According to Wikipedia, the term business cycle refers to fluctuations in production or economic activity over several months or years. These kinds of business trends tend to span a period of several years, and the same may hold true for patient volume/revenue cycles in chiropractic practices; however, more common are shorter cycles that can be as brief as a few months, weeks or even days. These natural and inevitable dips in practice volume do not necessarily indicate a negative trend worthy of panic or despair, assuming you can move beyond the prevalent thinking that such dips can be "fixed" or avoided through better control, firmer management, stronger affirmations or more worthy goal statements.
Outdated myths sustain this control ethos and support the notion that a dip in volume is a sign of a defect in your philosophy, belief system, procedures, purpose or intention. Many chiropractors have adopted the point of view that "downs" can never be part of a successful practice, that progressive, unlimited growth is the only viable business model, and that they are - at all times - in total control of everything that occurs in their practices. This philosophy and the corresponding tactics promoted by a number of sources in our profession, has resulted in a great deal of disappointment and stress for many.
Closer to reality is the fact that fluctuations in patient volume and revenue are inevitable, should be expected and (be sure you are sitting down) can actually be stimulating for a practice. Seeing your business through a cyclical lens will help you maintain a more realistic and sustainable perspective on practice growth and resist buying into the fallacy that success always means more.
If, during the inevitable slow times (days, weeks, months) in your practice, you keep moving forward with appropriate strategic actions because you love what you do and genuinely want to make a difference in people's lives, you can trust that the tide will turn for you. The key is staying in flow during the natural ebbs in business by making them work for you, rather than against you.
What to Do During an Ebb: Eight Action Steps
Following each ebb is a return to flow. The tide recedes and comes back in. The river is low or dry until the snow melts and it once again runs full. We even see it in politics. One party rides higher for a few years or terms, and then the other. During an ebb, the tendency is to pull back and become conservative in the use of resources. It may seem counterintuitive, but an ebb is often the best time to invest in yourself and your practice. The tide will shift when you change your own focus and attention. Instead of fretting, stewing, stressing and becoming anxious, work toward being in flow. Here are eight actions to consider when you find yourself in an ebb.
1. Consider numbers in context. An ebb in patient volume or collections is not necessarily a trend. Two days with an increase in cancellations or no-shows does not constitute a trend, nor does one week with a drop in new-patient referrals or office visits. Review your numbers for the current month and quarter and compare them with the same time periods for the past several years. You may find that the ebb you are experiencing is seasonal (despite prevailing wisdom that a practice is not seasonally or demographically influenced) or you might simply take comfort in noticing that your practice has always had ups and downs - and probably always will.
2. Examine your attitude. When you find yourself in an ebb or slow period in your practice, what's your typical response? Do you become panicky, upset, worried, frustrated or pressured? Do you lose concentration and not give the patients right in front of you your full attention because you are fretting over earlier no-shows? Do you waste time throughout the day when you aren't seeing patients by becoming distracted with minor issues or riding your staff about getting the patients back in for care? All of these emotions and behaviors are signals that a shift in attitude is in order. Here's a short story about a chiropractor who, upon experiencing a slow period in her practice, was able to shift her thinking, reframe the situation, change her attitude about how she viewed the challenge, and ultimately understand exactly how to manage the ebb.
Dr. Allen* had been in practice for more than 20 years when she experienced a 15-20 percent decline in numbers over a period of a few months. Naturally, she was concerned but also frustrated because she likes to stay busy. Because her practice had been humming along pretty nicely for so long, she also resented the fact that she now had to become more active in business and marketing decisions in order to turn the trend around.
She drew an interesting parallel of having an adult child return home long after she felt she was "done" with child rearing. Yet she knew that if something like this actually happened in her family, she would embrace her child with open arms, an open heart and probably even an open wallet. Once the doctor understood that this was similar to what her practice needed now - attention and TLC - she realized how much she loved practicing her profession and embraced the idea of doing what was needed in order to reinvigorate it.
If, like Dr. Allen, you determine that the ebb you are experiencing is neither temporary or minor, then obviously you will need to revisit your business strategy, evaluate your marketing efforts and take actions steps to get back on track. Having said that, notice that most of the tips outlined in this article are relevant to large turnaround efforts as well as to smaller ones.
3. Refocus your attention. When you experience an ebb, where does your attention go? Does a downturn monopolize your thinking and move you into scarcity mode, or can you take a deep breath and remember why you do what you do? This is easier said than done, but to the degree possible, shift your attention away from the current ebb and toward positive action steps you can take to help turn the tide.
Move away from overanalyzing yesterday's no-shows, last week's less-than-robust collections, or last month's dip in bottom-line profitability and focus instead on what's going well and how to get on track with your action plan. Think about what you value, what excites you about being a chiropractor, and the positive results you have with patients. Paying full attention in the moment to a project, business task or a patient, or taking a quiet moment for meditation or prayer, increases your capacity for concentration. It also lifts your spirit, expands your inner boundaries, and makes life and work more meaningful. You may be surprised to find that as you shift your attention, business begins to turn around.
4. Use downtime wisely. If volume is down, ask your staff to rearrange your schedule so you have one or two half-day blocks of uninterrupted time to address compliance issues, clear the decks of paperwork backlog, update your Web site, work on marketing projects, or engage in a staff training activity. Focusing on these activities with the level of attention they deserve (remember, these are important business functions - although no doubt you'd rather be caring for patients) will help stabilize and grow your practice in the long run. Although you don't have to personally do every business function in the office, you are ultimately responsible for making sure that your staff has the training and resources they need to do their jobs effectively, as well as for setting business strategy and marketing direction, keeping an eye on financial solvency and developing yourself as a good leader.
5. Update your strategy; embark on projects. Dr. Zelar* used a slow time in his practice to create a yearlong, quarter-by-quarter strategic plan. His plan included goals and projects (and action plans) to help him achieve these objectives. His intent was to design a practice that would stay steady during future ebbs, develop his staff into a high-functioning team, purchase and implement an electronic health record/documentation system, and enhance his rehab services. These projects were phased in over specific quarters so that the office would not become overwhelmed and end up with many incomplete projects. As a result of Dr. Zelar's careful strategy and planning, he and his team achieved their goals while staying focused on delivering quality care to his patients.
6. Filter the psychobabble self-talk. When you buy into the notion, attitude or paradigm that an ebb in patient volume is a signal of impending doom, lack of purpose on your part, insufficient belief in what you are doing, philosophical disconnect, or an incomplete adoption of someone else's "program," the best thing you can do is pause the tape that is running in your head. Step back and think (or, better yet, write down) what is authentically true for you in terms of purpose, values and goals for your practice and your life.
7. Avoid comparing yourself with others. If you mention to a colleague that business seems a little slow and she, in return, tells you she's busier than ever, you will likely feel a bit of angst. However, keep in mind that you could have the same conversation with the same colleague three months from now and find your roles reversed. No one is immune to fluctuations in practice.
8. Take a vacation. Get away, even if just for a long weekend, to renew yourself. Of course, you'll initially tell yourself that you can't afford to go, but do it anyway. A change of scenery and a change of pace may be the best way to turn the tide.
Take the Right Approach
What have you paid attention to in the past year and how has that fashioned your results and shaped where you are today? What is meaningful, productive and positive versus negative, unproductive, dispiriting or even destructive? American philosopher and psychologist William James said, "The greatest weapon against stress is our ability to choose one thought over another." The critical choices you make on a daily basis relative to your thoughts, attitude, perspective, attention, focus and behavior determine how well and how quickly you will emerge from an ebb in your practice. With the right approach, you may find that you not only withstand inevitable practice downturns; you may also come out stronger in the end for your efforts, confident that you are in the right profession and with a more secure future on the horizon.
*Names in this article were changed for client privacy.
Click here for previous articles by Shelley Simon, RN, DC, MPH, EdD.