Doctor of chiropractic salaries and practice numbers are on the way back up as post-pandemic life starts to take shape
WHEN THIS YEAR’S SURVEY WAS RELEASED, MOST OF THE AMERICANS WHO WANTED THE COVID-19 VACCINE HAD RECEIVED IT, AND MANY WERE TAKING A BOOSTER SHOT — and while the Omicron variant of the virus was still out there, most health care providers, including chiropractors, were operating in a “business as usual” manner. Finally, Americans seemed to feel confident in returning to a near-normal life in a post-pandemic world. For doctor of chiropractic salaries and practices, this has meant good news.
Information we received via our survey showed some very steady upticks across the board — on average, billings, collections, doctor of chiropractic salaries and total chiropractor compensation have all gone up, as has spending on things like office space and advertising. Last year these numbers showed ups and downs, but this year the trend is a steady rise.
Over the last few years, the traditional gender gap of 80/20 between male and female chiropractors has narrowed, with a small dip last year we attributed to women who had had to leave the workforce due to dealing with the pandemic — studies had shown that women were largely in charge of educating children and other pandemic-related responsibilities. This year the percentage of women responding to our survey rose to 27%, narrowing that roughly 80/20 gap. When it comes to chiropractic school enrollees, an almost 50/50 split between males and females persists.
There is strength in numbers, as chiropractors have been increasingly joining forces with other health care providers to bolster patient satisfaction as well as manage cost savings. Approximately 44% of DCs said they have employed a massage therapist as part of their practice (a big jump from last year), followed by 16% of chiropractors who have employed an acupuncturist and 11% who employ a fitness trainer.
Our 25th Annual Salary & Expense Survey suggests that last year’s dips (such as massage, which took a large pandemic hit) have been, as we predicted, temporary, most likely an inevitable impact from the coronavirus pandemic that has faded as patients have resumed their regular health care habits in the new normal.
Gender and doctor of chiropractic salaries
From an all-time high of 28% female in 2020 and a drop last year to 25%, the percentage of female chiropractors in the survey rebounded this year to 27%. Female chiropractors had been largely impacted during COVID-19 shutdowns in terms of job losses or leaving employment to care for families and other duties. Females doctor of chiropractic salaries increased this year — but what hasn’t changed is the discrepancy in salaries between male and female DCs.
Male chiropractors still report more income than females — significantly more. This year, males made $165,000 while females reported $105,000. In last year’s survey, total compensation for men came in at about $161,500, while female chiropractors’ total compensation weighed in at only $80,039; and in 2020 those numbers were $153,000 and $104,000, respectively. So, while the number of female chiropractors has seen mostly growth over the last few years, they remain consistently behind their male counterparts in terms of earnings, even at times when overall earnings are on the rise.
The challenge of diversity in chiropractic
Last year, given increased national attention to issues of race and diversity, we added a new question: Are you a minority-owned practice or do you work for a minority-owned practice? This year we hoped our responses would reflect changes from last year’s stark divide of 15% minority-owned to 85% non-minority-owned practices. It didn’t happen. This year showed 87% non-minority-owned practices.
Where do we go from here?
Most chiropractors’ incomes and earnings have increased modestly but significantly; however, our average respondent reported seeing 142 patients per week — a decrease from last year’s average of 168.
This may be a lingering pandemic effect as practices build back up to pre-COVID-19 levels, or, as suggested by the overall increased revenue, that patients are simply purchasing more products and services per visit.
The average DC profile
Our salary and expense survey attracted a wide range of doctors across the nation, with responses from practitioners between the ages of 25-87 years old, and from those who have been in practice for less than a year to 30 years or more.
By averaging the responses to many of this year’s questions, we can see what the average respondent might look like:
- male (27% of respondents were female)
- 53 years old
- a solo practitioner (56%)
- licensed in one state (80%)
Our average respondent:
- owns one clinic (88%)
- prefers to practice in the suburbs (54%)
- sees 142 patients each week; patient-visit average (PVA) of 68
- attracts almost 10 new patients each week
- and sees patients about 31-40 hours a week (45%)
- The average respondent has:
- average billings of $664,250 and collections of $467,800 for a reimbursement rate of 70%
- sells products to patients for 8% of gross revenues
- pays CAs $36,600 and himself $112,900
- and enjoys average total compensation of $181,600
Finally, this typical respondent spends roughly $33,700 per year on office leases or mortgages, $11,800 on advertising, and $2,400 on malpractice insurance.
Billings & collections
Average collections decreased compared to last year’s numbers, while average billings rose a bit.
Average gross billings were reported at $664,244 which is an increase from last year’s $650,700. Collections were reported at $463,161, which is an increase from $424,800 in 2021.
This year’s billings and collections numbers equal an average reimbursement rate of 69%, a 4% increase over 2021. DCs appear to be billing for more overall, and receiving a slightly higher percentage of that money back than in previous years.
How do MDs compare to doctor of chiropractic salaries?
As chiropractors assess their earnings and expenses, familiarity with their financial environment in the health care industry can provide valuable context to their conclusions.
Some DCs team up with MDs to create a more comprehensive practice; others consult regularly with general practitioners in their community. As such, we annually compare our salary survey to data collected by Medical Economics.
In Medical Economics’ 92nd Physician Report, published in June 2021, respondents indicated that the average salary for a family care physician was $234,000. This is sharply contrasted with specialist physicians, who typically top out at about $400,000, with cardiology and urology being the top specialties.
Comparatively, the average total compensation reported for DCs in this year’s survey was $181,600; this is up from $172,900 in 2021.
Medical Economics also reported that the highest median income came from the West and Midwest regions, but salaries for all regions were between $254,000-$290,000. They found that urban physicians earned more ($276,000) than their suburban and rural counterparts ($268,000 and $265,000, respectively).
In addition, Medical Economics found that median earnings were significantly higher for men than women, with a $70,000 gap in pay, compared to a gap of $74,000 that persisted for the prior two years’ surveys. They also noted that private-practice physicians earned $14,000 less than in the previous survey year.
To compare more statistics between chiropractors and medical doctors, visit Medical Economics at medicaleconomics.com.
How patients pay for treatment
While a DC’s true specialty lies in the ability to provide successful chiropractic care, you likely have several other income sources, such as retail, diagnostics or consulting.
DCs still report that their major source of income comes from patient chiropractic care, highlighting the dedication and commitment DCs have to their patients. About 86% reported patient treatment as their major source of income, which is the same as in 2021.
Other sources of income include retail products at 8%; diagnostic testing at 8%; and consulting at 3%.
We also asked what percent of treatment is paid for by the following: cash from patients, individual or group health insurance, Medicare, Medicaid, personal injury coverage, Workers’ Compensation, barter or trade, and other.
The majority of treatments are paid in cash (42%) or by individual or group health insurance (30%). Personal injury coverage paid 15%; Medicare paid 13%; Medicaid paid 3%; Workers’ Compensation paid 1%; and barter/trade paid for 1% of treatments.
Solo DC vs. group practices
This year’s survey showed a slight increase in the number of DCs practicing in groups (or partnerships) at 23%; this represents a 1% rise from last year’s 22%. However, since 2013, the number has hovered between 22-30%, showing that a fair number of DCs have found success in joining forces.
The 56% of doctors reporting as solo practitioners fell from last year’s 63%. Those indicating they were working as an associate increased this year to 16%, as did the number of franchisees at 2%.
When it comes to billings and collections, solo practices saw significant increases in both amounts this year. Solo DCs reported average billings of $429,800 and collections of $313,700, compared to average billings of $369,653 and collections of $263,737 last year.
The solo reimbursement rate was up a couple of percentage points (73% compared to 71% last year).
Group practice billings and collections fared better over solo DCs across the board, in keeping with the established trend, but reimbursement rates were slightly down this year. This year’s group billings were $1,069,270 (compared to $1,064,210 last year) and collections came in at $797,348 compared to $827,496 in 2021. The group practice reimbursement rate decreased a bit from last year, coming in at 75% from last year’s 78%.
The average total compensation for solo DCs this year was $166,800 compared to $123,850 last year. The average total compensation for a DC practicing in a group setting increased from $210,5000 last year to $218,400 this year. Doctor of chiropractic salaries for solo DCs averaged $94,500, a big increase from $82,500 last year, and those participating in a group practice averaged $139,300.
Note: Total compensation for unincorporated DCs is defined as earnings after tax-deductible expenses, but before income tax. For DCs in a professional corporation, it is the sum of salary, bonuses and retirement/profit-sharing contributions made on their behalf.
Solo practices spent $2,400 on insurance (an increase from last year’s $2,045), and $11,800 on advertising. Group practices spent more on insurance than last year ($3,800 compared to $3,600 in 2021). They also spent $21,225 on advertising, almost the same as the $21,000 they spent in 2021.
Group practices are spending more this year on office space, too, at $50,000 compared to $42,700 last year. Solo practices spent a lot more on office space this year at $33,700, compared with last year’s $20,750.
Integrative care still on the rise
In response to reader requests years ago, Chiropractic Economics expanded its “integrated clinics/DCs only” breakdown to provide a more comprehensive look at the profession.
We continued that trend this year by asking respondents to indicate if they were practicing as a DC only, in an integrated clinic or in a multidisciplinary clinic. An integrated clinic includes those practices with both a DC and a medical doctor on staff. A multidisciplinary clinic is defined as having a practicing DC and any other complementary medicine practitioner on staff (e.g., acupuncturist, PT, LMT).
This year 65% reported offering chiropractic care only, approximately the same as last year; 41% said they operated as a multidisciplinary clinic, significantly more than last year; and 30% responded as an integrated clinic.
Here is a breakdown of income by clinic type:
Billings — Integrated health care practices reported the highest billings ($1,400,000), while multidisciplinary practices reported billings of $715,000 and DC-only practices came in at $602,600.
Collections — Likewise, integrated practices saw the highest collections ($930,400) while multidisciplinary clinics reported collections of $487,000, and DC-only practices had collections of $434,000.
Salaries and total compensation — Multidisciplinary, integrated and DC-only clinics saw a range of salaries. Integrated DCs had an average salary of $108,500 annually, compared to $121,000 in 2021. Multidisciplinary clinics had an average of $116,500, and DC-only clinics had the highest doctor of chiropractic salaries at $134,850.
Total compensation for unincorporated DCs is defined as earnings after tax-deductible expenses, but before income taxes. For DCs in a professional corporation, it is the sum of salary, bonuses, and retirement/profit-sharing contributions made on their behalf.
Regarding total compensation, integrated DCs tied with DC-only clinics at an average of $163,000. Multidisciplinary clinics came in at $129,260.
Types of clinics
More practices identified as “rehab centers” this year (7.9%) than last year (5.3%). However, those clinics labeled as “wellness centers” showed a slight decrease, going from 24.6% last year to 22.5% this year. The term “medical spa” appears to have largely disappeared, as less than 1% reported that designation.
Most practices — 74.3% — identified as “clinics.”
The gender gap
Our annual survey consistently illustrates an approximate 80/20 male-to-female split that makes up the working chiropractic industry, and this ratio has been relatively consistent but slowly rising for the past few years. This year’s results saw a small increase after a decrease last year, likely due to the post-COVID return to work many women experienced, but a number still closing in on the ratio at chiropractic schools these days, which is closer to 50/50.
We’ve seen an increase in female respondents over the last few surveys, except for a small dip in 2021; this year, 27% of respondents were female as opposed to 25% in 2021, 28% in 2020 and 23.3% in 2019. These results allude to an overall positive trend we’ve seen regarding closing the gender gap. Even though doctor of chiropractic salaries and total compensation increased for both males and females, male respondents are still making more.
This year’s female DCs reported earning an average annual salary of $87,500 compared to $71,750 last year. Total compensation is $104,900 this year compared to $80,000 last year.
Male respondents saw an increase in annual doctor of chiropractic salaries with an average of $141,000, rising from $112,000 in 2021. Total compensation for men showed a smaller jump, with an average of $165,000 compared to $161,500 last year.
Twenty-nine percent of female DCs reported working 31-40 hours in patient care per week; 15% reported working 21-30 hours. Of the male respondents, 80% reported working 31-40 hours, with 54% working 21-30 hours.
DCs by U.S. region
Most DCs’ compensation figures increased compared to 2021’s numbers. Reported regional DC total compensations (rounded) for 2022 were:
Midwest — $121,300
West — $191,600
East — $134,000
South — $152,300
The Midwest saw the largest reimbursement rate this year, with an average of 73%. The South, West and East followed behind at 71%, 70% and 65%, respectively.
As you grow older, your salary as a DC should increase also. The results of this year’s survey showed that experience and age still reign — mostly — when it comes to earning larger paychecks.
DCs aged 46-55 earned the most with about $200,000, with those 56-65 earning a bit more than $150,000, those 36-45 earning $150,000, and the rest making less than $100,000 in doctor of chiropractic salaries. The youngest and oldest groups of DCs, those 26-35 and 66-85, earned the least money.
With more available retail space, a developing infrastructure and a large range of potential patients, it shouldn’t be a surprise that many DCs choose to set up their practice in the suburbs. Over the course of many surveys, the majority have responded that the suburbs are the ideal location for their practice.
This year was no different, with 57% of DCs reporting the suburbs as their location preference.
Although the numbers were similar to last year’s, there was a very slight uptick in suburban DCs at 57% compared to 54% last year. The number of urban practices dipped slightly from 31% last year to 29% this year. The number of rural practices dipped a bit from last year at 14% from 2021’s 15%.
Suburban DCs reported the highest average doctor of chiropractic salaries at $150,500, with their urban counterparts reporting an average of $98,000. Rural practices increased to an average salary of $94,000, versus $81,000 last year.
Suburban practices had average billings of $699,950 and collections of $479,275 for a reimbursement rate of 68%. Rural practices reported a reimbursement rate of 77%, with $480,000 for billings and $372,000 for collections. Urban DCs had average billings of $686,100 and collections of $469,000 for a reimbursement rate of 68%.
Who’s working for you?
We asked respondents for anonymous salary information on full-time employees only — not part-timers. We defined “full time” as employees who work 30 hours or more a week.
Approximately 18% of DCs in our survey do not have any employees, while approximately 20% employ one or two full-time people, and 25% of respondents reported they employ five or more people.
The average salary paid to full-time employees was: DC: $112,900; associate: $63,200; PT: $57,750; CA: $36,570; and LMT: $30,430.
For more DCs, operating as a businessperson is invariably a huge part of being a doctor of chiropractic. And as the business world continues to change and evolve, generally, so do the expenses involved in running a practice.
We’ve highlighted three standard spending areas in the profession: malpractice insurance, advertising, and an office lease or mortgage.
Office lease or mortgage — Average yearly costs were $33,700, an increase from $26,500 last year.
Advertising — Average costs in this year’s survey were $11,800, an increase from last year’s $10,000.
Malpractice insurance — Respondents reported an average expense of $2,400, less than last year’s $2,500.
2 recent variables
Our national discussion over the last 24 months has repeatedly touched on two issues — the COVID-19 (coronavirus) pandemic, and the state of racial relations in the U.S. To incorporate this timely information into our survey we added new questions last year pertaining to these topics.
Last year, most DCs who responded to our survey reported some pandemic-related loss of income, though 24% said they lost no income. This year income has increased almost universally across groups, suggesting the effects of the pandemic are waning in most areas.
When asked what percentage of their patients were Black, Hispanic or of color, the DCs in our survey reported numbers in nearly the widest possible range, from 1% to 99%. According to our data, approximately 23% of patients seen in suburban clinics are non-white, followed by 53% in urban practices and 10% in rural practices. While this data suggests that non-white individuals are definitely embracing chiropractic as a treatment choice, the number of chiropractors of color lags behind, as our survey showed only 13% of practices are minority-owned.
Doctor of chiropractic salaries offset by product offerings
Our survey shows approximately 88% of chiropractors in our survey sell at least one product in their practice. As this number has consistently remained high over the years, it’s clear that DCs across the board find success through the integration of quality care and providing patients with the best products available.
A commitment to retailing top-industry products benefits the DC financially, but doing so also creates an important relationship between patients and the products they need to achieve wellness.
So which products do respondents offer? Are you selling the same products as other DCs? The top five include:
1. Hot/cold compresses — 52%
2. Nutritional products/supplements — 51%
3. Topical creams/ointments — 47%
4. Pillows, kinesiology tape, orthotics — 43% each
5. Educational material — 42%
Of chiropractors surveyed, 29% sell cannabidiol (CBD) topical products to patients, while 30% sell edible products containing CBD; these topicals and supplements are made from the non-psychoactive component of the cannabis plant.
Your skill in treating patients with regular adjustments and issues related to the musculoskeletal system can undoubtedly position you well for a comfortable career. But if you feel stagnation coming on and are looking for new paths to explore, year after year our survey demonstrates that joining forces with complementary specialists is a surefire way to expand your practice, boost your bottom line, and perhaps revive your passion.
In 2022, 73% of DCs reported having other specialists working in or consulting with their practice. Those specialists include LMTs, PTs, acupuncturists, fitness trainers and nutritionists, in addition to MDs and DOs.
The specialists who become a part of your health care team allow you to offer a wider range of treatment options and programs. When evaluating how this benefits you, the numbers speak for themselves: Clinics employing specialists see more patients per week (157, compared to 150 patients per week in non-specialist clinics); bill more (average of $714,922 versus $602,555); and collect more (average of $487,063 versus $433,930).
Chiropractors employing specialists averaged a higher total compensation ($176,000) than those without specialists ($130,000); those with specialists also averaged a higher salary than those in practices without specialists ($123,000 and $104,000, respectively).
While 73% of respondents have at least one specialist on staff, the most common specialist was an LMT (44%).
Other popular specialists include:
- Acupuncturist, 16%
- Fitness trainer, 11%
- MD/DO, 9%
- Nutritionist, 8%
- PT, 6%
And 7% of respondents indicated “other” for specialists they have in their clinic.
Respondents (both clinics with specialists and clinics without) also reported that they offer a wide range of modalities, even if they do not have specialists who provide them.
These modalities include:
- Chiropractic, 99%
- Instrument adjusting, 57%
- Electrotherapy, 55%
- Exercise programs, 53%
- Nutrition, 50%
- Kinesiology tape, 49%
- PT/rehab, 43%
- Laser therapy, 30%
- Decompression, 29%
- Massage therapy, 25%
- Weight-loss programs, 20%
- IASTM, 19%
- Acupuncture, 18%
- Homeopathy, 9%
- Medical services, 4%
- Other, 5%
- None, 0%
About this survey
Our 25th Salary and Expense Survey had 409 participants responding to an anonymous, confidential web-based questionnaire. During March and April 2022, Chiropractic Economics magazine invited practicing chiropractors (and CAs on their behalf) to complete the yearly survey.
We extended the invitation by email as well as through announcements in our e-newsletters and social networking sites. Additionally, we encouraged a number of state, national and alumni associations to distribute the survey to their members.
Regional representation — Our response to this year’s survey was wide-ranging, with participants from 43 states. The regional breakdown is as follows: Midwest, 28%; South, 35%; East, 14%; and West, 23%.
Statistics — You will find references to averages (or means) in this year’s survey. Reader feedback has indicated that the survey is better understood by only stating averages. The average is the number calculated by dividing the total by the number in the set — an arithmetic average.
ALLISON M. PAYNE is an independent writer, content creator, editor and proofreader based in Florida.