The Graduation Question... What Now?
Posted on 4/2/2011 by Alan Rousso
Categories: Coaching Distinctions Procedures Business Views

You finally made it! You have accomplished one of the greatest goals a human being can be called upon to fulfill. You are now a Doctor of Chiropractic. After the exhilaration of knowing that you now have the honor of practicing as a professional... how many of your dreams will turn into nightmares?

Too many students are caught by surprise when they begin to understand that although they have graduated, the road ahead can be even more challenging by time, energy, and yes…money. If you ever want to possess the fervor, love, excitement and purpose of chiropractic, just speak to a newly graduating student. They are filled with dreams, and hopefully… new goals. Those goals should also include the beginning of the journey, not just the end results.

What does that mean? That means that you need to answer the question “What Now?”.

What are your choices after graduation? The choice you make can influence the rest of your career. It should be considered closely, and no one answer is right for everyone. I will attempt to give you the four best choices along with the pros… and cons. Regardless of your decision each can provide you with the challenge and excitement you should have, once a “decision” has been made. Those choices are:

1. Open a practice
2. Purchase an existing practice
3. Become an associate
4. Be an independent contractor 


Opening a brand new practice is probably one of the most rewarding experiences a confident individual can make. Why confidence? Because opening a practice from nothing requires everything! It challenges you with real estate locations, leases, loans, forms, logos, equipment, staff, furniture, etc., etc., etc.. Get the picture? Everything!!! And once the basics are in place, the challenge begins. How do I get enough new patients, and keep them, to build the practice of my dreams? You will require attorneys, accountants, and hopefully, a coach or consultant, to help you with all the decisions you will need to make in regard to your new business.

This business requires a focused, goal oriented individual who’s willing to do whatever it takes… legally, ethically, and professionally. These are not just good character traits, but good business traits as well. The reputation you build will last the rest of your professional life… good for you, or not so good for you.

Measure your choices carefully in everything you do from the style of your advertising, to your stationary, and most importantly, the impressions you make with the people you contact. All contribute to the success that opening a practice can bring.

Important point of interest

Please be sure to have enough working capital for professional and personal expenses that will last at least 4-6 months. Many practitioners are under capitalized, which accounts for the major reason new and experienced chiropractors can be out of business, before they get started!


Purchasing a practice can be just as challenging as opening one from scratch. The questions that should be asked are:

Is this where I really want to be?
Am I overpaying?
Are the terms and conditions appropriate?
Who can I trust?

Although there are many “formulas” to figure out the correct purchase price of a practice, it is not too dissimilar from buying a home. Someone decides on the price, and the buyer determines what the real value of the practice should be. Look at the equipment, the length of time the practice has been established, the number of files, how many active patients, and why is the doctor selling?

As you can begin to see, this is not an easy decision, nor is the responsibility of running an existing practice. How will your techniques measure up, what was the practice “style” of the existing practitioner? - Was it a PI practice and do you want a family practice? All of these factors can determine the success of the transition.

Important point of interest:

Have a team of professionals available that you know and can trust to help you make the right decisions concerning the purchase of a business, and make sure you do your due diligence in every aspect of the practice.


Becoming an associate is probably the goal of over 50% of the graduating students. They believe that they will gain “experience” in learning how to run a practice. This is only partially true! More often than not, the associate becomes the head doctors’ extra pair of hands, which require time and energy in the adjusting rooms, taking x-rays, doing examinations, and writing reports. When is there time to learn about the business of running a practice? Hardly ever! Few, if any associates, leave an associate position ready to face their lifelong dream - opening or buying an existing practice!

Many graduates also feel that if they are currently cash poor, that working as an associate will help them to save money from the salary they earn. This is also only partially true. Many doctors start to feel the exhilaration of making money - and spending it. Lifestyles increase, and sometimes, so does debt.

Important point of interest:

Select your associate position carefully! The doctor you associate with can help you, take advantage of you, and sometimes, can hurt you. As in any profession, there are both good and not so good professional people in chiropractic practice.


An independent contractor is someone who rents space from an existing practitioner and pays a flat rental fee or a percentage of earned income. This can give the new practitioner the advantage of both being the associate, and opening or buying a practice. Please check with your accountant or your coach regarding the new rules issued by the IRS, when it comes to the definition of an independent contractor.

Many chiropractors are told that even though they are an IC that they will have a restrictive covenant, that they can’t take their patients with them, or that they must take care of the existing DC’s patients - this is simply not correct.

An independent contractor means that you are running an individual practice within another DC’s office. Remember it! Being an IC can help you get started and save you a tremendous amount of money. Once you’ve built up the volume of your practice, you can then select to move the practice to the location of your desire.

Important point of interest:
Be aware of all the rules concerning an IC. You do not want to be hit with tax liabilities before being able to open in another location. This cannot be stressed enough!

All of the above examples are a brief summary of what the newer graduate is faced with. Practice can and should be fun, exciting, and rewarding. But without the experience of a professional team, the newer DC can be faced with horror, instead of happiness. Select your choices carefully, and remember “what’s next!”

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