Team
Hire, onboard, train
“My assistant runs the table and I am not sure that is legal here.”
Most doctors find out what their state permits after they have already built the practice around an assumption.
It varies enormously. New Jersey names decompression and mechanical traction explicitly among tasks a chiropractic assistant may perform. California requires the doctor to be physically present — “immediate and direct supervision,” in the rule’s own words. Arizona, Florida, Georgia and Colorado have their own versions. And roughly twenty states say nothing at all about chiropractic assistants, which means the question is answered by your board’s discretion rather than by a statute you can read.
Silence is not permission. It is an unanswered question, and you want it answered before an inspection asks it for you.
What we do and do not do about that
We tell you what the statute says and where to read it. We will point you at the rule, the board, and the specific language that governs supervision in your state.
We do not give legal opinions. Your board decides, and boards change their positions. Confirm it with yours — in writing, if you can get it.
What this pillar covers
Who you are actually hiring for. The person who runs a decompression table is not the person who runs a busy adjusting practice. Different temperament, different tolerance for repetition, different relationship with the patient over twenty-plus visits.
Onboarding that does not depend on you. If training a new assistant means a week of your time, you cannot hire without losing a week. The training has to exist outside your head or you are the bottleneck by design.
Training on the table. What competence looks like, how you assess it, and what the assistant must escalate rather than decide. This is a clinical safety question before it is an efficiency one.
The case conversation, for people who are not you. Your team will be asked whether it is working, how many more sessions, whether it is worth it. They will answer whether or not you have prepared them to, and an unprepared answer is the one that loses the case.
Selling without feeling like selling. The most common thing we hear from clinical staff is that recommending care feels like pushing. It is not a motivation problem — it is a clarity problem. Someone who understands why the plan is twenty-four sessions can say so without persuading anybody.
The order matters
Clarity, then accountability, then consistency.
Most practices try to fix a team problem by adding accountability — a scorecard, a meeting, a conversation about expectations. Accountability without clarity is blame. You are holding someone to a standard that was never written down, and they experience it exactly that way.
Write down what good looks like. Give it to a named person. Then hold it.
The thing doctors get wrong about staffing
Replacing the person rarely fixes it.
If three assistants in a row have struggled with the same part of the job, the problem is not the third assistant. It is that the job was never defined well enough for anyone to do it.
Repetition across different people is the signature of a missing system. One person failing once is just a failure.
Individual results vary. Nothing on this page is clinical, legal, or billing advice. Supervision requirements, delegable tasks and scope of practice are determined by your state licensing board — confirm with yours before delegating any clinical task.