Dr. Benjamin Kuhn has commented regularly on my blog since I started it back in January. We’ve talked back and forth on Facebook as well. But I finally got to meet him a couple weekends ago at the NUCCA Conference when it was out in Dallas. I stopped by one night to see some friends and meet some people, Dr. Kuhn among others.
He’s a really good guy with an intensity about upper cervical and NUCCA that is very apparent. His confidence and certainty in what he does is infectious. I even felt more confident in what I will be doing… as soon as the Texas Board sends me my license!
I’m grateful Dr. Kuhn could take time out of extremely busy practice/family schedule to answer questions for The Atlas of Life.
Brandon: Why did you decide on a career as an Upper Cervical Chiropractor, and more specifically, NUCCA?
Dr. Kuhn: “As with many upper cervical doctors, it was initially a personal experience that pushed me towards upper cervical. I had been a full spine chiropractic since I was a baby for general wellness as well as treatment of the issues that arise as young boys grow up and do stupid things.
For the most part, I was in great health with no real issues, however I started to notice in my early teens that I was getting very consistent and bothersome muscle knots near my right shoulderblade. Regular adjusting could only buy me at most 24 hours of moderate relief before I was right back in the same boat again. I simply dealt with it for several years, not having any better alternatives until my wife convinced me to come and see her NUCCA doctor.
I had all of the classic objections … “how can he help my upper back by pushing on my neck” … “this costs a lot more than I’ve paid before, I’m not sure it will be worth it” … and the list goes on. What eventually “sold” me on the care was something Dr. Creswell (my Doctor) said, “I want to see you for the rest of your life as few times as possible”. Finally I broke down and did book my appointment, and within a couple of days, my problems evaporated and never returned.
Now I didn’t rush out and apply for chiropractic college right then, it was a few years later when the time and opportunity for a career change came about in our lives and we decided to move our family to Davenport and “do the chiropractic thing.”
While it’s true that my initial experience was with NUCCA and what I knew of the technique both experientially and rationally made sense to me, I was not locked in to tunnel vision. I went to Palmer with the goal of looking objectively at as many techniques as possible and making my final determination off that, which I did … and frustrated a great many of my technique instructors as a result!
In the end I realized that NUCCA was the only technique which most fully addressed any of the issues I could think of as far as safety, efficacy, and in holding with the primary chiropractic plank of find it, fix it, and leave it alone!
I won’t get into all the criteria and questions I asked of any technique I looked into, but here’s a short list for anyone to consider:
– efficacy … how long does it take to get someone “better”?
– if the body is a self-healing, self-maintaining system, then why does a person need to get ADJUSTED (not checked) every week/2 weeks/month perpetually? A body that has actually been made subluxation-free should not immediately start falling apart again.
– if you use a certain metric for identifying the subluxation, then why do so many techniques not use the same metrics for ensuring the subluxation was corrected post-treatment?
– and the biggest one for me … how does the technique theorize that it overcomes the stretch reflex?”
Brandon: You had a fairly large family while going through chiropractic school at Palmer. Can you tell us what that was like and maybe offer some insights to new chiropractic students going through school with families as well?
Dr. Kuhn: “I did have 15-month-old twins when we moved to the quad cities and my youngest son was born at the end of second tri (pulled me out of my Gross 2 final practical!). While it was definitely a different experience than many other students had, I didn’t find it overly difficult.
My best advice would be to schedule yourself and know your priorities. For me, school time was exactly that, and time at home was time for the family. That and I knew that if there ever were a conflict, then family won out. Now I am a bit of an oddity, as I have almost never studied for any class or exam (except for a brief review/refresher with friends around a fire with some drinks the night before).
I know that many others cannot do the same, but it’s just a matter of scheduling – if you are a night person, then study at night after the kids are asleep … if your are *shudder* a morning person, then get up earlier and study then. Also, there was generally times during the day where you could find 15 minutes here and an hour there to sit and go over notes.”
Brandon: You stirred the pot somewhat when you were at Palmer by frequently writing about administration accountability for the Palmer Beacon. What was the reaction to your writings by both students and faculty/administration?
Dr. Kuhn: “I started at Palmer while Dr. Riekeman was still chancellor, and the circumstances surrounding his “stepping down” as well as the response we as the student body got from the administration but more specifically the board of trustees was what got me started.
The following year was when Palmer decided to disenfranchise their alumni association. Both situations have an absolute mountain of backstory as well as all the soap opera-esque trappings of ego, money, and politics.
In the end, I did a lot of exposing and asking hard questions based off of all of the information I could gather (seeing a trend here?). In general, it made the administration nervous as I was a source of criticism they couldn’t contain or strongarm with leverage. Students were either at least partially educated on the facts and looked to me for guidance/leadership/information, or they were afraid that they would somehow be kicked out for asking questions (or simply didn’t care – a valid stance) and buried their heads in the sand. As for faculty, I ended up making a lot of very positive relationships and having a lot of very enlightening discussions in quiet corners with instructors who could not publicly make any of their fears or opinions known for fear of retribution.
In the end, I still think that Palmer is one of the best places in the world to get a chiropractic education, and I wouldn’t trade the experience for anything … it really helped me realize my potential and grow into a more active player in my own life.”
Brandon: You recently purchased the clinic you’ve been working out of for the past two years. What insight can you reveal to a new doctor looking to buy a practice of his/her own?
Dr. Kuhn: “The purchase of the clinic I have been a part of for the last 2+ years (plus as a preceptor) has been a goal I’ve been aimed at and working towards since I was halfway through school, and so far has been a great choice! There are really two different scenarios that I think people need to look at, each with it’s own pros and cons as well as it’s own unique considerations that must be scrutinized.
When buying an existing practice as I have, any doctor out there needs to take a very good look at a few key features:
1. Get at least the last 3-5 years of financials from the seller.
– Without those numbers for gross collections, accounts receivable, historical costs, and growth/loss trends, you have no real idea of what you are buying and should stay far, far away! Once you have the financials, make sure that the existing business can support both your financial needs PLUS the loan repayment!
2. Why is the existing owner leaving and why are they selling? What are their plans for after the sale?
– In my case, the existing owner wanted to put more effort into other projects and less into managing the clinic, but is staying on as my associate. To help facilitate the “voluntary” transfer of patients he is working reduced hours and has implemented a significant fee increase, both of which help push new and existing patients in my direction.
3. Where do the revenues come from?
– are they from primarily new patients? If so then where are the new patients coming from and how portable to you are those sources (referrals will be less easily swayed than say those from screenings or other generic advertising). Put systems in place to maintain, improve, or replace those sources.
– If the main revenue is from existing patients, then realize that doctor attachment plays a significant role and there is a good chance of losing a higher percentage of those patients … plus you will have to build sources of new patients, so really in this case you are buying a diminishing revenue stream – something to keep in mind when it comes to price!
4. Is the purchase worth it?
– I know … seems like a silly question, but if you can’t make MORE than you can by starting out on your own and still pay the loan, then either the asking price is too high, or you don’t need to buy the practice.
If buying and starting up your own practice, then there are different considerations, most of which are covered fairly well in our business classes at school, but I would definitely suggest that ANYONE looking to open up an upper cervical practice now should make the investment for digital x-ray immediately! With what you save on dark room buildouts, HVAC, processor, film, and chemistry costs, it will pay for itself in no time if you don’t immediately break even.
Some final tips which are absolutely necessary in both cases:
– a good business plan is worth it’s weight in diamonds. It’s tedious and a hassle to put together, and most people won’t even read all of it, but the fact that you have done one (don’t farm it out!) gives lenders much more faith in your application and also helps you realize the realities of the details prior to jumping in with both feet.
– if at first you don’t succeed, talk to another bank! I worked the deal to purchase my clinic for 2 years before it finally got approved done. By the time I had finalized things I had approached 3 different banks, 2 separate investment firms, structured a vendor-financing agreement, and finally had one of the banks step up and say they wanted my business. A good thing to keep in mind through all of that is what your business as a clinic is worth to a financial institution … it won’t necessarily get you a better deal, but it WILL get the branch managers and commercial account advisors on your side and working for you.”
Brandon: Your clinic was one of the first, if not the first, upper cervical clinic in Canada to go to direct digital radiography. What effect has that had on your clinic?
Dr. Kuhn: “The move to digital x-ray has been absolutely fantastic!!! It has cut our time in x-ray in half, reduced our costs tremendously (film, chemistry, and processor maintenance), and projects a much more sophisticated and information-age-friendly view of our clinic to potential patients. We would have switched sooner, but there was no system in place that would allow us to do a proper analysis of digital films available – so I made one! “
Brandon: You created software to analyze NUCCA films, and are in the process of expanding this software to Atlas Orthogonal and Orthospinology. What drove you to do this and what was it like to create it?
Dr. Kuhn: “The process was a fantastic experience, but again not a fast one. Actual writing of the program started in early April of this year and is now completed, but development started (again) nearly two years ago in concept.
I initially tried to work with an existing x-ray firm to help them develop a tool that could satisfy the rigor that upper cervical doctors are known for, but was met with apathy or lack of response time and again. So finally I just decided to bite the bullet and hire a programmer on my own to create a program that I could offer to the community which would do everything I wanted it to and which I knew would do it properly.
I have training and strengths in computer programming, spatial relations, and geometry/physics, so putting the mechanics of the NUCCA analysis into a digital format without resorting to simply scanning in existing templates was a good fit for me. I designed al the major aspects of the program and worked with my programmer often to debug and perfect all the aspects of it to where I am now extremely happy with the result.
I currently only have the NUCCA analysis built in as automated, but the other vector-based upper cervical techniques share similar analysis requirements, and so fine tuning the program to their needs is a simple matter.
I’m also working on creating a “demo” version of the software which will serve two purposes. First, it will be a free (or nominal fee to go to upper cervical research) download which will have several built-in films (no import capability) allowing doctors to try the software at no risk. Second, I intend to have certified technique doctors analyze the included films and build in an option to turn on/off their analysis to assist new doctors in refining their point choosing and analysis to the highest calibre.
Anyone interested in the software should send me an e-mail (at least until I get a website up for it!) at dr.kuhn@providencenucca.com
My next project which I plan to start development on early next year is going to be a postural and range of motion measurement system that will provide more information quicker and easier than anything on the market to date. Full postural scans with measurements in all planes in less than 60 seconds which your staff can easily do with no added time for the doctor. I’m excited!”
Brandon: Can you describe your involvement in the short action film “The Takedown?”
Dr. Kuhn: “The Takedown” is a short action piece that a good friend of mine is putting together. It’s primarily a promotional piece for Movie Prop Services in Edmonton, Alberta to help showcase their ability to outfit large-scale productions, but aside from that we’re all just having a ton of fun!
I am one of the generic central/south american commandos as well as playing the occasional SWAT member. plenty of chances to play with weapons and get an insider look at the film industry. I’ve already lined up a number of prospective patients from short conversations – just shows you can educate/market in ANY situation.
Anyone interested in seeing the film once it’s completed can feel free to add me on facebook (also you can see some of the many still images from the set).
Who knows … maybe soon I’ll be Dr. Kuhn, action star!”
Brandon: What is your vision for the future of Upper Cervical Chiropractic?
Dr. Kuhn: “My goal for Upper Cervical Chiropractic is to see us on the map!! And I mean everywhere, being talked about by everyone and having every upper cervical doctor in demand for media interviews. I want to see the public demand for information on what we do and can provide being so strong that we can’t keep up with the wave.
I want the first question of an MD who cannot help someone to be “Have you tried Upper Cervical Care?”. Yes, I know the patient should have come to us first, but we frankly don’t have the numbers right now to support that level of involvement.
I want to see (maybe even found) a new chiropractic school that stays true to what chiropractic is and teaches exclusively upper cervical techniques – then I want to see it succeed wildly so that the other schools are forced to re-evaluate their medipractic tendencies and rise to the demand of the market for pure chiropractic and upper cervical focus.
I want it to be a self-evident and generally accepted fact that everyone should be aligned first and only consider emergent care after that. I want a passion for Upper Cervical to burn the world!!!”
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{ 4 comments… read them below or add one }
Wow, how great it is to see a young chiropractor who is excited and on purpose for upper cervical chiropractic. When I went to school and when I was new in practice I did not run into any chiropractors or students that appreciated upper cervical chiropractic. This is a breath of fresh are for me and gives me hope that this wonderful profession can survive.
Great interview! A lot resonated w/ me on this one.
My second is due @ the end of 2nd Tri as well…..better yanked out of a class than bed at 2am!
Stretch reflex…I was just talking about that w/ a UC student-doc here at Palmer this week.. I know the CLEAR Institute and Pettibon have done some good research into this – wondering why I don’t hear more about this in the UC arena, as I believe that to be just one of the major reasons UC adjustments (when delivered w/ specificity) hold longer than those adjustment delivered under traditional rotary break care.
What?!? A true subluxation based / non-medipractic school? Funny you say that, I was wondering just last week why folks haven’t put their resources together to erect such a magnificent idea! I nominate you and Brandon to lead this effort!
I’ll help when I get out.
Congrats on your expected child, Scott! It makes things a little more difficult, but also a lot more rewarding!
And yeah … the stretch reflex issue was always the main deal breaker for me. I used to say that anyone who thought they could set and hold a vertebra (against the reflex) through 1″ of muscle, skin and fat with a quick adjustment had never tried to hold a 3-year-old who really wanted down.
Dr. Doble – Thanks for the props! It’s always nice to be appreciated for trying to live up to your own expectations.
And for the school, there were some doctors in Alberta and BC who were looking to possibly start that, but I think the red tape and bureaucracy made it prohibitive. I still think it’s worth pursuing though!
Digital films with instant analysis are going to change everything. I’d like to have a patient education module that “runs” over the back drop of the pre and post. Where the pre morphs into the post, hopefully showing a reduction and a return to the vertical axis! Keep up the good work, Doc Kuhn.