Associating to Owning a Practice with Dr. Emily Gerson
As a practicing DC, your career will change over the years as you get more experience. This was the case for Emily Gerson, DC, of Denver, Colorado.
Instead of starting her own practice right away, Dr. Gerson chose an associateship. Then when the time was right, she opened her own successful practice and hired an associate. She shares her experiences through it all below.
How did you choose chiropractic?
“I was an athlete, a track and cross country runner in high school and I was injured all the time. I went to a couple PTs, and nothing really helped. Somehow I ended up in a chiropractor’s office. I walked in and I was like, ‘Oh wow, this is awesome.’ He treated me all through high school and ultimately treated my entire team. He kept all of us healthy and competing, and I just thought it was really cool.
I went to college thinking I would be premed and it turned out I just couldn’t hack chemistry! I figured there were other things I could do that would let me be able to help people. I ended up a history major.
When I graduated, I kind of floundered for a long time with a couple different jobs – health care marketing, working at a dot-com, (it was the heyday for that!) nonprofit management and even at a technology school. (Clearly, I was not very focused or passionate about anything, and I pretty much hated each job I had. It was not the best.)
Throughout that whole time, though, I was always a chiropractic patient. Every time I would walk into an office, I had this feeling like ‘this is what I am supposed to be doing.’ Fortunately, I had a very supportive husband who just said, ‘Well, then do it already!’
I got my undergrad degree from Colgate University in 1996. I hit up every community college in Denver and it took me two years to do all my science prerequisites (there were a lot!) just to get into chiropractic school. I finally started at the University of Bridgeport College of Chiropractic in 2002.”
Did you know you were going to start out as an associate?
“I always wanted to be my own boss and have my own practice one day. I didn’t know what that would look like, but that was globally, the big picture plan. When I graduated chiropractic school, I was nine months pregnant with my first son. Being a new mom and new chiropractor at the same time is not the best decision, perhaps. I took six or seven months off with my baby when he was born. I looked around and realized I wasn’t in any position to start my own practice at that point.
Also, geographically, we didn’t know where we wanted to live long term, but we were pretty sure it wasn’t where we had been. So, I definitely didn’t want to start a practice if we were going to potentially be moving. I was fortunate to find a part-time associateship with a well-respected chiropractor in my neighborhood.”
How was your experience in the associateship?
“Clinically, it was fantastic. I would call him after almost every day and ask him questions and we would talk clinically through the case. I really learned so much that way – how to talk to patients, how to treatment-plan, different clinical pearls, pain referral patterns we had never learned in school! That was fantastic for me. Personality-wise, it perhaps wasn’t the best fit. I often felt like I wasn’t meeting expectations or treating patients exactly the way he wanted me to. It was probably more me being insecure as a new chiropractor, not knowing if I was doing a good enough job.
In terms of getting my hands on a lot of people, it was awesome! It was a pretty high volume sports medicine practice so I got to see and treat a lot of different people and issues. One benefit to keep in mind is that if you go to work for someone who is already established, you have built-in credibility. Patients trusted me from the very beginning, because they trusted the owner to make a good hiring decision. Having built-in credibility when you first start is actually very useful. That position also helped me learn how to communicate, set patient expectations and develop relationships with them.
One thing that was a little tricky was that my technique was a bit different from the owner’s and he wanted me to pretty much mirror him exactly. That’s a tough spot. Innately, I just didn’t treat the same way that he did and I couldn’t really develop my own style so much because I was trying to mirror his. That definitely impacted my confidence as a new chiropractor. I would say that I got to develop my own style as I gained more experience and had more opportunities over time. It was useful for me to learn that though.
When I was in a position to hire my first associate, I made sure that clinically and philosophically we were on the same page, but I understood that our hands/touch/technique would likely be different, and that was ok. They were similar enough, but we didn’t have to treat exactly the same. And I actually think that patients appreciate having different options.”
As an associate, what didn’t you want to ask but needed to know?
“Oh my gosh, there is so much. Some things you just don’t know or realize until you are actually in a working situation.
You need to know who is responsible for bringing in new patients, how that happens and what counts as a new patient. It gets complicated and confusing sometimes. My first associate had worked at another clinic before mine and she said she was promised all the new patients. But, that didn’t actually happen and it turned out the owner was very territorial. I think it’s important to get a sense of that. In my practice, unless a patient specifically says they want to see only me, they will get scheduled with my associate.
There can be a lot of things that are unclear – who counts as a new patient, how do you track referrals, is the associate or the doc responsible for bringing in patients and keeping the schedule full, what are the expectations if you don’t have patients scheduled? If you see a patient and they refer someone who comes in six months down the road, who gets credit for what, when? I think you just want to get a sense of how the owner acts/treats all of these scenarios and understand their expectations, and also get a general sense of if they simply seem fair.”
How did you know you were ready when you did go out on your own?
“An opportunity presented itself. I had practiced for around five years as an associate in Connecticut. Then, I moved to Colorado and was working as an associate for around four years. By then, I pretty much knew what I liked and what I didn’t. My Colorado job was a good gig and I was mostly happy, but I always had the dream or vision that I wanted to be on my own. I didn’t know how that was ever going to happen though.
It turns out, I was a patient of an acupuncturist business owner who rented space in her building to a chiropractor. She came to me one day and said, ‘Hey, my chiropractor is leaving. Do you want to rent the space?’ And I thought, ‘If that’s not the kick in the butt that I need to make this work, I don’t know what is.’ I also knew that we were settled and planning on staying in Colorado long term, so I felt comfortable going for it!
It was cool because that rental arrangement included front desk support and administrative staff. So, I kind of walked into an already existing, successful business and just had to start treating without worrying so much about the front desk/admin part. For me, that was amazing because it was definitely scary going out on my own.
As an associate, I had been participating in insurance and I decided that when I was on my own I didn’t want to do that. So, I was going cash-only. And, geographically I was moving around six miles away. (It doesn’t seem like a lot, but it is!) Between changing geographically and not taking insurance, I really was taking a chance and had no idea how it was going to go. My first day, I was super psyched because I was pretty solidly booked. People just followed me. They liked me enough, I guess. So that was awesome. I just kept doing my job and kept growing.”
What advice would you give students still in school? Is there anything you wish you would have known?
“I wish I would have known that being a chiropractor is really a lot of hard, physical work. I think they don’t talk about how physical the profession is or focus enough on proper adjusting technique/ergonomics. You need to figure out how to safely do your job so you can do it long term and not get hurt. I think self-care is really important – getting adjusted, acupuncture, a massage – whatever feels good to you, but they should tell you to make that a part of your lifelong business plan!
I wish I would have known that nights and weekends were going to be a big part of the job. Maybe my husband wishes he would have known that, too, because it’s definitely been a stressor over the years. It definitely helps to have a flexible and accommodating family/support network.
It sounds stupid, but I definitely wish someone would have said, ‘Wherever you practice, make sure you can control the temperature in the room.’ As I said, it’s a physically demanding job. You get hot. It’s awful treating in a room that is too hot or too cold. Sounds basic, but it’s a big deal!
Find mentors and connect with other colleagues. Get treated a lot, by a lot of different docs. I think those are the things that really helped me the most. You don’t have to learn all the different techniques, you just have to know they exist and be open to them! Realize there are a lot of different ways to be a chiropractor and figure out what feels best to you, and also be willing to change that over time.”
Trying to decide if you’d like an associate position? Take a few minutes to learn additional benefits and considerations of associating. Or, read more about Dr. Gerson’s experience.
Posted in Chiropractor Entrepreneurs