What I'd Tell a CMCC Student About Their First Six Months

Graduation season is here at CMCC and NWHSU, which means a new cohort of chiropractors will start practicing this summer. Boreal Spine & Sport is an active preceptor for NWHSU and is building a formal pipeline with CMCC, so I see this transition up close every year. The patterns that separate the new clinicians who do well from the ones who struggle aren't really about techniques or technical skill at graduation. They're about habits in the first six months.

This post is what I'd tell a new graduate sitting across the table from me on day one — the same conversation I have with the students wrapping up rotations here this spring.

The first six months are about habits, not technique

By the end of school, you have most of the technical skill you'll have as a new clinician. Your manipulation skill, your soft tissue work, your ortho exam, your imaging interpretation — these will all sharpen with practice, but they're already serviceable. What distinguishes the clinicians who improve quickly from the ones who plateau isn't what they know on day one. It's the habits they build around what they do every day.

The habits worth building are unglamorous. Take a thorough history every time, even when it slows you down. Do a movement screen on every patient, even when the complaint is local. Re-examine on follow-up visits to see what actually changed. Document like a colleague might read your note next week. None of these are exciting. All of them compound.

Slow down on the first visit

The biggest single mistake new clinicians make is rushing the first visit. The pressure to look efficient, to "get to treatment," to not seem like you're stalling — it's all real. It's also the wrong thing to optimize for early.

The first visit is where the diagnosis, the prognosis, the relationship, the trust, and the plan all get set. We covered the diagnosis-vs-prognosis distinction in a recent post — the prognostic information is what shapes the plan, and you only get it by asking. Patients almost never complain that the first visit was too thorough. They frequently complain that it was too rushed.

Be honest about what you don't know

You will not know everything. No one does. Saying "I'm not sure — I want to check that with a colleague before we proceed" is one of the most trust-building things a new clinician can do. Faking confidence is one of the fastest ways to lose it the first time it cracks in front of a patient who notices.

This applies particularly to imaging. If a patient brings you an MRI report and you're unsure about a finding, say so. Look it up between visits. Come back with a clear answer. The honesty earns you far more credibility than the original confidence would have.

Refer when you should refer

The professional reputation of a new chiropractor is built quickly by the cases they refer well. A red flag identified and acted on, a sports MD referral made at the right time, a non-responder sent back with a clear note instead of held onto — these are the cases your future referring physicians remember.

The temptation is to hold onto every patient because every patient is income. The math doesn't work. The patients you hold onto past your scope are the ones who damage the network you'll spend years building. We covered this in our piece on referral relationships — the relationship is patient-mediated, and how you handle the cases at the edges of your scope is most of what shapes it.

Build active care into your default

The single biggest practice-level decision a new clinician makes early is whether their default treatment plan is passive-leaning or active-leaning. The patients who do best, the colleagues who think most highly of you, the referring MDs who send more patients — all of them respond to a clinic that defaults to assessment, education, manipulation when indicated, and graded loading.

If your default is multiple passive modalities and an open-ended visit schedule, you'll get short-term symptom relief, lukewarm long-term outcomes, and a referral network that doesn't grow. The clinics that grow over a 5–10 year horizon are the ones that built their patient experience around active care from the start.

Track your outcomes

The simplest version of this: at the start of care, record a meaningful outcome measure (numeric pain rating, NDI, RMDQ, KOOS, whatever fits). At reassessment points, record it again. Look at the data. Notice which presentations you're moving and which you're not. Adjust.

You will be tempted to skip this step because it feels administrative. The clinicians who skip it don't improve as fast as the ones who don't. The data is feedback, and the feedback is the loop you're trying to close.

Stay curious

The body of literature in musculoskeletal medicine is moving faster now than at any point in this profession's history. Read at least one peer-reviewed paper per week in your scope of practice. Subscribe to one or two journals you actually open. Listen to one good podcast in rotation. Six months in, you'll already be ahead of the cohort that didn't.

The principle from load management applies to professional development as cleanly as it applies to athletes: there are no bad ideas to engage with, only too many too soon. Pick a small number, engage with them deeply, and let it compound.

The last thing

The most important thing I'd tell a CMCC student about the first six months: the patient is the work. The plan is the work. The note is the work. Everything else — the marketing, the social media, the practice growth — follows from how seriously you take the clinical work itself. The slow version of practice growth is the one that produces a career. The fast version doesn't exist.

If you're considering a sport-focused chiropractic career and want to see how it actually runs, our doors are open at Boreal Spine & Sport, and our preceptor program is one of the more thorough on the prairies.

References

1. Glaviano NR, Kew M, Hart JM, Saliba S. Use of the Selective Functional Movement Assessment with a patient with sacroiliac joint pain: a case report. Int J Sports Phys Ther. 2014;9(7):1052–1058.
2. Bussières AE, Stewart G, Al-Zoubi F, et al. Spinal manipulative therapy and other conservative treatments for low back pain: a guideline from the Canadian Chiropractic Guideline Initiative. J Manipulative Physiol Ther. 2018;41(4):265–293.
3. Lin I, Wiles L, Waller R, et al. What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. Br J Sports Med. 2020;54(2):79–86.

Author: Dr. Michael Minenna D.C., B.Sc., SFMA, FMS — Boreal Spine & Sport, Winnipeg, Manitoba.