Welcome to Entrepreneurship 101, a new series offering students and new DCs real-world guidance on the biggest practice ownership decisions.
This article, Entrepreneurship 101, explores starting a practice, one of the most exciting (and intimidating) decisions you’ll ever make. I’ve done this three times, and there is real joy in designing your professional life from the ground up: The space, systems, people you’ll serve and the care you’ll deliver. Although owning your own practice is pure freedom, it comes with real risk. The US Bureau of Labor Statistics has data from 2024 on healthcare start-up failures:1
- 17% fail in the first year
- 45% fail by year five
- 64% fail by year 10
The biggest reason for failure is running out of cash. A US Bank study found 82% of small business failures are tied to poor cash flow management.2 Another common problem is compliance and legal problems; every state has regulations on what conditions you can treat and services you can provide, as well as how you can advertise and how you can charge. The third major reason clinics struggle is a mismatch between the care model and what the local market actually wants. In the early months, you are essentially betting that your location, technique and service mix, pricing and payment mix (cash, insurance, personal injury) will match local demand. Many doctors don’t realize they missed the mark in one of these key areas until the money runs dry. The good news is that you can take specific, strategic steps to sidestep common pitfalls and design a start-up that thrives.
Care model and location
Choosing where and how to practice are key decisions to make early; your location must fit your care model, which will set almost everything that follows, including how many staff, how much space, what equipment you buy, what you charge and how you market. Be strategic; do not make these decisions by default. You may assume you’ll return to your hometown and specialize in a technique you love, but they need to be a match. The hardest path to financial stability is starting a new practice with a service most people nearby are not looking for. Make early ownership easier by designing a practice that matches services to local demand and budget. Start with: What matters more now, a specific location or practice style?
If location matters more, start by defining the area patients will typically come from, such as a 10-15 minute drive in suburbs, 20-30 minutes in rural areas, 10-20 minute transit ride or a half-mile walk in cities. Check census and city websites for age, income and family size demographics. Read local Facebook or Nextdoor groups to learn how residents think about health, convenience and price. Research clinics’ Google Maps listings to note hours, same-day availability, languages, insurance accepted, prices and services. Read reviews to spot complaints, such as limited hours, hard parking or long waits. Turn what you learn into an initial plan to match services, visit length, hours and starting prices to what this community wants. For example, if the area is largely young families, prioritize short visits and simple family care plans. If the area skews older, think gentle techniques and short, flat walks from parking. If the area is more affluent and not insurance-driven, a boutique model with added cutting-edge services may appeal. But if most people have strong employer insurance, you’ll want to leverage that, not work against it. If your dream model doesn’t match the market, lead with what fits best and add your passion as an extra or expand later once your base is stable.
If practicing in a specific way matters more, before picking a town define your ideal model in detail: Service mix, visit length, who you’ll serve and how you’ll get paid. Strategically match the model to your energy and skills for long-term fit. If you crave variety and connection, a 300-visit-per-week practice might burn you out. If you love efficiency and flow, a slower, conversation-heavy model might frustrate you. A boutique wellness model can be rewarding if you enjoy longer visits and deeper conversations, but you will see fewer people per day, and prices must reflect that. A multidisciplinary model with additional services and providers requires a strong interest in business management and headspace for detailed operations.
Once your model is defined, start with a wide search by picking states where scope of practice supports your ideal services. State chiropractic associations are a great resource for initial information on scope of licensure, as well as billing compliance, business and employment basics and more. If your care model involves anything out of the ordinary, speak with a healthcare attorney; an hour of advice now is far cheaper than fixing a problem later. Then choose regions of the state that fit your family and future plans, and refine that list to the communities with demographics to support your care model. Census data, chamber of commerce reports, economic development sites and local universities all have data to help you understand local population growth, income trends and major employers. If applicable, call the human resources department at large employers to learn insurance plans, whether chiropractic is covered, referrals required and typical copays.
Finalize your location
Once you have your community and model, evaluate specific spaces based on fit to your model. Your business neighbors matter, as being near errand locations, such as grocery stores, coffee shops, pharmacies and schools typically means strong visibility; a proven driver of success even if your web presence is strong. Since easy access and parking encourage repeat patients, visit during rush hour to see how simple it is to pull in, find a spot and walk from the farthest space to the door. Nicer finishes, prime locations and easy parking all raise prices; if you’re tempted to stretch your budget, consider rent in visits. If a site costs $1,000 more per month, how many extra patient visits are needed to cover it? Will the enhanced visibility, access, parking or neighboring businesses at that site realistically deliver them? And how many other DCs are within the immediate area and already drawing off those benefits?
Financial foundations
Start-up success is about surviving long enough for growth to arrive, which means paying rent, staff, loans and bills even when there’s not enough money coming in. Most new practices need two to three years to reach steady profitability,3 where the clinic reliably covers expenses and pays the owner. Many new DCs underestimate that timeline and don’t save enough, so they run out of money before the practice turns the corner. Sadly, we sell practices such as this every year; beautifully equipped new offices with no profit because the cash ran out too soon.
Before you finalize plans, carefully project your costs. There will be many start-up costs, such as permits, buildout, equipment, furniture, computers, software, signage, legal and accounting, utility and rent deposits and launch marketing. Then you’ll have monthly costs including rent, utilities, staff pay, taxes, supplies, insurance, loan payments and ongoing marketing. Get quotes from vendors and look at financials from similar practices for sale to reality-check your numbers.
Most start-ups are funded with a combination of savings, gifts, investor contributions, credit cards and loans. You need enough for start-up costs plus at least six months of office expenses (aka working capital) and personal expenses. Those funds must cover all needs while your patient base grows because if you run out of money early it’s unlikely a bank will extend more to a first-time owner.
Once you know your numbers, test your model with math. If your model is based on longer visits, you’ll see fewer patients per day, and prices must support that. If you want faster visits, you may need more space and staff to keep flow smooth, which raises costs. Calculate how many visits you need to break even at different visit price points within what your research shows is appropriate for your market.
Final thoughts
In sum, start-ups can be a strong path to ownership if you can be steady in the face of risk and uncertainty. Improve your odds by matching your care to the market and managing your money with discipline. And if that feels like more risk than you want, there are still other paths to practice ownership, which we will cover in the next article.
Crystal Misenheimer, CBI, CM&AP, a leading expert in chiropractic practice sales, is the first and only chiropractic broker to earn the coveted Certified Business Intermediary (CBI) designation from the International Business Brokers Association (IBBA) and sets the gold standard in expertise, quality and service. A former clinic owner, she is uniquely qualified to provide comprehensive support on the complexities of clinic valuations and practice sales. Contact Misenheimer and her team at 888-508-9197, marketplace@progressivepracticesales.com or online at progressivepracticesales.com.
References
- What percentage of small businesses fail? 2025 data reveals the answer. Commerce Institute. https://www.commerceinstitute.com/business-failure-rate/. Accessed October 29, 2025.
- Managing cash flow: The key to success for SMBs. June 2022. M&F Bank. https://www.mfbonline.com/managing-cash-flow-the-key-to-success-for-smbs/. Accessed October 29, 2025.
- How long it takes for a small business to be successful: A year-by-year breakdown. July 2024. FreshBooks. https://www.freshbooks.com/hub/startup/how-long-does-it-take-business-to-be-successful/. Accessed October 29, 2025.
