Why You Shouldn't Build a Practice on Your Personality
Dr. Dennis Short runs 28 chiropractic clinics in Kentucky, all on insurance, while the rest of the country chases cash. He grew up on welfare in Newfoundland, built one of the largest chiropractic groups in the US, and warns: if your practice runs on your personality, you do not have a business. You have a job.
Episode Details
Most successful chiropractors think their practice is working because the systems are dialed in. Dr. Dennis Short calls that a dangerous illusion. If the practice is really running on your charm, your warmth, and your relationships, the moment a second doctor walks in to replicate you, the wheels come off. You're about to get your ass handed to you. That's the warning Dennis gave to a chiropractor visiting his house asking how to scale, after the visitor couldn't answer a single basic question about his own codes, collections, or patient visit average.
Dennis is the founder of Bluegrass Chiropractic with 28 locations in Kentucky and a 29th opening this year. He grew up on welfare in Newfoundland, graduated chiropractic school in 2001, and now runs one of the largest chiropractic groups in the United States. Every clinic is insurance-based at a time when most of the profession is being told cash is the only path. He's also a professor at Campbellsville University School of Chiropractic and the author of The Ultimate Chiropractic Practice.
In this episode, Dennis breaks down why insurance still works (especially in "Any Willing Provider" states like Kentucky where Blue Cross can't deny in-network applications), why most doctors abandon insurance not because the model is broken but because their documentation is broken, and why geography is the most under-appreciated input into the cash-vs-insurance decision. Rural Kentucky utilization is roughly 10x what it is in big cities. A $50,000 deductible state and a Medicaid-rich state are not the same business. You don't pick your billing model first. You pick your market first and let the model fit it.
The conversation also gets into the operational systems that let one operator run 28 offices, including procedure manuals for every workflow, daily KPI sheets that hit Dennis's desk from each clinic, the two-bump referral curve (personality bump on visit one, effectiveness bump at visit 12-15), why most large practices are pouring money into Google AdWords while having zero internal marketing systems, and the 6-month "checking in" outreach that reactivates between 14 and 40 percent of dormant patients for free. He also covers the talent shortage (there are roughly four open chiropractor jobs for every chiropractor looking) and the broken associate contracts he sees regularly, including bonus structures that would only pay out if an associate saw 250 patients a week.
If you've ever built a practice that depends on you being in it, considered opening a second location and felt the math break, or quietly wondered if your charm is hiding holes in your systems, this episode is the wake-up call from someone who's stacked 28 of these and still runs the daily numbers personally.
Key Takeaways
- Don't Build a Practice on Your Personality: Dennis's warning shot. If your practice works because patients love you, you don't have a business. You have a job nobody else can do. The next doctor who walks in to replicate you will fail, and so will the second location.
- Insurance Still Works (In the Right Geography): Dennis runs 28 clinics on insurance in Kentucky, an "Any Willing Provider" state where Blue Cross can't deny in-network applications. In closed-network states like Florida, or in $10,000-deductible markets along the country's rim, cash makes more sense. Pick the market first, the model second.
- Most Cash Conversions Are Hiding Documentation Failures: Dennis sees a lot of charts where the case history describes severe sciatica with foot drop and the diagnostic code says "unspecified low back pain." That doesn't get an insurance company to pay for 24 visits. It gets you three. Doctors then blame insurance and switch to cash, when the actual problem was their documentation discipline.
- The Two-Bump Referral Curve: Patients refer on visit one because they like you (personality bump). They refer again at 12-15 visits because they're well (effectiveness bump). If your PVA is only 5-7, you're losing the second bump entirely. If you're not likable, you're losing the first. You want both.
- Internal Marketing Is What Most Million-Dollar Practices Ignore: One operator Dennis knew was doing $3M in a single office while spending $1M on ads. He had zero internal marketing systems. Dennis's 6-month "checking in" outreach (no soliciting, just a touch) reactivates 14 to 40 percent of dormant patients for free.
- The 28-Office Operating System: Procedure manuals for every workflow (he name-checks McDonald's salt-shaker manual). Weekly Zoom calls with every doc. Quarterly doctor meetings, twice-yearly all-hands shutdowns. Daily KPI sheets from each office pulled from the EHR and reviewed by Dennis personally. Doctors keep autonomy over technique. Operations get standardized.
- Don't Hire Yourself Twice: Most doctors hire associates who look and think like them. Dennis hires the opposite. Male owner, female associate. Sports owner, pediatric associate. Diversifies service, reduces drama, and de-risks the practice from a single technique or patient type. Same logic that keeps him diversified across PI, Medicaid, sports, and family care.
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