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Solving the Practice Puzzle

After climbing a great hill, one only finds that there are many more hills to climb.” Nelson Mandela could well have been speaking to the graduates of any health practitioner training program when he uttered these words. After completing gruelling studies, the new graduate embarks on the road to, hopefully, a successful career – most begin this journey by establishing a practice. And, within the first five years, many find themselves disillusioned with respect to their work, or just not able to build the business that must sustain their careers – and families – for years to come.

May 3, 2010  By Maria DiDanieli

After climbing a great hill, one only finds that there are many more hills to climb.” Nelson Mandela could well have been speaking to the graduates of any health practitioner training program when he uttered these words. After completing gruelling studies, the new graduate embarks on the road to, hopefully, a successful career – most begin this journey by establishing a practice. And, within the first five years, many find themselves disillusioned with respect to their work, or just not able to build the business that must sustain their careers – and families – for years to come.

Furthermore, after years of practice, many, if not all, health practitioners reach a point where they find that something is missing and/or they need help in meeting their practice goals. This can occur at any or all levels of practice. From the new grad to the seasoned professional, RMTs, as well, can find themselves hitting a wall, with respect to practice growth, life fulfilment and a host of other practice issues.

When this happens, practitioners, including RMTs, may look for help in the form of a practice consultant or coach. A culture of these has arisen, making it difficult for professionals to decide which coach or service to work with, or whether such a service is right for them at all.

Furthermore, some coaching services have marketed themselves in ways that raise serious doubts regarding their ability to live up to what they promise, making it even harder to decide whether working with coaches or consultants is a good investment of time and money at all.


This article will review some of the general features of practice consultants and coaches, who might benefit from these services, how to choose the most appropriate coach or consultant and what to be wary of when selecting someone to work with.

Practice consultants

For an RMT seeking outside professional help and guidance in practice growth and management, the first question to ask is what sort of help is needed. If the answer leans toward the business and administrative mechanics pertaining to the practice, then a practice consultant might be the best choice.

A consultant, or consulting firm, will employ templates to examine the existing protocols within the office with respect to items such as billing, patient software, accounting practices, office flow, staffing schedules, training and protocols, some aspects of marketing, admission sequence, patient care packages, etc., and make suggestions on how to establish, change or build on these protocols. This may require some days of observing the current work environment before offering assessments and suggestions to employ. Following that, the consultant may assist in implementing new strategies and following their progress to evaluate whether these strategies are efficacious for that practice or not. Strategies can be tweaked as necessary until a formula is arrived at that ensures efficient flow within the office but adheres as closely as possible to the consultant’s guidelines – again, the purpose here is to streamline the administrative structure of the practice.

A practitioner’s relationship with a consultant is usually much shorter than that with a coach – its goal is to be finite with the endpoint being the successful implementation of practice management protocols that facilitate staff proficiency, practical business structure and efficient patient flow.

The career point when a consultant might be extremely helpful to a practitioner is usually somewhere near the beginning – five years or less in practice. (Although, this does not mean that a seasoned professional might not, at some point, benefit from the services of a consultant.) Many technical aspects of practice management are being taught more and more in colleges, in order to prepare graduating students to run the practice they plan to build. However, a boost in efficiency, guided by a practice consultant, might be helpful when a young practitioner is trying to get a practice “off the ground.”

Coaches for health-care practitioners
In contrast, the impact of a coach may begin at the business and administrative level but will extend beyond this to touch on many other aspects of being a practitioner.

Coaches are usually equipped and trained to address broader issues such as the practitioner’s paradigm, approach and communication with patients – especially new/potential patients – staff fulfilment and satisfaction, approach to marketing, overall life balance and the practitioner’s confidence and satisfaction with his/her own work. These are issues which crop up, of course, with new graduates but which also are faced by practitioners at all levels of their career. Furthermore, the right coaches can benefit those practitioners who are involved in their profession beyond clinical practice in activities such as teaching, association positions, business/franchise development, community programs, etc.

A practitioner’s relationship with a coach could be finite – if that is the appropriate direction for that individual’s situation – or can become a permanent fixture, benefiting the practitioner until he/she retires. Professionals are advised to enter into a coaching relationship with longevity in mind. Also, as much time and energy can be lost when one skips around from coach to coach – leading to a hodge-podge of approaches that lack continuity, precluding the practitioner from mastering systems that are meant to serve for years and years – it is advisable that a coach be selected carefully, the first time round.

Because the relationship a practitioner establishes with a coach can be long and touch on issues and practice aspects that are deeply important, it is crucial that coaches respond to their individual clients’ needs by setting reasonable, practical and attainable goals. Conversely, since the relationship is built on trust, it is imperative that the practitioner ensure the coach’s values reflect his/hers, and that lifestyle and professional goals can be addressed by that coach.

All of this means that the practitioner must do some careful groundwork and research prior to deciding which coach to enter into a relationship with.

A good coach must be able to provide personalized formulas that will empower the individual to fulfil his/her role as a practitioner, a businessperson and, where applicable, as an employer, while recalling the professional’s accountability in all practice-related situations. Finally, a coach must be able to access the key to a particular client’s fulfilment and satisfaction in order to establish balance at work and play, while enriching each individual practitioner’s commitment to excellence in his/her practice.

Many coaching services aspire to these – and perhaps other – results when working with clients, making them, one would think, a desirable addition to a practice. Why, then, is there still some cynicism toward practice coaching?

Detractors of the coaching culture may be concerned with the empty “cult-like” potential of some coaching paradigms as well as whether these may project a negative image of the profession’s direction to its critics. As well, the all-encompassing “guru” coach, or coaches that promise exorbitant financial gains, or expound on how to exponentially and immediately multiply patient numbers, are considered less than credible entities of which practitioners should be wary.

The concerns are threefold. The first is that the individual practitioner will waste time and money and then be disappointed with the results. The second is that the practitioner will be led to practices that are less than ethical, in the name of developing business success. The third concern is that this type of coaching casts a bad light on the profession, making it appear that a lucrative business is the main foundation to the health practitioner’s purpose and that pushing as many patients through as possible – thus reducing the amount of time and attention available per patient – is the paradigm of the profession as a whole.

A good coach will note that no one coach can help meet all the challenges for every practitioner. This is where practitioners must be discerning in choosing a coach who is aligned with his/her practice and lifestyle goals and values, and will help to meet these through a customized and realistic program.

Finally, although salary is a real, and global, consideration for any field, RMTs, as a group, and regardless of practice paradigm, realize income is only part of the raison d’être for any health professional. As well, most RMTs know that a lucrative practice alone does not make a successful or happy practitioner. Success and happiness are also related to excellence, practitioner efficacy, wellness-oriented patient-centred care, life balance, and fulfilment, both personal and professional. And, with this, a good coach should also agree.

For those RMTs who feel lacking in the latter considerations – and who might also, in fairness, need help boosting practice numbers – the right coach can be helpful and, in fact, necessary to stay afloat, maintain staff consistency and morale, and prevent burnout for him/herself.

But, how many practitioners have poured countless dollars into a coaching/consultant relationship offering limited benefits? At times, this certainly may be a function of the coach/consultant’s lack of adeptness. But, the dynamics through which the practitioner searches for this type of assistance may also have something to do with the outcome.

The process for scouting the optimal practice management guidance system will now be examined. Of course, the author acknowledges that there are many different ways in which to go about this – but the point, here, is to highlight some salient features that might make the quest more worthwhile for the practitioner.

This first step is crucial to success in almost any venture. An RMT should not embark on seeking help with practice management issues without first having established three things:

  • a definition of who he/she is, as a practitioner, an employer, and a person,
  • the differences between where he/she is and where he/she would like to be (this comprises practice and personal challenges, needs and goals),
  • that he/she is the one responsible and accountable for the direction of his/her own practice – and, in fact, his/her life, in general.

Why is this so important? If an RMT passively hands him/herself, and the practice, into the hands of an outside element expecting a magical transformation, then that RMT will certainly experience disappointment. This will be true regardless of how erudite or talented the coach/consultant is. Improvement, refinement and achievement must be a journey that is shared by the practitioner and the coach/consultant, wherein the practitioner’s individual values and aspirations lead the way, and the coach’s blend of training, experience and ability provide realistic, practical and ethical tools for reaching these destinations.

Once an RMT has worked out the purpose and direction for a practice enhancement relationship, and has decided which type of service would be the most useful – coach or consultant (see above) – it is time to research individuals or groups to work with.


The question of how your coach or consultant has trained may be considered a mechanistic one, addressing only one dimension of their potential merit. Nonetheless, it may offer some insight as to whether that individual is the right one to work with.

Janice Hughes is a Canadian-trained chiropractor whose career branched into coaching for chiropractic practices all over North America.
“Some people ‘fall into’ coaching,” says Hughes. “They begin to teach those around them about their own systems and, before they know it, their helpfulness develops into ideas that seem to really benefit practitioners in practice – and so they begin coaching professionally.”

“Others,” continues Hughes, “enrol in one of various available training certification programs where they may learn one, or more, of the many different coaching methodologies.”

One of the most prominent educators of coaches – a group whose credentialing is fast becoming the most sought after, for coaches of all fields and professions – is called the International Coach Federation (ICF). In existence for more than 10 years, the ICF strives to train career coaches – for all disciplines – who meet international standards of practice. The ICF has set standards of practice and core competencies that every credentialed coach must be trained in, examined in and pledges to uphold and practice. The ICF aspires to support the development of coaching as a self-regulating and distinct profession on an international level, and has developed its education and credentialing with this goal in mind. The interesting thing about this group is that it stands independent of all the disciplines for which it trains coaches. At this time, more than 4,000 coaches, worldwide, hold ICF credentials.

A particular practitioner may prefer to work with a coach who has formal training in his/her discipline; however, the next feature to consider is how well that coach understands what you, the coach’s client, are dealing with in practice and which issues and opportunities are involved in your particular line of work.

Also of interest to the practitioner questing for a practice consultant or coach might be the experience(s) that individual brings to the table.

In terms of experience, there are a few particulars that might prove revelatory. The obvious are expanse of experience – number of years or of clients – references and testimonials from other/previous clients – both satisfied and unsatisfied – and which RMTs the coach has successfully worked with in the past. This last feature points to the coach’s area of specialization, in terms of what sort of needs, goals and paradigms are best served by his/her coaching methods, values and approaches.

Another consideration, when scouting for a coach is where he/she is located, with respect to jurisdiction.

Practice consultants are usually somewhat local, as they will need to be present in your office and available to work alongside you and your team. Therefore, the consideration of location applies more to coaches.

It might be worth considering a coach’s country of location – or jurisdiction, if he/she is in another Canadian province – when scouting out whom best to work with. With the current potential for relationships afforded by the Internet, and the international accessibility of any location by phone, e-mail, etc., any RMT can, theoretically, work with any coach, anywhere. But, does a coach from out-of-country, or even out-of-province truly understand the environment in which a practice is situated enough to guide the RMT in a meaningful and relevant fashion?

When asked about potential differences in coaching chiropractors in Canada versus the United States, Janice Hughes rose to the occasion.

“Yes, there are definitely differences in practice needs and goals when you work with a Canadian versus an American practitioner!” Hughes says.

These particulars may result in some variations in practice. For instance, the way a Canadian RMT is expected to communicate with patients may be different. As well, beliefs and attitudes toward care, and taking responsibility for one’s health, vary slightly between the two countries’ systems.

Therefore, if an RMT is investigating the possibility of working with a coach who is based outside of his/her country, it might be worth investigating how well that coach understands the environment in which the RMT is trying to grow, both professionally and personally.

Other considerations
Regardless of training, coaching method, experience, etc., coaches and practice consultants will agree that a practitioner must strive to work with someone who:

  • is adept at effective communication,
  • can properly assess the practitioner’s needs,
  • respects the practitioner’s paradigm and who he/she is,
  • has a value system that resonates with the
  • practitioner
  • practices ethical strategies, and
  • “walks their own talk”.

Janice Hughes adds that it also might be worth asking whom the coach is coached by? The choice of the coach, for his/her own support and growth, can be revelatory in terms of the values and paradigm of that coach.

This article has been an attempt to collate and discuss those elements that could bring an RMT and a practice coach together, what the relationship should entail and how it should progress, but is, by no means, the final word on this subject.

Your practice should be a reflection of your personal goals, values and beliefs with respect to the work you do and, therefore, your choice of working with a coach or practice consultant – and which to work with – should follow a process of careful thought and meticulous research. Practice management and enhancement activities draw from the practitioner’s store of time and money and, so, should be relevant, ethical and practical and should be aimed at sustainable, positive outcomes for the practitioner and the practice, including the patients who seek care. Some of these outcomes will be objective and measurable while others may be in the realm of the subjective – one set is not to be considered less meaningful than the other when deciding which strategy, individual or group to work with.

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