Talking about inactive patients always feels a little dark. So much so, many practices turn a blind eye thinking that a good percentage rate, often examined through retention rates provides the justification to turn that blind eye. I think that's a mistake.

We often hear that losing a patient is the most expensive patient to lose and I would agree with that for two reasons. The first is reputation and the second is not adjusting your marketing strategy between inactive and active patients. 

When did you last take a deep look at your inactive patients?

There is a lot your inactive patients can tell you and even if your stats are good, you should still want to know what they have to say and you should still be tracking that statistic for early warning signs. 

You should also be marketing to them differently because what they have to say is invaluable to knowing how to improve your statistics and protect your reputation.  It's this last point that ties the importance of this issue into medical referral marketing. 

Your reputation is everything when it comes to medical outreach and patients who don't return for care have a lot to say about that reputation, even if they are a small fraction of your practice. Examining your patient reviews on social media and on review sites like Yelp won't necessarily raise a red flag, only a small percentage of your inactive patients will take the time to post a negative review - the others do it by word of mouth and sometimes their audience is their MD, maybe even the MD that referred them to you in the first place.  A correlation you may see when an MD stops or slows down what was a good referral relationship.

Most practices try to reactivate or market to their inactive patient base in the same manner as they do their active patient base. For example, many offices simply keep them on the newsletter list, the birthday card list and assume social media posts will keep them engaged but it fails to address the reason they left. The needs from a marketing perspective are different than the needs of your active patient base and this should be factored into your marketing strategy. 

Think about this way -  you have 1,000 patients and 30% have not been to your practice in over a year for a variety of reasons. Maybe they feel fine, maybe they don't have any pain, maybe they had a bad front desk experience or find your office hours or billing procedures inconvenient. Maybe they didn't think your care or the experience in your office was exceptional. What are these 300 patients saying about your practice? 

Take the time to find out and change how you're marketing to this practice demographic. 

I'm not one to pose a problem without offering a solution. If you think you this situation applies to your practice, consider joining our membership blog for only $4.95/mo,  for solutions and additional insight. Your reputation is everything when it comes to building medical referrals and a successful practice. 

You've had a positive meeting with an MD but you haven't seen any referrals. There are several likely causes but the two most common reasons are:

1. Old habits die hard. An MD may have truly appreciated your approach and information with every intention of referring patients. However, they get busy and their regular routine is easy to fall back into. To overcome this problem make sure you are maintaining consistent outreach and when you are able to speak again, talk about their patients who aren't getting better with the regular approach, or patients who have tried and failed traditional care. This last step is effective at reminding them of your services when faced with a difficult patient as another possible solution when the "habitual" routine fails. Consistency on your part, will result in consistency on their part. 

2. Objections. Did you uncover every objection the MD had? An objection can be any reason at all that simply means they aren't yet sold and not every MD will be forthcoming. You have to control the conversation and make sure you are asking questions that will help the physician voice any concerns. These can range from more serious concerns over safety to more simple ones such as insurance coverage and cost. The objections will vary from doctor to doctor which is why following a sales algorithm is so critical. If you're going to take the time to meet with MDs don't you want to make sure you actually get the referrals? If so, you need to know that it is not only about the features and benefits of your care but also uncovering and addressing physician concerns. If not, even the best presentation may fall flat.

If a physician you have met with has not referred, then next time you speak, ask them if a question or concern has come up since you last spoke. This will allow you to respond to and overcome an objection to get things on track. 

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This is a really popular question I often get! The realistic answer is that there is no finish line to cross because you should always want to meet the physicians in your area. It's similar to asking how many friends you should have - do you ever really stop trying? Of course not. It's the same with medical relationships - you should always want to meet physicians in your community, to know who to refer to, to know who not to refer to and to just be a part of a professional community. 

What does vary is the phase of practice you are in. If you are new, you will be actively reaching out to and meeting as many MDs in your community as possible, looking for ones that you align with both in therapeutic approach and in part personality wise.  As you become more established you will transition from actively knocking on physician doors, to meeting physicians through activities such as hospital grand rounds and introductions by other physicians and through reputation.  

There is no magic number or equation that says if I meet this many MDs I'll get X referrals. There are a lot of variables that come into play. How outgoing are you? Are you more shy and introverted or are you a natural born sales person? What is the climate in your area relative to physician attitudes towards alternative care - the same could be asked about the area you live in and economic pulse all factors that drive how patients seek care and are referred. What's the competitive environment - how many of your competitors are also seekind medical referral relationships? Do you have established networks - maybe a family member or good friend that is in the medical community? How likely is it that the first physician you meet will refer you 100's of patients?

With so many variables the only accurate answer is there is no number - you should always want to meet and mingle with the physicians in your community - and degrees don't matter - you never know what specialist is an influencer in the medical community or can escalate you into the hospital system if that is your end goal. 

If you think in terms of numbers the intent is lost - is your intent numbers based for what MDs can do for you or is it relationship based upon which referrals are a benefit? Which one do you think is better for a stable source of new patients that spans the life of your practice? 

It's not to early to start planning for National Chiropractic Health Month. I know it's not until October but you need to be ready to go on October 1st, not start planning. This is a great time to not only engage your current patients and attract new ones it's also a wonderful opportunity to work on your new and existing medical relationships. 

To execute without pressure and to make the greatest impact, now is the time to start making initial plans, especially if you plan on placing any paid advertisement ads, renting space,  ordering specialty food and placing branded product orders. As all of these cost money, planning early ensures you have time to shop around and plan your budget. 

ACA will soon be providing members with a NCHM campaign kit which will further aid in simplifying your events! But events such as these are not just for October, they can also be planned to boost the times in a practice that would otherwise be slow.

January is a great example, when deductibles are reset and holiday spending is being paid off. August is another when families plan the last of summer vacations and pack in the rest of the summer festivities. November and December bring along the rush of the Holiday season and travel. All of these times interrupt the natural weekly rhythm and statistics of even the most established offices. 

When you look at your practice stats do you see months that tend to have dips in them? If so, plan public relations events just in front of these slower times, or look to use these quieter practice times to book more public relations events and plan your other marketing efforts for a strong start when the normal routines return.

Events can range from small daily office events to larger events such as community health talks. Each month, each week and each day has something that can be used to boost practice engagement and presence to help overcome anticipated practice lulls. But to be successful and mindful of spending, planning a couple of months in advance will yield the best results!

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Can't get past the front desk? Doctor won't meet with you? Don't give up there are other ways to meet MD's! Getting in front of an MD is one of greatest hurdles for most outreach efforts! Here are some ideas to enhance your opportunities!

• Attend your local hospitals Grand Rounds. These are usually free to attend, don't require an RSVP and take place during lunch. To find them in your area try a Google Search with these key searches "Name of Hospital Grand Rounds" or "Name of Hospital Continuing Ed" Typically these will bring up the calendar of upcoming events. Look to ones that will be of interest to you and will appeal to those physicians you wish to meet. At the very least you'll probably learn something new!
• Network with the MD's you can meet. If you already have relationships work with them to meet other specialists in their network. It helps open doors if you have an introduction and it helps quickly find the physicians your most likely to have success with. 
• Patient Reports. Never underestimate the power of patient reports. Many DC's routinely receive referrals from MD's they have never met but did send reports to. Make it a habit to ask your patients to communicate with their MD's about their care and send a final report. 
• Attend DO continuing education seminars. Many states allow some of these CE credits to apply to chiropractic CE's. This provides a great opportunity to sit side by side and meet physicians in your community. 

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It's important to have a targeted goal and a supporting message with each outreach.  Running a chiropractic office is time consuming, so it’s critical to be time effective. Having a set goal and message will keep time on your side and make impact with the MD. A goal may simply be to meet and establish contact with an MD. Or, it may be to further a previous conversation. It will be different for each MD, but once you determine your goal, you can define your message. If a goal is to meet an MD for the first time, what’s important information to convey? In this case, your goal may be to uncover what the MD currently understands about chiropractic care and be prepared to talk about chiropractic basics such as a main condition chiropractic is known to be effective for. Future goals will be built off the outcomes of your previous goals and will include moving the conversation forward to educate the MD on a wide variety of topics including, which patients are suitable for referral and overcoming objections which are typically focused on treatment plans, scope of care, safety and costs. Be targeted with your outreach and you’ll make the most of every encounter.

Additional bonus: By having a goal, you can move forward through an algorithm of sales that ensures forward motion and effective time management. This helps make the most out of each encounter.

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Can't get past the doctors front desk? Doctor doesn't have time to meet with you? Don't give up! Here are our top three tips to meeting more MD's in your community:

1. Attend your local hospital's Grand Rounds. These are usually free to attend, don't require an RSVP and take place during lunch. Focus on topics that will interest you, allow you to ask intelligent questions, and which would attract other doctors who would likely have patients to refer. To find Grand Rounds in your area, try a Google search with terms like "grand rounds" or "continuing education" along with the name of your local hospital. The more integrated and active you become over time, the more likely you may be the one presenting at Grand Rounds!

2. Network your existing MD relationships. Have a neurologist you know? Ask them to provide an introduction to their internal medicine friends (and other specialists). If that still proves to be difficult in obtaining time, make it worth their time and spike the interest factor by offering to sponsor a small round table discussion on back pain with an existing MD friend and his or her chosen colleagues. Just make sure to make it worth your time by controlling the topic, format, reminders and restaurant reservations! Tip - Have the MD provide the initial invitation.

3. Patient Reports. Patient's medical doctors should be a top priority in your outreach, but if you're having trouble getting time with them go the more subtle route by sending them a patient discharge report. Many DC's routinely receive referrals from MD's they have never met as a direct result of taking the time to send a patient report. A simple short report at discharge (assuming this is not a medical legal case) is all that it takes to illustrate beginning and ending pain levels, treatments and length of treatment to really paint a picture on the efficacy of your care. Your intake forms should provide a space to request patient consent to share their progress, findings and outcomes to any MD they have previously seen for the condition that they are presenting to your office for.

For many offices, it's usually clear where your office is and thus your front door. For many others, especially those in large office buildings or in urban areas it's not as clear.  Even if your office is easy to find, there can be road closures or construction that impedes timely arrival.

You can easily enhance patient experience by anticipating issues such as difficulty in locating your offices front door in a large building or alerting patients to road delays. This enhances their experience and yours by preventing frustrated and stressed patient arrivals, not to mention on time appointments!

Here are some tips to consider:

• Post clear directions on your website. Include photo's of your front door or parking structures to park that are closest to your office.  
• If sending electronic reminders for appointments, include your address and if necessary parking instructions as well as a link to your website for directions. Make sure this is mobile friendly as that is the most likely time they'll realize they are lost!
• When a new patient calls in, alert them to any possibility of confusion and provide oral instructions and/or an email that clearly outlines how to get to your office. 
• If unexpected road construction or delays are incurred, call your patients and let them know of any detours or potential delays as appropriate for the duration of the delay. 

This last one happened to me for a recent dental visit. I could have easily left 5 to 10 minutes earlier to get to my appointment had I known of the road condition. Instead I arrived 10 minutes late, stressed and anxious. As did the patient who entered right behind me. 

Finally, a fellow medical marketer shared how this could be taken a step further by suggesting a video or a video montage of pictures be made illustrating where to park, the elevator, the hallways, a map and a picture of the offices front door.  I would add to that a suggestion that you highlight the front staff waiting for them at the desk with smiling faces and waves. 

These very small considerations that make a huge and positive impact on your patients overall experience with your office and makes your office standout from the competition. 

Lately, I have seen more chiropractic advertising utilizing the terms “Doctorate in Chiropractic” and “Board Certified” but with no designation as to what they are board certified in.  Did you know there are possible advertising violations especially when using the “Board Certified” designation erroneously? Let’s review.

The Chiropractic Degree

A D.C. (Doctor of Chiropractic) or D.C.M. (Doctor of Chiropractic Medicine) degree is considered a 1st Professional Degree.  This degree designation is defined by the Department of Education as follows: 

“First-professional degrees represent a category of qualifications in professional subject areas that require students to have previously completed specified undergraduate coursework and/or degrees before enrolling.  They are considered graduate-level programs in the U.S. system because the follow prior undergraduate studies, but they are in fact first degrees in these professional subjects.  Holders of first-professional degrees are considered to have an entry-level qualification and may undertake graduate study in these professional fields following the award of the first-professional degree.”  

Other 1st Professional Degree’s include Dentists (D.D.S or D.D.M), Attorneys (J.D.), Veterinarians (D.V.M) Osteopaths (D.O.) and of course Medical Doctors (M.D.). 

Using the term Doctorate

The department of eduction defines the research doctorate, or the Doctor of Philosophy (Ph.D.) and its equivalent titles, “as representing the highest academic qualification in the U.S. education system.  While the structure of U.S. doctoral programs is more formal and complex than in some other systems, it is important to note that the research doctorate is not awarded for the preliminary advanced study that leads to doctoral candidacy, but rather for successfully completing and defending the independent research presented in the form of the doctoral dissertation (thesis).”

Most often I see chiropractors referencing where they received their "Doctorate of Chiropractic" from or using the designation "Chiropractic Doctorate" in their CV's or "About Me" sections of their websites or business cards. There is no specialty for a doctorate study program in Chiropractic that I am aware of and thus no one D.C. that can truly say they have a “Doctorate in Chiropractic” although they may also hold a Ph.D. for another specialty in which case it should be added to their credentials as the designation can be supported with another degree.

If a medical doctor asks what your doctorate is in they are assuming it is something more than your D.C. degree and looking for an answer more along the lines of an additionally credentialed specialty focus or in research. Yes “Doctorate” sounds fancier and super smart, and those who have earned this designation certainly are, but you won’t be feeling so smart when the medical doctors you are trying to work with call you out on the designation!

Illegal? Not than I am aware of. Embarrassing - Absolutely!

For further definition on the 1st Professional Degree and Doctorates visit www.ed.gov

Stating You Are Board Certified 

All chiropractors take boards which they must pass to gain licensure - but that doesn’t mean you can advertise you are "board certified". When you say you are board certified (for your D.C. degree) it implies that you have more training than other chiropractors which is misleading and therefore in violation of medical advertising laws.

We often see chiropractic specialties that are truly board certified referred to as a “Diplomate”  status and if you have one you should most definitely advertise the additional accomplishment. To see a list of specialty degrees for the chiropractic profession click here.

These distinctions are more than just a potential source of embarrassment. There are possible regulatory repercussions in the form of advertising violations if you are found to be misleading in your advertising.  This is a major topic in my classroom and one guest lecturer I have in each trimester to discuss these concerns is Marc Abla from the Illinois Chiropractic Society who provides a little more clarity on the topic in this short video.

Illegal - as in the sense of jail time? Probably not. In terms of $$ - most likely if it is reported.  Embarrassing?  Yes, all healthcare specialists abide by the same marketing laws - have you ever seen an M.D. advertise that they are “Board Certified”  for their M.D. degree?

Please also make sure to check with your state board, that the title you are using is appropriate for your state (i.e. Chiropractic "Physician"). 

Don’t compensate for your D.C. degree - it’s impressive just for what it is!

Stroke has been a long standing point of contention over the years between chiropractors and medical physicians. In 2007 one of our most compelling papers was published in Spine and JMPT (Cassidy et al) indicating that there was no increased risk of stroke with manipulation and rather that patients were likely seeking care for the symptoms prior to their stroke. Further studies would go on to illustrate that blood flow and injury to the arterial wall were also not caused by the head positions during SMT setup. Today we have a new study that not only states that "Manual therapy does not result in an increased risk of CAD" but one which is also relevant and important for screening patients, understanding the typical pain distribution associated with stroke and a step-by-step risk benefit assessment.  This is an absolute must read for all chiropractic practitioners, but also one to be shared with healthcare practitioners who still influence their patients treatment options based on erroneous and outdated opinions. For patients who may be nervous and influenced by headlines this paper would also be reassuring. 

The full text can be found here: https://www.tandfonline.com/doi/full/10.1080/07853890.2019.1590627