Unreal Practice Expectations
I remember the excitement and anticipation I was
feeling 50 years ago as I realized my dream of graduation from Canadian
Memorial Chiropractic College was only 2 months away. I was ready, or at least
I thought I was, but what was to come certainly didn’t fit my expectations.
I had experienced my education at CMCC through the
worst of its years: low enrolment, internal upheaval at the college board
level, and subway construction going on under the classroom building and I mean
literally. There was a good side to this in that our class was fortunately
exposed to the likes of Drs. E. Homewood, H Himes, and R.J. Watkins. These men
were extraordinary chiropractors and it was through them that I, still today,
carry a commitment to the power of Chiropractic.
I returned to my home town in British Columbia to join
in practice with the man who had inspired me to enter this field. His name was
Gordon Potter. Gordon went on to get his
MD degree and was then responsible for the Saskatoon experience that later included
Drs.WH Kirkaldy-Willis, and D. Cassidy. (This is another story).
Shortly after joining with Dr Potter, he sold his
practice to me and moved to Australia, so here I was in what would seem to be
perfect position. The one area of the education at CMCC that wasn’t covered
(well that is being nice) was how to run the business of practice. I had no
idea about setting care plans past symptom relief. Needless to say I had my
first lesson arrive rather quickly – if you are a half decent Chiropractor you
will see reduction of symptoms within 5 to 6 visits. This, I thought, was great
and while it got me great marks in Clinic, it creates a drop off of patients in
practice. Month’s end continually arrived and the bills seemed to be
approaching faster each month.
The only real practice management program around at the
time was Dr. Jim Parker’s and his method was to schedule a new patient three
times a week for 2 weeks, two times a week for 2 weeks and 1 time a week for 2
weeks, then once a month. The idea was
to build a “maintenance” based practice with a secure stable income. Sounded great to me – so implement and move
ahead, which I did. There can be no
doubt about this – it worked, even though there was no clinical justification
for the care plan or the shift in the visit scheduling. At this point I must remind you that we are
talking about the 1960s time frame so no insurance coverage, no care codes, no
CE credit requirements and a visit fee of $2.00 per visit. To top this off, it
was at the height of the attack on Chiropractic with the local MDs doing
everything they could to discredit you.
Things were not as “rosy” as I had dreamed while in the
shelter of College but I survived and in doing so saw a change going on the
profession. The desire and push within the profession for greater acceptance
was moving Chiropractic toward low back pain management. Then came “Socialized
Medicine” in Canada with the inclusion of Chiropractic services which included
a raise in pay to $4.00 a visit. Well, I thought I had it made and it was just
going to be easy street from here on out. Lesson 37 (I just don’t want to talk
about lesson 2 to 36 – just too painful). What I didn’t see was that we were
limited to 12 visits a year at $4.00 – wait – maintenance based practice at
once a month – hey, no problem – that meant all I needed was 30 patient visits
a day on the once a month plan to generate $2520.00 a month – gravy days!!!!! I
mean I know that gas was about .35 cents a gallon then so $2500 was a lot of
money. It turned out it wasn’t as much
as I thought. (I was still in student poverty mode). Not only did this place a
huge demand on the need for new patients but also frustration in trying to
schedule patients onto the once a month plan.
As we had sold the public on spinal care and pain management.
I also noticed that all I ever saw in the office were
patients in trouble, and they had high expectations that I would “fix” them in
a few visits, no matter how long their challenge had been going on.
Over the next 20 plus years I saw the fee from
socialized medicine climb very slowly while the cost of operations of the
practice climbed and climbed and climbed.
The profession had agreed to a contract that would not allow us to bill
the patient more than their fee, so, the only answer was to see more patients.
Practices had to see 40 to 50 patients a day to have a survival practice. I got
very good at maintaining a high volume practice and after running at 120 to 130
patients per day I began to hate what I was doing. I was seeing patients with
complaints all day long and the minute I got them out of pain they were gone.
This was not the vision I had when I graduated. This was not the Chiropractic I
had dreamed about so many years earlier.
I have watched the decline of Chiropractic to the point
where Chiropractic offices have become: weight loss centers, supplement
dispensaries, Physical Therapy offices and/or stop smoking clinics, among other
things. Listen up – I am not questioning
the value of any of these but what the hell happened to Chiropractic? Did
Chiropractic stop getting results? I don’t think so!
It all comes down to just some sound business
fundamentals. When you lose your unique
marketing position you will get a decline in the return on your investment.
Chiropractic was once the leader in the alternative health care professions.
Today we are not even mentioned. Today the public views us as a strictly back
pain management profession in competition with medical pain killers (more
effective at killing pain) and Physical therapy (that has better insurance
Where do we go from here?
We need to get back to our roots! This does not mean
back to a profession that is only philosophy based – that time has passed us
by. Today is the time of evidence based care. I think I heard someone ask,
Today Chiropractic stands at the most critical
crossroads in its history. As a profession and as individuals we have the
opportunity to retreat from the march into the medical model and to restore the
real power of Chiropractic. Neuroscience
of the last 15 years now supports the basic tenet of Chiropractic – it is the
nervous system that controls the destiny of a person’s health. The search for
the evidence of what we have claimed for over 100 years is finished. The only
question that remains is whether the Chiropractic profession is willing to
stand up and be counted. We are no longer limited to back pain relief or by the
constraints of insurance coverage.
I am watching practices around the world present
Neurologically Based Chiropractic, a concept that I founded fourteen years ago,
and flourish in the times of diminishing practices that are stuck in the pain
relief model. What are you missing? It
costs nothing to check it out!
I will be doing a series of these “The Truth of the Matter” articles for the DCTree — see the next article in the series HERE.