Noah: Welcome to DC2Be Revolution. Helping chiropractic students think big in order to live large. I’m your host Noah Volz. Today I’m here with Dr. Bobby Maybee. He has been practicing for 12 years and is currently in Portland, Oregon and in addition to that he is using his own experiences and those of chiropractors and students to write a “Survival Guide” for chiropractic students and young grads. Thanks for being here.
Dr. Maybee: Absolutely, as a precursor to the show I want to make sure that everyone understands that I am not a guru. I'm not here to sell anything. I’m just a clinician who has experiences that I would like to share.
Noah: Thanks, so what is the survival guide that you’re creating for chiropractors and why do you feel like it’s something that’s needed in the chiropractic profession?
Dr. Maybee: I think what your viewers and other students are starting to realize is what you are taught in school and what you actually need to be a successful chiropractor are usually two different things. There are a lot of people that are sharks in the water just waiting for you to fall in. Most students are pretty lost in their first couple years and so these individuals circle around trying to sell you something.
The first two years are very important and there is a lot of bullshit out there. So, what I do is collect questions and concerns and some of my own experiences and other people’s experiences into a survival guide. Reminding young doctors to watch out if you see this situation or that situation. For instance getting into associate contracts versus independent contractor contracts. What are the pitfalls with the two? How do employers blend the two together? Which is usually to your detriment, and how to protect yourself legally. I also talk about the right kind of mindset to have. That it’s not always what you know; it's not the widget, or the technique, or the delivery system, or the philosophy that will get it done.
You have to do the work, you got to work hard. Nothing in this profession is given to you. Everyone whose got anything, whether you like what they got or not, they worked hard for it. Young docs have to respect that. As a more seasoned chiropractor who's seen younger chiropractors come into practices either to observe or to be a new employee they come in and look around and say to themselves “I can do this too.”
When in reality they have no idea what it took to get to a level of opening an office, hiring employees, and developing the networks that get the patients to come in your door. They have a naive assumption that it falls in your lap. It does not work like that and it never will. The book is meant to prepare people for that reality. For the idea that there is a certain amount of sweat equity that you have to invest in the beginning. If you don’t think that; it’s going to be a rude awakening. The book is about shaking people. It’s actually not about survival, because we are not all struggling, some of us, most of us are quite successful. It’s more like “watch your ass” because there are things you got to watch out for and if you're not looking you're going to get hit in the back of the head and it’s going to hurt.
Noah: Perhaps this is naive of me, but I think of it like a video game. There’s going to be these traps, there’s going to be these pitfalls, and there’s going to be these monsters trying to get you. You need a map or a survival guide to help you navigate all of those obstacles and that's really the goal of this show too. To allow seasoned docs to share the information and the knowledge that students need in order to navigate these obstacles. What were your first two years like?
Dr. Maybee: I like your video game analogy. It is good because the people that I’ve seen who are the most successful at running practice think of it as a game. They don't get emotionally tied into the practice. There's a lot of personal pride and ego tied into being successful, but a lot of these people are trying different things and they learn to go around pitfalls after they fail the first time and it's like a game and if you can treat it like that then I think you'll be far ahead compared to other people who really tie a lot of emotional value into what they're doing with their practice.
I was a chiropractic assistant or whatever you want to call it while I was in undergrad. The husband and wife chiropractic team that I worked for pretty much said that I have a job when you get out of chiropractic school with your license.
The whole time I was sitting in the back row of Chiropractic College saying I've got a job and this is cake. I just got to get out of here and go back to my hometown. When I got back there they slid that contract across the table. It said we’ll pay you five hundred dollars a month and we’ll give you like forty percent of whatever you make after that. It was a rude awakening! I should have discussed that before I moved back to town. My first pitfall was contract negotiation, which meant that I declined the offer. I made up my mind that I was going to work for the best in the state of California. The doctor who is doing the best in the state. I’m going to work them. I don’t care who it is. I made calls and looked at some of the ads trying to find who had the biggest practice around. I got in. It was basically a cash based, industrial medicine, personal injury, high-volume practice in the Bay Area. We had six offices spread out through the Bay Area, We were big enough that TV became a reasonable way to advertise so we had a lot of TV coverage. We were able to reach all those people within the area.
I spent my first year there as a scrub, basically doing all the dirtiest support work including working long hours and driving long distances from one practice to another to fill up holes. It was high volume so I was adjusting a lot of patients and learning how to do the most basic things like how to wash a table appropriately and how to fold laundry and the basic treatment plan and how-to adjust somebody without hurting them and how-to listen to their concerns. All of the basic stuff that you would never think of coming out of school.
In the second year I started becoming a manager. I was running my own clinic within one of those six. I started to earn the respect of my boss. Eventually after those two years I sold the stock I had in the corporation and started my own practice with a friend of mine in a small town on the beach in California.
Noah: It seems like you learned from the ground up by doing every single job until you became the CEO. You’ve done every job there is to do and you can delegate effectively.
Dr. Maybee: At one point I was responsible for interviewing and determining who we should or shouldn’t hire. I was usually flabbergasted at the students. This is to give students a fair warning. The students who are graduates that were coming to our practice were asking for enormous salaries for just showing up to the job. But they couldn’t do the most basic things. They actually refused to do the most basic things. We'd have them shadow us and be like, “can you answer that phone” or “can you do this and that.” Simple tasks. When you own your own practice sometimes you have to clean the toilet, there’s no one to call.
Younger chiropractors need to know that it's not pretty most of the time. You have to pick up phone sometimes, you have to clean the toilet sometimes, and you have to discharge a patient to defend your staff when they're being rude. A lot of students assume that they can get someone else to do all the dirty work. You can't. You can’t because when you start out on your own it's just you. There's no one else.
One of the advantages I have in writing this book is that I have practiced in almost every single scenario. I’ve worked in high volume, low volume, evidence-based, not so evidence-based and more. I have a unique perspective. I’m not like your typical guru that will sell you unicorns and rainbows and say everybody’s going to win and you're going to make eight million dollars if you just follow my plan. That doesn’t exist. You are going to get kicked in the teeth and if you get back up you’ll win. Then you're going to get kicked in the teeth again, but if you get back up you'll win. If you keep getting back up every time you get kicked in the teeth you can look back after about four or five years and you will realize that you’ve won a lot.
For the first five years you're going to be completely different every single year. If you're not completely different than who you were the year before then you probably aren't progressing at all. My point of view is pretty strong because I’ve been in the trenches for a longtime now.
Noah: People say that it's going to be hard work a lot, but they don’t explain that to the extent that you’re saying. I appreciate your take and your dose of reality. You’ve been a part of so many practices. You’ve seen it all. How do you choose to practice now?
Dr. Maybee: In the words of my personal mentor Dr. Stuart McGill, it depends. My practice is patient-centered. It is so patient-centered that I try to deliver what the patient expects, within reason, and what I think each patient would benefit from based on my personal experience and intuition .
Based on what the history, based on my previous experience, based on their expectations, based on what they think chiropractic can do for them and more. I take all that information and create a treatment. It can be an adjustments only, it could be manual therapy and adjustment, and it could be rehab driven. It totally depends. I don’t like the cliché of a toolbox but that’s what I have.
I have a cookbook and I'm waiting to see what the patient wants from the menu. It's more of a communication based practice. Things like pain science and biopsychosocial model of pain discuss how it’s valuable for the clinician to discuss with the patient what they expect. I think that patients are also customers. You’ll hear a lot of young, indignant clinicians who say I did this for my patients because I'm the doctor and they’re the patients and so I determine what they need.
The patient didn't like what you offered them. They wanted to be adjusted but you felt like they didn’t need to be adjusted today. If that is what they wanted as a customer you need to bridge that gap and explain why you’re doing what you’re doing. You need to bridge the gap and do both what they want and what they need. There are a lot of young doctors or clinicians out there that neglect the idea that these patients are customers.
In the cash-based chiropractic world; chiropractic can quickly become a commodity if you base your business on price. If you only compete on price and not on value you become a commodity. If someone doesn’t like the product you're giving them then they’ll find someone else who has a better price or who will give them what they want.
You have to bridge both of those gaps. You have to consider your patients as customers and then be ethical. The ethical box you operate within should never be broken in any way.
Because I practice this way it can get crazy. I can get crazy because you never know what's going to come in and what you're going to do and how they’re going to experience it. There's no system.
You never know what you’re going to see, but I do see certain trends with certain people. If you practice that way you start to see certain things come up. Patients talk in a certain way and may be more oriented one way or another. You learn from the history that the patient is a prostitute who doesn’t like doctors in general and always comes in and says “it's just my rib.” You realize there’s a whole bunch more problems going on there, but if you really listen you understand that this person doesn’t want you to tell them there's a bunch of serious problems. They want you to say everything’s cool, let's just get you patched up and get you back out there. All these biopsychosocial challenges makes practice really fun. Eventually patients are showing pictures of their kids because you're actually listening to them and your learning from them.
Noah: Chiropractic is more than treatment, its communication and its relationship building. That’s what makes the chiropractic umbrella so unique. We’re slightly outside of the hospital model and there is a lot more bedside manner. When you were a hiring director seeing students coming out of school what clinical practices would you have liked students to have when they came in your door?
Dr. Maybee: It’s not the schools job to make you successful. It is their job is to make you confident and make sure that you don't kill anybody and don't have sex with your patients. If the schools do their job there is no guarantee of success whatsoever. Success depends on communication skills. Being able to communicate with people efficiently and being able to demonstrate empathy. Knowing when you need to be a teacher, when you need to be a father, when you need to be a brother, or sister to your patients.
Communication is the biggest predictor of success. If you want to learn anything that’s the thing you should be learning, besides business skills and things like that. Sometimes that's trial and error. Schools won’t teach you how to communicate, you have to learn that on your own. You have to sit down in front of people and flub through conversations and say something completely insensitive.
You have to make the mistake of not taking enough leadership when you're talking to a patient about their care and then realize that they’re not coming back. There’s lot of different ways of talking and you don't realize the damage you’re inflicting. When it comes to the research you can actually damage people with your words. You can also damage your business by the way you speak.
Communication is the main thing and then business skills are important. If you see somebody out there who's successful in business and you're not, just remember that dumber people than you have been successful too. You don't have to be a genius to be good at chiropractic business. What you do have to be is diligent. You have to put in the work. You have to be a good communicator, but you don't have to be all that smart.
There's a 10 hour learning curve. If you pick any topic in business there's a 10 hour learning curve to each thing you want to learn. If you put in a couple hours to learn how to convert you're independent contractor position into an S corp. and how to reap those tax advantages you can do that. If you put in 10 hours in Facebook marketing you'll learn that. All that stuff has a learning curve and you can do it on your own. You can do it for free. We didn’t have this stuff when I was in Chiropractic College.
In order to learn something you had to visit a chiropractor's office and ask them, “how do you do that?”
“How did you get all these referrals from a medical doctor? How did you get an attorney to to send patients to you?” Any piece of information you ant can be found. There's no excuses anymore, it's just applying your time and focusing on what you actually need to accomplish versus what you think you need to accomplish.
The schools can't give you any of that stuff. They can't give you any of it. You have to get it on your own. Don't rely on the schools, don't rely on your government, don't rely on anybody, rely on yourself because if it all goes downhill and you end up in a bankruptcy court or a divorce court or down at the bar you can’t blame anybody.
Education is changing. It has to change. What I learned in school is not the same as what is being taught in school now. You'll have people that you will mentor someday and they’ll be learning completely different things. People who make money off of the old way, they’re getting very nervous right now because things are changing and they can’t control it.
There's a whole industry around subluxation. I call it the subluxation industrial complex, like the military industrial complex. It's the same names you see over and over again. They sell a certain model. They have to sell it to young students by saying if you don’t have this model you won't be successful.
They know that students are panicking. That they are not equipped to be out of school. So they’ll equip you, but they're going to equip you in their model and their model is not current. It doesn’t reflect the current understanding of the human body. They are focused on the bone out of place model. They are using words that aren’t used anywhere else in the medical literature.
The evidence-based chiropractors use the best evidence available to tell us what’s the best thing to do for our patients and that could change. When it comes to pain science research certain modalities go out of the window really quick and some of them should have been gone a long time ago. Like ultrasound. And who knows maybe 15 years from now we will recognize that kinesio tape doesn’t actually work. Who knows, things are constantly changing.
Noah: The research just wants to know if it works and how well it works and that’s a whole different model of practice.
Dr. Maybee: That's a rough generalization too because then you have to stratify patients into certain categories so not only does it work and does it work better than something else but what category of patients does it work best for? You have to go to the next level, you have to go into the biopsychosocial model and say for this type of person will that work or would this work better? The current level of research doesn’t have this information because it takes a lot of analysis. Research is just a guide anyways. I mean the evidence is just a guide, but you have to understand how to read the evidence in order to get anything out of it. The evidence can justify anything if you look for it in the right place.
That's the argument we tend to get into a lot of times in chiropractic. Some people put the belief cart before the evidence horse. That is one thing that could get better in schools how-to read and interpret research and literature and understand the importance of it. As a student of chiropractic you need to know how to utilize those tools and to know when someone is selling you crap because there's a lot of crap out there. That crap is directed at young students. Many of those programs and that consulting are not based in any sort of evidence, but it is packaged like its evidence based. The rest of the world is laughing at this. Some people don’t care if they're getting laughed at. They're just going to keep doing what they want to do. But the public is getting smarter and it won’t be long before they won’t get fooled anymore.
I run a facebook group with a few of my friend called the Forward Thinking Chiropractic Alliance. It’s been around for a couple years and we have about 3,200 members. We bounce a lot of ideas off of each other in the group. You can request to join, but not everybody gets in.
I'm just clinician, I am not a guru. I’ll be a teacher if a student appears, but I’m not chasing you down to sell you anything. Watch out for those guys. If you’re going to be a chiropractor and you’re going to see patients your mentor should be someone who actually sees patients. Your mentor might be someone you have lunch with or someone in a facebook group. Be a skeptical customer. Also, go visit a lot of offices. Not just the huge offices, but the small ones.
Have a good sample size of how practices are done and based your decisions off of those examples. Lastly, have certainty. We all need certainty. It's one of Maslow’s hierarchy of needs. Your pursuit here in the profession is to find as much certainty as you can, whether it’s through evidence, through clinical practice itself, and experiences in a networking group or mentorship group that reassures you that you’re on the right path. Then there is gratitude. Don’t forget that no matter how hard it gets, no matter how many times you get kicked in the teeth be grateful for the people who come in to see you. Be grateful you have the opportunity to do the things you do on a daily basis. This is probably one of the most rewarding professions I think anyone’s ever be involved in.
Noah: Thanks for coming on the show.
Writing with originality, generosity, compassion and purpose, Dr. Noah Volz imparts valuable lessons in an entertaining, engaging and snappy way―backed by a wealth of experience. As an author, chiropractor, and entrepreneur, he has started and run multiple companies and has been the host of the DC2Be Revolution YouTube channel and podcast.