Buying an existing chiropractic practice should be the most efficient and fastest way to financial success. For the new graduate, associate practitioner ready to branch out, or an experienced D.C. looking to expand, the benefits are numerous and the potential pitfalls many. For the last twenty-eight years, we have assisted hundreds of chiropractors in their quest to purchase the practice of their dreams. Regardless of the changing economic conditions over the last three decades, the basic guidelines for practice buyers remain the same. We must look beyond the statistics and the various rule-of-thumb formulas to determine a fair purchase price.

We get inquiries from chiropractors from every state in the country wanting to know the fair market value for a particular practice. Many have taken the advice of management consultants or fellow doctors and believe their simple pricing formulas. These formulas usually declare that a practice is worth a certain percentage of the gross or net income. Or, they follow the advice of their accountant or financial advisor who utilizes a more complex business valuation formula. By and large, these approaches are not relevant to each and every chiropractic practice. Each practice is a unique and distinct entity with qualities that distinguish it from all others.

There is virtually no business in the world that has the exceptional characteristics of a chiropractic practice and, therefore, no simple formulas or business valuations from other fields of endeavor apply. Even medical and dental practices do not share the specific and unique qualities of a chiropractic business.

Determining the value of Goodwill is the major factor in pricing a practice. Specifically, how effectively can it be transferred to the purchasing doctor? Goodwill implies the guarantee of a certain cash flow. This is what the purchaser is buying. Also inherent in the concept of Goodwill is the transferability and guarantee of continued profitability. The practice buyer must feel assured that practice profitability will, at least, stay steady once the sale is consummated. A buyer should never pay for "potential," as that is his or her burden to fulfill and not a quantifiable, salable or transferable commodity.

What do the statistics tell us?

As the famous or infamous saying goes, "There are lies, damn lies and statistics." We chiropractors have invested in the belief that certain practice numbers indicate success, failure or mediocrity. Sellers may want the buyer to believe that a certain gross and net income, patient visit average, office visit average, collection ratio, etc., translate into fair market value or sale price. While the purchaser should definitely look closely and evaluate these numbers, the question remains, of what value are those statistics to him or her? Are they good, bad or average compared to other practices in the demographic area? How do they compare to national practice statistics? Most importantly, can the buyer duplicate or surpass those numbers, and what procedures will be in place to insure that happens? This is ultimately what the purchaser is buying. Every buyer of a chiropractic practice wants to equal, at a minimum, or, better yet, increase the vital statistics of the practice being bought. In the final analysis, the bottom line is, "How much money will the buyer take home after all overhead is paid?"

In addition to a thorough statistical analysis, other factors to consider when determining fair market value of an established practice include a compilation and assessment of the following:

1. Office location, appearance, accessibility, visibility, equipment and layout

2. Staff profile

3. Gross and net income

4. Accounts receivable

5. Payor provider profile

6. HMO/PPO affiliations

7. Referral alliances

8. Active patient list

9. Office procedures (overall practice philosophy, consultation, examinations, report of findings, adjusting techniques and ancillary care.)

Only after a comprehensive review and evaluation of all of these factors can we look beyond the practice finances and statistics and determine a fair market value.

Dr. Greg Kingsbury, founder and president of ChiroEquity, a chiropractic brokerage and consultant company, can be reached at 1-908-419-7510 or by email at This e-mail address is being protected from spambots. You need JavaScript enabled to view it or This e-mail address is being protected from spambots. You need JavaScript enabled to view it

When assessing the assets of your practice, your staff should be your most coveted element. Nothing can make or break your practice like your staff. A well-trained, happy staff propels your practice to new heights. An unhappy, unmotivated staff is a "ball and chain" that will doom your every good intention. You cannot outperform a bad staff. If your staff is poor, your practice will also underachieve. There is no getting around it.

Where to Start

If you are in the process of hiring new people—or replacing staff—it can be much simpler than you might think. A great deal of the final product of your staff will be due to how you treat and train them; it’s rare that some super staff person is going to show up, brilliant right from the start. All you really need in a new staff member are some very basic qualities and your training, stats, goals and motivation will take care of the rest.

1. Does the applicant tend to smile naturally? Sound too simple? Well, it’s critical. If a person tends to be naturally friendly and have the disposition to smile, then you have a person with good energy who will be a natural fit with your patients. Too many people think you need an overly professional person and that can lead to hiring a person who is "all business" but not a naturally warm person, which is essential.

2. Does the applicant desire to be productive? Most people are only happy when they do, in fact, feel like they are making a positive contribution toward progress and success. You need to make sure the people you hire do have the drive to achieve progress. It is a natural drive, but some people do lack it and, if they do, they won’t work out.

3. Do you enjoy spending every day with this person? Do they like to have fun? Will the other staff enjoy spending their days with this prospect?

Sound too simple? It can be that simple IF you provide quality training, proper motivation and the systems in place to keep everything on track. Given the preceding elements, all you really need is to find friendly people who naturally smile and who are happy when they are part of progressive success.

More time, less stress, more fun

It’s understood that chiropractic is an "on purpose" profession. Those associated with it realize the joy that comes with it. And, when we hear a doctor say, "I can’t find good staff," the truth is there is no such thing as a "gem." You don’t just bump into genius staff—the magical, miracle bullet that bowls you over with excellence. Generally, you don’t find them, you make them.

If you continually find yourself not being able to find or keep "good staff," it probably means you haven’t taken the time to train and motivate your staff. Unless you’ve only hired naturally "negative" people, the problem with your staff is that you didn’t put effective, steady systems in or failed to ensure they were followed consistently.

Top Reasons We Fail to Properly Train Staff

1. We don’t have time to train staff. With a busy practice, handling day-to-day tasks, it’s too hard to find the time to train staff.

2. We were never trained on how to train staff. In case you think you missed that class in chiropractic college, you didn’t. They simply don’t cover how to train your staff in typical chiropractic schooling.

3. We don’t know what to train them on. There are myriad important elements that can make or break your practice, but they may not naturally occur to you.

4. We don’t recognize training staff as a top priority. Again, you may not have learned this in school, but proper training of your staff is crucial to your success.

Setting the Course

Make sure staff understands what the goals of the jobs are. In other words, if you just tell them, "I want you to do this," but don’t tell them why, they may not be in support of doing the tasks because they don’t know why you feel they’re important. Show what the goals and statistics of the jobs are. Fully explain to them exactly what it is that their results are supposed to be and why.

For example, we feel a front desk person should make sure all patients enter and exit satisfied and with another scheduled appointment. The stats of that job would be percentage of kept appointments and the percentage of rescheduled appointments. As soon as someone comes through the door, they are to smile and say hello, including the patient’s name. They should tell the patients how happy they are to see them. (My specific rule was we had to say their name at least five times per visit.)

In my travels, I visit a lot of chiropractic offices. Out of an average ten visits, the front desk person only looks up and greets me two out of the ten visits. Eight out of ten times, the staff person never greets me or lifts his/her head up to make eye contact. This is a train wreck from the very beginning. If you don’t make the patient feel welcome, it’s all uphill from there on. Conversely, if you make people feel warm and welcomed from the beginning of each visit, it makes all the difference in the world.

Goal, Stats and Motivation

If you give your staff the path toward excellent results, they will embrace it. If they are the kind of people who are motivated by being part of the progressive success—and they should be—then showing them the way will invigorate them. This can be achieved through setting goals and keeping stats. Without them, you will eventually become a rudderless ship, leading to bad feelings and stress by all.

Give them step-by-step procedures to accomplish the goals. If goals are not accomplished, you can go back, step-by-step, and figure out what was missing. Stats allow you to pinpoint when you go off track. The system allows the person to be in control of their area and keep it on track.

A trained staff = a happy staff = a great team = a productive, low stress office.

Positive Reinforcement over Negative Reinforcement

You have to acknowledge the staff for what they are doing right. When a doctor mentions something a staff member does wrong—and that is the majority of the direction—it has a negative, morale-plummeting effect. As doctors, we have been trained to find out what is wrong and correct it. But with managing people, that mode, in itself, is demoralizing. Try to positively reinforce what they are doing right and make an effort to comment on that. Of course, you have to address when staff is making errors, but don’t allow that to be the majority of what they hear coming from you. For instance, you could say, "Ah, I see patients keep coming back because Mary makes them feel welcome and always mentions them by name." No one is happy at work if all they hear is what they are doing wrong. Give positive feedback and your staff will love being a part of the practice.

Ever been to a traditional Italian household? Dinner may have been over for hours. It could be midnight. It doesn’t matter what time it is. Regardless, you walk into their house and out comes all the food. Saying no is futile. Not only is all the food coming out of the fridge, but trying to deny a mandated second helping is useless. The warmth is thicker than a quadruple piece of lasagna. THAT is the level of warmth you should strive to achieve in your practice. No, you aren’t going to be whipping out a plate of spaghetti, but the friendly atmosphere should be as close to this level as possible. Only a quality staff will allow for this.

If you are reading this article, go back and read the article over again. This information can really make a solid impact on transforming your practice to a stress-free, fun place to take part in.

Dr. Fred Di Domenico graduated in 1987 from Los Angeles College of Chiropractic. After twelve years in practice, he began teaching for The Pettibon System™ and now is one of the founders of Elite Coaching, the most successful coaching system for doctors using The Pettibon System™.

Dr. Di Domenico can be reached by phone at 1-800-696-9036, by email at This e-mail address is being protected from spambots. You need JavaScript enabled to view it , or visit www.elitecoachingllc.com.