Nov
11
The early stages of business planning : difficulties and strategies
Filed Under Getting Started, Our Story, Vision and Mission | 1 Comment
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Amanda and I have been working on our business plan for our center for natural medicine for a while. We started planning long before I had any business classes in my program at NCNM. In fact, we’ve been planning since I started school! However, we still have a lot of work to do. Why?
I believe that the early stages of the business planning process are the most difficult. We have had multiple meetings of 3-4 hours where we did nothing but flesh out the basic idea behind our business model. We’ve revisited notes from these meetings several times, only to come back at some later meeting to rehash similar ideas. This process is slow and sometimes frustrating. Every once in a while I despair that we are making no headway at all!
Still, I think this is all a very important part of building a sound business. While we haven’t done all that much that could be put in an official business plan and submitted to a bank for a loan review process, our work has been extremely valuable. There are three major reasons I believe it’s important to take plenty of time to ruminate over the most basic elements of a business plan.
- Good ideas take time : Just like cramming for an important test doesn’t leave you the time to comprehend the material, trying to cram for a business plan will find you in a business to which you do not feel passionately connected. When you first start conceiving of your new clinic, your ideas will be rough and disconnected. As time goes on, you start to see the relationships among your various ideas and new ideas are born from that fertile ground. Further, as you accumulate experience simply by going through your normal days you will be better able to refine your current ideas and come up with new ones. All this time spent will pay off with handsome dividends in the end
- It’s more complicated than you think : While your clinic idea may seem simple, with enough time you begin to see the complexities involved. If you don’t leave yourself enough time to fully explore the plan, you may end up rudely awakened by some unexpected difficulty. Failing that, you may simply miss out on a great opportunity that you would have been able to take advantage of if you had fully comprehended the intricacies of your situation earlier.
- It’s more fun / less stressful if you take your time : It’s simply more fun to have big ideas and work out their implementation when you have time. Trying to cram a business plan into the last 6 weeks of your schooling is only going to stress you out. That’s pretty contrary to the spirit of natural medicine, isn’t it? Give yourself a break!
Anyway - our business plan is really coming together and with every meeting I get more and more excited about our basic concept. I’d like to explore that concept in future posts both here and at Deepesthealth.com. Until then, thanks for reading.
Eric
Aug
26
Where do you find help in getting started with your natural medicine business?
Filed Under Business Planning, Getting Started, Personnel | 1 Comment
This is the last in a series of three articles about getting started in your natural medicine business by Bonnie Koenig. You can find the previous two articles by clicking on either I’m an acupuncturist, not a business person or Open for Business…I think. You can find Bonnie’s bio here.
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In the last two articles of this series I have reminded practitioners that running a small business can be a full time job, just as practicing medicine can be a full time job. I then focused on the types of help one could expect. This leaves the question of where to find this sort of help.
In the initial stages of starting a business places like SCORE (I looked in my yellow pages for this) will work with small business owners to work out what they want their business to look like and also discuss the types of licenses they might need. At the time I contacted them, I was sent a wonderful packet of business related information that outlined what various government offices (state, county and city) needed what from me.
Another great place to check out online is Insights for Acupuncturists. This site is geared towards acupuncturists, obviously, but it can be applied to anyone who will be in a healthcare practice running a small business. Lisa Hanfileti, the site creator, is an acupuncturist with a biology background. She graduated back in 2000 and she and her husband, a medical doctor, set up their office.
Very often practitioners tend to think small at the beginning. Lisa did not. While she discusses the pitfalls of this at points in her website, the important thing about this is that Lisa had to find out a lot more about various aspects of running a business than many of us have had to. This makes her site a great resource. One thing to remember is that this is a website geared towards anyone trying to start an acupuncture practice. Some information must remain general as exact laws vary state to state, county to county and city to city. Lisa is good about pointing your towards specific offices that may need to be contacted to find out specifics.
If you don’t have a vision of what your practice should look like there are many personal coaches out there. You can search online or ask your friends who they used. Like natural healthcare providers, business coaches use a variety of approaches.
Jenn Givler is a business coach I’m familiar with. Her website is Create a Thriving Business. Jenn works with practitioners who are trying to figure out what they do and do not know about the process of running a business. She says, “I refer to this as putting an infrastructure in place for running a business.” Jenn can take new practitioners through the process of visualizing their ideal practice, focusing on the strengths they have to create this ideal practice (not just their healing strengths but their business strengths) and then help them clarify the areas where they need help.
Additionally Jenn will keep working with practitioners through all phases of their business, whether that be creating new marketing opportunities or creating new opportunities for revenue streams as well as re-evaluating the business and what help is needed as the business vision grows and changes. On Jenn’s website you’ll also find a link to her group which keeps people in contact with like minded people who can offer feedback.
One area many practitioners get stuck is figuring out how to market their business. Of all the business tasks this one is often the most hated task for practitioners. Not only do practitioners seem to dislike it the most, but marketing is one of the most ongoing tasks a business owner faces. If that isn’t enough, marketing is the one task that most often needs updating and changing.
One of my favorite books on running a small business is Lynn Grodzki’s book, Building Your Ideal Private Practice
When I started the Acupuncture Marketing Blogthere were very few sites out there for me to draw information from. The Alternative Health Practice Blog existed (but did not look nearly as lovely as it does today). It’s a great resource, though updated about as irregularly as I update the Marketing Blog.
Kevin Doherty came out with his site Build Your Dream Pracice. Kevin is an acupuncturist and he also does some web design and personal coaching. Kevin’s information is about keeping acupuncturists in business and one area he really focuses on is website information.
Burton Kent is one of the newer names on the scene. Burton began with Acupuncture Clinic Marketing. I’ve had conversations with him about his “No More Closed Clinics” blog post. Burton’s area is marketing. However he’s used acupuncture and had fantastic results with it. He feels that acupuncturists can benefit from the information on marketing that he can provide. He’s also serious about the no more closed clinics. Both Burton and Kevin offer ebooks and some personal coaching.
Another great source that new practitioners might overlook are people who are currently in practice. These people know what has worked for them and what hasn’t. They understand the little pitfalls and misunderstandings based on how you, as a healthcare provider, might think and the way the government offices might think. They can also tell you how to find good help and may know where you can find office space. The downside of another practitioner is that their understanding of the laws may be incomplete so you might not details or get inaccurate information from them.
Finally, when you know you need to find employee help, how do you do so? Many practitioners have gotten good help via word of mouth. While any position may come via word of mouth, nowhere is this more true than with insurance billers. In fact, if you talk to someone specializing in this area, get references from people in your healthcare specialty.
Finding office help can be more challenging. You can post on Craigslist or in your local paper. Ask other practitioners and friends if they know anyone who would be good for a specific job in your office. Very often they may think of someone who is looking or can at least have that person send you a resume. Always check your references.
Office cleaners and laundry services are usually contract positions. You will often find advertisements on Craigslist or in the yellow pages. Again, ask other people in your local area who they use and you’ll probably get some names as well. As many small businesses, not just healthcare providers, use services like these, you may have a larger pool of people to from whom to find referrals.
The biggest gift you can give yourself while your business takes off is the gift of help. As a healthcare provider, I know that finding help was also one of the most challenging things I needed to do. By asking for assistance in various areas of your business you will find you get a lot more satisfaction from what you do than if you try and make do on your own. A streamlined office that is organized and well run is invaluable when you are seeing that one extra who patient who absolutely MUST get in. Further, a well run office can make sure you get to the point where you have that “extra” patient you don’t have time for from time to time.
That’s it for this series!
Bonnie
Aug
25
Open For Business…I Think
Filed Under Business Planning, Getting Started | Leave a Comment
This is the second of three articles written by Bonnie Koenig about the first steps in starting a business. You can read the first in the series by clicking on I’m an acupuncturist, not a business person! You can find Bonnie’s bio here.
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Starting a business after having been a student for years can come as a shock. Instead of being told what to do and what to study, now you are in charge and have to start figuring out what to do and what to study. It seems like there is so much to do starting out that it can feel overwhelming, particularly because there is always the fear of forgetting an important piece of legal work.
The first step in creating a business is creating a plan. Creating a plan can be as formal as writing up a formal business plan or as simple as creating some goals. In either case, it’s important to have a vision of what you are doing in the business and how the business looks. For instance, are you working with other practitioners? Are you the one running things? Are you just a partner who does your own work and someone else takes care of most things? Are you renting your own room from someone else? Is there someone making your appointments or are you doing it yourself?
The clearer your picture of your ideal practice, the easier it will be to create that ideal practice. For instance, if you see yourself in charge of others or intend to start out with an employee, such as a receptionist, you will need to find out minimum wage laws and OSHA laws, whereas if you are going to begin by doing everything yourself or working in someone else’s office, you don’t have to worry about those things.
If you have a hard time envisioning your ideal practice, it might be a good idea to find help. Business coaches abound and many specialize in helping small business owners understand their vision. If you know what you want to do when you start up your practice but don’t know how to get that done, there are places that can help you with that too and not all of them are expensive.
The government offices you work with can also be very helpful when they understand you are just starting out. I’ve had to do this for a small company I worked for. This was a huge advantage because I was far less nervous when I did the same thing for my own business a few years later. Yes, the government does want their cut, but the people working in these offices understand it’s far easier to train someone right than try and correct mistakes and misperceptions later on.
After you have set up your business and know what it is you want to do, you may need help with running your business. What sorts of help depends upon your own skills and what you like. If you aren’t sure but are feeling overwhelmed with running the practice, you may again want to seek out a business coach to help you define what roles you really want to play (in addition to healing) and what roles can be given to others.
Office help can range from someone who just answers the phone and appointment scheduling to hiring someone to take over all the administrative tasks. Obviously you need to pay someone who is doing your bookkeeping, phone answering, insurance billing and overseeing other employees more than you would someone who just answers your phone.
If you aren’t ready for an employee you can still find help. You can hire out your accounting to a bookkeeping firm. You can hire insurance billers to do your insurance billing. There are companies that will come in and pick up your laundry. Cleaning people are typically hired as contractors rather than as direct employees.
Every time you hire someone, there will be a cost. Very often we only look at the dollar amount. However, you also need to factor in your time. Money is wonderful and in the beginning we are often struggling and have to maximize our financial income. However, at some point, we need to create a life not just a living wage. At that point we can think about hiring or contracting help with the tasks that are the most burdensome to us.
Some people really enjoy the day to day challenge of running a business. Ultimately being in charge means that if you have extra space you can rent out that space or take on associates, thereby increasing your income further. The more amenities you have in an office, (such as a receptionist), the more you’ll be able to charge for others to use your space.
Some people think the idea of setting up and running a business seems overwhelming. The money isn’t really that important and all they really want to do is practice their healing modality. That’s a valid practice vision as well. There are practitioners who have run their business for awhile and who want assistance in their practice, taking the overflow and allowing more patients to come through the doors. There are many models, some of which include just renting space and assisting in paying any employees. There are also more formal models of working as an associate, which is basically becoming an independent contractor to a practitioner who pays you per patient.
The challenge in all of this is finding the people who can help you with the areas you are less comfortable with. In the next post in this series, I will point out some good places that you can look up in your local area and online.
Bonnie
Aug
23
I’m an Acupuncturist, Not a Business Person
Filed Under Blogging, Business Planning, Getting Started | 2 Comments
This is the first in a series of three by Natural Medicine Business Success contributor, Bonnie Koenig, writer at the Acupuncture Marketing Blog, among other sites. You can view her short biography by clicking here.
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The business of being an acupuncturist is very different from practicing acupuncture. This is often the reason that those students who are the stars of acupuncture classes achieve only mediocre success in their personal practices.
Successful business people have one set of skills and this particular skill set is not necessarily the same skill set required to be an exceptional acupuncturist or other healthcare provider. Additionally, it’s human nature to absorb more from studying those things we love as opposed to those things we are told we have to learn. This means that people who love the business end of running their practice often learn more far quickly than those who run a their practice business rather under protest.
I checked out the school of business at my undergraduate alma mater. They have a total student body of approximately 2500 students. Their business school has 480 students. There is a requirement that in addition to the regular core undergraduate classes that 49 semester hours (students normally average 16 to 18 credit hours per semester, with 20 credit hours being a doable but heavy load) of business classes. This means that if you only studied the business courses, you would need an additional 3 semesters, or a year and a half minimum to learn what this college feels is appropriate to someone who wants to manage a business. This is for an undergraduate degree. The masters level coursework is an additional two years (assuming mostly full time enrollment).
Acupuncture students are lucky to get two business courses during their entire education.
Certainly you don’t need a business degree to run a business, nor am I suggesting this. I point out the fact that business majors get this much subject matter because as new practitioners we often expect ourselves to just know this information. Many business people say that most business information is just common sense. Most of our life lessons apply to business. The problem is that many people who are new to running a business don’t realize what they already know and even if they do, they don’t really know how to apply it.
Initially, I had thought to make this point and offer suggestions in one post, but it’s gotten ponderously long. I’d like to tackle a couple of points in future posts.
In the first post, I’ll discuss the need for finding good help. Good help may start with finding people who can offer some basic business advice to those just starting out. Additionally very few practitioners are strong in all aspects of running a business so at some point we’ll need to find help. Part of this post will focus on the types of help we may need, from deciding if we need a book keeper or legal assistance or maybe we just need someone to do our laundry.
In the second post, I’ll discuss some of the places practitioners can go to find assistance in starting their businesses. Some of these resources are online and some are offline. I’ll offer some potential pros and cons for the different types of services and try to help practitioners set appropriate expectations for the type of help they receive.
Starting up a business requires a lot of effort and energy. Very often, as healthcare providers who have just come out of school we tend to minimize the amount of work starting a business requires. We also like to just push through this part of creating our business because suddenly our student loans are going to come due. However, creating our ideal healthcare business takes time and effort. Thinking carefully about exactly what we want can lessen headaches in later years.
Bonnie
Aug
20
Natural medicine business planning : Start Early!
Filed Under Business Planning, Our Story, Vision and Mission | Leave a Comment
All of the advice I’ve ever been given about business planning boils down to one essential truth : the early bird gets the worm! Business is as complicated as healing - when we think it will be quick, it’s slow. When we think it’ll be slow, it speeds up! When we think we have a handle on something, a new permutation crops up. When we believe that something is way too complicated, we find it to be fairly simple when we get down to it. These contradictions stymie many people who are trying to plan their business. This is why starting as early as possible is such a sound strategy.
Amanda and I have been working our business model seriously for about six months. We hope to open in just over a year. So, we’ll have seriously worked on our business for a little over 18 months by the time we open our doors. At first, it was a hazy dream - and it stayed that way for a long time. At this point, we have a fairly good idea of what we’re doing, and have already pre-hired our first employee! I want to mention the decisions we’ve already made and the process we walked through to get to where we are right now.
1. General vision and mission : This is always the first point in any business planning model, yet is one of the most frustrating things to work on. I think a lot of people’s business planning careers start and end at the vision and mission. While it sounds fun, when you get down to it this part can be pretty frustrating. The majority of the six months above has been taken up by hammering out our vision and mission statements.
What is a vision statement?
I don’t like to talk about “vision statements” as much, because while it is important to have a boiled down sentence or two to work with, far more important is the process. The vision is the more ethereal part of the mission/vision pair, and often authors talk about it as the ultimate goal of the business that, if you were to achieve it, would be really “something.” It is the guiding principle of the business, not necessarily something to set goals around and tirelessly work to achieve. Instead, everything that the business does is related to the principles set out in the vision. It can be used in making decisions about the business (should we expand? should we hire these new practitioners?) as well as making sure you keep on track with your original ideas. While in the early stages of business planning, we have referred to and revised our vision statement OFTEN.
Sometimes the process of creating our vision statement(s) has been pretty frustrating. Just when we though we knew what we wanted, we’d visit someone’s clinic or hear something from a mentor that would totally change our thinking. This is why it’s so crucial to work on, explicitly, WELL in advance of the time you plan to open. With our vision intact, I feel much more confident about moving forward with decisions about concrete things like building leasing and employee hiring, because I know that we have already made the decisions about the kind of business we want to be.
For our natural medicine clinic, our principles rest on three pillars: Community building/interactivity, Environmental and social integrity and dedication to the deepest principles of our medicine (this includes things like continued scholarship, personal cultivation and the like). Your principles will differ, but it’s important that you figure out what they are as soon as you are able.
What is a mission statement?
The mission statement is different. It is here that you answer the questions about what, exactly, you will be doing and on behalf of whom. In other words, here is where you talk about the actual modalities you are practicing and who you are hoping to serve. In our case, we will be using Chinese herbal medicine, acupuncture, Qigong, Swedish and Deep tissue massage, Shiatsu and Lomi-Lomi Hawaiian massage. We have a couple of foci when it comes to demographics. We really want to serve people experiencing cancer, but also will specialize in the treatment of mental and emotional maladies. Finally, we have an interest in promoting “every day” health, helping people to overcome the seemingly minor diseases (like the common cold, basic aches and pains, etc) that, in our opinion, eventually accumulate to bring about the major diseases.
Having clarity around these issues really helps us to focus our studies and our thinking around business strategy. There is more you can put into a mission statement, but these are the basic ideas. I love having this figured out while already in school, because it helps me choose the doctors I want to work with in clinic as well as focusing my non-school related research. It has directly shaped the choices Amanda has made about her continuing education.
2. Where you will be practicing and the size/type of practice you will have
Because this post is already getting dreadfully long, I will just focus on one more point Amanda and I have worked very hard on. After establishing our vision and mission, we started to figure out what our actual practice is going to look like. This includes WHERE we will practice (country, region, state, city, part of the city, etc) and the actual form of the clinic itself. Of course, all of this presupposes that one will have some version of a private practice - perhaps in clarifying mission and vision you will find that you don’t have a particularly strong one and would prefer working under someone else’s vision and mission. This is certainly 
okay to do!
Deciding where to practice
I really don’t believe there is a “best” way to decide where to practice natural medicine. Some people say you should do it based on economic information - where are there fewer practitioners, but plenty of patients? Some people say you should just go where your heart leads you. I figure you need to use both of these methods to find the perfect place to practice. Amanda and I knew that we didn’t want to leave the Portland area. Our life is here, our daughter is established in her friends and school, and we love the many features that Portland offers to people like us. There’s the heart connection.
Knowing this, we began to look deeply in the city and find areas that are still under-served by natural medicine practitioners. We looked for parts of town that we could see ourselves living in happily, places well served by coffee/tea shops, natural groceries and abundant open space. We also had to consider property values as well as the availability of leasable space that we could afford. Ultimately, we narrowed it down to a couple areas of town. We’re pretty clear that we’re going to choose one particular area, which I won’t reveal here.
Many students at my school (National College of Natural Medicine - NCNM) have revealed to me that they’re not sure where they want to practice. I think this is a crucial thing to figure out as early as possible. If you don’t know WHERE you’re going to be, you can’t even begin to figure out the needs of the place or your economic needs (like, do you need to be saving money because you’re going somewhere with high property values?). These things can be stressful to consider, but the decision isn’t going to go away just because you don’t think about it! 
Finally, discussing the basic structure of your practice is also important. Will you be a sole practitioner or have a group? Will that group be separate partners or employees with you at the helm? Will you be part of an integrative health center, involving many Western practitioners, or would you prefer to stay with other natural healthcare providers? Are you interested in being part of a hospital or other Western clinic? Are you thinking about integrating spa services into your clinic? How big are you hoping to get? All of these questions are important to start thinking about early on. Your last year of school is a great time to network and find other graduating students who have similar ideas to your own. Don’t put this off until tomorrow!
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All of these concepts are important to start thinking about early on in the business planning process. This is because all of these questions have huge ramifications on the rest of the business planning process. How will you know what equipment you need to buy if you don’t know what services you will be providing? And then how can you start to understand your pricing structure and expected profit margins if you don’t know what you need to buy when you start out?
They’re also important to think about early because they’re often difficult to nail down. If you wait until 6 months before you hope to practice, you might find yourself barely able to articulate your vision by the time your student loans begin to come due. Not a comfortable position.
Offer up your ideas about the beginning of the business planning process in the comments! Also, look for increased frequency of content starting today!
Eric
