348 - The Chiropractic Business Model is Broken (Do This Instead)

The chiropractic business model that we inherited is broken.

Yeah, right.

The chiropractic business model that we inherited, 135 years of chiropractic we inherited, we're like the 10th generation to inherit this broken chiropractic business model, right? 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. What's up, Remarkables? Welcome to another episode of the Remarkable CEO Podcast. Chiropractic's #1 business podcast. I'm Dr. Steven Franson.

And I'm Dr. Pete Camiolo.

So, Dr. Pete, we introduce ourselves as the #1 business podcast and why people should— why should people listen to us? Because today we have an incredibly important conversation. We're talking about profit, right? So, no profit. Remember, every remarkable business has 4 things in common. They've got a remarkable purpose. They've got a remarkable product. They've They've got remarkable people and they make a remarkable profit. So if you would like to increase your profit, today's conversation is for you. I hope everybody's nodding their head. Some people are pulling their cars over and getting their notepads out. Today we're going to talk about optimizing your business model, specifically your financial model, so you understand that so you can optimize your profit. Well, what do we know about profit? Let me tell you what, man. We know about profit because we know about business, right? So The purpose of the business is to solve problems for another person at a profit, right? So we're going to have a profit conversation today. So who are we? Dr. Pete and I have both built 1,000-a-week chiropractic practices. Now, you might not have that level of insanity in your mind right now, but you know what? What I know to be true, if you hear somebody who has built something big, you can learn from them, right? So Dr. Pete and I have both built practices over 1,000 a week, both multiple 7-figure practices. I think we have 12 or 13 businesses between the two of us that we have started over the year. We've done over $200 million in revenue. We currently have the privilege of coaching over 500 chiropractors who are adjusting over 500,000 people a month and making $250 million a year. Dr. Pete, I know you and I know you know business and you certainly know how to make a profit.

Doc, it's great to be together here today. When you start thinking about those numbers, I'm remembering back to just the desire in my heart when, you know, really started going into coaching and I felt like, you know, God called me into this and it wasn't necessarily something that I chose, but I was called. And so, when I said yes to it, it was really for one purpose only, Doc. It was to make a bigger impact because I loved having a big impact in my office, seeing 200-300 people a day walk through your doors. Man, that fills you, that fills you, that floats your boat. You could keep doing that. You know what I'm saying? So, the fact is it was like something— the only reason— thing that's going to get me out of that boat walking on the water is going to be something even more extraordinary, even something more impactful. And I still remember meeting with my team and kind of seeding the idea that it was possible that God might call me out of this, the four walls of this awesome business, which we had just rebuilt and built our second office just just an awesome facility. And anyway, the end of the day was, it was for one reason, to make a bigger impact. So when I hear those numbers, I'm just like, man, that's what it's about. And by the way, I feel like we're just scratching the surface, Doc. I mean, the fact is, what we know what the world needs right now is chiropractic. And what chiropractic needs now, because we see it, is more successful chiropractors, specifically chiropractors who understand, go from believing to now understanding business. You can believe all the things about having a great business, but do you understand it? Today, we're going to increase your understanding just a little bit. You know, it's a podcast, you know, so we're going to do our best, but, you know, have a deeper understanding of your business so that you can have more influence over the profit, right? You can understand how to take your purpose, your product, and your people to drive a better profit, right? That's what we're going to be doing. Dr. Stephen, honored to be with you today. Thank you for the the deep work that you always do in preparation for helping us serve chiropractic and chiropractors and helping us continue to move the needle. I know that for all of our listeners, I know for many of you who've reached out to us, how grateful you are for the podcast. So right back at you. Thanks for being a great listener. It's an honor for us to be a part of this. Thank you for joining us in the conversation each week. And if you're new to the podcast, welcome aboard. Make this a regular. So hit that subscribe button, make it a regular part of your week. Every Tuesday, we bring you a new episode. I've been doing this for 7 years. Every week consistently. And you can go back to listen to almost 400 episodes of what I would say is our best work. So, welcome to our conversation today.

Dr. Pete, always a pleasure and right back at you. We're in the mutual admiration society. I just so appreciate getting to work with such a pro like you, man. So, guys, when we're out and about, when we're in the wild, right? So, when we're free range and we're out there speaking and running into these awesome chiropractors all around the world so often, people come up and give you a hug or give me a hug and say, hey, thank you so much for the podcast. So thank you so much for the podcast. They're like, I cannot believe you guys don't gatekeep and you just give this all away. And we do, right? This is our purpose, right? To make a bigger impact, right? So that you can make a bigger income. You know what? I always say the same thing. Well, they're like, how can I ever thank you? And I'm like, two things. Number one, implement. We're not here just to— this is not a jacuzzi experience. As my friend, Pat and Tempo always says, we want you to change behavior, right? So otherwise we were just entertaining entertainment, and we ain't entertaining. So it's like we're here to move the needle, right? So we want to change. We want this to be an inflection point for you. So number one, implement— implementation. Good ideas are great. Implementation is everything, right? So David Drucker taught us that once. It's like Peter Drucker, excuse me, said, you know, implementation is everything. So implement what we're, what we're teaching you. Number two is share it, right? So share it. You know, so many chiropractors out there who are struggling. Specifically with this topic, profit. Oh my goodness. Right. So it's like the one thing everybody has in common is like, what do you think all chiropractors struggle with? And people would say, new patients. I'm like, yeah, that's probably everybody's first sort of knee-jerk reaction. But at the end of the day, it's profit, like running a profitable business. Because today we're going to, you know, it's going to be controversial what I say here. Right. So, but at the end of the day, we're going to help you understand. It's like the chiropractic business model that we inherited is broken.

Yeah.

Right.

The chiropractic business model that we inherited, 135 years of chiropractic. We're like the 10th generation to inherit this broken chiropractic business model. Right. I'm going to expand on that. Right. So, so listen to me. If you run a lifestyle business and you're an owner-operator and you intend to spend your whole life adjusting patients, you own the practice and you want to spend your career adjusting patients, that is a honorable profession. It's an awesome job. It's an awesome life. And you're going to make a huge impact and you're going to make a great income, right? Because the chiropractic business model is set up for the owner-operator. I own the practice. I'm a sole practitioner. I'm the sole provider. And I adjust patients. This is what I do. And I hire other team members to maybe support me while I do the things, right? So that's the owner-operator model, right? So, and you can make a great living. And it's a lifestyle business. And one day you'll be able to hopefully sell your practice, which is not a business, it's a job, to somebody else who wants to take over your job and buy your practice. Right. So at the end of the day, Dr. Pete, that model works until it doesn't. So it works until you start hiring other professionals, right? When you start adding other practitioners, if you add an associate doctor, another DC, what have you, this is where the model breaks, right? So it's just the financial model breaks. And we're going to talk about that today. We're going to unpack that because we don't want models breaking, right? So we want to make sure that you understand modeling so that you can be predictive and proactive and you can map this out with an understanding of the economics of how a business actually works so that you can set yourself up for success. It can be what I call windshield leadership, where you're looking forward, right through the windshield, not just rearview mirror, where at the end of the year, you have this meeting with your accountant and they tell you, this is the money that's left over. And then you have the leftovers for you as the owner-operator practice owner who's trying to run a business. Dr. Pete, that model is broken and it's time that we fix that shit.

Yeah. I mean, it's, you know, when I was thinking about this episode and some of the key phrases that came to my mind, one was, we've been doing this series at our church, it's called the Intentional Series. So, we're just talking about being intentional about every area of your life. And I was thinking the intentional CEO, like what would it look like to become the intentional CEO? You know what I'm saying? Where you do everything with an intention. Whereas, we talked about being proactive versus reactive when it comes to our health. Think about that. We teach this in our office every day. We know when people walk in our office, subluxated, toxic, and deficient, or both, right? Either they're suffering from the cause of toxicity or deficiency or both. And we know that that's what's going on. And then we have to meet them where they're at, give them a plan, and guide them in this beautiful transformation journey, this arc of this journey. And yet, we don't necessarily apply that same thing to our own story, not our health, but our business specifically. So, we know, we tell people, you know, you're reacting now to this situation that you're in, but let's get on the other side of it. And the beautiful thing is, just like with our patients, if they go through your process and they experience the healing, they can get on the other side and become intentional and proactive about their life and enter into this place called the Wellness Club. Well, the same is possible for you as a CEO. You might come limping into this call today like an initial intensive patient who sits in front of the doctor who finds out they're in phase 2 or phase 3. And you're like, God, you know, I just don't even know how I even got here. The pain really just started showing up when I got my taxes with my when I met with my advisor, but the symptom was actually way earlier in the process. It was actually leading up underneath the surface without symptoms, and then you show up, something happens, and now next thing you know, you're in crisis. So then you call and you're in the office and I'm about to show you your X-rays, and then we're going to have to come up with the initial intensive plan, corrective and wellness plan. That's what we do. As coaches, that's what happens. People come to us, Dr. Stephen, and we recognize like, okay, let's look at attraction, conversion, retention, the team, and then collections. Today we're having a business conversation around the profit. Well, we look at all of those pieces and say, you're in phase 2, you're in phase 3, subluxation degeneration. Like there's some longstanding issues here. We have to get it correct. And what you said, Dr. Stephen, was so important. I want to double-click on it, which is you inherited a broken business model. So just let that sink in for a minute. The profession as a whole, we haven't done a good job, which is what I feel, Dr. Steven, we're attempting to do for the profession of chiropractic is to transform the profession and our understanding of business so that for the next generations to come, it could be a different narrative than what it has been. And we can pass a different baton to the next generation of chiropractic and chiropractors and of course the people that they serve. So, while there may be a broken model and maybe you're part of that and that's something that you've experienced, we're in the process of giving adjustments. And I hope that today's adjustment specifically lands.

Yeah, 100%, Dr. Pete. And I know that that transformation is happening for our clients and hopefully our listeners who are implementing. And that's the key, right? So, success is reserved for the action takers. So, if you haven't changed your behavior, you haven't learned anything, right? That's the evidence of changing, of learning something is you actually change your behavior, right? So most chiropractors that I know don't struggle because of lack of hustle or lack of passion, right? Or lack of purpose or lack of effort or lack of work or lack of time or lack of, right? So you follow me? It's not that. The issue is not a passion gap. Or an energy gap or an effort gap, but rather a knowledge gap. And what we're trying to do is we're trying to close a knowledge gap here. And it's just understand that at the end of the day, you can't hustle your way out of a broken business model, right? You can't out-hustle a jacked-up financial model. You can't adjust your way out of a broken financial model, right? So you have to understand that. And the old expression, when you find yourself in a hole, first thing you want to do is stop digging, right? So, so many people ask the question, Hey, how can I scale this practice? Or how can I scale this? Or the question is not how can I? It's more what should I? Right. So not can I scale this? It's should I scale this? And for the way that you are practicing your practice model and the way you've set up the economics, your financial model, you shouldn't scale it. Right. So because at the end of the day, it's not financial. I mean, it's efficacious, right? So it wouldn't— it doesn't math. Right? So scaling means that you can grow something and preserve profitability or increase profitability. That's what scaling means. It doesn't mean just do more.

Right?

So the solution that I grew up with was always just do more, work more, see more new patients, convert more, adjust more people, just do more.

Right?

So, and we can do more. We can, we can volume our way out of problems as an owner-operator. In other words, the person that's head down, bum up, taking care of all the patients, but you can't just do more when you start creating a a business that has multiple professionals working inside of it, right? It has to be modeled properly. So Dr. B, let's talk about this. Let's lay some terms down. So when we talk about the business model, right? So your business model has a few components to it. Let's consider, let's stay with our narrative around the practice versus the business. You have the practice model and you have the financial model.

Okay.

So the practice model is, you know, how do you set up the practice? How do your systems, processes, procedures, your operations, how does that run? That's all your practice model. Like, like we were a, corrective care chiropractic office. Our objective was to move as many families as possible towards wellness care, right? So, and keep people under wellness care for life. That was our practice model. We practiced Gonstead chiropractic. We were adjustment-centric, but we taught the three-legged stool, break your bad habits, add your exercises, and get your adjustments in rhythm, right? So that was our practice model. We had at least two adjusting doctors and at least one other special doctor in a rotation. We had a check-in CA, check-out CA, an office manager, back office CA, tech CA, new concierge. Our practice model was all about flow. And we had a high-volume environment where it was very simple, very sexy. Right? So admittedly, it was more bar fight than ballet most days because we were seeing 300-plus people a day. But we had built the physical plant. We built the systems, the process, the procedures. Everyone was trained up. And we were a machine. And it was a machine that was driving better health outcomes. And changing the belief systems of our patients. We were changing the, we were literally changing the trajectory of the health of the families in our community and therefore the community. Like, I know that was true. That was our model, education-based, clinical outcomes as a priority, and then just giving, loving, and serving, right? So that's a practice model, right? So we could go deeper on that with maybe an operations conversation around, you know, your day 1, day 2, day 3, day 4, week 1, week 2, week 3. That's, you know, that's a conversation for another day. Right. Practice model. Business model is how do you set up the economics of that? And the business model is made up of things like, what is your pricing model? What is your overhead? What are your compensation models? Right. So, and understand like, what is my target profitability? Right. So understand beginning with the end in mind, it's like, how much profit do we want to make? Dr. Pete, you have to set up a business model so it's formulaic. So you designed this thing, you begin with the end in mind, and you reverse engineer that. It gives you these guardrails, what we call the remarkable standards around how to set up things like, well, if I want to have that as a profit margin, and I know that that's what I want my profit margin to be, now I have to reverse engineer this business, understanding we're going to be like, all right, so I need to know like, what are, what overheads can this business tolerate? Right? Overheads are going to be made up of everything everybody's thinking about right now, which is your rent, your utilities, your labor costs, your marketing, right? So it's like, what does it cost you to run that business? And then understand it's like, well, what does it cost for me to deliver an adjustment? And that's called cost of services delivered, right? So what does it cost for me to sell a product at a profit? That's cost of goods sold, right? And you got to reverse engineer that all the way up to come up with, well, this is what my collections need to be, right? So it's like, if I want to make this kind of profit, this, with all of these constraints, I understand that this is what my revenue needs to be. Dr. Pete, I know this sounds like a lot, but I would so much rather create my future, right? So do that windshield leadership where I'm actually designing a creative process to realize the outcomes that I want to manifest my vision versus playing problem whack-a-mole and just picking up the crumbs and being, and accept whatever the leftovers are. Hey doc, Stephen Franson here. 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? 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. 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 I've helped 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? 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, 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. 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.

One of the questions that I get regularly, Doc, is, and this might speak into some of you, is what am I going to do when I become the CEO? Meaning I move myself from a position of being, let's call it an owner-operator. I do it all. And I become a CEO? And I just smile and I'll say, you'll see. You'll see. There's so much to do. And it's just like you said, how long did it take for you to become a chiropractor? Like how much work and time and energy and effort did you come in and just become a chiropractor and then become a great chiropractor? It's like that kind of same energy and effort goes into becoming a remarkable CEO, which is why we're actually, the title of this podcast is Remarkable CEO for Chiropractors, not just for anybody, even though we can speak to anybody about this. We get a lot of non-chiropractors listening to this, the reality is, Dr. Steven, what you said was the better question isn't can I scale it, it's should I? And what we're answering today is giving us a level of intelligence, right? The business intelligence that's needed to be able to do that. Understanding most of us have probably are more in love with the practice model than the financial model, just by nature of chiropractors, right? They love giving serving, making a bigger impact, and making a bigger income as a result of doing that. Like you said, you can't adjust yourself out of a broken financial model. You can't adjust yourself out of a broken practice model, even though that's what most chiropractors do. That's what we inherited. And we would just lay ourselves on the altar, sacrificing ourselves for the mission, right? And we could justify it every which way you could possibly want to justify it. So, while that is noble, right?

It's not sustainable.

It's not sustainable and it's not wise. And the casualties that along the way, it's just starting with you and then your family and those closest to you. And then unfortunately, your team members, right? So, it's— the patients are probably the least likely to be harmed by this. It's going to be you, your family, your team, and unfortunately, this profession because we're just passing on a subluxated model. And Dr. Steven, that was— so that was— that's— I know you're speaking into the listening. Some of you this year in 2026, you're listening to this and we happen to be right around that tax time of the year, right?

So we're—

this episode's coming in right at the right time for all of you. But it is this idea of you doing more and volume— voluming your way out of your problems. I'm just going to challenge us to not do that again in 2026. Our theme this year is the year of breakthrough. And if you have a broken model, you're not going to break through. So, you got to fix it. We got to fix what's broken so you can break through. You can't break through with a broken model. And you're going to end up spinning your wheels, same story, 1 year from now. And we don't want that to happen to you. And I know many of you have broken through. You're breaking through. Through. And so congratulations, unlike Dr. Steven, you said implementing this. So, Doc, I would like to double-click on something today, which is just slowing it down just a little bit, helping our doctors understand just the idea of the gross profit. You talked about cost of goods, we talked about— yep, services delivered, some of these terms we throw out there. I think it'd be really good for us to have a conversation as chiropractors, not as— you know, your financial advisors.

But that's right.

That's right. To help you guys understand this, because at a minimum, coming out of this conversation today, for you to have a better understanding of that would be a major upgrade.

Yeah. So, I mean, we in the Remarkable Practice, we teach chiropractic business school. Right. So, and this is like a conversation that's very specific to anybody that's in the chiropractic ecosystem.

Yeah.

You know, even if you're not a business owner or a practice owner, right, you need to understand how this works.

Right.

So let me just review some of the terminology and give you a framework. And we'll also, Dr. Pete, let's include, let's give them a resource. So we have something called the Remarkable Money Metrics. It's a PDF that summarizes a lot of these standards that I'll be making reference to. So if you want to get your hands on that, we'll give that away today. And let's be honest, guys, you don't want to do this on your own, right? This is costing you a lot of money, right? So it's like, we'd be very happy to help you with this. We'd be very happy to walk through this with you. We have a Remarkable Money program inside of the Remarkable practice with our CFO, Bob Siegel, we have an extraordinary program where we can help you claw back the money that you're leaving on the table, right? So you're just literally, you're literally just losing money, right? So if you'd like to have that conversation, there's a click, click a link somewhere here in the show notes where you can set up a phone call with us and we can talk to you through these numbers with your practice and help you find the money that's already in your practice, not to mention what you can do in 2026 to increase that. So there's my, my solicited or unsolicited request to get on there and give you guys some direct help, right? So don't just listen to the podcast and go on to the next episode. I want you guys to actually implement. If you need help doing that, we'd love to help you do that.

All right.

And when we talk about the business model, I talked about the practice model. I talked about the financial model, right? So the financial model, we had a few components. Pricing models are incredibly important, right? So talking about your money model. Which is understanding how do I, how do I price my services? How do I price my products? Right? So Dr. Pete, let's do a separate and distinct episode on that. Just talking about money models and talking about how to price your services and how to price your products in a way that you're making a profit, understanding core offerings, understanding bolt-on businesses to add value, right? So drive better outcomes for your people. But also to add profit centers in the business, right? So you can add these, add these bolt-on businesses, but you have to position them properly and keep the main thing the main thing. But there's so much profit to be found in these bolt-on businesses and additional profit centers, right? Let's do a separate and distinct episode just on that, right? Yeah. Compensation models. This is critical. This is where almost everybody falls down. They don't know how to pay their staff, their team, their CAs, their office managers. They do not know how to pay their associate doctors. How do you pay your associate doctors to optimize the relationship and drive profitability, right? So it's like they don't know how to do that, right? That's a comp model conversation. And frankly, you don't know how to pay yourself, right? So, you know, at the end of the day, remember, as an owner, you get paid 3 times. You get paid your salary for the work that you do. You get paid distributions of profits, and then you get paid for the add-backs that you're allowed to run through your business because you own the business, right? And I'm not talking about monkey business. I'm talking about business expenses, right? So it's, there's 3 ways you get paid. Are you getting paid that way? Do you have fully loaded books? Right? That's an accounting conversation. It's like, let's do this legitimately.

Right?

So, you know, we're not having a tax filing conversation. We're having a business strategy conversation. As CEO, you have a fiduciary responsibility to your business and to your team to run it as profitably as possible. Are you? Right? I subscribe to the biblical law of dominion, right? Which says, do you demonstrate the capacity to manage well that with which you've already been entrusted? Categorically, you will be blessed where you demonstrate. Everybody triple underline that word. Do you demonstrate the capacity to manage well that with which you've already been entrusted? You want to make more money? You want to make more profit? How are you doing with the money you're already making in the business? Are you demonstrating the capacity to manage it well? That's this conversation, Dr. Pete. This is what we're talking about. It's like, it's like, okay, roger that, Franzen. I just heard that finally. I've heard you say it 20 times. And today it hit me between the eyes. Great. That's exactly where I'm aiming with this, right? So it's just like time for us all to grow up as business people and understand economics, understand accounting. Accounting is the language of business. If you do not speak accounting, if you do not understand accounting, you do not understand your business. And if you do not understand your business, that's a knowledge gap that's costing you a lot of money. So close the knowledge gap, right? So when we talk about comp models, that's a critical component to this. And then you have all the other overheads and expenses, right? So if you break it down, Dr. Pete, from the top, top line revenue, that's what we call collections, right? So in chiropractic, it's collection, your revenue, like how much money did you make? Top line collected, not services, not billed. How much did you collect? That's revenue, top line. And then under that, you're going to have expenses that you're subtracting from that because you're trying to calculate your gross profit.

Right?

So you have a gross profit, which is an absolute number, a dollar amount, and then you have a gross profit margin, which is that as expressed as a percentage of top-line revenue. Okay? So gross profit is a real number. How do you get there? Well, you add together a couple of things. Everybody understands COGS, right? Cost of goods sold, right? So if you sell pillows for $200 and you pay $100 for that pillow, wholesale and you sell it $200 retail, what you've done is you've marked it up $100 or 100% markup, right? So you have a 100% margin, gross margin on that, right? So you paid $100 for it, you sold it for $200, you made $100, right? So cost of goods sold on that pillow is $100. It cost you $100 to buy the pillow that you sold for $200. That's COGS or cost of goods sold. And then there's a very important number that we understand as chiropractors because we're in a service industry. Which is an analogous number, which is COSD or cost of services delivered. Cost of services delivered is what does it cost me to deliver an office visit? If your office visit sounds like this, chiropractor adjusts the patient and then my CA does some tractioning with them and teaches them some CBP exercises and maybe does a modality like Softwave or Shockwave or you name it, some kind of modality. So, you have to add together 4 things. Number 1, the cost to pay the chiropractor to deliver the adjustment. Number 2, the cost associated with paying this tech CA to be involved in that office visit specifically, right? And then number 3 is the whatever consumables happen during that visit, right? So if it's face paper for the adjustment, that's a consumable. And then finally, the percentage that you get whacked for a credit card, that's a merchant account fee, right? So those 4 things, that's called cost of services delivered, right? So the chiropractor and the tech CA are called direct labor costs, right? So those are your direct labor costs. Those go into cost of services delivered. So you take those two numbers and subtract it from the top line revenue, your collections, and that's going to leave you with gross profit. And then you take that number and express it as a percentage of the top line revenue. And now you have gross profit margin. That's your gross profit margin.

Right?

It's an important number to understand.

Right?

So now we have all the other expenses. Okay? So here's the way I want to look at the start to beat is we've set remarkable standards for everything. Right? So the remarkable standard for gross profit margin is I want to see chiropractors that are adjustment-centric seeing somewhere between 70% and 80% gross profit margin. Okay? Somewhere between 70% and 80% once they've paid for all COGS and cost of services delivered. You take the 100% collections and subtract COGS and COSD, and you end up with the gross profit margin. It should be somewhere around 70% to 80% of your top line revenue is left over. Okay. So listen to me. That means you've got 70% to 80% of your top line revenue to run the rest of the business and still make a profit. Okay. So if you're an owner-operator and you do all the adjusting, you have a single doctor, you want to see somewhere around 80% gross profit margin. If you bring in associate doctors and other professionals, you'll probably be closer to 70%. Gross profit margin. So you have between 70% and 80% of your top line revenue left over to run the rest of the business, all your other expenses, and make a profit.

Okay.

So all the other expenses are things like payroll, including your payroll, doctor, right? The indirect payroll like CEO, COO, check-in CA, tech CA, back office CA, office manager, marketing manager, right? Those are all indirect labor costs. So that's payroll. Then you have rent, utilities, insurance, taxes, et cetera. All that subtracts, right? And now you're going to be left over with an amount of money, and that amount of money is called profit or net profit, right? Net profit in fully loaded books is what is it actually, what is the profit in this business? And as an owner, you pay yourself 3 times. Number 1, you pay your salary. If it's a salary as a chiropractor, make sure that goes into cost of services delivered, direct labor cost up top. If you're the CEO, that's an indirect labor cost, right? So that's one of the other payroll expenses that gets subtracted, and that's going to leave you with a profit margin. Okay. And that profit and profit margin, you pay yourself distributions of profit out of that profit margin. Okay. So don't pull all the money out of the business and cash strap the business. The rest of it should go into savings, peace of mind account, investment account for growing the business, et cetera. But you pay yourself out of that profit. So, Dr. Pete, we get paid 3 times. Number 1, we get paid the salary for the work that we do. Number 2, we get paid distributions of profit. So it's important that we get profit. And number 3, add-backs, everything that we're allowed to run through the business because we own the business. That's kind of the fringe benefit associated with the brain damage that comes with owning your own 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, welcome everybody to the CEO portion of the podcast where we get to have a luminary from the chiropractic profession on. I will say personally, I've known Dr. David Fletcher from CLA since 2008. I've had the honor of having him as a coach. I've had the honor of having him as a colleague in this profession and, and really a luminary as far as a thought leader in chiropractic. And I'd like to say I also have the honor of calling him a friend. So if you have not known of Dr. David Fletcher, you're in for a treat. If you already know of Dr. David Fletcher, that's probably why you're listening right now. And just make sure you have your notes out. Make sure you're ready to learn about how to communicate chiropractic and how to utilize technology to serve the purpose of your practice. So, Dr. David Fletcher from CLA, just introduce yourself briefly to the group and then we'll get right after it.

Well, it's a pleasure and an honor to be here. And most importantly, what I love to begin with people when they ask that question is I'm a chiropractor and I love being a chiropractor. And I think that my journey, which has intersected with yourself, TRP, CLA, and otherwise, has really embellished the relationship of the unique experience that we have a choice to embrace as chiropractors. And I thought we'd spend some time today, you know, and, and you'll— it'll uncover who I am, uh, really focusing on, on this principle of cultural authority that we as either chiropractors embrace or we let dissolve around us. And, um, and so my journey was really one that, uh, busy, busy guy in practice didn't necessarily always know how to scale. I just took everybody and did a family practice, and which was wonderful. Um, I have a background in some research advocacy and otherwise, so I was always on the hunt to know objective data that validated what we had that was reproducible. And I came across Christopher Kant and Patrick Gentempo, who were my mentors in the early days, and they had begun with, uh, with Chiropractic Leadership Alliance, or CLA. As time went on, I became their academic advisor, I became their communicator, and I met so, so, so many wonderful chiropractors along the path. Eventually I took over CLA, and that was years ago now, 15, 16 years ago now. And as a result of that I've had a wonderful ability to have that interface between technology, the principles of chiropractic, and the ability to watch the practices represent that through the growth and, and dimensions of growth.

I love that. So in the TRP ecosystem, we talk about the practice systems of attraction, conversion, retention, team building, and collections. There are also seasons of practice, from launching a practice to building one to scaling one, and then ultimately to exiting. As personally in my practice, I've utilized the CLA scanning technology since 2008. So I realize I'm coming to this with like almost a curse of knowledge. But for those that are listening that don't have that, that might be in, you know, that have needs in any of those 5 domains, or if they're looking to move from build to scale, or maybe they have an eye on exiting, or shoot, how do I launch? Maybe if they're coming at this from a completely like they don't even know what we're talking about standpoint, please just take a second to talk about what is the technology that, that Chiropractic Leadership Alliance, that CLA, uh, has, and how can it be utilized in a practice?

Well, the intention was originally not to necessarily have a technology to sell. It was a technology to communicate. And the reason that that was so powerful was that, um, this cultural authority that I was talking about was, is, and was getting dissolved And we are starting to recognize chiropractic as more of a spine therapeutic rehabilitation model, when in truth, the philosophical model that drove us to begin CLA and to, to embrace that message was the principle of neurocentricity, meaning everything that we, we function in as human beings is relatable to the clarity within our nervous system or coherence as we have it. So we wanted to help people understand that the impact of a vertebral subluxation went far beyond the spine, but was the source of the, you know, eminence of the expression of potential. And so we looked, said, how can we identify where there are interference patterns within the central nervous system? So we focused primarily on the two largest divisions. Sensory was not as more subjective. So what we did was we focused on the motor nervous system by identifying how to read EMG as it relates to energy expenditure. And then we looked at the autonomic nervous system in two dimensions. One, the global set points, and, and we, we pioneered heart rate variability within chiropractic. And then we also utilize thermography to look at the spinal connection to the control of the organs and glands through the autonomics. To put it very simply, our 3Tech scanning gives you a 360 view of the ability of that person to interpret themselves in their environment and how much it's costing them to be out of sync with their environment. And, uh, it's a beautiful piece of technology.

Yes, that's, that's great. And I love what you said there where we didn't create technology to sell, we created technology to communicate. And that's, you know, from within the practice is what you're speaking of. It's not about how to sell more care plans.

No, not at all.

How to communicate with clarity what's going on in the nervous system. And I'll tell you, having certainty in communication is one of the biggest ways to retain people in practice. And this is one of the biggest pain points that we have in chiropractic is there's a lot of stuff out there about attraction. There's a lot of stuff out there about conversion and helping people commit to care plans. But in the retention world, yes, it's a remarkable practice. We have a whole set of systems on how to retain well. But at the core of that is having certainty in your communication with people. And I know for my practice, boy, the technology has paid for itself time and time and time again. If all I looked at was retention, not including attraction when I use it, screenings, not including conversion when I'm able to communicate with people in their early care as well. Let's talk a bit from the business owner side of things, from, from scaling your practice. And yeah, by that utilizing, you know, leveraging team where perhaps you were doing something before. Can you speak to the technology's power within a practice to allow the owner of the practice to leverage this technology and their team to take the practice to another level?

Absolutely. You know, I think I got kind of quoted and famously sort of conceptually, uh, brought forward around this kind of conversation that says you get paid to the level at which you communicate and deliver with certainty. And one of the things that's so critical is, is that we're doctors, and what we are are clinical scientists, each and every one of us. And what we actually get paid for is not identifying where a subluxation is or identifying where a problem is that we can interact with, but how we can manage a care plan. And to do that, what we need to do is have objective data that we can track and compare to, while at the same time bring our patients, clients, however we refer to them, into our world so they see that we have this, this tell, don't sell principle of what it is that we do. And one of the most important aspects of that is that objective data gives us the certainty. That's what we're going to get paid for. But it acts as an invitational platform so that people realize that you are delivering what you say you can deliver. And at the same time, they are embracing it so that they are deciding how they're going to let that impact their lives and change their lives around that. And that's always why we wanted to get into this whole model of interfacing easy-to-use technologies. Now, from a CEO perspective, it has to be efficient, it has to deliver the team relationship and otherwise. We have scaled this down so that it's wireless technologies. Yes, there's 3 different techs that we apply in one examination, but the examination takes anywhere from 5 to 7 minutes in totality. So there's no blocks. It's staff-driven, meaning that the staff are trained and they can deliver repeatable exams, reproducible exams. So the doctor has the confidence clinically, has the certainty in communication, and has now what we refer to as a neuroplastic care planning, you know, juggernaut that's sitting in there. So if anybody challenges them, you know, whether it's on an academic level or on an insurance-based level or otherwise, there is a foundation now. And when we go to do volume-based practice, it's not even so much that that's what we want to do, it's that we have to do it. There's such an attraction to to, you know, showing people what it is that matters, that when it comes to attraction— and you mentioned it— whether you take it into a screening environment or most importantly, as you engage the 4 generations of every family within, you know, with whoever's starting, this becomes the centerpiece of your practice. So attraction, conversion, the retention is based upon care plans, which is exam to exam to exam. And when you base it on that, You know, the average, the average therapeutic-based PVA, if you will, is somewhere around, you know, 12 to 14. We look at our PVAs and we're in the 60s and 70s in our client base. And people just need to do the math on that. There's no hand-holding. It's just, you need this and here's what we're going to deliver. And so it makes the practice very fast, very efficient, very easy.

Yes, I love that. And, and as your average there, that probably means the, the practices that have really learned how to leverage your technology along with systems end up far north of the 60 or 70, even triple digits is pretty common.

Um, you know, just, just in terms of the embracing of it, um, we have 16,000 of these installations, you know, in 26 different countries right now. The chiropractic profession has embraced this principle of a neurocentric approach to chiropractic, you know, listen and not everybody over the years has, has continued to evolve with it. But we know, watching the data sets come through, that we're looking at millions and millions of scans being delivered through our servers each and every year. That means that there's millions and millions of people hearing the story of chiropractic through a neurocentric, philosophically right-managed model. And that makes us very happy, but it puts a lot of people in front of chiropractors.

Yes, I love that. So what, what I'm hearing as a user of, of CLA is, man, I'm glad I got in on this early, right? What I might be, what I might be hearing if I'm, if I'm listening to the reverberations of the CEOs listening to this, the decision makers listening to this, is, oh man, I'm glad we've been in this short term. Or maybe, holy cow, like, I'm actually looking for more certainty in my communication. I'm looking for ways to utilize my team to help me leverage my time and my ability to serve people. And if I could have ways that help in attraction and conversion and retention and in collections, like, I should be all in on this, right?

Yeah, certainly.

You know, as an advocate of CLA and the technology, I'd say absolutely. I think what you've said there is the ROI is obvious. If you're a practice that's hanging out in the, you know, teens, maybe the 20s with your PVA, Just imagine, just do the math on your collection visit average on what it would mean for a case to take that to 60, 70. It just— the ROI is obvious. And the, the, um, how quickly you get that return back is going to be simply based on how quickly you train yourself and you train your own team systems to get this thing up and running and communicate it to your people.

Well, if we're talking business and numbers, let me share with you, as I came on the call, I thought, let me take a look. So I had my team look in the server banks, and we— I talked about millions and millions of them, and we divided— it was real simple math— we just divided the number of clients that are actively scanning, not, not just that we've installed with, but actively scanning in this, and said how many scans across the universe are being done on average. This is on average through our network, 126 scans per month. Okay, now on average, each one of those— and some people are charging $300 a scan and other people are charging $30 a scan— but on average, the We recommend that there's a, you know, whatever you charge for a cash visit is what you would charge for a progressive scan. So let's just go on the low side that it's $50. You know, the realities are is that this is generating in exams alone, not retention or not attraction or otherwise, it's delivering $6,600 each month in just exam fees associated with recurring examinations. On average, we have people that are doing 400 and 500 scans on a monthly basis. Very active. We have lots of those people. So just imagine the decision that they were making and putting, you know, those numbers in play every month in their practice just from exams.

Yes, absolutely. The, the math is, is easy, and the impact is huge, right? The impact of communicating chiropractic in a way that people understand it better, they can go tell others about it better. It's It's why the technology was created, right? For communication. So at this point, hopefully people are wondering, how in the world do I get my hands on this stuff? So, you know, thank you and CLA for being great success partners with the reMarkable practice. Give the listeners a sense of how do they get in touch with you? How do they learn more? How do they get in contact with you?

Which is a wonderful way. So the website, which has won I don't know how many awards because it does a lot of really cool journeys that you can go on through it is insidecla.com. And you will, I'm sure, put this on, you know, the notes, etc., and whatever else. But in there, we also realized that, and I said it before, is that we're clinical specialists, each and every one of us. And so there is an entire library of downloadable ebooks. Obviously, the website itself profiles the technology, does case studies, and does a lot of, you know, interviews, if you will, with with users that are in there. So testimonials and otherwise, get a feel for, for the people that use our technology. More importantly, go and download some of these fantastic ebooks that we've been able to present over the years. Dig in. And here's one of the most exciting things. Honestly, we don't refer to them as salespeople or representatives. They're Insight Advisors. Our skilled team really is somebody who's going to handhold you. And I use the term invitational before. We really focus on inviting people to see a critical shift, which you referred refer to as conversion. But it's this critical shift, not away from or dismissing where you are, but a shift towards this efficiency so that you can scale so that you might find an exit that's faster than you thought it was. You know, Chris, you talked about the seasons that we're in. We're all in them. You know, at some point it doesn't go on forever, meaning you practice, you gotta make some decisions, maximize your opportunities now so that when it comes time to scale and when it comes time to exit, you've made the right decisions at the front end.

End of this career.

Yes.

Excellent. Well, yes, be sure to check out the show notes. Those of you listening, be sure to check out insightcla.com for that information. And some of that's available even to people who don't yet use the technologies. Yeah, absolutely. Check all that out. And of course, come to our immersions where oftentimes you'll always see somebody from the CLA team, if not Dr. David Fletcher himself, there with us at the immersion.

I absolutely circle each immersion on my, on my calendar. CLA loves being along with TRP in its journeys, and we've been doing it. I think we were the first success partner that was associated with TRP. So we have a long and wonderful relationship with each and every one of the— why? Because we value the same things, and that's what makes friendships but collaboration so perfect.

That's great. Well, on behalf of the Remarkable Practice, Dr. David, thank you so much for all you've done for the profession. Thank you for being here, continuing to serve the profession in this manner, and I look forward to seeing you at our next immersion.

Can't wait.

Thanks again.

You bet. 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. And if you'd like to connect with us personally, direct message us on Facebook, LinkedIn, or Instagram. Now go and be remarkable.