Stop Adjusting, Start Cashing In: The Power of Niche Chiropractic
In this Practice Builders Podcast episode, Dr. Vince Leone interviews Dr. Kyle Pankinen about how he built a $1 million‑plus chiropractic practice in the tiny town of Lamberton, Minnesota (population 850). Kyle recounts his path from a college internship with his uncle, to opening a 960 sq ft office in 2000 with community newspaper publicity, and spending a decade delivering traditional chiropractic services. By 2010 he outgrew his space, acquired a city lot for $1, and doubled his clinic size. Despite high patient volume, his bottom line stalled, prompting an “aha” moment in 2014 when he added cash‑based niche services—spinal decompression, laser therapy, neuropathy, knee and plantar treatments. After a few years of trial‑and‑error, Kyle partnered with Specialized Practice in June 2020 (mid‑COVID). The partnership provided protocols, reporting tools, marketing systems, and sales training, enabling him to scale the niche services. Within four years his monthly collections rose from $48 k to $100‑$110 k, surpassing $1 M in annual revenue, and his clinic expanded to 3,500 sq ft. Kyle shares strategic advice for early‑career chiropractors: master core adjusting skills, adopt a differentiating niche (often decompression) early, become comfortable discussing money, and use structured reports of findings to convey value. He emphasizes that most spinal patients need non‑surgical care, and that focusing on high‑value disc and stenosis cases can drive both clinical success and profitability. The episode concludes with encouragement that any chiropractor, even in a small town, can replicate this model by offering differentiated, cash‑based services.
Chapters
Welcome to the Practice Builders Podcast hosted by Dr. Vince Leone and Dr. Kyle Pankinen, your source for building cash services. Let's dive in.
Hey, welcome everybody to the Practice Builders Podcast. I'm with our co-host, Dr. Kyle Pankinen. My name is Dr. Vince Leone from Specialized Practice. Dr. Kyle, how are you today?
Hey, I'm great. Had a good week in practice, and I'm excited to be here with you today doing the Practice Builders Podcast.
I love it. I love it. Today I want to talk about Kyle's story because Kyle is so— Dr. Kyle is so interesting. He practices in a town of 850 people and has a $1,000,000 practice. Now that— because, you know, some people are like, there's just no way. And whenever I tell Clients that story that or not that story, but that hey, if Kyle can do it, you can do it. I know that, you know. But we want to focus on Dr. Kyle's story and how you know how did he get to where he's at? He does all four niches. You know, decomp neuropathy, knee pain, plantar. I think you have some functional medicine going on, or you did at one point. I'm not quite sure how you do this, but let's, let's dive into your story because I think that doctors will get a lot of value hearing how you started traditional chiro, how you got into niches, and then how you grew. So let's, you know, give us a little snapshot of How did Dr. Kyle get started?
Yeah, so I was still in chiropractic college. I was finishing up my final T10 internship for my uncle, who's a chiropractor, Dr. Vince Pankin. He's in Perham, Minnesota. And you're getting towards the end, you're like, what am I going to do? Uh, you know, I'm going to graduate from chiropractic school, so I either got to start on my own or find a doctor to work for. My uncle At that point in his practice career, really wasn't financially well on and off enough to bring an associate doctor on. So I knew I had to branch out on my own, and I started looking at some neighboring towns around the Perham, Minnesota area where I was practicing with my uncle or interning. And I got a phone call from a gentleman named Steve Krinke, who was the president of the Economic Development Authority in the little town of Lamberton, Minnesota, where I happened to graduate from. 850 people, and we had a long conversation, but it basically went something like this: Kyle, we heard you were in chiropractic college. Would you consider coming back home if we helped you get started? Well, it's not every day. It's not every day you get an offer like that. Wow!
I did not know this.
Yeah. So they helped me to. They had a little office building in town. That was a little— it was a little bank building, but that bank needed a bigger building. So they were going to move out of there to a bigger building up the street that was a business, an insurance business, because the insurance business was going to move across the street and build a bigger office for themselves. So it was going to be like 3 different moves for these businesses.
Yeah.
Well, that first office was about 960 square feet. That was April of 2000, we opened. Never forget my first patient. I was so nervous. I did the history, wrote everything out, got to the— took her to the exam room, and I literally froze. I was like, exam? What am I supposed to do? I literally had to like stare at my examination form and be like, oh yeah, supposed to check range of motion next. So I'd go over and check range of motion. Or pal patient.
How did you wait? How did you get this patient? Where did she come from?
She was. I'm trying to think how that first patient found out of me. Well, I know being small town, they had put it in the local newspaper. This new business started.
Oh, perfect! I love it.
So I had a lot of publicity going into it. I mean, in a small town of 850 people, this is big news—a new business starting. So she came in, I fumbled my way through that exam. Long story short, she ended up being a patient till the day she passed away and referred me oodles of patients. But so from 2000 to 2010, I just did traditional chiropractic.
And 2010, so 10 years, for 10 years traditional.
I practiced 10 years in that little building traditional. And then by that time, I had outgrew that little tiny office space. And in 2010, there was an open lot just up the block from my existing space that was actually a double lot. And I approached the city and said, I'd like to buy that lot. Oh, they were so excited and they sold it to me for approximately $1.
What? Yeah, small town values. I love it.
Well, rural America, a lot of the towns are struggling. And, and at that time, Lamberton was struggling too. And so they were just happy that somebody wanted to do something with the lot, period. It's not like businesses were clamoring to get into Lamberton. And so I built a new clinic in 2010, doubled the size of my practice building from about 900-some square feet to about 1,800. Fast forward to 2014, 2013. I kept building the volume of my practice up, adjusting traditional therapies, electric stim, ultrasound. I did buy a really a low-level laser, but I didn't use a lot. Some orthotics, things like that, but just everyday stuff that any chiropractor would know and do. And but I was in practice now for 14 years, and I'm like, I would look at my bottom line every year, and it's like I treated a boatload of patients this year. I worked my tail off, and we are getting nowhere financially. I mean, we're just getting by month by month. You come out of school, you got student loans, you build a new practice, you got a lot of payments, you got a house, and it's just like I can't keep busting my butt like this and getting nowhere financially. I have to do something different. And I finally had the, what I call the aha moment, where I'm like, uh, I talked to a friend of mine, a colleague of mine, Dr. Jim Huffling in Superior, Wisconsin, and he started talking to me about things like decompression and laser therapy. And so, you know, I thought, hey, decompression, cash-based service. So in 2014, I bought my first decompression table, and, uh, and then subsequently, then I bought a laser, and I started to at least explore the world of niches. And I kind of fumbled my way through it for a few years. I didn't do really well at it. Fast forward to 2020, and for about a year I had explored. I've been researching Dr. Vince Leone, this guy that always was showing up in my Facebook feeds, and I'd see him on YouTube, and he was talking about niches and specialized practice. And so, after talking to him and researching him and and dragging my feet for about a year. In June of 2020, I signed on with specialized practice right in the heart of COVID right in the heart of it. I mean, it was practices. Yeah. And practices all around the United States were being shut down. But thankfully in Minnesota, we were allowed to stay open. And I saw an initial dip. It was March and April. My practice went down like 20 or 30%, but then it rebounded and came back up in June. I signed on Dr. Vince. At that time, I had built my practice to about $48,000 a month, which pretty good for most chiropractors, but still financially things were pretty tight. And what we did is I had the niches in place. I had decompression. I had just started some neuropathy knee. But I didn't have the flow of patients as far as getting people in the door for these niches in any big way. I didn't really have any good systems and things like that in place. And so specialized practice taught me how to do those systems, to do proper report of findings with these people, to qualify these patients, and also help me with the marketing component. And so fast forward now to 2023, we eclipse the $1 million plus in collections mark. So from June of 2020, $48,000 a month, now we average right at about $100,000 a month. And this month, May of 2024, we're going to be probably about $110,000, uh, in collections this month. So in less than 4 years, we have doubled a practice that was already well established for 15, 20 years. But now with just adding niches and all that growth, all the growth has been in cash-based services. So now my practice is 50% insurance and 50% cash, or even a little bit more is cash, but we still accept insurances and so forth like that. So I still have my traditional chiropractic practice, but we added in the niches, and almost all of our revenue growth has come in that area. And we actually built an expansion onto our new building that we built in 2010. We built an expansion in 2022 to go from 1,800 square feet. Now we have 3,500 square feet. And I wish I would have built it bigger because we're running out of room again.
I remember when you built that. And I think that's— once you built that, I think that's when you When we went past $100,000 a month? Yes.
So the first year, yeah, the first few months into building that is when we first eclipsed. I think we finished building it late in 2022. We had a few months in there and then I think it was March of 2023. Yeah. What was the first time we eclipsed $100,000 a month? And now You know, we don't do it every month, but we'll probably have the way this year is at least six to eight months this year where we'll be a hundred thousand plus, and we'll be probably approaching one point two million in collections this year. That's one doctor, five staff in a town of eight hundred fifty, and then my town of eight hundred fifty is actually one of the bigger towns in my area.
True story. So, um, well, that's really interesting. Um, I think if you were talking to a young doctor, right, because here's who I'm concerned about. Um, well, I'm concerned about the guy that's been in practice for 20 years and he's still doing $20,000 a month. Um, but I'm concerned about the young doctors in the, say, the first 5 years of school because You know, you're saddled with this big debt typically. So you may be a little nervous to take on more debt, right, with the equipment, etc. But, you know, at the same time, you know, when they're younger, they typically are a little more tuned into some of the social media platforms that they can, you know, use to generate new patients. But I don't know, what would you say to a young doc? That is thinking of getting into these niches? And I don't know, like, what would be your advice to a young Dr. Kyle?
Yeah, if I had to do it, if I had to go back and tell myself my first year practice or second year, I would say, you know, build your clinical skills up, build your confidence up, get good. You gotta be a good— you gotta be good at adjusting. You gotta be good at chiropractic because that's your bread and butter. But I would also at the same time say within that first 1 to 3 years, you need to do something that's going to set you apart.
Yeah.
From your competition. Because only— I don't even think 10% of chiros out there are what we would say. They're generalists. They're not specialists.
Yep.
And so you need to do something earlier in your career to set yourself apart That's gonna attract a certain subset of patients to you. And as we shared on our previous podcast, decompression is probably the starting point into the world of niches for most young docs because you can enter that at a reasonable price. You can get a laser and a decompression table. You don't have to get the high-end ones right away out of the box. And you can get some specialized training in disc conditions and hone in your clinical skills, your exams to focus on disc and learn a decompression protocol and start to implement that early in your career. That's gonna set you apart because dirty little secret in chiropractic is the public sees us as spine pain experts. But most chiropractors struggle with disc conditions. They struggle with spinal stenosis.
They, they do. And also in school, I don't know about you, but like my school was heavy into wellness right now. What in the world is wellness? Wellness is a different thing to probably— if you ask 10 different people, they'd probably all have a different idea of wellness. And so, but I'll tell you one thing for sure. No one in the, in the, in the kind of general population thinks of chiropractors as wellness doctors, right? So we really need to just follow what the public thinks of us. We, we're pain docs, right? We, we are supposed to fix painful conditions related to the spine and sometimes the joints. And so, I mean, look, if you want to be like a Chris Zaino, like Chris Zaino. Look, Dr. Chris Zaino, he's a unicorn. He's probably, you know, maybe 2,000 adjustments a week. He's got a bunch of doctors, and, and he probably— I, I don't know why I like it— probably goes to the bathroom at a restaurant and comes out with 2 new patients. I mean, he just is a magnet for new patients. He's on fire. He's on— he's like the chiropractic message. I love it. Here's the problem: he's a unicorn. And what I would tell my younger self or younger doctors is don't try to be a unicorn because that's like a 0.01% chance of success. Put yourself, give yourself the odds of success. You already are an expert in spine. Become an expert in disc. Add a niche like decompression so that you can, you know, charge a relatively high-value cash case fee. because you deserve it. But don't— just don't put your eggs in a basket where it's like, hey, if you're not that guy, and you know if you're that guy and you're not, and probably each class usually has one. We had— what is his name? Brian Clay. Brian Clay was kind of a Chris Saino. I don't know if he was quite as big. I don't think he was, but he was kind of a— he was like kind of that unicorn type. He was rocking and rolling right out of school, like just crushing it. But he was the only guy. I wasn't that guy. You know, you weren't that guy. My dad was kind of that guy, right? But I wasn't that guy. And if you're listening to this podcast, you probably aren't that guy either, because it's such a small, tiny fraction of our industry. And it's just like, if you're not that guy, just recognize it, but then go with the odds. The other thing I would say, you got to learn how to be able to talk money with You just have to, and I'm not saying like closing, like you got to become some expert salesperson, but you have to be able to talk, be able to talk money with patients and not fumble and bumble through it and be all nervous and stuff. And walk them through a very structured report of findings that explains why you're recommending. And we'll get in, we'll do a whole podcast on ROF, right? But you got to be able to talk money with patients because if not, then they're not going to trust you and believe you and have confidence. in you, and then they're not gonna— they're not gonna sign up with you.
Yeah, 100%. So that would be— that's— you gotta, you gotta try to enter in a niche early if possible to distinguish yourself. You gotta get that clinical confidence. You gotta get confident talking about money. And most people, they realize value when they see it. If they walk into a doctor's office that shows them Clinical skills and confidence, and you can look them directly in the eye and say, "Mrs. Jones, we have a really good shot at helping this condition. We have the tools. We have the training. It's going to cost some money, but if you can give them a really good sense that you're the guy or the gal that can make a difference in their life to fix or at least significantly improve." Their chronic pain condition that they're coming in, most people are willing to pay money because medicine doesn't have the answers for pain. What is medicine gonna offer? Pills, shots, and surgery. That's all they got.
Yeah.
Pills don't fix anything. Shots temporarily mask it. And for spinal condition, only about 2 to 3% of cases truly ever require surgery. That means 97 to 98% of them need the type of care that we offer. Most of those patients are gonna be chiropractic, but about 10 to 20% of them are disc cases. They're spinal stenosis cases. The, the 10 to 20% that costs the healthcare— the healthcare world 95% of the cost of treating is in those groups. And so If you have a specialized service like decompression and a really good protocol built around that, you're gonna take on these challenging cases and you're gonna get paid more. So you're gonna have success clinically and you're gonna have success financially. That's how you build a practice early on in your career is distinguishing yourself like that.
I love it. I love it. And that's a great place to wrap it up. And so I really enjoyed hearing more of your backstory, Dr. Kyle, because I wish someone called me up from my hometown and offered to start a business for me. That sounds pretty cool. But, you know, there's something to be said for really what you built there. And, you know, now you are the resident expert. I mean, Kyle's probably, I would probably say within a because we advertise within about a 50-mile radius. Dr. Kyle is pretty much famous in that area at this point.
We get patients routinely from an hour to an hour and a half away, driving a circumference around Lamberton in all directions from that far out. And some of these people are coming for you know a decompression protocol. It's a three-month protocol, so there's quite a few visits, and they are. They are coming because we're offering something that they're not getting anywhere else, and so it's we're differentiated. And absolutely. So if I can do it in a town of 850, you can do it wherever you're at too.
Exactly. That's what I wanted to get across. Okay. So let's wrap it up there. Thank you everyone for listening. And you know again. I just will continue to say is if you got value out of this, if you could share it with a friend or colleague, if you could, you know, leave a review, uh, in the review if you want to talk about what you would like us to talk about, 100% would love that feedback. Give us a 5-star rating, but most importantly, share this with someone else. Our goal is to help as many chiropractors as possible grow their practice, impact their community, And truly make a difference in their life. So, uh, any parting words there, Dr. Kyle?
No, I'm just excited about the journey that lies ahead, and I'm excited for the people that are going to listen and get— hopefully get value out of this. And, uh, we're just gonna have a lot of fun along the way.
I love it. Okay, that's gonna wrap it up for this, uh, episode. So we'll see you all in the next one. Have a blessed day. Take care.
