What I Wish I Knew in My First Five Years of Practice
PRACTICE MANAGEMENT
(That Would Have Saved Me $200K and a Decade of Stress)
Chris Tomshack
DC
“G.K. Chesterton once wrote,“Experience is merely the name men gave to their mistakes.” He wasn’t wrong, but I’d have preferred cheaper mistakes.”
I SIGNED MY FIRST OFFICE LEASE ON A THURSDAY afternoon in March. I was 28, freshly graduated, and so confident I could build a thriving chiropractic practice from scratch that I didn’t bother reading clause 14 about the personal guarantee.
That clause cost me $42,000 when the landlord decided to sell the building 18 months later. It was the first of many expensive lessons, and I do mean many.
The Tuition Nobody Tells You About
Chiropractic college teaches you anatomy, biomechanics, radiology, and a hundred other things we genuinely need to know. It does not teach you how to run a business, though. And running a business, it turns out, is what you’ll spend roughly 60% of your waking hours doing for the first five years.
The Small Business Administration estimates that the average small business owner spends $120,000 to $150,000 in their first two years on mistakes they could have avoided with proper guidance. For chiropractors who tend to be fiercely independent and allergic to asking for help, that number often runs higher.
I tracked mine obsessively after that lease debacle. Over my first five years, the total came to a shade under $200,000 in wasted spend, bad hires, useless marketing, and penalties I didn’t see coming.
Every dollar of it was avoidable. Every single one.
G.K. Chesterton once wrote, “Experience is merely the name men gave to their mistakes.” He wasn’t wrong, but I’d have preferred cheaper mistakes.
1.1 Hired for Warmth and Fired for Incompetence
My first front-desk hire was lovely. Warm smile. Great with patients. Couldn’t operate a spreadsheet if her life depended on it. Couldn’t collect a copay without apologizing for it. Lost referral leads like they were loose change falling through a hole in her pocket.
I kept her for 14 months because she was nice.
By the time I let her go, I’d lost an estimated $35,000 in unbilled services and botched follow-ups. Not because she was a bad person — she wasn’t. Because I didn’t know what I was hiring for.
The Lesson:
Your first hire needs to be someone who can run the front of your business like a tight ship. Personality matters. Competence matters more. And having a proper training system — documented, repeatable, with clear performance benchmarks — matters most of all.
I built that system myself over two painful years of trial and error. It took roughly 400 hours and cost me a small fortune in turnover. I later discovered that franchise models hand you this system on day one, prebuilt and tested across hundreds of offices.
I wish I had known that before employee number four.
2. My Marketing Strategy Was “Hope”
For my first 18 months, my marketing plan consisted of a Yellow Pages ad, a website my nephew built for $500, and the vague belief that if I was good enough, people would find me.
They did not find me.
I spent $28,000 that first year on marketing. I use the word “marketing” generously because it was closer to throwing darts blindfolded in a dark room and hoping one hit a patient.
The thing about marketing a chiropractic practice is that it’s a craft. It requires understanding your local demographics, testing messages, tracking cost-per-acquisition, managing your online reviews, running consistent reactivation campaigns, and knowing when to spend more versus when to stop hemorrhaging money on something that isn’t working.
None of this was covered in a single class I took. Not one.
What eventually saved me was finding a mentor who’d already figured it out — someone who could look at my numbers and tell me in 30 seconds where the holes were. That kind of guidance is baked into every decent franchise model. You don’t need to figure out what works because someone’s already bled for that knowledge.
I bled plenty on my own. My accountant can confirm.
3. Compliance Nearly Ate Me Alive
If you’ve never been audited, congratulations. Your day is coming. Mine came in year three with a Medicare audit that fumed my stomach inside out for six weeks. Not because I was doing anything wrong on purpose — I wasn’t. However, my documentation was sloppy, my coding was inconsistent, and I’d been filing claims the way I thought they should be filed rather than the way they needed to be filed.
The Result:
A $16,000 repayment demand and a compliance consultant who charged me $8,000 to fix the mess.
Compliance in chiropractic isn’t optional, and it isn’t static. The rules change. The documentation requirements shift. What was acceptable last year might trigger an audit this year. Keeping up with all of it while also seeing 25 patients a day is like trying to read a novel while driving — technically possible, profoundly inadvisable.
Franchise networks typically have compliance teams whose entire job is staying current on this and pushing updates to every office in the system. You get the benefit of a full compliance department without paying for one.
I paid $24,000 to learn what they could have told me for free.
4.1 Negotiated Like a Chiropractor, Not a Business Owner
Vendor negotiations. Equipment purchases. Supply contracts. Insurance fee schedules.
Every single one of these is a place where money either stays in your pocket or quietly walks out the back door. For five years, I negotiated all of them alone — one small practice against companies that do this for a living.
It’s like arm-wrestling a gorilla. Possible, I suppose, but the gorilla doesn’t seem particularly worried.
A single-location chiropractor has almost no purchasing power. A network of 200+ locations negotiating as a group? Different conversation entirely. The discounts on supplies alone can run into five figures annually. Equipment financing terms improve. Even insurance negotiations carry more weight when there’s volume behind them.
I once paid full price for a decompression table that a colleague in a franchise network got for 30% less. Same table. Same vendor. Different bargaining power.
That one purchase alone was a $12,000 education in the economics of scale.
5.1 Didn’t Build a Practice — I Built a Job
This is the one that took the longest time for me to see. For five years, I worked in my practice every single day.
If I didn’t show up, nothing happened. No patients got seen. No bills got processed. No phone got answered. I was the engine, the fuel, and the steering wheel.
I hadn’t built a business. I’d built an elaborate, expensive, exhausting job — one that I couldn’t take a holiday from without the whole thing grinding to a halt.
As Michael Gerber wrote in The E-Myth, “If your business depends on you, you don’t own a business — you have a job.” I read that line in year four, and it hit like a freight train.
Building a practice that runs without you standing in the center of it requires systems, documentation, trained staff, and operational playbooks. It requires you to work on the business, not be trapped inside it.
Some chiropractors spend a decade figuring this out through brutal repetition. Others plug into a franchise model where the infrastructure already exists — the operations manual is written, the staff training is built, and the systems are proven.
I took the decade route. I don’t recommend it.
So What Now?
If you’re in your first five years of practice, the most valuable thing I can tell you is that the money you’ll waste making mistakes that other people have already solved is far more than the cost of getting proper support from day one.
Whether that’s a mentor, a coaching group, or — yes — a franchise model that hands you the playbook, the math is the same. Doing it alone is the most expensive option on the menu.
Find a chiropractor who’s 10 years ahead of you, buy them lunch, and ask them what they’d do differently. Then do that instead of what I did, which was confidently march into every avoidable mistake like a man who thought he was too smart to need directions.
My GPS has been right more often than my instincts. It cost me $200,000 to admit that. Consider this article the cheaper version.
Dr. Chris Tomshack is founder and CEO of Healthsource Chiropractic, America’s leading network of premium disc and spine centers. Contact him at [email protected] or 440-967-5458. Download the Premium Spine & Disc Practice Blueprint at: www. TheChiroBlueprint.com
