Exploring Practice Opportunities
After identifying which community fits you and your family, career and personal goals, your next step is to evaluate your career opportunities. Surprisingly, students have indicated their preferred career type is an associateship or opening own practice.
Did you know?! In BC, renting an office space in an existing practice is a great alternative.
Please continue reading to learn more.
Some questions to reflect on when identifying your career type may include:
- How many hours of work is sustainable and healthy for a work/life balance?
- Do you prefer working solo or with others?
- Are you willing to take on management responsibilties?
- What are your strengths and weakness?
Do your research to ensure it is a good fit for you when purchasing a practice, renting space, etc. Also, evaluate your employer's or partner's personality, physical size, technique etc. when considering working in a practice.
Renting space or is commonly practiced today as it is cost-effective and encourages collaborative care by various health care providers.
Here are some benefits:
- Income earned is yours (after you subtract the cost associated with sharing an office).
- Independence in running your own business.
- Flexibility in scheduling your day and going for vacations.
- Freedom in promoting your practice (avoid advertising that is not in accordance with the College Professional Conduct Handbook).
- Filing tax deductions as a self-employed professional.
- Find a reasonable rent in your desired area.
|Notes||Health Care Professionals||Business Professionals & Corporations|
|Definitions||Rental from a Medical Doctor (MD), Doctor of Chiropractic (DC) etc.||Rental from a Realtor, Accountant, Gym, Business, Corporation etc.|
|Legal/Patient Records||Obligated to follow legal health care standards such as handling patient records, as well as clinical and billing records.||Based on a corporation model, keeps the patient records for the next DC.|
|Clinic Type||Multi-disciplinary.||Multi-disciplinary, may have more than one DC on staff.|
|Marketing||If leased with another DC, will follow the CCBC marketing guidelines.||High risk of using advertising terms which are not accepted by CCBC.|
|Regulations||Has a heath care regulatory body for legal liability.||Does not answer to any health care regulatory body.|
Caution: At times, although legal, the lease may not in favour of the new DC.
Here are some questions to ask:
- What happens if the health care professional part ways (e.g. moves out, retires, sells practice etc.)?
- Is there a non-competition clause?
- What happens if you see a patient of another DC? Is there a clause on patient sharing?
- Do you have a vacation schedule in place?
Job Shadowing is where recent grads have a great opportunity to work in a practice before making a long-term commitment to practice at that location. You can identify if it's the right fit for you by evaluating the following before choosing your long-term career path:
- Do you like the practice style of the host DC?
- Are you comfortable with the patient demographics?
- Do you agree with the office operation? For instance, the application of clinical guidelines, how medical records are handled, and how is the patient experience?
Locum, Salaried or Associateship
These options may create an unequal professional arrangement where a new grad gives up rights in exchange for the opportunity to practice in a clinic. It is hard to recognize the pitfalls and foresee how it can affect the grad long-term. It is best to consult both the legal and healthcare lawyers.
Did you know?
- If you are on a fixed salary, and your patient base increases you will be unable to earn a higher income.
- Legal actions are taken either by you or the employer, due to terms being unfavorable (e.g. compete clause is not favorable to the recent grad, once they are ready to leave the practice), resulting in expensive legal fees and years to receive a lawful decision.
Working for Corporations
Similarly to working with health professionals, where a new grad gives up rights in exchange for the opportunity to practice in a clinic, this option comes with even a higher risk. It involves working for a company (e.g. gym) that isn’t a part of a health care regulatory body. Such company isn't obligated to follow health care guidelines, and if there are health care lawful actions against it, business law will work in it's favour.
When entering into any arrangement with an individual, group, business or corporation that is not a health care professional or owned by one, there are additional legal clauses that need to be addressed. Specifically there are laws and regulations that apply to new chiropractors, that do not apply to the business group, corporation etc. (this will have to be addressed in the contract).
Here are some cautionary signs to consider:
- Employer has no legal responsibility (if the contract is with non-health care professional).
- Possibly no patient files control (e.g. take files upon termination), patient records belong to the company.
- Refer to 'Bylaws of the College of Chiropractors of B.C. under the Health Professions Act' - Section 72 on record-keeping guidelines.
- A portion of your salary is dispensed to the employer.
- The owner has control over operations, and working conditions.
- Chiropractor faces fine for HPA/Bylaws college regulation.
- Employer advertises terms such as ‘specializes or specialist to handle health care needs’ which isn’t permitted by the college guidelines (refer to healthcare lawyer). In some cases the grad pays for 100% of advertising but will only receive 20% of new patients.
- Cost minimum and maximum to ‘rent’.
- Vacation policies.
- Is there an exit strategy in pace?
- How are the patient records handled? Who pays for copies?
- Competition clauses.
- Notice to the employer.
- What to say/not to say to patients.
Scenario: A gym hires DC, RMT etc. The DC treats gym members; however, patient files and records are kept by the corporation. The gym may use terminologies in its advertising that you as a chiropractor may not be allowed to use (e.g. "We have a specialist on staff to handle your health care needs.") - please refer to a health care lawyer for advice on this issue.
A business partnership is a specific kind of legal relationship formed by the agreement between two or more individuals to carry on a business as co-owners. In our sector, individuals agree to run a chiropractic practice - pool resources, share profit, loss and some liability as per their written agreement. This option entails contractual arrangements, which should be evaluated by your professional advisors.
Here are some key contract points to consider (not limited to):
- Terms of termination of the partnership
- Include clauses on departure, disability, death, and disagreement.
- Individuals role
- Identify each person responsibility as a partner (e.g. financial, administrative etc.).
- Office lease
- Address the following: Should your name be on the lease? When is the renewal date and is there a price increase? Are there short-term and long-term renovation plans?
- Business decisions
- Are you comfortable with following the guidelines of a majority vote?
- Do you have authority to handle staff issues or implement office procedures?
- Profit sharing
- Have your advisors helped with the profit distribution among the partners? Is it fair to all parties?
- Long-term plans
- Do you and your partner(s) want to incorporate the practice in the future?
- Liability, insurance, buy-outs and more...
Owning a Practice
Advice from a BC practitioner: "I explored other practice opportunities, subsequently purchased the practice. That allowed me to gain experience with patient care before the added responsibility of administrative duties."
The owner of the practice, also known as 'sole practitioner', is responsible for all attributes of the practice. Visit Canada Business Network for information on if this is a right option for you and how to get started.
For this option, we would strongly encourage seeking career advice on how to start this journey. Becoming a sole practitioner allows you to purchase an existing practice or start one from scratch, here are some aspects to consider:
|Purchasing an Existing Practice||Starting Own Practice from Scratch|
|~ What is the market value and is it fairly price?||~ Do you have the expertise and skillsets to plan your practice space and hire trades people?|
|~ What kind of patients does the current practice attract and treat, and how does it compare to your preferences?||~ Have you evaluated the location, target patient demographic, and the competition in your community?|
|~ Do the facilities or the equipment require upgrading?||~ Do you know how to build your patient base from scratch?|
|~ Is the clinic staff well-versed in their roles (been there a long time)?||~ Do you have the finances and time to wait months for the practice to open?|
|~ Have you considered if you and the existing DC are compatible? Tips: Shadow the health professional for a minimum of 6 months before committing. The transition for patients may be easier if they are seeing someone with a similar personality, practice style etc.||~ Do you have business advisors to assist you with things that are outside of your skillset? Tips: Seek professional advice for all aspects of a business. Each fiscal year, budget for unexpected costs every month.|
Explore Practice Opportunities
Students, in their final year of study, are excited and counting down to entering the workforce and utilizing their skills. Here are some tips on how to best locate the next opportunity:
- Visit BCCA Bulletin Board for updates on practice opportunities within BC, in addition to office sharing and purchasing a practice or various equipment.
- Meet with your current and graduated colleagues. They already know your practice style and personality, and can assist with filtering opportunities that fit you.
- Consult with your chiropractic mentor - they can guide you on what to expect as a new DC in BC, and extend a word to their network.
- Look up websites for chiropractic practice opportunities.
- Ask around. Talk to your family and friends, and ask them to keep an eye out for opportunities.
If ever in doubt, contact the BCCA for assistance. Contact Dr. Jay Robinson at 604.270.1332 for resume and interview tips, and any other career guidance you need.