Chiropractic + Naturopathic Doctor

Features Business Management
The Smaller Centre Chiropractic Practice


February 4, 2009
By Lloyd R. Manning

Topics

When starting out, a chiropractor must often choose whether to practice
in a larger city or opt for the smaller centre. Frequently the smaller
community provides the opportunity to develop a more diversified
practice, and provides enhanced community acceptance with less
competition. Still, there are downsides.

Is it for you?

smaller  

When starting out, a chiropractor must often choose whether to practice in a larger city or opt for the smaller centre. Frequently the smaller community provides the opportunity to develop a more diversified practice, and provides enhanced community acceptance with less competition. Still, there are downsides. When weighing the options, what will be the advantages and disadvantages of the city versus a peripheral, small town. Why would anyone not practice in the larger metropolis, with all of its conveniences rather than in some berg that offers fewer creature comforts and is a million miles from anywhere?  What are the motivating factors for both?   

Weighing the big city against the smaller town

In small-town Canada, most often, you escape the rat race, the noise, the pollution, and the crime. Often, an initial attraction is that people are friendlier in smaller centres than in larger cities. But, are they, or is this just a perception?  Ask different people – and expect different answers. A comparison will indicate that broad-based familiarization increases as the town’s size decreases. Still, you may not know your neighbours any better in a community of 15,000 than in a city of 150,000. However, the neighbour-to-neighbour and friend-to-friend support is stronger, in a smaller town, than in the larger city where people are more inclined to “do their own thing” and more carefully guard their privacy. Consider, also, that, as you are bringing a needed service to a tiny town, you should have no difficulty fitting in.

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A survey conducted by The American Medical Association indicated that final year resident physicians preferred to practice in urban areas, where they believed the amenities would be better for their families. All wanted good schools for their kids, swimming pools and golf courses, spousal employment, and the other perks that are part of a metropolitan area. Chiropractors, I wager, are no different.

But, unlike a city, in the smaller centre, business is done on a more personal basis. Doctors, lawyers and ministers are called by their first name. Daily, you meet the local entrepreneurs on the street; the grocer, the druggist, the restaurant owner. You see them in the coffee shop, in the store, may attend the same church, service club and enjoy the same recreational facilities. Your kids all go to the same school.

A disadvantage for many residents of smaller centres is the lack of specialized medical and other professional services. Although most communities have a hospital, a dental clinic and general practitioners who can provide basic and emergency medical services, it is often necessary to travel to a major city to get anything other than routine tests or treatments.

All towns have a supermarket, innumerable convenience stores and a cafe on every corner. Yet, there are fewer specialty stores or boutiques. Many lack the extent of diversity and competition that one would see in a city.  If interested in major league sports, the theatre, or fine dining, one must travel to a metropolitan centre. Still, one should always ask him/herself; how often would I go there anyway?   

Although “quality of life” tops the list of necessities as defined by young physicians – and, undoubtedly, chiropractors as well – it seems that everything in our society is reduced to money. You may have that evangelical instinct to help those in need, but not everyone is so motivated.  And, the reality is, the landlord, auto repair garage, and the utility company will be looking for dollar bills, not your goodwill. Thus, you must assure yourself that, while accomplishing your personal goals, there is the potential, in the smaller centre, to develop your practice into a sound business venture.

Gross earnings in small towns are generally lower
In most rural communities, clients do not like to pay big-city fees. But even though operating costs are slightly less in smaller towns, given an equal patient load, most chiropractors feel they could charge more money in a larger community. However, it is not the fee differences, only, that should be considered – it is the “bottom line”, that is, what remains after paying all the bills? To evaluate this, you must research your own comparisons and make your decision based on what you learn about the town in question.

Also, keep the following in mind: if the town wants to build an arena, run a rodeo, have fair days or support school kids for a trip to anywhere, money is raised through contributions from the local businesses. Although this happens in a city, as well, it seems that in a smaller centre, the merchants and businesses are being hit most everyday to support this or buy a ticket for that. Often, it is your best patients and friends that do the “hitting-up.” And, you can’t refuse without being considered “cheap.”
 
Considerations when building your practice
The initial cost of establishment, leased space improvements, furniture, fixtures and equipment is about the same, no matter where you locate. You can usually rely on the local hospital or medical clinic to provide X-ray, ultrasound, and diagnostic services that lie outside of your scope of practice.

Opportunities for post-graduate or continuing education are about equal, in city or county locations. If travelling to out-of-town seminars, and the like, the cost for the rural practitioners is substantially more – but the results justify the cost.

Dr. Fred Murray, DC, of Lloydminster, Alberta, is of the opinion that the minimum population-base to sustain a chiropractic practice would be 5,000 persons. When he started practicing in Lloydminster as an associate, the population was 7,000. Today it is 25,000 and supports seven chiropractors, all of whom are busy. However, the late Dr. Ken Tenove successfully practiced chiropractic in St. Paul, Alberta, with the population, at that time, never exceeding 3,000. It is now about 6,500 with two chiropractors.  (A major consideration is the community’s trading area. Many smaller centres support a large rural population from which they draw patronage.)  Murray is also of the opinion that the time required to develop a chiropractic practice, which will provide a decent standard of living, is about equal whether one is in a city or smaller centre – starting from scratch, Murray notes it takes about five years.

If you buy an existing practice, the establishment time can be substantially less, with many of the initial costs paid up-front. However, a practice must be paid for. You must decide which route is best for you; buying an established one, or suffering lower earnings over a longer period while developing your own patient roster. Furthermore, much depends on the effort that you are willing to expend, and the hours you are willing to work.  

In smaller centres, opportunities to advertise are limited. The only vehicle worth anything is the telephone book yellow pages, and certainly having a good web site will help. Although a slower process, the most common, and the best, advertising will be referrals and word-of-mouth. To really leverage these, you must get involved in the community’s affairs.
 
Can you sell out, if and when desired?
In everyone’s life, there comes a time to move on or just gallop off into the sunset. This begs the question; is a county chiropractic practice saleable?  Yes, no, maybe, and all with qualifications. Regardless of where you are, you must have something to sell.  As a chiropractor, your greatest asset is the probability that a sufficient number of patients will return, no matter who the DC happens to be.  However, you cannot sell your feel, your touch, or your expertise. When you leave, that goes with you. In most smaller centres, when the DC departs, the practice simply fades away.  New entrants will often wait for this to happen and then scoop up the patients at little or no cost.

The best long-term plan to insure your practice will continue, when you have left it, is to bring in an associate who will acquire your practice on a buy-in basis.  This is known as an earn-out, which means purchasing over an extended period.

In conclusion, as you set up your practice, you must determine what is important to you and your family. What do you want, and expect, from the community in which you will live and what do you want and expect from your professional chiropractic practice? Will the centre you choose meet with your objectives and overcome your constraints? For many, a rural practice will do this. For others, this is the last place they should be. The challenge may not be your own opinion of the location – it could be your spouse’s. If you cannot understand how anyone can live in a smaller centre, never move to one! On the other hand, many less populous places offer an excellent opportunity to develop a profitable professional practice while providing you with a high quality standard of life. •


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