Calling the Shots on Your Contract – by Dr. Jen Faber

Dr. Jen Faber
Dr. Jen Faber

When new chiropractors kick-start their career by working in a practice, they’re eager, hungry and ready to learn from a mentor who knows the ropes. On the surface, this path can offer training on the job and get you prepared to build your own practice someday. But just because you want someone to “take you under their wing,” doesn’t mean you should feel like you have no say in what you get in return.

Yet it oftentimes does.

Why? Because it’s easy to go into defeating thoughts that take away any chance you have to negotiate. Ask yourself, if you’re an associate or want to be, have any of these thoughts run through your mind:

“What say do I have?”

“I have no idea how to negotiate.”

“I have no experience, so I’ll just take the best offer I can find.”

“All I want is a job that’ll pay the bills, and I’ll figure out the rest later.”

This is a confidence gut check. It’s an opportunity to reframe your mind on how you go into a job offer and give yourself the personal power on negotiating and knowing how to do it.

Let’s set the stage here. Our profession gets a bad rap on “eating its young” when it comes to associateships. Sadly, that’s because chiropractors feel overworked, underpaid and taken advantage of by the practice. But that end result doesn’t come fully from the boss. The employee (a.k.a. the associate) also needs to set standards before day one so you go into that job with a contract that works for you …

And not one that was just created for anyone who will sign it.

Having come out of a job that nearly drove me to leave the profession all together, I know that feeling all too well. In hindsight, had I known even one tip on how to negotiate, I would have put myself in a level playing field and perhaps even the wisdom to walk away from that job before getting hired and find something better.

So I want to share with you the tools that I would’ve told my younger self back when I graduated. Negotiating is all about the approach and implementing key strategies to create a contract that actually works in your favor.

Step 1: Go Shopping

Typically the first question that runs through your mind is, “How do I even know what to ask for?” And if you’re right out of school, it’s hard to know the baseline for what’s a standard contract. So the first step here is to do your research. Go on chiropractic job boards and read the offers. Identify what the opportunities are in your location or comparable areas if you don’t know where you want to practice yet. Look at the incentives and compensation to determine what works for you and what doesn’t. Create a list of what you’ve see in offers that appeals to you so you can bring that knowledge to the table on interview day.

Step 2: Know Your Conditions

After you’ve done your market research, you’ll want to create your own job offer. Design an ideal contract that matches what you want. This is a concept known as ‘conditions of satisfaction,’ which is all about developing standards for yourself.

And this is vital because chiropractors typically go into a job offer with no preparation or strong identity on what that ideal offer looks like. You don’t want to go into this process blind, because it will make you feel like you have no say in the game, and you will come across that way when a contract is presented to you.

So think about the standards you want to create for your job contract. This relates to three key areas: compensation, benefits and vacation. For compensation, know what the standard of living is in your area and what you need to make to match it. Also think about the structure. Do you want bonuses or incentives as you grow your patient base? What benefits do you want to receive in addition to your income? How much time off do you want to have? More importantly, how much time off do you want to give your work-life balance?

What exactly will cause you to be satisfied with your job offer? Be honest and specific. And then know those conditions before the interview, during the interview and especially when you negotiate the offer.

Step 3: Don’t Accept the First Offer

Any job offer that you get will be in the practice owner’s favor. It’s not necessarily because an employer is trying to take advantage of you. It’s because that employer is looking to bring a doctor into their practice and ultimately wants a new hire to be a good fit for them. This is no different than listing a house for a higher price, because the status quo is that the price will get negotiated down. That’s just smart business sense.

So don’t accept the first offer thinking that the employer won’t budge or that you have no voice in the matter. This is how any business contract works. There’s an offer. Then a counter offer. Then an agreement.

Use the conditions you’ve set to let the employer know what you want and what will make the job and offer a good fit for you. State what you need in order to move forward so both of you can have a dialogue and come to a mutual agreement. This sets such a stronger dynamic then just signing on the dotted line and hoping for the best.

The big takeaway here is this:

Don’t be willing to just take any offer just to get the job now, because you could spend years stuck in a contract that ultimately stunts your future growth. And you are worth way more than to just settle for some job when you’ve spent time, money, effort, and passion to become a chiropractor. So know that not only can you negotiate, but you should. And when you do, you’ll be able to see red flags, figure out the best fit and attract a job that matches what you want.

Jen Faber, D.C.
’06 Davenport campus graduate

After breaking away from burnout and frustration early in her career, Jen Faber, D.C., is now on a mission to coach freedom-seeking chiropractors on how build a practice they love through her individual coaching and online training programs. She is the creator of the House Call Practice Program and the Unleashed Coaching Program to empower chiropractors with the guidance, tools, and strategies to build a successful practice. Visit her online at www.drjenfaber.com.

Is It Really Tendonitis? – by Dr. Cody Scharf

Tendinitis and tendinosis. One you’ve probably heard before.  The other, probably not. While they both sound the same, in reality they are worlds apart. Let’s compare.

Tendinitis is, by definition, inflammation of a tendon.  Tendinosis on the other hand is defined as chronic tendinitis and implies chronic tendon degeneration without the presence of inflammation. Basically, one is short-term with inflammation, the other long-term, without inflammation, though both are caused typically by overuse.

soccerTendinitis, the most popular diagnosis of the two, usually presents with swelling and tenderness at the sight of pain, often accompanied by stiffness, and less often by weakness. Tendinosis presents most often with stiffness, tenderness to the touch, and weakness–almost identical to tendinitis. Recovery of tendinitis lasts anywhere from days to six weeks, a relatively “quick fix.” Tendinosis recovery can last a few short weeks to a couple months or more depending on the level of degeneration. If left untreated, tendinosis often leads to “tear” injuries.

While both conditions are classically treated with conservative measures, the difference in care is absolutely critical to resolution of the problem. Conservative management stems around rest and anti-inflammatory medication for tendinitis, while conservative management of tendinosis aims to restore tendon regrowth and strength through manual therapy and eccentric exercise.

Tendinitis and tendinosis, both, occur most often in the Achilles tendon (ankle), patellar tendon (knee), proximal hamstring (high hamstring), common extensor tendon (elbow), and the supraspinatus tendon (shoulder).

With both of these problems being so relatively close, while treatment is vastly different, proper diagnosis is vital to the recovery process! So which one do you have? Let’s go to the research.

While tendinitis is the wildly over-popular diagnosis among general practitioners, it may not be the case. Most research coming out on this topic is now showing that at a cellular level, once believed tendinitis actually is, in fact, tendinosis.

According to Almekinders and Temple, “Most currently practicing general practitioners were taught, and many still believe, that patients who present with overuse tendinitis have a largely inflammatory condition and will benefit from anti-inflammatory medication. Unfortunately this dogma is deeply entrenched. Ten of 11 readily available sports medicine texts specifically recommend non-steroidal anti-inflammatory drugs despite the lack of clinical evidence.”

In light of this, chances are that if you have been diagnosed with tendinitis the diagnosis was incorrect. Furthermore, traditional, conservative treatment, of such, with the use of anti-inflammatories, corticosteroid injections, and/or pain medication may have left you worse off long term even though pain may have dissipated short term (but this conversation is for a different time). These methods were designed to eliminate inflammation, not regrow tendon. As mentioned above, treatment of tendinosis should be aimed at restoring tendon function and strength through manual therapy and eccentric exercise. Drugs will not help! Treatment should also include load management when deemed necessary.

With all this said, while we cannot assume a tendinitis diagnosis was incorrect, lingering, worsening, or reoccurrence of pain would suggest that it may in fact be tendinosis. It is recommended that treatment plans geared toward tendinitis, in these cases, be reevaluated.

Tendinitis is one of the most commonly diagnosed injuries and all too many struggle to find relief. With the proper diagnosis and treatment plan, it doesn’t have to be that way!

– Cody Scharf, D.C., Davenport ’04

 

Originally posted on Dr. Scharf’s blog. Republished with permission.

Resource:
Almekinders LC, Temple JD. Etiology, diagnosis, and treatment of tendonitis: an analysis of the literature.Med Sci Sports Exerc. 1998;30:1183–1190.

Advice for new chiropractors

Each week, we’re asking our alumni to share their advice and experiences on the Alumni Voices blog. This week, P. Burdoc Nisson, D.C., shares his personal list of Do’s and Don’ts for new chiropractors.

If you would like to share your own practicing tips and more, follow @palmercollege on Twitter and like our Facebook page to see the weekly question on Wednesdays.

Dr. Burdoc Nisson
Dr. Burdoc Nisson and grandbaby

Do’s & Don’ts:

1. Make sure that you are in the best health that you can be (get adjusted, eat well, etc.).

2. Make sure that you have everything to help the patient that they are read for.

3. Don’t overwhelm the patient.

4. Do what the patient’s body wants done first, check if that worked and then find the next thing that patient’s body wants now.

5. If the patient’s body is not telling you what is next but is not “done,” try having them move, walk or rest.

6. If the patient comes back the next time feeling exactly the same, find out what you missed.

7. Get to know which local health practitioners do things differently than you do so that you can refer to each other.

8. Refer patients when they are not improving fast enough.

9. Use all of your senses to work with the whole patient (physical, emotional, causal, mental, spiritual).

10. Keep learning.

- Dr. P. Burdoc Nisson

How do you educate your patients about chiropractic?

“I educate my patients by showing them their posture in all 3 axis on every visit as well as explaining each of the examination test and findings as well as letting them know what nerves are being affected adversely and what organs they supply. I educate them every visit by telling them about their posture and activities of daily living and why it’s so important for the spine to be in good biomechanical condition because it affects the nervous system adversely if they are misaligned/Subluxated. Most of the new patients have been to my website and My YouTube Channel, so they have a pretty good education by just watching and listening to me treat actual patients in my office.”

– Dr. Gregory E. Johnson, Houston, Texas

What’s your advice to students?

What advice do you have for current chiropractic students?

“Learn HOW to find subluxations. Learn HOW to adjust them. At the entrance of the Palmer clinic (Campus Health Center) there is a sign that says: ‘ENTER TO LEARN HOW.'”     – Dr. Francisco Montaño Benet

Do you have advice you’d like to share? Leave it in the comment section below!

The best advice I received from a chiropractor was …

Some of B.J. Palmer's original epigrams around the Davenport, Iowa, Campus.
Some of B.J. Palmer’s original epigrams around the Davenport, Iowa, Campus.

We went on Facebook and asked our alumni, “What’s the best advice you ever received form a chiropractor?”

Here are their answers:

• Dr. Jon Søvik – “You should become a chiropractor.” – Atle Aarre, D.C., ’91 alumnus

• Dr. Brad Yee – “… to study to be a chiropractor ….”

• Dr. Karen Doherty – “Why be a C.A. when you could be a Chiropractor?” asked my student doctor Alliette Pike. That was in June 1977. That question changed my life. PCC ’81”

• Livtar Khalsa – “Exercise!”

• Dr. Bob Kauffman – “Early to bed, early to rise, work like hell and advertise!” – Dr. B.J. Palmer via epigram (of course!)”

What’s the best advice you’ve received? Leave it in the comments below.

Chiropractors: How important is it to have a mentor?

We got on Facebook and Twitter and asked how important you think it is to have a mentor as a chiropractic student and as a chiropractor. Here are some of the answers:

“Only if you want to be successful.”    – Bobby Moore, D.C.

“VERY, VERY IMPORTANT!!!”    – Brad Meylor, D.C.

“It is of the utmost importance! I was surprised at how few students had mentors while I attended Palmer.”    – Brandon Perrine, D.C.

“I have had some great mentors in my life. Although I most often just stumbled into them, keep your eyes open. They can help you become so much better than you expected to be. I was blessed with two on-campus mentors while a student at Palmer. A mentor can make the difference between you becoming an okay chiropractor and a great chiropractor.”    – Doc Nisson

“Everyone can use a good mentor. I am thankful for all the mentors I’ve had in starting my chiropractic practice.”    – @ChiroLasVegas, Twitter

What do you think? Tweet us @palmercollege, post on Facebook or leave a comment below.

My chiropractic miracle: My baby, home where she belonged

My wife was a brittle diabetic and developed preeclampsia. In 1978 my daughter, Sara, was born, c-section, six weeks early. Standard medical practice was for premature newborns to remain in the hospital until their due date—in this case, for six more weeks.

I was able to suit up and visit my daughter in the NICU (neonatal intensive care unit) multiple times each day. Little Sara had tubes everywhere. A tube to her lungs prevented any noise from her attempted cries. Her arms and legs were flailing about whenever she was awake.

One day, I walked around the incubator and contacted Sara behind her ear, first on one side, then the other. I moved my finger around contacting at different directions with very light force. When I hit the right angle, Sara instantly calmed down, stopped flailing her limbs and went to sleep—all vitals normal.

When the nurse wanted to stop me and asked the chief resident how to approach me, the resident said (and I heard his comment), “He’s her father, let him be. He may know something we don’t.” He knew I was a chiropractor.

Now that Sara was doing so much better, they could no longer justify keeping her in the hospital after two weeks. She came home perfectly normal and is now 35 years old.

Barry Isaacson, D.C. (Davenport ’75)

 

Chiropractic miracles: Hope for the hopeless

We have seen incredible changes in individuals since our office opened in 1986. Specific chiropractic has had a rich history in seeing sick people get well and in seeing seemingly hopeless cases turn around. I’ve compiled a number of examples on our website of people who have greatly benefited from chiropractic care. Visit the Results page to read more.

In health,

Joseph A. La Barbera (Davenport ’85)

My chiropractic miracle: The gift of time

Several years ago I was asked by one of my regular patients if I made home visits. I replied that I did when the situation called for it. He then asked what I was doing at lunchtime today. That day, he took me to meet a man named Jim.

Jim lived in a one-story ranch style home attached to the end of a 50-foot oxygen hose. The hose was attached to a machine that generated oxygen. Jim was captured in WWII and, while a prisoner of war, had pneumonia among other conditions. When he returned home, he worked refinishing gymnasium floors. As a result he was barely able to breathe at the time Jim and I met. He told me breathing to him was like trying to breathe through a drinking straw. He wanted to know if there was anything I could do to try to help him with the severe neck pain he was having. He was bluish in coloring due to the lack of oxygen.

I started working on Jim that evening after I finished with patients. I would go to his house three times per week. His neck pain improved, and he began to report that it was easier to breathe. Plus, his coloring was improving.

One day I received a call from Jim’s wife that he was in the hospital with pneumonia and would I consider coming there to help him. I did as requested and soon he was out of the hospital. I continued to make home visits.

One Monday evening as I arrived at Jim’s home, I noticed a lot of strange cars in the driveway. I carried my portable table to the door, which was answered by a crying woman. She apologized for not calling to cancel my visit because Jim was dying. I told her that I believed that I was supposed to be there, and she directed me to his bedroom.

Looking into that room revealed a panicked scene with Jim writhing on the bed fighting for air and his wife and daughter holding his hands. Jim was not on his foam wedge that he used to breathe better when he slept. He was too rigid.

At that moment, I had my biggest test as a chiropractor. I knew that he did not have the lung capacity for CPR, but I could not just stand there and watch. I said to myself, “You are a chiropractor, and you need to do what a chiropractor does.”

I analyzed what I needed to do and adjusted his axis. This produced immediate relaxation in him, and he calmed down. I was able to put the wedge under his back to help him breathe, then I did some lung reflex work on him as well.

Jim’s wife asked his daughter if she noticed anything different. His daughter replied that Jim’s hand was warming up. His wife said that was exactly what was happening to the hand she was holding.

After I did everything I could think of to help, I told Jim I would see him tomorrow night. He reminded me that I did not work on Tuesday afternoons. I smiled and told him that in this case I would be available. He thanked me for all I had done and for being his friend. We gave each other a hug, and then I went on home.

I found out from Jim’s family that Jim was able to get out of bed that evening. He then proceeded to talk with everyone there, saying what he had to say. Once he had done that, he laid back and calmly passed away. His family called to thank me for making such a bad situation better.

That night, I was shown what an adjustment can do—and that I had the courage to apply what I was taught. I am sure that my fellow chiropractors have their own stories like mine where they experienced the wonder of chiropractic. We have a wonderful gift in our ability to apply chiropractic for our patients, and we should how profound it can be.

Sincerely,

Geoff Mohn, D.C. (Davenport ’85)