"Lines" are being discussed in this column because of a recent comment from an executive of a large HMO. He used a phrase that provoked a near-cataclysmic reverberation to my ears.
The inclusion of chiropractic services in a large health plan was being negotiated. The person negotiating on behalf of the chiropractic profession began by discussing a provider fee with the network, a moderate and fair fee that was in line with cost containment. The provider fee offered by the HMO was so low that it was an economic insult, making it virtually impossible for any practitioner to be solvent if the fee structure was accepted.
"That fee is unacceptable, and we will not accept those fees for chiropractic providers," the chiropractic negotiator communicated to the HMO.
"If you don't take it, there are hundreds of chiropractors standing in line to get into this network who will," came the response from the HMO executive.
When this exchange was conveyed to me, I was stunned. Upon reflection, I pondered why licensed, competent and qualified health care professionals would stand in line to accept such a low fee from an HMO that obviously places no value on their services, and exploits the chiropractor and the patient with arrogance and impunity?
For days the phrase "standing in line" resonated in my head like a haunting melody. I thought I would use this column to seek the counsel of my colleagues, whom I often annoy or commend with commentary that is controversial, challenging, stimulating, and, to some, downright infuriating. I'm hoping to provoke a response from the readership of this column and encourage thoughtful dialogue on reasons why less-than-acceptable behavior is not only tolerated and accepted, but hundreds of colleagues will "stand in line" to accept this kind of conduct and assault on one's professional integrity. What would persuade a health care provider, more specifically a doctor of chiropractic, to knowingly accept circumstances that counter every set of core values generally espoused by most self-respecting professionals?
There is an enormous difference in concept and courage to "stand in line" and join hands to peacefully dissent for the elimination of tyranny, versus "standing in line" of one's own volition to encourage and foster the continuation of behavior designed to relegate a total profession to less than "valued" status.
Think about it the next time you "stand in line." Are you doing this based upon some benefit that you personally desired? Or has the decision been demanded of you by the same forces which for decades have attempted to "contain and eliminate" the very profession that tens of millions of consumers are demanding today?
Collective and personal self-esteem have been discussed for many years in chiropractic. There are sociologists who have written about the lack of cultural authority of the chiropractic profession and detractors who have taken delight in labeling the chiropractor as "marginal and deviant." There are also those who have charged chiropractors as being akin to "rabid dogs and killers," and those who have portrayed the DC "cultist and substandard."
There is one segment of society, however, that has kept the image and attitude of the doctor of chiropractic so high that it has been willing to "stand in line" to receive our unique services: those often-maligned services that resulted in the attainment of improved health when all else failed, and have restored and literally rebuilt the lives of countless individuals when all hope was lost. Patients silently experienced these unorthodox services under the threat of being ostracized by their traditional providers. Yet these individuals - the patients doctors of chiropractic serve - have been willing to "stand in line" (metaphorically) in the offices of doctors of chiropractic across this country to obtain our services. They wait in the halls of legislatures across this country to rightfully help chiropractic gain licensure. Now, the fastest growing group, the baby boomers, is demanding the services it knows will help achieve a quality of life that is significantly better than it would enjoy without chiropractic.
There is significant evidence that the wellness movement, maintenance care, and patient-centered participation are causing patients to have a say in directing their health care. Simultaneously, some doctors of chiropractic are willingly "standing in line," significantly undermining efforts to demand equality of participation by the most demeaning category of any group of health care professionals.
What is wrong with this picture? What is wrong when those who provide the service are less enthused, motivated, and disturbed by the demeaning circumstances surrounding the inclusion and reimbursement of chiropractic than the patients who are demanding the service?
I hope this column will stimulate, provoke; anger; disturb; cajole; or simply aggravate readers enough to think about joining forces to help make things right.
Perhaps chiropractors should make individual commitments along the lines of Peter Finch's 1976 Academy-Award-winning role in "Network": "I'm mad as hell and I'm not going to take it any more!"
"Standing in line" should become the mantra for the chiropractic profession. Chiropractors must decide where they will stand in line, how they will stand in line, and ultimately ask themselves if they're willing to stand in line. We'll stand in line only if it will reinstate our image; restore our self-esteem; provide us with the framework to advance the wellness model; enable practitioners to earn a reasonable living; and encourage our patients to continue to seek our services.
Conceivably, doctors who previously stood in line to accept the same sorry share of an allotment from an HMO that is unfit for a professional, will now stand beside and not in place of their colleagues in a demonstration of quiet professional force, individually committed, personally driven and ultimately successful in removing the barriers and the shackles to advancement.
I've heard several rationales for why doctors stand in line for pathetic reimbursement:
- "I am willing to take so much less than my normal fee because this gives me an opportunity to convert families to my care."
- "If I don't, my neighbor down the street will, and then I won't have any patients."
- "The company is just too big."
- "I guess my family and I can survive if I work harder."
When will the revelation or the epiphany come to you that you are in charge of your future? You alone determine if you are willing to accept less than civil treatment; that you and other practitioners can change the course of health care inclusion for chiropractic. History has demonstrated that in many instances the line in which you stand determines the stand with which you are aligned.
Standing in line can be good. What do you think?
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