Overall, according to the latest Chiropractic Economics survey, chiropractic is doing well, even in the midst of a pandemic, while the gender gap further narrows
THIS YEAR’S CHIROPRACTIC ECONOMICS SURVEY WINDOW ROUGHLY COINCIDED WITH THE EARLY DAYS OF THE CORONAVIRUS (COVID-19) CRISIS IN THE U.S. — so we didn’t know what to expect from our survey respondents. At that time, various states were responding to the virus in various ways. Would chiropractors have to close-up shop for the foreseeable future?
The answer turned out to be no; in fact, chiropractors were and still are considered essential workers by the U.S. government. In March, the “Memorandum on Identification of Essential Critical Infrastructure Workers During COVID-19 Response” was issued by the U.S. Department of Homeland Security, identifying chiropractic as an essential service.
Information we received via the Chiropractic Economics survey showed a few minor rises and falls, but overall chiropractic remains as strong as it was in last year’s survey. The flow of money into practices is up, according to the respondents — 51% of those surveyed say gross billings are up, and 49% say their collections are increasing.
A narrowing gender gap in the demographics was a pleasant surprise, as in recent years the roughly 80/20 split between male and female practitioners has changed very slowly, 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 35% of DCs said they have employed a massage therapist as part of their practice, followed by 14% of chiropractors who have employed an acupuncturist (a 3% increase from last year’s 11%).
Our 23rd Annual Salary and Expense Survey shows there is reason to be hopeful for those entering and those practicing in the chiropractic field.
A narrowing gender gap
A persistent gender gap of roughly 80% male and 20% female respondents narrowed this year — from 23% last year to 28% female, bucking a long-standing trend in the annual survey. However, the narrowing gender gap doesn’t seem to have affected the gender difference in salaries much. Male chiropractors still make more money than female chiropractors — significantly more money.
In our 2020 survey, total compensation for men came in at about $153,000, while female chiropractors’ total compensation weighed in at only $104,000. Last year those numbers were $134,000 and $100,600, respectively. So while the number of female chiropractors is growing, they remain behind their male counterparts in terms of earnings.
With the majority of practices up and running during the COVID-19 pandemic, DCs across the country are facing a golden opportunity to make the case for chiropractic care. DCs in the Chiropractic Economics survey are seeing an average of 142 patients per week — up from 129 in last year’s survey. Evidently, greater numbers of people are seeing the value of chiropractic care, especially in an integrative or multi-disciplinary setting. The millennial generation, for its part, strongly values health and fitness, indicating that the patient of the future will be predisposed to the wellness message.
The industry is moving in a positive direction, with support from government officials and health care organizations who view chiropractic as an effective option for musculoskeletal pain management and maintaining overall good health.
The average DC profile
With more than 400 practices responding, our salary and expense survey attracted a wide range of doctors across the nation. We heard from practitioners between the ages of 25-76 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 (28% of respondents were female)
- 49 years old
- a solo practitioner (57%)
- licensed in one state (78%)
Our average respondent:
- owns one clinic (91%)
- prefers to practice in the suburbs (55%)
- sees 142 patients each week, has a patient-visit average (PVA) of 58
- attracts 10 new patients each week
- and sees patients about 31-40 hours a week
The average respondent has:
- average billings of $649,400 and collections of $448,000 for a reimbursement rate of 69%
- sells products to patients for 8% of gross revenues
- pays CAs $37,200 and himself $90,500
- and enjoys average total compensation of $144,000
Finally, this typical respondent spends roughly $27,300 on office leases or mortgages, $13,200 on advertising, and $3,100 on malpractice insurance.
Billings and collections
Average collections increased compared to last year’s numbers, and average billings rose, too.
Average gross billings were reported at $649,400, which is a significant increase from last year’s $546,500. Collections were reported at $448,015, which is an increase from $395,500 in 2019 but a slight decrease from 2018 ($449,000).
This year’s billings and collections numbers equal an average reimbursement rate of 69%, a bit less than in 2019. 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.
Gross billing has steadily increased by small increments since 2017, except for a drop in 2019; but that drop may have been due to having many more survey participants that year.
How do MDs compare?
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’ 90th Annual Physician Report, published in April 2019, respondents indicated that the average salary for a family care physician was $242,000. This is sharply contrasted with specialist physicians, who top out at upwards of $400,000.
Comparatively, the average total compensation reported for DCs in this year’s survey was $144,000; this is up from $123,400 in 2019.
Medical Economics also reported that the highest median income came from the Western and Midwest regions, but salaries for all regions hovered near the $275,000 mark. They found that the type of area — urban, suburban or rural — had a negligible effect on salaries.
The average number of patients seen by general physicians was 85 per week. In addition, they found that the median earnings were higher for men ($300,000+) than women (a bit less than $250,000).
To compare more statistics between chiropractors and primary care 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 and 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. Nearly 85% reported patient treatment as their major source of income, which is up from 76% in 2019.
Other sources of income include retail products at 7%; diagnostic testing at 5%; and consulting at less than 2%.
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 (40%) or by individual or group health insurance (31%). Personal injury coverage and Medicare each paid for almost 11% of treatments, followed by Medicaid (3%), Workers’ Compensation (3%), and barter or trade (1%).
Solo DCs vs. group practices
This year’s survey showed an increase in the number of DCs practicing in groups (or partnerships) at 24%; this represents a 2% rise from last year’s 22%. However, since 2013, the number has hovered between 25-30%, showing that a fair number of DCs have found success in joining forces.
The 57% of doctors reporting as solo practitioners came in close to last year’s and 2018’s 55%. Those indicating they were working as an associate increased this year at 15%, while the number of franchisees decreased to 1% from last year’s 3.5%.
When it comes to billings and collections, solo practices saw ups and downs in both amounts this year. Solo DCs reported average billings of $352,100 and collections of $269,800, compared to average billings of $356,200 and collections of $267,700 last year.
The solo reimbursement rate ticked up (77% compared to 75% 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 $1,253,400 (compared to $847,000 last year) and collections came in at $863,850 compared to $592,200 in 2019. The group practice reimbursement rate remained steady from last year, coming in at 69% from last year’s 70% and 71% in 2018.
The average total compensation for solo DCs this year was $118,800 compared to $111,100 last year. The average total compensation for a DC practicing in a group setting increased from $148,600 last year to $207,930 this year. Salaries for solo DCs averaged $73,000, a decrease from $99,500 last year, and those participating in a group practice averaged $133,300.
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 $2,540 on insurance (an increase from last year’s $2,430), and $4,900 on advertising. Group practices spent more on insurance than last year ($4,500 compared to $3,960 in 2019). They also spent $36,800 on advertising, a notable increase from $22,550 in 2019.
Group practices are spending more this year on office space, too, at $45,100 compared to $35,900 last year. Solo practices spent less this year at $20,850, compared with last year’s $22,800.
Integrative care still on the rise
In response to reader requests years ago, the Chiropractic Economics survey 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 64% reported offering chiropractic care only, the same as last year; 27% said they operated as a multidisciplinary clinic, the same as last year; and 9% responded as an integrated clinic.
Integrated health care and multidisciplinary clinics saw an increase in billings and collections compared to last year, while DC-only practices took in less but collected a bit more than they did in 2019. Here is further breakdown of the numbers:
- Billings — Integrated health care practices reported the highest billings ($1,430,000), while multidisciplinary practices reported billings of $787,100 and DC-only practices came in at $411,930.
- Collections — Likewise, integrated practices saw the highest collections ($970,500) while multidisciplinary clinics reported collections of $616,750, and DC-only practices had collections of$303,100.
- Salaries and total compensation —Multidisciplinary clinics and integrated clinics fared better salary-wise
than DC-only clinics. Integrated DCs had an average salary of $160,200 annually, compared to $117,900 in 2019. Multidisciplinary clinics had an average of $103,100, followed by DC-only clinics at $71,600.
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.
With regard to total compensation, integrated DCs averaged $204,500 while DC-only clinics came in at $119,500. Multidisciplinary clinics came in at $156,200.
Types of clinics
- Practice label — More integrated practices identified as “rehab centers” this year (9.5%) than last year (8%). However, those clinics labeled as “wellness centers” showed a slight dip, going from 24% last year to 22%this year. The term “medical spa” appears to have largely disappeared, as less than 1% reported that designation.
- Specialties — Most clinics reported “general” as their main specialty. “Family” was the second-most-popular emphasis for clinics this year, with “sports/rehab” coming in third.
A narrowing 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 if not slowly rising for the past few years. This year’s results saw an approximate 5% increase, 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 larger jump, more than a 20% increase over last year’s total. This year, 28% of respondents were female as opposed to 23.3% in 2019 and 22.6% in 2018. These results allude to a positive trend we’ve seen regarding closing the gender gap. While male respondents are still making more, the salaries and total compensation of female DCs increased this year.
This year’s female DCs reported earning an average annual salary of $76,400 compared to $75,000 last year. Total compensation is $104,100 this year compared to $100,600 last year.
Male respondents saw a decrease in annual salary with an average of $97,500, falling from $111,300 in 2019. However, total compensation increased for men, with an average of $153,200 compared to $134,100 last year.
Working hours and gender
Forty-six percent of female DCs reported working 31-40 hours in patient care per week; 32% reported working 21-30 hours. Of the male respondents, 46% reported working 31-40 hours, with 23% working 21-30 hours.
DCs by U.S. region
Most DCs’ compensation figures increased compared to 2019’s numbers. Reported regional DC total compensations for 2020 were:
Midwest — $110,000
West — $117,100
East — $132,700
South — $173,900
The West saw the largest reimbursement rate this year, with an average of 85%. The East, Midwest and South followed behind, at 71%, 68% and 68% respectively.
Age, salary and weekly working hours
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 41-50 earned the most with $145,300, but those 61 and older only earned an average of $121,000. The younger DCs (up to age 30) earned $79,700, a sizeable decrease from last year’s average of $115,700.
Paychecks decreased for DCs aged 31-40, who reported an average total compensation of $102,000, which is down from last year’s $109,000 and 2018’s $127,200 average. Historically, DCs aged 41-50 have made the most money, and that held true for this year.
In this year’s survey, DCs in all age groups except 61+ averaged 31-40 hours per week in patient care.
With more available 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 55% of DCs reporting the suburbs as their location preference.
Although the numbers were similar to last year’s, there was a slight increase in suburban DCs at 55% compared to 53% last year. The number of urban practices dropped slightly from 28% last year to 27% this year. The number of rural practices dipped a bit from last year at nearly 18% from 2019’s 19%.
Urban chiropractors reported the lowest average salary at $89,000, with their suburban counterparts reporting an average of $106,000. Rural practices decreased to an average salary of $89,000, versus $113,140 last year.
Suburban practices had average billings of $636,100 and collections of $461,000 for a reimbursement rate of 72%. Rural practices reported a reimbursement rate of 64%, with $410,500 for billings and $262,000 for collections. Urban DCs had average billings of $738,000 and collections of $542,300 for a reimbursement rate of 73%.
Who’s working for you?
Chiropractors want to provide the best possible care to their patients. But are you providing that same kind of care to your employees?
By offering your employees benefits such as health care, paid time off and retirement plans, you are investing in the success of your business and the performance of your employees (in addition to their happiness).
Overall, many employees’ benefits have remained about the same this year compared to previous surveys. According to our 2020 Chiropractic Economics survey, about 25% of respondents reported that they provided health care to their employees, which is the same percentage as last year. Those who provide some type of retirement plan increased from 25% last year to 32% this year.
Paid time off, which could include vacation or sick days, dipped slightly to 65% this year, down from 66% last year. Those offering bonuses decreased from 52% to 48% — and profit sharing dropped to 8% from last year’s 10%.
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. Almost 14% of DCs in our survey do not have any employees; approximately 36% employ one or two full-time people; and 29% of respondents reported they employ five or more people.
The average salary paid to full-time employees was: DC: $90,500; associate: $71,400; PT: $65,200; CA: $37,200; and LMT: $29,000.
Attracting the type of patient you want often means differentiating yourself and the type of services you provide. For instance, DCs who want to work with athletes might add “sports and rehab” to their practice name. Those who want to work with children may want to indicate that with a “family practice” designation, while a “wellness center” strives to attract patients who aim to live a healthier, more balanced lifestyle.
In this year’s survey we asked respondents if the primary emphasis of their practice was general, family, nutrition, pediatrics or sports/rehab. There was a decrease in the number of sports/rehab practices with nearly 9% this year compared to 13% in 2019 and 12% in 2018.
Family practices decreased, coming in at almost 13%. The “general” classification increased from last year’s 56%, and was still the most popular choice at 64% this year.
“Clinic” remained the most popular label this year at 67%. The wellness center label decreased in popularity to nearly 22% compared to nearly 24% last year. Rehab centers increased slightly to 10%, up from 8% last year. Medical spa and franchisee rounded out the bottom, with small figures similar to previous years.
When comparing solo DCs and group practices, both were most likely to label themselves as clinics — 72% of solo DCs and 62% of group practices carry this designation. It also was the most popular label, by far, amongst practices that defined themselves as multi-disciplinary (53%), integrated (61%) and DC-only (74%).
For more DCs, being 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 chiropractic practice.
We’ve highlighted three standard spending areas in the profession; namely, malpractice insurance, advertising, and an office lease or mortgage.
- Office lease or mortgage — Average costs were $27,300, an increase from $25,700 last year.
- Advertising — Average costs in this year’s survey were $13,200, which is an increase from last year’s $11,600.
- Malpractice insurance — Respondents reported an average expense of $3,100, which represents a slight increase from last year’s costs of $2,950.
Our survey shows approximately 91% of chiropractors 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:
- Nutritional products/supplements — 52%
- Hot/cold compresses — 52%
- Pillows — 47%
- Topical creams/ointments — 46%
- Kinesiology tape — 42%
Of chiropractors surveyed, 29% sell cannabidiol (CBD) products to patients, up from 23.5% 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 face stagnation 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 2020, slightly 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 $766,300 versus $447,800); and collect more (average of $552,900 versus $322,800).
As a result, chiropractors employing specialists averaged a higher total compensation than those in practices without specialists ($164,000 and $105,000, respectively).
While almost 53% of respondents have at least one specialist on staff, the most common specialist was an LMT (35%). Other popular specialists include:
- Acupuncturist, 14%;
- MD/DO, 10%
- Nutritionist, 7%;
- PT, 11%; and
- Fitness trainer, 7%.
And 7% of respondents indicated “other” for specialists they have in their clinic.
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.
These modalities include:
- Chiropractic, 99%
- Instrument adjusting, 61.5%
- Electrotherapy, 59%
- Exercise programs, 59%
- Nutrition, 49%
- Kinesiology tape, 49%
- PT/rehab, 45%
- Massage therapy, 42%
- Laser therapy, 35%
- Decompression, 32.5%
- IASTM, 26%
- Acupuncture, 22%
- Weight-loss programs, 20%
- Homeopathy, 10%
- Medical services, 10%
- Other (dry needling, PEMF, CBD, aromatherapy and others), 7%
To see the full magazine version with additional graphics go to https://cdn.chiroeco.com/wp-content/uploads/2020/05/CHEC_08_2020_FULL-1.pdf.