Contemporary Practice Management: Dr. Jeff Langmaid, The Evidence Based Chiropractor

The core 360 belt is the best aid to train the abdominal wall. The Core 360 is a patent pending, first of its kind training belt that helps you move, breathe, and perform better. We use the Core360 belt with almost every patient at Winchester Spine and Sport. The biofeedback is second to none. And it's an amazing way to teach proper respiration and can be even used during higher level movements in the gym. Teaching proper respiration is about as fun as a rash. With the Core 360 belt, you take all the headaches away. Visit Core360belt.com and use the code GESTALT for 10% all off. All belts. Ohmtrax sensors not included. Again, visit Core360C O R E360B E L T.com and use the code GASTALT for 10% off. Enjoy the episode. All right, everyone, welcome to another episode of the Gasol Education Show. Brett. We're back for another round at Parker Orlando. So we're happy to have on our special guest, Dr. Jeffrey Langmaid. So you guys are both straight off the stage. So I know how tough that is. You taught all day and to come back and sit down. So, Jeff, I appreciate that. Awesome Orlando, great facility. It's just a fun weekend.

Oh, yeah, it really is.

The only complaint I have is that there's too many dang good speakers. It's tough to get between that bounce.

Yeah, Jeff and I were competing.

I know, I know. So he probably had a couple more than you. But anyway, so Dr. Langmake, the evidence based chiropractor. Right. So that's your handle on social media and stuff like that. So before we hopped on, you actually told a great story of kind of how this all started. It started in a multidisciplinary spine care clinic, correct? That's correct.

Yep. Yeah. Many years ago, probably 15 years ago, I came out and like to say I practiced about every way you can practice a chiropractor. Came out as an associate. Like, had a bad term agreement. Like, just didn't last. Right. And it was my mentor. I could go into the story, but the bottom line is I ended up then having my own private practice, small boutique practice in Rhode island, which is where I grew up. And then I was super fortunate to be able to join a surgical practice, which 15 years ago, I think there's less than 25, definitely less than 50 chiropractors practicing in an orthopedic group. And this group was like the big guys in the city. So we're talking chiefs of the hospital staff. They're tied in with USF Health in Tampa here and 12 locations, 50 surgeons and two chiropractors. And when I first joined that group, it was like sink or swim. Like there wasn't really too much opportunity that they were going to push chiropractic and help me build a practice. But I was practicing in their organization so that's what really generated the thought of, well, I guess I better reach out to my colleagues and build a referral based practice because it's kind of my only option. And that's really, really the seeds where I actually got into what are these guys doing and how are they making decisions? And I noticed that they were really focused on imaging. As surgeons would be reviewing MRIs and CT scans, they also were constantly to each other referencing studies. I was like, this is fascinating. I haven't checked out PubMed since I graduated. At the time I was like, did I never go back on that site in my life? So it really opened my eyes to wow, if I can start showcasing the literature that supports who I am, what I do now I stand a chance to be able to show up and be heard and hopefully open their eyes in a way that was at that time like pretty self serving. Like I want to have, I don't want to have tumbleweeds in my front area. Like I want to have and build a practice. So it was pretty much the only way I could really get traction initially. And then as we were talking about that's what then that worked. I started to see a little bit, it was hard, uphill, happy to go into the details. But then I started using the same systems for primary care, internal medicine, sports focused docs in my community got a little traction there. A lot of closed doors, a lot of bad meetings and you know, everything that I talk about today was definitely scar tissue of like challenges and every mistake in the book, I made it. But throughout that process you learn, right? And that's what started to showcase to me how can we as chiropractors have systems and processes that can help us build relationships that are productive in a way that regardless of how you practice as a chiropractor, you can implement. And it wasn't just about me, but it could be a system system that similar to, I mean, what you guys talk and teach as well. What are systems we can implement where chiropractors can provide a high level of care, understand better what's going on with the patient and serve them? I was just thinking about it from the marketing side, how can you build systems and processes externally that enable you to build referral based relationships in a B2B sense business to business, whereas most chiropractors focus 90% of their energy. B2C business to consumer. And I view that as a huge opportunity. And I always say the benefit of not many current referrals going to chiropractors from primary care physicians at scale is it gives you the that gap is the opportunity. If every primary care doctor referred every patient, that should be to a chiropractor. You either have to be 10 times better than the next chiropractor or 10 times cheaper. Those are really no one's, one's really hard and the other one's not a good option. But the gap is the opportunity. And right now I still believe there's ample clearly opportunity for us to build relationships with other healthcare providers. But you gotta have systems and tools. And I struggled for many years and then finally figured out a system that works most of the time.

Yeah, well then let's kind of expand on that as far as business to business. So now, I mean as healthcare expands like crazy, the days of having your local down the street family physician that isn't incorporated with the hospital system is kind of going away. Is it more difficult now? How do you get around kind of working around those in network referrals and big hospital systems and stuff like that?

It's certainly a challenge. There is mass consolidation as you brought up. So it's pretty wide. What I've seen there are some hospital systems that have every doctor under lock and key, every referral going out is being tracked. It's all intra, it's being super monitored. There are others where the physicians have a good amount of autonomy. So it really is system dependent. Just because somebody's in a bigger system doesn't mean that they're handcuffed. It's more likely that they're handcuffed, but it doesn't automatically mean that the other is that I always say you just gotta find your dance partners. So if you are a doc that's let's say a cash based practice, you might want to reach out to concierge medicine physicians who already have cash based patients. Right. So a lot of it is looking at how you practice, who's your ideal patients and then who are your dance partners. If it's pediatrics, maybe you're looking at midwives and doulas more than OB GYNs. There's always going to be people in the healthcare space, whether they're the physicians themselves or the supportive and secondary providers. That can be great referral sources in some cases. It might take a little more digging to find those dance partners. Kissing a lot of frogs to find that prince. But I'm convinced that you can always find that in your community, with very rare exception.

Sure. Well, and then, you know, we always talk about too, sometimes it is difficult to find that dance part. Once you do, then it's just about nurturing.

That's right.

You know, then once you nurture it, it kind of goes from there. So I think that was a great answer. Concise, which I love. We always love good guests that are concise. And so. But now let's take that to the next step. So online marketing, I mean, if you're not marketing online, you're basically missing a huge population, which was a main tenet of your talk today. And one of the things that I really enjoyed was you talking about a lead magnet on your website. Having a website that's functional enough to have a lead magnet and then having a lead magnet. Can you kind of talk about a lead magnet? Sorry. And then not only that, but like, what are some of the best ones you've seen as far as simple ways of education? I know, Brett, you built your practice initially on education. You did talks all over the world or all over the. And you've got some great stories of giving talks to two people, one that.

Was sleeping, the other one that was dying.

But talk to us about a lead.

Magnet, I think it's about teach and invite consistently. That's really the heart of the message I try to get across today, is when you as a chiropractor, healthcare provider show up and you're teaching, educating, entertaining, inspiring, and then you're inviting your call to action. And you do that consistently, you're going to make a bigger impact. And you got to get out of your own way sometimes to get that process started. But one of the biggest areas of opportunity, as you mentioned, I believe is on a website. And the example was kind of went through in the talk. I'll give the short version here is most healthcare providers pay for their website and you pay every single month. And you're like, my website gets me some new patients. It's a great portal of entry, but it's like so non optimized. You're just like letting heat off the engine. As I say, meaning you might have, let's say 1,000 people visit your website per month. That would be a relatively normal number for many chiropractors. And then you look at your new patients. Are your new patients 50amonth, 100amonth? It's probably not 500amonth. The delta between those two numbers is insane. In most practices it's like 50 new patients a month, 1,000 website visitors. And as I said, and I say it all the time, it's like nobody cruises chiropractic websites for fun except for me. So if they visited your website, they were there for a reason. Nobody's just like cruising chiropractic website.

So what is a good kill rate? I mean like what would be a number that would be that I love to have.

It's a great question. I like about a 2 to 5% conversion of web traffic onto your email list via the lead magnet. So that would be a great opt in conversion percentage would be 2 to 5%. So the lead magnet would be a, let's say a PDF download or a video or something of value in exchange for the email address. Most people are familiar with this. Something pops up on the screens. Cole pop up box. That's a great way to deliver a lead magnet. Now you might say, well, what's the best lead magnet? That here's the beauty. Depends what kind of chiropractor you are and most importantly, who do you want to attract? So if you are generic example, a practice really focused on lumbar disc issues, right. You're probably going to want to have a lead magnet that might be like seven days to low back pain relief. Why? Because that's going to be really enticing to the ideal patient, your low back patient that visits your website and it just helps get them in your ecosystem. It doesn't mean that 100% of the time they're gonna find relief in seven days. But you probably can put something together pretty cleanly and clearly. Hey, step number one, here's some stretches and exercises. Step number two, decreasing inflammation. And guess what? By the time you get to day seven, if you're still struggling and suffering with this issue, why don't you give us a call today and you built some trust along the way.

When you look at chiropractors websites, tell us your top three or the biggest mistakes they're making on their website.

Oh, this is easy. Number one, wellness awaits you as a her image and headline. I'm like, I don't know what. I just don't know what the hell that means. Wellness awaits me. Okay, well probably not that many people are visiting for, you know, because they're desiring the theme of wellness. They might want to improve their life and have performance issues outside of pain, but be a little more specific. And it's just like the corniest crap ever. And it's like I think one of the one or two of the big website companies just do it on like every template and I'm like, what does.

This mean with the same stock image over it?

Horrible.

Someone out running, someone in a yoga pose.

Super cheesy. So wellness away to is a bad hero image. Or that main headline I think is a challenge. Not having a lead magnet is clearly another challenge. And not putting enough content up consistently enough. Google rewards content producers so Google, every time that you post a new blog, let's just use a blog as a generic example, but a blog to your website that's a context clue based upon the words and keywords in your blog to Google about who you are and what you're about. The more you feed the Google engine, the more they reward you for free. If Your website is one page long and with 500 words, it's not giving Google a lot of information to say here's what these guys are about, here's what this practice is about. So let me show it. When people are asking these questions, I like to say your website should be proactively answering the questions people in your community have about their health. If you're doing that by teaching and inviting consistently putting out content, you not only help better user experience, people get to sort around, see what you're about, understand, learn, but you also give Google positive ammunition to be able to make associations about who you are, what you're about. So as people search questions into Google, every time you put out a blog, I view it as like a little bit of an extra lottery ticket that's like, okay, great, here's one more opportunity that I can show up when people are searching about topics regarding their health.

Here's somebody who's site you give. Give us an example of someone that we probably all know of their website that you really like. That way we can get an idea of what you're actually looking for.

WebMD, Wikipedia. So I think any website I don't have it necessarily as super hey favorite. Yeah, I don't have a favorite that comes to mind right off the top of my head. But I would say anybody that's producing content at least weekly onto their blog is probably doing a good job. Of course there's always like the underlying architecture of the website company like structuring and making sure that everything is SEO driven from like the homepage down. But let's I'm going to go under the assumption that you have a high quality website company that's taking care of that. That's why you pay them. Right? So then it becomes what are you producing to really enable Google to find you at the highest level possible? I don't have a great chiropractic example.

Send them to your website. Come on.

Well, Yeah, I mean, smartchiropractor.com, we produce, we have 100 plus blogs around marketing, clinical and business principles. Why? Because we want, when people are searching chiropractic marketing search terms, when people are searching how to write emails, how to have a lead magnet, we want to show up. So you know, and how do you show up? You have to have, you have to give the answer, right? You have to show you. So it's not that complicated. But I think a lot of times there's just, I don't know if it's either a lack of knowledge or people assume. And again, I just think this is a bad idea. It's like, oh, I pay my website company extra, like thousand dollars a month for like this SEO thing and it, it's just not doing anything right. You need consistent content production. It's the number one way you can improve your website.

Well, I think too, I mean, the old theory was, you know, just when I was young was the simpler the better, like the less words, the less. So it sounds like that it's a little bit different because for optimization you need to like for YouTube, they want the content rich, you know, so 100%.

Yeah. Every time you're putting out something of value now you bring up a good point where maybe once a year you take a look. You don't need a bunch of dead weight on your website either, right? So maybe once a year you take a look and say, all right, let's take a look at our traffic over the last year for our blogs. And you just. And Google Analytics does this super well where it's just like a grid, like you can like search and it's beautiful, it's free. And then you just look at maybe your lowest 10 blogs, then you might want to trim the fat, maybe you want to reword how they just didn't get traction, right? So maybe if you put out 52 blogs in a year, one a week, maybe you look at the bottom 10%. So you look at the last five have the lowest traffic. In all things being equal, you say, okay, let's get those off the website because they're not really producing, they're not getting traffic. Or I Go back and I reword them or re. Change the angle so that it hits a little harder.

Yeah. Or different keywords, stuff like that. Yeah.

So what's define blog and what's a good blog and things like that.

Yeah. So a couple components to a blog that are super important. One is the headline or the title. The second is really how you structure your keywords and meta description. And the third is the body copy. So I'll define what that means. So you have your title of the blog. Right. What is the blog about? And that is really essentially what the blog is about. Now I want to encourage everybody, you need to think like a consumer, not like a doctor. So you don't have a blog necessarily, necessarily called cervical radiculopathy. You're not gonna beat Wikipedia and WebMD. You're looking for people in your circle of practice usually. Right. So you might want to frame that in terms of Is my arm pain coming from my neck? I always use that example because that's consumer speak. That's what somebody's typing into Google. Like is my arm pain coming from my neck? That's what they wanna know. Like there are very few people are like cervical radiculopathy, what's the answer? Right. You know, that's what doctors search and that's not necessarily what consumers search day in and day out. So I'd focus on that from a titling perspective. Keyword and meta description. The keyword's pretty self explanatory. What is that one to five words that you would love to show up on Google if people were searching around. And many times it might be the same words as your title. So it might be in this case, is my arm pain coming from my neck? Is your keyword straight? It might be cervical radiculopathy. Is my arm pain coming from my neck? You can have a little more context.

Disc herniation, disc.

Right. Disc bulge, whatever, anything related to that.

How many words would be ideal for keywords?

I say probably under 10 words for sure. I usually like to keep them like two to six words. So more than one because you need to give a little more context. But two to six and then you have the blog copy itself, which is just the written word. Right. The words of the blog. The ideal length that we see with that is around 1,000 words. If you're less than 1,000 words, you're not going to give as much context to be optimized. And if you're over 3,000 words, you don't need to write the next great American novel. Right. So it's like 5,000 words. Nobody's reading it. 3,000, you're really pushing it unless you're a really good writer. So your best bang for your buck is around 1,000 to 2,500 words. That gives you great on time page. To read a thousand words takes a certain amount of minutes, not second. That doesn't take two seconds. Right. So on time page you want to have it long enough so that people are on the page reading. That helps Google understand this is valuable. People are reading it on timepage and then the second component is. That's usually enough to flesh out an idea. Right. You know, around, you know, it's hard to break down a complete concept in 100 words. You probably could do a better job, right? So around 1000 works for Google and as healthcare professionals, I think it works for us well.

And the nice thing too is you don't have to be overwhelmed. I think initially when people look at the blog, they're like, oh my God, I can't take that time to write a thousand word blog. It shouldn't take you that long. The thoughts are there. You deal with it every day. It's just a little bit of rewording made to get the keywords right and stuff like that.

What's the frequency? How often would you recommend per month.

Or per week or what's. I'm a big weekly blogger. Yeah, I'm a big weekly blog guy. You could always go more. I mean again, if you want to do like a content assault, like you could obviously go crazy and like publish multiple per week. However, I like weekly and one of the reasons I like like weekly, which is I'm glad you asked that question, is that also gives you the opportunity to promote it. So when you publish weekly, here's my grand thing, and I do this myself. I publish a blog each week and I send an email telling my email list about that blog each week. So that drives traffic, right? So now I'm manufacturing traffic and then Google is like, we're not working to give you this traffic. You seem to be getting traffic without us giving it to you, AKA I promote it in my email newsletter. And now Google's like, you know, they're like, I'm willing to bet on the good horse, right? So this is already, this guy must be doing something. This person must be doing something to drive traffic, will help him out. It helps accelerate your search engine optimization by manufacturing or juicing the results yourself. But it's also in the best interest of you and your people, patients, clients. However, you Want to define it, your audience. Because if you're writing something, chances are you're writing it and you'd like them to see it. So that's my answer.

The other thing, too, we've said on this podcast a couple times, and my wife always shoves it down my throat just because there's so many good examples. It's like the difference between your email and social media. We haven't even touched on social media, but we don't own social media. Right. So. So I wanted to. One of the quotes that was in your presentation by Daniel Murray, it was a tweet by him. Most of your audience is not ready to buy. The goal of marketing is that when they are ready to buy, your brand is at top of mind. So talk to us about why that's important, to have them top of mind when it comes to your website and your email versus maybe social media.

Yeah. Your website and your email list is owned, not rented. Right. So the real estate, you own that real estate. In other words, you're able to directly communicate with those people whenever you want. And you're not subject to the algorithm as much. There's always a little bit of it. We could get really esoteric here, but, you know, Facebook and Instagram, everybody remembers, like, if you were more than in practice 10 years, you remember the heyday of Facebook where it's like, I would publish. I had 100 people following my page. I published something 100 people saw, and now it's like, you know, you have a million people and 100 people see it, and it's like, gosh. Which speaks to the importance of consistency. But the owned properties of your website and email list are two of the most important avenues you have because you're not at the whim of an algorithm that can change daily as much. The second component of that is I think it just ties back to being teach and invite consistently. If you are able to answer the questions people have in your community about their health, you're going to build that brand awareness. And the more people that know about you before and trust you and like you before they need the care you deliver, the more likely they're gonna choose you when they're in need of the service. And number one, I think it's great to do because as doctors, we're all teachers at our heart. So I think that we have a certain responsibility, quite frankly, to get out there and educate the public. People don't know anything about their health. I mean, it's insane. I say this when we talk about referrals all the time. I'm like, imagine, you know, you look at a traditional primary care physician, how do they make decisions about spine care and how bad it is? Often, not always. Many of them make poor decisions not because they don't like their patients, because they don't know exactly what to do. So they rely on antiquated ways. That is guideline discordant. And then I usually say to chiropractors, I say, imagine if they know that much about the spine, imagine how little they know about chiropractic. They don't know anything. And that doesn't mean you need to tell them everything they never wanted to know about chiropractic. But just likewise, you communicate to your patients or your community. How can you help them understand more about who they are and what they do? How can you build trust? What are you passionate about that helps them live a better life? And the more consistent you get that message out there, the less paid advertising you have to do because you built brand and you've shown up. Put in the work.

Besides optimization, what are the other ways that you get people that people might not be thinking of to your website? Like what are some.

Great question. I think the number one thing is utilizing your patient list and your email list to highlight the things that you're putting on your website, which almost nobody does. And that's the obvious one, right? People on your patient list, they already know trust and like you, they've been in as clients, patients, practice members, however you define it. So using your email to drive traffic to your website is a great way to go about it. Some other ways to do it are to cross promote, use your social channels as well to cross promote the items that you're putting on your website. All of your ecosystem, if you think about all your properties, meaning your social pages, your website, where you're showing up in person, events, if you're doing instructional seminars or webinars for people in your community, whatever it might be, these should all work together. So every time you're showing up somewhere is an opportunity to showcase and drive traffic back to your website in some capacity. Now, you might not want to do it every single time. You want to do it where it matches up and makes sense. But certainly your social channels should be driving back and forth and you should have your social channels of course listed on your website, so there's continuity there. And then utilizing your current patient email list and helping stay top of help yourself stay top of mind and help them stay in the ecosystem of your practice, especially if you're putting out great content. Why wouldn't you want to have them hear that?

Right, right, absolutely.

And of course you can go to paid ads eventually. Like to me, you could do retargeting or then just demographic targeting eventually. But those should be downstream. Those shouldn't be the first things that you think of. That should be the last thing.

Yeah, it's home based. That's right. Take your practice, your website's home based. So let's switch gears just a little bit. So you kind of gave us a little sneak preview. You got a new book coming out, huh?

That's right.

So the Payday practice. So I love this theme. Recurring revenue. That is like the day and age. It doesn't matter if you're a chiropractor, you're a movement therapist, whatever. Recurring revenue is the big thing. Gyms have kind of had that figured out for a while. Most people with the membership, they don't utilize it, but they still pay for it. Or, you know, little things like that. But talk about a recurring revenue based way of thinking in chiropractic.

Yeah. So I'll lay out the big idea. So the big idea is, and this is the subtitle of the book, which is, you know how to cover your monthly expenses in one day guarantee. And my belief is, is that. Which is the big idea. That's the goal. Right. It's gonna take a while to get there. But imagine if your overhead, your expenses were covered with recurring revenue each and every month. I have a feeling practice would be in many people's cases, a lot more fun, with a lot less stress and just more dynamic. Because too many healthcare professionals, in my opinion, whether, you know, you have your best month ever and you're like, Damn, it's the 31st of the month. We like killed it right on. And then you show up the next day and you're like, back at zero. Let's get to it. It's like, you know, and ideally, you know, you're like, okay, it only took to the 28th day of this month to cover our expenses in the last three days is when we actually made the profit. And then, you know, of course, as the practice is more successful, you pull back that number, right? And you're like, okay. But essentially there's a fixed amount of expenses that every provider has. And those expenses are not going away. They're your monthly expenses and they're recurring. And the insanity to me is that so many of us as health care providers, chiropractors, whatever, whatever, you know, we are 100% reliant on a fee for service model, which means we're trading time for money. What's our most valuable asset that's non denominational across everything time. So every single dollar that we make is based upon hands on care. We saw everything go wild over the last couple years when people couldn't do it. Whatever else injuries happen. Like there's such vulnerability with that. That's insane to me. I'm not suggesting that anybody changes what they do. What I am suggesting is imagine if like 10% of your revenue, 20% of your revenue was generated without you doing fee for service care through membership and subscription model. It'd make you less vulnerable, it decreases your stress. And my big argument here is that it would actually be a better patient experience because I don't care what type of provider you are. And I'm happy to get into specific examples. I believe there's a continuity, subscription, membership, however you want to define it model for every single type of provider. I have yet for one to stump me. Maybe one will, but I've yet for one to stump me because the question becomes again, who are your ideal patients? What are the challenges they're dealing with and what are you passionate about and where do those things meet? So I'm happy to get into specific examples. But that's what the payday practice is all about, is highlighting to docs of all types how they can start to think about this and implement it in their practice in a real way.

So we just interviewed a prime example of that. So Josh Satterley's clinic gym hybrid. I mean people now it's kind of a hot topic of adding a gym and we've kind of talked about that extensively. That's the easy one. What are some of your other thoughts on other ways chiropractors? Let's say it's a chiropractor in the middle of America. They're in, you know, thousands square foot office in a strip mall and they're doing okay. But then how do you start adding that in little by little?

It's not going to work for them. Just kidding. So I think there's three primary models that docs can look at. One is I'm gonna say supplement and nutrition. And I like to think about it in terms of every day, not therapeutic, but everyday. Everybody, meaning 70% of people that visit chiropractors statistically take at least one supplement per day every, everybody, every day kind of things. A multi omegas, magnesium, asleep, whatever it might be. So there's a huge opportunity right there. So one is nutritional supplements, drop ship, no inventory, auto, unsubscribe and save. So some people love that, some people don't like it. So that's one model. If you're not jamming on that, no worries. Second model would be in what I'll call in person services not directly given by you. Great example would be Satterlee's model clinic gym hybrid. Right. Where you have in person services that are an extension of the care but that it doesn't require you to deliver the service yourself. I think that's a super powerful way to go about it. And we all know, in many cases, we know that this is the truth. People come in with a challenge because of their daily habits quite often and they don't change jobs, they go back to doing the same thing, sitting too much, not exercising enough. And we're like, you feel better? Great, see you later. And it's like they need movement based guidance. Everybody does. 99.9% of the profession of the world. So in person services, clinic gym hybrid example. The third example would be in my opinion, health coaching. So some healthcare professionals, chiropractors are passionate. Maybe it's about weight loss, optimizing life, whatever it might be. But there's health coaching that can be done through apps Like Zoom would be a basic example. But you could create anything from a course to a course would be ideal through like a passion IO or a kajabi or something like that. But a membership course that helps people, your ideal patients with whatever their biggest challenges are that you're also passionate about. So whether you want to do nutritional supplements, subscribe and save drop shipped, whether you want to do in person services, a great example would be a clinic gym hybrid or whether you want to do health coaching that's scaled through a membership program. I think those really apply to 99% of providers. Now that doesn't mean that you can get it done tomorrow, but it's right now. I think my big goal is to plant the seeds of opportunity and then talk about the implementation. But you got to open your mind to the mindset of that. You got to talk about the why before you talk about the how.

Sure.

What about obviously in medicine we see seen a movement toward like concierge medicine where you pay a monthly fee or pay an annual fee and then you have basically access to your doctor. Like you know, at any time do you see that happening in our profession at all or for sure.

I think that's a combination of the in person services and the health coaching. Right. So that would could be Insert X dollars per month and you're going to be able to have access to online tools and resources almost in a concierge fashion. And then maybe X amount of visits, right? Or X amount of touchstones, which would be more towards a clinic gym, but it might be less of the gym and more of the. This allows you X amount of visits. Almost like, I'll say this, a modern day maintenance and wellness care, right? Where it's like, okay, how can we apply the principles of what's going on outside our profession into what we do? The challenge with it is that ultimately you're still trading time for money. If the only thing involved in your plan is delivering one movement, assessment, adjustment, whatever it might be per month or something like that, you're still trading time for money. But you may be able to add on a little bit of a coaching or a supplement to that that enables you to create a delta or a gap that's your profit more so than just the visit, right?

Well, we talk about maintenance care. It shouldn't be a negative order like if you do it in the right manner. I mean we do it incorporated in our practice all the time. I mean that's the goal. As a young clinician, for me, that's what filled by practice for sure. You see people once a month or whatever that might look like for them, whatever is best for them. And you, it allows you to see them more and to deal with their acute injuries. But then also I was just thinking, I mean it could be something as simple as now, normatex are huge, right? Recovery after races. I mean those simple things could also be part of it.

Recovery centers, love it. Memberships to recovery centers. And we see it popping up all over the place. Sorry, Stephanie there, but they. Exactly. I see centers popping up all over the place and I know some of the financials on the investments on some of these because I have friends that have done so on these recovery centers that might have, let's say cryo. And then they have a NormaTec, maybe they have IV, right? Things like this and they're on membership models. And this isn't like revolution. It's like Amazon, Netflix, you know, it's like. And then I look at the supplement on the supplement, World Athletic Greens Ritual. Billion dollar unicorn. Companies that are built upon, subscribe and save taking from your patients are subscribed and saved to these things right now. And the example I used during my talk as well, often us as providers, the patient asks us for a recommendation for something, we spend 15 minutes poorly describing something they Go on Amazon, buy the wrong thing, bring it back to us. Why don't you have an E commerce store that enables them to purchase from you the actual thing you'd want them to have? And that technology is getting there. And that is one of the most powerful ways these people know trust and like, you don't take that lightly and send them off into the sunset hoping they're going to find the right thing. You should be offering. It doesn't mean you need to dilute what you do. It doesn't mean you should become super distracted with other business models. But it does mean, I think you should be considering how you build this in as your practice evolves. I think it's a 100% necessary component of practices moving forward.

Yeah, I love it. I just love the idea of. Because you're 100% right. I mean, if you were to get injured, would you have steps in place to be able to have some revenue that comes in? May not be a lot, may not be your lion's share, but little things like that. And I think just reshaping this negative nature. We talk about that a lot of like, people don't think that you should make a comfortable income or, you know, a professional income when it comes to being a chiropractor. And that's just not the reality.

I think too now there's a movement at least like in small town America where people are wanting to help you out. Like there there's actually like a movement to do more business with small business, even if you have to pay a little bit more. I mean, people now you see it all the time in our area where they're like, yeah, you know, you see the jokes of like, yeah, but Nate, fill in the blank with the big company. They're not sponsoring your little league baseball team and stuff like that. So I mean, I think now more than any ever even I think of myself too, like, I am going to do business with my local flooring company now more than I'm going to do business with Lowe's simply because now, like, I just think differently about it. I think like now is like a perfect point for that because people are looking to do business locally. They're kind of getting tired of like the Walmart's, the Lowe's, the Home Depot's.

Yeah, I couldn't agree more. I think it's really, if you can consider talking, you know, maintenance, wellness and ongoing care. It's really, who is your ideal patient population? What is, what are their desires? What are you passionate about? And then what Are they already get super complicated? What are they already buying? What are they already purchasing for their health that that makes sense for you to be able to include. And not everything's gonna make sense. That's cool. Like you just start by choosing one like you know, don't need to make it too complex. You don't need to like to really change your like continue your in person care, continue doing everything that you're currently doing but at least have something on the back end that enables them to continue on their patient journey but also enables you to generate some revenue passively, you know, which is an arbitrary term to a certain degree and you don't want to overstate it like this dream of like sitting on a beach with passive income. But you know it still takes work to get there but you should have something coming in each month as a provider especially as a chiropractic practice and a chiropractic provider that's recurring by nature.

What are the overreaching supplement companies that you that do well in that model company name on?

So there's a couple different options of course, standard process, big you know, bear in the industry. They've been around forever. I think that they do a great job. I personally love Thorne's rebranding. Thorne has been spending a ton of money, you know on partnerships with like F1 drivers, Daniel Ricardo, my favorite F1 driver and a bunch of other guys. So they've been and I love their rebranding. I think they also provide a great product. You lined me up for this one. And so I created a company called Basis Health that just is launching. It's not actually live yet. That's non GMO professional grade physician built and that we've also been building these just everyday everybody supplements. So just core supplements that are not therapeutic meaning they are not. You have this. So I'm prescribing this but are the greens multi magnesium fish oil that are the most common everyday that everybody potentially.

Would benefit from taking?

That's right. That's right.

Well now there's more supplement companies that are trying to grab physicians like us to make individualized things. So I mean and I mean in this day and age drop shipping is becoming easier and easier. There's more companies and so I mean just things as simple as like McKenzie lumbar rolls are a hot topic with our audience and so now you can drop ship those to your patients. You can brand them with your logo on them. Like there's just so I just think that the more you can be creative the better so the more you can reach them.

I agree. And by no means do I suggest that, like, every healthcare provider needs to become like a NASCAR driver, like, wearing a logo. I'm like, you know, it's like, you know, I'll tell you what, I had a great day in practice on behalf of Pepsi Cola, you know, so by no means do I think that, like, you know, you don't need to, like, go, you know, you don't need to go ham on this stuff. You don't need to go, like, swing the pendulum the other direction. But so many of us, the pendulum is one direction right now, which is 100% fee for service. No continuity. No. I said this during the talk, but it kills me. I see chiropractors that have insert number 1,000, 5,000, 10,000 patient files, and they still don't have a full schedule week to week. And I'm just like, you have so many holes in your bucket. You cannot convince me that these people went back to doing the same thing. 99.9% of them went back to doing the same thing. And they're older. Gravity's undefeated, right? Gravity's undefeated. Injuries continue to happen, you know, so the fact that you are unable to keep a schedule full is not a you issue. It's a system and a process issue. And I think that's the most important thing. And there's plenty of resources that docs can reach out to to help them, but it shouldn't. You can't always focus on new patients. You know, it's like, you know, the old gold and silver, right? You know, keep your old friends or, you know, whatever, whatever. However the saying goes, you know, new old friends are silver and gold, whatever. But your past patients, the best way to keep your practice full is to keep your current patients. That doesn't mean keep them captive in the basement. It means keep them engaged in your ecosystem by consistently reaching out, by having continuity, by understanding how you can help them long term and by staying in touch with them through some, like the systems, email, lead, magnets, by teaching and inviting consistently, which so many of us, we believe, and we do in our practice, in our four walls. And we're so proud of what we're able to do with our patients out, the communication we're having. But then we go home at the end of the night, and if the patient didn't come into our practice, we're like, oh, well, I taught everybody that came in. Well, what about everybody that didn't?

Right? Right. What about the people for next week? You know, what about those. I think that's a great way to kind of wrap this all up. I mean, it's something that we're passionate about too. I mean, you can't be the best in the world if you don't see a bunch of patients. And so the first part is getting those patients in your door, especially with young docs. And you're gonna have failures, but if you keep reaching out to them, reactivations are so important. We always say in our practice, reactivations are new patients. Right. And that is gold, because they already know what to expect, usually when they're walking in. And now you have a second chance. Like, you know, whatever happened that you lost them in the first time, now you have another chance to re educate them and to get them back in your web. And again, maintenance care is not a bad thing, nor is, you know, we're not saying to hard sell to your patients. If I'm reading you right, we're saying provide them with the things that they want and allow them to support you. Yep. So that's.

Well said. I got. I got a question for you. Since you're in the podcasting world, tell us, because we feel like we could write a book in our podcast. What is your favorite podcast? Why? That way, if people aren't listening to your podcast, give them a starting point. What was one of your favorite episodes and why?

A favorite episode that I've done.

Yeah.

For years. For the mine. That is a really, really good question. Some of my favorite episodes. So most of my episodes are me. Like, 80% of my episodes are me breaking down a single research paper. Yeah. So. And 20% or less have an interviewee, so to speak. So most of them are when I'm interviewing, talking about research, I think. And I break down one study in, like, 20 minutes each episode. So while one specifically doesn't stick out, what I will tell everybody is avoid the first 50, because the first 50, I'm like, start at 51. Hello, this is Jeff Lang. It's like. It's like worst version of NPR possibly imaginable. Yeah, it was very, very super struggle bus. And I'm like, so it only took me about 50 episodes to get passable. So. Yeah, so thank you so much. I would say some of my favorite episodes are highlighting the empower, showcasing what we do as chiropractors and why it's so important. So one of my favorite episodes is probably citing a study that was microdissectomy versus spinal manipulation for sciatica and the fact that five to ten years out whether you had a microdiscectomy or received spinal manipulation, the response results were the same without any of the harms, any of the risks, any of the costs. And I think that is one of the most powerful studies imaginable. There's another study that I don't know the title of, but that showcased in the line in the study which I think was so powerful, was that spinal manipulation had a statistical and clinical significance over placebo. And I feel like there's so many times if you look at my YouTube videos online and look at the comments, don't look at them with your children around, but, but there is like, you know, it's placebo, it's placebo. Number one, there's nothing wrong with placebo. But number two, it's fact. What we do impacts the peripheral central nervous system, impacts the segments that we're adjusting, impacts brain function. However you want to define that. Biochemical markers, as I say in the research, and I think that that is just so important that movement based care is the fix. And in spinal injury we were talking about it just before we came came on, but specifically relative to the spine. And I practiced in two orthopedic groups. One was the largest outpatient surgical center in the world. And I will say this true as day surgery, Sept in red flags is not a fix for spinal issues. It provides temporary relief and permanently alters biomechanics and creates a host of other challenges. That doesn't mean it's worthless, but it means that we need to take better pride in what we do. And it also means we need to communicate and better gatekeepers on the front end. For sure, for sure. And some of it comes down to everything. Who are you building relationships in your community so that they can better refer into you? How are you showing up so your patients and the people in your community, future patients, understand that you are the portal, you are the best first option, that movement based care is where it's at and that if and when you need surgical intervention, it's going to be there. But that's not where the fix is. It's not where people should start. And it's not where after 14 days of taking a Tylenol or for physical therapy visits and that meets their insurance criteria that you go under for a laminotomy, laminectomy or foraminotomy. It means that you need to take some personal responsibility. That's hard. But as chiropractors it means we need to get our message out there. Because when 90% of people have back pain. There's 25 million ESIs given per year, epidural steroid injections, and over a million elective spine surgeries. And our market share is less than 15%. That means that there's a communication issue. No national organization is going to fix that. What's going to fix that is us showing up every single day and doing our best in our practice, which I think most of us do most of the time. But it does require extra work.

I think too. Like, where Jeff's unique in his space is that there is a whole movement in evidence based chiropractic that is like trying to tell us that we shouldn't adjust our patients. Like, they're giving us a million reasons not to adjust our patients. And what's so ironic to me is like, they're like, we'll read the read. I'm like, yeah, there is thousands of papers to support what, you know, us delivering manipulation in a good way. So I, I commend you for that because, like, in a world where, you know, in the evidence based world, it's literally not cool to say that you're adjusting your patients. I mean, I spend my life on weekends saying, why the hell would you not take advantage of one of the most powerful tools that we have to get people better from a musculoskeletal standpoint.

I 100% agree. You can't.

I don't get that.

What you can't have. I always think about it. I say segmental, regional and whole body. There's whole body movement, regional movement, and segmental movement. You cannot have optimal regional and whole body movement if you don't have optimal segmental movement. Like, it's just, you are by definition compensating. Like, you know, so you're going to, in your. But you can always get away with everything. You can get HSL patients all the time. You sit all day every single day. You can get away as days become weeks, become months, become years. Things add up. Shit adds up, right? So it's like your gravity is undefeated. Like, injuries happen. Like biomechanics matter. You can always get away with something for a certain amount of time. You don't know how long you have. George Burns smoked, you know, 20 cigars and like, he's fine, but like, you know, it's like your body, every, all of us have different tolerance levels is my point, of anything. And the same is true of how we experience pain and how we experience gravity and how we experience aging. And there are things you can do to move the needle a little bit. One direction, there's things you can move another direction. But you cannot have optimal whole body motion and regional optimal motion without segmental optimal motion. It's a pyramid. It has to be built on a strong foundation. And that doesn't mean that every segment is going to be optimal every single time. It needs to get adjusted every single day. But what it does mean is that if you're sitting hours per day, if you're stressed out, if you're nutritionally deficient, if you, whatever it might be, tracing it back, I'll go, I'm gonna go there. Tracing it back to 1895. If you have thoughts, traumas and toxins, if you are eating like crap, if you have negative thoughts all day and you're not moving, well, you're gonna have an uphill battle. One person might be able to get away with it for a whole lifetime of they're living their best life and live to 120pain free. But quite often that's gonna catch up to you. And in my opinion, us as chiropractors, we do get that experience to understand nutrition. We do have a unique slant. My wife's a physical therapist, talking about it all weekend. She's like, there's no physical therapy conferences that I go to that talk about human performance. And I mean that from a business and a mindset stance. She's like, everything we do is technical technician specific. But when there isn't, there's a person in there, right? And there's a mental component to that. And of course, then how are they moving? Are they sitting all day every day, are they driving to work? Things add up.

But since you're the expert in it, why do you think this is on that point, why do you think that there's a group in our evidence base? You would think that they would be on a crusade to figure out, to support what it is. But in this weird irony, it's almost like they're trying to give us reasons why we shouldn't be. It's the weirdest. It's reactionary dichotomy.

It's reactionary to me. So there is the whole. It's a reaction. Bye, Will. It's a reaction to something they don't like. So it's a reaction to a vitalistic chiropractic approach. And then it's gone the other way. You know, talking about. I was talking about this with Alex Vadan earlier, earlier this weekend. It's like, you know, people, there's so many chiropractors that pride themselves on super high or super low pva. And it's like, what about like, just like whatever should be normal, you know what I mean? Like, yeah, it's like I get my patients out of my office in two visits. I'm like, well, you are doing a shit job. You can't change somebody's life in two. People have habits. They might feel better, but we all know pain is the last thing to come, first thing to go. It doesn't mean that they are functionally and foundationally improved. That doesn't mean that everybody is going to be functionally and foundationally improved. That's okay. That's why you need to understand your care plan is based upon. Your care plan is based on two things. Our findings and your goals. What's your evaluation? What's their health goals? Those two things should combine and that should provide what your care plan or your recommendations, treatment plan, however you want to define it, is. But I firmly believe, to answer your question clearly and succinctly, it's a reaction to something they don't like. And quite frankly, I'll get really real. I think it's many times a money issue, and I'll just call it as it is. They see super successful vitalistic chiropractors meaning money, and they are reacting to the fact that their practice is struggling and they build up an intolerance and a hatred and then they try to pride themselves on going the other direction. And I think it's just, it's too bad.

And it's just that actually hits it.

But nobody wants to talk about that. But I'm glad you brought it up.

But I mean, since that's your handle, I mean that's, you know, that's an important topic to talk, you know, because we see that all the time, like in that. And we're in that group. So I pick on them, you know, ingest and good nature. But because like sometimes like the evidence based chiropractors, they're also our most struggling chiropractors, which it shouldn't be that way. I mean like the evidence based chiropractors, they should be leading the charge, basically.

So. Yeah, well, what a great way to finish. I love that tangent. It seems like you get on a tangent almost every episode, which is a good thing because it needs to be said, needs to be heard. So. Jeff, what a pleasure. Go to thesmartchiropractor.com their lead magnet, right on their front page. They got it pulled up right now watch our five minute marketing makeover. What an easy way to kind of go through Some simple stuff that we talked about today. And I think you just gotta start somewhere, you know, just start somewhere. Even if it's as simple as paying someone to go through your website, which I know that you offer that service as well, and just give some actionable steps where you can start. And sometimes paying that 10 grand to that developer with the complicated website design and stuff like that isn't always the best way to go. And having a little bit of coaching with that is. Is never a bad thing. So check out Jeff Evidence based Chiropractor Podcast, evidencebasedchiro.com and Smart Chiropractor anywhere else. Did I miss anything?

No. That's great. I really appreciate what you guys are up to. I am not a. I don't teach the clinical aspects of care. I think it's super, super important. And I have just been super wowed. I've been following the guest list at what you guys. I feel super jazzed that you asked me to be on because I'm like looking at the guest list of who you guys have been able to land and I'm like, oh, this is sick. So thank you. Thank you so much for what you guys do.

You deserve.

Absolutely. I mean, again, if you don't have any patience to work on integration or work on these things, then it doesn't really matter. So this is vitally important and this information is great. So thank you. We'll see you next time. All right, we got some cool stuff coming with Jeff, so just hang tight. We'll have some awesome stuff coming out and thanks for being here and good luck with patience on Monday, guys. I hope you enjoyed this episode of the Assault Education Show. If you liked it, share it, subscribe to it, send it to your friends, send it to someone that needs to hear this message. We really want everyone to be able to tune in and get the best clinical advice that they can, which we're hoping that we're giving to you with these special guests. So if you have any questions, please feel free to reach out to us. Or if you have any suggestions on upcoming conversations, let us know. For a list of our upcoming courses, we're adding them all the dang time time. So go to gestaledu. Com, click on courses and they'll all be right there for you. All right, have a good day.