I have a confession to make. Years ago, I looked down on chiropractors with small practices. My own best friend from chiropractic college ended up starting a micro practice out of financial necessity, working out of a room in someone else’s office, and I felt sorry for him. I never told him that, but I did, and looking back, that makes me a pretty crappy friend.
I was wrong. And if you run a small or micro chiropractic practice, or you’re thinking about starting one that way, I want to spend some real time explaining why.
Where This Thinking Comes From
When I started my own practice, I had absorbed a specific set of beliefs, mostly from practice management groups and coaching circles: a small practice isn’t a real practice. If you’re not seeing 300 patient visits a week, you’re not a serious chiropractor. Small practices aren’t profitable. Bigger is simply better, full stop.
None of that came from my own experience. It came from the outside in, and once I actually started working with chiropractors who run small and micro practices, and once I looked honestly at my own numbers next to a friend who built a much larger one, I realized how wrong all of it was.
The Opinions You Should Actually Value
Here’s a useful way to think about whose opinion should carry weight in your decisions. Picture your relationships as a target. The bullseye in the center is your spouse, your kids, your closest friends, the people who are genuinely on your team and want what’s best for you. The rings get less important as they move outward: extended family, coworkers, acquaintances. Social media and practice management culture live way out on the crest of that target.
The people out on that crest often aren’t even real, and even when they are, they’re rarely being honest about what’s actually happening in their business or their life. You cannot know what someone else’s overhead looks like, what their debt load is, or what they’re actually taking home, from a highlight reel on Instagram. I’ve watched people who look wildly successful turn out to be barely scraping by, and I’ve met genuinely wealthy people who live so modestly you’d never guess it. Looks are deceiving in both directions.
This is part of why I don’t publicly talk about my own numbers. A statistic without context, how many patients you see, how much you gross, doesn’t actually mean anything on its own.
Small Doesn’t Mean Insignificant
I want to challenge an assumption a lot of chiropractors carry without ever examining it: that significance requires scale. That being a “world changer” means having a giant practice, a huge following, or a massive income.
Think about how few people, in any field, actually become household names with generational impact. In chiropractic specifically, how many practitioners can you actually name who you’ve never met in person? A handful, maybe. Out of every chiropractor who has ever practiced. That’s not a knock on ambition. It’s a reality check on where significance actually comes from.
A friend once had me do an exercise: draw a tombstone and write down what I wanted said about me when I was gone. Nothing I wrote had anything to do with money or my practice size. It was entirely about how I was as a father, a husband, a friend. That exercise reshaped how I think about legacy, and it happened around the same time I was going through a divorce and closing my first practice, a season where I had prioritized the wrong things and was starting to see the cost of that clearly.
My own father passed away eleven years ago. He wasn’t flashy. He wasn’t the “cool dad.” He was quiet, high character, and deeply responsible, an engineer who cared more about doing things right than being impressive. I still think about him constantly, and the impact he had wasn’t built on scale. It was built on the people closest to him. If one of my four kids misses me half as much as I miss my dad, I’ll consider that a successful life. That’s not a metric any practice management seminar ever taught me to value, and it’s the one that actually matters.
Small Can Absolutely Be Profitable
Here’s a story that reframed how I think about wealth entirely. I had a patient for six years before I found out he was genuinely wealthy, a farmer who could have paid off everything I owned with the cash in his pocket. He never once acted like it. I also know someone with the kind of money where buying a baseball team is a realistic option, and he wears sneakers from a 5K he did fifteen years ago. You would never guess either one of these men had serious money by looking at them.
The lesson: just because something looks small doesn’t mean it’s unprofitable. Net matters far more than gross. A friend of mine built a large practice with multiple doctors and a big location, and for years I quietly envied it, assuming he was doing dramatically better than I was. When we finally compared real numbers over lunch, our actual take-home pay was only a few thousand dollars apart. He was grossing roughly four times what I was, but once you paid the associate doctors, the overhead, and everything else that comes with scale, the difference nearly vanished. For me, that additional headache wasn’t remotely worth it. For him, it might have been the right call. Neither one of us was wrong. We were just running different races.
Contentment is an undervalued virtue, and it’s worth asking yourself directly: how much is actually enough? You can still want the nicer car, the bigger space, more staff. There’s nothing wrong with ambition. Just don’t confuse acquiring more with becoming content, because if you can’t find contentment with a little, a lot won’t fix it either.
Why Starting Small Often Makes More Sense
If you’re just getting started, or you’re deciding how to structure your practice, there’s a real practical case for starting small and keeping overhead low. Every chiropractor I’ve worked with who went from struggling to solidly stable the fastest did it by running a low overhead, small or micro practice. It’s a far easier problem to outgrow your space and be too busy than it is to be stuck with a large space you can’t fill. I would take “I don’t have enough time” over “I don’t have enough people” every single day of the week.
You don’t have to stay small forever. But starting small, proving out your model, and growing deliberately from there tends to be the smarter path, not the lesser one.
Turning Small Into an Asset, Not Something to Hide
This is where I spend a lot of my time with clients who run small and micro practices, and it’s honestly one of my favorite parts of the work I do. Historically, chiropractors with small practices have tried to hide it, to present themselves as bigger than they actually are. I think that’s exactly backwards.
Being small is a genuine asset, and it deserves to be highlighted, not disguised. One-on-one time with the doctor. A personal, unhurried experience. Not being treated like a number the way people often are in larger, higher-volume offices. There is a real segment of patients actively looking for exactly that, and if your chiropractic website and your messaging are trying to hide the fact that you’re small, you’re actually hiding the thing that would attract your ideal patient in the first place.
The shift starts with how you talk about your own practice. Stop being apologetic about its size. Present it as intimate, boutique, and personal, because that’s exactly what it is, and that’s exactly what a specific group of patients is searching for.
The Bottom Line
Make decisions based on what’s actually best for you and your family, not based on the opinions of people standing on the outer edge of your life who don’t know your real circumstances. You may find that you genuinely like staying small. My best friend from chiropractic college, the one I used to feel sorry for, still runs a micro practice more than twenty years later. He’s never hired staff, has never wanted to, and does a phenomenal job running it exactly the way he wants to. I was wrong about him then, and I’ll happily say that publicly now.
You are not insignificant because your practice is small. In a lot of ways, it’s the small, intentional things, the time with your family, the patients you treat like people instead of numbers, that actually make you significant in the first place.
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