In a nutshell… Yes – there’s a good chance you are.

“But wait!” You say. “Perhaps, if I use a paid service of some kind, but my practice is mostly referral based so I highly doubt it.”

Well, the issue here is really one of perspective, or point of view.

Recently I (this is Dr. Counselman by the way) began helping a few friends of mine with their new website for a frozen shoulder treatment protocol. (Which is one of the most impressive treatment methods I have seen in my 18 years as a chiropractor. You can check it out at: or contact me at if you have questions about this program).

With this project I speak with a lot of their frozen shoulder certified doctors about a ‘pay for a referral service.’ In doing this I have had a few doctors tell me that it is either too expensive or that they would never “pay” for a referral which I respect but not sure I agree with.

And so being a chiropractor that first and foremost wants to make sure that anything I am involved in is fair – and furthers our profession as a whole – I started thinking about the cost of an average new patient and how relative it is to the return on investment that patient type has a track record of providing. Obviously there are similar online ‘pay for referral’ (or calls) that vary from $40-$100. That is easy to quantify, but how about those patients that just come in from your website who, for example, found you online? Sounds free right? Well how much time, effort and/or money did you put into creating or having the website created that will prompt people to pick up the phone and call your office? And that is just the beginning. To actually be found by the search engines you have to put forth a lot of personal effort (building links, managing social media, researching keywords, onsite factors, and even placing paid ads online) or hire a service. Most doctors hire out a service for this. If you are paying $500 a month for this are you seeing 5 new patients from it? If so… there is your $100/NP. Obviously those numbers are all over the board depending on circumstances. The point is; it’s a common misconception that getting patients from the internet is “free” – no matter how you slice it, there is an expense associated. You goal is of course just to keep that expense to a level well below the profit level .

How about a health care booth or spinal screening? I don’t know about you but I have easily paid $1,500 for a booth, paid staff, created marketing materials and taken up multiple days of my own to bring in maybe 20 new patients – assuming I am that successful. Obviously, there is a cost associated with each new patient in these instances as well.

Now, the Holy Grail. What every clinic desires, strives for, and hopefully achieves. A primarily referral based practice. Once you get to this point you are not paying for patients anymore, right? My perspective is that you would be incorrect. You have spent years of your time, blood sweat and tears building your practice. You have nurtured every patient relationship and treated each person like they were family. Along the way you have given all your time, poured in untold amounts of money into your infrastructure and marketing in its many forms. By sacrificing all this for the sake of your patients they love and respect you enough to supply you with a steady flow of new patients. But don’t think that didn’t come without a cost. No chiropractor opens a practice day one and reaches that enviable state overnight. Time and effort = money. No one can argue that.

Even though attaching an accurate cost to new each patient may be difficult and especially with those referred into the practice, the point is that new patients cost money. Not just to chiropractors but this can obviously be extended to every health care field with a minimal amount of extrapolation required.

So, let’s say I spend (in one way or another) $100/NP for 10 new patients. Will I make back more or much more than $1,000 from 10 new patients? That is a question only you can answer. Do patients come back for multiple visits? Most do. Are some patients (PI) much more valuable than others (cash), in many instances yes. Will some of these patients become lifelong patients and refer others – getting you eventually to that ‘Holy Grail’ practice? If you have the lifelong treatment conviction and shape their care and education that direction… chances are many will.

The point then shifts to what the focus of the issue should really be, and that is the return on investment, or ROI. Yes, I said it. Are patients just a dollar sign to us? Obviously not; if that is your belief then I hope you will do our great profession a favor and maybe go sell used cars or something. However, without profit you do not stay open, your practice does not exist and those potential lives that could have been changed through your care might never receive the help you could have provided them.

If the numbers work out to where your income grows while your treatment simultaneously improves people’s lives then to me it doesn’t matter what the price for a new patient or lead ultimately is as long as they are brought to you through an ethical means. To me it’s a no-brainer.

Recommended Posts

Start typing and press Enter to search