The Practice Gap
The Practice Gap
#34 Building a Clinic from the Ground Up with Aleksander Chaibi, Phd, DC, PT.
Ever wondered what it takes to master multiple disciplines in healthcare and then turn that knowledge into a thriving clinic? Meet Aleksander Chaibi, a chiropractor, physiotherapist, and PhD holder whose journey is inspiring. From studying physiotherapy in the Netherlands to an unexpected detour in Belgium, and finally landing in Australia to pursue chiropractic, Alexander's story is filled with serendipitous twists and turns. He opens up about his evolving fascination with the human body and how his critical views on Norway's funding system for physiotherapists fueled his drive for further education. His diverse work experiences, from hospitals to psychiatric clinics, eventually guided him to specialize in headache disorders, even collaborating with a neurologist to develop an innovative research protocol.
In this episode, we also follow Aleksander’s entrepreneurial journey, transforming an antiquated building into a state-of-the-art clinic with the help of an architect. He shares advice for new clinic owners, highlighting the importance of interpersonal skills and work ethic over clinical skills when hiring. You can learn about key interview questions to assess a candidate's fit and how to manage and train therapists effectively through communication and practical experience. Aleksander also underscores the vital role of journal writing and observing colleagues in professional growth. His remarkable ascent from a novice physiotherapist to the owner of a clinic with 20 employees offers a masterclass in dedication and expertise, promising more insights into his research endeavors in future episodes.
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Elisabeth Aas-Jakobsen, DC, MSc
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Hi and welcome to the Practice Gap, the podcast for closing the gap between the practice you have and the one that you want. I'm Elisabeth, a chiropractor, a business owner, coach and entrepreneur, on a mission to help you move from frustration and overwhelm to clarity, focus and joy in practice. 3, 2, 1, go Three, two, one go. Hi, Alexander Chaybe, and welcome to the studio.
Speaker 1:I am so happy to have you here you are you're many things and you are a chiropractor, yes, and a physiotherapist, and you hold a PhD. Could you please tell a little bit about yourself to the audience?
Speaker 2:Yes, first, thank you for having me. I've heard your podcast before. I find it very interesting. Yeah, it's true, I have three degrees. That has taken me a long time. I started off as, and graduated as, a physiotherapist in 2003-4. Then I worked for a year in Bergen, on the west coast in Norway, and then I traveled to Sydney and studied chiropractic and since late 2007 I've been practicing in Oslo and 2009-10 I think, I started thinking about doing research and tried, and I contacted a lot of different research groups in Norway because I was interested in headache disorders and one guy outside Oslo, at Aarhus, he found the study interesting.
Speaker 1:Just Aarhus is a hospital. That's a hospital, yes, sorry.
Speaker 2:So, yeah, it's better to approach hospitals and research groups at hospitals because they normally have better funding possibilities. So that's the reason why I did that and he found it interesting, even though he's a neurologist and we started cooperating quite early, developing a research protocol which took about two, two and a half years, and then we obtained funding and started a project.
Speaker 1:That's a long journey and I see a lot of questions here. Let's start in the beginning. So you are a physiotherapist in Bergen. What made you move to Australia and become a chiropractor?
Speaker 2:Well, that's a good question, because I actually have a story there, because when I started physiotherapy I was I would say I was a bit immature. I didn't really know what I was getting at.
Speaker 1:Like immature, like how old were you?
Speaker 2:I was maybe 20, maybe or yeah around 20. And I lived in Bergen then and I applied different places and actually got accepted in the Netherlands. So that's where I did my study in Eindhoven. And I went to this Kilroy travel agency and I said I need one ticket one way to Eindhoven. And I went to this Kilroy travel agency and I said I need one ticket one way to Eindhoven and I ended actually up in Belgium. But I didn't realize I was in Belgium until I stood on the airport and I was a little bit confused. And then there was actually a transit bus to Eindhoven. But that bus arrived about 11 pm and everyone was picked up except me. But I had a mobile phone at that time, so I was able to call a taxi and I asked the taxi driver to drive me down to the cheapest motel in Eindhoven city and the day after I actually walked up to Funtis University where I did my study.
Speaker 1:What made you decide to become a physiotherapist?
Speaker 2:Oh, I'm actually I'm interested in sports. I was a little bit interested in the human human body at the time, but not really. I think I was more confused than anything, so I just had to start at something. Yeah, actually in second grade of the physiotherapy study I was maturing a little bit and starting to understand what I was actually doing. My grades improved a little bit as well. But then I realized there's the we have in Norway. We have this funding from the county, where the physiotherapists receive a lot of money and are reimbursed by the government. But not everyone has that. About 30-35% of the Norwegian physiotherapists has it and it's a little bit of a corrupt system. And I realized that and I actually contacted some politicians and asked about it. I didn't receive an answer, so then I gave that up.
Speaker 1:So already, as a student, you were a troublemaker. No, not a troublemaker.
Speaker 2:No, I'm not seeking knowledge, that's a much better thing perfect so I realized this is a really mafia way to go. So I was trying to steer away from that. And that's where I thought how can I extend my knowledge within the human body? Because I was starting to get a lot interested in it, and so I considered manual therapy and chiropractic and other master degrees within physiotherapy, and then I ended up in Sydney because that was more attractive for me how was the first year you worked as a physiotherapist in Bergen?
Speaker 2:Yeah, I was actually not in Bergen the first year you worked as a physiotherapist in Bergen.
Speaker 2:Yeah, I was actually not in Bergen the first time I was at the hospital as well, because my internship as a physiotherapist was split half a year at a hospital, førde Hospital, where I practiced at different departments like orthopedic, neurology and pulmonary departments. The second part of the internship I practiced at a private clinic just in Bergen and I got a good relationship with the owner there and I just continued. But actually I did also work part-time at a psychiatric hospital as a physiotherapist as well, trying to help actually convicted psychiatric patients to have a better life interesting.
Speaker 1:And then so the decision when. When did that? When did you decide? Like, what was the moment? Was this something like tipping point? Was there something somebody said or something you experienced?
Speaker 2:like what made you like I'm doing another degree that was, uh, maybe at the beginning of my final year at the physiotherapy. I was because there's a lot of it's a long waiting list as well. Uh, to get into a master program in physiotherapy you need a lot of clinical experience and you need some coursing etc. And that role was a little bit too long for me. So then I applied in England and Denmark and Australia and even the United States, and in Australia especially in Sydney, they have, they had they don't have it anymore but a qualifying program where I did a few more subjects in a qualifying year in addition to all the other subjects in order to get into the master's. So I actually got accepted as an exception for one year.
Speaker 2:So I did it in three plus internships in Norway.
Speaker 1:So good. So you are finished. How was it what? Oh, yes, okay. So you choose Australia because of the beautiful weather and it's far away, and, of course, you get this in. You take away one year from the whole program, so you are done with school and then you decide to go back to Norway. How was that?
Speaker 2:That was all right, because I knew where I was supposed to Norway. How was that? That was all right, because I knew where I was supposed to work Did you have a job. Before you, I had a job because when I went back to Norway, I started a process and I knew where I wanted to go and that's where I went. I had a perfect internship where I actually continued for two more years and learned a lot.
Speaker 1:So then you are there. What happened? You said two more years. What happened Then? You'd been working for three years so what happened then?
Speaker 2:Then the guy I worked for he sold his clinic, and the new owners didn't have the same philosophy as myself, and so then I started up my own clinic in Oslo centrum as well and how many years ago did you open up your own clinic?
Speaker 1:that was in 2010 2000, so that's 14 years ago when you how was the like, when you went from a clinic where you worked to opening up your own clinic? What was the biggest challenges you had?
Speaker 2:there was some challenges in terms of getting the full picture of how to run a clinic, negotiating with the owners of the building licenses for different programs, etc. Also contracts in terms of assistance or other therapists in, because we are a multidisciplinary clinic. So just had to push through and get the knowledge because the even though the clinic I worked for was clinically exceptional, all the other factors which comes from from running a clinic yeah, it was not as good so how many people are you in your clinic?
Speaker 1:how many therapists are you is in your chiropractor, like how many people are in your clinic right now right now it's maybe about 20, I think 20 yeah, is it one clinic or more than one clinic?
Speaker 2:we have two. We had three but we had to close one one clinic, so now we have two and both are running pretty good. Oslo clinic is twice as big as the Bergen clinic in terms of therapists but size it's equal.
Speaker 1:I suppose you don't didn't start out with two clinics and 20 people. When you first started out, was it only you or did you have an associate, or what was the like? How many rooms did your first clinic have?
Speaker 2:It had. I think it was about three, so it was me and a massage therapist. To begin with. This was an old building. To begin with looked like a really old boat, to be honest, with dark doors and narrow corridors etc. But then we just expanded really quickly. We took one room after the other in the same floor oh.
Speaker 1:So you're pretty lucky. You had a building where you could just add them a room as you grew.
Speaker 2:Yeah, we could at that time, because this is a huge building in Centrum Eight floors and a lot of rooms and it was run by a family as well. So we just talked to the landlord and he was helping us throughout the growth process. The family sold the building in 2019, I think and then new, more professional owners came in and they want restore the whole building. And then we took a little bit more like 60, 70 more square meters and took the whole third floor, Ruined the whole clinic down to the concrete and we'll build it up with an architect. So now it's really, really nice.
Speaker 1:It sounds like you had a. From the overview it sounds like a fairly smooth ride. But if there for new people who would love to open a clinic and to have the growth to have like a bigger clinic, do you have any advice to give?
Speaker 2:I would say this is a people business. We need to consider the environment. Basically With people I mean you need to trust the people you get in. They need to have a really good work ethic and work moral and if they have a smile around the mouth you come a really long way, because clinical skills can be worked on. But communication skills is a little bit harder because that's something they've adapted throughout life.
Speaker 1:So during interviews, consider more the person's social abilities and interpersonal skills first, and then professional or practical skills second do you have any good questions, like if you're a clinic owner and you are you're interviewing a potential person who wants to work for you.
Speaker 2:Do you have any like good questions or different question that you you have found very valuable because I guess your experience it increases with every interview you do yeah, to begin with it was, it was probably more practical oriented, and now it's uh, it's much more environmental and interpersonal skills, uh, oriented, along with work ethic and work moral, because if the desire is there, the will and and and ability, you can achieve whatever you want. But some, some people don't have the will to build practice and and they will never succeed, uh, unless unless they take their like a, yeah, reality check of what they actually want so if I, I would say okay, alexander, I'm a chiropractor, I want to work with you where, like, how would an interview look?
Speaker 2:I would probably start off by asking you all right, eliz, who are you as a person?
Speaker 1:Okay, so yeah, that's a good question.
Speaker 2:Because an open question will often reflect how prepared they are and how they go about presenting themselves, and I get a lot of information about interpersonal skills. Some can be really self-inflicted, some could be really introvert, etc. And I get a lot of knowledge from there and basically a freestyle interview from there. But there are some key points I need to address. I need to address interest areas, see if they complement the clinic or if they can bring something new. I also need to ask them about the future how they see the future.
Speaker 1:Yeah, how they see the future.
Speaker 2:Uh, if they like some goals yeah, wishes and goals. Basically, if they like to attend courses, if they are interested in in research. It's a thing I'm interested in, but it's it's all a matter of gaining knowledge and using that in clinical practice and sharing it as as well and not at least what's the biggest learning, what is the biggest kind of?
Speaker 1:when you look back, it is like the biggest learning situation you were in you where you actually said, like you got somebody into the clinic who was a really wrong fit. Have you had any of those experiences?
Speaker 2:I've had a few.
Speaker 1:How did you deal with it? When you realized it's like, oh, this is a bad fit.
Speaker 2:Yeah, I've. We need to confront it. But it's difficult because you want to change a person and it's basically the same as raising children. You need to try to find an entrance into communication. You need to help them realize what's going wrong. If it's professional skills, that's a little bit more serious than interpersonal skills, but I find both very valuable. And then we start off by just small talks and I need to follow up. You need to follow up these conversations, maybe weekendly, and if we don't see any change, you just need to tell the person that I don't think this is a right fit for us or for you, and I think you're better off moving on, because staying in that environment will affect the whole clinic and you have as an owner.
Speaker 2:You have a responsibility responsibility for all the therapists and employees, not only your own practice or an individual therapist, but a general rule I've learned is to try to focus on the successful parts of your business and not the negative parts, because human beings are really obsessed by negative things and that really drains you of energy.
Speaker 1:Yeah, good advice there, and I think a lot of chiropractors who run their own clinic I mean they're excellent, excellent clinicians, but most of us are. We never learned how to really run a business and it's learning the hard way.
Speaker 2:Yeah.
Speaker 1:And I do believe that we can learn from other people's experiences.
Speaker 2:Definitely, and we can learn from other professionals as well. I actually started up the clinic in 2010 with a lawyer. Aha, that's an interesting yeah he was a patient of mine at the first place and we developed a good relationship and he was interested in health and I was interested in health and he had a really good contact network and he taught me a lot on negotiating and economy etc. So that's a bachelor's degree in economy just there. Practical learning.
Speaker 1:Very cool, that's a new one. Probably we should all have that kind of help. One last question on this session here what are the factors you see in those who work for you, if it's a chiropractor or physiotherapist or a osteopath or a massage therapist? What are the qualities that make a really excellent, excellent practitioner?
Speaker 2:yeah, I think the the most, absolutely most important is good communication skills with other therapists but, more importantly, with the patient. Because if you have excellent communication skill around the rational of your hypothesis, diagnosis or your working diagnosis and your differential diagnosis and the rationale for why the treatment or the self-treatment can help you, and if the therapist is able to put that information on the level, or maybe a little bit above the level, of the patient to generate trust and and credibility towards the patient, then the next step will be to to work on the patient's confidence and if I were to use a catchphrase here, I would say try to to stimulate yes, I can towards the patient. The other factor that is important is to have good diagnostic and and practical skills as well, because that you can compensate on both sides. You can compensate by having a little bit reduced practical skills with excellent communication skills or excellent practical skills and maybe a little bit reduced communication skills, but if you on the upper hand on both of those two, you I consider them are really good therapists.
Speaker 1:For the people who work with you. Do you have some? What are the advice when they start out? What are like the three top advice you give them?
Speaker 2:We actually have a routine or a guideline. When we employ people, we go through communication.
Speaker 2:We have maybe 30, 40 slide presentation one hour and then follow up with Q&A and then follow up with practical intervention. Maybe I observe, or somebody else observe, the therapist in action and then give one-to-one feedback. Then we have a practical workshop on journal writing, because that's really important. Most therapists independent maybe physiotherapists are a little bit better, but the rest inclusive include including physicians are really terrible when it comes to journal writing, and that's something that I'm really interested in to improve journal writing. So we have a session on that as well. And then basically observe your colleagues, not only to learn practical tricks but also to gain information about how they communicate with the patient, because every time you observe you pick up one or two things that you can implement in your own style and in time, 5, 10, 15, 20 years, you will develop a really nice way in terms of communication and practical skills and then you become a really good clinician.
Speaker 1:How many years to?
Speaker 2:become a really good clinician. I think you'll be decent in five, you'll be good in 10, and you'll be excellent in 20, and you'll never finish.
Speaker 1:Well, that's great. Thank you, Alexander. I will have you back for another podcast after this break. And just to sum up a little bit, you've had quite an interesting journey from being a physiotherapist going to work a little bit and then going back to school and then starting to work and then opening a small clinic and now you have like 20 people working in your clinic and we haven't even started talking about the research part, but we are. We will go get back to that for the next podcast. Thank you thank you.