The Long Game of Being Seen:A letter to mobile chiropractors

Lucas Marchand, DC 3/10/26

There is a quiet theory that forms after a few years in practice: growth in a local service business is less about clever marketing than about ubiquity. Not worldwide recognition — just the kind where patients begin to say, almost casually, I see that chiropractor everywhere.

For mobile chiropractors, this carries particular weight. Without a storefront or a sign on a busy intersection, you begin from invisibility. No passing traffic. No walk-ins. You operate out of a vehicle, and at first it can feel like shouting into a void.

Then something small happens. A patient mentions they saw your van in their neighborhood. Someone recognizes your name from a local Facebook group. Another says they read a review about you months ago. Individually, these moments seem trivial. Together, they form the thing most practices eventually run on: familiarity. People trust what they've seen before.

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The Flywheel

In Good to Great, Jim Collins describes a massive metal flywheel — 5,000 pounds, mounted on an axle. Your job is to get it spinning. The first push moves it almost imperceptibly. The second push moves it slightly faster. You keep pushing in the same direction — turn after turn, with no single dramatic moment — until at some point the momentum takes over and the wheel begins driving itself. Collins' point is that no one push deserves the credit. It's the accumulation of consistent effort in one direction that produces what eventually looks, from the outside, like an overnight success.

A mobile chiropractic practice works exactly this way.

The flywheel for your practice turns something like this: you take excellent care of patients → they leave reviews → reviews build search visibility → new patients find you → you take excellent care of them → they tell someone. Around and around. Slowly at first. Then faster. The mechanism is simple. What's hard is that the early rotations are nearly invisible, and most practitioners quit before the wheel builds any real speed.

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The Phases Are Real — And So Is the Timeline

There are roughly four phases a mobile practice moves through, and it helps to know where you are.

The first is obscurity. You exist, but the market doesn't know it yet. Bookings are sparse. The phone is quiet. This phase is not a sign of failure — it's simply the physics of starting from zero. The flywheel hasn't moved yet.

The second is early traction. You have a base of regulars. Word has started to spread in small circles. You're moderately busy but still dependent on the patients you already have. The flywheel has begun to turn.

The third is sustainable momentum. Regulars keep returning, and new patients are finding you organically — through search, referrals, or your vehicle showing up in the right neighborhoods. You're no longer dependent on any single source.

The fourth is a full schedule. New patients require a waitlist. The flywheel is largely self-sustaining.

The honest and sometimes frustrating truth: moving through all four phases typically takes anywhere from two to ten years. I've heard of practices filling in six months. That happens — usually when someone carries over an existing patient base, steps into an underserved market, or benefits from timing they couldn't have planned. But in my experience, and in watching peers navigate this same road, that's the exception. I've been in this long enough to have struggled well into year five. That's not failure. That's the flywheel still turning.The range is wide because markets differ, niches differ, and consistency differs. But the direction of travel is consistent for those who don't stop pushing.

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Reviews Are the Clearest Metric You Can Track

Of all the inputs to the flywheel, Google reviews are among the most measurable. Research from local SEO firm Sterling Sky confirms that hitting 10 reviews triggers a noticeable ranking boost — though the gains plateau shortly after, making review velocity more important than raw volume over time. Sterling Sky The thresholds roughly track the phases above: at 15–25 reviews you can begin competing for less competitive searches; at 40–50 reviews an algorithmic shift happens, with businesses roughly three times more likely to appear in the top three local results; at 75–100, you're consistently ranking for competitive searches; beyond 100, you're difficult to displace. Spokk

What matters as much as count is cadence. A business with 40 reviews and a velocity of three new reviews per month will typically outrank one with 100 reviews and no recent activity. D&D SEO Services The algorithm, like your patients, favors evidence of ongoing activity over past reputation.

Think of reviews as the most visible turn of the flywheel — the one you can actually count.

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The Real Problem Is Obscurity, Not Strategy

The most dangerous moment isn't year one, when expectations are still calibrated for difficulty. It's years three through six — when you've done everything right, the effort is real, but the schedule still isn't full. That's when people quit. Usually right before the wheel picks up speed.

The math is straightforward: a practice needs roughly 20 or more new patients per month to sustain itself if care plans run six to twelve visits — accounting for the reality that some patients need only one visit and others will stay for years. That number is achievable. But it requires enough visibility that strangers are finding you, not just people who already know you personally.

Which is precisely why the early years are the critical window. Not because the work is harder then — it isn't — but because obscurity is most dangerous when cash reserves are thinnest and momentum hasn't yet arrived.

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What Happens Over Time

Collins observed that the companies he studied never experienced a single defining moment of breakthrough. The transformation that looked dramatic from the outside felt, from the inside, like one more turn of the wheel. Patients begin saying things like I've seen your van around or my neighbor mentioned you. None of it sounds dramatic. But it means the flywheel is moving on its own.

After that, the strategy doesn't change. You keep showing up. You keep taking excellent care of patients. You keep collecting reviews. You keep driving the same neighborhoods.

There is nothing revolutionary about it — which is precisely why it works.

If you practice out of a van or a portable table, you're running one of the more demanding models in healthcare. The early years can feel invisible. But invisibility is temporary, and the flywheel is undefeated.

Keep pushing in the same direction. At some point, the wheel does the rest.

Have a wonderful week,

Dr. Lucas Marchand