There are certain people that come and go in your life that you take for granted at times.  Whether you are a 16 year old that doesn’t think you need your parent’s advice, a professor in undergrad that helps guide you into a profession, or a one of a kind clinician in chiropractic school.  I’m going to take a little time to dedicate to my clinician at National University of Health Sciences, Dr. Grant Iannelli.  I always enjoyed my time that I spent with him but the last couple of years make you really appreciate the person that he really is and some of the principles that he inst,illed to help mold me into the person and chiropractor that I am today.

As you enter your last couple of trimesters in chiropractic school, you have to decide who you would like as a clinician.  Some people wanted to work in the afternoon, some people in the morning, the people that lived in the city wanted to work in the city clinics and we even had a couple of people that went to Florida or other clinics in the area.

I am a morning person and I wanted to get my shift done so I could get on with my day when I was in school.  The clinician that I wanted to work with was Dr. Grant Iannelli.  When I first figured out that this is who I wanted as a clinician, I didn’t quite comprehend the impact that he would have on my life at the moment and further into my life.

Dr. Iannelli and I saw eye to eye on a lot of things in the chiropractic profession and in life, he is a Michigan fan, I kept my mouth shut on that topic as Nebraska football was nothing to write home about at that time or now for that manner.  But he did help me understand a profession that is not always well understood by people in and out of the profession.

Now I am not saying that I practice the same as I learned from Dr. Iannelli, but he was one of the first people that laid the principals that I stand by today.  I learned to think through the treatment process and the general course of care.  I helped Dr. Iannelli with his individual patients in the afternoons, this is what helped me see how patients can respond to the lasting care of an individual doctor.  In clinic, you have a handful of patients that have been coming to the clinic for years but they are used to different interns treating them.

The time that I learned the most was just sitting in Dr. Iannelli’s office and just talking about different treatments and life in general.  Kristina lived in the Chicagoland area when I was there for about 2 years but Dr. Iannelli was an outlet for me as he would just talk about life and some of the finer points of practice, owning a business, and how it all translates to life.  At the time that these conversations were taking place, I never realized how much I would use these conversations as reflections on how to handle different and difficult situations.

Handling tough cases in which patients do not improve, finding the next alternative and how to continue to build a patient base.  Business classes are not necessarily chiropractic school’s strong point but Dr. Iannelli did a good job guiding a person into how to best go about the business side of things and developing an idea into a business model.  Maybe I am more inquisitive than most or I am inherently skeptical about things but Dr. Iannelli was there to answer the weird or difficult questions.

While I don’t talk to Dr. Iannelli all that often anymore and that happens when you live halfway across the country but I do look up to him as a mentor, friend and someone that would be there for advice in both practice and life.  Having a security blanket with a few good mentors in your life can be invaluable when navigating this thing called life.

National helped me really grow as a person and I learned more about myself during that timeframe more than probably any other time in my life.  Kristina and I were living pretty far out of our comfort zone, but we did really enjoy out time in Illinois when we reflect back on out time there, but as I look back at my time Dr. Grant Iannelli was a huge impact on my experience at National and I thank him for that. 

If you would have told me as an 18 year old graduating from high school in Valley, NE that I would end up in central Nebraska practicing chiropractic, I would have told said you’re crazy. But a few good decisions in my life including a girl and an intense drive to succeed have led me to where I am now.

My decision to think about chiropractic, started in the library at UNK when one of my classmates told me I should check out the profession.  I was pre-med at the time and was still trying to grind out school and playing college baseball at the time.  I never had one of those ah-ha moments, that most chiropractors have in their journey. 

My exposure to chiropractic was very limited, to non-existent growing up.  I knew what they did but had never been to one personally.  Classmates in high school had visited local chiropractors for headaches and low back pain but I had never talked or been to one.

I knew that I wanted to work with the public and help people.  Shadowing a local chiropractor was the next step.  I liked it, the thought process that was going through my mind was that I could do what I thought I would enjoy doing all while owning a business and not be married to a phone if I was ever on call.  It would also be conducive to having a family in the future as well.

My sophomore year in college, I shadow a local chiropractor to see if this profession and absolutely loved it.  After a few days of shadowing, I was actually offered a job and ended up working in that office for about a year and a half.  The college credits essentially were a wash as I already was on the correct track but ended up picking up a Chemistry minor in order to expedite my education as I was already that far into that track as well.

I only applied to one school, which was National University of Health Sciences in Lombard, IL.  At the time it was the only school that required a bachelor’s degree in order to be admitted and it has a very strong reputation for being evidence based.  (If you know anything about the history of chiropractic, there is a lot of anecdotal evidence but not a lot of it is researched based and that is where chiropractic has run into problems with other professions).  The intriguing issue for me was that the education I was going to receive was going to be based on the current research that was available. 

If anyone asks me where I went to school, I proudly say National, there are not many alumni in the state, in fact I think there may only be 6 total.  It is a small but good group.  I would gladly refer people to attend National.

National is one of the smallest chiropractic schools in the country and can get a bad reputation within the profession as it does not teach the philosophical aspects of the profession as much as the other schools and this is what made me fall in love with my education.  Yes, it can be difficult at times but if I could do it all over again I would, in a heartbeat.  I met some of my very best friends and colleagues during those 3.5 years in school and we still keep up to this day.

We continue to say that we are going to have a reunion, which could be very interesting both in actions and conversations.  But I continue to hope that the gang can get back together again….you too Mark.

As I get into practice, I appreciate my journey into the profession more and more.  I don’t get really fall for anything that is outside the lines of current research.  Some people will say that the entire profession is not supported by research but numerous guidelines indicate that chiropractic care is well within the lines of conservative care and can be a very cost efficient way to reduce headaches and low back pain, especially when a chiropractor is used as a first contact.

This was just a quick review of how I stumbled into the chiropractic profession.  As always, I am going to be on a constant crusade to educate young professionals about the advantages of student loan refinancing.  Please read previous posts and as always I appreciate the feedback.

http://refer.credible.com/2C6pJM

My normal working schedule is Monday thru Friday 7AM to 5 PM with a lunch break in the middle, I travel to Arnold every other Saturday morning to work for 4 more hours.  I hear from other doctors that I don’t need to work that hard and I hear from patient that I need to take some time for myself.

I absolutely love what I do and the people that I am able to help on a daily basis.  Whether you come in for a simple DOT Physical or can’t hardly walk into the office because you are in so much pain, I want to be there for you.  When I leave the office for the day and I miss a phone call from someone that is trying to get in, I genuinely feel bad.  If you call for a DOT physical, there are times that I will come in at 6:45 in the morning because I want to make things convenient for the patient.

Now there are limitations to this request as well, if you call at 4:30 on a Friday and think that I am going to stay late, you may be a little crazy because I do try to make it convenient for people but the patient also has to take my schedule into consideration as well.

As I said before I absolutely love what I do for work and for people but I actually may be addicted to work.  I always tell people that I don’t have a lot of vices in life, but I truly do love to work and to play golf.  So in the summer I do take some time off to play a little golf but I do feel like I am letting patients down by not being in the office.

My alarm goes off most mornings around 5:10AM and I am out the door most days by 6AM depending on which office I am at and am ready to see patients by 7AM.  I justify this schedule because Kristina and I are on a mission right now to get some debt paid down. 

On this mission to pay down debt, I have not only worked long hours in the offices and try to build a practice that I can be proud of but I also do insurance reviews in order to pick up a few extra bucks.  As the debt gets paid down, I will ease up on the work schedule but have no idea on the specifics of that.  I am just going to keep showing up and treating patients at this time.

Between writing a blog, working at the offices, doing insurance reviews and trying to have somewhat of a social life, I stay pretty busy.  This past weekend, I did not have any commitments, I didn’t have to go to Arnold, no reviews and it rained most of the weekend so I was able to just lay low.  I cherish these weekends but by Sunday afternoon, you wonder if it has been a productive weekend.  Let me tell you, it is, it gives you a chance to regroup and evaluate everything from life and practice.

So, why do I work so hard? I work endless hours in order to serve my patients in order to accommodate as best as I can but the trade-off for something like this is that it will eventually pay off dividends for Kristina and I in the future.

I know that this post is not much but it does put some perspective as to why the lights are on at the wee hours of the morning and when you call the office, someone will almost always pick up to get you scheduled at your convenience. 

As always, if you have any questions or comments I would love to hear from you.

Secondly, in my crusade for student loan refinancing a link has been given with Credible, who I think makes the process the easiest.  Check out previous blogs and be sure to check out Credible.

http://refer.credible.com/2C6pJM

Now, I’m going to preface this by saying this is my opinion on this topic and I understand that people are under different circumstances and that there are numerous, rationale reasons to use the IBR system but I am going to advocate for individuals that have six figure student loan debt to not use the program.

When you graduate professional school, whether you are a doctor or a lawyer most people don’t really think about how they are going to pay off their student loans, they just think that they are going to rule the world based on the education that they just received.  It is a real slap in the face when you finally start to face the fact that these loans are going to need to be paid.

As I stated in the previous post, most government backed loans are at 6.8% and I believe that the interest is the same no matter what you select for your repayment plan.  The problem with this is that with individuals with a six figure loan amount, you are never able to get ahead of the interest on these loans, at one point, I believe I was paying a little over $900 a month in interest.

With many young professionals, you are not making much money when you graduate, most of the time as a young professional your salary might be minimal enough to pay very little, if any on your income based repayment plan.  Numerous chiropractors don’t pay themselves hardly anything when they are fresh out of school as they pour almost all the money that they make back into the business.  Now that sounds well and good, but when you start to analyze what the interest is doing while you are paying little to nothing on your loans, it will make your heart sink.

Another problem with income based repayment is that whatever you have left on your loans after 20 years of paying, will roll onto your personal income tax.  So the thought process is, if I pay the minimum amount for 20 years, the rest will be forgiven, but the caveat is that the “forgiven” amount is that it does show up on your income tax as income for that given year.

Let me give you an example, this will be very general in nature.  Let’s say you are a new chiropractor and you have $200K in student loans when you graduate.  The first five years you don’t make enough money to qualify to pay anything on your student loans…your interest will continue to accrue.  After five years of doing nothing you are up to $260K.  Now, after five years you start making a little money and you can pay a little every month, but you still aren’t touching the interest because your $900 is now $1000 a month, you can kind of see the perpetual cycle with this.  Now after 20 years of payments, you would be close to 45-50 years old and you could potentially have between $300-400K in student loans left.  If you roll that amount into your personal income, so in addition to paying on your loans for 20 years, you will now owe an additional $100-150K in taxes on the amount that is forgive.  This is a very brief explanation but if you can piece personal finance and compounding interest together, it is easy to see the vicious cycle that you can fall into at this point.

With all of that being said, if you are young medical doctor or lawyer that is going to go work for a non-profit and can have your loans forgiven after 7-10 years, then by all means, go for it.  But in the world of chiropractic, this is just not an option for young chiropractors.

The reason I write about this, is because I am all about personal responsibility, now if there is a program that you can take advantage of to make your life easier to pay off student loans, go for it.  I took out the loans, ultimately I am going to have to pay them back, and this is why I am becoming such an advocate for student loan refinancing.

There are options that are 20 year repayment, that means when you are done with the repayment after 20 years you are done paying and don’t have to worry about the tax implications.  But you will have to face the fact that your payment will start immediately and not when you can afford it.

I have been established in practice for over 5 years now, I have told myself that I want to pay off my loans as fast as possible.  Don’t ask, but I started to listen to Dave Ramsey and while I agree with him on the premise of debt reduction some of the steps that he indicates to take are not realistic when starting a practice and growing operations.  This why I have refinanced my loans twice and look forward to being student loan free in 2-3 years.  By refinancing I was able to reduce the interest that I pay from $900 a month to roughly $300, so the majority of my payments go towards principle plus Kristina and I have been getting super aggressive making extra payments.

Income based repayment is not a bad program, but I feel that it is a terrible program for young professionals that have no shot of working for a non-profit and have six figures in debt as you will never be able to get ahead of the interest while making minimum payments.  The taxes when it is all said and done will make you cringe if you wrap your mind around the numbers. 

Unless you are one of those fantasy thinkers that thinks that the government is going to forgive all student loans (it probably won’t), go ahead and get aggressive with your loans and get that huge monkey off your back.  If you have any interest in refinancing, I highly recommend Credible, as you get numerous options in one place and the options run the gambit.  Click on the referral link below to check it out.

Again if you have any questions or comments on this topic I would love to hear from you.

http://refer.credible.com/2C6pJM

If you would have told me 10 years ago that I would take out a loan of over $150K for a piece of paper, I would say that you are crazy.  That’s exactly what I had to do to get the education that I wanted and I will be paying for it for the next couple of years and I do not regret it one bit.

You don’t realize when you are going to school how the loans actually work because the school just tells you that you will need to take out “said” amount in order to pay for school and living expenses.  When you sit down at exit counseling before graduation, you get a piece of paper indicating what you owe in school loans.  Now a six month grace period is granted to everyone with government backed loans, but you don’t think much about it because you feel that you are ready to go conquer the world and make the money back in no time.

The standard repayment plan is a 10 year plan but many people are suggesting that chiropractic student’s move towards income based repayment or pay as you earn plans, I will go into why this is such a bad idea in a little while.

Now maybe I graduated at just the wrong time, but I have talked to friends that have student loans with interest rates from 2-4%, but I graduated the rate was 6.8% and I believe that it is roughly the same since then.  The friends graduated from college roughly 5-10 years before I did.

I started on the standard repayment for the first year out of school, I was just trying to get my feet under me and grow a patient base.  When I decided to start my own practice, I switched to income based repayment because it would lower my payment in the short term and give me a little cash flow for the business, at the time this was great but in the long run this was a stupid decision as I did not really understand what the program all entailed.

About a year into practice by myself, two years out of school, I started to really look at the numbers and was wondering about the number that was my student loan.  It kept going up while I was on income based repayment, like I said I will get into this later, but we decided to get out of that program in order to really start attacking the loans as I did not want to be hampered with this loan forever.

Kristina and I really started to look at student loan refinancing.  I initially thought this was a bad idea for me but the more I looked into this it was a great idea for what I was trying to accomplish.  I would never qualify for forgiveness because I work for myself and I didn’t want to have student loans for the next 20-25 years. 

I started to search around Credible as it gave me the most options for refinancing my loans from numerous different lenders.  I investigated other options but the interest rates were by far the best with Credible.  Initially, the rate was at 3.14% but it was variable over ten years.  I stuck with this rate for about a year until the rates really started to creep up, as it is based on the Federal Reserve rate and if you haven’t noticed interest rates have started to increase.  Just recently I actually just refinanced again to a five year loan at roughly 3.75% but this time it is fixed.  We have been getting super aggressive with the loans recently and have a goal of paying them off significantly sooner than the term of the loan so the shorter term loan was okay in our minds.  It was tough to press the button initially but I think it will be good overall.

If you have any questions or advise on this topic I would appreciate the feedback.  If you ever consider refinancing your student loans feel free to use my name as a reference.  It really is worth looking into for people that have a stable income and a desire to pay your loans off sooner rather than later. 

Next week I would like to address why income based repayment and pay as you earn is such a terrible idea for professionals like chiropractors and how it will end up costing you more money in the long run.

When you really think about that, an entire generation is paying on student loans with interest rates that are nearly double the mortgage rates that you can take out at the same time.  I understand that this is an unsecured loan but the country is going to end up with a generation that is riddled with debt, with no real shot to pay them off in a timely manner while contributing to the economic growth of the country.

One final thought, I was once told by a friend that your student loans should be looked at as an opportunity cost, as you would not be able to make the kind of living without taking out the loans.  While I truly do believe this, it is really tough when you make the payment every month to think about it like this, but it will be worth it in the long run.

Use this link to explore your options with credible which is feel may be very much worth your time.  http://refer.credible.com/2C6pJM

I got to thinking about this topic as I have been updating offices and equipment, but as the business owner and chiropractor in the offices, what exactly do I expect out of myself and the offices on a day to day basis.

When Kristina and I purchased the Minden office, we knew walking into the situation that we would need to upgrade the office and the tables.  Not that the tables were bad, but I prefer to work with flexion-distraction tables, and the Minden office was equipped with Hylo tables.  This was going to be a process as financially it was not possible to do everything that I wanted at one time. 

If you can remember, I started practicing with a couple of used tables in the Kearney office and then eventually upgraded to a table that I prefer.  When the office was moved in Kearney, equipment was updated again to tables that would be conducive to a growing office and to things that I liked.  I worked on tables in Minden that I did not necessarily like but made do.  A month ago, that all changed, we upgraded all of the equipment in Minden and took a few “newer” tables to Arnold, so that all of the offices had the necessary things that would allow me to treat patients to best of my ability.  I’m 6’5”, I don’t need to be running to a chiropractor daily due to tables that do not rise up to my level and be bending over all day, this was the main point of getting new equipment.

All of the offices have quality, new to almost new equipment at this time.  The equipment is not only comfortable for the patient but it allows me to perform my duties as effectively as possible.  The offices run the gambit.  While the Kearney and Arnold offices are not ideal in my mind, they are fairly inviting, comfortable and serve the purpose.  They are open concept, so privacy can be limited but for the most part patients are good with it.  The Minden office is the most inviting office in my opinion, we have tried to make it the everyman office.  All walks of life come through the doors and the offices try to allow for an environment that is welcoming to everyone.

With that all said, after this purchase I started to really think about what I owe my patient when they walk in the door and the expectations that I place on myself.  Empathy, Optimism, Quality Equipment, comforting environment to walk into and lastly, the truth.

I feel that when a patient calls or walks into the office that you, the patient is putting enough trust in me to give them relief and if I can’t get them relief then at least guide them in the right direction.  Empathy is key to allowing me to determine what the patient is dealing with.  While I can honestly say that I have not experienced a lot of the conditions that present in the office, I try to put myself in the patient’s shoes and try to at least walk them through some of the symptoms that they are describing.

Humor can be a great thing when trying to give optimism to a case.  A patient may be in extreme pain when they come into the office and a little laughter can ease the mood and take the patient’s mind off of the situation.  After being in practice, you can kind of tell based on how the patient is able to respond to pain how long of a process it will be, my hope is to use that to my advantage to walk the patient through the pain and symptoms that they may be experiencing.  Giving the patient a logical path and length of time will give the patient a little optimism with recovery.

Lastly, I owe you the truth.  If I ever have the privilege to treat the readers of this post, I feel that I will attempt to guide you as far as I can through the pain that you are suffering from.  While it is not my favorite thing to do, I have to swallow my pride and tell patients that I am not able to help them and they need to seek alternative care beyond myself from time to time.  While I will attempt just about any case, there are some things that you cannot linger on and the patient may need to move on.

I write this in the hopes that it keeps me accountable to my patients and that it reminds me on a regular basis that I owe my patients the best.  Now, there will be days that get tough but I hope that patients will continue to hold me to these items.  Empathy, Optimism and the Truth are big factors in building a trusting patient base and I hope to continue to grow through these principles.  The buildings and equipment are beneficial in having a welcoming environment but the factors that hold the practice together are the principles that I hold myself too.

I am going to start to address the debacle that is chiropractic student loans in the coming post and it may either be a really long post or be broken into the numerous small posts.  This is a topic that I am becoming fairly obsessed with and am looking to guide a future generation.

Roughly a year ago, Kristina and I were perfectly content working in Kearney and traveling to Arnold one day a week.  Heck we had just moved offices in Kearney and were just settling in there. We were in the process of putting new floors in our house and we received a phone call from Roy Wakefield on a Sunday afternoon.

I had known Roy for about five years since I started practicing in Kearney and would always tell him that if he ever needed to get out of practice and retire, to let me know.  I would say this half-jokingly because I never in my wildest dream would have imagined that we would buy a practice.

I walked out into the driveway to tell Kristina that Roy had just called, we kind of chuckled and said…ah, hell lets run down to Minden real quick and talk to Roy as we did not have any floors or any television in the house at the time, so we had nothing better to do at the moment.  So we loaded up the dog and decided to take a little drive and this is where our lives change in a matter of about 20 minutes.

Now, I had known that Roy’s office had animal heads in the waiting room and trees outside, so I kind of knew what I was walking into but Kristina, I believe was a little in awe of the office.

So we walk into the office of Wakefield Chiropractic with an open mind and are interested in seeing what the details were, not that we were all that interested at the moment.  Wakefield Chiropractic was one of the most established and recognizable practices in Central Nebraska for some time so I knew that the office had a reputation of being well respected.

As I have stated in the past, I am very much a numbers person, we started to get into the numbers and then the wheels really started to turn in my mind.

I knew what the Kearney and Arnold offices was capable of but this was a whole different animal in our minds.  I had never had any type of employee, payroll, work comp. insurance and all of the other aspects that come along with operating a business on this level.  I had always just been a single person office that would answer my own phone and take the day as it comes. 

I don’t think we were even out of Minden, when Kristina and I looked at each other and said we have to do this and take advantage of it.  As many people know, I tend to overthink things, but this decision just felt right. Our main hang up was the schedule and how to make the money work until things got established enough.  Kristina and I had a few connections in Minden, a few phone calls were made to see if we were crazy or not. 

Probably 4 hours after leaving the Minden office for the first time, I called Roy and said that we were going to do this.  He kind of laughed and said “you may need to sleep on this and give it a week to let it sink in.”  Kristina and I were heading to Chicago for a friend’s wedding, we drove out there, so we had plenty of time to mull over this decision. 

After numerous conversations with friends and family, it only solidified our decision to take the plunge to Minden.  I started to meet with people and ironing out the details with Dr. Wakefield.  One last wrinkle, I would need to start working in roughly 2 weeks.  Details were coming at us fast and furious. 

Another issue, I was inheriting two secretaries that had been to the office for over 25 years a piece and had yet to meet them.  I headed to Minden on a Friday afternoon and started to get a mental grasp around what exactly I was taking over, the girls seemed to be open to everything that I was hoping to do with the practice. 

The first couple of weeks were a little strange for me as I was trying to figure out a daily routine that would work for everyone involved in the picture, me, Kristina and the girls, just to make sure everyone was comfortable with the situation.  I was working on tables that I was not accustomed to and providing services that the girls had never heard of.  We had a few bumps in the road but for the most part is was smooth sailing.

We are a little over a year into the Minden office and things are starting to click along nicely.  I told myself it was going to take a while to get everything in place and allow patients to be comfortable with my techniques and ways of operating.  In the past year, we have replaced the carpet, painted the entire interior of the building, brand new tables, added therapies and services and most recently the outside of the building was redone and painted.

The purchase of the Wakefield Chiropractic allowed the business to grow and prosper throughout the last year and we do not regret the decision for one minute.  We hope to continue to grow the Minden office through by introducing the community to services that I offer and through continued quality chiropractic care.  DOT Physicals and acupuncture have always been a niche part of my practice and I hope to continue to allow patients to experience the benefit of these services.

We cannot thank the community of Minden enough and look forward to continuing a prosperous business for many years to come.