We recently spoke to students at The Canadian College of Naturopathic Medicine on the theme of “Your First Ten Patients”. A good time as always, but we were nicely upstaged by superstar Mary Caracoglia, ND, who told the story of her remarkable first year in practice.

Mary received her license to practice and opened her doors in October. Twelve months later she had taken home over $80,000.

This is the how she did it.

What You Need to Know First

I want you to see this through the right lens. It’d be easy to dismiss this as good luck, the result of some special skill, or setting up in an area with no competition. None of that is true.

• Mary’s area is “saturated”. The only naturopathic college in Ontario is in Toronto, and many practitioners stay there after graduation. While I don’t buy the competition excuse, really–and Mary is proof that it’s not a big factor–you should know that Mary accomplished what she did in a market that was by no means free of competition.

• Mary’s not “special“. (No offense, Mary ) She’s wonderful, positive, bright and energetic, but most practitioners I meet have those traits in abundance. Like you, though, she has moments of uncertainty, fear, and disillusionment, too. In her words:

“I want to start off by saying that something most grads don’t talk about is the feeling that just after all of this school, all of these tests, all of this clinical experience…you can feel completely INCOMPETENT and scared out of your mind.” - Mary Caracoglia, ND

Mary’s just like you, folks. The difference is not in her personality. It’s in her behavior. Here’s my distillation of how Mary did what she did.

Strategy 1: Start Early

“Most grads from my class didn’t look for space during the summer… instead of starting work in October which was the earliest you could start once getting your NPLEX results, they had to wait until January.” – Mary Caracoglia, ND

Mary graduated in April, but had to study all summer and write board exams in August in order to finally get a license to practice by mid-autumn. Most practitioners simply wait until then to start the process of opening their practice. Not Mary. By June she was spending a day a week working on her practice–a practice that wouldn’t start until October.

Why it worked:

Starting early gave her several advantages:

• Study breaks
• A jump on the rest of her graduating colleagues
• Time to form relationships
• Time to pick the right location

The first two are nice, but not earth-shattering. The last two are game-changers, as we’ll see.

Strategy 2: Choose Your Location Wisely

“You need to spend a lot of time thinking about what you want…keep in mind that what you think you want will change the more offices you see and people you meet. I literally cold-called as many places as possible.” - Mary Caracoglia, ND

The last benefit of starting early–time to find the right location–was one Mary put to great use. She called over 40 offices inquiring if they were interested in renting space, and then gradually booked meetings to see the space, meet the players, and get more details.

Why it worked:

I don’t know of anyone who’s looked at that many spaces, but the logic here is pretty clear:

• Other than buying a practice, your single biggest opportunity for new clients when you start your practice is referrals from other health care professionals…
• …The easiest way to do get those referrals is to set up shop with someone busy who will refer to you like crazy…
• …The easiest way to do that is to look around. A lot.

That’s what Mary did. She found two places with the right fit, that would benefit her the most. And by “benefit the most” I mean deliver referrals. A ten percent better split and a nice waiting room don’t mean anything if you’re not seeing any patients. You need the referral traffic.

If you’re starting out, or thinking of moving your practice, do some speed dating. Get on the phone. Visit as many practices as you can. And if you’re not thinking of moving? Maybe you should be…:)

Strategy 3: Focus Your Marketing on Personal Connection

“I met a great number of other health care professionals and created a referral network.

I literally stood at the front desk or hung around the waiting room in the offices introducing myself to patients checking in and out with reception. I told them who I was, and offered them a free consultation on the spot. Most people were willing and interested.” - Mary Caracoglia, ND

Why it worked:

Health care is a business that delivers very personal services to people. It’s no surprise, then, that the best way to grow that business is by forming personal relationships with people.

Mary did the usual marketing stuff. She’s online, but not in a big way. She wrote articles. She has a website and blog. But her most of her marketing was about creating relationships with people. Meeting local practitioners and business owners. Talking to prospective patients. Mary’s job is to treat people, in person. So she went out there and met people, in person.

Sound squishy? Hard? Not your bag, baby? It wasn’t entirely easy for Mary, either….which leads to the next strategy.

Strategy 4: Stretch Yourself

“That’s something [lack of confidence] you need to get over very quickly. There’s nothing special about me. I’m not shy, but it’s uncomfortable to go to a networking party by yourself. I was terrified. But you do it. And it gets easier.”

“You will have days where you question your decisions and question the path you chose…days where you need to push through because you are completely out of your comfort zone “- Mary Caracoglia, ND

The Mary that graduated in April, and the one that had a successful practice a year later were the same person, personality-wise. But they’re world’s apart in terms of their skills, experience and wisdom. Mary succeeded because she learned. And not just any old learning. She learned to connect with people. To market herself. To talk about what she does and why it works. She learned things that are scary to think about, but that deliver results.

Why it worked:

What Mary grasped intuitively is something we can all take to heart: The skills that got you to graduation aren’t the same ones you need to successfully grow your practice.

To grow a successful practice you need to continue to learn. It’s the way out of the Cave, as we call it in The Practitioner’s Journey. The good news is that you’ve already proven you can learn. Now, though, you’re going to have to do it in a new way: without a net. Far fewer lectures and textbooks, far more being scared out of your pants. You need to take some risks. Emotional ones, just like Mary.

Strategy 5: Decide to be Busy

“I was sick of hearing that it takes three years. You can’t expect people to just find you…be proactive and find them….Other practitioners are sitting in their offices. I’m parking myself in the waiting room. I’m talking to people.” - Mary Caracoglia, ND

Mary said one phrase to the students, and then later to me, many times:

“I just wanted to be busy.”

Seem simple? Don’t blow this off. This philosophy is what drove Mary’s actions.

• She started right away, staying busy during her study summer schedule.
• She decided to start two locations, instead of one, knowing that she wasn’t likely to stay busy full-time in one office right away.
• Rather than sit in her office and hope, she stayed busy hanging around the waiting room, meeting new patients as they arrived to see other professionals.

Why it worked:

1. Practice success is directly related to practice activity. Note that Mary didn’t say, “I just wanted to have a lot of patients.” She said she wanted to be busy. And that was 100% within her control–she could be as active as she decided to be.

2. She was busy with the right stuff (see strategies 1 through 4). It’s easy to be “busy” hiding in your office, updating your FB status and checking email. Wrong kind of busy.

Can You Copy Mary?

Can anyone do this? I think so. Your mileage will vary, based on billing rates and practice models and a hundred other things, but the blueprint is there:

1. Don’t wait
2. Find a productive place to grow
3. Get out there in the world
4. Do what you’re afraid of
5. Stay busy and focused

It’s not rocket science. Just that age old recipe of elbow grease, focus, courage, persistence and all the other good stuff that makes practices–and the world–go ’round.

And for you veterans: Your first day of practice might have been long ago. But you can have another first day tomorrow, right?

As I start the early stages of our next book, I’m becoming more and more intrigued by practitioners who grow their practices very quickly. Sometimes it’s right out of the gate, other times they seem to limp along for years, until something changes and they take off.

I think there’s great inspiration in these stories – they’re worth sharing. I’ll break this into at least a couple of parts, with more CAM professions to follow. Regardless of the modality or profession, though, like always the advice is readily transferable.

Many of the people I’ve spoken to were seeing one or two patients a month for a long time, then took off. Take heart…

Happy New Year, everyone.

-Dan

Brooke Thomas, Rolfer
New Haven Rolfing

Many of you will know Brooke from this blog, and from our last book. She grew her third practice from zero to 15 clients per week in a month, then went on to start a great program for wellness pros. She’s an amazing model for the power of building a few key relationships.

Specifically the thing that helped the most was by connecting with, and offering free work to, the holistic community in New Haven. There was going to be a lull period of a few weeks before I received my new license to practice in the state of Connecticut, so I couldn’t charge for my work. I figured instead of sitting on my hands, I could put them to use by running what I called my “Help for the Helpers” promotion.

I put out word to the holistic community (mostly by introducing myself to the owners of a couple of big wellness hubs in town- a yoga center and some wellness centers) and let them know that I had this lull where I couldn’t charge.

Lots of people came, many of them are still my long term clients and many have also been my biggest advocates in town. It’s been the best thing I did for sure.

Laura Allen, Massage Therapist
Thera-ssage

Many massage therapists will know Laura. She’s very active in the profession, and very supportive of practitioners. She took her practice from zero to $300,000 a year in 5 years, and put her advice in her book, One Year to a Successful Massage Therapy Practice.

The one thing that makes the biggest difference for me is that I SCHEDULE my marketing time. Every single day I specifically devote a half hour to doing marketing activities for my business. It is scheduled just like a massage appointment.

I might be working up a new ad, calling clients I haven’t seen in a while, sending out birthday cards with a discount coupon, or anything else that seizes me on that day.

Tonia Winchester, ND
Arbour Wellness
Tonia’s first naturopathic practice was, in her words, a “flop.” She was seeing less than two patients a day, on average, but she tripled her practice in a six month period and is still growing steadily.

I followed a link to Brooke’s blog, and really connected with her style and approach.  So in a blink I signed up for her course.

And then did nothing with it until after my wedding.

Then in August 2010 it was like a switched turned on, or the faucet started dripping, and then pouring.  I did the first module of Brooke’s course, she calls it The Cleanse.  The reframe of “my why” was probably the most vital thing I have done in my practice building journey so far. I realized that I don’t NEED patients so I can pay my bills, but I know patients will benefit from my unique, amazing, gifted me.  It would be a pity not to share the goodness that I can bring to the world.

Things were differently immediately.  There is still lots of room for growth, but the trend is stupendous and I know it will continue until I’m at a place where my schedule is filled.  Patients are starting to refer, people who see my talks are starting to book, people who see advertisements for my talks are starting to book.

In sum, in all honestly, my progress has been due to a mental / spiritual re-understanding of my place in this world.

Ann Ross, LMP
Urban Healing Arts Studio

When she first opened her doors, Ann was seeing only 2-3 clients per month. After vowing in the new year of 2006 to make it happen, she grew in that year to 8-15 clients per week, and has grown every year since. She’s now on track to earn six figures this year with the addition of three new therapists to her business. She helps other therapists do the same at her blog Massage Marketing Mentor.

I recommend that therapists team up with other health care providers in attracting clients. If it had not been for renting space within a chiropractic clinic I don’t believe I would have grown my business that quickly.  The exposure I had was incredibly valuable.

Therapists need to seek out relationships with complementary businesses.  Chiropractors, Acupuncturists, Yoga Instructors, PT’s, Naturopaths etc. are great resources when looking to gain exposure. I recommend therapists create some type of offer to the customers of the other business.  Because the other business already has created a trusting relationship with their client base, those clients will be more likely to book a massage appointment with the therapist.

I love how each story is a little different. At the end of this series, I’ll share some common threads that I’ve seen.

If you have a story of turning your practice around that you’d like to share, feel free to get in touch – it might seem to you like it’s not important, but you’d be surprised at how one little idea can change someone’s life. – Dan

Back in 2006 (wow) we listed five things we wished we would have done in practice right from day one. Since the New Year is almost upon us, it seems like the right time to pass on a few more. Even if you started your practice long ago, you can still pretend like the new year is a fresh start, right?

1. Think Illness Not Wellness…

…at least when it comes to marketing. We all want to feel like we’re in the wellness business – and we are. But for many practices, people who are already well don’t make great clients. Time and time again, we find that people seeking “wellness” don’t really need that much help. They pop in for a visit and the reassurance that they’re on the right track, then they vanish.

People with problems you can solve – sick people – make great clients. And they refer others. And the people who you help out of illness are far more likely to buy into wellness programs – they know first hand what being sick is like. Advertising “wellness” isn’t nearly as effective as marketing a solution to a health problem.

Get people in the door because of illness. Then keep them by getting them well.

2. Restrict Your Hours

Work less, earn the same. Have a life. Why? Here’s why.

3. Book Effectively

When the schedule looks like a wide open slate, it’s easy to think that booking efficiently isn’t critical. It is. I wish we’d spent more time early on focused on how effectively the hours were booked, and less time on how many of them there actually were. Get a waiting list going. Book wisely. Enjoy the results.

4. Use Social Media – Especially Facebook

This one’s a  bit of a cheat, because Facebook wasn’t around when we started. But if it were day one for us right now, I’d be all over it.

Facebook is quickly becoming the largest source of traffic to our website other than Google searches, and there are vast amounts of people in the right demographic. More than half of users are women, and the older age groups – those with both health concerns and the money to spend on them – are the fastest growing by far.

If you’re already doing this, great. If not, start with the easy part: get a Facebook account and just start exploring. Don’t be scared – you can lurk and learn at first. When you’re ready, here’s a good resource for starting your practice page.

5. Create Marketing Partnerships

Sometimes you can’t reach everyone you’d like to. It takes time, money and energy to market directly to people who might user your services. Wouldn’t it be nice if someone could reach some of them on your behalf?

I wish we’d spent more time creating partnerships early on. Not just Please-Can-You-Send-Me-Some-Clients referral relationships, but partnerships based on cross-promotion and offering value to each other’s clients. Added bonus: sometimes health care is a lonely job. A few more colleagues is a nice thing to have.

It’s never to late to start any of these. And if you’re inclined toward Fresh-Starts-In-The-New-Year, maybe there’s something here that’s a fit. -Dan

Reader M. asks:

“Any advice for a new practitioner debating between joining a practice or starting a practice of my own? I am faced with an opportunity to join a thriving practice. I’m weighing the convenience/earning potential (esp. in the beginning) against loss of practice identity and opportunities down the line.”

If you’re only considering growth, there are really just two benefits to joining a practice. The first is the referrals you might gain from other practitioners in the practice. The second is exposure – growth you might experience simply from being in a busy office – walk-in exposure, signage, traffic, goodwill, and other benefits of the location and the business.

The challenge is that it’s pretty difficult to quantify either of them. Here are a few questions to help you out:

How busy is the practice?
You’re going to get the best mileage in exposure and referrals from a busy office. Practitioners who aren’t wildly successful just don’t tend to refer as much. There are exceptions, but they’re just that: exceptions. (And for practitioners in search of associates, the same applies: if you want to attract and keep associates and other partners, you need to be running a busy practice.)

While joining a multi-disciplinary setting may offset competition a bit, don’t count on it. Cash-starved practitioners want to solve patient’s problems with their own modality. A prosperous clinic is the best home for your practice.

Will the other practitioners refer?
Traffic volumes aside, some practitioners just don’t refer. How do you find out? Interview, interview, interview. Meet everyone in the practice. Do lunch. Chat. Get to know them, and understand the dynamic between practitioners in the office. Find out how much referral is currently going on – within the office, and to CAM pros outside. The keyword here is collaboration. A practice that refers out will be more likely to refer within.

What’s the track record for other associates?
This is an important one: how many have come before you? How long have others in the practice been there? How many people have come through? If you see signs of a revolving door, with many practitioners coming and going, you can bet there’s usually a good reason.

What are the location benefits?
Busy street? Great signage? Long clinic history? Established brand? Strong, regular marketing? These are all positive signs. Make sure you know up front how many of these benefits you can tap into. Is there signage space for you? Can you market your services to existing patients in the practice? Can you feature you name and information on joint advertising? The location benefits of the practice are only as good as the extent to which you can leverage them.

What’s the business relationship?
It’s hard to discuss all the variables here, but some important things to consider:

• Do you own the patient files?
• Are you an employee, associate, independent contractor, tenant, etc.?
• What’s included? Staff? Space? Equipment?
• What’s the duration of the arrangement? How can it be terminated on either side?
• Is there a non-compete? If things don’t work out, can you set up shop down the street?

How effective is the front desk/reception?
Here’s one of the best-kept secrets of great practices: the person who controls the appointment book controls your practice. If they don’t promote you, or if they (perish the thought) actively solicit your patients to see other practitioners instead of you, all your efforts will deliver small returns.

If they aren’t serious about the job of booking appointments, you’ll feel it.

Why are you being asked to join?
Are you being invited for the right reasons? Reasons that indicate a bright future for you include:

• A practice that’s so busy it requires more help
• A practice that wants to expand it’s range of treatments to improve patient health outcomes (as opposed to attract more patients to existing services). If you’re a lure for new patients and nothing more, those new faces might never make it as far as you.
• Practitioners that want to help new graduates gain experience – intern programs and the like.
• Practitioners who want to collaborate for the good of patients.

Reasons that aren’t so great for you:

• Someone covering their monthly overhead by filling the space with associates

How Much Do You Value the Non-Financial Benefits?
There are other benefits to playing well with others. Camaraderie, convenience and learning opportunities are all pretty darn fine reasons to hop on someone else’s ship instead of building your own. Do those outweigh the downside of joining a practice instead of building your own?

Can you hedge your bet?
What if things don’t work out? Can you make a clean break with your files and your brand intact? Here are some ideas to exit-proof your escape:

• Get your own phone number and have it forwarded/answered at the clinic. Otherwise, if you leave, people may still call the existing clinic with your old number.
• Have your own yellow pages listing with your own number.
• Have your own website and email address.

The trick is to ensure that you could open up for business down the road tomorrow, and still count on all your patients contacting you, not the previous clinic.

What do you really, really want?
This is what it’s really about in the end, isn’t it? Choosing the path that’s right for you as a practitioner – one that keeps you healthy, happy and jumping out of bed in the morning, and lets you make a decent living doing what you love. If running your own show is a requirement for that, you’re likely going to be disappointed in someone else’s business. It may seem difficult, but make the smart, joy-driven decision, not a fear-based one.

How do you get the answers to all these questions? Some are introspective, some are simple observation. The best information, though, is going to come from interviewing practitioners who are, or have been, part of the practice in the same capacity in which you’re going to join. Whenever possible, you need to talk to people other than the person who you’ll be making the agreement with – that includes patients, too.

Spend time in the clinic. Hang out. Make an appointment as a patient. Take the time to drink up the whole experience before you make your decision. You won’t regret it.

The SBA has a bunch of podcasts available on their site. I haven’t had a chance to listen yet, but the titles sound enticing. Lots geared toward startups, including:

Check List for Starting a Business
Financing a Small Business
Creating a Business Plan

There are also transcripts for the non-casters.

Small Business Administration Podcasts

There are a million conceivable things to do when you start your practice, but what’s really important in the big picture? What’s going to lead to increased referrals and practice growth? Here’s a few seemingly innocent but critical things to do from day one. And if you’re already well past day one, fear not – it’s never too late to start.

Track Your Referrals
Discovering where your referrals come from is the single best way to get more of them. You can use our five P’s or something of your own, but make sure you track them from day one. Before you know it, it’s going to be day one of year two and having referral source data is going to be incredibly helpful in figuring out how to spend your marketing dollars.

Accept Debit and Credit Cards
Just do it. I know it’s expensive. I know it’s a hassle. Just do it.

Still not convinced? Follow the link.

Make Sure the Phone Is Answered
You might not be able to afford a receptionist right away (although it may well be worth the risk). But if you miss those calls, you’re going to lose business. Consider an answering service at the least – one that can book appointments on your behalf.

Act Like You’re Busy
Whether you want to treat this as metaphysics or practical behaviour, acting as if you’re a busy CAM practitioner from day one is going to get you there faster. It’s particularly helpful in how you manage your appointments.

Pay Yourself
Get in the habit of paying yourself consistently. It’s far too easy for your practice to consume all the cash flow, and for you to find yourself five years down the road still breaking even. Just look at how easy it is to spend all the money in your personal bank account. Your expenses have a habit of rising to meet the available cash, and your practice is no different.

It doesn’t matter how much. Ten bucks a month is fine – what’s important is to start the habit. Just set up an automated system and forget about it (except for regular raises!). Everyone in practice can afford ten bucks, and believe me, it will make a difference.

And don’t forget those raises. Stretch yourself. Pay a tiny bit past what you can afford, and you’ll find your practice will grow to accommodate the increased expense.

About.com has an pretty compelling list of 10 reasons to buy a business instead of starting your own, and they all apply to holistic/CAM practices. Given the high failure rate for small business, it’s worth considering.

Buying a Business: The Safer Alternative:

1) Much lower risk of failure,
2) Business generates cash flow from day one (preferably positive cash),
3) Proven business concept and processes,
4) Proven products, services, marketing and sales strategies,
5) Established customer base providing referrals and references,
6) Established suppliers,
7) Trained employees in place, Immediate credibility and perception of success,
9) Seller likely to lend support and may assist with financing,
10) Easier to secure affordable financing to complete the acquisition.

Source: http://entrepreneurs.about.com/od/buyingabusiness/a/buyingabusiness.htm

First in a four part series on starting a holistic practice. You need to be a member to read the other three, but this one’s a freebie…

Starting A Practice At A Glance Part 1 – Writing A Business Plan – www.holisticpro.com

Although it might lean more toward silicone than supplements, StartupNation has a pile of resources for anyone starting or growing a business.

They’ve got articles, podcasts, tips and tools on everything from website analytics to life plans. Definitely worth a look…

http://www.startupnation.com/

There’s surprisingly little help for CAM startups online (hence this site, I suppose…). However, the Canadian gov, and a few of the provinces, have specific info for starting your alternative health practice.

A fair bit of it’s Canadian-specific, but it’s worth a spin through. Some interesting industry stats, too:

Starting an Alternative and Complementary Health Care Business

(In addition, the province of British Columbia has a PDF that’s not listed on the main Canadian Small Business site: http://www.smallbusinessbc.ca/pdf/alter.pdf )

If anyone knows of comparable resources for the US, UK, Australia, etc, let me know…