Category Archives: Practice Management

Playing to Win in Chiropractic and Healthcare

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Bill Walsh, Head Coach of the 49ers, conferring with Joe Montana

Bill Walsh, Head Coach of the 49ers, conferring with Joe Montana.

Practice Management as a Sport in Your Chiropractic and Healthcare Business

I enjoy sports.

Well, enjoy isn’t quite right… Enjoy is too passive. I don’t think you can just “enjoy” sports.

It is an activity you play to win.

That summarizes it. You embark on a pursuit where you want to achieve something — but you may not. You may lose! So, you have a goal – to win. And not to lose.

But I think the keyword is…”PLAY.”

I will come back to this.

All Kinds of Sports

Many of you have kids or grandkids involved in some kind of sport — baseball, track, chess, even online games. Maybe you play yourself.

I recently bought a book for my grandson who pitches. It’s called Ninety Percent Mental by Bob Tewksbury, a former Major League pitcher. Reading it, I realized his tips apply just as well to running a practice — because where you work has all the elements of a sport:

  • A scoreboard
  • Plays and routines
  • Teammates and coaches
  • A playbook
  • A time limit
  • Goals and obstacles to overcome

Tips on Winning in Your Chiropractic Healthcare Practice

Tewksbury talks about two things that stuck with me:

The “Little Man” — the inner voice that tries to derail your performance with negative thoughts. Learn to recognize it and silence it.

Pre-game Routines — controlled breathing, visualizing success, positive affirmations. These help players stay calm and focused when it counts.

Here are two of my own:

1. Stay focused on your Goals. This means both the big ones — your purpose, your why — and the practical ones, like what you want to achieve by the end of the week. Visualize them. Commit to them.

But then…play!

2. The importance of Play.

A sport is an activity you play to win. The keyword is PLAY. Not fight, not stress —but play.

When work becomes too serious, mistakes multiply and stress fills the room. In a chiropractic practice, patients feel that. Trust me — I’ve seen it work both ways. A too-serious office, and numbers go down. A focused but playful office, and numbers go up.

Bill Walsh

When I lived in San Francisco, I was a huge 49ers fan. Before Super Bowl XVI in 1982, coach Bill Walsh arrived at the team hotel in Detroit a day early — and paid a bellhop $20 to borrow his uniform.

When the team bus arrived, Walsh — in full bellhop attire — tried to grab Joe Montana’s luggage (Montana was the starting quarterback). Montana, not recognizing him, brushed off the “silver-haired bellhop” and told him to get lost. When the team finally recognized their coach, the place erupted in laughter.

The relaxed 49ers went on to win their first Super Bowl, beating the Bengals 26-21.

Regardless of your role — doctor, owner, front desk, or bellhop — be goal driven.

But playfully.

Ed

This weeks cool tune is from the Playing for Change series: The Weight, with Ringo Starr and Robbie Robertson.

By the way, Joe Montana said this about chiropractic: “Chiropractic care works for me. I’ve been seeing a chiropractor and he’s really been helping me out a lot. Chiropractic’s been a big part of my game.”

Be Dangerous – In Chiropractic and Healthcare, Standup for Your Patients

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standing with integrity and purpose

Integrity and Purpose are the Keys to Your Growth in
Your Chiropractic and Healthcare Practice

We live in a world where what we perceive can be manipulated.

Advertising, public relations, and sophisticated behavior modification strategies are powerful tools. They can generate consensus, approval, and demand for a product, service, or idea.

A status quo is generated and supported this way.

For example, when I was a kid, everyone smoked cigarettes. Everywhere. It was heavily pushed and advertised — with M.D.’s no less. And by the Federal Government! (I still remember some of the slogans…! “Winston tastes good like a cigarette should.”)

For years, research continued to show that cigarettes were very unhealthy, but this threatened those who profited from their sales.

If you challenged the manufactured consensus and the messaging, you were attacked, like this man was…

Dr. Jeffrey Wigand was a Vice President of Research and Development at Brown & Williamson – tobacco company. In the mid-1990s, he exposed that industry giants were intentionally engineering cigarettes to be more addictive. They responded with a powerful negative P.R. campaign, compiling a 500-page dossier of smears to brand him a liar and using anonymous death threats to silence his testimony.

Cigarettes finally moved to the sidelines, but those same companies (Philip Morris and R.J. Reynolds) moved into the cheap (addictive and harmful) food business—buying up corporations such as Kraft and Nabisco.

There is a money-making complex of industries in which one hand greases the other, a matrix that includes captured lawmakers and professional organizations. Their interests are money and control to keep the money coming. And they have powerful tools to keep this game going.

Many of us are not always familiar with the details, and your patients may be naïve about the attacks launched and sustained through direct and indirect campaigns by these industries.

But to whatever degree you are aware of it, you are on the battlefield – as a player or a piece.

And if you speak up and speak out, if you stand up for your purpose — you can be attacked.

That’s what happened to these doctors:

Peter McCullough, M.D., a renowned cardiologist and professor, was an academic pillar until he advocated early, repurposed treatments for COVID-19. His protocols threatened the pharma-only mandate, so the establishment unleashed a negative P.R. campaign, branding him a “misinformation spreader.” They stripped his journal editor roles, forced him out of his university health system, and revoked his board certifications.

Pierre Kory, M.D., a leading critical care specialist, promoted protocols similar to McCullough’s early protocols. He was attacked for disseminating “dangerous misinformation,” and faced platform censorship, suppressed Senate testimony, and lost hospital affiliations. The American Board of Internal Medicine later revoked his certifications.

Simone Gold, M.D., J.D., an emergency physician and founder of America’s Frontline Doctors, spoke against mandated protocols. The establishment painted her as “unhinged,” deplatformed her group, fired her, and she was arrested and sentenced to prison after January 6.

Eric Nepute, D.C., a vocal chiropractor, got the full-on attack. He dared to suggest that patients focus on immune-supporting nutrients like Vitamin D, Zinc, and Quercetin. The federal government responded by suing him for a theoretical penalty of half a trillion dollars—an absurd effort to bankrupt him and terrify any other practitioner from prioritizing natural health over the pharmaceutical mandate. (I’d say he has bragging rights!)

== == ==

For decades, the chiropractic profession has been the target of this exact same machinery.

When you have a product, service, or clinical truth that threatens a vested interest, you will be fought. So, you are encouraged to hide out. Stay safe. Be agreeable and… tame.

But when you hide, compromise, or try to be “accepted” by a corrupt medical establishment, you are indistinguishable from the thousands of other providers they already control.

They win.

But when you are “dangerous” — when you stand firmly for the truth that the body is designed to heal, not to be a lifetime customer of the pharmaceutical treadmill, you become a beacon.

You are then no longer just a piece on their game board.

Patients today are not looking for more of the same. They are looking for a doctor who stands for real health.

Being dangerous is your greatest marketing asset. It builds a level of trust that no institution can break.

The patients who are waking up to this reality will seek you out because you are a target. They will trust you because you refused to compromise.

Oh, Dr. Nepute — he is even more dangerous now. He operates 30 clinics!

Stand for the truth and help more people be healthy. That is how you build a business.

Don’t be a piece… be a player.

Be Dangerous…

…and Goal Driven,

Ed

P.S. Doctors McCullough, Kory, and Simone – and others – will be speaking at the Wisconsin Society of Chiropractic Society of Wisconsin’s VAXCON, April 24-25 at the Dells, WI. See you there! Link.

*References

On Dr. Jeffrey Wigand & The Tobacco Industry: 

·  On the “Tobacco-to-Food” Strategy: 

·  On the Doctors (McCullough, Kory, Gold): 

·  On Dr. Eric Nepute:

Why Things Don’t Get Done in Your Chiropractic and Healthcare Practice

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everybody, somebody, anybody, nobody taking responsibility in a chiropractic office

The Importance of Goal Driven Job Checklists

Why don’t things get done in a chiropractic practice – or any professional practice?

It’s rarely laziness. It’s usually just a lack of clarity.

Last week we discussed Accountability — and how it helps grow and sustain a practice.

There is real science behind this, but it is sort of obvious. People perform better when they have something, or someone, giving them feedback!

Like a coach! (Hi! Call me! 🖐️😁)

But in order to be accountable for something, you kinda need to know what it is that you are being accountable for.

That’s where the work activities break down.

We say we want accountability — but we haven’t clearly defined responsibility.

That is why job descriptions matter.

Most of these, the ones I have seen, are so confusing as to be impractical.

A good job description defines what it is that you are responsible for…and why. It defines the purpose of the job, its specific duties, and its outcomes.

And those outcomes…? You can measure them.

With a good job description, a person knows what they are responsible for and they have the stats that shows them how they are doing.

They can be their own manager!

Now the CEO/Clinic Director doesn’t have to police. They get to coach and that’s the culture we want.

Here are the 4 parts of a Goal Driven job description, or what I call a Job Checklists:

  1. Purpose of the job.
  2. Duties of the job.
  3. Outcomes of the job.
  4. Statistics (metrics, Key Performance Indicators) of the job.

Here’s a fast example:

= = =

Chiropractic Front Desk Coordinator

Purpose

  1. Ensure that patients complete their programs by keeping their appointments.
  2. Keep the appointment book full, rescheduled appointments to a minimum, and ensure patient flow is smooth and efficient.

Duties

  1. Always answered the phone with a smile.
  2. Greeted every patient personally when they entered the office with a smile, by their first/last name, as appropriate.
  3. Followed clinic and office policies as outlined in our office manual.
  4. Confirmed appointments as necessary for the next day’s schedule.
  5. Ensured that all patients had a treatment plan and set multiple schedules off them
  6. Ensured that the flow of patients never got jammed or “plugged up.” Got help when needed to “unplug” the flow.
  7. Never let patients wait more than 15 minutes.
  8. Asked for patient referrals each day.
  9. …

Outcomes

  1. All patients are scheduled for their appointments
  2. All patients keeping their appointments.

Performance Monitors

  1. Percentage of Kept Appointments
  2. Office Visits

This is a sample, but I am sure it comes close to what your front desk does… or should do.

= = =

Review your job checklist with your team monthly. Improve them and use them for training. You can co-coach each other!

But remember: responsibility comes before accountability.

Help others take responsibility for achieving their goals.

  • Define it.
  • Measure it.
  • Coach it.

And stay Goal Driven.

Ed

P.S.

Everybody, Somebody, Anybody, Nobody

“There was an important job to be done and Everybody was sure that Somebody would do it.

Anybody could have done it, but Nobody did it.

Somebody got angry about that because it was Everybody’s job.

Everybody thought that Anybody could do it, but Nobody realized that Everybody wouldn’t do it.

It ended up that Everybody blamed Somebody when Nobody did what Anybody could have done.”

– Charles R. Swindoll

Leaders Like You – in Chiropractic and Healthcare Practices

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Doctors and team members of Excel Chiropractic, Lake Geneva, WI

Empowering Others in Chiropractic Healthcare Practice

You are a leader.

You may not consider yourself a leader. But you are. So is everyone on your team.

Not only by the service you provide, but by the example you set.

What is leadership? Let’s take a look to see if you fit:

  • “Leadership is not about who you are or where you sit. It’s about what you do to make a difference in the lives of others.” — Jim Kouzes & Barry Posner, The Leadership Challenge
  • “Leadership is not about being in charge. It is about taking care of those in your charge.” — Simon Sinek
  • “Leaders become great, not because of their power, but because of their ability to empower others.” — John C. Maxwell

I think you’ll have to agree, both you and your team are leaders. Servant leaders in chiropractic and your healthcare practice.

But, as you know, leadership is tough. It isn’t easy.

But you did it in 2025.

You helped others in big ways and small, regardless of your role.

It is possible, quite likely in fact, that you may not have acknowledged the vital role you and your teammates played in the wellbeing of others last year.

Why not? Well (lol) … because of all the #@#% that occurs when trying to get things done. The list can go on and on… there is so much noise and changes that occur in practice that sometimes it is difficult to see the road we are on.

But, you made it through another year. And in your wake, people are better.

All of us at Petty, Michel and Associates are proud to work with you. We appreciate your struggles and celebrate your wins as independent health care leaders!

In this New Year, stay true to you purpose and your role as the servant leader that you are – and your path to your goals in 2026 will be straighter and more certain.

“We never know how far reaching something we may think,
say or do today will affect the lives of millions tomorrow.”
B.J. Palmer’s 1949 book The Bigness of the Fellow Within

Ed Petty

Ask Lisa: It All Goes Back to the Goal!

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theory of constraints the goal by Eliyahu M. Goldratt for the chiropractic office

I recently took a book off my bookshelf to re-read …

The Goal by Eliyahu M. Goldratt is one of my favorite business books. I love that Eli drives home being human, while at the same time having great capacity to improve systems and procedures in the workplace. As a business owner this relates directly to you.

Keep reading to learn how.

A few key takeaways from the book and how this ongoing process can help YOU improve your collections and income include:

Keeping in mind that the true goal of any for-profit company is to make money now and in the future. Two features of this are:

All operational decisions are evaluated based on whether they help achieve this goal.
Performance measurement is framed around three metrics:

  1. Throughput, or productivity (Service productivity is reflected in your NP, PV, charges, and collections stats)
  2. Inventory (making purchases intended to sell, such as supplements, pillows, exercise rehab supplies; and
  3. Operational Expense, which is money you spend to turn your inventory into productivity. This can include your practice management program and billing program’s monthly payments, maintaining and enhancing the office space, and maintaining functional chiropractic equipment such as your adjusting tables.

So, what specific actions can help you achieve the true goal for your business?

1. Identify constraints or bottlenecks in the office.

a. Look at time studies of the doctor(s) and staff. Can scheduling be done differently to open up blocks of time for more patients and/or paperwork.

b. Look for a breakdown in policies and procedures. How can it be done more effectively with better results?

2. Second, maximize and support the constraint,

a. decrease interruptions;

b. delegate tasks that are not directly clinical;

c. work on office flow for greater capacity.

3. Take note of variables. When a variable is presented such as doctor or staff
vacation and holidays , make adjustments to accommodate and still maintain your
goals.

4. Repeat steps 1 through 3, and you’ll find another constraint/bottleneck to work
through.

It may not feel good at first, but each time you cycle through the steps, according to the theory of constraints, you actually are improving the quality of your practice and its value!

Want to learn more about specific action steps for identifying bottlenecks and improving your collections and income? Give us a call. We’ve got your back. Just Ask . . .

Lisa
lisa@pmaworks.com

PS: Another great book that directly relates to this topic is “The Goal Driven Business” by Ed Petty.

Preparing for a Powerful New Year in Your Chiropractic Healthcare Business

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Previously posted on (Goal Driven.com)

petty michel and associates end of year business preparation checklist

42 more days until a New Year is here.

Before we know it, it will be at our morning doorstep. Like a happy eager dog ready to be taken for its morning walk, tail a wagin’.

But before we look at all what is coming, we have the next few weeks to wrap up 2025. This includes the Holidays, both in business and in our personal lives. We also have all the year-end admin details to complete.

NOW is the time to nail everything down — to plan the events and complete the admin tasks.

And while doing this, filling the end of the year with Christmas cheer, ready for 2026 — your best year yet!!

We’ll prepare for the New Year in a few weeks, but let’s finish off this year with a flourish. Consider these 4 actions:

  • Relationships. Focus on re-bonding with all your patients and supporters from this last year.
  • End of year care. Encourage them to come in and get care.
  • Referrals. Bring in their family and friends for an end of year check-up.
  • Year end admin checklist. Review and complete all year end admin duties that need to be done.

Most important is your connection with current and past patients and supporters.

Remember:

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

Be ready to take a little extra time to chat, to communicate, and to listen — and an extra “a cup of kindness, yet.”

Marketing. I gave a list of some marketing activities you can do for November and December in a recent newsletter. You can review them here. Get those planned and going.

End of Year Administrative Checklist for Chiropractic and Healthcare Businesses

In addition, we have put together a short list of administrative items that should be reviewed and completed by year end for your chiropractic and healthcare office. It is by no means complete, but the idea is you want to get them taken care of as soon as possible, or at least scheduled, so you can focus your creative energies on launching your 2026.

Block 2-3 hours in early December to work through this list. Delegate sections to your manager, billing staff, and bookkeeper.

You can also contact Lisa who is an expert in these subjects. You can contact her anytime.

Just Ask Lisa! (Lisa@pmaworks.com)

The checklist covers these categories:

2025 ADMIN WRAP UP CHECKLIST

  • FINANCIAL & TAX
  • CREDENTIALING & LICENSING
  • EMPLOYEE ADMINISTRATION
  • INSURANCE & PATIENT ACCOUNTS
  • COMPLIANCE & OPERATIONS
  • BUSINESS ENTITY & LEGAL

Download the ADMIN LIST below and tend to the admin.

Meanwhile, have a great time with your patients over the next 6 weeks.

And let’s prepare for your best year ever – in practice, in business, and in life!

And stay…Goal Driven,

Ed

Download the Checklists HERE

What is Special about L.L. Bean and How Does it Compare to Your Chiropractic or Healthcare Practice?

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“Originally published on Goal Driven.com – republished with permission.”

LL bean womens boot
The Key to Building a Chiropractic and Healthcare Practice that Lasts

L.L. Bean. You’ve probably heard of them.

I just received a Christmas shopping catalogue from them (hard copy!). They are a clothing company out of Maine. Founded in 1912 by Leon Leonwood Bean. I probably bought something from them years ago, and I am on their Christmas list.

We also receive a catalogue from Patagonia each year. It is another clothing company. It was founded more recently, in 1973 by a rock climber, Yvon Chouinard.

I like both companies and I will tell you why – in a minute.

= = =

Recently, I saw an ad of a young man (chiropractor) coming off a stage saying that he just sold his practice for “seven figures.” It was a bit of brag and sounded like he wanted to help other doctors reach that level. He said he was able to grow his business quickly and sell it thanks to his marketing.

I’m all for marketing, and I truly hope he can help with other chiropractic practices.

But it made me think: aren’t there significant financial advantages to owning a business in the long term that compound?

When you own a practice for 10-20 years, you’re not just collecting a salary — you’re able to take advantage of tax benefits that can add $30-50K annually to your real compensation! These can include vehicle expenses, health insurance, retirement contributions, continuing education, and equipment depreciation. These can all reduce your tax burden.

Over 20-25 years, these ownership benefits can add $500K-$1M in value that disappears the moment you sell.

And beyond tax advantages, long-term ownership allows your business equity to compound alongside your income. A practice worth $500K in year 5 might grow to $2M by year 10 or $5 -10M by year 25 – or more — IF you have good management, create a strong reputation, and even bring on other providers, or add other locations. And all the while — taking profit distributions, building retirement accounts, and enjoying the flexibility that ownership provides.

The doctor who sells early gets one payday; the doctor who builds strategically gets decades of tax-optimized income plus a potentially much larger exit.

Back to L.L. Bean and Patagonia

Now, back to those Christmas catalogues! Both show how patient, long-term ownership and excellent management, products, and services can build generational wealth over decades of brand-building and customer loyalty.

L.L. Bean, a billion-dollar empire, is still family-owned. Patagonia, now worth billions, wasn’t sold at all. Chouinard transferred ownership to the Patagonia Purpose Trust to ensure profits protect the planet in perpetuity.

Both companies show how owners who focus on purpose-driven growth and lasting customer relationships can build enduring companies that dwarf what any early buyer would have paid.

Purpose and Values of Your Healthcare and Chiropractic Practice

But here is what does not show up in the spreadsheets of these two companies: their values and purposes.

And, their discipline to stick to them!

Selling your business earlier rather than later can be a valid choice. However, if you ensure it remains focused on its purpose and values, you’ll enhance its profitability and make it more valuable for whoever takes ownership next.

L.L. Bean built its reputation on an unconditional guarantee and commitment to customer satisfaction. “At L.L.Bean, we design products that make it easier for families of all kinds to spend time outside together.”

Patagonia’s environmental purpose became so central that Yvon Chouinard ultimately gave away his $3 billion company. “We’re in business to save our home planet.”

The lesson is that a business rooted in purpose beyond profit attracts loyal customers and dedicated employees and creates a brand that competitors can’t copy.

Your purpose — and the discipline to stay creatively and positively true to your goals — pays off.

So…

Stay Goal Driven!

Ed

P.S. And have fun doing so – maybe fishing, camping, or just outside and enjoy the fall. (Or spring, if you’re Down Under.)

Building a Practice Through Relationships

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a happy bus driver like a chiropractor with happy people on their bus

Advertising has always been important. When we grew our Wisconsin network to 25 offices, we invested heavily in newspapers, shared mailers, radio, and even TV. Today, the focus has shifted to social media, SEO, and now Artificial Intelligence — positioning your practice for AI discovery will soon be essential (more on that later!).

But advertising is expensive. What truly sustained our growth was relationship marketing — connecting authentically with patients, referral sources, and our own team.

What Is Relationship Marketing?

Relationship marketing involves creating trust-based relationships with patients and referral sources, generating loyalty and organic referrals through genuine care and ongoing connection.

Examples:

  • Host a community event like a holiday food drive — invite patients and their families to participate and offer consultations in exchange for donations.
  • Encourage patients to refer loved ones with a personal touch (“Let’s check your spouse before their next soccer game!”).
  • Build partnerships with local professionals — massage therapists, trainers, or nutritionists — and support each other through referrals or shared promotions.

Your Most Important Relationships

Don’t overlook your team. When doctors and staff work together with shared purpose and positive energy, patients notice. It’s almost magnetic — phones start ringing and old patients return.

As Stephen Covey reminds us in The 7 Habits of Highly Effective People, success comes from empathy, communication, and a win-win mindset that creates synergy — or, as some might say, Universal Intelligence at work.

GETTING AND KEEPING PEOPLE ON YOUR BUS

As a doctor and clinic director, you are like a bus driver. You aim to make sure you are on time and complete your shift according to schedule.

One day, you turn around to look at the back of your bus and wonder why there are so many empty seats. “Where is everyone?”

Well, maybe you missed some stops and the people never got on! Or, you didn’t take time to say “hi” when they boarded, so they all left at the next stop. Or, you were so busy driving, you didn’t ask about your assistant’s new workout routine.

Take time to connect with people.

More than anything, you are in the people business.

Enjoy the ride!

Ed

“What’s Wrong with a Chiropractic and Healthcare Personality Practice, He Asked?”

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a group of women sitting at a chiropractic vendor booth waiting for potential clients to stop by and visitJust wrapped up an outstanding chiropractic convention put on by the Wisconsin Chiropractic Society here, you guessed it, in Wisconsin!

We enjoyed catching up with old friends, some we’ve known for decades. And making new friends.

For more on the Convention, you can check out our Facebook site, link below.

Personality Practice

While I was out listening to a presentation, I was told that a doctor dropped by the booth and asked about my book, The Goal Driven Business. He was told that it was about how to improve profits and outcomes by shifting from a personality-driven practice to one that was goal-driven. He felt that the personality practice was better.

I am sorry I wasn’t there to explain more – and hopefully he is reading this email.

Let me explain: A Personality Driven practice is propelled by the doctor’s behavior – their feelings, attitudes, and habits. What they personally do.

When opening a new office, the new business owner, of course, builds their new business on their behavior. It is their ambitious determination that is driving the initial growth of the practice. So, yes, a Personality Driven practice works at the launch of a new endeavor. What else is there? A dream, and the raw desire to manifest it.

So, the Personality-Driven practice works — at first.

However, after the practice is up and running, it needs to transition into a Goal Driven and systematized business.

The concept of a systematized business was hugely popular in the 1980s, thanks to Michael Gerber’s book, The E-Myth. In it, he says:

“The system runs the business. The people run the system.”

B. J. Palmer said something similar, much earlier. And he built a school that many of you may have attended. In his book, Up From Below the Bottom, he says:

“The size of a chiropractor’s business depends upon:

1st – His ability to notify people who he is, what he is, and where.

2nd – His systematization to take care of it as it grows and increases in volume.”

Gerber comically explains what happens when you don’t have systems running your business.

“If your business depends on you, you don’t own a business—you have a job. And it’s the worst job in the world because you’re working for a lunatic!”

–Making the Shift from Personality Driven to Goal Driven–

Making the SHIFT from a Personality Practice to a Goal Driven business is not easy. This is because you have established survival habits that have shown you that the practice depends on you, your feelings, attitudes, and overall behavior. You are the doctor, after all. You see the practice as DOCTOR-CENTERED.

A better approach, I recommend, is to keep it GOAL-CENTERED.

There are two echelons of goals to consider:

  1. Higher goals, including your purpose and “why.” This is your North Star.
  2. Practical goals, or outcomes. For example, you could have front desk goals (percentage of appointments kept), Billing and Collections goals (percentage of collections), and marketing goals (new patients and returning patients), and patient goals (patient completing tx program with an excellent review.)

Get your team on board with these goals. If you do, they can now help you put together the best approach to achieve your goals. These are the systems.

So: Personality Practice – YES! When starting a new business.

But once it is running, NO. Gradually back out and put in place goals and systems. And train your people on these.

For more details, read The Goal Driven Business.

If you want help with this, contact me. I’d love to help. (Been doing this for a while, so lots of tips!)

Services@pmaworks.com

Stay Goal Driven. Stay Free!

Ed

Photos of us and our friends at the Chiropractic Society of Wisconsin Fall Experience

Hobby, Practice, Business. Which is it for You as a Chiropractic Doctor?

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The 3 Phases of Practice Evolution

Is your work as a doctor a hobby, a practice, a business—or simply a job? Let’s explore.

1. HOBBY

Every practice begins as a hobby—or at least, it should. Early in your career, you’re driven by fascination with the science, philosophy, art, and technique of chiropractic. Your passion keeps you going, while business operations take a back seat.

2. PROFESSIONAL PRACTICE

The next phase is building a true professional practice. This stage is entrepreneurial and personality-driven, fueled by your presence and commitment. You create strong patient relationships and build loyalty through consistent care and connection.

3. PROFESSIONAL SERVICE BUSINESS

Finally comes the service business stage. Here, your practice is structured, systematized, and able to operate independently of your constant management. You may step into a CEO role or scale back to part-time patient care, but either way, the business runs on clear goals and proven systems. This is what people call “scaling.”

DIFFERENT PATHS, DIFFERENT GOALS

Not every doctor wants to build a business. I once knew a chiropractor who loved nothing more than adjusting patients. He wasn’t concerned with scaling or management systems. His secretary kept the office running, his patients were happy, and so was he. That was enough.

Most doctors, though, do want to grow—to serve more people, expand their caseloads, and run a strong practice while still enjoying their profession.

Then there are the entrepreneurial doctors who aim to scale beyond themselves. By setting goals and creating reliable systems, they can expand without adding more hours or overwhelming overhead.

But many who try to scale fall into what I call the Practice Roller Coaster. The excitement of practice gets buried under stress, inconsistency, and management struggles. What once felt like a calling begins to feel like just another job.

BREAKING THE ROLLER COASTER CYCLE

There are exceptions—many doctors do successfully build thriving service businesses. I’ve helped dozens achieve exactly that.

Five years ago, I wrote The Goal Driven Business after observing this cycle of burnout. In the book, I explain the hidden barriers to growth and outline the step-by-step process for building a scalable, independent practice.

If you find yourself on the Roller Coaster, here’s how to reset:

  1. Hobby – Fall back in love with chiropractic. Make practicing fun again.
  2. Professional Practice – Build and enjoy your patient community while earning a solid living.
  3. Professional Service Business – If you’re ready to scale:
    • Read The Goal Driven Business for a complete roadmap.
    • Or, reach out to me directly through our Goal Driven Consulting program for hands-on help building a profitable, self-sustaining business.

Take back your future. Build a business that runs without depending on your daily management.

Stay Goal Driven,

Ed

 

Preventing Procedural Atrophy in Your Practice

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eroded asphalt highway

In any business, routines and procedures can slowly be shortened, skipped, or abandoned. When this happens, quality slips, and the practice begins to decline. I call this Procedural Atrophy, a key concept from The Goal Driven Business.

When results falter, doctors often try new approaches. These may work temporarily, but without consistent systems, the same decline sets in again. This creates the Practice Roller Coaster—a cycle driven more by personality than by clear goals and structure.

Think back to what you did when your practice was thriving. Did you call new patients after their first visit? Hold morning team huddles? Run patient education classes, progress exams, or referral drives? Chances are, when numbers dip, it’s because those proven actions have slipped away. The solution is often simple: return to what worked before.

 Solution 1: Set the Standard – Quality

Stand out in a noisy world by being consistent and excellent. Define exactly what a successful patient outcome looks like—for example, a patient who pays, stays, refers, feels healthier, understands their care, and is happy with their results.

Then, create brief checklists that outline the essential procedures needed to achieve this. Examples include:

  • Day 1, Day 2, and ongoing patient steps
  • Collections
  • Internal and external marketing
  • Team communication and coordination
  • Leadership and management

These checklists keep your practice systematic, repeatable, and reliable.

 Solution 2: Accountability Reviews

Consistency requires feedback. Use monthly statistics, chart trends, and review them with your team or a coach. This ensures everyone stays focused and motivated. Just like in life, accountability keeps us on track.

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Bottom line: What you provide for your patients, team, and community is valuable. Don’t let your practice erode through neglect of the basics. Stay consistent, keep improving, and remain Goal Driven.

Ed

Scripts are Secondary in Your Chiropractic and Healthcare Practice

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female chiropractor discussing care plan with patient

Why Scripting Can Fail—and How to Make It Work

A script is a prepared set of phrases, questions, or responses designed to guide staff or doctors in patient interactions. Whether word-for-word or just an outline, scripts help keep communication consistent, especially for new team members. But even the best script can flop if it’s missing one thing—authentic human connection.

Connection Comes Before Words

Think of connection like a radio signal. A carrier wave must exist before any music or voice can be transmitted. Without it, nothing gets through. In patient care, that “carrier wave” is trust and genuine interest. If it’s missing, your words—no matter how polished—won’t land.

I once had a doctor greet me after a minor surgery with a cheerful, “I can’t tell you even had it done!” It was a nice line, but it felt canned. The delivery lacked authenticity, so the message didn’t connect.

How to Create the “Carrier Wave”

  • Be authentic – Avoid sounding rehearsed.
  • Be curious – Take a few extra seconds to ask a follow-up question.
  • Recognize the person – Make patients feel valued and respected.

When you connect first, your scripted lines gain power and meaning. Without it, patients may feel unheard, leading to fewer new-patient conversions, lower follow-through, and less word-of-mouth.

Using Scripts Effectively

  • Review and practice scripts every couple of months.
  • Role-play different delivery styles (bored, overexcited, glum) to sharpen awareness.
  • Use scripts to keep patient conversations moving forward, not to replace genuine interest.

Bottom line: Scripts are useful tools—but they only work if you first connect with the human being in front of you.

For more helpful business tips visit our Goal Driver Blog [LINK]

Ed

The Power of Intention in Your Chiropractic and Healthcare Practice

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In the daily routine of healthcare—especially chiropractic work—it’s easy to get lost in the mechanics: forms, schedules, insurance, and technology. But behind all that is something far more important: people.

You’re not just working on bones or adjusting spines; you’re working with *life*. Your mindset, intention, and emotional presence directly impact your patients’ healing. Research supports this: for example, a British study found **a 61% improvement in outcomes** when providers maintained a positive, optimistic attitude.

Some healing modalities—like certain chiropractic techniques and practices like Reiki—explicitly incorporate intention as a key part of their method. This isn’t just theory; there’s growing scientific evidence supporting it.

Practical Ways to Use Intention in Your Practice

1. Present Time Consciousness
Before seeing each patient, take a brief moment to focus. Set a clear intention for their healing. One doctor used a subtle button sound to remind himself to be fully present.

2. Reinforce With Positivity
After adjustments, reinforce the moment with confident, uplifting words like “That adjustment felt great,” or “This is going to help.”

3. Leverage Collective Intention
Studies, including those by author Lynn McTaggart, show that intention becomes more powerful when shared by a group. Apply this by:

  • Partnering with patients– Get their buy-in and visualize outcomes together.
  • Team meetings – Discuss and send focused intention toward helping specific patients improve.
  • Group classes – Encourage collective healing energy and goal-setting among your patient community.

Intention isn’t fluff—it’s a tool backed by experience and research. Use it deliberately, involve others, and watch your results shift.

Read the full article with references at:  Goal Driven.com

Ed

He walked away when I asked, “Who is going to do it?”

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distressed overwhelmed male business man When you are the bottleneck

Many years ago, I attended a large chiropractic conference. I was new to the profession and curious about how things worked.

One of the seminars at the conference was on how to generate new patients. There must have been several hundred in the room. The speaker was charismatic and had some sensible recommendations. The audience seemed enthused.

I was sitting in the back of the room. When the seminar was over, I was one of the first to leave and walk into the hallway where attendees began to cluster to discuss the presentation.

I remember one doctor in particular. He was tall and had his name tag with ribbons hanging down. I didn’t understand what the ribbons meant, but I figured he must have been important.

I asked him how he liked the seminar. He was deliberate, almost authoritative when he said that he liked it and was going to implement some marketing projects. I told him that I thought that was good.

But then, thinking about it, I asked him, “Who in your office is going to do it?”

I remember him looking down at me. He seemed perturbed, as if I had insulted him. He looked up and walked away. Didn’t say a word.

I’ll never forget it.

This was a long time ago, but it made an impression on me.

REMEMBER THE OLD MAXIM
“Do what you do best, and delegate all the rest.”

You can’t do it all.

In the beginning, when starting and growing your practice, yes, you pretty much had to do most everything.

But at some point, you must create other team members who are trained and motivated to share the load. I know practice owners know this, but it’s easier said than done.

This is why a manager is so vital to your practice. Your manager is the fulcrum point that helps you make a team. They are a servant to the team — as you are to your patients.

They help put in the systems that allow all your internal and external marketing procedures to be effective. And not just marketing. Standard procedures for patient retention, patient services, patient reimbursement, and so on.

They take the load off of you, so you are not the bottleneck!

We’ve found that most staff and managers are very willing and want to help their offices grow. But in most cases, they are not sure how, or how best to work with their team, or their doctor.

It is because of this we have developed our Practice MBA program.

Take time each week to train your team.

And for some of you, our manager training program is just what you need to answer the question,

“Who is going to do it?”

Stay Goal Driven,

Ed

P.S. Get on our Waitlist today to ensure you get a spot. First come first serve. Only 15 spots available this fall.  [LINK]

Should You Scale Your Chiropractic or Healthcare Practice?

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chiropractic scaling graph

Scaling a chiropractic or healthcare practice involves more than just growth—it’s about achieving exponential progress through strategic systems. Unlike linear business growth, scaling leverages economies of scale, scope, learning, digitalization, and networking effects to accelerate success.

Key factors include reducing overhead, adding services carefully, improving skills through experience, and using efficient software.

However, scaling requires a solid leadership and management structure to avoid pitfalls like the “Practice Roller Coaster.” Whether aiming to expand one office, add doctors, or prepare for a sale, scaling can drive your goals. Specialized training on scaling will be part of an updated MBA program this fall.

Key Points:

  • Scaling vs. Growth: Scaling is geometric, not linear, leading to faster growth as you expand.
  • Critical Elements: Economies of scale, scope, learning, digital tools, and networking effects fuel scaling.
  • Foundation Needed: Agile leadership and management are essential to avoid instability.
  • Applications: Scaling suits single or multi-doctor offices and can prepare a business for sale.
  • Next Steps: Upcoming MBA training will cover scaling strategies.

Please let me know if you’re interested in this fascinating subject.

Meanwhile…

Help others achieve their goals!

Ed

For more details, contact Ed Petty, the author of the Goal Driven Business and founder of the Goal Driven MBA Program.

Read more about scaling here:  https://www.goaldriven.com/post/should-you-scale-your-chiropractic-healthcare-practice

Streamlining Patient Flow for Better Service Capacity in Your Chiropractic and Healthcare Practice

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team meeting strategy planning for good setting good goals

A well-designed patient pathway enhances patient experience and increases a practice’s capacity by optimizing scheduling and treatment efficiency. Drawing from Eli Goldratt’s The Goal and the Theory of Constraints, identifying and resolving bottlenecks—such as delayed doctor’s notes, overwhelmed front desk staff, or unclear patient billing—can significantly improve patient flow. Common issues include administrative burdens at the front desk and patient confusion over charges, which can lead to missed appointments.

To address this, practices should map out key patient interactions (e.g., Day 1, Day 2, and Day 12) with the entire team, creating a clear flow chart of actions like payments, doctor visits, therapy, and financial consultations. Rehearsing this flow, like a sports team or musical group, helps identify redundancies or missing steps, ensuring a smooth, efficient process. This patient train follows a predictable track, helping patients understand their treatment plan and stay committed to their health goals.

By regularly reviewing and refining this pathway, practices can maximize capacity—potentially handling 40-70 daily visits plus 2-4 new patients—while improving patient satisfaction. Working on the business in this way keeps operations streamlined, helping patients achieve better health outcomes faster.

Be a Goalineer(sm) and keep your practice on track!

Read the full article online [LINK]

Ed

PS Want help with this? Contact me  If you have any questions about creating a Goal Driven Business, just schedule a call or reply to this email.

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PS: Get on our waiting list for our next MBA program if you are interested. I will be sending you special information about practice management, leadership, and marketing.

Sign Up Now for Fall 2025 Waitlist

———————————————

goal driven business www.goaldriven.com

For more information on how to create a more profitable business that is more fun than what you are doing now, please purchase and then use the book,

The Goal Driven Business at www.GoalDriven.com

Discipline Drives Chiropractic Practice Success

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The Role of Discipline in Practice Success

Success in chiropractic or healthcare practices often correlates with discipline, much like weightlifting. While not universal, many successful doctors embrace the discomfort and effort required to achieve their goals, similar to consistent training.

Why Discipline Matters

Discipline means doing what’s necessary, even when it’s tough, and avoiding distractions or shortcuts. Like weightlifting or enduring hard work (e.g., the author’s father throwing sawdust down his shirt to toughen up for a grueling job), disciplined professionals push through challenges to achieve lasting success.

Jim Collins’ Insights on Discipline

In Good to Great, Jim Collins identifies discipline as key to transforming good businesses into great ones, applicable to chiropractic practices:

Disciplined People:

  • Leadership: Great leaders prioritize the practice’s success over personal gain, showing diligence and humility.
  • Team: Hire self-disciplined staff who don’t need micromanaging.

Disciplined Thought:

  • Face tough realities with courage while maintaining faith in long-term success.
  • Focus on what the practice is passionate about, excels at, and can profit from (Hedgehog Concept), avoiding distractions.

Disciplined Action:

  • Success comes from persistent, incremental efforts, like pushing a flywheel, not one grand action.
  • Stay focused on long-term goals, as greatness stems from disciplined choices, not circumstances.

Apply Discipline in Your Practice

Knowing what to do isn’t enough—discipline is executing it consistently. Embrace challenges, stay focused, and build momentum for lasting success.

Seize the Future,

Ed

Why Practice Systems Aren’t Enough

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team meeting of professionals

What you need to do

     “The size of a chiropractor’s business depends upon:
1st – His ability to notify people who he is, what he is, and where.
2nd – His systematization to take care of it as it grows and increases in volume.
– B.J. Palmer (1920, from Up From Below the Bottom)

B.J. Palmer, a pioneer in chiropractic, emphasized two keys to growing a practice: effective marketing to establish visibility and robust systems to manage growth. In the 1920s, he built a chiropractic college with 1,000 students, showcasing his ability to promote and systematize. Similarly, Michael Gerber’s The E-Myth (1980s) stresses that systems, not individual effort, drive business success. Quotes like “Systems run the business and people run the systems” highlight the need for structured processes.

However, many chiropractic offices struggle to implement systems effectively. The missing piece is clear leadership and accountability. Doctors and staff are often too busy to manage systems, and most practitioners lack the desire to oversee them. A dedicated manager and a goal-driven team are essential to bridge this gap.

Action Steps to Implement Systems:

  1. Lead as the Clinic Director: Dedicate a few hours monthly to strategic oversight, emulating Palmer’s leadership in driving innovation.
  2. Instill Purpose: Hold monthly team meetings (2 hours) to reinforce your practice’s philosophy and align the team.
  3. Appoint a Manager: Designate an administrative coordinator for 2-4 hours weekly to oversee systems.
  4. Define Roles: Have the manager collaborate with the team to create and maintain job duties, reviewed by you.
  5. Coach the Manager: Meet twice monthly (1-2 hours) to review the manager’s progress and provide guidance.
  6. Use Frameworks: Apply *The Goal Driven Business* to structure system implementation.

The Outcome:
A manager handles daily operations, freeing you to focus on growth. This shifts your practice from surviving to thriving.

Next Steps:
Read The Goal Driven Business for detailed guidance. Assign a manager now or book a consultation (May 2025). Stay goal-driven to build a scalable, successful practice.

And Stay Goal Driven,

Ed

Book a Consultation NOW!

How Steve Jobs’ Vision Can Transform Your Chiropractic Practice Learning from Visionary Success

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steve jobs

Apple, founded by Steve Jobs in 1976, is now the world’s most valuable company, with a market capitalization of $2.9 trillion and $54 billion in cash reserves. But in 1997, Apple was on the brink of bankruptcy. Jobs’ strategic overhaul turned it around, offering lessons for chiropractic and healthcare practices.

In a 1997 interview, Jobs shared a key insight: “If you do the right things on the top line, the bottom line will follow.” He emphasized that a clear strategy, passionate people, and a strong culture drive quality products, marketing, and operations—ultimately boosting profitability. For chiropractors, this means focusing on vision and values to achieve sustainable success.

The Top Line: Your Practice’s Foundation

Your “top line” is your practice’s vision, values, purpose, and the team that embraces them. When these are aligned, marketing, procedures, patient outcomes, and profits follow naturally.

Top-to-Bottom Framework:

  • Top Line: Vision, values, purpose, mission
  • Almost Top Line: A team aligned with these principles
  • Middle Line: Policies and procedures
  • Almost Bottom Line: Patient outcomes
  • Bottom Line: Net income

Focusing on the top line creates a “vision-driven” practice, much like Jobs’ approach at Apple.

Insights from a Chiropractic Leader

A seasoned chiropractor recently shared a video on social media, responding to a colleague concerned about high practice expenses. He identified the biggest cost: an “under-trained” team. His solution? Hiring passionate individuals and training them not just in chiropractic techniques but in the practice’s “why”—its purpose, mission, and vision. Team members who didn’t fully align were let go. The result? A thriving practice.

When I commented that his success stemmed from his own clear “why,” he agreed: “It all starts from the inside out. If the doctor has a big WHY and can teach it, the team will follow.”

Sustaining Your Vision

Keeping your practice’s values alive requires ongoing effort. It begins with your example as the leader and continues through consistent team coaching. In our MBA program, we explore proven strategies to maintain this focus, from vision to execution.

Apple’s Core Value and Your Practice

In 1997, Jobs defined Apple’s core value: “We believe people with passion can change the world for the better.” This resonates with top healthcare practices, where passion for patient care drives impact.

Does your practice reflect this passion? A clear vision, a dedicated team, and consistent coaching can transform your chiropractic business, just as Jobs transformed Apple.

Stay Goal Driven.

Ed

Momentum Magic: How the Flywheel Effect Boosts Your Chiropractic Practice and Service Business

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flywheel effect

What separates good businesses from great ones?

It’s momentum—created by doing what works consistently and improving it over time. In business, especially in healthcare services like chiropractic, success often comes not from radical change but from steady, thoughtful progress.

Avoid the Trap of Constant Change

Healthcare entrepreneurs often seek out the next big thing—new therapies, machines, or procedures. While innovation can be beneficial, abrupt changes to proven systems can disrupt staff and confuse patients. A smarter approach is to test new ideas first, and only implement them if they complement what’s already working.

“If something works—fix it, refine it, but don’t toss it.”

The Flywheel Analogy

Jim Collins, in Good to Great, uses the image of a massive flywheel to illustrate how lasting success is built. At first, it takes immense effort to turn. But with consistent effort in the same direction, the wheel picks up speed and begins to turn on its own—powered by its own momentum.

The key lesson: there’s no single breakthrough moment—just consistent, focused effort over time.

How This Applies to Your Practice

  • Identify what’s working—and keep doing it.
  • Make small, strategic improvements over time.
  • Adapt to market changes gradually and intentionally.
  • Build systems that generate results with less effort over time.

By steadily turning your business flywheel, you’ll transform your practice from good to great—creating a self-sustaining engine of growth.

Keep building. Keep refining. Momentum will do the rest.

Ed