What Does It Take to Build a Successful Practice?

Daniel Kalish, DC

Those in private practice want to help people. That’s what we signed up for. However, most often, no one tells us what the entirety of the job entails. So I’m here to tell you that achieving your goal of relieving human suffering involves a blend of three things: people skills (or what I call patient communication), business skills, and clinical skills development and self-care. Occasionally, I’ll meet a practitioner who is naturally gifted in all three of these areas. These people are rare indeed. For the rest of us, we need to consciously address each of these components of running a Functional Medicine practice in order to succeed.

I call these key components the “three Ps”: Patients, Practices, and Practitioners. When brought together in just the right way, they result in outstanding clinical results and financial success. Yet if there is one weak link in the chain, the entire endeavor falters. Lack of communication and sales skills combined with poor business management plague our profession and limit the potential of even the best-intentioned practitioners.

I had to learn about the importance of each of the three Ps individually, from different groups of people, none of whom had the big picture in mind. The monks who taught me meditation understood spiritual development at the highest levels whereas the doctors who taught me my clinical skills were not very good at business management. My communication skills teachers were all psychologists and psychotherapists, but they had no clue about Functional Medicine models. And all the business training I received was mostly from people not even in the healthcare field! What a mess. Those of us striking out on our own to create Functional Medicine practices need to focus equally on all three areas to succeed in the long term.

My specific route to mastery of the three Ps was random and unplanned. Initially, I thought I just needed to learn the clinical side. My first five years of training were taken up by understanding the practice of Functional Medicine, including the science, theory, and application. Then I realized that many of my patients, though they liked me, had no idea what I was talking about and no sense of my bigger picture of health and healing. At this stage, I began to study communication skills. How can we get our message across? Is it what we say, how we say it, body language, showing a diagram, choosing our words carefully? And importantly, what do we want to communicate? How do we convince someone to make challenging lifestyle changes, adopt supplement programs, and follow through with labs?

Much of what we do in the treatment room involves convincing people to make challenging changes in their lives. While studying communication, I realized that much of what I was doing was actually “selling.” Sales always felt wrong, and it seemed to be somewhat tawdry and beneath me. I was doctoring, not selling; I was a healer, not a salesman. Yet I had to “sell” lab kits and supplement programs in order for patients to get better. I also had to sell patients on exercise programs and diet programs to get results.

Around year seven of practice, I realized that sales wasn’t a small part of what I did; instead, sales encompassed the most important part of what I did. Those who bought the lab kits and supplements and bought into the diet, exercise, and meditation programs all became healthier while those who didn’t would never get the improvements they sought.

After years of clinical training and communication skills development, I woke up one day to the reality that I was running a small business. If you had asked me early on if I was running a small business, however, I would have said “no” because my state of denial was that deep.

I was so engrossed in taking care of patients and so deep in continuing my study of biochemistry and nutrition that I didn’t realize my staff were employees not friends and that my income was really the “P” in my Profit & Loss (P&L). I didn’t know what my margins were, even though most every month I somehow covered all the bills and could usually fund my retirement plan. My business plan was “cover the credit cards next month and pay rent.” My patient follow-up system was wondering out loud to my office manager, “What ever happened to Sue? Did she schedule a follow-up?”

Beginning around year 10 of this adventure, I put all my energy into developing my business skills.

You can probably appreciate that this approach I took was nuts. Totally nuts. It was like a basketball player focusing on shooting skills for five years and learning how to dribble and then at year 10 finally playing on a team. We need a balanced approach to skills development right from the start.

So my call to action for all of us is to work toward equal development of the three Ps. Each week, take time for self-care and clinical and communication skills development, and each day put an hour into developing your practice. Do a quick self-inventory as well. Ask yourself: what area do you tend to put energy into? What area do you need to develop more fully?

Developing your strengths will yield incredible benefits, including you feeling great, you being healthy, and you developing spiritually and emotionally; your patients getting healthier; and your clinic running profitably and sustaining you and your staff with financial stability.


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