May 22, 2016

Chiropractic Student Question: ASSOCIATE OR GO IT ALONE???

By Dr. Dan Golden In Chiropractic Success, Practice Management

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A branch of The Golden System of Practice Management was designed especially for upper class Chiropractic students.  As I presented this program a multiple Chiropractic College the subject of entering practice as an associate or diving right in as a solo practitioner was always raised.  The advice I offered is as follows and, in some regards, is much more applicable today that it was 20 or more years ago.

I think the vast majority of Chiropractic students dream of and have the desire to have their own practice…their own place.  Doing so requires considerable planning which should begin while still in Chiropractic college. 

First and foremost decide where it is you wish to practice.  You can build a successful practice anywhere, however; you should where you plan to spend the rest of your life. Practicing where you wish to live predicates happiness!

    Entering solo practice requires start up capital.  Securing an office location, determining necessary square footage, build out costs, signage, marketing and a cushion to cover expenses while starting the practice.  I advise a six-month expense cushion.   

It is of utmost importance to overhead as low as possible.  Refrain from the urge to purchase new or get locked into an expensive long term equipment/furnishing lease.  Start with what you need as there will be ample time to purchase what you want.  From an entry business perspective the object is to have income greater than outgo as much and as soon as possible.

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As a student begin acquiring furnishings and equipment as funds permit.  Go on Craigslist, contact state and local Chiropractic associations and see if they know of anyone selling used equipment.  Check with Chiropractors in the area you plan to practice and see if they know of any such deals.  Have the basic necessities paid for before you ever open your doors.   

Entering practice as an associate with the intent to purchase the practice is an entirely different ballgame.   There are a variety of different associate relationships whose suitability is influenced by a  number of factors.  Compensation, benefits, raises contract negotiation, profit sharing programs, partnership, eventual practice purchase and provisions for termination?  No matter what….have everything in writing.  Have all documents and contracts drawn by an attorney.

If purchasing a practice, what is the value of a practice?  Does the purchase include equipment, real estate, accounts receivable?  What does the seller feel the “blue sky value” of the practice to be? 

Rule of thumb when considering purchase of an existing practice is the fair market value of the equipment, plus a percentage of the accounts receivable, fair market value of real estate and “blue sky.” 

Determining equipment value is relatively simple.  There a variety of sources to available to do so.  If the practice carries accounts receivable there will also be a profit and loss statement reflecting charge Vs collection percentages.  Never agree to pay more for accounts receivable than the highest percentage provided in the P&L….several points less.  In practices accepting third party pay determine an average third party pay reimbursement.   Real estate value is quite simple. 

The greatest variable is “blue sky.”  There is no one absolute formula to assess “practice value.”  Value boils down to two primary factors…..transition time and level of participation.  The longer the selling doctor stays in transition the more valuable the “blue sky.”  The greater participation by the buyer in new and existing patient management the more valuable the “blue sky.” 

Finally…..whether a student is anticipating entering practice as an associate or solo practitioner it is vitally important to have a very strong foundation of business  and practice management principles upon which to establish and grow their practice.  Those principles are best obtained from the masters who have not only talked the talk but walked the walk as well as those most familiar with the Chiropractic practice environment in today’s world of business.  The only (and least expensive) place to secure such information is at a ChiroSushi Summit wherein masters with decades experience are coupled with the rock stars of present day Chiropractic practice understanding.

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