Dr. Brian Capra: Everyone, welcome back to the UAC Best Practices podcast. I'm Dr. Brian Capra from UAC. I'm here with my co-host, Dr. Allen Miner, and a very special guest, Dr. Olivia Joseph. The goal today is just to share best practice that you can take it, implement in your practice, and get great results like a successful husband and wife team like the Doctors Joseph are. Dr. Allen, want to take it away?

Dr. Allen Miner: Yeah, I'm trying to think back how long I've known you, Olivia and Brian, and I don't know, it seems like probably at least six, seven years.

Dr. Brian Capra: Long time.

Dr. Olivia Joseph: Say about a decade.

Dr. Allen Miner: Yeah, probably. So, you practice out of the St. Louis, the suburb of St. Louis. And you know, the first thing I'll touch on that I've just always been impressed is there's a lot of people in chiropractic who I think all chiropractors are trying to figure out how do I maximize healing potential for my clients and revenue within this profit center of my brick-and-mortar business. And I think that what you and Brian have done is best in class. You guys are in a number of verticals with traditional chiropractic care, but then you also offer decompression and then you offer, I believe how I always know you is kind of as a functional expert. So, then there's the functional side and then you guys have a nurse practitioner doing PRP and stem cells, and you really have that.

Dr. Allen Miner: There are all kinds of different terms these days. I'll let you name how you guys describe your clinic, but can you just maybe briefly talk about how you integrate all of that? Because I see so many doctors, really, they're challenged with, you know, when somebody comes in the door, where do you direct them? I see so many offices that they focus on one of these verticals and they lose sight of the other verticals and you guys’ shine. And I know I'm seeing the end product where you, it is probably perceived by us as a lot easier because you guys are so graceful, but there's probably been so much work and pain working out how you do it. So, can you just give a little insight maybe from where you're at now to back to how it started? You know, when somebody comes in, how do you direct them? What have been the benefits? And then we'll get into your best practice. But I just, I think you guys have such a fascinating practice model. I want to start there.

Dr. Olivia Joseph: So, I think initially we started out with just two simple offerings, chiropractic and nutrition. That was pretty much it. And what happened was they both grew and grew and grew big and strong enough where, like we said, we weren't robbing Peter to pay Paul. And there have been times in our practice where we integrated a new service or a treatment. There have also been times where we got rid of, like we got rid of our acupuncture department. And I can explain why, you know, in moments which was thriving, by the way. If you looked at it, it would have been called like a high-volume acupuncture practice to chiropractic. Right. Or to acupuncture. But we just had to, when we looked up the space, the time units, the dollar productivity. Like, I needed those rooms to hire another functional medicine practitioner, and it was going to be way more profitable, and it kind of hard to get rid of it because I knew what amazing clinical results we were getting. But at the same time, that was the first service that we had to let go because of COVID.

Dr. Allen Miner: Pause there Olivia. I just. That's brilliant. Because that is, you know, that's the analogy of is you willing to tear something good down for something great? And how many clinics would just. Even though it doesn't feel like a lack mentality, when you have something positive and cash flowing, there's a tendency to want to hold on to it. But for you to actually say no, time out, we can have a bigger impact, help more people in a bigger way, and make more revenue. That's fascinating. So, did you try to sell it? You just shut it down?

Dr. Olivia Joseph: Shut it down. Just shut it down. And I was the one running the department. I was the one, like, I started doing care plans and treatment plans. In acupuncture that kind of wasn't heard of, like, especially. So, we treat. I was doing care plans with nutrition and acupuncture combined based on the demographic I was seeing. And no, we just had to shut it down. And I hired another functional medicine practitioner and filled his schedule fast and then had to hire. So, I think what the moral of the story is we started out pretty much just two services, but they were both strong enough where they didn't pull from each other. When somebody comes in on my side just for functional medicine, that is not a chiropractic patient. Very easy to get them to chiropractic because they're already in functionally. The fee system's way different.

Dr. Olivia Joseph: Right. So, if somebody's used to coming for, you know, $2,000 worth of testing upfront, to send them to chiropractic is an easy referral. And then on the chiropractic side, it's such a large volume of people that they're seeing what's going on in our office and under our roof. And when a patient that's stubborn or even one that's like not responding well, stubborn as well, or not getting the best results or even just interested in those other services, they're already getting a good experience on the chiropractic side, they're getting good results. They already trust us to come into that higher dollar productive service. But to this day, we have people that come in just for functional medicine, just for chiropractic, just for, you know, one service or another.

Dr. Allen Miner: Do you, I'm curious about that. Do you market decompression separate than chiro, separate than functional? Do you, are they all kind of their own separate tributaries?

Dr. Olivia Joseph: Yeah.

Dr. Allen Miner: And so, when they come in, if they came in on a decompression ad, do you address that first and then refer over or how do you guys integrate all of that back and forth?

Dr. Olivia Joseph: So, if you come in for decompression, you're going to be getting chiropractic care too. It doesn't mean you're coming over to the functional medicine side at all. Same thing, if you come over to the functional medicine side. It's usually for you know, whatever a marketing campaign was, if it was thyroid, if it was diabetes, something of that. We're mostly referral though, honestly like, we're mostly still a referral-based practice. We do tailor our marketing specific to a department. Even like for injections. Like if we're doing specific, you know, marketing towards injections, then that's the report of findings and the treatment plan that they're going to get.

Dr. Allen Miner: I won't ask numbers, but I am curious, of the four departments, which one top line revenue does the most business?

Dr. Olivia Joseph: I would say chiropractic and functional medicine are about the same. They really are. The one that has the most potential is the injections, right? That's the one that's got the most potential. That's the one where we have the most capacity. And then again like if you're measuring your options, like am I going to keep acupuncture in my clinic or look how much this nurse practitioner can do in injections. It's kind of a no-brainer, right?

Dr. Allen Miner: Yeah. So how many staff members do you guys have?

Dr. Olivia Joseph: Oh gosh, we just hired like six more because it's been really challenging to find full-time. So, we've had to like we've retained our core people for so many years and years and years and years, we have very little turnover. We have, you know, staff turnover. But we've just brought in like six new hires because it's a struggle to get people full time. I should know this number. Brian would know. I'd say with practitioners, we've got 10 providers, and we've got probably 24 total.

Dr. Allen Miner: Okay, so then that leads me into the best practice question. 24 people working under your roof. How? What are you guys doing? Let's talk best practices. You know, what are you using with data, with strengths. Talk. Let's, let's. And I just say all this to build up. You've got a lot of credibility in this space because you've got a big team, a successful team. So, talk to us. What can somebody listening use, glean from what you guys are doing?

Dr. Olivia Joseph: So, I think one thing I figured out early on, so I've been in practice for 21 years, and in the last 18 years, we've been in this practice, this, like this bubble of, you know, functional medicine and chiropractic in a variety of capacities. And Brian, my husband, has from day zero, he's like a statistician. Like, he is using stats to drive almost every decision. I'm not saying sometimes there's no emotion because we're business partners, we're husband and wife. We're business partners with another husband-and-wife couple.

Dr. Olivia Joseph: So, there is emotion. We're all best friends and we were having babies, and we were doing all this, but really it came down to the numbers. And what I mean by that is like every year, over and over and over, Brian goes deeper and deeper and deeper into stats in many of the decisions that we make. And, well, like I said, getting rid of acupuncture, yeah, that was hard for me, but I really had to make it not an emotional decision. And look at what's the greater good of the clinic and the people that we can help and serve. So, what ended up happening, like stats. Just recently, even Brian did this whole evaluation on every one of our providers.

Dr. Olivia Joseph: Not by department, so not by department, by provider, t...