Stop Seeing Patients 5 Days a Week
Most chiropractors grind five days a week and wonder why they're stuck. Dr. Nikki Cottis runs a 7-figure practice with three associates and sees patients two and a half days a week. She breaks down the systems that made it possible: hourly rate filtering, ClickUp automation, and an associate comp model that aligns the whole team.
Episode Details
Most chiropractors grind five days a week, work 12-hour days, and wonder why they're stuck at the same revenue level they hit two years ago. Dr. Nikki Cottis was there. Then she got fired from her associate position when her boss came back from maternity leave and didn't need her anymore. Her husband told her she was opening her own practice. She didn't believe him. Ten years later, Chiropractic Connection in Gulf Shores, Alabama, is a 7-figure practice with three associates, and Nikki sees patients only two and a half days a week.
Nikki is also a coach at The Wealthy Practitioner, helping other chiropractors do the same thing. The systems she's built aren't theoretical. They're the ones who let her be home with her 7-year-old daughter, take vacations without closing the office, and run a coaching company on the side. Her core thesis: once you hit roughly $20,000 a month, seeing patients five days a week is the trap that keeps you stuck. The grind doesn't multiply. It plateaus.
In this episode, Nikki walks through the operational frameworks that make her schedule possible. The hourly rate framework: profit divided by hours worked equals your real hourly rate; delegate anything you do that's worth less than that and that you don't enjoy. The cost-to-deliver-an-adjustment metric: total monthly overhead divided by patient visits, gives you the floor every service must price above (hers is $31). The associate compensation model that doesn't pit team members against each other: pay base plus bonus on TOTAL office revenue, not personal collections.
The conversation gets specific on ClickUp. Nikki uses ClickUp to run almost every task in the practice. Every new patient creates a task with a subtask checklist. Every care plan discontinuation triggers a workflow for taking the card off file, updating the spreadsheet, and removing it from the email system. New leads from HubSpot auto-create ClickUp tasks for the front desk via Zapier. Patient journey gifts and cards are automated based on the first-visit date. She's the only chiropractor most operators have ever met who runs ClickUp like an agency runs ClickUp.
If you're stuck at $50-60K a month, wondering why hiring more people hasn't changed anything, considering opening a second location but haven't fixed the first, or just exhausted from the 12-hour-day grind, this episode is the operations manual from someone who built the systems that got her her time back.
Key Takeaways
- Stop Seeing Patients 5 Days a Week: Once you hit ~$20K/month, the grind stops working. CEO time becomes mandatory. Nikki sees patients 2.5 days a week and runs a 7-figure practice. The other 2.5 days are working ON the business, not in it.
- You're the Bottleneck. It's Almost Always You.: When practices plateau at $50-60K/month, the cause isn't market or marketing. It's ego. The owner won't invest in a real team, won't pay them well, won't let go of being the face.
- Cost to Deliver an Adjustment Sets Your Pricing Floor: Total overhead ÷ patient visits = your true cost per service. Nikki's is $31. Every care plan, every package, every promo must price above that. Without this number, you're running on vibes, not math.
- The Hourly Rate Framework: Profit ÷ hours worked = your hourly rate. Delegate anything you do that's worth less than that AND that you don't enjoy. Nikki spent 2 hours every Tuesday answering patient texts. She now pays $50 for someone else to do it. She gets 2 hours back to grow the business.
- Pay Associates on Total Office Revenue, Not Personal Collections: The compensation model that aligns the whole team. Bonuses tied to personal numbers create competition between associates. Bonuses tied to total office revenue make everyone pull in the same direction. Nikki recommends ~$70K base plus $25K bonus opportunity by year two.
- Always Be Recruiting: Poach from hotels, restaurants, and bartenders. They're on their feet, trained in hospitality, and often looking for year-round work. Keep a hiring page live on your website even when you're not hiring. Some of Nikki's best hires came from striking up a conversation at a bar.
- ClickUp Runs Everything: Every task in the practice has a ClickUp ticket with subtasks. Care plan discontinued? Subtask checklist for taking the card off, updating spreadsheets, and removing from email. New lead from HubSpot? Zapier auto-creates a ClickUp task for the front desk. Patient journey gifts? Automated. This is the system that lets her run the practice from 2.5 days a week.
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