Many chiropractic clinics especially high-volume or corporate-style practices offer jobs that are commission-based instead of salaried. While these roles can offer big earning potential, they also come with unique challenges that not every chiropractor is prepared for.
If you're considering a commission-based chiropractic position, here’s what you need to know before you say yes.
What Is Commission-Based Pay?
In a commission-based role, you're paid based on your production meaning the number or value of services you deliver.
Instead of a flat salary, you earn a percentage of collections, patient visits, or revenue you generate.
Some positions include a base salary plus commission, while others are 100% commission after an initial ramp-up period.
Pros of Commission-Based Chiropractic Jobs
✅ Higher Earning Potential with Patient Volume
If you're fast, efficient, and capable of seeing lots of patients per day, commission-based pay can reward your performance. High producers often out-earn their salaried counterparts.
- Great for motivated, growth-minded DCs
- Some clinics offer tiered commissions, so the more you produce, the higher your split
✅ Performance-Based Incentives
Commission jobs often come with:
- Bonuses for hitting patient visit or revenue thresholds
- Incentives tied to retention or reactivations
- Upside earning for business-building activities
You’re not limited by a capped paycheck you get paid for the value you create.
✅ Fewer Admin Responsibilities
In many commission roles, especially in larger clinics:
- You don’t handle billing
- You don’t worry about marketing
- You focus solely on adjusting and patient care
This setup allows you to maximize clinical time without juggling back-office tasks.
Cons of Commission-Based Chiropractic Jobs
❌ Income Instability (Especially Early On)
Your earnings depend on patient volume and early on, that may be inconsistent. If you're building your own schedule or new to the area, expect a ramp-up period.
- There may be slow weeks or seasonal dips
- No paid vacation or sick leave in most commission roles
- Some new grads struggle with cash flow in the first 3–6 months
❌ Pressure to Hit Quotas
Even when not explicitly stated, commission-based jobs often carry invisible pressure to:
- Hit visit or revenue targets
- Retain patients longer than clinically necessary
- Adjust more patients per hour
For some DCs, this can feel ethically uncomfortable if production becomes more important than patient outcomes.
❌ Less Control Over Scheduling
In some clinics, patient visits are pre-scheduled or pre-assigned, which means:
- You may not control your ideal patient type
- Your pay is dependent on the clinic's marketing or management
- Your performance is tied to systems you don’t run
Questions to Ask Before Accepting a Commission Role
Not all commission jobs are created equal. Before signing a contract, ask:
💬 What’s the average monthly income for associates?
- Ask for real numbers and if you can, speak to another associate currently employed there.
💬 Is there a base salary or draw against commission?
- A base pay during your ramp-up period can provide essential financial stability.
💬 Are you responsible for generating your own patients?
- Some roles expect you to hustle for your own volume; others feed you patients through in-house marketing.
💬 What’s the commission split and are there tiers?
- Common splits range from 40–60% of collections, depending on experience and volume.
💬 Is there a threshold you have to meet before commission kicks in?
- Some clinics require you to produce a minimum monthly amount before you see any earnings.
Final Thoughts
Commission-based chiropractic jobs can be a great opportunity or a frustrating experience depending on your goals, personality, and support system.
A commission role might be right if:
- You’re a self-starter and comfortable with sales
- You want unlimited earning potential
- You prefer to focus on clinical care, not operations
A salary-based job might be better if:
- You need stable income
- You’re still building clinical confidence
- You want mentorship and long-term growth