What to Know Before Becoming a Chiropractor

Posted by Bill Esteb on Feb 24th 2021

At one time or another over the last 40 years I've been asked to speak at 21 different chiropractic colleges around the world. That may come to an end with the revelations below, but no matter. Your career choice is one of the most important decisions you'll make.

In surveys that rate these sorts of things, some aspect of delivering health care comes up among the top 10 most desirable careers—based on income, personal satisfaction and working conditions. If you're considering such a career, here's what you'd want to know before enrolling in one of the 46 chiropractic colleges around the world:

Why Do You Want to Become a Chiropractor?

In other words, what are your motives?

I often ask chiropractors why they became chiropractors during my telephone consultations. Over the years I've noticed that certain motives are common among those having difficulty thriving in practice:

  • Heard that you can make a great income
  • A way to become a doctor faster than being an MD
  • Couldn't get into medical school
  • Wanted to work with my hands

Conversely, I've seen some common denominators among those who have the inner drive to succeed as a chiropractor:

  • Wanted a way to significantly help people
  • Had a life-changing experience with chiropractic
  • Fascinated by the many facets of health
  • Second-, third- or fourth-generation chiropractor

Suggestion: It's troubling that such a large proportion of chiropractic students haven't been adjusted until they get to chiropractic college. Before enrolling, sit down with a chiropractor, or two or three and get adjusted. Ask what they love about being a chiropractor. And what they dislike. Still interested? Good.

Do You Want to Own and Operate a Small Business?

Unlike medicine, there aren't many different career paths for chiropractors other than private practice.

It's called a practice, but it's a small business. They're called patients, but their customers. Your practice will face all the same challenges as other small businesses, plus additional issues because of the position of trust you hold delivering health care:

  • Marketing strategies to get new customers
  • Hiring, training, managing and firing staff
  • Managing cash flow and monitoring your P & L
  • Making payroll, withholding and filing taxes
  • Securing appropriate insurances
  • Setting and enforcing policies and practice procedures

This is on top of the obligations of managing the clinical aspects of patient care.

I've noticed that many struggling chiropractors resent the business aspects of chiropractic. If you're not cut out to be an entrepreneur, you can likely become an associate or subcontractor for a chiropractor who is. There's no shame in that. However, it will likely reduce your earning potential and many associate chiropractors complain that they often feel exploited.

Suggestion: Snag a copy of The E-Myth Revisited by Michael Gerber. This delightfully short and highly readable book will explore the three hats you'll need to wear as a successful small businessperson. If the very thought of reading a business book produces an allergic reaction, consider that a significant insight.

Chiropractic College is a Privately Held Business

When you think of an Ivy League college or state university, you think of institutions with huge endowments and deep pockets. However, chiropractic colleges are small businesses too. Their profit motives and hand-to-mouth existence may influence certain policies. It may even make them less than forthcoming regarding your prospects of being a successful chiropractor.

Chiropractic colleges make money by charging for tuition, and assisting students to get loans to pay for it.

Is it a fair trade? It seems tuition has gotten out of sync with the realities of the post-graduate practice marketplace. Simply put, today's health insurance policies are designed largely for catastrophic health problems and require huge deductibles to be fulfilled first. The typical chiropractic case fee rarely reaches these amounts. So, while patients may have insurance, they don't have much coverage. That means you'll largely have a cash practice that could take many months, even years, to produce a professional income. Especially, if you're saddled with a quarter million dollars (or more) in student loan debt!

Worse, the admission's department has no incentive to administer the psychological testing that would warn introverts that they're likely to have a more difficult time in private practice than extroverts.

Finally, so afraid of being categorized as a trade school, most chiropractic colleges see their purview as merely helping you pass the various examinations needed to get a license to practice. And while some colleges pay lip service to "helping you become a successful chiropractor," it's mostly window dressing.

Suggestion: While at chiropractic college, take as many off-campus seminars as you can. Without the subsidies of student loans, you'll find most seminars and webinars are firmly anchored to the real world. Most presenters are keenly interested in your success. Their reputation depends on it.

Chiropractic College Instructors Are Often Marginal Chiropractors

This is hard to write because there are some remarkable exceptions. I've met many of them. They are chiropractors who have enjoyed amazing success and feel called to pass on their experience and wisdom to the next generation of chiropractors. I wish there were more of them.

However, teaching at a chiropractic college is not an especially high-paying job. Thus, it often attracts those who may be brilliant, but have difficulty in successfully running a small business. Unfortunately, these instructors can taint their syllabus in overt or subtle ways based on their less-than-happy practice experience.

Keep your eye on the prize. Since you won't use most of what you're taught in chiropractic college, lighten up. It's merely an obstacle course put in front of you to see if you have what it takes to be trusted with delivering care and leading patients.

Suggestion: Unless you have a scholarship that depends on your test taking, you may want to rethink the emphasis that is traditionally placed on grades. The diplomas (and licenses) of the valedictorian and the student who barely graduated are virtually identical. Rest assured not a single patient will ask about your GPA.

Understand the Politics of the Profession You're About to Enter

Like virtually every human endeavor, chiropractic is riddled with politics. Simply choosing a particular chiropractic college can be a political statement!

The primary political bifurcation in chiropractic can be reduced to two different visions for the profession:

Vision #1: Chiropractic is a means of reducing nervous system interference using chiropractic adjustments to restore optimum function and promote well-being.

Vision #2: Chiropractic is for the treatment of various musculoskeletal health problems, producing relief by using spinal manipulation and other non-drug interventions.

To the uninitiated, both visions sound perfectly delightful. What's the problem?

Advocates of the first vision acknowledge the distinction between chiropractic and medicine. Proponents of the second believe that chiropractic should integrate with mainstream medicine and that philosophical foot dragging impairs the acceptance and utilization of chiropractic care.

Each point of view has passionate supporters and detractors for reasons beyond exploring here. It's a stalemate that has been going on for over a century.

Ironically, the practice act in most jurisdictions, providing for the licensure of chiropractic, was based on the assertion that chiropractic was a non-duplicative healing art, separate from medicine and based on a different operational philosophy than medicine. In fact, until various states embraced chiropractic as a separate and distinct discipline, chiropractors were often jailed for "practicing medicine without a license."

Suggestion: Do some research about the earliest days of chiropractic and the move to obtain licensure. Ask chiropractors about this philosophical schism and the point of view they've reached and why. Find out how each vision influences their day-to-day practice, record keeping, patient communications and other professional obligations.

It Takes Two Very Different Skills to Excel in Practice

Successful chiropractors, by whatever measure you wish to use, usually exhibit two important skill sets.

1. Marketing chops. I'm putting this one first because without some type of ongoing promotion, a practice can starve for new customers. It takes far more than hanging out shingle and having great intentions to help others. That's because gushing referrals are rarely enough to keep a practice going. Nor is being on all the insurance lists of approved network doctors. Or even delivering amazing care. You'll still need a strategy to introduce new people to chiropractic. Which is why extroverts often have an advantage over introverts.

Back when I had a regular guest lecturing gig at a major chiropractic college, I surveyed students, asking how they intend to get their first batch of new patients after exhausting friends and family. The answer? Social media. Good luck with that.

More effective will be pursuing public speaking opportunities, developing a robust, high-converting website and probably even some pay-per-click advertising.

2. Delivering the goods. Like any skill requiring eye-hand coordination and a good dose of intuition, some chiropractors are better adjusters than others. Yet, even with all the focus placed on adjusting technique, from a patient's point of view, it's mostly a hygiene factor. In other words, there's a reasonable expectation that you're proficient and won't hurt me. However, if the reason why patients consult your practice doesn't resolve, don't expect referrals.

The symptomatic results for which patients initially seek chiropractic care are based on provoking, stimulating and restoring the inborn ability of the patient to heal by reducing nervous system interferences, usually along the spine. Turns out, the patient is the doctor!

That means along with being a proficient adjuster, you must know your limitations and possess the communication skills needed to assure patients as the healing process unfolds.

Suggestion: The common denominator among the most successful chiropractor is above average communication skills. Becoming a better communicator, as with other social skills, is a learned behavior. Enroll in a Toastmasters group. Practice the eye contact and the ability to think on your feet that the best communicators use. Even if you don't want to give lectures or seminars, it's a skill that will positively enhance every aspect of your life.

Setting Boundaries as a Professional Caregiver

Something I don't see discussed much in chiropractic circles is the importance of establishing and maintaining clear boundaries. In other words, what is the chiropractor's job and what is the patient's? Vague or unclear boundaries invite misunderstanding, frustration and ultimately results in an underperforming practice.

Here are some of the more common boundary-busting behaviors I see:

Caring Too Much. Becoming emotionally invested in what patients do, or don't do, is a significant occupational hazard. The key is to care, but don't care too much.

Wanting it More Than the Patient. Related to caring too much is when the chiropractor wants optimum health more than the patient does. Each of us gets to value our health differently.

Taking Patient Choices Personally. This is when you make the case for the optimum care plan, but the patient chooses something far inferior. Is it because of something you forgot to say? Nope.

Selling Your Time Rather Than You Talent. Certain chiropractic techniques produce amazing results and can be successfully delivered in a minute or less. Others can take considerably longer. A faster technique means you can help more people.

Projection. This is when you make assumptions about what the patient knows or the value he or she places on their health. Or worse, when you decide that since you couldn't afford the care you're recommending, patients can't either.

Needing to Be Liked. Countless chiropractors minimize a patient's problem or sugarcoat their recommendations in the hopes of being liked. These chiropractors imagine that being liked increases the likelihood that their recommendations will be followed. Granted, being likable is important. More important than being respected?

Getting Your Social Needs Met. This is the dark side of extroversion. It's a common liability among extroverts. Practice is a party—and you're the main event. As patients come and go it's tempting to squander valuable time (your most precious resource) gossiping, retelling a joke or other small talk.

Doing More Produces Better Outcomes. These are chiropractors who adjust every spinal segment and do everything short of washing and waxing the patient's car. It's often a sign of insecurity. Less is more.

Suggestion: Being a chiropractor is far more than helping patients function at a higher level. It means showing up as a leader. Knowing yourself. Having the courage to install (and enforce) clear boundaries. Look for self-development opportunities that will bolster your self-esteem and confidence. Know what's yours and what's theirs. I found Landmark Education to be especially helpful.

Being a Chiropractor Can Be Emotionally and Financially Rewarding

Still interested in becoming a chiropractor? Because I've saved the best for last.

If you tend to march to the tune of a different drummer, chiropractic could be a perfect fit.

If you prefer to zig when everyone else is zagging, chiropractic could be the ideal career.

If you tend to color outside the lines, chiropractic could be a calling and a livelihood.

Granted, chiropractic still suffers from professional bias, urban myths and misunderstanding. And there's still some negative brand equity. But the rewards for the right person are significant:

  • Reap the benefits of being self-employed
  • Work as few or as many hours as you wish
  • Be the object of appreciation and adulation
  • See profound changes before and after your care
  • Enjoy the emotional fulfillment that few experience
  • Receive the reverence afforded doctors
  • Earn a professional income while helping others

Become a chiropractor. It's a great career choice. I highly recommend it.

Back in 1992 I wrestled with the idea of becoming a chiropractor. My mentor at the time suggested that I might make a bigger difference by reminding the profession of the patient's point of view. All these years later I'm thankful for his advice. Although being able to witness firsthand what the body can do when nervous system interference is reduced is mighty appealing...