EP31: From ABC to AFP: The Secret to Next-Level Patient Retention

Most chiropractors are still operating with the old-school mindset of Always Be Closing. But what if the real key to growth isn’t closing—it’s future pacing? In this episode, Dr. Austin Cohen breaks down how shifting your focus to Always Future Pacing transforms the way patients commit, engage, and stay. Learn how to create anticipation every visit, build trust through clarity, and make every touchpoint count—before, during, and after care.

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Transcript

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This is the Austin Cohen Podcast where we talk real strategies for chiropractors ready to grow beyond the adjustment. If you're building a business, developing your leadership, and trying to build wealth without burning out, you are in the right place. Let's get to work what's up everybody? Welcome back to the Austin Home podcast. Happy November. You guys have now been listening to this podcast for 30 episodes, so congratulations and I hope you've gotten value outta this 30 episodes.'cause man I'm getting value sharing this with all of you. And so thank you to so much great feedback for all the people that have shared their feedback because it's been pretty cool to listen to what some of you guys have been doing. Shout out to my. Corrective chiropractic family lot of record months in October, and one thing we talked about recently was like, now is the time to put the gas into the fire. This is when most clinics start to slow down and they start to calm down. Nope, yes, the week of Thanksgiving. Shut it down the week of Christmas, shut it down. But those are two out of the seven weeks upcoming, and it's very easy to start making excuses for why you're gonna be slow the next seven weeks. You're gonna blame the holidays, you're gonna blame people outta town. You're gonna blame the economy. You're gonna make excuses. And deep down the mature clinicians know that all those are stories they're telling themselves because why are there other people doing really well? And it's easy for me because, with 13 locations, I'll see some doing really well and some not doing really well. But same economies. But it all comes down to mindset. And it's normal. Like I was on a phone call today with one of our team members people gonna slumps, that's normal. And fortunately, I'm grateful for such an awesome team who can be really self-reflective and look within and think, not sharing the slump to me to complain, but more so the strategy about, Hey, how do I lead better? How do I create a better experience? Where am I missing here? What's off with my mindset there? And it's interesting how, if I look at our October for corrective chiropractic as a whole, I look back at our, we do a doctor's call once a month, and if I look back at that last doctor's call, it was all about. The podcast episode where we talked about visualize, affirm gratitude, and many of my doctors took that very seriously and trusted my process in that, and the ones who did had unbelievable months. And so just shout out to them. Really great to see that is more true than anything I've ever done in practice as far as systems, is the flywheel effect of being a magnet. You visualize, you affirm it and you write gratitude out. So today, what are we gonna talk about? Man, today we gotta talk about the real reason why people drop off.'Cause I'm learning a lot with chiro 80, and I'm learning that most of the chiropractors out there getting their patients to stay for about three weeks. And I think a lot of it has to do with, because no one is telling them where they're headed, where they're going, it's. Patients come in because they're symptom-based usually. Now that's not why they stay, because hopefully their symptoms are gone and you've gotta figure out why are they gonna stay with you long term. And that's where obviously the education comes in and that's where the future pacing comes in. Because here's the deal, the old way, the old mindset shift when I was a young chiropractor was this always be closing, easy to do when someone's emotional decision, what's not easy. My mantra, which is a FP, always future pacing. When I when we focus our energy on closing it, everything becomes transactional. Your energy is transactional. But when you focus on future pacing with your patients, and that's where the energy goes, it becomes transformational rather than transactional. And take it and think about it. Are more patients gonna stay in a transactional or transformational relationship? Bingo, transformational relationship. In a future pacing, that's where that happens because they know where they're going. It's you're building trust with them. There's anticipation for where they're going and it keeps them excited about their journey for where they're headed. So really my goal by the end of today is you'll have practical steps you can start implementing that will make your interactions more engaging, more personal, and really more powerful for your patients. So people aren't quitting chiropractic care'cause it doesn't work. We know that. They're quitting because they know they don't know what's next. And when you can be very clear in your communication for them, and also then lead your team to have that same experience, you win the game. The way we always think about it is we're all cashed. We're out of network with every insurance company, and we know that there will be times where people leave us and go in network. What I want to happen is when they go somewhere in network. Every interaction they think in their brain, wow, my other chiropractor did it differently. Corrective chiropractic did this, corrective chiropractic did that. And every interaction, I want them to be thinking about that because if I'm just like everybody else, why would they stay with me? It doesn't matter. And that's where the future pacing and that's where the experience is gonna come into play. And I'll share some great examples about that. The old way, I graduated chiropractic school in 2009 and it was really all that a, b, c mindset. Just closing people on care plans. Close'em at the re-exam, close them on upgrades. I just closed, close, closed. And from a patient perspective, I bet there was times they felt like a number rather than being a person on a journey, not a patient, a person on a journey. You're calling patients not when you need something from them. But you're calling them because you want something for them and you're being proactive and it's a completely different mindset shift. And here's what I know, what I'm about to share right now. It takes work and it takes time. But what it does is it, rather than you just patching up and band-aiding you leaky bucket, you're actually building a steel titanium bucket. There are no leaky holes in this bucket. Okay? That's what you really wanna be focusing on. In chiropractors, it's very easy, like when you sign up, like everyone knows this. When you have Chiro 180, you know that it takes work. In the beginning, you gotta enter your new patients in your new patient manager. Yeah, it takes a little bit of work. Maybe take two hours of work. It's a little bit of work, two hours. But what it does, it gives you information for the long term. It gives you your black hold number. It gives you. Your referral sources and your ROI by who's referring you business into your clinic, it gives you your churn rate, it gives you your resign to drop off ratio. It shows you your commit percentage. It shows you your doctor performance report, like it's giving you all this data by putting in the work, or you can be reactive. And when you don't have, when you're low on new patients and you can figure out what you're gonna do or when people aren't closing into care, then you can be reactive and think about what you're gonna do now, or build the process early, build the programs. All comes down to an energy shift of always be future pacing. It is a philosophy where you're guiding people, you're not really, you're not pressuring anything. So it's every touchpoint before visits, during visits and after visits. Think about it like this in your SOPs, when you're documenting future pacing, you put in patient clarity and patient direction. Lemme give you some examples. So what I was talking about with one of my team members not that long ago, was. He was just mentioning his close rate has gone down a little bit, which is normal, and, but we, what he was asking, really self-reflecting questions and internal questions, and I love that. So we talked about, all right one thing we did before that worked really is before day one, office manager calls the patient and says, Hey Johnny, we're so excited to see you tomorrow. By the way, thank you so much for filling out the new patient paperwork and paying your deposit before you come in. When you get here do you, have you been to this building before? No. Great. Where you park is, you're gonna park in any of the spots that say the story at the air more. Feel free to park in any of them, and then you'll come to the second floor. We'll greet you right when you go off the elevator. Also, we have kombucha, hot tea, coffee in our office. Would you like us to have anything waiting for you when you arrive? No, but thank you very much. What are they thinking? Wow. Wow. Wow. What do I always talk about? Wow. Experience. Welcome, optimize, win. Wow. And that's what we're looking for is we're, once again, we're trying to create wow experiences. So then what do we do? We do that. So we ask them if they have any questions, and then they come in for their appointment, and then what happens next? The doctor will call them after their first appointment and say, Hey, Johnny, listen. Great meeting you today. I'm about complete with your spinal health score. Once I get this updated, I'm gonna be able to figure out exactly what you need and put you on the path to performance. And what we're gonna be looking at is really understanding what do you need over the next few months to get you the results you're looking to get where I know you wanna get back into running and I wanna be able to do that long term and sustainable. Do you have any questions for me? Nope. Great. I'm gonna finish going through and updating your spinal health score. Then what we'll do is I'll put together the plan for you tomorrow and we can go through that to help you get the results you're looking to get to as well. Okay, great. Johnny's thinking what again? Wow. Johnny comes in gets adjusted. Hey Johnny, it's Dr. Cohen. Hey man. Just wanna check in. How's your body holding up after your first adjustment? As I shared with you earlier, you could be sore, you may feel nothing, you may feel better. What's tell me about your body. Hey, doc, I actually feel the same. Great. That's what we're expecting. Do you have any questions for me about anything we went over today? Nope. Everything makes sense. Hey, great, Johnny, listen. I'm really excited for this journey that we're gonna be going on together. I will explain to you every single thing we do at all times. So any questions you have, let me know. What, at your next appointment when you come in, go ha and have a seat in the white chairs, and then that's called our, let me show you visit because we're gonna show you again how to do all the exercises to make sure you're doing them correctly. Like I said, anything you need, let me know. You have our office number to text us whatever questions you have. But really excited to get started in our initial intensive phase. Great. What am I doing in these conversations? I'm letting him know it's gonna take months. I'm letting him know it's gonna take a journey. I'm letting him know what phase he's in. I'm letting him know there's a spinal health score that we're gonna be tracking, and that's gonna be the objective tool that we're gonna be utilizing to make sure how he moves through all the different phases. It's not subjective, it's not based on feelings, it's based on facts. It's based on data, it's based on objective. And he's now anchored into his score too. He's anchored into, oh, got a D, he got a C minus, whatever. It's, it doesn't matter. But he knows there's room for improvement, and I need to explain to him as his doctor, where we're going to get him to the highest score possible on what he can do. So that is an example of how somebody could future pace. Now, during adjustments, I call it the, it's all the F's. Hey Johnny, here's what I'm feeling for, by the way, when I'm putting my hand and touch these joints I'm looking for the triplets. Tender taut. I'm, look, I'm looking for the temp. I'm looking to feel where the temperature is. I'm looking to feel where it's tender. I'm looking for top fibers. We're looking at those different things. So that's what I'm feeling for. Hey, by the way, hey, Johnny, here's what I found. When you were face down, your right hip was sticking up a bit higher than your left hip was. Hey Johnny, when you walked into the office today, you know what I noticed? I noticed that your right shoulder is starting to get, come down and balance that more with your left shoulder. Now, we'll reevaluate that in two weeks for you so we can see exactly where you are. Remember, you're still in spinal stab, you're still in initial intensive, and in two weeks we're gonna be graduating you a spinal stability and strength phase. I'm just constantly letting'em know where they're going. Hey, I adjusted today. This your T two area, by the way, I noticed your f you had some forward head posture. Yeah. You been in front of the computer a lot recently. Yeah, so this area was loaded up a lot of extra weight. By the way, you're still about three weeks out from your first re-exam, where we'll track again, your spinal health score, get that updated. So we'll be able to look and see range of motion. We'll look at posture, we'll look at all the mechanics of your body, so we'll get that updated. I'm always talking about where they're going, by the way, now, if you're using Chiro 180, then the step one is always find your black hole. Where are people dropping off? Yes, it takes work to find that number. Find it because that will fix all your problems. Once again, you don't wanna be the reactive doctor who's always putting out fires. Build the fire department. You do that by finding your black hole, and if you know it's a nine, then guess what you do at visit five. Have the doctor make a phone call. Hey Johnny, just wanna check in. You've been in my office about two weeks now and you're getting so far. The results have felt pretty good on my end, how you've been feeling. Doc, I've been feeling so much better. Great. Listen, you are two weeks away from your first re-exam and as you start to go through, what starts to happen is now you're starting to feel better. People start thinking why do I need to be coming this often? Whatever. I understand those questions and concerns you have, but how? Lemme tell you this, in two weeks, we'll reevaluate. We'll track your progress, we'll see where you are. We'll update your spinal health score and then I'm gonna give you some exercise to start doing because I do wanna lower your frequency down to coming in less so then at visit six you could do something different. You're always future pacing. You're always future pacing. Okay? You're not selling care plans. You are showing them the roadmap to a better version of themselves. Start thinking different mindsets, different belief systems, different language you're telling of yourselves. The power of the tongue guys, like retention does not come from hard closes. It just comes from consistent clarity. This is not hard. This profession, you're changing people's life. People understand that they'll be on this earth one time. And you're creating a journey and a path for them to live that at the best possible way, show them that, lead them into that. Patients who know where they're going. They will stay longer and they will for refer more people to you, and they will give you that sense of trust. So start changing the language. Lemme give you guys some strategies or some action steps if you're note taking right now. Number one is this audit your patient communication right now. Are you future pacing your patients or are you following up reactively? So for example, a patient says to you, how many more visits do I have left? Now you're reactive thinking. Patient says, how much longer do I need to come? Reactive? When's my next re-exam? Reactive. I wanna quit care. Reactive, future pace them. Be proactive in your communication. And if you need to build scripts, that would be step two, build scripts. What does your reminders look like for your pre-visit and your post-visit calls? You have a visit, five phone call or a visit, six phone call. It doesn't matter. You're just creating touch points to explain the patient experience. Number three, teach your team. Listen, I do a great job of future pacing. I had to learn that the hard way. I used to be reactive. So what I got really good at was every visit when you're outside my bay, I'll talk to you about whatever you want. When you're inside my bay, inside my semi open adjusting area, we're only talking chiropractic. Why? Because that's why you're here. You're not here to be my friend. You have friends everywhere. If someone feels like they're my friend, they can quit at any time. But when they feel like there is a value exchange for why they're coming in there and they trust me as their doctor, that's when they'll stay forever. Number four, celebrate the milestones with them. Hey Johnny, you're halfway to your first updated spinal health score to get you into spinal stability phase. You're on track for moving into spinal stability strength phase. So what, here's what I wanna see. I wanna make sure that we have increased range of motion and we are postures, has slight improvements, and then if we see that we're gonna move you into that next phase of care, great. Celebrate the wins. Hey, you're halfway to your first set of x-rays, Johnny, whatever it is. I don't know why I keep using the name Johnny, but I do. So that's what we're gonna stick with for today. The other thing is this guys make this a FP. Make it a standard for your company. Don't just make it a system. Make it the standard and change the language. We're getting out of the closing mindset. Like I said earlier in this conversation, it's easy to close people. They're emotional states. Yeah, they're gonna sign up. Why? Because they're in pain. You're looking for commitments. You're looking to future pace them and transform their life. So those would be some five action steps I would take for those that are new to this now. I think here's a closing reflection that I want you to think about. If every patient walked out of your clinic knowing exactly what's next, you see a hundred a day. If all hundred in that day knew exactly what was next, not just in their care but in their health journey, what do you think would happen to your retention? What would happen to the culture of your clinic? Start thinking of that and in the last 30 episodes I've done, I've only given strategy and tactic and things that, and mindset shifts and belief systems. And every single thing I'm sharing with all of you are things that we are still doing in practice to this day. How I was in my office yesterday practicing and the exact same things I'm sharing with all of you are things that I was implementing too as well. Is why we've been able to build a 40.2 black hole. Why? Because people stay, most PVAs aren't even 40 for chiropractic clinics, and we have a black hole of 40, which means if I calculated all the people that have quit care in my office in the last 12 months, just to be able that quit, it averages a 40.2 visit mark when they quit. Obviously, our PVA is much higher than that because PVA is total visits, which is factoring in all patient visits divided by new patients. Think about that as you move forward. If everybody who came today knew where they were going, what would that do? The impact of your clinic, and I'm gonna leave you with that. I cannot wait for four more months from now to see everyone at Growth Summit. I cannot believe how close it is.'cause I talk about all the time. I think there's only seven spots left, by the way. So all you fence dwellers out there who were fenced dwellers for an adventure summit that sold out and were fenced dwellers at a gross summit last year with that sold out. Yeah, we're down to the Final Slots Use Code podcast to get in for$50 off. You'll get a welcome email from me and it will be one of the best business experiences for chiropractic you've ever had. Hope everyone has a great day and we'll talk to you later. thanks for listening to the Austin Cohen podcast. If this episode helped you grow, share it with another chiropractor who's ready to go beyond the adjustment, and don't forget to subscribe so you never miss an episode. To learn more about building your business, leadership, and life on purpose, visit chiro one eighty.com or follow Austin on Instagram at Dr. Austin Cohen.