I am a chiropractor, and I own my own clinic.

I am a strength coach, and I own my own gym.

I am a business owner, and I recognize the limits of each of those practices. And, in all three of those capacities, I am a witness to the changing landscape in healthcare, which is being reshaped due to changes in law, repayments and consumer desires.

But out of this chaos I think I’ve come up with a hybrid healthcare idea that makes perfect sense for me and my clients, and I think it can make sense for you, too.

Origin of the Idea

Quick history: I graduated from chiropractic college in 2006 and then opened a small office in Henderson, Nevada, with a partner. I was “Full-Body” certified in ART, and we worked the local race circuit to build up our clientele. So we had a pretty active client base. I fell in love with the SFMA, FMS and TPI in 2011. In 2012, we started seeing a significant decline in repayments from insurance. At the same time, I had been going to a CrossFit gym for about four years and treated many of my fellow box-goers. And then we got inspired to more fully combine our work with our passion—our sweat with our smarts—and we opened a hybrid facility in February 2013.

The idea basically came from two core convictions.

The first was teaching patients to move better. This is THE most important aspect of healthcare. See, doctors know that people need to exercise to keep their hearts healthy, keep the weight off, and keep their joints moving. However, if it hurts to move, most people will NOT move enough. So moving pain-free is a “first-principle” matter in healthcare. The idea also stemmed from an inherent limit within the current style of chiropractic: The better you are, the fewer visits you’ll see from each patient. It always bothered me that to make a decent, TESLA-driving living within chiropractic, I felt that you had to
sell your soul to the devil and push six-month care plans. We kept stats on every patient, and I was only averaging 4.7 visits per injury with my patients—and that included teaching home therapy as well. So the “customer value” was less than $1,000. And that was at a cash price of $85 per follow-up. In fact, I was seeing five to 14 new patients per week, and my schedule still had room. I ran that by my “straight chiro” friend, and he said that was a big number.

I also was seeing the huge influx of boutique gyms popping up—CrossFit boxes, Orange Theory, small yoga/pilates places. Although their average sale was small, it was recurring monthly revenue.

So we threw our hat in the ring.

Current Business Model

We ended up moving into a 5,000-square-foot office—more than triple the size of our old place. Along one side is our clinic with three large treatment rooms, and the doors of the treatment rooms open out to the gym. We want to empower our clients to get right back to training. The gym is an open-concept training space like a CrossFit gym, with a large, multipurpose rack as the centerpiece. We keep the place very clean and everything (save for the rack) is on wheels and can be moved. We change the floor plan every six weeks to keep it interesting and let our clients know we care.

We still have clients who are “treatment only” and have never used the gym other than for rehab. We also have a few gym members who have never been patients. And we have a large portion of people who get treatments and use the gym.

Most clients are looking for recommendations for what to do post-injury. And if you are trained in the FMS/SFMA model, you are probably performing a lot of rehab that looks similar to exercise. We use kettlebells extensively in rehab, and most of our lowback patients will work in some deadlifting before they leave. So, our thinking goes, why not keep them around by extending the exercise piece to them? That way, with our highly trained coaches, we can closely monitor their progress and correct their mistakes as they work their way back to good, functional health.

This develops the sweet spot for the business: gym memberships. It cures that part I don’t like about treating people as a chiropractor—when it goes on forever—and yet also encourages the doctor-client relationship to last as long as possible. As a business owner, it’s also reassuring to know that you have recurring monthly cashflow. Done correctly, this can become greater than 60 percent of your monthly revenue.

In our model, we try to perform a “discharge” FMS/YBT on each patient. This is included in their care plan, and it’s actually run by one of our trainers. It empowers the coaches and sets up a great conversation about the next step. Clients are invited to work out in the gym, and based on their FMS, we recommend Group, Small Group (4:1 ratio) or Individual (1:1) training. If they are a perfect fit, this sale is easy. One caveat, though, is a lot of patients were referred to us by another gym or another trainer. We work hard to send these people back to their gym with our training recommendations. As much as we’d love to have them join our gym, it would be bad karma and bad business to try and “poach” these people.

They often note our advantages over their old gyms, though. A big one is the quality, caring and attentiveness offered by our coaching staff.

In our model, the “traditional” CA role is boring and out of date. Our trainers function as CA’s. We find motivated, smart, hungry personal trainers and train them in the FMS and SFMA. They understand the system and know where they can help, but they don’t ever perform something beyond their scope. Instead of applying hot packs and EStim for the 18th time in a day, they are an active part of the patient’s case. They help reapply tape, teach home exercises, and offer some soft-tissue solutions. Thee trainers love it, the patients love the trainers, and this frees up the doctor to do what only he can do: diagnose and adjust.

One more bit of advice: Get every member of your team operating at the highest possible legal level of their training. Empower, don’t stifle. It has worked great for me.

For example, our head coach is Brian Chandler. He’s a licensed massage therapist and spent years in a big-box gym as a personal trainer. He is now trained in the SFMA, and he is able to help a lot of our clients through the transition from treatment to rehab to training. While doing this, he absolutely loves the challenge of getting our clients moving better. They perceive him as an expert, he works his butt off, and when the client needs to be manipulated, he refers them to me. This helps build the relationship AND it positions our facility as something special. Who else offers that? Chandler is also used to spending one hour with clients, which is perfect in his model. No one expects that a personal trainer will bill their insurance, either.

So the trainers in our clinic are treated as high-level players. The patients and clients positively respond to that “air of excellence,” and we can all help bounce ideas, exercises, and outcomes off each other because we are all using the same operating system. It’s the Functional Movement System, and it works great.

Recommendations

Looking back, we had a bumpy start to our gym. The main bump turned out to be time. You are only one person, and you may be asked to coach, treat, bill and manage. For a while, my Monday-Wednesday-Friday involved coaching classes at 5:30 a.m. and 5:30 p.m., then treating patients all day between. Most lunches were meetings to grow the business. I also cold-called 18 doctor’s offices to pitch my concept. On many Saturdays I would do presentation at local gyms or travel to teach with SFMA. It was crazy, but somehow I made it through. Here are some of the lessons I learned along the way: First, develop a system to “selling” at your clinic. I don’t mean a hard-style close in the ROF, but a systematic approach to how each patient gets processed and goes through care. You should work to make this so smooth that it runs even when you’re not there. This way your clinic revenue won’t take a dip while you get distracted by this new venture (ask me how I know). Second, develop early traction in the world of exercise. Host workshops for patients about mobility or shoulder care that are focused on a very active population. They have to perceive you (or your head trainer) as an expert in the field. And see if you can start your gym in someone else’s. We started an early class in a local CrossFit gym that let us use its space for free. Actually, we traded care (and the owner went to the finals at the 2012 CrossFit Games), so it was just a time investment.

Recap

I believe this is the model of the future. With the changes in healthcare and repayments declining, it becomes battle of value versus time. By leveraging our knowledge of movement, we can better help our clients. When your trainers can help with rehab, it establishes them as experts in the eyes of your patients. Then the lead in to the gym is easier. Plus, if you are able to capture just 10 percent of your chiropractic clients into a recurring revenue membership, you will have a highly successful gym. And you’d probably worry less about repayments and be more present with your patients. It works out for everyone.
By the way, we are looking to add a couple more clinicians to our team in the next year. If you are interested in joining us, please contact me. And if you have any questions about this model or need some help, I’m happy to share with you what I’ve learned. If nothing else, I can point you to someone who can help.

Resources

Here are some resources that have been helpful to us:
Gym Business Consultant: Thom Plummer. (http://www.thenfba.com/)
I met Thom through TPI, and he was incredibly instrumental in getting our systems up and running. Plus, he is quite inspirational and an all-around good guy.

Injury Risk Measurement: Move 2 Perform (www.move2perform.com)
The Move 2 Perform software prints out a report for each client, categorizing them into a risk bracket. This is the single best tool for client retention. Once you run the client through the test and print a report, the client essentially sells themselves on training with you. I can say that this tool also single handedly helped us land a 12-week,$14,000 contract to train the local fire department.

Equipment: Perform Better (www.performbetter.com)
The crew at Perform Better will hook you up with the right equipment. Plus, I would HIGHLY recommend their 3-Day Training Summits. It’s the best three days you can spend, and I would HIGHLY encourage you to take your trainers.

Functional Movement Systems (www.functionalmovement.com)
The FMS and SFMA are the single greatest tool in our arsenal. It’s not just the diagnostics (which are fantastic); it’s that the clinicians and the trainers are all communicating the same way. A DN for Hip IR, moving to a 2:3 makes sense to our crew, and the patients feel confident.

Dr. Jason Hulme, DC, Active Spine and Joint Center (http://www.activesjc.com/)
I met Jason at the Functional Movement Summit at Duke University a few years back. More than anyone else I know, he has developed an incredible system to implement the Functional Movement Systems into clinical practice. His consultation fee is money well spent to systematize and communicate your office systems.

NPE/Net Profit Explosion (www.netprofitexplosion.com)
I took NPE’s online-training course and it helped us get over the hurdle of not having great sales systems in our gym. Once we started running their systems, our gym revenues quickly beat our clinic revenues, which was awesome. Looking back, I wished we would have found them sooner. I can’t recommend them enough! I would talk to Ric Isaac there, and he can get you set up.