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The Four Seasons of Practice
Episode 112th July 2022 • Align Your Practice • Dr. Clifford Fisher
00:00:00 00:17:37

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Do you know the Four Seasons of Practice – Launch, Build, Scale and Exit? More importantly, do you know what season you are in, and are you happy there? Or would you like to grow into the next season? Would you like to maximize the season you are in or learn the tools to grow into the next season? These are the four seasons of a chiropractic career. 

In this episode, we will talk about the four seasons and help you determine where you are and give an overview of each of the four seasons. Share with you transitions from launch to build, then build to scale, then scale to exit. Knowing these steps will help guide you and give you an understanding of where you are and where you want to go.

About the Host:

Dr. Clifford J Fisher

Dr. Cliff Fisher – Owns several offices all over the US and has a coaching business Dream Leadership Institute to help people find the greatest version of themselves. He will help you get to a foundational understanding to create the business and life that align with your being.  

 

Dr. Joseph Esposito, CEO

Dr. Joseph Esposito, D.C., C.C.N. C.N.S., C.C.S.P., D.A.B.C.N., F.A.A.I.M. C.T.N., is the Founder and Chief Executive Officer of AlignLife. As such, he is responsible for the direction of AlignLife as it expands further across a dynamic and rapidly changing health care landscape. Dr. Esposito has more than 20 years of experience in a broad range of businesses, including chiropractic, nutrition, technology, and internet marketing.

Dr. Esposito has extensive post-graduate academic accomplishments, as well as 15 years of experience managing successful chiropractic clinics in multiple states. He is also the founder and CEO of Aceva LLC, a service-based nutritional company providing products and services to the AlignLife clinics. As the former CFO of an internet publishing company, Dr. Esposito understands the power of leveraging the internet to impact the lives of millions of Americans.

 

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Transcripts

AYP Intro/Outro:

Align Your Practice podcast with Dr. Cliff Fisher where your best practice and life awaits you. Are you tired of running a practice on your own? We want to come alongside you with experts to help you create your dream practice in your dream life. Here is your host.

Dr. Cliff Fisher:

All right, welcome back. Episode number one. I'm super excited for this one, we're talking about the four seasons of practice. And so I'm super excited to jump into this with you, Joe. I know you've had all four seasons, not a lot of chiropractors have, most of them just go through launch most get stuck in build some scale and very few exit gracefully. And

Dr. Joseph Esposito:

I agree and, you know, last podcast that the first initial, I think we called it, episode zero, that's a kickoff introduction. We talked about the the consumer being educated in the marketplace being a little more seasoned. Well, the same goes to the chiropractic profession, we are now getting more seasoned, where we're, like you said, we have these four different seasons of practice. And it's important for whether they're student on right now or a season doc, to know where the heck are you right now, in your practice, right. So you know, awareness around.

Dr. Cliff Fisher:

I think when we were talking, I just I love the realization we both had, just as far as like, so many things are like a chiropractic practice, as this like. So the four seasons of, of practice are also very similar to the three phases of care. And so we'd have that initial intensive, then we have corrective, then we have wellness or maintenance. And same thing with what with practices, we see it when people start a launch, then they grow into build, and then they go to scale. And then hopefully they have a graceful exit. And that's what we're what we're building inside of the line life.

Dr. Joseph Esposito:

So yeah, let's break down those four. So you know what those are. So if you're listening right now, it was the first thing we want to accomplish in this podcast is find out where are you right now. And if you're student, obviously, you're gonna get into the first phase. But there are four stages. And the first one, I'll go through the first, maybe do the second, I'll do the third. And we'll kind of walk through these things a little bit. So the first is launch, which is launching a clinic. Now, if you're taking the career choice as an employee, you wouldn't this discussion wouldn't be as Ballard, we will be talking about your career, which is a little bit different. So this is a little bit more for those that actually start a clinic. And that's only a small percentage of you that will be doing that. But this is a meaningful conversation if you choose to open a clinic. So the first phase is launch, meaning launching the clinic, kind of like launching a rocket, a lot of energy, a lot of work a lot of time, a lot of there's some fear, there's money, there's resource, right very heavy in the beginning of launching a rocket launching a clinic. So we state that as the first 12 months of practice. And we had talked before we got on Cliff that the goal would be about somewhere on 200 visits a week, minimum of like 150 By the end of that 12 month cycle. But this frame is from opening to 12 months into practice. And the other thoughts around launch.

Dr. Cliff Fisher:

I think the biggest thing is it's really Doctor heavy like this is where it is on the doctor shoulders like this is where you are the you know, you're building this with your heart, your head, your hands, your feet. Not a lot to leverage, like you said, not a lot of resources Ness for a lot of people. And then not a lot of people around you to help support. So this is really digging in this is the trenches of building it so that you can train it. So as you're building, it makes sure that you're taking the lessons. So when you start to bring people on that you're training the you're able to train the people to do those other jobs.

Dr. Joseph Esposito:

And I think and Bill, sorry, launch, there's a lot of room for error. I think like I was mentioning in our previous talk. This is where you sign leases, you get loans you hire, there's a lot of potential issues, mistakes, lost revenue and pain in this first phase of practice, the others in the machine is moving down the road. But this face, I think there's a lot of risk here. And that's where groups such as the line life that we we talked about and other groups that can help assist doctors to prevent them from getting too much scar tissue and too much damage on the journey. So you got to survive that first year with profit, sanity. Right. And in still have inspiration to serve your community.

Dr. Cliff Fisher:

I feel like this one is that whole trajectory thing if you're not like if you're just like we talked about earlier, like if you're launching a ship to the moon, if you're pointed horizontally, you're going right into the dirt versus right yeah, to be pointed in the right direction. And so I think that's a really critical piece of this launch one, and even from the basics of tax structure to company structure, like all these things that honestly, we were not taught in school, I wasn't taught in school and talking to students, I don't feel like they're taught ins in that.

Dr. Joseph Esposito:

Absolutely not, you know, you say corporate structure, do I do a C Corp? Well, that's kind of silly for a startup company. Yeah, it's not worth the money. And it doesn't provide the values you need versus an LLC, or an S corp. I love that you're going out because that's another podcast that we're going to do is talking about corporate structure, you know, yeah, bringing on an attorney on here that can help a student, a new doctor, or even existing doctor that's in the wrong corporate structure that doesn't serve the business. So I love that you brought that up. So in launch in a line life, we've actually quantified. I think, I don't have the number in front of you. But it was interesting, was well over three to 4000 decisions to make. And we stopped there. But we projected like 1000 decisions from the table, the color, the brand, the logo, the square footage, the carpet, I mean, we can go on for hours on the decision. So in a line life, what we like saying is that we've taken out about 85% of all decisions that we've just done it so much, that let's take off all the decisions that a lot of pain and mistakes are made. And let's give you the 1000 decisions, which are creative and fun, and not have to deal with all the other mess behind the scenes that create the mistakes.

Dr. Cliff Fisher:

I'm just and I think when you're saying that, like for me, my head's just spinning like that would have saved so much time. So I could just get to adjusting patients get to taking care of my community versus like, picking a color picking where should this wall go, you know, all that stuff was,

Dr. Joseph Esposito:

especially if you've never done it, you may have an emotional desire for a decision, like, oh, I want to do this and your like, X ray machine by the front desk, maybe that's not the smartest move with the amount of lead I need and the confusion and whatnot. So yeah, we got to get the emotions out in business. And we have to get to proven systematic implementation to drive success and patient outcome, right? I mean, that's where a lot of the heavy lifting is that watchface.

Dr. Cliff Fisher:

Yeah, so then the next phase, so just like you were saying, so we get out of launch, after about 12 months, sometimes, you know, people get out of it faster. And then we're getting into the build phase. And the build phase is basically what we're at that point. So the launch phase, you're really training the doctor, the build phase, you start leaning in and training your team. And so that's really where you can start to leverage your time, money, energy and focus by having a bigger, better team around you. And the thing I love about the way we do it, Joe, and align life is we already have all the systems created. So your team can just come in, and they're right alongside of you the whole time. So it's not like a reset, you have to pull away from taking care of patients.

Dr. Joseph Esposito:

No, that's a good point. Because the the limiting resource here is time. And when I talk to business owners, I talked to a chiropractor that was in the Align life system, and their family owns a franchise and it was in tanning salons. And they were leaning on the expertise and knowledge of the family and saying I can help you launch your chiropractic clinic. And your later when the doctor was almost bankrupt and saying, Can you help me, he learned lesson and said, You know what, what I realized is that in a tanning salon business, the owners in the back, and the staff is up front selling the packages and putting them in rooms. I didn't realize that my family that was guiding me to open a chiropractic business. And the reason I think I went through almost a bankruptcy is because I'm running the business, and I'm providing the service and all the work and you're the practitioner, you're the face of the business. So it it's a limiting factor of time, because as you scale your business, you don't have the time to train. And that's why like a line life can provide a service back end training virtually to train your staff. Because eventually you don't have the time to get to the next level. Because you're busy seeing patients.

Dr. Cliff Fisher:

And even if you had the time, most time people don't have the systems and structure to do it. I think rightfully right, like, probably a lot of those doctors have the time they don't even know what to do. They don't even know which direction to look. So that's where I love that. And then. So then, as we're going through these phases, a couple things that I think about a lot is like we talked about, like procedures, we talked about flow, we talked about team and we talked about communication. So having all four of those verticals, working optimally. So that's really where you start to train your team and build and then you move into the next phase.

Dr. Joseph Esposito:

Next phase would be scale. And scale is when we start either hiring another practitioner at another clinic. It's when you truly scale and you don't exchange dollars for time or for service, you're actually building a business. And we both know that most people create themselves a job when they open a chiropractic clinic, they don't create a business. And by that being if you're listening, if you create yourself a job, that means if you were to leave for vacation tomorrow, and you don't go to work today, you're on your way to maybe driving to work right? Now, let's say you just don't go to work and you have, and you leave for two weeks. Well, you should have another doctor in the clinic that takes care of the patients keeps the business going. That's when you have a business, a job, a glorified job, when you build yourself a job is when you own the business. But if you're not there, nothing happens. And that's a scary position to be in because that change yourself to the business and my by Count, I love what he said, When I first open business, he says it's called the velvet prison. Beautiful. You've built it. Like you're stuck and you're chained inside this prison, which is your own business. I don't want any chiropractic to feel those restraints.

Dr. Cliff Fisher:

Yeah, I know for me, like when I was in the build phase, like I didn't take vacation for four years, I worked every Memorial Day, Labor Day holiday, like it was brutal. And then when we built it up, then we started to scale. Like I remember taking a vacation for like a week, and I felt it was crazy. And then by the time I exited, I was taking five to six weeks of vacation a year. So

Dr. Joseph Esposito:

yeah, you weren't the only people I know that run multimillion dollar clinics on the other side of the country for a number a period of time, not that you designed it that way. But that's your life circumstance. And you actually pulled it off successfully for a period of time until you changed your your direction, your values, but to run clinics for years, that far away tells me you know systems, and you know how to run a business, not create a job. So it is interesting the scar tissue you had when you started, never get a vacation to what you created. And throughout the podcast, I want you to drip in the scar tissue and the lessons learned. Because whether it be the students on the call, or a doctor that may be struggling that has a job but not at a business. I want you to kind of feed some of those lessons you had throughout the podcast. I think that'd be really valuable.

Dr. Cliff Fisher:

Yeah, absolutely. No, I think there are big ones. And I think so many of them were fear driven thing, and the patients wouldn't go along with it or whatever. But I think like the end of this is the exit. And so how do you have a graceful exit? And so in that, I mean, you can't sell your belly at prison, anybody, nobody wants to buy it. They want to buy a business. And so build it to sell. There's a couple there's a book on that. And there's a lot of thoughts on that. But what's your thoughts on that, Joe?

Dr. Joseph Esposito:

Yeah, I think you want to sell a business that a job, like you said, because the value of that business is significantly higher, we're talking not 10%, higher, about like three to 400% higher when you have a business, meaning you have practitioners working in your business, and an investor can buy the business. And that increases your valuation. And we will break down valuation for those who are interested because you want to dorable scalable and transferable transferable means that you take the asset and you sell it for X number of dollars. And what what is a shame to me is some of chiropractors when they're done, they close shop and that center is no longer serving patients that breaks my heart 3040 years in a location. And it's God, I want chiropractors to look at their business, like people look at a church. We're going to this church here, we expect to be here for at least three to 400 years. Yeah, no mindset. When you put up a clinic, leave a legacy, leave that clinic working and serving your community. But unfortunately, most doctors don't know how to sell it. They don't know how it has value. They don't know what to do with it. And throughout this podcast, we are going to teach and empower you to build a business that has value and I'm excited about that component because I think that's the last step of maturity this profession cliff is that there's not really a lot of data and understanding that about each edge.

Dr. Cliff Fisher:

Yeah, no, I 100% agree. And I know we both had successful exits. And as you know, my practice is thriving, it's doing great. I sold it to my partner we built it to sell and you know it wasn't my plan to sell it when I sold it but when we did it was easy and effortless. Not easy. It was easy it was relatively easy it wasn't like a piece of cake but but he says you're such

Dr. Joseph Esposito:

a I got to cut you off and say you're such a good at setting expectations that I was actually on the calls with you because I have helped many people exit and it was the silliest conversation because it was like your partner's like no, I wanted what's best for Cliff and cliffs like I want what's best for my partner and it was authentic and healthy. It was actually a beautiful experience that the gentleman has on the call it does contracts was like, Are you kidding? I've never seen two partners trying to support each other and an exit. And that's we want to teach you guys, if you're on a call, people do exits that are like literally, violently, emotionally, violently, physically violently. It's just like an unhealthy thing where it's traumatic, that should not be traumatic, it should be a loving giving transaction that's healthy with proper expectations, right? I mean, you really well, well, and

Dr. Cliff Fisher:

we still talk once a month. So I feel really grateful for my partner. And it's awesome. So I think for this, like, I guess the biggest takeaway for me is that I want you guys to one, recognize that there's phases in practice, know where you are, and know where you want to go. I think those are the big takeaways from today. So there'll be a PDF associated with this, that will be below and it'll give you some ways to great and understand where you're at, in practice who you are, and then also give you some Where do you want to go. And so,

Dr. Joseph Esposito:

so what you said, what you said in the beginning was the first phase like launch is like, you want to make sure you train the doctor, train yourself because you're carrying that business. And the second phase is where you're at like, a 150 to like 300 visits is where you start bringing in the staff, making sure the staff is level up to back your vision, your purpose, your mission. And then as like, when you're bigger than that, then it's training your patients to actually be advocates and promote the practice. So there's a journey in the patient side. And then it's a journey in your career. So ending our podcast today. Know where you're at in your practice. Are you in launch you in build? Are you in scale? Are you in exit when you know where you are? As we continue this journey on his podcast, we're going to teach you how to build the tools and the resources to get to the next level successfully.

Dr. Cliff Fisher:

Awesome. Yeah. Great wrap up on that thing. It's super important. So yeah, check out the PDF below. If you guys have questions or anything, always feel to reach out, you can direct message me or Joe, I know if you guys want to talk about different things. This is where we do thrive. And I just, I don't know, I don't think there's anything I'm more passionate about, than chiropractic stuff for my wife and family. So thank you very much. Excellent.

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