Time to start thinking big: The 27th annual Chiropractic Economics Salary and Expense Survey (2024)

When you first look at several of this year’s Salary and Expense Survey numbers, they don’t quite seem to make sense. We’ve got some big increases in practice income. The DCs in our survey billed significantly more, and then collected more, with an average reimbursement rate of about 71%.

Then you get to the salary question…and on average, this year DCs are paying themselves about the same or in some cases, less. So, we have DCs reporting increased revenue but flat or decreased salaries and total compensation.

Some possible explanations for this trend? We could be observing a period where many DCs are reinvesting in their practices and spending more on upgrades and enhancements, rather than reacting to increased revenue by bumping up their own salaries; the numbers we’re seeing elsewhere in this survey support the idea that now is a good time to invest in growth.

DCs could also be exercising financial caution, having just emerged from an extended downturn fueled by the coronavirus pandemic.

Other parts of the survey bear out the theory that a lot of DCs are growing their practices right now. Many are working more hours than last year, past the typical
31- to 40-hour work week most usually embrace. The number of respondents whose practices have employees is up; nearly 30% now employ five or more full-time people.

A couple of other notable findings:

More minorities?

Minority use of chiropractic is reflective of a larger issue in healthcare: the disparity in healthcare access and use between racial and ethnic groups. A study published in October in the Journal of General Internal Medicine investigated the use of nondrug approaches to low-back pain and found that even though such approaches are recommended over the use of painkilling drugs, that utilization of these interventions was less likely among Black and Hispanic adults.

“Black Americans were as likely as White Americans to access occupational therapy or physical therapy but half as likely to access chiropractic care,” noted a Boston Medical Center press release about the study. “Furthermore, while access to occupational therapy or physical therapy was generally similar among Americans with various incomes and insurance providers, use of chiropractic care was low among low-income adults and those with public health insurance. There remains a need to understand the causes of racial and ethnic disparities in access to chiropractic care, occupational therapy or physical therapy.”

The year 2024 marks the fourth time we have asked this question in our survey: Are you a minority-owned practice or do you work for a minority-owned practice? The percentages have not been very encouraging. Last year, the number was 11%, and that represented a decrease from 13% the prior year. This year, for the first time, they are on the rise, indicating more non-white DCs are graduating from chiropractic school and entering the healthcare market as practitioners.

The percentages of non-white patients our respondents reported seeing grew by a few percentage points, too. Progress!

Speaking of progress…we still have issues with gender and $$$

As usual in our survey, a big difference exists between women’s and men’s salaries as well as total compensation. Again this year, women’s compensation lags behind that of men by around $20,000. This disparity isn’t unique to doctors of chiropractic; female medical doctors’ salaries have been trailing men’s by about $70,000 for several years, and this year, according to Medical Economics, the gap rose to more than $85,000.

In summary

Despite whatever is going on with DC compensation this year, it’s clear consumers are not holding back on healthcare spending the way they have in previous years. Potential new patients are out there, ready to pay for the services they want and you provide.

About this survey

Our 27th Annual Salary and Expense Survey had 408 participants responding to an anonymous, confidential, web-based questionnaire. During February and March, Chiropractic Economics magazine invited practicing DCs (and CAs on their behalf) to complete the survey.

We extended the invitation by email as well as through announcements in our e-newsletters and on our social networking sites. Additionally, we encouraged a number of state, national and alumni associations to distribute the survey to their members.

Regional representation — Our response to this year’s survey was wide-ranging, with participants from 40 states.

The regional breakdown is as follows: South 42%; Midwest 25%; West 19% and East 14%.

Statistics — You will find references to averages (or means) in this year’s survey; readers tell us they better understand the survey this way. The average is calculated by dividing the total by the number in the set — an arithmetic average.

The average DC profile

Our Salary and Expense Survey attracted a wide range of DCs across the U.S., with responses from practitioners between the ages of 25 to more than 80 years old, and from those who have been in practice for a year or less to more than 50 years. By averaging the responses to many of this year’s questions, we can see the average DC in our survey is likely:

• Male (24% of respondents were female)
• 54 years old
• A solo practitioner (50%)
• Licensed in one state (77%)

Our average respondent:

• Owns one practice (79%)
• Prefers to practice in the suburbs (54%)
• Sees 111 patients a week; has a patient-visit average (PVA) of 37
• Attracts 10 new patients each week
• Sees patients about 31-40 hours a week (40%)

The average respondent has:

• Average billings of $716,322 and collections of $506,543 for a reimbursement rate of 71%
• Sells products to patients for about 9% of gross revenues
• Pays CAs $34,983 and himself $99,327
• Enjoys average total compensation of $143,098

Finally, this typical respondent spends roughly $29,878 per year on office leases or mortgages, $9,457 on advertising and $2,946 on malpractice insurance.

Billings and collections

We’re happy to report the DCs in our survey are billing for larger amounts, although they are receiving a slightly lower percentage of that money back than in 2023.

Average gross billings were reported at $716,322, which is a significant increase from last year’s $663,010. Collections were reported at $506,543, another significant increase from $489,129 in 2023’s survey.

This year’s billings and collections numbers equal an average reimbursement rate of 71%, a 3% decrease from 2023’s 74%.

Editor’s note: Several DCs in our survey reported billing and collection numbers so high (including a couple in the hundreds of millions) that we chose to remove the top 5% and bottom 5% of earners from these calculations in order to get numbers nearer to what the average DC experiences.

How patients pay you

While a DC’s true specialty lies in the ability to provide effective chiropractic care, you likely have several other income sources, such as retail, diagnostics or consulting.

DCs still report their major source of income comes from patient chiropractic care. About 86% reported patient treatment as their major source of income, which is more than in 2023.

This suggests a significant number of DCs are focusing on the nuts and bolts of practice rather than dividing their attention between patient care and other income streams such as consulting or product retail.

Other sources of income for DCs include selling retail products (8.6%), diagnostic testing (5.2%) and consulting within the industry (4.6%).

Solo DCs vs. group practices

This year’s survey showed a slight dip in the number of DCs practicing in groups (or partnerships) at 23%; this represents a 3% decrease from last year’s 26%. However, since 2013, the number has hovered between 22-30%, showing a fair number of DCs have found success in joining forces with others.

The 50% of DCs reporting as solo practitioners fell from last year’s 52%. Those indicating they were working as associate DCs fell five percentage points to 12%, but the number of franchisees or those working in a franchise ticked up slightly from 2.6% to 2.95%. Four percent indicated they worked as independent contractors, up from last year’s 3%.

When it comes to billings and collections, solo practices saw some changes. (Remember: Overall, both billings and collections are up.) Solo DCs reported average billings of $403,622 and collections of $289,272, compared to average billings of $399,223 and collections of $280,218 last year. So, solo DC billings and collections were up a bit, boosting last year’s declining 70% reimbursement rate to 72%.

Group practice billings and collections fared better over those of solo DCs across the board, in keeping with the established trend, but reimbursement rates declined. This year’s average group billings were $1.47 million (compared to $1.19 million last year) and collections came in at $903,884 compared to $885,766 in 2023. The group practice reimbursement rate is 62%, a significant decrease from last year’s 75%.

The average total compensation for solo DCs this year was $113,142 compared to $137,372 last year, but the average total compensation for a DC practicing in a group setting increased from $195,777 last year to $218,593 this year. Salaries for solo DCs averaged $85,154, a big dip from $93,583 last year, while those participating in a group practice averaged $126,056, up from $120,365 in 2023.

Editor’s 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 $2,397 on insurance (up a little from last year’s $2,223) and $4,321 on advertising and marketing, a sizeable decrease from last year’s $7,966. Group practices spent a tiny bit less on insurance this year ($4,397 compared to $4,985 in 2023). They also spent $22,102 on advertising, a sizeable decrease compared to the $32,041 they spent in 2023.

Group practices are spending more this year on office space, at $46,638 compared to $45,825 last year. Solo practices also spent more on office space this year at $22,346 compared with last year’s $19,392.

Integrative care slowly rising

In response to reader requests years ago, Chiropractic Economics expanded this survey’s “integrated clinics/DCs only” breakdown to provide a more comprehensive look at the chiropractic profession.

We continued that trend again this year by asking respondents to indicate if they were practicing as a DC only, in an integrated practice or in a multidisciplinary practice. An integrated practice includes both a DC and a medical doctor on staff. A multidisciplinary practice is defined as having a practicing DC and any other complementary medicine practitioner on staff (e.g., acupuncturist, PT, LMT).

This year, 58% reported offering chiropractic care only, a few percentage points less than last year; 28% said they operated as a multidisciplinary practice, the same as last year; and 10% responded as an integrated practice, a slightly bigger number than last year’s 8.5%.

Here is a breakdown of income by practice type:

• Billings: Integrated practices reported the highest billings at $978,102, followed closely by multidisciplinary practices at $955,907, and DC-only practices reported $638,210.
• Collections: Likewise, integrated practices reported the

  

  highest collections at $716,537, followed by multidisciplinary practices at $602,286, trailed by DC-only practices at $437,182.

• Salaries: Multidisciplinary, integrated and DC-only practices saw a range of salaries, but all decreased somewhat since 2023’s survey. Integrated DCs had an average salary of $136,500 annually, compared to $143,444 in 2023. DCs in multidisciplinary practices had an average of $105,795, down a little from $109,500 last year, and those in DC-only practices had the lowest salary at $90,868, down from $97,046 in 2023.
• Total compensation: 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 pulled in $234,616; DCs in multidisciplinary practices made $181,959 and those in DC-only practices made $115,812.

What type of practice do you have?

Slightly fewer practices identified as “rehab centers” this year (5.7%) than last year (6%). However, those practices labeled “wellness centers” showed a significant decrease, going from 20% last year to 16.7% this year. The term “medical spa” appears to have largely disappeared, as less than 1% reported that designation.

Most practices — 71% — identified as “clinics,” just 1% less than in 2023.

Gender and $$$: Why do male DCs earn more?

Our survey consistently illustrates an approximate 80/20 male-to-female split that makes up the chiropractic industry, and this ratio has been slowly changing for the past few years. This year saw 24% females answering the survey, so we’re still closing in on the ratio at chiropractic schools, closer to 50/50. We’ve seen a slow but steady increase in female respondents over the last few surveys, except for dips in 2021 and 2023. Females made up 25% of respondents in 2023, 27% in 2022, 25% in 2021, 28% in 2020 and 23.3% in 2019.

These results allude to an overall positive trend regarding closing the gender gap. Whether salaries are up or down; however, male DCs always make more money.
This year’s female DCs reported an average salary of $84,077, a slight decrease compared to $85,154 last year. Women’s total compensation is $122,464 compared to $112,425 last year. Males saw a decrease in salary: $102,033, a fall from $109,991 in 2023. Total compensation for men also showed a drop: $150,559 versus $159,710 last year.

Only 55% of female DCs worked 31-40 hours in patient care per week; 34% reported working either 21-30 hours or 11-20 hours. Of males, 37% reported working 31-40 hours, with 29% working 21-30 hours and a little over 19% working 41-60+ hours per week.

Regional roundup

Reported regional DC total compensations (rounded) for 2024 were:

• Midwest: $129,920 vs. $121,500 in 2023
• West: $105,641 vs. $161,900 in 2023
• East: $113,975 vs. $140,100 in 2023
• South: $182,490 vs. $194,500 in 2023

Note: In this year’s survey, 42% of respondents were from the South, an unusually high number; typically, the Midwest represents the highest percentage of respondents.

Growing up, and growing wealthier

Your DC compensation should increase as you grow older and acquire more wisdom and experience. The results of this year’s survey showed those things still reign, mostly, when it comes to earning larger paychecks.

DCs in their 60s ranked highest in earnings with $162,202 in total compensation, with those in their 40s bringing in $159,277 and those in their 50s making $150,342. The youngest and oldest groups of DCs earned the least money; those in
their 20s and 30s earned about $144,000 and about $121,000, respectively, and those age 70 and older made an average of about $99,800.

It’s all about location

With more available retail space, a developing infrastructure and a large range of potential chiropractic patients, it shouldn’t be a surprise that many DCs choose to practice in the suburbs. Over the course of many surveys, the majority have responded that the suburbs are the ideal location. This year was no different.

 

Although the numbers were similar to last year’s, there was a very slight dip in suburban DCs at 54% compared to 56% last year. The number of urban practices grew slightly from 26% last year to 29% this year. The number of rural practices dropped a bit to 14% from 2023’s 18%.

Suburban DCs once again reported the highest average salary at $110,850, with their urban counterparts reporting an average of $80,885. Rural practices rebounded to an average salary of $80,844 versus $66,000 last year.

Suburban practices had average billings of $916,523 and collections of $590,211 for a reimbursement rate of 64%. Rural practices reported a reimbursement rate of 84%, with $426,207 for billings and $359,904 for collections. Urban DCs had average billings of $618,032 and collections of $430,757 for a reimbursement rate of 70%.

Paying your employees

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 18.5% of DCs in our survey have no employees, while about 40% employ one to three full-time people and 28% of respondents reported they have five or more full-time employees.

The average salaries paid to full-time employees: DC $98,722; associate DC $48,739; CA $34,983; PT $13,077 and LMT $17,807.

Costs of doing business

As the business world continues to change and evolve, generally, so do the expenses involved in running a chiropractic practice. We’ve highlighted three standard spending areas in the profession: malpractice insurance, advertising and marketing and an office lease or mortgage.

• Office lease or mortgage: Average yearly costs were $29,878, a decrease from $30,509 last year.
• Advertising and marketing: Average costs were $9,457, a big drop from last year’s $16,512.
• Malpractice insurance: Respondents reported an average expense of $2,946, less than last year’s $3,372.

Minorities and chiropractic

While more and more people are learning about and embracing chiropractic care and its non-drug approach to pain management, research still indicates people who are Black, Hispanic or of color may not be as quick to see a DC for a health issue.

Reasons for such disparities in healthcare can be multiple, according to the National Institutes of Health, and can involve interwoven factors such as financial status, educational level, location of services, neighborhood safety, transportation, employment and many others.

We have good news to report, however. When asked what percent of their patients were Black, Hispanic or of color, the DCs in our survey reported approximately 27.5% of their patients are minorities. That’s a noticeable increase over last year’s 23% and suggests minorities are getting the message about what chiropractic care can offer them, and then seeking it out.

Even though the number of DCs of color lags behind as well, as our survey showed only 14.6% of chiropractic practices are minority-owned, this is an increase from last year’s 11% and thus a positive development.

Retail product offerings

Nearly 91% of DCs in our survey sell at least one product in their practice. As this number has remained consistently high over the years, it’s clear DCs across the board find success through the integration of quality care and providing patients with the best products available.

A commitment to retailing industry-leading products benefits the DC financially and also creates an important relationship between patients and the products they need to achieve wellness.

So which products do survey respondents offer? Are you selling the same products as other DCs? The top five include:

• Hot/cold compresses: 51%
• Nutritional products/supplements: 50%
• Pillows: 48%
• Educational material: 42%
• Topical creams/ointments: 42%

Of DCs surveyed, 21% sell cannabidiol (CBD) topical products to patients, while 10.4% sell edible products containing CBD.

Partnering with specialists

Your skill in treating patients with regular adjustments and issues related to the musculoskeletal system can undoubtedly position you well for a comfortable career as a DC. But if you feel 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 2024, 53% 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, DOs and nurse practitioners.

The specialists who become a part of your healthcare 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 (124, compared to 90 patients per week in non-specialist clinics); bill more (average of $989,017 versus $528,939) and collect more (average of $617,271 versus $377,618).

DCs employing specialists averaged a higher total compensation ($184,647) than those without specialists ($111,891); those with specialists also averaged a higher salary than those in practices without specialists ($116,483 and $84,839, respectively).

About half of respondents have at least one specialist on staff; the most common specialist was an LMT (38%). Other popular specialists include:

• Acupuncturist: 17%
• Nutritionist: 8.4%
• Nurse practitioner: 7.8%
• Physical therapist: 7.8%
• MD/DO: 7.8%
• Fitness trainer: 7%
• Other: 3%

Respondents reported they offer a wide range of modalities, even without specialists on staff to provide them. These modalities include:

• Chiropractic: 98%
• Instrument adjusting: 65%
• Electrotherapy: 64%
• Exercise programs: 60%
• Kinesiology taping: 45%
• Nutrition: 42%
• Physical therapy/rehab therapy: 42%
• Laser/red light therapy: 39%
• Massage therapy: 38%
• IASTM: 31%
• Decompression: 29%
• Acupuncture: 27%
• Cryotherapy: 24%
• Weight-loss programs: 15%
• Shockwave/vibration: 12%
• Homeopathy: 9%
• Medical services: 5%
• Thermography: 2.5%
• TECAR therapy: 0.6%
• Other: 3%
• None: 0.6%

 

ALLISON M. PAYNE is the associate editor of Chiropractic Economics.