Chiropractic + Naturopathic Doctor

It’s about time

Anthony Lombardi   

Features Business Management

Making the most of a precious resource

I became a chiropractic student in the fall of 1999 and graduated in the winter of 2002. I started my own practice six weeks later. Ever since, I have been finding ways to use and manipulate time to improve the quality of treatment I deliver and enhance the overall patient experience.

For me, time is power. Power to get people better faster and differently than what they are used to. This is powerful because it allows me to have distinction, which gives patients something to talk about when engaging others with similar problems – and this leads directly to referrals. It’s also power because it attracts other chiropractors and therapists who wish to work with me and help me help more patients.

It’s basic physics: power=work/time or P=W/T. I am able to manipulate this formula in different ways to ensure each treatment is a powerful one. During my assessment, my functional approach allows me to reduce the amount of time it takes to find the problem. By reducing the time variable during assessment, the power value increases. Because I can spend more time on treatment, I can do much more work on the soft tissue and peripheral nervous system, and this, in turn, further increases my power variable.


For my associate therapists, time can mean money, and time can also reflect the quality of their work. For instance, chiropractors who have RMT designation begin to realize that once their practice begins to grow they shy away from doing massages because they can make significantly more money seeing chiropractic patients. For example, a one-hour massage requires four 15-minute time slots and one 15-minute time slot for table preparation. A one-hour massage costs the patient $85, while five 15-minute chiropractic appointments cost patients $50 each – which means they would be earning $250 in the same amount of time.

Time can also reflect quality of treatment and how valued your associates feel. Our physiotherapists spend 30 minutes with each patient – that’s two patients per hour. In addition, only the physiotherapists (not assistants or kinesiologists) spend time with the patients, and the treatment is always one-on-one.

One established physiotherapist told me that jobs are quite easy to come by in their field. However, finding a good job that involves mentorship, reasonably long treatment times, and fair pay is more difficult. He said in his experience, a therapist may be paid $35 per hour and be pressured to see four to six patients an hour in a full day. In my practice, I make sure our physios see two patients per hour in a relaxed work environment, while they work on incentive percentage rather than salary – so the more patients they see the more money they earn.

It’s important that your clinic employees receive enough “time” as well. Naturally, time can be in the form of paid hours at work, but even more significant is providing time for them in the form of meetings and communication. Frequent interaction with your employees ensures the growth and development of your practice and the nurturing of the employer-employee relationship. In my practice, I meet with every member of the support staff individually for five minutes per week so that duties and responsibilities are clarified and understood. calculates that Canadians put a value on their time that amounts to an average hourly rate of $27.75 after tax dollars. During times that I run behind schedule at work, I often think about this statistic because not only does it motivate me to stay on time but it motivates me to give my patients the best treatment experience possible – when it’s their turn. I respect my patients’ time and the fact that they chose to spend it in my office. I make it a point to demonstrate this through quality assessment and treatments that produce outstanding results.

What if you could decrease your time while increasing the time of patient visits? This way, people would perceive a high sense of value associated with your services along with the high quality of your clinical treatment. This can be accomplished through refined assessment and pinpoint treatments – which complement the core of our profession.

I use the EXSTORE assessment system. I find this effective because it can be completed in about three minutes, which allows me more time to spend on treatment.

Acupuncture, electroacupuncture or medical acupuncture allows you to provide restorative aid to inhibited muscles, normalize neurogenic inflammation and control the autonomic nervous system, while allowing you to be omnipresent in more than one room at once.

Multiple rooms
The more rooms you have at your disposal, the easier you will be able to clone yourself (and your treatments) within the universe of your clinic. Usually, I have three to five rooms available so I can assess or reassess patients and get them started on needles. Then I move on to the next patient, do my soft tissue work and adjust them before starting a third patient on needles – from which time I return to the first patient where I apply soft tissue and joint manipulation. I repeat this process throughout the day. Patient visits last about 20 minutes long. I am able to see five or six patients per hour because I’m able to be in more than one place at
a time using my assessment system and

Text messaging
In our office we use text messaging daily to remind patients of their upcoming appointments. Patients receive a text reminder the day before their appointment. Patients can also text the clinic to request or change an appointment. This doesn’t tie up phone lines and it streamlines the time our front end staff is occupied so they can spend more time serving patients in the clinic. I also use text messaging to notify the front desk when I’m ready for the next patient. Because I’m busy assessing and treating from room to room, I text the front desk letting them know to bring the next patient into an open room. Once I leave one room, I step right into another room with a brand new patient that I’m able to work with. This way I can spend time treating patients as opposed to spending time walking back and forth from the waiting room.

Here are some other ways to maximize your time:

  • Train one or two people to bill insurances and prepare outstanding accounts – then meet with them every week. The meetings take an average of seven minutes and it keeps things updated and your coworkers accountable from week to week.
  • Hire associate DCs, physiotherapists or RMTs to work out of your office at the same time as you or during times when rooms are free. Generating passive income takes some financial burden off of you and provides a place where your patients can access several treatments throughout the day and evening.
  • Once every four to six weeks I meet with every DC, PT and RMT on our team to review goals, address ways I can help make their patient care better, and set new goals.

Lastly, do not forget to spend time improving yourself. I spend five minutes everyday reviewing eight to 10 motor points and another five minutes reviewing two or three different “moment of truth” questions, just in case I get one I’m not prepared for.

Every aspect of our practice needs to be continually monitored to ensure long-term success. Please email me at if you have any questions – I’m happy to take the time to reply.

Dr. Anthony Lombardi, DC, is consultant to athletes in the NFL, CFL and NHL, and founder of the Hamilton Back Clinic in Hamilton, Ont. He teaches his fundamental EXSTORE Assessment System and conducts practice-building workshops to health professionals. Visit for information.

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