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Dynamic Chiropractic Canada – March 1, 2010, Vol. 03, Issue 02
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Is a Group Practice Right for You?

Pros Versus Cons and Key Considerations

By Mark A. King, DC and Steve W. King, DC

We are often asked about the advantages and disadvantages of group practice versus solo practice. Both practice set-ups have their advantages and disadvantages.

The first question we always ask is: "Do you play well with others?" For example, if you like team sports over individual sports, then you are more likely to do well with a group practice. If you have always been a solo sports or activities participant, then a solo practice will typically match up better with your personality. You need to take an honest look at yourself and determine your personality type.

With a group practice, you have less independence, but you also have less isolation and less tendency for tunnel vision. Historically, medical practices and law practices have been group practices. Chiropractic practices, on the other hand, have typically been solo practices. We suspect this is due in part to the fact that chiropractors are often independent types, and with this maverick personality, they tend to want to be the decision-maker.

The most common group practice in chiropractic is actually when two chiropractors are married, so they are somewhat forced into a group practice. This can be a great thing or it can be quite a strain on a marriage. Specific guidelines need to be followed in this case if the practice (and the relationship) are going to be successful.

Some of the obvious advantages of a group practice include shared expenses. This is especially advantageous in tough economic times and with ever-shrinking reimbursement from insurance plans. For example, in a group practice, if you have an X-ray unit, then more than one doctor is utilizing it, so the unit is sitting idle less and generates more aggregate income for the practice. With the group practice, you can all discuss patient care, office policies, marketing, and any number of different things that come up. On the flip side, you may not want all those extra opinions, particularly if you don't value them.

With a group practice, vacations are easier. This allows for greater continuity of care for your patients. On the other hand, you may not like your patients being treated by another doctor, or you may perceive that your patients will not want to see another doctor and that you are the only one they like to see.

With a group practice, you can cover more office hours during the week, allowing for a more moderate work schedule, if you so choose. For example, you can work opposite shifts if your space is small. One doctor could work Monday, Wednesday and Friday mornings, and the other doctor could work the afternoons. On Tuesdays, Thursdays and Saturdays, the shifts could flip. This keeps the office open longer and allows for efficient patient flow and more convenience for the patients.

It helps a group practice if doctors use a similar chiropractic technique. For example, pairing a Gonstead practitioner with an Activator practitioner is not the best combination. Some combinations can work; for example, a Gonstead practitioner matched with someone who does nutrition. In this case, it is clear that the Gonstead practitioner will not do the same amount of nutrition work and the nutritionist will not do the Gonstead adjusting. They will each handle their area of specialization to help the patient.

In a group practice, it is important to establish specifically how each doctor will be paid. What if one doctor has a much larger practice / patient base than another doctor? For example, one doctor collects $40,000/month and one doctor collects $20,000/month. How is that going to be divided? If it is clear and understood by all, then that's fine, but it needs to be established in writing to avoid conflicts. Typically, with shared expenses, it is clear how the money will be distributed. With an owner/associate doctor set-up, the percentage of pay can be established up-front to avoid any problems and confusion.

With a group practice, you will need to have a clear-cut "boss" of the practice, or at least someone in charge of the various areas of the practice. For example, one doctor can be responsible for the hiring/firing of employees, another can be in charge of the office computer system, and yet another can be in charge of office policies and procedures. It can be divided several different ways, but our point here is that the distribution of responsibilities must be clear. Lack of clarity and communication will lead to confusion and eventual sabotage.

The above are some of the key points to consider when deciding whether to pursue a group versus a solo practice. As stated, there are advantages to both, but we will leave you with two suggestions to ponder: Figure out your personality type, and once you establish how you will set up your office, set-up clear, defined roles for all involved.

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