The workplace stereotype is that all employees dream of becoming their own boss, of striking out on their own to open their own business and call their own shots.
Not William Updyke, DC. The California chiropractor had his own practice for 10 years and taught at Palmer College of Chiropractic West, but now he’s an employee at a worksite health clinic for a tech company in San Jose, and he couldn’t be happier. “It’s been better than I expected it to be,” he says.
Updyke is one of a growing number of chiropractors choosing to work in company health care clinics located at or near worksites. It’s a career path that offers attractive benefits, but one that also requires tradeoffs and a loss of autonomy.
Worksite clinics: A growing industry
In an effort to control health care costs, improve care and attract workers, more employers are opening health care clinics, either at worksites or nearby, to provide primary care for employees and their beneficiaries.
These clinics don’t replace outside health care coverage or provider networks, but are designed to provide more accessible and less expensive care, says Larry Boress, executive director of the National Association of Worksite Health Centers (NAWHC), an industry group.
“The more care that can be provided for employees onsite, the better, because it’s in everyone’s interest,” Boress says.
There is no formal definition of what constitutes a worksite clinic, which can range in size and capabilities from a nurse-staffed first aid station to a 25,000-square-foot building equipped with everything from gyms and massage tables to imaging equipment.
NAWHC estimates that 30 percent of all employers have some sort of onsite or near-site clinic. According to a 2017 study by benefits research firm Benfield, 42 percent of large employers will offer worksite-based health clinics by 2019, with another 26 percent offering near-site health clinics.1
Their ranks include private employers, such as Northrop Grumman, Honda, Coca-Cola and MillerCoors, as well as government entities like school districts, the city of Chicago, and the state of Montana.
These types of clinics are particularly popular with Wall Street and tech firms that regard them as another benefit to recruit and retain employees in a highly competitive marketplace, Boress says. Workers value the easy access to everything from nutrition counseling and mental health services to acupuncture and chronic disease management.
How they’re making it work
According to the Benfield study, 44 percent of clinics are run by third-party vendors, while 31 percent are run by company employees and 17 percent by a community health facility, such as a hospital. Another 8 percent use a hybrid approach in which the employer contracts with local health care providers to provide medical services, but manages the business operations itself. Some clinics are shared by several companies that can’t afford their own.
The services offered vary by employer, but can include primary care, physical therapy, optometry, mental health, acupuncture, dermatology, nutrition, wellness coaching and chiropractic. According to Benfield, nearly 90 percent will offer treatment for workplace injuries by 2019 and close to 75 percent will offer physical and occupational therapy.
While only 5 to 10 percent of clinics currently offer chiropractic services, Boress says that number is growing.
The Foundation for Chiropractic Progress (F4CP) and software company ChiroTouch last year commissioned a survey from NAWHC to learn more about chiropractic on the job. The association surveyed 10 worksite clinic vendors that operate more than 970 clinics, as well as employers.
The survey found ample evidence for chiropractic having a robust future in clinics. Key findings were:
- Eighty percent of employers indicated that musculoskeletal issues are among their top cost drivers, a primary reason for offering chiropractic services.
- Fifty-five percent of employers said their employees have expressed interest in chiropractic services at their clinics.
- Employers who have DCs on staff have found that the visits and costs are lower for chiropractors than for other health providers who treat the same condition.
- Patient satisfaction with chiropractic care offered at worksite clinics is high.
The study also identified areas that need to be addressed for more employers and clinic vendors to offer chiropractic:
- Reviewing and understanding the different training, skills, treatments and clinical experiences offered by the various chiropractic colleges and what can be applied to worksite clinics.
- Identifying a qualified DC who has the willingness, training and clinical experience to be part of a worksite center.
- Ensuring only necessary chiropractic services are provided.
- Adapting a DC’s practice to fit into an integrated clinical team, and how chiropractic care can complement physical therapy services.
- Having space for the unique equipment used by DCs.
- Evaluating the need for a DC and the anticipated performance and cost-impact.
The pros of clinic practice
The best part of being a clinic DC is being free to concentrate solely on chiropractic, says Sherry McAllister, MS(ed), DC, CCSP, executive vice president of the F4CP.
“All they have to worry about is the care,” she says.
All the responsibilities and headaches of running a practice, such as marketing, purchasing, payroll, scheduling, and paying for continuing education are taken care of by the clinic operator.
“Running a practice doesn’t even compare to this,” says Updyke, who works for Premise Health, a Tennessee firm that operates more than 600 clinics.
After a decade of running his own practice, Updyke relishes the benefits of being an employee: a salary, flexible schedule, paid vacation, health insurance, 401(k) and other benefits. Arrangements vary, but clinic DCs usually don’t have to bill insurance or third-party providers.
Daniel Lord, DC, CCSP, began as a clinic chiropractor for Crossover Health, a California vendor that operates about 30 clinics. Eventually, he rose to become physical medicine senior program manager for the company. Being salaried and not having to worry about insurance and collections leads to better care, he says.
“We’re incentivized to help the patients as efficiently as possible. It could be three visits, it could be 10 visits, whatever the patient needs,” he says.
“I could not care less if something is billable or not,” he says, adding that he can offer such services as lifestyle counseling without worrying whether he’ll be compensated for it.
Many clinic DCs also welcome the chance to work closely with specialists and other health care professionals under a single roof. That naturally leads to collaboration and a team approach to health care delivery, says Lord.
“You can pull a doctor into the room for consultations on difficult cases; you can consult on so many different things,” he says.
Working closely together also builds trust between caregivers and helps eliminate the skepticism some medical doctors feel toward chiropractors, Lord says, adding, “As soon as [MDs] see how you manage to relieve their patients’ back pain, pretty soon they’re sending them right over.”
The cons of clinic practice
Along with the benefits of being a company employee, there are certain drawbacks as well.
For example, clinic DCs report to the clinic medical director, who is usually an MD, but sometimes a nurse-practitioner or physician’s assistant. The director can set hours for clinic chiropractors, supervise their work and establish policy and procedures. That might not sit well with chiropractors who value the autonomy that comes with being their own boss and owning their own practices.
“There definitely is a loss of independence. If you’re being told what to do and when to do it, that definitely can be a rub,” McAllister says.
She also notes that clinic chiropractors are employed at the discretion of the employer and can be dismissed for cause or laid off for other reasons. Dismissal can mean starting over and having to build a practice from scratch.
Clinic DCs are restricted in the services they offer. Most clinics limit procedures to evidence-based care. Those who want to do more than treat neck and low-back pain, or who want to employ a holistic approach could be frustrated, Lord says.
They also must be comfortable working as part of a team, consulting and, in some cases, deferring to other health care providers.
“It’s a whole different type of practice than private practice would be. You have to want that,” Boress says.
And while clinic DCs don’t have to worry about billing and collections, they do have to report data. Clinic operators examine such things as utilization, patient satisfaction, net promoter scores, claims data and treatment efficacy, Lord says. The information is used to evaluate the effectiveness of the DC and the role of chiropractic in the clinic.
Updyke says his clinic accepts the value of chiropractic: “They’ve looked at what they’re saving and they don’t bother us anymore on the chiropractic side. They know they save a lot of money each year.”
Finding the right fit
Lord, who recruits chiropractors for Crossover Health, says the popularity of the jobs lets him be choosy with applicants. He looks for DCs with three to five years’ of clinical experience who want to provide evidence-based care and who are expert in spinal manipulation.
Lord says he avoids applicants who want to treat conditions other than neck and back pain and the occasional sports injury, as well as those who want to offer holistic services or sell supplements.
“I’m not going to give a lot of nutrition advice if there’s a nutritionist down the hall,” he says.
Candidates also must be willing to be part of a health care delivery team and be comfortable with the culture of the company whose employees they are treating, he says. For example, an older, conservative DC might not be a good match with a tech company with a lot of younger, progressive employees.
As most worksite clinics are operated by third-party vendors, it makes the most sense to apply to them rather than to the employers who contract their services. Companies like Crossover
Health, Premise Health, Concentra, Paladina Health, QuadMed, Optum and others routinely post openings on their websites as well as on LinkedIn and other job sites.
Most employers are looking for chiropractors who have at least a few years’ experience and good patient ratings. Networking also helps, as vendors in the NAWHC study cited recruiting in the local community and recommendations from DC employees as the most common ways to find job candidates. McAllister recommends uploading a résumé at the beginning of a job search so the vendors will have it on file if an opening appears.
The decision whether to work at a clinic requires careful deliberation, McAllister says. She recommends that chiropractors first work in an onsite clinic on a part-time basis to see if they like it before committing to anything. Shadowing a clinic DC on the job can be another option, she says.
Updyke says he recommends DCs who are tired of the hassles of running a business consider taking a job at a worksite clinic: “There is nothing I don’t like about this job.”
James F. Sweeney is a freelance writer in Cleveland. He is a former newspaper and magazine reporter and editor. He can be contacted at firstname.lastname@example.org
1 Employer Market Intelligence: Employer Market Trends. Benfield Research. http:// www.benfieldresearch.com/pdf/BenfieldGallagher%202017%20Employer%20 Market%20Trends%20Research%20Preview. pdf. Published spring 2017. Accessed July 2018.