Chiropractic + Naturopathic Doctor

Wake-up Call

Anthony Lombardi   

Features Leadership Profession

“The future belongs to those who prepare for it today.” – Malcolm X

“The future belongs to those who prepare for it today.” – Malcolm X

In 2012, chiropractor and expert Dr. Mark Sanna, member of the American Chiropractic Association (ACA) Governor’s Advisory Board and member of the President’s Circle for two chiropractic colleges, reported that total North American chiropractic college enrolment had fallen from a high of 15,398 in 1996 to just over 10,000. This 5,000-plus drop represents a 35 per cent decrease in student enrolment overall. He suggested that many factors may be responsible for the decline including lack of referrals by disenchanted chiropractors who felt they had not been well prepared for practice upon leaving school.

Were you prepared for business and practice management when you graduated? 90 per cent of the chiropractors surveyed reported that they were not.



In 2007, the third annual Chiropractic College Alumni Survey asked chiropractors from five different chiropractic schools who graduated in the years 2000, 2002 and 2004 the following question: Were you prepared for business and practice management when you graduated? An average of 90 per cent of the chiropractors reported that they were not.

The words of Malcolm X (above) are very prophetic whether you are a chiropractor today, a chiropractic student or a chiropractic college. Chiropractic school enrolment is down, the numbers of chiropractors leaving the profession are at an all-time high, and a record number of chiropractors graduating from school are not confident enough to open their own practices. Although most don’t see it, this is the perfect opportunity for economic and business growth in our profession. But if chiropractic colleges, chiropractors and chiropractic students don’t act fast, we may miss out on adjusting the future.

“Confidence is preparation. Everything else is beyond your control.” – Richard Kline

With the knowledge of Dr. Sanna’s report and access to the 2007 Chiropractic College Alumni Survey, I prepared a survey of my own to see how chiropractors today feel about the business training they received in chiropractic college. One hundred fifty-three chiropractors from Canada and the United States answered my survey. Please see Figure 1 for a summary of the results I obtained.

Ironically, these results echo the results of the large survey conducted in 2007 where it was found that only about 10 per cent of chiropractors felt prepared to enter practice. The majority of chiropractors in my survey reported fear as the biggest reason chiropractors are not opening their practice so I asked the 153 chiropractors surveyed what their biggest fear was and this is what they said:

  1. I have a fear of not getting any patients.
  2. I have a fear of not having enough money to start a practice.
  3. I have a fear of failure.

Clearly, these are fears that almost all entrepreneurs have at one time or another. I believe the difference is that we, as health professionals, are brought up within a culture where the focus is more on the art and science of diagnosis and treatment and less on business and economics and, therefore, we receive minimal training for this other very real element of opening a practice. For example, according the Chiropractic Council on Education, the minimum number of hours for completion of a doctor of chiropractic degree is 2,419 hours (not including clinical practice). Of these, 468 hours need to be in anatomy, 408 hours in diagnosis, 271 in X-ray . . . but zero hours of training in business are required to graduate as a chiropractor. One college that is known to house one of the more extensive chiropractic programs in North America dedicates only 3.2 per cent of its curriculum to business and practice development. Now that we have this information, we can understand why chiropractors feel unprepared, feel fearful and lack confidence about their practicing future.

Figure 1.  2013 Survey – Two Simple Questions
1. Do (or did) you feel confident enough to start your own practice or to run your own business once graduated from chiropractic school?

  • Not at all confident – 46 (38.7%)
  • Little confidence – 47 (39.5%)
  • Very confident – 26 (21.8%)
2. How do you feel your chiropractic college prepared you to run your own viable practice?

  • I feel I was poorly prepared – 64 (53.8%)


I would suggest that there are some remedies we can apply to help mitigate this problem in our profession.

“We make a living by what we get, we make a life by what we give.” – Winston Churchill

Thirty-three per cent of the chiropractors I surveyed revealed that they were taught business practice courses in school by non-chiropractors or by chiropractors who never practised a day in their life. This was troubling to me, and further reinforced my understanding as to why chiropractors lacked confidence in business. For this reason, it is extremely important to adopt a chiropractic mentor in your life. Achieving clinical and business success requires you to put your patients’ goals above your own financial goals by making the commitment to find a mentor you admire in your profession. Seeking out a mentor will allow your own practice goals to take on a specific direction through the guidance and support of their mentorship. I was fortunate to find my mentor early in my career, and that allowed me the luxury of gaining confidence early on.

Debunking the Myths
“A myth is an image in terms of which we try to make sense of the world.” – Alan Watts

There are two myths we have to debunk to allow chiropractors to move forward into the world of business practice:

  • that you need money to start your own practice; and
  • that you need to be quite confident to be successful.

Money is not necessary to start your own practice. In the beginning you will be able to leverage your skills to obtain space within an existing office or practice – for no money at all. By working on percentage you will be able to join an existing health team or chiropractic practice where you step in and earn right away. The amount of income you generate is based on the number of patients you see. You are running your own practice and over time you will grow, save money and create opportunities to expand.

Next, did you ever hear the saying: “confidence is overrated”? It turns out whoever said that was right. Dr. Tomas Chamorro-Premuzic is an international authority in personality profiling and psychometric testing who in July 2012 published a study in the Harvard Business Review that revealed: “If your confidence is low, rather than extremely low, you stand a better chance of succeeding than if you have high self-confidence. This is because someone with low confidence is more likely to be aware of where you need to improve. And because achievement is 10 per cent performance and 90 per cent preparation – the more aware you are of your soft spots and weaknesses, the better prepared you will be.” The key, Dr. Chamorro-Premuzic states, is to “work hard and never lose sight of your goal.”

Challenging Our Chiropractic Colleges
“Today I do what others won’t so tomorrow I can do what others can’t” – Unknown

Without a doubt, chiropractic colleges need to shoulder some of the responsibility for the lack of satisfaction and business production among chiropractic graduates. Something drastic should have been implemented in 2007 after the results from the third annual chiropractic survey were received. Colleges need to consult successful alumni and make them part of their business programs so that students can receive current business advice from real-world professionals in their field. This strategy needs to be actively pursued by chiropractic colleges: they must seek out the people who can make their business programs better rather than asking for volunteers. It is a big challenge but necessary in order to change their culture and their enrolment – but the need for this change is eminent.

There is a disconnect in chiropractic education between clinical and business studies that desperately needs to be addressed as soon as possible. Conversely, chiropractors and chiropractic students need to take a more proactive, self-driven approach to learning business development by looking to role models in the profession for guidance. In practice we achieve clinical success one patient at a time, and business success by working together.

Dr. Anthony Lombardi is a private consultant to athletes in the NFL, CFL and NHL, and founder of Hamilton Back Clinic, a multidisciplinary clinic. He teaches his fundamental EXSTORE Assessment System and practice building workshops to various health professionals. For more information, visit

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