Chiropractor Jenifer Epstein was adjusting the back of a patient when the table on which he was lying broke.
She tried to catch him, injuring her own back in the process.
She was used to patients who had hurt their backs. “I didn’t think I was going to hurt my back,” she said.
Epstein practiced for several more years on what she described as a very bad back following the 2008 injury. But she eventually herniated three discs in her lower back while putting her son’s stuffed animals into a bag – an injury related to the initial one.
The injury, along with personal woes stemming from a painful divorce, prompted her to shelve the chiropractic degree that she labored to earn from New York Chiropractic College in Seneca Falls, New York.
Now, fresh off a stint as a financial planner, Epstein is picking her degree back up and preparing to take over Hershey Family Chiropractic in Derry Township.
“Everything fell exactly into place the way that it needed to,” Epstein said, “And now I have the opportunity to heal people again, which is all I’ve ever wanted to do.”
Re-entering the chiropractic field after nearly five years will be a challenge. But it is one for which Epstein feels she is equipped, thanks in part to what she learned during her hiatus and also to changes in the reputation of chiropractic care – which is being touted by some as an alternative to opioids.
A career change
After the injury, Epstein could have gone through physical therapy, but opted out, noting that it would have taken time away from her son. And because of what was happening in her personal life, she didn’t feel she was mentally ready to take care of patients again.
Instead, Epstein began selling insurance and financial planning services in the Harrisburg branch of the New York Life Insurance Co., a firm based in New York City with offices across the country.
Initially she wasn’t enthusiastic about her new field.
“I was like, ‘Oh my God, am I really going to be an insurance salesperson?’” she said. “I went to school for seven and a half years, spent $200,000, to be an insurance salesperson?”
She overcame her initial dismay and quickly took to sales.
All the while, though, she felt like something was missing from her life and began combing through job postings online.
Through job-search website Indeed, she met Anthony Manes, a Pittsburgh area chiropractor who was looking to sell Hershey Family Chiropractic, which is 15 minutes from Epstein’s Harrisburg-area home.
After driving to Pittsburgh to meet Manes and his wife, Epstein agreed to purchase the practice from Manes over a five-year period. She declined to disclose the price.
Epstein plans to take over the office, located at 395 E. Chocolate Ave., the first week of October. “The five years is just them providing a little bit more of that hands-on type of support that chiropractors don’t get in school,” Epstein said, noting that chiropractors aren’t typically trained on how to run a business.
But because chiropractors’ lives are defined by private practice, it is vital that they know how to run a business, said Dean DePice, founder of TLC4SuperTeams, a consulting firm in Montgomery County that works with chiropractors.
An internist who lacks business skills could get a job at a hospital. But chiropractors don’t have as many options, according to DePice.
“You really have to know what in the world you’re doing to run a team and bring the knowledge to the community – why people need to get checked and things like that,” DePice said.
Aside from obvious challenges such as attracting patients and working with insurers, another hurdle for new practitioners today is getting a handle on compliance issues, such as privacy rules, state reporting, sales tax and electronic records requirements, said Annette Bernat, vice president of communications and external affairs for the American Chiropractic Association in Arlington, Virginia.
A startup provider faces steep upfront costs to comply with state and federal requirements and more costs when regulations change, Bernat said. She added that doctors sometimes hire consultants to assist with the process, further increasing costs — which can be tough for a new practice that is still trying to find its footing and where cash flow might be tight.
Epstein continued to offer chiropractic care to her friends and family during the nearly five years she spent in her financial career. But she was out of health care industry.
And things have changed. For chiropractors, though, some of the changes have been for the better.
In recent years, the profession has gone from being perceived as an “alternative” form of health care to being recognized more frequently as a valuable component of integrative care, Bernat said.
Bernat noted that chiropractic care is now available in the health systems for the federal Department of Defense and Veterans Affairs, where the field’s nondrug approach is valued by other providers, as well as by patients who want to avoid prescription painkillers.
And more people are embracing chiropractic care, DePice said, noting that the U.S. now has more chiropractors and more people receiving chiropractic care than ever before.
Chiropractors treat more than 35 million Americans annually, according to the American Chiropractic Association.
“More people are choosing chiropractic care regardless of the presence or absence of symptoms,” DePice said.
The opioid epidemic, meanwhile, has clarified the role that chiropractors can play in helping to alleviate chronic pain and avoid addiction, according to Epstein and Bernat.
Chiropractic services can, in some cases, replace interventions with higher risks and safety issues, such as opioid prescriptions.
The American College of Physicians last year updated its guideline for the treatment of acute and chronic low-back pain to recommend first using non-invasive, non-drug treatments, including spinal manipulation – a centerpiece of chiropractic care – before resorting to over-the-counter and prescription drugs.
Before she takes over Hershey Chiropractic, Epstein is spending three to four days a week fleshing out her business plan with help from Integrity Elite, a chiropractic-focused consulting firm in Pittsburgh.
She plans to open with a team of two employees – a practice administrator and a practice representative – and is looking to hire at least one other chiropractor, if not more, depending on patient volume over the next three years.
To stand out in an increasingly popular field, Epstein is leveraging the marketing and networking experience she gained at New York Life.
Social media is part of her marketing plan. But Epstein also plans to collaborate with area orthopedists and neurosurgeons, with whom she’s already begun to network.
She’s also positioning herself as a more conservative option for orthopedic patients who may not need surgery right away.
“I’m just trying to give people an alternative,” Epstein said, “and trying to make it accessible and … be an advocate to get people out of pain so they can have that better quality of life for longer.”
Editors note: This story has been updated from its earlier version to show that Epstein worked for five years as a financial planner, not 10 as originally reported.