How To Win At The Associate Game

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 the following:

Associate Doctor:

• 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 management
  
  

• learns about patient management
  
  

• takes time to gain confidence.

Established Doctor

• 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 or flunky.

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 progress
  
  

• 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 referral practice
  
  

• 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 partnership/buy-in/buy-out.

Getting Paid- The Ups And Downs Of The Bottom Line

There are two primary ways for an associate to be paid:

• Salary plus commission
  
  

• Straight Salary

Understanding the four stages of associateship

Having had numerous associate doctors over the years, I have noted four basic stages through which associates go:

1. Thank you for this wonderful opportunity to work and learn in your office.
   
   

2. Wow! I'm doing a lot of work!
   
   

3. I'm doing all this work and you're making all the money!
   
   

4. The 'Adios' stage -- time for you to either consider partnership with the head doctor, or go out on your own.

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 But Confidence

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 :

1. pay him a percentage of your earnings as 'rent'. (You and he must determine what's fair.)
   
   

2. 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.
   
   

3. 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!
   
   

4. 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.

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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.

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