By John Whitney
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;
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
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.