How to Hire an Associate

Hey there, and welcome back. I'm Dr. Vince Leone, executive producer and co-host of the Practice Builders Podcast. With my partner in crime, Dr. Kyle Pankinen, we deliver proven strategies to help you grow fast, specialize with confidence, and build profitable staff-run practices. Let's go ahead and dive into today's episode now. Hello and welcome everybody to the Practice Builders Podcast. My name is Dr. Vince Leone.

And I am Dr. Kyle Pankinen, and we're glad you're listening today. We got a great topic which, uh, Dr. Leone is going to introduce soon.

Right now, as a matter of fact. And we're calling it When to Hire an Associate and How to Maximize Their Value If You Do. And I think this is kind of a— I don't know if it's a hot topic, but it's, it's certainly a topic, uh, amongst successful chiropractors because I know some have been burned by associates. Um, I know associates have felt the burn, like, I'm not paid enough, or I'm expected to do too much. And, and, you know, the exact opposite from the owner's side. So, what we want to go into this, uh, into on this episode is, uh, really kind of two halves to the episode. First, when is it revenue level? Is it volume? Like, what are the indicators that Um, are telling you— because if you want to scale, you know, and you don't want to kill yourself, you need an associate, right? So we need to figure out, okay, well, when and what are the indicators that is your business is telling you that you need an associate? And then if you're at that point and you pull the trigger, how do you make the best use of that relationship, uh, so that they are profitable for the business and you can continue to grow. So, let's go ahead and dive in on that front half, Doc. When to hire an associate. What's your first, you know, what I like to call leading indicators that your business is saying, hey, you need to at least start thinking about hiring an associate?

Yeah, I think the biggest thing for me with that is this is something that's really fresh. In my practice, 'cause we literally just hired an associate this year, starting my 25th year practice. And for me, it came down— this is something my wife and I, who has been with me since day one of practice and does all the behind-the-scenes stuff, but we've talked about many times, we really need to start thinking about bringing an associate doctor. But what really came down to for us was Capacity in the sense with one doctor and I had 5 full-time staff, I felt I had gotten to a point in my practice where I just had literally maximized the volume. And as far as how many patients I could physically treat in a week and also the revenue that I could generate with one doctor. And we got to a point where it's like, we're doing $1 million plus. How much more can one doctor physically do? And, and to do it year after year after year by yourself.

Mm-hmm.

And so I think once you hit to a point where you're like, you know, I'm busting my butt and I'm maxed out what I think I can Physically, mentally, emotionally do, I think that's a time to self-reflect and say, okay, it's probably time to bring in an associate doctor. Unless you are somebody that says, okay, I'm content with where I'm at right now, we can just coast. But when you start to get that mentality, you know what's going to happen to your practice? It's going to start to go down. So, you always have to have a growth mindset, even if you internally would like to slow down a little bit. Otherwise, you are going to slow down. So, capacity is number one.

That's a really good point there. And I think that you need to have a plan in place where the role of the associate is to help the practice grow. You know, and so I think a rev like, and I want to get your thoughts on this. Like in terms of a revenue level, like when can we afford to hire an associate? And typically, you know, you you want your labor costs around you know twenty-five thirty percent of total gross. So I'd like to see you know if we're for instance hiring a an associate for $10,000 a month. And oh, by the way, there's doctors, you know, trying to hire associates for $3,000 a month. And it's just like, how can you live on $3,000 a month? It's kind of sad. But the point being is, say it's $10,000 a month. I'd like to— I'd like their production to account for about 3x, right? So their production should generate about $30,000 in revenue. And You're probably going to need to be somewhere in that $75,000 a month total revenue, you know, roughly $75,000, $85,000, something like that. I think that's at the rough level when you can afford to have a good associate that you pay well, that can, you know, you can get a good person in that will then allow you to focus on some of the higher value activities like we talk about in Practice Nirvana, right? So where you're, you're You know, the associate will do the bulk of the chiropractic adjusting, you know, maybe 80%. They're going to do the vast majority, if not all, of the new patient for chiro. And then the main doctor owner then does all the high-ticket niche, uh, new patient exams and enrollments. And then, um, you know, and then they, they pick up the 20%. of the adjustments. And these are the people that have seen you forever and they don't want to see anyone else, right? So, there's always going to be those people. We know that, you know that. But I think revenue level, $75,000, $85,000, I think is when, you know, because then— and then the goal is then to break $100,000, $125,000 and allow you to, again, focus on those higher-value case fees.

Yeah, you can't pinch yourself so tight because you have a— You have an associate doctor where, yeah, I think what we— from the studies we did, you know, a lot of doctors are getting about $60,000 to $80,000, kind of is the range of an associate doctor or somebody right out of school, which is what we hired. And so, you know, $100,000 or $10,000 a month maybe is a little bit on the high end of what most are getting. But you're right. You have to calculate, okay, this is going to cost me this much extra income per month. Do I have enough demand and enough capacity, enough office space, enough staff, everything I need to bring this associate doctor in so that that doctor can generate enough revenue to, one, at a minimum, match what you're going to be paying them, but hopefully well exceed that? And you're also probably going to need a little bit of ramp-up time to get them to that point, too.

Yeah, 100%. And that is relatively high. And take that with a grain of salt, right? It's location dependent. We have a client in Northern California, very expensive to live there. You know, he's got a million-dollar practice. That's what he's offering, $10,000 a month. Can't find anybody, by the way. But the point being is If you're in like where Dr. Kyle lives in rural Minnesota, you can probably afford to pay quite a bit less, you know, mid-market, you know, maybe $6,000 to $8,000 a month. But you get what you pay for. I mean, shoot.

Yeah.

If you're trying to nickel and dime someone that is going to take over The vast majority of all your patients, I mean, you want someone good. And I don't know that— I mean, my preference is not to hire the newest, like the guy fresh out of school or the gal fresh out of school. That's, that's, that's not my preferred. I always talk about the kind of— you hire the struggling chiropractor, right? They've been in practice for 5 to 10 years, um, kind of, you know, beating themselves up, $10,000 to $20,000 a month, you know, and, uh, they're just tired of the marketing, tired of the business side, tired of the staff management. They're like, I didn't want to— I want to be a chiropractor. I don't want to be a business owner. That's who you want. Someone has good hands, good with patients, um, and would love to work in a nice office. And they've seen the other side, right? So that they can now make a career. I don't like the young hotshot out of school because they're going to work for 2 years and they're going to be gone, right? There's no retention there. Um, you want someone that's going to be with the practice for the next 10, 20 years, ideally, right? And then stays with the practice when you sell it. So, it's a little off track in terms of when. One thing you had mentioned also, Dr. Kyle, you were at a max capacity physically.

Yeah, I mean, a lot of doctors out there, once you've been in the trenches 10 and 20 or 30 years, I'm right about 25. I mean, let's face it, you know, we all start to age a little bit. We start to the shoulders start to hurt a little bit.

Yourself, I'm not aging.

Yeah, I don't want that.

I'm pulling the Benjamin Button.

I'm going back. Evidence.

But there's a physical obvious element that you need to physical element. You know?

Yeah. You get you get for to keep it simplistic, you get beat up.

I mean, 100%.

And When those— when you come home on the— after the end of the workday and your wrists are aching and your feet are aching a little bit and your knees are aching, then you start to have thoughts in your head. Well, how many more years can I do this level, this volume, and get away with it before my body starts to really break down? And so I don't— just in the last year or two myself, I've personally noticed. There is a few little— not that hurt bad at all, but there is a few little things. It is like, okay, I am getting some shots across the bow here that my body is telling me that maybe it is time to slow down just a little bit. And so that was an indicator that I saw that is like, all right, it is time to bring on an associate doctor. Not only— So we talked about physical Stressors on the body. But what about the doctor that just is maybe mentally close to burnout? I have been there a few times in my career. I do not think I have ever been to a point where I can say I was completely burned out, where I am like, I am just done with this. But I have been borderline burned out over the years several times. And I think if a doctor is in that stage, in their practice where they're like, this is really a grind. I'm mentally, physically, emotionally, whatever, getting close to burnout. I don't recommend you bring in an associate doctor when you're fully in burnout phase. It's probably too late then.

Mm-hmm.

But if you're, if you're seeing some of those signs, I think that's a good time to consider bringing an associate doctor in.

Why do you think that is? Because I, I, that's, that's an interesting thought. Are you thinking they're going to kind of give a, get a shot or give a shot in the arm to the practice?

I think it's going to just take some of the stress off of the, the solo doc who in a sense is trying to basically, they're, they're, if it's up to the solo doc to run the ship. to keep it going, to produce the revenue, to pay all the other employees, to provide for their own family. And over time, that can really wear on a doctor. And so, basically, it's bringing in reinforcements is how I look at it.

Oh, that's a good point because energy level is really key. Like, if you think, oh, why am I getting burnout? Is it because I'm doing the same thing every day? Or is it because, uh, my— I, I don't have the energy level because I'm aging, because it's a physical thing, and I don't have the energy level to want to build, right, and to expand and, and, and do what it takes to grow the practice. You take that off your plate in terms of the physical adjustments on a daily basis, and now you're using more of your mind, like especially with these high-ticket niches, and you're you know, elevating your skill sets, uh, whether it's treatment protocols, exam protocols, you're, you're, you know, kind of strategizing on marketing and building a team. A lot of doctors, you know, that I've experienced, they really get energized when they start to be able to use their mind more and not just use their physical body adjusting all day, every day. So I think that's a really good point. Energy, I think, is, is huge. And, um, Yeah, so I can see how that could help with the, uh, if they're trending towards burnout. Like you said, if they're burnt out already and just done, probably not a good idea to hire an associate.

Correct, correct. I've noticed this just yesterday in practice. I, uh, the morning was really just routine, just a lot of just routine chiropractic stuff, and I noted my energy just was not really that there. But in the afternoon, I had 2 new patients that were both niche. They were both decompression cases, and I noticed in the afternoon my energy levels just shot through the roof.

Interesting.

After I consulted with them, because that— those are bigger cases, they're a little more complex. Did a thorough exam on those, and you know what, it got the juices flowing again. And, uh, so I think in a model like what we propose, where we become the specialists, take on these high-value ticket niches, A doctor can come in, or the main doctor can focus on those types of cases that really are— they're more rewarding, not only from a clinical point of view, but also from a financial point of view, hopefully. And then the associate doctor can take some of the daily grind of the day in and day out, just regular chiropractic. patients and adjustments and take some of that burden and stress off of the main doctor.

Yeah. And one last note on the timing, like when, or a leading indicator, um, is this is, you know, just talking to a client in, um, uh, a couple days ago. He was so busy That he— 2 ROFs had to rush through. Neither of them signed up because he didn't have the time and the focus and the energy because he's running adjustment, adjustment, adjustment, and then— and just basically squeeze the ROFs in. And you really can't squeeze these ROFs in. You know, it's not a chiro ROF where they're using their copays, right? These are people that are investing good money. Uh, for a significant treatment plan. And if you try to, you know, just rush through that and skip steps, because we have a very structured format to our ROF, um, it's probably not going to go well. It did not go well in these 2 situations. And, you know, so that's lost revenue, uh, it's lost, you know, patient volume. So you have lost referrals, and then that patient didn't get the care. So when you have the associate in place, it's going to allow you To prepare properly for an ROF, have the time on the front and the back so that you're not rushed, not thinking like, oh, I got 5 patients waiting. That's not the mindset you need to have in an ROF, to be thinking I got 5 patients waiting and I gotta, you know, get through this. Um, so that would be another indicator if you find yourself, um, essentially just not being able to properly Do either, either your day 1 or day 2 with your high-value cases, then you need to start thinking, hey, I need to do something so that I can, uh, you, you know, use this time appropriately and wisely and these patients get what they need. Um, any last thoughts on the when before we go on to how to optimize once you bring someone on?

No, I think we covered that pretty good. I mean, those are the capacity, the physical signs, the mental-emotional things. All those things that you got to just kind of checklist in your mind or write it out on paper, the pros and cons. But if you are starting to see some of those things be like, yep, we are at capacity. Yep, I am getting physically beat up. Yep, I am close to burnout, that type of thing. Those are definite indicators that it is probably time to— Time to change. Bite the bullet and get her down.

Yeah. And, and if your revenue is at a, at a high enough level, I mean, if you're at, you know, $30 grand a month and, and you're experiencing all those things, it's— there's another problem. Like, something else is wrong. You know, there's a systems issue, there's a new patient issue, there's a, you know, pricing issue. Like, you need to, need to be generating pretty, you know, decent revenue to, to be able to afford an associate, to have the systems in place to, to maximize it. Speaking of Once we do have an associate on board, how do we optimize this individual, male or female? Um, I'll start off really quick, Doc, with, with just strong systems in place, or, you know, so what are called SOPs, standard operating procedures. How are things done in the office on a day-to-day basis? What's the verbiage? Uh, what does day 1 look like? What does day 2 look like? Um, you know, how long are patients in the office? How long do adjustments take? Like, all this stuff. Really needs to be outlined, written down, and in a clear format so that the doctor has something to follow. Because you don't want someone coming in and and starting to make things up. That's not the goal. The goal is for them to come in and fit in to the system that's already working really well. Have clear instructions on what that is because if you don't have clear instructions. To the associate, it's your fault, not theirs, when they go off script. Hey there, it's Dr. Vince, and if you're getting value from this episode, please make sure to hit that subscribe button so you never miss an episode. And if you know another doc who's ready to grow their practice, share this with them. It might be exactly what they need right now. Thank you in advance, and now back to the show.

Totally agree. One thing that I've seen, or I've tried to tell my new associate doctor, is I want you to clone me to about 80% of me. In other words, love that. an associate doctor can't become you because they're not you, but they should be able to clone you to about 80%, and then the other 20% is their own personality and the way they relate to people and stuff. But as far as your day 1 and your day 2 and how you examine patients and how you manage and what type of treatment plans and protocols and all those standard operating procedures that you do and that your patients are used to, they need to, they need to very closely mimic that on a day-to-day basis so that When you're out of the office and for a week of vacation, the patient's like, well, I don't wanna see that doctor. He's totally different.

Hmm.

And they have some degree of comfort in seeing the associate doctor because they know that, oh yeah, he's very similar to what the main treating doctor has been all these years. So you have to get 'em to a point where they're very closely matched. to what you are doing in practice. So that, that's one that I've really stressed to our new associate doctor, and he's done a very good job of that.

That's a great point. And I think culture fit is important too, right? They need to be aligned with, you know, in other words, if you have a high-energy culture to the practice and you bring in, um, a bump on the log, it's just, it's not a good culture fit.

Right.

Versus, say you have a, you know, a heavy Medicare practice and then you bring someone bouncing off the walls. That's not really a good culture fit either. So in the interview process, you want— you know, I'm not saying politically aligned. I'm saying like just energy aligned. Like they should, just like Dr. Kyle said, they should be kind of 80% like you. And so you want someone that's going to fit into the culture of the practice because The worst thing would be is to make the investment into an associate, and then your staff doesn't like him or her, patients don't like him or her because they're just, they're not, you know, they're, they're just, they're not a good fit in the practice. And God forbid they have some issues with, you know, some no-nos in the past. Like, you know, you need to, you need to do some type of Research, background check on the individual, that they have no complaints against them for, number one, sexual, you know, improprieties, because that unfortunately happens in our world, right? There's a lot of hands-on. And so you want to know that if they have an issue with that in the past. You want to know, and that's a— that one's going out the door. The reason why I bring that up, that same doctor in Northern California, we just had a long call the other day. That's why all this stuff is coming up, is he had an associate and then, uh, was accused of sexual misconduct while working for this doctor.

Wow.

So now, was that the first time that ever happened? I don't know. But you know, where there's smoke, there's fire. So culture fit, I like that. Uh, I like the doctor being 80% like the, the main doc. Last thing I will say on this is a lot of times the doctor owner, when they bring on an associate, they're thinking, okay, now go get new patients, you know, go market, go do screenings, go do all this stuff. I personally, I feel like this is asking too much. This is why if the doctor was a great marketer, they'd have their own practice. I mean, if they knew how to get patients left and right, why would they come work for you? That's probably the issue is they don't know how to get new patients. They're a good doctor, they're a good adjuster, they're good with people, but they're not a good business person. You know, there's some doctors that can walk into a restaurant for lunch and walk out with 3 new patients. The vast majority— that's about 1%— the vast majority of us have to use, you know, good marketing tactics and strategies. But asking your associate doctor to be generating new patients— now, if they do, I think that's a bonus. But if they come in and they're on time every day and they're a good culture fit and they're a great adjuster and their patients love them, that's it, right? Don't— in my opinion, don't ask the associate to do too much and wear too many hats.

I agree with that in the sense that I think that is asking too much of an associate to go out and do all this marketing and so forth. A good doctor that's bringing on associates should have all that marketing already Mm-hmm. In place and be bringing in a steady stream of new patients, almost to a point where they're like, I can't process any more new patients. There's, there's, 'cause I, we have some days in practice where we're full, we have a couple new patients scheduled, and then people, you always get those patients that call in, that's a, they're a new patient. Oh, I woke up this morning and I gotta see somebody today. I'm miserable. But your schedule's full. Well, every practice has those. Well, if you have an associate doctor, there you go. You always have those. So a good associate is always gonna get that overflow of patients from a really busy practice already that you maybe just can't process because you're already at your capacity. So that associate doctor will pick up some of that slack and you'll gain new patients just from that alone. And that's one of the things I've seen. already with adding an associate that, you know, we've gotten in some extra new patients that if it was all up to me, it was like we would have had to say, well, we can't get you today, but we can get you in tomorrow. Well, they, they hang up and they go call another chiropractor is what they do because they gotta see somebody that day, right?

Mm-hmm.

And so you get— you miss a lot of the really acute cases because of that. You'll get the chronics because the chronics Okay, I can live with this for another day or another week or another 2 weeks until you can get them in your schedule. But those really acute weekend warrior type things, they want to see somebody today and preferably right now.

Mm-hmm.

And those are the ones, they're going to go to the doctor down the street that's not very busy, that can— you can just walk in and get an adjustment. But so, The associate will help pick up some of that. And, you know, you don't need to have them rely on marketing. You want them to be good clinically and good at exams and good at treating patients. The business and the practice and the owner doctor should handle the marketing.

100%. And I think the, the furthest you can go on the marketing front is just retention. Hey, we're gonna You know, we're going to have our recommended care plans. Patients are going to stick to it, ask for referrals, you know, once in a while, if that— but that'd be the extent on the marketing front. Any other thoughts on optimizing the associate relationship, Doc?

The only thing I thought of is you mentioned staff, and that is the— that is, I think, if you bring in a doctor that doesn't mesh with your staff, you're going to have trouble from day one. So you need somebody that's going to come in that has a certain degree of humility. And somebody that's going to come in that he's not afraid to do some, maybe some trivial or menial tasks, at least to start with, so that the staff— they want to show the staff that I'm not better than you, that I'm just a person too. Even though I'm a doctor, I'm still just an average everyday person. And those little things like that go a long ways towards the staff really liking that. new associate doctor, and then, then they want to work for them and they want to help them and, and help them grow. So the staff is the key, and it's the key for the, the, the old doc too, in a sense. The staff, if they love you and you treat them respectfully and, and the way they should be treated, they'll drive growth in your practice.

Mm-hmm.

And, uh, so that you have more of a A staff-driven practice. Patients in my office, they rarely say, boy, that Dr. Kyle's great. You know what they say? Oh, I love your staff. Your staff is great. They're so nice. They're so friendly. They're so helpful. When we get reviews, like online reviews, 8 out of 10 of the praise is for my staff and about 20% for me. What are you doing wrong, Doc? Come on. I don't care. They love coming in. Patients do. So, I'm all for let the staff get the praise. I just want to get the patient the results, but all those other intangibles, the feel-good things, the staff provides that. And that is huge to practice growth.

Really great point there. I love that. Last note I'll say on optimizing the associate relationship is, you know, consider, you know, being a mentor. to the associate because they're obviously, or most likely, they're going to be younger than you. You know, maybe not, but probably. And, you know, if you built a successful practice, you're going to bring in an associate, you know, just obviously, you know, they're there for their job. But, you know, pay it forward and try to share your experience. And who knows, you know, if you got a million-dollar practice— oh, by the way, that ain't that easy to sell. I mean, trust me. So point being is, you know, because a million-dollar practice is going to maybe sell for $758,000, something like that. Most doctors can't get a loan for $800,000, guys. So if you mentor your associate properly and they're in the practice, you know, 5, 10 years, whatever, they have a long track record. They know now, they know the business. You've mentored them. Hey, this is how you run marketing. This is how you run staff. They learn, because no one taught them before— we don't learn this in school— they can potentially then get the loan to buy the practice. Now you have a nice exit strategy, you get a decent comp on the practice, and everyone wins, you know. So, and that, you know, again, retention. You pour into the doctor, um, share your experience, and, uh, you know, potentially you could get rewarded for that.

Beautiful. I love that plan. I had a doctor years ago that talked to me about— shared a concept called retire in practice. So you hire an associate, and then over a period of 5 or 10 years or whatever, they gradually buy your practice out.

Yeah.

And by the time you get to retirement age, they become the owner, and then they can hire you back on as their associate doctor, and then you can practice in your retirement years, maybe at a part-time level. Yeah. So that you still have some income in retirement, but you're maybe only practicing 2 or 3 days a week.

Yeah, a couple days a week, you know, have, you know, get all like cover all your expenses. You know, you can, you know, have the little toys and stuff based on your nest egg. So, yeah, that's a really Really interesting concept there. Um, but, uh, I, I think we, we kind of hit this pretty good. Uh, I don't think we need to go any deeper on this. So any last words there, Dr. Kyle, on this topic?

No, I just, I think that the associate model is a, is a great thing. It's a, it's a good way to get another doctor in, in the door in a sense, because most, most chiropractors coming out of college nowadays to start a practice on their own from scratch is almost impossible. So, you want to find someone like that who's really hungry or like Dr. Vince said, the struggling doc and bring those in. But I think an associate-type position can be a win-win for the owner doctor and the associate if you do it right.

100%. Okay. That's a wrap on this episode, When to Hire an Associate and How to Maximize Their Value. Hope this was valuable for you. And if you think it was, please share with a colleague, give us a like, give us a subscribe. If you have any questions or thoughts, you know, questions, thoughts, feedback, feel free, send it to support@drvinceleone.com. Otherwise, we'll see you all on the next episode. Take care. Hey, it's Dr. Vince again, and hope you enjoyed that episode. And if you're ready To grow your practice fast with high-value decompression patients, then the Decompression Accelerator could be a phenomenal option for you. This is our 90-day sprint to help you scale with proven systems, staff-driven protocols, and full marketing support, and it's all guaranteed. Spots are limited. Head to www.decompressionaccelerator.com to learn more.