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Dynamic Chiropractic – May 31, 1997, Vol. 15, Issue 12
Dynamic Chiropractic
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Dynamic Chiropractic

Too Many DCs, Not Enough, What to Do?

... and What About Censorship at Our Colleges?

By Michael Pedigo, DC

Are there too many doctors of chiropractic in today's market? That's not an easy question to answer, but a subject that is being discussed more and more these days. The primary reason we hear more doctors expressing concerns that the colleges are graduating what they consider to be too many doctors is that most practices across the country are seeing fewer patients and being paid less per visit than just a few years ago. I hear figures like the average practice is down 30 to 40% and income is down 40 to 50%. I don't know how valid those figures are, but I suspect in major metropolitan areas where managed care has hit the hardest they are in the ballpark.

We have a situation where more people than ever before want to avail themselves of chiropractic care, but less and less are able to do so because they have no (or very limited) insurance coverage. Patients that have to go through a medical gatekeeper have a difficult time of getting authorization for care and/or don't like to ask their MD for authorization. I am seeing the effects of this in my practice this year. Last year many Medicare patients had an HMO that contracted with a chiropractic group so they had direct access to chiropractic care. This year, that chiropractic group lost its contract with the HMO to a company that requires a medical gatekeeper's authorization to obtain chiropractic care. As a result, my HMO Medicare patients have dropped about 90%!

We also have a situation where PTs are making serious inroads into providing spinal adjustments. They may not call it that, but that is what they are learning to do. Just before the chiropractic centennial in Washington, D.C. a couple of years ago, at the same convention center as our centennial meetings, there were 8,000 PTs at a convention with the major educational item on their agenda being spinal manipulation. Now many medical gatekeepers refer patients that want chiropractic care to the PT.

There has been significant research in the past few years that prove some of the value of spinal manipulation, especially for low back pain. Of special note is the AHCPR guidelines for treatment of low back pain, which came down hard on most PT and medical treatment procedures and rated spinal manipulation very high. This has accelerated the desire of PTs to learn how to do what we do. Competition from other health care professionals is increasing. You can argue till the cows come home that what we do is different from what they do, but most patients don't know the difference and they don't ask a DC for on opinion. We just don't get an opportunity to see most of those patients.

Add to this mix all of the problems managed care brings to the table, i.e., no chiropractic coverage, limited chiropractic coverage, extremely limited chiropractic coverage via the requirement of having to go through a "gatekeeper," and of course reduced fees with greatly increased paperwork, and you have an environment that is very different to practice in than it was a few years ago.

Add to that new doctors graduating with $80,000-$100,000 in student loans and the inability to join some managed care groups until they have been in practice for three years, and you have an environment that is even more difficult for these new doctors to succeed in than it is for those of us that have been in practice for several years.

Are the colleges being honest with the students and telling them what it's really like to practice today, or are they inflating how easy it is to build a practice? The answer is, some are and some aren't. If a college does not properly inform students, wouldn't that be like a doctor misleading a patient just to keep them coming back for more care than they need? Is it right for some colleges to censor what chiropractic information they allow on campus, i.e., some colleges will not allow ACA to provide students with their Journal or ACA Today? What do they fear about having informed students? Why would they make it difficult for students to get information about and from the profession's largest and most influential chiropractic association?

I am optimistic about the profession's future. If it sounds like I think the future is bleak, I want to make it clear I do not believe that to be the case. We are one of (if not the only) major health care professions that has a realistic opportunity to greatly expand our market share. If we do that, then the questions about there being too many DCs will go away. Approximately 12% of the population is under chiropractic care at any one time, and approximately 30% of the population has seen a DC at some time in their life. Compare this to the medical and dental professions, where just about every person breathing has a family MD or dentist.

The last time I checked, 100% of the population had spines, although some would argue that there are many "spineless" people. If you consider that only 30% of the population has ever visited a DC, that leaves 70% of the population without a chiropractic doctor. There is no shortage of people that need chiropractic care, but there is a lack of knowledge by society and decision makers about how chiropractic care is a cost-effective means to improve the quality of their life. Our goal is clear: increase our market share.

It's time to educate the public on a scale that has never been done before. That will not be easy. It will require this profession to come together and be united on this issue. ACA and ICA are addressing this very issue. Last year, NCMIC and ACA/ICA each held leadership conferences. Both conferences identified the profession's number one need. We must educate the public about chiropractic health care. It didn't take a rocket scientist to make that discovery. The real question is, what are we going to do about it?

Out of the ACA/ICA conference, the Alliance for Chiropractic Progress was formed to address this one issue. The first planning meeting will take place May 24-25, 1997. This Alliance Work Group will consist of representatives of the Alliance Steering Committee and all interested chiropractic groups, associations and vendors. Success will require broad base support from the profession. I would like to see every state association represented there, as well as many vendors and other chiropractic organizations. The task at hand is monumental, but worth the effort. If there has ever been a time to put aside personal and/or political differences for the common good of the profession, it is now!

As we develop a plan of action, it will be important for every DC to understand that they to must be a part of the effort. For any PR program to be effective, it requires a positive educational program. It will also require we stop shooting ourselves in the foot by stopping the kinds of ads that make the profession appear unprofessional, weird, cheap and/or cultists. An ad such as "home of the $12 adjustment" makes the profession looks like McDonald's cutting the price of a Big Mac. Ads that make claims which go beyond what the public finds believable, reasonable, and rational need to stop or be modified into a form that the public finds plausible. False and outrageous claims need to be done away with! The most beautiful picture in the world looks tarnished when it is splattered with mud.

We have a wonderful profession with much to offer society. It's time to communicate that message in such a way that people will first listen with an open mind, and then be motivated to seek our services. If we do that, we will have all the patients we can handle and the quality of life will increase for millions.

Michael D. Pedigo, DC
San Leandro, California
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Dr. Michael D. Pedigo is a past president of the American Chiropractic Association and the International Chiropractors Association, and the only doctor to receive the Chiropractor of the Year Award from both organizations. He practices in San Leandro, Calif., and can be contacted with questions and comments via his Web site: www.drpedigo.com.

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