Yes, I have heard the hue and cry of the practice builders hawking the high volume practice, and I have heard the indignant replies from field doctors such as "ludicrous." "A 40-hour week with 1,200 patients leaves two minutes per patient." The eternal question rings on, "How many patients a day can the good doctor see," and yet do a good job of doctoring?
Now in the first place, the volume practitioners I have known practice many more hours than 40 per week. For instance, when I was interning with Dr. Gonstead, he came in at 8:00 in the morning (sometimes earlier) and stayed at least until 10:00 at night (sometimes much later). That's 12 hours a day with two hours set aside for lunch and dinner, and he did this seven days a week. Yes, he did see over 200 patients a day in a full spine practice; I was there at the time. Now that's 1,400 patients a week, but he worked an 84 hour week.
Actually this number would be a "snap" for practitioners practicing upper cervical technics. With assistants doing the instrumentation and the doctor purely confined to adjusting and some consultation, 200 patients a day would be relatively easy to care for in contrast to Dr. Gonstead's full spine practice; but again the high volume practitioners I have known all practiced more than a 40-hour week, regardless of technic.
Now let me reflect on my own practice. I considered 80 patients a day to be a comfortable level of practice and the 80 per day included a goodly number of children. I practiced Monday, Tuesday, Wednesday, and Friday, 9:00 a.m. to 10:00 p.m., with three hour off for meals. That's 10 hours a day, eight patients an hour using Meric, Basic, HIO, and Barge methods -- a relatively easy task for the accomplished adjuster. I also took time for instrumentation, occasionally took the patients' weight, usually checked their blood pressure, looked in an ear or two, and listened to their hearts and lungs when necessary. Now I hasten to add that I also practiced Thursday and Saturday until noon, and both days often stretched to 3:00 p.m.; 50+ hour weeks were common for me in my volume years of practice. Yes, I have seen over 100 patients in a day, but my weeks commonly would be in the 400 patient level. Now compared to many other chiropractors I have known (visited in their offices and watched them practice) my patient load was in no way extreme; in fact, it was quite common. Dr. Richard Herfert in Michigan at one time saw twice as many patients per day as I, and he did a superlative job of adjusting and patient consulting. Remember that many volume practitioners give weekly patient lectures, so they do not talk to their patients to any extent during the adjustment, they simply go from room to room where the patients have been placed on the adjusting tables by their assistants. Dr. Clarence Gonstead and Dr. Richard Herfert were just two such chiropractors, and I know many more who follow this modus operandi.
Now what does this all go to prove? And haven't times changed? Well, it proves that a chiropractor can have a volume practice even today. But yes times have changed. If the chiropractor wants to employ orthopedic, neurological and ancillary procedures, he will not be able to do them personally. Such a chiropractor must employ auxiliary personnel and use computer record keeping which calls for more employees. Remember that the volume practitioner of the past (and commonly still today) used adjustments only in practice. Can this be done today? Absolutely! There is also something unique about the high-volume practitioners of today and yesterday; they lived their practices. They had and have an all consuming love to give service, the patients feel such a presence and respond accordingly; this brings patients to their offices night and day.
So be done with it my friends. Those entrepreneurs (intomanures) that hawk unrealistic volume practices, and those who hawk the increased use of modalities to gain increased practice income, will always be with us if we patronize them. Wake up chiropractors and in our collective enlightenment the hucksters will go away. They function only in green pastures and obviously we have given them one. I hasten to add there are legitimate volume practice and practice management teachers; we just must learn to differentiate. Caveat emptor.
"Enuf said."
Fred H. Barge, DC, PhC
La Crosse, Wisconsin
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