Are you struggling with the uncertainty, constantly changing rules, and ambiguity regarding the future of health care? Do you long for some sort of guarantee or "insurance policy" that will protect you against third-party audits, declining practice volume, or other bad news? Do you find yourself feeling anxious and looking frantically for some new tactic that will increase your sense of security? If so, you're far from alone.
In the past, chiropractors characterized their professional lives as being "high demand, high control." Their services were in high demand and, because of the attention they gave to practice management, they felt largely in control of their businesses. Setting goals was of paramount importance, and the use of positive visualization and affirmations to achieve success was the talk of the day. Doctors who felt control slipping away would spring into immediate action by attending a seminar or hiring a consultant to help them improve production and profitability. In the past, these tactics often worked quite well.
Though a range of experiences exist, chiropractors in significant numbers today are reporting decreased demand for their services, patients who don't seem to value chiropractic services as they once did, lower reimbursement, and declining profitability. Simultaneously, the demands associated with the administrative side of practice have become more and more burdensome. As a result, many doctors are experiencing a lack of autonomy that has left them feeling overwhelmed, discouraged or bored. They are lacking emotional vitality.
Practitioners who deny the emerging reality (or ignore it, praying that the "good old days" will magically reappear) tend to become resentful and have difficulty managing their own emotions. They complain and rage against the system, and become negative, pessimistic and grumpy. For doctors simmering in this stew of discontent, there is not only dissatisfaction about how the profession has changed in recent years, but also a high degree of anxiety about what the future may hold.
As you might expect, their fears and worries manifest as stress, anxiety and even depression, and professional concerns spill over into their personal lives as well. The resulting negativity does not endear them to family, friends, staff and colleagues, and they soon find themselves without the support they once had. This combination of factors - lower demand for services, loss of control, high administrative demands and low support - is a recipe for burnout.
Without the joy and fulfillment one's chosen profession brings, burnout is inevitable unless steps are taken toward changing one's situation, attitude or both. For practitioners who take a proactive approach, however, there is still cause for optimism and hope.
Regaining Emotional Vitality
There are still plenty of chiropractors who are thriving in practice today, despite experiencing the same level of diminishing control and burdensome regulations as their colleagues. These doctors have chosen to meet reality head on, rather than fight it. They tend to be confident, purpose driven, and adaptable. They don't take the fact that the profession is in transition personally, but simply view continuous change as a business challenge to be addressed. They manage themselves well, develop new practice models, and take on leadership roles in their practices, communities, and professional organizations in an effort to co-create their preferred future for chiropractic. These practitioners know that a diet of "gloom and doom" day in and day out won't result in change.
If you'd rather be among those who are able to maintain or regain emotional vitality, if you'd prefer to focus on opportunity instead of limitations, and if seeing possibilities for a brighter future is your goal, you can take steps toward adopting an attitude that will see you through the next few years and serve you well. Of course, it's always useful to practice good self-care, and even more so during challenging times. If you're not already following you own good advice about proper nutrition and exercise, now is the time to begin. You may not be able to control the insurance company that wants to audit your charts, but you can control what passes your lips and how - and how often - you choose to move your body. Maintaining optional health, as well as practicing stress management techniques like meditation, guided visualization, and yoga, will bolster your resilience and make you better able to cope with continuing changes in the practice of chiropractic.
Three Doctors, Three Challenges, Three Strategies
Here are three scenarios that offer insight into the ways in which chiropractors in today's evolving environment are commonly challenged, along with two possible strategies for addressing and solving the challenges. The first strategy is to objectively evaluate the current reality and then set about making the changes necessary to improve the situation, system, or infrastructure. This might involve new procedures, staffing changes, a different approach to practice marketing, or becoming more disciplined around time management and leadership.
The second strategy is to assess and acknowledge the current reality, stop fighting or ignoring it, and instead work toward adopting a new mindset or attitude. One might consider evaluating and improving emotional and social intelligence, cultivating presence and mindfulness, managing anxiety and stress levels, and depending less on career as the primary source of satisfaction.
In considering either of these strategies (or the third strategy, a combination of both), it's important to discern the differences between evidence and interpretation. What are the facts versus what is the story being told to oneself? What "old tapes" play over and over that color perception? What data points are missing or incomplete? What are current known and unknown factors? What's certain and what is uncertain at this point in time?
Doctor A: Overwhelmed
Doctor A says he wants to increase his practice volume by 50 percent by the end of the year. The problem is that he already feels overwhelmed. His perception is that he works "all the time." When pressed, he admits to only being in the office about 22 hours a week. He strongly resents the administrative work associated with practicing. He does not like marketing, a task that always falls to the bottom of the to-do list. When he's reminded that increasing his practice volume, if he were able to do so, would also increase the non-clinical tasks he doesn't enjoy, his response is that the extra income will re-energize him.
Burnout Alert: Are You Smoldering?
Doctors who are experiencing low control, high demand, and low support are prime candidates for career burnout. Signs and symptoms of burnout include working harder and harder to "prove" that you are capable of coping; not taking care of yourself physically; denying that problems exist; boredom; chronic fatigue; sense of being overwhelmed; withdrawal; obvious behavioral changes such the misuse of drugs, alcohol, or food; significant sleep disturbances; excessive cynicism, anger, or feelings of resentment; hopelessness; anxiety or depression.
If you have a few or more of these symptoms and feel like you might be teetering on the edge of burnout, read "Primary Prevention for Career Burnout: Building Resilience" in the June 17, 2008 issue. Also, don't hesitate to seek professional assistance from a career coach or therapist if burnout signs and symptoms persist or escalate.
The second thing he would likely come to realize is that, deep down, he's ambivalent about increasing his volume by 50 percent. That sounds good in the moment, but the work involved would only add to his sense of being overwhelmed, and the idea that more money will buy contentment is magical thinking.
If Doctor A were honest with himself, he'd see that the changes he needs to make are related to developing better systems within his office so that he (a) feels less overwhelmed with the administrative tasks necessary to run his office; and (b) has time to do strategic marketing that will increase his volume to a level that is sustainable (i.e., probably not 50 percent). On the mindset/attitude side of the equation, Doctor A would be wise to pay attention to how much time he spends worrying about his practice. Learning to compartmentalize and self-manage - to focus on work when it's necessary and then "turn it off" during personal time - would help diminish his sense of overwhelm.
Doctor B: Bored
Doctor B is bored. Although she has been in practice for barely more than a decade and is not even close to retirement age, this doctor says she "feels like a robot." Doing essentially the same work every day, she is no longer challenged. Instead of seeing each patient as an individual, she's begun to view them as just one long line of broken parts and herself as the mechanic tasked with repairing people. Doctor B resents being bombarded with patients who say, "Fix me." She feels flat and intellectually fatigued. She procrastinates in getting to administrative work and important projects, instead wasting time surfing the Internet and snacking at her desk, both of which are taking a toll on her physical and emotional well-being.
An assessment of the reality in this situation reveals that the nature of practice is that, ideally, there is a steady stream of patients coming to your office. The nature of practice is also that almost all of these patients are seeking help for some concern, problem or pain. It's easy to slip into feeling like a mechanic when you hear the same stories day after day. If your goal is to care for and guide people toward health and wellness, constantly hearing complaints about pain is even more frustrating. It's important to remember, however, that for each patient, their pain is their current reality and it's what they are most intently focused on, along with how successful they are under your care.
Chiropractors frequently fall into the trap of thinking that the way out of boredom is to increase the number of patients they see and thus access flow or a greater sense of satisfaction. This may work in the short term, but it's probably not sustainable. The real cause of boredom is usually that the doctor's skills are more advanced than what the majority of patients require. Because there are only so many truly "interesting" cases out there, the remedy for boredom is to challenge yourself to become more engaged with each patient you see, and become more curious about them as individuals. When you communicate more deeply with patients about what motivates them, they feel heard. You'll find yourself becoming more empathetic, asking better questions, and being a more effective coach and teacher. Curiosity leads to more engagement, a higher degree of presence, and ultimately better clinical outcomes.
In addition to becoming consciously curious, Doctor B could consider promoting her practice in a way that would attract a somewhat different clientele - patients with issues aligned with the doctor's personal interests. For example, Doctor B might focus on sports medicine, pregnant women, or on doing more nutritional counseling. In other words, mix it up a little - but with foresight and careful planning. To do so, she would need to make a commitment to cultivating a new niche, as opposed to making a halfhearted or short-term marketing effort toward that goal. Doctor B could also work on a strategic plan for her practice and engage in new professional development activities to combat boredom.
Doctor C: Discouraged
Doctor C is discouraged, resentful and mildly depressed. He remembers the "good old days" when he had more control and fewer administrative burdens in his practice. He's earning less than he did just a few years ago, and doesn't see his income going back up in the future. Lacking the motivation and energy to market his practice, he's biding his time until he can afford to retire. Unfortunately, he still has two children to put through college, so even though he's in his late 50s, that day is not exactly around the corner. He frequently rants about the injustice of "the system," which only adds to his level of discontent.
Having once had a great deal more autonomy than he does now, Doctor C's current reality is the same of most every other chiropractor in practice today. Compliance, regulations, and paperwork are part of the business. Since he can't yet retire, if Doctor C intends to circumvent full-blown career burnout, he should focus on improving his understanding of what he can and can't control, and work toward adjusting his attitude so he can continue to practice without becoming more resentful and angry with each passing year. This might look like knowing which battles to fight and with what attitude, and which ones to simply let pass. This is easier said than done. Doctor C is a good candidate for professional coaching, or perhaps even therapy if depression is indeed an issue.
More of What's Not Working Isn't the Answer
If you can't cope effectively and find some level of meaning and joy in your practice the way you're managing it today, doing more of what's not working won't make the future any brighter. Taking good care of yourself physically is certainly an important aspect of overall well-being. Giving the same level of attention to emotional vitality as you do to your physical state will help you remain grounded and cultivate the competence and skills to cope with the uncertainty, challenges,and stresses that are inherent in practicing chiropractic today.
Increasing your self-awareness and connecting with your own vitality will help you move beyond outmoded approaches to and attitudes about practice. The result will be an ability to see opportunities for the future, a career that has greater meaning, and an awareness of possibilities for shaping new models of practice and contributing to the profession in a positive manner.
Click here for previous articles by Shelley Simon, RN, DC, MPH, EdD.