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Dynamic Chiropractic – April 22, 2008, Vol. 26, Issue 09

Providing a Service for the Times

By Jeffrey S. Solomon, DC, DCSI

You don't have to be paying much attention to notice the pace of life is picking up lately. People have more responsibilities packed into an average day than at any time in history. That being said, people often let things go that are important to them because there is just not enough time in the day.

Most of the time, individuals are limited by transportation and geographic factors.

The unfortunate result of this continuous lifestyle is that too often, there is not enough time to get to a chiropractor (or any other doctor) unless it's a dire emergency. Could this scenario be limiting a chiropractor's success? It limits many a businesses success. That's why I am a mobile chiropractor.

My name is Jeffrey Solomon and I have been practicing chiropractic since 1982. I had a crazy idea back in the late '80s that has turned my world around and brought me great satisfaction and success as a chiropractor. A passing encounter with a sarcastic patient triggered the thought of putting a chiropractic office in a truck type of vehicle. That thought followed the patient blaming me that he was still hurting because he was not getting treated. He complained, "You need to come to me. I'm a busy guy." I laughed and told him that was impossible. But the patient's comment struck a nerve. As I walked down the hall to my personal office, I looked into my exam room and a proverbial light bulb went off. What about an office in a truck that goes to the patients - what an interesting concept! I was fairly certain someone should have done it before. I became obsessed by the concept and had to find out who was doing it. Thorough investigation revealed it had never been done before.

I was still fairly new in practice and while things were progressing well, I could not imagine going through life not having attempted to make a mobile practice work. It just made so much sense. So I spent about five years leafing through truck and RV magazines, scrutinizing equipment specs to see what would fit inside a large vehicle, figuring out how to power everything inside, creating a marketing plan and acquiring some financing. The truck needed to have everything you would have in a traditional office. What emerged was a 30-foot-long, 240-square-foot, state-of-the art, custom-designed chiropractic office on wheels.

Things literally got rolling in late 1992 and within 15 weeks, I was treating 100 patients per week on the road (while still maintaining my traditional office) and mobile chiropractic was profitable. For almost four years, I exhausted myself running both practices, so I tried to put a couple of associates in the mobile practice in my stead - unsuccessfully. Having discovered how profitable the mobile practice was and how much fun I could have doing it, the right thing to do was to dedicate my full-time efforts to the project and open up the doors of this concept for others. I considered it a win for the public, for patients, for doctors and for me. So I sold my traditional practice in 1997 and have been enjoying a doctor's life on the road ever since.

Presently, I have four mobile chiropractic offices and there are a number of other mobile chiropractic operations around the nation. They vary in methods of delivery, but the general approach is the same. We all are selling the public the opportunity to take better care of their bodies without having to go through the various obstacles that discourage them from visiting the chiropractic office. There are common daily barriers like having to find time to make the appointment and taking the time to drive to our office. And of course, there is the time in the waiting room. There are a lot of people who want to utilize chiropractic and take care of themselves, but with the hectic world we live in, they just don't take the time. What's great about bringing the service to the patient is when you pull right up to where they are and say, "I'm right outside and here for you." All they have to do is walk out the door. Mobile service removes many of today's obstacles.

Monday through Friday, I serve patients around Miami's corporate and industrial centers. I repeat two routes twice a week and a third route is closer to where I live and done once a week. For greater availability, I also see patients by appointment in the evening and on weekends at home, where the mobile office is parked. (On the road, I work off generators and at home I plug a land line into the house for power.) It's important to note we don't go house-to-house. While that may be practical in some communities and for some chiropractic specialties, it's not practical for maximizing profitability in the South Florida marketplace. A typical stop might have the mobile office outside of the Miami Herald newspaper or at a Florida Power and Light facility where I make chiropractic services available to everyone working there; others from outside that business may come to the mobile office at any particular site we serve. I don't typically make specific appointments, but generally we have consistent times when service is available at different locations.

Patients expect me on common days and ranges of time. When I arrive at a location, my assistant (who travels in the office) calls and informs the appropriate people of our presence, or an e-mail goes out to tell patients we've arrived and how long we will be there. We inform them that if they have time and need to be adjusted, they can come out for care. Any number of people may come in and see me while I'm there. Treating the patient in the mobile office isn't any different from seeing someone in a stationary office. As is standard practice in all chiropractic offices, we do patient consultations, chiropractic and physical examinations, chiropractic adjustments, therapeutic procedures and diagnostic studies as needed. Exercise plans, nutritional advice, lifestyle counseling and even supportive health care products and supplies are easily provided out of the practice on wheels.

The office itself is compact in general, but not so much that it doesn't have all of the trimmings of a customary office with plenty of room to move around comfortably. There are two adjusting tables, a reception/waiting area with countertops and seating, a computer with wireless access and printer, display cases, storage space and a bathroom. The most recent turnkey mobile unit cost about $145,000. Financing has been easy with both leases and business loans. Each unit has an effective working life of 15 to 20 years depending on how it's maintained. The cost of oil changes and gas and some occasional mechanical repairs is equivalent to the amount you would pay for electric and maintenance in a traditional office. This creates a substantial facility cost savings when compared to the average fixed-site chiropractic office. Personnel costs also are significantly reduced, as it takes less staff to operate. I am aware of a few smaller, less-appointed models that have been created by other chiropractors in the U.S. with prices around $80,000. An X-ray machine was installed in my first three units, but they were pulled out because their practical use in my approach to practice was not efficient. In light of the ease of referring a patient out for appropriate diagnostic studies and especially with the benefits of MRI, eliminating the X-ray and developing system has been an improvement in efficiency without undermining the quality of care.

Services are provided Monday through Friday at corporate and industrial sites located in the prime business sectors of Miami-Dade County. About 20 to 25 patients a day are treated utilizing the help of a CA who also is a massage therapist. We choose to serve locations where the businesses provide good insurance with good reimbursement rates; out-of-network plans are preferable. Approximately 95 percent of our revenue is from insurance. While cash is accepted, it's only about 5 percent of the business. My specialty in sports chiropractic lends to the use a combination of full-spine and extremity adjusting techniques along with an assortment of therapeutic activities. Most visits last about 15 to 20 minutes, with some additional time required on first visits and re-examinations. Promoting a mobile practice is different than that of a traditional practice. Advertising and marketing are not done to attract the masses, because it's generally not practical to make individual house calls. The goal is not to be driving all over the place. Traditional practices typically utilize shotgun marketing methods; you advertise in the Yellow Pages and hope a certain number of people in your neighborhood will see it and come to you. Maybe an ad is placed in the local newspaper, sent out in mailing, or perhaps you do something on the radio. Essentially, most chiropractors try to recruit patients from about a three- to five-mile area around their office.

This traditional approach doesn't fit a mobile clinic whose location changes daily. Instead, we focus on marketing to groups of people at a single location or a group of locations proximate to each other - basically corporate and industrial sites. I do what I refer to as "sniper marketing" - aiming at a specific target location. The targets chosen are companies with good insurance reimbursement plans.

Often, I call a target company to find out what type of insurance is provided to the employees. If the benefits are suitable, I will either use networking skills to try to find someone who knows an employee within the company or make an introduction on my own to a decision-maker - the higher up the corporate ladder the better. With assistance through networking, or on my own, I tell the contact about our services as a way of providing "convenient wellness" and offer our services while sharing the variety of benefits we provide. Offering courtesy introductory programs that include safety talks, health awareness presentations and health fairs are what often leads to establishing the availability of the onsite chiropractic services for the employees. If a company has a newsletter, we might place an ad.

The mobile office itself is of great advantage to advertising exposure. Like the broad side of a barn, the RV-turned-office serves as a moving billboard, with literally thousands of drivers a day seeing the office on wheels around town. The focus of our marketing efforts is the convenience of the practice. Our tag line says it all - "Tired of Driving? Tired of Waiting? Mobile Chiropractic: Where the Doctor Comes to You."

Taking health care to the public has become my life's mission. I feel strongly about the benefits of a health care model that brings service to the true stakeholder - the public. Care is provided as it was done more than 100 years ago, although in higher volume at sites where people congregate. Modern transportation options and equipment technology, transportability, availability and affordability lend to ensuring the success of such an endeavor. This delivery model can increase the effective provision of health care service and improve the well-being of the population throughout the U.S., especially the underserved in both urban and rural communities. It's economical, productive and profitable. It's time to serve the public better. It's a good time to take health care back to the streets.

Dr. Jeffrey Solomon is a former president of the Florida Chiropractic Association and the ACA Council on Sports Injuries and Physical Fitness, and served as a staff chiropractor at the 2006 Winter Olympics in Torino, Italy. He is the president of Mobile Chiropractic of Florida Inc., and can be contacted at .

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