Chiropractic + Naturopathic Doctor

Chiropractic Assistant Education

By Brandi MacDonald   


The most common questions posed to me regarding staff are “when do I
add to my current staffing complement?” and “when do I hire my first
chiropractic assistant?” Our staffing resources may be one of our
highest fixed “expenses” in our business apart from our building cost

The most common questions posed to me regarding staff are “when do I add to my current staffing complement?” and “when do I hire my first chiropractic assistant?” Our staffing resources may be one of our highest fixed “expenses” in our business apart from our building cost (i.e., leases, mortgages, etc.). Because of this, most chiropractic practices are grossly understaffed in an effort to “save” money. Either the practice doesn’t have enough chiropractic assistants, or it has one – the doctor – who is the treatment provider, phone answerer, billing clerk, scheduler, booker, patient advocate, etc. The limits placed on a business, when it is understaffed, far outweigh the cost of having an adequate staffing complement. This issue, I want to explore some options for you to consider when staffing your front end.


When to add staff to your existing complement?
The mechanism, for adding staff, involves analyzing your practice, and current staff structure, and asking the following questions:


1. Are you carrying out low priority activities, in your practice, that you could pay someone far less to do, thereby freeing up your time to engage in those high priority activities to build your business?

To figure this out, first you must determine what your hourly fee is. Your hourly fee is determined by how many patients you currently serve an hour times the amount collected per patient. So, if you are worth $350/hour, and are answering the phone, do you enhance or diminish your value? Could you pay someone $15/hr to answer your phone, and free up your time to see more patients? This would serve to increase your hourly value.

Another way to think about this question is “How much does it cost you to perform low priority activities?” In chiropractic practices, whatever you focus on, expands – so where is your focus? Would it be possible to broaden your focus to include expansion, versus stability of the front end, and let someone much more versed in this area do this job for you?

2. Is/are your current chiropractic assistant/assistants able to take time off for vacations or time away from work?

In chiropractic, we tend to understaff and don’t have any cover-off ability for our staff. Therefore, staff feel stuck in their jobs with limited flexibility, and this most certainly will lead to lack of retention. Staff require time off, just like we do. Practices flourish when there is a plan in place to allow people to take planned time off.

3. Is your chiropractic assistant feeling “overwhelmed” with current job duties and unable to do anything extra in your practice?

I have previously written about the pyramid of training wherein staff moves from basic activities to more advanced duties, such as marketing, patient education, objective tests, health talks, etc. These advanced practice-building activities can only be done with an appropriate staffing complement. When this doesn’t exist, staff will begin to feel overwhelmed, and job duties will not be carried out as effectively or efficiently as we would like. An overwhelmed staff leads to an overwhelmed office, which limits patient interaction and practice growth.

4. Are you feeling overwhelmed?

Sometimes, as business owners, we feel responsible to do absolutely everything because we are afraid others won’t do it as well or correctly as we will. This is a dangerous place to be, in chiropractic. Patients require 100 per cent of you, and when you feel overwhelmed, they do not get it. Well-trained staff exist, in our practices, to have lower priority activities delegated to priority activities, and to provide stability in our offices so that focus, for the DC, can be where it should be…that is, on the patient, and the growth of the business.

If you have answered yes to any of the above questions, it may be time to consider either hiring a chiropractic health assistant – if you don’t have one – or adding to your current staffing complement. In this time of perceived economic stress, rather than retreating and “hunkering” down, this is a time to make well-informed business decisions about the biggest resources we have in our practice – our teams.

In chiropractic, we often talk about staff as a business “expense.” Today, I want to challenge you to consider that hiring, and retaining, of staff is actually an investment. I, like many of you, have previously made “bad” investments with staff. These have actually “cost” our business. When I began to invest in the right staff, establish a stable team and then continue to invest in the team, our business flourished. Just like any well- timed, right investment, chiropractic assistants will provide tenfold what we invest in them, given the opportunity.

John Maxwell, author of The 21 Irrefutable Laws of Leadership, stated this principle well. “Hire the best staff you can find, develop them as much as you can, and hand off everything you possibly can to them.”

Chiropractic demands the best of us, and we are in a time when our public needs more of us. If you ask me whether you can afford staff or afford to add staff, I will ask you,

“Can you afford not to?” •

Brandi MacDonald manages a multi-doctor, high-volume clinic in Edmonton. She is the owner of True Concepts, which consults with chiropractors all over North America regarding staffing. She also is an international speaker for chiropractic assistants. She can be  reached at

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