The Pillars of Patient Care in Chiropractic and Healthcare

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pillars of patient care in chiropractic supported by Goal Driven leadership, team management and marketing

Here’s What’s Really Driving Your Results

Labor Day in the U.S. is over, and I hope you had some healthy recovery time with family, friends, and nature.

Today is your Monday and Tuesday, all in one. So this is a short note… straight to the point…

…You and your team have 4 months to make this your best year — even better!

Actually, let’s do it in 3 months so you can cruise in December. So, here’s a plan to consider that can help you and your team over these next 3 months:

Everything you do is in service to your patients in chiropractic and in any healthcare service.

Their results, their happiness with you and your team, and their service are what will make your practice the best.

So focus on this first and foremost.

But… your services must be supported.

There are 3 categories of support:

  1. Leadership. This is the persistent fire that drives you and your team to achieve your patients’ goals — and those of your practice. It is the motivation, the discipline, and the energy that drives everyone to do their best. And on the best teams… EVERYONE is a leader. And Goal Driver!
  2. Marketing. People don’t automatically know your services exist, or what they can do. And what is more — they don’t care. Therefore, you have to keep your message out there. Marketing includes everything you do to acquire and retain patients. Marketing is not just advertising.

The need for marketing never goes away. Even if you have all the patients you need, atrophy is real.

3. Management. Management keeps all the moving parts in your business in sync. It takes care of your people, keeping them and your procedures aligned and coordinated. It keeps the structure in place – and improving.

There it is! Your plan for ending 2026 with a full and happy practice!

It is ALL about the quality of care and service your patients receive, but that depends on your leadership, marketing, and management.

Let’s end the year with this in mind … and in HIGH GEAR!

Stay Goal Driven,

Ed

Ask Lisa: Want to Sell or Grow? How to Elevate Your Practice’s Value Now

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how to elevate your practice's value now

In today’s healthcare landscape, practice value is a complex blend of operational effectiveness, modern technology, financial health, and clinical reputation. Whether a practice owner is looking to sell, partner with, or simply build a sustainable business, several areas can significantly enhance its market value.

Keep reading as I delve into a few of these areas with you.

  1. First, maximizing financial and collections management and diversifying revenue streams remains critical. Practices that depend on a single payer, service, or a narrow patient demographic are viewed as high-risk and are rare nowadays. Enhancing value requires rigorous billing and collections processes to minimize days in accounts receivable.
  2. Integrating ancillary services and hiring non-DC providers can boost revenue per patient while providing comprehensive, whole patient care one-stop. Group chiropractic practices are getting more on board with implementing a hybrid model by hiring PTs, LMTs, Acupuncturists, MDs, PAs, as well as continuing to perform ancillary services such as custom orthotics, ultrasound, EMS-Interferential, Laser, EMMS, Nutrition Counseling, Exercise and Rehab Education, ergonomic and backpack checks, and Shockwave therapies. Yes, all of these are billable and some are insurance payable.
  3. Clean, auditable financial records and practice statistical reporting are the foundations of a high-value practice. I’ve been there and have helped clinicians and managers with this while working at offices to help improve collections and revenue.
  4. Adopting robust, user-friendly digital systems and procedures. A modern (EHR) system that integrates seamlessly with billing and patient portals is a significant asset. Offices and clinic owners need and want systems that reduce administrative burdens. I’ve seen this – the better and more open staff are to learning the plethora of features in your practice management and EHR programs, the better collections are. Newer technologies in advance scheduling, automated appointment reminders, and digital intake forms minimize costly no-show rates and maximize physician utilization. The EHR-rating website Capterra just updated its list of top-rated, and compliant, chiropractic software programs. Click [Here] for details. Insert hyperlink with here as link name.
  5. A tech-forward practice signals to prospective buyers that the business is built for the future. For example, technology to administer and record a precise adjustment can help prevent wear and tear on your body, and includes devices such as the Activator, Impulse Adjuster, Sacro-Occipital Technique (SOT) Blocks, Impulse Adjusting Instrument, ArthroStim Adjusting Tool, PulStar FRAS Adjusting Instrument, and the Atlas Orthogonal Percussion Instrument.
  6. Patient retention and brand loyalty serve as powerful indicators of value. A practice with a high volume of recurring, satisfied patients represents predictable future cash flow. On the other hand, a steady flow of new patients under the pain relief only model can also prove a powerful indicator of value-based services. Implementing structured patient feedback systems and maintaining a strong online reputation can drastically lower patient acquisition costs.
  7. Additionally, standardizing clinical and operational workflows ensures that the practice can function smoothly without relying entirely on the founding physician. When operational knowledge is documented and transferable, the practice becomes far more attractive to external buyers.
  8. Cultivating a positive workplace culture reduces staff turnover, which is notoriously expensive in the healthcare sector. A practice staffed with skilled people demonstrates operational leverage and shows revenue generation is diversified across the clinical team.
  9. Ultimately, improving a healthcare practice’s value is about reducing risk and proving scalability. By implementing and maintaining solid financial workflows, embracing modern technology, and fostering patient and staff loyalty, practice owners can maximize their business worth and ensure long-term clinical success.

Now through October 31st I’m offering a complimentary 30-minute consultation on how you can boost your particular practice’s value and answer any questions you may have

Complete the easy form below for details on this complimentary offer.

Complimentary Offer

And just ask…
Lisa

*Offer does not apply to current active PM&A clients. You’re already getting the best bang for your buck in Abbondanza with us anyway!!  😉

Structure Supports Function in Chiropractic and Life

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goal driven recursive principlesA Recursive Principle

Our last two newsletters have been about structure.

Practice growth depends on putting the right structural elements in place at the right time. Internal procedures, hiring, training, marketing, and many other elements come into play. In addition, aligning each function with the others is part of the challenge for the practice owner and the practice team.

But your patient has their challenges as well. Their success depends on how well you lay out, and then help them follow, a structured pathway to their health goals.

Structure is needed to help ensure the function of the practice – its energy and capacity for growth – occurs unfettered and unimpeded. It is also needed so your patient sees how they will progress to their health goals and how you will help them.

Lack of Structure in a Chiropractic Practice and the Practice Roller Coaster

I have seen this in so many offices…

…an otherwise ambitious, caring chiropractic doctor with well-meaning, positive staff grows the business over many months. The appointment book starts filling up, the patients come in with summer cucumbers as gifts, and the adjusting tables are full.

But 6 months later, appointments are spotty, the tables are empty, and the doctor wonders where the patients are. Where is the “leak?”

The Practice Roller Coaster is a well-known malady.

The energy is there – and so is the hope, the care, and the drive.

But the structure wasn’t.

It may have been at one time, but it didn’t hold. Successful procedures that helped grow the practice dropped out. Others that were needed were never put into play. The improvements needed were overlooked.

The structure – the policies, procedures, and people – wasn’t organized to continue the progress and growth.

You might even say that the misalignment and lack of structure impeded patients’ and the practice’s progress.

Perhaps you have experienced this. Maybe it sounds familiar.

The Recursive Principle – Structure Supports Life

What is amazing about chiropractic is that its basic principles can be seen at different levels of life and work.

  • The spine. The chiropractor adjusts the spine (structure) to improve the body’s function. (This is why all professional football teams have chiropractors!)
  • The patient. The practice team puts the patient’s care plan (structure) in place and helps the patient achieve their health goals.
  • The practice. Leadership, management, and the team ensure the practice procedures (structure) are in place – and continually improved – to allow the practice to grow.

Structure supports function.

And I think you’d agree… function has its own goals.

Function is life – and life naturally wants to thrive.

You do, right?

Whether you are a chiropractor, a support professional, or the director, you work with the structure that helps the patient’s life and the practice’s life flourish and reach their goals.

Give us a call if you are wondering if your practice needs an adjustment.

And stay.. Goal Driven!

Ed Petty

Your Patient as the Hero

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stick man bending over

How to help your patients on their health journey

Last week, we reviewed your journey as an entrepreneur, a doctor, and a support professional.

But what about your patient? What about their journey?

Are they making it all the way to better health, or do they leave after their symptoms subside?

Generally, most offices look at a patient’s journey, or pathway, covering three phases of care: Acute, Corrective, and Maintenance. I have seen other variations, but they are all similar.

The idea is that as patients make regular visits, they progress through their phases of care.

Patient Visits (for example):

I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I

Acute ————> Corrective ———————————> Wellness

How to Improve Patient Retention?

First, it is NOT about improving retention. That is secondary. It IS about helping the patient achieve their health goals by getting through their Phases of Care and into Wellness/Maintenance.

  1. Make a list of key procedures for each visit.
    1. Break down what happens on each day, by each team member. Who does what?
    2. Make a list of key procedures done on Day 1, Day 2, Day 3, etc. Progress exam on Day 12? Good Patient Award after visit 12? Patient education on Day 8 and 14? Great Patient Award after visit 24? (You can download a sample. Link at end of article.)
  2. Practice – rehearse — these steps with your team.

Practicing Your Patient’s Journey

Below are simple steps for a fun team-building and practice improving drill. It WILL improve retention as a byproduct of helping your patient better achieve their health goals.

  1. Schedule extra time over lunch. Get your team together.
  2. You, or someone you delegate, act as the patient. (This is something I often do when I visit offices.)
  3. Each staff member, and the doctor, goes through their procedures for each day.
    1. On Day 1, for example, how did the Front Desk greet the patient and what did they say?
    2. How were they routed to the consultation room?
    3. What did the doctor say?
    4. Who did what for the rest of the exam and x-ray? Review it
    5. How were they routed back to the front desk, and how was the next appointment made?
    6. Day 2. – Same step by step. Practice it and then discuss it.

 

What you are looking for is:

  1. Procedures
    1. Were any procedures dropped out?
    2. Missing procedures.
    3. Redundant procedures.
    4. Unnecessary procedures.
  2. Application of procedures.
    1. Was the team member genuinely interested in the patient
    2. How well were the procedures communicated — with kindness, intention, and patience?
    3. Were the procedures correct – nothing left out, nothing extra included, everything correct?

The best teams practice.

Do this exercise at least once per quarter and be the best… and help your patients be heroes on their journey to their health goals.

And, of course, stay Goal Driven.

Ed

Download: Sample Patient Pathway and Flow Chart 2026

The Hero’s Journey – Your Journey in Chiropractic and Healthcare

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heros journey chiropractic journey

Moving from One Stage to the Next

You are reading this because you are on a journey.

And you are also a hero.

You see things differently—you left the institutions and their mandates and took a different path. Like pioneers. Most of you reading this are involved with an alternative path of service – of helping people – chiropractic, nutrition, biological dentistry, acupuncture, midwifery, and more.

To us at PM&A, your goals are noble, and you are on a hero’s journey!

For nearly 40 years, our singular goal has been to help you, and others like you, succeed on that path.

A few years back, I wrote a book called The Goal Driven Business, where I laid out the methodology we’ve used to help doctors of all types, chiropractors, medical, dental… and business owners navigate that journey.

Your Progress as a Chiropractic and Healthcare Practice Owner Unfolds in Stages

The goal for any business practice or career is to operate at a level where you can do your most, at your best, comfortably. We call this Stage Full Capacity.

When you begin your career or practice, you may not have fully defined your end goal—just a general sense that you want to be successful.

Operationally though, the real goal is to deliver services at your highest comfortable capacity. That’s the most logical and economical level, since expenses like your building, equipment, and staff are mostly fixed — and you’ve already invested serious time and money developing your skills.

Getting to this goal means passing through other Stages first. Each one demands its own unique strategy. Apply the right strategy for the Stage you’re in, and you move to the next one. Fail to, and you stay stuck — or slide back down.

In our Goal Driven System, we’ve mapped the journey to Full Capacity into 5 major stages. For details, read the book The Goal Driven Business or contact me!

  1. Stage 1. Beginning – You’re just starting out. (Well, sometimes, we crash and burn and need to start over!) The strategy: actively getting out with the message: “Get to know me, and here’s what I can do for you! ” (The Goal Driven Business, Page 75)
  2. Stage 2. Goals and Roles. You’ve generated interest and delivered services — now it’s time to clarify goals and roles: who does what, when, and why. Like a growing organism, this is your cell-differentiation phase. Set your blueprint here, while you keep growing promotions and services. (Page 101)
  3. Stage 3. Stability Stage. Here is where you strengthen your people and procedures. Stage 1’s efforts are still firing, and your goals and roles are defined. The driver now is management — take care of your people, refine your procedures, and keep improving without any big change. (Page 141)
  4. Stage 4. Acceleration Stage. In time, with the earlier stages in place, you are going to hit your Best Ever! This is the most dangerous Stage — most practices never make it past this level. They hit it, crash, and try again — sometimes for years — until they settle. Key drivers: lean management, professional discipline, and extraordinary customer service. (Page 175)
  5. Stage 5. Full Capacity – Team Leadership. This is the goal: in business and in your career. All pistons firing at maximum — but at a sustainable RPM. (Page 211)

Whether or not you reach Full Capacity, we applaud your courage and purpose — your refusal to fit into a system that doesn’t always put health or people first.

You, and everyone you work with, are heroes in our eyes. And you might be surprised to learn: you’re heroes to the people you serve, too.

Carry on — and stay Goal Driven.

Ed

P.S. And reach out if you need some guidance along the way.

Does Your Chiropractic and Healthcare Practice Structure Determine Your Practice Function?

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comparison of two buildings one with poor structure resulting in poor function and the other strong structure, strong function. similar to a chiropractic businessHow a few adjustments can improve performance!

Over the years, I have worked with many talented, intelligent, and dedicated chiropractors and doctors—both men and women who were compassionate and effective with their patients.

However, not all of them were successful in business.

The reason was that they lacked organization—and organizational discipline.

That is to say, they lacked the business structure that would support a strong practice function.

What is Chiropractic Business Structure?

It is showing up on time.

It is the routine consultation, history, and exam procedures you do with all patients on their first visit.

It is the standard re-exam visit.

It is keeping up with patient notes.

It is also the regular team meeting that follows a routine procedure.

It is your monthly marketing programs.

It is effective financial management.

And especially, your weekly and monthly management review and planning meetings with your team and coach – if you have one.

Over and over and over – daily, weekly, monthly.

That is structure.

What is Chiropractic Business Function?

Ah… FUNCTION… this is the life of the practice!

It is getting to know your new patient as a unique person.

It is having a chuckle with one of your staff.

It is sincerely congratulating an established patient for a success in their life – and feeling happy for them.

It is cheerfully participating in an event promoting the good works of you and your team.

It is feeling pride at the end of the week with the care you and your team provided.

It is the structure of your business that allows the function of your practice to achieve its full potential.

Sound familiar!

How to Maintain Your Chiropractic Business Structure

THE HUMBLE CHECKLIST. I write about this almost quarterly. I don’t have to reiterate it here. There are some links below to earlier references.

But here’s the trick: you must put someone in charge of ensuring the checklists are getting done.

It’s a reminder role. And in all honesty, most of us need at least some reminding, nudging, even nagging…now and then, right? (How’s that exercise and workout program going for you…?)

Your practice manager should do this.

We went over this again and again in our MBA program.

So, there you have it.

A practice is like a body – its function depends on how well it is structured.

Make the adjustments as needed, and keep it aligned – and enjoy the full potential of your practice.

And stay – Goal Driven,

Ed

 

Why Are Group Practices – Chiropractic and Others — Growing?

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group of 4 chiropractors of a group practiceIs a Chiropractic Group Practice for You?

In 2014, roughly three out of four chiropractors owned their practice solo.

By 2024, that’s down to about half.

And the flip side of that decline is real growth: the share of chiropractors working in a multi-doctor or multidisciplinary setting has roughly doubled in ten years — from about 22% to about 48%.

Doubled. In ten years!

We’ve seen this happening in the field. But with better research tools, I was able to confirm it. Two separate industry surveys, from the National Board of Chiropractic Examiners and Chiropractic Economics, both show the same trend, year after year.

Why is this occurring

  1. Administrative demands keep piling up. Prior authorizations, OSHA compliance, personnel management, documentation requirements — it’s a full second job that doesn’t shrink just because your practice is small.
  2. Marketing has gotten harder and more expensive. With more providers, more provider types, and more channels to compete on — social media, review sites, paid search — its more than any solo doctor can keep up with alone.
  3. Overhead keeps climbing. Equipment, staff, and competitive wages all cost more than they used to, and they cost the same whether you’re splitting them one way or four.
  4. Third-party pay keeps shrinking. Medicare’s actual chiropractic payment rate has fallen roughly a third since 2001, adjusted for inflation. Commercial insurance pays better, but it comes with its own squeeze — visit caps, prior-authorization requirements, and tighter claim scrutiny every year.
  5. Succession has changed. Aging solo owners need someone to hand the practice to — retirement, sale, or simply relief. An associate who eventually buys in solves that. Staying solo to the finish line often doesn’t.

This is one of the reasons corporate chains like The Joint are growing — from about 309 clinics in 2016 to nearly 1,000 today. That’s roughly tripling in under a decade.

A group practice has many advantages:

  • Shared overhead — rent, equipment, and staff, split instead of carried alone.
  • Focused management to smoothly take on the increased administrative and marketing demands, and better support the doctors and staff.
  • Local market strength — a three-doctor practice out-competes both the franchise down the street and the lone operator across town.
  • Real vacation coverage — your practice doesn’t close when you do.
  • Camaraderie — a colleague to talk through hard cases and hard days.

But you don’t have to sell your name to get that. An independent group practice gets you the same advantages, minus the franchise fee, the corporate playbook, and institutionalization.

And the timing works in your favor: chiropractic use is climbing nationally, not shrinking. The demand is there. The only question is whether your practice is built to catch it.

Here’s what group practice owners already know — most independents don’t: none of this works without dedicated management. The practices that thrive as groups are built on a management structure that has a purpose.

That Shift — from a personality-based, one-doctor practice to a business built on goals and led by a team — is exactly what I cover in my book from 2001, The Goal Driven Business.

Ready to make the Shift? And if you already are part of a group practice — is it time to upgrade your management?

Read (and apply) The Goal Driven Business.

And stay Goal Driven,

Ed

Let me know you bought the book (email an image!), and I will send you another at no charge.

UPDATES: Fulcrum Closure August 31, 2026

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Note:  This article pertains mainly to offices in the Midwest, but you may find the information interesting if you live outside of the Midwest

Following up on my June article, I wanted to update you on insurance plans and who will be managing them at the time of this writing.   Plans and which company is managing them are quickly changing, but it’s only fair to keep you in the know as these changes impact your bottom line and admin burden.    Here is an updated listing of the payer groups and what is scheduled to happen now and going forward with contracts and claims:

Plan Managing company and other information
Health Partners Optum UHC is managing effective 7/1.  As of this writing, 1) no pre-auths/clinical submissions are required, and 2) Use Health Partner’s payer ID, 94267 for claims
Cigna Unknown at this time.  Possibly direct-contract (groups only) or going to American Specialty Health.  Continue sending claims per patient insurance card.
Aspirus Medicare Advantage Whole Health/Tivity
The Alliance Whole Health/Tivity
Aetna Whole Health/Tivity
Aspirus Commercial HMO Unknown at this time
Quartz Direct contract only via invitation from Quartz
Zelis Direct contract for now
WPS Chiropractic Management Services, Brookfield, WI

Remember!

  • Tip: Use the actual payers’ IDs for claims submission.
  • Tip: Continue doing your financial consultations after verifying new patient benefits. Patients who are already in the middle of a care plan shouldn’t need a separate exam due to the above changes.

Are patient pre-pay packages looking like a better option for you and your practice?  Let us guide you within the can-do’s and can’t-do’s to set up these plans!

Additional Questions?  We can help!  And we will find an answer for you.

Lisa
920-334-4561

The Fully Engaged Goal Driven Practice

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Coach game plan

How to Have Sustained Motivation

How engaged and driven are you in growing and improving your business?

How about your team?

Would you say Very Engaged, Not Engaged, or Actively Disengaged?

Employee Engagement

Each year, Gallup grades the engagement level of both employees and managers in the U.S.

Gallup defines employee engagement as the level of involvement and enthusiasm employees have toward their work and workplace.

In 2025, it was 31%.

Managers were also surveyed. They usually rate higher, but they also rated at 31% in 2024.

Being Engaged, Goal Driven, and Successful

A team that is fully engaged is a team that wants to see patient successes. They also work hard to generate more patients through referral procedures and promotions. They stay inspired by the office’s purpose.

According to Gallup, comparing high-engagement vs. low-engagement teams, high-engagement teams had: [2]

  • 21% higher profitability
  • 17% higher productivity
  • 59% lower turnover

lower absenteeism, fewer safety incidents, higher customer ratings

It’s The Manager

Gallup’s core findings were that the manager accounted for at least 70% of the variance in team engagement (Gallup, State of the American Manager, 2015, since reaffirmed [1]).

In most practices, the doctor is the manager. But in a busy, growing practice, it’s hard for a doctor also to be an effective manager, business owner, property manager, and everything else. That’s why we’ve always recommended bringing on or assigning a qualified person — often part-time — to take on the manager role.

It’s also why we offer the Goal Driven MBA course for practice managers. (More on that in future emails.)

Increasing Engagement

Look at yourself and your team as athletes playing in a health care conference.

Are you winning?

That’s the question Jim Loehr and Tony Schwartz asked when they studied elite athletes for their book The Power of Full Engagement.

Their conclusion: performance depends on managing energy, not just time. Like athletes, people perform best by alternating focused effort with deliberate recovery.

Recovery time for your office could include:

  • Monthly team meetings that discuss how the office is doing statistically, patient successes, promotional plans, team member wins, and a fresh angle on why the practice exists.
  • Short weekly meetings.
  • Daily case management meetings.
  • Individual coaching of employees and professional development.

These are not just meetings – there are review and revival sessions. They are huddles, chalk talks, and reviewing game films.

Why? Because you want to win.

The best teams do this.

You should too.

Stay Goal Driven,

Ed

References

  1. Gallup Business Journal, 2015. Drawn from Gallup’s report State of the American Manager: Analytics and Advice for Leaders (2015).
  2. Harter, J.K., Schmidt, F.L., et al. Q12 Meta-Analysis: The Relationship Between Engagement at Work and Organizational Outcomes. Gallup, Inc.

The Frog Doesn’t Notice

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How your practice can quietly erode.

There’s an old story about a frog dropped into boiling water — it jumps out immediately.

But put that same frog in cool water and slowly raise the heat, and it stays put. It never feels the moment it should have jumped.

Biologically, this isn’t actually true of frogs. It’s a fable.

But it’s true of practices.

No one decides one morning to lower their standards. You never wake up one day and say: “Patients are going to get just a bit less of me today.” Or, “the business performance will drop over the next month.”

It happens one degree at a time — an exam abbreviated and rote because the schedule was tight or a report of findings that never quite landed.

In an earlier newsletter, I wrote about “procedural atrophy” — how the steps that made something work are shortened until the quality quietly deteriorates. This can continue to occur until a “quality threshold” is reached. This is the point beyond which poor quality is obvious – in patient complaints and practice decline.

GRADUAL DECLINE IN PERFORMANCE IN YOUR CHIROPRACTIC AND HEALTHCARE BUSINESS

Procedural atrophy erodes not just what gets done, but the intention and care behind it.

The difficult truth about this is that — we agree to it. Not out loud. Not on purpose. But each small degradation gets accepted because nothing bad shows up right away. That acceptance becomes the new normal. The next shortcut looks small, too, because we’re measuring it against the last one, not against where we started.

This is the flip side of the elephant story I wrote about before*. The elephant never tests its ceiling — it’s held down by an old belief about what’s possible. Erosion is the opposite problem: a floor that quietly drops, with nobody really deciding to lower it.

To prevent this from happening, from slowly slip-sliding away:

Look at your numbers now and what they were in the past.

Check your purpose from years ago and what it is now.

Review your policies and successful procedures – and what is being missed now.

Review your patient successes.

Do this with your team.

When I have done this with chiropractic offices, we always unearth rusty old goals, policies and procedures.

“Oh yea, back when our numbers were higher, we would always call the new patient after the first adjustment to see how they were doing.”

It takes work, and comparisons can be uncomfortable. But it’s the only way to catch water that’s heating up too slowly to feel.

You must look at your business objectively – that is why we implement a fast and simple statistical management system for all our clients.

This is how you stay focused on your goals and what you’re actually capable of, instead of drifting toward whatever is easiest to accept.

Stay Goal Driven,

Ed

* Increase Your Capacity

Goal Driven Metrics Program for Your Office

Pop and Pray and the Flying 7 in Chiropractic

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chiropractor side posture adjusting from x-rays

It’s not just spines that get out of alignment

When was the last time you heard these terms? “Pop and Pray” or “the Flying 7?”

For those of you not familiar with what these phrases mean, they are derisive depictions of nonspecific chiropractic care.

“Pop and Pray” would mean adjusting without knowing exactly what you are adjusting because of the x-ray and exam you may or may not have diligently performed on the patient. You adjust (pop) and hope it works (pray).

The Flying 7 means adjustments of always 2 cervical, 3 thoracic, and 2 lumbar adjustments — on everyone. A cookie-cutter approach.

DEBATE ON SOCIAL MEDIA

I recently read a thread where chiropractors were discussing the importance of x-raying patients. An x-ray was shown with a broken bone, and the original poster (a D.C.) pointed out the importance of x-rays.

And oh my, the back and forth.

  • One poster made an engineering-style case for x-rays. Paraphrasing here: “…X-rays are what let you measure positional distortion — vertebral alignment plotted on X, Y, Z coordinates, with rotational and translational deviation from normal captured as a specific, quantified diagnosis rather than a guess.”

He went on to say that without X-rays on each patient, a Chiropractor’s craft is reduced to “pop and pray” — or, as he put it, “rattle a few mechanoreceptors and hope for the best.”

  • Another poster asserted that using x-rays to rule out pathology is a weak rationale, and frames x-rays from a medical perspective!

The debate went on and on.

Not being a chiropractor, I am not taking any sides to the discussion.

BUT… I was pleased that there was a discussion – and I think that is important.

DISTRACTED BY MANAGEMENT CONCERNS IN YOUR CHIROPRACTIC BUSINESS

Not taking sides on the clinical debate doesn’t mean I haven’t seen its business-side cousin play out in real time.

I have been seeing chiropractors adjust patients since the mid-80s!

Too often, doctors are distracted by the condition of their business, and though they carry on with cheerful banter, I have wondered just how focused they were at times.

And, as a management coach, I often discover that their performance covers up their pressing concerns about their business, staff, and or overhead issues. It is not that they don’t care about their patients, but their business needs as much “adjusting” as their patients.

On the other hand, I have seen doctors take time to focus on their notes, on the x-ray and then on the patient in front of them. They are deliberate, specific about what they are doing…some almost geeky. And their patients were happy and satisfied and their schedule full.

This is why you need a good management system and coaching help to keep everything in alignment – so that you can put quality of care first.

CLARENCE GONSTEAD’S COMMENT

A doctor I worked with once told me a story about the time he spent with Clarence Gonstead at Dr. Gonstead’s office at Mt. Horeb, here in Wisconsin.

One night, late, my doctor commented to Dr. Gonstead, “Dr. Gonstead, it’s 11 pm and you have so many patients out there in the waiting room.”

He said that Dr. Gonstead replied, “No I don’t.”

“I only have 1 patient and that is the one I am seeing at the time.”

===

ALIGNED SPINAL STRUCTURE, ALIGNED BUSINESS STRUCTURE

That is the point – whatever system you use for helping your patients – therapy, no therapy, x-ray, no x-ray, do it with your whole heart and complete attention.

And to help you do that, get some help with your business — if needed. Whether you use our services or others, a solid management structure and team will allow you to focus all of your attention on the patient you are seeing at the time you are seeing them.

Stay Goal Driven.

Ed

What Is Your Full Capacity in Your Chiropractic and Service Business?

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chiropractor adjusting a full capacity waiting roomWhy Running Below It Costs You More Than You Think

The idea of full capacity is so simple that it is easily overlooked.

WHAT IS FULL CAPACITY AND WHY IS IT IMPORTANT?

Full capacity is when you are serving as many people as possible, given the available space, equipment, and staff. In other words, what is the maximum number of people you can see in a day – comfortably – given full support?

This number will vary, of course, depending on how you practice.

Full capacity is a vital goal for financial survival. You are already paying full price for your space, equipment, and team. With lower production, your overhead rises and your profits decline. Overhead actually jumps. If you’re running at 50% of full capacity, you’re not paying “half the overhead” — you’re paying close to the same rent, staff wages, and equipment costs as if you were at 100%. That’s why practices at half capacity often feel like they’re working just as hard, if not harder, for a fraction of the profit.

WHAT GETS IN THE WAY OF FULL CAPACITY IN YOUR CHIROPRACTIC AND SERVICE BUSINESS

Let’s say you have a busy month. See lots of patients. Your front desk is busy scheduling and keeping the appointment book full.

One afternoon, during a momentary lull, you notice the front desk staff has a few moments, so you give them some insurance work to do. A week later, the chiropractic insurance department does the same.

The following month, everything seems the same… the front desk is busy.

But visits are down.

What happened? Can you guess?

Any system or flow pattern will accumulate unnecessary additions – extra checks, additional actions, or routings that start to slow the flow.

This gradual shift and increase in systems is called “Process Creep.”

PREVENTING PROCESS CREEP

Step back from your practice and ask the engineering question: given my space, staff, and equipment, how many visits can we see each week? What is our full capacity?

For practical purposes, use Visits as your metric.

That number is your Full Capacity Goal. Once you know that, you work backward: what’s standing between where you are now and that number?

You need to look for the capacity barriers in the way – and remove them! These are different types of bottlenecks. I discussed this in earlier articles and in my book, The Goal Driven Business*. Some barriers are in the systems, while others can be in the people.

It could be patient notes, patient scheduling, or even too many services available. Not enough new patients, interestingly, often goes back to a mindset.

Complexity occurs naturally — so you have to work to simplify the flow and eliminate unnecessary steps. This gives you more time to engage with your patient – your customer.

But it all starts with:

  • Determining your Full Capacity Goal – the real ceiling, not a guess
  • Removing the barriers standing between you and it

Contact me if you want to explore what might be holding you back from reaching your full potential!

And stay Goal Driven,

Ed

Email

*References

Ask Lisa: Practice Roadmaps to Help Your Bottom Line.

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chiropractic roadmap business plan

Ever get the innate sense something is missing in bridging gaps you may be experiencing in your practice? As a result, you may tend to keep guessing and overthinking processes. Understandable from both a clinical perspective, and in today’s reimbursement landscape. Documenting and mapping out a business plan/practice roadmap can help calm the chatter.

According to Investopedia, “A business plan is a document that defines in detail a company’s objectives and how it plans to achieve its goals. A business plan lays out a written road map for the business from marketing, financial, and operational standpoints.”

A business plan can help You navigate and evaluate the revenue cycle categories, which by the way are our specialties:

1.) Credentialing: The better HMO/PPO payer networks you participate in based on your geographic location and patient insurance type, the better the value of your practice.

2.) Practice Appraisals are a great foundation to your overall plan to see what your practice is worth at the time the appraisal is done.

3.) Network participation assessments: Have you recently ran reports on each payer group in your practice management software to see if you are getting reimbursed per contract? Where are any shortfalls you may want to voluntarily opt out of participating in? You’ll want to make sure you opt out of a network voluntarily, and intelligently – getting kicked out of a network involuntarily can bite you in the ass later on if you or your successor want to be in the network and continue filing insurance for patients. A common question on credentialing and re-credentialing requests is if you have ever been terminated involuntarily from a payer group or government program.

4.) Accounts Receivables: Where are your payer and patient receivables month to month? Is it increasing? Decreasing? According to Healthcare Financial Management Association (1), your ideal A/R percentages should fall here:

0–30 Days: ≥ 80% of your total A/R should fall into this category.

Over 90 Days: Less than 10% to 15% of your total outstanding A/R should be in this bucket.

Over 120 Days: Should ideally be kept under 15%. Accounts older than 180 days are often written off as bad debt.

If your financial policies are strong, you should have very little outstanding cash accounts over 90 days. Auto claims with attorneys and commercial secondaries should be about the only claims out in these categories.

5.)Meeting state and federal compliance requirements. Have you had a compliance assessment completed?

We can, have, and do help offices in each of these areas. Just Ask…

Lisa

Happy 250th Birthday, America!

Reference:  hfma.org- 7 KIPS Providers Should be Tracking

Still Independent After All These Years – Chiropractors and Other Doctors that Put Health Freedom First

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declaration of independence and American flag in celebration of the 250th birthday of America for chiropractic offices.

What you and the Founders have in common

This is the U.S.A.’s 250 year anniversary.

That is a Big Deal.

If you read the Declaration of Independence, it reads almost like a poem.

We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty, and the pursuit of Happiness.

56 delegates from 13 colonies got together in 1776 in a sweltering building in Philadelphia. Reports indicate there was a lot of bickering and that the delegates were pretty much a bunch of radical nonconformists.

But they all agreed upon certain things:

  1. The tyranny and abuse the colonialists experienced from those who ruled over them. (England)
  2. The opening line above – “that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.”

In certain respects, I have to compare those men back then with the chiropractors and other independent health professionals of today.

For example, among the delegates were:

  • Franklin — Printer, inventor, self-made. Deeply irreverent. Did not fit any mold.
  • Jefferson — Brilliant, contradictory, restless thinker. Not a crowd-pleaser.
  • Adams — Cranky, blunt, famously difficult. Cared nothing for being liked.*
  • Tom Paine was there too. He wasn’t even a delegate. From what I can tell, he crashed the party and was loud, outspoken, angry, and uncompromising! **

I am featuring these men because, honestly, they remind me of you and the many doctors and business owners we have worked with over the last nearly 40 years!

All different, but all shared common GOALS – Liberty.

I can’t help but see the connection between what these brave men fought for and what the brave men and women continue to fight for today in chiropractic and independent, integrative health care professions.

We’ve been rooting for you since we started, and will continue to do so.

Have a great 4th and celebrate our nation’s independence — and while you are at it, the independence of your profession and business as well!

Keep to your goals!

Ed, David, Linda, Lisa, Phyllis and Barbara

* Founding Brothers by Joseph Ellis .** Wikipedia

Your Front Desk – Practice Driver or Practice Denier?

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front desk comparison in the chiropractic officeI walked into two businesses recently.

I needed some printing done so I visited a local printing business. It was near a local college. As I walked in, I noticed that the front desk was covered with a see-through plexiglass, from the ceiling to the counter. There was a small opening just above the counter. The woman behind it looked up, begrudgingly, as if I was interrupting her. I asked her some questions and soon decided NOT to work with the company.

But here’s the weird part…

It was a printing company that made signs. So, it had its own sign, a colored banner actually, up at the top of the plexiglass on the Front Desk. It read: WE ARE ALL VACCINATED.

Now, I don’t keep up with all the new trends, like the latest songs, clothing styles, and what is popular nowadays. So, I am asking, is this the new COOL?

Then, the next office I visited was a chiropractor’s. So, I walk up to the front desk. Well, not all the way. In front of the front desk was high table, belly-height. I guess this ensures that I just don’t get too close to the person who is on the other side of the desk.

So, from a distance of 4 to 5 feet, the woman at the front desk looks up from what she was doing and with a concerned and cautious look, asks how she could help me. I attempted a conversation, but she was not interested. I said that I have known the doctor for many years and wanted to drop something off for her. She was still not interested in me or the promotional material I was leaving for the doctor.

== == ==

What the heck?

What is wrong with people nowadays?

No… “Howdy partner, what brings you into town?” “You from these parts?”

Is everyone scared or angry?

So, this takes to me to the point of this newsletter… your Front Desk.

== == ==

Why do you have a Front Desk?

What is its Best Purpose?

→The purpose of your front desk is to fill up your appointment book.

→The ideal outcome of the Front Desk is a fully scheduled – and kept – day.

How does the Full Desk fill the book? You name it:

  • Being friendly and conversational is a good start.
  • Not being frightened of germs or cooties from cheerful older guys
  • Converting phone call inquiries to appointments
  • Generating referrals from existing patients’ families, friends, employer, and clubs/associations. (This can be a significant source of new patients.)
  • Retaining existing patients.
  • Getting involved in community events that generate more new patients.

Basically, the front desk should own patient volume – and be rewarded for it. They should be a “Demon on Control,” and “Aggressively Friendly.”

Keep it simple.

Do not burden the Front Desk with insurance or other admin duties. That clogs up the flow. (This is too typical and tempting, so guard against it.) And don’t frighten your Front Desk staff about the dangers of germs or other people!

Keep it simple and focused to fill up that appointment page/sheet/screen.

And remember – “There’s always room for 1 more!”

Stay Goal Driven,

Ed

Scale Your Chiropractic and Healthcare Practice?

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chiropractic practice growth graph

 And what does this really mean – to scale?

I’ve been seeing ads all over social media blasting away about “scaling” your practice – chiropractic, dental, any service business.

But what does it mean?

The online Webster’s dictionary does not have a definition for it as it is used in business.

It’s really a math term.

Scaling is keeping the basic proportions of an object the same but just increasing its size by multiplication. “Growing,” as opposed to scaling, is just adding things. For example, you may add more new patients, but you also add to your expenses.

More for Less

Scaling is getting more for less.

When we launched our multiple clinic centers here in Wisconsin in the 90s, we did add locations, doctors, and front desk staff.

But, we were careful not add the same number of billers, managers, or marketers. We developed systems to keep our growth limited in most areas while increasing production.

Scaling is driven internally. Scaling is improving what you have – your people and your systems.

So how do you scale?

You improve your people and systems each month.

And improvement is done through coaching.

The Best Coaches

Vince Lombardi, former Green Bay Packers coach, is credited with focusing on fundamentals in training camp, and is reported to have said:

Practice does not make perfect. Only perfect practice makes perfect.

And what did Dr. Clarence Gonstead say – while he was adjusting 300-400 visits or more a day?

I need more new patients?

No! He said:

Practice. Practice. Practice. Never stop.*

If coaching improves what you already have, and this produces scaling, what gets in the way of coaching and practicing?

The Biggest Barrier to Scaling Your Chiropractic and Service Practice

Your biggest barrier to scaling is not new patients. It’s that you don’t have enough time to practice and improve your business.

That is the hidden reality with nearly all competent and decently run practices. The clinic director does not have enough time to work ON the business.

Michael Gerber’s The E-Myth is practically required reading in chiropractic. Every doctor nods at his advice to work ON the business, not just IN it. And then goes back to adjusting.

Why? Because something is missing.

A manager and a management system that supports improvement.

The research by Gallup reveals:

“Gallup finds that the quality of managers and team leaders is the single biggest factor in your organization’s long-term success.” *

The manager takes care of business operations so that the doctor can:

1) focus on improving patients, and then,

2) focus on improving the business.

Most practice/office managers I have worked with are willing and capable, but not quite sure about what to do or how far to go. Good management is a skill, just like doctoring.

If you have a manager, encourage them to read our Tuesday Goal Driver newsletters. Coach them so they improve!

And stay tuned for more information about our practice MBA this fall. You can also sign up for our Practice MBA Waitlist where we will offer special info on practice management.

Fall 2026 Practice MBA Waitlist

== == ==

Scaling is generating more production with the same or less resources.

The key to scaling is improving your systems and people.

And the key to improvement… is a competent and motivated manager.

Keep Driving,

Ed

References

*It’s The Manager, Clifton/Harter

*Clarence Gonstead, Wikipedia

Communication: The Real Practice Builder in Your Chiropractic and Service Business

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chiropractor understanding patient

Seek to Understand First

Last week we reviewed the Japanese concept of Ichi-go Ichi-e – “One Time, One Meeting.”

The lesson was simple: Be present. Be interested.

But why is that so important?

Because communication creates relationships. And relationships create practices.

But you think you already know this, right? Well, yes and no.

Intellectually, perhaps you do. But in real life… a practice is busy, and life is full. So, communication often devolves into a text or is abbreviated.

Authentic human communication takes time — time that busy people don’t always make.

Communication with Your Chiropractic Patients

Doctors rightfully focus on adjusting and treating patients. Staff members believe their primary job is scheduling, collections, insurance, or even marketing.

The Clinic Director is looking at the bottom line.

But underneath it all — is communication.

Communication is the operating system that allows all the other “applications” in your practice to function.

Every patient who walks through your door is asking a question:

“Do you understand me?”

Not necessarily with words. But they are asking it, nonetheless.

Patients want competent care. They also want to be heard, understood, and valued.

When patients feel understood, trust grows. Trust is the foundation of every successful relationship.

And when trust grows, recommendations are accepted more readily, appointments are kept, referrals occur naturally, and relationships strengthen.

Communication Within the Chiropractic and Service Team

The same principle applies inside the practice.

Your practice is composed of people. Staff, chiropractic associate doctors, and providers often wonder why things are managed the way they are, why something was changed, or… whether their work is any good or appreciated.

Over the years, I have seen staff members leave practices not because of pay, benefits, hours, or workload.

They left because they didn’t feel understood. Their questions went unheard, and their accomplishments went unrecognized.

And people don’t always get up and just leave a relationship. They usually leave mentally first – months ahead of time.

I bet right now, you can think of how this applies to you and your situation.

This applies to any team. It applies to family and family members as well.

And it certainly applies to your patients.

__ __ __

Communication is more than talking. It is more than giving instructions. It is more than conducting meetings.

Communication requires being there — with attention and genuine interest. Then it needs understanding the other person’s point of view well enough that they know you understand.

It also requires time, but it is time well invested.

When the quality and quantity of communication in your practice improves, the practice numbers will go up!!!

As Stephen Covey says, in his 7 Habits of Highly Effective People, Habit #5 is:

Seek First to Understand, Then to Be Understood

Stay present. Stay interested. Listen to understand.

The results may surprise you.

People stay, and are happy and productive, where they feel understood.

Patients.

Staff.

Providers.

Family.

Keep driving – what you are doing is important!

Ed

P.S We work this concept strongly on our Practice MBA course this fall – with tough but fun exercises!

And remember,

A practice is a network of relationships – created and sustained through communication and service.

What’s Happening with Fulcrum/Chiropractic Care?

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Note: This article pertains mainly to offices in the Midwest, but you may find the information interesting if you live outside of the Midwest.

As you may have heard, Fulcrum/Chiropractic Care (a Minnesota-based, nonprofit physical medicine benefit management organization) will be ceasing contract operations effective August 31, 2026.

For those of you participating with Fulcrum, please watch your emails from Fulcrum and/or each payer group for further details and timelines. Whole Health Inc. will be taking over most of the below payer groups, and have advised some offices, via email, that they will be in contact.

We strongly recommend you ask Whole Health for a contract to review, along with a Fee Schedule.

Below is a sampling of what we know to date. Please refer to the FAQ included here Fulcrum Health Inc.  for a full list of the payer groups impacted.

  • Aetna/Allina
    • Termination date with Fulcrum: 07/31/2026
    • Contract through MultiPlan to stay in network (non-Minnesota), and SecureCare (Minnesota offices)
  • Aspirus:
    • Termination date with Fulcrum: 07/31/2026
    • Aspirus is working on a transition plan; no further details at this time
  • BPA
    • Termination date with Fulcrum: 5/31/2026
    • Claims for dates of service on or before 5/31/26 must be submitted to Fulcrum no later than end-of-day 7/17/26.
    • No further details available at this time.
  • Cigna
    • Cigna will contract their chiropractic network through First Health.
  • Quartz
    • Termination date with Fulcrum: 6/30/2026
    • Quartz will handle services in-house and will contract with provider groups only. They are focusing their outreach based on member utilization, geographic coverage & network needs. Provider groups that haven’t submitted claims within 12 months may not be contacted. If chosen, Quartz will send a group contract via Docu-sign and should have been received by 6/1/26.
  • The Alliance
    • Termination date with Fulcrum: 8/31/2026
    • The Alliance is actively finalizing the contract and coordinating transition details with the new provider network partner. Once completed, their new provider network will reach out with next steps.
  •  Zelis
    • Termination date with Fulcrum: 6/30/2026
    • No further details available at this time; however, if you are credentialed and contracted directly with Zelis, you should not be impacted by this change.
  • WPS
    • Termination date with Fulcrum: 7/31/2026
    • Fulcrum is sharing provider credentialing files with WPS. WPS may contact providers or providers may reach out to WPS at Provider Contracting.
    • WPS informed me that the administration of their chiropractic network will transition to Chiropractic Management Services. To remain participating, providers will need to reach out to  CMS Services LLC.
    • WPS indicated their termination date with Fulcrum is 7/1/2026 (different than Fulcrum’s termination notice indicating termination on 7/31/26).

Additional Questions? We can help! And we will find an answer for you.

A big Thank you to Wisconsin’s Robyn Tozer for her work in helping to get initial updates – Thanks, Robyn!

Lisa

Ichi-go Ichi-e in Your Chiropractic and Service Business

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ichi-go ichi-e

For better case acceptance and retention in your chiropractic and service business
–be present and be interested.

________________________________________

We live in a fast and shallow world.

We spend more time in front of screens than we do with people. Conversations are reduced to texts.

In the office, scripts are learned, smiles are trained, and interest is manufactured.

Everyone does their best, but staff and doctors are often rushed. And our culture has become used to a kind of electronic operating system that insulates us from one another.

But in the end, we are people, not systems. We are social beings.

Your patients want to be seen. They want to be heard and understood. They want an honest relationship.

Remember that:

A practice is a network of relationships – created and sustained through communication and service.

A relationship is created through communication. The requirements for communication include attention and interest.

Be Present

Years ago, I spent some time in Japan. While I was there, I attended a traditional Japanese Tea Ceremony with a few others. On the wall was a plaque, like the one at the top of this article.

It translates to “One time, One meeting.”

The idea is that, at this moment, this moment is its own. It will never happen again. Therefore, respect this moment, this time, with this person.

Just be here. Don’t think about what to say next. Respect this time.

Be Interested

Every person who walks through your door has lived an entire life you know nothing about. Each has a hobby, a loss, a dream, a funny story. It is always there.

People, your chiropractic and service business patients are interesting. You can always find something interesting about another person. And when you show interest – genuine interest, the other person feels it immediately.

They can also sense if it is fake!

When practicing “scripts”, or what to say and when to say it, rehearse being present with your patient. Practice being interested in them.

Real interest is never faked.

In every successful practice and healthcare business I have visited over the last nearly 40 years, these two qualities were naturally demonstrated by the doctors and staff.

And when it was present, there was a lightness and happiness that pervaded the practice – and it showed up in the numbers!

Practice MBA

This September, we will go deep into this subject and practice these points in our next Practice MBA program. We are putting the program details together now. Stay tuned for more info coming, and if you really want the inside scoop, you can sign up for our Waitlist below.

And thank YOU for being a subscriber and reader. Please forward to a colleague or friend if you want.

We are interested in you, so feel free to contact us anytime.

Stay present, stay interested, and

Keep drivin’ to your goals,

Ed

Do You Have ADHD — Most Chiropractic Entrepreneurs Show the Signs

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If you own a chiropractic practice, or any other type of service business you likely have some degree of ADHD.

How do I know this? Experience!

We have worked with business owners, and especially chiropractors, for 40 years. You all have the American entrepreneurial spirit our ancestors had — go West, homestead, start a business, make a claim!

WHAT IS ADHD?

ADHD — Attention Deficit Hyperactivity Disorder — is officially defined as a condition characterized by persistent patterns of inattention, hyperactivity, and impulsivity that interfere with daily functioning.

That’s the clinical version. But I wouldn’t call it a “disorder.” In fact, for many entrepreneurs, it might be closer to a gift.

Research consistently finds ADHD traits at significantly higher rates among entrepreneurs than in the general population.* Here are a few you may recognize:

  • You can see the big picture, but become impatient with the details.
  • You get excited about starting things, but follow-through is weak — “shiny” new programs and equipment draw your attention, while maintaining systems and procedures drift away.
  • You struggle with time management and organization.
  • You get bored easily, especially with tasks that require prolonged mental effort.

ADHD and the Chiropractic and Healthcare Entrepreneur

On the plus side, these same characteristics often help a business owner:

  • High risk tolerance lets you bet on yourself and act before all the information is in.
  • Creativity — I have been genuinely impressed by the sometimes genius-level solutions of many chiropractors.
  • High energy and urgency create a driven intensity that people find both exhausting and magnetic.
  • Comfort with chaos makes the startup environment feel natural rather than threatening.

But these same traits can stall the growth of a practice:

  • Starting things is easy — finishing them is hard.
  • Detail and administration are not strong suits.
  • Structure, routine, and repetition are exactly what the ADHD brain resists — yet consistency is what a growing business requires.
  • Impulsivity and changing directions can confuse and demoralize staff who need steadiness from leadership.
  • The practice remains dependent on the owner’s daily presence and energy.

Whether you have an ADHD brain or not, you are still an entrepreneur, and some of these traits just come with the job.

I am sure this is why Michael Gerber wrote The E-Myth, and it is why I wrote The Goal Driven Business. There are plenty of other books and researched solutions to this business dilemma.

IF THESE AE THE SOLUTIONS, WHO WILL IMPLEMENT THEM?

The big question is — who is going to implement the solutions? The entrepreneur?

Doubt it.

THE ENTREPRENEURIAL BRAIN — AND WHY IT NEEDS A MANAGER

Gallup put it plainly in It’s the Manager — the quality of managers and team leaders is the single biggest factor in an organization’s long-term success.

Many of the traits associated with ADHD are noble and admirable, and I applaud the courage it takes to build something.

But passion without structure stalls. And structure — is management — putting systems in place, keeping them in place, and steadily improving them.

The most honest advice I can give you is this: get a trained manager — someone whose brain complements yours — who loves the structure you resist and maintains what you build.

This September, I’m opening a small cohort of 20 managers and their entrepreneur doctors for our next Practice MBA Program – our 4th.

If that interests you, stay tuned. We will be putting up a Waitlist next week with more information.

Ed

* Research on ADHD traits among entrepreneurs has been documented extensively, including studies by Johan Wiklund et al., published in the Journal of Business Venturing. Wiklund et al., Entrepreneurship Theory and Practice, 2025. Estimated 29% of entrepreneurs meet ADHD criteria versus 4-5% of the general adult population.