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Episode 312th July 2022 • Align Your Practice • Dr. Clifford Fisher
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After the Launch, the key is now to build your practice. This stage of the Four Season of Practice can be the longest phase, but it does not have to be. Join Dr. Cliff and Dr. Joe as they discuss the Build and what the right questions are so that you can grow in the build and put yourself on the right trajectory to enter Scale.

Listen as they discuss these concepts and more:

  • Who should you hire and why organization charts are critical? 
  • Are your staff liabilities or assets driving revenue?
  • What is the biggest ROI in your practice?
  • When should you be hiring and in what order to get and keep momentum to grow faster?
  • Why should you be leveraging team and software to grow your practice?
  • What are your gaps in procedures, flow communication, and team? 
  • Shift from competency to mastery of systems and procedures.
  • Learn when to hire a doctor and what you have to level up. 
  • Learn the ceilings and how to break through the ones that are holding you down.

Download the pdf here: https://bit.ly/AlignLifeLaunchBuildScaleCommunicationPDF

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 also is 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. Hey. So episode number four. I'm super excited. We're gonna dive into last week we did launch this week, we're going to do build. So Joe, what were some of your takeaways from last time with launch?

Dr. Joseph Esposito:

No, I love that breakdown in the form that Dr. Clarino made was so valuable. He's such a visual guy, because he can build and create anything. So it's such a wonder to have him on the team because he he helps me think about practice in a nonlinear like a three dimensional way. So I love that form that you showcase. I know you have another one for build. So with launch, I think I love this scenario of like trying to great create a perfect meal timing is everything a launch because you need money. You need to build out you need leases, you need hiring staff, you need marketing, it's a lot for a single doctor at a school with no experience a pull that off. And that's why there's such a failure rate in first year doctors and Adeline life our our skill set is to be able to do all of those verticals at the same time because we have experts in the different fields and allowing the doctor to get quicker to seeing patients driving revenue and creating inspiration verse, stress and fear in practice.

Dr. Cliff Fisher:

Yeah, like, I'm like, I'm spinning on my your whole thing and preparing a meal. Now we gotta get a restaurant staff, that's kind of what build is like, now you gotta get like, now you have somebody cooking, you have somebody, you know, serving you have somebody, you know, cleansing

Dr. Joseph Esposito:

analogy, and they gotta market your restaurant, you gotta there's a lot to it. So yeah, let's get into build. So build is when, after one year in practice, now you're starting to build the practice, meaning build a team, build a patient base, build a reputation in the community, there's a lot of build here inside of this phase. And this is the longest phase in practice. It's the phase up until the point that you hire another practitioner, or you open another practice, it's when you start to scale scale, meaning you're not exchanging dollars for a time, you're actually building a business that scale. Most Cairo's, as Cliff has said numerous times of the podcast stop here. They build the whole career, they never scale. And they never sell, they never exit. So we want to guide you through this. So if you're in build, you're going to be showcasing some areas of pain. And then our idea is to give you some clarity on how you can prepare for scale.

Dr. Cliff Fisher:

Awesome. I think one of the sad things is I think, if somebody's even done build well, they're their buildings worth more than their practice. And we want to change that.

Dr. Joseph Esposito:

That's such a good, good clarity, because that's so true. So let's talk about a built inside of build, what are the paints? Well, I can give 50 of mine over the years, before we the first 10 years of practice, but for me, it's not building the right team. Number one is wrong people in the wrong seats of the bus. It's hiring people that have my personality. That's why I like them, because they're like me, meaning they don't have the skill sets that I don't have. They're just a very passionate extrovert. They're not detail oriented. They're not systems based. And I'm just hiring people. I like creating a mess of the practice, because I didn't understand per se profiles, business, behavioral profiles, all the things that you're an expert in class, I didn't understand any of that stuff. I just hired people I liked. So that was probably my biggest pain because I had a lot of turnover in the first couple of years in practice, because no one taught me and I learned in school. I never learned from my mentors. And I didn't know where to go to get the lessons to learn on how to unboard and build a team. What are your What was your biggest pain and Bill?

Dr. Cliff Fisher:

Mine was the same that was it was the team like getting the right people I was too nice. Like I didn't hold the line. I didn't hold people accountable. So we have a lot of those tools to help hold our team accountable. But you can't even hold people accountable until like what you said Joe, like, I didn't have the right people I did the same thing. I hired people I liked and I didn't even think about like if there's a different role for somebody who checks in there's a different role for a tech ca there's a different role or a different person, human for the back office. And so I think understanding your org chart, which is like a bunch of steps ahead of where we're at, but I think that was my biggest pain like that was the worst and I think that inhibited my growth like if I would have known that I would have been so much faster out of the gate versus taking two three laps. around before I'm finally got it.

Dr. Joseph Esposito:

And I also under hire, I know, in time I waited too long to my staff was burnt and left and I had to rehire the first staff. But I never hired a second and third and fourth staff in time that I always hit stagnation, growth, and then I lost morale. And that's a big lesson I learned is, I gotta hire sooner, but I didn't know what their job was, and how to make them an asset. So I looked at staff as liabilities, I literally did like, Oh, you gotta pay the totally wrong way of doing it. Your staff are assets. And if you have a system, job descriptions training matrix, like we have in a live life, we're talking as sometimes it was 30 days to create an asset, that's crazy. Definitely, within 90 days, you have a person that joins your team becomes literally an asset driving revenue, better patient experience. And as little as 90 days, I would have never dreamed that 25 years ago, I thought my mind their liabilities for years, because I didn't have the training system, right? I mean, that's

Dr. Cliff Fisher:

100%. And you know, that like training is going to be our best ROI. Hands down. Marketing is going to be a way just in second. But like, just like us, I did the same thing I hired late, I lost the momentum, like we were growing, growing. And then I lost the moment, I had to build it up again. And it just made for a slower grow versus like, being intentional, like, okay, when I hit this point, I need to bring on this person. So then it will grow to the next level versus like, oh, I need to grow to this level, then I'll hire that person.

Dr. Joseph Esposito:

Here we have a clinic in a line life system that's just about one year in practice, and they have their second staff, their office manager hiring, they're hiring the doctor. So it's not timing, like first year, fifth year 10. No, it's your momentum of scale. And you may be hiring your second staff three months in and you're like, Are you kidding? It's based on your scale. So if you're dialed in on your marketing, your communication, your training, and everything's dialed in using let's say, the Align life system, you're gonna move fast, and you can't wait, I'm gonna wait to my second year to hire or my third year to hire, you can't have that mindset, you have to hire based on a momentous growth. And the faster more aggressive you grow, the quicker you have to hire. So you're hiring before you're ready, but you want in business momentum is everything. I'd like to tell it on my first practice I ever opened. It's just a funny story. So I were sitting there. And again, I signed the lease, but I didn't order furniture. And it didn't come for six weeks, I couldn't open because I didn't know how to hire, buy the furniture before it was built out. I didn't. I didn't know the order. No one told me. So we're sitting there an Office meeting. So I hired two people to start. I didn't have job descriptions. I didn't know what each one would do. But someone told me to hire two. So we're we got these two people were sitting on the floor. And we said, let's, we will you take notes. And they said, I don't have any paper. I'm like, Okay, well, the other woman had a little notebook with her. She had the paper. I go, can you take notes on the means because well, I don't have a pen. And because I don't have a pen either. i Okay. Well put on the list, Pat, well, at least remember to buy pants because they didn't have anywhere to write it down. And I said, Why don't you call Office Depot and see if we can get an order? Well, we don't have phone too. We have cell phones then. So it was like we couldn't make the call. So just how funny it was that first meeting. We didn't have chairs to sit answer on the floor, no pens, no paper, no phone, we couldn't really do much. So I thought you'd get a kick out of that story.

Dr. Cliff Fisher:

And it seems funny, but like how many people end up there? Yeah, like don't have the tools that they need.

Dr. Joseph Esposito:

Yeah. And you don't know. So with a line life, we have different people literally focusing on different verticals like someone's looking at the build up while someone's looking at marketing and building your marketing. And someone's training you or the team. So it's not as scary as it was for you and I. But after that meeting, I realized I have no idea what I'm doing. And I didn't know how to train those people. I was paying payroll, and picture paying payroll for eight weeks before. Oh, my God Wars because you have no furniture. And you're starting to eat up your cash pretty quick. And you mentioned last time. The number one reason these go under is not because of bad doctors or bad people, or the wrong community. It's running out of money.

Dr. Cliff Fisher:

Yep. Right. Yep. Yep.

Dr. Joseph Esposito:

Yeah. What are the thoughts? Can you ever build like, there are so many, but I want to hit the top ones here. What do you think

Dr. Cliff Fisher:

I think for me was actually implementing the training schedule. That was the biggest thing, like, people think, Oh, we're too busy and build because they're starting to grow. And that's actually the time where you really lean into it. And so training your team having three hours Week is what align life what we recommend? Yeah.

Dr. Joseph Esposito:

The other one for me, Cliff is marketing. I never had a marketing calendar. I was trying to market like, what do we do today? Like I was always trying to solve today? What could we do today to market? I was so in crisis for years, the first couple of years, even though I was successful, and we grew a big, bigger business, I was still in a state of crisis. So some of you on the podcast right now, maybe ultra successful in the first two years, you did really great, but you're still in crisis. Because you need systems, even though you're a masterful clinician, you got the gift of gab, you could speak well, you're personable, you're good looking at you got all these tools, and you're building a bigger business, but you're still in a state of crisis. And we want to help all of you in that state to help reset your culture. So you have, and I love what you did. And one of the trainings cliff is you not only had the current 90 day calendar, you had the next 90 day calendar of marking so you were literally six months out making plans. It was so refreshing because you knew what was happening five months from now because you were adding workshops and, and lectures and events to the calendar three months out. Yeah, so brings so much peace to me as a business owner, because I was scared, I wouldn't have the new patients.

Dr. Cliff Fisher:

Yep, yeah. As you build them out, like we have a rolling 12 month calendar. So you know, every time we do an event, we're like, Yep, let's update that. Yep, we want to do that. Nope, we don't, we didn't get great ROI. Let's not do that event. And so we're very intentional. So I think in build, and especially in scale, you need to start to be way more intentional, because this isn't just impacting you anymore. It's impacting a team. And so showing up prepared and ready to go, it really shifts your role. I don't think you get less busy and build from when you start adding to remember you actually get your busyness just shifts, like your intention has to change.

Dr. Joseph Esposito:

And I like what Dr. I think was Dr. Moriah. At our last conference said a join the we had the the group of clinics communicating to the tribe, that you know, when you're off by an inch or two, and the golf swing makes a bigger difference as you get towards the next level of scale. So these mistakes and build like you're saying, are become giant holes in scale. Like you just said, marketing. If you don't document and what we have an align life, we have like a marketing event report inside of a program called a prosperity plan. And that's where you document the events. One at a cost would you get what was the return? What's the outcome? Because then a year from now you're gonna do the events again, and you want to know how we do? How do we do better next time. But what we do is we end up doing all these events. And then next year, we're like, we're too busy, and we just don't do them. And then we go up and down and up and down. You deal with this very volatile practice and build a lot of times up and down, up and down. And we want you to have consistent month over month scale and growth, which shows that you're hitting on all cylinders, and there's no contradictions, there's no gaps. There's no holes in your system. Because I love with Dr. Stephen France and says there's a natural state of a chiropractic clinic as growth and love when he says that, because that innately feels good to me. You should constantly be growing, if you're doing your things correctly.

Dr. Cliff Fisher:

Yeah, 100%. And I think you're so spot on, if you're not growing, you're subluxated. And where's the subluxation? Is it in leadership? Is it in team? Is it in communication? Is it in flow is it procedures, but the problems change, and they become just like you're saying with MRI, like they become a bigger problem. Because, you know, being off an inch with one person is or like, if you're off one degree flying from LA to San Diego, not a big deal. But if you're a degree off flying from, you know, LA to New York, you're I don't even know if you're Canada. You know what I mean?

Dr. Joseph Esposito:

That's a good point. That's a good point. Because now when you're investing, let's say on your team or your marketing, and there's another practitioner, which may be 80% is convicted as you 80% As trained and experienced as you and you're paying another salary, you don't have the leniency or the liberal approach with your dollars to not monitor and and report on these things. So with align life, the reporting mechanisms, and the cultures that we teach, allow you to see the holes before there's the boat is sinking, right? I mean, it's like whoa, what's that there? Why you're not getting return here. You know, everything from our digital dashboard showing the return on investment on your digital ads to the prosperity plan, looking at your events, and on and on. We have the ways to see the gaps and the holes in your systems before they become gaping holes damaging your business.

Dr. Cliff Fisher:

Yeah, I love it. So let's dive into this. So what are some of the biggest procedures on you know so build is really like the theme of this is training your team. This is where you're really spending that time and energy on training team. So for seizures, how does that show up different so. So I'll hit procedural. So clinical assistance. So like, you need to train your team to help you take your X rays do some of your exam work, so that you can spend your time adjusting and leading the team.

Dr. Joseph Esposito:

This is good because as you prepare for another doctor coming on board, let's get the team level up to help on some of these clinical services. Because now you're managing bigger entity, more patients, another doctor, and you got to start leveling up some of these things in clinical that can be handed off, obviously, not the adjustment, but some of these things. So I think that's a big one, clinical assistants, but

Dr. Cliff Fisher:

Upper Cervical guy. And so that took me literally five years to give up taking x rays. Yeah, so that was a tough one. And so And after doing it like the the my, my CA, her name was Katie, she was awesome. She took better films, and I took so wild. Yeah, I was like, Oh, why did I hold on to that. The next one is to leverage software, I think that's a big one. And I love our car HD leveraging it to do your data stats, all that stuff. Don't miss that to take your notes.

Dr. Joseph Esposito:

Yeah, the line life we spent, we built a dashboard. That's cost over $300,000 programming time, that allows a clinic to really diagnose we call practice diagnosis for that reason, because you could die, close the gap in your practice. Practice diagnosis is an exclusive dashboard designed initially by people in the banking industry, that we use those programmers to kind of give us an insight of how to look at a business on one sheet of paper. And then Pyro HD actually built this customized align life platform, which is so valuable. That's what I mean by leveraging software. Most you aren't going to spend 300,000 on this elite level customized dashboard that we have on line life, but at least leverage some of the tools so you know your numbers, know your KPIs, use your EHR system. And definitely a shout out to carry HD, which is a great software that if you haven't looked at it, it's something that we would highly recommend, give a shout out to tell him that cliff and Joe sent you over there and take a look at it. But we've we've I used to own the software in the chiropractic profession with over 400 people and I'm sorry, foreign to clinics utilizing it. And and I'm really happy with where we're at now. But I just want to make sure that number two is showcased. Leveraging software's huge.

Dr. Cliff Fisher:

Yeah. This part like so. In the first one, you you become competent in the scripts. This is where you start to master the script. So you start to be, you know, more intentional with your facial expressions more intentional with your hand movements more intentional, really, with everything and then just cleaner and they become part of your natural vernacular, versus sounding like a robot. So many people are so concerned with the scripts that they sound like a robot that they don't even spend the time and working out basically to get good at those.

Dr. Joseph Esposito:

Yeah, and you've probably level up more doctors in line life than anyone because you've done some of this script work. And I liked what you said. Because knowing the script, owning the script, and mastering the scripts are three different stages. And we're looking at amplitude of voice and pausing and eye contact and nonverbals. And on and on. And on that you mentioned. Mastery is a whole different world from knowing the script remastering different worlds.

Dr. Cliff Fisher:

Absolutely. Alright, Joe, take us away with flow. So,

Dr. Joseph Esposito:

okay, flow. There's three things, the number of steps I love when Joe Clarino taught this at the last revolution that we just had. And again, revolution, if you don't know is our annual convention. We do it on March of every year. And we have so many spots open for people that even if you're outside of online life, so keep in touch with us about the next revolution. So number of steps Joe talked about this at the last revolution of like, really, when you get busy enough, you're looking at your extra room, how many steps does it take you to get the get the film's done? How many steps does it take you in your adjustments? Is your room too big is your table too far away from the computer like all of these little things that you could move because too many steps could be a minute per patient extra. And if you're doing 80 patients a day or 100 patients a day that's 100 extra minutes, right? So we got to really look at those next one time patients are waiting. People will refer to you when they know you have the capacity to serve them. They are not going to refer you when you're behind for them. Because people are selfish by nature. Humans are selfish. We want to make sure we're taking care of I'm not going to refer you to my grandmother who's in pain in her low back because you're already late for me. So that's an important one that when people don't realize that stagnates growth growth, next one is cluster booking huge. You have to cluster but from day one, the first day you're in practice, I don't want you to have more than one hour of adjusting time half hour on the morning after on the evening. When you first open the practice, so you want to expand, you want to start by condensing, adjusting time. So you could spend time in the community, spend time train your staff, spend time learning and mastering communications and flows, you do not want to be waiting for an adjustment to come in every 90 minutes or so. So cluster booking, we have it down to a science online life and corporate actually reviews every clinics cluster booking to help make sure that we can support them.

Dr. Cliff Fisher:

Love it, I'll do team like I think this one is. So in the beginning part, it's like Dr value this time with team we need to really grow team value. So they really need to understand the value of it. And this is then where the training curriculum becomes crucial. So you know, we have a, we have a 12 month training curriculum that we train on and align life every week, the whole team has it all the officers habit, they know what to expect, they know what to be prepared for. And then we also have the training schedule. So we then we make time, so not only do I have the curriculum, but we schedule our time out every Tuesday, every Wednesday, every Thursday, whatever that time is, each office is a little bit different. But every week, I know we have weekly training on Tuesdays. So that's how you build that team up by training. And so

Dr. Joseph Esposito:

each and last one is communication, that the doctor to the patient, and the communication doctor to the team crucial at this level that you're communicating well to the team. And last one is Table Talk, which is communicating obviously, in depth in education to the patient. So one is you're talking to patient about expectations, but also talking to patient about Table Talk, which is a little bit of tick every time that they come in the office. So in summation from my point of view, Cliff, and I let you finish up with without launch done well, your office may not have efficiency of flow, right, you may have a hired crack, and then you go into build and if there's gaps in flow, you're going to carry it to build. Now in build you look at all these things that cliff and I discussed, if these aren't dialed in, when you get to scale, and you hire another doctor, and you have patients already waiting, you're not leveraging software, your scripts are mediocre. You're gonna get into pain when you bring another doctor on. And you may not feel it until they're hired. So cliff and I are here to give you awareness. Use this as a self auditing tool to where gaps are so you know what you got to level up before you get into scale. Final thoughts,

Dr. Cliff Fisher:

great donation Joy, I love it. I think the biggest thing is like recognize these are the ceiling. So these things are invisible ceilings that are going on in practices. And if you don't master if you're not a four or five on all of these, you'll stay stuck in build like most people, most practitioners do. And so if you guys do want more thoughts or help, like we have, you know, different tools available where you if you want to understand yourself better, we can do that. If you understand your team better. We can point you in the right direction there. But yeah, this is a critical, critical big step. Don't skip over this. It's easy to do.

Dr. Joseph Esposito:

Awesome. Looking forward for the next podcast where we talk about scale cliff, I can't wait.

Dr. Cliff Fisher:

I know. All right. Talk to you guys. But

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