Whether you are new to the business world or old hat, we all have a concern about what lies ahead in this economy. At colleges, I hear that new doctors are worried about debt load, finding money and figuring out where and what to do next.

Robert Kiyosaki, author of "Rich Dad, Poor Dad" offers up some tips on success in the December edition of SCORE.

Q: How does someone get rich in a tough economy?
A: Don't let your fears prevent you from seeing the opportunities. Education helps people's minds see what their eyes cannot. What appears to be the worst of times may actually be an incredible opportunity. Then apply sound principles and strategies to take advantage of them.

Q: What one thing would you tell someone who feels that this is the wrong time to be thinking about starting a small business?
A: I'd tell people to invest in themselves and teach their minds to see opportunities that their eyes don't. This comes with financial education and personal development. This may be the very best of times for entrepreneurs with business ideas. Technology has leveled the playing field in terms of ease of entrance. In addition, there are more outlets than ever before to communicate your messages and tell your unique story.

Q: What is the secret you've adopted for being positive and energized?
A: I continue pushing myself beyond whatever comfortable boundaries I may have previously set for myself. I continue to learn and expand my mind, look for opportunities where others see obstacles and think in terms of a "rich life." Additionally, I surround myself with others who share this same mindset.

Read more about Robert Kiyoskai at  www.score.org as to why we need to look at this economy as a positive opportunity for future business.

Read on and be encouraged that you will be successful when you focus on the priorities that really matter! Happy New Year!

Well ... it's here ... 2009. If you're like most Americans, New Year's Day is a time for family, food, football and .... New Year's Resolutions.

We have a few gastronomic traditions for the day at our house. They include lox and bagels, black eyed peas and collard greens.. Generally before my stomach has "settled," my wife Ellen inquires about my resolutions for the coming year. Often they involve "carry over" items relative to exercise, eating habits and a balanced lifestyle.

This year I'd like to ask each of our readers to actively assist with the Starting Into Practice blog. It's a concept which has been used in many different settings. 

A few years ago, the Florida Speaker of the House, implemented an initiative to survey residents for "best ideas" to reform government. The program produced a  body of work known as, 100 Innovative Ideas For Florida's Future. Some believe that many of the topics may serve as the basis for the Speaker's possible run for governor in the future. 

I'd like to propose that each reader submit at least one item/idea to improve their practice. No doubt, the sharing of plans will be helpful as we each look forward to a great 2009 ... and it's real easy. Just hit the comments hot link below and type.

Here are a few of my items for implementation and Happy Days and New Year!

• Conduct regularly scheduled staff meetings

• Weekly luncheon with a new business contact

• Create yearly marketing calender for internal and external events

What plans do you have for the New Year?

With a new year ahead, don't be surprised if you are hit up early in the year for "donations" of every kind. Every Cub Scout, high school sports team, charity and advertising magazine will be looking to their community to help support very worthwhile causes.

Being new to both a community and business, your budget may not be able to sustain the requests, but you also cannot afford to give to everyone. This is where you must remember that "charity begins at home." 

Here are a few tips for balancing the delicate task of giving.

First, set a manageble marketing budget. (for example, $1,000 per year)

When the budget is gone, offer your expertise to:

• Write an article instead of placing an ad

• Volunteer to assist a sports team as a coach or at a one-time-event

• Host a special one-time meeting for a club

• Donate something that costs just a little (cookies for a bake sale, a toy, a gift you have made.)

• Offer to print posters on your office printer

Giving is a wonderful thing and adds to your contribution to be recognized as a community citizen!

Use your imagination to give what you can, but remember as a new business, costs need to be kept in check for your future to be successful.

My mother had a tradition.  It happened every New Year's Day.  After the tree was taken down and the ornaments wrapped and stored she started - like clockwork - to clean out every drawer and closet in the house.

With a basket in hand (this was way before super-sized, extra strength trash bags) she started in the kitchen and purged everything that was over a year old.  If it hadn't been used, or was outdated, it was tossed. 

Every closet was cleaned, old clothing examined, missing buttons replaced and the rest either sent to Goodwill or put back in the closet.  The desk was cleaned and reorganized.  On and on it went until the job was complete.  Somehow I inherited this "gene" and although I try, something comes over me on January 1 and the clean out begins. 

My daughter, who has her own home, called me a few years ago to state that the phenomenon has been passed on to her, too.  Not a BAD thing!

I encourage you to do this in your office.  

Years ago the computer gurus claimed that computers would do away with paper.  NOT!  I find that we continue to print just about everything that comes our way. Some offices still use paper ledgers AND a computer ledger system!

I confess ... I even print these monthly blogs and have them in a nice 3-ring binder.  Some habits don't change.  I still have seven file cabinets in the basement that are going to be the 2009 clean-out project. 

In approaching this or any clean-out project, I am reminded of something Dr. Sportelli told me years ago when he was cleaning out his archives.  He asked himself "if I ever need this article again, would I know where to find it?"  If the answer was yes, he disposed of the papers.  If the answer was no, he kept it. With today's Internet access I suspect he, too, is disposing of more.  

Earlier this year, Dr. Erin Palmer commented at one of our teleconferences that her generation "didn't buy textbooks or keep manuals." If she needed it, she knew where to find it on the web.

Technology has changed us.  Let's get rid of the old paper once and for all. 

I, for one, promise to print less and save a few trees next year. How do you plan to clean out in 2009?

There seems to be a resurgence of "old time chiropractic ads" in newspapers. These are the ones that might include a $10 initial fee or some similar offer that reminds me of what D.C.s did back in the '50s and '60s to get new patients.

But do they work? And is that the image you want to portray?

These ads may bring in a few patients - but is that how you want to spend your advertising dollars?

If you're getting some "cheap advertising" by purchasing already made ads and placing them in your free or local newspaper, maybe it's time to evaluate if your advertising dollars are working effectively for you.

There is a direct correlation between mass advertising cost and effectiveness. In other words, you get what you pay for.

If you want to get the most out of your advertising dollars, ask yourself these questions:

• who do I want to target (people in a certain demographic, a certain area, etc.)?
• how can I reach them best?

You'll find some good advertising ideas on the Starting Into Practice website. What have you learned about advertising? Comment here and share your tips with others.

Tough economic times have hit the United States and, really, the world.  Some businesses such as Wal-Mart are prospering, while others are closing their doors, declaring bankruptcy or asking for a bailout. 

In order to survive, you must be a visionary. 

You have to realize what your customer – the patient – is looking to buy.  Their dollars will be spent for necessities and services which they deem to be indispensible.

A visionary doctor has to realize that he or she is a people person.  People come to your office because they want relief of their pain.  However, they rarely choose a doctor for their prices or the amount of initials after their name.

That means you must sell yourself! 

In the ‘70s, there was a commercial where a woman recommends a shampoo to her friend, and then “She told two friends, who told two friends and on and on and on.” 

This is word-of-mouth marketing. It shows the power of the personal recommendation.  I still find that this works best to get referrals, even in the toughest of times.  While most of us will tune out the daily barrage of messages that are thrown at us on a daily basis, we will still listen and trust our friends’ and families’ word-of-mouth recommendation.  People will come to you, because they feel they know you.

As the New Year arrives, people will naturally set their goals for the coming year. 

This may be the year where they want to take care of themselves by exercising right and eating right.  Volunteer your time at weight loss group sessions, civic groups, chamber of commerce meetings or church groups. 

Your goal should be to meet three people per day.  I don’t mean just to say hello, I mean to get their first and last name and their address.  Give them one of your business cards and get one back. 

Once you have met your three people for the day, go back to the office and write them a quick “Thank you” note.  Tell them it was a pleasure meeting them and invite them to give you a try to help with their pain or for ways to live a healthy life in an unhealthy world. 

Include two business cards in the letter; one for them and one for their friend.

A true killer for any practice is sitting around waiting for the telephone to ring.  Get out and meet people, who will in turn become a future patient in your office.  It may stretch your comfort zone, but successful people will do what unsuccessful ones won’t!

Routine is inevitable, but in the day-to-day operation of your practice, be careful not to let complacency slip in the back door and get comfortable. 

It can seem like you say the same things over and over - "you have a reversed cervical curve" or "the cause of your pain is a subluxation located in the lumbar spine."  Sound familiar?  

Catching yourself in this pattern is tricky, but important if you want to talk with your patients, instead of at them. 

Ask yourself:  

1. Do your staff members leave the room during patient consultations because they've heard it all before?
2. Do you remember your patients by their names and faces or by their x-ray listings? 
3. Do your patients nod and smile during your canned, generic ROF until you've finished telling them all you know? 
4. Do you fail to allow time in your schedule for questions because they shouldn't have any after your knowledgable mini-seminar?  

Laugh at yourself.  It's oK. We've all done it. 

You've learned so much and you know exactly what to do and you can't wait to get your hands on their spine to save the world, right?  We all have our methods of getting The Big Idea across, but do you preach from the chiropractic pulpit or discuss conditions and concerns with your patients?  

No two patients respond the same to a diagnosis, adjustment, treatment plan, or patient education protocol.  You already know this.  Your patients are people first, consumers second.  

They expect you to be different than other providers, so give them what they came for....individualized healthcare!    

When there's an allegation of malpractice, I think every doctor would agree they want one thing when it comes to legal representation. 

They want the best.

Your reputation is on the line. This is definitely one area where the bargain basement attorney may not be the best value.

In the event a claim is filed against you, your malpractice insurance company is responsible for providing you with a defense and paying the cost of your defense.  But this is an area where there is a huge difference.

You want to make sure the attorney representing you is the best.

• Has the attorney ever defended a chiropractor before? 
• Are they well familiar with the chiropractic profession? 
• Does the insurance company provide defense counsel that has chiropractic specific training and resources? 

Beyond your attorney, another person you want on your side through this process is your claims representative.  This is the insurance company employee who works with the doctor and the attorney throughout the claim.  Same issues apply. 

• Are they familar with chiropractors? 
• Have they worked on chiropractic claims before or are they part of a medical malpractice company that only works on chiropractic claims infrequently? 
• What kind of chiropractic specific training and resources have they recieved? 

All these issues will have a big impact on you throughout the entire process of the claim.  So again, when shopping for a malpractice insurance policy, ask questions.  Ask about the company's experience with chiropractors.  Ask about the number of chiropractors they represent. 

In short, look for the best value with your coverage.

I am a firm believer in education and that we, as doctors, must educate our patients as to their diagnosis and any diagnostic reports. 

I find that when time is taken on that initial visit to explain the following points, it can put their mind at ease, help with patient compliance and make them an active participant in their health care:

• Explain the anatomy! One thing we can all agree on regardless of the school you graduated from is that anatomy has not and does not change and no other specialist knows their anatomy like a DC!  You will be surprised how many people are unaware of basic anatomy.
• Discuss test results. I am shocked how many people are told they have a herniated disc but have no idea what a disc is!  I describe the disc as a round thick slice of an onion with the center few rings taken out and filled with jelly or a grape. Who has not seen an onion slice?
• Use pictures.  I use my Netters more now than I did in the anatomy lab to show patients what their anatomy looks like ... please do not use the same one from lab.  Also, I keep a 16x22 inch dry eraser board with erasable markers in my initial consultation room and often draw pictures or flow charts to help patients get a visual of what I am saying.

Perhaps the easiest thing to "impress" them is to interpret the terms of their diagnosis and test results. Words that you take for granted (spondylosis, degenerative disc disease, facet hypertrophy, scoliosis, etc.) can scare the heck out of your patients.

Put their minds to ease by teaching them. I have 80-year-old patients asking if I think they have arthritis........like it is something they can avoid and to have it is life threatening!

Make your office visit stand out from any other experience they have ever had with any other doctor by taking the time on that initial consultation to teach them what they need to know so they can be an active participant in their treatment. 

Well, here we are in December ,,, the month of no-shows and cancellations. With all the "holiday stress" there is a high possibility that the first thing to be skipped is the regularly scheduled appointment.

That means that now is a great time to encourage your staff to take extra time to confirm appointments ... in person as well as by phone and email!

Communication experts say that in order for a message to lock into the brain it needs to be heard three times. Challenge staff to repeat the appointment three times with every patient.

Call the patient two days before to confirm their appointment. Hand the patient a reminder card with the date(s) and time of their upcoming appointment.

This one is short and sweet ... no shows and cancellations compromise the patient's care. Stress creates more need for care, not less.