Starting a Chiropractic Practice: 7 Things You Should Know Before Taking the Plunge

When it comes to starting your own chiropractic practice, it’s a different world today than in the past. Establishing a clinic of your own arguably takes more strategy than it once did. But the good news is you have more options than ever to help you own and operate a clinic successfully.

Chiropractor turned chiropractor consultant Tom Necela, DC, CPC, CPMA, CCP-P knows a lot about being strategic. It’s even part of the name of his company.

He founded The Strategic Chiropractor nearly 15 years ago. Since then he’s been helping chiropractors run their practices more effectively with smarter business strategies and improved procedures in things like billing and insurance coding.

He also assists chiropractors with buying and selling practices. In fact, in the past few years, that service has come to dominate his consulting, reflecting what Necela says are changes in how many chiropractors choose to start their careers.

Below, Necela provides advice on how to go about owning and operating a chiropractic clinic of your own. If you’re one of the following, you’ll find his insights both thought-provoking and valuable:

• Recent graduates from chiropractic school
• Practicing chiropractors looking to establish your own clinic
• Current chiropractic students with a keen eye to the future

You’ll also find insights below from Northwestern Health Sciences University (NWHSU) and Mary Beth Minser, DC, a graduate of NWHSU. Since the school was founded in 1941, more than 5,000 chiropractors have graduated from the NWHSU chiropractic program.

1. Be aware of the demographic shift in the chiropractic field as Millennials enter and Baby Boomers wind down

“For a long time, the norm has been to graduate from chiropractic school and start your own business from scratch as quickly as you could get licensed,” says Necela. “But that’s proven historically to be the riskiest way to enter the profession.”

Rather than being on the fringe, Necela suggests the chiropractic field may be changing in ways that make it more similar to law, dentistry, or medicine – professions where establishing a solo practice right out of school is less common.

Necela says he’s seeing more young chiropractors open to other possibilities, and for good reason.

These millennial chiropractors are more risk-averse. Necela says, “They tend to be more cautious about diving into entrepreneurship,” in part, because of their larger student loan debts, often in the six figures.

But he adds that they’re also bringing a more sophisticated level of business awareness about what it takes to succeed as a chiropractor, a development that may also signal a profession that’s maturing.

Meanwhile, the profession itself is evolving as a generation of older chiropractors retire. Many of these Baby Boomers are putting more thought into how they want to wind down – and sell – their chiropractic practices.

2. Get ready to handle the large financial burden that comes with starting from scratch

Although the field may indeed be changing, starting your own practice right out of chiropractic school is still a common way to begin your career. But that doesn’t mean it’s right for everyone, says Necela. Ask yourself the following questions:

Are you prepared for the initial investment?

Starting a new practice means investing a lot of money up front, and getting it off the ground takes time. “Are you prepared to have zero income coming in for a while? If you don’t have enough financial cushion to get you through the initial stage of starting from scratch, then don’t start from scratch,” says Necela.

How well can you market yourself?

Unless you’re buying an existing chiropractic business (more on that below), you need to know how you’re going to attract patients through marketing. Just having “great hands,” says Necela, won’t get people through your door. “Chiropractors may not like to hear that, but it’s reality.”

How well do you know the business end of a chiropractic practice?

Understanding how to bill patients, knowing codes so you get paid from insurance – things like these are crucial to run your business effectively. “I’ve seen chiropractors that are great at making diagnoses and handling the clinical work, but when it comes to how to actually get paid, that can be another story.”

To prepare for the business aspects of the profession, Necela suggests taking full advantage of what your chiropractic school offers in terms of courses, events, and job-shadowing opportunities. But he says that’s usually not enough.

Another way to learn about the business end of being a chiropractor? Become an associate at an existing practice after you graduate.

NWHSU INSIGHT:  A growing trend for chiropractors is to join forces and share clinic office space not just with fellow chiropractors but also with massage therapists, acupuncturists, physical therapists, and athletic trainers. This not only lets you share expenses, it also gives patients more options to meet their unique needs.

3. Be open to the advantages of starting as an associate chiropractor

“An associate position is not a punishment,” says Necela. Although you’ll earn less money as an associate, Necela says there can be tremendous value in working for someone else.

Get paid to learn. “You just spent the last few years of your life paying to learn. Now, somebody else is going to pay you to learn. You should milk that for all it’s worth,” suggests Necela.

Hone your clinical skills. This can be a valuable time to get better at the practice of chiropractic care before you strike out on your own. You’ll also have a knowledgeable resource to turn to when you have questions.

Learn about the day-to-day business side. See what goes into running a chiropractic business beyond the clinical work. For example, get a firsthand understanding of billing, insurance, accounting, marketing, and office administration.

Enjoy not being the boss. It can be a great way to ease into your career before becoming a full-blown owner-operator. And for those who have no interest in being a business owner, it can actually be a rewarding career path.

Network via your employer. If you’re working for a chiropractor that’s well-established, you can benefit by tapping into his or her professional network. The connections you make could lead to opportunities down the road.

NWHSU Alumni Insight: Mary Beth Minser, DC, was the owner/operator of Minser Chiropractic Clinic from 1990 to 2017. We asked her about her experience after graduating from NWHSU’s chiropractic program.

“I always knew I wanted to start my own practice. But before I did, I was an associate for about a year. And in that time I tried to learn everything I could about what it meant to run a practice.

Sometimes I hung out at the front desk. I spent a lot of time learning things from the billing officer. I didn’t just focus solely on my role as an associate chiropractor.

But that said, you can also learn an incredible amount of information as an associate when it comes to clinical skills, especially when you work for a chiropractor who shares similar views on practice methods.

What you want to do while you’re an associate is to learn what you love about practicing and what you don’t. For those who eventually open their own chiropractic clinic, the associate experience can play a crucial role in helping you create a successful practice that’s right for you.”

4. Manage your student loans wisely and set a goal

Although graduates may be eager to beat down their student loan debt, Necela cautions young chiropractors to think strategically. “Know what your goal is and then take the necessary steps to reach it. If you’re working as an associate but someday want your own practice, then you need to plan carefully for that.”

Necela has seen young chiropractors become trapped in associate positions because they sank way too much money into paying off their student loans. Then, when they wanted to break away and establish an office of their own, they lacked the funding to do so.

5. Think carefully before you sign a non-compete agreement (because it’s a big deal)

Let’s say you come out of school and aren’t sure what direction to go. You know you someday want your own practice, but you’re not ready for that step yet. So, in the interim you take a position at someone else’s chiropractic office.

It’s possible your employer will want you to sign a non-compete agreement. This is a legally binding document that prevents you from entering into competition with the employer after you leave. A non-compete is typically designated for a certain duration, often around three to five years, and covers a specific geographic radius.

Think about your future practice

Necela says that there’s nothing inherently bad about non-compete agreements. They’re a legitimate way for established chiropractors to protect their business.

However, he warns chiropractors to not just sign a non-compete out of desperation. “You want to use some forethought.”

If you’re serious about someday having your own practice, consider where you might want that practice to be before you sign a non-compete agreement. Necela points to a recent client as an example.

A chiropractor living in Chicago took a position – and signed a non-compete – with a chiropractic office 90 minutes away for two years.

He’s now buying a practice back in Chicago, and his non-compete agreement doesn’t apply to the area. “He gained experience, saved some money, and he’s coming back home. He’s ready to really rock it now,” says Necela.

Take non-compete agreements seriously

Necela says there’s a big myth out there that non-competes aren’t actually enforceable and you don’t really need to worry if you signed one.

Although state laws vary, generally speaking, Necela says, “They absolutely are enforceable.” He adds that it’s not only “ridiculous” to sign a non-compete with no intention of obeying it – it’s usually illegal and always unethical.

NWHSU INSIGHT: If you’re a new chiropractor, joining an existing practice that’s part of a major health insurance provider’s network can be a big career advantage. Also, if you’re looking for other employment options as a chiropractor, consider a salaried position within a private health system, the Veterans Affairs (VA) system, or a community clinic serving low-income and underserved patients. 

6. Understand why purchasing a practice can be a super-smart career move

“If I wanted to have my own practice today,” says Necela, “I think I’d buy an existing business. Because when you do that, you’re buying momentum.”

“Let’s say you have $20,000 saved. Sure, you can take that $20,000 and invest it in a brand new practice. But by the time you bought equipment and paid for other initial start-up expenses, you’d quickly have little to nothing to live on or pay yourself,” he says.

On the other hand, Necela suggests the same amount of money could be a down payment toward buying a practice.

“In that scenario, you’d be able to purchase a practice where the current owner was making a six-figure income, with plenty of momentum. Because of that purchase, you’d now have more than enough income and cash flow to pay yourself and your loan – plus a cushion to spare thanks to the current patients that came with the practice.”

In fact, chiropractors interested in buying an existing practice may want to explore associateships with an opportunity to own.

From associate to owner: Establish a solid plan and avoid the pitfalls

Necela says an associateship where you can transition to owner can be a great option, provided you keep a number of factors in mind such as these:

• Have a clear plan. Define the purchasing plan clearly, and verbally agree on it. Then bind that plan with a contract. Don’t rely on a vague “someday” agreement.
• Figure out the financing. Assuming you will need it, make sure you can secure financing. Without it, all the discussion and subsequent paperwork is a waste of everyone’s time.
• Work hard to follow the plan. You’ve taken all the steps. Now stay focused and keep the plan in motion. Follow the steps and the timetable to make it a reality both parties will be happy with.

For more information on this topic, see Necela’s blog post, The Art Of Chiropractic Associate Buy-In and Buy-Outs.

7. Know you could lose 80% of your patient base over a period of 10 years—if you don’t take certain steps

Regardless of how you start your chiropractic career, Necela says every new chiropractor should remember how important it is to maintain a connection with your patients.

In fact, he says, “Even seasoned chiropractors often forget about the valuable bond they’ve created in the process of helping a patient. It’s a bond you need to proactively nurture.”

And when you don’t do that? According to Necela’s estimates, you could lose 80% of your patient base over a period of ten years.

That’s why it’s crucial to take the time to educate existing patients on the value of chiropractic checkups and also make a concerted effort to stay in contact with them.

For example, email a monthly newsletter to your patients with engaging content, and if they miss an appointment, don’t be shy about following up with them so you can reschedule.

“We can’t put patients in a steel frame suit so that they’ll never get injured or experience pain again. So when you keep in touch with them, they’ll be much more likely to come back to you when the time is right.”

For more information on Necela and his services, check out The Strategic Chiropractor website.

If you’re still researching career possibilities and would like information on becoming a chiropractor, check out our post on How to Become a Chiropractor.

For information on Northwestern Health Services University’s chiropractic program, contact us today!

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