Whether you are a recent student or you are an experienced chiropractor just venturing into owning your own practice, it all starts with the Launch. In this episode, Dr. Cliff and Dr. Joe take a deeper dive in the first season of the Practice, Launch. With over 50 clinic launches, they will discuss how to avoid the biggest pitfalls that new, and even older, entrepreneurs stumble into when starting out.
Listen as they discuss these questions and more:
About the Hosts:
Dr. Clifford J Fisher
Dr. Cliff Fisher – Owns several offices all over the US and has a coaching business Dream Leadership Institute to help people find the greatest version of themselves. He will help you get to a foundational understanding to create the business and life that align with your being.
Dr. Joseph Esposito, CEO
Dr. Joseph Esposito, D.C., C.C.N. C.N.S., C.C.S.P., D.A.B.C.N., F.A.A.I.M. C.T.N., is the Founder and Chief Executive Officer of AlignLife. As such, he is responsible for the direction of AlignLife as it expands further across a dynamic and rapidly changing health care landscape. Dr. Esposito has more than 20 years of experience in a broad range of businesses, including chiropractic, nutrition, technology, and internet marketing.
Dr. Esposito has extensive post-graduate academic accomplishments, as well as 15 years of experience managing successful chiropractic clinics in multiple states. He also is founder and CEO of Aceva LLC, a service-based nutritional company providing products and services to the AlignLife clinics. As the former CFO of an internet publishing company, Dr. Esposito understands the power of leveraging the internet to impact the lives of millions of Americans.
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Align Your Practice podcast with Dr. Cliff Fisher where your best practice and life awaits you. Are you tired of running a practice on your own? We want to come alongside you with experts to help you create your dream practice in your dream life. Here is your hubs.Dr. Cliff Fisher:
Welcome back, I'm super excited. We were going over the last podcast of the launch build scale. And then what we felt like we needed to do is do a deeper dive into like, what are the problems? What are the challenges? And how do we go from, you know, what's the ceiling? What's keeping us in one? Launch builders scale? So Joe, what are your thoughts on that? And have you had a lot of great thoughts after?Dr. Joseph Esposito:
Yeah, no, I think I think we went through the challenges of launch and how there's a lot of potential pain there. So let's break down, launch as to how to support launch and where the holes are in the gaps, a little bit more detail. And then we'll continue down the journey. So wherever you are, in practice, we want to give you some navigation around that season, to help guide you and bring value and power inside of the season you're in and some awareness of what the next season is, if you choose to move in that direction. And you made a good point, I believe last time cliff is that most people end up in build, which launched the first year, then you're building your practice, some don't scale, meaning they don't open a second practice, they don't hire another practitioner, they just run their clinic, and many don't exit. So we want you to all embrace the beauty and the value of scale and exit. So we're going to bring more awareness around that as we continue this podcast because we don't think everyone should end in the build phase. Right.Dr. Cliff Fisher:
100% I think that's a horrible tragedy. And I think that's one of the things that really inspired me when I was younger. Around 2004, my mentor had passed away. And his practice kind of did that kind of faded out. And it was just horrible. And he had been practicing for 4050 years, had a great practice. And then it just kind of, you know, never became what it should have beenDr. Joseph Esposito:
never had the legacy, which I think all Chiropractic Clinics need the legacy play because we need more chiropractors and more clinics serving people. I mean, that's the, the truth of the matter. So let's go to let's go back to launch, we gave some insight last podcast on it. So in launch, I'll give my perspective I've helped open probably over 50 clinics in my lifetime, personally run about 10. And I've went through a lot of the hassle with that I was opening, I was building out my second clinic about eight, nine months in my first hand. And I did that consistently over six years six practices. So I have a lot of value back 25 years ago, and since then put up over 40 clinics, so So I think when we're looking at the lunch, it's kind of like, to me planning a meal, like I was always bad at having a dinner party because I was making the vegetables and I overcooked the vegetables while the meat was still in the oven, or the meat didn't come out because the vegetables and then I had this other dish and then I didn't bring the beverages out or it's tiny, right and a great deliberate great meal, you got to know every piece of what's going on, it's the same thing in a practice, you can be working on the build out and never hire the staff. You can hire the staff three months before, but you don't realize you don't have permits for a build out. Now you have staff that were great, but you hire them three months early, or you sign the lease, but didn't get the loan yet. So now, you may not get the loan, now you're stuck in a lease. So timing, just like creating a great meal. The launch phase requires experience to understand how to make that perfect meal, you have me cooking the meal or a seasoned chef, you're gonna see timing with that chef and a perfection the way they deliver that meal. And I'm going to be stressed and making mistakes along the journey. So hopefully that's a good analogy for the language.Dr. Cliff Fisher:
Such a killer. I mean, honestly, it's an all of them, but especially in launch, I think that's such a great reference because how many people have done that, like, bid off too much more than they could chew, honestly, you know, they're like, Oh, I'll do all these things and they don't realize all the steps.Dr. Joseph Esposito:
So help me through this cliff. I'm thinking build out is one vertical and this isn't a line life. We have three verticals. So the first one is wild build outs happening and our team is helping refine the blueprints helping with you know, making sure that we have the contractor hired and we're moving forward. We have the millwork designer already set up with how the desks gonna look right. You even up with some of those verticals. And making sure that that's we have a Zack paint color There's carpets, we know every wall, which wall of the extra room has which poster that that is associated with the communication cycle in that particular room. I mean, that's obsessive. We've taken this. And then while that's happening at the same exact time, marketing, building websites, landing page, social media, and all of that's going on. And the third is training, training the doctor training the staff so that we know how to manage patients. But those are three verticals and align life marketing, build out, training, all happening with a system and a team that's experienced launching clinics, such a difference versus a doctor at a school saying, Okay, I'm going to just go ahead and sign the lease today. And hope for the best. Right? Yeah. AndDr. Cliff Fisher:
how many times have we seen that go sideways, so fast? Like,Dr. Joseph Esposito:
yeah, the biggest fear, I think in life is the biggest pain I'm sorry, in stress in life. You know, relationship, stress is really tough. But I think the worst stress is financial stress. Yeah, can't pay the lease, you ran out of money, you can't pay your staff, that feeling I don't know, if you've had it, I've had it, where it's not have the dollars, because there's other lives and people involved, that's too much for me to handle. And I don't wish that on any doctor that's opening the clinic.Dr. Cliff Fisher:
And you know, most most businesses as a whole fail because they run out of capital, that's their issue. And so I think one of the things I love about a Lyme life is it will help you have a better understanding of how much capital you need, and then how to spend it because people will spend it on like, I, I bought an office. And the doctor spent so much money on the build out and has a beautiful clinic, but he didn't put the money to, you know, on the other side of it, where I think would have been a better spendDr. Joseph Esposito:
your how many offers I bought over the years of beautiful build outs of unfortunate doctors that never built a team never did the marketing, but they had such a beautiful place, and ended up renting on pennies on the dollar. The doctor went bankrupt. It's such a shame. So instead of buying those offices, I want to support those offices. My next level of practice management is supporting those practices. So so the if you're in lunch, just know, make sure you figure out and get counsel, uh, knowing what you don't know, because that's where the pain and the issues are. I love what you put up here, Cliff, because I think there's a lot we could learn. And in some of this training that you and Dr. Joe chlorine are one of our partners, friends and very learned colleagues that has helped and guided a lot of align life doctors on all phases ofDr. Cliff Fisher:
practice. I think he said he had over 80 students go through his clinic.Dr. Joseph Esposito:
Yeah, I don't know, any human in chiropractic that's had? I think it's more than that, to be honest, I think it could be that he remembers, but you have five, six in one, one.Dr. Cliff Fisher:
Should be right. So on the launch phase, I think the biggest thing, so all three phases have procedures, flow team and communication issues. And so what we're gonna do on this one is we're just gonna dive into one of those issues. How are you doing? How do you know if you're in this phase, or if you're out of this phase, and so and then, in this PDF that will be included with this, you can download it and you just grade yourself? So how's your new patient system? You know, is it the same? Is it consistent? You know, is it a wow experience? Are we wowing our patient? You know, what are those? are we hitting the right touch points? And so that's the biggest thing, and then gettingDr. Joseph Esposito:
the connection? Are you finding like there's there's a lot of juice in that one little phrase new patient system training that we do in a line life to help level up. So when they're out of the new patient flow, there already have massive value and trust in the chiropractic profession.Dr. Cliff Fisher:
Yeah, I mean, I know for us we do communication on that alone is six months. Training those that one little sentence, you know, and then the scheduling, like how important it is that a block schedule. So many people think, oh, I'll just wait in my office, all the patients will come like versus like, you know, schedule hour here hour there, then go market.Dr. Joseph Esposito:
But we all know as as new doctors come out, they want to make the patient feel value. And I think that's associated to time. And a lot of these doctors are doing 10 minute adjustments and causing a problem because when they start cutting down the amount of time the patient feels like you don't value them as much and you really cause pain in the growth of your practice. So scheduling is such a big conversation I we could spend just on this topic. So it's hard for me to even move on but I know we want to keep these timely. That's a Big time we break down in the future.Dr. Cliff Fisher:
Scheduling is a big deal. And here's my gauge how long it takes you to adjust your family members. That's how long it should take to adjust everybody. The rest of its justifying your care.Dr. Joseph Esposito:
100% 100%. That's right that down.Dr. Cliff Fisher:
When I think I heard it from Reggie gold for the first time, and he said, How long does it take you to just your wife? And like, two, three minutes? He goes, Why are you spending more time with somebody else's wife? I'm like, Oh, thank you very much. Next. That's funny. So, flow. So this is a big deal. ThisDr. Joseph Esposito:
is where we learned one on procedures. What's that one?Dr. Cliff Fisher:
So progress exams, progress reports, re exams re report, okay, okay. Okay, making sure you're doing those. I think that's one of the places where people cut corners, honestly, is they're like, they get too busy to do those. And then they don't do them. Right. So then they have a leaky bucket, and people just fall out.Dr. Joseph Esposito:
It's a key point in your training and align life about retention is this is like the middle piece, right of driving retention. So I think that's huge. Okay, let's go to flow.Dr. Cliff Fisher:
Alright, so flow, we have visit length. So just be mindful of that, like some I know, some doctors, they spend 45 minutes, if that is make sure you charge appropriately and align life, that it's not our model. So you know, we're gonna focus more on, you know, taking the time we need. The next one is number of tables. So many people, people get locked in a one room and they can't have any efficiency by having only one table.Dr. Joseph Esposito:
I agree that second table will like more than double your capacity.Dr. Cliff Fisher:
Yeah. And then the other thing in flow is check in and check out like, how's that process? You know, are people scheduling every visit? Are people paying every visit? Or do you have them on auto debit? Do you have them scheduled out for their entire care plan, or care plan. SoDr. Joseph Esposito:
I think that falls in line with the concept that one of the hardest clinics to run is a clinic that has low volume, like 100 visits a week or 120 visits, because they're not pre scheduled. They're not prepaid. They're not conditioned to the flow of the office, you walk in a 500, visit a week practice, everything is already done up front, and they follow the flow. So check in and check out it's a great discussion for the the launch practice.Dr. Cliff Fisher:
Yeah, and just like, again, it's like starting off with good habits. Like, you know, fixing somebody's bad golf swing takes way more work than just teaching somebody a good golf swing. So, so huge. And then the next one is communication. So the DCS really gotta communicate value, like people come into the office, they think they have a two or $300 problem, and we show them a two or $3,000 solution. So we need to be able to communicate value.Dr. Joseph Esposito:
Yeah, this goes to the first podcast that you and I did together, I had mentioned, you know, selling adjustments for selling outcomes. This is where the value comes in is we got to be talking about outcomes, we're gonna be talking about problems and their goals, not selling adjustments and trying chiropractic, that's not what this is about. It's about creating plans that give outcomes and that's where the value is in, in the conversation. The next one is day one through day four. Cliff, your master of training this, you trained so many officers in the line life to success. Last one, doing almost a million dollars a year in the first 12 months of practice. Easy. And it's really mastering day one a day four. And there's so many holes that can occur in this. So I think doing an audit on day one a day four, if you're in the launch phase, like do it every month to make sure you're you're hitting the key points in all four days.Dr. Cliff Fisher:
Yep, 100%. Like, that's so good. Then the last one is team. So you know, finding and training your unicorn, the unicorn is that first person you're expecting to do all the jobs because you only have that one team member and then growing into that space where then you bring on the you know, which gaps to fill, because that unicorn is the uniforms that could do all these things. But they do have a strength. And if you can hire around that person, then they stay if you don't hire around that person, you actually lose them and lose that traction you had. And so understanding who they are, and then hiring around that person to to give them the support.Dr. Joseph Esposito:
Awesome. Excellent.Dr. Cliff Fisher:
And then policies, you know, just having clear policies, I think people need clear expectations and clear agreements. And so and I think, you know, it's like playing scrimmage football versus playing professional football, like you go out there and like, oh, yeah, you kinda have an idea. Here's what's gonna happen versus like, No, we come in we huddle. We have a plan for the day and then we, you know, make the day happen versus not.Dr. Joseph Esposito:
Yeah, I think the policies are so important. And that's, I think, if you learn this early on in practice, it's going to make you have a more fun practice to runt. Always going back to policy. Is your Are you setting up the right expert? vacations for your staff, right expectations for your patience is going to change actually the mechanics and the culture of your practice very important to, to do early on. So you don't have to fix a culture down the road, which is a lot harder to do.Dr. Cliff Fisher:
Yeah. And then the last one is Doctor driven meeting. So doctors in the beginning, you you're driving the meetings? And how are the meetings? And then is the team is this? Is this a Clifford Joe Show? Or is this actually the, you know, the Align live show? Like putting or whatever the office? Like? Is it your whole office involved in it? And so that's really where you start to see that shift. But right at that point, they're Doctor driven? And are they meaningful and impactful?Dr. Joseph Esposito:
Yeah, it's a good point in the beginning, you're doing you the left, and eventually, you're an attendee of the meeting. And it's by run by an office manager? Yes, I guess if so. That's awesome. So that's kind of a layout of the first stage launch, where you can, in a sense, audit and align life, we go deep on this with what we call a practice analysis, where we'll be asking these questions in a digital format. So you do have actually a survey and get an outcome to see where you're at have true self awareness as to where you are in practice, then we can level up the trainings based on that survey. This is a general idea on a document, but in a line life, we'll take it the next step deeper with surveys and trainings.Dr. Cliff Fisher:
Awesome. Yeah. So that's launched. So that kind of sums up launch. Like if you feel like you're struggling this great at see where you're at. But this typically people are going to be zero to 150. The breakdowns, the pain we talked about on the last podcast, but really the breakdowns is, you know, you're just stuck and you don't have you know, you're losing team members typically in launch. Like that's where people are, like, I'm not hiring the right person. But after five people, it's not that you're not hiring the right person, you're not the leader is not the right person, or you need to grow. Yeah, so and then just making sure your procedures are tight, that new patient and your flow your visit lengths, right, and then you're communicating value.Dr. Joseph Esposito:
Yeah, sum up, it's like creating that perfect meal, you got to you gotta be trained as a chef, if you want the perfect meal, you want to be trained as a refined chiropractor that understands all the components of procedure, flow, communication, and team as noted in this document, so use this document, test yourself. If you have questions, please reach out to the line life, we'd love to answer them.Dr. Cliff Fisher:
Yeah, absolutely reach out to align life and then thank Joe Kareena for helping or for creating this thought process and he just killed it. This is a really valuable, this million dollar piece of paper rightDr. Joseph Esposito:
here. Awesome. Yeah, you know, for free insights. I, I don't want to thank Joe too much because sometimes too much gratitude for all his contributions and love of the profession, but I gotta kid with him a little bit.Dr. Cliff Fisher:
Absolutely. Alright, so next time, we're going to dive into build. And so tune in for that one. We'll get billed and we'll break it down just the same way. What are the challenges? What are the struggles how do we bust out to build in this scale, so stay tuned. We'll see you next week.