Why High Margins Are Killing Your Practice's Exit Value
High margins look like success. They're actually killing your practice's exit value. Dr. Austin Cohen, owner of 13 Corrective Chiropractic locations, explains why he runs secondary clinics at 15-20% margins, why "contract to expand" is his 2026 mantra, and the clarity framework that separates scalable practices from expensive jobs.
Episode Details
Most multi-location operators think high margins are the point. Dr. Austin Cohen disagrees. If your clinic CEOs are running at 40-60% margins, he'll bet you have high turnover, low associate loyalty, and an enterprise value that collapses the moment your top doctor walks out the door.
Austin founded Corrective Chiropractic and Chiro 180 in 2009 and has since scaled to 13 locations across the Southeast. He owns the real estate on 10 of them. He's also an Enneagram 3 who spent the first five years of his career being what he now calls "a control freak who justified it as helping." The shift from there to running a 30-person company with defined seats, scorecards, and an actual culture is the arc of this conversation.
In this episode, Austin breaks down why he runs his non-primary clinics at 15-20% margins on purpose, how he uses the Traction framework (roles, seats, KPIs, SOPs) to create the clarity his team needs to win without him in the room, and why his 2026 mantra is "contract to expand." He's shutting down one of his 13 locations on purpose. Most operators only know how to add.
The conversation also gets into the endurance-athlete-to-CEO translation. Austin has done Navy SEAL training, 100-mile runs, and 40 miles through the Grand Canyon. He makes a direct case that how you handle suffering physically predicts how you handle difficult decisions in the business. Most operators quit hard business decisions for the same reason amateur runners quit hard runs: the why wasn't big enough.
If you're running one location and trying to figure out how to add a second, or running multi-unit and wondering why your margins look great but your turnover is worse than you'd like, this episode is a masterclass from someone who has been in the weeds for 16 years and has shut down the ventures that didn't align with him, including a full franchise program.
Key Takeaways
- High Margins = Low Exit Value: Austin runs his secondary clinics at 15-20% margins on purpose. High-margin multi-unit operators tend to have high turnover because the money stays with the owner. Sharing the upside with clinic CEOs builds loyalty, lowers turnover, and raises the enterprise value of the business.
- Contract to Expand: Austin's 2026 mantra. He's shutting down one of his 13 locations to reinvest energy into the ones that matter. Most operators expand when they should be pruning.
- The Unhealthy Enneagram 3: Early-career Austin listened to every phone call from his adjusting bay. He told himself he was helping. He was actually creating distrust and capping his team's growth. Self-awareness is the foundation of scalable leadership.
- Clarity Creates Confidence: Every role has seats (from Gino Wickman's Traction), every seat has defined responsibilities, and every responsibility has a KPI and an SOP. Patients quit care for the same reason staff quit jobs: they lose clarity on where they're going.
- Family vs Team: "We're a family" is a weak core value because you can't fire family. Core values have to survive the "can I fire them?" test. Austin's four are FOFO (fortify ourselves, fortify others), PPI (purpose-powered impact), Accept the Challenge Set the Standard, and Better Together.
- How You Do Anything Is How You Do Everything: Austin has done Navy SEAL training, 100-mile runs, and 40 miles through the Grand Canyon. The reps build a mindset that shows up in the business. Operators who quit hard runs tend to quit hard business decisions for the same reason.
- Relationships Still Beat Everything: After 16 years and 13 locations, Austin's answer for the biggest opportunity chiropractors are missing isn't AI or marketing. It's a relationship capital in the community. Every listener is one relationship away from a million-dollar practice.
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