Chiropractic + Naturopathic Doctor • October 2015 • The Right Fit

The ultimate goal for chiropractors and massage therapists is better health for our mutual patients.

We take different routes to this end, but the wellness-based approach and techniques used are similar. Chiropractors and massage therapists both rely primarily on manual techniques. Successful practitioners take a patient-centered approach to management. In addition, both practitioners have experienced some form of resistance from allopathic medicine and from the public.

This common ground helps explain the many examples of chiropractors and massage therapists working successfully side-by-side. During nearly four decades of chiropractic practice, I have had the pleasure of welcoming many registered massage therapists (RMTs) into our clinic. Some have stayed a few months. Others have established long-term relationships with our clinic and have remained for many years.

Each of these caring individuals has taught me something about treating patients, managing a clinic and the joy of being a health-care provider. There have been a few bumps along the way, but these have only helped improve the situation to everyone’s benefit.

If you have considered adding massage therapy to your clinic, I hope some of these experiences and learnings will help you develop a mutually beneficial relationship.

There are several ways to include massage in your practice. RMTs can rent space in your clinic and manage their own practice. This makes your day a lot easier.

However, if the therapist is not highly motivated, you may end up getting more involved than you had planned.

Alternatively, you can hire a therapist as an employee. You provide all referrals and perhaps even prescribe what treatments are provided. This arrangement involves more work and responsibility on your part, but allows you to maintain full control of your clinic.

I have found good success with a middle ground approach. The RMT rents space in my clinic. I provide staffing support, which includes booking of appointments and managing accounts. I cover the costs of telephone service and all utilities. I refer my patients who I think may benefit from massage therapy. In some cases, if there are specific issues, I will make recommendations to the RMT about treatment. I am far more comfortable referring my patients to a therapist I know, than having them visit another therapist at another location. However, the expectation is that the RMT will build, promote and maintain his or her own practice.

Whichever path you choose, be certain that all the important parameters are clearly defined in an agreement.

To avoid misunderstandings and conflict, creating a concise clinic/therapist agreement is very important. This agreement should clearly establish responsibility of each party for all details. I have seen agreements from other clinics that are several pages long and are more complicated than they need to be, but this is certainly preferable to a handshake.

Start with the basics. How will you establish the rental fee? This can be a flat rate with built-in increases it can be based on a percentage of the therapist’s gross income; or a combination of both.

Consider establishing minimum and maximum amounts. If the therapist undergoes a slow period or takes a number of absences, they are still responsible for making the minimum payment. This helps you cover the fixed costs of having the RMT there, and helps protect you from the risk of spending resources on a therapist who is not fully committed to a longterm relationship.

A maximum rate is beneficial to the therapist. As their practice grows, gross income will rise, but the fixed costs generated for the clinic will not increase substantially. A maximum rate ensures the therapist will receive the benefits of their hard work.

The agreement should also cover details such as responsibility for supplies, linens, clinic access, telephone costs, advertising and any other administrative fees. Whatever the agreement includes, it helps if both parties remain flexible. No matter how well conceived an agreement may seem at the outset, if it does not work for both parties, it will not benefit either in the long term.

I have had many discussions with therapists about the rates and fees charged and what is and is not included. A great starting point is to research what others are doing.

A colleague did just that several years ago. He canvassed a number of clinics that included chiropractic treatment and massage therapy. In addition to rental rates, he asked about who covers linen costs, yellow pages or other promotional advertising, computer software updates, telephones and stationery.

I was happy to learn my clinic was well placed regarding these details. Some clinics offered a bit more for a bit less, but most clinics were charging far more than we did.

Rates and responsibilities can vary widely, so be prepared to discuss this with your potential therapist.

Just as I would not consider a therapist in my clinic to be simply a source of income, the RMT should not consider the clinic simply as a work address.

There is an opportunity here for you to create a mutually beneficial long-term relationship. If a chiropractor helps the therapist build a practice and in turn, the RMT helps the doctor with his or her practice, then both will succeed.

It is easy for me to refer my chiropractic patients for massage therapy. Likewise, if their patient is suffering from back pain or a headache, and that person has never been to a chiropractor, the RMT can have them consult with me.

There are many other ways the therapist can become an asset to the clinic. They can arrive early for appointments. They can, and should, maintain a professional appearance and attitude. They can offer to help with tasks in the clinic and offer advice about details which they think need attention.

These efforts cost nothing but can help cement a long-term relationship for the therapist with the clinic. These are not issues that generally show up in an agreement, but can be discussed openly with the therapist.

There are some massage therapists who will far exceed your expectations in terms of attitude and work ethic. Others may not turn out quite as you had expected. Perhaps I have just been fortunate, because we have managed to avoid any real disasters.

As the clinic director, it is up to you to be fully cognizant of what you are getting into. If your objective is to simply look for a source of income, you may be in for a difficult time.

An advertisement that is currently running in my area lists a chiropractic clinic for sale. The copy says, “Hire a massage therapist and work rent-free.”

It is reasonable and acceptable for you to acknowledge that there will be a financial incentive to hiring a massage therapist, but if this is stated as a major goal, the chances of developing a beneficial long-term relationship are slim.

It would be wise to do some research about the therapist you are considering bringing into your clinic. A good first place to check is your respective provincial licensing body. Talk to other therapists you may know as well. Make sure you contact any references provided by the therapist you are considering for your clinic.

If you are satisfied and confident that this therapist will represent your clinic well, the chances of building a positive, long-term relationship are much higher.

Managing a solo chiropractic practice can be very rewarding. However, like running any business, there are many challenges. When you add massage therapy to your practice, you increase the services you provide to your patients and the potential for growth.

A new member of your clinic staff can bring new ideas and a fresh approach. You will have another source of new patient referrals and, yes, you will augment your income.

If you do choose to take this step, choose carefully. A bit of homework now will save trouble later, but will also help to ensure a positive, long-term arrangement.

DR. DAVID LEPRICH is clinic director at Welland Avenue Chiropractic and Massage Therapy, which he established in 1977. He is a past president of the Canadian Chiropractic Association, a current board member of the Canadian Chiropractic Research Foundation and theatre chiropractor to the Shaw Festival Theatre in Niagara-on-the-Lake, Ont. Dr. Leprich can be reached at [email protected].