The Practice Builders

Dr. Vince Leone and Dr. Kyle Pankonin

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Welcome to the Practice Builders podcast, the show where innovation meets strategy for growing thriving chiropractic clinics presented by Specialized Practice and hosted by Dr. Vince Leone and Dr. Kyle Pankonin. They're here to share proven tactics to help you build cash-based revenue streams, maximize staff driven services, and reduce reliance on insurance.

1d ago

60. Creating a Remarkable First Visit

🎙 Episode 60 – Creating a Remarkable First Visit In this episode of The Practice Builders Podcast, Dr. Vince Leone shares a micro-training on how to create a first visit that builds trust before the patient ever meets the doctor. Patients are forming opinions from the moment they pull into the parking lot. The way your office looks, sounds, smells, and feels can either reinforce confidence or quietly work against you. Vince breaks down a simple Weekend First Impression Audit to help you identify the small details you and your team may have stopped noticing, from the front desk and waiting area to the bathroom, treatment rooms, paperwork, and patient greeting. The goal isn’t a major remodel. It’s making a few low-cost, high-leverage improvements that create a more professional and intentional patient experience. Key topics include: Why first impressions directly impact trust and close ratesHow to audit your practice through a new patient’s eyesSimple improvements to your front desk, waiting room, bathroom, and treatment areasWhy your team’s greeting and communication matter just as much as the physical spaceThe challenge to identify 3–5 small improvements you can make this weekThe big takeaway: clinical excellence matters, but patients experience your practice before they experience your clinical skill. Make sure those first few minutes tell them they came to the right place. 🎧 Listen now on your favorite platform!
Aug 3

59. Do You Need That MRI?

🎙 Episode 59 – Should Every Patient Get an MRI and How Imaging Decisions Affect Diagnosis Case Acceptance and Treatment Outcomes In this episode of The Practice Builders Podcast, Dr. Kyle Pankonin breaks down a nuanced framework for deciding when an MRI actually belongs in your decompression practice. Most doctors fall into one of two traps: never ordering imaging, or ordering an MRI for every patient. Neither is right. The real question isn't whether a scan looks impressive — it's whether it will change your management plan. History and exam always come first; the MRI is there to confirm or clarify, not to replace them. He also discusses why over-relying on brief medical radiologist reports can leave you with incomplete information, how to avoid scaring patients with scary-sounding terminology, and why an MRI is just as valuable for identifying good decompression candidates as it is for ruling out surgery. Key topics include: Why an MRI should only be ordered when it will change the diagnosis, treatment plan, or referral decisionWhen x-rays are enough — and when persistent radiculopathy or worsening neurological deficits mean it's time to scanWhy Modic Type 1 changes matter and what they can signalHow a $30 chiropractic radiologist review can catch what a brief medical report missesWhy treating the image instead of the patient is one of the costliest mistakes in decompression careHow to use the MRI as a communication tool — simple analogies like "blown tire" build trust and case acceptanceThe big takeaway: an MRI isn't a shortcut to a diagnosis, and it isn't optional busywork either. Used well, it's a tool that sharpens your clinical picture and helps patients understand exactly why your treatment plan makes sense. 🎧 Listen now on your favorite platform!
Jul 28

58. Specialists Win: Why the Future of Chiropractic Belongs to Specialists

🎙 Episode 58 – Specialists Win: Why the Future of Chiropractic Belongs to Specialists In this episode of The Practice Builders Podcast, Dr. Vince Leone breaks down a nuanced framework for deciding when every patient really needs an MRI in your decompression practice. Most doctors fall into one of two traps: chasing every high-value cash service, or staying stuck as a generalist competing on insurance and price. Neither builds a lasting practice. The real question isn't how many modalities you offer — it's whether you're becoming known for solving one or two specific, high-value problems exceptionally well. He also discusses why clinical excellence alone can't save a practice from becoming commoditized, how positioning and marketing are what actually let patients see the difference before they walk in the door, and why the doctors who reinvest in their specialty create a flywheel that compounds over time. Key topics include: Why "commodity chiropractic" happens and how it traps practices into competing only on insurance and priceThe Practice Nirvana model — a general chiropractic base feeding one or two high-value specialties like decompression or knee painWhy specialization builds authority, better protocols, and stronger referrals over timeHow generalists compete on price while specialists compete on value, trust, and outcomesDr. Leone's own journey from a struggling generalist to scaling a specialized practice to multiple seven figuresThe 3 practical questions every doctor should ask about their practice's positioning The big takeaway: generalists compete, specialists differentiate. The future belongs to doctors who stop trying to be everything to everyone and instead become exceptional at solving specific, high-value problems. 🎧 Listen now on your favorite platform!
Jul 20

57. Building A Three Therapy Center

🎙 Episode 57 – Building A Three Therapy Center In this episode of The Practice Builders Podcast, Dr. Kyle Pankonin breaks down how to combine spinal decompression, Class 4 laser, and shockwave therapy into a system that drives better outcomes and doubles your cash-based revenue — and why using them the wrong way is one of the most expensive mistakes a practice can make. The episode is a lesson in matching the right therapy to the right problem. Too many docs reach for one device to solve every case, or buy expensive tech without a clinical system behind it — and a $12k table with a great protocol will outperform a $60k table with a poor one every time. Instead, Dr. Pankonin frames it like a football team: decompression restores mechanics, laser accelerates healing, and shockwave restarts regeneration in stubborn tissue — each with a specific job to do. You'll learn: The two most common mistakes docs make with combo therapy — and the one question that fixes both: "which therapy is best for this patient's condition?"When to use decompression, laser, or shockwave alone — and when to stack them, with real case examples for shoulder, lumbar disc, and plantar fasciitisWhy Failed Back Surgical Syndrome has a 26.2% failure rate while decompression succeeds 90.5% of the time in similar cases — and the three-therapy combo built for itHow to stop selling individual sessions and start selling outcomes by building branded "recovery programs" (Lumbar Disc Recovery, Heel Pain Recovery, Shoulder Recovery) in 6, 12, or 24-visit tiersHow this exact shift took Dr. Pankonin's own practice from 95% insurance to 50–60% cash-based, more than doubling revenue and landing in the top 1% of clinics nationwide A must-listen for any doc running these three therapies who wants to stop treating in isolation and start building programs patients actually buy into. 🎧 Tune in and learn how to turn three separate tools into one system that changes outcomes — and your bottom line.
Jul 14

56. Decompression Case Review

🎙 Episode 56 – Decompression Case Review In this episode of The Practice Builders Podcast, Dr. Kyle Pankonin breaks down two real decompression cases that show why this therapy belongs at the center of a modern chiropractic practice — and how to frame it so patients choose it over pills, shots, and surgery. Both cases are a lesson in patience and patient selection. First, a man with years of recurring low back pain that chiropractic used to fix — until a 2025 injury and a large L5-S1 extrusion changed everything. He was only 25% better at month three; by month four he hit 75%, and today he's on maintenance feeling his best in years. Second, a 57-year-old post-surgical patient no one could help who reached 98% improvement with the right protocol. You'll learn: Why chronic patients whose pain has stopped responding to standard care are your most natural decompression candidates — they already trust youWhy large disc extrusions often respond better than small bulgesWhy breakthroughs often come late — and how setting the full 24-visit expectation keeps patients from bailing earlyThe post-surgical waiting periods that make a patient a safe candidateWhy you always correlate MRI findings with a thorough exam — the pain generator doesn't always match the imagingHow to frame decompression against surgery using the real numbers: 85–93% success versus surgery's ~72% first-time rateWhat the research actually says about muscle relaxers, opioids, gabapentin, injections, and ablationsA must-listen for any doc who wants to become the go-to authority on disc and spine care in their market — because when you can show patients the data on every alternative, decompression stops being a hard sell and becomes the clear choice. 🎧 Tune in and learn how to turn complex disc cases into some of the most rewarding wins in your practice — clinically and for the patients whose lives you change.
Jun 30

55. I Need To Think About It

🎙 Episode 55 – I Need To Think About It In this episode of The Practice Builders Podcast, Dr. Vince Leone and Dr. Kyle Pankonin tackle the four words every decompression doc dreads at the end of a strong ROF: "I need to think about it." It's rarely a real maybe — it's a soft no from a patient who hasn't reached enough certainty to commit. This episode breaks down why patients hesitate, how to prevent the objection before it surfaces, and exactly what to say when it does. You'll learn: Why "I need to think about it" is almost always a polite no — and why most of those patients never come back without proactive follow-upThe five root reasons patients hesitate, from not understanding the condition to not yet trusting youHow plain-English analogies — the dried-up sponge, the ice cream sandwich, the stepped-on garden hose — build the understanding that drives a yesWhy tracking your own success rate gives you the confidence and hard data to lay a patient's fear of failure to restThe exact language to uncover the real objection — "while you're here, what specifically do you need to think about?" — and why going quiet after is the whole moveHow to close the loop with take-home materials and a scheduled next appointment instead of letting an undecided patient drift awayA must-listen for any doc playing in the deep end of high-value cash services — because the difference between 2 starts a month and 6 often isn't your treatment. It's what you do in the 10 minutes of objections that follow the plan. 🎧 Tune in and learn how to turn "let me think about it" into "let's get started" — because patients buy hope, certainty, and a clear path back to their lives.
Jun 26

54. Red Flags That Tell You a Patient Is Not a Good Candidate for Spinal Decompression

🎙 Episode 54 – Red Flags That Tell You a Patient Is Not a Good Candidate for Spinal Decompression In this episode of The Practice Builders Podcast, Dr. Pankonin breaks down six major red flags doctors should watch for when selecting spinal decompression patients. Successful decompression starts with proper patient selection. An MRI may show disc degeneration, bulges, or stenosis, but that does not automatically mean the patient is a good candidate. The MRI must match the patient’s symptoms, history, and exam findings. He also discuss why doctors need to set realistic expectations, screen for psychological and compliance barriers, and look at the bigger picture when patients have significant comorbidities like obesity, smoking, poor conditioning, or lifestyle factors that may limit results. Key topics include: Why the MRI must clinically correlate with the patient’s symptomsWhen severe multi-level central stenosis may limit decompression outcomesHow fear-avoidance, disability mindset, anxiety, or depression can affect resultsWhy “miracle seekers” often become disappointed patientsHow poor compliance can sabotage a 24-visit decompression planWhy comorbidities and lifestyle factors must be addressed before or during careThe big takeaway: not every patient with a bad MRI is a decompression candidate. The goal is to identify the right patients, set clear expectations, and create the best possible chance for a successful outcome. Doctors should define success around meaningful improvement, such as at least 50% pain reduction and better function, rather than promising to “fix” or “cure” the condition. 🎧 Listen now on your favorite platform!
Jun 15

53. How To Explain Disc Injuries So Patients Actually Understand

🎙 Episode 53 – How To Explain Disc Injuries So Patients Actually Understand In this episode of The Practice Builders Podcast, Dr. Kyle Pankonin tackles the real reason patients walk away from disc treatment — and it's not cost or fear. It's confusion. When you bury a diagnosis under terms like "annular tear" and "foraminal stenosis," patients can't say yes to something they don't understand. This episode hands you a plain-English analogy toolkit that turns complex disc injuries into something any patient can grasp in seconds. You'll learn: Why technical jargon — not price or fear — is the hidden conversion killer in your report of findings, and how to dismantle itThe four questions every patient is silently asking, and how to answer all of them before they ever have to askThe full analogy toolkit — Jelly Donut, Sponge, Ice Cream Sandwich, Tire, and Garden Hose — and exactly what each one explains, from annular tears to nerve impingementHow to draw a straight line from each analogy to decompression, so the treatment becomes the obvious solution instead of an upsellThe three differentiators that make patients say "no doctor's ever done that before" — and why clear communication sits at the center of themHow dialing in your explanation can lift conversion from a typical 40–50% all the way to 70–80%, helping more people avoid surgeryThis is a must-listen for any decompression doc whose great clinical work isn't translating into accepted care — because the gap usually isn't your skill. It's the moment between the diagnosis and the patient's understanding of it. 🎧 Tune in and learn how to make every disc injury make sense to your patients — because confident patients say yes, and confused patients say "let me think about it."

5

out of 5

3 Ratings

Welcome to the Practice Builders podcast, the show where innovation meets strategy for growing thriving chiropractic clinics presented by Specialized Practice and hosted by Dr. Vince Leone and Dr. Kyle Pankonin. They're here to share proven tactics to help you build cash-based revenue streams, maximize staff driven services, and reduce reliance on insurance.

Creator

Dr. Vince Leone and Dr. Kyle Pankonin
Years Active

2025 - 2026
Episodes

60
Rating

Clean
Copyright

© Dr. Vince Leone and Dr. Kyle Pankonin
Show Website

The Practice Builders