observations from our travels in the world of chiropractic

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November and December Marketing — and Your Higher Purpose

Petty Michel Associates Practice Promotions

November and December are special times for patient marketing, whether you are promoting to prospective patients, active, or inactive patients.

Usually, we have found that internal marketing is better during this time of year as you don’t need to compete with commercial businesses as they slug it out in an advertising frenzy. You can prepare now and schedule your external promotions and community services for January and February. Of course, if you see an excellent opportunity for external marketing now, take it. But the primary focus should be internal for these two months.

November and December are “cozy” months. In North America — we have Thanksgiving. This is a time we give thanks for all our blessings and gifts and family and friends. It is a time when people feel grateful. Christmas is also a time of good cheer and giving, as is Hanukkah and other holidays.

And, for some of you, it is also the season of the yearly hunt — when you bring home the ring tail pheasants, the turkeys, and “da ‘tirty point buck.” (Wisconsin-ese for “the 30-point buck.”)

Your promotions should align with the spirit of the season to be most effective. Donation drives are often held. There are many churches and associations in your town that need help as they prepare to assist the less fortunate.

“Toys for Tots”, “Food for Families”, or “Coats for Kids”, are many popular promotions by local media stations. I don’t doubt that they are helpful, but I do sometimes question their sincerity.

Of course, you want more customers, that is the nature of business. But you must lead with your mission statement first.

Any promotions should stem from your higher purposes.

The Higher Purpose Company
In The High Purpose Company, (Arena, 2007) Christina Arena reports on her team’s study of 75 companies’ efforts at Corporate Social Responsibility (CSR).

She shows how corporations, by doing good, by providing better conditions for employees, more sustainable sourcing of raw materials, and contributing to beneficial causes in their communities, generate more income.

“The central findings of my research can be distilled in the following way: superficiality fails whereas authenticity prevails. Companies that falsely approach corporate responsibility as a form of marketing, public relations, or even philanthropy don’t produce the most meaningful results. In fact, they often waste their money and create additional liabilities. Conversely, companies that truly approach the practice of corporate responsibility as a fully integrated business strategy, wisely investing in profitable solutions to meet unmet social and environmental needs and problems find their performance greatly enhanced.”

According to the Harvard Business Review, business spent more than $15 billion in 2016 on Corporate Social Responsibility (CSR) programs. (Davidson, July 7, 2016) And according to, Linda Novick O’Keefe, founder of Common Threads, “that number is rising as businesses see signs that investments in CSR improve company performance, talent recruitment and retention. (O’Keefe, 2016) “Giving in Numbers”, a study published by the CECP that analyzes giving and corporate societal engagement trends, revealed companies that increased giving by at least 10 percent between 2013 and 2015 actually experienced upticks in revenue and pre-tax profit, while all other companies saw a decrease in both.”

Your “WHY?”
Marketing must be honest, and it has to tell why you are doing the marketing. As Simon Sinek reminds us:

“Very few people or companies can clearly articulate WHY they do WHAT they do. By WHY I mean your purpose, cause or belief – WHY does your company exist? WHY do you get out of bed every morning? And WHY should anyone care?

People don’t buy WHAT you do, they buy WHY you do it.

All organizations start with WHY, but only the great ones keep their WHY clear year after year.” (Sinek, 2009)

I recommend finding charities or causes in your community that your patients care about. That you care about. Then, go talk to the head of the charity yourself – get involved – personally. Emotionally.

One office paid their staff for one hour for every two hours they went out of the office and worked on a community project.

And it doesn’t have to be charities. A Kid’s Day with “Saturday with Santa” can be a ball. One office holds a patient appreciation party with their patients each December with a Christmas Elvis impersonator singing Christmas carols. The one I attended was packed, and a little wild. But everyone talks about it for the rest of the year.

Your patients, and your neighbors, want what you want – a better and healthier community. Communicate that in all your promotions and you’ll get better results, and have more fun.

And, many thanks for you do from all of us at PM&A!


A list of sample promotions on our web site – see reference below.


Arena, C. (2007). The High Purpose Company. Harper Collins.

Davidson, R. H. (July 7, 2016). CEO Materialism and Corporate Social Responsibility.        Harvard Law School Forum on Corporate Governance and Financial Regulation. Retrieved from https://corpgov.law.harvard.edu/2016/07/07/ceo-materialism-and-corporate-social-responsibility/

O’Keefe, L. N. (2016, Decembr 15). CSR Grows in 2016 as Companies Embrace                Employees’ Values. Huffington Post – The Blog. Retrieved from https://www.huffingtonpost.com/linda-novick-okeefe/csr-grows-in-2016-as-comp_b_13657368.html

Sample Promotions. Chiropractic Practice Marketing Ideas For 2016. Retrieved from   www.pmaworks.com: http://pmaworks.com/observations/2016/09/20/chiropractic-practice-marketing-ideas-for-fall-2016/

Sinek, S. (2009, September). Simon Sinek How Great Leaders Inspire Action. Retrieved    from TED Ideas Worth Spreading:  https://www.ted.com/talks/simon_sinek_how_great_leaders_inspire_action

November 1, 2017   No Comments

Tent Poster – Calm Mind – Patanjali

Undisturbed calmness of mind is attained by cultivating friendliness toward the happy, compassion for the unhappy, delight in the virtuous, and indifference toward the wicked.”

― Patañjali, The Yoga Sutras of Patanjali




For a printable copy of this tent poster visit: Patanjali -Calm Mind

September 15, 2017   No Comments

The Real Reason For Low New Patients

Why Two Chiropractic Doctors Couldn’t Grow Their Practice

A few years back, a long-time client of ours gave me a call and said that he had hired two new doctors.  He asked if I would visit his office and see if I could help them grow their caseloads.

I told him that I was happy to pay him a visit.  A month later, I was touring his office and interviewing his team.  I then went out to lunch with the two new associate doctors.

I got to know them and asked them questions.  They were not shy about their goals. They told me that they wanted a “high volume” practice.  They boasted that they felt that it would not be difficult to see as many visits per month as the senior doctor by the end of the year.

They went on about philosophy, BJ Palmer’s “Green” Books, clean food and wellness. Both were young and looked fit and seemed eager.

They said that they wanted marketing help. They talked about how they had been working on social media, but felt that the owner doctor wasn’t supporting them enough by buying advertising.  It wasn’t blatant, but they seemed to be blaming him.  I acknowledged this and said that was something we could look into.

I knew that their practice statistics were very low. I told them that marketing comes down to caring about people – caring enough to talk to them, and caring enough to be honest about how you can help them.

They nodded like zealots. “Absolutely!”

I then said:

OK, look around this restaurant and describe a possible health issue with some of the customers. Just pick one and do a very preliminary screening based upon the way they are sitting or walking.”

This didn’t go as well as I had thought it would. Both doctors, I discovered, didn’t look at the fellow customers in the restaurant.  So, I prodded and finally got one of them to mumble a possible health issue with someone who was walking out.

I then asked each for their business card. Neither had one on them.  I paused to give them a look: “What?”

I had taken a couple of their cards each before lunch and placed two of them in front of each doctor.

Then I said:

“I liked what you both said about wanting a large practice and wanting to help more people. I would like to help you. So, to start, I would like you to get up from this table and find someone in the restaurant, introduce yourself, and hand out your card. If possible, make an appointment for them to come see you.”

They both looked at me as if they saw a ghost.  Gripped by fear, they both slumped down in their chairs. Neither would do it.

Seeing this, I suggested they talk to the cashier or waitress, or the manager.  Now the fear turned to a dismissive attitude, as if this exercise was beneath their dignity.

We ended lunch and went back to the office. We met with the owner doctor and discussed the situation. Over the following weeks the two doctors agreed that the relationship wasn’t working out and decided to leave on good terms to start their own office.

— — —

You don’t have to be a hyper-extroverted charming salesperson to be an effective marketer. In fact, this may act against you. The largest office I have ever worked with was seeing over 2,000 visits per week.  And the owner was serious and gruff, and talked like an angry fishing boat captain.

Marketing starts with a burning desire. It begins with an almost obsessive drive and purpose to help others by getting them into your office.  Marketing then depends on your belief and confidence in your skills and service. And it hinges entirely on how much you really care and empathize with each patient or prospective patient. And then, there is the effort you put in. You gotta do the work, and this means sometimes long hours, long weeks, and long months.

And as the C.E.O of your business, it also means getting the rest of your team to feel the same.


  1. Desire. Drive
  2. Confidence and belief.
  3. Compassion and empathy.
  4. Effort. Work. Sweat!

There are thousands of different methods to market your services. These may include “social media,” big goals, and “philosophy.” They may include newsletters, workshops, or back to school promotions. But in the end, marketing is communication, whether done electronically, through print, in groups, or one on one.  It is always and especially – one on one. In time, you will find what works best for you.

But no number of manuals, books, or coaching will do a damn thing for you if you don’t have the desire, the belief, the empathy or put in the work.

August 17, 2017   No Comments

Tent Poster – Epicticus

“Nothing great is created suddenly, any more than a bunch of grapes or a fig.

If you tell me that you desire a fig, I answer you that there must be time.  Let it first blossom, then bear fruit, then ripen.”


For a printable copy of this tent poster visit: Nothing Great Created Suddenly-Epictetus

July 25, 2017   No Comments

Tent Poster – Campbell

“If the path before you is clear, you’re probably on someone else’s.”

~Joseph Campbell





For a printable copy of this tent poster click the link: Campbell – Your Path

June 28, 2017   No Comments

Tent Poster – Wim Hoff

“We have healing power inside us.  But we block it because we feel we need to take pills and become dependent upon outside forces…

We have an inner doctor.”

~Wim Hoff

For a printable copy of this tent poster click link: Wim Hoff

June 23, 2017   No Comments

Patient Education: A Simple and Fun Method for Chiropractic Offices

Patient education is definitely a clinical function.  But… it is also good marketing.

And note that your entire office IS the marketing department and each team member has a marketing role.

To help everyone on your team better participate in patient education, use this simple and fun method:

Get a whiteboard and place it where patients can see it.  Assign someone to write something on it each day so that your patients, or you, can comment on it.

For example, you could write:

  • What does this mean?

“Pain is the last to show
… and the first to go.”

This will be a cue for the doctor or a team member to talk to your patients – and can also provoke your patients to talk to you.

Here are some other examples:

  • “What does a chiropractic ADJUSTMENT do?”
  • “How is pain like an iceberg to your health?”
  •  What does A.D.I.O. mean?

At your morning team meetings, or weekly meetings, go over each subject so everyone has a better idea on how to educate patients on the topic.
For active PM&A members, go here for a more complete list:  PMAmembers.com

June 20, 2017   No Comments

New ABN Form Effective 06.21.2017

New ABN Form and Implementation Instructions

Frequently asked questions and answers for the ABN form

New ABN English 2017(PDF) – Form CMS-R-131 goes into effect June 21, 2017. You may begin using the new one now(April 2017), but on and after June 21 per CMS, you may not use your current ABN.

New ABN 2017 (DOC) Form CMS-R-131 goes into effect June 21, 2017. You may begin using the new one now(April 2017), but on and after June 21 per CMS, you may not use your current ABN.

New ABN_Spanish 2017(PDF)-Spanish Version Form CMS-R-131 goes into effect June 21, 2017. You may begin using the new one now(April 2017), but on and after June 21 per CMS, you may not use your current ABN

ABN-Use(Doc) How and when to use the Advanced Beneficiary Notice for Medicaid Services

Script-for-ABN-form(DOC)– Script for explaining the form to the patient

Final Revised ABN-2012- Advanced Beneficiary Notice for Medicare Services – expires June 21, 2017.

June 20, 2017   No Comments

Has Your Office Been Target by Medicare for an Audit?

Ms. Lisa Barnett with Petty, Michel and Associates specializes in preventing Medicare Audits. She has helped those who have already been targeted find a fast and safe way out of trouble.

You are not alone…. Things do Happen…..
You are busy and possibly you have overlooked a certain requirement. Your computer has gone through updates and you have not kept up. Or possibly your documentation is simply inadequate in the eyes of medicare or the government.

Whether you are faced with a prepay audit or a post payment audit. I can help !

With 10 years of experience in the chiropractic industry and with documentation; and a chiropractic advocate for 30 years I care and I want to help.

Call today for your complimentary phone consultation and record review. 920-334-4561

June 9, 2017   No Comments

The 3 Key Ingredients to Motivating Your Chiropractic Team

Most of your staff are not engaged in the success of your office.  Most of them JUST DON’T CARE. 

At least that is according to a 2015 Gallup report that interviewed over 80,000 working adults.

The report showed that there are twice as many “actively disengaged” workers in the workplace as there are “engaged” workers who like their jobs.   The percentage of U.S. workers in 2015 considered engaged in their jobs averaged 32%. The majority (51%) of employees were “not engaged,” while another 17% were “actively disengaged.” (“Actively disengaged” means that they are actively sabotaging their work.)

But let’s say your office is different, which I am sure it is.  You are motivated enough to read this article and I am sure that is reflected by your team as well. But all the same, take a look with me at the level of motivation of your office.

How was your last team meeting?  Were you there? Was everyone sitting on the edge of their seat and contributing new ideas and plans on how to reach new goals in the office? Or, were most everyone pretty silent?

Sure, your employees smile and look busy when you are around, and often work hard and they do care.  But really, how much?

What would your office be like if the motivation, creativity, and level of pro-activity was always very high at “10,” or even ranged from 7-10?  If they felt that it was “their” business, where they took responsibility for the quality and quantity of outcomes, and regularly worked to improve the business – and themselves?

I have been reviewing the subject of motivation for some time, from my own experience over the years and from what social scientists have reported.

I have incorporated certain principles into a new system of business management that are specifically designed to unleash everyone’s innate motivation – including business owners like you!

Motivation is the foundational in a chiropractic office, or dental office, acupuncture – even with therapists and other service firms. It is a bedrock for any healthy practice and business.

Here is one very useful principle specifically about motivation and how you can use it to generate more engagement – and productivity — with your team.

3 Goals System of Business Management: Principle #5

Self-Determination and Motivation

Everyone wants their own sandbox to play in.

You do. This is one of the reasons you went to school – and why you started your business.

We all want to have something that we can call our own where we can create and demonstrate our competence. What we get in return is feedback that we can do something good, that we have power, that we can make something beneficial happen, that we can … make a positive difference.   If only to ourselves, we can say: “Look what I did. I did this. This is my creation.”

You can see it in children, for example, when they bring you their colored scribbles on crumpled pieces of paper to proudly show you their great work of art.  This is their sandbox.

Of course, we all work for money. But we also have deeper motivations that if tapped into and nurtured, can be very powerful.  By harnessing these motivations, and then linking them with others who have a shared goal, we can create a dynamic team driven business that is very profitable.

This has been explored by social scientists who have studied what has come to be called Self-Determinism Theory.  I have also seen it in action. Essentially, it states that we all have innate drives and inherent needs that motivate us to be more self-determined rather than determined, or controlled by, outside forces.

External motivation, like the fear of being fired, can only motivate us so far. Threats, criticisms, negative reinforcement may produce short term action, but in the end, they demotivate, or worse.

The level of employee motivation has a tremendous influence over the success of your business. 

An unmotivated staff, one that only becomes engaged to the level of “I will perform just good enough so that I don’t get fired or criticized,” will weigh the office down.

Self-Determinism Theory (STD) has three components, all of which easily apply to your business. These are:

  • Autonomy
  • Competence
  • Relatedness.

And by the way, while reading this, consider how this also applies to you as well!


You do not want your treatment plans second-guessed by a clerk in an insurance company. Neither does your front desk want you breathing down their necks about where all the patients or practice members are, or why they used the blue pen.  You should train and educate your team, but then get out of their way and let them succeed or fail.

Think of helping a child ride a bicycle. Sure, they will need your help for a while. A push now and then. Perhaps some training wheels. But you will have to let them fall down a few times and allow them to get the courage to get back on the bike and succeed. You can continue coaching them to improve, but you must let them go.

Even if you see employees appearing idle, or having brief personal discussion with another employee, back off. Tolerate minor errors. Give your team some rein.  Come back around later to coach them and train them to improve. Mostly educate them on the mission of the office and of their roles, and get them to understand what outcomes they are supposed to be producing. Once they see that the statistics measure their performance, they will be more self-directed and want to do all they can to win the game!

We all want to be free to create our own enterprises, even if we work for someone else. As long as what we do is in line with the purpose or mission of the business and our role, there should be no problem.  This helps us demonstrate our competence, which is the next element of Self-Determined Theory.


Doing a good job, all by itself, is its own reward. It pushes away self-doubts and shows us, and others, how good we really are. It is positive reinforcement.

And the better we can do a good job, the better the results will be, which demonstrates to us just how awesome we truly are!  Plus, as we increase our skills, we also will find that our duties are easier to perform.

Your team wants to improve their skills. Help them do so.

Sign them up for seminars, webinars, give them monthly reading assignments, and give them a coach or three of them.  But this has to be done in conjunction with your supervision. You will need to guide them through the training so that they see how it applies to their roles and the business as a whole. Quiz them on what they are learning and have them give presentations to the team on what they are learning.  The old maxim applies: “to teach is to learn twice.”

And where possible, make sure they earn certificates and can wear pins or insignia that testify to their competence. This goes along with Game Theory – people win at one level and then want to go to the next level. They want their “badges.”

Business owners throw staff into their jobs and expect them to produce with little or no training. Without exception, the offices I have seen that provide more training and coaching for their team — do better.  Companies spend an enormous amount on employee training. $161 Billion in the U.S. last year (trainingindustry.com). And, it pays off.

One study showed a comparison between car companies and how many hours they trained their new employees: Japan spends an average of 364, Europe averages 178, and the United States – 21 (Pfeffer –The Human Connection).

And you can guess which country has cars with the best frequency of repair record.

Children want to be super heroes and wear their capes.

Don’t we all!


This is the feeling of being connected – and there are two aspects to this.

Family. First, “relatedness” is the feeling of not being left out of the “loop” and of being included. Staff meetings help with this as does the general work environment. This is the sense that we are in this venture, job, and profession together. That we are part of a family.

Keep your team involved with your decision making. Give them some of the issues you are dealing with and encourage their input. They are stakeholders – it is their office too!

Greater Purpose. The other aspect of relatedness is that people generally want to be associated with a greater purpose. The more that each member can connect to the greater purpose of the group and make it their own, the more motivated they will be. Taking it a step further, if employees have higher goals of their own that coincide with the organization’s and they are allowed to pursue them within the organization, there would be no reason for employees to work anywhere else.

Train your team, let them own and creatively improve their own areas – and help to do the same for the entire office. Nurture camaraderie and a spirit of family – and always remind them – and yourself — why we are doing what we are doing.

Do this, and not only will your business be more successful, but you too will be more motivated and have more fun in the bargain.

#   #   #

Self-Determination Theory: Basic Psychological Needs in Motivation, Development, and Wellness. Ryan, R. M. & Deci, E. L. (2017) and Why We Do What We Do: Understanding Self-Motivation Paperback – August 1, 1996
© Edward W. Petty,    From the upcoming book: “Three Goals:  A New Practice and Business Building Methodology That Is Simpler, Faster, And More Effective and Fun than What You Are Doing Now.”  By Edward Petty, due to be published sometime before the Singularity. © May, 2017

May 8, 2017   No Comments