As insurance benefits for chiropractic care fade, there is a reactive, growing interest among new practitioners in practice management groups and seminars. It is the inevitable teeter-totter of economics in the healing arts.When times are lean, "the doctor gets paid last," as the old saying goes. But those of us who are now longer in the tooth have seen it all before.
My observation of practice management firms (PMFs) has led me to believe that all consultants will include two basic themes in their recommendations: First, encourage patients to return often for maintenance adjustments, which today is thought of as "wellness care"; second, encourage patients with chronic, difficult or debilitating disorders to follow an optimal and comprehensive treatment plan, considered by many to be a "corrective" plan.
Is there anything wrong with these recommendations? No. In some fashion, I do this every day. Several PMFs do an exemplary job of teaching good management skills, but some should be teaching pickpockets and bloodsuckers, rather than doctors. What is wrong is the unabashed abuse that a minority of practitioners portray in their dealings with patients, usually under the guise of, "It's good for the profession."
However, in the wellness model, deceitful recommendations are not the norm, but instead, simple enthusiasm. Doctors who promote wellness visits are usually dedicated to helping people. The wellness theme is not naughty, but how many adjustments can the human frame withstand? I've seen annual treatment packages sold to families, with no limitations. But what is the goal? A firmer and more beautiful nervous system? I get confused. My chronic pain patient might be your wellness patient. So, just what is a wellness patient? Is it someone with no complaints, and just "itty-bitty" subluxations that require small, fine-tuning adjustments?
A DC who promotes copious amounts of wellness care cannot comfortably do so unless he or she believes in its value. The operant word here is "believe." One of the greatest early practice-management stars (let's call him ... "Dr. J") was a master in the revival of the true believer. He used to start out his lectures like a Pentecostal preacher - slow and controlled. Then, over the next hour or so, he would build a crescendo of deep-throated, melodious bellowing, like an evangelical auctioneer. Chiropractors would weep; a few would faint. I heard Dr. J speak when I was about 15 years old, at a college homecoming. Some young doc in the front row jumped up and did what I later called a "buzzard lope," flapping his arms while he did some stiff-legged trot along the stage. When Dr. J left the stage, I remember feeling goose bumps as big as snow cones, up and down my spine.
But of course, why wouldn't a DC who is fired-up about chiropractic not want to encourage people to "get their adjustments?" PMFs often promote a high-volume practice. Consequently, we all see testimonials from chiropractors doing hundreds or thousands of treatments per week, usually using the "all the treatment you can tolerate" package approach. What isn't well-known is that any doctor can do this. How? Simply pay patients $10 in cash per visit to come into the office. Try it, and watch your practice volume blossom.
As I previously noted, the second common category of chiropractic practice management is the recommendation of corrective care for significant musculoskeletal (usually spinal) problems. I do this every day. But, the operant word here is "significant." Chiropractors who turn a patient's $500 problem into a $5,000 problem should be ashamed of themselves. Scaring patients into spending a lot of money on "correction" of insignificant vertebral positions found on X-rays is, thankfully, not the style of the majority of DCs.
It's not my style, but it could be. If I wanted to scare patients, I would use the same language used by cancer specialists. "Mrs. Kopopkins, X-rays show that the subluxation we found in your lumbar spine is slowly spreading to your thoracic spine. If we don't do something soon, it will inevitably move all the way to your neck!" Yes, I could be really scary. "Mrs. Kopopkins, because of the severity of your subluxations, I am recommending that you join a subluxation support group. They meet on Tuesday night, in room 318, at the Home for the Severely Subluxated."
As I sit here writing this article, I cannot remember when I got my last adjustment. It may have been several weeks ago. So, according to some pundits, I may be slowly dying and not even know it. But, I would rather bet on my demise using evidence-based criteria, rather than "fear-based."
John Hanks, DC
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