115 - How to Build a Successful Broken White Line Practice with Dr. Rachel Hovey

Do I want where my patients stay my patients, or do I want where it's becoming our patients? And that's, I think, a key thing, just what I said right there. Is it a mine or an our? And that ability to recognize we're making that shift from mine to our is a critical piece of growing a team, especially a shared care plan-related, like more hands-on deck way of delivering adjustments. Hello and welcome to Build Your 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. Welcome back to the Build Your Remarkable Practice podcast. I am back here with Dr. Rachel today, who's fresh off of Florida and looking so nice and tan. Welcome back.

Thank you.

Awesome. We were just chatting. We're both in seasons of running practices and motherhood and nearing that age where nobody's in diapers and nobody needs help going to the bathroom and like you actually can lay and get a tan now.

Yeah, it was really nice. Like I was saying, it was actually a really good vacation on all ends. So not that I don't mean that like non-gratefully, but yeah.

Yeah, I know. I feel like for a while you're in a season where you're like, do I look tan? Because I have an imprint of a baby across my chest from my tanning.

Yeah, exactly.

They were covered in a blanket and we were still laying in the sun and they were nursing, right? Yeah, that was, that was vacation. Oh, that's great. And we were just chatting about how awesome it was also to have practices set up where you leave and go on vacation and can entrust that everything is going smoothly back home. And that sounds amazing and also takes a lot of preparation to get to that point in practice where practice can be moving whether you're there or not.

Yes. And it's a refreshing feeling to have too, you know, and I think it, to some level we all want that. It's just finding the steps to do it, you know, gracefully, tactically, and let your patients feel like they're being taken care of too. But it's definitely something that, Lona, I know you and I both see many practices being like, that's a great idea, we need to move towards that. Whether you've been in practice coming outta school or you've been in practice for like 20 years, it's becoming the model that even your patients want too.

Yeah. And, and it allows more adaptability for everyone, quite frankly. Right? Absolutely. Yeah. We, so that's the episode today. We're gonna talk about if you're listening and interested in bringing on a doc to the practice eventually, maybe you're not there yet, but you know this is something you're going to want, or maybe you You're in the throes of doing it and you're like, I need all the pointers that I can get. Talk about how to start to prepare your practice for the knowledge that you are gonna bring a doc on eventually. And what does that look like in your own headspace, in how we communicate with practice members? And then also as we're starting to prepare for like, I'm gonna onboard maybe a newer doc and I'm gonna need to train and onboard. And there is an element of it can feel heavier before it feels lighter sometimes because you have hopefully a very productive practice happening by the time that that's, you know, that you're bringing another doc into it and you need to train in a doc, which may be your first time training in another doc. So Rachel, I'll just share the story quick. I can remember I brought in my first associate in 2013, and I went to school with her. She's amazing, I love her, and she's actually helping train some of my docs at this stage now too. But I remember leaving the practice on one of the first shifts that I ever had where I was leaving and she was continuing to adjust, and I remember leaving and it just felt like the most glorious feeling to know that people were still being seen by someone I trusted and I wasn't there. I don't know if you have a feeling like that that you can remember, but just, I remember thinking like, wow, is this okay? I think this is pretty amazing actually, that the practice is still producing and still being the mission that's happening, but it's not me doing it.

Absolutely. Yeah. And another feeling on that too is when you do go on vacation, your patients don't even know you were gone for a week or two. That's another goal for that nugget of where, where you wanna be?

Yes. Yes. So both of us have what's called like a, a broken white line practice, meaning we have multi-docs that see everybody kind of in a shared way of delivering care. So someone might start with their day one with one of the docs and then see a different doc very quickly after that point, maybe once they're converted. Or I know Rachel, in your case, they see two docs on their first day, one day two.

Yep.

And there's a lot of intention and thought that goes around like, well, how do you even choose like which style I'd want, right? Do I want where my patients stay my patients or do I want where it's becoming our patients? And that's I think a key thing, just what I said right there, is it a mine or an our? And that ability to recognize we're making that shift from mine to our is a critical piece of growing a team, especially a shared care plan related like, more hands-on-deck way, way of delivering adjustments, um, is that it really does become all like, we're all in this together and we're all serving the patient, right? Mm-hmm.

For sure.

And so when you decided to bring in associates, like, were you always of the thought process like it was going to be a broken white line, like we were all gonna see everyone together? How did you make that decision?

Yeah, actually, so I started off in practice as like an independent contractor per se, and then I moved into buying a practice. And so it was when I bought the practice that I was in, I was the independent contractor and we had two other doctors. And then I immediately though switched it to be a broken line practice because I learned that from other people. I saw that, I saw that that was like the, like what I really wanted practice to look like. And for many approaches, and I think the biggest thing when it comes to it though is it, it can, it can be scary and it can be like, oh, I don't, I don't didn't understand like how that would really work. But in the end run, it's, it's such a win-win-win for everybody with that brokered line practice. So I took a practice that, and it ended up working really well because the owner broke her foot, another doctor was on maternity leave, and it was just like, guess what? You get to see all of us and we get to learn that approach. And so I think when it starts that, when you're, let's say you have a practice right now where it's just you and you're bringing on an associate, I think the biggest thing is the mindset with it first. Is really making sure, like, your patients understand that this is a win for everybody.

Yes.

And at first that can not feel maybe genuine or true, but it really is true. I mean, you have two doctors that look over your care, that talk about you, that have different strengths, and you really need to push that first with the patient. So I'm even coaching a doctor right now who has had an associate for a year, and she's seeing like 200 visits herself, and her associate's only seeing like 20 a week. And it's like, you got to just bite the bullet. You got to just bring her in and help them see that win for all of the patients. Because at that point, it's just a mind shift that you need to make with, with your patient base.

Yeah, that was great and interesting too, because you got to see it from the vantage point of also being the doc being brought into the system and what went well, what didn't go well, which I want to come back to that. And from my point of view, I had started to scale. I had a second location before I had any business having a second location, meaning like I needed more hands on deck and I, and I didn't have them. So it was out of necessity that I knew I was going to pull myself back from some care, and I needed someone that wanted to come in and see volume with me, um, knowing that I just needed to pull some of my time out of the main office. And then when that went well, I realized, well, this is the model, especially I believe for women who want to have kids too. It's like it just created such versatility, um, and flexibility for, you know, now having done this for while. I think between myself and my practicing docs, there's been 6 babies born, and we've been able to kind of pool resources, if you will, to figure out how are we going to do this? And so I think a lot of women, we choose to practice this way where we share. And I do believe, like you said, 2 heads together or 3 heads together, you really are getting insight from all of them. Or you look at a set of X-rays together and you talk about it. Um, how do we approach this? Or this happened, like, what do you think next? Or try this style of adjusting. Or I did this with them last week and it seemed like it worked really well. It becomes that, you know, communication becomes critical that you didn't have to account for before because it was all happening in your own mind. That is a piece of it. And, and Rachel, you said like preparing, you know, what happens in your mind first of how, how are we going to approach this to the patient, how do we say it, and do I believe it, right? You need to go visit some practices that practice this way to see it in action. I would highly suggest that you see how it can be such a great thing.

For sure. Yep, exactly. And, and sometimes you do need to see it before you can understand the, you know, the reality of that. Because I mean, similar to you too, you've probably had doctors come in and shadow, and we're like, well, that looks a lot easier than it— than you think it may look too. And obviously it's going to be hard in the beginning, and, and when it comes into bringing in that doctor, whether you've you've never had an associate, or you have an associate and you want to bring that practice together, like, I think the biggest thing is, is taking it slow. Like, as much as we know that doctor can probably handle adjusting 80 people, or 80% of the people, excuse me, you still need to be there right with every— in the beginning and kind of walk through and talk through. Like, this is— we talk through your adjustment with this patient, we talk through how this special case with this person, even though, you know, we know it may not be super special, but to the patient that goes a long way. So for us, when we bring in a person, it— we take them like 2 weeks before they really get their hands on a lot of people to make sure that we don't rush that process. And then right away they're like, oh, it wasn't the same, it wasn't this, and it wasn't that. And then really— so we actually just hired another doctor, she starts next week, but she's— we've been lucky that she's been our associate for a while. And it, and it's just like, you have to take it slow and you have to walk through it with them. And also, and my doctor, new doctor, is really good at this, and some may not be as, as, you know, confident in saying this, but also being like, I want feedback, make sure you tell me. Like, I know we're gonna feel different. I even just saying Like, I know it's going to be different adjustment. You know, we're different humans, but I want to get to know your body as best as possible. So allowing your doctors to accept feedback.

Yeah.

Makes that process so much more gentle.

Yep. Yep. That's so great. You said a lot of things there that I think people should go back and re-listen to there where it's just even like, how do we coach ourselves to then encourage the associate to have some words to like Yes.

Okay.

Yes. The first couple weeks, let's take it slow. Let's just introduce them. Let's be a face that they're starting to recognize that's in the clinic. Now let's maybe have a clinical conversation in front of the patient where we're kind of like passing the batons back and forth a bit, or just at least pointing out things, especially with some of the patients that, you know, like I need to make sure that they overhear me explain something so that now I've entrusted the new doc with some of this knowledge about this patient. And then obviously your stamp of approval on this person carries a lot of weight, right? So we're wanting to make sure that that's happening, of course, in person wherever it can, but also through the other content that's coming out from the office. That's how we're introducing the excitement we have around a new doc coming in and the talents they bring. And then the part that I think is we don't train on enough probably is how we want to empower the doc to have the words to say to like, hi, I, you've maybe been here 57 times, you've ever met me, or 500 times before you've ever met me, and now I'm your next chiropractor here. Because some of us that have practices that have been around for quite a while, you know, they— some of our OG patients have seen associates come and go, right? And so that ability to humbly enter that relationship where you're like, I'm so excited to get to adjust you today. If there's something that you particularly like, or if you, you know, need me to be a little more forceful or something, you just let me know. I'm going to err on the side of caution because it's the first time I'm accessing your spine. That can be a really great way to just, again, respectfully enter into that relationship with somebody that may have years of trust built into this relationship. Right?

Absolutely. Yeah.

Yep. One of my newer associates did such— she did such a beautiful job of just really jumping in. She had a big smile saying hello. And then just saying, I'll take feedback. You can, you know, certainly can let me know if something you don't like or something you do like. And I think she entered it more gracefully than almost anyone because she just led from that place of view where it was not going to be like an insult to her ego to hear something. Yep. And we're all learning. That's why it's practice, right? Yep.

Yep. And just being present and being like around a lot too. Like, I know that sounds obvious, but just making sure you just see every patient. See them, see them, see them, see them, see them. They've seen your face many times before you do adjust them too. Yeah.

Yeah, I totally agree. And then once it gets to that point, it's like, okay, I'm not totally abandoning you to, to essentially abandon you, but to go on vacation or to like have the main doc take some time so that there actually is an opportunity for everyone to start to actually be adjusted by the new doc. I think that can speed things along too.

For sure.

So that might be where you take a, your first 2-week vacation maybe that you've ever taken.

Yeah, absolutely.

And you're encouraging people right before that vacation, like, I'm going to be gone, but this will be a great chance for you to get a Dr. Eric Janowitz or whatever, and she's going to take great care of you.

Yeah.

And you're just hyping it up, right?

Yeah, for sure. And that's how we get stretched the most too, is when we get challenged. I mean, there is— we all know there's been many times in practice where we've been like, I have no idea how we're going to do that. I don't, I don't know how we're going to see that many people. I know. And it helps, like, especially if you have younger doctors that don't have the experience to just like have to jump in and grow that muscle.

Yep.

And go that way too. But I think another important piece though, to remember when you're adding in multiple doctors is remembering then to then like be efficient with your schedule. So I think you and I both do this in our practice, but we have like DC 1, 2, and 3. Mm-hmm. And so I think that's a really important piece is, and we're even revamping that now because we've changed, we're just changing around some of our doctor's hours. But like being efficient with your time, with your schedule, with doctors too, because I've also seen it where like right now I'm thinking of a specific practice where there it's husband and wife team and they're, they're separate but they're coming together now and they're like, holy cow, we see how much more efficient we can be when it's one doctor that's strictly adjusting and then another doctor that can focus on like new patients, progress exams, progress report reports. And they were like, we literally can double our schedule when we didn't know that we could even grow much more before too. So it's becoming like, make sure you have a strategy for like the adjusting flow too. So, right, like I know both of you and I, we have like one doctor that's strictly adjusting that shift. That, that's literally all they're doing so that they can stay in flow and they can keep that going. And then we have DC2, that's kind of a backup that does both. And then if we have 3 doctors, that one's strictly doing like the backend stuff, reports, or what we call like our parking lot stuff where it's, you know, the other things in the clinic that need to get done.

Yep. Yep. No, that's really great. Kind of again, like we've talked at times before about like how do you start to recognize, oh, okay, I've just grown to whatever the volume, and now it's time to hire the next CA, right? The same is true, and we dial in that the CA has like maybe a— where at first we might have one CA and they're doing everything, and then we tease that out, and now there's two CAs, and one's more the chica and one's the coca, and teasing out those roles and responsibilities. The same is true, I believe, with like when we add docs. It's like, okay, somebody might have more focus or more emphasis or more ownership over conversion, and someone else. Doesn't mean that we're not cross-trained and that we both can't do those things, but we might have somebody else that's more tailored around what they're working on is retention-related activities or seeing higher volume because they're set up for higher volume because of what the other person is doing in the conversion, you know, aspect. So lots of ways to do that, but the point is just like that takes a lot of understanding our model of delivery, um, and how we want to do our technique, how we want to do our exam, how we want to position another doc coming in, or a tech CA for that matter to someone else that's sharing in some of the, like, patient-related activities clinically so that we can be more efficient and actually make it more productive. And I think that's painful when that doesn't happen and you added someone and maybe we thought that they were going to go out and get all their new patients and, and didn't, and now we're both, like, frustrated. Um, and so having, you know, awareness of how does our model work, how would I best utilize a doc like, when, and when will be the right time to bring them in? And then, am I going to be doing this broken white lion versus a through and through, like, I see my people and you see your people? Um, and why, why am I choosing that? For whatever model that you would take, I think getting around clinics doing it successfully and asking them some of those questions, like, what would you, you know, teach me about adding the next stack? What are some things I should know? Because cause those are the great places to get resources of what to do and what not to do.

For sure. Yeah. Like, like you said, but kind of back in the beginning, I think it's mentally hard to see that sometimes, especially if you've have been in your own practice for a very long time. But really it's not as hard as we think it is. And like, that's probably one of the biggest feedback I think, Loni, you probably get too with coaching clinics is like, it really wasn't that hard. It was just, it's just having the conversations again with people again. And like I said, and just being open and Having the clearness with your patients. And if something isn't good, then let's talk about it, you know?

Right. You know, one thing that I think can feel hard is if you have a practice that is really built around your personality, which in the build season, that's something to really reflect on is like, do I believe that my patients really, or my practice members really are starting to understand chiropractic, right? Right. Like, yeah. Do they say like, oh, that was an amazing adjustment, or they're like, you're so great. Do I also help them realize like, Your body's the one that's doing the healing. Like, that was a great adjustment, but your body is the one that's like actually doing this for us, right? Where I'm giving chiropractic credit instead of me being like, yes, I am the best doc. Because if I somehow have built my persona too heavily into things, or my skill set is the greatest, then it is gonna be really hard to onboard another doc and have a broken white line practice.

Absolutely. And that could be the reason why it's holding you back too, is because of that exact reason there too. And then it's not about the main thing anymore, right?

So, and so that's where like, well, how do you unwind that? Well, you do it by trying to like always push the credit back to chiropractic. You also, when you, you know, would look at your systems and how you're teaching and table talking, making sure that we're really trying to stay where we're teaching about their spine, their nervous system, they're learning something, not Hey, it's my persona that's like keeping you here and engaged. And this was like, that's just having a relationship, even though we do have a relationship, of course, right? Making chiropractic the main proponent of the relationship. Then when we go to onboard that next doc and we can sing their praises of like how great they are at adjusting or how we're excited because they have this extra skill set or this extra technique that they can bring to the table too, and I'm going to learn it too, or whatever. Now they're seen as an equal. And that is a big piece of this, is that clinically we need to seem like, yes, there may be someone who is the lead doc or the clinic director, but also we want everyone to know that, like, you're in great hands no matter who you see. Right? Right. And that's why we're a team that is built together. Right?

Yeah. And I think one another piece to that that helps it take it to the next level is you'll have to probably overcommunicate more than you ever did to— and like, so for instance, for us, we have a doctor meeting once a week, we have a doctor communication within our office, like work for patient updates. We make extra alerts on certain things. So it's— those are things you have to do though too, right? You know, so that when you see the, see the next patient, it's like, oh yeah, Dr. Lona adjusted you last time, but she mentioned XYZ. And so that they know you're communicating too, because your patients don't think they do, but you— we need to make sure it becomes a higher level. So having the systems too in place to keep that communication all the time within your office. So you'll probably have to add an extra meeting. I'll probably have to add an extra line of, you know, backend stuff. But those are the important pieces that make it so that you know what's going on and that your patients know that you guys know what's going on too.

Yep, yep, yep. Your expansion can grow a lot more, and your complexity does become, you know, like the organizational has to become more complex when we add more people to it on some level. And that's why we want to really have good systems in place, um, so it's repeatable and we still have visibility into the things we need to have visibility to. So really great nuggets for those of you that are like, eventually I'm going to need to re-listen to this because I know that in the next year to 2 years I will be bringing on an associate. That's the goal is like, but this, you know, start somewhere so you can come back to it and start right now with some of the things that Dr. Rachel and I brought up of like making chiropractic, you know, the thing that it's all centered around, making sure that we're positioning even like things like our, our cluster booking so that if our desire is to grow, And maybe our patients that are in the beginning got used to longer appointment times. Like, we want to keep streamlining those things so that as we keep growing and more people— it becomes busier and busier— that the people like realize like, this is a great thing, more people are here, I love it. And that is all part of how we like put our headspace around how we roll this out to our practice members.

Absolutely, love that.

Thanks, Rachel. Thanks for your time. I know we'll be back together in a month or so.

All right, awesome. Thanks, Teri.

Thanks for listening to this episode of Build Your Remarkable Practice podcast. Remember, what the world needs now is chiropractic, and what chiropractic needs now is more successful chiropractors. If you like the podcast, please subscribe, share with your friends, and leave us a review. And if you'd like to connect with us personally, please click the links in the show notes to schedule a call.