#102 - Strategies and Tactics for a Successful Associate-Practice Owner Relationship, Part 2

Welcome to The Factor Podcast, where we talk about the stuff they didn't teach you in school, how to grow your practice, refine your clinical skills, and get better results for your patients. We're here to help you navigate the real-world challenges of being a healthcare provider, from delivering top-notch patient care to running a business that doesn't run you into the ground. Whether you're fresh out of school or scaling your practice, we're diving into effective cutting-edge treatments to get patients better faster. We'll also talk about business strategies and tactics to help you work smarter and not harder, and the mindset shifts required to thrive as a top performer in your field so you can build a career you love without burning out. If you're ready to learn what works and what doesn't from leading experts, industry innovators, and respected clinicians across a wide range of specialties, you're in the right place, my friend. Let's dive in. Hi there. Welcome back to The Factor Podcast. I'm your host, Jessica Riddle, and today we're diving into part 2 of our business focus series with Dr. Lisa Goodman. In our last episode, we explored the career-defining question of whether to become a practice owner, an associate, or an independent contractor, and what those decisions really look like in the real world. Today, we're shifting gears a bit and taking a closer look at the associate-practice owner relationship from the inside out. Dr. Goodman will share some practical strategies for structuring compensation, navigating salary negotiations, and how to create a long-term partnership That benefits both the provider and the practice. Whether you're hiring your first associate or negotiating your first contract, this episode is packed with actionable insights you can put into practice right away. Let's jump in.

So little breath there, and then let's move on to what associates' responsibilities are. So jumping back to the job description, associates have a responsibility to negotiate their compensation prior to accepting the job. If there's anything they don't like in their job offer— their hours, their pay, the required farmers market stint— they should negotiate that before they start. Everyone can be really excited to accept a job offer, especially right out of school, But this is the time. If your owner really likes you and they've narrowed it down to you to where they've offered you a job, ask right then and there for what you want. They could easily say no to you, and they probably will, especially if you have a shortlist, but that is the time for the action plan. So you say, hey, I know you offered me a base of $50,000 with a percentage. I would love it if you would offer me a base of $90,000. They might say, well, I actually agree that you deserve to make $90,000, and here's how that's going to happen. And I think this can happen in the first 6 months based on your percentage. And here's what I'm going to commit to help you make that happen. If by the end of 6 months we aren't there yet, let's regroup and figure out what we both need to do to make that happen. So that's more of an action plan and open communication. But an easy one might be, hey, you get 1 week of paid vacation and you say, hey, my family lives on the East Coast, I'd really like 2 weeks of paid vacation. 9 times out of 10, they're going to agree to that. So make sure you ask for what you want before starting the job. It's honestly, it is easier to negotiate because like we said before, you may not have an opportunity to have that meeting for another year. Why do I do that? It just, it really does distract everybody when associates have a good week and they constantly want to change their arrangement. And we really should be focusing on patient care and we'll look at that arrangement. Again, in a year. Associates also have a responsibility to show up with integrity. Do what you say you're going to do. This goes to the job description. If you sign the job description and you love the practice and the owner, show up every single day doing your absolute best work with integrity. Integrity— I have 2 teenage boys— means doing what you say you'll do when no one's looking, right? When nobody else is around, you're still practicing As the best that you possibly can. So there are going to be days as an associate where your owner's not around and potentially you're also in charge of, or working independently with other staff in the office. Integrity is huge. So associates have a responsibility to show up with integrity. Associates also have a responsibility to communicate well. If you don't understand a task or a role or something that's been asked of you, It is your responsibility to ask why, why, why did you ask me to do that? Or it's also, if you find something that's not working in office that's really bothering you, it's your responsibility to bring a solution to your owner. What can you do to help the situation? Owners have a lot on their plate. We're juggling 2 coffees after all. So if you come to me and say, hey, this part of my table is really squeaky. Like, I just wanted to let you know. Okay. I will fix it for you. As an owner, that's my role. But maybe you could come to me and say, hey, I've noticed this part of my table's really squeaky. Is there someone I could email that's fixed our tables in the past? And maybe I could get them to come out during one of my breaks. You see the difference there? I'm still gonna pay for the repair, but it's probably gonna get done faster if the associate's able to take the, take the leadership role on getting that happen to happen besides just putting it at that bottom of my to-do list.

Yeah.

So associates have a, have a huge responsibility to be solution-oriented and to always ask for clarification. I also believe in under this integrity thing that you have the responsibility to take accountability. This really goes both ways. But anything that you feel didn't go great with a patient, or you know, you've been late 3 days in a row and you know that you're already on the last nerve of your owner, just take accountability. Say, hey, I've had a really stressful week. Something's going on. I will be better next week. And then of course be better. If something happens with a patient that you're worried about, bring it up right away. It's way better to bring it up before the patient brings it up to the owner. Those things can all be worked through. This is all communication. And again, as an associate, if you don't feel like you can bring that to your owner, if you don't think that's going to go over well with a solution-oriented conversation, might not be the best fit for you. There are a lot of owners out there who aren't great at communicating and don't want to hear it. And that's not going to be great for your growth and to be feeling inspired as a chiropractor. Associates also have a responsibility to be loyal. I love it when my associates share our Instagram content. I love it when they share where they work with their friends and family. I love it when they talk about us wherever we go. I love it when they stay with us for more than a year. We'll talk about kind of my 3-year plan, 3 to 5-year plan as a good starting point. It's, it's important to feel loyalty where you work. You aren't the owner, but to feel some kind of ownership goes a really long way for you. We'll talk about trust again. So I think on my last slide I might have had a little footnote about this, but one of my favorite books is The Speed of Trust, and it really talks about trust from the top down and the bottom up. So in a chiropractic practice, if owners trust their associate and associates trust their owner, that's where it all starts. Beyond that, our patients have to trust us. So if there's a breakdown at the top, our patients can see that and they can feel it through email communication and also through all the other staff have to also trust the doctors in the practice and back and forth. And we have to trust them. But it also goes beyond that into the community. The community has to trust your brand and has to trust chiropractic. So at the end of the day, this all goes back to also making sure that our profession is being trusted. So trust your owner. And again, if you don't feel that you're in a situation where you feel trust with your owner, reach out to me. Maybe I can give you a couple of tips to help get inside their head and talk to them. But I will tell you that having internal conversations with yourself, or worse yet, having conversations with another employee about your frustrations without bringing a solution or bringing it direct is a recipe for complete disaster. So Always go direct. Reach out to me if you need advice. I oftentimes do quick 15-minute phone calls with folks just to kind of get them put on the right foot, because I want you to be happy in what you're doing. Give 100% all the time when you're at work. Give all the time. As owners, a lot of times we don't feel— we feel like we're giving all the time. And sometimes it does feel more like financial and supplies, but we love to feel people giving back to us. And that always results, should always result in more success and financial success for you as well. If you show you're invested in the practice, it will come back to benefit you. As an associate, you also have a responsibility to provide a clear exit strategy. So let us know when you're leaving and I'll talk about that more in a minute. Okay. So I'll go through this one a little bit quicker so we can get to the meat in the last couple of minutes. Employers have an opportunity here. As an owner, we bring on an associate. We have an opportunity to expand our hours, expand our expertise, offer more services, definitely increase revenue. But how about this one? New ideas, new growth, new blood in the practice from a new graduate who's, who's got, hey, have you guys considered getting rid of your paper travel cards and doing it all digitally? I remember when that someone brought that to me and I thought, never get rid of these paper cards. And then we did, and it's been amazing. Okay. So new ideas, new growth. We can also diversify as owners. We have an opportunity now to do side projects, AKA writing a book and helping the profession when we bring associates on. And we have an opportunity now to spend more time on building our brand and our practice than just doing it by ourselves. We also have an opportunity for mentorship. Associates, your opportunities are awesome. You have opportunity to have a low stress job. If you don't have business experience or desire, being an associate in the right practice is the way to go. This is very low risk. We're going to talk about risk and reward in a minute, but maybe I'll talk about it now. Owners have pretty much all the risk. So sometimes when people are evaluating compensation structure and they think an offer of 35% is way too low, well, what has to be taken into consideration is The 3 months it took to find the right associate where the owner has spent more time on interviewing and training than they have on the business or treating patients. They've lost revenue there. And then they take on all the risk of investing financially into you, but also just energy and time into you as an associate. And then the associate eventually will move on and they have to do that interviewing and training all over again. So there's a lot of risk because we never know when associates are going to leave. So sometimes you want to weigh the income and benefit with the amount of risk you're putting into a position that versus the amount of risk your owner's putting into a position. But associates can make a very good income and should have very good benefits. Your malpractice should be paid. You should have health insurance offered to you. You should have continuing education offered to you. These are things that I think any good owner would offer to you. You should have paid time off. Associates will gain instant credibility if you join a practice that already has a great reputation. very easy to bring in new patients when you're at your gym. You mentioned you noticed somebody has something, a low back issue they need support with, and you can say, hey, are you— do you have somebody who's working on that with you? And they say, oh no, I don't. And you say, oh, I'm just right over here at Washington Park Chiropractic. They've heard of this name for 20 years, so instantly they're like, oh yeah, I'll come, I'll come there and see you. So instant credibility as an associate. You'll also get priceless mentorship if you're in the right Program. You will get tons of clinical experience. You'll gain all kinds of experience and things that you aren't comfortable with yet, maybe ordering imaging or how to talk to a patient about something really serious that you've discovered, or working on those acute cases. Um, associateships should be fun, should be a fun team. Even if it's a team of 2 or 3 people, it should be a super fun team. And then you have an opportunity to make this your career. Okay. So I think we're all on the same page now, um, as far as Communication and trust, and those things being the foundation for a good relationship between an employer and an associate. So how do employers show associates that we value them? Well, the first thing is pay them. I'll tell you what, people like getting paid well, and people don't want to feel like they're being paid very little. That doesn't necessarily mean you have to offer a high base or even a salary. You can do a percentage base or a scale based on the number of patients that they treat, but make sure that you're paying them. I prefer a retention bonus versus a threat of legal action for the idea of the non-solicitation non-compete agreement. So what I like to do is set up a An agreement with my associate that if they stay on for 3 years or 5 years or whatever you think is reasonable, that at the end of that time period, they will earn X money as a retention bonus. So that's a thank you. It's almost like being vested. Like, thank you for being here, for showing your loyalty. And I'm gonna write this check or whatever it is, 90 days after their 3 3-year anniversary. So why 90 days? Because it's a retention bonus. It doesn't have to be, it's not something I'm taking away from them. It's something I'm choosing to give them. So I can say, I'd like to give this to you if you don't send out an email soliciting the patients, or if you don't open across the street from me. And so that's why we set it up for 90 days out, for example. So these are, I've never had a problem with this and I've even actually had associates want to email patients and I'm more than, I'm like, go for it. More than happy to. This just comes down to communication. It just comes down to making sure everyone's on the same page. And I say, you know what, that those patients loved you, go ahead and email them. I'll tell patients where my old associates went because I believe in the benefit, the growth of chiropractic. But I think a retention bonus goes a really long way to retaining an associate for 3 years. Without it, it's like a contract, but it's only really worth it. All contracts have an out. All contracts have a 2-week or 4-week notice or something like that. At-will employment. You really can't hold someone to it. But if they know they're staying for a potential bonus, they'll probably be more likely to give you 3 years. So feeling valued. I like to pay my associates. I like to provide a retention bonus. And they also, by the way, can stay on after 3 years and they still get the retention bonus. So if someone's like, hey, I'm, I'd like to sign another 3-year contract and I want to keep them, I'll pay them their retention retention bonus and sign them on for another 3 years. So definitely occasionally gift your associates when they're not expecting it. Give them bonuses, give them gift cards, give them time off, buy them lunch. Those are really easy things we can do to make sure our associates feel valued. Pay for continuing ed. I've got $500 for my associates in continuing ed every year. But if one of them came to me and said, hey, I'd really like to do This $3,000 pediatrics program, I'm like, oh, I'll pay for that. But can we extend your 3-year contract by another year or something like that? And for CEUs, you actually can recoup the payment of a CEU if the, if the associate doesn't stay on as long as was beneficial to your practice. So just look into the verbiage of that and make sure you give them time off. You can also make sure your associates feel valued by giving them responsibility within the practice. So there are things.

Mm-hmm.

And work on what their strengths are, right? There are things, areas where they're going to have a lot of strengths to offer. Maybe one of your associates is great with social media and reels. Task them with that. Can you make 2 reels a week for us? Give them the responsibility, but also give them the autonomy to sort out how to do it and make sure you tell 'em why every time. And it's like, hey, because I've noticed that you do awesome social media, would you do that for us? And maybe pay them for each post that they do or something to that effect. Or maybe pay them if every time they get 50 likes or 10 shares Or something like that. So give them, give your associates some responsibility. And then lastly, to help an associate feel valued, you really want to make sure you listen to them and hear what they're saying. This falls under trust. Make sure you always do have time to set aside. If somebody wants to talk to you, put everything else aside. Yeah, I have 5 minutes. I have 10 minutes. Let's talk now. One little tip I want to give owners here is when you have an associate or any employee who wants to talk to you and they will, they'll just bring up random problems that Bad times. You're like, I am on my way to pick my kids up and you're bringing this up now. Don't worry about it. Let them bring it up. Listen, say, hey, yeah, I, you know what? I have about 5 minutes. I gotta pick my kids up. Tell me, tell me what you wanna tell me. They're gonna bring up whatever. Hey, I haven't had a raise in 5 years or something. Or they're gonna just bring up, hey, the hydrocolator's been broken for 6 months. Don't get mad. Don't get upset. Don't get defensive. Just take in the data. It's just data points. You just say, hey, I appreciate you bringing that to me. Let me take a, take a few minutes or a few days or a few hours to think about it. And we will regroup and talk about this later. Whenever an associate or an employee wants to talk about something, you're not required to give them an answer during that talk or meeting or email. So take a minute, think about it, chat with somebody that you trust about the answer and bring it back to them later. So make sure you listen, make sure you hear, and make sure eventually that you respond in a way that helps them to feel valued. And give them leadership role eventually. Everyone in our office is a leader. Another Simon Sinek, right? Leadership at all levels is really important to me. Everybody at our office fills a leadership role, even our interns. Associates, how can you help your employer feel valued? So this might also hit a nerve with employers. I don't know how many of you guys out there, I know I do. I know I just feel like I do so much for people. And oftentimes, all you hear about are the things that are broken, They're not getting paid enough or the work is too hard and the hours are too long or whatever it can be. In years past, I'm talking about, I really don't get too much of that now, but it's hard. It can be so hard to employ people and multiply that by one associate, by 4 associates and some, some other staff, maybe 10 people. Every single one of them has something that they need help with. So how can we feel valued by our people? Well, we wanna see our associates feel, not feeling, but like showing they're invested. Are they contributing to the positive culture of your practice? Are they emulating the mission and the values that you built your practice on? If you haven't done your values and mission statement and thrown that up on your website yet, or your handbook, put that stuff down. That is so, so valuable. And your associates should show up every day showing you that they're part of the investment of your practice. They should contribute to your growth by either internal marketing, AKA patient communication and good treatment planning. They should anticipate your needs. They should come in and say, hey, I've noticed so-and-so's struggling a lot. His wife is sick. Maybe I could pick up a couple of more shifts until something gets better with them. Like, are your associates anticipating your needs. So I think associates can really add that in. It goes a really long way. Associates can also help us feel valued by open communication. Be respectful with communication, be direct and upfront. There's no reason to talk about a problem first with a lot of other people. Just bring it to the person who can make the difference for you. And then show your appreciation. Say thank you. Bring your boss a coffee once in a while or a tea. Associates also should show and demonstrate leadership and integrity. This is how this will help me feel valued as an owner. And they should ultimately trust and respect the process. We talked about that, just putting out there that the process is that we're going to do a review in a year or 6 months. And I'd rather that we write all your ideas down, write everything down as far as what you think should happen, but let's have that conversation in 6 months or a year. Respect the process. That isn't to say they shouldn't bring any, any small topics up or things they need corrected. In the meantime, I'm just talking more about the compensation structure at that point. And then they should show loyalty to your brand. Okay, so getting paid. We'll talk briefly. I don't want to take up a whole bunch more of your time. You guys have been a great audience, by the way. Getting paid. Here are your 3 choices. You can offer somebody a salary. This— a salary only adds the greatest amount of risk to the employer. When I offer somebody a salary of $90,000 a year and on their first day they have 12 patients during that first week, I know I'm gonna have to find that salary money somewhere other than what they're producing. So that is all risk on me. But if I'm confident that I can get them up to whatever number of patients they need to see to pay that salary in the first 3 months, that might be a really good space for you to be in. Certainly a good space for the associate to Or you could offer a complete commission structure. This puts almost all the risk on the associate. Okay, hey, I will hire you. I'm gonna pay you zero, but for every patient you see, I'm going to pay you $20 or 40% or whatever it is, maybe $50. That's a commission structure and that's 100% on the, the associate. So not a great deal if the associate's trying to pay bills and get on their feet after school, pay their loans. But a great deal for an owner because the owner is like, doesn't cost me anything until you start seeing patients. Enter base plus commission. So this is a great way to feel respected. Okay, great. You are right out of school. I'm going to offer you $50,000 base. And for every patient you see, $20 or 35% or something like that. So most of the time you can do your math, your breakeven at $50K a year is Maybe 20 patients or sorry, maybe 50 patients a week. So if you're confident that within the first 3 months, your associate's gonna see 50 patients a week, that's a pretty good base salary, $50,000 a year. And then for everyone over that, you can create your structure however you like. So base plus commission is sort of sharing the risk and it's showing some respect to the new associate and also making sure that as soon as they go above and beyond that number of breakeven patients a week, that the owner is going to make some money too. So that's, those are kind of your choices. I personally like the base plus commission the best. And remember when we talked about the residency, some of you out there might be saying $50,000 base, how can I live on that? Well, again, this is like a residency and this is somebody who's taking a chance on you and having to train you and making sure that you're a good fit for the practice. And it can be 6 months to a year before you're bringing any revenue into the practice that's going to cover the base that you've been offered, even at something like $50,000. In fact, I'll address that question too. We are all small business owners, small practices, tiny entrepreneurs, right? So if you wanna make $90,000 coming outta school, you can, you can go to The Joint or you can go to another type of franchise. These models are now available to us. There are also spas, medical spas, Canyon Ranch, places like this that are hiring, or even Google, Facebook, right? They're hiring internally corporate for chiropractors. So those jobs do exist. I'm not trying to say they don't. But for most chiropractic offices, we are small businesses. We can't just offer $90,000 out of the gate, even though you may feel that you deserve it. The other thing I'll add to that is when you come out of school, you absolutely have the degree you earned. You absolutely are a doctor of chiropractic, but you have zero experience. And one of the things that earns more income for anyone in any job is years of experience, not just the degree coming in with it. So those will all go up. Every single person I hire, I'm like, yeah, this is going to be great for a year, but a year from now you'd be making twice what you're making right now. So I encourage you as an associate to be patient with your earnings. It's not all going to come on the first week at work, but it is going to come if you do your part and I do my part and we're all in it together. Trust me, everyone's going to be happy financially. So what do I think is the perfect Associate relationship is something that involves mutual trust, something that is longer-term agreement. 3 to 5 years is great. A relationship that involves mentorship from the owner and leadership and autonomy from the associate. So I'm not having to micromanage. I'm not having to check up on everything because it's just obvious it's being done. Something with competitive pay and benefits. Something that is I like a base plus commission. I like a work hard, play hard environment. So when you're at work, you are doing your work with integrity, doing what you said you're going to do, and making sure that when you're outside of work, you're having your free time. You are not called on upon at all, and you can go hiking, skiing, travel, hang out with your family, and in all that free time that you deserve. This job should— this relationship should have fair and clear expectations. Making sure that everyone's on the same page from the jump. And anytime throughout the relationship that either person is feeling undervalued, disrespected, untrusted, that should be a conversation instantly. But remember to bring a solution to it. Both sides. If you aren't happy with whatever's happening, come in with a solution or ideas. Also remember that any conversation you have right away doesn't have to come with a solution that day. It can come with a solution later on that day or the next day. It should be done pretty quickly. Never offer any threats. Never threaten to sue someone. If you are in a situation where you are feeling like scared that this person's gonna take advantage or steal information from you or steal patients, and you don't feel good about it, and that's leading you to threaten them, I mean, this is not a good relationship and it should probably end. There are awesome associates out there. So if you ever have to end a relationship with somebody, it is difficult to put the effort into finding a new person, but more often than not, you're gonna be really happy that you did. Same thing with associates. If you're unhappy or feeling like you don't love the owner that you're working for, there are really good opportunities out there. I also know some people who set relationships up with owners and associates. So if you want to reach out to me about any of those resources, let me know. I don't currently do it, but I have really good people who do. And then I do think the perfect associateship includes a retention bonus and a clear and easy exit strategy. And what I mean by that is if you know Your 3-year anniversary is coming up in October. You and your owner can start talking about that now and say, hey, what are you thinking? Are you thinking of staying on? Are you thinking of leaving? And they're like, gosh, I really want to, I think I'm ready. I think I'm ready to open my own practice. We can still be really supportive about that. We can share our templates that we've used in our EHR. We can share marketing ideas. We can potentially even say, hey, would you like to spin off and open a location that has my brand on it? Or could I invest in your practice? I mean, there's so many great positive things that can happen. When you have open communication about your exit strategy versus being afraid, socking away money, trying to open a spot, not telling your owner where you're gonna open it, telling all your patients secretly to come see you. Honestly, it can all be out in the open if you ask me. It can all be mutually supportive and beneficial. And so I think a perfect associateship includes a clear and easy exit strategy. This should also be the true value in hiring and becoming a chiropractic associate. Should be a win-win. Associates should be doing what you love. Owners should be reaping rewards of hard work. When you're eventually able to support an associate, you deserve to reap financial rewards and also some flexibility rewards for that. And I don't think we should necessarily have to apologize for that, but just make it clear. I'm not here in the office on Thursdays, Fridays, and Saturdays, or whatever your days are. And that is, that's the ownership and responsibility of the associate. And making sure they understand that, that that's their role. Strength in numbers. So when we have more people, we will all do better financially. We'll offer more services, we'll reduce our total overhead, and we'll have a lot more really fun clinical cooperation. We can transfer patients to each other versus referring them out to another provider. We will have improved brand value with our diverse services, more availability, and a larger network of brainpower and chiropractic adjusting power. improve our brand value by hiring an associate. And then never forget this, that abundance begets abundance, right? High tides raise all ships. What's good for chiropractic is good for chiropractic. I would want anyone who opens a practice across the street from me to be successful. I believe the more successful our profession is, the more successful all of our individual practices will be. And same within your practice. If you have a situation where your associate is competitive with you as an owner, or your owner is competitive with you over patients as an associate, I don't like it. And if you have 2 associates in your practice and they're being competitive with each other, who gets the new patient that called in from Google and who gets this referral? I don't like it. So those are things you want to work a strategy around. Sometimes that can come from a compensation structure that is driven more toward commission versus more toward kind of an overall success for the company. So again, I can talk about with that with anyone separately if you're interested in knowing more about that, but competition is not great when it comes to that kind of attitude inside a practice. And then hiring an associate is always going to be a cool teacher-student type of relationship where everybody can learn from each other.

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So this is my info. You can read chapter 1 of the book online for free right now. You can order it on Amazon. And I would— I went a little longer than I think I was supposed to, but I hope that was really helpful and good information for everyone. I would love to answer some. If there's any questions in the chat, let me know. Let me know what you have, Jessica.

Awesome. Thank you so much, Dr. Goodman. This was really great information and we've gotten a ton of great comments and questions in the chat here. I'll try to take these kind of one at a time.

Okay.

Someone was asking earlier about that they're a little bit concerned, or one of their fears when it comes to hiring an associate has to do with not only associates potentially taking their patient base, but then those other professional referral relationships, right? Like if you enter—

Lawyers.

Exactly. Lawyers, other healthcare providers. Maybe you're into doing like sports or rehab. It might be gyms in the area, things of that nature. How do you handle those relationships in your practice and make sure that you're still maintaining that relationship?

Right. So it ha— it still happens to me as trying to free up my time. We will get an email from someone who wants to meet with us, like a pelvic floor therapist who's like, oh, I'd love to network with your practice. And I instantly think, oh, Dr., my associate, Dr. Andrea would be great to meet with them. But in the back of my mind, I'm like, wait, then I'm not making the relationship with them, but Dr. Andrea's making this relationship with them. So it's, it kind of is actually the same, the same. It's a fear, right? And so I think, I don't know if you're gonna love this answer, but I think that when you've jumped into trusting your associate and building that relationship with them, you have to go all in with it. And so you have to allow them to meet with that pelvic floor therapist and then ask them to report back to you and tell you how it went. It's like you kind of do have to give it up, but there are ways to integrate it to make sure that you also create that relationship. So perhaps the associate who met with them copies you on a follow-up email. Oh, it was so great to meet with you. I'm copying our owner here and I know she's going to be really interested in referring her patients to you as well, or the patients she sees. So making sure that you are connecting the dots, or after the initial meeting, maybe there's an opportunity for a happy hour because it's— let's say it's a law firm, we do personal injury cases, and you have one of your doctors meet with a lawyer and he's like, yep, these people are great, we want to meet with them. We say, well, why don't we set up an after-work happy hour so the teams can all meet each other? So maybe there are ways to have them do The initial meet and greet, but you do just something together as a team later. But the more you want to extend into the community and the more that you want those relationships, which I have a huge— I have a whole chapter about that in the book because I think grassroots is the way to build the best community-based practice. You just want more and more and more and more of those meetings. You can't do them all yourself. So at some point, I think we do have to have an associate that we trust. And when they eventually do leave to open their own practice, they are going to take those referral relationships with them. And you're going to start from point B again. The last thing I'll say on that is that I did write in the, in the presentation, the reality is expect them to leave. So I do think that if we set our expectations that the associate's going to leave, they're going to take some patients with them and they're going to take some referral relationships with them. It makes it less of a blow when it actually happens. And that, that's more of like the reality that it is going to happen. Absolutely.

And when it comes to your associate leaving or kind of spreading their wings or even expansion, I know that oftentimes a doc may hire on someone as an associate. And then at some point, if things are going really great, they may offer them an opportunity to buy into the business or potentially expand into a second location. Do you have any kind of advice, best practices, or thoughts on Making that decision of that tipping point of like, okay, now we're ready to double down and, and give this associate their own location and allow them to become not only an employee, but an owner.

An owner. Yeah. I mean, I think it's the same decision that you make when you're first hiring an associate. So your associate should be incredibly busy before you even think about adding another location. And they should be somebody who has shown leadership in your practice. They should be somebody that you, they can, they could handle any sort of billing issue question, any sort of maintenance issue, any sort of HR issue that you would trust them to interview your front new front desk office manager for you before and choose who to hire. These should be things you've trained for a year at least where you've given them more and more and more responsibility before you start talking about. The worst thing is, is if you get put in a position where an associate says, hey, I'd really like to open my own practice. And, and you're stuck with like 2 weeks to decide, ah, do I offer to support them in a, in an expansion role? Or it, it should be something that's been happening over a year, I would think. And that they've really proven that they're invested there. They've got integrity, they've got trust, and that they could take on any, anything that you've taken on as an owner.

Absolutely. Someone else was talking about their apprehension in hiring someone is With the variable nature of insurance reimbursement, with the variable nature of sometimes doing personal injury cases where you might see a patient for quite a while before you ever get the payment from the attorney or from the settlement, what advice would you give to someone that has a variable income stream like that to kind of help them mitigate their risk when it comes to giving a flat salary? Or is that the type of scenario that really works best with that? Small base plus commission with the understanding that it takes time sometimes to realize the income from some of the reimbursement?

So this is why, for those of you still hanging onto this chat, this is the meat, the, the juicy stuff. This is why I don't do a percentage. I do a cost, a flat rate per patient seen, because I will choose to pay my associate for seeing that patient cuz they did the work today. I'm gonna pay 'em at the next pay period for the work they did. I'm not gonna wait until that check for that visit came in and pay 'em a percentage off that check. Or worst case scenario, the lien comes in 3 years later and now I have to pay them off that lien that came in. So the way we structure it is that if a patient sees 50 patients a week, that averages out to $50,000 a year. Let's see, how's a simpler way to say this? Well, let's just use 100 patients a week.

Okay.

So if you have 100 patients a week and you've done the math and you say, well, we collect about $65 a patient, $6,500 in a week, I'm going to pay them 40%. So I'm going to pay them whatever it works out to, $100,000 a year. So you go 100 patients a week, you're making $100K. Does that sound good to you? That sounds great. So what that does is it averages out a Medicare patient. You might get reimbursed $20 for a car accident patient. You might get reimbursed $280 for A regular patient who bought cost-saving package might only pay $60 for that visit. And a regular patient who paid time of service visit might pay $80 or $85 for that visit. You're taking all those numbers out of it. You're simplifying it for your associates. You're saying, hey, you saw 100 patients this week. I'm plugging into your salary is $100,000. The next pay period, you only averaged 90 patients per week. I'm gonna plug in $90,000 as your pay for that period. So at the end of the year, that's gonna average out to whatever your actual salary was. But pay period to pay period, I like to pay based on the doctor doing the production, not the actual payment. And the reason that that also helps a lot with— I'm going to answer the first part of your question with long-term planning— is if your associate does leave and then you receive a lien in 3 years later, there are times where an associate will say, hey, when that lien comes in, remember I get my percentage off that. And that might hold up. So it's better to not have to wait for a lien or an insurance payment to come in to pay the person who did the work. So to answer the first part of your question, how can you do that with an unstable— you're sort of like not sure you're gonna be able to have the money to pay them until the insurance check comes in. That's where you have to make sure that your base is something you can afford before you hire an associate. So you may wanna save. And there's a book I love called Profit First. First, Mike Michalowicz, who talks about setting up different bank accounts for future planning expenses and savings expenses and paid time off expenses and things like that. And you may wanna make sure that you save enough to pay at least 3 months of base salary for somebody. And then at that point, if they should be up to at least breaking even for you, so you could afford them for another 3 months at break even. And then at that point, they should be profitable for you. So I like paying based on the productivity the day of versus waiting for payment to come in. I completely agree with you there.

And I think anyone in any type of role or job may get frustrated if they feel like they're doing the work, but then they're having to wait for payment on that and they're like, I saw the patient. I think too, sometimes when you attach their reimbursement to what they're billing, then that brings in kind of the question, especially for new docs.

Yeah.

Like, are they overbilling services? Are they doing things they don't necessarily need to do for that patient just in order to get a higher reimbursement.

And that opens up a whole nother conversation about this. What is the practice? What is the style of your practice and what are your goals? If you're, if you're treating patients for financial benefit, this is the wrong room to be in right now. If you're treating patients for patient benefit and understanding that that is gonna grow your practice in spades, this is the right room to be in right now. So yeah, I think paying for people for the job that they do matters.

We have a few associates here in the room and one of them was asking, after my first year, I've done an amazing job. My boss is really, really happy with me. How do I kind of broach the topic of asking for a pay raise and what should I base that on? Like, how should I quantify? Like, I would like to make this based upon XYZ, because it's always better to go into those conversations with some hard numbers and some justification for what you're asking for.

Okay. So I've had associates ask me, once they're a year into an associateship, who have not completely met their goals yet. They're doing well and I'm happy and I love them, but they haven't completely met their goals yet and they want a raise. And sometimes they say, my rent went up and I need to make more money. I will tell you right now, that's the worst thing you can say to somebody because we all wanna make more money and we all have expenses that went up and we get it. But it isn't the reason that you should be paid more. The reason you should be paid more is because you met your goals and you're trending in the right direction. So here's what I have to say. This may be an unpopular opinion, but it's factual. So let's use our example of 100 patients a week, $100,000 a year. Now our, we do 15-minute appointments in our office. The most an associate probably could see with a 4-hour, 4-day work week is like 100 patients a week.

Yeah.

So if they're seeing, so they've been told, if you see 100 patients a week, you make $100,000. If they see 70, 60, 70, 60, 70, 80, 70, 60, and a year now they go, hey, I know I've been doing great. My patients love me. I've done all these things you wanted me to do. I'd like to talk about a raise. I'm still looking at the schedule and saying, you have a built-in raise. If you can get to 100, you make more money. So what that means is if, if an associate still has control over their income by more production, there's not really a conversation for a raise at all. If they've hit 100 patients a week for 6 months and they have a waiting list, That's an easy conversation. I probably will mention giving you a raise before you'll even ask for it at that point. So it's not necessarily just about, did I, did I do everything on my job description to-do list with integrity and trust and a good attitude? It still comes down to, do I have the finances to— does the owner have the finances to pay? And the way they'll have the finances to pay Is if you have a full schedule with a waiting list. And so once that happens, that should be an easy conversation. Hey, look, I've been full. I have a waiting list for 6 months. I'd like to talk about a raise. I mean, they should say easily, yeah, I'll give you $110,000, $120,000, $150,000 a year for that matter. If that's all, if that's what you're going to do and I don't have to do anything to get you there, that's where that conversation comes into play.

Tell me a little bit about some red flags that you should look for when interviewing. And this could be if you are the doc that's looking to hire on an associate, and then what are some red flags if you you're an associate and you're in an interview for potentially joining a practice?

Okay. I'm going to answer in reverse. If I'm an associate and I'm looking to join a practice, I want to meet other people on the team. I want to talk to the owner, obviously, but I'd rather more people in the interview. I might even be outgoing enough before the interview to say, hey, if at all possible, do you interview alone or do you have other people join? I'd love to get a sense of the team dynamic. So red flags would be if you're being interviewed solo and you don't get to meet anyone on the team. The second thing is I recommend asking if you can speak to a former associate or a former intern or someone who doesn't even work there anymore. It's almost like a reverse reference. Can I call someone who used to work here and ask them about it? Those are 2 really good ways to understand if the fit is right for you. Oftentimes as owners, we just want to find someone who's a good fit for our practice, but it's as important that our practice is a good fit the associate as well. So those are 2 kinds of recommendations to avoid red flags, but red flags, I think it's, it should be fairly evident that if an owner is, is very demanding in the interview, wants you to do spinal screenings 4 weekends a month, every weekend without compensation, I should say, without proper compensation for those side gigs, wants you to work more than 40 hours a week. Is, is giving you too much information without proper training. Some of this kind of rolls into the first few weeks on the job too, which are probably your best time to listen to your gut. If it feels nurturing and like someone's really providing a lot of information for you, a lot of training, that's going in the right direction. If somebody's leaving you kind of hanging, leaving you high and dry, I would say for— I'll kind of roll this now into the other role, but For both parties, an interview should feel— it should feel like you want to hear more from that person. You want to hear more. They're talking to you. They're telling their story. They're talking to you about how they do patient care treatment plans or how they have treated previous employees, kind of going both ways. When they're answering questions, it should not be an answer to a question and period. It should be the answer to a question that just leaves you wanting to hear more about how they do that. People should be able to, to tell a story. So that's gonna be the relationship that they have with your patients as well. So as an owner interviewing an associate, I already mentioned one of my biggest pet peeves was, why are you interested in our practice? Or why are you interested in working here? And they say, oh, I just, I'm looking for anything right now I can get. You will be shocked at how many people say that. Associates should have looked up your practice, looked at your social media, know what your specialties are, know where they can fill in the gaps, offer solutions. So anyone who kind of gives you a generic answer that shows they haven't even looked at your website is immediately out for me. Immediately out. Anyone also who didn't write a cover letter is immediately out for me. I like an email or a cover letter or something that introduces them to me. Anyone who doesn't have any questions to ask when you say, what questions do you have for us? And they say, oh, nothing really. Anyone who's late for an interview is out immediately. They should leave time to find your practice. And then if they do ask those questions that make it sound like they're competitive in nature, how do we make sure that I am equally getting new patients as the associate you already have? Or how can you guarantee I'm gonna see more patients? Or things of that nature where it's just really how the questions are phrased. I think they're fair questions. It's just more not Not as solution-oriented questions. So trying to guide those, trying to guide the interview in the direction where you're gonna, where you're gonna gain information about how they can provide solutions to your practice versus problems. Oh, and lastly, always ask them about a former job and why they left, or a former, a conflict with a former coworker, because the first thing you want to see is, did they take any accountability? For that conflict, or did they, or do they come into the interview and completely blame the conflict on the situation, the management, or the team? Because that can happen, but it's most likely going to happen to you if it already happened to them as well. Oh, that's a really great point.

I think that's a great takeaway for anyone who's interviewing someone for a position. Like, how does that person have personal accountability for their actions or their role that they played in any type of conflict or difficult situation.

Now, I— I interviewed somebody last week who, for not an associate position, but something else, and asked her what she liked about her former job. And she said, I loved the team. I had such a great team. I loved going to work every day. Fast forward down the interview a little bit. When I asked about how she helped at her former job, she said, well, a lot of times people would not show up for their shift or not come in. And I said, Well, earlier you said how much you loved your team, but now you mentioned people not showing up for your shift. So how did you, did you love those people as part of your team? And she said, honestly, like, I just always was trying to help the team be better. And just, it showed that she looked at it as like, what could she do to like the team more? And she never said, well, those people brought us down and those people were negative. She said, well, it wasn't their fault they called in. I was trying to help. So it's just different how people answer that question. And it'll make you again, like, wanna hear more like, oh, that's good. What else? That kind of thing.

Oh, absolutely. A lot of docs I've heard will require a preceptorship before they consider hiring someone as an associate. That's kind of the first step, right? That's the long-term training wheels. Let's try each other out type of scenario. I've often heard of a lot of students who always wanna precept before they consider joining a practice. What has your experience been with preceptors, and do you recommend that as well? Do you feel like that's a great proving ground, so to speak?

Okay, so this also might be a slightly unpopular opinion. I have interns. We have an intern plaque, a wall of fame, so to speak, with everyone's name on it. It's awesome. I love all of my former interns so much. It doesn't— it hasn't gone great to hire an intern, and I'm gonna tell you why. And I'm not saying you shouldn't do it. I think a preceptorship's awesome. Because it is like a 3-month-long job interview or a 2-month-long or 6 months, however long job interviews. You really get to know the person. And I'll tell you, 100% of the time, if you love your intern enough to hire them, they're gonna do everything they say they're gonna do. They're, they're gonna come to work with integrity. They're gonna— patients love them already. They're— they fold in easily. Hiring interns is one of the easiest things you can do. I, I know I already spoiled the punchline, but Hiring interns is like the easiest thing you can do because they, they know your practice, you know them, you trust them, your staff knows them, you've been adjusted by them. They're amazing people. The problem is when you are somebody's first employer, they always wonder what else is out there. They're always thinking about the grass being greener, or they're hearing from somebody else. Who had an inter— who have— has a preceptorship, what they're doing, or they're hearing, thinking maybe, in fact, you make it look so easy because your office is so cool and easy and awesome to work at. I have had— I think I've hired 3 interns, and after about 1 year, they've all left because they've opened their practice. They've been ready. That you've prepared them so well that you prepared them to leave. And I laugh and I smile because I'm still friends with them, and I support them, but I'm like, ah. So let me tell you the flip side. If you hire somebody who's worked at a personal injury chiropractic firm for 3 years and they've treated 300 patients a week and they got paid $60,000 a year and they had to wear scrubs or a uniform or something and they are sweating and they're overworked and their body hurts and you bring them into your beautiful, gorgeous oasis of your practice. And they're not interested. They, they could be opening their own practice right now after 3 years of experience, but they don't want to. They want to be an associate. You bring them in, you say, ah, come on over here. I'll take care of you. You pay them better. You give them better benefits. You give them better uniforms or whatever they wanna wear. The appreciation is through the roof from that associate cuz they've already seen what else is out there, if that makes any sense. So it doesn't have to do with the interns. Interns are awesome employees. It more has to do with their process and their drive and their desire. And they, and they've never seen anything other than what you've had to offer. So I find with 18 years under my belt that some of the absolute best people I've ever hired are people who've spent a year at the joint or spent 3 years at a personal injury law firm or moved to town and had worked as another associate. I've never hired an associate from in town that is just switching practices.

That is really insightful.

I haven't heard that perspective before.

That, that's pretty great. I have one final question here, and then if anyone else has any questions or comments, please go ahead and leave those in the chat. I know we've went a little long, but this has just been such great information and conversation here. Someone was asking about, as an owner, what do you do when your associate doesn't really want to build the practice? They're happy to work only part-time hours. They're just kind of sitting back on their laurels and are completely complicit in being and just fine being where they are.

Okay. So I've had these associates and what happens is people will put an internal threshold on themselves. So you've asked them to see 100 patients a week and you know it's possible cuz you've had other people do it and you do it yourself, but they literally are always at 60. They will never go. You're like, you're bringing in new patients. Your other patients are converting to wellness care. How in the world can you not go over 60 patients a week? There is something that happens where they, they know it and it may not even be conscious, but subconsciously, however they're scheduling their appointments, they're very comfortable with seeing 12 patients a day or 14 patients a day instead of 20 or 24 or 25. And that, that'll just continue. That will continue. So you have 2 choices as an owner. If you don't love the associate and there's other problems with the relationship, then just end it. If you love the associate and your patients love them, and they're probably going to be around for a while, there's a lot of benefit to that. So you need to change their arrangement. They can't work anymore an 8-hour day if they're only using 3 hours of it for patient care. So at that point I might say, hey, I'd like to reduce your hours to 25 hours a week because you can still get in these 60 patients. And I'm gonna bring another associate on for 25 hours a week to also see 60 patients. And now between 2 people, we're seeing 120 patients and everybody's happy. So that's a conversation where I might say, is this an internal threshold that you've applied to yourself? I haven't seen over the last year that this has changed at all. Are you happy making $60,000 a year or whatever that number is? You might be surprised. Your associate might say, I'm, I'm quite happy making $60,000 a year and having all this free time. And I don't want to see more than that. That's a great answer. So to me, it's just about putting it out there and asking them what they think will work for them, but it's not fair for them to have 40 hours a week when they're not filling their schedule. So I don't know. I hope that helps.

No, that's amazing. Thank you so much. This has been such a pleasure today to talk about this important topic. And it seems like we've had some great attendees here that have gotten a ton of value from here. Again, guys, if you're interested, Dr. Goodman does have an incredible book that goes over all sorts of things about chiropractic entrepreneurship and being a healthcare provider and entrepreneur. There is a QR code there on your screen that you can scan to download chapter 1 for free. We also have a link in our offers, which you'll see on the offers icon. There's a little red button. You can click that button to download the PDF of that first chapter as well. And then be sure to look out for the follow-up email you'll receive after this live broadcast ends. You guys will receive that in a few hours with a link to the recorded replay. You'll also have a link to where you can check out her book online and purchase that full book, or of course download the PDF of the first chapter as well. And for those of you watching the replay, you'll get that also. And even those of you that are listening on our podcast, when we produce the audio version of our training today, you'll have that in the show notes as well. So thank you all so much for joining us today. Dr. Goodman, any kind of final words you'd like to, to say today?

Thanks so much for having me. The final thing I wanted to answer, one more quick thing from the chat, which was yes, the book covers How to start a practice from zero to— from actually the last few weeks of chiropractic school all the way through the end of the first year of your practice is really what the goal was. So for someone who asked that, it's super valuable information for anyone wanting to answer all the tactical information, what you actually need to do to stay compliant. And then also all the branding, building a brand, building a business, even from your logo and your name and all the way through to patient experience, risk management, how to talk to patients and create treatment plans and how to be profitable and make all the money you wanna make and all those things. So it's a cool book for all those reasons. I think it's, it's definitely worth it. Thanks for having me. I hope I get to come back and talk to you more about things. I love the business management topics. So reach out to me, like I said, if you have any questions at all, my email address is on there too.

That wraps up part 2 of our conversation with Dr. Lisa Goodman on building successful associate practice owner relationships. From compensation models to negotiation strategies and building trust on both sides, I hope you're leaving with practical tools you can use to grow your career or your team the right way. Now we wanna hear from you. Have you ever had a nightmare experience as an associate, an independent contractor, or maybe even as a practice owner? Maybe you took a job that turned out to be nothing like what was promised or hired someone that had you pulling your hair out and thinking, what did I do? Well, we're collecting anonymous horror stories for a future episode, and yours might be featured on the show. No names, no judgment, just lessons that we can all learn from. Be sure to click the link in our show notes and fill out a quick form to let us know your story. And before you go, please be sure to also check out a link in our show notes to our next upcoming free live masterclass scheduled for April 17th. We're going to be talking about hemp in healthcare, clinical applications for better patient outcomes with Dr. Clint Sellers. In this practical, clinically focused training, We'll learn all about the endocannabinoid system, key cannabinoids like CBD and THC, and how to use hemp-based therapies to address common need states like chronic pain, sleep disturbances, stress, and more. It's totally free to attend this masterclass, so be sure to click the link in our show notes to register and get on the list so you can receive the link to the webinar training. We also offer the recorded replays to anyone that preregisters, so If you're afraid you might not be able to join us live, be sure to head to that link, fill out your information, and then you'll receive the email with the recorded replay after the live broadcast. Thanks for listening. 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 We'll have all the important links as well as info about our sponsors in the show notes, so be sure to check those out.