Practice Management

Risk Management and Your Home

We frequently discuss in class some "worse case scenarios" involving lawsuits and asset protection. Transfering total ownership of your home to a spouse may seem like a logical choice, but in today's world of 50% divorce rates, having your spouse own the farm may not be so wise. Here is an article by David Mandell offering other solutions.

Survey of Income and Expenses

Chiropractic Economics does the annual survey of chiropractic incomes and expenses. This is a pdf version and it's several pages long, but has interesting numbers. Take a look.

Women in Business

Women own nearly half of businesses in the U.S. and financial institutions are finally catching on! Many banks and other organizations now have special programs to help women start and successfully operate businesses. Here's a list of links that will direct you to some of those sources of good information.

How much do D.C.s make?

We hear a wide range of figures for the average chiropractor's income. There is sometimes confusion because we don't know if the figure mentioned is GROSS income, NET income, TAXABLE income or TAKE HOME IN YOUR JEANS income. This article rambles a bit, and doesn't help clarify the confusion much, but it presents some numbers, which you may find interesting.

Here's my estimate for the average chiropractor using figures from some of the same popular sources.

ASSUMPTIONS: 30 visits per day, 4 days per week: actual collections(not billings) of $35 per visit. 3 new patients per week @ 150 entry fee(x-rays and exam).

Using these assumptions, we see the following possible income: $4650 per week, $18,600 per month, $223,200 per year (48 weeks).

We also know that it costs money to make money, and using the Chiropractic Economics Magazine figure of 55% for average expenses, we end up with an annual net profit of $100,440 or $8370 per month, from which federal and state taxes must be paid, kids must be sent to college, and payments made on the spouse's Benz.(payments on your Hummer are largely a business expense)

Many variables come into play with average chiropractic incomes. For example, if you see more than 30 patients per day, work more than 4 days per week or collect more than $35 per encounter, it stands to reason that you will make more money. Also, if you work three days per week, see 20 patients per day, and collect $25 per encounter, and don't x-ray new patients, then you will make less money. If your rent is $5000 per month, driving your expenses to 75%, your net profit will be lower, even if your collections are relatively high. Some chiropractors see lots of patients, work lots of days and charge high fees, but can't collect what's due them.

So you see the variables play havoc with average chiropractic incomes.

Ethics in Action-Finances

Here's a short article I wrote recently for Straight From Sherman.

Ethics In Action

 By Leslie M. Wise, D.C.

  Download podcast of this article here.

In a recent workshop for faculty, Dr. Norman Ouzts, Chairman of the South Carolina Board of Chiropractic Examiners, indicated that complaints filed about D.C.s to the SC Board are heavily weighted in the category of financial misconduct, with sexual misconduct a distant second place. This gives rise to the important consideration of what chiropractors can do to assure that we are absolutely fastidious about the financial conduct of our practices, and avoid public sentiment that we are less than honest.

In our ethics and practice management classes at Sherman, we make the following suggestions regarding financial interactions with patients:

• Always discuss fees very early in the doctor/ patient relationship, preferably on the first encounter. Be sure to deal with initial visit fees, such as exam and x-rays, as well as the fees for subsequent routine visits. Patients hate surprises. Be willing to state your fees when asked.

• Have a written policy on fees and collections. Include it in your practice brochure, and on your website. Transparency is best when it comes to money. Patients will appreciate your willingness to discuss finances, even when they are hesitant to open the discussion.

• If you use pre-paid plans of care, be especially scrupulous in your explanations of what a patient gets for their pre-paid fee. You must have a refund policy, if a patient decides to drop out. Some states require that you keep all funds collected in a special escrow account until the services are actually delivered. Put it in writing and answer all questions before taking payment.

• If a dispute over money arises, be willing to take the high road. Ask the patient what would make him happy, and do it, even if it involves writing a check for a refund to which you are not legally obligated. 

As ethical chiropractors we have a fiduciary responsibility to our patients, which means that we are obligated to look out for their best interests first, and that includes their financial best interests. Absolute financial integrity, with no hint of shady dealings will help assure that our profession gains the esteem we rightfully deserve.

Chiropractic incomes

ChiroEconomics does an annual survey on incomes of chiropractors. Here are a few numbers for 2005. Their numbers make it sound like all DCs get a paycheck or salary, which is generally not the case.

Metals as Investment

We've discussed gold as an investment. Here's one of my favorite resources. It's way more information than the average person is interested in. There are some essays on the philosophy of metal accumulation which might spark your interest.