In the ever-evolving field of chiropractic care, the decision to hire or become an associate chiropractor can be a transformative opportunity for both practice owners and emerging professionals. As the demand for holistic health solutions continues to rise, many chiropractors find themselves at a crossroads—whether to expand their practice or seek mentorship in a supportive environment. This blog explores the value of hiring an associate, the benefits of becoming one, and the essential dynamics that underpin a successful partnership. By understanding the expectations, responsibilities, and opportunities involved, both owners and associates can cultivate a thriving practice that prioritizes patient care while fostering professional growth.
Why Hire an Associate
Owners should consider hiring an associate when two things are true: they want to grow their practice and they are capable of being a strong mentor. Growing your practice does not mean hiring an associate to do your marketing and bring in clients for you. Growing your practice means that you are either 1) too busy to see the patients already seeking you out 2) you want to add hours like evenings or Saturdays to serve your community 3) you want to add a speciality such as pediatrics to your sports practice. But hiring an associate without taking on the responsibility of mentorship may lead to two very unhappy people.
Why Become an Associate
Chiropractors may want to strongly consider becoming an associate if they want their primary focus to be patient care, need a consistent income, do not have the drive for entrepreneurship or crave mentorship. The fact is that we graduate from chiropractic school without an option for a chiropractic residency. Many doctors leave school and open their doors alone in their own practice without being shown the ropes. Associateships are a great tool for continued learning and growing our profession.
Associates and Independent Contractors
Briefly, it is important not to confuse these two opportunities or use the terms interchangeably. An independent contractor (IC) is a temporary or part time opportunity to fill in at a practice (ie. maternity leave coverage) and has many differences from an associateship. Not the least of which is employers not paying employer taxes, unemployment or workers compensation insurance for their IC. Some owners mistakenly label a new hire as an IC in order to avoid paying more in insurance and taxes or because the think employees are complicated. Be sure you check the legal definition of your particular situation before making a determination – but when in doubt, if a doctor is working for you full time, you most likely have an employee in your practice.
Expectations
I have interviewed many owners and associates and what is quite clear, is that both parties come into this relationship with different expectations. It is similar to coming into a marriage with different expectations, and it is really important to discuss our expectations prior to entering into a long term relationship! Let’s explore the most common expectations of owners and associates when embarking on this relationship.
Owners oftentimes expect that their associate will do a lot of marketing and take over a lot of their shifts. Simultaneously owners expect that existing patients will be excited for the new hire and that practice revenue will increase quickly.
Associates enter into this relationship expecting to be busy with patients, make a high salary quickly, have good work life balance, flexible schedule and receive ongoing support and training.
In reality, owners become the new human resources manager with all of the responsibilities that come along with that title including reviewing the handbook, managing payroll and time off. The reality is also that most owners cannot afford to pay the associate six figures on their first day, as revenue is only made as patient care increases. Additionally, patients are often very slow to accept the new doctor and really just want to see the owner. And shockingly – after interviewing many associate chiropractors, one thing that I hear commonly is that while owners initially want associates to provide patient care and increase hours and services, they reflexively become competitive with their associate for new and existing patients essentially blocking their associates ability to grow.
Ultimately, many owners and associates feel taken advantage of, unsupported, frustrated and unhappy. But all is not lost! If both parties discuss their expectations, both parties can be quite satisfied with the arrangement.
Responsibilities
In addition to expectations, owners and associates come to this relationship with responsibilities! John F. Kennedy famously said “Ask not what your country can do for you, ask what you can do for your country”. This is the same idea at a chiropractic practice! The more everyone is willing to put in, the more everyone will get out of it. And if you ever find that someone has stopped trying or adding value to the practice, it is time to find out why!
Owner responsibilities include: waiting to hire until you meet the criteria above, setting forth clear job responsibilities, a plan for growth and a roadmap of resources, paying your associate well including benefits, insurance and CEUs, providing ongoing training and mentorship, making it clear that you trust your associate, create a feeling of ownership for your associate, providing inspiration, support and a fun, positive environment to work in.
Associate responsibilities include: Negotiate your contract prior to agreeing to it, execute the job description and timeframe that is expected of you, show up with effort and integrity every day, be a leader within the practice, take accountability, exhibit loyalty and trust your owner. Give 100% every day and communicate your exit strategy as soon as you know it if you plan to leave.
Both parties’ responsibility: communicate well and often, truly trust one another, ask questions, listen and learn from each other.
I always recommend hiring someone you actually like! A doc can have a great resume, but if the two parties don’t have shared values and mutual like and respect for each other the foundation won’t sustain a long term relationship.
Opportunities
There is no doubt that there is tremendous opportunity in adding an associate to a practice. It can and should be financially beneficial. A great practice should be more financially beneficial to both parties than a solo practice would be to either of them alone. But financial wins only come with shared vision and mutual growth. Hiring an associate is a great opportunity to teach, to expand care to your community, to learn from someone who has a different education, experience or generation than you. Having an associate should allow you to diversify your time in the community or spend more time with your family. While at the same time affording your associate the ability to focus on patient care and earn a good income.
Owner Fears: Contracts and Timing
The most difficult topic to discuss and agree on between owners and associates is the topic of the contract including duration and exit strategy. While popular for many years, the ‘non-compete’ clause of a contract is no longer enforceable in many states. This clause was meant to protect owners so that a former employee could not leave an associateship and open a practice across the street thus becoming instant competition. However, most states will side with anyone wanting to start a business and provide for their family and community. Therefore, I come to the biggest fear of any owner hiring an associate. Owners fear that their associate will build a ‘mini practice’ inside their own and after a few years, will open a practice in the community and most if not all patients will follow them. The second biggest fear of owners is that their associate will learn and leave. Meaning, that after about a year the associate has gained enough knowledge to jump ship and open their own practice.
This is where communication becomes so important. It should be easy to see why owners have such hesitation when it comes to fully supporting, mentoring and trusting associates. Because they never know when they are going to leave and what will happen with patients when they eventually do.
Retention Bonus
One option for making sure that your associates feel valued, and that owners feel comfortable with timing and exit strategy – is the retention bonus. Rather than imposing a threat of legal action in a contract that is not really enforceable, is to create an agreement that puts support and growth first. Agreeing to a set of terms that results in the associate receiving a large sum of money at the end of term is a pretty great deal. For example, agreeing to a three year employment agreement with the understanding that after that time, the associate receives a payment allows the doctor to know when the end of the term is and enhances communication. If the associate leaves prior to the end of the term, no bonus. And of course, the associate is welcome to renew another three year term with the same agreement going forward.
Final Thoughts on Value
The relationship between practice owners and associate chiropractors holds significant potential for growth and mutual benefit, but it requires careful navigation. Both parties must enter this partnership with a clear understanding of their expectations and responsibilities, fostering open communication to create a supportive and productive environment. By emphasizing mentorship and collaboration, owners can empower their associates to thrive, while associates can focus on patient care without the pressures of entrepreneurship. As both sides work towards a shared vision, they can not only enhance the quality of care provided to their community but also cultivate a rewarding professional experience. Embracing the opportunities that come with hiring an associate can lead to a flourishing practice where both owner and associate can grow, learn, and succeed together.
Dr. Lisa Goodman is a former advertising media manager turned chiropractic entrepreneur and she believes we work in the best profession in the world! Dr. Goodman is a clinician, international speaker, author of The Manual for the Chiropractic Entrepreneur and founder of Washington Park Chiropractic in Denver, CO.
Much more about starting your practice and networking are available in my book, THE MANUAL for the Chiropractic Entrepreneur available now on AMAZON!
