Featuring Dr. Jamie Richards
Dr. Jamie Richards runs a practice that brings in over a million dollars a year. It's open three days a week. He works one shift every other Wednesday and takes most of the summer off.
Most chiropractors hear that and assume there's a trick. There isn't. What he did was answer one question before he started building, which most of us never ask.
What do you actually want?
Most practice owners are chasing a volume number. Two hundred visits a week, then three hundred, then four. The assumption is that the life you want sits somewhere past the next milestone, and more volume is the road there.
Jamie reverses the order. Decide what you want your life to look like: where you live, how many days you work, and what you need to earn to fund all of it. Then build a practice that produces that number and no more than you need.
This is the same conversation we have with clients every week. People come to a first meeting wanting to talk about their investments. We'd rather start with what the money is for. You can't tell whether a practice is working until you know what it's supposed to be working toward.
And when Jamie's coaching clients do that exercise, most of them find the gap is much smaller than they thought. He described doctors who were about thirty visits a week away from the life they'd described. They were running as if they were three hundred away.
Once you know the target, Jamie's next question is where the practice is leaking.
His rule of thumb: a practice with good retention should need roughly five newly accepted cases a month for every hundred weekly visits it sustains. The profession's usual assumption is about double that. The difference is patients who start care and quietly drift away, so the front door has to keep replacing them.
That changes where the effort goes. If half of your new patients don't stay, chasing more new patients is expensive and never ends. Fix retention first, and the new-patient number you need drops by itself. That frees up time, marketing spend and team capacity.
Laurence Tham made the same point on this show a few weeks later with his bucket analogy. Two practice builders on two continents arrived at the same answer.
For high-volume practices that aren't making the money their volume suggests, Jamie's first move is usually price.
He described a practice seeing around four hundred visits a week and collecting about seventeen dollars a visit. Busy, established, and not very profitable. Over a structured transition they raised fees, restructured care plans and ended up at roughly a hundred and fifty visits a week. They were making more money than they ever had.
The owner's reaction was the interesting part. They understood the math. They still couldn't quite believe they were seeing less than half the people and taking home more. Busyness had felt like success for so long that giving it up felt like failing, even while the numbers said otherwise.
That's a money lesson as much as a practice one. Revenue is what the practice brings in. What you keep depends on the margin, and a full schedule can hide a thin one for years.
The other shift Jamie talks about is the one he calls an acceptance mindset.
He dislikes the phrase "I signed another one up." It suggests you talked someone into something. In his office, the doctor decides at the report of findings whether to accept the case, the way a surgeon or an orthodontist would. They agree on a defined phase of care. If the patient isn't ready, that's fine. The results are good for ninety days, and the door stays open.
It matters to him for two reasons. The first is that his completion rate on that first phase runs in the high nineties. The second is his own sanity. Early in practice, every "no" felt like a verdict on him. Once the decision became his to make, it stopped keeping him up at night.
This wasn't a straight line, and Jamie didn't pretend it was. A café above the practice lost him about a hundred and fifty thousand dollars when COVID hit and he didn't cut his losses in time. A property bought in a hurry during an attempted move to the U.S. cost him roughly a quarter million more.
He's candid that those losses pushed him to grow the practice. It went from about six hundred thousand in revenue to over a million while he paid them down. He's just as candid that he wouldn't recommend losing four hundred thousand dollars as a growth strategy.
For most chiropractors we work with, the practice is the engine for everything else: the salary, the savings, the retirement plan, and eventually the sale. A practice built for the life you want is also usually the most valuable version of it. It makes good money, doesn't depend on you being there every hour it's open, and has a team and systems a buyer can step into.
The practice built on pure volume is often the reverse. It's high revenue, thin margins and heavily dependent on the owner, and it's harder to step back from and harder to sell.
So before the next growth plan, get clear on the number. What do you need the practice to produce for the life you've described? How far away are you, really? Then ask whether more volume is the way to close that gap, or whether retention and price would close it faster.
The one thing: Decide what the practice is for before you decide how big it should be.
Find Dr. Jamie Richards at Life by Design for Chiropractors.
Listen to episode 045 of The Chiro Money Show →
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