By Phil Mancuso, D.C.
The economic reality of the times is that many
recent graduates are hamstrung with thousands of dollars of student loan
debt, and can't afford to set up their own practices, let alone run the
risk of going 'belly up.' Many DC's feel that associateship is a modern
form of slavery. In the worst of cases, the new doctor is treated like a
lackey, existing solely to do the bidding of the senior doctor in a practice.
In the best of cases, it's a marriage made in heaven, where both parties
grow old gracefully together!
In order to establish a winning relationship between
new and old doctor, there has to be an equal exchange of values. Consider
Considers the first year of the associateship
as a residency
Uses the first year to gain experience
with real patients (different from student clinic patients)
Learns about the business end of practice
learns about patient management
takes time to gain confidence.
Willing to share and teach
Willing to give up the ego that says only
he or she can really get patients well
Must realize in advance that some patients
will be lost as the new doctor makes the usual mistakes that come with lack
of experience in patient handling.
Must want to grow and expand, not just
ease his patient burden.
Must be able to share all his patients
Must not treat associate doctor as a gopher
Patients will accept you as an associate if:
You are not treated like a flunky
You contribute to the case from the beginning
by doing the examination and x-rays or the consultation and release statements.
You give the first adjustment.
You call the patient after his first adjustment
to make sure the patient is comfortable.
You do periodic adjustments, re-examinations,
or check blood pressure.
You show an interest in the patient's
You don't take it personally if patients
don't accept you immediately. Remember - time is on your side.
Associate Positions: How To Choose
Entering into an associate relationship is like
entering into a marriage - If it's good it can be terrific. If it's bad
it can be horrible. Some things to look for when entering into a practice
as an associate:
Someone who is willing to share and teach
Someone who is well respected in his community
and by his peers
Someone whose practice is primarily a
Someone who is respected by his staff
Someone who is ethical in his dealings
with his patients and others (like insurance companies)
Someone who is success and goal oriented
Someone who is willing to try new concepts
and ideas of treatment
Someone who shows by his actions that
his intentions towards his patients and towards others are well meaning
and from the heart
Someone whose shares your values
Someone whom you admire and want to emulate
Someone who doesn't promise you the earth,
moon and stars
Someone with whom you are compatible.
Someone who may be interested in a future
Getting Paid- The Ups And Downs Of The Bottom Line
There are two primary ways for an associate to
Salary plus commission
Understanding the four stages of associateship
Having had numerous associate doctors over the
years, I have noted four basic stages through which associates go:
Thank you for this wonderful opportunity to work and learn in your office.
Wow! I'm doing a lot of work!
I'm doing all this work and you're making all the money!
The 'Adios' stage -- time for you to either consider partnership with the head doctor, or go out on your
Things To Remember
Set your goals. Determine the type of practice
you want to have, for example:
Lower volume, more time spent with patient
Higher volume, less time with patient
type of technique -- straight, mixer,
chiropractic, chiropractoid, etc.
Small town doctor
Family practice, PI, WC?
Small personal practice
Large multi-doctor practice
An Innovative Plan For The New DC With Nothing
It has been my observation over the past twenty-three
years that there is seldom a scarcity of confidence in the new practitioner.
However, it's an economic reality that the new DC is faced with the double
burden of enormous student loans to repay and the specter of the high cost
of opening, marketing and equipping a new chiropractic office. So, what
we are faced with is a new graduate with no money but lots of ambition!
For those who find themselves in this situation,
here's an approach you might not have thought about. Hang onto your hat!
You go into an established practice and work for
absolutely no salary. I know, you're wondering how you'll survive. The key
here is your confidence and the cooperation of the head doctor. What you
will be doing is building your practice within the wall of the existing
practice. The head doctor will train you, promote and help market you to
the community, and give you full use of his staff and facility. In return
you will :
pay him a percentage of your earnings as 'rent'.
(You and he must determine what's fair.)
work in his practice on your off days doing
exams, x-rays, (you get training, experience to use in your own practice,
and become familiar with the patients in his practice.
And this is the best part: determine a percent
amount that you will take every week from your practice earnings and put
it into an escrow account with your social security number on it, so that
it can only be cashed in by you. At the end of a specified time, if you
wish to buy into the practice, the money in the account can be used for
a portion of the down payment. If for any reason you wish to sever your
relationship with the doctor, or if you're not interested in buying into
the practice, you takes your money and leaves!
Take out a loan to cover your living expenses
for 6 months -- it's much less than you think, and certainly less than the
cost of setting up an office!
(I'm currently looking for my "final associate,"
one who is interested in either the above plan, or a partnership buy-in,
buy-out situation. I'll write later to let you know how it works out!)
Before signing any contract:
Request a one month trial period to see if you
like the practice and the practice likes you. Once you have narrowed down
your selection, this is the courtship or dating period. Now is the time
to apply al the information above.
Have your accountant and attorney look at the contract
Hire an accountant and an attorney!
Remember that when you go for an interview that
you are interviewing also, so don't be nervous, and don't be afraid to ask
important questions. Your time spent as an associate is valuable and should
offer a good return in experience to you and benefit to the practice. Ask
what management seminars the doctor has been associated with. The more knowledge
there is to be shared the better. Once your choice is made, give it 100%
of your commitment.
About The Author:
Dr. Phil Mancuso has been a practicing Chiropractor
since 1972. A graduate of National College of Chiropractic, he has been
lecturing to patients and Chiropractors both in his community and nationally.
Markson Management Services twice honored him with their 'Chiropractor Of
The Month' award, and in 1993, his office received Markson's coveted 'Staff
Of The Year' citation. Dr. Mancuso lives in New Jersey with his wife, Carol,
and their son Michael.