Associate or Employee: Do they work?

By John Whitney DC


Just today, I received an email through the Internet that asked me if I had a contract that would "really make an associateship work". I told the DC that I would supply him with an associate agreement that would "really work", as soon as he sent me a marriage contract that would "really work".

The lesson is obvious. Contracts don't "work", people do. I amsure the DC knew this. The request was probably born of frustration and disappointment with an associateship; all too common.

A few months ago I contacted a DC who, for years, conducted seminars where he taught one how to construct an ideal associateship, from the standpoint of the host doctor. He told me he no longer offers the seminars. He basically told me that after teaching chiropractors how to form ideal associateships, he found that he was wrong; associateships do not work. I was a little surprised, but since it was the same thing I have been telling people for years, I was not shocked. As with all things, there are exceptions.

I mention this mind-set at the beginning of the article in order to modify the almost Pollyanna attitude one usually encounters during the courtship of the employee and employer. It appears that too often that the participants are carried away with their own desires. Reason and judgment are often impairedby the sheer desire to have the situation work out well.

I am a big fan of, "positive expectancy"; it is a powerful and positive management principle. Positive expectancy management requires maturity, and dispassionate reasoning in it's application; it is part of the Pygmalion Effect and affects every aspect of our lives. The paradox is, one must balance the history of associateships (bleak), with good management/communication skills. One could argue eloquently for either side. That is why it is a paradox. We should all learn paradoxical logic early in life.

In spite of the foregoing, chiropractors in large numbers are choosing associateships as a method for getting into practice. My record show that approximately seven of every ten graduates start off as associates. Pity.

Experience in this area tells me that host DCs ,(employers), often are looking for an associate for the wrong reasons, not considering the options to solve their real or imagined office challenges. Many office challenges can be solved by improved office procedures, delegation to paraprofessionals, physicians assistants, outsourcing work, and/or simply working more efficiently. Hiring an associate should be a last resort and should take place only after discussion with an office management consultant, and after your operation has been examined by an office management consultant. Don't tell me you cannot afford it. If you are considering hiring an associate you can't afford not to get a qualified opinion; too risky, too much at stake. Please do not make this decision without counsel.

Let us assume that the host doctor decides that an associateship is in the best interest of the practice. Where does one look for an associate? How does one qualify the hoards of fresh-faced hopefuls being churned out by our for-profit institutions? And what about the, "fresh faced hopefuls"; if you are one of that number, what is the best way to go about finding a fair, rational and generous employer? So much dross, so little gold.

The host doctor stands a much better chance of finding a suitable candidate if she chooses from, other than, new graduates. It is common knowledge that the mixture of ignorance and arrogance associated with new chiropractic graduates makes them especially difficult to work with. The most successful experience for employers seems to come from choosing a fairly new DC who has had a few burrs rubbed of by falling on their faces, at least once. New graduates hate to hear this perspective, but it is difficult to argue with the reality of the perspective. As always, exceptions exist. It appears to add to the chances of success if the candidate is not a "collegian", but perhaps chose chiropractic as a second career, and shows signs of maturity, is not a, "kid", perhaps is married, or has a significant work history prior to graduating as a chiropractor. Need I say that a reversed baseball cap does not an ideal candidate make?

For an employee, a good potential employer is one who has a stable practice. Beware the waning practice. This employer is likely looking for someone to boost the practice back up to where it used to be when the owner was enthusiastic about his job. It is possible that you are a turnaround professional, but unlikely. This concept bears a little more consideration. You simply would not believe the number of employers whose basic goal is to find some new graduate who is just full of enthusiasm and expect them to raise the employers practice to great heights. It is probably the most frequently heard reason for hiring an associate. Is that incompatibility, or what? No wonder most associateships end in acrimony, and disappointment.

A good prospective employer may be one that has trained and groomed others like yourself, having them go on to fame and fortune on their own after an apprenticeship. The employee must check to history of the employer, talk to the licensing board, the state/provincial association, local DCs, folks in the community, other associates that have been employed by this doctor. Inquire about the stability of the staff. If the office is know to turnover staff frequently, you can bet it will be a risky place to be employed; many doctors are poor managers, not necessarily nasty people, just poor managers.


The contract

Most associate relationships end badly because of a gross mismatch of expectations. The host expects the associate to materialize new patients in great numbers, as if by magic. The associate expects the host to give her unbridled authority, relentless instruction, many positive strokes, and generous bonuses. A solid contract cannot provide all of these needs but it can help define what one can expect.

Most contracts are made up by the host, looking very much like it was constructed by a jailhouse lawyer on airplane glue, or borrowed from another DC who got it from another DC, and cobbled together in 1962 from a magazine article. These are not exaggerations, unfortunately. Unless your attorney is extremely familiar with this area of contract law, look elsewhere. Many good contracts can be had from practice management consultants, text books on the subject,or associates who are happy with their contracts. Extract the parts that appeal to you, show them to your attorney and have her construct the language to forge a proper agreement that will fit your needs.


Pay Scale

There are all kinds of convoluted formulae circulating out there in chiropracticland. Most compensation packages include a base salary with bonuses depending on the amount of money you generate for the office. The industry standards are set arbitrarily by the chains of chiropractic clinics that operate throughout the country. The largest chain pays approximately $3000 per month, (plus 7% of the collections, once the associate reaches 100 patient visits per week). This scale is paid after a six weeks training schedule, during which time the associate is paid peanuts. There is a rule of thumb that is quite fair; "30%". If the associate is paid, no matter what the formulae, 30% of the collections of the billings he has generated, that is considered fair. As a matter of interest, in medicine, it is 40%.

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