In this era of ever-increasing health care costs, combined with a higher consciousness regarding the advantage of safety, health and wellness programs, more employers are incorporating proactive, preventive services provided by doctors of chiropractic.Through the use of a one-on-one interview format, this column has been created as a means of sharing the stories and outcomes achieved by DCs engaged in this specialty area of service. This issue's interview features Dr. David Thorpe of Fayetteville, N.Y. Dr. Thorpe is the immediate past president of the ACA Council on Occupational Health and is the founder, president and CEO of an occupational consulting corporation in central New York.
Briefly tell us about yourself and why you decided to become a doctor of chiropractic.
I have been a very happy practicing chiropractor for more than 27 years. I first became interested in chiropractic when I was a freshman pre-med student at Syracuse University. At that time, I met and befriended a fellow biology major whose father was a chiropractor. Through that interaction, I developed an interest that blossomed over the next few years. Eventually, I became a patient of my friend's father and as a result of that relationship, we discussed at length the pros and cons of the profession. It was during my junior year of my undergraduate training that I made the decision that chiropractic was what I wanted to do for the rest of my life.
Describe how you became interested in occupational health and applied ergonomics.
Within the first few years of practice, an occupational health nurse came to my office as a patient. Although she had not previously consulted a chiropractor, she came with an inquisitive and open mind, and we hit it off very well. It wasn't long before she was referring many of the injured workers from where she worked. Eventually, she invited me to evaluate the facility, provide training programs and assist with their overall health, wellness and safety programs. Thankfully, she was very patient, as I initially felt somewhat overwhelmed with all that I was exposed to and what was expected of me. My interest in this specialty gradually expanded and consequently, I began to look for educational opportunities that would provide me with additional skills I needed to provide the growing number of services requested by my clients.
My exploration began through programs that were not specific to the chiropractic profession, including many hours of self-study and investigation. Finally, I learned about the diplomate program on occupational health and applied ergonomics offered through Northwestern Health Sciences University. For three years, I traveled from my home in Syracuse, N.Y., to Hartford, Conn. This program provided me the qualifications to sit for the board examinations leading to the DACBOH designation I earned in May 2000. With each class throughout that three-year program, I became more confident and was able to provide a greater number of services. As my reputation grew and we became busier with an ever-increasing number of services that my company was able to offer, I was able to provide opportunities for other DCs to work within my company (both full time and per diem). Additionally, we have had to move into a larger facility to accommodate the growing demand.
How many years have you been working in occupational health?
I have been working within this specialty for a little over 22 years. My company has provided a variety of services to more than 200 client companies during that time. What started out as simply providing a limited number of services for a single client has now grown into a full-fledged, very profitable business.
How do you market your skills and services?
I differentiate my efforts into two primary areas: internal marketing and external marketing. Internal marketing has to do with my one-on-one interaction with potential client company representatives as I treat their injured workers. Within this scenario, I communicate directly and actively with claims adjusters, business owners, human resource directors, safety personnel, middle management, work supervisors, etc. I provide them with timely information, carefully limit lost time and assist them with recommendations for the earliest possible return to work. These proactive outreach efforts all provide positive identification for who we are as a service-oriented company. Additionally, the vast majority of my patients work somewhere and their interaction with decision-makers allows me to introduce my company to prospective new corporate clients. Many are actually decision-makers themselves.
Our external marketing is conducted through a different approach. Through the years, I have found that some things seem to work better than others. I have never found that print media is particularly effective, nor are other types of traditional advertising. Direct interaction with interested groups and organizations, providing immediate, take-home-value educational programs, seems to be the most productive way to introduce my company to prospective clients. I also provide incentives for current clients to make referrals, which reinforces the powerful word-of-mouth, satisfaction-driven relationships with new clients.
What have you found to be the primary obstacles you have had to overcome in marketing your services?
There are some similarities to marketing a traditional chiropractic practice; however, working directly with the corporate world provides some unique challenges. Of interest, I feel that my greatest advantage (being a doctor of chiropractic) also can be perceived as an obstacle, at least during the initial relationship-building stage with companies. This factor I jokingly refer to as the "C" word among the less-than-well-informed. It is always enjoyable watching the skepticism and resistance gradually fade away as I consistently demonstrate my effectiveness in a very competitive marketplace. It is highly rewarding to be able to show the many advantages of being a chiropractor in addressing the great majority of client needs. I enjoy meeting the professional challenge of showing how chiropractic can provide companies with a strong, competitive edge in the realm of occupational health, wellness and safety.
Other issues relate to some companies' overall indifference or apathetic attitudes about workplace illness and injury. It is not uncommon for me to encounter corporate executives who, frankly, have the distorted belief that health and safety interventions are unnecessary and that those who claim to be injured within the workplace are embellishing their symptoms and malingering.
Additionally, I sometimes run into company owners and managers who perceive a need for improved safety; however, their overzealous push to enhance productivity often leads to increased safety hazards and sacrificing quality. The key challenge is to help such clients understand that safety is a bottom-line issue. Also, as a component of our educational and marketing strategy, we do not emphasize safety first but do emphasize "safe, quality production." It must be understood that for companies to be able to afford and engage our occupational-health and related services, they need to be able to show an increased profit as the result of our working together. To address this concern, our marketing message always places significant emphasis on their return-on-investment priority.
Describe the various services you provide for the companies with whom you are currently affiliated.
We provide services related to the prevention and management of work-related injuries and illnesses, as well as guidance regarding state and federal compliance issues. We are an A-to-Z company. What I mean by that is that we will either provide our clients with a needed service or contract with another company that will provide it for us. Our focus is in providing services that will assist our clients in reducing the number and severity of injuries, as well as the associated costs. We separate the types of services we provide into two distinct categories: in-office services and onsite services:
- post-offer, pre-placement physical screening;
- DOT and non-DOT drug testing and alcohol screening;
- lift- and strength-testing;
- return-to-work exams;
- DOT physical examinations for commercial-vehicle operators; and
- medical-management services.
- accident prevention and safety program management;
- needs assessment/loss-source analysis;
- safety training programs;
- health and wellness training programs;
- environmental hazard identification and control;
- ergonomic assessment, intervention and training;
- OSHA compliance assistance;
- onsite chiropractic care; and
- occupational nursing services and other onsite medical-management skills.
What kinds of bottom-line outcomes have you observed as the result of your involvement with the business clients you have served?
Over the years, we have provided a variety of different services to many different companies - some in a cafeteria style where I am in and out; others where we provide a more comprehensive menu of services for our clients.
In those companies that utilize only a single service, we observed that they have not had the significant impact we might have had if they elected for us to assist them in other areas of need. When we provide broad-scope safety, health and wellness program management for our client companies, we have had significant success in reducing the number and severity of injuries and their associated costs.
For instance, a self-insured, medium-size, ball-bearing manufacturing plant (the number of employees has fluctuated between 150 and 300) was able to reduce the incidence and severity of neuromusculoskeletal injuries by more than 50 percent within the first year. Their average annual cost for the previous three years was $430,000. Throughout the next 14 years of our relationship, they have had numerous years with zero lost-time days and one year in which their total work-related injury cost was only $62. Additionally, their DART rating is now consistently below 1.0. The industry standard based on their SIC classification is 8.0, which indicates that this type of industry has a very high exposure and injury potential. We were able to successfully intervene through our unique, chiropractic approach to health, wellness and safety.
A records microfilming and storage company (approximately 50 employees) was about to be dropped by its insurance carrier when they contacted us. Despite their small workforce, they were averaging greater than 400 lost-time days annually. We were able to decrease their exposure to less than 20 lost-time days within the first year of our relationship, which was followed by four successive years of zero lost-time days. The company was then purchased by a larger company and had its operations moved to another city, which terminated our relationship. Our noteworthy success, however, was positively acknowledged by all involved.
We have had similar success with numerous other companies. The extent of that success is often determined by the type and depth of services we provide. For optimal outcomes and sustained relationships, client companies need to have some indication of success early in the relationship. Client commitment to health and safety varies greatly from company to company, and this often impacts their level of cooperation and the positive result we are able to achieve. There are also differences in the dynamics between union and non-union companies. So, taking all of these factors into account (with our best efforts), we are often still able to achieve positive outcomes that are demonstrable within the first year.
Considering these remarkable statistics, do you feel other doctors of chiropractic could expect to be able to replicate these outcomes?
Without a doubt! We believe the key to our success is knowing what we are doing. Consultants need to be familiar with basic safety and ergonomic principles and have a clear understanding of the industry with which they are working. Unfortunately, I believe it is common for DCs who are interested in working within this specialty to be unprepared when they approach industrial clients. Corporate owners choose their consultants very carefully. In our training, we were taught the five qualities that corporate decision-makers use in choosing whom they wish to invite to serve on their health, wellness and safety team. Professionals who consistently demonstrate likeability, credibility, availability, accessibility and affordability are strongly favored over others.
Consultants must approach this work with adequate technical skills, as well as a proper attitude. If the doctor's sole purpose is to obtain patients for their practice, it is highly unlikely they will be contracted by the firm, as this is considered crisis care and clearly not representative of futuristic, proactive thinking. The consultant's focus should be on prevention of injury and illness, first and foremost. Often, however, a secondary benefit is a notable increase in referrals for crisis care when it is required, not only from the workers, but also from their family members.
What advice can you share for doctors who may want to work within the field of occupational health and applied ergonomics?
Interested doctors can begin by grounding themselves in skills development and technical know-how. This can be accomplished by contacting the continuing-education department at Northwestern and participating in the diplomate program. During the time they are preparing themselves with technical skills, they can begin a gradual process of marketing themselves within their communities. In addition, I urge ACA-member doctors to join the ACA Council on Occupational Health. It is a specialty council whose purpose is to promote and assist its members as they work in this field. You can obtain a membership application by visiting www.acacol.com. Doctors also can join the International Academy of Chiropractic Occupational Health Consultants (IACOHC), which can be contacted through its Web site, www.dc-occhealth-org.com. The IACOHC also maintains an educational resource center for interested doctors.
Do you feel providing occupational health services has a bright future for appropriately trained doctors of chiropractic?
Yes! There is clearly a significant professional opportunity within this area of specialized services. Astute business owners are becoming more and more receptive to creative solutions for their ongoing health, wellness and safety concerns.
It is also exciting to mention that for the most part, these services are cash-driven. Outside of treating injured workers through the workers' compensation system, there are no managed care companies or claims adjusters to hassle with. Our company bills our corporate clients and we are typically paid within 30 days and receive a thank-you for our services. We also receive monthly retainer fees from many of our clients (ranging between $200 and $3,000 per month) for defined services. It's a wonderful feeling and very profitable. In an era in which managed care has eroded profits for all health care providers, adding services that are cash-driven can be a very attractive alternative. In my role in advising medical management, I am commonly called upon to assist employers with the determination of and appropriateness of care. It is highly rewarding to be on this side of the decision-making process.
Frankly, I feel that the prospects for chiropractic involvement in occupational health and applied ergonomics are almost limitless. The only things that would prevent a conscientious doctor from enjoying great success in this endeavor are indifference to the trends that are driving the health care marketplace and procrastination. So get involved!
Click here for previous articles by Joseph J. Sweere, DC, DABCO, DACBOH, FICC.