Dr. Allen Miner: Hey, Dr. Mark, how's it going?
Dr. Mark Mouw: Doing great. How about yourself, man?
Dr. Allen Miner: Doing good. I'll just start before we get into this master class. You're looking fit and trim. What you been doing?
Dr. Mark Mouw: Yeah. So, Lynne and I started a 90-day reset about 14 days ago. Eric and Shannon Kowalke had one last year. Just wasn't right timing for us, but we said I'm 50 this year and our daughter is a senior and she's going off to school so it's no better time than to get back to being healthy. So, we started 14 days ago on a crazy cleanse. It's been fairly easy for me to be honest but working in between that and then we go into a 75 day, what they call reset with macros and tracking and workouts. So, it's been good, but it has been really good.
Dr. Allen Miner: Cool. Right on. Good work, man. Well, what I want to talk about is I think very pertinent to a lot of UAC members in who are either wanting to go through this or have just come through it. But after 20 plus years in practice, you just stepped out from being the adjusting doc one, you have three other associates but you're still, you were very much to the heart of that practice and now you're no longer adjusting. And at Chiro Match Makers we see that work well, not very often. And I think you've done it expertly and I think maybe due to some of the other clinics we've gotten to watch inside of Chiro Match Makers and how they, how successful clinics handle this transition where a founder of a clinic who's adjusted for 20 something years. It's a big thousand-week clinic. How did, how you. That's what I want to talk about today. How did you find somebody? What was the process to successfully remove yourself, so the practice didn't take a dip. So now you bought back your time freedom. Working on the practice now, not in the practice. Although I think you love sales. I know. So, you're still doing a lot of the initial, you know, consult report stuff. But let's talk about that today. So, let's just start with how long have you been in practice? Give a little history on the practice and then how it transpired.
Dr. Mark Mouw: That'd be awesome. So, we just had our 20th anniversary January 5th. So, we had a big celebration in our office actually last week. So, it was fun. We had five days tons of energy giving out T shirts of 10, 15, 20 years of healthy adjusting to our patients. It was so fun to see that we gave out hundreds of those T shirts over the last couple of weeks. That's been great. Yeah. So, everybody, you know Lynne. Lynne's a chiropractor as well. We started as a mom-and-pop shop was her and I opened the doors, and we were just hoping to be successful enough to pay off our loans, make a great living. But we had a big goal of to build a beautiful practice. And within our first couple years, we brought our first associate in, opened a second office, sold that office to a couple of associates we have and had 14 associates over the last 20 years. We currently have three associates before I brought my replacement in.
Dr. Allen Miner: That was a separate. You had a separate clinic? Bought it, put some in it, sold that off. You've always had this original core practice.
Dr. Mark Mouw: Yes, that was our core practice for 20 years. We started another one from scratch 17 years ago, owned it for three years and had a sellout to our associates that were in it, which was what was planned from the beginning. I was never a person who wanted to have multiple practices. To me, it's always easier to manage one big practice. Being able to see it instead of 6, 7, 8, 9, 10 of them. I love the docs that are out there doing that. I know you've done that, Allen, and I can appreciate that. But I've never really wanted that inside of our practice. And I always thought it's really easy to have one overhead with multiple people instead of multiple overheads spread out. So, it's been good for us to have this one large, big practice. So Dr. Amber's been with us for 14 years. Dr. Andrew's been with us for 10 years. Lucky enough, my son went to chiropractic school. So, Dr. Jordan's been with us for seven years now, which is crazy. It's gone so fast. And then we got to the point we launched a second clinic within our clinic call the Nerve and Disc Centers of the Midwest.
Dr. Mark Mouw: And we did that two years ago with the intent to have more complicated cases that came into our office. So we add decompression, we added neuropathy. And it's been really good in growth to our practice. Been able to see some really awesome results, saving tons of people from surgeries and so forth. But at that point, for the last seven, eight years, I've only been adjusting and in my office on Mondays and Wednesdays because I work in Chiro Match Makers Tuesdays, Thursdays and Fridays. And also, was in the TRP coaching system as well, coaching clients. So, we were able to run a very successful practice. Lynne has an adjustment since our daughter was born, and she's almost 18, so she runs part of the front of the house for the last, you know, multiple years.
Dr. Mark Mouw: She's only there 10 hours a week. So, we do have a COO and an office manager. So, we've pulled Lynne really out of that over the last three years. I know, Allen, you've seen that. And the next iteration was to get me out of the adjustatorium. And believe me, I love adjusting patients. But that next iteration to grow the practice was to pull me out, let the practice run, and that was to bring in a fourth doctor to see the patients I was seeing and me to go into not only the CEO role, which I was already running, but also, I'm just. I'm doing day ones and day twos on Monday, Wednesdays, yet mostly day twos on our complicated cases and then handing off to our doctors. And it's been super successful, and it's been really fun to see that iteration in our practice.
Dr. Allen Miner: You mind sharing numbers? This stays inside of UAC. So, volume, collections, where's the practice going to be at this year? Like, what do you guys do on a weekly basis? And for annually, what are you projecting for this year?
Dr. Mark Mouw: So, we're anywhere between 925 and 1025 visits per week. Our annual projection for this year is to push 3 million. We were at about 2.6 last year. We grew this. You know, the chiropractic practice there. Nerve and Disc is a DBA because of Star Clause. It's inside of our clinic. So literally we have two front doors. We have a sign for each business over those doors. But I moved into that Nerve and Disc Centers because once again, as we all come out of school 20 years ago, we name it after ourselves. So, I named it Mouw Family Chiropractic. Right. So, all of a sudden, you know, with still the negative equity we have, we put Nerve and Disc Centers up as a DBA, but it really runs as a separate business in our office. Different colored files, all of our spreadsheets are calculated separately. We know exactly what our CVA is on both businesses. Expenses on both businesses. There’re two credit cards. You know, it really runs as two separate businesses even though it's under the same roof. So, our chiropractic practice last year was 2.2. And then our Nerve and Disc after two years was at 400,000. And I do believe that can push to around seven this year. Six is our projection. So, 2.4 in the chiropractic and then six inside of the Nerve and Disc Center.
Dr. Allen Miner: So, we've set the stage. You've built a successful clinic. You have unwound your wife. I mean, I've been in that position too. I've been on vacation with you, and you guys were having to answer phones because you didn't have the right people in place, which I think was what put you guys over the line. Like, we got to systemize this. So, I watched you put a leadership team in place. And so, then the last thing is you still are. We're adjusting. I think maybe the majority of people, or at least percentage wise, on Mondays.
Dr. Mark Mouw: I was seeing about 25. So, Monday, Wednesdays I was seeing 250, and we were at a thousand. So, my other docs were each seeing around 250. So, it was really split up evenly in there, which is good. So, I run more of a solid line model, which would mean that each one of my associates see and convert their own patients, so they have their own practice within my clinic, even though they're still an employee.
Dr. Allen Miner: So, then you decide, all right, I'm going to step out. So, talk about how you approached it and why it's been successful.
Dr. Mark Mouw: What's been. I think the knowledge behind what we've done in Chiro Match Makers had allowed me to do this the right way. And knowing that there's two types of associates. There are business builders and there are caregivers. And when we approach that process and understanding what's successful in our practice, what I needed is I didn't need somebody else doing a day one, day two closing care plans, because I already have three doctors doing that. I needed a doctor that would want to come in and just see patients because I'm still doing day ones and day twos. The next iteration is to free up Dr. Jordan because Dr. Jordan could go into that role. So that's the next two to three years. Just long-term play for where he'll be. He'll replace himself next. But inside of that process, what I wanted to do is I wanted to find a caregiver. And I knew the best place to do that was we went through Chiro Match Makers, obviously, is what we're going to use. And I was sent a doctor from over in Omaha who was in his mid-60s. And I interviewed him. 41 years of experience, heart of gold.
Dr. Mark Mouw: Was retired for six months. Worked in a pain practice the last time. Freaking hated it. Life grad way back when, was in the military, flies airplanes. I mean, just a really cool guy. Super in shape. Rose three times a week for an hour after seeing patients yet, which is so super cool. And he's like, doc, I just want to come in and work in a place. I'm bored out of my mind. My wife is still working part time. We don't need to, but I just love seeing patients. So, we brought him in, and that process was fun. And I can talk about that process, but it was...
Dr. Allen Miner: Yeah, let's. I want to break that down.
Dr. Mark Mouw: Finding the right person was important.
Dr. Allen Miner: But first let's just unpack. You know, we've got 70 open jobs with Chiro Match Makers. We placed over 200 associates last year. We see inside every different kind of practice, and we talk to owners all day. And one of the most common red flags we get is, oh, 60-year-old Doc, I don't want them. 40 years. You know, kind of old dog, old habits. We hear that a lot, you know, and there's kind of the other extreme is new students, they don't know anything. They have no skill set, no hands, no bedside manner. But you know, I've always had good success with the season docs myself as well. So just touch on that a little bit. Why? You know, opposite to maybe what most people. I bet when you said 60, some people watching immediately went, why? I don't want somebody that old. But what's your benefits of hiring somebody that seasoned?
Dr. Mark Mouw: Well, I'll start out by saying We've had 14 associates, and I'm split seven. Seven. Seven seasoned doctors and seven new doctors. And what, you pick your poison. Right. There are great things about both. The new doctor coming out of school, the new grad, they're potter's clay. The problem is they haven't had 10,000 laps. I said you need 10,000 adjustments before you know how to really take care of a person and get people adjusted. Right. So, it's going to take them whatever and how fast your practice is and how many patients the person can see, how many times, how many, how long is it going to take them to get 10,000 laps and can you afford to do that? On the other end of it, it's the seasoned doctor. Oh, they have bad habits. I need to break those. Yeah. You know what If a person wants to listen, they're a type of caregiver or a doc that really wants to... Maybe they've been roughed up. We usually see that in Chiro Match Makers. Right, Dr. Allen?
Dr. Mark Mouw: It's like that doctor has been out five or six years. They open their own practice, they close down, they maybe worked the joint, something like that. All of a sudden, that doctor comes in, and they're just like, man, they're just looking for a beautiful landing spot because they want to take care of people. And that's really what I found with Dr. Mike. He was successful. The interesting story was, is Chiro Match Makers actually sent him to an office about 25 minutes from me in Omaha. A young couple who I know, and we sent them in, and they were upset that we sent an old doctor into them. So, Adriana reached out to me. She's like, he doesn't have his Iowa license because I'm on the Iowa side of Omaha. Would you still be interested in talking to him? I'm like, yes, absolutely. So spoke to him, brought him in, job shadow. He adjusted me. I mean, hands are gold. And here was the iteration that was important to me is that every time I grew from myself to the next associate to the next associate, clipping from 300 to 600 to 900 to whatever it was, I could bring a young doctor in because I didn't have the patients there for them to take over.
Dr. Mark Mouw: But when I had patients that I had been adjusting for 20 years and I consider myself a good adjuster, I needed to bring somebody in that had hands to do it. And that's the iteration that there's no way I could have brought a doctor in to replace myself. That was less than two years of experience to see 250 people boom from day one, which there's a training process we can talk about. So, I needed somebody. I needed that old dog to come in to give people the benefit of understanding that, wow, I even break him up. He has more experience than me. He's better than I am. He's 41 years in practice. He's going to be awesome. So, my established patients knew I wouldn't be sticking them with somebody who was going to be learning on them, but they had the confidence that they could get well and stay well with him.
Dr. Allen Miner: Yeah, it's. There's a lot to unpack here, and I want to. Because you hit a key point. I just want to recap. And that is when you're a seasoned doc who's a really good adjuster, you can't just bring in somebody. You need an A player who matches your skill set, because your patients will smell that in a heartbeat. And I want to talk about that transition, because so often practices take a dip, people leave, they're not happy about the transition, and that is, I want to unpack. But first, let's talk salary a little bit. You know, we've seen. Just to give everybody an industry update at CMM, you know, the Bureau of Labor Statistics puts the average salary at 89,000 around the country. And we find that to be pretty average. But about second quarter last year, the joint bumped up to $100,000 base in most of their markets. And we saw that really quickly ripple through the profession. And you know, by our estimate, right now there's somewhere in the neighborhood of four to five openings for every one available associate. So, there's a supply problem. There are not enough associates. And now you got the joint paying $100,000.
Dr. Allen Miner: And so, we've seen that have an impact. You know, we. What's unique about us is we don't use job boards. We found all the D and F and C players are on job boards. Why do you go on a job board when you lost your job, or we find the job hoppers tend to be on there. So, we have had much better success. Our recruiters all day long are calling, talking to, you know, I think have the biggest database in the country. We know every state who's an associate, who's an owner. So, when we have a job in Iowa, we can pull up and see who all the associates are we've spoken with, and we start running our job in front of them. And the advantage to that is the A players aren't on a job board. They've been head down, bum up for three, five, seven years in a clinic. They're not really looking for a job. They're probably making that average salary of 89,000, maybe 95, maybe 75. So, we found right now, when we can come along with a price point that's north of a hundred, you'll get that A player's attention.
Dr. Allen Miner: So, it truly is head hunting. We're poaching. But there's this bubble in chiropractic right now because we have the resources and the access to these associates. If the job's good enough, we can pull them out, which is essentially what we did for you. Now the ROI on this, we found, needs to be a minimum of three. I prefer four to one. So, if you're paying somebody at 105, 110, 115, I pay my docs a 125 base. I just don't want to mess with it. You know, they need to bring back 4 or $500,000 on the income that they're generating. So how did. Do you mind talking? Where did you put the salary at? What are they Generating give some real-world experience to what I just said.
Dr. Mark Mouw: Yeah. So, he came in and what I did, I started at 95,000. And what he does is he has escalators for after he sees a certain number of visits per month and that is pretty easy to attain. He's seeing 225 to 250 a week. What was different from his schedule to mine is he is in Monday Wednesdays, which I have been for the last five or six, seven years. He's also in Thursday afternoon and Friday morning. So, he's only in really three days a week, what I would call six shifts or three days. He's making 95,000 at 800 visits per week. He then for every 200 visits over he gets a $500 bonus. So last year...
Dr. Allen Miner: A month, 800 a month.
Dr. Mark Mouw: Yeah, I'm sorry, yes. 800 visits a month. It's of 200 over thousand, 1200, 1400. So, there's a growth and push forward for him to grow and continue to see more patients which lies about most, you know, back on me as well as, you know, doing day ones and day twos because he's seeing most of those patients I'm converting. So, he made 103 or 104 last year and he should be on target to do 110 this year as they continue to grow. And he's ecstatic, ecstatic. And the reason why is because he has the stability and he's actually living in his best life because he's doing what he loves best, just adjusting and educating patients. He's a true teacher, caregiver, doctor.
Dr. Allen Miner: And a true. Something we got to point out is caregivers are motivated. Think engineer or accountant. These are the same profiles. They could have been an accountant in another life. They're detailed people, they're loyal, they're systematic, they're procedural and they like stability and predictability. So, these people like a solid salary. They're not motivated by high end bonuses like we are. You know, they want stability. We see about a four or five... We get four or five times the applicants on jobs with just a good base salary than any kind of combo commission bonus incentive program. So that's worth noting. Now here's another point let's talk about in the last couple minutes the transition because so often two things. I think you did it the right way. What's common is you get an owner; they're getting maxed out. So, they bring in the new doc and they have, they want to build up the new doc’s clinic next to the owner. And now that you're having to pay north of $100,000 to get a solid A player associate, that sucks. If you're seeing 300 people as the owner and you got an associate over here seeing 25, 50 people, you're trying to grow their clinic and you're paying them 105,000, yet you're still doing most of the work.
Dr. Allen Miner: That's where this gets upside down. What I'm a fan of is when you find a caregiver, I want to put the volume they're expected to be at right out of the gate because people tend to their thermostat resets. If they all of a sudden are sitting around only seeing 25, 50 people, they never really do seem to grow it as big as the owner grew it. So, I'm a fan of the owner taking all of the adjustments, putting them on the associate right out of the gate. So, he's starting at 250, 300 a week, she's starting at that level because that's all they know from day one. And now you just bought back your time freedom. But that transition is what's key. So how did you do that handoff so that people, you didn't get the complaints of, "I've gone to Dr. Mark for 15 years. You're not him." How'd you do that?
Dr. Mark Mouw: Yeah, and that's true. Like some calls like you and I have every day. It's the doctor's burnt out, they're overloaded. What they want to do is bring a doc in and either take off on vacation right away and do no training, or what they want to do is that I want them build up the other 300. And it doesn't work that way. You just don't see it ever work. And the reason why is that that doc is more of a supporting doc. That's what you want. The doctor who can just build up the next 300 is going to leave you in two to three years down the road and do their own thing anyway. They're going to leave high and dry. So, what I did is I brought him in. He actually started with me last February, so he'll be with me a year in February. He spent 90 days literally standing at the table next to me watching me adjust, educate patients, talking about how I was adjusting them and doing my notes. And he's 68 years old, just to let you know, in February last year. So, he's 69 now, but he's 68 years old, doing my notes, figuring out our systems, procedure and process of the floor.
Dr. Mark Mouw: I didn't do that for 90 days. At that point. He then started to see patients and we were sharing patients. If I was in a consult room doing an ROF, he'd jump in, see patients. And what I told patients is we were co carrying them. And this was in May. Well, then in June. I was gone for a couple weeks in June and July with vacations and national dance with my daughter. So, I'll let patients know, Dr. Mike's going to take great care of you. Before, when we didn't have that, I was gone. My docs, the other three, would have to absorb 250 visits the weeks I was gone. So, we couldn't grow because we had to block out their new patient time zones. Now what that did is that allowed them to keep all their new patient time zones open. Dr. Mike could just see my patients. So then when I ended up getting back at the end of July, I let most patients know that Dr. Mike was going to be their primary care provider. He was going to take great care of them. They had a great experience because they had been adjusted by him a couple times now.
Dr. Mark Mouw: And those things stabilize. What was nice I would say about 10% of patients saw Dr. Mike, but they had seen my other doctors over the years because when I was gone, they would. So, we didn't lose any patients, but I did have about 10% of my patients go to the other three associates, which was okay, they stayed inside the office, but they had seen them for 10 years when I was gone. So that wasn't a big deal. But he absorbed that, and it worked out great.
Dr. Allen Miner: Here's what we noticed, Mark, and what I think you applied is we started noticing Chiro Match Makers when an owner was pregnant or injured and brought in an associate. And they stayed there for about six to eight weeks. Just literally look like, look, I can't adjust you physically, but I brought somebody here and I'm going to walk them through everything I do. I'm going to, you know the listings. You're literally the docs calling out the listings. The adjustment, what to do. The patient, that confidence gets transferred. Instead of like just, all right, you're on your own, doc, go figure it out. That's what people didn't like. And so, and you weren't injured. So, you just told him, you know, he's helping me here. And so. But it's that if that's the part is that's key, is you staying there for about almost till you know you don't need to be, but you're still around. Patients don't feel abandoned. They feel like all of your knowledge, they've heard you transmit your knowledge to the associate oversee the work. So, they're confident in the associate. It lifts them up. And then the other key part in this, Mark, that you also touched on, I don't want to skip on, is I think there's just a trust innately that this doc had confidence that he'd practice longer than you.
Dr. Allen Miner: And so that's really where that transition works. And then the last thing is recognizing you're the special sauce in that practice. All these owners who've grown these clinics, that's a skill set that's harder to hire for. You can convert people. It's easier to find people to handle the workload. There's much fewer docs that can do the day one, day two. And so, you still maintain that. So, the practice keeps on growing. You're just not doing the physical work of it. And I think that's a key point that a lot of docs miss often, sometimes.
Dr. Mark Mouw: Well, what is great is we can, I mean, we don't. We can continue to do what we do is see the volume when I'm gone, because we just need the adjusting there. My other docs can absorb some of the ROFs, but if we want to turn down neuropathy when I'm gone for two or three weeks, my goal is to be off out of my office for three weeks, 30 days. This summer, Lila's graduating, she's going off to college, she's leaving the area. So, we went into that, and it's been a goal of mine for two years. And that was the iteration of going through the process. The way it was is I didn't want to hurt the mothership, but I also wanted the time, freedom to be able to step away and do that. And this is the process that I was given. And by the way, what I'll state is that there's a lot of great doctors. Dr. Bart Patzer, Dr. Kevin Priestley, I mean, they're awesome. They're in their adjustatorium. Jody Sura, he's one of my accountability partners that I'm on every other week. Yet he's 60 some years old and he's in his adjustment and he's in his glory and all these guys love doing it.
Dr. Mark Mouw: Stepping out and not adjusting isn't something you need to do to be successful. That's the really cool part. Inside of our own businesses, we get to choose what it looks like. You want to see patients five days a week? Knock your socks off. You don't want to be in your office at all and you want it run for you. Just put the right people in a position and that's possible. We see it. But have the goal, have the purpose, but do it correctly and hire the right team, have the right person, the right role, doing the right job. That's where you're actually going to see what your goals are, and your purpose are as you move forward.
Dr. Allen Miner: Absolutely. Well, I got to wrap it up. Last thing is Dr. Brian Dahmer had a question about what's the best retention tool for key staff when you're not in the practice every day. I still own four clinics: I'm not in them. Brian. It's a great leadership team and its weekly check ins and for us it's doing scorecards. So, we record their day ones and day twos and give them scorecards on that regularly, so everybody knows everybody's staying on track. And then finally, I think a great salary. Pay your people better than any other chiropractor is going to pay them in your community and they don't have anywhere to go. And the ROI on that should be five, tenfold very easily for a successful clinic. Just pay people well. It's amazing how far that goes. Do you have anything to add to that, Mark?
Dr. Mark Mouw: Yes, yes, yes and yes. And I would just add one thing is we track stick rates. So, we have our conversion stick rate, we have our 3-, 6- and 12-month strict rates of our patients because we're a wellness based practice. If things are going to go sideways, you're going to see your stick rates go down. That means people aren't doing their KPIs and their scorecards. So that's where you need to come back in over top and make sure your leadership team is making sure that transition going forward.
Dr. Allen Miner: Yeah. On a simple level, people want to know what's expected of them that A players, they want to be measured on that, so they know they're doing a good job. And when they have that feedback loop, you don't really have to motivate people. So, thank you Dr. Mark. I got to get over to sales call so appreciate the call. Thanks guys. Have a great one. See you.
Dr. Mark Mouw: Appreciate you guys. Bye-bye.
Dr. Allen Miner: Bye.
