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Survival

Dear Editor:

Thank you for being the first one in the chiropractic media to really attack these issues and exploit what most of our profession would rather keep behind locked doors!

I am a chiropractor in solo practice since 1999. I went to every DE as a student, excelled in any course dealing with the communication of chiropractic, and I continue to excel in adjusting and diagnostic skills. I have well-known contacts in chiropractic, and went through my share of practice management seminars.

I have done everything the gurus tell you to do - from public speaking to standing on street corners and handing out business cards with a kind word and a smile. I have a good relationship with several medical doctors in my community. I have a phenomenal bedside manner and I practice sound, professional, and honest business. I consider myself to be a solid candidate for chiropractic success.

However, I am not a chiropractic success. My practice, which I started in 1999, before purchasing and integrating another practice into my own five months later, has never seen the 100-visit-per-week mark; has never seen collections over $10,000 in one month; has never seen over eight new patients in one month.

"He just didn't try hard enough," or "He doesn't have the right tools," some will say. I have tried as hard as anyone can be expected to. The right tools? There are always new things to learn, however, no trade magazines, other than those that I have seen in chiropractic, are so plastered with individuals selling their "cookie-cutter" methods to achieve success. If there are other health professionals in the world achieving success - and there are plenty - it is not because of a seminar. Rather, it is because there is a perceived value by the public on what that health service can do for them. Hawkers trying to sell their methods are ultimately directed toward teaching doctors how to create perceived value. I do believe that when things aren't going right, you first need to look in the mirror. However, too many of our colleagues are blaming themselves for things that are completely out of their control. There are many ingredients that go into creating a successful practice.

The problems in chiropractic are also problems shared by the broad health care picture. What other profession do you know of where a customer /patient comes into your establishment to purchase a product and/or service, yet has in the back of his or her mind that he or she has no responsibility or obligation to pay for that product or service? What other profession do you know of where one is regulated on how much they can charge for a product and/or service, whether or not they will get paid for a product and/or service, and indirectly dictated to about what they can and can't do for that patient with regards to products and/or services (referring to insurance companies)? And you have to collect from a third party that you have no relationship with, with privileges that afford them the ability to treat you quite insignificantly.

I have come to the conclusion that health care in general is just bad business. The structure of insurance reimbursement is antithetical to free enterprise and the freedom America stands for. However, chiropractic has another strike against it. This is the problem of perceived value. Let's face it, most people don't just jump into your office for subluxation care, nor do they plan on a lifetime relationship with your adjusting table. It's very hard work changing people's paradigms. It's even harder work changing people's paradigms for a pathetic $17.50 per visit and mountains of paperwork!

I feel that I speak for many doctors when I say, "Love the profession; hate the business." Ultimately, chiropractic is a business like any other, and that means its dual purpose is to provide a service and receive adequate payment for that service. We will never survive when DCs are accepting $10 per visit. We will never survive when insurance companies are dictating what we can do through third-party reimbursement.

We will never survive when the public has no idea what we do! This is destructive to us as a profession and destructive to our sense of worth as human beings. There are many "horror stories" about associateships because the resident DCs are getting paid so little for their services and products. When three people are starving and there's only one piece of pie left, two people are walking away hungry.

Cash practice? Great idea, and all of those who have achieved it will say, "I did it," and ask, "Why can't you?" The truth is, not every chiropractor has the ability to create the perceived value necessary to shift the paradigm of patients so that they are willing to forego the benefits of the insurance that they pay for. Furthermore, the care has the potential of becoming a game show like "Let's Make a Deal," because if the doctor wants to put food on the table for his family, he'd better accept what the patient wants to pay. I agree with regulation of students into chiropractic schools. I don't think that a few minutes' time is shortchanging patients; an adjustment with most techniques only takes a few minutes. When you go to the medical doctor, you don't get counseling time about your love life as an extra. I like most of my patients as people and would enjoy a conversation with them. However, this is for a time outside the office.

Jaded: This is how practice in this profession has made me feel. In my "jadedness," I still treat patients and the service I provide the same way that I did when I first opened the doors. However, instead of looking forward to the next day, I'm looking forward to the day I get out of this business!

name withheld