–Some people ask, “why we even bother to try and teach and mentor chiropractic students on what ‘real world’ practice is all about”?  The reason behind their wonder?  ”Students already know everything”, they say.

Admittedly, the sarcasm is often times well-placed… The fact is you can read all you want about how to fly a plane, but until you go out and do it for real, learning directly from a pilot whose actually done it thousands of times before, you have no clue as to what it really takes to fly. As Dr. Tom Owen puts it, “knowing is not going”.

While at Logan, my classmates and I would discuss what our future practices were going to look like someday… and what our lifestyle would be like as doctors and no longer as starving students.  But none of us knew.  The things we did “know”, and just accepted as undeniable truths, turn out to be the same myths that students still accept as undeniable truths even today.

Graduation happens… And then what?  We quickly if not rudely awaken to the fact that it is not at all like we dreamed of while sequestered in our “theoretical” environment on campus.

The myths I’m referring to are those relating to what it takes to be a successful doctor of chiropractic, and learning or assuming what it takes to build a thriving practice to help (far) more people (than what you are able to right now).

The irony is this “knowledge” leads instead to stunted success and to limited growth in practice.

Reality is, of graduate DCs who REMAIN in practice, many fight just to make overhead.  Others maybe produce enough to provide for their family, without much left over.  Some manage to build something they’re proud of, but practice is still missing something…

It’s not as fun, and it’s more stressful than they expected or dreamed it would be.

And I now know why this is….

The students who believed the myths become doctors who still believe the myths.  They still have not figured out that the myth is just that… a myth.  It’s what they know that ain’t true that hurts them.

If you’re reading this and you are still in school, you must not buy into the myths.  Doing so will be detrimental to your future.

If you’re in practice, and it’s just not as what you at one time believed it would be, you must identify which one(s) you accepted and are still believing as truth.  I won’t repeat the oft-used “definition of insanity” here, but have you reached a point yet where you’re tired of the headache you’ve developed from beating your head against a wall?  Because as long as you adhere to the same myth, the wall ain’t moving.

Once identified, correct the mistake by applying truth based on sound principles and on the required attitudes, actions, concepts, and procedures.  And watch what happens next…

School prepares us well with basic doctor skills, and to pass our boards.  We graduate as competent DCs, knowing when to treat and when to refer.  But school is not where we find the knowledge and skills necessary to  grow a self-sustaining referral practice in the real world.  It is, however, a place where many of the myths alluded to originate or are promulgated.

Is it any wonder why so many of our colleagues struggle to make it when it should not and need not be that way?

Do something about it!  A Chinese proverb says, “The best time to plant a tree is twenty years ago.  The second best time is now.”  Correct the mistakes, re-route the ship.  I promise you, your true potential is far, far greater than where you are at today.

In coaching many DCs in practice, and directing hundreds prior to opening their own practice, I’ve identified a “theme” that recurs, not often thankfully, but recurs nonetheless.

It has to do with a person, we’ll call him “Ralph”, who is faced with some problem that has yet to be overcome.  He has already figured out the reason for his failure, or so he is convinced… at least at first. 

What I mean is I believe Ralph truly is convinced about “why” something is as it is, why something won’t work, or why he hasn’t been able to overcome… but there comes a time in coaching that it becomes obvious, maybe to everyone but Ralph, that he is so hellbent on defending his “reasons”, he would rather be “right” than embrace a solution and move forward.

It’s rather fascinating to ponder… I suppose we all might have weak moments when we’re guilty of such behavior.  But whether of pychological or spiritual origin, I wonder why certain, otherwise highly intelligent people embrace this Victim mentality… “I’m going to continue to fail, and here’s why”.

As one of my mentor’s has said, those who fail will always make excuses… or what they’ll refer to as “Reasons”.  We all get knocked down, we all face adversity, we all will find ourselves in a place where the answer is not readily apparent… No one is exempt from these moments.  It’s part of life, isn’t it?

But doggone it, do not stay there.  It may take work and searching for wisdom to figure your way out…The questions to ask yourself include, “Okay, now that I’m here, what next?”  “What’s my next step to put the failure behind me and to overcome?”  And when someone in-the-know is throwing you a lifeline with “Solution” stamped all over it, don’t be so proud, or bitter, or strangely comfortable in this role that you cling to your “Reasons”, choosing to remain a victim rather than climb out of the muck.  

Maybe the most interesting (and telling) of these cases is when the stated ”reason” for failure changes… just kindof morphs into something else… as solution after solution is offered. 

Here’s one example.  Dr. Ralph has too many of his new patients (most who truly need care) opt against care, or they discontinue their treatment prematurely. 

Dr. Ralph has it figured out… he must be charging too much.  “I’m pricing myself out of the market” he claims.   Interesting that other doctor’s in markets with nearly identical demographics to Ralph’s charge just as much or more for their care… but he is convinced.  He has his reason, and he’s sticking to it. 

With a little checking,  it turns out, Ralph has difficulty communicating the value of care to his patients… often a symptom that he himself is not very confident in what he offers. 

Well, how about working on that?  Ralph, what value do YOU place on the care you provide your patients?  How about comparing the ”life-changing” care you offer to a few hours spent in the ER for a kidney stone ($6,400… never mind this was not treatment of the stone, just diagnostics and some pain meds).  How about the cost of braces?… how much will a parent, in your community, plunk down to have wires fastened to their kids’ teeth… largely for cosmetic reasons mind you, not truly “health” related?… Between $4,000 and $6,000?  

What’s the cost of surgery on a wrist, or on the spine?  Surgeries which YOUR care might prevent!  I don’t know… what can your care enable people to do again??  What will it save them from??  Is it worth it to them??

“Well, that’s not it”, he says, “I do value my care, but my patients won’t”.  He’s convinced.  And the problem has bled over into all areas of his starving practice, because he defends this scenario, “even if people come in, they won’t value my care enough to actually pay for it.”  Bad place to be, concept-wise.

Okay then, if you won’t go there doc, how about this?…  let’s work out some new financial options your office can offer, allowing patients to receive your care while making more ”affordable” payments.

Problem solved, right?  I mean, if the whole issue of poor acceptance is monetary, than this should be the solution, right? (or at minimum, will offer many more patients the flexibility to work payments into a doable budget).

Nope.  Not this time.  His “reason” just morphed… did you see it happen?   Quick as Optimus Prime into a semi (my kid loves Transformers).  And it doesn’t really matter what it’s morphed into… it might be, ”Well, you know I’m really more of a “pain relief” doctor, and I don’t understand what “treatment for condition” nor what “wellness” are all about“.  Or it might have become, ”Well, you’re Italian and I’m Irish, so that solution won’t work” (what??)  Or, whatever… and what really just happened is, Ralph was never really looking for an answer anyway, because it might involve moving out of his comfort zone, and worse yet, would mean he’s no longer ”Right”. 

So here’s a question for you… is there an area in your life where you see yourself as a Victim? 

Do you have “reasons” for why you haven’t overcome? 

 Or, do you rather see yourself as Responsible, knowing with the right direction and the right wisdom applied, you will, without a doubt, no matter what your present circumstance, rise above any setback or “failure” you experience?  Are you looking for answers, or to be ”Right”?

I was clueless back then.  Not just in a culinary sense, but in my concepts of what things were really worth my time and attention.  I was so focused on getting through all the requirements, while maintaining my 3.something GPA.  Then came state Boards.  Being from a suburb of Buffalo, many people have asked me how I settled on North Carolina as the state I would live and practice?  My honest answer?  I placed my finger over Buffalo on a map, and traced an imaginary line due south!

Using no other line of reasoning than climate, I decided it would be Virginia or North Carolina, wherever I could first find a decent associateship.  How’s that for strategery?! 

So end of 1992, my headspace was all about graduating and passing these two state boards… which I did, Saints be praised!  And in February of ’93, I was blessed to land a decent associateship (I know, most often an oxymoron) in Durham, NC.

You see, I knew I wasn’t prepared to run my own practice.  It had nothing to do with my “book knowledge” of patient care.  I just somehow intuitively knew that real-world practice was going to be quite different from what I or my classmates really understood.  And other than going the Associateship route, I was unaware of any specific resources or coaching/management where I could obtain that knowledge even had I wanted to immediately open on my own.

But today, a real, workable game plan does exist.  There are preferred ways to go, and not-so-preferred ways as well.  The key is following in the footsteps of success, and to learn from other people’s experiences who learned lessons the hard way.  A smart man learns from his mistakes, but a wise man learns from others’ mistakes, so that he won’t have to make them himself. 

In economics, it is called “Opportunity cost”.  When a decision to go in a certain direction is made, one not only pays the consequences if it is a bad one, but also misses out on all the good that would have come from making a better decision. 

In the context of the total number of years (hopefully) you intend to practice, one bad decision may cost you hundreds of thousands of dollars paid out in needless overhead, not to mention grief and frustration.  In opportunity cost, that same bad decision might mean touching far fewer lives through chiropractic care, and millions of dollars in lost revenue you otherwise would have earned.   

 So what are students thinking??  Here are some of the things I’ve heard at our recent college bootcamps… “I’m going to need (somewhere between) 80,000 to 300,000 dollars to open my own practice”.  ”I’m going to practice in ______ because I grew up there and will have a good start with all my friends and family”.  “I’m going to look for the most affluent areas I can to open a practice because it’s easier to grow where people have lots of disposable income”.  ”I’m going to open a practice in Myrtle Beach because I love the ocean and I love to golf”.  “I’m going to open in the big city because that’s where all the people are”.  “I need to purchase all the latest equipment, like digital X-ray, and (basically) build out a Taj Mahal practice”.  ”I’m going to cover my walls with ’Discover Chiropractic’ posters, and display all sorts of products for purchase in my reception room such as pillows, vitamins, Biofreeze, etc.”

How do these thoughts sound to you?  Do any of these seem like good ideas?  Let me know and we’ll talk.  Someone has gone before you and has already figured these and a thousand other decisions out.

If I get hit by a truck, take me to the ER.  If I have a heart attack, call 911.  If I have a genetic anomaly or inexplicably develop a disease such as diabetes or a cardiomyopathy requiring  life-sustaining medication, then give me that medication.

Some conditions are beyond chiropractic care to be enough.  Not that one won’t still be better off with chiropractic care than without it.  But in cases of life-threatening emergencies, or health issues either not associated with subluxation, or too far gone beyond full recovery, then give me the best that Allopathic care has to offer!

But for most everything else… I’m looking for my good colleague for an adjustment.  Some of you don’t get this.  Particularly if you’re a student or a new grad.  But thousands of DCs in practice today haven’t gotten this either.

I have an ongoing conversation currently with a newer grad who has been open in his own practice for about six months.  An extremely bright and intelligent young man.  Yet maybe due to the chiropractic education received from his Nurturing Mother, he has little confidence in his abilities beyond pain relief and improved joint mobility.   His main hangup is that while he’s aware there is research “out there” on the effectiveness of the adjustment beyond pain relief, he has not (yet) witnessed any such cases with his own patients. 

The origin of his lack of confidence in this area could take multiple blog posts to address.  I would request multiple comments from students who are being fed the “when all else fails, try adjusting your patient” gruel at their school… the “a subluxation does not exist” drivel that too many at our institutes of higher education are being misled to believe as scientific truth. 

We therefore have an entire generation of new grads and soon-to-be-grads, as well as gobs of DC veterans, who have NO IDEA who they are nor what they can provide for a suffering humanity who are desperately seeking their care in their community. 

If you are in practice, and are not aware of any conditions that have ever improved or resolved in your patients other than their pain symptoms, then you’re either not asking the right questions, or in some cases you’re not treating beyond simple relief of pain.

I used this example with this new doctor…  “I live in central North Carolina.  I have heard some claim that there are mountains in NC.  Some have stated, anecdotally, that the Atlantic ocean can be reached without leaving my state.  There is even proof of this in the geographic and travel resources.  However,  I have traveled to the outskirts of Wake, Chatham, Durham, and Orange counties, but have yet to see any mountains, and have not seen a coastline… since I’ve not seen it myself, I cannot believe these claims to be true.”  The real truth is, either I haven’t traveled far enough, or in many cases, I’ve just been looking in the wrong direction.

Didn’t plan on this post going in that direction, but just as well that it did.  This one can’t be ignored.  Our profession will never be #1 when so many of our fellow “Doctors” are practicing as glorified physical therapists.

What else needs to happen before our profession rises to it’s rightful place in the American public’s healthcare decision making?  We’ll dive into this one more deeply, but I’d love to hear your viewpoints.  Feel free to type out a quick comment.

“til then…

But dreams based on myths don’t come true.  Here are some of the most common myths about practice success that plague the minds of chiropractic students and graduates alike:

• If you graduate from “this” school…or hang “this” sheepskin on your wall…
• If you use “this” technique, that’s all you need… 
• If you use “this” piece of equipment… 
• Just get good results with your patients, and it’ll open up the floodgates of referrals into your practice… 
• “I’m intelligent, I’m a Go Getter, I’ve always been successful at  anything I’ve done, I can figure this out on my own… (How hard can it be?)”…  
• Or BJ’s famous, “just drive your car ‘til you run out of gas, and build your clinic there.”

  Maybe ½ or ¼ truths, or flat out untruths.  It’s remarkable to me how many students and new grads are in the, “If you build it, they will come” camp. 

 Speaking of which, chances are you’ve heard that quote before.  It comes from the 1989 movie, “Field of Dreams”. 

 In it, Ray (Kevin Costner) hears a voice whispering to him as he walks through his Iowa cornfield.  For the record, the voice says, “If you build it, HE will come”.  Later in the movie, Shoeless Joe repeats the phrase, “If you build it, he will come”, referring to a player whom Ray recognizes is his father as a young man.

 Anyway, it’s one of those often misquoted quotes, but I digress.

 How many of you have this vision of your practice?… find the location, fix it up nice, hang your diploma next to your license, turn the key to unlock your door on opening day, and “Here They Come!”… New Patients are coming out of nowhere, drawn to the great, new doctor in town… and thus begins the practice of your dreams.

 Like Costner’s movie, for most, it’s just a dream, a fantasy.  A very small percentage of doc’s might “make it” with that vision because the planets have aligned, or things just seemed to have randomly fallen into place.  It has happened.  But the odds are stacked high against that scenario.  

 For most of us… if you buy into the myths… let the struggles begin!

Are you clinging to one of the myths?  What commonly held beliefs have you seen that didn’t hold true in the real world?

Hello, and welcome!!  Last post we discussed moving a resolution or a goal from “thinking” to reality.  The above quote commonly attributed to Johann Wolfgang von Goethe is one of my favorites.  He was known as Germany’s “Shakespeare”, and he would have been a fan of this topic. 

How do I know?  Check out a couple more from the man, who incidentally is also credited with being the first to identify the Incisive bone, part of the Premaxilla (Ahhhh, flashbacks of Gross Anatomy):

“Enough words have been exchanged;  now at last let me see some deeds!”

“Knowing is not enough; we must apply.  Willing is not enough; we must do.”

As true today as when T-Rex caught the scent of our early ancestors…  There is power in “Action”.

We’ve talked about the power of taking (even small) steps in the direction of our goals.   Now if you’re someone who is a Go-Getter in all aspects of your life, and have a history of 1) setting goals, and then 2) making the necessary sacrifices to move towards them, then well done and carry on!  You are in an ultra-elite minority.

For most though, when resolutions or goals are made, various “reasons” crop up that keep them as “good intentions” only.  Necessary changes are never made, or sometimes steps are taken but are given up too early.  

When change seems to be too difficult, overwhelming, time consuming, or fill in the blank excuses here, the way to overcome is to first decide to commit to the goal, and then to take a step in the right direction, even if it’s seemingly insignificant.  Action!

How is this applicable to the student?

Are you a procrastinator?  Spent many all-nighters cramming for exams because you don’t keep up regularly?… Have to “drink from a fire hose” right up ’til the last minute before rushing to take a test?   I am very familiar with this strategy of studying, and through much personal sacrifice and peril have come to this conclusion… its flawed.  

How about this instead?  Take a small step.  Commit to read over your notes for just a few minutes each day.  Don’t even think of it as “studying”.  After a week, build up to five minutes per day.  Increase your review time as needed once a test date is still days away. 

Looking to save some money to fit your student budget?  Take a small step.  Order just the plain coffee instead of one of those Tensor Fascia Lattes.  Or make coffee at home instead of stopping by St. Arbucks.  Eat pasta or rice and beans an extra evening per week.  Eat your roommate’s leftovers when he or she is not home.  I’ve tried that one too… also flawed.  Who in the world dreamed up Tofurkey?? 

Have you given much thought to life after graduation?  If not, take a step.  The next time you have some downtime, such as on a Saturday morning, use it to relax.  Get your coffee, or Diet Coke, kick back, and dream of your future… only good things allowed.   Not the “How To” yet, just the destination.  

• Are you working in someone else’s office or in your own clinic? 
• Where is it located? 
• How big is the office (how many rooms)? 
• What does the decor look like?  
• What kind of patients do you serve? 
• What is/are your most used technique(s)? 
• Is your office “all cash”, or do you accept insurance? 
• How many patients do you serve in your ideal day? 
• What kind of income do you have?  etc.

Whether you’re in early Tri/Quarter, middle, or close to graduation, it’s never too early to visualize and prepare for  the real world ”beyond the four walls”.  Now take a step toward that dream.  Write me a comment on what you’ve come up with.

‘Til next time.

     And then there’s that week between Christmas and New Year’s, where people and things seem to move at half speed.  Work still gets done, but the feeling is like a ship that cuts engines and drifts into port. 

     Many people look upon the New Year as a chance to hit the reboot button.  It’s a clean slate.  A time to start over, or to reinvent one’s self.  There’s a feeling of hope… tomorrow’s going to be a better day.  And so new year’s resolutions are made, and new goals are set.

     Now resolutions and “true” goals are not the same thing.  A goal takes time and real soul-searching to figure out, and it requires a deadline be placed on it otherwise it’s really just a “wish”.  If you’d like to see more on that, check out Tom Owen’s blog posts on The Process of Setting Goals For Chiropractors series.

     But whether a resolution or a goal, both share this in common…

      They are often set, but never reached.

     Raise your hand if you’ve ever been guilty of this.  I can see most of you raising your hand right now, except for you right there, in the sweater… That’s okay, read on anyway.

     The reasons for failure to achieve are NUMEROUS.  Too many to fit into 900 words or less.  So I’m going to focus on just a couple that many have had first-hand experience with.

     1) Often the resolution or goal was decided on during an emotional moment… maybe out of anger over one’s situation, maybe during an endorphin (or other-induced) high, maybe during an ultra-relaxed time of reflection.  Whatever the reason, it never moves beyond the thinking stage. 

     For some, it might be because past resolutions or goals were made but never reached, and the previous failure has made them gun shy to repeat the process.

     2) In many cases action is taken, but for one reason or another the person gives up.  Maybe too much sacrifice was required to gain the desired outcome.  Especially if the goal is a big one, and drastic lifestyle and habit changes are required.  Many charge ahead at full sprint like a couch potato chasing a Krispy Kreme truck, only to realize they’ve entered the Boston Marathon.

     If you’ve set goals for 2010 and are already in danger of falling into one of the above scenarios, this post is for you:

“You cannot change your destination overnight,
but you can change your direction overnight.”
                                                                                         — Jim Rohn

     There is power in action.  Even the smallest of actions trumps just thinking about a goal.  If you’ve not started yet , or if you’re goal seems too overwhelming to achieve, make a decision to take an action step no matter how minute, and do so daily.

     For example, one doctor from Tennessee was in a slump, mentally, physically, and in his practice.  He confided that being in shape was key for him to perform at peak capacities in all of the above areas, but he had not exercised in months.

     When I asked why, he couldn’t give me a good answer, other than motivation and time constraints.  He said he already knew of a good workout routine consisting of mostly calisthenic and dumbbell exercises.  So I made him promise me something.

     Before his head hit the pillow that night,  he would do just one repetition of ea exercise.  Just one.  One push-up, one sit-up, one squat, etc.  And that he would do so daily for at least 2 weeks.  He kept his promise, although I don’t think he fully understood why I made such a request.  This would take him less than 2 minutes/day to fulfill, and was hardly enough to restore his fitness.

     But it was enough to get him started.  Some call it “greasing the groove”, performing a particular movement just once, but repeatedly over time.  Small, seemingly trivial steps that put you into action while allowing your brain to build new, permanent habits.  And over time, you slowly but incrementally add to the steps your taking.

     The doctor I was speaking of is now back into his full routine, getting back into shape, and all else is following.

 So what small step can you take in the direction of your goal, even if so small it may seem laughable? 

 Take that step, then repeat it multiple times, and slowly but incrementally add to it. 

 Pat Riley, current Miami Heat team president and coach of five NBA championship teams, challenges his players to “improve just 1% each day”.  He says, “There’s no such thing as holding on to what you’ve got… any time you stop striving to get better, you’re destined to get worse…”   Exactly what we tell our patients! 

      I’ll end with a story about UCLA basketball coaching legend, John Wooden.  As I’ve heard it, Coach Wooden would begin the very first practice of every new season with the basics.  Do I mean “dribbling”?  Or ”passing?”  Nope, more basic than that.  Try “this is how you put on your socks”… and “this is how you tie your shoes”.  A seemingly trivial, almost laughable, small step.

  ’When you improve a little every day, eventually big things occur… not tomorrow, not the next day, but eventually a big gain is made… seek small improvements one day at a time… and when it happens, it lasts.”  -Coach John Wooden

One example?… For the most part, you’re all in it together, studying with and helping one another to get through. Once you’re gone from there, it doesn’t take long to realize your old “support system” is gone.

If you’re in school, what is your goal right now?

If you’re a graduate, think back to when you were slogging through on campus. What was your goal back then?

When I’ve asked the goal question, what I most often hear from students is “just to ‘get through’”…

• …the next exam
• …the next paper
• …the next dissection or lab module
• …outpatient clinic requirements
• …National Boards, etc…

It’s hard to recognize when immersed in that environment that while school is obviously necessary, the real goal IS NOT just “to graduate” or “to pass all my boards.” School is a stepping stone for the real goal…

So what is the “Real Goal”? How does this sound? “To reach and change thousands of lives, to save lives, to make a lasting impact on your future community, and to grow an abundantly successful practice!” If we all focused on that, we would eventually make chiropractic the #1 Healthcare choice in America.

But it’s hard to have that kind of impact when so many are just gettin’ by. Enough to put food on the table is a blessing, but are we maximizing our God-given talents??

A particular couple comes to mind. Palmer grads. Bobby’s a likable, Go- Getter kind of guy. Rebecca graduated as her class Valedictorian. She was a Teacher’s Assistant in the basic sciences. Smart people. Hard workers.

They graduated and were ready to “conquer the world”. Succeeding at everything else they’ve done in life, why would practice be any different?

Four months into their brand new practice, Rebecca was coming home in tears, ready to get out of the profession. Things were not going as planned. They were spinning their wheels, and taking a downhill trip that was tremendously draining both mentally and emotionally.

Thankfully, they sought out and found the right kind of information and got turned things turned around in time (I told you they were smart). They are now growing an abundantly successful practice in Ohio. You can check out Bobby’s testimonial here .

Where do you think our universities are lacking in preparing students to excel in practice?