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Dynamic Chiropractic – January 15, 2009, Vol. 27, Issue 02

You, Doctor, Are the Problem

By Tom Necela, DC

Many DCs are currently experiencing unprecedented economic turmoil. As a result, I have been fielding calls and e-mails from a growing number of chiropractors who are worried about the diving economy and the impact a new president may have on their practice. My response is one they don't usually expect: It doesn't much matter who is in office. The bottom line is that the events going on around you are far less important than the events taking place within you. Let me give you an example to prove my point.

Recently, a client of mine was complaining to me about a major insurer who lowered reimbursements for the chiropractic adjustment. Had I believed his take on the situation, I would have concluded that the world is against chiropractors, the insurance companies are against us, the MDs hate us and it is futile to fight.

But if you believe you control most of your successes and failures (as I do), then your reaction is that of someone in control. So, I responded to this DC by saying I would look into the situation to see what could be done to make the best of it. It turned out that the payer did, in fact, lower the amount it would reimburse for CMT, but they also raised E/M fees! This doc was too preoccupied with complaining about how the insurance company was stealing from him on one hand to notice the gift they gave to him on the other.

Victor or Victim?

Proactive thinkers who believe they have the ability to affect their own destiny seek out what worked well, so they can use it next time. They learn new strategies and bounce back. They get sound advice to solve new problems. They do not feel they already know everything and cry when things suddenly change on them. As chiropractors, we all have a choice to be a victor (of our own fate) or a victim (of the economy, circumstances or other people). It is our choice. I don't believe it has anything to do with political persuasion, regardless of who is in office. I think it has everything to do with personal confidence, skills and philosophy.

Make no mistake, just adopting a positive mental attitude, reciting some maxims every day about how you constantly attract wealth, or telling yourself in the mirror that you are a success is not going to cut it. Let's get really specific here, doctor:

  • Do you possess all the tools necessary for your practice to succeed?
  • Are you teachable, willing to learn new ideas?
  • Have you surrounded yourself with a team of experts who can help you achieve your goals?

Breaking the Glass Ceiling

Like it or not, you cannot reach the next level - no matter where you are at currently - with the same manner of thinking and actions. You will hit a ceiling; the problems will become increasingly complex and your usual solutions will stop working. Your ceiling may be accelerated by outside events or agents, or it may be delayed by several strokes of good fortune. The good news is the ceiling is made of glass and is breakable through application of proper tools and effort. Either way, it is your responsibility to figure out how to surmount that obstacle, what tools you need in place to achieve it, and with whom you need to consult to help you get there.

Challenges mount, and if you don't have a game plan or some able assistance to break through this glass ceiling, you and your practice will shrink back to the "comfort zone" and never achieve any new victories. So, yes, in a way I am stating that the current status of your practice is all your fault. If your business is struggling right now, your situation should give you an obvious answer: You don't know everything. If you are doing reasonably well, take a good look. There is always room for improvement.

Ditch Nostalgia and Develop Proactive Strategies to Succeed

I challenge you to take a great, proactive interest in improving your practice. Act as if your life and your livelihood depend on your mastery of chiropractic, both clinically and as a business. Why? Because they do! Here are some concrete questions to ask that many chiropractors simply ignore until it is too late:

  • Are all your services being paid on the first try? Well, why not? Could it be that you are part of the problem?
  • Is your A/R mounting for no good reason? Better find that problem fast.
  • Do you even know what acceptable benchmarks for A/R, services per visit and other metrics even are? Use them and see how you stand.

Unfortunately, many of us fall prey to being either asleep at the wheel or more concerned with how we can get back to "the good old days." You have met people trapped in this phenomenon. They are the ones who attend high school reunions and place disproportionate value on times past. In chiropractic circles, when you ask these people what would constitute a good year, a good income or a good anything, they reflect back on their "glory days," when their practice was really setting the world on fire.

Sorry to break it to you, but this type of thinking is misguided for individuals and certainly for a profession. Certainly, one can recall the easy life of a DC but the big question is, "Did you do anything to deserve that windfall?" If you didn't, then you were just at the right place at the right time, and consider yourself fortunate for having been there. On the other hand, if there were certain techniques or strategies you used that contributed to your past successes, this is great news. Figure out what made them work well, modify them to suit current needs and you will likely see success again.

Your Business Is a Reflection, Not an Exception

The fact of the matter is no one is perfect. Your practice - your business - is a proportional reflection of yourself and your lack of perfection. Like it or not, doctors, we are always the biggest part of the problem - not the economy, our staff, the insurance companies or the patients. When we realize this, life gets better for us (as well as our staff) because we begin to seek ways to clean up the messes we create for ourselves.

Let's face it, no one is truly "self-made." Like him or not, Obama didn't get there on his own. When he takes office, just like every other president, he needs to surround himself with the brightest minds he can find in order to succeed.

Hospital CEOs don't try to figure out billing problems; they have a team of experts who are dedicated to the task. They don't try to make flyers in their spare time; a marketing department handles that for them. They don't stay up late at night poring over chart notes or worrying whether their facility is compliant; they have hired specialists who handle it for them.

The biggest businesses in health care, and the leaders who run them, all know the value of delegating, creating a team of mentors and experts to bounce ideas off, and eliminating the aspects of their job they are not good at. What makes you think you are an exception?

Chiropractic Needs Successful Chiropractors

If you are committed and willing to take responsibility for your own actions, dedicated to improving your practice, and smart enough to know you don't know it all, then you are on the path to success. Some people will read my words as arrogant or perhaps bloated self-praise from a would-be know-it-all. They have the right to their opinion. However, the fact of the matter remains that I am confident in my ability to help myself and others who are ripe and ready to better their business, and I would like to challenge each member of our wonderful profession to "step it up" a notch and take more control of their own destiny.

Chiropractic needs successful chiropractors to survive. Perhaps the first step for you, doctor, should be to adopt some healthy confidence - in your own abilities to get patients well, in your unique marketing strategies, and even in your praiseworthy procedures in your office.

Without such bravado, you are likely to fit in well with all the other milquetoast practitioners who are offering the same or similar services as you. Then you will be subject to the whims of the economy, the fickleness of health care consumers and the challenges of trying to sell the same thing as everyone else, although on a smaller budget.

Be well, be confident, and go out there and help some people. There are plenty of folks throughout this country who need your able assistance, and they need it now more than ever.

Dr. Tom Necela maintains a private practice in Washington state. He is also the founder of The Strategic Chiropractor, a consulting firm for chiropractors. Dr. Necela can be contacted with questions or comments via his Web site,

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