Do you need to expand your staff? As you get busier in your practice, a natural progression is considering hiring staff / more staff to help you. But does it make sense to expand your staff now – or could it actually be an unwise decision?
This question comes up often among chiropractors I mentor. Many feel stretched thin, but they’re also hesitant to bring on new hires. The fear of adding payroll pressure, being overextended with time (including the time it takes to train someone), and potential new hires not taking things off your plate as quickly as you’d like – these are all valid considerations.
If you're at this crossroads, you're not alone. Let’s explore how to know when hiring is a wise next step for your practice vs. when it may be more of a stressor than a solution.
The Growth Tension: Too Soon vs. Too Late
As a practice gets busier, hiring often feels like the “next right step.” But rushing into expansion can bring challenges:
On the flip side, waiting too long can also cost you. Many chiropractors hit burnout by trying to “do it all,” wearing every hat from clinician to admin to marketer – until quality of care (and personal well-being) starts to suffer.
The sweet spot lies in expanding with intention, not reaction.
5 Smart Questions to Ask Yourself Before Hiring
Here’s a simple self-check before bringing someone new on board:
1.Is my patient flow consistent – and supported by a system, not just referrals from patients? Being busy yourself doesn’t mean an associate will be busy. If your current marketing approach only attracts patients who want to see you, then an associate may sit idle. If an associate sits idle, they are less likely to stay. That’s why it is key to have a system in place or focus on getting help with this first to attract new patients aligned with the practice (not just with you).
Your patient flow should support growth – not just for today, but sustainably. That’s why many chiropractors I work with get this system in place before hiring.
2. Am I ready for a mindset shift? With any type of hire, it requires an upgrading of mindset. The next level of growth requires an upleveling; asking yourself, Who can I delegate this to? vs. When can I do this & fit it in?
It requires being good with another level of letting go of control. This includes sometimes being OK with it being done 70% as good as you currently do that same thing. I used to cringe when I had a mentor who was strong with operations say something like that to me. I thought, I have high standards; 70% is just not good enough.
But from over 20 years of experience with hiring and having a team, I have learned that It is about upholding high standards, continuing to seek hires who do things better than how you do them; but also being compassionate if people don’t do certain things quite as good as you.
3. Will hiring free me up to do more revenue-generating or high-impact work? Especially for admin hires, it’s important to ask: How will this shift your role? If you're still doing the same tasks, revenue may stay flat, while expenses increase.
Not all hires are created equal. An associate can generate revenue. An admin frees you up so you can generate more. But either way, if your day-to-day doesn’t change after bringing someone on, your revenue likely won’t either.
Before you hire, ask yourself: If you were doing your new hire’s admin role yourself before, what would you do with the time you free up? What revenue-generating activities will you do now in that time you used to do admin?”
If the new admin hire is going to do part or all of someone else’s current admin role, consider what revenue-generating activities can they support the practice with, such as in-house marketing or support retention.
4. Do I know my break-even point? Don’t hire out of panic or from pure excitement for potentiality alone. Hiring from a place of desperation rarely ends well. Likewise, hiring too soon because you think you need support – without clarity on how it fits into your revenue model – can lead to costly missteps.
Before you bring someone on, calculate your breakeven point. If you’re hiring an associate, decide how long you’re willing to carry them before they must become profitable – and hold yourself to that.
For associates, even a temporary “wash” can be OK if there’s a plan to make them profitable by a certain timeframe. For admin hires, this means getting crystal clear on how much time you’re buying back – and what high-value tasks you’ll focus on in return. Don’t just fill that freed-up time with busywork.
As chiropractors, you are compassionate and care deeply about people. But caring doesn’t mean clinging. If a team member isn’t a fit, it’s better to let them go than to carry the emotional and financial weight indefinitely. Set clear expectations and timelines—and follow through with leadership.
Ask yourself, What is the breakeven point – and what’s the timeframe for hitting it? At what point does it not make sense to keep that person on? (be clear about criteria before hiring someone).
5. Do I have onboarding, retention, and culture-building strategies in place? A great hire without structure may still underperform. Be ready to support their success from day one. This is the place that is often missing in many chiropractic practices, especially with first hires for a role.
Culture-building is also something that requires stepping into more of a CEO leadership hat vs. just being a great clinician. It requires intentionality with developing skills in this area, because it’s not always a skill that is second nature for everyone.
Other questions to consider:
The Takeaway
Growth by hiring is powerful – but only when done from a place of strategy, not stress. Here's what to remember:
Final Thoughts: Expansion as an Impactful Growth Step
At the heart of it, expanding your staff isn’t just a business decision – it’s a leadership moment. It’s about stepping into a new season of your practice, one where you no longer need to do everything alone … and where your energy is protected so you can focus on what only you can do.
So, before you rush to post that job ad (or before you talk yourself out of hiring again), pause and ask yourself: What kind of growth feels aligned, sustainable, and supportive to the kind of practice I’m here to create? Who can I get help from to attract more patient flow (especially for associate hires) and/or with getting systems in place that support hiring and onboarding someone successfully (including a good hiring system to save time, unnecessary heartaches, and money)?
With the right foundations in place, hiring can feel less like a risk – and more like the next clear, expansive step forward.
Recent laws in New Jersey and California represent a disturbing trend that will negatively impact a practice’s ability to collect monies from patients, as well as expose them to significant penalties if the practice does not follow the mandatory guidelines to a T. Please be aware that a similar law may be coming to your state. The time to act is before the law is passed.
With estimates showing over 30 million Americans affected by peripheral neuropathy – and a significant portion underdiagnosed – it’s increasingly likely that chiropractors are already treating these patients. What’s missing is structured recognition, comprehensive management and targeted tools to slow progression, improve function and support systemic health.
Each year, ICD-10-CM is updated on Oct. 1. For 2026, there are 74,179 total codes, with 487 additions, 28 deletions and 38 revisions. Code changes are based on date of service, not the claim submission date. Services performed on/after Oct. 1 must use the new codes. While no changes affect the common spinal or extraspinal codes most frequently used by DCs, several updates may still affect your claims – particularly for comorbidities, referred pain, or trauma cases.
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