#47: Bill Esteb on Identity, purpose and longevity in Chiropractic practice.

What separates chiropractors who thrive for decades from those who struggle to find fulfillment in practice?

In this episode of The Practice Gap, I sit down with chiropractic legend Bill Esteb to explore the foundations of a successful, purpose-driven practice. Bill shares insights gained from more than 40 years of working alongside chiropractors around the world, covering everything from practice identity and patient communication to marketing, boundaries, fees, and long-term professional satisfaction. 

We discuss:

•  Why identity is more important than strategy 
•  The difference between therapeutic and wellness-focused chiropractic 
•  How to build a thriving family practice 
•  Common boundary mistakes that create stress and burnout 
•  Why patients—not chiropractors—are the heroes of the healing process 
•  How to attract patients who value health, not just pain relief 
•  The role of purpose in creating a fulfilling and sustainable career 

Whether you're a new graduate or a seasoned practitioner, this conversation is packed with wisdom that can help you build a practice aligned with your values and vision.

 "Identity is based upon purpose." – Bill Esteb 

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Kind regards,
Elisabeth Aas-Jakobsen, DC, MSc

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Transcript

Welcome To The Practice Gap

SPEAKER_01 0:13

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 Elizabeth, a chiropractor, a business owner, coach, and entrepreneur on a mission to help you move from frustration and overwhelm to clarity, focus, and joy

Meet Bill Esther And His Path

SPEAKER_01 0:33

in practice. Hi, and welcome to the studio, Bill Esther. Bill Esther has been on my uh would love to talk to uh Liszt for a very long time. I had one of his books when I went to uh chiropractic school 30 years ago, and it was called The Patient's Point of View. You are not a chiropractor. So please could you start by telling the audience a little bit about yourself?

SPEAKER_00 0:59

It's true. Well, my background is in the media. Um, I worked at advertising agencies and uh digital audio recording studios and things like that and radio. And uh I was working for a film production company in Colorado, and two chiropractors moved in next door to our production offices. They were chiropractors, and uh we heard stories about chiropractors, so frankly, we kind of uh ignored them uh until one day they were carrying videos under their arm and in the hallway, and and you know, we do video and what's what's going on. And so they explained that they were getting ready to harness this newfangled contraction called the VCR, the video cassette recorder, and uh use it for patient education purposes in chiropractic. And uh, well, that's the kind of thing we do. And we struck up a conversation and they suggested that uh if we wanted to work together to help create this uh revolutionary new uh piece of patient education, that someone from our production team should attend one of their seminars. So I got the short straw as the uh writer and producer of the um of the company, and I flew to uh Spokane, Washington, and uh attended my first three-day renaissance seminar back in 19, well, it was January of 1981. And what I heard during that seminar not only resonated with me personally, but it totally made sense to me. And I went back and suggested to our team that uh we help these guys create their video. And nine months later, the uh Renaissance uh Peter Graves video showed up. And as part of the research to create that video, I began chiropractic care myself just to find out what this adjustment was and just what what was going on here. And so I started care in February of uh 1981 and have been under care since then, receiving weekly uh adjustments uh since that so it's been 45 years of regular chiropractic care. So uh while I'm a patient, I'm certainly not a normal patient. So I guess that's the short story.

SPEAKER_01 3:27

What was it that uh made you uh become like when you first came into the off the chiropractic office and decided to become uh active patient? How can you remember like what made you like tick this as kind of cool? Or like what yeah, what fired you up about it?

SPEAKER_00 3:46

Well, you know, that's what's kind of interesting about my particular journey because I entered the chiropractic practice as a research project. So I didn't have an obvious ache or pain or something that you would normally consider something worthy of consulting a chiropractor for. So instead, I entered with number one, I had this obligation to write this video script. But secondly, I'd say, uh, and maybe even foremost, was the idea that I appreciated the philosophical underpinnings of the profession. In other words, this notion that the nervous system is the master system and controls the whole show was uh suddenly self-evident to me. I mean, it that made total sense to me, although no one had ever said it like that before. So um I uh I was much more enamored by the philosophy of it that uh you know, that a stomach problem um might manifest as a stomach problem, but what it may actually be is a brain-to-body, body-to-brain communication problem. So that made sense to me. And uh so the the the nerve the the the real drama, the real breakthroughs, the real uh I wouldn't call it a miracle, but uh th those sorts of things happened later. So showing up on a non-symptomatic basis, I think was probably uh the the unique aspect of it.

How Chiropractic Changed Over Decades

SPEAKER_01 5:26

For those in since then 1981 until now, what are the biggest uh changes in the profession as uh when you look uh to it as a whole?

SPEAKER_00 5:39

Well, I think the biggest change, and probably the most unfortunate change, is that we have uh that for many purposes which probably don't need to be discussed here, that we have a growing number of chiropractors who go through the process of chiropractic college and emerge practicing a version of what I would call therapeutic chiropractic. Back in the day, let's say going back to the 1950s and 60s, even chiropractors were seen more as the family doctor, and whole families would show up. And what's happened in the period since is that increasingly people are showing up in chiropractic offices for back pain, headaches, you know, spinal conditions, and it's not the whole family, it's the individual, it's it's a single member of the family. And because chiropractic has kind of taken on a medicalized spinal specialty, if you will, rather than a whole body phenomenon, uh you don't see the family practice as you did, you know, maybe 75, 80 years ago. So I think that's the most significant change. Now, that said, another significant change that has shown up is the fact that chiropractic is far more accepted today than it was 50, 75 years ago. I mean, it's not so much uh have you been to a chiropractor, it's which one have you been to? So uh on one hand, there's there's there's kind of a more acceptance on on the negative side, there is uh a loss of what I would call the chiropractic philosophy of what what really put chiropractic on the map in the first place.

Defining Philosophy And Subluxation

SPEAKER_01 7:42

How do you f uh how do you define chiropractic philosophy?

SPEAKER_00 7:48

How do I define chiropractic philosophy?

SPEAKER_01 7:50

What is if you would explain to someone else what uh somebody has no idea what chiropractic is, um what is chiropractic uh uh philosophy?

SPEAKER_00 8:01

Right. Well, uh the way I see it is that what chiropractors do is work with the nerve the nervous system, ensuring uh uh integrity uh between brain and body, body and brain. And chiropractors uh use an intervention called the adjustment, which is adding energy to opportune times and places along the spine to help reduce nervous system interference so the body can function as it was designed. And this thing, this entity, this uh issue that chiropractors provide an intervention to is typically called the vertible subluxation. Vertible meaning of the spine, and subluxation meaning a disconnect or a or a less light uh condition, um, in which the body has embraced this vertible subluxation as a response to physical, chemical, or emotional stress. So to me, vertible subluxation is a gorgeous creative response that the body uses in its attempt to accommodate stress. So I don't see subluxation as a bad thing necessarily, but merely a uh a means that uh the body has used as a survival strategy to adapt to stress. So that's kind of the short answer.

Building A Purposeful Family Practice

SPEAKER_01 9:36

If you if you um had a younger doctor, we if you would talk to somebody who had been, let's say, working for two years and are a little bit frustrated and wants to build a family-based care, uh like um like to have a family um practice. What suggestions would you make to that person to make that happen?

SPEAKER_00 10:02

Yeah, that's a big, big, big, big uh uh question. But uh a couple things come to mind. Number one, make sure that you have a clear identity. That is, you know that your purpose is not to adjust, your purpose is adjusting patients helps manifest or advance your purpose. Um uh and to be proud of being a chiropractor, and uh uh that uh much like what I said earlier, is to avoid practicing chiropractic therapeutic chiropractic. That is, I would make sure that every patient understands that while they've presented with headaches or back pain, you won't be treating headaches and back pain. That's the practice of medicine. Instead, what you'll be doing is resolving the uh structural and neurological cause of the headache or back pain. So we don't we don't really treat that uh sort of uh condition, although people who have headaches and back pain um report uh delightful success with their uh their uh uh involvement in chiropractic. I would uh make sure that uh that that new practitioner had incredibly clear boundaries. In other words, they know what their responsibility is and they know what the patient's responsibility is, and they don't they don't make that vague or ambiguous. Core boundaries is the cause of all kinds of uh challenges and frictions in a particular practice. I would make sure that every patient knew that they were buying the doctor's talent and not the doctor's time. I think there's a big there's there's quite a misunderstanding that uh somehow drawing out the patient visit and adding uh additional theatrics somehow communicates a greater value. And uh that's that's not my been my experience. Uh most people are not living to get adjusted, they get adjusted so they can go live. So um adjusting, getting in, getting out, and on with their life is something that you want to make sure that uh you communicate. I think the notion that uh thinking that enough new patients solves every problem uh it is is a uh unfortunate belief, which is not true. I mean, when you have a lot of new patients, it can hide and cover up a lot of other uh misunderstandings or shortcomings in a practice. So uh new patients uh is rarely the problem. It's it's keeping patients, and that means explaining a bigger vision of chiropractic than merely pain relief. And I think the other uh issue uh would be that many uh chiropractors have a very short time horizon. In other words, they view the relationship as uh based upon how long it takes to resolve the patient's problem rather than an eternal view or a long-term view of uh seeing chiropractors as uh seeing patients as a uh long-term relationship uh punctuated by periods of dormancy. So, you know, those are just some of the things that come to mind just off the top of my head.

Boundary Mistakes That Create Friction

SPEAKER_01 13:16

Um if we go back a little bit here to setting boundaries, that was actually one of the things I talked with some of my younger colleagues uh yesterday during lunch that came up. Um when you talk about setting boundaries, could you give some examples of good ways you um think to set boundaries? Okay, this is what I can do, this is like this is my responsibility, this is yours. How how like do you have any uh good examples?

SPEAKER_00 13:45

Yeah, this is a huge, huge issue. And it's so subtle, so nuanced that uh many chiropractors don't see it or are or are uh oblivious to it. But examples of poor boundaries would uh include being emotionally invested in patient choices. In other words, we subtly change the report of findings into from a report of your findings and uh a recommendation of care, we turn it into a sales presentation where we are hoping or emotionally invested in what the patient does. And so instead of showing up objective and neutral uh as we would expect from a licensed professional, we show up, well, the chiropractors can show up as being emotionally invested in trying to produce a particular outcome or decision on the part of the patient. Spending more time than is necessary with the patient uh suggests a boundary issue. Uh, downplaying significant findings of your examination would be a sign of poor boundaries. Softening or reducing your recommendations uh because you're seeking approval from the patient would be a boundary busting uh activity. You know, feeling defensive when patients uh indicate that they are frustrated with the pace of the recovery. Uh that defensiveness shows that you're invested in something you can't control, namely how quickly you can revive the patient's ability to self-heal. Gosh, uh you know, when uh when you don't explain to patients how to disengage from the office, from the practice, uh that can be uh a form of poor boundaries. Or allowing a patient to amass a large outstanding balance without expecting to be paid. Uh that's a sign of of poor boundaries. Gosh, does that help?

SPEAKER_01 15:47

Yeah, it it's uh very excellent, excellent.

Fees Self-Worth And Cash Patients

SPEAKER_01 15:50

One of the things uh that comes up as seen as a problem with a lot of uh newer doctors and old people have been working for a long time. Uh when the people who pay cash, they're not insurance patients. Uh they have they might be very easy to make a plan for somebody with insurance. But they they take the money issue and they when they give recommendations of care, they think about the patient's uh uh money or the cost. And so two questions about that. I'm sure that's pretty pretty common. Do you have any suggestions for how chiropractor can uh work with the mindset and also maybe to have some thoughts about maybe making different uh unusual um price structure, like suggestions or ideas for uh what do you you think the things you've seen actually work in practice with when working with other chiropractors?

SPEAKER_00 16:48

Yeah, this is all headspace stuff. Um and there's nothing uh that is a more combustible combination than fees and self-esteem and all the rest of it. Uh one of the biggest mistakes chiropractors make, particularly young chiropractors, is that they attempt to x-ray the patient's pocketbook to determine how much they should charge, or you know, they soften their recommendations so that the patient doesn't just uh reject them out of hand. And here's the thing part of it is that you've attracted patients who aren't interested in health care, they're interested in pain relief and to get it as cheaply as possible. So part of it is you get enough patients, one after another after another after another, who doesn't want real health, they want pain relief. Then you already have misconception of who's out there in your community to accept chiropractic care. Because here's the truth something we value, we come up with a way of affording. And I don't care if it's a hobby or a sport pursuit or a luxury automobile or anything else. If we value it, we come up with a way to pay for it. So, what many chiropractors are encountering, and maybe they don't realize this, but they're encountering people who don't really value health. They want to be pain-free as quickly as possible and as cheaply as possible. This goes back to the whole notion of attracting patients who want relief, the therapeutic chiropractic that I mentioned earlier. This is headspace stuff. That is, you cannot charge and collect a penny more than what you think you're worth. So part of this goes back to having a profound respect and appreciation for the real value of chiropractic. And I think what happens for many is that chiropractic seems easy to deliver the care to. We don't value it because we uh it's so easy to do and so seemingly repetitive. So this has to do with your headspace about about money. Uh, there is the quick fix other than the realization that uh someone's gonna be the cheapest chiropractor in town and someone's gonna be the most expensive. And uh you want to be choosing very carefully which one you show up. Tragically, many look around and see what others are charging and simply charge the same amount. And uh this is uh uh a path to obscurity, frankly. So this is a whole seminar, you know, and I'm not sure that that I can answer all.

SPEAKER_01 19:31

This is this is great. Yeah. I'm sorry for the little uh big

Marketing Strategy That Attracts Your Tribe

SPEAKER_01 19:36

questions. To make it a little bit easier, if you met a younger chiropractor who's setting up their practice in a new town, what in this day, what are the um best ways for that person to market themselves? Or do you have suggestions of what they can do? It's quite a big one, too.

SPEAKER_00 19:55

That's a big one as well. Well, here's the short story. Um The short story is you want to encounter as many strangers as possible so that you can tell the story of what chiropractic is. Okay, that's the short story. Now that can manifest in many, many, many, many different ways. If I were uh running the zoo, I would I would hold seminars, I would conduct lectures, I would get in front of groups of people and tell the story of chiropractic, neutralize and dissolve some of the myths and misconceptions about chiropractic. But people can do that on Instagram or Facebook or other social media outlets. They can certainly do it by posting blog posts and all the rest. I mean, there's a lot of ways of doing that. I think the real issue here is are you really clear about what chiropractic is and isn't? And are you persuasive and compelling when you make an argument for chiropractic? That's it. Because what you're looking for is to attract your tribe, people who resonate with your particular worldview. And the problem that so many chiropractors face is that when you show up as a back doctor, you're likely to attract patients who have back pain. Okay, that's kind of the first right answer. That's great, but you're you're not attracting people who want better health. And so it goes back to this back pain, better health uh notion again. Uh it's a recurring theme. And you can help a lot of people with a form of physical medicine where you're treating symptoms. But the people who are spending money at the yoga studio, the Pilates studio, they're runners, they're marathonners, they're eating uh organic uh fruits and vegetables and free ranging chickens and all the rest, who have money to spend with on health care, don't see back talk back doctors as a part of their health care team. They drive past the chiropractor because chiropractors are about back pain. This has to do with identity. Something we discussed at the very beginning of this conversation. Who are you? What do you do? Who do you want to help? I'm not sure that, but I would say this is that most chiropractors lack a strategy for obtaining new patients. In other words, they use tactic after tactic after tactic after tactic and attempt to get strangers into their practice rather than having an overarching strategy, which is supported by tactics that amplify or complement that overarching strategy. When you go tactic to tactic to tactic, you end up after five, 10, 20 years, with no equity in a brand. One of the wise choices that a new chiropractor would want to make is number one, what is my identity? And what would be a strategy that would attract patients who would be attracted to that identity? And this is, I mean, this is an advanced course in marketing. You know, to do it proper. You know, chiropractors don't get any marketing advice at chiropractic college. They don't get any, they get the skills, but they don't get the what it takes to attract a tribe of people who want those skills. And so that's that's really the issue here in play.

SPEAKER_01 23:21

Excellent. Uh very good.

Purpose Creates Identity And Longevity

SPEAKER_01 23:24

What are just for a chiropractor who hasn't found his or her identity, what are some ways they, if they want to work on it and find it, what are some ways they can, where can they start?

SPEAKER_00 23:38

The most important uh issue of all, and is something I just brushed up against at the very beginning of our talk, is that one's identity is based upon one's purpose. And I made the quick observation that a chiropractor's purpose is not to adjust. Now, I hope chiropractors do adjust, but but what you do is not your purpose. What you do is a way of advancing or completing or manifesting your purpose. So, for example, my purpose, even though I'm in patient education, I uh do coaching with chiropractors and all the rest, my purpose is to serve God by providing information that helps alleviate unnecessary suffering. That's my purpose. That's not something I broadcast widely widely. I mean, one's purpose is a very intimate uh personal thing. Finding one's purpose is one of the most important tasks that any of us can ever pursue. Understanding your purpose helps you say yes to on-purpose activities and opportunities and helps you say no to off-purpose opportunities. Finding one's purpose, one's North Star, if you will, that guiding principle, that lighthouse that guides you in all of your daily decisions is crucial. And that is a whole seminar in itself. But uh identity is based upon purpose. And those who have a very clear identity know what their purpose is.

SPEAKER_01 25:09

What are the common factors for people who like after uh 20 and 30 years still have a burning desire to go into their office and take care of the patients? What are their commonalities?

SPEAKER_00 25:22

The commonalities of individuals who are passionate after 20 or 30 years, they have very clear boundaries because they're not in burnout, they're in passion, so they're living their purpose. They're that's about their identity. These are individuals who do not take patients home with them, like talk about them at the dinner table, that sort of thing. These are individuals who know their their place, they know their lot, they know what they do. They're comfortable in their skin, they have a clear identity, they've got great boundaries. Uh, these are individuals who are living the dream. Many of them that I meet are not heavily saddled with personal debt. So they're out of debt. Uh have the freedom to say no to off-purpose activities or invitations. They are disciplined, they are comfortable in their skin. And this is something that takes time. This is about maturity. This is about the slings and arrows and death by a thousand cuts one has survived to get to that level. Uh, there's no shortcut. It's it's about having clarity about one is what one's purpose is.

SPEAKER_01 26:33

If I'm in a practice for a couple of years and uh I have a dream of being that purposeful uh identity-field chiropractor in 30 years, what are some like overriding advice or things that I should be aware of? Of purpose trap traps or what sh what should be I if there were three things I should be super aware of, what are those things?

Patients As Heroes And Partnership

SPEAKER_00 26:58

Yeah, I I think I don't know if there's three, but one the first thing that comes to my mind is to make sure that every patient understands that the hero in this relationship is the patient. In other words, it is the self-healing qualities and capacities of the body, which is the hero. So the results that patients experience, the hero is the innate ability and capability of self-healing. A chiropractor with clear boundaries understands this and is very quick to when when patients gush about the success that they're enjoying in chiropractic, the chiropractor makes it very clear that the hero in this relationship is the capacity of the body to self-heal if the inner if the interference is reduced. That would be probably number one. Number two is the chiropractor understands that unlike medicine, where the intervention, the drug, the surgery, the doctor is the hero, in chiropractic, it is a partnership. That is, a patient has been trained by the medical community to want to delegate their headache to the doctor. Hey, fix my headache, and when it's done, give it back to me so I can get on with my life. That's a metaphor. But my point is that the chiropractor has a job to do and the patient has a job to do. Successful long-term patient relationships are born when the chiropractor is successful in enrolling patients in a partnership. So many patients come into the practice thinking that the healing that they're seeking, the relief they want, occurs on the adjusting table because they have been trained to trust the drug, the surgery, the intervention, and in this case, the adjustment. That's fine, but there's a job the patient must do between visits if they want to get maximum results in the shortest amount of time. So the chiropractor enrolls the patient in drinking more water, getting more exercise, getting better sleep, getting off of industrial seed oils, uh, becoming more metabolically uh flexible, getting sufficient sunshine, being you know, grounded, uh earthed, uh uh with being in nature and all the rest. I mean, uh the list is is is fairly long, but the key is to try to enroll the patient in a partnership. And that uh they don't have to, or nor can you demand that the patient follow through with these suggestions, but you have uh a moral responsibility to communicate what those uh responsibilities are. Because I'm, you know, if you've got patients, I mean, if it's true that subluxation is the body's gorgeous response, uh defensive response to accommodate physical, chemical, or emotional stress. And if those physical, chemical, or emotional stressors are still present in the patient's life, then your intervention is going to be palliative at best. It just won't last. It'll take a long time. So you want to really help bring the patient's awareness to these other activities beyond the spine that affect their overall health and the margin of health that they have and can express through their body.

SPEAKER_01 30:37

What uh do you have do you have any favorite metaphors for explaining?

Safety Pin Metaphor For Nerves

SPEAKER_01 30:44

Like if I would explain chiropractic to a patient. Do you have some what are your favorite metaphors?

SPEAKER_00 30:50

Oh, well, that's easy. That's the um safety pin cycle. You know, you can get these large safety pins through about what, five inches or so. Um, I don't know what that is in centimeters. I would use a safety pin to explain the afferent, efferent uh role of the nervous system. I would unclasp the safety pin to demonstrate uh interference of either the afferent or efferent nerve flow. And then I would explain what the adjustment is by reclasping the safety pin. I think that that has that's the simplest and easiest way to communicate chiropractic in my in my

Key Takeaways And Closing

SPEAKER_00 31:30

experience.

SPEAKER_01 31:30

Well, thank you so much, Bill. It's been absolutely wonderful. And for all of you people out there who hasn't read Hollywood's books, uh order them online. That's uh my little commercial for you. If I would uh try to sum up uh some of the things you've said, so it is um super uh important to have a clear identity and hinding your purpose and uh to be clear, uh on make your boundaries really clear. Uh those are like the uh from those are the big things you need to figure out if you're gonna succeed in practice.

SPEAKER_00 32:05

Yeah, I agree. That would kind of sum it up.

SPEAKER_01 32:07

Thank you. I'm so so happy that you took the time. It's been an honor to have you here, and uh I am so uh grateful for all the time you uh spent um helping chiropractors uh become more excited about uh their life as uh chiropractor and then helping all these patients that uh have better lives because of you.

SPEAKER_00 32:29

Thank you. It was a blast.