044 - When to Hire an Associate: Key Steps for Sustainable Growth

And that's again coming back to the vision. Like, are they here to buy you more time or are they here to increase your overall patient volume or are they here to generate more revenue? You know, all three of those are different scenarios that can have a different trajectory.

Hello and welcome to Build you'd Remarkable Practice Podcast. This podcast is dedicated to chiropractors who are in the seasons of launching and building their practice. Join myself, Dr. Lona and my co host, Dr. Bobby as we have conversations each week as it relates to building the practice of your dreams. And remember, you can have a remarkable practice as part of a remarkable life, not instead of one. We are here to lead you on the way.

All right. Hi guys. Welcome back to the Build you'd Remarkable Practice Podcast. And I get to have a great conversation about a really great good topic today too with Dr. Kevin Day. He's one of our newest coaches at TRP. I have loved getting to know you, Kevin. Like, you're just such a warm hearted. Could tell that you love chiropractic and you love chiropractors. So welcome to the podcast and just tell us a little bit about yourself.

Thank you. And it's truly, it's an honor to be on this podcast because I know how many people you guys reach out to and it's been awesome being a part of trp. It's a very humbling experience. I guess just going back to, you know, the beginning for me. Graduated from Sherman College in 2009 and started my own practice in 2010 and had zero systems. And I mean zero. Like open 12 to 12 or like from 7am until 7pm Monday through Friday, Saturdays and Sundays by appointment. Yeah, I'll, I'll see anyone anytime.

And you loved chiropractic that much?

I still do. But now I love life as well as it's part of it. And you know, it's now it's having the remarkable life as part of a remarkable practice. But I started implementing TRP systems probably eight or nine years ago and fell in love with it immediately. And you know, since implementing it, you know, you kind of fight it in the beginning. Like, yeah, you hear it, you listen to it, you're like, yeah, okay. But when you really start to apply it, you just kind of have this aha moment. And you know, since then I've been able to like pull myself back out of the pract and start to heal my body. Especially when I started getting into hiring other people to help me. And that's what I wanted to touch base with you on Today is the advantages of having associates and most importantly, knowing when to bring those on. Because if not, you can break your body down really quickly. As we were talking about earlier, being that sole practitioner, it's awesome. It has its benefits, but it also has its cons too. When you're the lone wolf and you hurt yourself, there's no one there to see your patients. And so I'm a big advocate for a mentality when it comes to serving your community and your patients. It doesn't all have to be done by you. And I love the idea of a office that's set up to have associates flourish and be successful within your practice. But I think most importantly, it's very important to understand when the right time is to bring on an associate. Because you can do it too soon and you can do it too late and be burned out.

That's a valid point too. I hadn't thought about too soon versus too late. Too late is not usually the thing you talk about. Right, But. Or it's what we hear. Like we hear people who have scar tissue around. Like I brought someone on, it didn't work out. I brought another on, it didn't work out. And likely they missed some of these cues or had expectations that weren't possibly real, which I think happens also frequently when we just maybe don't know what we're getting into, both as the owner as and as the associate. So, Kevin, I know you said you had kind of broken it down into three different areas that you wanted to talk about when you're asking yourself, am I ready for an associate? So what was your first, your first nugget there?

Yeah, and I think there are certainly more than three, but we're going high level that way. This applies to everyone across the board that's listening. And believe me, there are more than three. These three are probably the most important ones. And the first one would be patient volume. And that can be a confusing one for a lot of people because there's no specific number that a practice needs to be at in order to bring bring on an associate. Because as everyone listening knows, you know, it's a wide open frontier when we talk about chiropractic in terms of technique, case management, practice management. Right. So for some practices, 150 a week or 150 patients, you could see that in a morning. Whereas other clinics, that's an entire full week for one doc. Right. So I had a great call with an upper cervical doc. He's at 150 a week and he has a three month waiting list in order to get in. He is as full as he can possibly be. But then on the other end of the spectrum, you have people who can see, again, 150 people in a morning. So there's not a specific number that we're looking for. When, you know, you're trying to decide, like, is it the right time for an associate? I think a better way to go about it is looking at it through the lens of capacity. So a really good way to do it is, you know, take out your calendar and look and see, like, how many patient slots do you have throughout your day, count them up, and then see, you know, how many are actually being filled. So just using real simple math, let's say that you have room to see 100 people in a day. Or let's just use it as a week. Let's just use that metric as a week. We'll just use a hundred. And you're only seeing 80, well, then you're at 80. 80% capacity. If you're seeing 70 or 70 and so on. And it's my personal opinion, and just talking through others, I've come up with this, that I think 80% is a really good number to be at. You know, as you're below that, could you bring on an associate? Yeah, you can, but there's some other variables into it. But I think once you go above 80%, you're getting into that, that stretch and breakdown zone, that 90, 95%. I think that's when you really need to be considering bringing on an associate. But I think that 80% is a really good target to hit when we're talking about the capacity that you have in your practice to be able to see those patients. But that's.

That's a great description. I've never heard it talked about like that. As well as. I wonder if you don't mind commenting on this too, like when your first associates at about 80% capacity is at the time for the next one.

Yeah. So that, yeah, that, that becomes an even, even more rich conversation. Is what your capacity is may be entirely different than what that associate's capacity is. Right. So prime example, like, for myself, like, I can see 400, 450, sometimes 500. But that's like my breakdown zone. The associates that we have, like, they can see 200, 220, but their breakdown zone is like that, 180, 190. So, you know, that. That's another piece that we'll get into later on if we have, you know, do you have proper meeting rhythms with your Associates to know. One awesome tool that TRP has is a capacity tachometer. You guys haven't seen the visual of that. It is awesome. But it's a great way to check in and get visibility into, like, not only your staff, but also your associates. Like, where are you at capacity wise? Are you in that 80%, like that stretch zone where, like, yeah, everything's going well? I feel fulfilled, but I'm a little bit tired at the end of the day. That's great. Or are you in burnout mode? So you're absolutely right on that doc where it's, you know, once that associate gets to that 80% mark. Yeah. It's time to start actually talking about bringing on yet another associate and then you can continue to build, which is a really, really awesome thing when you can do that.

And I think. And maybe you knew this right away, but in bringing on associates, I think a lot of owners have the illusion that their associate is going to have the same capacity that they've had. Any comments on that? Yeah.

Yes, absolutely. And that's. I was going to come back to that on the tail end of it, but let's go ahead and address that. Is.

Sorry.

Oh, no. What is, what is your perspective of, like, what does success look like when you bring on an associate? And that's a, That's a loaded topic because we get into the, the different categories of, of associates and, you know, all chiropractors are awesome. And we're all gifted in certain ways, but some people are gifted to be what we consider to be an entrepreneur. That's like a race car, you know, setting an expectation of what they're after is really important to understand. But then there's the business builder, the person that loves to get out and get in front of the community and talk and promote chiropractic. And then there's the caregiver. The people that you don't want to give them the microphone, they don't want to be in front of the room. They want to be back in the adjustment room, delivering the adjustment, caring for patients, and that's it. Right. So that goes back to one of the most important things that we talk to with any coaching client is vision. Right. So what is the vision of your practice and how does that associate fit into that vision? Right. Are you looking to get away from having that microphone in front of the room? So you need that business builder or do you absolutely love that and you're wanting that caregiver model that you're going to go out and get those Patients and bring them in and then it's their responsibility to take care of them. I think that's, that's really important. But make no mistake too like finding an associate that's going to be a carbon copy or a clone of yourself, you're not going to do that, right? If so, then they would be out there building and starting and developing their own practice. So. And it's not that you know as.

Well as it leads to, I think a more diverse and dynamic team when you start to learn how to bring in other types of genius into the practice. Maybe you agree on technique and you both love the same technique, but you have different ways to communicate it, you know, 100%.

Absolutely. And, and I even think that's true like on male, female. Like I absolutely love having female associate doctors here. I've had Dr. Wall and she's been with me for six years and she brings a different perspective to the, to the practice as well. And I value that opinion because I'm a guy. I've got the, I look at my practice through the lens of being a guy and she looks at it through the lens of being a female and it brings that whole new perspective too, which I think is really, really valuable.

Yeah.

Yeah. So, you know, it's really important to define like who it is that you're really looking for. That way you fulfill that vision that you have for your practice. But before you even start talking about an associate, have the vision in mind, right? You don't want to hire the associate and say, okay, now I've got an associate, now what do I do? Right? Get the vision first. Get a direction and a trajectory and then start finding the right people to fill those roles. And I think that's really important.

And what Kevin just said there too about having the vision not only for like that I'd like an associate, but do I want someone who will be out in the community cultivating relationships? Is that what I envision this person doing? Or, or do I have an overflow of people that I know if we had great hands here and someone who loves chiropractic, you know, that we really need someone in the practice. I think many times people haven't clarified that ideation of who they really need as far as is it someone who's building the practice alongside them out in the community or somebody that they need that's doing reavowals and, and adjusting and table talk and all that. And so if you accidentally get them flip flopped, you're hoping for someone that's going to Build the practice and instead you hired someone who just would be great if you kept them in the four walls of the practice all day, every day. You know, those are really challenging relationships then. And that's usually where I think it ends poorly because there was a lack of vision in the delineation of that role, right?

100%, yeah. And it's going to be a very, very difficult road. And there's a really good chance that not only will that associate have, you know, a bad experience, but you will have a bad experience as a CEO. And guess what? Your patients are going to have a bad experience as well, and you run the risk of potentially even losing team members as a result of it. So I, I think the vision is probably one of the most important things that any young CEO looking to add associates can, can do. First and foremost. I think that's a really important part, too. And then it also goes into the second one too, which is, you know, on the financial piece and understanding, like, what is the role of that first associate? Right. I think from my perspective, talking through other docs, I've seen that they think once they get that associate, their life's just going to be so much better. And if I can just get that associate, they can see all my patients, we're going to make so much more money and I'm going to have all this free time and I don't have to be in the practice all the time. Is that right?

Nope, not in my experience.

No, it's not. I think that's true across the board as well. So there's some common laws, I guess, to discuss on that. And then just also understanding, like, what is, what is the real expectation that you can get when you bring on that first associate, that second associate, and so on. And, you know, one of the things I was taught early on, and I think this is true as well, is the, the first three years, you know, the year one, plan on taking a loss. Right. Year two, plan on breaking even, and year three, plan on reaping the benefits of those first two years. And that's real high level, but relatively speaking, I think that's, that's pretty accurate.

So if you do it faster than that, good job. Right. But also just knowing that, that you're planting a seed, just like the day your practice opened, likely it was not producing the income you wanted. Right. Like you, you're. You're making an investment.

Yeah, it's. And that's exactly what it is.

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The second thing is, do you have the financial ability to take a hit to make that investment? Because that's what it is. Like you are investing in another person to grow your practice to generate more revenue. But in the beginning, guess how many patients they have? Zero. Right. And I think another illusion that people have is like, okay, if I can get this doctor 50 visits a week, then they're going to be profitable and they're going to be successful. Well, guess what? Those 50 people can't come from your schedule. Right? That's, that's not how it works. They have to be 50 new people coming in and getting on their schedule in order to make that grow. And by no means doesn't mean that you can't allow those people to be on their, on your schedule from yours. But again, it's that, it's the clarity on the financial piece that that's 50 new people joining the practice, not 50 of yours. Right.

And, and Kevin, I think that is a big, big area that we misstep is that we think by adding an associate, the practice all, all of a sudden is going to have more capacity. And sometimes there is some. Right. But what commonly happens is like, let's say you're seeing 300 a week now you're seeing two, you know, 240, and they're saying 60 a week. Right. Like, or, or maybe you went up to 310. Right. Or 325. Right. Because there's other things that have been issues for preventing capacity. Right. It's not just another set of hands, too. And that's why it's so important to look at the entire lay of the land too, where it's like, well, yeah, if the goal is to get to 450 a week with this new chiropractor, what are the other parts of the practice that probably have constrictions that prevent that to happen? Do you have the new patient stuff dialed in so that you can be feeding to chiropractic all of that? Right.

Yep, absolutely. And that was on the tail end of number three coming up, actually, which is, you know, is your, is your team ready? And, and I'll, and I'll come back to that because I think it's, I think it is really important to make sure that you have the right systems, you have the right procedures in place, you have the appropriate meeting rhythms with your team and all of the systems. Hey, guess what? That's what TRP is. Right. That's what we as coaches love to teach people, especially in this build phase, is to get those systems and procedures airtight so that you can bring on those associates. But I think it's important also to, you know, come back on that financial piece and say too, that like, yeah, you can, you can reach that profitability point so much faster than one year, providing that you lay out a good plan. I think it's, I think it's realistic to say that 90 days can, it can be accomplished, but that's a lot of work before that patient even shows up. Right. And that's, that's what kind of segues into. To my third point. But I think it's important to highlight that if you put a proper plan in place, especially in the marketing side of it, to get that patient who's going to be walking in on day one and have zero patients. I think if you put together an appropriate marketing plan, you can get that person to profitability in 90 days if you do it correct. But I think relatively speaking, the industry standard is that first year anticipate taking a loss. So guess what you're going to have to build up some savings because you're going to pay that person regardless of whether or not. Now, there's a lot of different financial models that you can construct. Contract as far as, you know, associate compensation, but you don't want a new doc straight out of school, who's going to be your associate and then get paid $0, day one. You have to pay them.

They're not going to sign their contract.

Yeah, correct. Yeah. So in that contract is a financial agreement, and you're going to come to, you know, an agreement with them on that. So I think that's, I think that's really important to understand is the second piece is make sure that you are financially able to take a hit and to pay that associate, even if they're not generating new patients. And also understanding that you can't just shift that patient load from your schedule to theirs and expect that to suffice as covering the, the baseline amount of patients that they need to be seeing. And it's okay to do that. Right. And that's again, coming back to visit to the vision, like, are they here to buy you more time or are they here to increase your overall patient volume or are they here to generate more revenue? You know, all three of those are different scenarios that can have a different trajectory. I think that's really important.

Right. And I think a lot of times people want kind of a hybrid of those three. Right. And like, well, I do want more freedom and more time, and I do want them to increase the volume and the capacity and, you know, all, all of the above. And so again, just realizing, like, well, how much effort and time has it gotten me to? Let's just stick to the scenario I said earlier, like, to get to 300 a week, you know, if I add this new associate, are we going to get to 600 almost immediately a week? No, probably not, because all of a sudden I shaved off a day or two in my schedule. Right. And so we just have to have realistic expectations. Going back to what you had said is like, you know, have I really spent time looking at what the trajectory could be here and weighing out, you know, what matters most to me? Is it that we are growing in volume or is it that I know I need a day out of the office or, you know, and what is that going to do to those project?

Yeah, and that's, that's awesome insight and I, I think a good way to look at it as well, because it is, it is a hybrid. Like, you are going to get A little bit more time, you are going to make a little bit more money. I think the first associate, and at least this has been in my, my experience, that first experience can save you and start to back off that patient volume. For me personally, like I again, I was seeing about 500 a week and my body was breaking down. And I'll never forget when I brought on our first associate and like I could just feel my body healing over a two year period just because I wasn't over the table seeing all of those folks. So 100% I anticipated this and I gave her a portion of my schedule so that I could get out of that breakdown zone where I was personally and there are other people that can see a lot more than I can, but that's, that's for me in my life, that's where I was at. So I think that first associate does that. As far as like buying you a little bit more freedom in terms of the schedule, I think the second associate is where you can start to say, okay, this is more of a financial gain when you bring on that next associate. And then the third associate, I think is when you can really start to buy a lot more time and start to step back from the practice, if that's what you want to do. Right. We were talking earlier beforehand is like, do you still love it? Do you still want to be in it? Do you still want to continue to adjust on a regular basis or not? So that comes down to again, what that vision looks like. That's important.

Kevin, this is great. And I think so many people need just to sit with this conversation because a lot of us want this. And then when just like anything, we got to really sit with it and like, okay, is that, is that a now decision? Is that in my three year, you know, that's what I'm working towards and what do I need to do? Like, like you said, like, am I prepared? Also if I'm paying someone $75,000 a year as a starting contract that I have that money set aside, or at least that amount of, of flow into the practice, that that's not going to hurt everything else that we're trying to build if things don't go exactly the way that I had them planned immediately.

And I wish $75,000 was still the number. That would be really nice. Yeah. And I think there's some still that can do that, but a lot of times I'm seeing it's even higher than that as a standard. So you do have to be financially ready. But you know I want to get into the third one too, because I think it's, I think it's deserves some time and that is making sure that your team is ready and that also that your patients are ready in order to onboard an associate. And the very first thing is when you talk to your patients, are you talking chiropractic or are you talking chiropractor? Right. Do they think that you are the reason why, you know, they've been able to reach the level of success and health that they have or have you been teaching them chiropractic? Right. I think that's really important. And that gets into the conversation of solid white line versus dotted line. Right. You know, the difference of like when you bring on that associate, will you allow them to see your patients? Yes or no. Will you be allowed to see them? Yes or no? In my opinion, I think yes. I think that's one of the most important things that, that an associate or having another team member can provide for you. Right. And so have you trained your patients to be ready for that? So in our practice, what we do is, and of course there's exceptions to this rule, but this is the, the 95%, like on visit 5, 7 and 9, I have the, the patient, let's say it's my patient. On visit five, they're going to see one of the other associates. On visit 7, they're going to visit another associate. And then on visit nine, they're going to visit yet another associate so that they are familiar with that person. And, and they also, like, let's say I actually want to go on a vacation or I hurt myself. Right. Those patients are going to be comfortable with those other providers. And we make it very clear across the board that we have case management day. So every Tuesday morning we are in front of the computer screen, we're going through the X rays and each doc presents each case of each new patient to all docs. So we're all familiar with every case that comes into our practice. And that way when we're, when we have that patient sitting in front of them or in front of us, we can say familiar with your case. I've covered your case and I know exactly what's going on. And that keeps continuity with their care. And it just, they hold your clinic at a much, much higher standard when you do that. So I think, I think that that kind of conversation is really important. That solid line versus that dotted line.

Yep. And we, we do things very similar to Kevin, where it's like, you know, at 8:30 on Wednesday mornings we have done our doc training, which is more clinical TR at 1:45 on Mondays the docs are reviewing who the new patients are and the cases are too. And I agree that especially when you get more than one associate having more heads together on cases because it's like you can't, you can't do that willy nilly. It needs to be a specific time that you're always reviewing.

Yeah. And that, and that's honestly the kind of the third point that I had under that, you know, as your team and are your patients prepared for that is having the proper meeting rhythm set up. And we do something very similar in our practice where, and I'm, I'm pretty heavy on training and so we, you know, we typically will train in the morning and in the afternoon and the docs, we train in the morning and then we train with our staff in the afternoon. But we have. Tuesday is technique. So we, we work on technique. Especially if you got a new doc coming in and they're still learning, teach them, don't let them just practice exclusively on their patients. Teach them what you know. Right. That's what they're there to do, is to learn. Wednesday, and this is in the past, we changes now. Tuesday is our case management, but Wednesday we would do our case management and then Thursday would be communication, like breaking down. Like, how do you communicate with your patients? What are you going to say when they say this? Right. So you've got years of knowledge and let those associates leverage those conversations that you've had in patients, you know, practice on your table talk. Are you going through the dirty dozen? Guess what? That's a great time to take some laps through that and make sure that they are as well versed in teaching their patients what we do as you are. Right. You can't just assume that just because they've graduated that they know how to communicate effectively with their patients. So again, that goes into like preparing your team as well as preparing your patients to bring on that associate and having proper meeting rhythms and reporting systems, which is the final piece. I think it's so important to touch base on having the proper reporting systems. When you are the sole practitioner and you're the only document you have a pretty good pulse on which patients are staying, which patients are leaving, which patients are struggling. Guess what? When you're not the only person delivering care, you no longer have that kind of visibility into how well your patients are doing, which ones are falling off and which ones are staying on and which ones you need to lean into. So that's where proper metrics and reporting systems becomes far more valuable than what it ever was as a sole practitioner. And that's why it's important, like get the vital signs, get your metrics up and running now before you add an associate. And you're trying to figure it out as you go along because if you don't have those metrics, you have no idea, number one, how long a patient's staying with. And number two, like if they're dropping off, when and where. And then you have no idea what to train on because they. Because you don't know when a patient's leaving, if they are leaving. So I think it's really important to speak to the fact of having good metrics before you even consider bringing that associate on.

So good. Kevin, you gave us so many nuggets right there. I think anyone that's considering in the future that they would have a multi doc practice, like go back re listen to this, take some notes and put it somewhere that you'll remember to listen to this when you're about to make that decision.

So I hope so too. That'd be great.

That was excellent, Kevin. I know you're taking new clients for coaching too, so people can probably reach out through the TRP website. Ask to get set up for a Strategy call with Dr. Kevin Day. I know he'd love to talk to you about this. Maybe you're kicking around the idea of an associate. Sounds like something he's done quite successfully, multiple times. Not without scar tissue, I'm sure.

Absolutely.

Any last parting thoughts before we wrap up today?

You know, I think it's. It's just an awesome opportunity and we're such a small group as far as being chiropractors. And I think it's important as you guys consider bringing on an associate, making sure that you have the right environment for them to thrive and be successful. And most importantly, never burn a bridge, right? Let's just say always begin with the end in mind, right? Like, hey, if this starts to go sideways, let's make sure that we know what the action steps are. That way we're still friends, right? The last thing that you want to do is burn a bridge in a community that's already so small, right? So I think it's very important to also keep that in mind. Like again, beginning with the end in mind. With associates, we're too small of a profession to make enemies and especially when they're interested in being a part of your practice. So I think that's, that's really good parting advice.

That is great parting advice. And that's also why I love you. You're like so salt of the earth, so humble, so sweet.

Like, appreciate that.

Amazing. So. All right, well, Kevin, you have a great rest of the day. I know. We'll have you back on the podcast soon.

All right, thank you.

Hey Doc, I have a question for you. Do you feel like you own a job or a business? If you're like most chiropractors, you feel like you own a job. In fact, if you're being honest, you probably feel like your job owns you. Hey, I'm Dr. Steven Fransen from the Remarkable CEO Podcast for Chiropractors. Are you ready to make a bigger impact and a bigger income, but you want to do it in a way that it doesn't just demand more of your time and your energy to do so? Would you like to get back your time freedom? Create greater leverage in your practice? What would it be like to have a world class team that wants to grow your practice? Or finally dial in the seven figure associate doctor? Are you ready for your business to become more productive and more profitable? If this sounds like you, then be sure to check out the remarkable CEO podcast for chiropractors. Join me, Dr. Steven Franson and my co host, Dr. Pete Cameolo as we share the insights, strategies and stories that we've gleaned along our own journeys of going from owner, operator to CEO. This practical and tactical podcast will inspire and equip you to make your own ascension as we keep it real, teaching from the scar tissue of our own experience of turning pirate ships into battleships with our own practices. And now, for thousands of chiropractors around the world, follow the link here in the show notes and check out the Remarkable CEO Podcast for Chiropractors.

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