This is the third post I’ve done on our favorite books for practitioners. You find the other two here and here.

1. Essentialism by Greg McKeown
This was one of my favorite books last year. I love the idea of doing more by doing less, and this is the best book I’ve read on learning to focus on what’s truly important. McKeown offers a clear blueprint for deciding what’s essential, stripping away everything else, and doing just the stuff that matters.

Essentialism, for me, is essential reading. As one reviewer said, “If your life is manageable, filled with satisfying activities, and you’re progressing at the pace you want, you may not need this book.”

2. The One Thing by Gary Keller

“If you chase two jackrabbits, you will not catch either one”

That’s the Russian proverb that opens The One Thing, a book that’s a great companion to Essentialism.

I first found this in an airport bookstore. I was at first just attracted by the design, to be honest. It’s a beautifully done book. When my flight was delayed, I went back to the store and ended up reading the whole thing on the spot. It’s a fast, super enjoyable read, filled with tidbits on personal productivity, destressing, and generally improving your life. An inspiring and helpful choice for any practitioner.

3. The Miracle Morning by Hal Elrod

I was introduced to Hal by a friend before I’d read his book, and picked it up to give it a quick skim. I ended up reading most of it in one sitting, and I was pleasantly surprised at how useful it’s been.

The Miracle Morning is about getting more from your life by taking control of your mornings. I’ve always been a morning person–I get more done in two early hours than the whole rest of the day, it seems–but this book reminded me of how important it is to make the most of this time.

Early mornings are the one time in the day you can control. Even if you’re not a morning person–and Hal most certainly was not–this book can make a huge difference in your life. The bonus is Hal’s inspiring personal story and his engaging style.

4. Total Money Makeover by Dave Ramsey

I think I found Dave Ramsey’s podcast before his books, but I’ve come to love his stuff. He’s got a no-nonsense approach that might be a bit much for some, but he’s got legions of fans, and he’s helped untold thousands of people get out of debt and take control of their personal finances.

Your ability to manage your home finances has a huge impact on your practice. It’s easy to think the opposite–that your practice is affecting your home budget–but the effect flows both ways, to the extent that I don’t think you can run a long-term successful practice if you spend more at home than you earn. If you want to get your debt and spending under control, and reap the resulting rewards in every part of your life, this is the book for you.

5. Mindset by Carol Dweck
A fundamental and critical idea for practitioners to internalize is that you can LEARN to be an entrepreneur–it’s not a birthright or special personality type. The challenge I find, though, is that not everyone believes it. This book is a great resource for helping to embrace the idea.

Dweck makes a great case for the fact that it’s not just our abilities and talent that bring us success, but whether we approach them with a fixed or growth mindset.

“A fixed mindset is one in which you view your talents and abilities as… well, fixed. In other words, you are who you are, your intelligence and talents are fixed, and your fate is to go through life avoiding challenge and failure. A growth mindset, on the other hand, is one in which you see yourself as fluid, a work in progress. Your fate is one of growth and opportunity.”

My only complaint about this book is that maybe it shouldn’t take a whole book to get the point across that a growth mindset is what creates the basis for success. But unless you’re already embracing this idea fully, it’s absolutely worth reading.

Enjoy!

The post Another 5 Books Every Practitioner Should Read first appeared on The Practitioner's Journey.

In The Practitioner’s Journey, we use the metaphor of a bridge to describe a trusted source of referrals. One type of bridge is other health care professionals–local chiropractors, acupuncturists, massage therapists, naturopaths, MD’s etc.

The idea that these people can be great referrers isn’t rocket science. What’s hard is that you’re likely scared half to death to approach them. And so you spend all your time tweeting instead of meeting, intimidated by the idea of approaching someone new.

Let’s fix that right now. What follows is a simple, and best of all, comfortable, way to connect with other health care professionals in your area.

1. Stop thinking that this is something it isn’t.
First, it’s okay to be scared. It’s okay to feel squishy. Because what you have in mind probably IS scary and squishy.

What you have in mind is probably to walk into someone’s office, introduce yourself, and say, “Oh God, I’m so amazing, may I please have some referrals?”

So let’s not do that, because it will both suck and not work.

2. Change your goal.
Let’s do this differently.

Instead of the goal of asking for a referral, which is scary and lame, let’s reverse it. Instead of asking for something, how about we give something?

Why? Because asking for something from a stranger isn’t that effective, and even more importantly, asking for something from a stranger is so intimidating that you almost certainly won’t do it.

“But what do I have to give?” you ask?

3. Use the following script, more or less.
I’d suggest you get in touch by email, and just say, more or less:

Hi <first name>,

I’ve just opened my new practice here in Anytown. I’m looking for a good <chiropractor/acupuncturist/massage therapist/etc> to refer my clients to, and I was wondering if I could drop by your office to learn more about your services and what conditions you have the most success with?

You can modify this to suit you, but the premise is simple: get in touch to offer referrals. It’s easy, it should be true—what great health professional doesn’t need to refer?—and it’s genuinely helpful to them. And all those things make it comfortable so that you’ll actually do it.

4. Stay connected.
What we’re really doing here, of course, is starting to build a relationship, and that takes some ongoing maintenance. So follow your bridges on social media. Subscribe to their stuff. Stay in touch, and refer to them where appropriate.

That’s it. Squish-free networking, complete with a dose of helper’s high.

The post How to Comfortably Ask Other Health Professionals for Referrals first appeared on The Practitioner's Journey.

Time, money, and courage.

Those are the three things you can invest to grow your practice. The trick is that you have to invest in at least two of them to make decent progress. Choosing only one fails almost every time.

Just time and you spend hours in your office. Alone.

Just money and you go deep in debt with no reward.

Just courage and you lack credibility.

Which ones are you investing?

Ask yourself:

• Have you invested in your practice financially since you left school? You can be frugal. You can bootstrap. But don’t forget to invest in the thing that pays your bills.
• Have you put in the time required to “turn pro”? You don’t need to burn yourself out, but you do need to show up more than a handful of hours a week.
• Are you doing things that stretch you? When was the last time you introduced yourself to a stranger? Spoke to a group? Focused on meeting instead of tweeting?

There’s a risk to taking no risks. A big one. So you need to pick two.

Yes, it’s scary. But just pick two and you can knock it out of the park in one year like this practitioner.

The post Pick Two first appeared on The Practitioner's Journey.

I had dinner with a practitioner recently who told me that her Twitter following of several thousand people had generated a grand total of…drum roll…three patients.

Her point wasn’t to condemn Twitter, though, but to make the point that social media isn’t the best way to grow a new practice.

Why? Because of this critical little fact:

The basic unit of practice growth is CONVERSATION.

You’re in the people business. Health care still fundamentally takes place with two people in a room together. That’s how it’s delivered. It’s personal. It’s up close. And that means your efforts to find patients should be the same. The more people you connect with in real life, the more new patients you’ll get. More conversations=more patients.

If you’re struggling to grow your practice, ask yourself this: How many conversations am I having with new people each week?

Why Are You Tweeting Instead of Meeting?

Because it’s easier. And by easier I mean less scary.

That’s why you’re tweeting instead of meeting. It’s why you’re posting to Facebook instead of shaking hands with someone new. Why you’re connecting on LinkedIn instead of connecting over lunch or coffee.

But you don’t get paid for easy. You get paid for risk and value. And if you don’t take any of the former, you don’t get to provide the latter. If you don’t get out there in the real world and meet new people then it takes an awful long time to grow a practice.

If you gain a dozen new Twitter followers for a year, you’d have over 4000 new followers. And there’s a good chance it could make almost zero difference in your practice.

But if you met just one new person a day for a year and talked to them about how you help people? You’d meet less than 400 people, but be an absolute rock star.

The point here isn’t to abandon or ignore social media. It’s to point out that if you’re substituting social media efforts for the high-value work of actually meeting real humans in real life, you’re selling yourself short.

Sure, keep tweeting. Just make sure you’re meeting.

The post Tweeting vs Meeting first appeared on The Practitioner's Journey.

Hi All,

We’re doing a rare, in-person business session for ND’s on October 25-26 in Toronto, ON.

There are only 24 seats. You can find all the details and register here, but here’s the executive summary:

For two days in October, we’re going to gather a select group of motivated ND’s together to solve real practice business problems in real time. Whatever it is that’s holding you back from getting where you want to go, we’re going to tear it down, and find a way to fix it. Whether it’s associates, staff, marketing, finance, admin problems or just sheer chaos and overwhelm, you’ll walk away with a written plan to solve it.

This is an amazing opportunity to tap not just our brains, but great thinking and wisdom from smart, motivated colleagues. If you’ve got a practice challenge, someone in the room will have already solved it. And if not, we’ll figure it out together. You’ll leave feeling confident, relieved, and with an actual written plan to get things done.

It’s first come, first served, and we won’t be adding extra seats, expanding, or making exceptions. We’re keeping this small for a reason—we’ve got a lot to accomplish, and we want to over-deliver.

Registration is now open. Early bird price is $999. We expect to sell out all 24 spaces at that price, but the price after August 8 will be $1300.

Everyone is eligible–If escaping the business shadows that have been hanging over your head sounds like what you need, please read the full details, and email us any questions.

We’re both extremely excited about this. Practice can be lonely and overwhelming at times, and it’s our hope to have people connect at a high personal and business level, and truly solve some tough challenges. We’d love to have you join us!

– Dan & Tara

NDSuccess.com Business Mastermind – Oct 25-26

The post ND’s: Solve Your Biggest Practice Problems This October first appeared on The Practitioner's Journey.

Nothing, actually.

Even when you make a great decision, nothing’s happened yet. You haven’t added any new patients, gotten out of a relationship with the wrong associate, or signed a lease. You haven’t changed your practice, or changed your future. You’ve only changed your mind.

The part that comes after deciding? That’s when things happen. But it’s also the frightening part. So what do you do if you’ve decided, but the next step is scary as hell?

My prescription: watch this video. I find it helps. Really.

Have a great week. Be brave.

Can’t see the video? It’s here.

The post What Happens When You Decide first appeared on The Practitioner's Journey.

We’ve talked about making great decisions before, but over the years we’ve discovered that the best and worst decisions we’ve made aren’t just about the decision itself. They’re about the context of the decision–where we are, how we feel, and what we’re doing while making it.

This is particularly true of decisions with high stakes–things like firing someone, choosing a new associate, or making a big financial commitment. Decisions don’t get made in a vacuum. What we see as possible, inspiring or vital in one environment or state of mind can easily seem pointless, illogical or impossible in another.The decision you make when you’re rushed, tired, or scared is different from the one you make when you’re relaxed, rested and confident.

Your job is to make as many big decisions in the second state as you can.

Here are some ways that have helped us create positive states for decision-making, and as a result, better decisions.

1. Remove yourself from urgent environments.
   Important is not the same as urgent. Urgent is what jumps out at you. It’s the ringing phone, the looming deadline, the chirping inbox. Urgent is the next fire you need to put out. It’s small picture stuff. And, not surprisingly, you can’t make good quality, important decisions when you’re putting out urgent fires. Take some time away. Try to make high stakes decisions away from the office.
   

 

2. Wait.
   You can’t just turn off the phone and expect to be suddenly clear-headed. You need time. Important decisions tend to have long-lasting consequences. Hiring the right person versus the wrong one will change everything in your practice for a long time. You need to give the decision the time it deserves. Very few big decisions can’t be slept on. Do not be allow yourself to be rushed.

 

3. Separate Decision & Action.
   Often what stops us from deciding is the fear of what we’ll have to do once we actually decide. Give yourself permission to see the decision-making process as a separate step. If you’re considering firing someone, for example, then just let yourself focus on the decision, and the positive results. For the moment, forget about what’s required to make it happen.

 

4. Set your fears aside.
   We’ve written about avoiding fear-based practice mistakes. The secret here isn’t to simply try harder to not be afraid–which tends to just make everything scarier–but to acknowledge that you are afraid, so that you can recognize that it might be affecting your decision-making. The question you should be asking yourself is, “If I wasn’t afraid, what would the right decision be?” or “If I was giving advice to close friend, what would I tell them to do?”

 

5. Get meditative
   I don’t mean you have to meditate, although you certainly can if that works for you. I mean change your state through activity. Walk. Hike. Go for a run. Swim laps. Rake leaves. Paint your bedroom. Do something that: a) doesn’t take a lot of focus or brainpower; b) is repetitive and c) isn’t related to your problem.

 

6. Talk it through. And, of course, it’s hard to decide big things on your own. Find someone you can talk to. It’s amazing how many times they’ll see something you don’t. And no, they don’t have to be someone who understands your practice–sometimes an outside perspective is exactly what you need. In any case, many positive, smart heads are better than one.

What we’re talking about is essentially matching the size of the decision to the state of your mind. Need to choose a paint color? Just pick it. Paint is cheap, and you can re do it. No state change required.

Need to choose a new associate, or a new clinic? Use every single one of the steps above–you’ll be glad you did.

You can’t make big decisions effectively in a small state of mind. Create the right decision environment and you’ll find better decisions every time.

The post How To Make Great Practice Decisions When the Stakes are High first appeared on The Practitioner's Journey.

I consult on several practice sales a year. Sometimes it’s for buyers, sometimes for sellers, or sometimes it’s mediating for both, but the biggest challenge in every case is always the same: deciding what the practice is worth.

The problem is not that the math is hard. The problem is that there’s no right answer. The right number, in the end, is really the one that everyone can agree on. The trick isn’t the number, it’s getting agreement, and, more often than not, helping people see the value in buying a practice.

If you’ve found a practice for sale, or you’re selling yours, this post is designed to get you started in deciding what a practice is worth.

What Really Matters in Practice Valuation
It’s usually not that hard to figure out what the tangible assets of a practice are worth. Real estate, furniture, inventory–they’re usually not the sticking point. The difficulty comes in trying to decide what the intangible assets are worth. How much are your client files worth? What’s the value of a patient who came to see you six month ago? Six years ago? Six days ago? How much is your “brand” worth? Your logo? Your referral network? Your awesome admin assistant?

The answers to those questions, it turns out, tend to be in the eye of the beholder. Buyers and sellers naturally have a different idea about what things are worth.

What matters most is to put energy where it belongs. There’s an important principle to work from here: It’s almost always more important to get the deal done then to get the price exactly right. 

The greatest risk in buying or selling a practice is not that you’ll pay too much, or sell for too little, but that you won’t buy or sell at all. 

I believe you’re far better off to overpay a little for a good practice then to build from scratch. And you’re better off selling for half price than just walking away.

Does this mean you shouldn’t take valuing your practice seriously? Not at all. It just means that when you’re second-guessing yourself every step of the way (which is normal) keep in mind that there’s no right number.

How to Value Your Practice

Having said that, I’m going to suggest four ways to approach valuing your practice. These are fairly broad strokes, but they’ll get you started. Besides, saying things like, “present value of a practice’s future earnings stream discounted at an appropriate risk-adjusted rate of return,” just makes everyone unhappy so we’re going to keep things simple.

The more ways you can value a practice, the better. After all, if you’re selling, you need plenty of evidence to support your valuation, and if you’re buying, you need plenty of evidence to justify spending the money. So you may want to give all these a try.

METHOD 1: Use an Established Professional Standard
Some associations have recommendations for valuing patient/client files. Often this is based on giving files a value based on age or activity. You might, for example, have different values for active, semi-active, and inactive files. You can find examples of that for massage therapists here, and for naturopaths here.

Pros:

• It’s simple. It’s pretty easy to add up files and multiply by some standard amount. Then you can add in real estate and other assets, and you’ve got a ballpark number.
• It creates common ground. What I like best about this method is that it gives some sort of starting point. If your association is recommending it, then at least a seller can say, “I valued my files using this professional standard.”

Cons:

• Inaccuracy. Per-patient valuation, and recommend rules of thumb tools (below) tend to ignore differences between practices. What if your clients are worth twice the average because you operate differently, or have better retention and return rates? What if your “brand” is worth more? These are all part of your practice’s “goodwill” and vary from practice to practice.

How to Do It:

• Contact your state/provincial/regional association.
• Contact your national association.
• Contact your regulatory college or governing body.
• For each, ask about standards, and ask for recommendations of other practitioners and professionals to contact who might have some insight.

METHOD 2: Ask Your Peers
Many of the integrative and alternative professions don’t have established standards, and it can be hard to find information on what other practices have sold for. Often, your best resource is to simply start asking around.

Pros:

• Relevant info. Talking to other acupuncturists about practice sales is going to give you more relevant info than talking to a valuation expert who’s never looked at an acupuncture practice
• Contacts and support. Finding people in your industry who have done this before can really ease your mind, particularly if you’re buying. They’ll also likely point out all kinds of little details and pitfalls you haven’t thought of.

Cons:

• Small sample size. If you talk to three people who’ve bought or sold, the odds of their practices being like yours are low.

How to Do It:

• Email your practitioner peers asking for advice.
• Put the word out in discussion groups, forums, social media, etc. (if you don’t mind going public)
• Remember: it’s probably not your friends who know, but someone they know who can help. It’s a networking job. You should be able to come up with several people just by putting out a few feelers.

METHOD 3: Use a Valuation Rule of Thumb
There are plenty of “rules of thumb” used to value businesses. They’re simple financial estimates to ballpark the value of a business.

Here are a few examples of rules of thumb:

• One year’s gross revenue
• Average of last 4 years gross revenue
• 70% of last year’s gross income
• 2 times one year’s net income

These are generally ways of valuing the “intangibles” of the business, and don’t include significant assets like real estate or equipment.

Pros:

• Simple: If you have a rough idea of what a “rule” should be for a practice, it’s really easy to quickly assess a rough value.

Cons

• Too Simple. These really are rules of thumb. They’re for quick-and-dirty estimating, and should be used accordingly. I like the rules of thumb based on net income or profit better, because expenses can vary so much between practices. A practice that bills $150K with $20K in expenses is a lot different than one that bills the same $150K with $80K in expenses.
• Which rule to use? For many professions, there simply aren’t enough practice sales tracked to really know what the multipliers should be. There’s lots of data for dentists, for example, and some for chiropractors, but what about reiki or rolfing?

How to Do It:

• Use Method 1 & 2 above, but ask about business valuation standards while you’re at it. The math is easy–it’s just deciding on a “multiplier” that’s hard.
• Ask your accountant or lawyer for a quick-and-dirty guess.
• My rough rule of thumb? If you can pay one year’s net income or less for a practice, then you’re on to something. That means a brand new practitioner could buy a busy practice and go from zero to a great income in two years. Most people don’t do that building from scratch.

METHOD 4: Hire an Expert
There are people out there who specialize in this stuff, and they’re good at it. If you want to move past the guessing and ball-parking of the other methods, this is your next step.

Pros:

• Accuracy. When you use this method, you’re generally using real data,  worked up by someone who has some advanced business analysis mojo.
• Credibility. Having a practice valued by a pro can lend some cred to the sticker price.

Cons:

• Cost. It takes time and money to hire a pro. They’re going to want to do a real valuation, not just make a ballpark guess. But if you want professional advice based on real numbers, you should consider it.
• Relevance. It’s hard to find a specialist who understands some of the less common health care professions. They’ll give you a value, but you’ll still need to explain that to a new practitioner who likely has very little appreciation for why buying a practice is so important.

How To Do It:

• Ask your accountant or lawyer. Often they’ll know someone who does this stuff.
• Ask a few business owners. Someone will know someone.
• Search online. There are a few specialists for some professions, like chiropractic.

Whatever method you use, remember to do your homework, and don’t forget that buying and selling practices is good for practitioners, patients, and professions!

The post How to Value a Practice first appeared on The Practitioner's Journey.

“It’s like driving a car at night. You never see further than your headlights, but you can make the whole trip that way.”
– E. L. Doctorow

Doctorow was talking about writing a novel. But you might just as easily think of building your practice the same way.

Sometimes you just can’t see the whole path. But that doesn’t mean you can’t keep walking it….

***

The post On Uncertainty first appeared on The Practitioner's Journey.

Hi All,

Tara will be teaching a one-day course on IV Therapies for Common Complaints in Brampton, ON on October 5th. This is a great way to dramatically expand your IV education and practice, and get those hard-to-find IV CE hours. (It’s approved by the BDDT-N for 5.0 PT/IV hours, which means ND’s from Ontario, BC, AZ and many other places are eligible to claim the hours.)

The day’s content is clinical, but we’ve added some extensive IV business material that attendees will take home with them – everything from real forms and tools for your IV practice, to effective costing and HR strategies. It’s really our whole approach to running a profitable IV suite, packaged up for you to take away and apply in practice.

You can find all the details at ND Success. Early bird pricing of $249 runs until June 28th only. Price goes up to $329 after.

The post For ND’s: IV Therapy for Common Complaints – Oct 5, 2013 first appeared on The Practitioner's Journey.