Declining conscientiousness is impacting chiropractic teams. Here’s what you can do about it.
It’s Monday morning at a thriving chiropractic practice. The first patients of the day are arriving. The schedule is packed, the rehab area is set up, and adjusting rooms are ready.
But the front desk is empty.
A quick glance at the doctor’s phone reveals a text:
“I won’t be coming in anymore. Please mail my last paycheck.”
No warning. No handoff. No chance to prepare. Your team members quit.
This is “ghosting”—when someone walks away from a commitment without explanation—and it’s showing up in chiropractic practices across the US. It’s not just front desk positions, either. Insurance staff, rehab techs and even associate DCs have been known to vanish from one day to the next.
Ghosting isn’t just a staffing problem
In chiropractic, every team member’s reliability directly impacts patient care, compliance and revenue flow. Ghosting isn’t just inconvenient. It’s a symptom of a deeper cultural shift in the workforce.
Research shows that conscientiousness, the trait of being dependable, disciplined and thorough, is declining. Conscientiousness has long been a key predictor of career success, relationship stability and even longevity. In a chiropractic practice, it’s the trait that ensures patients get scheduled, insurance gets billed correctly, rehab is done safely and adjusting rooms run on time.
The conscientiousness decline
Recent research, including data from the Understanding America Study, points to several troubling trends. People in their twenties and thirties self-report being more easily distracted, showing less tenacity and being less likely to follow through on commitments. The COVID-19 pandemic seems to have accelerated this shift, with reduced face-to-face interaction and an increase in digital reliance making it easier to disengage from people without confrontation. Which makes the act of team members wanting to quit more likely.
The ripple effect in chiropractic practices
Declining conscientiousness doesn’t just affect when team members quit. It disrupts the entire patient experience and team dynamic. At the front desk, the absence of dependability means that new patient calls can go unanswered, scheduling errors can pile up and patients may lose confidence in the practice.
In the insurance and billing department, missed filing deadlines can delay payments, incorrect submissions can lead to denials and incomplete documentation can create compliance risks.
In the rehab area, a lack of attention from techs can leave patients unsupervised, result in skipped or incorrectly performed exercises and increase the risk of injuries. Even among associate DCs, lapses in reliability can cause treatment plans to go unfinished, chart notes to be incomplete and patient trust to erode if the provider disappears without notice.
Why this is happening
Several factors are contributing to the drop in conscientiousness. Technology plays a major role, with constant access to smartphones, streaming services and social media fragmenting attention and making it easier to avoid uncomfortable conversations. Walking away from a job is as simple as sending a text and blocking a number. Which is why it’s so easy when team members quit for them, but hard for you.
Reduced in-person engagement also means fewer social connections and less sense of accountability. At the same time, other personality shifts are affecting the workforce, including rising neuroticism, which increases stress in fast-paced, patient-facing roles, and lower extraversion, which reduces ease and confidence in patient interactions.
Why chiropractic leaders can’t ignore this issue
Chiropractic care quality depends on team reliability. Missed shifts, incomplete documentation and communication breakdowns directly impact patient retention, compliance and revenue. When documentation and billing processes aren’t maintained, audits and reimbursement delays follow. And every missed appointment or late claim submission costs money. Ignoring these trends only increases turnover and further decreases operational stability.
When patients sense major instability, they may even leave the practice.
The good news? You can nurture conscientiousness
While personality traits are partly shaped by early life experiences, conscientiousness is malleable. Chiropractic leaders can foster it through intentional hiring, training and culture-building.
At the front desk, hiring decisions should prioritize dependability over experience, looking for work histories with consistent responsibilities and long tenure. Clear daily checklists help ensure all calls, reminders and appointment verifications are complete before the day ends, and cross-training allows other staff members to step in if needed. In insurance and billing, it’s essential to establish claim submission timelines and review them weekly, incorporate regular internal audits to catch errors before they reach payers and recognize staff members who maintain high accuracy rates and timely submissions.
In the rehab area, protocols should be clearly documented for every patient program so they’re easy to follow, and regular shadowing can identify and correct missed steps before they become habits. Connecting a rehab tech’s performance directly to patient outcomes helps them understand the importance of their role.
For associate DCs, clear expectations for patient volume, re-exam schedules and timely chart completion are critical. Encouraging associates to view their patient base as their own “practice within the practice” fosters ownership, and regular check-ins focused on both patient care and team integration reinforce accountability.
Build a culture of reliability
Conscientiousness should be woven into the DNA of the practice, beginning with onboarding, where reliability is established as a core value. Measurable key performance indicators (KPIs) for each role should be tracked and discussed regularly. Recognizing acts of commitment, whether that’s a front desk staff member catching a scheduling error, a billing coordinator resolving a difficult claim or a DC staying late for a patient in pain, reinforces the behaviors you want to see repeated. Over time, these practices create a team culture in which dependability is expected, valued and rewarded.
Turn a workforce weakness into your practice’s strength
In a labor market where reliability is becoming rarer, a chiropractic practice known for its dependable, detail-oriented team will stand out. Patients notice smooth operations, consistent care and personal attention, and they will reward it with their loyalty and referrals. Staff members benefit as well; working as part of a high-functioning, respected team boosts morale and reduces the likelihood of disengagement and reduces the chance of team members wanting to quit.
Final thoughts
Being “ghosted” by a team member wanting to quit is more than a frustrating experience. It’s a reflection of broader shifts in the workforce that affect every role in a chiropractic practice. The solution is not to accept higher turnover as inevitable, but to intentionally build a culture that develops and rewards conscientiousness. From the front desk to the billing office, the rehab floor to the adjusting room, reliability and follow-through keep patients cared for and the practice thriving.
In today’s distracted, fast-moving world, conscientiousness may be the most valuable asset your practice can cultivate. Protect it, develop it and make it the standard that sets your chiropractic team apart.
Mark Sanna, DC, ACRB LEVEL II, FICC, is the CEO of Breakthrough Coaching, a practice management company for chiropractic and multidisciplinary practices. He is a Board member of the Foundation for Chiropractic Progress, a member of the Chiropractic Summit and a member of the Chiropractic Future Strategic Plan Leadership Committee. To learn more, call 800-723-8423 or visit mybreakthrough.com.
