Over the last few years, the most pressing question asked by students getting ready to graduate is, “Should I start out as an chiropractic associate or as an independent contractor?”
Rumor has it that one method may be better than the other.
In some cases, a field doctor may be offering a position or proposal that seems irresistible. Whatever the case, consider the facts and remember that if an offer sounds almost too good to be true, it probably is.
The first question to ask yourself is, why do you want to do either? It is smart to explore your options before diving into what may be shallow water.
The associate option
Consider the advantages of being an associate. You start by seeking a doctor who is practicing similar to the way you want to practice. Call the doctor and ask if you can shadow and watch their style in taking care of patients.
As an associate, you will have an opportunity to learn more about systems, procedures, protocols, and marketing in a real-practice setting. It will be a hands-on learning experience that can increase your capacity and understanding of how to be more efficient with consultations, examinations, streamlining systems, and time management. You will also learn more about how to manage a business.
Understanding patient documentation is crucial, and almost every state has different requirements. You need to become skilled in how to handle insurance and proper coding based on diagnosis and documentation.
Having a stable income from the time you start out can also make a huge difference. You’ll learn how to properly manage staff and become part of the team, and be the backup doctor in the office for clinical decisions.
The doctor may even, at some point, want you to transition into the purchase of the practice. The only downside is resentment and, if that is the case, you should talk with the doctor you are working for. It might be your salary, working hours, or lack of flexibility,
but remember that you are learning your craft and all aspects of a practice from a master who has already put in the training time with management mentors. This will help to launch your career faster than if you were opening your own practice and asking other doctors for their advice.
The contractor option
As an independent contractor, there is far more flexibility in your independent practice. You can set your own hours of practice (typically within the parameters of the hiring doctor’s office hours).
You have the flexibility of working in multiple locations and offices for other DCs, or possibly in a location that may not have a chiropractor or chiropractic services, but wants to add them. You are considered to be your own employer, with pay based on a percentage of what you bring into the practice by way of patients and collections.
Independent contractors pay their own liability and malpractice insurance. Generally speaking, there are no company-sponsored benefits such as health insurance, paid vacations, or holidays like those enjoyed by an employed associate as a part of a contractual agreement. Independents most likely will not get the marketing and training needed to manage their own practices and may not have the permanency and job security that an associate would have.
Pros and cons
Guidance is a key advantage that the associate clearly has over the independent contractor. The associate and independent contractor positions, according to the law in some states, contractually can’t be blended. There are employment rules in every state that primarily affect the independent contractor model.
When entering into a relationship as an independent contractor, the hiring practice must not have direct control over the way you work. If the relationship is determined to be one of employment rather than independence, it can have serious ramifications.
Some states have put highly specific definitions in place that you should research before signing on the dotted line. That goes for both for associates and independent contractors. Before you decide, do a SWOT (strengths, weaknesses, opportunities, and threats) analysis on yourself. Consider a preceptorship with a doctor you want to model yourself after.
Working with a mentor as an associate may be the simplest course available. Independent contracting is part of the new era of employment law. Be cautious about working with someone as an independent contractor but, if you do, follow the exact rules set forth by your state and your agreement with the doctor. Whichever you decide, do your best and focus on helping your patients.
Timothy Gay, DC, is the executive vice-president of Life Chiropractic College West Health Center, and a contributing writer to Chiropractic Economics. He can be contacted at 858-354-4222 or at tgay@lifewest.edu.
