October, 2011

Competitor or Associate?

Part 1 of 2 Parts

By Lawton W. Howell

Regardless of the size of your practice, you should have a plan to expand your practice with associates. As a solo practitioner, you are limited in the size of your practice. But when you have associates, you can break through the glass ceiling and, more importantly, prevent creating one more competitive colleague. The profession is filled with horror stories of the problems and failures of recruiting, employing, training and retaining associates. You can successfully impact your future when you adopt sound business principles for the associate employment process.

Failure to develop associates for your brand of chiropractic will impact the following:

  • Hamper and restrict your personal lifestyle choices
  • Affect patient-centric care access and protocols
  • Limit your exit strategy
  • Increase you inability to develop affiliate sites for your brand of chiropractic
  • Increase the number of competitive colleagues in your marketplace

Profit Center

An associate should not be viewed as an overhead or expense. In reality, an associate can function as a profit center when you construct your associate program correctly. While there are a number of ways that an associate can serve this role as a profit center and not an expense, let's examine a few:

  • You can expand your office hours to make it more convenient for patients to keep their commitments, using the associate to cover those office hours you prefer to avoid; for example, lunch time, Saturdays or Sundays, or early-morning or late-evening hours.
  • Your associate can become part of your marketing team by performing spinal screenings and external lectures in the market-place to attract additional new patients.
  • The associate can help deliver patient-education workshops.
  • The associate can administrate rehabilitation or physical therapy programs.
  • The associate can be-come involved in networking groups.
  • The associate can cover your office hours as needed for vacations or discretionary time, instead of you having to employ day cov-erage.
  • The associate can be groomed to provide you with an exit strategy at retirement, whether by choice or by force.
  • The associate can be trained to open an additional office as an equity partner to extend the reach of your brand.

Hiring an Associate: The Time Frame

The best time to begin the process of employing an associate is today, even if you don't believe you need one. The first huge mistake that leads to failure and frustration is not allowing adequate time to recruit and screen candidates for a position.

Often what occurs is that a decision is made to add an associate to the team and then there is a rush to find someone. Don't rush the selection process. Frankly, it is not uncommon for it to take six months to find the right candidate who is congruent with your brand of chiropractic. In fact, the best policy is to have a continuous process of recruiting and screening candidates.

You just never know when you will need an associate. Better to be prepared with a folder of qualified candidates, rather than needing to find one quickly.


Before you begin the process of recruiting, you must work the numbers. Begin with the associate's responsibilities; you need to develop a compensation package that will include salary, incentives and benefits.

Once you know the amount you will need to invest to employ an associate, you then must project the offsetting revenue en-hancement you expect.

Much like new equipment (you only purchase or lease the equipment if you expect it to generate more revenue than your in-vestment), people are no different. There are a number of important factors that will contribute to your compensation package, in-cluding geography and responsibilities. For example, the compensation offered to a technician associate who will primarily only perform patient care will be different than the associate that you expect to host spinal-screening events and deliver lectures in the community.


Next, develop a recruitment brochure about your brand of chiropractic and what is expected from your associates. Make sure to include demographic information and images about the lifestyle in your marketplace, and have a photo tour of your office from the exterior to the interior.

Show examples of your marketing and your community outreach support. Support this brochure with a Web site that shares your "story" and why they should have an interest in joining your practice. Include all the information in your printed brochure and you can do a video tour of the office instead of photos.

Including information about housing, schools, churches and community lifestyle will help attract a candidate who will need to consider relocating to your community. Spend a little time and visit some successful companies' Web sites; click the link each provides about job opportunities to get an idea on how to implement your own opportunity. Of course, you can include all posi-tions on your team in your recruitment brochure and on your Web site.


Now it's time to begin the recruitment process. Post your opportunity with all of the appropriate chiropractic colleges and link the posting to your Web site page. The post should be continuous. Never give up!

As you receive inquiries or resumes, acknowledge instantly that their interest has been received and is under consideration.


Contact the candidate by telephone and conduct a "sensory" screening by asking appropriate open-ended questions to get a "feel" for the candidate and to see if they are worth further consideration. This component of the screening process should only take about 10 minutes. Use a simple checklist to "record" your initial perceptions of the candidate for later review.

This is your quick-screen protocol to weed out those associates you perceive are totally incongruent with the your brand of chi-ropractic. If they are not congruent with your brand, they will not function well in your practice, pure and simple.

Request a printed resume and current color portrait from each of the candidates who passed your initial screening process. Send a letter to those you are not considering any further to advise them of their status. After receiving the formal resume and color portrait from candidates who are still under consideration, initiate a series of telephone interviews, focusing on specific patient care philosophy, adjusting techniques, scope of patient care, compensation expectations and their general expectations in the short-term and in the long-term. (Included in this process is screening by other members of your team.)

Have your office manager and your insurance staff conduct a telephone interview. Employing an associate is a group project, as the associate will be spending a significant amount of time with everyone on the team, not just you.

After completing this process, if a candidate has still made the cut, they are invited to visit you and are required to bring their spouse. It is appropriate to reimburse travel expenses and the visit should be for a couple of days. This stage of the process will include having the candidate be interviewed face-to-face by the entire team and by you.

As part of the process, the candidate will follow you around as you care for patients and perform your normal daily tasks. But here is the one critical component that is often ignored or overlooked during the screening process: dinner with the candidate and their spouse with you and your spouse. You will learn more about this candidate during dinner than you can during the formal screening process. My advice: watch the spouse!


If the candidate makes this cut, then your next step is to secure the following:

  • A personality and behavioral analysis report
  • A background and licensing report
  • A credit report

Each of these reports will provide additional screening issues that might have been missed during the verbal and in-person in-terviews.

Employment Offer

Once you have completed the screening process, and if the candidate is congruent with your brand of chiropractic, you are ready to offer employment as an associate in your practice. Read my above recommendations carefully; do not offer and imply employ-ment until you have completed and reviewed all of the previous elements of the recruitment process.

When you offer employment, prepare a letter of employment including your compensation package and the responsibilities of the position offered in detail, and the scope of your internship training program and how to attain permanent employment status.

After reviewing the job offer, the candidate accepts the position and acknowledges the requirements and responsibilities by dat-ing and approving each of the documents provided. When the position is accepted, you submit your associate employment agree-ment for approval along with the effective date of employment.

Editor's Note: Next month, we'll look at the particulars of your associate agreement, training procedures and protocols, and some cautions.

Lawton W. Howell is the founder and chief executive officer of WellnessOne Corporation, a chiropractic alliance marketing group based in Las Vegas. Direct questions and comments regarding this article to 877 WELNES1 (toll free), send an e-mail to , or visit www.growmypractice.wellnessone.net.

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