Activate Your Practice Podcast
The Activate Your Practice Podcast is hosted by the Chairman & Founder of Activator Methods, Dr. Arlan Fuhr. This podcast will cover a variety of subjects. Dr. Fuhr will interview guests from different backgrounds and professions, as well as talk about his 50+ years in chiropractic care.
Activate Your Practice Podcast
The Business Mindset Behind Successful Chiropractic Practices with Dr. Mark Sanna
Every breath has significance when you're the son of a chiropractor – especially your first one. Dr. Mark Sanna, CEO of Breakthrough Coaching, opens this compelling conversation by sharing how a chiropractic adjustment from his father literally gave him his first breath as a "blue baby" born without oxygen. This profound beginning shaped his lifelong connection to a profession that he now helps others master through his coaching enterprise.
The heart of successful chiropractic practice, Sanna reveals, lies not in clinical skills alone but in the foundational business principles rarely taught in school. "It's not how much you make, it's how much you keep," he emphasizes, sharing how his 30-year discipline of consistently investing 10% of his earnings has created financial freedom through the magic of compounding interest. This wisdom proves especially valuable for new practitioners who possess time – the most powerful wealth-building asset.
Sanna addresses the challenging reality of insurance reimbursements frozen at 20-year-old rates despite rising delivery costs. He advocates for a balanced approach incorporating cash services, where practitioners effectively communicate the value of investing in health. "Your job is to make their health a priority," he explains, highlighting how skilled practitioners help patients recognize that discretionary spending on wellbeing delivers returns no other purchase can match.
The conversation shifts to sustainability practices for busy practitioners, with Sanna offering a counterintuitive insight: "You're either expanding or contracting." He explains that regular environmental changes – whether weekend retreats or seasonal homes – provide the mental expansion necessary to prevent burnout and maintain practice vitality. This perspective challenges the notion that constant presence equals greater success.
Breakthrough Coaching distinguishes itself through integrity, systems-based management, and consultants who've personally implemented these principles. Sanna particularly emphasizes succession planning – helping practitioners create actual value in their practices that translates to retirement security while ensuring continued patient care. For listeners contemplating practice growth or transition, this discussion offers both strategic wisdom and practical next steps toward building a sustainable chiropractic legacy.
Ready to transform your practice with proven systems? Connect with Dr. Sanna at mybreakthrough.com or call 800-723-8423 to discover how coaching can help you achieve your practice goals faster and with greater certainty.
Hi, I'm Dr Arlen Ford, the chairman and co-founder of Activator Methods International, and today I have with me Dr Mark Sanna, who is the CEO of Breakthrough Coaching. Good morning, mark.
Speaker 2:Good morning, arlen, great to see you.
Speaker 1:Well, we're glad to have you here and you know you've built an amazing organization to help chiropractors in the field and I would like to have you give me a little background. How did chiropractic find you?
Speaker 2:Well, thanks, arlan, and thanks so much for having me here on the podcast and allowing me to address your audience. My background in chiropractic is I'm a chiropractic kid and my dad God bless him is 91. He's in his 61st year as a chiropractor, still gives a great cervical adjustment, which was a fantastic thing, and my history, you know, goes back to the time before maybe chiropractic was as accepted as it is today. And I certainly can remember getting into scraps on the playground when people called my dad a quack and I'm like, oh, he's not a quack and going after him.
Speaker 2:But the story they tell me and there's a lot of chiropractors who will say I owe my entire life to chiropractic and I really do. I was born a blue baby, so no oxygen, and at that time they would not allow chiropractors into the delivery room, right, probably even the dad wouldn't go in the delivery room. But dad is watching through the window and seeing his little boy not breathing and it came in and actually gave me a chiropractic adjustment and I breathed and that my first breath on this planet was due to a chiropractic adjustment from my dad.
Speaker 1:Well, that's pretty dramatic. It's a dramatic start.
Speaker 2:It's a dramatic start and chiropractic has just been a part of our lives ever since. Some people go through the journey of discovering chiropractic, for us it was always there. We were kids, we got the mumps. Dad would wake us up on the hour, adjusting us Morning. The mumps are gone and we were all upset because we had to go to school the next day.
Speaker 1:What's your definition of a successful chiropractor?
Speaker 2:Well, for me, a successful chiropractor, a successful person in any business, is somebody who really has taken a look at what their core values are and builds their business, builds their practice, around their values. You know there are so many creative ways to be a chiropractor. You can be anything from pediatric to geriatric to sports and in between. And for me, my core values are truly my faith, my family, my personal fitness, my financial freedom and my ability to have fun. No-transcript groundwork of who am I, why am I going to be in practice? And it's not for the money.
Speaker 2:I can tell you that that you and I both know. Parker said it many, many years ago loving service is my first technique, right, and if you're chasing money, you're always going to be chasing money. And when you go in there and you give great loving service, you have to know the business, and that's part of my story as well as God bless my dad. He taught me how to be a chiropractor, but he didn't teach me how to be a business person. So I've been broke and didn't know what that's like to go through that and then to actually learn good business principles. But I like a chiropractor who knows why they're in practice. It gives you a sense of certainty, and I also feel that there is a certain amount of security that comes from knowing that your financial needs are met, your family's financial needs are met, and that's from giving great service.
Speaker 1:You know you struck on something there, because I'm around students a lot and, coming out of chiropractic college, they're quite qualified to be a chiropractor but they don't know step one in business, and so I kind of hear you saying that you had to learn that. What would you say were the couple of things that you learned that helped you propel up to the place where you are today?
Speaker 2:Yeah. So for me it was a big learning that it's not how much you make, it's how much you keep. And so when you first start generating income and you know, my dad was first generation American and went through the depression, and so they never had money and never learned how to manage money but what I learned later on is that not only do you have to have money in the bank, there has to be a level of profitability in the practice. Nobody ever talked about profit and it was just okay, great, open up the envelopes, put the money in the bank. If there's money there, we're happy. If there's not, we're not so happy.
Speaker 2:And I didn't learn until later in life the value of savings. Tell you, today, 10% of my earnings and this is for at least the last 30 years has gone into an investment account and I've never touched it, never see it. And that compounding interest is the key to creating wealth. And if you're a student listening to this, your 10% might not be as big as my 10% is, but you have the advantage on me of time. So as your 10% grows in compounds and compounds, it gets you into a situation where your money's working for you and you're not working for your money. So I wish I had learned those two lessons is like being rich is no good if you don't have any money in the bank and the power of compounding interest over time. I think I wish I had had that information. You said what would you tell your younger self? That would be probably one of the lessons I'd write in that letter.
Speaker 1:Well, you know, I'm a Dave Ramsey fan. And if you've ever listened to Dave Ramsey and that's something maybe we should stress to students is check Dave Ramsey out, because he's talking about being debt free and how you have to have a budget and you have to live within it, and I see many young practitioners making quite good money but they're spending it all on dumb things and I think that's lifestyle which changes and goes away, and all that kind of thing.
Speaker 1:Then all of a sudden they end up when they're 55 and they're saying what am I going to do for retirement if they'd have been doing what you've been doing for 30 years? You know, it's easy to be a millionaire if you put money away.
Speaker 2:Absolutely, absolutely.
Speaker 1:What do you think the reimbursement system today is? It's changing and I'd like to hear a little bit about what your thoughts are on the insurance reimbursement.
Speaker 2:Well, that's a great question. My dad has a quote. He says, mark, I spoke, I practiced before there was insurance reimbursement, when they had insurance reimbursement and when they took it away. And so there is no doubt in my mind that insurance reimbursement, when you look at the reality of today, is declining for chiropractors. There are many chiropractors who are being paid on fee schedules that are literally 20 years old, that there has not been an increase in their reimbursement rate for 20 years. And now it costs you a heck of a lot more to deliver an adjustment today than it does 20 years ago. I can tell you. You know, when we look at inflation and overhead and cost of staff and all of that, there should be commensurate increases in reimbursement. But there's not. And so today you absolutely and I'm not saying step out of insurance.
Speaker 2:Insurance has a purpose, but you must, must, must be able to embrace cash services with a patient. You have to be able to deliver value, communicate value in a way that the patient is willing to pay their discretionary income for their health. So your job is to make their health a priority. You know, you ask people what's the most important thing in life, right? Not money, it's health. If you don't have your health doesn't matter how much money you have, and so knowing that you are delivering a service that can improve the quality of people's lives, their longevity, their ability to stay mobile and autonomous in their older years, that's a big darn deal. The third-party payer system has not caught on to that. It's for sick care.
Speaker 2:Chiropractors, we do health care, and so being able to deliver a service and charge a fair price for it and be paid cash is essential. That's not to say that, as the chiropractic profession, we're not working very diligently behind the scenes to make sure that some of the terrible reimbursement practices literally abusive reimbursement practices for chiropractors, are not being addressed. We are addressing them. We have legislation climbing up Capitol Hill again for a Medicare Modernization Act, which hopefully we're going to have this time come around and be able to have our patients be reimbursed for their exam. Imagine we have to do an exam to be paid. We don't even get paid for our exam for Medicare to be paid. We don't even get paid for our exam for Medicare. So having fair reimbursement, having fair access to chiropractic care, those are things that are absolutely at the top of the minds of the leaders of the profession today.
Speaker 1:You know, having a practice that's cash has been a lot of the ways a lot of people have gone. I've got several people in our activator club our instructors and so forth that have just switched to cash. It was a bit difficult in the beginning, but it turned out in the end to be the way to go and they wouldn't go any other way. And so what do you think of a cash practice?
Speaker 2:Yeah, I often say you know, when you address an audience and I ask them raise your hands, who are the guys who, or gals, have gone all cash and those will be the one who raise their hand. I said well, you didn't have to raise your hand because you're the ones who are smiling. Exactly, it truly is. The third party payment system that we're involved with is really a square peg in a round hole. We're not meant to fit in that hole and, that being said, the pioneers who've gone before us, the people like my dad and yourself who fought the battles to be able to have us recognized in the health care system that there is a cultural authority that comes from having insurance reimbursement there.
Speaker 2:It's not easy to start a practice from scratch completely as cash, but certainly there is a point in your career that you will reach when you should no longer be beholden to insurance reimbursement. That you've built a practice, a following of patients who will come and pay the money for the service that you've given. That's a great point, and so I think every chiropractor should be thinking of okay, when do I meet that point where I no longer have to take these things? Insurances that are four visits, five visits with pre-authorization and a stack of paperwork, but I can go in and enjoy my patients and enjoy delivering my care and my adjustments, you know having a successful practice is fun, but it can also be stressful.
Speaker 1:I remember being, you know, in Minnesota for 25 years and having a big, big practice, and it was fun as could be, but by the end of the week you were looking for something you know to relax with. What do you do to help people with that kind of problem?
Speaker 2:What do you do to help people with that kind of problem? Well, I tell you the one thing, and I'm sure you know, arlen, that when you're managing an office of that size, you can't do it alone. You've got to have great people around you. You have to know how to delegate, you have to know what you do well and stay in your wheelhouse. You must keep the big picture of the business. You've got to watch your bottom line, but you don't have to micromanage everything. If you're going to have a really successful practice, you need folks to take care of all of the myriad of things that you don't even think about. My goodness, just HR alone today, where people quit my text. Or things that you don't even think about. My goodness, just HR alone today where people quit my text, or they ghost you. Or people say you know, listen when we practice. Never have a staff member call and say I'm taking a personal day. What do you mean? A personal day?
Speaker 1:Well, you got a hundred people coming.
Speaker 2:Yes, personal day. Well, you got a hundred people coming. Yes, exactly. So I think have a great team, pay them well, pay them as much as you can possibly pay them. And the reason is you want them to stay. You don't want them looking at other things, you don't want them driving Uber. You want them to say this is the best job on the planet. I love Doc, I want to be here. I think that's really key. So, number one have great people around you.
Speaker 2:The other thing is understand. You know you say you got to sharpen the saw means you got to recharge your batteries and you cannot be a healer, you cannot be a business person, you can't be an executive or an entrepreneur if you don't take downtime to recharge your batteries. And literally that means you know staycation is fine, but change your environment. Go out of town, even if it's for a drive, and meet new people, have new experiences, and you're going to come back into that practice energized and revitalized. I've spoken to some docs who haven't taken a scheduled vacation in 20 years. That is just not the way to stay healthy and balanced in life, right.
Speaker 1:No, you're really onto something here. I've had a theory for years and I've never talked much about it. But ever since I became successful this is 30 years ago I always had a retreat. And I remember in my Minnesota practice I had a lake house 38 miles from the practice. I would leave on Friday night and I wouldn't come back till Monday morning. It took me exactly 41 minutes to get there, but when I drove across the bridge I knew I was in a different country, a different feeling. I relaxed and I started to tell students to this day I have a summer home in Phoenix. Somebody said how do you survive the summers? I said in the White Mountains, home in Phoenix. Somebody said how do you survive the summers? I said in the White Mountains. You know, it's the break that really helps us continue along. You know life in practice.
Speaker 2:You know, arlen, I have a saying you're either expanding or you're contracting. And if you're in the practice think about a boxer in the corner of the ring and they're getting hit, and they're getting hit, and they're getting hit eventually you start hiding in your corner and that's kind of what it's like. If you're in practice and you're getting the hit, and you're getting the hit and you're getting the hit, you start to contract inward. Getting out of that environment allows you to expand your mindset, expand your vision. Right, move your body and be in nature. Right. Being in nature is tremendously expansive, right. Being stuck in four walls in an office all day long, that's not tremendously expansive. So, you know, do a little pulse check. If you're listening, am I expanding or am I contracting? And if I feel like I'm in contraction phase, take a day, take a couple of days and get out and change your environment.
Speaker 1:Now, what makes breakthrough coaching different? You know there's several of them out there. However, I've kind of noticed maybe you can confirm this there's not as many out there in the coaching business as there used to be. It's only the ones left that are really good at it that are left. Am I correct in that observation?
Speaker 2:Yes, yes, it's a really interesting profession. You know, I was very, very fortunate to grow up and always have coaches, because my dad always had coaches and we came up with some great, great mentors. The vision early that having a coach is a really important thing in business and life and having somebody having an outside perspective on my practice that I'm so inside of was really, really important to me. I think what's happened is that the pace of change is accelerated. Yes, the pace of change is accelerated and right now, with AI and all of the beautiful changes that are coming from that, it's harder and harder for the practicing doc who's in there delivering adjustments every day, to keep up with all of the changes, and whether it's changes in reimbursement or changes in marketing I mean, marketing has transformed with AI. What you can do now in your practice with AI would have cost you thirty, forty thousand dollars to have somebody do what an AI assistant could do for you now online, right. So I think what has kept Breakthrough Coaching on the forefront number one is our integrity that we don't go in any gray zones. We stay straight all of the time. We know that value is the most important thing and having certainty in your procedures. We also know that systems are what makes success. We also know that systems are what makes success, and if you're baking the cake fresh every day, you might forget something in the recipe, but if you're working a recipe and you're working a successful practice, knowing those systems are really key. And so we've had literally 30 years of refining systems in thousands of chiropractic practices. So it gives you a national vision. Trends move nationally.
Speaker 2:I think what's also different is we're not a mom and pop shop. We have a team of consultants that were all Breakthrough Coaching members first. So remember, in the beginning I said I was a client of the company. I don't know if I told you that I was first a client of Breakthrough Coaching, hired them to manage the practice and then I bought the company and that's how I got involved with Breakthrough Coaching. And so I followed that with all of our consultants. They've all been successful, brought their practice over the million-dollar mark and have an aptitude to coach, and so that's been one of our secrets is you're coached by somebody who's been in your seat, not 20 years ago, 30 years ago, but right now, and knows what's happening in your region and in your area to keep your practice growing, keep it moving, keep it on the cutting edge.
Speaker 1:Who is the ideal client for you?
Speaker 2:For me, the ideal client has been out of practice 5, 15 years. They are interested in growing their practice, maybe taking their practice to the next level. One of our specialties is we have the number one program for multidisciplinary practices. So bringing a nurse practitioner or a PA into your practice, but doing it smart, doing it in a stepwise fashion. You do it wrong, you can sink the ship. You do it right, it's a beautiful way. Collaborative care is a beautiful way to deliver service. So I like to work with folks who want to be coached, who want to grow their practice and who are also interested in their exit strategy. So that's kind of the unspoken conversation in chiropractic is what's my plan? And a lot of docs. Their plan is to work till they drop dead and I want to make sure that they have a successful plan for succession in the practice, a successful plan for sale of that practice eventually, and I like to say you don't ever have to retire.
Speaker 2:You just don't have to own your practice. You could work in it, but having an exit strategy is really key and I love working with docs toward that end.
Speaker 1:I think that's a huge, huge thing, because I remember one time some of my friends who were getting up in age came to me and said what do you think my practice is worth? And I said nothing. And they said what do you mean? Nothing, I'm doing 100 people a week or whatever it was.
Speaker 1:And I said it's not worth anything until you can have it turned over to somebody that can actually carry it on. And they said well, how do I do that? And I said there are plenty of people out there. Just be careful who you go to to get a succession plan going. And I remember a couple of my friends good friends that retired and they're making the same amount of money per year for 10 years. They were 65 when they retired.
Speaker 1:They're making the same amount of money for 10 years. That's how they sold their practice. Now, if you're out there listening to this, you know you can call Mark and he can tell you how that goes, because there's contracts, there's all different kinds of things to help you take a good practice. You don't want to leave it either, because you want your people taken care of. And so in the activator world, you know, we now have, oh, 2,000 proficiency-rated doctors and you can go to an activator practitioner around the world. That only took 15 years.
Speaker 1:You know people want a quick success around the world. That only took 15 years. You know people want a quick success. But what we're trying to do is is say, we want you to be able to get a standardized adjustment wherever you are. And so this is why there's such a good well, we're having our doctors look for young kids coming out of school because they know the technique, so then they can teach them the business and that kind of thing. So, uh, how do they get a hold of you, mark? Because you've been generous with your time here, I want them to know how they can get a hold of an expert, and so tell us how we contact you.
Speaker 2:Well, thanks, arlen. You can find me online at mybreakthroughcom and you want to spell out the word breakthrough M-Y-B-R-E-A-K-T-H-R-O-U-G-Hcom. You can give me a ring at 800-723-8423. It's 1-800-7-advice the word advice and a good thing about having. So there's not a lot of Arlen Fours in the world. There's not a lot of Mark Santas either. So if you Google Mark Santa, you're going to find me and you'll find my LinkedIn profile and on all the social media. So that's kind of having an interesting name also makes it kind of easy to be found.
Speaker 1:Well, you know. There's one last question I had. I know a lot of people that practice, manage and things like that, and one of my friends said you know, 80% of people don't want to be successful. He said so we only help the 20% that do. And I wonder does that make any sense to you that those numbers you know what?
Speaker 2:We are an interesting profession. We are a profession of very independent thinkers, and so we don't often join our state associations or join our national organizations, because we think we can do it on our own. And you can only coach somebody who wants to be coached. I've learned that over my career and so that it may be right that it may be that 20% who understands yeah, I can do this on my own, but I can do it faster, better, smarter. Having somebody who's already been there take me along the way, you know. I like to say if you want to make a million bucks, don't ask your buddy, who's making $80,000 a year how do I make a million bucks, because he'll tell you how. And you want to have somebody who's already been there, been in your shoes, gone through what you're going to, and then can share their life experiences with you, and that makes the journey so much less rocky, it makes the climb smoother and it makes it happen quicker for you.
Speaker 1:Do you also take new kids out of school?
Speaker 2:We do. We have a new practitioner program that starts them at a very, very low fee to get them into the program. It's still individual. We do one-on-one live coaching, so we are a coaching company. We put on beautiful seminars. We have an amazing website with great resources, but we are a coaching company and so we absolutely love to work with students. I have a call this afternoon with a gal who's just getting started in Birmingham, alabama, so shout out.
Speaker 1:Oh, there you go. Well, dr Mark Sanna, the CEO of Breakthrough Coaching, thank you for your time and wisdom, and I hope your students are listening and some doctors out there that are getting ready to retire, and I hope we've been of value to you. Thank you much, mark.
Speaker 2:Thank you, arlen, thank you so much.
