A friend once told me to never be held hostage to ultimatums. It’s good advice. They never lead anywhere good.

You’d be surprised, though, at how often they appear in practice.

• Your staff member says, “I need a raise, or I quit.”
• Your associate says, “I need a bigger share, or I’m leaving.”
• Your patient says, “I’m not coming in unless you stay open late.”

None of these are unreasonable things for someone to want, but when they come as ultimatums, they forgo discussion and ruin relationships. Once you give into one ultimatum, you can be sure there are others to follow.

Why We Give In To Ultimatums

One word: fear.We have a tendency to fold when presented with an ultimatum because we’re afraid of the consequences of staying strong.

• We’re afraid that we can’t live without the person making the ultimatum. I can’t pay my bills without this person’s help/rent/percentage.
• We’re afraid that we’re in the wrong. They’re probably right. I have been giving too little.
• We’re afraid we’ll be disliked. If I don’t agree, then I’m a bitch.

The truth: ultimatums hold you hostage. You might think you can’t live without someone, but the reality is that once you give in to a no-choice demand, you can’t live with them for any length of time.

Ultimatums are the grown-up version of a temper tantrum. They don’t belong in your practice.

How To Deal With Your Next Ultimatum

Does this mean that every ultimatum means you break up? Not necessarily. Often ultimatum-givers a) don’t realize quite what they’re saying; or b) don’t realize that you might actually stand up to a bully. Once they’ve been enlightened, they may change their position. Here’s how to bring the light.

1. Restate the Ultimatum in Simple Terms

Ultimatums often wear disguises. They come as veiled threats, where the subtext says, “or else” but the surface conversation is more passive.

Your first step is to drag the subtext into the light. Clarify by saying, “Just to be perfectly clear, my understanding is that you are leaving unless I do X.” Important: This is NOT a question. It’s you restating what you heard. Before they respond, you need to move to the next step.

2. State Your Position on Ultimatums

Follow that same phrase with, “If this is an ultimatum, then I accept your resignation/decision to leave/etc. If you’d like to discuss ways we can continue to work together, though, I’d be happy to do that.” Ideally, this sentence follows the previous with no break.

The goal here is simple: to clarify that an ultimatum means goodbye, plain and simple. You need to be clear that an ultimatum has no power in your relationship other than to end it.

3. Stand Firm

More often than not, the first two steps will result in some serious backpedaling on the part of the ultimatum-giver. If they don’t, then stand firm. If this really is an ultimatum, then accept their offer. Say goodbye. Thank them for the relationship to date, and move on.

Remember: The only way for the first two steps to work is if you are truly strong in your resolve to say goodbye to ultimatums. Don’t be afraid. No one is indispensable.

Ultimatums are black and white, one-sided demands that have no place in a healthy practice. Don’t be held hostage.

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Adding associates is a tried and true way of taking your alternative medical practice to the next level. In a majority of cases, though, associates come into their own and decide it’s time to leave, becoming your competition in the process.

Here are a few considerations for your first (or next) associate that may help them stay in it for the long run:

Don’t Add Them Too Soon Adding an associate if you’re not busy in your own CAM practice can be more trouble than it’s worth. Associates work best when they can get a steady stream of referrals from the office they work in. If you and your associate are competing over each new patient, then you’re splitting the same meager pie, and it’s going to create resentment. The exception to this is when you add other types of practitioners. If you’re a chiropractor, for example, it makes sense to add a massage therapist or acupuncturist to your practice even if you’re not fully booked. You can both see the same clients without “poaching” each other’s business. The rule still holds, though, that the busier you are, the happier you can make your associate.

Involve Them in Your Practice Most alternative health associates are just starting out. They’re fresh out of school and are inexperienced in practice and in business. Your role as a mentor to them is just as important as the dollar value of the patients you deliver to them – perhaps even more so. Include them in your cases. Discuss patients. Challenge them. Answer their questions. Encourage them, and remind them that everyone is new at the start. Weren’t you, once?

Consider Alternative Payment Models The % of billing model is an extremely popular one, though it may be frowned upon by the IRS if you live in the US, and want your associate to be an independent contractor. After some time, associates may begin to resent paying a percentage – the more they make, the more they have to give you, and for someone unfamiliar with the workings of business, this may seem unfair. Consider leasing your space and services for a flat fee to an associate, and be open to discounted payments in early months during their startup.

Give Them A Future Most smart and talented associates will eventually leave if you don’t give them a compelling reason to stay. They’ll eventually become competent CAM practitioners, and once they understand the intricacies of running an office, they’ll realize that they can be you, and grow a business of their own! If you have a great associate and you want them to stay, consider opportunities for partnerships, real estate ownership and other equity investments. If you’re seeking an associate, decide what the future might look like for the right person, and make that clear to your prospects. Most associates don’t want to be associates forever.

Open the Books A common misconception among new alternative medicine practitioners is that it’s not that expensive to run an office. After some time, they’ll look at your operation and think, “Let’s see – a phone line or two, rent, assistant. That’s not much. This guy’s making a killing off me.” Consider explaining the true costs of running a business. Show them the costs of photocopy cartridges, faxes, wage burdens, utility bills, insurance, taxes, maintenance and other less obvious expenses. Open your books, and explain how much of their monthly fee to you actually goes in your pocket. It’s almost always a lot less than they think.

No Non-Compete? Non-competition clauses may seem attractive to you, but many associates may be turned off. It’s not uncommon for new docs to want practice in a specific geographic area, and a non-competition agreement means they’ll have a difficult time eventually starting their own practice in the same area if they start out as your associate. What option does this leave them? They either start their own practice as your competition, or work as an associate for your competition – both outcomes are less desirable than having them in your practice!

Related posts:

1. Practice Growth Workshop for ND’s
2. How To Deal With Your Next Practice Ultimatum
3. A Great (and Free!) Practice Growth Book