Chiropractic + Naturopathic Doctor

Looking Inward – Part 1

By Scott Newman Shawn Veltman   

Features Business Management

Whenever the economic climate starts to look rough, the vast majority
of practice owners start to worry about what a decline in patient
numbers will mean to them, their staff, their practice, and their



Whenever the economic climate starts to look rough, the vast majority of practice owners start to worry about what a decline in patient numbers will mean to them, their staff, their practice, and their family. Automatically, they start to think about ways to try to “drum up new business”.  However, this might, in fact, be the perfect time to examine existing systems, and determine ways to better leverage their potential for practice success.

It’s going to be a lot harder, in tough economic times, to get new patients but, also, to get them to stay. So, perhaps it would be more worth your time to examine your existing patients and practices, and make these work better for you.


In this two part series, we’ll discuss four important areas of your practice that you may want to re-examine. These are:

  • investing time in new patient visits
  • patient retention strategies
  • patient reactivation programs
  • efficient use of strategies for best outcomes

Take a second and answer the following two questions:

  • How much time does it take you to see a patient on their 50th treatment?
  • How much time does it take you to see a patient on their first treatment?

You didn’t have to think about it at all, did you? Of course you spend a lot more time with a patient during their first few visits, than you do after they’ve had dozens of visits with you.

Now, let me ask you three more follow-up questions:

  • How much revenue do you generate spending an hour with a new patient?
  • How much revenue do you generate spending an hour with existing patients?
  • Who is more likely to come in for a future visit: the patient with 50 visits, or the patient who’s on their first visit?

If you’re like most of our clients, your answers to these questions are something like this:

“I’ll generate a LOT more revenue per hour by spending time with regular patients, and those are the patients who are likely to continue their treatment with me.”

So, if you generate more revenue by spending your time with existing patients, and you’re more certain they’ll continue to be members of your practice, then why in the world would you spend so much time up front with new patients?

You’ve surely heard the old carpenter’s saying “Measure twice, cut once.” What that’s telling us is that it’s better to take a little more time up front and be sure we’re right, than to make a mistake and be left with a disaster on our hands.

In the case of new patients, the “measuring twice” piece is in making sure you’ve answered all of their questions, dug deep to see if they had any questions they weren’t asking, and made sure they understand the full treatment process.

The only way you can do this is to help them understand what you’re doing, and how it works. When these things aren’t focused on – when things get rushed, and patients walk out without these understandings – new patients are far less likely to come back.

When new patients don’t come back, you’ve effectively robbed your existing patients of time they could have had with you, and you’ve robbed yourself of that time.

On the other hand, when you ensure that every new patient who sees you walks away with a real understanding of what will go into their treatment, you’re much more likely to keep them and have them become long-term patients.

Let’s change gears, and talk about patient attrition.

Who’s more likely to be in for an appointment within the next month – a patient whose last appointment was yesterday, or a patient whose last appointment was six years ago?

The answer – and the point – is obvious. The patient who was in more recently, will be most likely to come back.

In fact, it’s such an obvious point, that almost all practice owners overlook the importance of it – which is extremely costly, both in monetary terms and in terms of patients lost.

This point is important because it is a vital factor in two of the most impacting and important marketing activities your practice can engage in – patient retention and patient re-activation.

They’re both incredibly powerful strategies. However, most consultants and “experts” spend more time talking about patient re-activation, and for good reasons – it’s one of the absolute best ways to spend your marketing energies and it’s pretty easy to track.

But, even though most chiropractors clearly understand the importance of patient re-activation, they also understand that there’s a more powerful strategy: “I don’t want to have to RE-activate my patients! I don’t want them to be leaving in the first place!”

So, what systems do you have in place to let you know when a patient is getting ready to stop seeing you altogether? Many chiropractors will say, “It’s impossible to set up a system that lets you know when a patient is not going to continue treatment.”

Here is the real question you should be asking: how many days can go by between appointments before a patient can be considered inactive?

When we ask this question of chiropractors, they are often puzzled. They explain, “Well, you can’t say. There are too many variables. Just because John Smith is inactive after 20 days, doesn’t necessarily mean Jane Doe is.”

In fairness, these DCs are half right.

But the half they get wrong is that in almost all cases – certainly enough to set up a reliable and very effective system – the most relevant variable is how many visits the patient has had.

In the case of patient retention, one of the models we can create is an analysis of just how much time can go by between visits while patients remain active.

DCs already have an intuitive understanding of this. On average, patients may have only four days pass between visits one and two, while they may have 12 days, or more, pass between visits 34 and 35.

But, can averages be trusted? In fact, in many cases, they can hide a lot more than they show. For example, if you have 500 patients who are 20 years old, and 500 patients who are 60, the average age is 40. But that tells you nothing about your REAL patients.

So we recommend you don’t work on a model of “average days between visits.” Instead, it’s much more useful to look at cumulative totals. How many patients have just had their visit within one day of their previous visit? Within two days? Within 10 days? Within 100 days?

We suggest that chiropractors consider adopting the “90 per cent method.” Simply stated,  you can find out what’s “normal” in your practice by looking at what 90 per cent of your patients do.  Then, you can flag anybody who falls outside of that range, and get in touch with them to help keep them on track. 

For example, let’s say that we generate the model for your practice, and it shows that 90 per cent of all of your patients let no more than 35 days pass between their 19th and 20th visits. In this practice model, the 90 per cent method says that when a patient has 19 visits, and more than 35 days since their last visit, you should be actively getting in touch and trying to bring them back in.

The 90 per cent method lets you know when you should start making active retention efforts.

Yes, it does differ based on how many visits your patients have had. Yes, you can make it extremely specific. In fact, the more specific, the better. That’s why we often set clients up with a visit-by-visit breakdown, and create systems that automatically flag patients who are crossing the “90 per cent threshold.”

It will be the absolute highest return on any time, effort, or energy you can spend on marketing and practice growth, and it will drastically reduce the number of patients who “slip through the cracks.”

Please check the June issue of Canadian Chiropractor for part 2 of this article, where Shawn and Scott will discuss patient reactivation strategies and overall efficient use of strategies for best practice outcomes.•

scott_newmanScott Newman is a senior consultant, specializing in designing and implementing patient reactivation systems. He can be contacted at .

shawn_veltmanShawn Veltman is a practice growth expert operating aout of Hamilton, Ontario, and the founder of SV&A Chiropractic Consulting.  He has helped practices in Canada, and the U.S., develop systems to bring back patients, retain existing patients, and run their practices more effectively.  For more information about SV&A Chiropractic, visit .

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