Why Most $1M Chiropractors Never Stop Working IN Their Practice

Dr. Erik Kowalke opened Higher Health Chiropractic in West Michigan on August 1, 2011, with 13 patients booked. Three weeks later he was at 300 visits a week.

Then he hit 1,000 a week. By himself. For three years.

A 1,300 square foot office. A 45-minute wait every shift. Roughly 240 people between 2 and 5 in the afternoon, and he'd open the door fifteen minutes early to squeeze in more. You'd expect him to describe it as a nightmare. He describes it as a busy restaurant you're excited to go to.

Today Higher Health runs two locations with six doctors and about 100 new patients a month. Erik is also the founder and CEO of SKED, the scheduling software a lot of practices run on. And he's handed off everything in the business except the vision.

How does one chiropractor see 1,000 visits a week?

Two things. Efficiency down to the second, and families.

Every button click, every hand movement, every word mattered. Ten extra seconds times 240 patients is half an hour gone in a single shift.

But the bigger lever was lifetime family wellness care. One of those 13 opening-week patients had a spouse and seven kids. That's a family of nine starting at three visits a week. Twenty-seven visits from one guy with low back pain.

Families stick, too. When dad's back is slow to improve but he watches his kid's headaches clear up, he keeps coming. So Erik built the entire practice for families: hours around school and sports, a family re-eval form instead of six separate ones, and an office where a stressed mom doesn't have to worry about her kids wrecking something.

Is a high-volume practice a burnout practice?

Erik's answer: only if your mission doesn't match it.

His take is that you don't run out of people who need chiropractic care. You run out of capacity to see them. "You only attract what you've built capacity for." If you're stuck at 200 a week, it's usually between the doctor's ears.

The real breakdown point he sees, going from 500 to 1,000, is the marriage. More nights, more Saturdays, more events. The spouse starts pulling toward the family and it becomes business versus home. He and his wife did all of it together. If he was at the office at 10 PM, she was there too.

His rule now: the marriage is the scale. If it's off, he's not communicating the vision clearly. And vision talks happen in scheduled whiteboard sessions, never on date night.

When do you stop being the bottleneck?

For Erik it took shingles. In 2016, on his first two-week family vacation in five years, it got into his eye. He couldn't leave the house. He was still doing every single report of findings himself.

One of his associates took over all of them overnight, for six weeks, and did great. Better than that, he got better at everything else too.

That's when it clicked. Erik had been holding his people back by doing things they could do. So he kept giving things away until all that was left was vision.

His test for the wrong person on a team is dead simple. It's the meeting on your calendar you're dreading. And he's learned to decide fast, using clear agreements with outputs the person reports on themselves, so the decision is never emotional.

Should patients be allowed to reschedule their own appointments?

Most owners would say no. Erik has the data.

He ran ten years of appointment data looking for any link between reschedules or cancellations and patients dropping out of care. There was none. They log about 4,000 app scheduling events a month, and over the years visit volume tracks right along with them. More flexibility, more visits.

The person moving Monday at 10 to Tuesday at 10 isn't quitting. They're fitting you into a busy life.

The office itself is built to keep people coming back. The entire practice gets a new theme every four to six weeks. Candyland. March Madness, with a basketball hoop over every trash can so kids can shoot their face paper. Monster trucks, and he bought 120 Monster Jam seats for patient families.

If you want to run a family practice, the kids have to want to be there.

Common questions

Q: How many patient visits can one chiropractor see in a week?

A: Dr. Erik Kowalke saw 1,000 visits a week as the only chiropractor in his practice for three years, in a 1,300 square foot office. He credits obsessive efficiency and a family-focused model. He also argues there's no universal number: success at 250 a week is valid if it matches your goals.

Q: Does letting patients reschedule their own appointments hurt retention?

A: Not according to Erik Kowalke's data. He analyzed ten years of appointment history and found no correlation between rescheduling or cancellations and patients dropping out of care. Visit volume tracked with the number of appointment changes, which he reads as patients fitting care into busy lives rather than skipping it.

Q: How do you get more Google reviews for a chiropractic practice?

A: Erik asks the moment a patient shares a win, even on the office tour. He asks them to share their story so people with the same problem can find the practice, has the team send a link from a button in the EHR, and tells them he'll ask about it at their next visit. Higher Health is approaching 1,000 reviews.

Q: How do you build a family chiropractic practice?

A: Make it easy for a busy family. Erik Kowalke's practice runs hours around school and sports, uses one family re-evaluation form instead of separate forms per person, and evaluates families together. It also changes its whole office theme every four to six weeks so kids want to come back.

Q: How do you know you have the wrong person on your team?

A: Erik's test: you've exhausted your training efforts, they're still not progressing, and the meeting with them is the one on your calendar you dread most. He avoids emotional decisions by setting clear agreements on what gets done by when, with the person reporting their own numbers.