by Dr Richard Mitton
Most chiropractors take the time to define the optimal characteristics of their ideal clients and CAs before they put out an ad, yet they often don’t do the same amount of preparation when they plan to take on a new associate. Most principals take on an associate relative to the best applicant who will fill their short-term needs, not someone with the ideal requirements and credentials to fit into their long-term vision and plan for the practice.
So here are a few things to put on the table for discussion with a potential associate prior to making a decision about the best applicant for your practice:
- Philosophical Congruence
Each associate will bring a unique blend of new ideas, technical preferences and beliefs about their chiropractic scope of practice, given their training and exposure. Diversity will often strengthen a practice but strong opinions about vitalistic versus mechanistic philosophies is probably one of the most disruptive influences of a practice that I know. Congruent philosophies and open mindedness are foundational keystones to any practice as they underpin all else that follows.
- PVM Alignment
Like philosophical alignment, the need for associates (and all team members, for that matter) to be working towards the same vision is so important for team unity. I generally find that most teams benefit from an open review of the practice vision (or purpose/vision/mission statement) two times per year or as new members join the team. This allows everyone to discuss what the PVM means to them, get the new team member(s) engaged with the guiding statement, and allow time for modifications to be made if required.
- Technique Similarity
Many sole practitioners unfortunately create practices where clients are reliant on the unique qualities or personalities of the chiropractor. This can be comforting for a delicate ego, however, one day when the practice has to be sold (as none of us last forever), the goodwill is less valuable as loyalty is less transferable. The ideal practice to sell is one where the clients are certain about chiropracTIC, not necessarily the chiropracTOR. The ability of a DC to take holidays without the practice numbers dropping for the associate or locum is a reflection of the success of your education process and is often directly proportional to your technique congruence. Clients want to know that when the principal is away, the associate or locum will give them a similar adjustment. Some variety can be healthy but personally I think there needs to be 75-80% congruence in technique with the other 20-25% being the ancillary techniques used after the primary corrections are delivered, not the primary technique for 20-25% of the clients. Discuss all techniques used and in what proportion with your potential associate and then watch what they actually do in practice (eg on the other team members) before confirming their appointment.
- Team Growth
All team members, particularly the principal, must be interested and committed to pursue personal and professional growth; if you’re not growing, you’re receding. The expectation of attending weekend seminars and functions as a team to strengthen bonds is an essential part of growing any practice. There is nothing more disruptive for a team eager to grow together than some members of the team having different values and priorities such that they don’t make themselves available for planning meetings and team growth events. Expectations need to be clearly stated in the associate (or CA) contract.
- Practice Values
I think that just like a healthy marriage or primary relationship, it is essential for a practice to have some common values like love, family, community, service and excellence. Like work-shopping the practice PVM, practice values are a great topic for an open team discussion and consensus building. Some variety of values is to be expected and can be very healthy to a practice but the core values, like your core techniques, need to align at least 75-80%.
- Point of Difference
As mentioned above, a team needs to align but, at the same time, what makes a good team stand out is often their diversity and unique characteristics. A team will be strengthened by some team members having high people skills, another having a meticulous eye for details, certain techniques or numbers. They say we should always employ someone better than ourselves to grow as an individual AND as a team.
- Contract and Review Timeframe
Over time, the needs of the principal and the associate can change with the dynamics of life and practice. It is healthy to review how the associate agreement is working for both parties annually but probably at the first 6-month mark as well. Items worth reviewing include: percentage of services paid, hours, contribution, marketing, seminars that individual and team members attend, performance reviews (for the principal as well), option for the associate to purchase the practice, expediency of invoice/wage payments, and intended holiday absences.
- Exchange of Clients
Whenever an associate commences practice in an office, there is commonly a 15% transfer of clients to the new DC because of indifference, hours or personal reasons. It is not ethical for the associate or the principal to actively or intentionally procure clients from the other chiropractor in their absence. The discussion needs to be had to express how and when this should take place before any resentment grows that could potentially infect the practice culture.
- Owning Goodwill as an Associate
Another discussion that needs to be had is the ownership of the goodwill. Even though the principal has invested years of their time and money, many associates become resentful that a growing amount of their hard earned fees go to the principal and that the principal is earning money from the associate’s practice growth. Most associates don’t understand the cost of establishing and running a practice until they have done it themselves. Both parties need to have their say and percentages may need to be adjusted with continued practice growth.
- Marketing, Archives and Proactivity
As part of a regular DC review process (possibly with each agreement review), how each party is aligning with and contributing to the practice PVM needs to be discussed. The expectation of each party to build their practice, communicate with inactive clients, and contribute to practice activities needs to be addressed and even put into the special conditions section of the agreement.
- Expense of Marketing
Just as many associates don’t fully understand the ownership rules relating to the goodwill of the practice (even when built by the associate), they also don’t understand the cost associated with marketing. Many principals are expected to pay for all of the practice marketing initiatives yet the associate expects to draw clients from such endeavours. A reasonable balance between time/effort, financial input, and eventual goodwill ownership needs to be openly discussed.
I hope that these ideas will help associates and principals alike iron out these common stumbling blocks, which prevent many practices from running harmonious and profitable businesses.
Reference: Syllabus 5