I'm Dr. Dan and I’m a chiropractor. I’m still licensed, but I don’t practice in a clinic. I was a practicing clinician for 5 years and then I decided to do something different.
This is the story of why I left clinical practice and how I got to where I am now.
- Why I Became a Chiropractor
- What Clinical Practice is Like
- Time to Change
Let’s start at the beginning with the four main reasons why I became a chiropractor in the first place.
Why I Became a Chiropractor
First, I saw firsthand that medical care couldn’t fix everything. A good friend and mentor of mine who was like a second father to me had a bad heart condition. He had excellent health benefits and spent his retirement years at a hotel next to Mayo Clinic. Despite one bypass surgery after another, his health kept getting worse. I even witnessed him experiencing a minor heart attack one afternoon in his hotel room. I remember feeling powerless and promising myself that I would do everything I could to help as many people as possible avoid a similar fate.
Second, I know what it’s like to be broke. When I graduated from high school, my dad made enough that I didn’t qualify for any grants. But he told me that I needed to pay for college myself because that’s what he’d done. So I worked 32 hours from Friday to Sunday at a hotel, rode the bus, ate peanut butter sandwiches, and slept on a friend’s couch.
Some semesters I could only afford 4 credits, but I never took out loans in undergrad. I planned to buy a small hotel after graduation and I felt that college loan payments would make that more difficult. I had gone to a chiropractor in high school but my parents’ insurance kicked me off when I turned 18.
There were times in business school college when my back hurt, but I was not going to spend hundreds of dollars on healthcare because then I would need to drop a college class to pay for it. Finishing college on a cash basis took me five years, and I wasn’t going to wait longer than that.
Third, I didn't like the approach of my family's chiropractor. He gave “wellness classes” that simply marketed products and clinical services. His idea of helping low-income people afford care was high-interest payment plans.
He had told a friend of mine that he would find a way to make sure her care was affordable. But after two months, my friend ended up stuck with a bill for thousands of dollars that took many more months to pay off (and the back pain had returned by then). I felt there must be a better way to practice healthcare.
Fourth, I took a healthcare economics class and I watched the news surrounding the creation of Obamacare. I felt that some of the biggest, most complicated, and most interesting problems facing the US involved healthcare.
I’d had enough. I was upset that my friends were suffering. Both had sought healthcare in one form or another, and neither were healthier than before they started. In addition, both were stuck with expensive bills. Whether true or not, I felt that healthcare providers cared more about making money than fixing the underlying problems that cause pain and sickness.
The healthcare industry was facing significant challenges and I was determined to find lasting preventive solutions for my friends and everyone else who wasn’t getting the care they needed. Furthermore, I was going to figure out a way to make those solutions so inexpensive (or even free) that anyone would have access to them.
I considered medical school. But my opinion then was that drugs and surgery were best for keeping people alive rather than helping them become healthy. I reasoned that if I only had completely natural treatment strategies at my disposal, I would be forced to figure out a holistic solution to pain and chronic disease. After all, necessity is the mother of invention. So I dropped the idea of owning a hotel and enrolled in chiropractic school.
Yes, I was idealistic. Then I graduated 4 years later and started practicing as a chiropractor.
…and reality hit me.
What Clinical Practice is Like
There is no way to accurately summarize what clinic practice was like in a few minutes. But two of the biggest “doses of reality” were overhead and the importance of focus.
Reality #1: Overhead
When you own a clinic, you need to spend thousands (if not tens of thousands) of dollars per month to keep things running. This includes rent, utilities, computer systems, staffing, business loans, and living expenses.
It’s like every 30 days you dig yourself into a deep hole that you need to fill in (and then hopefully build on a little) before the month is up and you need to do it all over again. If you don’t get good at filling in the hole, your clinic won’t survive.
To cover your monthly costs in 30 days (and hopefully earn some profit), the key is efficiency. You need to figure out what services people will pay the most for per minute of your time. Then you focus on getting really good at delivering those services, while also marketing them to the people who are willing and able to pay the most for them.
After a month or two of not covering bills, you get to the point where it’s not about greed. It’s about having the best chance of keeping your clinic open so you can continue helping people.
Reality #2: The Importance of Focus
In order to get (and stay) good at providing a service that people are willing to pay good money for, you need to put all of your focus and energy on it.
Before I became a clinician, I saw chiropractic adjustments as pretty simple. Then I learned that every single patient has detailed ways that they’re very different from anyone else. This includes past injuries, the specific angle of their joints, tight muscles you need to work around, and ways that you customize treatment methods in order to get the best result for a given patient. This is on top of remembering how to best interact with every one of hundreds of patients based on their personality and referring to previously mentioned details about their lives to show them that you care.
In order to effectively work with all of the details of being an effective clinician, you need to be so preoccupied with them that your mind goes over them constantly during work hours.
When a small company tries to do more than one thing, quality for everything typically suffers and the company ends up with nothing valuable. So they lose sales and customers go elsewhere. A good analogy is opening a restaurant. It’s hard for a beginner to make an elaborate meal without quality suffering in some way that turns off customers. Rather, it’s better to be like a stand that only sells ham sandwiches but does everything possible to make them high-quality and delicious. It is much easier to deliver high value when there are fewer “moving parts.”
This is a summary of a few things you need to do to have a successful clinic:
- Get really efficient at adjusting (roughly 5–10 minutes per patient).
- Charge a decent amount for each adjustment and focus on bringing in patients who can afford that.
- Constantly focus on and get better at the best way to work with the specifics of each individual patient’s case. This includes taking seminars, studying information on your own, and refining your treatment skills outside of the clinic with family members and close friends.
Chiropractors who are not focused on doing these 3 things well (in addition to others), will probably struggle financially and eventually need to close. On a related note, it is difficult to provide discounted care to people with low income and poor insurance. That can put you on a slippery slope to eventually making financial concessions to so many people that you can’t cover your overhead and can’t make the needed investments to operate your clinic at a high standard.
Patients often asked me, “What can I do at home to keep this problem from coming back?” I gave them handouts for at-home stretches and exercises that were part of a patient information packet. I also partnered with a physical therapist and gave a free 4-week class.
However, like a writer who can feel a good story inside but can’t seem to get anything close to it on the paper, I felt that I could be providing patients with much better solutions for at-home programs compared to what was available. I just didn’t know what they looked like or where to start. I could sense that figuring it all out would be a big undertaking, and I knew that I needed to stay focused on the details of being a clinician in order to meet my high standards for running my practice.
Time to Change
I became a chiropractor to improve healthcare. I wanted to help people who are as broke as I was in college, but business pressures required me to focus on those who afford care. I didn’t like focusing solely on chiropractic adjustments, because I feel they are not the full solution to helping someone be healthy. If a patient doesn’t change their lifestyle at home in between visits, I believe that chiropractic is just a bandaid for the problems that will keep coming up.
I wanted to go beyond simply focusing on the clinical services that provide the most profit to cover your overhead and instead figure out the absolute best way to fix the root causes of health problems in the US. I believe that the key is a lifestyle that includes activities such as drinking enough water, having a healthy diet, getting enough sleep, spending time in nature, good posture, deep breathing, meditation, and many more.
It’s difficult for a chiropractor to spend a lot of time figuring out and teaching the best lifestyle strategies because it doesn’t involve much revenue to cover your overhead. Getting patients to make their appointment times is hard enough, so you need a focused marketing and patient education message about the value of chiropractic appointments.
If a clinic educates patients and the broader community about lifestyle strategies, that can be overwhelming to its audience and send mixed messages about what specific actions it wants people to take. It will likely decrease the chances that people will become paying chiropractic patients. This reality of running a successful clinic was difficult for me to come to terms with.
Most of all, I wanted to find a way to make a difference by helping humanity in a way that no other healthcare provider could (or would). I wanted to reach people who have yet to find a solution that works for them. Maybe I could even help someone on the road to an eventual heart attack (like my friend 20 years ago) avoid it altogether.
But when I looked at my career, I realized that I had departed from that vision in my desire to make ends meet while running a clinic. It was time to reset and focus again on my real purpose.
So I left clinical practice in order to pursue it.
What did I decide to do instead? Click the follow button (and read Part II) and you’ll find out soon enough.