Where to Begin

How do you know when it's time to add staff to your practice? And how do you find the right person?

Employment Practices

Where to Begin to Hire Staff

As entrepreneurs, many chiropractors assume several roles, especially in the early years of building their practices. However, as the practice grows, many doctors find they can no longer be the office manager, bookkeeper, appointment scheduler, and treat patients at the same time. But where do you begin and what is the process to hire someone?


Assess Your Situation

If you're contemplating adding staff, ask yourself:

What are my business needs?
What hours are you open, and when are you busiest? How many patients do you see? Is your business growing slowly or rapidly?

What tasks need to be completed to make my practice more profitable?
Do you need someone to schedule and greet patients, answer the telephone, or complete your billing and claims processing?

Who Should I Hire First?
Typically, the first position you'll need is the front desk assistant who will act as the receptionist and the appointment scheduler for the office. You may also want to hire someone to handle insurance and third-party billing.

From there, you can begin adding clinical staff (i.e., clinical assistants and associates) if appropriate for your practice.

What Other Factors Should I Consider?
Once you've identified what position(s) you need to fill, here are a few other factors to consider before you move on to the selection process:

  • Should I hire a part-time or full-time employee?
  • Should I use a temporary agency?
  • Should I hire a relative?
  • What compensation should I offer?
  • What about benefits?

Part-time vs. Full-time Employees

Some doctors prefer to have someone on staff full time, either to meet the needs of their practice or because they like the continuity for their patients. However, a flexible work environment often can help you find and keep a staff of quality employees.

Those interested in part-time employment may include parents with school-age children and college students.

Many doctors find that with a little planning, the benefits of offering a flexible schedule outweigh the drawbacks.

Some D.C.s prefer the continuity a full-time position provides. While others recognize that a part-time position may open the door for equally qualified individuals who may not want a full-time position.

Using a Temporary Agency

With a temporary agency, you'll typically pay more per hour for someone who, most likely, won't have a chiropractic background. However, this may be an option to get assistance in your office until you hire someone.

Should I Hire a Relative?

Hiring a member of the family, typically a spouse, works well for many chiropractors. It can be a good way to get the practice off the ground. But, before you pursue this arrangement, you'll want to consider:

  • The financial benefits of employing your spouse, such as tax deductions for business expenses and childcare and the ability to have both spouses receiving employee benefits.
  • The need to validate your spouse's employment - treating him or her in the same way you treat the rest of your employees. This includes having the correct records on your spouse and following the proper personnel procedures.
  • The impact your spouse's employment will have on the professionalism of the office.
  • Your spouse's compatibility with the job.
  • How the arrangement will affect your personal relationship with your spouse.
  • The consequences if the arrangement doesn't work out.

What Compensation Should I Offer?

Compensation ranges vary widely according to responsibility level and geography. A trained chiropractic assistant who is also acting as your front-office supervisor would command a higher wage than an untrained college student who does little more than answer the phone while you perform the bookkeeping and billing responsibilities.

Carefully define just what you expect, then check with your state chiropractic association/society to help you determine a reasonable starting point for wages.

Another factor to consider is an employee's status as exempt or non-exempt.

Exempt employees receive a salary representative of payment in full of services rendered including all required or voluntary extra hours worked.

Non-exempt employees will be compensated for actual hours worked and hourly credits earned, such as paid time off. They will be eligible for premium overtime pay. Non-exempt employees will not be paid for time not worked unless they are being compensated for benefit days, such as vacation time or sick leave.

The Fair Labor Standards Act (FLSA) governs the status of exempt versus nonexempt employees based on their job duties. For more information on topics such as overtime pay, minimum wage, recordkeeping, reporting, and more, see the "Wages" section of the Department of Labor web site at www.dol.gov .

What About Benefits?

The most common benefits are: health insurance, life insurance, vacation, holidays and sick leave. If you don't have a benefits package, you must state that during the interview, or prior to making an employment offer.

Many offices are including a 401(k) plan in their benefit package to provide an additional benefit and increase employee retention and loyalty for long-term employees. It may be more affordable than you think! Contact your insurance consultant or your state association for a list of companies that specialize in employee benefits.

In a small office, you can't afford to have people on long vacations. Usually the rule of thumb is if the employee works six months, he or she is entitled to a week of vacation.

Over time, this may increase up to two weeks. Usually employees are not allowed to take two weeks in a row, since it's hard to have somebody out for two weeks if there’s only one employee. Part-time, hourly employees generally don't receive many other benefits.

Sick leave benefits are always an issue for full-time employees. One option is to provide your employees with "benefit days," in which a total pool of days are available for your employees to use as they wish-whether it be for vacation, sick leave or for personal time.


The information in the NCMIC Learning Center is offered solely for general information and educational purposes. It is not offered as, nor does it represent, legal or professional advice. Neither does this information constitute a guideline, practice parameter or standard of care. You should not act or rely upon this information without seeking the advice of an attorney familiar with the specific legal requirements of the state(s) in which you practice. If there is a discrepancy between the site and an insurance policy you have with NCMIC, the policy will prevail.