Q: Dear Dr. M, This may take some time and many issues are presented in a not so organized fashion. I need some help. I recently had a very miserable experience 'independent contracting'. This was more the associateship type arrangement with the required hours, tight control, etc, but with the very scant IC percentage and ZERO respect from the CA and support staff. Anyway, besides depleting my savings to live, this experience stripped me of my confidence to the point where I've spent the last few weeks literally reading everything in its entirety. I've re-read Strauss, ICA journals, technique manuals, Activator, small business books, etc. I am emotionally and mentally burnt out. I have had many interviews with docs looking for various types of arrangements. I have gone in with a list of questions to ask - fearful of getting myself into the same situation I was in before. I am tired of wasting my time. I'm evaluating some of my options as follows: I recently had an offer from a doc friend of mine to rent some space from him in a location where I think I may want to live in Georgia.(My husband & I are planning to buy a house next year) What are your opinions? We have the same straight chiropractic philosophy and both desire a subluxation based practice. I feel the rent is reasonable and there would be no lease obligations. As one renting space, I am essentially starting my own practice. I would get my own business cards and stuff like that, however, my name would not be on the door. I understand that with such arrangements especially where you use their CA, one would use that docs forms as well. Well those have his address/name on them as well. I would have access to a 12 X 12 room for adjusting/exams/ROF. Since I would be essentially starting my own practice, I would need some of the supplies/eqpt that you recommend when starting with a low budget, ie desk, educatonal materials, etc. Can you help with the rest of the list? The big things like reception furniture, x-ray, etc will be provided. I will need a stationary table as the other office provided that. Do you think there is a 'psychological' something, confidence, or whatever is owning and using your own eqpt? I never felt comfortable using another docs table in the other place. I think that my first experience had clouded my thinking in terms of exactly what that arrangement entails. This weekend I am attending a Fernandez seminar. Any opinion? I spoke to a GA doc that has been with him for several years and is very happy. I'm taking your advice and attending a seminar as a first timer at a deep discount. Which leads me to my other option: Some days I just say, what the hell, I can do this by myself and I spend hours in your Smart Start book for the 3rd or 4th time, planning ahead for the day that I start my own. You suggest opening in an area where you want to live and practice and not to worry about the other DC's in the area. What about those extensive demographic and psychographic studies others suggest? Obtaining customary fees in the area is easy - what about those docs that have a 'cooperative fee system'. They take what you can afford. Some take the insurance co-pay as full payment if the patient is not covered for chiro services or taking the in-network pyment even if th doc is out of network. Is that legal? What about docs who use say, yourself, a roller table. If the patient is insurance, can you bill insurance for your adj + therapy, but charge a flat adj fee for the cash patient even if they get the therapy too? I me a doc whos adj are $30, but he bills insurance $45 cause thats what they'll pay. Legal? O do you say your adj are 45 and give a cash discount? Again I apologize for this disorganized mess - we just bought a computer and this stuff has been building up( I couldn't get over to the school to use those PC's regularly) - and there's more to come As always, I appreciate all you do for us. When do you have time to run a practice if you spend so much time mentoring us? A: Thanks for the e-mail .. okay another associate or IC e-mail from hell. Seems experiences range from exhilaration to outright disgust with all shades in between. The basic answer for your question rests with your initial purpose of being an IC or associate. Often .. as we mentioned in class .. it was lack of funds to open on your own or fear of starting out on yourself. Lack of funds which also includes gross school loans and additional debt .. is scary but this too shall pass if you have a set goal and timeline. So .. the basic question is .. why did you become an IC .. what did you expect to get out of it .. were you able .. not restricted .. to generate additional patients and income .. were you able to market yourself or the clinic .. and most importantly did you learn anything positive from it. I realize you mentioned tight control and lack of respect .. but this unfortunately is what many find in the corporate environment. You depleted your savings to live .. was this due to poor salary or as a true IC .. you never surpassed quotas or grew a better clinic for yourself. Please don廠 take this as a slam on you .. it is not .. but to not repeat the same mistake you have to change and be sure everything changes for the better as well. Also .. I applaud you for delving into the books but be aware that your answers are generally not found there .. instead they are found within your comfort zone and how committed you are to make the proper changes. For example .. getting into a shoe box size office with other built in restrictions is repeating the same mistakes. If the rental space is for you alone .. not with another DC in the same location .. then this is much better. But .. if you are renting from this friend space in their office .. in a 12x12 space for everything .. it won廠 be too long before a growing practice (and you do want this) will not thrive here. You will grow as big as the box .. I hope you have bigger visions than this. What is your financial restrictions? If you are deeply in debt .. and I suspect you are .. and do not wish to further get in debt than you have to turn the curve around and begin making money. Nothing wrong with that. So .. what would I do? Seems you are anxious to get back in the game but are afraid to get burnt again. Okay that廣 fair. Seems you are dedicated to provide a great service and have been up to speed with your reading and ready to put it into action. Seems you are looking for a quick or easier answer and therefore have gravitated to your friends office proposal. This too is okay if worked right. A better IC position would be to pay a monthly rental fee and that廣 it. If you use supplies you may have a dollar arrangement or replenish it .. such as x-ray. I would have my own telephone line and use a better answering machine with a caller ID device so you can call back as soon as possible. If you use the DC廣 CA .. then she should know how to schedule your patients but don廠 expect allegiance ..she is being paid by the owner DC. I probably wouldn廠 want to work in just one room .. but this is how many successful IC arrangements are done. One DC I know charges new DC廣 in his office .. as an IC .. $500 a month flat fee .. offsets his rent. Another charges the same and gets a slight percentage over $5000 collections. This you can always work out. If you wish further details and contracts for an IC position e-mail Dr. Slater at: gatormark@aol.com and be sure to tell him I referred you. As far as fees .. never mind what the other DC down the road is doing. If cooperative fees were breaking down the doors than we would all be doing it. There are plenty of patient to go around and almost 90% never read promotional flyers or have ever been to a DC. Never mind about what is legal or not .. you have to make a living and once in your own business it is your business. I would say that most doctors of all stripes DC and MD are making patient arrangements. Hopefully these are the exceptions rather than the rule. Just you concentrate on practicing scripts to tell the story .. get your consultation and report of findings down and be able to talk money. I have many of these ideas in the Smart Start Book and on my webpage. Now it廣 time to stop reading and start talking ..practice with your husband .. role play the reports and the fees. Begin to think as if it is .. make believe you are already turning the key to this clinic .. even 12x12 .. what do you see .. where do you see the stops and the openings. Who and how do you expect to generate new patients .. this is the most important aspect. If there is a blank picture than you are not ready if there are shades of gray and defined lines than we have a chance. In conclusion .. fees and structure are the easy parts .. getting the new patients in and keeping them is the hard part. You asked where I get the time to answer all these e-mail questions ..well .. the answer is ..I don廠 have the time and it does take from my practice time. But .. this is where the flow is taking me and I always go with the flow. Have a Great Day Dr. M