Transcription
Hello everybody, and welcome to our Winter Mentorship Mini-Series, "Building a Successful Functional Medicine Practice." Hey, I am Dr. Dan Kalish, and for those of you that are brand new to this, um, I am celebrating my 30th year in functional medicine this year. I started off in 1992 seeing patients. And, um, my favorite experience of the last year or two is I walked into this room. It was at the Cassie conference. I go to the Cassie conference every year. If you don't go to the Cassie conference, you should go. C-A-S-I, Cassie conference. It's put on by Design Squirrel.
So I walked into the room because it's the Scientific Advisory Board I'm on. And I walked in the room for dinner, and there's some really heavy hitters here, like Dr. Diadama was there. I mean, there are some big-time important people in this room. Um, I'd like a small fry. And I looked around the room, I was like, "Gosh, I know all these people." You know, and I know I'm like, "These are my people. These are my tribe. We've all been at this for at least 30 years." You know, and how cool is that that this functional medicine thing that we all just imagined when we were young people in our 20s and 30s is now like a real thing, and it's super, super exciting.
And one of the things that I've seen since transitioning in functional medicine over all these years is, um, the growth of functional medicine as a business. And so I, in a very specific place where I am, my business model, what I do for a living is help people start functional medicine practices and make it really profitable, and train doctors on how to interpret labs and how to make the business model work. But I'm involved with advisory boards for a variety of different companies. I work with all the different lab companies, many of the top supplement companies, really closely. I've worked with IFM really closely for many years. I've been to all the IFM events over and over again and spoken at all of them. And so I, I get to see the industry from a lot of different angles.
And what my, I'm even more reinforced and more dedicated to you guys, to the those practitioners out there now than ever. And the industry is growing up around us. The supplement companies are experiencing exponential growth. The lab companies have all kinds of money to bring us new lab tests. We're really on an upward curve. And what I want to make sure is that you guys who are practicing can be super successful, have a profitable clinic so you can do this for as long as you want, and that you don't burn out. That's really the whole point.
So we say "successful functional medicine practice." That's defined by me as you're happy, you're healthy, you're helping a lot of people. Okay? And if you burn out as a practitioner, then we lose you, and we're down one. You know, and that's not a good thing. Okay?
So here's me. I founded the Kalish Institute. We do all kinds of classes and things. I've worked with Mayo Clinic. I'm working really closely with Richard Ward right now. Um, I'm, I'm certified. I passed the test. That was an easy thing to do. So we have, for those of you interested in business, we have our Business Essentials Bootcamp coming up in February. This is one of our more popular courses. You get 20% off if you use that code there, MINI23. And we only offer this maybe once or twice a year.
So if you're at a point in your practice where you want to develop it more fully, where you feel like, um, you want to get something new started, or if you're new in practice and you're wondering if you should even start a practice, I think this Business Essentials Bootcamp has been really good for people who are trying to decide, "Do I leave my day job as a chiropractor, medical doctor, acupuncturist? Do I start to transition? How can that work?" You know, how, what are the logistics behind that? So we do financial planning, business planning, marketing, sales, operations. It's a really good course. People like this one a lot. Okay? So if you're interested in business, check that out.
And then we have our, um, year-long mentorship starting now too. So if you're interested in really spending a year learning how to interpret labs and get into the deep end of the pool here, we have four or five hours a week where I'm reviewing labs with doctors. Everyone's submitting all their tests. There's a huge curriculum that I built out on how to interpret labs. And so you just get inundated with this. And by the end of the year, uh, people are really good at interpreting labs. And it's exciting for me to watch that transition. So it's very much an intensive course. But if you want to devote yourself to lab interpretation skills development, it's, I think, one of the better courses out there. You get $1199 off if you use that discount code. I think that's usually our, our biggest discount that we ever give. So if you're interested in starting, it's a good time. And there's a January class, so you guys can jump in if you want.
And then Rupa Health. If you're not using Rupa, you're kind of missing out. Um, pretty much everyone that we work with now uses Rupa Health for ordering labs. And you get $100 off your first order if you haven't used them yet. They have a, basically, you know, connected all the different lab companies under one platform. And it's a super easy platform to use. And you end up, I was probably accessed Rupa like five times today. All the information that we need for our labs is just stored in one place. It's super easy, super inexpensive. And it's probably saved me and my practice $25, $30,000 a year in staff time to use Rupa. So it's kind of a no-brainer, right? You get $100 off if you tell them, whatever you have to do, uh, for just, I don't know how you tell them. There's probably some little thing you gotta say, "Hey, I'm referred by Kayla. I should get $100 off." Okay?
All right. So this, this class, you know, the purpose of this class is really to start to think about what are the common roadblocks and to remove them. You guys are welcome to ask questions. You can type a question into that little box there. And I'm not going to cover all the slides in like a formal lecture. I'm just going to kind of jump around, see what you guys are interested in, what you're asking questions about, and cover most of the slides. But it's not like a super formal lecture. It's a little more of a brainstorming session so you guys can get the information you need. Okay?
But there are some common roadblocks. And the most common roadblock is that functional medicine is just an overwhelming subject area. And that most people don't have a clear clinical model that kind of is blended with a comprehensive business model, and then any legal strategy kind of mixed in there. I didn't put that on the slide because that freaks people out. But if you have a super clear clinical model, you know exactly what labs you're ordering and why, and what you're going to do with every patient, and then you have a good business model that supports that, and then you have legal strategy in place so everything's lawful and above board, you're not getting in trouble in any way, you can rock it, you know, and you can be super, super successful.
Um, we also then are going to get into the common pitfalls, which is like the disorganization and lack of attention to business. You know, that's kind of the primary things that undermine people, um, really. And it doesn't have to be that way. And I think the main takeaway point for today is that as much as we all put so much energy into our patients and helping them, we need to put equal amounts of energy into ourselves and keeping ourselves healthy, fit, educated on top of things so you can last. And then you need to put an equal amount of energy into your practice and the development of the operations and logistics and financial planning and business planning of the practice. And if you can have equal time and energy for all three of these until they're all humming along really well, then you can let the pedal off the gas a little bit in one area, you know. But until you get all three of these working really well, if you don't, you're going to end up with burnout.
And what we see almost all the time, doctors, practitioners burn out around the 10 or 12-year mark because they haven't been taking care of themselves, and because they've been working too many hours, because their practice business model just is crappy, you know, basically.
I'm just laughing because I was thinking about my first practice. It's not making this up. It's a true story, okay? So, um, I won't mention who it was, but it was Glenn. Glenn. It was Glenn's office. Glenn's office. And I was his associate. And they had, this wasn't that long ago, okay? This was 30 years ago. They had a ledger that was like this big, which was huge. It was like several feet long, a paper ledger. This is like paper. And the bookkeeping was done with a pen and pencil in this paper ledger. The entire office ran around this one ledger. And it was so wildly inaccurate. There's no number in there that made any sense. And so they would come to the point where, "Oh, it's time to pay Dan for his 50," you know. And they would look at the ledger, and it's just so, I'm very familiar with dysfunctional practice models and business models. They're just antiquated and horrible. And it's just, you, you want to put as much energy into the business development as you can because it'll just make your whole life so much easier going forward when you figured out.
Okay, then the other place where people call party is they just don't take care of themselves. And it's like a full-time job. I mean, lugging this body around. Like today, I got up at 5:00 in the morning. 4:45. This is not a sign of virtue. This is just like a survival technique, right? I did 10 minutes of stretching. 10 minutes on the rowing machine. That was like my cardio workout. Um, I did weights later. And then I did a 20-minute sauna. And I did about three and a half minutes in my cold plunge, which is 45 degrees, right? Now, I mean, it has a lot of work, right? And then I got my lemon water. And then I started my job job. And so that attention to meditation, to exercise, to detoxification through saunas, through shocking your cardiovascular system with cold therapy, to green juicing, or whatever it is that you do, having that, you know, extreme intention on yourself and the physical conditioning and emotional, spiritual conditioning of yourself is the key to successful practice. Otherwise, people burn out.
Okay, um, when we talked to doctors, and we did this survey a little while ago about what are the biggest challenges, the number one biggest challenge, it's hard to read this small type, was finding new patients. And then patient compliance and retention, online marketing. But if you look at almost all of the top three there, or really centered around the same question, which is getting and retaining patients. So we're going to talk about how you can get and get and retain patients, you know, what are the major ways that you can do that? Okay?
And then on the clinical challenges side, managing complex patients, you know, that's the number one thing. And so as much as possible, we want practices that are mixed. So you're not in a situation where 100% of your patients are incredibly complex, because that's going to lead to burnout, the cynicism, exhaustion, the doubt, the wondering why you're doing this. Large amounts of practitioners, majority of practitioners end up burning out. Okay? And that's not what we want. We want you to figure out what you're the best at, what drives your economic engine, and you can make money from, but more importantly, what you're really passionate about. Okay?
Typically, burnout hits around year 10 to 12. So we see those first five years, nobody really burns out in their first five years because you're just go, go, going so hard, right? Then you hit year five or so, and you're starting to build, build, things are getting better. But then somewhere around year 10, 11, 12, if you don't take care of yourself, you're going to be physically, emotionally, and spiritually exhausted, and things are going to fall apart. So we're trying to make it so that you can build, grow, and transition without the falling apart part.
Okay, um, and so, and then when we look at, okay, what makes a super successful practice? And that's one way to figure this out, right? Which is to see what's working for people, okay? And, um, what's not, you know? And, um, well, and I studied this, you know, because I've talked to like hundreds of doctors a year, what's working, what's not working. Um, I've had so many practitioners that I've worked with that have just burst into tears and just broken down once during our conversations because people are on the edge. Things are not going okay for a lot of us, you know? And a lot of this is going to center around, you know, business, the structure of the business. So we wanted them, for those of us that are struggling a little bit or wanting to make our practices better, you just want to look to the people that are super successful, where it's working really well. Okay? And there's a very predictable model that works really well. And I'm going to try to go through a few slides on that right now so you guys can get a sense of what are the things that you may be able to shift with.
Okay? So one is having a focused approach, but having a target market that's clear. For me, it's always been what I call the big five: which is fat, fatigued, depressed, female hormones, and GI problems. For most of my practice life, that's what I've been focused on. Fat, fatigue, depressed, female hormones, and GI problems. Patients that are struggling with those issues, I find that functional medicine works really well for that crowd. And there's a lot of people with those problems, you know, and they're really, I would say, easy to fix, but pretty straightforward to fix. It, we're not talking about mold, Lyme disease, you know, chronic Lyme with a neuropsychiatric overlay, chronic fatigue, and, I don't know, you know, dementia. Okay? I get patients with all those problems, but my focus is on fat, fatigue, depressed, female hormones, and GI issues. And so that, a certain percentage of my practice, maybe 30% or more, are very complex people that are way beyond the big five. But that the bulk of the patients that I work with are in this target market. And so I can have a sustainable business model because the bulk of my patients, maybe 60, 70% of them, are easy. They're going to get better in a year. And that 30% that are chronically ill or have neuropsychiatric Lyme disease or whatever kind of complex mold thing is going on or memory loss thing is going on, that group, that's really much more challenging, is I'm able to work with them without burning out because I have a structure to what I'm doing. And I only market to, um, the group that I want to work with. And then all these other people end up finding you anyways, right? So you don't have to go out looking for, you know, Parkinson's patients. They're going to find you if they find out that you're good at working with neurodegenerative problems.
Okay? Um, you want to have a reproducible model. And so for a lot of practitioners, if you've been in practice for a while, we see like that webpage, the homepage on the website, and it's like, "What do I do?" And there's like 37 different things that they list out, you know? And it's just like hard for patients to figure out what's happening, you know? And it's hard for you to scale that and to reproduce that if you're all over the map. So when I was coaching one of the IFM faculty a while ago, we looked at her, um, apothecary, you know, and she had a couple hundred different supplements that she was selling. She had like five or six different forms of CoQ10. And I was like, "Mary," that's not her real name, it's like, "Mary, hey, you know, we just got to scale this back, you know? Can you drop it down to maybe 75 or 80 products?" She was like, "Sure, I could do that." And so, you know, things are just flying out the door and getting rid of all kinds of stuff. So streamlining and making yourself more efficient. If you've been in practice for a long time, and if you're getting started now, or you're thinking about getting started in a functional medicine practice, do you want to start building your model first before you actually start your practice?
And if you think about, if you're opening a restaurant, you wouldn't open a restaurant and just have on the sign, "Just says restaurant," and then people come in and you say, "Oh, what do you want to eat?" And, you know, then somebody wants sushi, somebody wants a burger, somebody wants a burrito, somebody says, "Oh, I want French onion soup." And you'll be like, "Oh, okay, let me run out and get all that stuff and figure that out." No. When you open a restaurant, it says like, "Burritos," and then people know when they walk in that they can get burritos. And you've defined what you're doing, right? You have a model, you have a structure there, everybody knows what's happening. And if you're in a burrito shop and someone walks in and asks for sushi, you can immediately just think, "Well, no, we don't do that here." Okay? And so you don't have to offer everything to everybody. And in fact, you can't really offer everything to everybody. That's one of the bigger problems. Okay?
So you want a reproducible, clear clinical model. And then the bulk of your referrals, almost all of your business, should come from patients of yours. They call that "mining the install base," right? So current patients of yours should be generating the bulk of your business. If that's not happening, there's something wrong with your practice internally that you need to fix, okay? If that's not happening. So that goes back to these slides here when we, you know, questioned everybody, "What are your biggest problems?" Finding new patients, patient compliance and retention, understanding online marketing. Well, that's all the same problem because if you're getting and holding on to the bulk of your new patients, you don't need a lot of new patients because the old people are coming back and staying with you. If you improve your compliance and retention and people are staying on programs and doing programs and staying engaged, you don't need a ton of new people all the time. If your main problem is finding new people, really, the problem is probably more around retention and being able to keep people engaged with your practice. So we want to think about that, okay? And we can focus on that tonight, just a little bit, right?
Um, so I have these five pillars. We can skip around a little bit, um, because we probably don't have time to cover all of these, but I want you to be able to see them. So defining your niche. You talked about that a little bit. My niche was the big five: fat, fatigue, depressed, female hormones, and GI problems. Um, my favorite niche of all time was this guy in New York. This is my favorite niche of all time. I'm not saying you should do this, but it was a really good idea. And so we were at some kind of conference, just a long time ago, it's like 15 or 20 years ago, where somehow people are talking about their practices. And so, "So what do you do?" He says, "Oh, I work with new brides." I'm like, "New brides?" Like, "Yeah, it's like women that want to get married or getting married." His whole practice, he was in New York City. This whole practice in New York City was working with women who are about to get married. Um, he's like, "I'm like, that to me, it seems a little strange." I must have had a funny look on my face. He's like, "Yeah, they're completely motivated. They do everything that I ask them to. They want their skin to look great. They want their weight to be really great. They want to fit in the dress. They want to be energetic. They want to have their sex drive be really great. It's just a wonderful group of people to work with." So I find women who are getting, you know, married in the next year. And they were for other women who are getting married in the next year. And that's my entire practice. Um, that's a strange niche, but wow, how creative is that? I've had other people that work only with professional golfers. We have a doctor that did the mentorship a while back who only works with professional tennis players. We have people that only work with kids, only work with older adults, only work with dementia cases, only work with Hashimoto's. Another one of my favorites is we have one of my graduates that only does H. pylori. Who would have thought? You know, it's all he does. His whole practice is just H. pylori. He's not even just a gut guy. He's just a gut guy who only does H. pylori. Has a huge business all around just H. pylori. So your niche could be all of humanity, or your niche could be, you know, professional golfers. It really almost doesn't matter. It's whatever makes you really excited. One of my favorite new graduates from the mentorship, her niche is diabetes, and she does vegan diets. She's very strict vegan, and all her patients have to become vegan. And she works with diabetics who are willing to and excited about going on a vegan diet to reverse their diabetes. There are all kinds of different ways that you can do this, okay? But you don't have to do everything. In fact, it's a good idea to not try to do everything.
And here's my big five, you know, fat, fatigue, depressed, female hormones, and GI. The most common errors that we see, and this is if you're getting started, you have to be careful about this because you're going to, almost everybody does this. You need to avoid number one. You need to avoid, um, just working with really hard patients in the very beginning, okay? And you need to avoid just letting people randomly come to you. So when you set up your website, and you set up your marketing, you set up your messaging, you want to be really clear about the type of people that you want to work with, rather than just letting people show up and having, you know, fate dictate what you end up doing. Okay? And having it, the niche that you pick, and even if it's a broad niche, like, uh, pediatrics, or broad niche like, um, men's health, you know, even if it's a broad niche like that, just making sure that it's something that you really enjoy and that you can imagine doing every day for a really long time, right? And the thing that's nice about this is that when people get good at this stuff, then, you know, if you're doing men's health, then you get really good at men's health. If you're working with pregnant women, you know, and new women that have just had babies, you get really good at that. There's something nice about a niche that you really build up your expertise quite quickly. Um, once you've got your niche, you know, you can start to think, "I've chosen it right." You can start to think about how you're going to actually promote yourself. Well, my first niche, my first few years of practice was all around female hormones. And so all the lectures that I did, we didn't have websites back then, but, you know, all the public speaking that I did, and all the marketing that I did, was all oriented around female hormones. And that worked for me for quite a few years. It was very successful.
Uh, second pillar is forecasting financial success. And so this one is probably the most emotionally charged. Um, but we have a financial planning worksheet that we use. And this has been, uh, both a blessing and a curse on people that take the classes that we do. And, because it forces you to just deal with reality. And I'll just show you a version of it here. Let's see, I can pull it up. Uh, here we go. So it's our financial planning worksheet. So first of all, on the first page, it has this monthly forecast that's your income that's going to be coming in. And it takes all those numbers and it pushes them over to the second page where you can also include all your expenses. So you can end up seeing what your net profit's going to be, okay? What's your net profit margin? All right? And so as much as this is a, I kind of a mostly charged topic, this document probably has solved more practice problems than anything else that I've ever used in all the different classes that I've taught. Because when people look at the numbers, they get a reality check about whether what they want to do is realistic or not, you know, to pull off, whether they can really make it work or not. And oftentimes, doing a business plan, you know, financial plan like I just showed you, is way more effective way to figure out if something's going to work than just trying it and then seeing that it's not working and then losing a lot of money and then being, you know, kind of in a bad place because of it. So that's pretty important. All right? And, um, we want to make sure that as much as possible, you do the planning stuff first.
So let me just show you this in a little bit more detail. And if you don't have a financial plan like this, then you're seriously in trouble. You need to just rethink things, okay? So here you can see, um, new patient functions and consults, how many, how many labs you're going to sell, how many supplements you're selling, follow-up consults, right? So you can populate all these numbers here. And then on the expense sheet, you type in all your different expenses. Oops, sorry. So you figure out how much everything's costing you, right? And then it calculates for you what your actual profit is. And it's very lighting to start to see, "Well, wait a minute, my payroll tax and employee benefits and salaries and wages are adding up to be 32% of my income." You know, and really starting to crunch the numbers so you can see how, um, financially viable what you want to do is. And if you run through financial planning worksheets like that five or ten times, you will have a very good idea of whether what you're doing is a good idea or not, you know? And you can basically sort through things on paper so you don't end up making this critical error, error, you know, um, which I've seen so many times. We just don't want people to do that, okay? You want to use it to avoid that as much as possible. All right?
So, and in fact, I can upload that into the thing here so you guys can have a copy of that. We spent a long time developing it. There's a, here, drag and drop the file. Let me drag and drop that here. And then you can go download it right now, okay? Let me just put it in the little thing here. Hang on one second. Before you guys, I wasn't planning on doing this, but what the heck, you guys can have this. Uh, hang on one second. Let me get that figured out. I'll do it at the end, okay? You guys can download it. Take me a second. Okay.
So then again, back to the original thing I was talking about is that one of the most important things is to have a clear business model that is incorporating a clinical model. If you can have these two things together, you've got it made. And this is a system that I've been using, and I've been teaching this system since 2006, quite successfully. So I've been using this system for about 20 years or more, and teaching it for, what's that, uh, 16 years. Hundreds of doctors have used this, and it's not just me that it works for, okay? This can be really effective. So if you don't like this system or you want to take this idea and modify it, please do. But, you know, having this kind of a structure, some kind of structure makes a big difference.
So start off, or the way that I think about it is we have a model for how a clinical model for how people get sick. Simply put, it's due to stress. And stress hormones get a cola means you know, transmitter-related problems, the whole neuroendocrine system getting screwed up. That has negative impact on our immune response, that damages the gut, we get leaky gut, GI pathogens start to flare up, and then eventually we start to get toxic. So this is my model for how people get sick. And then at the same time, it's the same model for how we want to work with people. So we test and correct the stress hormones, neurotransmitters, mitochondria. We test and correct the gut, and we test and correct the detox system in order to pull people out of this downward cycle. So the clinical model, this is how people get sick, is the business model. And there's a lab test for hormones, one for the gut, and organic acids to cover the detox systems and whatnot, right? And so the clinical model and business model are wrapped together in one little package. And that really helps patients understand what's happening. It helps your staff understand what's happening. So there's not like this completely different thing every patient, every day, which can get super messy. Let's say, okay?
Um, the biggest mistake that we see besides burnout, and I guess it leads to burnout, is the high overhead business. So, and I've seen so many of these, and I've been involved myself with creating two or three of these. When I had my first really successful practice, we were bringing in over a million dollars a year. And I thought, "Wow, I've got it made." But at the end of that year, I only made like, I don't know, it's like $80 or $90,000. I don't know. I calculated by hours, you know, I think I was making like $28 an hour or something like that, because I was working non-stop. We were bringing in a million dollars, but I had a huge 3,000 square foot clinic in Del Mar, California, which is really expensive, right? We had a gym in the back. I bought all this gym equipment. We had, um, a psychiatrist, we had therapists, we had a guy doing brainwave mapping, we had nutritionists, I had my exercise people doing the gym thing. We had a huge front office with all this staff running around. I was like, five or six staff, okay? We brought in a million dollars, but it cost like $900,000 to run the thing. And so I just walked right into that, you know? And we helped a lot of people, and it was really cool to have this interdisciplinary clinic that I was in charge of. I mean, it was actually a lot of fun. I enjoyed it a lot. But, I really wasn't making much money, and I didn't see a way out, you know, because I was stuck with this high overhead. And just be careful around that, you know? Um, sometimes you can build your dream clinic, but it's not going to really sustain you in the long term in terms of, you know, finances. So you want to keep your overhead low. You want your margins to be between 40 and 60%. And, you know, I was at a conference a few years ago, and I did this over and over again for a couple years. Is I would ask everybody, I can't see you guys unfortunately because we're on an online thing, but I would ask everybody, "Okay, you know, who's got their margins between 40 and 60?" And like two people in the back would put their hands up. And then I would say, "Okay, who even knows what a margin is?" And if you get a room of physicians together, the vast majority of them are like, "I'm not really even sure what margin is." So if you're in that category, as I was, you know, you don't even know what your margins are, let alone what the term means, then you can go back to our financial planning document here, and you really need this, okay? Because this will show you what your margins are. Let me show you the document again. Go back to your financial planning document here, okay? And you fill out the first part, which is your income. Then go to the second page and do all your expenses. And then it'll calculate for you down at the bottom, uh, your total operating expenses and your net profit or net profit margin, okay? And you should have, so if you have a 40 margin, that's, you know, somewhere between 40 and 60 percent you want. You want as much as possible. You want to keep your expenses as low as possible, right? Um, and it's surprising what small numbers can do in terms of really destroying your profit margin. And if your margin is not good, then you end up in trouble over time because you're going to have to work so many hours to try to make up for the fact that your business model is not working really well.
So one of the ways that we've saved money, the most money, probably that I've been able to save, because when you look at my expenses, it's almost all staff. And that's been true for every clinic I've ever run. The vast majority, you know, 70, 80, 90% of the expenses staffed, depending on the rent, you know, rent is probably second. But the more that you can use, uh, technology, online scheduling, of course, we use Fullscript to do all our supplements. So we don't, I don't stock and sell my own supplements like I used to. We use Rupa to distribute all the labs. If I look at online scheduling, Rupa, and Fullscript, those three things together have probably saved at least $60 to $80,000 in staff expense. And I know because 30 years ago, we didn't have online scheduling. I had to pay somebody to schedule by hand, right? And call people by, you know, with by phone. It was all, none of it was automated. We didn't have Fullscript, so we would stock and sell all our own supplements. And we didn't have Rupa, so we would stock and sell all our own lab kits. And the amount of follow-up that you have to do for selling supplements and selling labs, it just takes a huge amount of staff time. And that's going to be your major expense. So the more that you can leverage things like Rupa and Fullscript and online scheduling, the more you can drop your overhead, the more efficient you can be. That's really what makes the business work. Okay?
And in the years when I had, you know, five or six staff people running around doing all that for me, distributing the labs instead of Rupa, selling the supplements instead of Fullscript, doing them scheduling manually instead of an online scheduler, you know, it's just a nightmare. We even have our online schedule now set up so that when the patient schedules, it takes their credit card. So we don't even have to collect money anymore for consultations. They sign up for a 30-minute consult, enter your credit card here, credit card gets billed. We never get that information. So we don't store credit card information at all. We're not in trouble. We can't get into trouble by having some, somebody hack into your system. Just done all online. We get the money. The credit card thing is all encrypted and it's done. So we don't, I have zero collections, right? Because people pay when they schedule. Super, super simple.
All right. And then I always like to talk about patient communication skills because that, I think, is really the main driver of all these businesses. And if the better you are at patient communication skills, the better you're going to get with patient compliance, and the longer people are going to stick with you, and the more they're going to be likely to refer. And so we also had a breakthrough a long time ago when we started to sell more complete programs. So for many years, I would just sell people like a month's supply, like a bottle of each thing that they needed. And then we started a, um, in standard program with my staff back in San Diego on those days, it's like 20, 25 years ago. And I gave them a bonus every time they sold some supplements. And so pretty quickly, they figured out that if I was designing a six-month adrenal program, that they would make more in their commissions if they would just save the patient, "Dr. Kalish wants you to do a six-month, you know, adrenal program. Would you like either a three or six-month supply?" And people go, "Oh, well, I don't know. I'll take three months for it, thanks." So we literally tripled our supplement sales overnight. We have been selling like $6,000 to $8,000 a month worth of stuff. And then when they implemented this, "sell complete programs" idea, we started selling $20-ish, $20,000 a month range, you know? And then the, what I saw from that was, I didn't really care about the money, to be honest. They don't really care about making money at all. But what I saw from that was that people were more compliant. Because patients would come back, I'd be, "How you doing?" And say, "I'm doing pretty well." You know? And then, "Yeah, at the month five of my six-month program, I'm about to run out of stuff." And what I realized was that when people bought complete programs for three months or six months or whatever, they stayed on them. It solved my compliance problems. It wasn't even intentional or anything brilliant on my part. It was just sort of a coincidental side effect of my staff wanting to make more from commissions. And other guys, "Wow." So now we only sell programs. I'm like, "How long is this parasite program for?" "It's for two months." And you, there's no point in buying a month's worth of a two-month parasite program, right? So everybody just buys things in a programmatic way, as a complete program, rather than getting a bottle of two of things and then getting everything else from Amazon, right? That's the last thing you want is people buying things off Amazon. So the more that you can educate people, the more that you can get involved in offering better quality service, in this case, the service of not having them run out of supplements to get a complete program, the better your compliance can be.
Okay? Now, I was never very good at patient communication when I first came into practice. The first doctor that was training me sent me to communication workshops. And I had to do these for quite some time. He made me do it, basically kind of insisted that I do it. And then I started to get better at it by watching Glenn deliver the information to patients and by doing these communication workshops. I really started to get better at it. Probably took me two or three years, but eventually I started to understand, you know, how to communicate better with people, especially people who are in pain or not doing very well. And so just a couple things that are kind of obvious, but I'll mention. You know, the first step with every new patient is developing rapport. And if you missed that step, then they're not going to come back, you know? They're not going to be a long-term patient. And so however you do that on an energetic, emotional, spiritual level, uh, you know, it just has to be this connection that the person has, and they really trust you. Um, I like to use what I call this condition description technique, which is always describing what I want them to do in the words of their condition. So if I want them to do an adrenal lab and a GI test, and if they're overweight, the reasons why I want them to do that all have to do with fat burning. If they're tired all the time, the reasons why I want them to do that all have to do with the energetics of the adrenal glands and how cortisol and DHEA relate to our sense of energy and mood. And the more that you can get in the patient's head and understand where they're coming from, the more easy it is to explain these things. And those, that's really where you get your compliance. So that, I don't have a generic description for why I want you to do an organic acids test. It's going to vary depending on what's going on with that person. And that served me really, really well. What I used to just describe the features and benefits of the test in a generic way, it's just not compelling enough for people to really want to do it.
Um, okay. And then this is what I want to dwell on for a few minutes, and then I'll stop and we can do questions. Okay? Uh, okay, so we do, yeah, let me just do a couple minutes on the follow-up, and then I'll catch all the questions. So keep typing in your questions. I'll leave plenty of time for that, okay? Um, follow-up, because this is where I see one of the biggest problems. And this is something you can work on right away on your own. You don't have to pay an expert to do this. So you want to learn where patient follow-up and patient sales are declining. What step is that happening in? And then create a system for catching these predictable dropout points and reversing the trend. And it doesn't have to be more complicated than a, than an Excel spreadsheet, a little worksheet. Let me show you here. So when we did this in my practice, I've done this several times. I've done this probably at least three or four times. We create a patient process flow. This is every step that a new patient goes through from the first day that they contact us to the point where they're on a long-term maintenance program, okay? So the first step is obviously that they inquire via email, phone call, whatever it is. So then you have to have this scripted. You have to have your staff scripted. So when they, someone calls on the phone and says, "What does Dr. Kalish do?" That they have a script. If they're, you know, not memorizing, reading from, but they have a script. You train them in. They use their own words, but they have to follow the script. So the, the patient gets a very clear description of what you do, why you do it, how you do it, what's your clinical model, right? That's where the model comes in. Very easy for my staff to say, "Oh, well, you know, Dr. Kalish is amazing guy, you know, and he's, uh, um, that was a joke. And he, he works with his model that he's created where he does these three body systems. So he's systems-oriented. And he tests and corrects adrenal and GI, uh, problems. And he does his organic acids test, which is really quite complex. And he's, you know, an expert at lab interpretation. Doesn't treat, you know, specific symptoms or diseases at all. Um, and he's really into lifestyle coaching, you know, something like that." So you have a really clear description of what you do that you convey. So that, that this goes well. Okay? And if people are inquiring at a great rate but not becoming new patients, you know, you got to work on this. And then the new patient consult. Same thing. If they're coming in as a new patient, but they're not buying labs, then you need to go back and look at your scripting, what you're saying during the new patient consult, so you can describe to the person more, uh, directly and more with more, in a more compelling way, why they should purchase the labs. Now, if they're buying the labs, but they're not coming back for their lab review consult, then you have to figure out a series of emails or phone calls they're going to capture them there. If they're doing the lab reviews, but they never buy their supplements again, you can see how this is going, right? So you have a bucket for each one of these. And if the bucket's leaky, you got to fix that one. To the point where they're buying programs, they're doing follow-up consults, they're reordering their supplements, they're doing another follow-up consult, they're redoing their lab tests, and eventually they're put on a long-term maintenance program. So you want to sketch out this entire process for your particular clinic. And then you have a spreadsheet. And when we did this, we did, it's been a very low-tech way. I'm sure you could buy some customer management system and do this in a complicated way. All we did was have an Excel spreadsheet that we looked at every day. And we used our email program to do the.
Follow-up. So the spreadsheet would have these 10 buckets, right? Inquired, did new patient consult, bot Labs, did the lab review, bought supplements, like that, right? These things just listed out. And then we have names in each column. And here are the people that did this. Here are the people that inquired. And then here are the people that did the new patient consult. So we could see, oh, well, there's all these people that inquired but they never did a new patient consult. Maybe we should follow up with them. And then all listed people who did the new patient consult but never bought their Labs. So we... well, right.
And if you do this for a while and you contact all the new patients who came in, this new patient, but never bought Labs, you say, "Hey, this is Dr. Kelly's office. We just noticed that you did your consult but you never bought your Labs. Can we help you? Any glitches? Any problems that we can help with?" You'll figure out what is going wrong and be able to fix it. So if you can get a very well-defined new patient process flow, all the way from when they first inquire to when they're on a long-term maintenance program, your business will run smoothly. It will eliminate the need for a lot of new patients because that one individual new patient will last and stay around a lot, lot longer. And they will eventually become an ongoing maintenance patient. And you will eventually have a full practice because these people, so many people are sticking around with you. The new patient concern goes away. If you don't have a good patient process flow, you're going to think that you need more patients. That's what I was saying in the very beginning. This is the main problem right here.
If you can fix this, it's like, and from a doctor's perspective, you end up offering a much better service. I mean, it's much better to actually keep people in your life and keep people healthy than it is to fix them and then they go away and they get screwed up again in some way, right? So this is better practitioner care. This is better doctoring. This is being a better practitioner as well as a better business model. It's not really about making money, it's about how you're going to take care of people in a more comprehensive way. And if you have a really good system like this set up, and there's many times when we experience, um, really good systems like this, and then many times when we experience really bad systems. You think about, um, I don't know if you go to like, what's a good example? Like a really nice restaurant, you know? And at my favorite restaurant ever, um, it's New York, Eleven Madison Park. And at that restaurant, you walk in and there's just, they've just thought of everything. For years, they've thought of everything. And you could be sitting down, this happened to me when I was there for dinner years ago, sitting down and I just kind of made a move like I was going to get up. I didn't even stand up, I just was leaning towards the aisle like I was gonna stand up, and someone came up, saw that, came up, grabbed me and said, "The men's room is over here." And I was like, they were mind readers. You know, they just had a system for what happens to people that eat a meal and they knew every move that everyone was going to make. And they always had someone right there to fill your water glass, get you a new bottle of wine, make sure you knew where the bathroom was.
And when we were leaving the restaurant that evening, it was raining really hard. I had to wait for a cab for a while, so I was kind of stuck at the, the front door with the guy that checks you in. And I was saying, "How do you guys do this?" And he said, "Oh, well, look up there at the top of the restaurant." They had a second floor, it was kind of hidden. They had a huge mirror, but it was a one-way mirror, right? And there was actually people up in the mirror thing looking down. And they had a row of servers at the bar, like five or ten servers at the bar, lined up. And the people up in the control room would call down to the bar and they'd say, "Okay, table seven needs a new bottle of wine. Table ten looks like that guy is going to go to the bathroom in a minute." And so people were constantly pumping out under instructions from this hidden group of people. So the service was just flawless. You want your clinic to run like that, where you're anticipating every single little thing that a patient's gonna need and then you're providing it in real time, right when they need it.
If you can get that figured out, when we did this first patient process flow, I went from wanting new patients, I'm not exaggerating, went from wanting new patients to having a two-month waitlist in about two or three months, just by doing this. I didn't change my personality. I didn't get better at interpreting labs. I didn't move and get a nicer location. All we did was change the patient process flow. And I went from being semi-desperate for new patients to having a two-month waitlist. I mean, this really, really works and it works quickly. If you can implement it, it's just a lot of organizing. And it goes back to the beginning here, which is the three P's, right? Which is putting all the energy into your practice at the same level as you do into your patient care. And then making sure that you're taking care of yourself as well.
Okay, so then a quick little thing here before we wrap up. It became late. We have our Business Essentials boot camp. I'll do questions in one minute. Okay, we have our Business Essentials boot camp starting in February. This is one of, pretty much, our most popular classes, to be honest, many '23. If you want to work on your business, financial planning, business planning, strategy, all that kind of stuff. We'll have a bunch of live calls, you can ask questions. It's a really good group of people that take this. It's mostly practitioners that are getting ready to start a practice. And then a few that have been in practice for a long time, but it's most people, mostly people that are their first couple years doing this and really want to get off to a good start. Okay, it's a well-run course. We've been doing this for a bunch of years and kind of have the whole system down for how this works for you. Okay, so it's a great class. Encourage you to take it if you're interested. You get a big discount, 20 off for that code. We have our mentorship, one-year lab interpretation advanced course starting in January. Also, if you just want to start a practice, you want to get the clinical training and the business modeling, this is really what the mentorship is. And I walk you through every week. We have a session together with a group of other doctors reviewing your labs. There's a whole curriculum online where you learn how to interpret the test and then you apply it in real time in the class. Okay. And if you're not using Rupa yet, I've been talking a lot about them. You should check out Rupa. Get $100 off right there.
All right, so now I'm going to grab some questions here. Do you cover Telehealth practices in the Business Essentials boot camp? Yep, absolutely. As a matter of fact, there's a whole section on that. And also something you can ask about in class. Um, I would say probably a third of the people that take that class are doing Telehealth. And it's a little different. The rules are a little different. And there's different legal strategy and legal issues you need to deal with too. Okay. Um, let's see. I want to do the business boot camp. I'm not sure if it's appropriate because I'm a nurse practitioner. No, you can totally do it if you're a nurse practitioner. We've had tons of nurse practitioners do that. Um, so Jennifer, you can contact me if you want. We can chat about that, or you can sign up. We could talk about it in class. It's a little complicated. Maybe you can schedule a one-on-one call for a minute and I can tell you what the, how that would work as a nurse practitioner. Um, oh, maintenance program that I offer patients. That's a really good question from Sheila. So my ultimate goal is to get the patient that wants to get pregnant, or the patient that wants their hair to grow back in, or the patient that wants your toenail fungus to go away, or the patient has fatigue, or whatever it is, to get them well and then to keep them well with a once a year check-in. And so my maintenance program is a once a year check-in and a once a year organic acids test. It gives me so much information. Sometimes we might do a GI panel too, but usually not. Once a year organic acids test, revamping of their diet, their supplement program based on that test. We look at detox pathways, glycolysis, beta oxidation, the whole mitochondrial thing, neurotransmitter issues, oxidative stress, cardiovascular disease prevention, diabetes prevention, cancer prevention, just general wellness, health stuff from organic acids. It gives you a huge amount of information. And once you learn how to interpret that test well, then the yearly consults are great and they go fast. It seems like I have patients that have been doing, I don't know, what we're up to, maybe 10 or 12 yearly checkups. We have 10 or 12 organic acids labs just laid out in front of us and we get to see where they were, where they are now, what their health is, what they need to focus on with your diet and supplements. And so to me, that's the ultimate service. And then from a business model perspective, those people buy supplements every month and, you know, that's one of the things that helps support the practice. Um, so it's where it kind of works out for everybody.
Uh, let's see.
So, uh, so the different kinds of practitioners that we train, um, we train acupuncturists, chiropractors, nurse practitioners, medical doctors, osteopaths. We have a social worker, right now, we have a couple of pharmacists in the training program. I have trained dentists in the past. I don't know if you have any dentists right now. I don't think we do. So there's a wide variety of practitioners that practice functional medicine. And really, on the mentorship calls, we might have five MDs, two chiropractors, three acupuncturists, and a naturopath, all mixing it up in the same call, all talking about their cases. And it's really quite a wonderful experience. And you get the medical doctors chiming in saying, "Oh gosh, that patient was on that medication and that's a little dangerous because of this." And then the chiropractors are always saying, "Well, did you check their neck? You know, maybe they have the pain is coming because they need an adjustment." So it's really wonderful to have these different groups. And when I first started teaching, I thought we would separate it out and have like an MD group and a DC group and a nurse practitioner group. But it turns out that it's actually better to work cooperatively across these different professional lines. But then everyone has the same goal of learning how to interpret functional medicine labs. Um, and I've, it's been, it's a really rewarding group setting. I think most people find it, uh, quite satisfying that way. Okay.
Um, let's see. Paul is saying, "My practice turns 36." Paul is not 36, for practice is 36. Um, yeah. And so for COVID, COVID was, you know, very destructive for a lot of practices, very destructive. And when COVID first hit, we started at the Chaos Institute of Telehealth, telemedicine class. And I did it for free for a while. Some of you may have been in that. We had 1400 people signed up for that free class because I was like, "Oh, this is not good." Like, you know, all these practices are going out of business. Okay, everybody get on the phone, order some lab kits. And we really helped a lot of practitioners survive. And a lot of those people are still with me now and are doing quite well. Um, and so I'm very into Telehealth as a backup option. And granted, Telehealth, telemedicine is a primary option. Um, there's a lot of legal hurdles you got to get around and figure out. So there's some special things you need to do. But it's very doable. And, um, something I definitely strongly encourage, especially if you took a hit from COVID. Okay.
Um, let's see here. Yeah, so I will share the financial spreadsheet. Let me figure out how to do that before the class is over. Okay. We'll give it another minute. I'll do it in a minute. Um, let's see here. Oh, online scheduler. Um, let me show you. I think you can see it. Let me show you here real quick. Um, let me see if I can just pull it up. You should be able to do anything here. We go. Oops. Here's my website. And new patients and schedule. Here we are. It's Acuity is the name of the program. This is kind of what it looks like on the free side, but obviously, this is a phrase that we don't charge people. But when we do the paid consult, then people, um, people, uh, enter their credit card information. So you think about like, I don't collect, I don't have to pay staff to collect anything anymore, you know? So we have, we have, um, here, I'm trying to upload the file. I'm talking here. We have all the labs are paid through Rupa. All the supplements are paid through Fullscript. Um, we have all the consults paid through Acuity. So we don't even have a reason to bill it anymore. And that really nice thing also, kind of the side derivative of that, is that we don't have to worry about, um, holding on to people's credit cards, you know? Because all these programs are just doing that for us. They're processing their credit card and it's hidden from us. We never see it. We get it. So there's no kind of liability, um, in that way, you know, which always kind of made me nervous. I'm trying to upload this document and I can't for some reason. So I will just have you emailed out to you guys, okay? So check your email box for something from us. But the follow-up email, we'll make sure I include that financial spreadsheet. Sorry about that. It's not letting me upload for some reason.
How do you show patients their lab results via Telehealth appointment? Um, so some practitioners like to work with a screen, like a Zoom screen, or GoToWebinar screen, or something so the patient can see it on the screen. In the old days, I used to actually do that and record things and then see, send people a copy of the recording. Now I don't do that anymore. I think it's a good idea though, because so people can have it. What we do now is we, um, you know, the patient gets a copy of their lab automatically, so they have a copy of it in front of them when I'm talking to them. But I don't think it's a bad thing if you can get a HIPAA compliant system to, to do it in that way, you know, where you're recording it. Uh, she's Jennifer, Jennifer, set up a call with me and we can talk about business model stuff. Yeah. And there, there's a bunch of ways. So what's happening in the industry now is there's a really big shift to direct to consumer lab sales. So health coaches can now buy labs as of this year. There's Rupa has a physician authorization program where if you're a health coach, you can have a physician on the Rupa staff authorize the sale of the lab to your customers or clients. And there's other ways that you can order labs directly too, if you're a practitioner who has a difficulty getting the lab testing done. So most of the lab companies have kind of solved that problem in the past year or so. Okay.
Uh, so if you're in the course for the one year, as a business essential, is it worth it? Yeah, so a large percentage of the mentorship students take the business class also. That's been a common combination. They're pretty different and I think they both are kind of synergistic. One of the ideas about IV overhead, about IV therapies or ozone therapies. So I'm really a fundamental functional medicine lab kind of person. So my whole stick is, you know, organic acids, fatty acids, amino acids, adrenal hormones, female hormones, GI microbiome. And I leave the fancy stuff like IVs and peptide depths and that and all the other complicated stuff. I've always stayed away from. Even when we had my interdisciplinary clinic, we had a pretty low-key version of of all these things. And I'm just a firm believer in doing the basics really well. Now, for some practitioners, when they pencil out the numbers, and it just goes back to the financial spreadsheet, which I can't upload, which I'll send you a copy of, if it pencils out well and you go, "Oh, well, if we do IVs, it only takes up this one room and the rent on the room is this amount and you don't have to pay the nurse this amount to monitor it and here's the profit level." So I would suggest for those of you thinking about multiple revenue streams that you make sure that you fill out the financial spreadsheet for the different things, right? So for example, do a monthly forecast just for the IVs with the expenses associated with the IVs. You can see how that pans out. Do a monthly forecast just for your chiropractic visits with the expenses for that. Do a monthly forecast just for your acupuncture. And then see that how that compares to your functional medicine consultations as an acupuncturist, right? So you should look at all these things separately so you can see what your profit margins are for these different areas. And a lot of times practitioners add in new treatments and they're actually losing money for them, right? So you want to be careful to make sure that you're not kind of cannibalizing your own practice in that way.
Okay. Do we have a refresher course? Uh, yeah, so Gerald, contact me and, um, we can talk about that. We have a ton of new things I've built out and also some other things for old mentorship people that want to come back. You can set up a, you just contact my office and they'll give you a, a link to my schedule. We can talk about that. Uh, um, yes, I work very closely with the health coach. And that's been really one of the better things that's happened to my practice. And not to my practice, to me, because she deals with 110% of the hassles that I used to. So that's been just uplifting. Are we offering an organic acids boot camp? We are. As a matter of fact, I, I will show you. We are. And, um, let me find it here because I know, I know we are because I'm working on a curriculum for it. Let me show you. We have a sh here. Oh my gosh, I've been really busy doing curriculum development, you guys. Let's see if it pops up on the website in the other night. Uh, classes. You go to the Chaos Institute website, you go to classes, boot camps. You got Adrenals, Business Boot Camp, Lab Wording Essentials, GI Effects, Long Haul. No, it's not posted yet, apparently. No, it's gonna be right after the GI one. Okay, so it's coming up, um, in the spring. The organic acids boot camp is coming up in the spring. Uh, let's see. Sounds like a charged patient before they come in. How do you handle cancellations? So, can't, cancellations, um, we get, we charge. If you cancel less than 24 hours, you get charged for your appointment. You know,
thinking about the lab essentials mentorship, but what you need to do the business boot camp too. I would say half the people that do the mentorship do the business boot camp. Sometimes they do the business boot camp first and then I go, "Oh, I like this mentorship thing, I'm going to sign up for it." Sometimes they do it the opposite way. They're in their mentorship, they're like, "Oh, I really want to work on my business," and they sign up for the business boot camp. Some people do them both together on the same day. They're like, "I'm all in. I'm gonna do this business class, I'm gonna do this mentorship class. I want to start a practice." Um, so if you have questions about that, just feel free to contact the office and you can set up a call time with me. I can tell you more details about that. Okay. Um, but you don't have to. They're independent. They're created independently. And many people just do one and not both.
Uh, let's see. I'm gonna see if there's any more questions here. I think I covered them all. Uh, let's see. The way over. Oh, over time. One last question. How do you charge for lab interpretation? I tried just my regular hourly fee for lab interpretation, which is really high. So it's a little more than most people probably want to charge. But most practitioners, I would say these days, are charging around $400 to $500 an hour. And you would charge the same amount for time when you're speaking to a patient as you would for time not speaking to the patient. I don't know if you've been doing your taxes lately, but I have because it's January. There's all kinds of tax planning. And my CPA, who I love dearly, I'm not against my CPA, he's a wonderful human being and we laugh and cry together all the time, every year he's gotten me through a lot. But when I talked to David and I say, "Okay, well, you know, here's my, you know, financial planning stuff for next year, what's my estimated tax is going to be?" I get a bill for our time talking together. And that's a lot because he charges a lot because it's really good. And then I get another bill for him figuring out what I need to do when I wasn't talking to him. And that's normal. Everybody does that, right? Every practitioner does that. You may never see the radiologists. They read their x-rays. You get a bill still, even though you didn't talk to your radiologist. So I charge for my time for doing lab interpretation outside of patient hours as much as I, same exact fee structure as we charge for when we're talking to patients. That's really important because you can't really work for free.
Okay. Viking, I'm gonna wrap it up now. Thank you for all the wonderful questions and I look forward to meeting with some of you in these courses coming up. Okay, bye for now.