“Civilization is a stream with banks. The stream is sometimes filled with blood from people killing, stealing, shouting and doing the things historians usually record, while on the banks, unnoticed, people build homes, make love, raise children, sing songs, write poetry and even whittle statues. The story of civilization is the story of what happened on the banks.”
— Will Durant, Life, Oct. 18, 1963

One of the four metaphors in The Practitioner’s Journey is the River. It represents the uncertainty that separates you from your potential clients. Things like cost, fear, disapproval, time, skepticism, and other perceived risks. Attracting more patients to your practice is almost always about finding ways to get them across the river.

The greatest challenge, though, might not be the river itself, but the fact that we focus on it instead of the banks.

The river is competition, or a lousy economy, or lagging insurance coverage, or public skepticism. But everything that gets your clients across it–everything that grows your practice–happens on the banks. The bank is where we find the rocks for stepping stones. It’s where we build bridges.

The banks are within your control. The banks are where you can take action.

The river, like so much sh*t, just happens. Best to focus on the things you can change.

Related posts:

1. We May Not Be Good, But at Least We’re Slow

One way to look at the big pile of people out there who might become your clients is to divide them into two groups.

The first is the kind that already knows what you do, and is looking for it. This group is small. But they’re sooo close to being your client. They’re already searching–you just need to be found.

The second group needs to be educated. They don’t know what you do, or how it can help. This group is huge. But you have to find them, and convince them.

Finding takes work. It involves relationships and credibility and time and money and effort. But it’s critical. You need to be finding.

Being found takes some work, too, but the convincing part is a lot easier. That’s why we all like being found.

The trick is that being found doesn’t look quite like it used to.

Being found used to be straightforward. You did something easy like put an ad in the Yellow Pages. Anyone looking for “massage therapy” could find you in the list. Getting good at being found just meant that you called yourself “AAA Massage Therapy” to get to the top of the list, or you bought the biggest ad. For that small, but already-convinced slice of the pie, that was a simple way to play the game. And generally the game could be won with a big enough budget.

The new “found” looks different. It’s not about your Yellow Pages ad, or the big sign outside.

• When someone searches for a massage therapist in their area, and your website comes up at the top of Google? That’s you being found.
• When someone is looking for a solution for infertility and your acupuncture practice comes up in Google Adwords? Yep. You. Being found.
• When someone searches for “Yourtown Chiropractor” and your Google Places listing comes up first because you took the time to claim it and complete it? That’s you being found again.

That’s just Google. You can add Facebook or Bing, or mobile search or whatever floats your boat. The difference? Not that it’s online, but that it’s cheaper. You can now be found by trying harder, instead of spending harder.

The new “found” rewards thinkers, adopters and triers. Not spenders. But the moral is the same: Spend plenty of time finding. But don’t forget to be found, too.

Related posts:

1. Grow Your Practice with Google Places
2. 5 Random Files: An Easy Way To Reactivate Clients
3. 3 Ways to Keep Chatty Clients on Time

The greatest misconception among health care professionals is that your training is enough to make you successful.

It isn’t. It’s not anyone’s fault, but the challenge, whether you’re in your first year or tenth, remains the same:

The skills that got you to graduation aren’t the
same ones you need to successfully grow your practice.

School taught you how to help your clients. But it probably didn’t teach you that much about how to find them. It didn’t teach you how to market yourself, manage your cash flow, deal with staff or provide amazing customer service.

So what now?

The good news is that those are all learn-able skills, and the one thing you’ve proven you can do is learn.

The trick, though, is that you can’t learn the missing stuff the same way you learned the other stuff. You can’t learn business the way you learned how to rub, poke, adjust, supplement and coach. Sure you should read books and take classes–there are great people doing great things out there. But you’re going to need something else, too: a little trial and error.

What makes us uncomfortable about learning the new skills we need isn’t the trial and error, though. It’s that we don’t get to learn them in the same context. You don’t get to do it all from the safety of a classroom or textbook. You don’t get to practice marketing on pretend clients and classmates. You have to do it all without a net. You have to get out there.

You can’t change the fact that you need to keep learning. But you can change how you look at the new context. Is working without a net scary? Squishy? Unethical? Dumb? Not for you?

Or is it the last piece of the puzzle that finally lets you do what you’ve wanted to all along?

I like the last way better.

Related posts:

1. Are You Waiting to be Picked?

Hi All,

Next year is almost here! Thanks to the many (wow!) of you who took advantage of the pre-order special on The Practitioner’s Journey workbook. The offer ends on December 31. Before then, you can get the digital workbook for just $9.95, or the original eBook and the workbook together for just $14.95. Click here to order. (Update: The workbook is here! You can get both the eBook and the workbook/stats package here.)

-Dan

The New Year is just around the corner. Here are four ideas to help you hit the ground running…in the right direction…

Strategy 1: Pick One Big Thing to Work On
It’s a new year, and the temptation is to try to radically transform everything. Forget it. You’re not going to change everything in your life or your practice overnight. Pick what you’re most passionate about. Or what will have the biggest impact. Solve your biggest problem. But pick ONE big thing. If you fix that thing, you can always move on to the next one, but start with one?

And while you’re at it, decide on what “done” looks like for that one thing. Things like “make more money,” or “grow my practice” don’t have finish lines. No finish line means you run forever.

One race at a time, with a finish line, will keep you focused.

Strategy 2: Decide That Your Practice Must Serve You

Remember when you were a kid, and you’d say, “You’re not the boss of me!”? It’s time to regress a few years and put that tactic back to use in your practice. It’s time to decide who’s the boss. Here’s the org chart as I see it:

In short: Your clients are the boss of you. You’re the boss of your practice. 

Your practice works in the mail room. It’s job is to serve everyone. Especially you. It’s there to make sure people get care, and you get paid. Nothing more.

Make the decision that your practice is there to serve YOU, which it does by providing you with income. I’m not kidding.

What does that look like in practice? You pay yourself first. That may sound trite, but it’s amazing how the bills always seem to find a way to get paid, but not so much the practitioner. Even just changing the sequence of paying yourself first, then the bills, can make a difference.

Letting your practice push you around is like choosing to let your car drive itself. It’s a painful and costly process that never gets you where you want to go.

Strategy 3: Plan to Take a Risk

Since most practitioners don’t start off as entrepreneurs, they also don’t tend to be big risk-takers. In fact, your job may well be about spending your time trying to reduce risk–the risk of injury, the risk of disease, the risks of aging, the risks of modern lifestyle.

The problem, of course, is that part of what you get paid for in practice is taking risks. That means if you want your reward to increase, you may have to increase your risk as well.

What it looks like in practice:

• Hire someone. Do you really need help, but are afraid to take the leap? Maybe it’s time to try. You don’t have to hire someone full time – try a smaller commitment first.
• Bigger space. Are you busting at the seams, but can’t do more in your existing space? Maybe it’s time for a move.
• New offering. New service? Product? What can you invest in to bring to your practice that will offer more to your existing clients, or attract new ones?
• Try a new marketing technique. Particularly one that scares you, like networking or public speaking.
• Invest in yourself. Do you understand marketing? Finance? Managing others? Spend some time and money on yourself to fill in the missing pieces.

There are of course, many more. What will yours be?

 Strategy 4: Choose to Be in Business This Year

More accurately, that should be “choose to accept that you’re in business,” because you don’t get a choice if you’re running a practice. It comes with the territory, and everything works better if you just choose to swim with the current.

Why? I think our free ebook, The Gift, says it best. You can download it for free. No signups. No catch.

What it looks like in practice:

• I think it looks a lot like this.

We’d love to hear your suggestions on how you plan to make the most of next year. Good luck in 2012!

Related posts:

1. 3 Ways to Keep Chatty Clients on Time
2. How To Earn $80K in Your First Year of Practice
3. Help for Your Practice in 2012

Tara emailed me the other day:

“Just pulled in to the grocery store and then pulled right back out because I remembered you needed a quarter to get a cart, which of course I did not have. The moral? Don’t make it tough for your customers to spend money at your store – the quarter is about them, not about me and they lost $100 worth of business because of it today.

Now I’m sitting in the their competitor’s parking lot writing this email.”

Compare that with another email Tara sent me a couple of days later:

“I was just thinking about how delighted I was with the fact the hotel had a little container on the bathroom vanity that contained Q-tips. Such a little thing, but it makes me want to stay here again. How much did that cost the hotel? Hardly anything, and they have a delighted customer.  It’s the little, inexpensive, but unexpected things that truly delight.”

In both of these cases, pennies were traded for dollars. In the first case, the store reached for pennies and lost dollars. In the second, the company gave away the pennies, and got dollars in return.

But the real story here is one of service. Providing it–or not–is what’s driving the flow of pennies to dollars. Tara and I are both service geeks. There’s a lot of joy in good service. Money, too, I think. It’s worth thinking about where you’re exchanging dollars and pennies in your own practice.

What’s most important about service in our industry, though, is what it means.

Most of us aren’t in the business of naturopathy, or massage, or chiropractic or acupuncture or nutrition. We’re in the business of private health care. People are paying out-of pocket for what we do, and when people people pay out-of-pocket for things, there’s always a reason.

Sometimes the reason is that what you offer actually works.

But I think more often the reason is that you offer great service. Because it shows you actually care.

Related posts:

1. How To Turn Your CE Into Practice Revenue
2. 7 Strategies for Taking A REAL Vacation from Practice

Tara just returned from a great seminar in Arizona. Awesome trip, great lectures, helpful stuff. And, Arizona versus a cold, rainy October weekend in Ontario? No contest.

Part of a great CE experience, though, is not feeling guilty the whole time for investing in yourself. If you’re like many practitioners, you may stress over whether you can justify the cost of travel, seminar fees, and time away from work.

For this seminar, Tara paid for the entire trip–flight, hotel, course, etc.–with ten minutes of work using the strategies below. Here’s how you can do the same.

STEP 1: Choose Wisely

It’s hard to leverage CE if you don’t pick the right stuff. I’m all in favor of learning for the sake of learning. But if you want to translate your continuing education into dollars, you need to be able to answer the following questions:

• Is this a topic, technique or tool that I will actually use?
• Will it appeal to my existing practice clientele?
• Will it bring new clients to my practice that I might not have found otherwise?
• How will I get the word out to clients, both new and prospective?
• How many NEW visits/treatments/appointments do I need to generate to pay for the cost of the CE?
• How long will that take?
• Can I start immediately?

There are many CE opportunities out there, and we’ve found that these questions are very helpful in narrowing the field down to what will pay for itself many times over.

STEP 2: Take Smart Notes

Stop being a human photocopier. No, really.

Your job is not to write down everything the presenter says – most of the time they give you the notes or slides anyway. Your job is to capture two things during your lecture or workshop:

1. Insights that will allow you to provide better care.
2. The actual names of real honest-to-goodness clients in your practice that you can help with your new knowledge.

You know what I mean. Stop writing down stuff you’ll never look at. Write down the names of real people. Jot down real action items that you can do when you get home to start growing your practice. And just listen.

STEP 3: Block Off Extra Time

Yes it’s expensive to go to seminars and conventions. Yes it’s expensive to take time away from the office. And so the temptation is to leap into work the moment you get back to make up for lost time and money.

Don’t. You need to create some time to leverage this new learning (see below) so that it will continue to pay for itself every day. Create some time when you first get back so you can do the most important part of learning: putting it to use. The first day or two after your workshop or retreat are critical in terms of recouping your investment. It’s worth the time. A full day should give you more than enough time. A half-day is probably sufficient to get a lot done.

STEP 4: Leverage Your New Knowledge

• Strike while the iron is hot. If you’re flying to a seminar, then work on the plane. Once you return to the reality of practice, the odds of leveraging your new knowledge decrease with each passing day. Get it done soon, or it’s not going to happen.
• Don’t try to do everything. If you’ve learned 150 new tips and techniques, or 75 new conditions you can treat, don’t try to tackle them all. Pick a handful with the biggest impact, and focus on those.
• Get the word out. Post to your blog. Send out a newsletter. Update your website. Post to Facebook. Tweet. Call or email the clients who’s names you jotted down. If you have an established practice, then your existing client base is the low hanging fruit. Let them know what you have to offer!

That last point is an instant cash generator. After this course, Tara gave the front desk a short list of a few existing patients whose names she had noted during the seminar. A few phone calls later, those people had booked appointments, and were delighted that Tara had thought to go the extra mile and bring something new to their case. And the CE was paid for.

Just the one strategy of jotting down patient names and calling them after the seminar paid for the entire trip. That’s ten minutes of work. And that’s just the beginning.

CE is fun. But it’s even more fun when you feel like you’re getting paid to do it!

Practitioner’s Journey workshop in Hawaii, anyone?

Related posts:

1. Practice Growth Workshop for ND’s
2. How to Grow Your Practice With Public Speaking

A practitioner once told me, “I’ve cried a lot of tears from comparing myself to others.”

What she meant was that constantly comparing yourself to other practitioners is exhausting and destructive. She meant that feeling like everyone around you is more successful than you are is a tough way to go through life, and ultimately, does nothing to help your practice.

But there’s a flip side to comparison that isn’t acknowledged enough. We do it when times are tough as a way to make ourselves feel better. As in, “Things are slow, but everyone’s been slow.” or “I’m in trouble, but at least I’m not that guy.”

Don’t set the bar that low. Choose your own set of standards. Create your own yardstick. Don’t find success in the fact that other practitioners are suffering, and don’t suffer when others find success.

Don’t compare. You can study. You can copy, and improve. You can teach and learn. But don’t compare. It either lowers the bar or it lowers your confidence. Neither is helpful.

Related posts:

1. How to Create Your Practice Marketing Plan
2. The Habits That Make & Break Practices
3. How To Turn Your CE Into Practice Revenue

When it comes to practice success, there are just two kinds of habits that matter: the ones you need to create, and the ones you need to undo. What to start doing, and what to stop doing, in other words.

There are things that don’t serve us. Like habits of self-criticism. Or working too long past the point where we’re actually doing anything. Giving in to ultimatums.

And then there are the things that do serve us, and should be habits. Like failing faster. Making a little bit of steady progress on important things every day.  Surrounding yourself with great people. Or remembering to be grateful.

The list, of course, is endless. The trick is that habits are often subconscious. We need to drag them out in the light and intentionally look at them. To do it, the question you need to ask yourself is this:

What one habit could you replace in the next 30 days that
would dramatically change your practice?

What do you need to add, and take away, that would make it more fun? More profitable? More whatever-it-is-you-want?

Here’s the most interesting part: Stopping a habit that doesn’t serve you creates more than enough time space and headspace to create one that does. And doing it the other way works, too–create a new, empowering habit, and it’ll often steamroller right over an old one…

-Dan

PS – An interesting post from Steve Pavlina on How To Maintain Not-Quite-Daily Habits that you might find helpful, too.

Related posts:

1. Quick Builders: How The Fastest Grow Their Practices (Part 1)

One of the barriers to practice marketing is getting caught up in trying to make things perfect. You put things off because you need to figure out X, or get just the right Y, or get some advice from Z. And the time ticks by.

And, of course, you really can’t get things perfect. Trying to hit perfect is a recipe for a) not getting anything done, and b) feeling like a loser for not getting anything done. It turns out, aiming for perfect is really just afraid to screw up in different clothes.

To beat that, we’ve been trying to, in essence, fail faster. Essentially the opposite of getting things perfect.

Really?

Yes. Really.

What The Hell I’m Talking About
This idea can be a hard sell, so I’m always on the lookout for…well, failures. As it turns out, there are all kinds of them once you start looking.

Here’s one:

Each year we try to connect with our best referrers. Some of them are patients who are real champions of the clinic, others are health care professionals who tend to send people our way.

Connecting helps us discover why people refer. Or how we can do better. But always, it’s just nice to show our gratitude.

To shake things up this year, we decided to offer our best referrers some certificates for a free initial visit that they could give away.

We’d never done that before, but we have extra help at the clinic and it seemed like a good experiment to try. It gave our referrers a way to give something in turn to someone else, and a way to reduce the barrier to entry for what is a costly service for some.

Rather than spend a whole bunch of time figuring out the best way to do it, though, we just…did it. Just pulled the trigger with limited prep.

The Results

FAIL.

So far, it hasn’t worked out. Last time I checked, not one of the certificates had been redeemed. Nice.

But of course, the best part about screwing up is what you learn.

Lesson #1: Be Specific

There were a couple of simple mistakes we made.

1. We didn’t put an expiry date on the gift. I wouldn’t normally do that for gift certificates that people pay for, but why didn’t we do it for one’s we’re giving away? Oops. We should have limited the time frame. Never even crossed my mind, though.

2. We didn’t tell our referrers what we were looking for. This became clear when one person said, “Thanks. I know just the person. They’re really active, healthy, and into nutrition. I’ll give it to them.”

WTF? Someone who’s active, eating well, and healthy has no reason to come to us! We’re looking for sick people who can barely function, not healthy ones! We should have said something like:

Do you have a client, friend or family member with a chronic health problem that no one seems to be able to help? Please pass on this certificate with our compliments.

Or we could have gotten even more specific, identifying three health concerns that we have the most success with. We did neither, and as a result our gifts are now languishing in desk drawers, glove boxes and under fridge magnets filled with grocery lists and kid’s schoolwork.

Both of these mistakes were simply problems with not being specific. Easily fixed for next time. But of course, there’s a larger lesson here. (Isn’t there always? )

Lesson #2: Failing Faster Works

Part of sharing this with you is so that you don’t have to make the same mistakes, but also to point out something more important: that we were better off screwing this up, then not doing it at all.

Here’s why.

The stakes in health care are high. People are trusting you with their most important asset. Most regulated professions have a whole infrastructure to protect the public – accredited schooling, ethics and jurisprudence training, licensing exams, continuing education. There’s a lot that goes into making sure you screw up as little as possible.

Here’s the thing, though: the stakes in marketing your practice are low.

Marketing a practice is mostly cheap. A bit of time here, some paper there, a few bucks over here. Even in a fledgling practice, a lot of it is small potatoes – mostly time. But your training makes you risk-averse. And that can bleed into your practice marketing efforts.

It’s okay to screw up. In fact, it’s essential. When you try to not make mistakes, you start looking for perfect. But Perfect is a distant destination, somewhere out beyond Never and Ever. Looking for it is a recipe for not getting anything done.

Our whole experiment cost a few dollars and a few hours. It didn’t work – at least not yet. But who cares? It’ll work next time, because we failed forward. Now we can do it again, better. If we had waited for perfect, we’d have nothing done, and still not know how to get it right. And in the meantime, we’ve connected personally with our best referrers to say thanks. And that definitely works.

• Been wanting to start a Facebook page for your practice? Just do it. It’s free.
• What about that email newsletter? Just do it. Screw it up if you want – it’s free.
• What about your Google Places page? Who cares if you make a mistake – it’s free.
• Twitter? Why not? How badly can you go wrong with 140 characters? And it’s free, too.

Not all these may be a fit for your practice – that’s fine. But if they are, don’t let fear of failing hold you back – the stakes are low.

Next time you think perfection is holding you back, ask yourself, “What’s the real cost of screwing this up?” Most of the time the true cost is a lot smaller than you think, and what you gain in experience is well worth it.

No related posts.

Any of these sound familiar?

• You just set a new personal record for the least number of new clients in a week.
• Your line of credit is maxed out. Credit card? Same.
• You’re being sued by a former patient.
• Your key – and only – staff member just quit. Effective now.
• You’ve been told you have 30 days to leave your current practice space.
• Your associate, whose payments make it possible to pay the bills, is leaving.

At least one of these probably strikes a chord. We’ve felt them, and we know practitioners who’ve experienced almost all of them in the space of a few months. They’re all cause for sudden knot in the stomach, and that anxious sense of near-panic.

I don’t think anyone gets a free ride in practice – we all know what this stuff feels like. What matters, though, is how you choose to deal with it. Here’s our best advice.

1. Don’t Knee-Jerk

This isn’t a car crash. Few disastrous things happen overnight in practice, and you likely have some time.

• Action 1: If panic has just arrived in the form of bad news, give yourself permission to sleep on it. Being tired makes everything worse. Tell yourself that you’ll take one night off from worry. This isn’t about avoidance. It’s about tackling a problem in your best form. You wouldn’t pull an all-nighter expecting it to improve you marathon time. So don’t do it for a major practice challenge.

• Action 2: Once you’re rested, figure out how much time you have to deal with the problem. How long can you keep going the way things are? Can you go 6 months without replacing that associate? Thirty days without more money? Three days? Chances are it’s longer than you think. But you won’t be able to think clearly and plan your next steps until you know your timelines.

2. Connect With Others

We have a tendency to not want to talk about practice problems. I suspect many of us would more readily talk about a death, an illness, or a divorce before we admitted that something was going wrong with our business.

But while the problem you’re facing right now is going to be yours to solve, you don’t need to go through the process alone. You need to not isolate yourself.

This isn’t about finding someone to give you solutions, although that might be a great spin-off. It’s about perspective. Someone outside your situation is going to help you realize that a) It’s going to work out, and b) Your problems in practice aren’t because there’s something wrong with you.

Their job is to help you rise above. They may not know it, but they’ll deliver just the same.

• Action: Book some time with friends. Bonus points if that time involves some stress-relieving physical exercise. (In order to pass Go, you need to also ensure that at some point your cheeks hurt from laughing. You know what I’m talking about.)

Practice is lonely work some times. Solving problems in a vacuum may seem like a good idea. It almost never is. It’s just a bad habit.

3. Look at The Worst-Case

This was the single most helpful tool leading up to our last sabbatical. It seemed like a million things could go wrong. What made the difference was deciding what the worst-case financial outcome was for leaving the practice. And then deciding whether that was a price we were willing to pay.

And of course, worst-cases are just that. They don’t come around often. If you can accept them, you can let them go and focus on doing the positive things that ensure that they never come to pass.

• Action 1: Ask yourself “What’s the worst case scenario here?” Then ask yourself if you can accept it.

• Action 2: Reflect back. There’s a good chance you’ve been through tough times before. Maybe this is the worst, maybe it isn’t. Think back to the two most challenging times of your life and note: you’re still here. This too will pass

4. Take Action…The Right Way

I’m listing actions here because the way out of panic and challenge is almost always behavior. You need to rest, de-stress and get your head on straight, but in the end, you’ll need to take action. You’ll want to focus on behaviors that you can clearly identify, complete, and repeat.

The simpler you can make this, the better. Moving out of panic requires the simplest steps possible. You need to feel like you’re taking action, and to feel momentum building.

• Actions: For simplifying marketing and growth challenges, try these two posts: Finding Low-Hanging Fruit, and  4 Questions That Will Help Get Your Marketing Done. For staffing challenges, try How to Find and Hire Incredible Staff.

Remember: it’s not the results of taking action that will relieve your anxiety soonest. It’s the actual action itself.

5. Don’t Hide from The Big Decisions

While small, consistent action goes a long way, occasionally you have to make a big decision. To move. To lay off staff. To dramatically change the way you practice.

The challenge is that we don’t really like to think about these things. I believe it’s because our minds can’t properly separate the thinking about something from the actual doing. We don’t want to think about firing an associate that’s making every day a misery because we start to get stressed about the doing part right away. We start to feel the financial pain of that action, even though we’re just thinking about it.

Give yourself permission to look at options without having to act on them. It takes practice to be mindful and to step outside your situation, so you may as well start practicing.

• Action: Ask yourself – or have someone smart ask you – what if questions. “What would happen if I left this office and rented space elsewhere?” “What if I fired so-and-so.” This is one of those small-big things. Using what if instead of should or can tends to reduce the anxiety around big decisions.

At some point, we all hit bumps in the road. Some are big, some small.
Just remember that the bump is part of the road, not the driver, okay?

Related posts:

1. Growing Your Practice With Words: 6 Steps to Great Writing That Gets Done
2. 3 Ways to Let Go in Practice
3. How to Manage a Long Absence from Practice