#101 - Strategies and Tactics for a Successful Associate-Practice Owner Relationship, Part 1

Hi there.

Welcome to another episode of The Factor Podcast. I'm your host, Jessica Riddle, and in today's episode, we're kicking off a new business-focused series. featuring Dr. Lisa Goodman. We will discuss the challenges and opportunities that come with starting and growing a healthcare practice, from the perspective of the seasoned provider looking to expand their team, and also through the lens of a new graduate trying to decide the best path forward as they step into the profession. Dr. Lisa Goodman believes that chiropractic is the best profession in the world. Certified in sports, prenatal, and pediatric chiropractic, as well as Titleist Performance Institute certified, Dr. Goodman has been a practice owner for 19 years. She has a degree in marketing and communications and spent 4 years in brand advertising before graduating as valedictorian of her chiropractic college, Palmer West. She's known as an international speaker, author, teacher, mentor, and clinician in and out of the office at worldwide events. In part 1 of this 2-part series, we'll explore the crucial decision-making process of whether to open your own practice work as an associate, or take the independent contractor route. Dr. Goodman will walk us through the realities of financial stability, the learning curve involved, and the potential long-term rewards of each path. So whether you're starting out in practice or looking to refine your career strategy, this episode is packed with valuable takeaways. Let's get started.

Awesome. Thanks so much, Jessica. I'm really happy to be here today. I have a couple of disclaimers to let you know about. My dog is anxious about the weather, so he may be coming in the room once or twice. Hopefully we don't hear him bark. And second of all, I am just coming down from a little cold. I feel great, but every once in a while I get a little cough. I'll try to mute my microphone, but just wanted to kind of throw those 2 things out there. This is really exciting for me. I want to reassure anyone in the room who's not a chiropractor. Presentation will apply to you. Just replace the word chiropractic with whatever your profession is. I believe so strongly in a strong relationship between owners and associates and taking that further between the entire team that's at your practice or your workplace. And I think that we all have a responsibility or a lot of responsibilities in making that team happen. So that's really what this presentation is about, is making sure that as associates, you feel valued by your owner and that owners also feel extremely valued in hiring an associate. So as we go through the presentation, we're just going to be flip-flopping back and forth from the viewpoint of an associate, kind of putting ourselves in their shoes and also putting ourselves in the shoes of an owner, talking about our expectations, talking about our responsibilities and how to make this a long-term and really mutually beneficial relationship. So a little bit about me. I own a practice in Denver, Colorado called Washington Park Chiropractic. I've been in practice for 18 years. I absolutely love being a chiropractor. I also love being an entrepreneur. There are so many ups and downs, but pushing this profession forward and watching students grow, mentoring students, watching them become business owners is So incredibly fulfilling. And we just have a lot of work to do still in chiropractic. And so I'm, I'm really happy to say that I'm one of the people that is doing my small part to help with that. I run a practice of about 10 people. We have 3 chiropractors, 3 massage therapists, and an acupuncturist. And we've really grown as part of a community-based practice that has answered the call from our community. What do they want? Oh, they want massage. Let's add that. They want acupuncture. Let's add that. So So I'm a big believer in starting small. I'm a big believer in not having to spend a ton of money to start a practice. In fact, all you really need is your education, your hands, and your table. Trust me, if you wanna know how to do that, let me know. I'm a big believer in mentorship, but not so much that you have to spend a ton of money for good mentorship. So also ask me questions about that. Anyways, I am a Denverite. I've been here for 20 years. My kids were born here. I have 2 teenage boys who are awesome. One of them works for me after school and on the weekends. And I am certified and specialized in sports, prenatal, and pediatric chiropractic. The prenatal patients are the best because they grow you more patients, right? It's pretty easy. I also like to call myself a student because I love going to continuing education. I love learning. I never wanna be the smartest person in the room. I come back from every presentation and I can guarantee you I'll come back from this one learning something from a question someone's asked me that I need to add in for next time or potentially take out for next time. So I love information and feedback. I do consider myself an educator. I mentor students who are doing internships from various chiropractic schools, always open to that. We have shadows come in all the time. And then of course, doing all of these presentations for everybody. I just recently published the Manual for the Chiropractic Entrepreneur. This is the hardcover version. Really excited. This is a labor of love. I really wanted to write my story. I remember when I opened my practice 18 years ago, I had absolutely no idea what I was doing for about 75% of it. And I thought to myself, I'm gonna figure this out and someday I'm gonna write it all down and share it with everyone else to save them 3 years of confusion. And so hopefully that's what that did. This is a really good jumping off point for anyone who's thinking about opening a practice or even trying to decide if opening a practice is the right decision for you, or if you should associate or potentially independent contractor, which We'll go through in this presentation as well. It's a great reminder for people who are already in practice and just need a little bit of a restart. You might read the book and think, man, we used to do all those cool marketing things and we should do those again. So some of it won't be news to you, but it may just spark some creativity in your practice. So I hope you take a look at that. It's on Amazon. It's a $25 investment and it's all you. It's how you can build your practice with your vision. It's not how you can build my practice. So hopefully you guys will check that out. Okay. Goals for today. So what we're gonna do is we're gonna talk about why would someone become an associate and why should someone hire an associate? So the answer, the question why. One of my favorite speakers, motivational guys of all time, Simon Sinek, is always saying why. Why are you doing what you're doing? What is your why? So every presentation I do starts with that as well. So that's the big question for today. We're gonna go through the response, the expectations we come into this relationship with, and then we're going to dial into the responsibilities and opportunities within this relationship and ultimately how everybody can find the most value. So when I wrote this presentation, I was in a fun mood. So there's a lot of little fun emojis that talk about our emotions when it comes to opportunities in chiropractic, when it comes to associates and owners, there's no shortage. So if you look at this slide, This person on the right is juggling a lot. Coffee, 2 coffees it looks like, papers, a phone, they're sweating, they've got their bag, their clock. That's an owner. Okay, owners are juggling a ton. There's also no shortage of owner, business owner memes on Instagram, or maybe I'm the only one who sees them, but we juggle a lot, right? So if that's you, if you feel like you can, you have great time management and you feel like juggling is what you're into, or just managing a lot of things at once, ownership may be a good fit. Good spot for you. If we go all the way to the right, this person is in a zen moment here, and they're an associate in a happy associateship because they have very little to worry about and they get to do the job that they have trained for and that they're most excited about. Now, who's this person in the middle? This is our independent contractor because they have a probably loosely defined job. They don't have anyone necessarily they can count on to help them, and they aren't necessarily an owner or an associate. They're sort of living in the middle, which is Great in certain situations, and we'll talk about what those are. Okay, so let's talk about associates. As an employer, why should you hire an associate? You should hire an associate only when you meet a couple of these needs. If you're trying to grow your practice, meaning you should already be big enough that you can't do it all. If, or so increasing patient loads. I'm, I'm in 4 days a week. I'm super busy. I have a waitlist. That's a great time to bring on an associate. If you're trying to increase availability, so let's say I'm in 4 days a week, maybe I'm only 75% full, but I know that if I were also open the other 2 days a week or 3 days or earlier or later by filling that in with another person, because I can't do it all by myself, that's another good reason to bring on an associate. Another good reason is if you want to offer a different service. If I'm a sports chiropractor, but I know that there's a demand for prenatal chiropractic, maybe I'll bring on an associate who has some training there. And then of course there's the financial benefit. So bringing on an associate should be beneficial financially to you. So those are all good reasons to hire an associate. Another good reason, which I think you should check this box no matter what, is if you're interested in being a mentor. If you're really not interested in being a mentor, it's difficult to forge this relationship because a lot, because hiring an associate and being a boss requires a certain level of mentorship for it to be really beneficial for everybody. So why should you become an associate rather than opening your own practice? So for example, if you would rather focus on chiropractic or whatever your profession is, massage, and you're just not that interested in payroll, paperwork, interviewing, hiring, inventory management, leaks, plumbing issues, you're not interested in any of that and all you want to do is treat, you should be an associate. And don't apologize for it. A lot of people also juggle this idea between what they should do and what they're best suited for. So some people come out of chiropractic school thinking, man, I really should open my own practice. But if you're not best suited for it yet, there's plenty of time for that later. Why else should you be an associate? Well, you're more likely to find a consistent income as well as some benefits if you're an associate versus opening your own practice. Opening your own practice is going to have long-term financial benefits, but short-term, It's gonna be a little bit tough. I know for me, probably the first 3 years in practice, I maybe made $30,000 and that was pretty much just enough to pay my student loan payments, right? So if that's not a position that you can take on right now, being an associate might be a better choice. If you still want mentorship, because let's also remember in our profession, we don't have a residency program, right? In medical school and osteopathic school, People come out and they go into a residency. The shortest residency is 3 years, so they get to work and get paid and learn on the job. Well, that's really what we're talking about here with new graduates is becoming an associate, but really in a situation where you're still learning. So if you're still craving mentorship and you want to continue learning, there is no reason to avoid being an associate. The last thing I would love for you to consider, and I don't hear enough about, is that this can be a career for you. I would love to hire career associates, and I can almost guarantee you that they will do better income-wise, work-life balance-wise, patient satisfaction-wise, if they're an associate forever versus opening their own practice. That's how my practice is set up is we all will do better working together than any of us could do on our own. All right. Let's talk about the independent contractor. I like that, Jessica, that this emoji is right over my head right now, because it looks like I'm like the one who's scattered and has no idea what I'm doing. But anyways, on the Bottom right of the screen is our little independent contractor guy. So this person, well, let's talk about the definition. The independent contractor. Let's talk about the definition. So independent person really means that they are alone. They lack a team relationship most of the time. This can be somebody who's running a room, maybe taking a percentage or paying a percentage of their treatment income to The place where they're renting the room from. But it's confusing. The parameters are unclear. Who's taking payment? Who's making the schedule? Are you listed on the website as a provider? Do you have an exit strategy? All these questions come into play. And the most important one, in my opinion, is this question about unemployment. If you're an independent contractor for 5 years at an office, And for whatever reason you part ways, your decision or the owner's decision, technically can't apply for unemployment. However, a lot of people do. And what happens when an independent contractor applies for unemployment is a lot of times the city or state will look at the definition of what this person did for a job and say, well, it looks like you were an employee. You were listed on the website. The practice made your schedule for you. You had business cards. You're not able to set your own hours, you look like an employee to me. So for all the owners listening, this puts you at risk because the unemployment insurance department can come to you later and say, hey man, this person was really an employee and you actually have to pay 5 years of unemployment insurance. And we also are going to provide them that benefit. So if a person looks like an employee, they are probably an employee. So be careful with that. But I'm gonna finish going through this slide cuz I got a little bit ahead of myself. I'm really passionate about the independent contractor conversation. A lot of owners, especially the first time you ever hire another associate, we want to do it as an independent contractor because it seems easy. We don't have to deal with payroll tax. So we go, well, I'm only, this is the first person I'm hiring. I don't wanna deal with payroll tax or deal with any headaches. Well, that's not a reason to call someone an independent contractor. Okay, so be careful. No, when you have an independent contractor working for you, no, or you're working as one, no unemployment insurance is being paid and no workers' comp insurance is being paid. So they, like I said, they can leave and apply for unemployment. They'll probably get it. So if it looks like a duck, an employee is one who follows the usual path of an employee and is dependent on the business that they serve. This also indicates a permanency of a relationship. I'm going to give you some examples in a second of where they do exist and where they They don't exist. But answer this question: how integral are the services that the IC provides to the employer's business? So for example, if I'm out of school and I get a job working 34 hours a week for a chiropractic office, and I'm on their website, I have their business cards, their staff makes my schedule, they really can't call me an independent contractor because I don't have another job that's a primary source of income, and I'm not setting my own schedule. That's really an employee. Now, if I'm out of school and I'm working for doing fill-in doctor work for people who might be on maternity leave or taking vacation, I'm 100% an independent contractor. I might be listed on the website as a locum chiropractor or a fill-in chiropractor. I probably won't have a business card. And yes, the front desk will make my schedule for me, but I'm actually in charge of saying, hey, I can work for you on these days. I can work for you on Tuesdays, Thursdays, and Saturdays, and they accept the terms. That's an independent contractor. So I encourage you to look deeper into these definitions. Definitely feel free to shoot me an email or put something in the, the chat about the definition of an independent contractor. I've got a bunch of information in here about it, but I feel like a lot of times owners take— try to take that shortcut of hiring an IC just to get a rent percentage. And make it kind of easy, but it's not about being easy. It's about making sure that we're legally meeting that definition, and IRS has a lot more legalese about defining that. Okay, enough about ICs. We're going to focus now solely on the associate employee. So let's put ourselves in the shoes of an associate. What does an associate, a new graduate or someone who's been doing this but moving on to a different location, What do they expect to happen as an associate? Well, this is sort of a brief kind of, well, pie in the sky. I expect to be successful right away and make an income. I don't, I don't actually think that's a totally unreasonable expectation. I expect to have some flexibility in my schedule because I'm a doctor and I've, I've kind of earned it at this point. I wanna be flexible, have that work-life balance. And I expect also That all of the work I'm putting into someone else's practice is going to stay with me when I leave. So that's what I think as an associate. I come in and say, well, all these patients that I'm treating right now should be my patients when I leave. I'm just going to leave that there for a minute. Now we're going to go down to what should an associate reasonably expect. So the first section there was in best case Best world scenario. Now we're gonna go to what should an associate reasonably expect? Well, reasonably you should expect to work full-time and that definition varies, but I'm gonna just go with an average of 34 hours a week, maybe up to 40 if you're doing other patient care notes. But I like to protect our bodies, not work too much. Sorry, other admin work. You should expect full-time work. You should expect to work hard. There's no shortcuts to growth in our profession. There's no shortcuts to growth in any profession. You should expect to come in and have to work hard. Nobody's going to hand you a full schedule. You should expect gradual acceptance by patients. So a lot of times when I've had an associate who's been there for about a year and they've really learned a ton from us and they're like wishing they were a little bit busier and they finally sort of find that time when they're, they're feeling good about leaving and going off on their own. They've collected so much knowledge. They've collected so much information and experience, but if they had stayed on a little longer, That tipping point of patient acceptance hits, I swear, at like the 1-year mark. So it is very gradual. Patients are pretty slow, and it's not to say they're not coming in to see you, but it takes a while to develop those relationships. Maybe 6 months if I'm— if I wanna dial that back a little bit. So expect that it's not— everybody's not just flooding into your room as the brand new shiny new toy associate and can't wait to see what you do. A lot of times they're— Super happy to see you. They're super happy that you're there, but it's very gradual, that relationship building process. And then you should also expect to help market and grow your practice. This isn't a presentation on marketing, but I'm just saying that at some point you're gonna have to input, and that may be through internal marketing, but you definitely wanna have some investment in the practice that you are part of. The reality of becoming an associate is that a lot of times associates feel very taken advantage of. They come in wanting rapid success, money, flexible schedule. They realize like, man, they're making me work really, really hard. Like Jessica said at the beginning, chiropractors have this reputation for eating their young. And I will say, I don't think it's just our profession. I hear this from dentists. I hear this from pediatricians, medical doctors as well. But you feel taken advantage of. And that's what the point of this presentation is, is how can we find that balance? Because It's no fun. However, a little bit of empathy to the other side. A lot of times owners are so worn out by the time they bring an associate in or overworked, they just wanna hand it off and say like, thank you so much for coming in. And I'm gonna have you do all of these things because you are, you are ready to go. And so that's where feeling taken advantage of can kind of come into play. Also, another reality is that the, your biggest fear as an associate is that you're sitting over here Churning, printing money for the practice and the practice owner, and you're being underpaid and underappreciated. So we want to answer those questions today because that's no fun. That's nowhere you're going to have longevity. We want you to feel well compensated and appreciated. So let's talk about it as an owner, as somebody who's employing an associate. So what do I expect when I bring an associate on? I expect them to work hard. I expect them to be happy, hopefully in my practice. I expect them to increase the revenue because why else am I bringing them on? See, these are the funny things. Kind of the elephant in the room is that the associate's like, I'm just making money for this practice. Well, the owner's like, yeah, that's why I hired you. Right? So sometimes it's like we actually are saying the same thing, but just with a little bit of a different tone.

Yes.

I want the associate to bring money into my practice. And I'm also going to expect to have a more flexible schedule once I bring somebody in to work for me. So if we remember back to the last slide, the associate's coming in saying, hey, I've earned my right as a doctor. I wanna have work-life balance. But the owner's saying, hey, I've done this for 10 years now. I'm bringing an associate in to work on Saturdays so I can have work-life balance. Again, saying kind of the same thing, but with a little bit of a different lens on it. What should I expect as an owner? I should expect to put on my HR hat because all of a sudden now I have a lot of compliance to deal with. I have all the things we talked about, payroll taxes, human resources, handbooks, even training, even down to training for harassment and discrimination and all those things. You're a business, you're a company now. So we gotta put that HR hat on. We should expect same thing, gradual acceptance from our patients. Again, we wanna bring this associate on and we want them to be busy. Because we want them to make revenue for the office. So we're not trying to hold back patients from this new associate. In fact, we're trying to say, hey, come and see this new doctor, they're amazing. Well, the patients are like, I want to see you, I'm used to seeing you. So there is going to be some gradual acceptance from patients for your new associate. So just be ready for it. And then you should also expect your associate is going to leave. Now, like I said, I am I am working toward those full-time career associates. I've got 2 great associates right now who are amazing. I don't know for sure that they're going to stay forever. Life changes, plans change. But one thing I do know for sure is that I've had 6 other associates who have left. And most of the time they are moving, starting a family, opening a practice. Never had an associate leave to another associate position, which always feels good. But they want to spread their wings and fly. So I'm saying basically right now, expect that when you hire someone that they are going to leave. They eventually will exit. So the reality of being an owner who's going to employ somebody is that we feel taken advantage of. That kind of reflects what we just saw on the last slide. We feel associates come in and take advantage of all the training, all the equipment, all the flexibility. And we a lot of times feel like we are paying them. Too much for, and earning actually not that much on them. What's our basic fear? Our basic fear, my basic fear, and in interviewing a lot of people, is that associates come in with the idea of building this mini practice inside your office. And then as soon as they leave, they take all those patients with them. And just so you know, non-competes are becoming nonexistent. Telling someone they can't compete with you, they can't bring patients with them. is something that is not really legal anymore or enforceable. And let's just be honest, with the social media the way it is now and the way people find each other, I mean, a patient's gonna find that your associate if they want to anyway. So I'm very open about these conversations, which we'll talk about later in the presentation. But my biggest fear is that my associate, having been there for, let's say, 3 years, having a full schedule of people who have passed that tipping point and learning curve of accepting my associate and loving them and probably liking them more than they like me. And now the associate's like, cool, I'm going to open a practice and I've got this ready-built patient base. That's our biggest fear as owners. I'd love to know if you have any other biggest fear as owners, we can talk about it at the end. All right. So what are our responsibilities here? So I think employers have a responsibility to wait to hire until there's a reason. We talked about the reasons in the beginning, but if your only reason is to make money, Bad reason to hire an associate. It's not going to go well. So wait until you really have a good reason to hire. Make sure that you, you have a responsibility to offer competitive pay and benefits. We'll talk about that on another slide. Make sure that the, your pay structure is easy to understand, very clear. And with that, make sure that you also include expectations of when the conversation can come up again about pay. So sometimes, and early on in my career, I have a great agreement with an associate. I pay well, we do continuing education benefits, all the things, and the associate gets a little bit of success and they want to talk to you 3 months in. They say, hey man, I'm seeing 50 patients a week now, I, I deserve more. And you go, it's been 3 months. That's not— that's zero on a scale of timeline for me. So make sure you have a Expectation that we will review this compensation structure in a year and we will, will not talk about it until a year. I mean, you can be nice about it, but that way nobody's distracted by their compensation structure. They should— the time to negotiate is before they start. And when they— and then when you have that agreement of when your next conversation is going to be, make it really clear. Make sure that your job description is incredibly accurate as well and detailed. You don't want an associate coming to you When you say, hey, I'd like you to work the farmer's market this weekend. And they say, that's not my job. It should be in your job description. In fact, just add the sentence and anything else as agreed upon with 4 weeks notice or something like that, so that you can then have those email conversations or in-person. Every time you have, by the way, an in-person conversation with your associate, make sure you just follow up with an email agreement on that. That way everyone's on the same page when we look back. Employers also have a responsibility to mentor and train their associate. I can't tell you how many times I've heard from associates who are frustrated because they're brought into a practice and they're just thrown in. Actually, I've heard this from interns as well. They're just thrown in. Okay, Wednesday's your day and I will see you on Thursday. And they are given zero training and they've got to see a whole patient load and they barely even know how to use the software. So you do as an owner have a responsibility Train your associates and mentor them. Set up times, set up meetings maybe weekly for the first month where they can talk to you about patient care, new patients, treatment plans, how that went, what you would maybe have done, what you might have recommended, conversations. How do you talk about wellness care? How do you talk about injury care? And set that up once a week for 4 weeks and then maybe every other week for a month or 2, and then maybe down to once a month, but make sure you're having ongoing communication. It'll be more fun and better off for everybody involved. Now, the next one's perhaps the most important responsibility that you have and the probably hardest and most challenging one for all of us, myself included, which is to trust your associate. If you've brought somebody in that you feel great about and you're trusting them with your patient care, then you should give them 100% of trust. And that's where open communication comes into play. If you have any doubts about the, the intention or integrity of your associate, Or how they treat patients, or if they're gonna call in sick, or how they're gonna talk about your practice outside of the walls of your practice. If you have any doubts whatsoever, it's not a good fit. So you have a responsibility to trust your associate. You don't have a responsibility to trust them if they're giving you signals that you shouldn't, but they shouldn't be part of your practice if you can't trust them 100%. And once you notice that happening, Definitely the easiest way to do it is just to have a conversation because side note, most of the time when any sort of employee is having a bad run, a bad day, a bad week, a bad attitude, they might have something going on in their personal life. And if you can show some empathy and concern and ask them how they're doing, that's a lot of times going to solve the problem that you're having at work. You also, owners, have a responsibility to support and promote your associate. That basically doesn't mean a job promotion necessarily. What it means is to let your patients know how amazing your new associate is, back them up 100%. It can feel weird to give patients up that you've seen forever, or even to have a new patient see the new doctor. But if you are hiring an associate, it is your responsibility to completely support them in your practice with your 100% support and backing. And then lastly, I think it's your responsibility to inspire them. We're here to make our profession better and to treat as many people with chiropractic as we can. And if you aren't there to inspire your associate, I think it's a lost opportunity.

That's it for today's episode. Be sure to tune in for part 2 of this series where we shift our perspective to look through the lens of the practice owner. Discussing compensation models, salary negotiations, and the key elements that make an associateship truly rewarding. Dr. Goodman will provide some specific guidance on how to structure pay, how new graduates can navigate earnings expectations, and what both owners and employees need to know about fair agreements. You won't wanna miss it. Episode 102 drops in 2 weeks. If you enjoyed today's episode, Be sure to follow, like, and share the show with a friend. You can also send us a voice or text message through our website at factorpodcast.com and let us know any topics or speakers you'd like us to cover on future episodes. And before you go, be sure to visit the show notes for any links and special offers from our sponsors. We'll see you next time. Hey guys, if you like what you heard today, I encourage you to visit our website at factor-store.com. That's spelled F-A-K-T-R hyphen store dot com to find out more information about all that we have to offer. We have a variety of online offerings as well as our hands-on Factor Rehab System course scheduled in cities around the globe. Be sure to also check out our event calendar and bookmark any of these upcoming live webinar dates coming up in the near future so you can join us live. And of course, the biggest compliment we can receive is for you to help us. spread the word to your friends, colleagues, and classmates. You'll find all the important links as well as info about our sponsors in the show notes, so be sure to check those out.