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Dynamic Chiropractic – May 6, 2009, Vol. 27, Issue 10

Is an Integrated Practice Right for You?

By Steven Peyroux, DC

Einstein said the definition of insanity is doing the same things repeatedly while somehow expecting different results. In today's health care environment, it is becoming increasingly difficult to prosper in an adjustment-only chiropractic practice. There - I said it. It's not popular to point out, but sometimes the truth isn't popular. The reality is that in today's economy and insurance reimbursement environment, chiropractors who are offering spinal adjustments only are either struggling to stay in business or working feverishly without getting paid what they are worth. If you find yourself nodding your head in agreement, read on.

Don't Change Your Profession; Change Your Model

There are a few proven models out there for chiropractors to consider. One is PT and/or MD integration. Done wrong, it's no panacea and can be a disaster. Done correctly, your practice can go from struggling to thriving, and (this is some of the best news) it can do so without you having to pour in the hours and labor. And integrated practice, done right, will leave you with case fees going from $400 to $4,000 (or even $8,000) while leaving you with spare time to do other things besides being a slave to your practice. You will find yourself with time to watch your kids play soccer, pursue a hobby, or do any number of things you've never had time to do.

Are You Ready to Pursue an Integrated Practice?

You have to be operating at a certain level before it makes sense to convert to an integrated practice. The following are the necessary benchmarks for a successful transition:

  • You should be averaging five new patients a week. If you are not already at this level (or higher), integration isn't the answer.
  • Amount of collections doesn't matter, but profit margin does. You need at least $10,000 of profit per month.
  • You need some level of staff. If you're the one answering the phone at your practice, you aren't ready for integration.
  • You cannot be a control freak and integrate. It won't work. You must be able to delegate some duties if this is going to fly.

Does Integration Run Counter to the Spirit of Chiropractic?

On the surface, it can appear that way. But in reality, you can still embrace the soul of the chiropractic philosophy while integrating your practice. How? If you are adding an MD, are you contradicting the chiropractic creed that the body can heal itself without the need for drugs? No. Your practice can still maintain the philosophy that one should avoid using drugs unless they are undeniably needed.

Just because an MD is on staff does not mean your practice immediately abandons the chiropractic philosophy. As a matter of fact, these days, many (most?) complementary and alternative medicine professionals come from allopathic and pharmacy backgrounds. They have discovered firsthand the dangers of being too quick to resort to drugs as the answer.

Also, believe it or not, PTs are not anti-chiropractic in nature. The therapy that PTs provide actually makes chiropractic adjustments much more effective. Adjustments with therapy are far more effective and lasting than adjustments alone.

How to Succeed Where Others Have Failed

As stated previously, simply adding a PT or MD to your practice is not a panacea. Done improperly, integration might not only not work out, but also fail miserably. You have to hire the right people, train them properly and structure your practice at every level. But done right, your practice will be transformed from an adjustment-only office to a full-service health care facility that has a plethora of insurance reimbursement opportunities available.

Your Patients Will Thank You

Adding PT or MD services is something your current patients will enjoy. Consider a car maintenance shop as an analogy. Do you prefer going to a car shop that can do only one function (just deal tires or just change your oil) or do you prefer a shop that can handle all your needs at one time and in one place?

Is it not preferable, especially with today's hectic schedules, to drop your car off and get the new tires, windshield wipers replaced, and oil changed all at once? Don't you think your patients will enjoy a health care practice that can address all of their needs, from adjustments to therapy to allergies and more?

Get Paid What You're Worth

In today's health care market, it is becoming increasingly difficult for chiropractors to earn what they are worth. With ever-diminishing insurance reimbursement available, and with potential patients having less and less money to spend on anything other than the roof over their head and food on their table, chiropractors who operate their practice in a traditional manner are finding it more difficult to survive, much less flourish. Doing the same thing (running an adjustment-only practice) will not yield different results. It's time to make an "adjustment" on your practice model itself.

In less than 18 months in the PT/MD integration model, you will be free from the brutal hourly schedule that creates insufficient revenue. You will own a practice that produces significantly higher income and have more free time to do the things you like to do most.

Dr. Steven Peyroux is the founder of Physicians Business Solutions (PBS). He has successfully integrated more than 500 clinics and has been lecturing, coaching and teaching an integrated practice model for over 15 years. Contact him with questions and comments at 1-800-908-8895 or visit for more information.

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