Performing Your Due Diligence Before Becoming a Chiropractic Associate

The majority of chiropractic students entering the workforce decide to begin their careers working as an associate at an existing clinic. This can be an intimidating time researching online practice opportunities, interviewing with clinic owners, and deciding on how well the clinic setup aligns with their professional goals and practice style. Unfortunately, I’ve seen many instances where new grads want to jump at an opportunity that they’re presented with so they secure a practice location quickly out of school and start paying down their student debt. In some cases, promises are made to the new grad on patient numbers and new patient expectations, operational problems exist within the clinic that the owner hopes adding a practitioner will help, and very little is discussed about the short and long-term goals of the clinic owner. The favourable aspects of the clinic are at the forefront of the initial conversations between owner and new grad, while potentially problematic aspects are pushed to the back-burner, only to be eventually uncovered once an associate witnesses them in practice.

I have consulted with several young graduates about the frustrations they were experiencing with their relationship with their clinic director and how their practice wasn’t shaping up how they envisioned it would. Personality clashes between the associate and the support staff and/or the clinic director were stressful to the point where they didn’t enjoy going into work. The patient base didn’t fit the demographic the associate was explained it to be, so the target segment the associate was expecting to treat was not part of the referral network for that clinic and the associate was treating conditions they weren’t truly passionate about. Ultimately, the common denominator behind these frustrations for the chiropractic associates was that they could have better prepared ahead of their discussions with the clinic owner to address important aspects of the clinic as part of their due diligence process.

Here are some important components of the due diligence process any chiropractor should consider incorporating when potentially signing a chiropractic associateship agreement with a clinic:

1. Understand the past, present, and future of the clinic: You’re excited to get started in practice as a bright, energetic, young chiropractor about to launch their career, so it’s easy to look into the future of where YOU want to go with your practice based on your goals and dreams. However, as as potentially new associate at an established clinic, it’s important to understand the history behind the clinic, how it has grown, and where it is headed. This will ensure your confidence that your goals are in line with the clinic’s which is paramount to fostering your early practice growth. Learn about the life of the clinic since it opened, about any changes in ownership and those owner practice differences, how many chiropractors have worked there and for how long, and how many more practitioners does it expect to accommodate. You can ask to see financial information (after signing a non-disclosure agreement), but you will likely find most clinic owners will refuse to divulge that information. This can be more for the protection of unrelated financial information, not necessarily because of poor performance. Instead, ask to see anonymous patient visit numbers over the past 1-2 years that demonstrates growth and justification for the practice to be bringing on a new associate. Are you replacing a chiropractor that is about to leave the practice? How long were they there and why are they leaving? Does your practice style resemble that of the previous associate? It’s not difficult to find out who that associate is and reach out to them directly. There is tremendous benefit in getting each person’s perspective first-hand. To summarize this point, there really isn’t any information about the clinic, within reason, that you should not be able to discuss with the clinic owner in order to understand the ins and outs of where it’s been and where it’s headed. Research as much about the clinic before meeting with the owner and plan out your questioning in a systematic fashion that demonstrates thoughtfulness and concern for mutual success of both parties.
2. Meet the team: The administrative and practitioner team of any clinic can influence every aspect of your practice as an associate. Even small clinics of two or three staff should have an identifiable clinic culture as you meet the people running the show. Do they promote internal referrals within the clinic? Does the staff room shows signs of team-building initiatives and workplace camaraderie? Does the clinic have regular general meetings to discuss business and clinical matters? Does the clinic hold outreach initiatives to give back and be recognized for giving back within the community? Aside from asking questions, scour the clinic’s website and social media pages to get a sense how active the clinic is as a cohesive unit, which translates into a productive work environment. Working with like-minded practitioners and support staff that help make the clinic environment a fun and a positive experience is indescribably valuable for workplace satisfaction as an associate.
3. Observe the patients: As important as it is to work with a team that is in-line with your practice style and goals, it’s equally important to work with the patient-base that falls within your target segment of the market. Don’t get me wrong - I’m not suggested that as healthcare practitioners we select only certain patients based on how well they align with our clinical focus. I am suggesting that it is important for you to see the clinical cases in practice that challenge and excite you professionally, and in turn stimulate you to grow and improve as a healthcare practitioner. We all see certain cases show up in practice that tend to get a little mundane or stale - it’s unavoidable. But make sure that the patient pool that the clinic pulls from is filled with the demographic you hope to be able to focus most of your practice on. For example, if your goal is to have a prenatal/maternity focus in your practice, it probably doesn’t make sense to work in a rural clinic where the average age is 65+ and most young adults tend to leave town for school or work in their late teens or early twenties. Having a regular flow of patients presenting with cases that align with your therapeutic focus is imperative for both your practice success and professional fulfillment.
4. Sign an agreement: This sounds obvious, but you would be surprised to hear how many of your colleagues have or currently work at a clinic as an associate without ever signing a formal agreement. I cannot encourage you enough to avoid this at all costs. Contractual agreements are not only for the benefit and protection of the clinic owner but also for the benefit of the associate. Agreements are terms set forth and agreed upon by both parties in advance and they should encompass almost every aspect of your financial relationship to the business. The agreement also serves as a tool to lay out the expectations of the associate and those of the clinic director. Identify patient visit numbers and/or financial targets you are both hoping to achieve and in what time frame. Set dates to review the progress of your actual versus estimated practice growth numbers. A thorough agreement should have a significant component of legal jargon - don’t be afraid of it. Once you’re happy with the terms, have the final draft reviewed by a lawyer or someone you trust with legal knowledge to understand exactly every clause of the agreement. The agreement is the initial backbone of your new relationship with the clinic you are embarking with on your chiropractic career.

Chiropractic clinic owners are not out to dupe new grads into joining their practice. However, if you’re not prepared to ask the right questions and dig a little into the ins and outs of a chiropractic clinic you hope to join, you may find surprises you hadn’t considered that pose a challenge achieving the goals and happiness in your career. By thoroughly planning and confidently executing on your due diligence, you will foster the healthy, exciting and thriving practice that you’ve dreamt about.