There is a negative stigma within chiropractic, and especially chiropractic school, about the chiropractic associate opportunity. As I said in a previous post, it’s a common phrase to hear “Chiropractors eat their young.” This can be especially true for the chiropractic associate.
Those of us in the chiropractic profession have either heard or lived through the nightmare associate job where you had to put in 60-70 hours a week as an overflow doc for pennies on the dollar. Or you are making money, but literally have no time to do anything but work and sleep. People graduate chiropractic school with six figure debt and want to make a lot of money right away, without taking into account how awful the job really is (I have a friend who went through this). Or they just want to have a job to pay their bills and take the first thing that comes along (I have another friend who went through this). I am talking nightmare scenarios here, but this is what many people think about when they think of an associate position out of school. Heck, this is what they tell us to expect while in school!
The reality of the real world
With that being said, the internship we all go through in chiropractic school is nowhere close to being a real world experience. The ridiculous amount of paperwork needed to appease the CCE is unrealistic. No one in practice fills out that much paperwork, so don’t look look to your school clinic experience to help you there.
The amount of instruction on business or technique in school is very minimal as well, ESPECIALLY on the business end. The schools may say otherwise, but don’t believe it. An entire trimester of class teaching you how to bill Medicare for the school’s outpatient clinic is NOT Business Principles. That’s called Medicare Billing 101.
We often talk about the philosophy, art, and science of chiropractic. But I think we need to add a fourth aspect, and that is the business side.
As chiropractors, we don’t have the six figure jobs waiting for us that MDs have after their residencies. We also don’t have the steady stream of in-network insurance referrals that push our practices to 3-4 week waiting lists like general practitioners. Walk-ins welcome, right?
We have to actually go out and find our own patients. Then, we have to effectively teach them what we do, simply because it is so different from the medical model. We also have to know about finances, accounting, office procedures, etc. None of this is taught in school. And learning it from a book is much different than learning it in real life.
There are some who can graduate chiropractic school and secure a huge loan to open an office and actually succeed right out of the gates. But those people are the minority. For the rest of us, getting a huge business loan would be career suicide, simply because of the overwhelming stress and pressure, as well as lack of experience, that comes along with it. And let’s not forget the business loan that needs to be paid back, on top of all the student loan debt already attained.
What to do?
So, with all those negative things I shared above regarding the associate position, I would absolutely recommend becoming an associate in a GOOD, PRINCIPLED chiropractic office. The experience you will gain is invaluable. Being an associate in a strong and busy chiropractic office will force you to quickly learn things that you didn’t think you could learn so soon. It will give you the opportunity to hone your skills and not have to worry about the finances of practice, which is much better than learning the hard way on your own dime.
Learning from a successful chiropractor in a busy office will give you the confidence to open your own successful practice as well… you’ve seen it and experienced it, so finally doing it won’t be such a stretch mentally. All this while earning a paycheck to pay your bills. It probably won’t be a huge paycheck, but then again, MDs don’t earn a lot of money while in their residencies either.
What about post-graduate internships?
There are also internship positions available after school in many cases. This is actually pretty common within the upper cervical community. I think this is a great opportunity for someone without a family who doesn’t mind working a job while interning.
There are two types of internships that I’ve seen: one where you don’t get paid, but work like an employee just the same, learning and perfecting your chiropractic skills. The other is the same, except you actually have to pay to do it.
Stay away from the second option. Anyone who charges you to do an internship post-graduation doesn’t have much to offer, in my opinion. At least not from the ones I’ve seen. That’s why they are trying to get you to shell out $15,000-$20,000 up front. So the second option is not really an option.
For someone with a family to provide for like myself, the first option is just not a possibility either. For someone without a family and in a position to do an internship in a great office, I say go for it. Just be prepared to work a job in off hours for some income, unless you don’t mind taking out additional loans to float you for 3-6 months while interning.
Conclusion
In short, yes, there are a number of associate positions to be very afraid of. But there are some positions out there that will really teach you and give you the opportunity to build confidence in the business aspect of practice. Because no one will come see a chiropractor who can’t keep his/her doors open.
I won’t get into the different types of associate deals to look for because that’s not the purpose of this post. That’s up to you. But, I highly recommend you DO take a position as an associate in a successful practice where you can learn the business aspect of a chiropractic office.
Because no matter what the schools tell you, they are NOT teaching you what you really need to know about the real world.
{ 4 comments… read them below or add one }
We do tend to “eat our young” when it comes to finding a great associate. Most of it is due to errors in communications, or lack of a contract. Handshakes are great for the first few months, but if the groundwork isn’t explained, it often results in disaster! There is also a good eBook to us as a resource at http://chiropracticassociateuniversity.blinkweb.com/ if you want to check it out.
Dr. D in Seattle
I am the guy that took out the loan to open my practice and am having a blast and working hard too. It is a lot of work, but the flexibility I have to work when I want to or market when I want/need to is unmatched. Loving every minute of running my own practice. Sending my massage therapist to Chiropractic school as well as a patient…both want to study upper cervical. That is very rewarding. There are late nights and early mornings, but by in large I am able to still be a good dad and husband because I get to choose when I work. We have actually made it a family gig where we will all go to the office. The boys help clean up and empty trash (stuff they can do), while Kelsey does the books, and I work on patient files. Then I check everybody for the ASC. I work for myself, but I do not feel like I am in practice by myself. Prepays have helped cash flow out a ton and I am amazed at how many folks will prepay commit care. No better way to initially commit them to care in my opinion. And I have had the opportunity to return some unused visits because they did so well under care (the opposite is also true!). Anyhow, the option about going out on your own may be scary…but don’t let it be.
Great points Dr. Yates. Good to read about success from the other perspective. Thanks for that!
Another great post, Brandon. Some comments below:
1) “Those of us in the chiropractic profession have either heard or lived through the nightmare associate job where you had to put in 60-70 hours a week as an overflow doc for pennies on the dollar. Or you are making money, but literally have no time to do anything but work and sleep.”
It isn’t just DC’s who “eat their young.” This is common in most fields, particularly the medical fields. The difference is that once they are put through the ringer, they are compensated accordingly. I mean, think of a surgical resident who works 100 hours a week for $40,000/yr for years on end. When I started my practice, I was working 60-70 hours a week and not making a penny for my efforts! LOL That didn’t last forever, but it takes REAL WORK to properly succeed in the health care market. A lot of my new graduates aren’t ready to really work, and instead, think they DESERVE to have the world handed to them on a silver platter. Guess again!
2) “The ridiculous amount of paperwork needed to appease the CCE is unrealistic.” I’m not sure what Parker does, but at CCC we have our paperwork modeled around being Medicare-compliant, which is a big issue. The idea is to train students to do the right thing, and once they’re out of school they can do whatever they want.
3) I liked Dr. Yates’ comments, but be careful about pre-paid care. In many states that follows the definition of what an insurance policy is, so you can get in a LOT of hot water doing that. Dr. Yates is exactly right that starting a practice is tons of work, but it is worth it when it works out! Like anything, you have to be smart about it. The last year of a student’s life should be spent talking to business professionals and reading business books. Instead, most of them are sitting by the pool or getting drunk most nights of the week (sorry, but you know it’s true), waiting for that $120,000 job they DESERVE because they made it through chiropractic school.