Chiropractic + Naturopathic Doctor • May/June 2021 • Building the dream team

Perhaps you work as an independent contractor, an employee, or maybe you rent a room at a clinic owned by other NDs, chiropractors, physiotherapists, RMTs or other health practitioners or businesses. If you’ve found it difficult to find the right team environment, maybe it’s time to create your own.

You’ve likely done stints with the big chains, moved into privately owned chiropractic or physiotherapy clinics that were more “clinically” focused, often unhappy with the split they’ve ended up negotiating.They enter “ABC” clinic hoping for team meetings, lots of inter-office referrals, and mentorship from senior clinicians, but it rarely comes. After three years of watching new NDs/DCs being brought in to pad the bottom line, you depart. Rinse and repeat. Sure, you may earn a satisfying income, but not feeling fulfilled or free.

The most important consideration to take into account, is that taking this step is less about being the “boss” and more about being the attendant. Being a clinic leader is actually a very lonel place. This doesn’t make it bad, but if you’re doing it for the right reasons, you’re serving a higher purpose, and you’re serving your people. The accolades don’t always come, your therapists don’t care that you are late paying your taxes, and maybe you won’t be included in water cooler talk.

Being a clinic owner/leader means lifting people up, helping them to exceed their expectations and be a better version of themselves – this is a purpose, a passion, a calling. It is not leasing a space and renting rooms out. Hopefully through all of that, you can afford to keep the lights on, and live an appropriately comfortable life for your efforts.

You must be ready to cut back some of your own clinic time in order to run the business. You will miss both family and recreational time running the busines, but at the end of the day, you should be satisfied.

Please take note, none of the advice included herein is meant as legal or accounting advice. It is the opinion of someone who has “been there, done that,” and you should always have professionals provide the final say on your plans.

Structuring your clinic with the appropriate legal strategy is important. You will need a corporate entity to begin. To reduce overexposure to unexpected HST expenses, you should keep HST registrants (RMTs/acupuncturists/ athletic therapists) separate from non-HST registrants (NDs/ physios/chiros). A physio or a chiro will likely have their own professional corporation so working with them and their advisors is a key factor here. Consider these issues in advance to avoid a failed audit and unexpected HST penalties in the future. In actuality, in many provinces physiotherapists CANNOT be contracted or employed by any private entity that is not owned in a majority capacity by anyone by a physiotherapist. As we’ll discuss later, to bring physio in, you should find a physiotherapist partner that you trust.

As a clinic owner, you can employ other NDs and chiropractors. Employment is simple, straight forward, but it does come with added costs. You need to factor in the employer CPP and EI contributions, which can add up to over 7%. So if you have an ND on a 60/40, you will end up with 27% before you deal with anything else. When negotiating a salary based on a split, you must take this into consideration; there’s also the straight monthly salary option. I don’t recommend this as it can be a disincentive to your therapist from wanting to work. They’ll happily show up, and work what they’re given, but may not be very energetic when it comes to re-booking clients. If someone demands it, you can do a low monthly salary plus bonus arrangement.

Contracting therapists is most common, but the key element is to avoid the CRA determining your contractor is actually an employee and hitting you up for all of your employer remittances and your contractor having to submit CPP, EI, and employee taxes. This is a disastrous scenario. You can largely avoid this by ensuring that the contractor is in charge of setting their own hours, can make changes to schedule, sets their own fee schedule, and owns the equipment in their own room. It goes deeper and more complicated than this, but this is the high level view. Demanding they are on-site certain hours, or that they must do certain tasks makes them an employee in the eyes of CRA.

You simply can’t put out an ad and expect to build a solid team. As a serious clinic owner, you want to develop your “pipeline.” These are relationships that you, your business, the educational institutions and current and former students has. You should spend at least a full year building a relationship with a practitioner before they join your clinic. They should have multiple opportunities to shadow and to bounce ideas off of their mentors, and the same for you as well. Hiring someone off of an ad is a crapshoot. People can really fake it in interviews however if they don’t have the chops you will end up with a revolving door, which is both frustrating AND expensive.

Beyond having long standing personal relationships and a year-long interview process, there are ways you can assess a candidate and learn how to “speak their language.” Remember, this is a two-way street. A candidate is trying to determine if they WANT to work with you. One method is to utilize personality tests (Myer’s-Briggs, Enneagram, “Love Languages,” etc.) and although they are admittedly controversial and should not be the end all, be all, the results of these tests are more of a road map to move forward, rather than an end point for decisions. Don’t forget to challenge the candidate. If you find someone who doesn’t provide high quality care, has poor emotional intelligence, or doesn’t know how to book clients or speak to them, your relationship is likely to be a short lived one. For more information on building your team, visit cndoctor.ca/dreamteam

DR. ERIK KLEIN is a chiropractor and CEO of Town Health Solutions, a network focused on the growth and development of clinical excellence and entrepreneurship for manual therapists. For more information, please visit www.townhealthsolutions.com/franchising.