361- You Cannot Scale Your Practice if You Do Not Keep Your Customers

[00:00:00] Everybody talks about scalability. Do you know what scalability means? Scalability means you grow a business by keeping your customers. A business is not scalable if you are not keeping your customers. So when we talk about retention, that's keeping your customers. So that is on purpose and good for business. So it's totally aligned.

[00:00:31] Hello and welcome to the Remarkable CEO Podcast, a show dedicated to chiropractors who want to transform their job into a business so that they can have a remarkable practice as part of a remarkable life, not instead of one. With your hosts, Dr. Pete Camiolo and Dr. Stephen Franson.

[00:00:55] What's up, Remarkables? Welcome back to another episode of the Remarkable CEO Podcast, chiropractic's number one podcast. I'm Dr. Stephen Franson. And I'm Dr. Pete Camiolo. Hey, Dr. Pete, it's great to be back in the studio here with you, man. I've been in the studio quite a bit with a whole bunch of our friends and colleagues and some of our success partners, some other experts coming in.

[00:01:17] So, man, it's nice to see you, brother. And I'm excited for the conversation that we're going to have today, just continuing this awesome series that we started about helping people unearth their primary constraints. So you guys have heard it probably if you've been listening to the series, you've heard it three or four times. And I'm going to say it again. So you just stay focused. I know you got a lot going on, really. And frankly, that's the purpose for this series. Right. So, yeah, we got a lot of challenges. We got a lot of opportunities. We've got a lot of distractions going on in our world and we've got lots of problems.

[00:01:46] Let's just face it. But what I'll tell you right now is if you're a growth practitioner, you want to serve more people, you want to make a bigger impact and make a bigger income. There is one primary constraint. There's one major constraint. This is one first domino that if you would just address this, slay this dragon, Dr. Pete, the practice will be pulled to the next level. If we can just focus on this singular issue, slay this one dragon, it's going to open us up to expansion.

[00:02:13] The practice will be pulled forward, will compress time. And then we'll have an opportunity to deal with the next issue because you know that every level has a new devil. There's going to be a new set of problems. Right. And we welcome those. Right. The stress of abundance that comes when you grow the business. So, you know, we've said throughout this series, you can't chase two rabbits, never mind five. Let's identify what is the one rabbit that you need to be chasing right now.

[00:02:40] That one key thing, that one linchpin, that one door. Once you unlock it, it swings open and doors swing on small hinges. Maybe the hinge that we need to be focusing on in your practice right now is retention. Patient retention in the category, in the domain of delivery. Right. Right. So it all comes down to retention. I know, Dr. Pete, we're very careful not to project our philosophy when we can help ourselves. Today, we can't help ourselves. Right. So at the end of the day, it's all about retention, guys. Right.

[00:03:08] So this is where all of the results live. Retention is what we all want because retention is what drives better clinical outcomes for the patients and happy patients send more patients. So it drives referrals. So retention, referrals and revenue. All of our favorite ours. Dr. Pete, we are in the retention business. And today we're going to unearth why that means we're in the compliance business. I had a grin the whole time you were talking. So if you're not watching, you wouldn't know. So that'd be weird.

[00:03:38] But if you watch on YouTube, you'll be like, why is he grinning? I'll tell you why. A couple of things. And it is two years from now. This is, by the way, the spring slash summer of 2026. This will be relevant then. If you didn't start with us in the series, I encourage you to go back a few episodes. It's absolute gold.

[00:04:04] We went through what we have identified as what we believe would be and are the constraint, the number one, the primary constraint in the first domain of attraction. We went through the domain of conversion or sales. So attraction or marketing, conversion sales. So if you haven't, please go back and listen to those two episodes. There was a preceding episode to that where we kind of set the frame for the series, which I encourage you to listen to that one.

[00:04:33] And I'm not just saying this because I want you to listen to our podcast more times. No, I want you to get the fullness of what we are bringing to you. And I say this, I hope humbly, but I say it as a coach and somebody who's dedicated my life to serving chiropractic and chiropractors. This is transformative when applied. And if you have an open mind, right, the best leaders are listeners and learners. And we are appliers of what we are learning.

[00:05:03] Application. I always tell my patients, I said, information doesn't create transformation. It's the application of the inflammation that's going to lead to your transformation. So I want to make it really easy for you to apply what I'm teaching you here tonight. I used to teach that, use that line in every advanced workshop I ever taught. It's like, you're going to walk out of here with your eyes wide open and a whole notebook full of stuff. And I said, but I want you to circle one, two or three things. You're going to highlight it. I want you to go home and tell somebody or tell somebody you're left or you're right. Do it in the class. What's the one thing or two things you're going to do when you leave here today?

[00:05:33] Because my hope, Dr. Stephen, is that the things we're going to talk about, which I'm very passionate about, about retention, about delivery, about chiropractic care as a lifestyle success strategy for healthy human beings. Very passionate about that. And my concern is that people don't consume chiropractic the way it was designed. And so we have watered down, we have mishandled, not stewarded well, that which we've been entrusted with.

[00:06:01] I think many chiropractors are really good at maybe telling the story initially and getting people to raise their hand, click the thing, take the first step, marketing. Maybe you're a fantastic marketer. So happy for you. We need great messages in the marketplace. We're accountable to that. Maybe you hang your hat on, dude, I can close people. I'm really good at getting people to say yes and getting people to start. And it's not hard for you. And I'm like, hey, brother. Hey, sister. Good for you. That's amazing.

[00:06:29] But where we all walk with a limp, and I don't speak from pontificating position here. I speak from experience. Where we all walk with a limp is in the area of retention. And I don't care if you're Dr. Stephen Franson with 300 plus PVA. Could have been higher if you asked him, which I can ask him now and he can talk about it. But at the end of the day, there are root causes and there are constraints. And there is one primary constraint that we have identified that we're going to jam on right now in this episode that I believe all of you are going to get a ton out of.

[00:06:58] So I hope you're taking notes because we're not pontificating here. We are laying it down brick by brick. And we want to create a pathway for you to break through this constraint in your business. I like to see us break through this constraint in the profession. That's right. And that's why I'm speaking to me. I'm projecting. I'm speaking a message that I hope lands in the profession on this episode, not just for a person, but for us all.

[00:07:22] And I believe what we're going to land on today and what we are going to discuss is that thing. Dr. Stephen. We're going to lay this out, guys. I want you to hear what we're saying. We're going to lay out a formula. This isn't a string of a bunch of good ideas. Okay. So there is a sequential formula. There's a process. There is a system for you to be following. Right. So we're just going to lay it out for you. We do not gatekeep in the remarkable practice.

[00:07:48] We are sharing it right here inside of this podcast for anyone who wants to tune in and listen. Right. So you can take your notes. This is going to be your assignment to put this into play. Right. So the metric, the KPI that we're going to be talking about here today is in the retention category. We're going to talk about churn rate is one of the KPIs we're going to talk about. We're going to talk about compliance percentage. We'll end up talking about stick rates and PVA. That's the KPI list that we'll be talking about.

[00:08:14] And when we talk about the business, we're going to talk about an incredibly important metric called retained revenue. Right. So it's like we're going to talk about the practice and the business because it's all all intertwined. These are conjoined twins. You can't pull them apart. Right. So we're going to talk about compliance driving retention. Right. So when we talk about compliance, guys, we're not talking about you're doing things legally and according to regulatory restrictions. We're not talking about that kind of like third party billing and compliance notes. That's not what we're talking about.

[00:08:42] We're talking about patients complying to the doctor's best recommendations for care. So when you hear us say compliance, we're talking about the patient complying to the doctor's best recommendations for care. Right. So you'll hear us very often summarize this as the three legged stool. Right.

[00:08:58] It's getting the adjustments, the recommended schedule of adjustments in rhythm, breaking the bad habits that we tell them are causing their subluxations and to enroll the exercises or lifestyle strategies that we give them. So add the exercises so that they'll hold their adjustments better. Right. So three legged stool is a way to summarize recommendations for care. So we're talking about patient compliance and the most obvious one is scheduling. Right.

[00:09:24] Making sure that a patient's following their schedule of care when it comes to the doctor's recommendations for care. Dr. Pete, this is such a big issue. Right. So there are bleeding neck issues and then there's internal bleeding. Right. So bleeding neck issues everybody knows about. You don't hide a bleeding neck issue. Right. When it comes to like attraction and new patients, when people don't have new patients, that's a very obvious thing, like a bleeding neck issue, like spurting. Like it's like this is a problem. Right. Or conversions aren't happening.

[00:09:53] New ones are coming in, but they're not starting care. Right. Those are the obvious things that everybody knows about. But my goodness, man, people miss the internal bleeding associated with retention issues. Right. So with patient dropout or patients going inactive, it's what's known as churn. Right. So when we start talking about your stick rate versus your churn rate, Dr. Pete, what we know is that there is a set of behaviors, this process, procedures, scripting.

[00:10:19] There's a whole equation that will drive greater patient compliance and patient compliance is the key to driving those better clinical outcomes that create happy patients that refer more patients. And that, of course, drives more revenue. Right. So we're talking about results. We're talking about referrals. We're talking about revenue. All of our favorite Rs are all tied back to this incredibly important metric of compliance.

[00:10:42] So like you said, we're not going to often project on people like on this podcast in terms of our art, science and philosophy of chiropractic. But we will do that a little bit today, which is simply put that we believe that chiropractic is a lifestyle success strategy for healthy human beings, that the longer you're healthy, the healthier you'll be. That being checked regularly and adjusted regularly and appropriately for by a chiropractor is is great for everybody.

[00:11:12] Right. We teach that everyone needs a chiropractor. I can't be everyone's chiropractor and I may not be your chiropractor type of thing. We teach this. We walk with that belief system. And so the idea of of retention, it's not something you're trying to force on somebody. It's not a motivation to the patient. It's your brand. It is your product.

[00:11:38] And so if people aren't buying this, if you're not having people stay. Then that's off brand. That's product confusion in our world, the world we come from. So everything that we teach in the remarkable practice system and the remarkable business system, two sides of the coin, speaks to that. The product of chiropractic care as a lifestyle success strategy, lifetime family wellness care, all of that. That's a big mouthful.

[00:12:07] That's a whole big old thing to boulder to really understand and tackle. So we're starting with that end in mind, that that would be the definition of success, that people start and stay under chiropractic care. Now, we're not going to tell you how frequently you should be adjusting them. That's not our role. That's your role as the clinician to determine the frequency of adjustments and how you structure your care recommendations.

[00:12:36] It should be based on what we teach, the two things, your clinical findings and their health goals. These two things come together to help me form my best recommendations. Dr. Stephen, you said something and it just can go in one ear and out the other. But if you didn't hear that language, that's language that should be integrated into your business moving forward. Are you ready to hear my best recommendations for you?

[00:13:02] Listen, if someone stops complying with your best recommendations, they're settling for less than the best and they're opting out of what you originally agreed to when you formed the relationship at the beginning in the at the at the what we would say the conversion process. So, Dr. Stephen, I want to start at the beginning of this, which is even before scheduling, you have to have a strong start, which starts with four specific agreements.

[00:13:31] We're going to get into them, but I'm going to touch them. The first agreement we agree to when we begin a relationship with a new person before they actually become a patient, they're still what we would call in the opportunity stage of the journey. Is that we would agree to what the problem is. And that's a that's a full stop right there, because if you and them are not in agreement about what the problem is, there's misalignment.

[00:13:55] Anything else I'm about to say and you're about to say for the rest of this episode, just toss it out because we never actually agreed on what the problem was. So that's the first thing you have to agree on the problem. And there's layers to that. Second agreement is we have to agree on what their goals are, not your goals, their goals. And most of us. Chiropractors often project goals or don't get goals or assume or assume. Yeah. And so there's that misalignment.

[00:14:24] So you might agree to the problem, but if you never agreed to goals, you're going to struggle with retention, which we'll unpack in a moment. The third agreement is that we agree to a path way forward. You are here. Let's call that A. You want to go here. Let's call that Z. In order to get from here to A to Z, there are ABC, EFG steps to take. Here is the path to get you there.

[00:14:50] And we're going to organize your care into stages based on phases. And the pace and the investment of your time and your energy and eventually your money is going to be directly related to that to get you from A to Z. So we commit and agree to a plan that includes a commitment to time first, which is the most expensive investment they're going to make with you is their time.

[00:15:17] And then a commitment second to energy separated from the time commitment, not bolted together, separated out clearly as an agreement.

[00:15:27] And then once that agreement is formed and that is we've agreed to it, then we move on to the fourth agreement, which is a financial agreement, which is organized in a financial plan, which organizes what the care recommendations are in a simple, clear way for someone to make it easy for them to say yes and move forward. If you want to start identifying where's my retention issues or my compliance issues specifically, start there.

[00:15:57] That I found actually even in coaching hundreds of chiropractors for the last 15 years is right there. There's usually weakness. I'm going to call it, we call it a weak start, not a strong start, a weakness somewhere in there. We're missing something and that's causing us to have a weak start. And compliance would simply be a symptom of that root cause, which we never had a strong start. Hey doc, Stephen Franson here.

[00:16:23] If you're like me, you know that we're in the business of saving lives and when business is good, everybody wins. That's the good news. But here's the bad news. Most chiropractors don't own a business at all. They own a job. It's a job they love, but it's a job. And far too often, it feels like that job owns them. Is this true for you? Do you own a business or a job? Have you built and do you run your practice on brute force?

[00:16:52] Does it rely fully on your time, your effort, a pound of your flesh? Are you responsible for all growth, for all new patient generation? How about new patient conversions? Is it all up to you? How about patient care and delivery? Are you a sole practitioner, an owner operator who owns the practice, but is also the only one that is head down and bum up, taking care of all the patients? Is revenue generation or collections all up to you? Let me ask you the most telling question.

[00:17:22] Doc, what would happen if you took 90 days off? What breaks? In my experience, most on-purpose chiropractors do not lay awake at night worrying about their practice. They worry about their business. Let's slay that dragon. The Remarkable CEO program has helped hundreds of chiropractors just like you turn the job that they love into the business that they've always wanted. Are you ready to run and build your practice on leverage instead of brute force?

[00:17:49] Do you want to create the scalability and durability that will allow you to make a bigger impact and a bigger income? What would it mean to grow your practice, increase your productivity, and your profitability? Do you want to get your time freedom back? Are you ready to turn your pirate ship into a battleship? If this sounds like you, then the Remarkable CEO program is for you. Just last year, 53 of our Remarkable clients received the 7-Figure Club Award,

[00:18:15] meaning they hit the million-dollar mark for the first time or their next million-dollar level. Be it 2 million, 3 million, 10 million, up to 36 million and growing. Now, Doc, is it crazy to imagine that your practice could be next? Click the link below and learn how to apply for the next cohort of the Remarkable CEO program. We look forward to working closely with you in creating the business that supports your Remarkable life, not competes with it.

[00:18:42] We're going to have to exercise some serious restraint here in this podcast because you guys understand that we teach a two-day seminar on what we're talking about right now. So we're going to do a half an hour podcast on this, right? So you just heard Dr. Pete just masterfully go through the four agreements, right? So this is the Remarkable practice, the TRP conversion process, right? It's called the four agreements, problem, goal, path, plan. And it's agreements. We have to agree. It's not we're just talking heads.

[00:19:10] We come to an agreement. This is a dialogue, not a monologue, right? It's asking, not telling, right? So you're asking provocative questions. You're not just teaching interesting information. You're asking them, what is the problem? And getting to the root cause of what brought them into the office, right? So it's not just, oh, I've got this symptom or I've got this chief complaint or I've got this. No, guys, the problem is the life effect. Their health has gone sideways and it's jacking up their life. They can't do the things that they have to do, can't do the things that they want to do.

[00:19:39] They don't feel the way they want to. That's the life effect. That's you've got to get them to tell you that, right? So that they have full ownership. And we agree there is a problem. And that is the problem that you are here to solve. The life effect. Number two is what is my goal? What are we trying to accomplish here? What's our objective? If you don't get point A and point Z, then you don't have the GPS system engaged in their minds. Like I'm at point A. I don't want to be a point A. I want to be a point Z. Great. Let's take you through an objective process.

[00:20:09] Let's do some tests. Now that I know what you're trying to accomplish, then you can give them your path, right? The what does it take to go from A to Z, right? That's the third agreement, which is the path, right? So now we've agreed on the problem. We've agreed on the goals. We've agreed on the path, which is just the GPS. You told me this is where I want to go. Well, you know, I'm giving you my best recommendations based on two things, your goals and my findings. Your goals, you said you told me what you're trying to accomplish. My findings from the examination that we just did.

[00:20:39] These two things come together and they tell us what you need to do to get what you want. Does that make sense? Yes, dog. Great. All right. So now we're on the third agreement. And now we move into the financial, which is simply the plan, right? So it's like, what is it going to cost me to get the things that I need to do to arrive and reach my goals, right? So it's very straightforward problem, goal, path, plan. It's a fast, incredibly efficient start. It's a strong start.

[00:21:09] And you create what's called wanting. In other words, the patient now wants the care because now they understand that it's the care that's going to help them get what they want, which is the outcomes. Dr. Pete, it's so incredibly important that we get a strong start because if you drag him in, you're going to have to drag him around. Right. So we've all been there. We know what it feels like when you feel like you're dragging a patient around. It's like you didn't get a strong start. You didn't generate wanting. And it's really incredible when I say wanting, this is a marketing term.

[00:21:39] People want things, right? So why do people stand in line to buy the new iPhone that comes out? They stand in line outside the store. That's just idiotic, isn't it? It's like, why? Because they want to get that new phone, right? So why do people go to one restaurant over another? Because they want. They watch a TV shoot. Why? Because they want to do that. Why do they wear a particular pair of jeans or sneakers? Because they want them, right? So you have to establish wanting. So just don't miss that. They already want a solution to their problems. That's why they showed up.

[00:22:09] Now you've got to get them to want chiropractic care. And that's a bridge you've got to build. And it happens through the four agreements. Problem, goal, path, plan. Listen, it's all going to come down to the patient following your best recommendations for care. Let's face it. Being a chiropractic patient can be a pain in the ass. If it's twice a week, three times a week, four times a week, for the next four weeks, whatever your recommendations are, it's going to be inconvenient. People are overscheduled. They're overwhelmed. They're overcommitted.

[00:22:38] Most people have more money than they have time. This is incredibly inconvenient, right? So you have to establish wanting to overcome not only the inertia of starting care, but the resistance to staying under care. Because people are economists. Everyone's always looking for the exit. So guys, it's so incredibly important that you establish wanting. They have to understand, like, why should I want to get adjusted even once? Why do I need to get adjusted in a series? Why do I need to get adjusted in rhythm?

[00:23:08] Why do I have to keep my schedule so I keep my momentum? Like, you guys hear all this? It's like, all of this is creating value. This is a patient education process. So people want to follow your recommendations for care. They want to comply to care. You've established wanting. I now understand why I should get adjusted at all. I understand why I need to get adjusted in a series. I now understand the cumulative effect of the adjustments. I now understand how what I'm doing outside of the office is working against you.

[00:23:37] So every adjustment is three steps forward. I want to take either no steps back or one step back. I don't want to take two steps back or three steps back between adjustments. Every adjustment is three steps forward on a journey. Now, if I stay in rhythm, I go three steps forward, no steps back. Three steps forward, no steps back. Three steps forward, one step back. And if your patients understand this, guess what, guys? They're going to want to comply to care.

[00:24:02] And once they really understand what causes their subluxation, Dr. Pete, this is the secret sauce right here, is people have to understand what causes their subluxation patterns. Specifically and personally thoughts, toxins, traumas. They have to understand macro versus micro traumas. They have to understand, yeah, it was probably a macro trauma that started this subluxation pattern. But it's the micro traumas. It's your bad habits and repetitive things that you do all day.

[00:24:30] That's what causes, ready? Your subluxations to reoccur regularly. That, it's your bad habits and the stresses of your life that happen regularly cause your subluxation pattern to reoccur regularly, which is why regular chiropractic care makes sense.

[00:24:54] Listen, guys, if you don't help a person understand how their thoughts, toxins, and traumas, their lifestyle, their bad habits cause their subluxation pattern to occur regularly, then regular chiropractic care in rhythm, following the doctor's recommendations for care, complying to the three-legged stool of adjustments in rhythm, break your bad habits, add your exercises.

[00:25:19] If they don't understand what causes their subluxation pattern to reoccur regularly, then regular, compliant chiropractic care doesn't make any sense. So, Dr. Steven, like you said, this is a seminar and we're going to put a bow on it here in the next couple minutes. So, we emphasize so far in this episode that, you know, a strong start is critical.

[00:25:42] And then you unpack some just gold that everybody hopefully is writing down and you can integrate that into your practice and language today. Like today, if you're listening to this on Tuesday, go to the office today and start saying that and start integrating that. If you're looking for some tools, like the three-legged stool that Dr. Steven, you've referenced several times. Guys, we have resources for you and we want you to take advantage of those things.

[00:26:09] And so, if you're a part of the Remarkable Practice, you know you can find these resources and you should be utilizing them inside of your business. If you're not a part of the Remarkable Practice family and you're not working with us directly, number one, we'd love to be able to serve you and work with you. If we can help you with this, that's what we're in the business of. But Dr. Steven, I'd love to give the three-legged stool to our listeners as a reference point.

[00:26:32] Because it's a simple message, but the idea that results come from three things done at the same time over time. And one of them is the adjustments in rhythm. And so, once someone starts, so you can find that in the show notes. So, once someone starts care, we have in our conversion process, the third day is we call a break-in.

[00:26:56] And at that moment, they're agreeing to, we're setting expectations and we're forming an agreement on what it means to be a patient in our office. A great patient. The ideal patient. And so, you have to know what are the things that you want your patients to be accountable to, to comply with, to be a great patient. So, you should organize that in a series, a set of office policies.

[00:27:22] Shouldn't be too robust, but simple and clear enough that someone can agree to it and remember it. And then you could actually follow through and hold them accountable to it. That's the key to having, to having a strong start with compliance is once the individual patient says yes to your care, you're not spiking the football and say, yeah, we got another conversion.

[00:27:47] But on the very next visit, very soberly, very intentionally, very carefully, you say, now let's have a powwow and discuss exactly what it is that you said yes to. And let me clearly state what you can expect from us as your chiropractic clinic and what we expect from you as a member of this practice. And we organize that into your office policies.

[00:28:17] And there's five policies that we teach. One of them is the adjustments in rhythm. Now, this adjustment in rhythm expectation is set by the chiropractor. And that happens on at the conversion. And then it's administrated by the team. So, the doctor's job is to establish the expectations, establish the expectation around compliance that's directly connected back to the clinical findings.

[00:28:44] And then the team, your role would be to administrate that, which is why we say the team's role is clinical as well. And so, the team and the doctor combine together to surround that patient, loving them on both sides to say, hey, we're going to help you with your compliance. Right? We're going to make it clear. You're going to agree to it. You're going to see that it's directly driving towards your better health outcomes. It enables us to do our best work, you to get the best results.

[00:29:14] We are all in this together. Chiropractic is a done with you experience in the program. And there's going to be expectations and agreements. We set those at the beginning. Expectations are what you set. Agreements are what you keep. So, you set the expectations. You keep the agreement. And we are in a relationship. So, we hold each other accountable. And everyone knows their role in the village. That is the key. So, if you're missing this, we call that day three. But it's just a missing piece for so many of us in our businesses.

[00:29:43] We're starting fast. We're going too fast. Slow down right there to speed up. You're going to get strong starts if you do that. And then the fourth one, real quick, Dr. Stephen, is, and then have the opportunity for these people to have their paradigm shift, their aha moment, their epiphany, where they go from more than just believing that you can help them and saying yes. And they begin to understand chiropractic. We always say that, you know, you don't have to believe in chiropractic.

[00:30:13] That's the good news because you can understand it. And the gray news is that you as the chiropractor probably have more information than anybody ever needs to know about health. But there are certain things that they need to know to be healthy. And you have an opportunity by creating a mechanism, a process, where every patient has an encounter. Every patient has that opportunity to have their epiphany, their paradigm shift. And they begin to understand. They begin the journey of understanding.

[00:30:43] And it takes time to truly get it. But you start that process, and it happens very early on in the patient journey. And if you do that, we would say that's the transition between conversion and retention. And when that happens, Dr. Stephen, you start to see people step into this understanding stage. Now we start seeing the better health outcomes. We start to see the referrals. You start to see the revenue.

[00:31:10] You start to see those outcomes that we want, retention, because they start to get it. But if you miss that step, Dr. Stephen, it just doesn't happen. Dr. Pete, this is one of my favorite conversations, because I think it's one of the most aligned conversation between practice and business. You know, because CEOs, this is a CEO conversation. Please don't miss that. Right? So let's face the truth here. So losing patients is off purpose and bad for business. Right?

[00:31:40] Right? So if you are like Dr. Pete and I, we understand that we want to create and collect ideal patients, as many as possible. Right? So we talk about scalability a lot. Right? Everybody talks about scalability. Do you know what scalability means? Scalability means you grow a business by keeping your customers. A business is not scalable if you are not keeping your customers. Right? So that's what when we talk about retention, that's keeping your customers. Right?

[00:32:07] So that is on purpose and good for business. Right? So it's totally aligned. So when we start looking at a scalable business as one that actually creates and collects ideal customers in our space, patients, practice members, whatever terminology you use. Right? So we know that compliance drives retention. It also drives results and referrals and revenue.

[00:32:30] The opposite of that, if you have poor compliance and compliance, meaning people are not following the doctor's recommendations for care. That's the precursor for them dropping out of care or going inactive. So first metric. So first metric. Compliance percentage. What is the kept visit average? For those people that when you open the office for the shift, who was on the book, what percentage of those people actually came in for their appointment? Period. That's kept visit average. That's compliance percentage.

[00:32:59] And that drives retention. And what is the retention metric? Stick. What's your stick rate? What's your visit stick rate? Like how many visits does a person typically get before they drop out of care? That's your stick rate. Or what's your four month stick rate? Or your 12 month stick rate? What percentage of your people stay four months or stay 12 months? Those are stick rates. And if people are dropping out of care, that's inactives. How many people go inactive?

[00:33:26] Or what percentage of people drop out of care and go inactive? That's called your churn rate. What percentage of your patients are quitting on a monthly basis? That's your monthly churn rate. Dr. Pete, we're in the business of saving lives. And when business is good, everybody wins. We have to understand there's operational performance metrics and there's financial performance metrics. We have to be able to look at this as CEOs. And what we know to be true is this retention issue is the biggest issue.

[00:33:55] It drives our scalability. We know that compliance drives retention. And losing patients is off purpose and bad for business. Please stick around for more business insights from this week's bonus interview with our remarkable success partner dedicated to helping you more successfully help more people. Enjoy. All right.

[00:34:20] I am here with an amazing success partner that we have who has been helping chiropractors and chiropractic offices and therefore more people access chiropractic for quite some time, if I'm not mistaken. So welcome to our call here. Glenn, great to have you. Tell us a little bit about who you are. Thank you very much, Lana. Dowland Associates, Dowland Design has been around since the mid-80s serving chiropractic.

[00:34:46] It started out when my wife was a CA working in a 400-square-foot chiropractic clinic. And we came in to help her work more effectively. And that doctor that she worked for us, our work, and a bunch of their friends hired us. And here we are, 39 years later. We have over 7,000 chiropractors served. And we help chiropractors be able to do more in less time and in less space is what it comes to. That's amazing. I love that.

[00:35:14] And if I'm not mistaken, you have your own healing story in your family of chiropractic transforming your family's life. That's why we do what we do. So chiropractic actually saved my first son's life. He came down with an ailment that the allopathic model gave him six months to live. And my chiropractor jumped in and said, stop treating symptoms, start treating causes. They found it was a challenge. It was a brain tumor, C1 to C3, which is very similar to chiropractic.

[00:35:44] It was putting pressure on the nerve, which was impairing some of his elements. They did a quick little recession. And he's a little over 40 years old now. So yeah, that's why we do it. Yeah, that's beautiful. So I had the privilege of having you look at our office and give us some layout help. And it has made a difference for sure. And so why don't you tell us a little bit how you work with existing clinics as well as new clinics,

[00:36:11] looking at layout, maximizing space, being able to see more people? So first place, when people see Davlin Design, they look at us as a designer. It sounds like it's an aesthetic component of this, an art form, which when you hire a designer, it usually means you're going to make things look really pretty, but it's going to cost a lot of money. And we're pretty much exactly the opposite. We'll make it look good. But most importantly, this is kind of the science of design.

[00:36:41] How do you pack 21 pounds of chiropractic in a five-pound office? So dealing with so many chiropractors over the years, we've realized that 87% of the chiropractors I speak to severely underutilize their space. So we come in and can take a bird's eye view and look at a space and figure out how to best flow patients. How do we pack more volume and more services in there?

[00:37:05] Studying with, you know, the different, studying with Steve and TRP and all of the coaches and all of the colleges. We listen to what they're teaching and then we figure out the best way to fit more into your space. Yes. Yes. And I will vouch for some of the things we just had in our conversation where you're like, oh, you can tweak this or have a CA do this over here. You know, that was super helpful. You know, it's funny. Again, I'm a very numbers crunching person.

[00:37:32] It doesn't take very much to double a practice. Doubling a practice seems like, wow, geometric. But I did some statistical analysis. And if you take three of your stats, your patient visit average, your weekly patient visits, and your fee per adjustment, and increase those statistics by only 1% per month, you've doubled your volume in 28 months. Works no matter where you are.

[00:37:58] 1% in PVA, 1% in new patients per month. So we keep them around longer. We attract more because when you have a better educated patient, they're going to refer more of their friends. And while you're not going to charge, you know, 1% more every month, when it comes time to increase your fee, let's say by five bucks, think about me. Save my son's life. What's chiropractic worth to me?

[00:38:25] Anything you want to charge me, just don't tell my chiropractor because I pay cash. So if we can tweak the improvement, the performance of your front desk CA by a little bit, she could do more. If we can help the doctor conserve time and motion, they can do more. And it's just very simple, you know, changes. Great case in point, the TRP clients nearby me owned his own 1,200 square foot facility. He wanted to add an associate.

[00:38:52] He wanted to double his weekly volume and he wanted to increase services, but he was in a 1,200 square foot brick building. He couldn't add on. So he was ready to move. That's what he called me back. Glenn, I'm going to move. What should I do? I looked at his space. I said, don't move. We were able to double his volume. We were able to go from one adjusting table and one exam room to three adjusting tables, one exam room.

[00:39:16] We were able to, he had two front doors, one facing one direction, one facing the parking lot. So it was even more of a challenge. We got him five modality bays instead of two and he was able to bring on an associate in 1,250 square feet. So that's what we're all about. That's awesome. All right. So you've got everybody thinking like, I thought my space was well laid out. And then you looked at it and you were like, oh, you're using half of your space well.

[00:39:43] So if somebody wants you to look at their current space or maybe they're getting ready to potentially move or open a practice, what can they do? How do they get a hold of you? How do they start this process? Okay. So first place, it's never too early to reach me. We will talk to you. We just launched something for TRP clients exclusively, and that is trpclinicefficiency.com. Basically, we're going to look at your space and let you know, we're going to actually give you a score.

[00:40:12] And this is where you want your score to be lower than higher. You don't want a score of 90% because that means I can't do very much more. So let's say a doctor has two or three years left on his lease. I look at it and can let him know that, well, you have a score of 65%. That means you can grow by 35% more. So if they at least know that, and we start talking about how that happens without him

[00:40:37] having to move, he can now implement everything TRP is teaching them and the marketing and the patient education and all of the growth strategies that TRP brings to the table. So, and then as he hits the next benchmark, we can implement phase one of change, hits the next benchmark phase two, and then hopefully we get him to the end of the lease. And yes, he might be in a pressure cooker, but ultimately it's got more cashflow, more revenue.

[00:41:06] And now he can either buy a building or move into the next facility and we'll let them know how much space they really need. Yeah. Oh, that's beautiful. Okay. And how to like, probably we'll link this under the show notes so people can connect with you and obviously they can find you online and reach out that way too. Absolutely. Absolutely. So TRP site audit was one of them. Also TRPClinicEfficiency.com. I like clinic efficiency instead of site audit.

[00:41:35] That sounds a little, I never want to be audited. Yeah. So it depends on the person we're talking to, but yes. And that'll get us linked together and then we'll take it from there. We'll show you the whole process. It's very easy. Takes a little work on their end as far as getting me photographs, but I can usually look at a space and in 10 minutes, just give you an idea of, man, I could do so much with this space and it's not going to cost you a lot. And you could do so while you're still in practice.

[00:42:04] I keep that in mind too. Yeah. I can't say enough good about like, just have a conversation with you and your knowledge of, you know, flow and really the demands on our offices, because I think that is a unique thing to understand the amount of people coming through an office and how disruptive certain little tweaks are. You are a genius as it relates to helping us see more people. Thank you very much. It's my pleasure and my honor. Awesome. All right.

[00:42:34] And we'll see you at one of the next upcoming immersions I'm imagining too. Looking forward to it. Thank you so much. All right. Thanks, Glenn. Have a great day. Thanks for listening to this episode of the Remarkable CEO Podcast. Remember, what the world needs now is chiropractic and what chiropractic needs now is more successful chiropractors. If you like this podcast, please subscribe, share with a friend and leave us a review.

[00:43:00] And if you'd like to connect with us personally, direct message us on Facebook, LinkedIn, or Instagram. Now go and be remarkable.