600 Visits a Week. No Money in the Bank

Dr. Chris Quigley got his practice to 600 visits a week. He had no money in the bank at the end of the week.

He opened Charles Street Family Chiropractic in Boston's Beacon Hill in 1990, trained in the low-fee, high-volume model. Ten years solo, he hit 300 a week. Then he added associates and got to 500 a week out of a 600 square foot office. He thinks that might be a record.

The volume was fun. The margins weren't there. Associates plus Beacon Hill rent (around $80 a square foot, thirty-five years ago) made the math stop working.

So he changed the model. Thirty-six years in, he runs a medium-to-high fee, medium-volume practice, and he likes it a lot better.

Can a low-fee, high-volume practice still work?

Chris says yes, but only if you keep overhead low. His couldn't be.

His pricing went through three versions. First, unlimited care at a fixed fee. Then doctor-recommended care at a fixed fee. Now it's per visit, sold as set packages, with the plan length based on age. Under 30 typically gets a 30-visit plan, 30 and over a 34-visit plan. Maintenance is 26 visits for the year, used whenever the patient wants.

His reasoning on price is simple. He wants to be the best of the best clinically, and the tools that get those results, like decompression and shockwave, aren't cheap. You can't give them away.

How do you build a team that stays?

Chris doesn't have staff problems anymore. When other chiros start complaining about theirs, his brain checks out. His three senior team members have been with him five, six and seven years.

His answer is EOS. A chiropractic college classmate who built roughly 200 chiro and PT clinics told him he runs all of it on Traction. Chris runs his practice on it to the letter. Every January, the whole team comes to his house for a planning meeting, part-timers included. Last year, what's this year's goal, how do we get there.

Then there's the book club. He pays team members $50 to read a business book and write a report on it. Handwritten, so it's not AI.

He also hires a lot of patients, and he recruits like a scout. If the barista or the server is a rock star, give them a card.

"The bigger the dream, the more important the team."

Which numbers predict where a practice is headed?

Chris checks five every week: visits, new patients, collections, and two forward-looking stats. Appointments already booked for the next 7 days and for the next 30.

Those last two are the ones he likes. Last week's new patient number is already written in stone. The 7-day and 30-day numbers you can still change. Every closed day two should add about 12 appointments to the 30-day number. If it's falling, something's broken. Not enough new patients, not enough closes, or the team isn't booking ahead.

He caught exactly that recently. The share of patients walking in without their next appointment booked usually runs about 10%. Two shifts in a row it spiked to 20 and 33%.

How do you close more care plans on day one?

Chris credits Close For Chiro with taking the stress out of day ones and day twos.

His version: every care plan is sold on day one. Day one is about 80% listening. Your job is to find what he calls the life effect, the thing the pain is stopping them from doing. Sleep, exercise, work and family come up over and over. If they leave day one saying "how do we fix this," day two is easy. Day two should be how we're going to work together, not whether.

The practice averages about 50 new patients a month with roughly 75% case acceptance. He's fine with that rate. Much higher and he'd suspect his fees were too low. With a third doctor coming on, the goal is 75 a month.

His associates help get them. A community outreach assistant books their events, and each associate does one to three a week: spinal screenings and chair massage. Chris tells them up front that's part of the job. If you can't get new patients, you can be the best doctor in the world and it won't matter.

Common questions

Q: What is a good case acceptance rate for a chiropractor?

A: Dr. Chris Quigley runs about 75% case acceptance on roughly 50 new patients a month, and he's comfortable there. His view is that if case acceptance runs much higher than that, your fees are probably too low. He credits the Close For Chiro day one and day two process for keeping the rate steady.

Q: What KPIs should a chiropractic practice track every week?

A: Chris Quigley tracks five: visits, new patients, collections, and appointments already scheduled for the next 7 days and next 30 days. The two forward-looking numbers are early warnings. If they drop, he checks new patient flow, day two closes and whether the team is booking patients ahead before it shows up in collections.

Q: How do you implement EOS in a chiropractic practice?

A: Chris Quigley follows Traction exactly as written and involves the whole team. Every January, everyone, part-timers included, comes to his house for an annual planning meeting to review last year and set this year's goals. He also pays team members $50 to read a business book and write a handwritten report.

Q: What is the life effect in a chiropractic consultation?

A: It's a Close For Chiro idea Chris Quigley uses on every day one. Patients don't come in because of pain alone. They come because the pain is stopping them from doing something that matters, like sleeping, exercising, working or playing with their kids. Finding that thing is the doctor's job, and it's often not what they wrote on the intake form.

Q: Should associate chiropractors do their own marketing?

A: In Chris Quigley's practice, yes. A community outreach assistant books events and each associate runs one to three a week, usually spinal screenings and chair massage. He tells candidates on day one that it's part of the job, because a doctor who can't bring in new patients won't build a successful practice.