Chiropractic + Naturopathic Doctor

XYZs of foreign practice

By Michel Tetrault   

Features Leadership Profession

It is estimated that five to 10 per cent of the population have the
necessary skills and maturity needed to succeed in living and practising
in a foreign country.

It is estimated that five to 10 per cent of the population have the necessary skills and maturity needed to succeed in living and practising in a foreign country.

If you have the “right stuff” your best chiropractic practice may very well be abroad.


Advising chiropractors about the many issues that come to play when looking to start up a foreign practice reveals a mnemonic that seems to apply here:let’s call it the S-T-U-V-W-X-Y-Z of starting a foreign practice.

Speaking the local language. This is often the first concern of English-speaking doctors when contemplating where to set up a foreign practice. Many DCs have to limit their choices to English-speaking countries when they do not see themselves being able to learn another language. However, speaking a second language open up specific countries that would be considered more ideal simply because the language card is a trump card.

When patients understand the benefits of chiropractic they will refer others for care. In pioneer practices, where the average person on the street knows nothing about chiropractic, success is built on referrals. A satisfied patient may or may not refer but an informed and enthusiastic patient will. The doctor will have to be a good communicator.

There are countries where it is accepted that patients are seen by foreign-speaking doctors through a translator. Saudi Arabia is a good example. Some patients in other countries like the Philippines, Singapore and some Latin American countries will also see a specialist doctor when a translator is available. The secret is to train the staff very well in communicating the chiropractic story under these circumstances.

Travel. Taking a trip to the country where you’re contemplating setting up your practice is highly recommended. Call it a reconnaissance expedition. Television travel shows are fascinating but certainly cannot substitute for the personal experience of spending time in a new place and meeting the local people face to face. Even a brief visit can reveal much about a country and its people, and about you and what you can tolerate under what circumstances. What is of particular concern is whether a true feeling of empathy and genuine concern exist inside the prospective doctor’s spirit for the local population. It is either present or not, and will weigh into the ultimate fate of the practice venture.

Understand the culture. This is more about you than it is about the people you wish to serve and live around – at least in the early years of practice. Everyone has a certain ability to confront adversity and tolerate a given level of change. Living in another country and getting used to the culture and the different standard of life can wear out a person’s ability to adapt to daily challenges and ongoing irritations that accompany a drastically altered lifestyle. Unless one’s tolerance for change can keep up with the degree of unfamiliarity that leads to frequent frustrations, the bottom can suddenly fall beneath your feet and the next thing you know you find yourself returning home to the familiar – defeated.

Understanding the ways things are done in any country is paramount to a successful marketing plan. Yellow page ads and coupons in local publications are not very appropriate in Asia and Latin America. How do you market your practice in the French Riviera or a small Swiss village? Using local publicists who understand the way things are done is a good direction to take.

Visualize your clinic. Visualization is a well-accepted concept by successful people in sports, business and personal management. It involves mental imaging of an action or event with specific focus and intention. On the more practical side, this also allows you to make better decisions about the details of your clinic: size, location, patient flow, procedures and other things. Make scale drawings of the clinic plans. Extensively review maps of the country and city or cities where you will be seeing patients. Think about every detail from patient flow to which charts or pictures you want to bring along and place on the walls.

Who, what, when, why. All of these questions apply here as they have never applied before. Whom do you know in the country? Someone who can help you build a framework of logistical and emotional support. This can be a prospective partner, employer, family or other relative, friend of the family or other contact with whom trust has been established and there is sincere interest in seeing things happen for you.

What information do you need to know to better prepare? What has to be resolved (financial, timing, language) before you can actually make the move?

When do you plan on taking a reconnaissance trip, to wrap things up where you currently are, and to start seeing patients in the foreign practice? 

Why have you decided to practice abroad? The risks of failure are higher if you are escaping or running away from something – or someone. Doing the right thing but for the wrong reason can easily backfire, simply because your degree of commitment may be lacking just when you need it most. If on the other hand, you have done your homework and feel strongly, almost overwhelmingly, about your decision, it stands to reason your opportunity for success will create itself.

X marks the spot. The location of a chiropractic clinic has been an important success factor seen in industrialized countries where the substantial middle-class population has been able to support a large growing number of chiropractors. Where there is one DC for every 10,000 people or less – such as in the U.S., Canada and Australia – the clinic location can usually be found in a retail centre or a stand-alone building on a busy commercial street. 

If a country’s economy and humanitarian laws favour a larger middle-class, the locations for a chiropractic clinic will likely follow the same experiences seen in English-speaking countries. In countries where the middle-class is practically non-existent, a two-class society has really only one group of people who will be able to pay for chiropractic care in private practices – the well-to-do folks. In this case, it is a mistake to try and locate a clinic using standards and criteria that work in Canada and the U.S.

When chiropractic is initially being introduced to a developing country, go where the prospective patients live and work. The wealthy that can well afford care expect to find first-class facilities in a first-class location such as in a street-level office in a financial district, a ritzy mall, a stand-alone building within a large secure community or in an office just in front of the main entrance to the large, secure communities.

In countries where there is great disparity between financial classes, people who can afford to live in middle-class homes or in exclusive communities have demanded secure, segregated home developments. This does make it easier for the chiropractor to locate in a nice neighborhood and maintain a good quality of life, even though the rest of the population, often over 80 per cent, live in poverty-afflicted areas.

DCs who understand these economic conditions and still choose to serve the poor usually arrange a free clinic for a couple of days per month in a church or community building located in the poorer communities. By lowering the financial barrier this way, you can help hundreds more people

Yes, there is enough money and emotional support. You will need these to undertake the challenge of opening a chiropractic clinic abroad. How much money? Typically, an associate needs $10,000 and an owner needs $50,000. When this declaration is spoken with confidence – it’s time to get serious.

Z factor. This refers to the degree of drive and enthusiasm needed to maintain the energy and focus required for a successful venture. When people travel, there comes a time during the trip when they run out of gas. These are dangerous times. Constantly having to cope with daily challenges can, at times, be daunting under the most familiar circumstances. Adapting to the lifestyle of a foreign culture can wear out even the most experienced traveller. Making a living in these conditions increases the exposure and the risks of being overcome. This is effectively countered by the doctor’s drive, reserves of energy and enthusiastic dedication.

Practising abroad is not like moving to another town or city in Canada or the U.S. The thrill and excitement of the adventure can quickly turn into a nightmare when you are not adequately prepared or do not have the adequate reserves of energy and tolerance for the changes outlined above.

There is more support and infrastructure available today to assist DCs who can make the transition into a foreign practice. Practising abroad can be a positive step in establishing the profession in a foreign country and changing the lives of millions of people who lack access to regular chiropractic services.

Additional information is available at the Chiropractic Diplomatic Corps site: .

Dr. Michel Tetrault  

Dr. Michel Tetrault, originally from Manitoba, now owns a chiropractic practice and wellness centre in the Philippines. He is executive director of the Chiropractic Diplomatic Corps, a non-government organization promoting increased availability and equal access of chiropractic to the world’s populations.

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