328 - Turning Your Metrics Into Growth and Impact with Dr. Josiah Fitzsimmons

How do you know if you’re charging the right fees, tracking the right numbers, or investing enough in marketing to grow your clinic? Join Dr. Stephen and Dr. Josiah Fitzsimmons of Lucro to answer those exact questions and share a clear path to building a profitable, purpose-driven practice. Together they walk through the numbers that matter most—lifetime value, customer acquisition cost, conversion rates, and schedule capacity—and show how to use them as tools for confident decision-making. 

Dr. Josiah’s journey went from scaling to $15M, weathering a steep drop to $5M, and rebuilding stronger than ever with a $7M practice and a mission-driven model. Taking this experience and new found appreciation of REALLY knowing your numbers: his new book-keeping business, Lucro, is helping other chiropractors simplify their data and find profit margins they can reinvest into people, technology, and marketing. By combining structure with purpose, you’ll discover how to grow without guesswork and create a patient experience that drives both retention and impact.

In this episode you will:

• Learn a quick break-even ROAS rule using your true profit margin. 
• See why most clinics underspend on marketing and how to set CAC targets with confidence. 
• Find the conversion-rate “sweet spot” that signals it’s time to raise prices. 
• Calculate real schedule capacity and close the gap between potential and actual volume. 
• Upgrade the care experience to increase PVA and lifetime value.

Episode Highlights

02:35 See how structure, KPIs, and accountability create the foundation for a scalable clinic.
03:30 Understand the five business domains and how removing one constraint unlocks expansion.
04:33 Hear how early discipline and work ethic shaped Josiah’s leadership journey.
05:28 Discover how visiting more than 50 clinics before opening led to a seven-figure first year.
06:42 Find out what other industries taught Josiah about structure, metrics, and scalability.
07:34 Learn how applying the TRP operating system turned frustration into growth and momentum.
08:58 Understand why knowing your numbers matters less than knowing what to do with them.
09:51 See the difference between operational metrics and financial metrics and why both are essential.
12:12 Explore the four Ps of a successful clinic—purpose, product, people, and profit.
14:27 Learn how profit creates freedom to invest in marketing, people, and technology.
16:38 Understand why undercharging limits impact and weakens your ability to serve.
19:17 Discover how to calculate and use the LTV-to-CAC ratio for smarter marketing decisions.
22:50 Learn a simple formula that shows your break-even return on ad spend.
25:21 See how using data instead of emotion builds clarity and calm in decision-making.
27:16 Understand how your conversion rate reveals when it’s time to raise prices.
30:04 Learn how to measure schedule utilization and close the gap between potential and reality.
32:45 See why most clinics run at only a fraction of capacity and how to change that.
34:18 Discover how retention, education, and value delivery increase lifetime patient relationships.
35:33 Learn how to design a “Disney Experience” that makes care memorable and personal.

Resources Mentioned

To learn more about the REM CEO Program, please visit:  http://www.theremarkablepractice.com/rem-ceo

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