Today's Chiropractic Lifestyle

Discussion Board

Survey

My Profession

Home Sweet Practice
By Randy Southerland

For Drs. Peter Kevorkian and Patti Giuliano, a husband and wife team in Westwood, Mass., the daily commute is measured in steps not miles. For nearly 25 years the couple has been practicing from their home in this quiet suburban neighborhood just 25 minutes from downtown Boston. Patients enjoy a homey setting on five and a half acres lush with meadows and gardens. After hours, it’s home for the couple and their two children. Combining home and office is a reflection of their practice philosophy, says Kevorkian.

“Chiropractic is as much a part of my personal life as it is my professional life,” he explains. “So, I believe that it makes a statement to my practice members that they’re coming into my home to receive a life-giving service rather than coming to my job. In the process, it says who we are as people.” This chiropractic couple has joined a rising tide of home-based businesses. Nobody knows just how many home-based businesses there are these days, but experts say they probably range into the millions, including part-timers and those who never bothered to get a business license.

Westwood Chiropractic is a revival of an earlier approach to practice that harkens back to the beginning of this healing art. In the late 1800s, doctors often turned their front rooms into offices, while merchants lived above their stores. Since World War II, zoning regulations and the separation of residential and business shifted practices to the office park, shopping mall or other dedicated locations. At the same time, the migration from cities into suburbs has further separated work and home.

Today relatively few DCs practice from their primary residence, either because local regulations won’t allow it or their homes can’t accommodate patient traffic while keeping living quarters separate.

For their first home office, Peter and Patti converted a basement and carport into office space. That experience led them to build out their current location from the ground up as a dedicated home office that can accommodate both family life and an 800 patient-a-week practice.

Entering the front door, a turn to the left takes you into the office itself. Further down the hall, behind a door that is usually closed, is the family’s living quarters.

“The boundaries are very clearly set in terms of the architecture and design of the building,” he explains. Creating a clear separation between home and work not only means greater privacy for the doctor, but also creates an aura of greater professionalism in the minds of patients.

“I would say it is necessary, particularly for certain professions,” says home office advocate Donna Maria Coles Jones, an attorney and business consultant in Charlotte, N.C., and author of “The Lifestyle CEO.” “I would not like to get a massage or even chiropractic care if I had to walk in the person’s front living room. If you really want to be at home having a separate entrance or a separate facility located on your property is optimal.”

The home office is not for everyone. In fact, the type of practice you develop is largely dictated by the size, configuration and location of your home office. A busy office requires parking and space for a waiting area, adjusting rooms, equipment and storage. Electrical wiring must be able to handle the added load of equipment such as X-ray machines.

Local laws and regulations determine where businesses can operate in any community. These rules vary from place to place and getting the zoning code manual from the local building codes enforcement office is one of the first steps any chiropractor should take. Even if the municipality or county regulations allow business in residential areas, homeowners or condo associations may also present hurdles.

More than one DC has gotten into trouble through the violation of zoning ordinances, neighborhood covenants or simply disturbing the peace. Heavy traffic coming in and out of a subdivision or condominium development is likely to antagonize neighbors.

One Atlanta area doctor who adjusted patients in her living room found sheriff’s deputies at her door. It seems the success of her practice had become too great to hide from the neighbors.
v “Someone must have gotten the idea I was a drug dealer with all the cars in my driveway and street,” she says with a laugh. She’s since moved to an established office in a local office park and now sees only the occasional after-hours patient at home.

Not only must the home be suited to the practice, but the surrounding area has to accommodate it as well. Thanks to its acreage, Westwood Family Chiropractic, for example, is largely hidden from surrounding homes by trees. Increased traffic doesn’t raise any eyebrows thanks to its location off a well-traveled highway. Passersby aren’t surprised to see the tasteful wooden sign ushering patients down a long driveway.

While any successful practice takes planning and forethought, the rewards—both personal and financial—can be substantial for the right doctor with the right kind of practice. Those benefits can make the shortcomings seem small in comparison.

Obviously, the commute is short and rush hour is a breeze. “I start at 6 a.m. in the morning and I work until 7 at night,” explains Kevorkian. “Many chiropractors I know start at 7 or 7:30 but they are on the road to get to the office much earlier, so that part of it is efficiency in the use of my time.”

Costs are lower for the home office. You will only need one mortgage avoiding high and sometimes unpredictable commercial rents. Utilities are lower for one location rather than separate home and office.

You will need business insurance since the typical homeowner’s policy doesn’t cover business related accidents. On the other hand, no special malpractice insurance is required since companies don’t really care where your office is located as long as your practice is safe.

Just as with any business, there are the tax benefits. The square footage of the office space is deductible along with the cost of utilities, build out, equipment depreciation and other typical business expenses.

While practicing at home has considerable appeal, there is the downside all too familiar to any business owner. “It is a delicate balancing act because you are really blending two worlds,” explains Jennifer Kalita, a Washingt

on, D.C.-based entrepreneurial consultant and author of “The Home Office Parent: How to Raise Kids & Profits Under One Roof.” “Prior to having a home office you got in your car at 8 in the morning and turned on the ‘business you’ and then on your way home you downshift into the more personal ‘family you.’ When work is across the hallway, that is tougher to do and you are more apt to say, ‘Well, let me just run into the office and knock out a few reports.’” Family time can easily fall victim to added work if the doctor doesn’t clearly lay out hours for both. An absent parent is also likely to engender resentment from children and spouse alike.

Having children in the home during office hours can prove challenging as well. Family members—particularly smaller children—may not understand they can’t come in asking for ice cream while daddy is seeing patients. In the case of Patti Giuliano it was an asset. She was able to spend more time taking care of their baby before walking down the hall to the office.

“Make sure your staff and your family understand that because this is a home office space doesn’t make it any less professional a space,” says Kalita. “Professional dress and etiquette are required.”

Chiropractors also face some special concerns because of the sometimes very personal relationships they develop with patients. Someone may show up outside of business hours seeking care and interrupt family time. It’s hardly unusual to receive calls on the weekends or evenings from someone in pain—you are a doctor after all.

Build out expenses for a house—particularly an older one—can be considerable to move walls, upgrade electrical to handle X-ray machines and other equipment, and bring the structure up to code. Few homes already have wheelchair ramps and other handicap friendly amenities that patients may require. Yet, creating a space that has the look and feel of an office is important. While some doctors do simply set up an adjusting table in their living room and treat patients, there’s no reason your office shouldn’t be just as professional in your home as it would be in any office building.