Creating a Win-Win

How to Work with a Chiropractor

By W. David Bond, DC

Whether you are just starting your massage therapy practice or have been in business for a while, you may have considered working with a chiropractor. But is working with a chiropractor a win-win situation for both of you? Or is the only benefit to the chiropractor’s bottom line? Let’s look at how you can make this alliance work for you.
Including massage therapy in their practices makes sense for most chiropractors. There are a multitude of benefits massage can offer to a chiropractic practice as both a marketing tool and a revenue source. And most chiropractic patients would generally agree that of all therapies that are adjunct to chiropractic manipulation, massage is the most popular choice. Patients love massage, not only for the reduction in their muscle spasms and pain, but also for the personal touch it provides—and touch is paramount in both chiropractic and massage therapy.
Massage therapy helps to relax a patient’s body and prepare it for receiving a chiropractic adjustment. As a chiropractor myself, I generally like to have the patient receive massage before, rather than after, the manipulation, not only because the patient is more relaxed when I deliver the adjustment, but also because there is a possibility that a deep-tissue massage can throw off a good adjustment if the therapist applies too much pressure on the recently manipulated underlying structures.
Chiropractic adjustment also extends the benefits of the massage. I often see patients who have only had massage without adjustment return sooner with similar complaints because the massage relieved the symptoms only temporarily. Indeed, together, massage and chiropractic make a lot of sense.
A Win for the Practitioner
The best-case scenario for the massage therapist is when she rents a room within the chiropractor’s office at a reasonable rate. The office is clean and professional with a steady flow of massage clients, both from the therapist’s already-established clientele and from the chiropractor’s patient referrals. The therapist sets her own hours, performs her specialty modalities, and sets her own prices and massage session length. It benefits the therapist to get referrals from the chiropractor’s advertising campaigns and existing patient load. It benefits the chiropractor to have the massage therapist move her existing clientele to the chiropractic office, too.
This is a business-within-a-business scenario, where the therapist is an independent contractor. The therapist maintains her own records and liability insurance policies, and provides her own equipment and supplies. She does limited deep tissue and has plenty of time between clients to change sheets, clean the room, set up, and reenergize for the next session.
Chiropractic patients who receive massage pay the massage therapist directly, and insurance collection or overhead is not a factor. The therapist then pays a percentage of the income to the chiropractor for the room rental and overhead costs. If the therapist sees 4–5 massage clients per day, that’s somewhere around 1,200 hours of massage per year. At $75 per hour or so, that’s a good income. The office split would be 60/40 with the office taking the 40 percent. The US Bureau of Labor Statistics puts the mean annual wage in this scenario for massage therapists at $39,920. 
Not a Win
The worst-case scenario for the therapist is when he works for an hourly wage, usually insultingly low, where the chiropractor sends patients in an endless assembly line for 15-minute warm-up massages before their chiropractic session. In this instance, all the patients try to extend their brief massage to a half hour or more of deep-tissue massage, because they feel cheated of time. The therapist never gets more than a couple of minutes between clients and he also winds up doing physical therapy modalities because the chiropractor doesn’t want to hire an extra chiropractic assistant.
This scenario usually quickly burns out the therapist, who is at risk of overuse injuries due to the constant physical demand, so the chiropractor is continually hiring fresh graduates from the local massage school (some chiropractors have even opened up their own massage schools). As a result, loyal patients never get comfortable with a therapist and therapists never have a chance to become familiar with individual patients’ needs. The therapist is hired as a part-time employee and gets no unemployment or workers’ compensation benefits, and still gets hit with a tax bill at the end of the year. The US Bureau of Labor Statistics puts the median hourly wage in this scenario at $18.34. Unfortunately, too many therapists face these tough challenges.
It doesn’t make sense for a chiropractor to cover the overhead and also pay the therapist at a high rate, but many new therapists have unrealistic expectations about making $75 per hour with no overhead just after graduating from massage school. It also makes no sense for the chiropractor to allow the therapist to recruit massage clients from the practice and perform massage off clinic premises—this can cause the chiropractor to lose income and patient compliance, and build distrust between chiropractor and therapist.
What Patients Want
Patients want massage combined with chiropractic. They don’t care how difficult it is to provide both specialties together and they also don’t understand why their insurance doesn’t fully cover the work. They just want to feel good. One positive is that more people are willing to pay extra for a chiropractic visit that includes massage therapy.
The best-case scenario for patients is they present to a chiropractor’s office and get a quality, full-body, soft-tissue massage for an hour or more, followed by chiropractic manipulation, and the work is fully covered by insurance. The chiropractor and the massage therapist create a hands-on, team approach to patient care. This synergy results in a patient who feels well taken care of and supported.
The Middle Road
Oftentimes, the middle road is the best course for the patient, therapist, and chiropractor. In this scenario, the chiropractor has at least one dedicated massage room that the therapist can lease to provide massage at her convenience. During busy clinic times, massage therapy is prescribed for specific body areas, and the therapist performs up to three, 15-minute spot massages per hour. The therapist has at least five minutes between each client and takes her own office notes. Compensation for the therapist is divided into different rates—a specific amount for each 15-minute massage or per hour of bodywork. Some therapists may prefer to be paid a base salary or by a percentage of their individual sales. The straight percentage is one of the better arrangements. When you massage, you get paid, when you don’t massage, you don’t get paid.
In this scenario, the therapist is considered an employee. The Internal Revenue Service has developed a test to determine whether or not a worker is an employee (Publication 1779, “Independent Contractor or Employee”). The chiropractor may be responsible for penalties, interest, and back taxes if the worker is hired under the wrong assumption. The therapist is also required to carry her own malpractice liability insurance coverage. The chiropractor is responsible for establishing office procedures and policies such as dress codes for everyone to follow.
One historical problem is that the therapists, as well as the chiropractors, are seldom paid according to their respective experience or skill level. However, in this middle scenario, the patient gets a pre-manipulation massage (which is not overly expensive) and if he wants an hour or more, he can schedule a session with the therapist during slow clinic hours. The patient pays extra for the massage visit or for the hourly rate not combined with chiropractic. The massage therapist has plenty of discretionary time and gets a decent income without getting burned out. The chiropractor has massage coverage for his patients during high-volume times and there is income covering overhead from the massage room most of the time.
Chiropractors and massage therapists can, and should, work together for the benefit of their patients/clients. With proper communication, respect, and understanding, the partnership can meet the recipients’ health-care needs and be a moneymaker for both allied professionals.

W. David Bond, DC, DNS, DAAPM, has been a practicing chiropractor in Southern California since 1988. He is the founder and director of the Bond Chiropractic Inc. in Valley Village and specializes in chiropractic pain management and soft-tissue/myofascial treatments. Contact him at or 818-501-8743.

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