At the start or end of a year, we often hear about lists of the latest ideas shaping our profession and so, here are chiropractic practice trends that chiropractors will see and experience in 2020 and beyond.

Rather than pull random predictions, I’ve also included references to why you will be seeing and experiencing these chiropractic practice trends (if you don’t know already).

  1. Big Deductibles & Bigger Premiums

Not surprisingly the chiropractic practice trend on the list is the fact that deductibles will stay big in 2020.  Despite all the changes in healthcare with the onset and dismantling of Obamacare, some things (unfortunately) stay the same. Deductibles remain big.  Worse, Medicare is paving the way for deductible increases as the Medicare Part B deductible increased to $198 in 2020 – which is a $13 jump from 2019 and a 7% increase.

Medicare blames the boost in the out of pocket expenses largely on the increase in cost of physician administered drugs.  Yes, your chiropractic patients will be paying more for your care, because in their faulty wisdom, Medicare has to spend more on drugs. Even worse still, patients will face increases in their premiums in Medicare and elsewhere.

What’s a chiropractor to do?  First, be informed, so you collect the correct amounts.  Second, use this as an opportunity to demonstrate the advantage of chiropractic care, which can not only save your patients, but the entire healthcare system.

Finally – let this continuing trend cause you to think seriously about why you don’t want to be entirely in the clutches of insurance payers who can (and do) impact your bottom line with their policy decisions and premium hikes.

I’m not saying that you have to rip off the bandaid entirely and go whipash-cash.  But if you are not moving to offer more cash-based services and reduce your insurance dependency, you are going to find yourself a casualty of our badly broken sick-care system.


  1. Increased Chiropractic Utilization from the Opioid Crisis

A silver lining in the dark clouds of American healthcare is the fact that chiropractic is perfectly positioned to help patients seek non-opioid alternatives to their painful problems. Multiple studies and media outlets are confirming that chiropractic is tied to lower opioid usage. While Physicians Weekly and MedScape popularized the Corcoran study published in the journal Pain Medicine and presented at the American Academy of Pain Medicine Meeting in 2019, they were not alone. The Health Payer Intelligence newsletter, which reports to Private Payer Insurance companies, took note of a JAMA Study showing reduced costs and opiod use with chiropractic as well as as a study in JMPT investigating the dynamics of chiropractic and opioid use in chronic pain patients.

Even better, for the first time in many years, there appears to be enough promotional effort from within chiropractic from national, state and other related trade associations who are advertising chiropractic as an excellent alternative to the dangerous opioid drugs AND ample evidence outside of chiropractic that opioids are not the answer to actually create a culture shift towards what we have to offer as chiropractors.

Better still, these efforts are coming at a time in our economy where the country is doing better financial and patients have more disposable income to actually consider choices beyond the traditional “what’s the cheapest” route.

What does this mean for the average chiropractic practice? The synergistic effect of all of these efforts may help increase the overall utilization for your services!  Only a few years ago, there were many, many DC’s moaning about the effects of the recession on their practices and their bottom lines.  The “talk” has certainly changed its tune as of lately as we’re seeing more and more chiropractors declare that they are having their BEST months and years ever!

If you are not already, play this smart and get behind the efforts to save your community from opioids and use the promotional efforts of the “big guys” to boost your practice. The easiest way to do this is to join a state chiropractic association, national chiropractic association and/or an organization like Clinical Compass that is actively promoting research supporting chiropractic care!


  1. Consider the Cash-Insurance “Infusion” Model

No, I’m not talking about infusion therapy where you administer meds or vitamins intravenously. What I am talking about is a paradigm shift for most practices AWAY from insurance and towards cash-based services.

To be crystal clear, this chiropractic practice trend does NOT mean you have to be 100% cash and tell all your insurance patients to take a hike.  Rather, we need to progressively move towards a model that is actually the reverse of what is seen in most chiropractic practices.  Right now, the majority of practices are 85% insurance and 15% cash and I believe that is an unhealthy ratio.

Instead, I believe that we need to move towards being mostly cash with a strategic infusion of insurance to balance us out.  This is not a novel idea proposed by me, but more along the lines of what we see in dentistry, orthodontics and other professions that face far fewer insurance challenges than us as chiropractors. And it’s in direct response to the fact that the amount of coverage by insurance companies has been steadily decreasing, while out of pocket and cash patients have been decreasing — for years now.

whenThe good news is that this is a model that we’ve been teaching with our private coaching clients for years and helping them successfully navigate the switch.  It’s a series of progressive steps that not only makes common sense, but when applied correctly, makes great financial sense as well.

In this respect, we’ve seen practices go from $300k and burdened by administrative requirements of running the 100% heavy insurance headache practice to $1.4M and only doing 30% insurance; while others go from a $500k and 95% insurance based nightmare to 35% insurance and $3M per year. This is not new ground for healthcare, as it’s been successfully demonstrated in virtually every profession outside chiropractic.  We were late to the insurance table and now we’re late to get off the buffet line. But we can take concrete steps to improving our practice.

For more info, see our upcoming FREE WEBINAR: The Cash-Insurance Infusion Model – How to Progressively Reduce Insurance Dependence, Increase Quality Cash Patients & Restore a Sense of Sanity to Your Business


  1. Chiropractic Student Loan Debt Demands Wise Financial Stewardship

The last several years have pointed to unprecedented levels of student loan debt for chiropractors and sadly, this chiropractic practice trend shows no sign of stopping in 2020.  Last year, we spoke to several DC’s who not only had $200k of student loan debt, but $300k as well (and even a few married chiropractors with $400k in combined student loan debt).

One source has estimated that the average chiropractic student loan debt is $232,000.

While this debt definitely makes life challenging for newer DC’s and is a reality for many, the good news is that we’ve also seen cases of docs paying off $200k in student loans very quickly.  And with some smart student loan planning and wise financial stewardship, it is possible to have your student loans not ruin your life.


  1. More Chiropractic Buyers Than Builders

As more doctors come out deeper in debt and fewer DC’s want to risk starting from scratch without a safety net or set of procedures to follow, the profession will see a continued growth in doctors buying an existing chiropractic practice. This chiropractic practice trend makes good sense, as buying a chiropractic practice allows you to immediately assume the income stream of the exiting owner and comes with a staff that knows how to run the business, existing patients and built-in momentum – whereas as startup venture contains none of that.  Admittedly, I am a bit biased since we’ve helped over 3000 chiropractors buy and sell chiropractic practices, but I’m not alone in this line of thinking.  In fact, there are some in the profession who consider that owning a chiropractic business is the fastest way to reduce your student loan debt.


  1. More Non-Traditional Exits Among Chiropractors Looking to Transition Towards Retirement

Traditionally, when chiropractors choose to leave our profession, they go one of three routes: they sell their chiropractic practice, they shut it down or they die with their boots on.  Obviously, two of those three routes are not desirable exits.

For that reason and more, we’ve seen exponential growth over the last few years in the number of chiropractors who are planning ahead and choosing “non-traditional” exit strategies.  The most popular chiropractic practice trend is what we call the “Sell & Switch” strategy which is really a traditional sale up front but instead of the doctor sailing off to retirement, they stay on and work with or for the buyer after the sale.

The benefits are easy to see for both buyer and seller (and the banks involved).  Buyers like the fact that the Seller can stick around in some capacity to help prevent patient attrition after the sale and to offer practice management advice.  The Seller gets to slow down towards retirement and earn extra income after the sale. And the banks like the fact that we’re reducing risk by keeping the exiting owner around for a defined time period to help with the transition.

I initially wrote about this approach in my Ultimate Chiropractic Exit Strategy Program way back in 2008, and since that time, we’ve assisted many chiropractors to put this plan into action for their practice.

As more chiropractors realize that they may not want to quit practice immediately and entirely, this strategy has become a more popular alternative to the traditional sale.


  1. More Grey in the Chiropractic Profession & Green in the Bank

As the number of Baby Boomer chiropractors continue to reach retirement age, the number of DC’s selling their practice will continue to increase. In this many of the “old myths” are dying out or already outdated and being replaced by a new chiropractic practice trend related to both when and how you will exit.  So, if you are in this age bracket, consider checking out one of our FREE Chiropractic Sale or Transitions Webinars where we will show how to you to maximize the green in your bank account as you exit.


  1. Better Bank Financing for Chiropractic Practice Sales

For DC’s looking to Buy a Chiropractic Practice, you will good news in that the bank financing outlook continues to improve for chiropractors, as it has since 2018 when the SBA revised lending parameters.

Unfortunately, this chiropractic practice trend does NOT mean that you can walk into any bank with your large student loan debt and get a loan to purchase a practice.  But what it does mean is that, among specialty lenders (who have experience in healthcare practice acquisitions loan), you WILL have a much better chance at a loan than in years past!

For more info, take advantage of one of our FREE Webinars on Buying a Chiropractic Practice.


  1. Large Practices Will Model Large Business and Grow Through Acquisition

Over the last several years, there has been an upward trend in large chiropractic practices expanding through acquisition.  In this respect, this chiropractic practice trend is simply following in the footsteps of the big guys like Amazon who are growing through acquisition of other businesses such as Whole Foods, Zappos and others.

The move makes sense.  By acquiring an existing local business, a large chiropractic practice can (a) eliminate a competitor and increase marketshare; (b) offer a satellite office option to improve patient access; (c) instantly gain an expanded patient base to promote to, who can exponentially increase their return on the investments.

And with the number of DC’s who are retiring and/or have smaller practices they are looking to sell, this strategy will not only become a more common and win-win transaction for both buyer and seller, it will become easier to do, as with each sale, experienced will be gained through the acquisition process.


  1. More Chiropractic Audits

Sadly, the “A” word will continue to accelerate for chiropractors as insurance companies continue to expand their budget operations for their auditing department.  Once considered a “revenue recovery” strategy, auditing is now big business and a money-making move for health insurance companies who, as we know, are in the business of making money – not providing health care.

With this trend showing no sign of stopping or slowing, it is even more important than ever that chiropractors stay informed on the latest billing, coding, documentation and compliance updates.  Even sources outside our profession have been taking notice and issuing their warnings.  Case in point, one of the largest lawfirms that provides healthcare audit defense has been attempting to warn chiropractors – whereas just a few years ago, they wouldn’t even touch our profession because we were too small and essentially went unnoticed on the audit radar.

Fortunately, there are now more experts than ever, in this chiropractic space.  Protect yourself and your practice – join ChiroHealthUSA, take a Mario Fucinari seminar or consult with a local expert who knows insurance regulations in your state.  Or else.


  1. More Massage = More Business for Chiropractors

The massage profession continues to grow rapidly to meet the public demand.  According to the American Massage Therapy Association, in 2005, massage was predicted to become a $5-11 Billion per year industry; in 2018, massage was a $18 Billion dollar industry!  The latest prediction from the Bureau of Labor & Statistics on massage is that there will be 22% growth from 2018 to 2028.

This is great news for chiropractors who continue to provide of the single largest employment opportunities for massage therapists.  From a business standpoint, it’s a win-win situation.  Most therapists focus on their clinical training in school and are hands-on practitioners with good people skills.  But running a business and getting patients and managing administrative tasks, insurance billing and collections – are often not their strong points.  Chiropractors provide an environment for massage therapists to thrive in their practice and the service is extremely popular with patients – as both a cash or insurance-based complement to chiropractic care.

Inside our profession, the trend is clear.  Chiropractic Economics routinely reports that chiropractic practices with massage therapy have higher revenues than those who do not.

If you do not have massage or if your massage department is limping along unprofitably, you are missing out.  Consider our Build a $300,000 Massage Practice In Your Chiropractic Clinic program for a step by step guide to creating a great massage department in your office – and reap the rewards today!


  1. DOT Physicals Keep Cash Services Trucking For Chiropractors

Another chiropractic practice trend that will continue to increase in 2020 and beyond is chiropractors offering DOT Physicals.  The number of DC’s doing this is still relatively small enough to not have reached a saturation point and the benefits are multiple.  The patients love the fact that they can go into a clean, convenient healthcare facility for their physicals – perhaps a DC they have already been seeing.  Chiropractors love the fact that this is a cash-based, straightforward service that can potentially bring in new patients who initially come in for their physical and eventually come in for other problems.  Due to the nature of the job, a large percentage of truck drivers who suffer from back pain and spinal related problems.  One Canadian study estimated approximately 57% suffered with these issues regularly; while a recent study in the British Medical Journal of Musculoskeletal Disorders showed that the percentage can be as high as 70% for car or truck drivers suffering from back pain.


  1. Niches Riches Continue to Increase for DC’s

There will be a continued growth in niches like Neuropathy, especially with the aging population and number of diabetics increasing.  Similarly, Stem cell clinics continue to grow to meet the demand of those looking to avoid spine surgery. And finally, Functional Medicine will continue to increase, particularly as American’s grow in awareness of disorders related to nutritional problems.

What’s the common bond here? Chiropractors are uniquely positioned as leading providers in all three of these areas.  From my observations, most of the success here is coming from DC’s who are well trained in how to market for and present big cases.  Since the profitability from these services falls outside the boundary of insurance and since most of the chiropractors doing well in these niches are selling big dollar cases, it makes sense that additional training would be required to successfully navigate these niches.


  1. Social Media Chiropractors Bringing In New Patients & New Income Stream

For the really adventurous DC’s out there, you will see a continued growth in chiropractors monetizing social media as a source of new patients and potentially, as an additional revenue stream. The former is no surprise. Marketing experts have been touting Social Media as a source for new patients for years now.  And some chiropractors have indeed mastered this to the degree that it has definitely outpaced all forms of “traditional” advertising.

The new twist on this approach comes full circle with a growing handful of chiropractors who may have initially set out to use their YouTube, Facebook or LinkedIn videos as patient promotion or patient education – and now they are actually generating revnue from the videos themselves (beyond the income the patient is bringing in).

From a business standpoint, this can be pure genius as you could be essentially paid twice for doing the same thing – one for the adjustment, one for the ad income generated by the video of the adjustment.

Fair warning, this is definitely not a “sure-fire” income stream, although due to the success of some of the most well known docs, like Y-strap aficionado Dr. Cipriano from Greenville, SC, Dr. Rahim in Los Angeles or Dr. Mondragon in Orlando, the game is afoot with millions of viewers.  Even Yahoo News declared that chiropractic “Cracking” videos are the new pimple popping videos.

Good for the patient? The profession? A viable income stream. The jury is still out and you may have to decide on that one.  But the videos themselves are strangely enticing to watch.



If you are looking to grow, buy or sell your chiropractic practice in 2020, the above chiropractic practice trend are definitely ones that you want to pay attention to this year and beyond.