PRACTICE MASTERY QUESTION #16

QUESTION:  Are there any guidelines for selecting a practice location?

ANSWER:  There is no best place to establish your practice.  There are, however, many potential locations in which your office will prosper, if properly planned. Here is an outline of parameters you should consider as you look for your ideal practice location:

Choosing the State, Province or Country:

When selecting the basic geography of your new practice,  be sure to consider:

• All the laws that govern the practice of chiropractic including the scope of practice, license or registration requirements, laws governing insurance coverage, laws governing workers' compensation, auto insurance coverage of chiropractic claims, etc., laws governing Medicaid or related public health funding programs, and laws governing professional advertising.
• The chiropractic demographics of the location, including the number of doctors of chiropractic active in the area, the state of political organization and recognition by the chiropractic profession and the direction and atmosphere of that chiropractic community.  The "atmosphere" issue is important because it is certainly easier to work in an area where most DCs share your chiropractic vision and values.
• Economic and population issues such as the number of people within easy travel distance from your prospective practice location, immediate as well as long-range economic conditions and prospects, living costs and conditions for yourself and your family, schools and neighborhoods.

The city or town you are looking at should be carefully evaluated, using the following guidelines:

• Calculate the ratio of population to active DCs in the region you are looking at.  For example, if there are 100,000 people in the city you are looking at and only 5 DCs, that means that there is a 1/20,000 chiropractors to people ratio.  If there are 100 DCs, however, this changes to 1/1,000.  In the United States, there is approximately one medical doctor for every 700 people and only one DC for every 5,000 people.
• Consider the style and pace of practice you want.  Is this best attained in a large city or small town?  Also consider what type of environment best suits your lifestyle and what kinds of recreation and other aspects of community life will be available.
• Who will your patients likely be? Are there major blue-collar industries present?  Is there a rural and farm population to be served?  This will be important as you look at your practice promotion and outreach efforts.  How large a white-collar population is there and where is it centered?

The prospective neighborhood or section of the community you are considering also deserves close scrutiny.

• Carefully look at the location first-hand.  Do not take anyone's word for any aspect of what the location is like.
• Get detailed maps of the city and surrounding areas.    Locate other chiropractic practices on this map. Look at population distribution and major businesses or industries.
• Locate population centers, identify residential vs. industrial areas, locate major health facilities such as hospitals and identify major retail anchors such as malls and shopping centers.
• Locate major traffic corridors such as expressways and major city roads (accessibility of your office is governed more by the type of route and the time it actually takes to travel, than actual distance traveled).   Travel these routes yourself at various times of the day to gain a realistic understanding of how difficult or easy it is for patients from various sections of the area to get to and from your office.
• Look at the going rental rate for retail space, usually based on a "per square foot" basis.  Compare with other possible locations.  Value, however, is seldom based solely on the rental rate.  That is why it is said that the first three key factors in a successful business are "location, location and location".  You get what you pay for and have to pay for what you get.
• Some successful practitioners have set up near an established practice where the doctor has indicated that they are nearing retirement.

Look carefully at the prospective site and facility. 

• Locate all available facilities and properties within your prospective area.
• Look for "For Rent" signs and inquire on your own about availability, prices, etc.
• Get a realtor to help, but do not place things in their hands alone.  Keep working independently.
• Contact the Chamber of Commerce or business development agency for help.
• Look carefully at the prospective space. (SEE LAST WEEK'S EDITION ON FACILITY LAYOUT). Too much space increases overhead.  Your costs will be rent per square foot and decorating and furnishing per square foot multiplied by the total area occupied.  Too little space stunts growth, impedes smooth practice flow and can lead to high-cost expansion later. Leave room to grow.
• Make sure there is adequate parking available and that there are a number of spaces specifically reserved for your patients, as well as yourself and your staff.
• Modern plumbing, air conditioning and heating are essential.  Look very carefully at these features, as well as adequate wiring and lighting.

Negotiate a good lease, and do not hesitate to get professional help.

• Personally become familiar with the landlord and negotiate a specific contract that protects your needs and interests.  Get legal and realtor help on this as early as possible, especially if you are doing this for the first time.
• Lock in your rent for the number of years you feel confident you will want to be at this location, without any major changes or remodeling.  Be sure to limit and/or tie any rent increases specified in the contract to an agreed upon formula, such as the consumer price index. 
• Try and obtain a first right of refusal if the owner of the property decides to sell.  Always seek to incorporate a clause by which the owner agrees not to rent the space to another chiropractic practice after you terminate the lease.
• Be very clear on what maintenance responsibilities each party to the rental agreement has.  Be sure to provide for a basis to upgrade your space with remodeling as you have the need and resources to do so.
• Have any lease checked by an attorney before you sign.  You will not be saving any money by neglecting this precautionary step.

There are few endeavors that hold more of a thrill for you as a chiropractor than opening a new office.  Whether you are a recent graduate about to open your first practice or a veteran of many years, the excitement of finding the right location, equipping your office and watching your active patient files grow, easily makes up for the amount of work and worry involved.  Wherever you set up, you may be there for a long time. Proper planning from the outset will pay off in many ways in the years to come.