“What role can non-chiropractor stakeholders play in chiropractic’s Int’l expansion?”
There are some national laws that are not cross-border friendly for a chiropractor who wishes to establish a chiropractic practice in another country, one where he or she is not a citizen. This has created several hybrid scenarios that have evolved as chiropractors looking to work within the local laws to get their clinics opened due to immigration and constitutional law policies that vary some from country to country.
This has begun to happen more and more over the last 20 years. Some have very favorable outcomes with normal practices growing stable over the years. Some not so favorable seen with excessive turnover of associates for a variety of reasons; such as poor business practices, questionable business practices, illegal business practices just to generalize. So the question remains: “Is this a good thing or a bad thing?”
What specific types of alliances or partnerships are seen today?
- A businessman or businesswoman sets up a chiropractic clinic and hires 1+ associates. Or one who partners with a chiropractor to open a clinic.
- The chiropractor’s spouse, who is a citizen, is the owner and also the reason why the practice and family relocated there.
- A corporation is formed between a citizen and the chiropractor to open a clinic.
- An existing business like a spa hires a chiropractor as an employee and chiropractic is an additional service in that business.
- A chiropractor in one country that sets up satellite clinics in neighboring countries; legal set up will vary by country where any of the above may apply.
- A patient of a local chiropractor entices the associate (a foreigner) to open their own clinic in a neighboring community and engages in either of the above scenarios.
- A patient takes over an existing chiropractic office left behind by a transient chiropractor and recruits their own associate(s).
These types of developments are clearly a necessary part of chiropractic’s International development. Most chiropractors would find it dubious to work for a non-chiropractor but even in the countries where the profession is fully developed, chiropractors work for MDs all the time; or are hired by corporations, HMOs, etc. Although the best long-term practice development is expected to come from chiropractors opening their private practices, in what-ever country they can do so legally, partnering with local actors has become necessary in many countries for reasons stated herein.
The question isn’t whether this should be tolerated or allowed. The right question is how to guide this process because it is happening; how to even encourage this, under proper ethical and professional guidelines. There are basic business and fundamental concepts that need to be considered for this to work properly, regardless of the country in question.
- Acquire the legal right to live and work in the country: work visa, alien registration card.
- Meet local health authority licensing / registration requirements
- Acquire a chiropractic license to practice, if available.
- Most pioneer countries have no law that licenses chiropractors, so an alternative health classification may have been determined for permission to treat the public.
- Department of Health may accept foreign certification of the chiropractic training.
- Copy of Diploma with translation in local language certified by their embassy
- Active license where chiropractic is fully regulated. (translations also)
- Meet local commercial business requirements
- Business license (city, other)
- Tax registration (federal)
- Labor law compliance (proper contracting)
- Proper contracting between the company and the chiropractor
- Term of agreement length
- Compensation agreement detailed
- Meet local contracting laws
- Addressing for any leave of absences
- Termination clause for cause and how to maintain coverage in the transition.
As much as there is a formal process required to properly set up a chiropractic clinic, the key success and sustainable factor will always be the mutual trust and respect between the chiropractor and their partner or employer. Realities of starting up a chiropractic clinic in a country that is relatively unaware of the profession at all will have a different start up experience than in the country where the chiropractor took their training and outside of the experience of the chiropractor. Reasonable expectations on what to expect and how to promote the chiropractic services is an ongoing learning process between the owner, the staff and the chiropractor, as they engage the community and the growing chiropractic family.
There are wide-spread reports of abuse that are endured by the associate chiropractor working abroad that we hope to minimize by somehow, always include the non-chiropractor clinic owners in the association activities. Some have had their passport unreasonably withheld to prevent them from leaving. Some have contracts changed on them after starting to work reducing the agreed compensation. Some experience harsh personal treatment by the owners. Associates have been unduly influenced to teach chiropractic methods to non-chiropractors.
There are also reports of abuses conducted by chiropractic associates so there is plenty of culpability to be placed across the board: associates leaving without notice and without a replacement to care for existing patients; associates moving down the street taking patient records with them; associates just plain being lazy and unproductive, late and uncooperative.
In conclusion, it will be impossible to control all the things that are and will be taking place in the majority of countries where the chiropractic profession remains in its early or pioneer years. It would be unwise to take a negative outlook on the role of non-chiropractor actors who have an equally vested interest in participating in the advancement of the chiropractic profession in their country, one that can significantly impact their future, the future of their families and of the country at large, because chiropractic matters and it matters to them.
There are several stakeholders that will be engaged in the formal development of chiropractic where there is yet so little advancement in law or local chiropractic education; and in particular, so few chiropractors and clinics to serve the country’s population. It will take more than just the relatively few chiropractors and willing clinic owners but several community players as well.
The Chiropractic Diplomatic Corps supports the development of patient associations in pioneer countries. There is an 80 year history in Europe of the Pro-Chiropractic Europe group. They have recently changed their name to the Chiropractic Patient Federation of Europe but their website is still http://www.prochiropractic.org. They have inspired the development of a sister group in Asia named the Chiropractic Patient Federation Asia – Philippines and their website is http://www.chiropractic.org.ph.
© 2016 Michel Tetrault, DC – Executive Director of the Chiropractic Diplomatic Corps and practices in Manila, Philippines