As a part of my interview series with prominent medical professionals about “How To Grow Your Private Practice” I had the pleasure of interviewing Dr.James R. Fedich.
James R. Fedich, DC. grew up in northwest Mt Olive, NJ. He opened a private practice in March 2004 on a shoe string budget, bought used equipment and boot strapped his way to one of the largest clinics of his type. Now, he helps other doctors with his book, “Secrets of A Million Dollar Practice: Proven Tactics to Grow Your Practice.” Podcast and the 5 CD audio “Chiropractic Practice Mastery Course.”
Yes, I was actually born in Kobe, Japan, on family business trip. But I spent most of my childhood in New Jersey. I’m am very tall at 6’ 5” so I played a lot of basketball. At age 13 we were driving to upstate NY to a family wedding. A young woman ran a stop sign and slammed right into the side of our car where my Mom and I were seated. We all ended up in the hospital, concussions, bruised ribs, my mom had a collapsed lung. I endured some serious back pain. I spent every day after school laying on the floor because back spasm, and worst of all I couldn’t play basketball! Nothing was helping.
Eventually my mother took me to a chiropractor, and almost immediately I’m back to playing sports after months of agony. I remember telling my parents back then I was going to be a chiropractor and I never changed my mind.
I always say, if I knew then, what I know now, I probably wouldn’t do it. The usually protocol is work for someone else for a few years this allows you to make mistakes and get back up. I graduated in December 2003. I signed my office lease before I even graduated. I was painting the place myself, buying equipment and waiting for my final board scores. So, if I had failed, I would be in big trouble. Luckily, I passed and opened in March 2004, less than 3 months after I graduated and never worked for anyone full time. I was lucky in that I liked the business of healthcare even before I was a practice owner, but honestly, I just jumped in and figured it out later, but I wouldn’t recommend other do that. Managing being a provider and a business owner can often be exhausting.
Yes, being a business owner and practitioner can be hard. You have to wear different hats. Many doctors love being a doctor, but don’t like being a manager and owner. First, you must schedule. Most offices have production days, days where you are seeing patients and producing cash. On these days and shifts, you shouldn’t be managing, marketing, etc, you should be seeing patients. Other days are less about production and that is when you do your other activities needed to run the business. So, for example, most offices are busy Monday, after the weekend, etc. Monday is a production day, you don’t have meetings, etc. For us, Tuesday is much slower. So I only see patients 9–12. Then we have an hour-long staff meeting, and then I have time in the afternoon for marketing and business activities. You have to schedule your week plain and simple.
Great question. This is the key to most business people. I think for health care providers it is even harder because we all went to medicial school because we like to help people. In the beginning, you have to do it all. You have to see all the patients, do all the marketing, etc. As you grow and bring on associates or partners, you will have more time and more demands for management duties. So you slowly adjust your schedule. I now have two full time associates, as well as other providers that can cover for me. So, two days per week, I only see patients half the day to free up time for other business duties. I could continue cutting back patient hours, but I have enough time to get my management duties done, and its hard to give up patient care. Few providers ever totally give up patient care, for one, it’s very profitable for the owner to see patients, and two, we went to school for it, and hopefully love it. I can certainly cut back more hours of treating patients, but I choose not to, I still enjoy it and it is profitable. In the end, it’s your decision, but it’s crucial to block the time to run the business.
Yes, there is certainly a lot of failure. I think the difference between successful versus unsuccessful practices, and in life, is the ability to bounce back. Failure is part of the deal — you learn, you grow. My biggest failure was the IRS. Don’t mess with them. I had a mediocre accountant and the practice was growing steadily the first few years. I was on a quarterly payment plan for taxes. However, as the revenue went up each year, the quarterlies didn’t cover my bill. Well, as I was putting all the money back into the business, when I get a bill for 20k, I don’t have it. So, I do a payment plan with IRS and the same thing happens next year. With the interest and fees, I have barely touched the balance. Now, same thing again, I owe another 20k. Once you owe the IRS over 30k, they start getting serious. Long story short, they threatened garnishing, taking property, etc, if the balance wasn’t under 30 in 10 days or so. I scrambled, wrote a check I wasn’t sure would clear. Lesson learned. I don’t do my taxes that way anymore, and I don’t use that accountant.
Someone told me this a long time ago. If your doors are closed because you didn’t pay your rent, you can’t help anyone. If the practice isn’t profitable, you wont be able to help anyone. If you can’t afford heat in your house and your freezing cold, how much help can you really be to anyone? You must take care of yourself and your practice in order to help others.
Time off. Many doctors get burned out. It’s a serious problem. More doctors are leaving the healthcare field due to burn out than any other reason. But, here is the catch, if you’re a solo owner provider, one week off can take you up to 12 weeks to recoup the business. Yikes. So, what’s the answer? I teach doctors this, in the beginning, take one day off every 90 days. So a long weekend every 90 days. Try to get out of town if you can. You will be surprised how often 90 days comes up. Once your doing that, and the practice is growing, take a four day weekend every 90 days. A four day weekend wont cause a practice slow down like a week will. Do that until your ready to take more time. I’m a huge fan of mentorship throughout one’s career. None of us are able to achieve success without some help along the way.
Mentors have been extremely valuable to me. I have been very blessed in this regard and it’s the reason I give back through my podcast and book. I was helped so much along the way, now I try to give back. I had a lot of great mentors. Dr James Santiago was a doctor I did my externship with him and he allowed me to work weekends in his clinic and weekdays in mine to get started. I learned from him how to balance excellence in patient care along with a profitable practice. Also, Dr Jay Morgan, he’s a mentor and coach who taught me so much, but mostly how to balance practice with family life and the real importance of each.
Everyone needs some coaching. If Tom Brady has five coaches what makes people think they don’t need coaching. I have had coaching from day one in practice. Even today, when I coach other doctors, I have a practice coach, business coach and a coach for my associates. I did many coaching programs, but some books really helped me out: “Influence” by Robert Cialdini, all of Dan Kennedy books and his newsletters and seminars, Jim Collins, Seth Godin, Jim Rohn, all have been a big influence on me.
I think I have gotten more bad advice than good. I think the worst advice every clinician gets is that if your proficient and good at your field, the business will come. I think that is still the worst thing to tell anyone and we have all heard it. Just being good at your craft does not ensure that you will be successful. In fact, if you study only technical excellence and nothing else, you will surely go out of business and not be able to help anyone. Please recommend one book that’s made the biggest impact on you?
“Leading An Inspired Life” by Jim Rohn is greatest book I ever read. Get a copy, put on your nightstand and read a chapter every night.