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Practice Management: Fall 2006

Sole practitioners become clinic managers for many reasons. They require associates to handle excess business. They want extra income to offset operating expenses. Perhaps they desire to mentor newcomers to the profession and thus positively impact the profession.

September 29, 2009  By Don Quinn Dillon

Sole practitioners become clinic managers for many reasons. They require associates to handle excess business. They want extra income to offset operating expenses. Perhaps they desire to mentor newcomers to the profession and thus positively impact the profession. Or, they wish to create several streams of income to increase the quality of their personal life, and to build a nest egg for the day they will no longer work. Becoming a clinic manager is an education in itself, and brings both challenges and opportunities for growth. Whatever the reasons, practitioners who become clinic managers soon find they must acquire a whole new skill set to manage a larger enterprise. In this article, we’ll discuss just a few of them.

Finding & Keeping Associates
There are immediate obstacles to going into professional practice privately, including start-up costs, monthly operating expenses that exceed cash-flow early on, minimal experience in attracting and retaining business and, of course, having no patients! Many therapists opt to associate in an existing practice for their entire professional lives, or they may decide eventually to open their own clinic or spa.

New therapists are keen and excited about their vocation.  They want to practice their craft skillfully, to work in a place where they’ll experience a sense of belonging, and to make a fair wage at the end of the day. Ideally they will also be open to learning from the seasoned therapists in the established location. Done properly, the clinic manager/associate relationship can be long and fruitful.

One of the greatest complaints I hear from clinic managers I’ve coached is that associates aren’t clear on their role. “The associates don’t do enough to promote themselves; they only show up when they have patients/clients!” Clinic managers want solid associates who will work diligently to promote themselves and build their practices. They want to ensure that the quality and reputation of the clinic is maintained. 


Associates may complain the clinic manager isn’t doing enough to promote them, or there is something intolerable about the way the clinic is run. Clinics may experience high turnover if the relationship isn’t clarified in the beginning.

To find and keep good associates, it’s essential to clearly define the relationship and expectations at the outset. Who’s responsible for the marketing? Who does the networking/creating business relationships? Who’s responsible for providing therapy equipment, lubricants, linen, business cards and brochures?

Consider these two models. Model one, the associate is self-reliant, provides all their own equipment, promotes themselves and may utilize common clinic services such as reception and payment services. This associate simply rents the space/opportunity for a flat rent. 

Model two, the associate is more reliant on the clinic for the skills they don’t have, such as attracting and retaining business, accounting and billing skills. This associate requires an internship to “learn the ropes” and benefit from the seasoned clinic manager’s experience. This rental agreement will be higher because the associate is paying for the skills and experience they don’t yet have. The agreement may be a combination percentage with a base rate and cap rate to allow the associate to get started without severely limiting their cash flow, but also to fairly cover operating expenses.

I write about this extensively in my book “Better Business Agreements: A Guide for Massage Therapists.” The clinic manager in the latter case has a greater role in promoting the therapist, and should utilize a number of integrated marketing strategies such as business cards, brochures, public speaking events, a website, quarterly newsletters, advertising and network business group membership.

When I launch a new associate, we utilize many of these promotional vehicles concurrently to get the associate up and running as quickly as possible.
To find and keep good associates, it’s important to be clear on the relationship at the outset, provide fair financial terms, and nurture the associate’s growth and development especially in the first year.

Creating Multiple Streams of Income
Earning all of your income from providing hands-on therapy is limited – there are only so many people you can treat a day to adequately recover for the next day’s work. However, as a clinic manager you have more means to generate income, including retailing products, accepting associates and providing complimentary hydro, electric (such as ultrasound) or spa therapies.

If you’re in a clinical setting, hydro and electric therapies can increase the number of patients you treat in a day by decreasing your actual hands-on time and preserving your energy.

In a spa setting, you can sell retail home-spa equipment and products, or add various esthetic services which can offset the direct strain of providing massage all day.

You may wish to visit chiropractic and physiotherapy clinics, or small-scale spas and see what methods they’re using to generate income by enhancing services or offering retail products complimentary to their services.

Having the right financial agreement with associates is vitally important to ensuring your business generates profit instead of debt. Many clinic managers suffer from creating percentage agreements that provide unstable income from associates, and thus do not cover the operating expenses.

This pulls money out of the clinic manager’s pocket, instead of putting more in. Clinic managers may be ignorant of true monthly costs of business operation, and then fail to bill associates enough for the opportunity and amenities provided.

You may be really competent at treating people, but let me advise that you to seek counsel on your financial agreements before you implement them. It may just save your business!

Balancing Personal And Professional Life
One of the commonly held beliefs of going into business for one’s self is the creation of more free time to attend to personal life. Business statistics show this is not the case! In fact, entrepreneurs work longer and harder, without the safety net of paid vacation and sick days, statutory holidays, and other employee benefits. However, I have found that with a little planning and diligence, one can effectively balance personal and professional life. Stephen R.Covey presents an excellent model in his book “First Things First.” Covey’s model uses the week as a planning platform. He describes: i) identifying your life mission; ii) determining the key roles in your life – self, mother/father, therapist, church member, spouse/partner, community member, etc; iii) create a key goal this week for each role which will yield the highest long-term results iv) implement your action plan; v) evaluate at week’s end how you did. Then, every week, repeat this process.

Covey makes particular points about cultivating the self with the analogy: “Are you ever too busy driving to stop for gas?” I use Covey’s method to divide my week into time-blocks to serve my roles as a spouse, parent, therapist, business manager, coach/writer/speaker, self cultivation/recreation, and community member.

I echo Covey’s endorsement that if you don’t allot time for the important things first, you’ll spend all your time on less important things. As a clinic manager you will likely have two roles – main therapist and clinic manager. You don’t want to be answering phones or going over accounting statements while you could be treating patients/clients!

Plan meticulously your time to provide therapy, and your management time. It may be worthwhile to scale back a few appointments to provide a few management hours each day, or apportion a full day to all your management duties. Either way, try and keep these roles clear and separate. Muddled focus equals muddled results.

There are many opportunities and challenges in being a clinic manager, including finding and keeping associates, creating multiple streams of income and balancing personal and professional life. My greatest joy has been the personal growth I’ve experienced, and the person I’ve had to become to fill these big
shoes of the clinic manager. I wish you well on your path.

don-d-head-shot-2.jpgDonald Quinn Dillon, RMT, is a therapist, writer and speaker and can be reached via his website at Don, along with clinic managers Scott Dartnall and Jim Smyth, are presenting a full-day seminar for clinic managers following this year’s Massage Therapy Canada Expo in Burlington, Ontario. Visit for details.

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