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I can imagine the horrified looks I would get from my friends, family and patients if I said, “Ciao I’m out of here.” Can you picture yourself sitting on a Mediterranean beach, sipping some amazing wine while not worrying about tan lines?  Nude beach anyone? Joking aside, I know I can. Italy is usually on the list of places to visit, especially for Americans. We hear the stories of picturesque countrysides, beautiful people, amazing food and drink; there just seems to be romantic fantasy surrounding Italy. What’s not to love?     Reason #1: Nationalized Health Care    I know there are many Americans who really struggle with this concept. If you’re already living the European lifestyle, then this will be an easy jump for you.  In 2007, Associazione Italiana Chiropratici (AIC) recognized chiropractic as a primary care profession.  The interesting facts about Italy are that they have one of the highest rates of medical doctors to patients in the world.  Italy is already saturated with traditional medicine and now Italians are looking for alternative forms of health care.  The best part is that the government covers it all.  That sure takes the hassle and stress out of worrying about insurance companies and getting paid on time.   Reason #2: Starting on the Ground Floor   It’s been 11 years since the Italian government has decided to make chiropractic a part of their national health care system.  From my research, it’s unclear how many chiropractors are in active practice at the moment.  Before 2011, there was only a metaphorical handful to help serve the 60 million Italians.  The other part of this is that there are no chiropractic colleges in Italy.  I went to Palmer College in Iowa.  The problem with cities that have a chiropractic college is that they are inundated with chiropractors.  In Iowa, I was surrounded by corn, pigs and chiropractors.  The advantage to Italy is that without a lot of chiropractors already in practice, the market is not saturated, which leaves plenty of opportunity for a thriving practice.      Reason #3: Italians live longer   You mean I get to eat pasta and drink wine while living longer? Sign me up for that! Ever heard of the Mediterranean diet?  No better place to reap the benefits of a well-rounded, healthy diet then from the region where it came from. According to, Italians live longer than Europeans living in other countries such as the UK and live longer, better quality lives than Americans.  On average, Italians are living 81.5 years, compared to 79.9 in the UK and 78.15 years for Americans.    Whether it’s for the national health care system, being recognized as a primary care physician or for the landscape and the food, Italy may be a viable option to help get your chiropractic career started.     For more info on job opportunities check out   For more information about chiropractic in Italy check out:   Kassandra Schultz D.C
Your Future Boss Isn’t the Only One who should Be Asking Questions (Your Future Self Will Thank You)     Whether you are fresh out chiropractic school or you have been in the workforce for a while, it is always good to be prepared when the time comes to go on a job hunt.  I thought after walking across the graduation stage, the hard part was over.  As it turns out, that would only be the beginning of a very difficult process.   Finding a position that works for both you and your future employer can be tricky business.  Using the tips below can help make the process a smooth one.   1.    Healthy Sense of Skepticism: Have you had previous associates?   Does the position look too good to be true? It very well might be.  This is the moment when it is better to ask the hard questions up front then to be stuck in a position that you can’t get out of (literally). In my scenario, I did not heed the warnings that came from other chiropractors around me.  I was associate number 5 in a relatively short period of time.  Imagine you just started dating someone and they had been married four times already, it may make sense to ask what happened in those relationships before you become #5.  In the same vein, knowing why the other associates no longer work there may provide clues into how your future boss operates.  If the boss won’t give you a straight answer, that might be your sign to keep on looking.   2.    Non-Compete: How Long & How Far?   This question is huge!! It was by far the biggest issue I had when I decided I no longer wanted to work for my former employer.  Threats of legal action, deformation of character, and a whole lot of unneeded stress all came as a result of a super strict non-compete clause.  This is probably the biggest complaint (besides $$) I heard from my classmates too. You need to know the exact details before signing on the dotted line.  If the fecal matter hits the oscillating cooling device, you may not be able to practice in the current town you live in.   3.    Can I have my lawyer look at the contract first?   I know, I know, lawyers…what a pain.  Honestly, mine became my best friend throughout this process. My lawyer told me straight out that he had never seen a contract so “strict” with non-compete, salary, and future compensation (we will get to that). It may cost you a couple hundred bucks, Euros, or pounds in the beginning, but it will be worth every shilling in the end. Also, the fact that my future boss was annoyed that I would even suggest having an attorney take a look at the contract should have been another sign that this was not going to be a good fit.   4.    How much am I getting paid for this gig?   You have to have the numbers clearly defined.  Do you get a base pay? What about commission? How many hours a week are you expected to work? Will there be times when the number of hours you work per week will fluctuate? Does the structure of your pay change over time? My contract laid out a base pay plan with with no extras for disability or health insurance and no money towards continuing education credits.  Plus, at the end of my first year of working, I would lose my entire salary and be solely on commission.  There was no extra money or separate marketing going to “my end of the business.” I was not the only one in my class to have such an offer presented to them.    5.    What are the future plans for this practice?   Before you sign on the line, be sure to ask about what the future of the practice looks like.  Does the doctor want to retire, and when? Does he want to sell the practice to you? If retirement isn’t on the horizon, is there an equity position available? How long before this opportunity is open to you? If you have no desire for an equity position, that’s cool but if you do, this can lead you down another road of broken promises- unless the path is clear from the beginning.    Kassandra Schultz DC  
​Which one Works for You?   I remember my first couple of months in practice.  I was working for a relatively high volume doctor.  In about two months, I went from adjusting a handful of patients every week in school, to upwards of 50-70 patients a week in my new job.  At night, I would go home with a sore lower back, right hand pain, and think, “how in the world am I going to keep this up for the next 30 years?” Five years later, with more mindfulness of posture, adjusting technique, and more reliance on an instrument, my body feels better, but certainly not perfect. I know compared to many doctors in the field, I am just getting started.  If you have been in the game for a while and you’re starting to think it’s time to add an associate, check out the three reasons why you should.  The caveat? You have to know which scenario you are want before you start hiring.   1.    Take a Load Off: Finding an Associate   You may now be at the point where you want to work less in your business.  Maybe you want to focus more on how to improve it versus being the practioner. Maybe you want to spend more time with your family, maybe the aches and pains of adjusting are catching up with. Or maybe you are tired of seeing so many patients yourself, or it’s time to take that long awaited trip.  For whatever the reason, you want another doctor to start doing the work.  You want them to sit in the office all day, listen to John, Dick, and Harry’s ailments for the day, do the SOAP notes, and develop an ulcer over insurance claims.  If this is the case, you want an employee.  It’s not that you can’t mentor the new doctor, but you are not selling your practice and you do not want to give up equity.  Perfect! Just make sure you are upfront with those details.  You have a salary laid out and what that salary includes, if commission is possible, paid time off, sick time, any kind of insurance, and the amount of hours and days the prospective doctor is expected to work.  Nothing is more frustrating for either party when a new employee does not know what is expected of them or when the new boss doesn’t know how to communicate to their new employee what they should be doing.     2.    Associate Plus an Equity Partner   A lot of times the prospective doctors who have the ambition, drive, and charisma to be a good chiropractor are not going to just work for a salary and commission.  A lot of great candidates might need a little more incentive, like a chance at some equity.  It will make them feel like they are working towards something greater, like owning their business, possibly making a bigger impact in the community, and the ability to start working “in” and “on” the business right from the get-go with less risk then opening up their own practice.  Plus, by doing this, it will keep one less competitor out of your area.  Here is the flip side; this needs to be laid out in stone.  How much equity are you willing to fork over and for how much? If it’s a broke student just getting out of school, are you willing to do a payment plan? Remember, an equity partner equals a business partner and are you ready to give up some of the title? Will your new business partner have a say in hiring/firing the front desk staff, marketing, financials, etc? If you have been flying solo for many years, this might be a bigger transition than you think.    3.    Pay Day   You may be approaching the season of your life where you might want to get out of the chiropractic business for something new or retire within the next five years or less. It is time to look for a buyer.  A great way might be to take the associate in the “#2 Scenario” and give them the option to buy after a certain period of time.  I believe most doctors care about their patients.  An associate who is an equity partner and has been working alongside you for a length of time would make for a relatively easy transition for the staff and the patients, but you have to be ready to let go.  Just like when you sell your house- do buyers want to see your family pictures and your stuff when they are house hunting, or do they want to envision themselves living in it? There will come a time when your smiling face either needs to stay home or go golfing.  You can’t hand the keys over to the kingdom if you can’t step away from the throne. If you think one day, somewhere in the distant future, like 20 years from now, you may want to sell your practice, do not offer this as option.  Unless of course it’s your kid getting into chiropractic because otherwise no one else is going to wait around that long. For advice on contracts and how to sell your business please contact your attorney for all the details. Kassandra Schultz DC   .
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