Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 1156
Infrastructure 241 I

From the Desk of Dr. Mark Studin
Academy of Chiropractic

Preamble: Many of the issues I bring to you are very small, yet each issue is just that, an issue. If you take care of the small issues, then you will be able to build and more importantly, focus on the bigger issues...a larger practice and more family time. -Mark Studin 2006

"Associates, when to hire, pros & cons and what to pay them"


Dr Studin: what are the pros and cons about an associate? how do you pay them? How much do you pay them? What do you deal with them? And what is your liability? how many years you in practice?

Guest Doctor: 21.

Dr Studin: everything your associates does, you are liable for everything. Every word they write, every person they touch, everyone they help and everyone they hurt. It's your responsibility, not just their, there's upsides and downsides. So the upside obviously is that um you can take care of more people, you could just expand your practice and the opportunity really isn't that someone's available. The opportunity is your practice is growing and you want to keep that going, don't think that because you have an extra set of hands, you're going to get busier. Remember the definition of insanity, do the same thing, Expect different results. You're going to see the same number of patients, you personally, will see less and your product gets watered down. So the issue is are you doing things to increase, the amount of business that comes in. So that's number one, you're trauma qualified, you've done all the programs, you've done everything. Your practice should be growing pretty steadily right now you had one lawyer seminar you should consider doing others because this way you'll constantly be on the inside looking out. These are the things you should need to do with your community. But when you bring an associate in, you should have them take four courses: PI bootcamp, MRI spine. It's hurt because they're going to be potentially deposed, that needs to understand that. Then the stroke evaluation course, that's for the stroke course and an evaluation of management, and the fifth one is the colossus documentation program. You don't want them to get into spinal biomechanics and connecting tissue disorders, etc. Because you are the reason for the referrals, and never forget those that control the referral's control of the game, the associate's going to look at you and goes, oh I saw a hundred patients a week for him. This guy, he collects $100 a week, he's collecting $10,000 on me and I'm only getting paid $1000 or whatever I am and he's making $9,000 every week I work well what associates don't realize is what you don't collect dollar for dollar, they don't realize you've got to pay the electric and the gas and the rent and all the other staff from the cleaning. They don't get any of those things. Don't think your associates like you, no matter how friendly they are, they tolerate you cause you're the gravy train. And if they can make 5 cents more an hour with a guy down the block, they're going to take it. And if they could open up 10 miles in one inch from you and steal all the referrals they will be there in a heartbeat. I remember no restrictive covenant, no matter how tight you write it or outside lawyer writes, there's going to go more than 10 miles. That's pretty much the national average. With that being said, you need an agreement with every associates. We've got those for use of the attorneys we work with and you need a staff office policy for every staff member, including your associates because you have very finite guidelines in writing with very strong teeth that'll screw them over if they screw you over. With that being said, right now good associates are hard to find and at a school is very competitive. So if you're going to get someone out of school, $1,000 a week at $52,000 a year, plus malpractice is bare minimum. I would say $65, $75,000 a year would be pretty much the going rate with a really good one out of school where we're really a little bit of experience and you can also put them on a bonus. Everything they bring in, you could give them a percentage of what their hands touch, they can't get a new patient and you treat the patient half the time. They treat the patient half the time and you're going to bonus some 20% on that patient. That's illegal. They can only be bonused on what their hands touch, and that's very important. So I would put them on a bonus of what's collected of what they bring in, I would do 25%. It's a little bit high for some, maybe a low for a couple of years. But I think that that's a good number. And if you run a typical chiropractic practice with a 50% overhead and you're giving them 25% of what they're hand touch, you're pretty much partnering with them to Work Day, bring in after the expense you keep half, they keep half and that's pretty fair. I would also consider giving them health insurance because everybody needs health insurance, and what other questions you have?

Guest Doctor: So who pays the licensure continued malpractice insurance?

Dr Studin: the owner. Now here's the thing, the five courses of malpractice you pay for the five courses I just mentioned, you pay for the half to take it as mandatory and I have to complete those within four months of being there after that, you'll sit and talk to them of what you want to do with them. What I would ask them, how much they want to make. Now if you get someone, oh, I just sort of Red Fox run through the bushes. if you get someone who's really good, what I paid was six figures, Andrea Grant. Some are worth their weight in gold, but you want to make them ready.

Guest Doctor: You'd recommend a salary as opposed to a percentage?

Dr Studin: both

Guest Doctor: a percentage of collections? as far as their base pay, what I've heard in the past is do a 50/50 split or a 60/40 split, something like that of whatever they collect as opposed to a straight salary.

Dr Studin: I don't like that. A lot of associates don't like that, you can give them a choice. Here's what I'll pay you, it's a straight salary plus a percentage of what you bring in. you're going to get paid less for what you treat of mine, but I'm handling them to you. Any monkey can treat someone who's handed people patients, but by the same token, other people don't have the talent to bring in business.

Guest Doctor: So when you say bring in, you mean they went out and got the patient through marketing or referral or whatever?

Dr Studin: Yeah. You're going to just hand someone patients and give them 60% of what they touch or 50% of what they touch is your hand. I think that's insanity.

Guest Doctor: right, then you're just splitting your practice with that other person.

Dr Studin: Yeah, why would I do that? Years ago in the 1980s, a long time ago, I had a kid that came in, I was paying him $50,000 a year at a school, which isn't bad, I knew him really well. And he was sending in 20 to 25 new cases a month. And after 4 months I went to him, I said, you're like hot stuff. I am doubling your salary to $100,000 a year. This is in the 1980s that's a lot of money.

Guest Doctor: Because he was productive.

Dr Studin: Yeah. You know what he said to me? He said, Dr Mark, I love you but I'm leaving. I'm giving notice. I was crushed. I'm going to Fredericksburg, Virginia. And he did and he was seeing a thousand patients a week in six months. He figured it out on my dime, which was fine, he had a place to play and learn and pick my brain. But you see, if someone comes in and they start producing, then you talk. But if something's not producing, you're the set of hands. That's it. Don't, don't overpay. On Talent. Overpay talent. Talent means you're bringing work in the practice, and how much of a bonus you're going to give or how much of an increase you're going to give them every year, you can account on it. If all you do is treat by patients and you don't bring anything in, you will get a raise every year probably, between five and 10% all you're doing is treating my patients. You're not adding to the practice. All you're doing is freeing me up to do other things, whether it be gone car shopping or get more patients. That's my business. 

PLEASE TAKE FURTHER NOTICE: CONFIDENTIALITY AND PROPRIETARY INFORMATION NOTICE:  This email including attachments is covered by the Electronic Communications Privacy Act (18 U.S.C. 2510-2521) and contains confidential information belonging to the sender.  Nothing contained in this message or in any attachment shall constitute an Electronic Signature or be given legal effect under 44 U.S.C. 3504 Sec. 1707.  The information is intended only for the use of the individual or entity to which it is addressed.  If the recipient of this message is not the intended recipient, you are at this moment notified that any unauthorized disclosure, dissemination, distribution or reproduction of this message or any attachments of this communications is strictly prohibited and may be unlawful.  If this communication has been received in error, please notify the sender immediately by return email, and delete or destroy this and all copies of this message and all attachments.