Choosing a Location

By John Whitney


Quo Vadis

Where will you go? School is a great lark, and a wonderfully sane way to escape for a few years . But if the buggy ride is just about over, it is time to get serious about your options and your future. It is also time to get real. To stop believing in the Easter bunny and Santa, and, "I've now got it made". Whoever nudged you to study the noble profession of Chiropractic probably got their influence from the '70s and '80s. This is not the '70s or '80s.

Managed care and a rapid rise in the number of chiropractors being churned out has created what economists would term an oversupply. Too many chiropractors chasing too few patients. The same is true for medicine. Little comfort that is. In fact, due to the recent positive findings on the affects of spinal adjusting, many MDs are trying their hand at it, so to speak. This, of course depresses your market further.

Don't get the impression that your future is bleak. Just dont get the impression that it is rosy either. You must be smarter than a lot that have gone before you. You are faced with making several tough choices. These are business choices. Historicals show that most new graduates do not use an ounce of sense when deciding where to practice. Anecdote, your aunt Maudes advice, whim, your desire to be close to the beach/mountains/home/warmth.

Historicals show that if you are a married male, you are more likely to end up in your wifes home town than any other single place. If you are single you are most likely to end up in your own home town. I'm not saying these are bad choices, in and of themselves . But it does not exactly indicate a lot of analytical thought went in to the choice.

Go where the opportunities are, go where the opportunities are, go where the opportunities are. To do that you will have to be able to recognize opportunity. And that is what this piece is all about. A long time a go someone explained to me that you cannot tell someone something they think they already know, it is impossible. Frankly, most new graduates fall into this catagory. I know what I'm talking about. For thirteen years I worked exclusively with chiropractic students transitioning into practice. Our records show that we had in excess of three thousand clients during that time. Your life is very familiar to me. I hope you are able to accept some well qualified advice.

Like any other business you must look around for states that have a high ratio of population to DC ; these will be likely prospects. There will be prospects even in areas where the ratio is not in your favour, but why make it tough on yourself. Look for the easiest targets first. Not exclusively; first.

You will probably find that California, New York, New Jersey, and Pennsylvania do not look appealing, numerically. You will probably find the numbers are more appealing in Rhode Island, Tennnessee, Alabama, Kentucky, Arkansas, Louisiana, South Carolina, Virginia, North Carolina and perhaps Washington. Again, there will be pockets that look good in areas that do not appeal when simply using raw numbers. What you are looking for is 1/5000 or greater, DC/ population. It is a way to start, and beats aunt Maudes advice hands down.

Once you investigate the raw numbers, it is time to refine your focus. How have the latest startup doctor progressed? What is the advice of the doctors with mature practices in your investigated area. What is the state of managed care in the area. Most managed care organizations (MCO) do not extend privilages to new graduates, often for three years.

Even when your investigations show that an area could be a good target, you are faced with the question of solo startup (schedule approximately $100,000 for that venture), associateship (count on a handsome income of approximately $30,000/yr), space sharing (independent contractor) requires an overhead of approximately $5,000/mo. Now, there are variations on the themes of all these methods, but basically they are your options.

From a numerical standpoint, purchasing a practice is the best way to go. Known historicals, diminish your risk considerably. When you look at a practice and know how it has been performing, number of new patients, numbers of visits per week, dollar amounts collected monthly, exact overhead, staff efficiency, that is all very revealing and reassuring. You can see what your money is buying. In solo startup from scratch, you could put out $100,000, and still have no idea if the business will flourish or flounder. It is like paying $100,00 for a practice................ with no patients. Who in their right mind would do that? (too many)

Conventional wisdom often advises you work as an associate for a while and "learn the ropes", then look for your own place. That, of course, assumes that the host doctor knows the ropes, (this is a new eara remember) and is a good teacher and a fair employer. These are often cavalier assumptions. "By their deeds ye shall know them" applies here. Check with associates who have worked for this host doctor before. There are few who area really nasty people but many who are blissfuly ignorant of how to be a rational and fair employer.

Try smaller towns, you can become a big frog in a small pond rather quickly that in the big pond. Life is saner/duller also. There is much to be learned to avoid costly mistakes. Signing a bad lease, alone, can spell disaster.

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