Inside Chiro School: My First Year as an Associate Chiropractor 

Wish you could have a firsthand account of what being an associate chiropractor is like? I’m Kit Harlow, DC, a recent NWHSU grad who just wrapped up my first year as an associate chiropractor. Want to get into the nitty gritty, but don’t want to pry? Look no further! 

I’ve done a couple pieces on chiropractic jobs recently but wanted to reflect on what it was really like my first year in practice as an associate at ChiroCenter Chiropractic & Wellness in the uptown neighborhood of Minneapolis, Minnesota. Like many chiropractic students, when my professors told me “The first year is the hardest!” I was quick to dismiss them, thinking it would be different for me. 

Well, I was wrong! Like all jobs and careers, my first year was a learning curve, especially not having been in the professional job space before embarking on my graduate school journey. Want an honest perspective on what it was really like? Advice on how to make the most of it? Keep reading! 

Why I Chose the Associate Route 

I graduated in April of 2024, and worked as an extern before completing boards and getting my license. This ended up being very beneficial, as I was able to work under my supervisor’s license, while still continuing to learn about insurance, applying for my own license, building a practice, how to manage a clinic, and more. It was great to have a sounding board, and close mentorship that would eventually translate to building rapport with my future co-workers. 

I knew I wanted to work at an established clinic as an associate, rather than starting my own business from scratch, simply because I do not want to be a business owner! Being an associate aligns more with my lifestyle, and I truly love being a team player at the clinic I currently work at. 

Choosing an Associate Chiropractor Job

Being an associate comes with its own benefits and drawbacks, like any position. Ultimately, each associate position is unique and can have different pros and cons depending on the clinic you work at.

It’s important to establish a vision of what you want your work environment to look like before considering an associate position. You should also take into account your own values. It’s easy to get pigeonholed into only considering how much you’ll get paid and how long your commute is. 

Some things I considered when I looked for an associate position: 

• Clinic location 
• Patient demographics 
• Chiropractic philosophy 
• Diversity, equity, and inclusion 
• Freedom to establish my unique practice within the clinic 
• Flexible hours 

Neighborhood and Patient Population

For example, I chose a clinic that was in the neighborhood I wanted to live in. It’s one of my values to serve the community I am a part of. This ties in closely with patient demographics – as the neighborhood I live in has a large proportion of LGBTQ+ residents, is diverse, working class, and extremely walkable and wellness oriented. I feel so blessed that I get to walk or bike to work, and more often than not, treat patients that are my neighbors! 

Chiropractic Philosophy

The clinic I work at also shares my chiropractic philosophy of being evidence based, with an emphasis on diversified manipulation. That being said, I am able to practice exactly how I want to, incorporating soft tissue and rehabilitation, including holding space for longer patient appointments when necessary. 

Diversity and Access to Care

Diversity and access to care was an important part of my process when searching for a position. The clinic I work in is women owned, with all practitioners identifying as women, and we accept all major insurance along with self-pay options. Our clinic has a parking lot, is accessible on foot, and is centrally located within Minneapolis. Most importantly, I feel that as a person who is a part of the LBGTQ+ community, I can truly be myself at work and know that patients feel safe and welcome in our space. 

Navigating the Associate Chiropractor Contract 

Now, the fun part: signing your first contract. This can be very intimidating, especially if you’ve never signed a formal employee contract before. The details are important and can dictate how your first 3-5 years in practice will play out. There is usually room for negotiations, so I recommend thinking about the following before locking in:

How will you be paid?

The first major one is of course, money. How will you be paid? Most positions offer either a salary, or commission-based pay model. For myself, I take home a percentage of what I bill, which increases based on the average number of patients I see per week, with the capacity to automatically increase based on how long I’ve worked at the clinic. Something to think about is how much money you’d ideally like to earn per year and different limits on how much income you can earn based on hours, patient numbers or commission percentage. 

What benefits do they offer?

Second is, benefits. Do they offer healthcare? Dental? 401k? Paid time off? Sick leave? Maternity leave? Will they pay for licensing renewal or continuing education? These things can vary in importance based on what your living expenses are like, if you are single or married, if you have children or want them in the future, or if you have pre-existing conditions that require different healthcare needs. 

What is the length of the contract?

Lastly, permanence. That’s right, the long game. Do you want to be at this clinic for less than two years? Most clinics will have a contract that is binding for a specific amount of time before it can be broken or renewed. They may have a non-compete clause stating that you are not allowed to practice within a certain radius after leaving and cannot take your patients with you.

Conversely, are there growth opportunities if you stay for five years? 10 years? Make sure to inquire about being able to buy into the practice if/when you are ready to upgrade your associate status, or if there are monetary incentives. 

Read the contract! 

If there is one piece of advice you should take before signing a contract, it is to read it thoroughly. Take it home to ponder or have someone you trust like a mentor or lawyer look it over before moving forward. 

The First Year is the Hardest 

My first year of practice is coming to a close. It has been significantly rewarding, and there were also times where I wondered if I had made the right choice in my career. It’s going to be tough at first! Building your practice, associate or not, will take time and patience.

Making money as an associate chiropractor

If you are not salaried, your first year of practice might not be as financially rewarding as you’d hoped. Do not panic. Apply for income-based repayment on your loans and get used to the fact that you may have to live frugally for another year out of school, especially if you don’t have another household income to pick up the slack. If you come from a background of previously being salaried it might take 3-6 months before you can accurately predict how much you will be paid month to month. 

Navigating insurance

The second learning curve will be insurance if your clinic accepts it. It will take at least 2-6 months to get in network with major insurances, Medicare and medical assistance in your area. You need to first get your NPI number and enroll in Medicare, regardless of if your clinic is cash-based or mixed. If you practice in Minnesota, enrolling in the department of human services for medical assistance and MinnesotaCare will be next. 

Building your patient base

Patient retention can also be a humbling part of your first year in practice. First impressions, clear communication, bedside manner, and managing expectations are key to success. Confidence, humility and workflow are things you have to learn. Finding your flow requires constant tweaks based on the patient’s energy, demographics, and pain complaints.

The biggest take home for myself was to not take things personally. Sometimes, patients missed a follow up appointment or fell off my schedule entirely. Remember that people will de-prioritize care for many reasons. Maybe it’s financial, time, miscommunication, family conflicts, stress, they feel better, or you simply weren’t what they were looking for. Each patient encounter is a chance to learn, improve, and reflect on how to tailor the experience. Many will come back to you eventually! 

Why I Love My Job 

Right, the rewarding part! At the end of the day, I could not realistically see myself in another career. I take pride that I earned the privilege to call myself a doctor. Daily, I help people take ownership of their health. 

I feel very lucky to be able to walk to work, and to work in a space that is collaborative, inclusive, creative, warm and kind. 

Being able to set my own hours, take time off when I want to travel, serve my own neighborhood and feel like a valued individual are a few of the reasons why I love where I work. I know that choosing the associate route was right for me. 

The work/life balance is unmatched, my potential to earn is great, and having time for my own interests and passions outside of work has been essential for my mental, social and physical health. 

In closing, I love my job, and I look forward to continuing to learn and grow as an associate chiropractor.