Education Resource Center

By Jeffrey D. Olsen, DC

Have you ever tried to slash your way to financial success by cutting expenses? There is only so far you can go before you’re working alone, in a place that no one would dare visit. It is far easier to add revenue to your top line by adding additional products and services that don’t require additional hours or employees.

Two Types of Income—Active and Passive

There are two types of income: active and passive. Active income requires the direct participation of the doctor in the patient care and would include activities like performing examinations, reading films, and providing adjustments. Passive income represents all other situations where revenue is generated without the provider’s direct involvement, such as selling orthotics or any other Chiropractic supportive adjuncts like nutritional supplements.

To highlight the difference between active and passive generation of income, consider an average visit to the dentist. Before leaving, you will have likely had a set of radiographs, a thorough cleaning, and a quick exam and consultation with the dentist. But in the hour and a half spent in the office, how much time will have been spent face to face with the provider? You hope not more than five minutes, unless you enjoy pain! The rest of the time, the doctor’s staff will have performed the time-intensive tasks (passive income generation) that free the provider’s time for drilling and filling (active income generation).

Of course, the dentist could take his or her own films or clean the patient’s teeth, but delegating allows the provider to act as the director and inspector of all the work being done.

Another aspect of passive revenues is making sure your staff is working at capacity. To test this, ask each staff member to watch your activities as the provider during a busy day, and list two revenue-generating activities they could fulfill without adding to the workday or interfering with their current duties. Most employees enjoy greater responsibilities because it generally means greater job satisfaction and job security.

If your staff is at less-than-full capacity, consider adding additional services or products that don’t require attracting additional patients. In other words, sell to the people already in your store. Things you can consider providing are nutritional analysis and supplements, weight-management products and counseling, cervical pillows, cold packs, postural supports, and orthotics. You want to provide products or services in your office that will serve as useful adjuncts to your patients’ care.

The Crucial Step

Once you have decided which additional services or products you would like to provide, you need to carefully consider how you are going to market them to your patients. This step is very crucial because you do not want to make your patients feel like your primary goal is to sell them a product. You need to clearly communicate to your patients how the product or service you are providing will enhance their Chiropractic care. Of course, any practice-building adjunct must help the patient and the doctor.

You need to find those products and services that complement your concept of Chiropractic care, without detracting from your primary focus—removing interference. Because custom-fit pelvic stabilizers have consistently improved my treatment outcomes, I will use orthotics as my example for the promotion of adjuncts.

Obviously not every one of our patients is a candidate for orthotic therapy, but four out of five adult patients older than 40 can benefit from using custom-made orthotics. By this time, the effects of walking and standing on hard surfaces, ligament laxity (age-related or post-partum), and repetitive microtraumas have often contributed to significant plastic deformation in the feet. Asymmetrical collapse of the arches can be directly responsible for secondary postural distortions in the knees, pelvis, and throughout the spine.

Be Consistent and Logical

The key to selling any adjuncts is presenting the products and services in a consistent and logical way. Presentation begins with the first patient encounter. Do all aspects of your advertising include the products and services you offer? What do potential or established patients hear if placed on hold—silence, a local radio station, or the benefits of holding adjustments longer by wearing custom orthotics?

Once inside your “store,” patients should see samples of the products and services you offer. It is important to balance both general educational materials with specific benefits and promotions. This subtle introduction to your adjuncts will often generate sales, referrals, and comments like, “I didn’t know Chiropractors could help with _______.”

Each stage of the patient visit should also direct the patient toward a treatment plan tailored for their specific needs and concerns. In addition to questions about the primary complaint, your intake forms should ask general questions about the patient’s diet, work, sleeping habits, etc. Patients will assume that, if you are asking questions, you will also be able to offer solutions for any potential problems.

Report of Findings

Are you currently giving a report of your exam findings? Ever wonder if you’re actually reaching your patients and motivating them to accept your treatment plan? Realize that this 5- to 10-minute one-on-one experience with the patient is critical to your success. This is your opportunity to further establish rapport and credibility, answer questions, and inspire people to demand your help!

The report is the perfect opportunity to reinforce your use of orthotics, pillows, and other supports or adjuncts. During the initial exam, you demonstrate an interest in the patient’s daily activities, including work environment, posture, exercise, and diet. While taking their radiographs, you explain your desire to see the effects of these daily activities on their physical structure. During the entire exam process, patients begin to realize that a Chiropractor leaves very few rocks unturned when it comes to improving health.

All your communications with the patient should reinforce the relationship of structure to function and health and remind the patient that chiropractic is the means to improve all three.

In the past, I would ask my patients what they saw when I put up their films. Of all the responses, the only consistently intelligent answer was that “something in the spine doesn’t look straight.” Everyone knows the difference between a straight and a curved line. Now, I like to draw a line connecting the femur heads or a vertical line connecting spinous processes, which draws attention to pelvic unleveling and lateral spinal curvatures. I simply point to the crooked lines and correlate them with the patient’s complaints. At the same time, I remind them that the problems we may have found in their feet or the way they sleep could directly contribute to the crooked lines—off goes the view box light.

Next, outline your treatment schedule and have the patient commit to following through with care. Whether it’s adjustments and orthotics, cervical pillows, rehabilitative exercises, or nutritional support, patients expect to be told what they need to do to improve their health. The most important thing you will have done during your report of findings is demonstrate your genuine concern and your confidence in providing answers and relief! There is nothing wrong with telling your patients about the best you have to offer (this will include your Chiropractic care plus any necessary adjuncts) and then letting them choose those aspects they consider valuable. The responsibility then falls on their shoulders for the outcomes they can anticipate. If you have your adjuncts marketed properly, they are more likely to accept your best care at a later date, when prompted.

Once a patient accepts my recommendation to include orthotics in their treatment, the work of casting, ordering, and fitting the orthotics is handled by my staff. There is no inventory to maintain, and turnaround time is short. Doctors simply verify the fit and proper use of the orthotics and monitor patient response and improvement.

A recent survey by the American Chiropractic Association reports that the average Chiropractor sees 26 new patients a month.1 If only half of those patients were examined for and showed indications of foot deficiencies and spinal-pelvic instability correctable with orthotics, the doctor could expect the following:

  • 13 pairs of orthotics per month x 12 months = 156 pair per year.
  • Each pair of orthotics can bring a new profit ranging from $60 to $180 (an average of $120 per pair) or more.
  • Potentially, this could yield an additional total yearly net profit of $18,720 without finding a single new patient or increasing time spent in the office.

Offering additional products and services is a great way to add revenue without having to recruit new patients. It is very important that you make sure the products and services you provide serve as an effective partner to your patients’ Chiropractic care. With careful consideration and the proper marketing technique, including additional products and services in your practice can help both you and your patients.

About the Author
Dr. Jeffrey D. Olsen is a 1996 Presidential Scholar and summa cum laude graduate of Palmer College of Chiropractic. He has been in private practice with his two brothers/partners since 1997, in Roanoke, Virginia. In addition to his practice, Dr. Olsen has instructed as an adjunct faculty member at the College of Health Sciences in Roanoke, teaching Anatomy and Physiology in the Physician Assistant department.


1 Goertz CH. Summary of the 1997 ACA Statistical Survey on Chiropractic Practice. JACA. November, 1998: 32

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