Share this page:

Mark Sanna, DC, ACRB Level II, FICC

It’s a fact: the educational demands that dictate the curriculum of chiropractic colleges leaves little room for teaching the essential skills of practice promotion.  For this reason, many chiropractors find marketing their practice frustrating—they simply never learned how. They are unsure of which marketing tools are most effective and how much they should spend on marketing their practice. In this article, I’ll provide answers to some of the most often asked chiropractic marketing questions so that you can maximize your marketing return on investment (ROI).

How do I set my marketing budget?

An established chiropractic practice should spend between 4—5% of the practice’s gross income for marketing. More important than how much you spend on marketing is how effective your marketing is at generating a positive ROI. I consider any marketing strategy that returns three to four times the cost to be successful and worth repeating. The only way to determine your ROI is to track the new and reactivated patients generated by the promotion. Include the income generated from the referrals of the friends and family members of these patients in your ROI. Tracking referrals for two to three levels gives you a more accurate picture of how well your marketing works.

What is the most effective way to allocate my marketing budget?

Marketing to your existing patients, referred to as internal marketing, has been shown to be six times less expensive than external marketing. This is the best place to begin marketing for most chiropractic practices. At a minimum, I would recommend publishing an electronic and printed monthly patient newsletter. The electronic version can be sent to your inactive patient list via email once you have received permission from the intended recipients. The printed version of your newsletter can be distributed to active patients when they come into your office for their scheduled visit. It makes much better reading than having patients peruse the pharmaceutical advertisements that dominate most popular publications. According to the Direct Mail Association, for every month that you do not communicate with a patient, the value of that patient to the practice decreases by 10%. This means that if you haven’t communicated with a patient in ten months, the value of that patient is essentially equal to that of a cold name – someone who has never been to your practice. If the only contact that you have with a patient are bills and recall phone calls and postcards, what type of long term relationship do you expect to cultivate?

Is a practice website an internal or external marketing tool?

 Your practice website is both an internal and an external marketing tool. It is likely that before visiting your practice, even when referred by a patient, your next new patient will have visited your practice website. Unfortunately, the design and content of most chiropractic websites is poor at best. On top of this, most chiropractors don’t know how to promote their site so that it doesn’t get buried in the search engines by competitive providers. An effective chiropractic website is an extension of the image of your practice. Your website must educate, promote the services you deliver and reflect the brand image and core values that embody your practice off line. An unattractive, difficult to navigate, static website can be worse for your reputation than no website at all. A reasonable budget for a professional website should be approximately $1,500 for the initial setup and then up to $100 per month for hosting and website maintenance.

What role does in-network insurance participation have in a marketing plan?

 When you become a participating provider for an insurance plan, you receive the publication of your name on the network “list” in exchange for a fee. Insurance companies consolidate the market of potential new patients, bundle your services, and sell them back to you for approximately 70 cents on the dollar. This means that you are paying 30% to market to this group of potential patients instead of the 4—5% you would normally spend on your marketing budget. Savvy chiropractors will carefully track the ROI generated by their insurance participation just as they would the ROI of any other internal or external marketing they engage in. When your practice reaches the point that your own marketing can generate the supply of quality new patients that your practice requires, you have reached the transition point where you can decide not to participate in those insurance plans that have a low ROI.

My practice is already busy – why should I market?

A chiropractic practice needs a good internal marketing program regardless of how busy the practice is. The average chiropractic practice loses between 15—20% of its patient base every year. Another 7—8% move out of your area each year or drop out of care for various reasons—the most common reason being that you failed to stay in touch with them and give them a reason to remain loyal to your practice. A strong internal marketing program along with an external marketing program that includes regular community outreach, will help prevent your practice from slowly eroding away beneath you due to the slow drip of attrition that may not become apparent until it becomes a significant effort to get the momentum back.

How do I calculate the ROI of my marketing efforts?

Marketing ROI is a simple calculation. You must know the dollar value of a new patient in your practice and your cost to obtain a new patient. The value of a new patient (the case average), is calculated by multiplying the average number of visits that a new patient comes to your practice (the patient visit average) by the average collections per office visit (the office visit average). In most chiropractic practices, $1,000—$2,000 for the first 3—9 months a new patient is under active care is a good case average.

To determine your cost per patient for a marketing program, divide the number of new patients generated by the program by the dollars you invested in the marketing program. If the result is a return of $3—$4.00 for every dollar you invested in the program, you have a good ROI and should continue with the program. A piece of advice: Stop looking for a big windfall from every marketing strategy you deploy. A steady 3:1 ROI, combined with consistent reactivation of inactive patients, plus a steady flow of referrals each month from existing patients can result in significant dollars on an annual basis.

What should I spend on yellow page advertising?

I recommend that you spend little to nothing on yellow page advertising unless your practice is located in a rural area with few competitors. Unlike many forms of marketing, yellow page ads are not targeted. Most yellow books are packed with chiropractic ads making it impossible for your practice to stand out. Use marketing tools that keep you in control of your own marketing destiny. Choose targeted strategies such as your website, newsletter, social media ads, and patient loyalty programs that allow you to focus your efforts on reaching the type of new patients you seek to attract and keep under care.

Your Marketing Education

While you might not achieve a postgraduate degree in marketing after reading this article, applying the principles we’ve discussed to your practice will help ensure that some of the most important gaps in your marketing education have been filled. Measure your results, monitor your ROI, spend your dollars wisely and you’ll achieve the marketing success you desire.


Dr. Mark Sanna is a member of the Chiropractic Summit, the ACA Governor’s Advisory Cabinet and a board member of the Foundation for Chiropractic Progress. He is the president and CEO of Breakthrough Coaching (www.mybreakthrough.com 1-800-723-8423).