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Dr. Brian Capra: Everyone, welcome back to the UAC Best Practices podcast. I'm Dr. Brian Capra from UAC. I'm here with my co-host, Dr. Allen Miner, and a very special guest, Dr. Olivia Joseph. The goal today is just to share best practice that you can take it, implement in your practice, and get great results like a successful husband and wife team like the Doctors Joseph are. Dr. Allen, want to take it away?
Dr. Allen Miner: Yeah, I'm trying to think back how long I've known you, Olivia and Brian, and I don't know, it seems like probably at least six, seven years.
Dr. Brian Capra: Long time.
Dr. Olivia Joseph: Say about a decade.
Dr. Allen Miner: Yeah, probably. So, you practice out of the St. Louis, the suburb of St. Louis. And you know, the first thing I'll touch on that I've just always been impressed is there's a lot of people in chiropractic who I think all chiropractors are trying to figure out how do I maximize healing potential for my clients and revenue within this profit center of my brick-and-mortar business. And I think that what you and Brian have done is best in class. You guys are in a number of verticals with traditional chiropractic care, but then you also offer decompression and then you offer, I believe how I always know you is kind of as a functional expert. So, then there's the functional side and then you guys have a nurse practitioner doing PRP and stem cells, and you really have that.
Dr. Allen Miner: There are all kinds of different terms these days. I'll let you name how you guys describe your clinic, but can you just maybe briefly talk about how you integrate all of that? Because I see so many doctors, really, they're challenged with, you know, when somebody comes in the door, where do you direct them? I see so many offices that they focus on one of these verticals and they lose sight of the other verticals and you guys’ shine. And I know I'm seeing the end product where you, it is probably perceived by us as a lot easier because you guys are so graceful, but there's probably been so much work and pain working out how you do it. So, can you just give a little insight maybe from where you're at now to back to how it started? You know, when somebody comes in, how do you direct them? What have been the benefits? And then we'll get into your best practice. But I just, I think you guys have such a fascinating practice model. I want to start there.
Dr. Olivia Joseph: So, I think initially we started out with just two simple offerings, chiropractic and nutrition. That was pretty much it. And what happened was they both grew and grew and grew big and strong enough where, like we said, we weren't robbing Peter to pay Paul. And there have been times in our practice where we integrated a new service or a treatment. There have also been times where we got rid of, like we got rid of our acupuncture department. And I can explain why, you know, in moments which was thriving, by the way. If you looked at it, it would have been called like a high-volume acupuncture practice to chiropractic. Right. Or to acupuncture. But we just had to, when we looked up the space, the time units, the dollar productivity. Like, I needed those rooms to hire another functional medicine practitioner, and it was going to be way more profitable, and it kind of hard to get rid of it because I knew what amazing clinical results we were getting. But at the same time, that was the first service that we had to let go because of COVID.
Dr. Allen Miner: Pause there Olivia. I just. That's brilliant. Because that is, you know, that's the analogy of is you willing to tear something good down for something great? And how many clinics would just. Even though it doesn't feel like a lack mentality, when you have something positive and cash flowing, there's a tendency to want to hold on to it. But for you to actually say no, time out, we can have a bigger impact, help more people in a bigger way, and make more revenue. That's fascinating. So, did you try to sell it? You just shut it down?
Dr. Olivia Joseph: Shut it down. Just shut it down. And I was the one running the department. I was the one, like, I started doing care plans and treatment plans. In acupuncture that kind of wasn't heard of, like, especially. So, we treat. I was doing care plans with nutrition and acupuncture combined based on the demographic I was seeing. And no, we just had to shut it down. And I hired another functional medicine practitioner and filled his schedule fast and then had to hire. So, I think what the moral of the story is we started out pretty much just two services, but they were both strong enough where they didn't pull from each other. When somebody comes in on my side just for functional medicine, that is not a chiropractic patient. Very easy to get them to chiropractic because they're already in functionally. The fee system's way different.
Dr. Olivia Joseph: Right. So, if somebody's used to coming for, you know, $2,000 worth of testing upfront, to send them to chiropractic is an easy referral. And then on the chiropractic side, it's such a large volume of people that they're seeing what's going on in our office and under our roof. And when a patient that's stubborn or even one that's like not responding well, stubborn as well, or not getting the best results or even just interested in those other services, they're already getting a good experience on the chiropractic side, they're getting good results. They already trust us to come into that higher dollar productive service. But to this day, we have people that come in just for functional medicine, just for chiropractic, just for, you know, one service or another.
Dr. Allen Miner: Do you, I'm curious about that. Do you market decompression separate than chiro, separate than functional? Do you, are they all kind of their own separate tributaries?
Dr. Olivia Joseph: Yeah.
Dr. Allen Miner: And so, when they come in, if they came in on a decompression ad, do you address that first and then refer over or how do you guys integrate all of that back and forth?
Dr. Olivia Joseph: So, if you come in for decompression, you're going to be getting chiropractic care too. It doesn't mean you're coming over to the functional medicine side at all. Same thing, if you come over to the functional medicine side. It's usually for you know, whatever a marketing campaign was, if it was thyroid, if it was diabetes, something of that. We're mostly referral though, honestly like, we're mostly still a referral-based practice. We do tailor our marketing specific to a department. Even like for injections. Like if we're doing specific, you know, marketing towards injections, then that's the report of findings and the treatment plan that they're going to get.
Dr. Allen Miner: I won't ask numbers, but I am curious, of the four departments, which one top line revenue does the most business?
Dr. Olivia Joseph: I would say chiropractic and functional medicine are about the same. They really are. The one that has the most potential is the injections, right? That's the one that's got the most potential. That's the one where we have the most capacity. And then again like if you're measuring your options, like am I going to keep acupuncture in my clinic or look how much this nurse practitioner can do in injections. It's kind of a no-brainer, right?
Dr. Allen Miner: Yeah. So how many staff members do you guys have?
Dr. Olivia Joseph: Oh gosh, we just hired like six more because it's been really challenging to find full-time. So, we've had to like we've retained our core people for so many years and years and years and years, we have very little turnover. We have, you know, staff turnover. But we've just brought in like six new hires because it's a struggle to get people full time. I should know this number. Brian would know. I'd say with practitioners, we've got 10 providers, and we've got probably 24 total.
Dr. Allen Miner: Okay, so then that leads me into the best practice question. 24 people working under your roof. How? What are you guys doing? Let's talk best practices. You know, what are you using with data, with strengths. Talk. Let's, let's. And I just say all this to build up. You've got a lot of credibility in this space because you've got a big team, a successful team. So, talk to us. What can somebody listening use, glean from what you guys are doing?
Dr. Olivia Joseph: So, I think one thing I figured out early on, so I've been in practice for 21 years, and in the last 18 years, we've been in this practice, this, like this bubble of, you know, functional medicine and chiropractic in a variety of capacities. And Brian, my husband, has from day zero, he's like a statistician. Like, he is using stats to drive almost every decision. I'm not saying sometimes there's no emotion because we're business partners, we're husband and wife. We're business partners with another husband-and-wife couple.
Dr. Olivia Joseph: So, there is emotion. We're all best friends and we were having babies, and we were doing all this, but really it came down to the numbers. And what I mean by that is like every year, over and over and over, Brian goes deeper and deeper and deeper into stats in many of the decisions that we make. And, well, like I said, getting rid of acupuncture, yeah, that was hard for me, but I really had to make it not an emotional decision. And look at what's the greater good of the clinic and the people that we can help and serve. So, what ended up happening, like stats. Just recently, even Brian did this whole evaluation on every one of our providers.
Dr. Olivia Joseph: Not by department, so not by department, by provider, to find out their dollar per visit average is, what their retention rate is. Just looking at everything, the report of findings, all that. And so. And he was talking to me, he goes, do you know who has the highest retention in the practice? And I said, I don't know. Who? It was me and the lead chiro. Right. And he's like, well, what does that say? He's like, we've got to use our strongest people to train the others on retention. Who has the highest per visit average? I do. The nurse practitioner has the most potential for that for sure.
Dr. Olivia Joseph: Who does the lion share of the production in that department. It's not me, I work three half days a week. That's it. But just kind of looking under the hood at the stats and I think it's also revealed people on our team not just practitioners, a lot of what their strengths are. Right now, we're doing this project to kick off the new year where we've split the office into teams. There's a loyalty team that's... And Brian came up with this concept too. There's a cash flow team, there's a appearance team with like aesthetics. So, we're broken into these teams where we have strengths and passions. Like, I don't want to be in the cash flow team. Actually. You know what he said to me when he came up with the teams? He was, "Do not sign up for the cash flow team."
[laughter]
Dr. Allen Miner: That's awesome. But that's your strengths. I mean, and that is when people are working in their God-given strengths, you don't have to motivate them. They have an energy in that area. They want to contribute to that area.
Dr. Olivia Joseph: You're totally right. And so, I signed up for team loyalty, and then I found I have one of the highest retention rates. You know, it's like stuff like that. So, I'd say we let the artists be artists in the clinic and the people that are really strong at marketing, business, statistics, let them be strong at that, which is what Brian is, you know. So, I think that that's probably what's allowed us to succeed.
Dr. Allen Miner: That's beautiful.
Dr. Brian Capra: Brilliant. Yep. Run up by the numbers.
Dr. Allen Miner: Yeah, it is.
Dr. Brian Capra: because it is... It can be so difficult to take your emotion out of something like that. Looks perfectly great, you know, on paper. By any means. Any other means? Yeah.
Dr. Olivia Joseph: Perfect example of that. So last month I was in my... We have a leadership meeting, right? And so, the leader of functional medicine team is there. Me, you know, whatever. So we've got six people in the boardroom and I say to my team, I said, "We have more cancels right now than we had a year ago. I don't know what's going on in the functional medicine department, but I'm like, our visits are down, and our collections are down." And Brian just looks at me and doesn't skip a beat. He goes, "Is that a fact?" I'm like, "Yeah." And he goes, "Did you pull up last year's numbers and compare them?" I'm like, "No." and he goes, "They're exactly the same." I'm like, "Dang it. Dang it." That's a perfect...
Dr. Brian Capra: Yeah. You can totally believe something is true without numbers.
Dr. Allen Miner: I'll say it again because you touched on it, but it is amazing when you have data how the emotion can just leave. And we found, especially with staff, it just... It's not about them. It's not to be taken personally. It really can transform things to where you're... That data is... It tells the truth without pointing the finger necessarily at somebody. And that I think...
Dr. Brian Capra: Yeah. It agonizes team too. Like, because, okay, our goal is to get better. Right? Let's talk about that. How do we get better?
Dr. Olivia Joseph: And I don't want to give the impression like Brian does all that, but I don't want to give the impression, like I'm a Pollyanna and I don't look at that. I have to run a department. I have two doctors who work for me in the functional medicine side. I'm month over month, I've got to know what my new patients are doing. My report of finding stats are. And then I'm looking at each doctor's individual production average in the sense... Well, man, he... This one recommends a lot more testing and supplements than this one. You know what I mean? So, it's kind of looking at things like that. So, I still look at it and understand it. I wouldn't say... And I say it's extremely important to be successful, especially if you have multiple services or multiple practitioners. That's... Yeah. So, the numbers matter. I'm not the, like I said, the statistician like my husband is. But I still have to look at that without emotion because I'm leading a team.
Dr. Allen Miner: Yeah, that's beautiful.
Dr. Brian Capra: Deeper more important, like you said, more complex, like we do at Genesis, because you can kind of... Even with chiropractic, you know, it's relatively straightforward. You know the numbers. And then you add one more service with what we have right now, for example, there's like 500 and something combinations of products. It's not 500 products, but there's co-tier... Once you get into tiers and all this stuff, and if you don't have the numbers, you're like completely lost. But if you do have the numbers, that benefit of having that platform of offerings is huge.
Dr. Olivia Joseph: Totally. And Allen, to justify what you said, there have been hiccups over 18 years when you...
Dr. Allen Miner: Of course.
Dr. Olivia Joseph: When a new patient call comes in, how do I know which service to direct them to? Do you know what I mean? And that takes good training. That takes good systems, you know, so that's part of the art, too.
Dr. Allen Miner: It's beautiful. Dr. Olivia, final question. You've been in UAC a long time. What's been the benefit? How's that contributed to you guys in your success?
Dr. Olivia Joseph: I think the benefit is the relationships. And we started really, really early on, and we haven't been able, just because of life... And we had a fourth kid five years ago, been able to participate as much as we did in the beginning. But I feel like, especially when we were really involved, that it was just kind of humble relationships in the sense where I spent an entire weekend side by side with Dan Pompa talking about nutrition and detox, and I didn't know who the heck he was, you know what I mean? So, like, kind of like that.
Dr. Olivia Joseph: And when I, when I do, you know, run into Mary Lee periodically at a, event, like, it's like, it's like you don't miss a beat, you know? Same thing with you guys. Same thing. I would say that, like, the relationship part for me has been the best. And then even, like the... There are just things you don't forget. Like, even remember Pat did the whole "Miles Davis you got to, like, burn down," right? Like, I was just reading a book last week that's talking about that, and I'm like, "Wow." Like, it was... That was such an amazing point and concept, and it circles back in your life. Like, greatness will circle back. Not always going to be great all the time, but if we put ourselves in places around greatness, like, it comes full circle.
Dr. Allen Miner: Well said. Beautiful. We're honored to...
Dr. Brian Capra: Awesome. Thank you.
Dr. Allen Miner: To be affiliated and associated and have you guys be part of the group. And thanks for sharing this. It's going to help a lot of docs.
Dr. Brian Capra: Thanks Olivia.
Dr. Allen Miner: Think bigger.
Dr. Olivia Joseph: It's great catching up.
Dr. Allen Miner: Thanks, Dr. Olivia. Have a great one. Take care.
Dr. Olivia Joseph: Thanks.
Dr. Brian Capra: Bye.
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