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The real estate market has lost an average of 22% in 2008.  The stock markets were down 46% from their high.  It leaves you wondering, where should we put our money?

3 years ago I consulted with a coach from the Small Business Development Center, who helped me discover my I.R.R.  I.R.R. stands for Internal Rate of Return.  This set me on a very powerful journey that has surely proven true in this economic downturn.  Let me explain.

I.R.R is the return on your money that you put BACK into your business.  So instead of buying shares of xyz stock you go ahead and invest in your own business.  We will work on an EXPONENTIAL gain of your investment.  I know that will beat anything else you see in 2009.

There is only ONE way to grow ANY business.  It all comes down to this equation, which I have talked about previously.  Your business is always a product of the number of new clients, multiplied the number of times they do business with you, multiplied by the money they spend each time.  To put it Chiropractic Terms:

Your Money = New Patients(NP) X Patient Visit Average(PVA) X Office Visit Average(OVA)

We typically use these monthly terms;

NP = The number of New Patients you see in one month
PVA = The average number of times a patient will see you.
OVA = The average dollar amount collected for each encounter

These are the only three areas you can invest money in.

New Patients – Investing in this category might include screening at local festivals or expositions, putting an ad in the paper, telemarketing, website or online marketing, social media, Dinner with Doc etc.

Patient Visit Average – Investments here might be a Brican Patient Education System, upgrading the aesthetics of the office, Neuropathalator, or even just spending the extra dollars on upgrading your paperwork with Patient Media.

Office Visit Average – Investment here might include hiring a billing consultant for 3 hours to make sure you are charging for what you do, adding supplements or pillows for sale in the office, or maybe outsourcing your billing to achieve a higher collection percentage.

NOTE: Hiring a practice management coach may be able to help you in all three categories.  I have been in Five Star for 7 years and I am also a big fan of Dr. Dill’s That Something Coaching Program.

The Magic

It is easy to understand that if you invest in New Patients then you will get more new patients and receive a linear growth. NOW, watch this for EXPONENTIAL growth.  Let’s say we spend $1,000 per month attending festivals and screening events that gets us a mere 5 more new patients per month.  Then we invest $300 in Daniel Clark’s New Patient Book for each New Patient along with $1000/yr spent sending out a newsletter to tackle our retention (PVA) category.  Finally, we invest $1,000 in a billing and coding consultant to help us make sure we are billing correctly and collecting timely patient payments to increase our collections.

NP        X        PVA           X            OVA       =          $$

Last year        20        X         15            X             35         =       $ 10,500

2009             25         X         20            X             40         =      $ 20,000

We invested $14,300 distributed over each of the 3 categories to get a small gain of 14-25% in each category.  However the whole practice received an additional $114,000 in revenue for a near 100% return on our investment.  What other market are you going to see that in?

Onward and Upward,

6 Comments for this entry

Dr. Michael Beck | Chiropractic Marketing
January 5th, 2009 on 10:58 am

Hey Doc, great post. I like the I.R.R. thing. I’d never heard of it mentioned like that.

I think you mean 1000% ROI where you said “100%”.

Brandon Harshe
January 5th, 2009 on 3:01 pm

I was actually talking with January about this the other day, in regards to what is good to invest in these days. Very insightful post.

Nick Tedder
January 6th, 2009 on 8:25 am

Hey Doc, I really enjoy this site. I wanted to start a newsletter to my patients in 09′ what are your suggestion on when, how, $?

Innately Yours,
Nick Tedder, DC
UCHC Team member

Darren White
January 6th, 2009 on 7:57 pm


I have not been very successful with patient newsletters. I have tried everything. In February we start our practice Blog, I will be experimenting most of 2009 and will share my experience on this blog. A blog allows for more interaction, easier to disseminate, more cost effective, and much easier to maintain statistic on.


January 9th, 2009 on 7:52 pm

thanks D, i have heard the same from other doc’s as well. I look forward to your blog!


Michael Polsinelli
April 10th, 2009 on 9:05 am

You can try an email newsletter. I use a service called mailchimp that is free for up to 100 subscribers. You can also set up email delivery of blog posts to your patient.