are closed and, and there's not much of a plan and, you know, nobody talks to each other to actually have a place that [00:23:00] everybody's talking together and everybody really understands them.

They feel the experience with the patient is so much better and the results are so much better along with that.

Dr. Kevin Christie: Yeah, you know, I want to touch on it because you kind of got me thinking there when you mentioned about the assessment, uh, if you were to kind of categorize three things here, one would be your assessment, two would be manual therapy, and let's just put under manual, anything like soft tissue, manipulation, palpation, and then you throw in the third thing, which would be rehab.

It's almost like early on in this process as a chiropractor, I think some chiropractors get heavy on the rehab because maybe the assessment. Isn't where it needs to be. And so they're almost like spending the time and doing the rehab to try to cover that up a bit.

Taylor Premer, DC: Yeah.

Dr. Kevin Christie: And I'm not saying everybody's like that, but I think that it happens.

Cause I, I mentioned the book a lot and I've done it recently on the podcast, but thinking slow and fast by Daniel Kahneman, he talks about system one thinking and system two thinking system. One thinking is. [00:24:00] Two plus two, it's just an easy reactionary thinking. No, no sweat doesn't burn any calories.

System two thinking is where you really have to grind your gears to think through something. And I, I try to talk to younger chiropractors with that first five years, six years, seven years. Um, you're going to be burning through system two a lot because you don't have the clinical experience yet. Even if you're really good in year three, you're just burning through that.

Uh, my, my, my words of wisdom now that I've been doing it for almost 20 years is that You will get better. Most of your day will be system one thinking and you'll have the occasional system too. So keep getting better. But I think what happens is, you know, to get really good at the manual component of what we do again, palpation, manipulation, soft tissue to get really good at the assessment that takes a level of mastery.

Um, and a lot of people. Don't dive into that mastery and realize, like, I'm just going to dive headfirst in [00:25:00] this and it's going to take me five years or whatever. But once I break through that and I'm 32 years old or whatever, I'm going to be a master for that age at palpation manipulation, at soft tissue, at assessment, and then, like, Brett talks about all the time as being a sniper and really now cherry picking a handful of things that the rehab will take care of and give them some things at home and not like overwhelming him with two things.

And so I can see that those three variables being kind of manipulated by chiropractors like, well, I'm weak on assessment. Let me overload the rehab. And is that what you kind of went through as well as your development as a chiropractor?

Taylor Premer, DC: Absolutely. Absolutely. I think that so many people discount the manual stuff that we do just because honestly, they're not good at it yet.

And so, like you said, it's an overcompensation, you know, I hate to say it, but there are millions of people that can teach a kettlebell swing or to teach a, you know, a side bridge or I mean, [00:26:00] no offense to Danielle, but she was a checkout girl at Walmart and she is a master at doing these things. But, you know, I think, uh, there's a certain level of people coming in to see a chiropractor that there was a preconceived notion of what needs to happen and that has to involve these.

And that's just my personal opinion. I'm a chiropractor's chiropractor. I love manipulation and I love manual therapy. And I find myself trending more towards the manual things. Now that I have that kind of escape net of the intern to be able to do those things. And so to your point, exactly. I think what, what has evolved maybe in the last two years with me is conscious of kind of that system to thinking of, okay, well, here is this, whatever it might be, a trigger point, fascial adhesion, whatever it might be.

I think that this is probably going to get better with rehab. So I'm going to leave this alone. That's going to be like my auto. Okay. So then that's going to come back versus I feel this. This needs to be ART. This needs to be needle. This needs to be, you know, more of a sniper approach. Like you were [00:27:00] talking about this, this needs manual therapy and it's going to clear up really quick.

This other stuff is going to clear up with rehab. And so kind of like almost delegating my own, uh, techniques in my head, which is clinical decision making and, and, uh, the functional triage that we talk a lot about is being able to make those decisions just through feel through, through that, and honestly, to your point, it just Takes time to develop that.

And so I think, uh, if I, if I could change a couple of things just from my first couple of years of practice, it would be that spending a little bit more time on the manual side and, and being okay with failing a little bit more versus just, oh crap, I really don't know what's going on. So I'm just going to pick 14 DNS exercises and hope to God something happens, you know, and, or, you know, I'm just going to keep rubbing on this thing until they feel better, whether they like it or not, you know?

And so, yeah, I, I think it's a hundred percent, you know, in this, in this Uh, unfortunately, the climate now is, is trending more away from the manual side, which is, uh, I think, uh, it's, I think it's a big mistake by chiropractors, PTs, athletic, whoever you are, if you're a [00:28:00] bodyworker period of getting more away from the manual therapy, because maybe the research is a little bit unclear of the mechanisms.

Uh, but again, like all you can do is just continue to pay attention to your patients, continue getting better at assessing, I think having a systematic approach of assessing assessment. Is what gets you there. Meaning my assessment, your assessment, Kevin, my assessment, breath assessment, they're going to look differently.

There's going to be some overlap for sure, but you know, you may, you may value things a little bit differently than I value things in my patient experience, but at the end of the day, if there's a reason why you're going down that track and you're paying attention and you're learning from your mistakes, you're learning from your failures.

Your, you know, successes, then you're going to be so much better at the end of every single day, let alone week, month, year, several years. And, and I think that that is a, that's an art that maybe, uh, people aren't willing to go through the sacrifices and the struggles of getting really good at this stuff.

And I think it's a shame because. There is nothing better than these tools that we have with us. And that is really, [00:29:00] to me, what classifies being a good chiropractor, a good healer in general. So yeah, I, I,

Dr. Kevin Christie: I had a patient actually talked to me about this. So he was pretty, very successful, uh, tech entrepreneur.

And he's like, you know, I come to you just like some people come to my businesses is for a core competency and every business has a core. Product or core competency. And he was like, for you, I come because the manual therapy is like, yeah, you give me the rehab or I do the laser or whatever that that's, that's fine and all that.

But I, I come to you because of what you're able to do with your hands and do it in an efficient manner. And, and that's where I think a lot of chiropractors are losing that. And I, and again, I want to reassure the younger chiropractors is that if you, if you work really hard to master the palpation, the soft tissue palpation, the joint palpation.

The, the manual, the manipulation and all that again, whether you use ART, dry needling grassed, and if you get really fricking good at that and you become just a killer at that, [00:30:00] then people are going to come in for that. And then you're going to also give them the rehab, cause that's going to help them get results as well.

If, if all you are really good at is exercise and frankly, not good. With the palpation assessments and the, and the manual, um, they, they can get that in a lot of places. So it becomes harder to differentiate yourself in the marketplace on a scale that will grow a practice that will then provide freedom.

Now, yeah, like I could open up a. A rehab only practice and get some people in there that value that and don't care about the manual. There's definitely that, but to build that thriving practice where your clinic is able to see 100, 125, 150, 200 people in a week, you can put a team around you so that you can do this for 30 years.

Um, that's where the, the sweet spots going to be, um, because we're seeing too many people burning out, I think, cause they're doing too many things and it, and they're not seeing a light at the end of the tunnel.

Taylor Premer, DC: Right. Or, I mean, they're [00:31:00] just not making a professional income, you know, like that is, that is a major thing.

You know, I, I completely understand, you know, if you're a cash practice and you want to see people for an hour, that's great because you can charge your hour hourly rate, but we're in small town, Missouri. And so like, we have got to see patients. Like I have got to see a little over a hundred patients a week for me to make what I want and for me to affect the change that I want to train in the community.

And so, um, I, again, like, but you can't devalue You know what we do every single day. And I think it goes back to having a plan for your patient having a plan for yourself. I mean, like, just, you know, figure out what you want in this life in this career, because it may be different than that. You know, you may want to spend an hour with your patient.

So you may want to, you know, go into the gym and do these other things, do programming for them, do all that kind of stuff, which is great. That's not what, you know, You know, gets me going in the morning, specifically, but if you don't have a plan for developing that and creating that, then I mean, now you're going to burn out and now you're up fifth grade.

Dr. Kevin Christie: Yeah. And I think, you [00:32:00] know, on the topic of say the, the cash based rehab, um, Cairo, that's doing 30, 60 minutes, getting more power to you, you know, I talk a lot about the hourly capacity. Like you have to be able to earn a certain amount of money of revenue per hour, per doctor. And so there's a lot of, um, Cairo's that aren't doing.

Well, with that, and then there are some that are charging a lot, you know, three, 400 an hour. The tricky part about that is, um, too many are trying to do that right out of the gates. They haven't done enough to position themselves as an expert to command that amount. So it's, it's kind of putting a cart before the horse, which is a little tricky.

And, and that's, that's definitely got its flaws and, and, But hopefully you get to the point where you are just, like you said earlier, a savant, if you can get to the savant level, then you can charge more. And so typically it's progression to get there. Um, but what makes you so unique that you can command four or 500 an hour again, at scale to do it to where you're [00:33:00] having not only a good hourly capacity, because that's one thing you got to do that.

But. If you're only seeing 10 people in a, in a week, or you can only see seven people in a day, that's going to have its own capacity limitations to be able to put a team or hire, and then free yourself up to be able to take vacations or travel like you guys do, or frankly, just, um, be able to cut down your shifts to four days a week down the road if you want.

And so it, it becomes a come pigeonholed a little bit. And that's what I'm worried about for a lot of the younger chiropractors.

Taylor Premer, DC: Well, and it kind of brings up the whole point of this discussion to Kevin is, you know, if you, let's say you do value, you think patients need 30 minutes of care. Well, if you can build a team around you, they can take 15 minutes away from you.

You can spend 15 really, really good minutes with a patient, give them a really good manual therapy, give them the rehab that you think. And then you can just add on that 15 minutes, even more, you know, What are that looks like in your practice for us? It's it's, you know, our intern program, you know, like [00:34:00] our goal is for patients to be here about 20 minutes.

So however that looks like that day, you're with the doc for 15 minutes and you're with an intern for five, or maybe it's five minutes with the doc and 15 with the intern or the CA. Uh, but I think, you know, if you, if you, you don't have a plan, if you don't have an idea of where that case is going early on, then it's really hard to just make audibles and kind of make that all fit.

And then the next thing you know, you're way behind and your capacity issues and patients are unhappy because they're with you for, you know, whatever, an hour and they're got to go back to work or, you know, whatever that, or they don't feel like they had enough time with the doc or it's just a, it's a delicate little balance.

And so making sure the product is really good is, I think what it's all about, you know, that's what makes Apple, Apple or whoever company it is, their product is so good. But then everything around surrounding it is also amazing.

Dr. Kevin Christie: Yeah. Our patients are in here usually 20, 30 minutes, unless they're just like a maintenance care.

And, uh, yeah, they get doctor time, they get, uh, intern time, or if we have a rehab [00:35:00] tech and they're getting all the things that they want, they like the team atmosphere. And I, you know, not everybody's going to be able to afford a team early on. And I get that. Well, our point is here is to start building the process to where you have certain revenue.

Numbers where he's like, if I get here, here's my profit, this is when I can bring someone on. Or if you've been out of practice for three to five years, the schools are different, but you have to be out a certain amount to take on interns, you know, like start planning for that ahead of time and have a vision and be open minded to delegate.

I think that was something that you had to overcome. Like you mentioned was, was the psychology of, of delegating and it's a different level of leadership. That I think some people are afraid of as well, because yeah, you, you have to train and you have to mentor a person to be able to do that, but it really frees you up in many ways.

Taylor Premer, DC: Very true. I think you just got to be a little bit okay with maybe the results not being perfect. You know, I'm Brett's kind of perfectionist. I'm a little bit myself. And so, [00:36:00] you know, just being okay with maybe things not going perfect right away, but building towards that perfection, you know, but you can't get to that point if you don't have conversations with them about what they did good, what they did bad, what they need to improve on, what you need to improve I think that, you know, if you are just You know, quickly out of practice, just maybe even starting to put a break in your schedule where that hour a day, you know, down the road and three, four years, that's going to be your intern time to educate, or maybe your new, uh, new doctor education time, or maybe your new CA education time and, and just like starting to just build that in your brain and start, you know, You know, take that hour to educate yourself, build a curriculum, like start putting PowerPoint slides together of like, Hey, when we talk about the foot and ankle, here's what I really, uh, here's what I'm valuing right now and what I'm seeing, and then this is what I'm really want my new associate, my new CA, my new intern to know when it comes to this specific condition, this specific case, uh, even just body parts and things like that.

And so I think that would be a really good use of your time. Because then you can double down with that information. And if you want to use it for marketing [00:37:00] events, uh, you already have those PowerPoint slides done. That way, if you get asked on a Tuesday to do a marketing talk on a Wednesday, you don't have to scramble around that night and put a bunch of stuff together to build it.

And so I think, uh, that would be a very good use of your time. I was lucky. We teach a course at Maryville, which is a small school here in St. Louis of the pre PT program. And so. That's what I did. I just started using the Maryville PowerPoint slides of biomechanics and anatomy to then just build my intern slides to then use for education, which then I'm going to use to teach if I teach seminars down the route or if I, you know, I'm having a, I have a talk with the football team in Troy here in a couple weeks and so like, I already have just a bank of things that I I'm built upon in the last five, six years that now I can pull from to, to start doing it.

And it forces yourself to get better, you know, like, okay, foot and ankle cases. Here's kind of where my gaps are. Okay. Where, where should I, maybe I need to get Thomas Schaub's book and start going through human motion again. Or, you know, here's the pictures that I, I kind of forgot about with anatomy. And Oh, by the way, here's my MDT notes on here's the most common reductive [00:38:00] movements.

ART. Oh, crap. I forgot about the soleus move or whatever it might be. And just start building that bank and library for your own self, but then for yourself down the road.

Dr. Kevin Christie: This has been great. Where are you guys traveling to next? And what seminar is it?

Taylor Premer, DC: Uh, well, Brett is headed towards, uh, to Britain. Uh, it's great Britain with a family vacation.

So I got a couple of weeks of just myself, but then, uh, we've got a DNS exercise to course in Raleigh with, uh, Lindsay Mooma, uh, that we're super excited about. Uh, that's the, the, in August. The last weekend in August, we're actually kind of splitting up. Uh, Brett is teaching a DNS, uh, baseball course in Chicago.

And then, uh, I'm doing the, uh, R2P, uh, alumni track on, on that Saturday, uh, where I'm going to talk about high school marketing and, uh, treating acute injuries and, and care for them and stuff like that. And so, uh, We've got all sorts of courses coming up. So we took a little bit of a break. We just had the DNS world Congress, uh, here in, in, uh, St.

Louis, which went great. We had 150 people, 14 instructors. And so that, that took me a couple of weeks to kind of, uh, come down from and, and, [00:39:00] uh, you know, recuperate a little bit, so, uh, but anyway, yeah, we had a, we have a, a new big intern group coming in, in the fall, uh, that we're super excited about. So we're already getting things lined up as far as onboarding and, and what that looks like.

Uh, you know, just trying to improve that experience for them and for us every single time, every time we get a new group coming in of, of, okay, here's what we, we kind of messed up on the last time. And here's, here's kind of why we want to approach it this time. So yeah, we're, we're super excited. So

Dr. Kevin Christie: good, good.

And where can they find out more information for these courses that you got going on?

Taylor Premer, DC: Yeah, it's Gestalt education. So gestaltedu. com. And, uh, yeah, we got our podcast up on there and, and a bunch of those, we've got a really cool podcast we're working on and hopefully, uh, while Brett's in Chicago, I'm going to fly out there and, and, uh, we've got a really amazing orthopedic surgeon that we're going to interview.

And, uh, we've got a bunch of, a bunch of good ones coming on. We've got to get you back on Kev. Talk about, talk about your new experiences. So,

Dr. Kevin Christie: yeah, are you going to be, you guys are gonna be in, I know he will, but are you going to be at a just a thon, the MPI just a thon? Oh,

Taylor Premer, DC: absolutely.

Dr. Kevin Christie: A just a thon is just marked

Taylor Premer, DC: on the calendar.

Yeah, there you go. We'll [00:40:00] do it then. Yeah. So a just a thon is just marked on the calendar. That is literally the Superbowl of, uh, of courses. And I've been lucky. I think this is going to be my 10th, maybe my 11th time taking, uh, being there. And it is just, the atmosphere is unmatched. Uh, the last two years we started doing a thing where, uh, I guess salt hosts a tailgate party on a Saturday night.

And so last, last year we had, uh, we had a stock trailer out there with a bunch of, uh, alcoholic beverages and music playing. And we did some interviews on there and, oh man, it's amazing. So, uh, now with the doctor track too, I think that's such a cool thing that, you know, even if you don't want to be in a room full of students, uh, you got, You know, a room full of doctors talking about manipulation and talking about palpation.

And, uh, it's just, uh, it's an unmatched seminar. If you haven't been, you have to go.

Dr. Kevin Christie: Yeah. Actually, believe it or not, this will be my first adjust a thon. I've been to all the other things and this is the first one. So I'll be there. I'm excited.

Taylor Premer, DC: I love it. I love it. I look forward to seeing you, my man.

Dr. Kevin Christie: All right, cool, man.

This was great, Taylor. I really appreciate your time.

Taylor Premer, DC: Yeah, no problem, guys. Thanks for having me on, Kevin. And, uh, yeah, we'll talk [00:41:00] soon, hopefully.