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Dynamic Chiropractic – August 15, 2006, Vol. 24, Issue 17

Does Chiropractic Practice Have a Future?

By Craig Liebenson, DC

Are you seeing diminishing insurance reimbursement? Are PTs manipulating spines in your city? Are you tired of patients having unnecessary surgeries or being overmedicated for pain when conservative chiropractic care is a better answer? What can we do to save chiropractic practice, or is it even worth saving?

Insurance companies are paying less and requiring more documentation.

PTs are becoming highly trained in all aspects of conservative care of the musculoskeletal system. Surgery rates continue to explode while opiate use among pain patients is epidemic. Can chiropractic care provide a value-added service to society or are we heading toward extinction?

Chiropractic care is being shown the door. Why? Because PTs are part of the medical establishment and have a vision (which they are carrying out) of themselves as neuromusculoskeletal (NMS) specialists. Chiropractic is the steward of the subluxation. The public's polluted perception is that once you start to see a chiropractor, you will have to keep going back.1 In other words, we (a) overtreat patients and (b) don't show patients what they can do for themselves. These are two cardinal sins in a highly competitive health care marketplace, where educated consumers drive decision-making.

What is the solution? First, chiropractors' strength must be asserted in the musculoskeletal field. We are trained in diagnosis and non-interventionist management of NMS disorders - less invasive than physiatrists and surgeons, more skilled in NMS than internists and with greater diagnostic acumen than PTs. If we are a "one-trick pony" whose only expertise is high-velocity thrust manipulation, the more organized and focused PTs surely will surpass us in the marketplace.

Chiropractors who have the ability to reinforce the practice of self-care management advice for NMS conditions (e.g., back pain, neck disorders, sciatica, sports injuries, osteoporosis prevention, fall prevention) can benchmark themselves in their community as NMS experts capable of providing conservative care. Expertise in promulgating self-efficacy can distinguish you amongst your peers and amongst the active, health-oriented baby boomers. Thus, your patient is satisfied, the third-party payer is satisfied and you know you have provided the highest quality, most cost-effective care to your patient.

Promoting expertise in patient self-care allows you to offer complementary care to that delivered by PTs, personal trainers and Pilates practitioners, thus opening up your potential referral sources. Much of this care is not covered by chiropractic PPOs or Medicare, so it automatically promotes a cash arm to your practice. General medical practitioners also are very happy to refer patients to a DC who focuses on self-management. They are impressed that you educate patients and release them from care once expertise in self-care is achieved.

Politically, rather than aggressively, attack PTs who are manipulating. We should develop proficiency in promoting appropriate attitudes, beliefs and skills to permit patients to help themselves. The question is, do most DCs even care about educating patients about self-care? If we do, we can market our services to other health care professionals. Our own patients - sedentary secretaries, the active aging, weekend warriors and elite athletes - will all refer friends and family to our functional, active-approach practice for high-quality NMS care.


  1. Environics Research Group. Attitudes Toward the Marketing of Chiropractic Services. Mississauga, ON: Ontario Chiropractic Association, Jan. 11, 2006.
  2. Ryan, J. Measuring subluxation; a report on public response. Chiropractic Business, Fall/Autumn 2000.

Click here for previous articles by Craig Liebenson, DC.

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