Starting a New Practice

1. Are you inexperienced, but don’t want outside help?
2. Is your ego too big to pay for and listen to expert advice?
3. Can you raise the money to start your own practice?
4. Are you willing to work 70 hours a week?
5. Are you too scared to open a practice?
6. Do you lack self-motivation?
7. Are you a passive person?
8. Is your spouse going to be supportive?

Every DC has a vision of starting his/her own practice, becoming extremely successful and enjoying the riches of life.  Reads like a fairy tale, doesn’t it?  Realistically, this scenario is a fantasy to the many DC’s who aren’t destined to start and operate their own practices.  How do you know if you have what it takes to start a new practice—or if you’d be happier as an associate? Your personal answers to the following questions will tell you.

1. Are you inexperienced in starting a practice, but don’t want outside help?

Do you know how to find, hire and train the best person for a chiropractic assistant (CA) position?  The American Management Association tells us that it costs over $12,000 to hire and train a good CA.  Frequently having to replace CA’s can sink a new practice.  Unfortunately, the average new DC goes through three CA’s his first year in practice.

Most DC’s who fail in practice have violated some major practice-starting principles, such as starting their practices with inadequate financing, not effectively or adequately promoting, or not finding and properly training the right staff.  These doctors will offer a thousand, and, one excuses for their failures. The truth is most of them did not know how to efficiently and successfully start a new practice and were not willing to get the practice-starting education they needed.

2. Is your ego too big to pay for and listen to expert advice?

A major reason DC’s fail when starting a new practice is ego.  Yes, ego!  You’ll hear them say, “I’ll show them how,” or “They haven’t seen anything yet.” This is the attitude displayed by the egocentric DC as he dashes headlong into failure.

I’ve never understood how a DC with no experience in starting a practice, no knowledge of what works and what doesn’t work, no knowledge of the intricacies of insurance, marketing, patient processing, overhead control, etc., has the audacity to think that he can successfully perform these tasks without the advice of an experienced consultant.  Audacious?  No, delusional would be a better description.

Would a prospector find gold wherever he chose to look?  Most don’t. 

Now, let’s assume there is a consultant who knows where gold is buried and has drawn a map of how to find it.  Wouldn’t it be wise for the prospector to pay for that consultant’s map (advice)?  Wouldn’t you hire a consultant who can show you the most direct route to a financially successful practice?  Sure you would, unless you are one of those who allows himself to be deluded by an over-inflated ego.

Wayne State University, the University that specializes in starting new businesses, reports that, “There is only a 4% chance of failing, if the start-up person seeks out and gets the correct answers (a map of how to get what you want)”.

3. Will you have a problem raising enough money to adequately start and finance a new practice?

The number one reason for new practice failure is the doctor doesn’t have enough money (or enough borrowing power) to last until his practice hits net profit. If you don’t have the money to start and succeed in your new practice, do you have the ability to motivate people (bankers, loan companies, parents, in-laws, etc.) to lend you the money?  Do you have this ability?  If you don’t, perhaps an associateship is going to be the better choice for you.

If you have a terrible credit rating or a bankruptcy in your background, an associate position is recommended, until you can clean up your credit history and save enough money to finance a new practice.

4. Are you unwilling to work 60-70 hours a week?

Are you lazy?  Heck no!  Who is going to admit to being lazy? However, you must be willing to work 60 to 70 hours a week for five years to establish your practice.  No, I’m not kidding about working 60 to 70 hours a week.

The Journal of the American Chiropractic Association (JACA) reported that the average established practitioner works 46 hours a week; the Wall Street Journal reported an average of 50 hours per week.  A doctor starting a new practice must be willing to work 20 or more hours per week more than the established practitioner.  This additional time is needed for the new doctor to participate in activities that will attract the number of new patients needed to build a successful practice.  If you are not able or willing to work these hours, become an associate—you’ll work fewer hours.

5. Are you too scared to open a new practice?

It’s normal to be scared when attempting to do something you’ve never done before. Considering today’s statistics from the Small Business Administration (SBA) that only 20% of new businesses will still be there in five years, it’s natural for you to be scared. However, being “too scared” means you do not have the self-confidence you’ll need to overcome the usual apprehensions and challenges of starting a new practice.

6. Do you lack self-motivation?

Do you wake up in the morning slowly and proceed at that same pace for the rest of the day?  Are you a chronic procrastinator?  If so, starting and owning a practice is not for you.

7. Are you a passive person?

All successful new DC’s are highly competitive, goal-driven individuals. They are determined fighters. They know most HMO’s and managed care plans will not welcome them and they are willing to fight for the remaining non-HMO/managed care patients.  If you are passive in nature, become an associate—let your employer do the fighting for you.

8. Is your spouse going to be non-supportive?

Does he or she understand the stress you will be under while arranging construction loans, building-out your office, negotiating equipment leases, talking to bankers, etc.?  Is he or she going to be supportive of you when you practice 40 hours a week in your office, plus spend another 20 hours as a member of the Jaycees, the Chamber of Commerce, the Lions, the Rotary, etc.?  If not, you should become an associate, not the owner of a practice.

How to Evaluate Your Answers

The reason I wrote this article was not to deflate your hopes and dreams of having your own practice, but to motivate you to seriously evaluate whether or not you are ready to be an entrepreneur (start a new practice).  If you answered yes to any of the questions posed in this article (except 3, 4 & 8)…don’t go against the odds, become an associate.  In time, you may develop the self-confidence and financial resources it takes to make it in your own practice or you may find yourself content and fulfilled as a career associate.

There are two other compelling reasons why you may choose to be an associate.  If you feel unsure about finding and reducing subluxations, or if you want to gain some specialized knowledge, becoming an associate is appropriate.  However, only associate with a highly successful doctor who will teach and mentor you.  How to find this type of doctor and how to avoid being trapped in an “An Associateship from Hell” are topics of the next two articles in this series.

More information on becoming an associate is available online at, Associate/Doctor Practice.

Dr. Peter G. Fernandez is the world’s authority on starting a practice.  He has 30 years’ experience in starting new practices, has written four books and numerous articles on the subject, and has consulted in the opening of over 3,000 new practices.  Contact Dr. Fernandez at 10733 57th Avenue North, Seminole, Florida, 33772; 1-800-882-4476; [email protected], or visit

Leave a Reply