Reviewed by the MMA Chiropractors Team. MMA Chiropractors has connected doctors of chiropractic with practice opportunities across the United States since 1989.

Chiropractic practices rely on two very different types of providers: long-term associates and short-term substitute chiropractors. Understanding the difference helps practice owners choose the right staffing solution for their needs — whether they’re expanding their team or simply need temporary coverage.

MMA Chiropractors has supported practices nationwide since 1989, providing licensed substitute chiropractors for vacations, medical leave, maternity leave, and unexpected absences, as well as helping practices find long-term associates when needed.

What Is an Associate Chiropractor? (W-2 Employee)

An associate chiropractor: is a long-term member of your practice team. They typically:

• Work a consistent weekly schedule
• Build their own patient base within your clinic
• Follow your practice’s systems, documentation standards, and treatment protocols
• Participate in staff meetings and internal processes
• Contribute to long-term growth and continuity

Associates are usually hired as W-2 employees:, meaning the practice handles payroll, taxes, benefits (if offered), and ongoing training. This role is ideal for practices expanding capacity or adding long-term clinical support.

What Is a Substitute Chiropractor? (Temporary Coverage)

A substitute chiropractor: — often called a temporary or coverage doctor — steps in when the primary doctor is unavailable. Practices use substitute chiropractors for:

• Vacation coverage
• Medical leave
• Maternity or paternity leave
• Continuing education
• Emergencies
• Short-term schedule support

Substitute chiropractors work short-term assignments: and operate as independent contractors:, not employees. They maintain their own malpractice insurance, follow your established treatment preferences, and help keep your schedule running smoothly until you return. This role is ideal when you need coverage:, not a permanent hire.

Key Differences: Associate vs. Substitute Chiropractor

Why Practices Choose One Over the Other

Choose an Associate Chiropractor when:

• You’re expanding your practice
• You need long-term patient capacity
• You want someone invested in your clinic’s growth
• You’re building a multi-doctor team

Choose a Substitute Chiropractor when:

• You’re taking time off
• You need short-term help
• You want to avoid cancellations
• You need continuity without long-term commitments

How MMA Supports Both Needs

MMA Chiropractors provides:

• Licensed, insured substitute chiropractors for temporary coverage
• Technique-specific matching
• Nationwide availability
• Support for planned and emergency absences
• Assistance with associate placement when practices are ready to hire long-term

Whether you need a doctor for a week or you’re ready to grow your team, MMA helps you find the right fit.

Need coverage or looking for an associate? Call MMA Chiropractors at 1-800-501-6111 to discuss your staffing needs.

When Should You Hire a Locum Instead of an Associate?

Hire a locum tenens chiropractor when you need temporary coverage for a defined period without the commitment or overhead of a permanent hire.

Locums solve immediate staffing gaps while you evaluate whether permanent expansion makes financial sense.

Common scenarios where locums are the optimal choice include:

• Personal leave: Vacation, medical leave, maternity or paternity leave, continuing education seminars, or family emergencies requiring one week to three months of coverage
• Seasonal demand: Tourist-driven practices experiencing predictable patient volume spikes during specific months
• Associate recruitment lag: Bridging the gap between an associate’s departure and hiring a replacement, which often takes 60-90 days
• Practice sale transition: Maintaining patient care and revenue during the months-long process of selling a practice
• Trial period: Testing whether adding a second doctor increases net revenue before committing to a permanent hire

Locums provide predictable costs, you know the daily rate upfront, and require no benefits, unemployment insurance, or workers’ compensation obligations.

When Does Hiring an Associate Make More Sense Than Using Locums?

Associates make financial sense when the revenue they generate exceeds their total compensation cost by a meaningful margin.

Indicators that you’re ready for an associate include:

• Sustained overflow: Turning away new patients regularly or booking three-plus weeks out for non-acute cases
• Owner burnout: Working six or seven days per week with no realistic path to time off
• Growth trajectory: Marketing efforts or referral relationships generating more patients than you can serve
• Service expansion: Adding specialties like sports chiropractic, pediatrics, or functional medicine that require dedicated focus
• Partnership planning: Building a multi-doctor practice with the goal of eventual associate buy-in or practice sale

The financial calculation is straightforward: an associate must generate enough revenue to cover their salary, benefits, malpractice insurance, and a portion of overhead while still increasing the practice’s net profit.

What Are the Legal and Tax Implications of Each Option?

Locum tenens chiropractors are classified as independent contractors under IRS guidelines, which eliminates payroll tax obligations but requires careful contract structure.

Misclassifying an employee as an independent contractor can trigger penalties, back taxes, and legal liability.^[1]

The IRS uses three categories to determine worker classification: behavioral control, financial control, and relationship type. Locums must control how they perform their work, provide their own tools (or rent from the practice), and work on a project basis without ongoing employment expectations. You cannot require locums to attend staff meetings, follow specific documentation templates beyond legal minimums, or integrate them into long-term practice operations without risking reclassification.

Associates receive W-2s, and the practice withholds federal and state income taxes, Social Security, and Medicare. The practice also pays unemployment insurance and workers’ compensation premiums. While this creates more administrative burden, it provides clear legal standing and allows you to direct the associate’s work, schedule, and clinical approach within your practice model.

Most locums work through agencies like MMA Chiropractors that handle contracts, credentialing, and invoicing. The agency invoices your practice, pays the locum, and assumes responsibility for proper classification. This transfers legal risk and administrative burden to the agency, though you pay a placement fee (typically built into the daily rate) for that service.

How Do Patient Continuity and Quality of Care Differ?

Associates provide superior patient continuity because they build long-term therapeutic relationships, while locums excel at maintaining care during defined absences without disrupting patient trust.

Patient continuity matters most in chronic care, multi-visit treatment plans, and complex cases requiring detailed history knowledge. An associate learns your patient population over months and years, recognizes patterns, and adjusts care based on accumulated insight. Patients develop rapport and trust, which improves compliance and outcomes. For practices built on long-term wellness care or functional medicine, continuity is a competitive advantage.

Locums maintain continuity during the practice owner’s absence by following established treatment plans, accessing complete patient records, and communicating effectively with patients about the temporary arrangement. Most patients accept temporary coverage when it’s framed as ensuring uninterrupted care rather than an abandonment. The key is thorough chart notes, clear protocols, and locums who adapt to your clinical philosophy rather than imposing their own.

Quality of care depends on the individual doctor’s skills and professionalism, not employment status. Experienced locums often bring exposure to multiple practice styles and techniques that can enhance patient outcomes. However, associates have more incentive to invest in your specific patient population because their reputation and income depend on sustained results within your practice.

Which Option Offers Better Scheduling Flexibility?

Locum tenens chiropractors offer maximum scheduling flexibility for short-term needs, while associates provide stable, predictable schedules for ongoing operations.

The flexibility advantage depends on whether you prioritize adaptability or reliability.

Associates require advance notice for time off and follow employment law regarding vacation, sick leave, and scheduling. Once hired, you cannot easily reduce their hours without risking unemployment claims or wrongful termination issues. However, this stability benefits patients through consistent appointment availability and benefits your operations through predictable staffing costs and workflow.

Many successful practices use both models strategically: an associate handles baseline patient volume year-round, and locums cover the associate’s vacation, the owner’s time off, and seasonal spikes. This hybrid approach delivers both reliability and flexibility.

Evaluating whether your practice is ready for an associate or needs flexible locum coverage? Request a placement consultation or call 1-800-501-6111 to discuss your staffing strategy with MMA Chiropractors.

Frequently Asked Questions

Can I try a locum before hiring them as an associate?

Yes, many practices use locum assignments as working interviews. A two- to four-week locum placement lets both parties evaluate clinical fit, personality match, and patient response before committing to employment. Discuss this possibility upfront with both the locum and the placement agency, as it may affect contract terms and the locum’s willingness to accept the assignment.

How much revenue should an associate generate to justify their cost?

A common benchmark is 2-3 times their total compensation in collections.

Can I hire a locum for ongoing coverage instead of an associate?

Legally, extended locum arrangements (beyond six months continuously) risk IRS reclassification as employment if you exert too much control over their work. Repeated short assignments with breaks between them maintain independent contractor status. For full-time, indefinite coverage, an associate employment relationship is the appropriate structure.

What happens if a locum or associate doesn’t work out?

Locum contracts specify assignment length and typically include termination clauses allowing either party to end the arrangement with 24-48 hours’ notice for cause. Associates are employees subject to at-will employment laws in most states, meaning you can terminate at any time (absent a contract specifying otherwise), but you may owe unemployment benefits and face potential wrongful termination claims if not handled properly.

Costs vary by practice. MMA Chiropractors provides individualized quotes rather than published rates, because every practice differs on hours, patient volume, location and assignment length. Contact us for a quote tailored to your practice.

The decision between locum tenens and associate hiring depends on your practice’s current capacity, growth trajectory, and financial position. Locums solve immediate coverage needs with minimal commitment and predictable costs. Associates represent a long-term investment in expanded capacity and patient continuity. Many thriving practices use both models strategically, associates for stable baseline staffing and locums for flexibility during transitions and time off. If you’re uncertain which model fits your needs, a placement consultation can clarify your options based on patient volume data, revenue targets, and operational goals.

Reviewed by the MMA Chiropractors Team. Updated September 2026.

References

1. Internal Revenue Service. Independent Contractor (Self-Employed) or Employee? https://www.irs.gov/businesses/small-businesses-self-employed/independent-contractor-self-employed-or-employee
2. Chiropractic Economics. CE Annual Salary and Expense Survey. https://www.chiroeco.com/ce-annual-salary-and-expense-survey/
3. U.S. Bureau of Labor Statistics. Occupational Outlook Handbook: Chiropractors. https://www.bls.gov/ooh/healthcare/chiropractors.htm
4. National Association of Locum Tenens Organizations. https://www.nalto.org/