Getting started in practice is thrilling, but it is also a daunting endeavor.
It’s a lot easier if you have an organized plan. The purpose of this checklist is to guide your thinking as a new practitioner and streamline the process of launching your practice.
- Decide where you want to live. You should practice within 30 minutes of there.
- Apply for licensure.
- Decide if you want to be a solo practitioner, associate, independent contractor, or partner.
- Get in good physical condition. Develop a stress reduction routine.
- Visualize and affirm what you want. Write goals, or create a mind map, vision board, or scrapbook.
- Continue to develop your skills, deepening your understanding and application of the science, art, and philosophy of chiropractic.
- Compose your mission statement and unique value proposition.
- Compile your financial data and budget to start up.
- Decide the type of office you want: professional building, storefront, home with an office, or condo.
- Select your mentors and professional advisers: practice management coach, lawyer, accountant, banker, insurance agent, financial planner, and compliance consultant.
- Calculate your target practice parameters: expenses, fees, and volume of new patients.
- Choose your location and check on possible issues with zoning, parking, and neighbors.
- Draft a business plan and arrange for financing if necessary.
- Choose an appropriate corporate structure, with your advisers’ help.
- Sign the lease or close on property for your practice if purchasing.
- Choose and order your equipment: tables, office furniture, computers and software, diagnostic and treatment tools, and disposables.
- Organize the build-out, keeping reception and business up front, new patients in the back, and daily patient care in the middle.
- Build office, get permits and inspections as needed (contractor should arrange).
- Get phone and internet services installed.
- Obtain signage, stationery, cards, appointment cards, office forms, and educational materials.
- Plan office opening for a month or two after you actually open to gain momentum.
- Apply for an npi number (nppes.cms.hhs.gov/NPPES/Welcome.do) and to panels and credentials you want, including workers’ compensation and major carriers.
- Develop a marketing plan and develop strategic alliances in your community.
- Start a Facebook fan page, Twitter account, and other social media as appropriate.
- Set up office procedures: job descriptions of assistants, office policies, and fee policies.
- Hire and train staff.
- Plan statistical analysis to track your progress: days worked, new patients, office visits, services rendered, collections, and accounts receivable.
- Establish billing and collections procedures.
- Activate marketing plan.
- Develop ongoing quality control and refinement systems, correcting as you go.
Calculate your finances so you know how much money you’ll need to make to meet expenses and then some. You may not be able to find work at that rate, in which case you may need to become an independent contractor (see below.) If your needs are met by a salaried position, and you want more experience before you open your own business, an associateship may be ideal.
Owner doctors who are looking for associate doctors, salaried employees who serve as staff chiropractors, will go to the colleges or state and local journals to search for candidates. If you are looking for work, be sure to list yourself at these resources.
As an employee, expect a similar status to that of other employees—your job will be explained, you will be trained, and you are expected to act consistently with the wishes of your employer. Look for opportunities to shine—they do make a difference.
In most locations, an independent contractor (IC) operates a separate business within an already established practice. ICs may pay monthly rent or a percentage of their income as payment for the owner doctor, but taxes are not taken out—ICs are paid their share in full, and pay their own taxes. When tax is taken out, most jurisdictions consider that an employer-employee relationship.
In most areas, an independent contractor isn’t bound by non-compete contracts, as the owner and IC operate separate businesses. But violating the spirit of the agreement is bad business, so everyone concerned needs to agree that the guidelines of fairness and common sense apply.
New doctors may choose to share the financial responsibilities and workload with a partner, and of course profits are also shared. Spousal partnerships are often already clearly defined, but if you enter into a partnership in an already operating practice, or if you start up with a partner, it’s essential that the rules be understood and agreed upon by all concerned. Guidance from professional experts may be needed to resolve areas of conflict or uncertainty.
Getting through school is challenging enough, and your education gave you tools to work with. Now, a new set of skills needs to be learned. This checklist doesn’t cover every eventuality; it is a jumping-off point to assist you in getting started. Seek the advice of professional consultants when you embark on your journey—the expense will come back to reward you many times over, based on how quickly and efficiently you can get up and running and how many landmines you avoid. Continue to invest in yourself.
Dennis Perman, DC, is a healer, author, speaker, producer, coach, and co-founder of The Masters Circle.
Bob Hoffman, DC, is a best- selling author, healer, entrepreneur, and visionary leader. He is president and CEO of The Masters Circle, which has reinvented the traditional model of coaching and consulting doctors of chiropractic. He can be contacted at firstname.lastname@example.org.