The 4 Stages in Business with Dr. Ronnie Simms

Hi, everyone. Thank you for joining us for another episode of Catch Up with ChiroTouch, our podcast series where we talk about the state of the chiropractic profession, best practices and recommendations to manage and grow your practice and share expert advice with a variety of guest speakers. I'm one of your hosts, Dr. Brian Blask.

I'm an account executive with ChiroTouch, where I consult with chiropractors to determine which software solution is best for them. Today, we have Dr. Ron Simms with us to talk about the four stages in business. Dr. Simms is a 12-year chiro-touch customer and is the founder of Back to Health Chiropractic in Northern California, where he has two locations and multiple associate doctors.

He's a passionate health educator and life coach to his clients and community. Dr. Simms is a health and wellness expert and has become a regular teacher and coach to over 50 greater Sacramento companies, community organizations, schools and churches. It is great to have you today, Dr. Simms.

How are you?

Hey, I'm doing well, Dr. Brian. Thanks for having me on.

You are a phenomenal speaker. You're a great educator when it comes to business and chiropractic. And we had you on our webinar series a few months ago.

I think it was about five months ago now where we went through a myriad of different topics related to COVID and chiropractic. So I wanted to have you back on this podcast so that we can kind of chat about the state of business and chiropractic and how you can really build successful business like you have in Northern California.

I love your mission. I'm on board with that.

So we had spoken before about the four stages of business, launching, building, scaling and exiting. So can you kind of get into that detail there starting at the beginning of kind of launching a business?

A lot of chiropractors want to own their own business, which I think is noble, but not everybody is cut out for that, nor are they educated about how to do that. So they just kind of wing it, you know, we're kind of the kings of the wings, you know, we just kind of go for it and without really any strategy. And for me, I associated with a great mentor for five years, and that really helped me kind of learn really how the business part, you say the launch, you know, as an associate, in a sense, you're launching in that you're trying to build your own associate practice within a greater practice as the owner, you're looking to reach your mission more effectively.

You know, at some point, if you're a volume chiropractor, like I've been blessed to be at some point, you hit the ceiling to where you realize that your mission ends with you. And that's a realization that I need to really think about that scaling. You know, a lot of chiropractors die on that build hill, or they build this practice with all their might, and they have spinning plates in the air, and they just can't seem to keep it together.

And they get a lot of new patients, but they can't convert them. Then they convert a lot of people, but then the new patients go backwards, and they just can't seem to figure it out. And it's because they don't have the business acumen, the little details, you know.

So, for us, that scaling is the hardest step to go from build, build, build to now scale and bring on the association. It takes some faith, but it takes a lot of planning.

So you started out there, you mentioned that you associated for five years. And that's kind of the business model I think a lot of chiropractors go through is you come out of school, you've just passed your boards, you're eager, you're hungry to adjust and treat patients, but you don't really understand all the aspects of the actual business. And I think that the associate ship does a lot for chiropractors to kind of get their feet wet with getting into the nuts and bolts of the business.

Is that really the way it worked out for you?

Yeah, for me, I think in that process, that's how it worked for me because I feel like I personally had some natural leadership gifts and always had kind of an entrepreneurial spirit. But I think chiropractic, we need to team up more, we need to create more systematic practices if we're really going to reach our mission of helping beyond your and my ability to help individually in the practice in terms of adjusting people. At some point, I hit my ceiling there and my mission just stops.

That's a frustrating thing. For me, my vision was always much greater than me. I think associateship helped me a lot, but for a lot of people, it helps them realize, gosh, maybe I am more of a team player.

One of my associates, Dr. Crispa, she's phenomenal. One of the greatest chiropractors I've ever been adjusted by and passionate, empathy, just the package. But she doesn't want to own a business.

She wants to leave at five o'clock and go home and be a mom and all that. I think associateships help you figure out, do I have that leadership to really own a business, or should I just have a really good associate practice and own that and be part of a team? I think too many chiropractors don't have the gift of leadership or they didn't get it developed properly and they go out and start these practices because they're going to run their own practice and then they realize how hard it is and then they try to sell it later and to exit it and they get fractions on the dollar.

They just don't get what they thought it was worth because they were the practice.

That totally makes sense. When you're going through that early stage of figuring out who you are and say you do want to go out, say you're like, you know what, I'm ready to do this. Do you think that first logical step there is building that business plan, writing it down, having that vision?

I always like to start with the vision of where I see this practice going, Lord willing. For me, it was I wanted to have a high-volume multi-associate practice when I started this in 96. For me, that was my vision.

I had a real clear vision on that and I knew it was going to be associate-centered. I knew it was going to be me and I tell my associates, I'm still practicing, I'm still adjusting. I'm 55 years old, I'm in the adjustatorium since I was 26, so I know what it's like to be day-to-day table side.

I don't want any of my associates in my practice to grow through my dilution. I want them to learn how they would track new patients and how to convert them to a new way of living and thinking and new lifestyle and how to retain that relationship over a long period of time and how to do that in practice while building phenomenal teams of people. For me, the vision was first.

The second thing was the mission plan, like how do you do that? I've always had coaches and I will always have a coach. I always want somebody who's going to give it to me straight, if you will, Brian, and tell me, tell me, hey Simms, you got to work on a few things here, buddy.

That's been huge for me is that humility of always having a coach, always having somebody pour into me so I could pour into others. It's hard to pour from an empty bucket, man. You need to be poured into.

To me, that's why we should team up in chiropractic to be missional. Then our purpose, our why is really we want to adjust and educate as many individuals and families as possible toward optimal health and wellness. That's just our purpose.

We put all that on paper and I read a lot. I really like Wickham's work on in his book Traction. I also read his book.

It's about the CEO relationship with his integrator. He has a business plan on two pages. I tell my associates, if you want to have your own business, you've got to get it on two sides of papers.

It's got to have your marketing plan. It's got to have your purpose, your mission, your vision. It's got to have your problems list, the areas you got to work on, your projects, your 180-day projects, all that stuff.

I think a lot of kids don't go into practice with thinking about stuff like that. They just want to try to go to a spinal screening, get 10 new patients and just hopefully take off on it and see how it works.

You bring up so many good valid points there. I think that we have to unpack a little bit of it is chiropractors in general and especially at the beginning stages, you have to have that why, right? You have got to…

As you talk about it, optimal health and wellness, everyone's going to be a little different. Like you said, we kind of all wing it sometimes in chiropractic, but having that why and developing that why I think is one of the most important things we've even mentioned here. Can you kind of go into more detail as to how you communicate that towards either your associates or to your patient base?

That general purpose for me is my patients and I have a wonderful relationship, and I have the freedom to enlist them in helping me reach our mission. And we're very focused on that. We educate our practice members continually in many formats.

We engage them. We constantly are learning and growing so we can continue to refine our offering as it relates to wellness and chiropractic and corrective care and all that goes with that. But that why, man, if you don't have that why, you need to find a team that has a why you can get behind, you know?

And that's why I just believe there's strength in numbers. If I'm going to reach my true mission, if I have a finely tuned team with five to seven, ten doctors, whatever your vision might be, for me, it's I'd love to have at least seven associates over three locations. Right now I have two and I have four.

So I'm on my way. But I think having that big why has got to be above yourself. It's got to be missional.

It's got to be can't be about Brian and Ron. If we really, really truly want to live that out, there's got to be some humility. When you start to scale, Brian, there's some really cool fruits that come from that.

For me, I walked through my practice the other day and there was a room full of people waiting to get their spines checked. Socially distance, of course, we have a good system in place for that. But I walked the gauntlet and saw everybody waiting to see Dr. Krista.

It was great that nobody knew me. I felt anonymous. It was quite nice.

There was a sense of like one lady goes, what doctor is that? And I thought, okay, I've created a scalable entity now, you know, where it's not all about Dr. Ron, you know. Back in the day, I always wanted that attention early on to kind of feed your ego a little bit like, oh, it's good to be appreciated, right?

Now for me, it's all about building strong teams of people that are behind the mission.

I think that is probably one of the most important things we're going to talk about here today. Because I don't think that people understand that. Because again, we said before chiropractic, you kind of do what you want.

And yes, it is nice for you to be able to walk in that practice and people know who you are. You want that family care wellness. And that's wonderful.

But if you truly want to scale, you have to build like that. You have to be able to, if like you said before, if Dr. Ron's not there, well, the practice still goes, right? It's not about you.

It's about the business you've built. So how do I get there? What do we do to scale it?

How do we take those practices next level? What you said is already the hardest to do. How do we do it?

Can I say that for me, this has been a 12-year maturation in that I got to a place in my practice where I began to realize, well, I don't really have that solid of a why. I didn't like our mission. Even though we were serving a lot of people and it was all about me, and it was basically pure horsepower on my part, which again, it's not a practice.

You're going to exit with grace. You're going to sell at a discount versus if you create a true business that you now, I personally am less than 35 percent of the revenue generation. So that was my goal is to get below 30, but not through dilution, through the growth of my associates.

In other words, I didn't want them to grow because I shrunk. I don't like that model. I don't think that serves chiropractic very well.

I will shrink someday though, Dr. Brian.

You want to build that practice not because you're seeing less, but because the actual company is growing, right? If you can take yourself out of the equation and you can still have that solid business, that growing business, that's where you need to be. I mean, is it systems?

Is it people? Is it the vision? Is it all coming together?

It's like a CEO finishing school is what I think chiropractors need to go through. It's what I'm going through. I keep going through that.

For me, obviously, you got to have robust marketing plans. You've got to have internal marketing initiatives. You've got to have outside-in initiatives.

You've got to have digital and web and social initiatives. We have to attract new people to chiropractic, but then you have to have the systems and the process and the procedure and the consistency and really the clarity around your offering and how you present that to the public and how you build your team to represent that on your behalf and build that true business, that true brand. Then you have to retain those customers.

There's a lot of little details that you make one small little mistake in your process procedure and all of a sudden you're wondering where Mary and Joe are and what happened to the other lady that really connected with in the report. I haven't seen her in like two weeks. You start seeing these holes in your bucket and going, what is going on?

We don't spend the time training. We train 90 to three hours a week. We have meetings and trainings and we have pre-shift huddles.

Every employee on my team has a scorecard. We have a scoreboard, which is continually live action of what's our marketing looking like? How many new patients do we have from XYZ?

How's our new patient load then? How many are we converting? What's our conversion percent?

How many are we keeping after month four, month 12, month 24? So, we believe that you don't reach your goals by really what you want. It's by what you measure.

So, we have a really strong measurement system that we look at everything. And so, we can then tailor our training to our specific associates or team members to say, hey, it's evident that you're struggling on retention. You know, you need to focus on XYZ, maybe more report of findings and more report of finding ROFs where you sit down with your client after a re-exam.

And go over the results after they've improved, you know, and having those times where you really reconnect with them and re-clarify their goals. And we do annual re-signs with our practice only because we want to like sit down with you and go, are you still into wellness? Do you still want to be the best version of yourself?

Do you still want to avoid catastrophe? Okay, good. Let's keep the same program.

And so, anyway, for me, we look at numbers and metrics to determine how to train in the attraction conversion retention paradigm.

That is a normal way of life, too. I mean, in any business or in any job, everyone has some sort of numbers or metrics that you're being measured by. So why not utilize that in your practice?

And now you can get a measurement. It's just like you kind of talked about when it comes to developing your team, right? And having a coach.

You are the coach, you're the leader. But it's all comes down to accountability. You have a team, if you're a chiropractor, and you've got six other chiropractors that you kind of meet with, you've got that accountability, or you've got a mentor.

They're giving you that kind of, hey, like you said, hey, Ron, you need to be doing this. Well that's checking on you. You have that set up in your practice where you're checking on everybody else.

We need to be able to get to these places to meet our goals. So track it. Use reports.

Use different practice management systems like ChiroTouch, whether it's ChiroTouch or not. You still need to be doing that to maintain optimal growth and accountability.

That's right. You're spot on. And so for me, that looks like every practitioner in my team has really what's the scorecard of the attraction conversion retention in team building domains.

And within that key performance indicators, for me, that conversion percentage at what we call R3, which is a report of findings when they actually start care. R4 is for us a four month re-exam and how they do in those visits and how they communicate where they're at and how they objectify their improvement is really kind of for us. What you got to get good results and you got to show the results, you got to objectify it and you got to make sure you hold people accountable.

So for me, I had to hold my associates accountable and they hold me accountable. You know, we have these key performance things like I need to work on this. And one associate, he's got to work on this one thing where he just he needs to tighten it up and he knows that he's now seen through his numbers and through the training that these little weak spots he has in his management and in his practice is why he's not reaching XYZ goals.

We started with you, we did our webinar series with you right at the beginning of COVID. Right at the beginning of our first webinar series guests. We did three of them with you.

It was phenomenal. And part of that was us talking about the idea that you have an opportunity as a chiropractor right now to really make your mark and we're essential business. And so what better time right now during a pandemic and a health crisis to become the leaders in healthcare.

So for you guys, have you have you done that? What has been successful for you that you can help share here?

We immediately just kept a positive attitude. People were confused, afraid. So we had a lot of conversations via email, via personal phone calls.

We did see our practice shrink like everybody else, but we rebounded a lot quicker than we thought. And we're actually seeing more patients per week than we were pre-COVID right now. I don't know if that's what's going on out there, but we just feel like people are at home.

They're tense, they're anxious, and they're having more flare ups, they're doing more home projects, they're taking on new workout programs. We are seeing a lot of new patients. So most of our growth has been through new clients, and we still have a fair number of people that are still sheltering in place, that haven't come back to us, but eventually they will.

So I think COVID will probably help us because we've just stayed positive, Brian. We focused on getting great results and talk about what we can do to make our bodies more resilient and more adaptive, and how can we build our immune system. So that's been kind of our messaging is, tomorrow, for instance, I have a corporate relationship where they have 3,000 employees that are doing a digital health fair tomorrow, and I'm their keynote speaker, and I'm speaking on how to supercharge your immune system.

And so we're just staying positive, we're educating, and we're teaching the chiropractic principles above down inside out. We're teaching holistic lifestyle, and we are doing our best to just digitally be in front of everybody on a daily basis, in Instagram, Facebook, and again, digital events. We've transitioned all of our education systems onto digital, so that all of our clients are getting our videos, on exercise, on just health information.

So we continue our core value of passionate education through this time, and I believe that's why we've grown. Also, I believe we have a pretty strong business model, and so we don't really have a lot of big prepays. We try to keep people in the here and now financially, so a lot of practices struggle with that, where they get prepays and all of a sudden something happens, and the people that prepaid aren't using the visits they prepaid for, so they want to refund.

It's like, so there's just business practices for me that really, I think, helped shelter us during this time. We didn't lay off anybody and we've been growing again through positivity.

It comes full circle with our whole conversation, is you have to have that mission and vision, and then we always talked about before when it comes to scaling and building, being able to have the internal, the external marketing, staying positive, like you said, getting that message out there. It's all part of the mission. It's all part of the vision.

It's also part of the business. It's also having the correct marketing systems in place, the correct practice management or software in place, to be able to go through tougher times, because nobody could have predicted this. But because you had a solid foundation, you're completely fine.

That's right.

You didn't have to really pivot. Then we get to the exit strategy. The last principle here is, what's next?

What happens when you get to end of your career? Do you just hang it up?

Yeah. There are several models that work. I have a friend in the midwest who is now selling his practice to his four associates.

It's about a $1.5 million transaction. Built a beautiful big associate-based wellness, corrective care practice. Now he's exiting with a nice founders fee.

Some doctors, like my mentor, who did this for a while, he would work in his practice a day and a half a week. He would come in and do team trainings and see his wellness patients. Then he built his coaching business on the side and then just recently sold his practice.

There's that model. Again, I don't think the model is to try to build up your practice just all about you and then sell it and expect you're going to make a big profit. You just not.

If you build a true business and you go exit that, there's going to be a lot of options for you and it's going to be a better multiple. I mean, why is it that chiropractic can't be like other businesses that you hear of that sell for multiples of their revenue? Why is that?

I think it's what we've talked about today and that is we don't really build true businesses. We all build really good jobs for ourselves. In that model, you have to save a lot of money because you're not going to get as much as you think in the end, so you better save a lot, so you can justify walking away or selling at a discount.

So those are just some thoughts I have on it. I think we got to be in teams, we got to build true businesses. Hey, and what about this?

What about having true businesses where your associates have ownership? So I think for the young chiropractor, if you're an entrepreneur and you're a leader, just message me or something and I'll talk to you offline. But there's some first steps you can take.

Obviously, write out your vision, like you said, Brian, and get a business plan going and read the right books and ask yourself the right questions.

Well, this has been phenomenal. To wrap it up then, bring it full circle. Where can people find out more about you?

Where could they message you?

We're Back to Health Chiropractic, Back to Health Family Care on Instagram. We do some really fun videos and educational moments. But yeah, through our website, you can email me.

That's perfect. Well, thank you so much. Thanks again, Dr. Simms, for taking the time today to share your experience and knowledge with our listeners.

It will help a ton of people yet again. So thank you. And thank you to our listeners for tuning in to Catch Up with ChiroTouch.

You can always email us at podcast at chirotouch.com. Again, that's podcast at chirotouch.com. Feedback, questions, recommendations on guests and content.

And remember to tune in every week on itunes, Spotify, or wherever you consume your podcasts. Thanks again for listening to Catch Up with ChiroTouch.

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