Why He Closes the Clinic Every Tuesday
Most chiropractors run their practices at 20% schedule utilization and don't realize it. Dr. Josiah Fitzsimmons does nearly $7M a year from a single 1,800-square-foot location and closes the clinic every Tuesday for team training. He breaks down the structure most owners are missing.
Episode Details
Most chiropractic clinics across the country are running at roughly 20% schedule utilization. Same hours, same team, same rent, but only one in five available appointment slots is actually filled. Dr. Josiah Fitzsimmons argues that the entire profession is sitting on a 5x revenue increase that no one talks about, and he's running a single-location practice doing nearly $7M a year out of an 1,800-square-foot space to prove the math is real.
Josiah grew up in a low-income household with eight siblings. His mom delivered newspapers, his dad waited tables, and Josiah started delivering papers himself at 3 AM in third grade. He earned a Division I football scholarship to pay for college, then built Vero Health Center from scratch. He learned about structure (as opposed to systems) in his third year of practice, and that single insight took him from $2M to $5.5M in one year. He's now targeting $10M out of the same single location.
In this episode, Josiah breaks down why he closes the clinic to patients every Tuesday and uses that day for one-on-ones, department meetings, all-team training, and strategic improvement. His Olympics analogy: athletes train for four years to run a 9.5-second race. Most chiropractors practice on their patients instead of practicing on each other. He also walks through the Disney experience framework that shapes every patient touchpoint at Vero. Doctors clean patients' glasses with their own shirts and hand them back. A team member walks patients to and from cars when it rains. New patients are greeted by name before they introduce themselves.
The conversation gets specific on the math behind scaling. Josiah's formula: 100 divided by profit margin equals the required marketing ROI to break even. 30% margin needs 3.3x. 20% needs 5x. 40% needs 2.5x. He explains why hiring for back-office roles based on interview performance is a trap (back-office people are bad at interviews because they're not people-people), why personality profiling for every role is non-negotiable, and why team is the #1 asset, not the #1 expense. He also covers Lucro, the bookkeeping plus CFO service he co-founded that's now serving roughly 500 chiropractic clients at $450/month, born from his own frustration that nobody could give him a clear answer on what good financial data should look like in a chiropractic practice.
If you've felt like your practice is plateaued, suspected your data is messy, or wondered whether it's actually possible to scale a single-location practice past $5M, this episode is the structural blueprint from someone who's quietly running one of the largest single-location chiropractic businesses in the country.
Key Takeaways
- He Closes the Clinic Every Tuesday: Josiah's $7M practice is closed to patients every single Tuesday. The team uses that day for one-on-ones, department training, all-team meetings, and strategic improvement. Most chiropractors practice on patients. Josiah's team practices on each other. That's why the other four days produce.
- Schedule Utilization Is the Most Important Metric Nobody Tracks: The average chiropractic clinic runs at 20% schedule utilization. Most practices could 5x their revenue with the same hours, the same team, the same rent — just by maximizing what they're already paying for. The single biggest unrealized lever in the profession.
- Structure Is the #1 Missing Piece: Most chiropractors operate on systems (day 1, day 2, table talk, retention). Structure is the org chart plus accountability for KPIs and core values. Josiah went from $2M to $5.5M in one year when he finally learned the structural piece. Systems are SOPs. Structure is who's accountable for what.
- The Disney Experience: Walt Disney World hides trash collection through vacuum tubes so guests never see it. Josiah's office cleans patients' glasses with the doctor's own shirt, escorts patients to cars in the rain with umbrellas, knows new patients' names before they walk in. None of it is one big thing. It's a thousand small things, compounded.
- Hire for Personality, Not Interview Skill: Back-office people are bad at interviews because they're not people-people. They're detail nerds on spreadsheets. Josiah hires every role to a specific personality profile, requires a 4 or 5-star alignment with that role's profile, and refuses interview-driven decisions for any position.
- 100 ÷ Profit Margin = Required Marketing ROI: At a 30% margin, you need 3.3x return on marketing to break even. At 20% margin, 5x. At 40% margin, 2.5x. Stop asking other chiropractors how much they spend on ads. Ask yourself how much you CAN spend based on your specific profit margin.
- Team Is the #1 Asset, Not the #1 Expense: HR stands for human RESOURCES. Resources are oil, gold, silver — things you want more of. Most chiropractors view team as a liability. Josiah's biggest growth came when he flipped the framing and made team scaling the primary focus, not the cost to manage.
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