88. How we recommend care plans
Spencer Dupre (00:00)
Yo, yo, yo, everybody. What is up? Welcome back to another episode of the, hopefully one of your favorite podcasts, the What Now podcast. What's up, Zach?
ZT (00:09)
What's up, what's up, what's up? It's definitely one of my favorite podcasts. Slightly biased though.
Spencer Dupre (00:13)
Yeah, it's pretty fun, dude. This has been a good, I think it's been like a good outlet for us. And I think it's been, I think it's just been interesting just to like, kind of think about how do we really been recording this like since we've opened for the past two years. And that's been pretty cool. Lot has changed. Lot has stayed the same. What's new in your practice?
ZT (00:24)
Mm-hmm.
hope so.
What's new in our practice? I wouldn't say a whole lot. We, I think I've mentioned before on the podcast, I was such a like, taker in of information that I was trying to change stuff regularly on the, in the practice. And so I was like, you know what, let's keep things the same, in some facets. So that would be one thing that is new is just staying consistent and letting that build.
I will say one thing that is new is we're really working on our day three, day four process, which I know we talked was a big takeaway from growth summit. but we've really been nailing down our day three and our day four. and even in like two or three weeks of implementing, that's been huge for our patient flow, which has been.
Spencer Dupre (01:15)
Yeah, can you just like for people who are like hopping into this episode, give like, what does day three and day four mean? Because in some circles, like you don't do the care recommendations until day three. And so.
ZT (01:17)
Mm-hmm.
Right.
Yeah.
for us, really quick day one is for not to go into too much depth. That's our exam. That's our scans, cans, consults, relief adjustment. day two, full spinal adjustment, report of findings, financial recommend or financial conversation. and then scheduled out from there. And then day three is really their first like regular visit, if you will. And so what we realize is we just kind of.
Spencer Dupre (01:33)
consult an exam.
ZT (01:52)
greet people at the door, hey, welcome in. You can take your shoes off. and then it's just like, boom. that's what it was before, but we do have, we do have wobble discs in our practice. I have a whole mobility section. and so now, thanks to Dr. Austin, when he shared, actually do a, let me show you day. So that's our day three. So let me show you what, to do on your typical visits. So.
Spencer Dupre (01:57)
Hmm
Ahem.
ZT (02:14)
RCAs will literally take off their shoes with them. walk them to a wobble disc on the chair, show them how to use the wobble disc, sit with them for two to three minutes. And what's been fun is I've even started to allow the CAs to just take a look, hey, look at what they're coming in for, what's their chief complaint. I haven't given stretches yet, but they know the stretches I recommend. And so if someone's coming in for shoulder and neck pain, our CA will just say like, here's a simple stretch.
that you can do as well after you finish with your wobble disc and then Dr. Zach will call you over. and so that's already helped the flow of the practice. and then day four is let me watch you. so we just want to make sure they know what they're doing, and still hand hold them through and not just assume because they've been to our office one or two times that they know what to do. so that way we, we start to incorporate that rhythm and really allow that flow to be nice and optimal. And I will say as like a.
more on the pain preventative side of things. I do notice a difference in adjusting patients that do do the wobble disc prior to their adjustment and don't. It just makes for a much smoother adjustment.
Spencer Dupre (03:13)
Yeah, can't I have been kind of like going back and forth between that because we were like What are we gonna be like? Let me show you to like a lot of the parents like Like that our CAs can do because we already got show parents like a lot of stuff like hey This is like this little tummy massage that you can do or this is like a way to Like massage the baby's legs or those kind of things But like to have our CAs do it
ZT (03:21)
You
This is.
Spencer Dupre (03:39)
I don't know necessarily how that would fit. then like, I know, definitely let me watch you. Like if you're like, Hey, let me watch your kid. Then the parents will be like, yes, of course. So yeah, that's good, dude. mean, I think that's something that we're trying to work toward as well. have a lot changing right now in the practice. So we're not necessarily switching up any of our systems or onboarding processes right now. We're kind of in the whole like, yo, we're just going to not try to not have everything fall apart right now.
ZT (03:39)
Thanks.
Yeah.
Hmm.
Yeah. Yeah. We just, uh, the two like big reasons we implemented it. And obviously in our situation, it's a little more like, not that it makes more sense, but there's just more that we can. Yeah. Um, was for one, I really liked what Dr. Austin said was like, you just had, you, you basically roll out the red carpet day one and day two. It's this great experience. And then day three rolls around and they just paid you 1500, 2,500, whatever your care plan costs. And you're like, okay, just.
Spencer Dupre (04:17)
It makes a lot more sense.
ZT (04:35)
Welcome into the practice. And it's like, damn, all right, that's how I'm going to be treated. Um, and I don't think we ever made patients feel that way, but we didn't want that to be like a secondary thought. Um, so that was like a big reason for it is continuing that handhold process, that white glove, which I think is still one of my favorite episodes that we've done is talking about like, uh, getting on your flight. I think it's like, yeah, flying the plane. Um, yeah.
Spencer Dupre (04:36)
Come on in.
are flying the plane. I think we have three parts. I think we have who's
flying the plane, and then flying the plane one, and flying the plane two.
ZT (05:06)
Yeah. so definitely go back and listen. think it's like episodes 40 ish, thirties. Yep. but, then the second reason was we would have people, their seventh, eighth visit, they'd come in, they'd just stand at the front or they'd talk with our CAs prior to getting adjusted and just create this kind of hiccup and lack of flow. And so it is interesting now seeing, the few patients that have gone through like the day three and day four process.
Spencer Dupre (05:10)
Something like that, yeah, somewhere in the middle.
ZT (05:31)
How like just so smooth they walk in versus patients that have been coming in for two and a half years now. and so our CAs have noticed that flow and they're like, crap, we should probably just teach people that have been coming in once a week for the last two years, how to do this too, because it makes their life easier. makes the practice flow a lot easier. so.
Spencer Dupre (05:51)
Yeah, dude, I think that it's just, it's just like really interesting. Well, I to say that like we've been doing this for almost two and a half years, which is crazy. It's like such a long time and such a short time as well. Like, I feel like I'm still like just starting and I feel like so much has happened, but so little has happened at the same time. Like so much has changed, but so little has happened. Um, but maybe that's just something that dude, it's been really productive two years for us. So, um, one of the things that we were just talking about,
ZT (06:04)
Excuse me.
Spencer Dupre (06:20)
that kind of prompted our conversation today was just kind of how things change in terms of like your recommendations, how you like as a doctor get more and more comfortable in like, like calling your shop, like for like a lack of better terms and stuff, like with your care recommendations or those kinds of things. And this is something that Kate and I have been talking about a lot as we go to bring on an associate is just like, how do we teach people?
What kind of recommendations to give people, right? It's like, cause I mean, at the end of the day, you're your own doctor. And like, feel like, you know, we just talked about being an associate last episode. And I think that like, it should be a thing where like your associates kind of have the framework to be able to make their own decision into what to recommend, but like, where do you start? Right? Like, I mean, do you do once a week? Do you do three times a week? What?
ZT (06:59)
Mm-hmm.
smooth.
Spencer Dupre (07:15)
Zach, like what are you at right now in terms of like how you're giving those care plans and have they changed since you've opened?
ZT (07:23)
Yeah, for sure. I would say, you know, when we first started, was still saying basically the same type of patients. but a lot of our plans were like five or six months long. because that's just what I was taught. And so I would get to like three months in and we would accomplish their goals and everything will look great on scans and stuff like that. And I was like, huh, I don't know if people need five or six month care plan. So we basically condensed all of it, to where.
Our biggest care plan that I recommend is four months long. Um, so we're about three to four months of care. Uh, most people are starting off twice a week. Um, that's what I personally have found to be the best. I think it's a big barrier of, uh, big barrier of entrance was recommending three visits a week with the type of people we see. Um, and so I was like, you know what? Cause when I would talk with them, they're like, I can do twice a week. And I was like, great. And so.
We just broke it down to twice a week for a little bit longer duration, as opposed to like three times a week for four to six weeks. So I would say that's where things have changed is just learning the demographic and the ideal clients that we're seeing and what works best for them while also still getting the best results. If that makes sense.
Spencer Dupre (08:33)
Yeah, I think that's like the very delicate dance. Like you have to walk the line of being like, clinically, this is what you need. Cause like we have some friends that are like, this is what you need. You're either going to come in for it or not. And it's a, it's a hundred visits or it's, you know, 86 visits or something like that. And then we have some friends that are like, well, here's four, here's a pack of six visits. Use them whenever you want. And yeah, so mean, I think that there's like,
ZT (08:39)
Mm-hmm.
Mm-hmm use them whenever you Right
Spencer Dupre (08:59)
different ways to do it. Like on the end of the spectrum of recommending care is like all the way on one, like on the left-hand side, like on the, on one side you have like your walk-in clinic where it's like come in whenever you want, however you want, as much as you want or as little as you want. And then you have like the step up from that is like the menu based care where it's like, we have these offerings. We have four times a month, we have twice a month, we have a six pack and we have a 12 pack.
ZT (09:14)
Mm-hmm.
Mm-hmm.
Spencer Dupre (09:29)
And then you have your like small care plan office that it's like, we recommend like eight and 12 visits or something like that, where it's like, yeah, you need eight visits or something like that. And then like kind of where we fall, like right now, I think like, as in like our medium, like in the medium care plan visit, we try to keep everything right now. We try to at least try to get people indoor for 90 days. We feel like 90 days is like a long enough time to create enough change in the body. No matter what frequency you're coming in, like you should be pretty good.
ZT (09:36)
Thanks watching.
Yes.
Mm-hmm.
Right.
Spencer Dupre (10:00)
and then where we used to be in like the PX model, because we were seeing a lot more like super neuro intense cases is the four or five, six, seven, eight, nine, a year long care plans. And I think that those have their place. And so we used to give out a lot of those. and then just our caseload just started to change. Like we started seeing babies with like all kinds of different stuff.
ZT (10:12)
Mm-hmm.
Spencer Dupre (10:23)
And I love people who are neat, who are going to be on 36 visits at the same time. It's not everybody needs 36 visits. I don't, at least I don't think. And so it's like hard. feel like to be in a spot as a doctor, especially a new grad, because like, you're like, bro, I got bills to pay like both, both in the business and personally. And so like, you kind of see like, it puts you in this like middle ground of like, yes, I need to get you good results.
ZT (10:31)
Hmm.
Yeah.
Thanks.
Spencer Dupre (10:51)
And yes, I also respect your understanding that you do have stuff to pay for. And it's not like our care is cheap. think our plans are anywhere from 680 to $800 a month is what people pay for. So it's not like we're giving out $20 adjustments or anything like that.
ZT (11:01)
Thank
Right.
Right.
Spencer Dupre (11:14)
Yeah, I I think that's it's kind of like a spectrum and like, think based off of your demographic, your practice and your personality, you can fall on either end. Like, know, like I know our boy, John, like in Houston, like he's good. He's doing like, Hey bro, you're coming five times a week or I'm going to see you twice a day for six weeks, stuff like that.
ZT (11:26)
Thanks.
I think it is very, very dependent on clinical goals and outcomes that you're looking for. and I think that's just something like to me and something I always at least tell my team, and tell myself is like, is this, am I making this plan? Because I think that's what they can afford. Is this what they need? and when I say need, like, what do I mean? Right? Like, are we going like full nervous system restoration? like
full detox, everything, or in our case, are they really wanting to come in to get rid of their low back pain and then we can nurture them into wellness.
Spencer Dupre (12:08)
What do you
mean by that though? Which side of the coin do you fall on?
ZT (12:12)
think typically in the middle, right? Cause low back pain can go away. Yeah. Low back pain can go away in like three visits. but one from my own personal story, like I was like when I first got into chiropractic, I saw my chiropractor for six visits. Cause that's what insurance allowed. and my back pain went away. but then it came back a year later. And so really being in that middle and then having the anecdotal stories and like the, case history to back that up.
But if someone's coming in with low back pain or headaches and that's their main goal and their scans for the most part aren't terrible, we're not going to recommend 36 visits, right? So.
Spencer Dupre (12:52)
Yeah, I mean, I think for us, like our main goal is like one, how do we, how do we make enough change in the nervous system for a majority of the symptoms to subside? Cause like, it's hard to like not being in a symptom based mindset and being like, this is for this and this is for that. Like it all does tie to the nervous system. And so that's like from a chiropractic side, from a business side, like you have to get people results.
ZT (13:08)
smooth.
Mm-hmm.
Right.
Spencer Dupre (13:20)
And I always tell people this because like, totally understand like the whole concept therapy thing of like, Hey, I'm to put this in it, like this idea into the subconscious mind so that it starts to elicit in the physical body. so like Zach and I, like, I mean, we're part, like we were, we're delts. And so like, we are like really big into whole like chiropractic philosophy stuff, but we're also like really well educated in the whole business thing. And so it's like, you have to acknowledge at some point, somebody's pain points. Cause I feel like if you just come out and be like, Hey, your lower back pain.
ZT (13:44)
You think?
I don't care about
how you feel.
Spencer Dupre (13:48)
your lower back pain is not even real. don't even, I don't care if your back hurts or it doesn't, you're subluxated and you're getting adjusted. Like to that, I feel like that comes off kind of abrasive, at least in our demographic. And so like maybe like in Utah or stuff like that, like people are really receptive for the, like for real, maybe people are like really receptive to that. But I feel like in Dallas, like people are like really straight shooters in Dallas. Like people, they don't want to be like beat around the bush. They're just like, tell me what's up and how are you going to help? And if I like you, then then I like you, you know, like
ZT (13:54)
Yeah.
Yeah.
Thanks.
Yeah,
100%.
Spencer Dupre (14:18)
People
really care about your personality and your experience, but they really want to be confident in you. And I feel like as we, the doctors, if we don't acknowledge that person's chief complaint, then we really miss that connection piece. Like we miss that piece of rapport. And so like a lot of times in my report of findings, the big thing that I'll say after I go over the scans and I say, listen, the scans are awesome and they're going to change. But my biggest thing is that I want your baby to sleep better at night.
ZT (14:28)
Mm-hmm.
Yeah.
It's nice.
Spencer Dupre (14:46)
It's awesome if the scans get better and the scans can be perfect. But if the baby's not sleeping at night, then we need to continue to work on something. Right? And so it's like acknowledging that and it's teaching them that the key to their, that the solution to their problem is the nervous system versus making the nervous system their problem, if that makes sense. So, yeah, that's kind of what we do. Zach, I would love to hear.
ZT (14:53)
This is...
Mm-hmm.
Right. Right.
Spencer Dupre (15:14)
And I'll then kind of do the same for like our prenatal pediatric population. This is obviously not advice. So you be your own doctor and recommend the care that you want. But in your office, Zach, what do you care plan? I would love if you would go through like your different common case types and what you typically care plan for those and what, and your reasoning behind them. They give me like your three most common cases that you see and your three most common care plans.
ZT (15:19)
Right.
you
Yes.
so three most common are going to be sciatica, headache slash migraines, and then neck and shoulder pain. neck and shoulder pain is typically going to be 20 visits. that's just what we have found to be, the sweet spot. frequency wise, we're going to be twice a week for the first eight weeks. And then we dropped down to one visit a week for four weeks. sciat. Yep. So on a 20 visit, we'll progress on the 10th and the 19th.
Spencer Dupre (15:55)
What's your frequency for that?
Are you doing progress scans?
ZT (16:09)
Um, included in our plans, uh, for everyone, not just for headaches and migraines or neck and shoulder pain. Um, so we're going to do 20 adjustments. Um, we're going to do two comprehensive re-exams. We're going to do cervical traction or remodeling. And so we get someone on a, on a dental roll for the first six visits working forward head posture. Um, and obviously I've gone over all of this with them leading up to this. Uh, we do one-on-one mobility training and then, uh, a little bit of soft tissue therapy. So that's all included in their plan. Um.
On top of other random things that we just don't talk about, but so 10th and 19th visit, there's going to be our re-exams, um, and then working in kind of a drip of mobility work, uh, to get them back in the gym or whatever their goals are. Uh, sciatica we're looking closer to like 24 or 28, 24 visits is to be three times a week for a month, twice a week for a month, one time a week for a month. Uh, and then the 28 is going to be, um,
twice a week for the first three months and then once a week for a month. Um, and that's really why, so like the 20 visit I felt would get people pretty close. Um, and then 24 wasn't necessarily enough or that three times a week was a barrier of entrance, which is why we created that 28. Um, so I would say most commonly for all three of those cases, pending scans and history, it's either 20 or 28.
Spencer Dupre (17:33)
Yeah. Nice. That was a lot shorter than I thought. What's your reasoning like behind that? where, like what's your reasoning behind the, because this is a big thing, like especially in the prenatal Peds world is like wellness is like once a week is reserved for wellness. So like what, I don't know dude, just tell me why you throw in once a week. Like why do you?
ZT (17:35)
Yeah, what about you?
Yeah.
Yeah, it's a great question. Something I've thought of quite a bit.
Spencer Dupre (17:58)
So what's your, and
then what's your wellness care look like? Why do you throw in once a week on the care plans? What's your wellness care look like?
ZT (18:04)
So a big thing that I speak on with patients is going from twice a week to once a week. Um, I want to make sure that their body is resilient and able to handle once a week. Um, very rarely have we like gotten to that once a week in a 20 or 28 and been like, too, too soon. Um, but every once in a while we have to add in a couple of extra weeks at twice a week. Um, but a big reason.
why is resiliency. And so I'd, you know, want them to be prepared for wellness or maintenance work, and want their body to be able to hold an adjustment for a full week, and then recommend wellness on top of that. So our wellness, we have two options once a week, for a month or every other week. and I say for a month as in like, that's the monthly monthly.
Spencer Dupre (18:51)
Yeah, each month.
What, how many people do you feel like that are on? Cause I mean, everybody, sounds like goes to once a week in your care plans. How many people do you feel like choose once a week as their wellness option?
ZT (18:59)
Cheers.
I would say it's when they first start typically 80 to 90 % start out once a week. Um, and some people they'll just straight up say, Hey, my goal is in the next three months to drop down to every other week, but I don't feel confident. And I let, I totally let that up to their decision. So I recommend, um, I said, Hey, I get adjusted once a week. My family gets adjusted once a week, but totally up to you if you want to go every other week. Um, but I would say 80 to 90 % stay at once a week.
Spencer Dupre (19:21)
Mm-hmm.
Yeah, I would say probably the same for us. I also give people the choice. used to be like, it's either once a week or bust. Or like I would give them either one or the other, be like, hey, I think every other week is good for you guys. I think that weekly is good for you guys. And then people just kept asking about every other week or vice versa. And so just put them all on the same sheet and just be like, hey, listen, like we have these family wellness memberships. It's available to your entire family. If you're, if.
ZT (19:40)
Yeah.
Mm-hmm.
I
Mm-hmm.
Spencer Dupre (19:59)
someone else in your family needs a care plan, then obviously we'll give them the recommendations. And I tell this to people all the time, just to let them know, like, hey, we'll see the rest of your family. And I just let them choose, you know, I say, if it was me making this decision, like as your doctor, this is typically what I say, like, you know, if I was making the decision for myself as the doctor, I would recommend probably this, just based off of everything that we see, I think it's gonna be more beneficial for you to choose option, whatever, A or B, weekly or every other week.
And, dude, sometimes like I used to really think like, I'll just tell them every other week just because like, maybe they'll afford it. They'll be able to afford it more. like, dude, sometimes people are actually like good on every other week. Like there's some families that we've been seeing for so long that like, can feel them feeling the redundancy of getting adjusted once a week. And I'm like, Hey, I think it might be time good for you guys to like switch to every other week. And, though sometimes people would be like, no, then I'm like, okay. And, that's fine.
ZT (20:32)
you
Right.
Yeah.
Spencer Dupre (20:53)
But it's like, hey, listen, like everything is good. And like, this is working the way that it should. And I think as the chiropractor, like it should be our goal to get people to every other week. Cause that means you're doing your, your good, like a job. You're doing a good job of optimizing their nervous system to be able to hold an adjustment. Like if you're adjusted, getting adjusted for like two and a half years or something like that, then.
ZT (21:13)
Well, I think too, it's not just like how good your adjustment is every other week or once a week, but also looking more at like, does your education look like on top of that? Right? So like, are we talking about the chiropractic lifestyle? And so that's typically if someone has been talking about and like showing signs that they're living a less toxic lifestyle or they're on top of their emotional
emotions, they're, physically recovering better from their workouts, those sort of things. then great. Let's get you down to every other week.
Spencer Dupre (21:44)
Yeah, I mean, the point of the adjustment is not to fix a symptom, but it's to restore a proper connection and facilitate the innate healing potential of the nervous system. And that is disrupted by the overload of physical, chemical, and emotional stress. And so if your life is overloaded by stress, physically, physical, chemical, or emotional, I always say that like stress, because people think it's like just stress, like, my life is busy.
ZT (21:51)
the same.
Yes.
Yep.
Spencer Dupre (22:08)
but they
also don't think about like how they they pick up Chick-fil-A every night. Or they also don't think about how they like, I spend 14 hours at the desk and I spend eight of those hours on the desk on the phone. They don't think about those things or they're like, so I always make sure I clarify like physical, chemical and emotional stress. Like where in what, where do we see an overload of stress in those areas? Yeah. And it's like, dude, that's the whole point of the adjustment, right? The adjustment is to help you manage life.
ZT (22:12)
Mm-hmm.
Yeah.
You
Yeah.
Spencer Dupre (22:37)
Chiropractic
is meant to help you live better, not just to clear out your symptoms. And dude, you can use it however you want. honestly, like it really does disappoint me sometimes whenever people don't graduate to wellness because like the whole goal should be to get on wellness and to stay on wellness. But dude, at the same time, I understand, dude, I just had this mom, she was like, listen, like, this has been fantastic. I have seven kids. And I was like, it's fair, like fair, right? She's like, I stay at home, my husband is a pastor. Like, you know, and I was like, I get it. That's fair.
ZT (22:41)
Mm-hmm.
the same.
Yeah.
Yeah.
Spencer Dupre (23:06)
Like I hold that, I can't hold that against you. cool. Well, yeah, I think that gives us a lot of insight. Before you were doing the 20 and the 24 and the 28, what were you given before then? Like, have you always done that? You've been like, hey, this is what.
ZT (23:13)
Yes.
It was
24 and 36. Um, and I just felt like it was such a big, like a stark difference between 24 and 36 because 24 was three months. 36 was six months. Um, and so I never had that tweener, which again is why I created that 28. um, I, I really love it. I will say, I know I think we've briefly talked about this. Um, one thing that took us, took me a while to realize, but shifting down to once a week, um,
Staff was not trained on from me, but stuff was not trained on. Yeah. HR did not do a good job. but one thing that I found once people should transition to once a week, even on a corrective plan, was they would start scheduling like every visit like each week. So like if they came in on Monday at five o'clock, they wouldn't schedule that next visit until.
Spencer Dupre (23:55)
It's always for us.
Toby.
ZT (24:16)
after their appointment. And that quickly allowed for a three visit plan to turn into four and a half, five, six months because they just weren't staying on that frequency. And so we did a really great job of scheduling everyone to their first progress. And then it was like, okay, schedule whenever. But now my awesome office manager that handles the scheduling out, she'll just take them all the way through their care plan.
Spencer Dupre (24:26)
Yeah.
ZT (24:43)
and if we needed to change it, can, but she'll literally print it out each visit on a, on a sheet for them. They can just take it with them, put it their calendar once they get home. and so we're starting to see a actual three month plan takes three months, an actual four visit, four month plan takes four months. which from a business side is super, super important and just like results side too.
Spencer Dupre (25:02)
That's great.
Yeah, that's pretty cool. Nice. Yeah, we...
ZT (25:07)
What about you
for the prenatal and the peeds?
Spencer Dupre (25:10)
So
yeah, mean, we have, in the prenatal PED space, see kind of like, you see the same people, like you see mom and baby mostly, right? Every now and then you'll get a dad. And sometimes I get kind of like.
Man, like I love whatever the dads are coming in because like for their wellness, but it's like when dad has a herniated disc It's like dude, like I'm not trying to like yes. I'm trying to get you chiropractic care, but like maybe not from me and So I'm like really quick to refer which I'm super excited to refer because I really love the I really really love the PT and chiropractic combo because like I just want to adjust you and like be done but like I feel like a lot of times like they need dude like
ZT (25:31)
you
Yes.
Thank you.
Spencer Dupre (25:53)
Mobility corrective exercise and like all those kind of things like you really do need that, bro And if that makes me a mixer then I guess I am but Like
ZT (26:01)
I don't think I
think it's the lens that you're I mean, I don't know if I just feel the need to like defend myself to the straight car practice. Yeah, yeah, I'm a big I mean, like mobility for us when I said that in our office, it's like, here's cat cow, like it's so basic, like as soon as people are like, hey, like, how can I get more depth on my squat? Or how can I improve my kettlebell swing? I'm like, that's a great question for our PT friends.
Spencer Dupre (26:10)
dude, you're a mixer bro. I'm gonna call you out here. We're stamping you bro. Nah.
Dude, just to have that conversation, think that if you are a chiropractor, I think that chiropractors that think that the adjustment can fix everything, I think that that's pretty ignorant. And I think that's bad. Maybe it's not bad. I think that it's just a disservice to your patient too, because your patients look at you as the authority and the trusting figure. And if you convince them that like,
ZT (26:30)
It's just a frontage, not a success.
Yes.
Spencer Dupre (26:56)
The only thing they have to do is get adjusted. Like I think the adjustment is the foundation of it, but you have to eat well and you have to exercise. Like we talked about it yesterday. Like you can't just get adjusted and lose 50 pounds. Like your...
ZT (27:02)
Mm-hmm.
No.
Card-Practice Clinics would be Boston at the seams.
Spencer Dupre (27:16)
Bro, like I'm like for real, but like, like I think that it is possible. think anything is possible through chiropractic care, but I think that the best chiropractors also know what else needs to happen. Not to support the adjustment. I think that you like you watered down chiropractic when you say like, you need to do this exercise to make your adjustment hold better.
ZT (27:41)
Yeah.
Spencer Dupre (27:41)
or like you need to take this supplement because I think that you say if anything supports the adjustment, I think that you also say that like the healing potential of the body is not perfect unless we have X. And I think that that's also wrong. So like, I think that it's also false to say like your adjustment will not be as effective unless you do cat cows.
But cat cows are also, it's a thing that you have to do. You have to be able to teach. Once your nervous system is working better, you also have to teach it to have move your spine better. Like you have to ingrain that neuromuscular patterning in there. Like that has to be a thing. You have to exercise. All that being said, I really like it whenever dads who have disc issues, see PT first, and then they just come to us once a week for adjustments. That's what I really like. That's my favorite like dad case.
ZT (28:06)
Right.
Spencer Dupre (28:32)
I do that a lot and I'm really excited for us in our wellness center to have a PT in there because I can just send them all those people and it's gonna be fantastic. We're gonna have the healthiest town in DFW in the South. But all that being said, I think that's like, we have to that conversation around the philosophy of referring really. How do you feel about that?
ZT (28:39)
You
I'm like a hundred percent with you. think that's one thing I've started to consider is like with our extra room, like what a massage therapist be best or would like a PT that can take over a lot of that mobility work that I'm doing because as much as I love it, like I have my huge background in training conditioning, just like you spent some can talk about all the different ways to exercise. I'd much rather adjust 200 people a day.
and stay on my chiropractic rug if you will, then move over to the mobility map. So, yeah.
Spencer Dupre (29:23)
Yeah, literally on the rug.
Yeah, dude, think that, honestly, like for acute cases, I really love, I love decompression for adults with back pain. I think it's fantastic if it works for you. I also really like dry needling. I'm terrified needles myself, but I think it works. I really like those in conjunction with the chiropractic care. think it's very helpful. And yeah.
ZT (29:33)
It's nice.
Yeah.
Yeah.
Mm-hmm.
Spencer Dupre (29:46)
We don't really see that many people I say like, I mean, for every like probably 11 moms and babies that we see, we see one dad like that. So, yeah, and usually they all come after like the dads usually come in because they're like, I see how well my family's doing, my body sucks. And they're like, I need to take care of myself. But all that being said in the prenatal PEDs office, pediatric wise, what do we mostly see?
ZT (29:53)
Yeah. Yeah.
Yeah.
Spencer Dupre (30:12)
One, we see a lot of, we just call them the chronic illness kid. So it's not just ear infections, it's not just, we see the chronic illness kid is the kid that has eczema, that is always sick, usually respiratory-wise. They get the tummy bug a lot or they have ear infections. In PX, they call them the poor plumber, meaning that like,
ZT (30:37)
So
can't just detox well.
Spencer Dupre (30:38)
Yeah, like the body,
their elimination system is just like tanked. So for those kids, bro, it really depends. Like that's what I think in the prenatal PEDs office is like, it really depends on the age of the kid and the birth history and how much medication they're on. Because like you can have one kid that has ear infections that I get that it'll get so much better in 18 visits. And then you have another kid that has ear infections.
ZT (30:41)
Mm-hmm.
soon as
Right.
Yes.
Spencer Dupre (31:04)
And they can go to the same school with the same age, but one of them can be a C-section and one of them can be a vaginal birth at home. And the vaginal birth at home will clear in 12 visits. And the C-section kid that was born in the hospital that was fully whatevered, and they're both two years old, that's like a 36 visit kind of kid. Like all of the kids that we see that are conceived with IVF,
ZT (31:18)
Thank you.
Spencer Dupre (31:29)
I, this is anecdotal, so don't take it as gospel or anything, or there's no research behind it, but just in our office, what we see is the kids that are conceived through IVF, their heart rate variability and their nervous system is so much lower than the other kids. takes a lot longer to stimulate their nervous system for healing. and so, or the kids like with sensory issues that also have ear infections, like, so that's a thing. in the pediatric space, typically what we go over, like,
ZT (31:45)
Mm-hmm.
Spencer Dupre (31:56)
the way that we care plan is through intensity. So instead of being like this ear infections, ear infections do best off of 18 or stuff like that. It's through intensity, intensity of one, symptoms, two, birth trauma, and then three,
ZT (32:05)
Yeah.
Spencer Dupre (32:15)
outside influences, like medication and other therapies. So how much work is the nervous system having to do to combat whatever is going on? So basically it's like, how much are we going to have to override the nervous system to make change happen? if a kid is a home birth at home with like a beautiful, like 45 minute pushing phase, because like really fast pushing phase is too fast and that we see a lot of issues. Like usually those are babies with torticollis, those things.
ZT (32:18)
Mm-hmm.
Thank
Mm-hmm.
Spencer Dupre (32:44)
It's like a really nice, like a really awesome, peaceful home birth with a breastfed baby. And baby's like 18 months old, but now baby is having ear infections and the heart rate variability is in like the eighties. And there's only like a couple of the like red bars on the thermal scan. That's like an 18 visit baby. Now, if you have an 18 month old kid, he was a C-section, he was in a helmet.
ZT (33:04)
Mm-hmm.
Spencer Dupre (33:11)
He doesn't speak. He has eczema and gut issues. That's like a 40 visit baby. So we got a program based off of intensity in terms of our kids' cases. our care plans go from 18 visits, which is twice a week for nine weeks, two scans at halfway and at the end. And then we do 18, 24, which that's probably our most popular one, which is twice a week for three months.
ZT (33:17)
Yeah.
and
Spencer Dupre (33:35)
And
then our more intense cases start to get into our three times a week. So 28 is three times a week for one month, twice a week for two months. And then we have 36, which is three times a week for a month, twice a week for three months. And then we have a 40, which is three times a week for two months, twice a week for two months. And then a 60, which is three for three and two for three. And those six months is like reserved for like our sensory kids, like our nonverbal kids.
ZT (34:00)
Mm-hmm.
Spencer Dupre (34:01)
GLP, just all language processing kids. So we kind of ramp up based off of intensity like that, because it really is kind of hard to have like, it's either this or that.
ZT (34:04)
Yeah.
Thank
Right. Right.
I am always very impressed by the practices that like they have two plans. I think it's impressive.
Spencer Dupre (34:17)
Dude, it's hard, bro. Which I get it,
you can just sell. Hey, you need another 12 at the end of 24, you know? But I don't want to have to that sale again. And that's just where we're at, you know? I think for wellness-based chiropractic offices, dude, if you're like, I just want my baby to not be so tight. Those offices, dude, that's great, bro. 12 is a plan, bro. Babies are good. Babies that respond really fast.
ZT (34:23)
Mm-hmm. Yeah.
Yeah.
Yeah. Right.
Spencer Dupre (34:42)
that we typically will put on 18s is like our latching, like tongue and lip tie babies. Typically like that does a lot better, especially if you're working with a lactation consultant to help build the breastfeeding skills with mom. We'll typically do 18 visits for that. And our motor milestone babies, typically if babies are like four or five months and still not rolling over, within like two weeks, they'll start to like pick up on their milestones. And usually we just see them for 18.
ZT (34:54)
Mm-hmm.
Spencer Dupre (35:10)
So for a lot of our babies who are like, everything is pretty good, but mom is like, something's not quite right. And they're like, we really want to get ahead of this. That's kind of where we see 18 visits happen. So that's how we kind of program our kids. Like each one of the kids really do get like a different kind of plan. Typically people and families have the same kind of lifestyle. So typically family members will have similar plans. That's what we do for that. For our pregnancy care, I worked with Matt Morris a lot for this.
ZT (35:26)
Thank you.
Mm-hmm.
Spencer Dupre (35:37)
because a lot of places are like, just put them on a care plan and that's totally fine. You can totally put moms on care plans. But what we did is especially because we really want mom to one value wellness for herself and for her baby. Two, pregnancy is really overwhelming for a lot of moms and there's a lot of stuff that's going on and they need the flexibility because who knows, dude, if mom's like thrown up all day at 34 weeks and stuff like that, like how she gonna end? Like she has two more kids at home and she's pregnant with twins.
ZT (35:55)
Mm-hmm.
Spencer Dupre (36:05)
and her husband is a pilot and he flies. how is she going to make it in three times a week? Come on. So we'll do, we have a pregnancy wellness membership. It's $60 or 65 in adjustment or something like that, which is like two 60 a month. They come once a week. And then after 28 weeks, we'll start to boost them up to ramp up the care. So the closer they get to their, their delivery will actually recommend more care coming up toward their pregnancy.
ZT (36:31)
Nice.
Spencer Dupre (36:32)
And our moms really like that because it keeps it really flexible. like say baby is breach, then we can see them more often. And so that's great. But then if they're not, then they're good. And that gets them like really enrolled in like the whole wellness membership thing. And so they really kind of understand like how it works. And then so whenever we do the free consult and the scan and adjustment for baby, whenever baby comes earth side, then they're like, it's a no brainer for me to come back once a week.
ZT (36:56)
Right.
Spencer Dupre (36:56)
and bring my baby. So instead of putting people on care plans, I was putting people on care plans and that was like a lot of work. And then like, what if you finish all your visits before and then like, or what if you have visits left over? It just makes it like super simple if you just do a membership.
ZT (37:06)
Yeah.
Christmas.
Yep. Yeah. I think that's, that's super, super smart for him. I've done that just a couple of times, like once or twice. for those that are like, put that work in a pain-based clinic. we've had a couple of people, like they just want to get prepped for surgery. whether it's like labor or reconstruction, meniscus, whatever that might be. So we'll do more of a membership up to their, surgery. So if they're like, I'm getting this in three months, boom. But again, it's happened like once or twice for us. It's not.
Not a huge thing, but I think that membership is super smart for that transitioning to pregnant moms. And I'm assuming they're babies onto wellness for y'all. Yeah.
Spencer Dupre (37:44)
Yeah, a lot of
times we'll have like a mom come in like for her pregnancy care. and then we tell them like, Hey, you're going to automatically be enrolled for your postpartum care into our regular wellness membership. So you'll be automatically taken off of our pregnancy membership. Your fee will go down to our regular wellness membership. And then if you would like to add the baby or anybody else onto the family plan, then you can do that. And dude, a lot recently we've had a lot of moms be like, Hey, I delivered the baby. And then.
ZT (38:07)
Mm-hmm.
Spencer Dupre (38:11)
mom, baby and dad all add onto the wellness plan. And so that's been pretty cool.
ZT (38:15)
Mm-hmm.
Yeah. Um, do you ever just start someone on wellness? Like, did I ever just come in and you're like, that's
Spencer Dupre (38:23)
Yeah.
Yeah, we did that for dude. Me and Kate, we like wrestled with this for a while because at one point we were just like, let's just get people in the door. And cause we were still trying to figure out like our whole sales process and stuff, because for a while it was just me. like the whole, all of our systems and procedures were all based around me and the way that I say things, the way that I do things. But when you add another personality in there, it doesn't necessarily feel authentic, like for everybody, because now it's like, I'm trying to.
think, okay, what would Kate say here? And how can I have a congruent like experience for people like that? And so we had to sit down for a while and like really rework like our day one and day two and say like, okay, it's that it's not just my practice anymore. It's our practice. And so like, what is the tone of our practice now versus just me? And so what we did for a while, bro, we were like, everybody's going on a wellness. I think one time we had like,
ZT (39:03)
Mm-hmm.
Spencer Dupre (39:16)
27 new patients and they all started on wellness. And that's just cause we're like, dude, let's just get people chiropractic care, bro. Like who cares how much they come in? Like it's better to get adjusted than not. But I think we were doing that out of a lot of a lot of sense of lack being like, well, we don't want to be told no, because there's a lot of new stuff going on. So let's just make it so cheap and affordable that everyone is bound to say yes.
ZT (39:20)
Yeah.
You
Mm-hmm.
Mm.
Spencer Dupre (39:41)
And then, then we switched to the opposite where like everybody is going on a care plan. It doesn't matter if you've been adjusted from before when you were in your mom's womb and you're 40, you're going on a care plan and you're coming in three times a week. And so like that was like, dude, we're making it way too hard because then people were like, well, I want to get my whole family on, but I can't afford to do my care plan, their care plan, my other, my husband's care plan, all that stuff. And it's like, okay, well it's like, I can't give you 50 % off of each care plan.
ZT (39:53)
Hmm
Thanks watching.
Yeah.
Spencer Dupre (40:12)
and so dude, we just started making the decision, bro. It's like, is this a good wellness family or not? Or does this person need a care plan or not? And we just ran it through the filter of like, if this was my own mom or my own brother or my own kid, like, what would I put them on? Do they really need that? And I think one of the big things that clicked for me, I think about this quite a bit, but we had this mom, she went through a care plan. Her daughter went through a care plan.
ZT (40:25)
See
Mm. Yeah.
Spencer Dupre (40:39)
and they had signed her husband up for an initial visit and the mom and the daughter were still in wellness. I had prepared the folder and I was just gonna give the dad wellness, but he really needed a care plan, but I didn't think he was gonna sign up. And I was going to go into the report and Logan told me, hey,
ZT (40:54)
Mm.
Spencer Dupre (41:00)
The wife said that whatever you recommend him, just put him on the monthly payment option. And so I just need to know what you're going to recommend him so I can set all that up. And I said, wait, really? And she was like, yeah. I said, well then I was going to put him on wellness, but really he needs a 24. And so I went in there and he was like, great, done. And I was like, why am I recommending care with my hand on people's pocketbook?
ZT (41:26)
Mm-hmm.
Spencer Dupre (41:27)
all
of the time, like, because people are coming in, not because we're the cheapest office, but they're coming in because we get the best results. And it's like, dude, I just need to make decisions from that place. It's like, dude, what do they need? And like, do they need it or not? And it's like the same thing. Like I had a report yesterday. It's this like high school kid. He like messed up his neck, like back squatting and he's seeing our PT friend and I saw him and I looked at his scans and I was like, he does not need a care plan. And.
ZT (41:39)
Mm-hmm.
Right.
Spencer Dupre (41:54)
He, did the whole wellness field that you can pick like biweekly or weekly. And the mom was just like, we'll do whatever you feel like is the best recommendation.
ZT (42:02)
That's a, think like working with people when you give them that recommendation, when it's like this or that, they're like, well, what's the best one? And so they're like, you've already guided them to somewhat of a decision, but they want that extra guidance of like, what's like, what's the best recommendation of the two options, which is always so, so interesting to me.
Spencer Dupre (42:12)
Yeah.
Yeah,
dude, I think that in chiropractic, we, like dude, like if you go to the dentist and the dentist is like, you need a root canal.
ZT (42:31)
Mm-hmm.
Spencer Dupre (42:32)
You're not going to be like, well, I mean, he's not going to be like, well, you know, like we could just not do the root canal. Cause you, know that you can't afford it. He's about the, you either need it and you get it or you don't. And like, these are my recommendations. You're coming for me from my opinion, you know? And I think that we, as chiropractors like need to do a better job of giving people like legit recommendations instead of,
ZT (42:41)
Yeah.
Spencer Dupre (42:56)
Instead of just like trying to say like what are they gonna sign up the most for for the sake of saying like I have a referral based high conversion cash practice who cares what your referral who cares what your conversion percentages bro who cares how many internal how many referrals you give her do you help people or not
ZT (42:56)
instead of just.
Right. Cause I, I know I've personally seen a lot of people from those referral type, you know, high conversion onto wellness clinics and you re-scan them and look at everything. I don't know what's been going on because you're not getting results.
Spencer Dupre (43:24)
Yeah.
Well, then, and like we have an internal referral base practice. We have a high conversion, high like to care and high conversion to wellness practice. At the same time though, it's like those people should do that because we are building them value. And it's not because we're telling them like, if you don't continue with your chiropractic care, you're going to have disc disease. Or like, if you'd like your kid is going to stop talking if they don't get adjusted or like.
ZT (43:29)
Yeah, for sure.
Mm-hmm.
Hahaha
Spencer Dupre (43:50)
those kind of things, dude. So I think it's important to give care in the way that you feel that's in most integrity with you, anything else to add?
ZT (43:57)
100%.
No, think it's, if you're like just starting in practice and you're like, man, this is overwhelming. It's going to take time. Right. think that's a big thing too, is if you are starting right away at a school and you don't have a mentor that can help guide you on making recommendations because you didn't do an associateship or maybe your internship didn't have that. that would definitely be a recommendation to get a mentor in that sense. but I think too, like if you're going through your internship in school.
ask the doctor, like ask the person that you're under, like, why are we making these recommendations, even if it's not the same model? Like if you're in a pain-based internship, but you want to be more pediatric prenatal, it's still nice to start to understand, like, why is this doc that's been in practice for 20 years making these recommendations? You start to get a feel for that, so.
Spencer Dupre (44:45)
Mm-hmm.
Yeah, if you were talking to startup Zach, which I guess we're still in startup mode, you can maybe or maybe not. If you were talking to day one Zach, like our episode one Zach, and you could tell you would only, and he could only give out one care plan, which one would you tell him to like, to write up? If you could only recommend one thing, like, because like, let's say you're like, I don't have a care plan based office.
ZT (44:53)
Yeah.
Spencer Dupre (45:16)
I don't give recommendations, people just come in whenever they want and I want to start giving care plans. What would the one care plan you would recommend the most?
ZT (45:21)
I would-
Probably the 20. Yeah, this is the one I recommend the most. So either the 20 or the 28.
Yeah, more about you. Yeah.
Spencer Dupre (45:31)
The 24
Yep twice week for three months. That's Probably I feel like it's good all around not too much not too long not too expensive good results Yeah, okay guys, let us know what you're doing for your care plans And if you found this was valuable, but thanks so much for listening to the one hour podcast. We'll catch you guys later. Peace
ZT (45:39)
Is this?
Yep. 100%.
Peace.