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Dynamic Chiropractic – June 20, 1990, Vol. 08, Issue 13

Are Practice Consultants Bad for Chiropractic? "A Personal Observation"

By Michael Anderson, DC

Yes, some are. But no higher percentage than there are bad apples in all other professions, products, services, and businesses that exist. Every walk of life has its good and bad. So it stands to reason that there are bad "apples" within the field of chiropractic consultants too.

The bad doesn't stop there either; there are bad chiropractors too. What hurts us all is when a bad practice management consultant teams up with a bad chiropractor. Of course there are also bad chiropractors that are not associated with any practice consultant. I know, I see it from both sides.

No one wants to hear any of this, but we all know it is true. This article or editorial will hopefully give us all a better perspective on practice management. MPI's Dynamic Chiropractic's stance in the July 15th, 1990 issue seems to say that chiropractic practice management consultants are not needed, or are what is wrong in chiropractic today. If any doctor or lay person was to sit in on the types of questions asked of a practice consultant at a seminar, in private consultation, or on the telephone, there would be no doubt as to the need of practice consultants in chiropractic. Chiropractors need practice management. They may or may not need a contract consultant, but the greatest percentage of doctors do need some form of practice manager to survive in today's world.

Business consultants are not something that is unique to chiropractic. Every successful industry uses consultants on a daily basis. There are two general types of individuals in all walks of life: the technicians and the managers. Technicians get things done. They get things done by physical effort. They are actual workers in the workplace. (If the term technician bothers you, please substitute the word "worker.") Managers, on the other hand, insure that what is done is done right and to maximum efficiency. Managers understand the reasons, purposes, and mechanics of what needs to be done. Managers are problem solvers. They can take the long view and the "outsiders" perspective. There are a few doctors in chiropractic that are good at both. Even those doctors who are good at both weaken in their ability in one area or the other as their practices grow. Face it, the more irons in the practice fire, the more difficult it becomes to manage all aspects of keeping the fire going.

The more successful and busy a technician becomes, the less time and energy is available to management. Industry proves this out. One of the biggest pitfalls of the average entrepreneur starting a business is doing it all. Yes, a highly motivated and educated person can get a business flying. Often this is on sheer energy alone. This personal energy draws people and success to him. However, there is a limit to how long a person can keep up the pace. The longer the entrepreneur does it all, the less time and energy there is available to manage. Lack of time and energy for management of the business always catches up to the entrepreneur. The symptoms are plateaus, cyclic growth, and occasionally failure or bankruptcy. This is one of the paramount reasons for most all businesses failing in the first five years. The same is true in chiropractic.

All successful businesses have managers and workers, and rarely is the manager also a full-time worker; he manages. This newspaper has editors that decide what needs to be done to get it printed, and there are others who actually get down in the trenches and do the work to get it printed. Without either side, the paper would not be published, and if it was published without both division's input, it wouldn't be as systematic, efficient, and as professional as it is. The same is true with the chiropractic office.

Most chiropractors that I have met became chiropractors because they wanted to serve people. Most chiropractors live for the moment that they can be with a patient. This is the technician or worker frame of mind. This is not the frame of mind that is necessary to develop and sustain a successful practice. Treating patients and seeing the miracles of chiropractic's healing principle work on a one to one basis is very rewarding, but this rewarding feeling is not management of the practice. Most chiropractors live to be in the trenches with patients. This is the healing side of chiropractic. It is the proper management of the practice that makes it possible to continue serving mankind and your community. It is difficult to be both worker and manager. That is one reason why chiropractic practice management consultants are needed. I might also mention that every practice consultant that I know also used practice consultants in their practices. Even someone who understands the management side of the practice occasionally needs outside, unbiased input.

Shouldn't our colleges teach us to be managers of our practices? Today's graduating chiropractors receive much more practice management than any present practice consultant did when he was in college. But that isn't enough. Even if a chiropractic college taught the full program of the average chiropractic consultant, there would still be a need for the consultant. Why?

Because like all other industries, chiropractic changes almost daily. Every patient is an individual and has the earmarks to be the one that can throw even the best of doctors and their staff off guard. You cannot read one single issue of "DC" and not believe this. There will always be a need for problem solving in the chiropractic office where the doctor doesn't have the expertise, time, energy, or desire to fool with personally.

You must also realize another aspect of being a chiropractic student. His focus is to graduate and pass boards. Practice management is not covered, for the most part, on boards. While the individual student wants to succeed in practice, his emphasis in college is more academic. I cannot speak for other consultant companies, but I can from personal experience since I am in the trenches of practice management daily. I average from 20-30 calls each day. These calls come from doctors not yet open in practice, to doctors who have been in practice for over 40 years. They range in age from their early 20s to their 70s. They range from doctors earning nothing to those earning over $80,000 monthly. They come from intelligent caring individuals: doctors who care for their patients, their families, their staff, and their ultimate retirement and doctors who work full-time in their practices, and those who assist with the state and national associations. The questions range from what equipment to buy, to site selection, staff management, the patient that doesn't respond, patients not paying, what insurance to purchase for oneself, how to deal with confused or irate patients, working with attorneys, medical doctors, and another 1,000 other possibilities. The doctor alone can ill afford the time, money, and energy to keep current. This is what a consultant does: A good practice management consultant allows the doctor the freedom to treat patients with utmost care and concern and let someone else worry about the management side.

You speak of bad consultants. Yes, I said they are there. I hear the horror stories far more than any average doctor. I hear the fear, anger, and frustration from the doctor who has been ripped off and doesn't want to be burned again. But what can you do? There are always certain risks anytime anyone refers anyone to a consultant, chiropractor, medical doctor, dentist, corner laundry, movie, and any other item we might want. Of course it is for this reason that we want our profession as clean as possible. I want it clean and you want it clean of anyone that might cause our downfall or our credibility to be hurt. But is it consultants who are at fault? I think not. They, of course, must shoulder much of the burden along with the individual chiropractor. It is all too often the doctor himself that suddenly finds himself against the brick wall, creditors breathing down his neck, and no new patients on the books that will do almost anything to survive. It is this doctor who will, under the wrong direction, do almost anything to succeed. A bad manager and a desperate doctor do not make a good team.

You also ask whether the American pursuit of happiness via money is at fault? I am sure that some doctors are motivated by possible financial gain rather than service, but I doubt seriously that the majority of doctors fall in this category. It is true that chiropractic has been attracting more and more students in the past ten years who are looking for a money career and not a healing career. There is one thing I am sure of and that is that it takes from $35,000 to $60,000 to open a chiropractic office today, depending on location in the country. Chiropractic has always had two fronts (just as medicine does) and that is the healing side and the business side. You can be more caring than the next doctor, more astute with diagnostics and treatment, but that alone does not help pay the overhead on the $35,000 to $60,000 investment that continues to create debt each month. Practicing chiropractic is a business regardless of what you might think. It is the business of natural healing, but it is a business. What is best for the patient should always come first, but it is still a business.

The issue of whether doctors should be prosperous is ludicrous; they should. Anyone who puts in the dedication and long hours, not to mention the finances to go the mark to open the office deserves a better than average salary. This does not mean cheating the public or charging higher than fair fees for services rendered. There must be balance between quality service, a fair fee, and a good honest return on the doctor's time, energy, and investment into the practice.

It also means that when his practice comes to an end the doctor has provided for his retirement. No one else will. You cannot depend on social security. A good practice manager will help the doctor to provide for the present and the future. What's wrong with earning a good living or a better than average living, as long as the work you do is fair to everyone concerned? Another point to consider is that if the initial investment to earn a living is higher than the average person's, and the average stress and overhead is higher than the average person's, then shouldn't the retirement be better than the average person's?

There is another point about money that is very important as you survey the importance of consultants and their value to chiropractors and chiropractic. A doctor who is current on his expenses, and is enjoying a few luxuries of life, is far less likely to turn to those procedures that hurt all of us. It is the doctor who is doing well, in my opinion, that is a better doctor. This doctor can focus in on the patient, not the patient's wallet. It is the doctor who is struggling to make a rent payment or who is behind on his taxes that is more likely to take advantage of his patients just to survive. Again, it is this doctor and the bad consultant who hurts us all. Every consultant wants his clients to succeed so that money is not an issue in practice. The responsibility of the consultant is to aid the doctor in reducing those lean times, so the doctor can only focus on the patient's needs.

Lastly, if there is a money problem in chiropractic, it is that so many chiropractors have a lack of self-worth for the services that he renders in terms of getting paid for those services. For some odd reason, too many chiropractors will give their services away as a routine procedure, will not ask for payment for good service, and just hope that the patient might pay. All of this too often goes on even while the doctor, personally, is in financial trouble. Consultants help doctors to realize that quality service with a reasonable fee warrants full payment. There is always room for that charity case that qualifies, but that is the exception and not the rule, as we see it, in many offices that come to us.

You are right about the U.S. economy fostering an environment that demands a more competitive posture. What this really means is that doctors will find they can no longer afford to make management mistakes. They can no longer afford not to have good running procedures, poorly trained staff, wrong office locations, and no community involvement. It also means that they cannot risk those procedures that hurt the profession and their communities. They must be honest and fair in all they do.

The bottom line is this: If a doctor realizes that he needs help to get started in creating a strong practice that will provide for his retirement, then he must choose the right consultant for him and one that is right for the profession. In this manner, the bad ones will fall by the wayside.

If I were the one researching and checking out a consultant, I would ask many questions. The doctor should make sure that the management company has a reputation that is in line with the doctor's own personal philosophy of practice. Check-out its track record and talk to some of its present and past clients. Having two heads is almost always better than one. But remember, both heads need to be on straight. Find a consultant that shares your dreams and goals, and your means of attaining those goals, and you should be okay. Ask questions.

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