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Tips for finding success in team-based practice

The ultimate goal for chiropractors and massage therapists is better health for our patients. This common ground helps explain why many chiropractors and massage therapists are able to work together successfully. During nearly four decades of chiropractic practice, I have had the pleasure of welcoming many RMTs into my clinic. Each of these caring individuals has taught me something about treating patients, managing a clinic and the joy of being a health-care provider. There were a few bumps along the way, but they helped improve the situation to everyone’s benefit.

October 26, 2015  By Dr. David Leprich

I hope sharing some of these experiences will help you as you continue on your journey to practice success as a massage therapist.

Choose your practice style  
If you are a student or recent grad, you may not have yet given a lot of thought to practice style. Now would be a good time to look at various practice opportunities.  

The style you choose should be based on your ability and desire to administer a business. If you are highly motivated and prepared to build and manage your own practice, consider renting space within an established clinic. This allows you to build a long-term practice on your own terms, within the clinic agreement. You will avoid having to secure and maintain a physical clinic space and benefit from sharing administrative and patient management functions with clinic staff. This places the responsibility for growing your practice squarely on your shoulders.

If you prefer to take a lesser role in running the business of practice, consider becoming an employee at a health clinic or spa. All patients and supplies will be provided to you. Your hours and rate of pay are pre-set and the administrative issues are handled by the spa. You simply show up for work, treat your patients, get paid and go home. This type of arrangement limits control over which patients you treat and often, how you treat them. This may also limit your ability to establish a long-term practice, however.


You may find success working between these extremes. You take responsibility for building your own practice, sharing promotional, administration and other costs. Whichever path you choose, be certain that all the important parameters are clearly defined in an agreement.

Establish a contract
Unless you are setting up a solo practice, creating a clinic/therapist agreement is vital. This should clearly establish responsibility for all details. Some agreements may be several pages long and are more complicated than they need to be, but this is preferable to a hand shake. Start with the basics. How much rent will you pay? This can be a flat rate with built-in increases, it can be based on a percentage of your gross, or a combination of both. Consider establishing minimum and maximum amounts. If you have a slow period or take a number of absences, you are still responsible for making the minimum payment. This helps the clinic owner cover the fixed costs of having you there and protects the clinic from spending resources on a therapist who is not fully committed to a long-term relationship.

On the other hand, a maximum rate helps you. Your practice will grow and your gross income will soar. The fixed costs you generate for the clinic will not increase substantially. A maximum rate ensures that you will receive the benefits of your hard work.

The agreement should also cover details such as responsibility for supplies, linens, clinic access, telephone costs, advertising and any other administrative fees. Whatever the agreement includes, it helps if both parties remain flexible. No matter how well conceived an agreement may seem at the outset, if it does not work for both, it will not benefit either party in the long term.

What is fair
I have had many discussions with therapists about the rates and fees charged and what is and is not included or covered. A great starting point is to ask what others are doing. A colleague did just that several years ago. He canvassed a number of clinics which included chiropractic treatment and massage therapy. In addition to rental rates, he asked about who covers linen costs, yellow pages or other promotional advertising, computer software updates, telephones and stationery. Rates and responsibilities can vary widely so don’t be afraid to shop around for comparison.

Become an asset
Just as I would not consider a therapist in my clinic to be simply a source of income, you should not consider the clinic simply your work address. If I help you build your practice and you help me with mine, we both succeed.

It is easy for me to refer my chiropractic patients to you for massage therapy. Likewise, if your patient is suffering from back pain or headache, and that person has never seen a chiropractor before, have them consult with the chiropractor you work with.

There are many other ways you can become an asset to the clinic. Make sure you are at the clinic early for your appointments. Maintain a professional appearance and attitude. Offer to help with tasks in the clinic. Offer advice about details which you think may need attention. These efforts cost you nothing but can go a long way in building a relationship with the clinic.

Keep your eyes open
Some practice situations may not be quite what you had in mind. Be fully cognizant of what you are getting into. If the clinic considers you solely as an income source, you may be in for a difficult time.

An advertisement currently running in my area lists a chiropractic clinic for sale. The copy says, “Hire a massage therapist and work rent-free.” It is reasonable for a clinic owner to acknowledge the financial incentive to hiring a massage therapist, but if this is stated as a clinic’s selling point, keep looking.

Do some research about the clinic or chiropractor you are considering working with. Check with the provincial licensing body. Talk to other chiropractors you may know. If you are comfortable with the clinic and the chiropractor, your chances of building a positive long-term relationship are much higher.

Managing a solo practice can be very rewarding, but it is not a simple task. There are many benefits to practising within an existing clinic or spa. Think about your practice style and your ability and desire to manage your own business. If you choose to work with others, choose carefully. Some homework now will save trouble later, but will also help ensure a positive long-term arrangement.

Dr. David Leprich is a chiropractor based in St. Catharines, Ont. He is a member of the board of directors of the Canadian Chiropractic Research Foundation. He is the theatre chiropractor for the Shaw Festival Theatre in Niagara-on-the-Lake and a chiropractic consultant to the Niagara Health System and Mentholatum Canada.

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