Transcription
Yeah, as I look at my practice, I look at other practices, and I've been obviously doing this for 10-12 years now, trying to analyze my own practice and how I can share that with people. One of the things I don't think I've adequately communicated is the real kind of hidden business model behind the business model, and I want to try to talk about that today.
And I have a case study I want to show you to explain that. And that, you know, I think maybe some of the reason why it's hard for me to articulate this is because it's been unconscious. I hadn't really planned this out, but I have a perfect example of this here. And we can look this, you know, you can look at this in two different ways. You can look at this as a patient follow-up system, a way to get people who you heal to stay well for the long term, or you can look at this as a business model for recurring revenue.
Now, I didn't ever, I did not purposely set this up as a recurring revenue model where I could make more money, but that's kind of inadvertently what ended up happening. And there's a key to this, and I want to try to share it with you today so you guys can start to implement this because I don't think you have to wait or mistakenly kind of discover this like I did. You can kind of plan this out purposefully. So let's take a look here at what I'm trying to talk about.
So number one is that, you know, there are these different phases. And you can see here on the health plans, let me get up a clean one here, it might be easier. You can see on the health plan, I have it divided up into two different things. One is that there is a wellness program, and then the other portion of it is that there's a therapy or a series of therapeutic programs. And this is really kind of one of the keys to making this whole thing work.
So the wellness program is what the patient would start with, and what you would want them to be on for the rest of their lives. The therapeutic programs below are designed to be term. So short-term, to me, is two months of yeast killing, six months of liver support, six to twelve months of an adrenal program. Therapeutic programs are solely based on the labs in my world, and they're short-term. The most, there may be six months to a year, sometimes only a couple months. So the therapeutic programs, very important to have a timeline on each of them, otherwise this gets really messy, and you get into problems just with, you know, follow-up and whatnot.
But the wellness program is what you want that person to be on for the rest of their life. For example, my mom has a wellness program. We ship her stuff, or she comes by the office every couple months to pick it all up. She has some vitamin D, some B12, she has curcumin because when she takes her curcumin, her joints don't hurt, and I think 100-some osteoporosis formula. So that's hopefully my mom will take that for the next 20 years, and she'll die when she's 100. That's her wellness program that keeps her fit and healthy.
The thing is that from a strategy standpoint, when you're working with a new patient, the time and energy and work that it takes to get a new patient to show up at your door, you want that person to basically be in your clinic for the rest of their life. And if they have children, you want their children to come into your clinic. Okay? And that's, I think, one of the reasons why I've been so successful is I've been able to pull this off again, not really intentionally. But in order to keep people around, in order to, you know, keep people around, the strategy needs to be a therapeutic program or series of therapy programs that addresses their chief complaints, that moves into a wellness program that they can stay on forever, which is some why they want to stick around and still be with you. Okay?
So the wellness programs can run independently of how often that person is coming in, and they are going to continue to basically buy supplements and lab kits from you in order to reinforce that wellness program. So in my clinic right now, for a long time, I did a yearly adrenal panel as the sort of check-in for my wellness patients. Now I've shifted it over, and I'm much more satisfied using an organic acids test as a once-a-year check-in.
Does a couple of things. Just like with my dentist, I go every six months or year, I get my teeth cleaned. Basically, she comes up at the end of the cleaning, looks around, and says, "Oh, maybe you need an x-ray. It looks like this cavity there. You should come back." But it's her way to check in with her patients every year or so and to identify problems before they get really bad. It's a great practice-building, business-building thing for her because she's got me in her office once a year. Again, my teeth cleaned. That's really easy to upsell me on a little cavity problem or an x-ray because I haven't had my x-rays in like seven years, whatever it is, that she's selling me as an additional service.
And so it's the exact same thing with our practices. Like, and I'm never going to leave that dental practice. I've been in that, going to that dental practice since I was like five years old. Doctor who now retired, he sold it to Dr. Amir Hardy, and now I see Dr. Hardy. I mean, I would, I would crawl, I would crawl there if I had to. I mean, why would I ever go to another dental office, really? It's only when I know since I was five years old. So.
And, um, it's the same. We want to instill that kind of feeling with our patients. But you've got to have a reason for people to stick around. Okay? And if you find out, and you don't have to do the yearly organics profile, I just found that that's the one that gives me the most to talk about and the most to work on for my wellness people.
So typical patient comes in, we put them through their therapeutic programs, which you guys know well. An adrenal protocol, a thyroid program, a female hormone program, clean up their gut, get their liver working better. Okay? So you fast forward to maybe six months or a year into working with this patient. Now you want to make sure that you have something that's designed specifically for this purpose that you've been talking about the whole time, which is moving them over to their wellness program.
Now, in the beginning, the wellness program might be really simple. It might just be like the multi-packs and some probiotics or something like that. It doesn't have to be super complicated. But the ongoing program, or the wellness part of the program, is something that they can start with when they first get started with you, but that's then going to continue when all the therapeutic programs have run their course. So your adrenal protocol is over, now you're sleeping well, that's great. We're going to kick you back to the wellness program. That's the underlying foundational program that's going to keep you well, keep you from having that sleep problem coming back, etc. Which I do as a follow-up. I want you to, you know, once a year, run an organic acids profile, and we'll do a short visit once a year and make sure that everything's staying on track.
So that's like my equivalent of offering a teeth cleaning, right? Gets patients back in the office, gets them re-engaged. And because I've been relatively successful doing that, we now have so many old patients that are coming back in that my practice is relatively full. You know, it's not closed. We still take in new patients. Probably could be doing a better job at retaining people. And you guys, you know, just hearing this talk, hopefully over the next couple, three years, can create even more robust patient retention programs, and you hopefully can retain and keep the majority of new patients that are coming into your practice for the long term.
Now, if you get a grumpy, unpleasant person, I wouldn't encourage them to do this because probably don't want to deal with a grumpy, unpleasant person, you know, once a year forever. But people that you like and you have a good connection with, this is a really great way to go.
So let me just show you a concrete example of this with a real person that came in about a week ago. So here she is. It's, uh, Lisa, is not her real name. 2014, we did the standard things I always do, her adrenal program, her gut protocol, and this organic acids test was part of her intake. Depressed, anxious, can't sleep, really bad brain-related problems. Put her on a basic program back in 2014. Miracle cure, she's feeling great. We did all the basics well, got her feeling really good. And if you look at the lab, the initial one, of course, we did an adrenal and GI program too. I just want to show you the organic acids profiles so you can see how this works.
So on the, on initial test, she had a problem with B6, her methylation was shut down, she needed B12, kynurenate was elevated, she had major brain problems, which we were able to correct with the amino acids. She had one liver marker I wasn't sure what that meant at the time, but later on, you'll see it was pretty important. And she had the usual gut problems that we see. Okay? So fixed her H. pylori, whatever the gut infection was, I can't remember now. Worked on the adrenals a bit, feels great. Six, eight months into the program, super happy. Moved her over to a maintenance schedule. And again, maintenance means once a year, I want you to run this organic acids test, Lisa, to stay on track.
So remember that again, one B, my B vitamin marker, B12 marker, kynurenate showing the brain problem, one liver marker, and two things going on with the gut. And where she got the biggest benefit was working with the brain. All her cravings went away, she lost all this weight, depression, anxiety gone, you know, just a typical great case. Here's organic acids profile number one. You can see the methylmalonate marker, a tattoo, kynurenate at a 1.2. So she has an inflammation driving problems with the brain. One liver marker, I just, actually butyrate, a couple gut things. Okay, relatively normal, normal for, you know, a patient that's got some problems.
So then we do her. And then you've got to imagine what happened when she's feeling great. I mean, she, by Funko, she's fixed. And my old version of Dan, we would have lost touch with her until she started to have problems again. But in the spirit of, you know, the once a year teeth cleaning, we have this once a year organic acids test that I really push patients to do. So she came back in 2015, a year and two months later, and hit her yearly check-in. And here's the test. And this was from a patient who was doing extremely well for the first six months. Now we see carbohydrate metabolism markers show up. The only one there before, energy production markers showing up that wasn't there before either. She's still got that B6 marker, she's still got the methylmalonate problem, and now she still has the kynurenate problem, but it's gotten worse. Okay? Now it's very high instead of just high. And her liver detox markers, she had one of them before, now there's two.
So what happened here? She developed new problems in that year. Carb metabolism fell apart, mitochondrial damage. The old stuff was still there, which is not good. You know, transmitters got worse, and her liver got worse. Now, this is just like you go back to see your dentist. It's been a couple, you know, years or whatever, you're not brushing your teeth carefully, and they say, "Oh, you have a problem with your gums or you have a cavity." We have to do it right. There's, this is a problem. This yearly checkup caught the fact that she had started drinking alcohol heavily again. Okay? And I wouldn't have known this if I hadn't had her do a yearly checkup. She didn't like, come into our office in the morning on a Wednesday at 9:00 and say, "Oh, hey, Dr. Cayle, is great to see you again. I'm an alcoholic and I started drinking again. I didn't tell you all that before." You know, this came up because I did the test.
So now we're in the second year of working with her. Oh, and then there's another thing that happened is that she, and I hate it when patients do this, she changed. She got married, and she changed her name. Don't you hate that? So you always knew her as like Lisa Smith, and now she's like Lisa Jones. So he screws up by your record-keeping. But this is an important part of the story. She ended up getting married right around this time, right around here too. And she's drinking a lot. You know, obviously, marriage is wonderful. Drinking a lot, not so great. Alcohol affecting liver, alcohol affecting the brain, alcohol affecting her carbohydrate metabolism, and her mitochondria getting damaged. Now, of course, she's not feeling very good either. And if we had lost track of her, we wouldn't have known any of this. She would have gone away, you know.
So now, what did we see on the labs again, just to reiterate? Pyruvate and lactate are elevated. They were fine before. This is alcohol's gonna do that. Of course, alcohol with sugar is gonna screw up your carbohydrate metabolism. There's hydroxymethylglutarate. So she's got some mitochondrial damage, probably from the alcohol as well. The B-vitamin markers that were there before are still there now, but they're a little worse. The kynurenate went up, it's a little worse. And then she's got these two liver markers, and I think there was just one on the original lab. Okay? So this is a woman who's really suffering and not doing very well.
Put her on a program, got her back on track pretty well, actually. I mean, she's been a really good patient. I like this woman. What got her back on track? You know, stopped the drinking, saw her probably, probably one or two times, you know, till things were settled down. And then I did my usual stick. Okay, you're back on track. This is really wonderful. I'm glad things are settling down. Glad you got married. A lot of stress with the marriage, you know, planning a wedding, always freaks people out. Kind of understand why you slipped. Let's do your organic acids profile again in a year. So in other words, intervening with a few visits, getting her stable, then putting her back on our once a year, teeth cleaning plan, here, organic acids.
And she disappears again for a while. I'm thinking things are fine. And then we get this lab back, just a couple weeks ago, her yearly organic acids profile. And really, I could hear she's doing these tests like once a year, exactly. Because I mean, like the last one was April, so she retested in April. We got the results in May. And I'm looking at this lab before I talk to her and I'm thinking, "Oh, this doesn't look so bad." Remember before, there were carbohydrate metabolism markers before, and they're gone now. That's good. There's an energy production marker before. Hey, it's something still there. That's understandable. The neurotransmitter markers are gone now for the first time. The B-vitamin markers are gone for the first time. The methylation marker of B12 has gone for the first time. So the B vitamins, methylation, and brain are all better. There's only one detox marker instead of two. So overall, things are quite a bit better. And there's this one yeast marker here, which when it was never there before.
So looking at the lab, you're thinking, you know, there's one thing that's new. Really, if you're going to summarize, is one new problem. Dr. Bennett all was not there before, but everything else is looking like it's really getting better. Looks a pretty happy set of circumstances here. Now, let's just go back when I show you a little bit of detail here, just to refresh your memory. Here's the second year's test. Remember, she got worse. Too much alcohol, carbohydrate metabolism. That's gone now. So her ability to process carbs is better. And in fact, when I asked her, she said, "Yeah, I've been feeling great. You don't crave anything anymore. It's going really well physically." Biochemical, your cravings were all gone. She still has one energy production marker. This got knocked out though. This got knocked out. The brain chemistry, which was her biggest problem, was all clear. And she felt it. Like, bringing on good job, bringing on detox markers. We knocked out one of these, but not the other. Okay? But where I want to show you again is her, the I've been at all on the second year test was down at a 23. Okay? And that's a nice, wonderful number, 23. And this is when she wasn't doing very well.
Now we got the new test back, and again, three markers are positive. Two of them were there before, energy and detox. But a whole bunch of, whole areas have cleared up, especially her most important one, which was in our transmitters. So I'm asking her how you're feeling. I'm thinking, wow, this is going to be like a little bit of a tune-up. She says, "All the way through the year, she was feeling great. Cravings gone, depression gone, anxiety gone, just symptom-free and feeling wonderfully." And whatever maintenance program I had her on was working beautifully. So we're sitting down, we're looking at this test, and I'm thinking, "Things are going pretty well. Lisa's finally doing okay." And then I look at the Dr. Bennett all number, and I'm like, "Wait a minute." Okay? Well, that's not just a little bit of a yeast overgrowth, is it? Remember when it was before? It was 23, and it went up to a 201. That's a big increase.
So she was feeling great physically, the program had worked on a biochemical level. But what happened? A couple months before she did the re, yearly retest, and she had a major confrontation with the new husband. You know, and turns out it's, she's already in a really horrific and bad marriage. And so what she decided to start doing was binging on sugar. She didn't start drinking again, binging on sugar four or five times every day, bag of cookies, another bag of cookies, whatever. She was eating four or five times a day, binging. Thankfully, she didn't start start drinking alcohol again. But the binging on the, on the, on the sugar was, was not so good. And that just alone, just drove her use markers through the roof.
So now we're into year three of doing this maintenance checkup. In year two, we helped her get off of alcohol. In year three, she's in the middle of, you know, an old, a recurrence of an old eating disorder and stuck in a really unhealthy marriage. So in the old Dan model, in the very first year, if I had treated her at the six-month mark, she's feeling better, we just let her go. Would have missed all these other issues. And so one of the things that's really wonderful about this work is that if you find out what your niche is and what your once a year check-in is, and the reason why that person has to come back, and I strongly recommend you make it some kind of a lab test so there's, you know, reason why they want to come back to you and track these things over time, that you can start to develop long-term relationships with all these patients that are coming in, and not just assure them through that initial short-term problem that they have that you can solve in that first year, but to have them be a regular long-term maintenance type patient that you're seeing, you're in a year out. Okay?
And that's really the business model, in a way. And as you can see with someone like Lisa, it offers a really comprehensive service to people as well. So you're not just getting them better and letting them go, but you're, you know, staying in their lives to help them with all the other issues that they may end up struggling with as time goes on. Okay? And I think that's a pretty critical issue for people to think about.
Now, not all my patients sign up for this kind of thing, and I don't maybe push it as hard as I could. But we have enough people doing this on a regular basis that it's really filled up my practice. And so there's much less concern for every one of these yearly maintenance people. There's much less concern for me each year about getting new patients because the schedule fills up more and more and more as years go by with Leases of the world, who we're just going to, you know, basically hopefully do this test once a year for the next couple decades as a maintenance kind of follow-up type thing.
So now, from a business model perspective, the reason why this is so profitable, if you just think about the numbers for a second. Let's say someone like her, she, let's say that she's on some maintenance version of a little 5-HTP, tyrosine, some probiotics, and some like female hormone supporters, maybe herb. Or let's say she's on three or four things like that. I mean, she could easily be spending, I don't know, this given a nice easy number, let's say, yeah, probably $180 a month. How about that? On her supplements, right? And then once a year, she has to drop $300 on the lab. So if you do the math on that, it's $180 times 12. All right? Yeah, $180 times 12. Well, actually, let's make it a rounder number. Let's make it lower so it's easier because this is realistic. People spend $150 a month, no problem. So let's say it's $150 a month for her program. $150 times 12, that's, oh, see that makes the math better, doesn't it? That's $1,800 a year plus the tests plus a consult. So let's say a 30-minute consult once a year, that's another $200 in my, have clinic. So she's spending roughly $2,000 a year with us.
Imagine that you had, you know, 50 patients, right? That were these long-term maintenance patients, which is a pretty realistic number of people. They get, that's $100,000 a year of income right there. Okay? Just with 50 people. 50, that's not a huge number. I mean, that means you're getting, you know, give yourself two years to build up this, you know, to build up to this. That's two patients a month that are you're moving to a maintenance program. Okay? So two patients a month. Should I keep the numbers easy here? Two patients a month, two years, you're gonna end up with about 50 people, and that's $100 grand in additional income.
Now, the beauty of it, and why this is such a wonderful thing, why I don't have to work so hard, is how much time are you actually spending, right? You're only spending 30 minutes per patient plus whatever you have to do to answer their emails and stuff. Here they are, right? So if you have 50 people doing it, that looks like it's about 25 hours a year of your paid time to generate $100,000 in sales. And that's where the real sweet spot in our business is. When you're working with a chronically ill patient population, you may be selling them $500 to $1,000 a month worth of supplements, but the amount of time that you're going to spend dealing with their case is going to be huge. And if you guys could each just get 50 long-term maintenance people in the next couple years, you have $100 grand in passive income coming in.
And I actually really enjoy this too. Like, I like talking to people. At least I like figuring out, binging on sugar four or five times every day, Lisa, this is not good. We've got to get you to a marriage counselor and figure this out. I might like being involved in people's lives in this way. It's really pleasant kind of relationship to have. And you get to know people really well as the years go by, and they have children, and their parents die, and things happen. You know, you're just a fixture in their life, just like my dentist is. You know, she knows everything about me. I've seen, I've been going to the same dental office since I was five years old. And that's kind of a wonderful clinical model and a really wonderful business model as well.
Now, obviously, if you can get up to a larger number of people, like let's say you have 200 patients. Let's say it's the end of your career, and you've attracted 200 maintenance patients over all that time. I just can't seem to spell maintenance, no matter what I try to do. How about we just call them wellness patients? So they can't spell maintenance. 200 wellness patients. What's the math on that? That's $400,000 a year. And you know, and that's going to take you 100 hours a year of work. I mean, you can retire on that, right? 100 hours a year of work. You work in like a couple hours a week, basically. You're seeing your old school maintenance patients, maybe to work one day a week, still generating a couple hundred grand in income. And you know, that's something you could live on. You don't have to worry about, you know, what's going to happen when you retire if you build up this kind of a practice. And I fully intend to do this when I retire. I'm just going to probably go to one day a week of patients and just, you know, get rid of everyone else and just keep the maintenance people. And I'll have a really comfortable income, work a day a week, you know. And that's where this business model can go if you start to develop the relationships with people.
It's really different. This is a different model than the way I was taught, which was a chronic illness model only. Only working with the most chronically ill patients year after year, just getting new chronically ill patients. Just to me, personally, that was too much in terms of, uh, too much work and, and too much stress. I really couldn't handle it. I kind of cracked and burned out because I was trying to be perfect and help everybody so much, which is way too much of a perfectionist to handle a chronic illness model. And most of those patients need a lot more care than I could figure out how to offer anyways. So I wasn't really offering them the best services. And I, and I understood that, you know. But the Leases of the world, totally comfortable with. They need people like you and me. And it's a really great way to stretch for all this.
So what I would say is, as you guys looking at your businesses, try to determine, is look at your current income based on the number of new patients coming in and your patient life cycle, how all that plays out, right? And then look at what would be the wellness program or potential residual income that you could generate depending on. I mean, I'm just making up the numbers that are pretty close to what my practice does. Maybe you only want to sell people $100 a month for maintenance products. So it's going to be a little bit less overall money, but you'll get more people into your group. Maybe you'll do an adrenal lab once a year and set in more organics test or do have some other kind of, you know, lab for their yearly check-in. But that's really where you should be thinking.
And the, the crossover, I think that you should know is when your current income no longer exceeds your wellness program income, then you know you've got it made. So in other words, when the wellness program income starts to generate more cash each month than your current income of working with new patients and putting them through all these therapeutic programs, then you know you've made a shift so that you're more heavily reliant in terms of servicing the ongoing patients that are the ones who year people. And then the new patients become less critical. Less. And of course, then you don't have to stress out about it as much because you've got the bulk of your income coming from these once a year wellness people. And you may mix it up. Some of you may want to do it twice a year visit, whatever it is. But I find a year here goes by fast, you know. Doing an organic acids test once a year, it's a really great model for keeping people engaged. And I'm telling you, it's, it's worked really well for me. And think about this, you know, and think about how it would translate into to whatever you might do in your own practices. All right.
Let me see. Any comments on that? Any questions? Leftover patient-wise, you guys good for the week? Okay. And let me know. Phoebe asked for more experts on diabetes and metabolic syndrome. If there are other questions that you guys want or other experts you want to get more involved, I'm going to bring in the plant-based people as well. And we'll also have our business track going in the background as well. Each week, we'll be bringing in some people like that. But let me know if there's something else that we're missing. We'll try to fill in the gaps to fill out the rest of the year. Okay? Take care, everyone. Have a great rest of your week. I know.