Creating the dream team: Everything you need to know about building a multidisciplinary clinic
By DR. ERIK KLEIN, DC
By DR. ERIK KLEIN, DC
Many RMTs work as an independent contractor, employee, or rent rooms at a clinic typically owned by other RMTs, chiropractors, physiotherapists, or other health practitioners or businesses. However, many yearn to operate in a more integrated team environment. Multidisciplinary clinics are common, usually run by physiotherapists or chiropractors; however they are not always truly about the team. If you’ve found it difficult to find the right team environment, here are some steps to create your own.
The why/finding it in yourself
Perhaps you’ve done stints with the big chains, moved into privately owned chiropractic or physiotherapy clinics that were more “clinically” focused, often feeling unhappy with the split they’ve negotiated. They enter ABC physio hoping for team meetings, lots of inter-office referrals, and mentorship from senior clinicians, but it rarely comes. After three years of watching new RMTs being brought in to pad the bottom line, you depart. Rinse and repeat. Yes, earning a satisfying income usually, but not feeling fulfilled or free. So you decide you’re going to do it yourself.
The most important consideration, is that being a business owner and clinic leader is actually a very lonely place. The accolades won’t always come, your therapists don’t care that you are late paying your taxes, and you won’t be included in water cooler talk. If none of that phases you, please read on.
Being a clinic owner/RMT/leader means lifting people up, helping them to exceed their expectations and be a better version of themselves. This is a purpose, a passion, a calling. It is not leasing a space and renting rooms out. Hopefully through all of that, you can afford to keep the lights on, and live an appropriately comfortable life for your efforts.
Please take note, none of the advice included herein is meant as legal or accounting advice. It is the opinion of someone who has “been there, done that.” Always have professionals provide the final say on your plans.
Structuring your clinic with the appropriate legal strategy is important. You will need a corporate entity to begin. To reduce over-exposure to unexpected HST expenses, you should keep HST registrants (RMTs/acupuncturists/athletic therapists) separate from non-HST registrants (physios/chiros). A physio or a chiro will likely have their own professional corporation so working with them and their advisors is a key factor here. Consider these issues in advance to avoid a failed audit and unexpected HST penalties in the future. In actuality, in many provinces, physiotherapists CANNOT be contracted or employed by any private entity that is not owned in a majority capacity by anyone by a physiotherapist. As we’ll discuss later, to bring physio in, you should find a physiotherapist partner that you trust.
Employees or contractors
As an RMT clinic owner, you can employ other RMTs and chiropractors. Employment is simple, straight forward, but it does come with added costs. You need to factor in the employer CPP and EI contributions, which can add up to over 7%. (An RMT with a 60/40 split, you end up with 33% before you deal with HST.) So, when negotiating a salary based on a split you must take this into consideration. You also have the straight monthly salary option. I don’t recommend this as it can be a dis-incentive to your therapist from wanting to work. They’ll happily show up, and work what they’re given, but may not be very energetic when it comes to rebooking clients. If someone demands it, you can do a low monthly salary plus bonus arrangement.
Contracting therapists is most common, but the key element is to avoid the CRA determining your contractor is actually an employee and hitting you up for all of your employer remittances and your contractor having to submit CPP, EI, and employee taxes. This is a disastrous scenario. You can largely avoid this by ensuring that the contractor is in charge of setting their own hours, can make changes to schedule, sets their own fee schedule, and owns the equipment in their own room. It goes deeper and more complicated than this, but this is the high-level view. Demanding they are there certain hours, or that they must do certain tasks make them an employee in the eyes of CRA.
Building your team
You simply can’t put out an ad and expect to build a solid team. As a serious clinic owner, you want to develop your “pipeline.” These are relationships that you, your business, the educational institutions and current and former students has. You should spend at least a full year building a relationship with a practitioner before they join your clinic. They should have multiple opportunities to shadow and to bounce ideas off of their mentors, and the same for you as well. Hiring someone off of an ad is a crapshoot. People can really fake it in interviews however if they don’t have the chops you will end up with a revolving door, which is both frustrating AND expensive.
Beyond having long standing personal relationships and a year-long interview process, there are ways you can assess a candidate and learn how to “speak their language.” Remember, this is a two-way street. A candidate is trying to determine if they WANT to work with you. One method is to utilize personality tests (Myer’s-Briggs, Enneagram, “Love Languages,” etc.) and although they are admittedly controversial and should not be the end all, be all, the results of these tests are more a road map to move forward, rather than an end point for decisions.
Don’t forget to challenge the candidate. If you find someone who doesn’t provide high quality care, has poor emotional intelligence, or doesn’t know how to book clients or speak to them, your relationship is likely to be a short lived one.
Registered Massage Therapists
Bringing in RMTs as an RMT clinic owner is fairly straight forward. You should be able to primarily use your network to find good candidates to screen. Beyond this, the schools have job boards and provincial associations/colleges do as well. The lowest item on the totem pole would be a public job board like Indeed, or Facebook ads, but this is not ideal.
Finding chiropractors to work at a clinic, especially in dense markets such as the GTA, is not difficult, but finding high-quality DCs will be. Most DCs spend a good part of their educational time building clinical relationships with clinics getting ready for their post grad life. So reach out early and often, find third year DCs, go speak to their class at CMCC and build that relationship. If that isn’t possible, fourth-year’s flock to “Practice Opportunities” every February/March to look for potential gigs. Having said all of that, just because a DC doesn’t have a concrete post-graduation plan doesn’t mean they are missing something. There are definitely diamonds in the rough, so keep looking!
Naturopaths, outside of very large densely populated centres such as the GTA are unicorns. Naturopathic doctors tend to stay in naturopathic practices in order to hone their skills. However, by reaching out to the third-year’s at the CCNM in Toronto, especially in person, and developing those relationships early, you can get ahead of the curve and find the right fit!
Physiotherapists can be the hardest group to integrate. This isn’t anything about PTs in general, this is about their regulatory body, because every province is different. Their regulatory bodies are notoriously protective, and it has really only been in the past five years or so where they have loosened up restrictions to group practices with RMTs, DCs, and NDs. For example, in Nova Scotia or New Brunswick, a PT cannot be employed by anyone who is not a PT or a majority owned PT corporation, or a regional health authority (aka hospital). In Ontario, it is more open, so check your jurisdiction.
If you are in a more protective jurisdiction, you may have to find a “physio leader,” who essentially wants to run a physio business out of your clinic. This type of relationship takes time, so start early!
Just bringing these groups together under one roof is only the start. You want to build a culture of togetherness and not one built upon collecting room rents, or processing payments and counting ‘your cut’. You want to hold monthly learning sessions or “rounds,” you want one on one sessions, you want to stay a part of their development both as professionals AND as people. Essentially, you want to treat them like you would treat family. Just be prepared for it to be more akin to a parent-teenager relationship vs. anything else. The mutual respect is there, however people’s individualistic needs and development will often be at the forefront.
Eager, keen clinic owners can definitely do this on their own, but you don’t have to be alone. Use your mentors, business consultants, friends/family, or join a network/franchisor where they will hold your hand through a lot of the ‘not so obvious stuff’ and have systems set up to facilitate these types of interactions. Figure out what your ultimate goal is, and then search out the best option to get yourself there. With realistic expectations, and the right purpose, this can be the most fulfilling experience of your professional life.
Dr. Erik Klein is a chiropractor and CEO of Town Health Solutions, a network focused on the growth and development of clinical excellence and entrepreneurship for manual therapists.
For more information, please visit www.townhealthsolutions.com/franchising.