DC practice numbers are up and down as the pandemic affected every practice differently in the Chiropractic Economics 2021 Salary & Expense Survey
When the Chiropractic Economics 2021 Salary & Expense Survey was released, the vaccines for CORONAVIRUS (COVID-19) were in the early days of distribution — so while the crisis was far from over, the U.S. as a whole believed it was seeing the light at the end of the pandemic tunnel. While hygiene procedures were still in force, most chiropractors were operating at a full or somewhat-limited capacity. Some of the larger and multidisciplinary practices even thrived, while some of the smaller did not survive.
Information we received via our survey showed rises and falls, many of them significant, and overall chiropractic in some regions looks to have taken a hit over the last 12 months. The flow of money into practices is down somewhat, according to the respondents — 52% of those surveyed indicate that both their billing and collection totals have either remained the same or decreased.
Over the last few years, the traditional gender gap of 80/20 between male and female chiropractors has narrowed, but this year the rise in female chiropractors shows signs of leveling out, likely due to the pandemic, with the percentage of females dropping a few percentage points from last year. The rough 80/20 gap persists, despite an almost 50/50 split between males and females enrolled in chiropractic schools.
There is strength in numbers, as chiropractors have been increasingly joining forces with other health care providers to bolster patient satisfaction as well as manage cost savings. Approximately 32% of DCs said they have employed a massage therapist as part of their practice (a small dip from last year), followed by 14% of chiropractors who have employed an acupuncturist, the same as last year.
While it reflects some recent downturns, our Chiropractic Economics 2021 Salary & Expense Survey suggests these dips (such as massage which took a large pandemic hit) are temporary, most likely an inevitable impact from the coronavirus pandemic that will fade as people resume their health care habits in the “new normal.”
Gender and salary
From a recent high of 28% female in 2020, the percentage of women chiropractors dropped this year to 25%, representing a leveling-off of this rise. This could simply be due to our receiving fewer responses than last year during a pandemic; in past years with more respondents, the number has showed steady growth. What hasn’t changed is the difference in salaries between male and female chiropractors.
Male chiropractors still report more income than females — significantly more. In our 2021 survey, total compensation for men came in at about $161,500, while female chiropractors’ total compensation weighed in at only $80,039. Last year those numbers were $153,000 and $104,000, respectively. So, while the number of female chiropractors has seen mostly growth over the last few years, they remain consistently behind their male counterparts in terms of earnings.
The challenge of diversity in chiropractic
This year, given the increased national attention to issues of race and diversity in the U.S., we added a new question to our survey: Are you a minority-owned practice or do you work for a minority-owned practice? The answers reflected a stark divide: Only slightly more than 15% of respondents reported they are a minority who owns or works from a minority-owned practice.
While this is a small number compared to the slightly less than 85% of non-minority-owned practices, it is a substantial number that is overdue to rise in future surveys.
Where do we go from here?
While most chiropractors’ incomes and earnings have flattened or decreased, likely due to the effects of the pandemic, our data suggests more and more patients are turning to chiropractic; for example, our average respondent sees 168 patients per week — a big increase from last year’s average of 142. For those practitioners who weathered the COVID storm, there are now more patients than ever who see the value and efficacy of chiropractic care.
Chiropractic Economics 2021 Salary & Expense Survey: the average DC profile
Our salary and expense survey attracted a wide range of doctors across the nation, with responses from practitioners between the ages of 26-85 years old, and from those who have been in practice for less than a year to 30 years or more.
By averaging the responses to many of this year’s questions, we can see what the average respondent might look like:
- male (25% of respondents were female)
- 52 years old
- a solo practitioner (63%)
- licensed in one state (74%)
Our average respondent:
- owns one clinic (89%)
- prefers to practice in the suburbs (54%)
- sees 168 patients each week; has a patient-visit average (PVA) of 60
- attracts 9 new patients each week
- and sees patients about 31-40 hours a week (37%)
The average respondent has:
- average billings of $650,700 and collections of $424,800 for a reimbursement rate of 65%
- sells products to patients for 7% of gross revenues
- pays CAs $31,700 and himself $102,200
- and enjoys average total compensation of $172,900
Finally, this typical respondent spends roughly $26,500 per year on office leases or mortgages, $10,000 on advertising, and $2,500 on malpractice insurance.
Billings and collections
Average collections decreased compared to last year’s numbers, while average billings rose.
Average gross billings were reported at $650,700, which is a slight increase from last year’s $649,400. Collections were reported at $424,800, which is a decrease from $448,000 in 2020.
This year’s billings and collections numbers equal an average reimbursement rate of 65%, a bit less than in 2020. While many DCs may be billing for more overall, it appears they are receiving a slightly lower percentage of that money back than in previous years.
Comparing MDs and DCs
As chiropractors assess their earnings and expenses, familiarity with their financial environment in the health care industry can provide valuable context to their conclusions.
Some DCs team up with MDs to create a more comprehensive practice; others consult regularly with general practitioners in their community. As such, we annually compare our salary survey to data collected by Medical Economics.
In Medical Economics’ 91st Physician Report, published in November 2020, respondents indicated that the average salary for a family care physician was $241,000. This is sharply contrasted with specialist physicians, who top out at nearly $400,000, with cardiology and urology being the top specialties.
Comparatively, the average total compensation reported for DCs in this year’s survey was $172,900; this is up from $144,000 in 2020.
Medical Economics also reported that the highest median income came from the South and Midwest regions, but salaries for all regions were between $263,000-$280,000. They found that urban physicians earned significantly less ($260,000) than their suburban and rural counterparts ($280,000 and $281,000, respectively).
The average number of patients seen by family physicians was 76 per week. In addition, they found that the median earnings were higher for men ($300,000) than women ($226,000). While both these numbers were down from the previous year’s report, the gap in pay of $74,000 remained the same.
To compare more statistics between chiropractors and medical doctors, visit Medical Economics at medicaleconomics.com.
How patients pay for treatment
While a DC’s true specialty lies in the ability to provide successful chiropractic care, you likely have several other income sources, such as retail, diagnostics or consulting.
DCs still report that their major source of income comes from patient chiropractic care, highlighting the dedication and commitment DCs have to their patients. About 86% reported patient treatment as their major source of income, which is the same as in 2020.
Other sources of income include retail products at 7%; diagnostic testing at 8%; and consulting at 4%.
We also asked what percent of treatment is paid for by the following: cash from patients, individual or group health insurance, Medicare, auto insurance, Medicaid, personal injury coverage, Workers’ Compensation, barter or trade, and other.
The majority of treatments are paid in cash (45%) or by individual or group health insurance (36%). Personal injury coverage paid 15%; Medicare and barter/trade each paid for 11% of treatments, followed by Workers’ Compensation (5%) and Medicaid (4%).
Solo vs. group practices
The Chiropractic Economics 2021 Salary & Expense Survey showed a decrease in the number of DCs practicing in groups (or partnerships) at 22%; this represents a 2% drop from last year’s 24%. However, since 2013, the number has hovered between 22-30%, showing that a fair number of DCs have found success in joining forces.
The 63% of doctors reporting as solo practitioners rose from last year’s 57%. Those indicating they were working as an associate decreased this year to 10%, while the number of franchisees remained the same at 1%.
When it comes to billings and collections, solo practices saw ups and downs in both amounts this year. Solo DCs reported average billings of $369,653 and collections of $263,700, compared to average billings of $352,100 and collections of $269,800 last year.
The solo reimbursement rate was significantly down (71% compared to 77% last year).
Group practice billings and collections fared better over solo DCs across the board, in keeping with the established trend, but reimbursement rates were relatively similar this year. This year’s group billings were $1,064,200 (compared to $1,253,400 last year) and collections came in at $827,500 compared to $863,850 in 2020. The group practice reimbursement rate increased from last year, coming in at 78% from last year’s 69% and 70% in 2019.
The average total compensation for solo DCs this year was $123,900 compared to $118,800 last year. The average total compensation for a DC practicing in a group setting jumped from $207,960 last year to $210,464 this year. Salaries for solo DCs averaged $82,500, an increase from $73,000 last year, and those participating in a group practice averaged $154,000.
Note: Total compensation for unincorporated DCs is defined as earnings after tax-deductible expenses, but before income tax. For DCs in a professional corporation, it is the sum of salary, bonuses and retirement/profit-sharing contributions made on their behalf.
Solo practices spent $2,000 on insurance (a decrease from last year’s $2,540), and $6,300 on advertising. Group practices spent less on insurance than last year ($3,600 compared to $4,500 in 2020). They also spent $21,000 on advertising, a notable decrease from $36,800 in 2020.
Group practices are spending less this year on office space, too, at $42,700 compared to $45,100 last year. Solo practices spent nearly the same this year at $20,750, compared with last year’s $20,850.
Integrative care still on the rise
In response to reader requests years ago, Chiropractic Economics expanded its “integrated clinics/DCs only” breakdown to provide a more comprehensive look at the profession.
We continued that trend this year by asking respondents to indicate if they were practicing as a DC only, in an integrated clinic or in a multidisciplinary clinic. An integrated clinic includes those practices with both a DC and a medical doctor on staff. A multidisciplinary clinic is defined as having a practicing DC and any other complementary medicine practitioner on staff (e.g., acupuncturist, PT, LMT).
This year 63% reported offering chiropractic care only, approximately the same as last year; 30% said they operated as a multidisciplinary clinic, a bit less than last year; and 7% responded as an integrated clinic.
Here is a breakdown of income by clinic type:
Billings — Integrated health care practices reported the highest billings ($1,055,500), while multidisciplinary practices reported billings of $860,600 and DC-only practices came in at $517,100.
Collections — Likewise, integrated practices saw the highest collections ($755,500) while multidisciplinary clinics reported collections of $460,200, and DC-only practices had collections of $395,700.
Salaries and total compensation — Multidisciplinary, integrated and DC-only clinics saw roughly equal salaries. Integrated DCs had an average salary of $100,000 annually, compared to $160,200 in 2020. Multidisciplinary clinics had an average of $101,400, and DC-only clinics had the highest salary at $102,800.
Total compensation for unincorporated DCs is defined as earnings after tax-deductible expenses, but before income taxes. For DCs in a professional corporation, it is the sum of salary, bonuses, and retirement/profit-sharing contributions made on their behalf.
Regarding total compensation, integrated DCs averaged $181,300 while DC-only clinics came in at $190,600. Multidisciplinary clinics came in at $141,300.
Types of clinics
Fewer practices identified as “rehab centers” this year (5.3%) than last year (9.5%). However, those clinics labeled as “wellness centers” showed a slight rise, going from 24% last year to 24.6% this year. The term “medical spa” appears to have largely disappeared, as less than 1% reported that designation.
Most practices — 68.4% — identified as “clinics.”
The gender gap
Our annual survey consistently illustrates an approximate 80/20 male-to-female split that makes up the working chiropractic industry, and this ratio has been relatively consistent but slowly rising for the past few years. This year’s results saw a small decrease, likely due to the COVID pandemic, but a number still closing in on the ratio at chiropractic schools these days, which is closer to 50/50.
We’ve seen an increase in female respondents over the last few surveys, but this year saw a small dip; this year, 25% of respondents were female as opposed to 28% in 2020, 23.3% in 2019 and 22.6% in 2018. These results allude to an overall positive trend we’ve seen regarding closing the gender gap. Male respondents are still making more than females, and their salaries and total compensation increased this year, while the salaries and total compensation of female DCs decreased.
This year’s female DCs reported earning an average annual salary of $71,750 compared to $76,400 last year. Total compensation is $80,000 this year compared to $104,100 last year.
Male respondents saw an increase in annual salary with an average of $112,000, rising from $97,500 in 2020. Total compensation for men showed a bigger jump, with an average of $161,500 compared to $153,200 last year.
Thirty-eight percent of female DCs reported working 31-40 hours in patient care per week; 25% reported working 21-30 hours. Of the male respondents, 37% reported working 31-40 hours, with 34% working 21-30 hours.
DCs by U.S. region
Most DCs’ compensation figures increased compared to 2020’s numbers. Reported regional DC total compensations for 2021 were:
Midwest — $146,300
West — $133,100
East — $97,900
South — $282,100
The West saw the largest reimbursement rate this year, with an average of 87%. The East, Midwest and South followed behind at 71%, 72% and 51%, respectively.
As you grow older, your salary as a DC should increase also. The results of this year’s survey showed that experience and age still reign — mostly — when it comes to earning larger paychecks.
DCs aged 76-85 earned the most with $112,000, with those 66-75 earning $82,200, those 56-65 earning $104,000, those 46-55 earning $109,300, and those 36-45 earning $108,200. The youngest group of DCs, those 26-35, earned $63,500. (Note: The age groups were adjusted into smaller age ranges this year, so the data may look quite different from last year’s results.)
With more available retail space, a developing infrastructure and a large range of potential patients, it shouldn’t be a surprise that many DCs choose to set up their practice in the suburbs. Over the course of many surveys, the majority have responded that the suburbs are the ideal location for their practice.
This year was no different, with 54% of DCs reporting the suburbs as their location preference.
Although the numbers were similar to last year’s, there was a very slight dip in suburban DCs at 54% compared to 55% last year. The number of urban practices went up slightly from 27% last year to 31% this year. The number of rural practices dipped a bit from last year at 15% from 2020’s 18%.
Urban chiropractors reported the highest average salary at $107,000, with their suburban counterparts reporting an average of $104,000. Rural practices decreased to an average salary of $80,700, versus $89,000 last year.
Suburban practices had average billings of $664,200 and collections of $394,200 for a reimbursement rate of 59%. Rural practices reported a reimbursement rate of 76%, with $482,000 for billings and $368,000 for collections. Urban DCs had average billings of $696,400 and collections of $495,900 for a reimbursement rate of 71%.
COVID losses and minority practice
Our national discussion over the last 12 months has centered largely on two issues — the COVID-19 (coronavirus) pandemic, and the state of racial relations in the U.S. To incorporate this timely information into our annual survey we added new questions pertaining to these topics.
Most DCs who responded to our survey reported at least some loss of income from the pandemic, though 25% said they lost no income. According to this year’s data, the average chiropractor-only clinic lost 16% of its income on average, while integrated clinics lost 18% and multidisciplinary clinics lost almost 21%.
When asked what percentage of their patients were Black, Hispanic or of color, the DCs in our survey reported numbers in the widest possible range, from 1% to 100%. According to our data, approximately 40% of patients seen in urban clinics are non-white, followed by 26% in suburban practices and 13% of rural practices.
While this data suggests that non-white individuals are definitely embracing chiropractic as a treatment choice, the number of chiropractors of color lags behind, as our survey showed 15% of practices are minority-owned.
Chiropractic Economics 2021 Salary & Expense Survey: product offerings
Our survey shows approximately 93% of chiropractors in our survey sell at least one product in their practice. As this number has consistently remained high over the years, it’s clear that DCs across the board find success through the integration of quality care and providing patients with the best products available.
A commitment to retailing top-industry products benefits the DC financially, but doing so also creates an important relationship between patients and the products they need to achieve wellness.
So which products do respondents offer? Are you selling the same products as other DCs? The top five include:
1T. Nutritional products/supplements — 32%
1T. CBD (cannabidiol) products — 32%
3T. Pillows — 29%
3T. Hot/cold compresses — 29%
- TENS products — 28%
Of chiropractors surveyed, 32% sell cannabidiol (CBD) products to patients, up from 29% last year; these products consist of topicals and supplements made from the non-psychoactive component of the cannabis plant.
Your skill in treating patients with regular adjustments and issues related to the musculoskeletal system can undoubtedly position you well for a comfortable career. But if you fell stagnation coming on and are looking for new paths to explore, year after year our survey demonstrates that joining forces with complementary specialists is a surefire way to expand your practice, boost your bottom line, and perhaps revive your passion.
In the Chiropractic Economics 2021 Salary & Expense Survey more than half of DCs reported having other specialists working in or consulting with their practice. Those specialists include LMTs, PTs, acupuncturists, fitness trainers and nutritionists, in addition to MDs and DOs.
The specialists who become part of your health care team allow you to offer a wider range of treatment options and programs. When evaluating how this benefits you, the numbers speak for themselves: Clinics employing specialists see more patients per week (145, compared to 142 patients per week in non-specialist clinics); bill more (average of $889,500 versus $452,400); and collect more (average of $502,500 versus $366,000).
While chiropractors employing specialists averaged a lower total compensation ($161,600) than those without specialists ($189,000), those with specialists averaged a higher salary than those in practices without specialists ($116,700 and $89,700, respectively).
While 70% of respondents have at least one specialist on staff, the most common specialist was an LMT (30%).
Other popular specialists include:
- Acupuncturist, 10%;
- MD/DO, 7%
- Nutritionist, 5%;
- PT, 5%; and
- Fitness trainer, 4%.
These modalities include:
- Chiropractic, 99%
- Instrument adjusting, 58%
- Electrotherapy, 53%
- Exercise programs, 62%
- Nutrition, 47%
- Kinesiology tape, 46%
- PT/rehab, 45%
- Decompression, 28%
- Laser therapy, 27%
- Massage therapy, 24%
- Acupuncture, 20%
- IASTM, 19%
- Weight-loss programs, 18%
- Homeopathy, 9%
- Medical services, 5%
- Other, 5%
Respondents (both clinics with specialists and clinics without) also reported that they offer a wide range of modalities, even if they do not have specialists who provide them.
Who’s working for you?
We asked respondents for anonymous salary information on full-time employees only — not part-timers. We defined “full time” as employees who work 30 hours or more a week.
Approximately 17% of DCs in our Chiropractic Economics 2021 Salary & Expense Survey do not have any employees, while approximately 35% employ one or two full-time people, and 26% of respondents reported they employ five or more people.
The average salary paid to full-time employees was: DC: $102,200; associate: $59,800; PT: $13,500; CA: $31,700; and LMT: $17,100.
For more DCs, operating as a businessperson is invariably a huge part of being a doctor of chiropractic. And as the business world continues to change and evolve, so do the expenses involved in running a practice.
We’ve highlighted three standard spending areas in the profession: malpractice insurance, advertising, and an office lease or mortgage.
Office lease or mortgage — Average yearly costs were $26,500, a decrease from $27,300 last year.
Advertising — Average costs in this year’s survey were $10,000, a significant decrease from last year’s $13,200.
Malpractice insurance — Respondents reported an average expense of $2,500, which represents a decrease from last year’s $3,100.