When To Add A Second Decompression Table or Laser

Hey there and welcome back. I'm Dr. Vince Leone, executive producer and co-host of the Practice Builders Podcast. With my partner in crime, Dr. Kyle Pankinen, we deliver proven strategies to help you grow fast, specialize with confidence, and build profitable staff-run practices. Let's go ahead and dive into today's episode now.

Hi, I'm Dr. Kyle Pankinen, and welcome to the Practice Builders Podcast. I'm doing a solo mission today. Dr. Leone is a little under the weather this week, and, uh, but we'll survive without him for a week here. And, uh, he's a very valuable though asset, and, uh, we love him and, uh, can't wait to have him back with us. And of course, he's done some of these without me too, so it's only fair that I get my shot at it once in a while. And so we'll do our best today. I want to talk and address the topic today The title being, Already Have Decompression or Laser? Do You Need Another? And I bring this up because this is a question that a lot of doctors have for me. A lot of the clients that we work with at Specialized Practice, when they start to add in these niches and cash-based services, we see a lot of them that really take off. Talking to one doctor just earlier this week, he's literally just started the decompression niche in the last month or two, and he's signing on anywhere from 4, 5, 6 new startups a week. Well, that is very significant, and he's only got one table and one laser, and he's already starting to feel the crunch. In other words, the crunch of Do I need to add another laser? Do I need to add another decompression? Do I need more staff? Do I need more space? So this is this is for doctors that have maybe already invested in decompression or laser. It's working. Patients are liking it. You're liking it. You're seeing the results. But now your staff is telling you your. Laser rep or your table manufacturer rep is telling you what, imagine if you had 2. So this episode is not necessarily, you know, convincing you to buy more equipment. It's to develop a process of thinking whereby you determine, yes, it's time to add more equipment. Or no, it's not quite the time yet. Sometimes the right answer is not yet. Maybe you need to shore up some other things. So we'll touch on some of those things as we go through. So it's really about timing. What's the right time to pull the trigger on that next laser, that next decompression table? It's about utilization. In other words, how much are you currently utilizing your current decompression table or laser? And then it's about the return on investment that you can get from adding a second piece of equipment. So there's some— as we go into this today, there's some common mistakes that I think that doctors make when they're contemplating adding more equipment on. And it's really about optimizing what you have. That's the big one, optimizing what you have before buying. So most clinics don't have an equipment problem, they have a utilization problem. So I just talked to a doctor, he contacted me via Messenger, a past client, and He's looking to sell his laser, and he bought a $50,000, $60,000 robotic laser, and he says it's just not working for me. Well, what does that mean practically? It means he's just not using it. He's, he's underutilizing it. And because I know the laser works, because I have 6 of those lasers, and we— and I've kept track Statistically every year on those lasers for 8 years in a row, and I know they consistently get 85 to 88% success rate across the board, hands down. And so it's not that the laser doesn't work, it's that he doesn't have confidence. He's not recommending it enough. He's underutilizing it. And so instead of learning What he needs to do better or how to utilize it better or learning correct protocol, he's just bailing ship. That's a classic case of underutilization. But I see— I've talked to many doctors over the years that have a robotic laser. We like the MLS Cutting Edge laser, M6 or M7 here at Specialized Practice. But they literally, as I like to say, they have a BMW or a Mercedes sitting in the shed. Collecting dust and not being used. They're underutilizing it. I've talked to many doctors who have a decompression table that, eh, I use it once in a while, but they don't have the protocols. They don't have the clinical acumen to really understand when and where to utilize it. So it sits and it basically collects dust and it is underutilized. So if your current table or laser isn't busy, Another one won't magically fix that. So here are some quick self-check questions that you can utilize to see, okay, do I need to add on another unit? So I would say if you're in the neighborhood of 70 to 80% of your available clinical hours when you're treating patients, If 70 to 80% of that is filled with laser and/or decompression, both, you're kind of at that threshold where it starts to make sense to pull the trigger on a second machine. So that's 70 to 80%. Like I said, if you have some type of waitlist or a scheduling bottleneck, Especially in your peak demand times. So in other words, you have people that, well, we want to start them on decompression, but we got to wait till we get a little room. We got to wait a week, or we got to wait 2, 3 days, or we got to wait 2 weeks. That's a problem. If there are bottlenecks where you have your, especially your peak demand times, what are those? Well, those are the times when everybody wants to get in, right? So that's usually early morning and late afternoon, or sometimes over noon hour if you allow patients over that time. If you're having more demand than what you can handle for that equipment at those peak demand times, then you got a problem. You have a bottleneck. And so with these niches, when you're starting people on these cash-based services and niches, you don't want a big delay. with these, because people, once they make up their mind, you finally get them to the point where they're ready to commit, they're all in, they generally want to start right now. And if you're having to put them off for days or weeks, you're going to lose momentum on a lot of those patients and they're going to fall out. If you're answering no to some of these questions, well, no, I'm not at 70 to 80 70 to 80% capacity. I'm not seeing bottlenecks. My peak demand times, we're processing fine. Nah, then it's probably not time, and you just need to focus more on optimization. So, so signal a signal. So if you're hitting a scheduling ceiling, patients are waiting. Or if you have more than one provider and, you know, this provider can't use the equipment because it's booked out too far, and so they're altering their care, their treatment plan due to equipment availability, then you're starting to think, okay, yep, we need to potentially pull the trigger. If you're looking to extend your clinical hours, Just to fit people in, well, maybe it's time to expand equipment. If your staff is saying, we're booked solid on the table, Doc, we're just, we're at capacity, we're booked solid, we can't fit any more in. When your staff start telling you things like that, it's time to start listening. So just a couple of short personal stories. So A couple of times in my 25-year career, I've had to make the hard decision that in order to keep growing, I needed to expand my capacity. And in this case, it was my physical capacity. I needed more space, I needed more staff, and I needed more equipment. So my first clinic, Started in 2000, very small clinic, just my wife and I started from scratch, 960 square feet. And we, we put in the blood, sweat, and tears and we grew that practice. And by 2010, we had more than outgrown it. We were busting at the seams and expansion on that current site really wasn't all that feasible. It just wouldn't have worked very well to add on to that existing facility. And so in 2010, I had to make a decision. Either this is what it is, we're kind of stuck at our current level of growth, or we need to do something. So we built new in 2010, just up the block from where my current first location was to my— the spot I'm at now. And we We doubled the size of our clinic from 900-some square feet to about 1,700-1,800 square feet, and we then started to grow even more, and so that by 2020-2022, right in there, again, same thing. We were at a crossroads. Either we are peaked out or we need to expand again. And so in 2022, we built an additional expansion onto our clinic and added another 1,500 square foot. And so actually it was 1,700 square foot. So 1,700 onto 1,800 to bring us to 3,500 Square foot. That expansion though was a major decision because— was it a big financial hit for me? Yes, it was, but it opened the floodgates. So we started with one laser, but that's all we really had room for. We had one decompression table back in the— oh, about 10 years ago. And now over that time, now we have 2 decompression tables and 6 lasers. And each time we invested in a new expansion, a new piece of equipment, the return on investment, it was almost dramatic, doctors. It was, we were ready for it. We needed it. It was a necessary thing. And the return on investment was tremendous. Quick turnaround with every piece of equipment that we've invested in. So a lot of doctors are afraid to pull the trigger. They know they need to expand. They know they need to add that second laser or that third or that fourth or the fifth or the sixth, or they need to add that second or third or fourth, whatever, decompression table, but they get gun-shy. They get scared off by the price tag, or this means we might have to do a build-out and expand our clinic, or get a new facility, or rent out or lease a different building to have that. And that is a risk, no doubt, but I would encourage you doctors that I have seen that risk firsthand pay off in numerous ways.

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So don't be afraid to pull the trigger when it is obvious that there are indicators that It needs to be done unless you're just at the very, very end of your career and you're looking to slow down. That's a different thing. But if you're still in your 40s and 50s, and even I would say early 60s, sometimes that is the answer is to take a mild risk and go all in and get that next. And so that, that's the only way you're going to get to that next level of growth that you're looking for. The other question that I get frequently from doctors with expanding laser or decompression is, what should I expand first? Well, if you listen to what I just said, I have 2 decompressions and 1 and 6 lasers. I think it's easier to expand your laser services, doctor, than decompression for one simple reason. There's only so many patients that are candidates for decompression therapy. Everybody that walks through your door in a chiropractic office is a potential laser patient though. And so for me, I have found it much easier to expand my laser services than decompression. And we've expanded decompression, no doubt. We, we needed that second table and that has worked very well. And it really worked, especially during those peak demand times. So, you know, when the people want to come earlier in the day, we can have 2 people running decompression at the same time. That really helped reduce a lot of bottlenecks that we were having when we had only one decompression table. But going back to the laser, if every person that walks through your door is a potential laser candidate, It's not hard to see how you can quickly utilize one laser up, in a sense, where it's busy all day long. And that's what we've seen as we add the next laser. We just recommend it to people. Everybody that comes in as a chiropractic patient, it's, we're gonna do chiropractic and laser, or we're gonna do— Laser and laser. Grafton technique and laser. We're going to teach you some exercises and do laser. Whatever you normally do, docs, just recommend laser in addition to it for every case. And of course, with laser, laser is the perfect complement to your decompression cases. They actually— I just— this was a really cool study, just came out in 2025. They actually showed that Class 4 laser actually can shrink the size of a lumbar disc herniation and also increase the A to P canal diameter of the central canal. And why is that? Well, laser reduces inflammation in the disc, it stimulates healing, and you have a disc herniation, then that can reduce in size. It reduces in size, it increases the canal diameter, which is exactly what decompression does as well. It increases disc height, reduces size of bulge or herniation. Therefore, laser and decompression are a perfect marriage. So you need the laser for your decompression niche, but, but you also need the laser for every other condition basically that walks through your door as a typical chiropractor. So I would say as a general rule, Most doctors should think about adding the second laser and optimizing that, and then the second or third decompression table would come after that. That's not a hard rule, but that's just a generalization I would make. Other things you need to consider when adding on a second laser or second decompression table is Do you have the staff? So you need the physical space. You also need the staff. So I have 2 staff people, that's their only job all day is to run laser, shockwave, decompression, neon track, setting up people on the neuromed for neuropathy. That's all day long. The robot is a wonderful investment Because it can mostly be run on attendant. In other words, they can set it and walk away. So, and you know, so you have to calculate that in. If I get this second decompression table, if I get this second laser, do I need to add on more staff? So things you need to think through. Is the laser that you're going to get, is it doctor-dependent or is it delegable?

Is it Can—

in other words, are you going to get the robot or are you going to get a handheld one? I suggest the robot because of that reason, that you can free up staff to do other things than just be standing there all day running a laser. And then, is onboarding a new staff person an easy thing? Well, it can be sometimes challenging to find the right one. Do you have physical space to actually put another Staff person. All things that need to be taken into consideration. When should you not add another unit? As we kind of bring this to a logical conclusion, you're just bored and you want something new. You're looking through the trade magazines and you're getting— you're seeing Facebook things and you're, you're kind of seeing the new shiny object out there and you're just kind of bored and want to dabble in or try something. That's not, that's not the right way to do it and to look at it. If your marketing is not dialed in, if you don't have good internal marketing and some type of external marketing going, uh, I've done a whole podcast on this, some of the things that we do from a doctor in the trenches day in and day out. But if you're going to add in new equipment, It's probably a good idea to have at least a pretty good robust marketing that's going to be built around that to drive flow and demand. If your staff is already overwhelmed, well, what effect is adding more therapy going to have on your staff? And again, ties back into, do you need to add more staff? But there are— if they're already at burnout, Overwhelmed. That's a big strong consideration into whether you're going to add this other piece of equipment. And then finally, of course, your current equipment is underutilized. That's the big one. So the goal here isn't more equipment necessarily, it's more impact with more chaos. But most doctors, as they get into the world of niches like we teach at Specialized Practice, the world of cash-based High-ticket niches and services. If you do this right, you will in a fairly short time be running up against these what I call good problems. Boy, this is taking off. My patients are getting great results. Revenue is going up. The demand is there, and we need to consider adding on this second laser or however many or. More decompression tables. That is exciting stuff, docs. That's the good stuff in practice. Those are decisions that, that you want to have to make versus, oh, things are going awful, what do we need to cut? Okay, and the practice of chiropractic as I see it today is really becoming such that there's very little middle ground. Either you have doctors that are— I see so many doctors that are just, just holding on. They're just, they're struggling. They're just surviving week to week, month to month, and they're keeping their overhead desperately low just to try to stay afloat. And then you have doctors that are just killing it. They have million-dollar-plus practices. They are continuing to expand in equipment and staff and size of clinics and stuff, and there's very little middle ground anymore. Uh, there's— so they're either starving or they're thriving is seemingly what we're seeing a lot more of out in the field. So these cash-based niches and services that we're talking about, they can help you to go from— Starving to thriving. And some— we see some doctors that literally are doubling their practices in 6 months, a year. We've even seen some quicker than that even, and it's so fun. It's so fun to talk to these doctors. They're so excited. This one doctor that I've been referencing a little bit who's signing on 4 or 5 cases here early on in his first weeks of doing decompression, Every time he gets a new one, he texts me, got another one, Doc, got another one. He's so excited about it. And I just keep encouraging him on and to keep his head down and to keep pressing forward. And, but we're gonna have to have that conversation one-on-one with him soon about when it's time to pull the trigger on that next table, that next laser. Do we need more staff? Do we need more space? So I hope this helped. I hope it just kind of, you know, not giving you definitive answers as to, you know, yes, it's perfect time for you or not, but to give you some things to think about as you ponder your next steps in clinical practice and expanding what you are offering. And so this should be a little what's your appetite We're super excited about the Practice Builders Podcast. It's growing. If you if you like us, give us a like, and if you don't, just keep your opinion to yourself. No, but no, we we love bringing this content to you. It's growing, and we are just so happy and so honored that you take time out of your day to. to listen to this, and we hope you find value in it. So for myself and Dr. Vince Leone, signing off for today. Have a wonderful day, and we'll be back real soon with another episode of the Practice Builders Podcast.

Hey, it's Dr. Vince again, and hope you enjoyed that episode. And if you're ready to grow your practice fast with high-value decompression patients then the Decompression Accelerator could be a phenomenal option for you. This is our 90-day sprint to help you scale with proven systems, staff-driven protocols, and full marketing support. And it's all guaranteed. Spots are limited. Head to www.decompressionaccelerator.com to learn more.