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Relationship Therapy for DCs & CAs
By Jennifer Maciejewski



Like all relationships, the working relationship between chiropractors and chiropractic assistants takes work. Although, some chiropractors opt to run their office solo, the DC and CA relationship is an example of a symbiotic relationship—they need each other to survive. The chiropractic assistant needs structure, office procedure guidelines and support from the chiropractor in order to succeed. The chiropractor depends on the chiropractic assistant to run the front office effortlessly, in order to focus on patient care.

When times are good, everything seems effortless, the office runs seamlessly. Yet, when the relationship hits unexpected change or a tough situation, you may feel like you’re walking on egg shells. If you’re not in sync with each other, patients may feel the tension as well.

DCs resist hiring chiropractic assistants to share the load for a myriad of reasons. Some feel that paying a CA simply costs too much or that the turnover rate is too high to warrant the investment. Others don’t trust that the CA is capable of keeping the office running smoothly.

Despite the out-of-pocket expense, investing in the right CA pays off. “You can only grow so far when it’s just you,” says Andrea Mills, D.C., owner of Serengeti Natural Healing and Chiropractic Center in northern Los Angeles County. “Finding a good assistant has made a world of difference in how this office runs.”

Whether you’re thinking about hiring your first CA or you want to strengthen your relationship with your current CA, keep these tips in mind for developing your relationship.

Hire the Right Person
Even if they have all of the requisite office management skills, not just anyone can be a CA. It’s best to match the person—their personality and skill set—that fits your needs and wants for the CA position. For example, a highly expressive personality may not be the best fit for a CA focused on collections and account management.

You’ll have an easier time of matching the personality to the position if you’re clear on what you want for the job. “It sounds obvious, but so many doctors have merely a vague concept of the position they’re hiring for,” says Kim Klapp, director and coach of the Assistants for Chiropractic Excellence program. “Determine what the position’s requirements entail as to skills, duties, hours, attitude, mindset, health philosophy, energy and personnel obligations.”

Some CAs and DCs believe the best hire is someone who’s in line with the DC’s chiropractic philosophy.

“You have to be a good chiropractic patient in order to be a good chiropractic assistant,” says Anita Tucker, who has worked as a CA for 11 years. “It never works out well when the person is not on board with what you’re doing.”

“Believing in chiropractic makes it easier for me to encourage patients to invest in their treatment,” continues Tucker, who works with Mills. “Most of the DCs I’ve worked with got into chiropractic because they want to take care of people, and taking care of the books and appointments is very distracting to that energy and that flow. I believe in completely relieving them. We’re EBAs—we do Everything But Adjust.”

Since the CA plays a key role in patient education and office management, hire a CA who complements your personality as well as your professional needs. For instance, if you have difficulty communicating the philosophy of chiropractic to your patients, look for an experienced CA with solid communication skills. If you are particular about the way in which the office is run, hire an assistant who hasn’t worked for another chiropractor so that the CA won’t come into the practice with a preconceived idea of the “right” way to manage it.

Set Clear Expectations
Regardless of the experience level of the CA, establishing clear expectations for the position is vital for the health of the working relationship. DCs need to spell out the CA’s job responsibilities and make time to address any concerns with the CA’s performance as soon as they notice a problem, whether it’s chronic tardiness or failing to order supplies in a timely manner.

“Working in a chiropractic office is like performing a play in front of a live audience,” says Cindy Hovi, D.C., who oversees two practices and a staff of four in Illinois. “It may look natural, but in reality it is well practiced and, most times, scripted. No director of a play would expect an actor to perform without dress rehearsals. No DC should expect a CA to work without solid training. Written office policies, job descriptions, educational materials and an appropriate, supervised training period are a must.”

Over the years Klapp has learned that many CAs don’t receive the training needed to perform their job effectively. Many times operating systems aren’t in place and the CA is left to re-invent wheel regarding office procedures. You’ll have more success with a new hire or your existing CA if you can offer an office systems reference guide and a personnel policy that outlines their job responsibilities, your expectations and your relationship.

Manage Effectively
In addition to outlining the job duties, DCs need to learn the most effective method of managing their CAs, which varies from person to person. Some CAs work well independently and need little day-to-day guidance, while others require direct supervision to thrive. If the two are not in synch, the CA will grow frustrated and look for a more harmonious work environment.

Regardless of the management style, it’s important that DCs make time to chat with their CAs each day, giving them the opportunity to ask questions, inform the DC about scheduling changes, and share insights that they’ve gleaned from patients. Since CAs have a more casual relationship with patients, they’re often the sounding board for concerns and questions that patients won’t directly address with their doctor.

Your management skills can make or break your CA and DC relationship. “Expectation management is the key in any successful relationship. It’s simply letting someone know up front what to expect, then delivering,” says Klapp. “If you hire a CA and tell that person that they’re going to be paid to do ‘A, B and C,’ but then you add to their job description ‘D, E and F’ [without changing their pay], it causes a tremendous problem. This one issue is often the foundation for resentment, poor attitude or performance, or even rationalizing theft in an attempt to compensate for the unfairness.”

Work as a Team
The power of a team approach often results in synergy throughout the office. “I’ve always talked about the DC/CA marriage, partly because there are a lot of DCs and CAs who are married, but also because it’s so similar to a marriage,” says Cindy Rondberg, who worked with her husband as a CA for 17 years. “You come together as a team, and you depend on each other.”

“We can never serve people at the level we want to by ourselves,” says Shawn Powers, owner of PowerSource Coaching. “The more we work at team building within the practice, the stronger our practices will be. Doctors have to let go of thinking they have to do everything. They need to learn how to delegate and delegate appropriately, according to the legalities of their state, their country, or their province, and to keep working on developing and innovating within the team. CAs want to be part of a team that’s working for something bigger than themselves. They want to make a difference.”

Relationship Killers
Kim Klapp, owner of the Assistants for Chiropractic Excellence program, outlines the top two complaints from DCs and CAs regarding their working relationship.

Problem: The main complaint that CAs have with DCs is lack of congruence between their goals and their actions. For example, a DC who professes to want to help more people and increase the success of the practice, yet continues to chat excessively with patients, talk on the phone when patients are waiting, play “Let’s Make a Deal” with patient fees, and make continual exceptions to office policies.
Solution: Offer support—follow the guidelines in place for the office regarding billing protocol and the expectations outlined in your office systems manual. So, when a patient sidesteps a CA’s recommendations and attempts to sweet talk you into eliminating a late fee, stick to the book and support your CA’s recommendation.

Problem: The main complaint DCs have regarding CAs is a lack of confidence with their performance. Because most doctors do not have adequate systems in place, DCs are left to guess whether or not the duties are being done, or feel the need to stand over the CA’s shoulder and check up on them.
Solution: Provide adequate training and practice effective communication. Klapp suggests developing a R.I.C.H. foundation based on Respect, Integrity, Caring and Honesty. Communication between both the CA and DC will help keep future issues from escalating into resentment and other relationship killers.

CAs Contribute to Your Success
Kim Klapp, owner of the Assistants for Chiropractic Excellence program, believes CAs can be either the practice’s greatest asset or liability, depending on whether or not they:

©2006 Today's Chiropractic