Both my father and grandfather were doctors of chiropractic. In those days here in California, their respective practices consisted of adjustments, nutrition and colon therapy as required. They could and did perform other primary care duties as needed, but not typically. They practiced just as they had been taught.
Today's chiropractors have several ways they can practice: alone, with other DCs or with other non-chiropractic providers. They can focus primarily on delivering chiropractic adjustments or add a long list of other services and products that can provide additional revenue streams.
We recently conducted a survey of doctors of chiropractic in an effort to better understand how our profession practices. While not definitive, these are the responses we received as to the working definitions DCs in the U.S. thought best described their practice:
Which of the Following Best Describes Your Practice?
- Single DC, Traditional Chiropractic (53.7 percent) – Eighty percent or more of your revenue from adjustment/manipulation/PT/rehab/massage.
- Single DC, Broad Scope (12.0 percent) – Thirty percent or more of your revenue from something other than adjustment/manipulation/PT/rehab/massage.
- Multiple DC, Traditional Chiropractic (17.0 percent) – More than one DC in the office; 80 percent or more of your revenue from adjustment/manipulation/PT/rehab/massage
- Multiple DC, Broad Scope (3.9 percent) – More than one DC in the office; 30 percent or more of your revenue from something other than adjustment/manipulation/PT/rehab/massage.
- Specialized Practice (4.2 percent)– More than 50 percent of your revenue from something other than adjustment/manipulation/PT/rehab/massage.
- Interdisciplinary Practice (3.9 percent)– Practicing with at least two other non-chiropractic professionals (not including massage therapists); some expenses are shared.
- Integrated Interdisciplinary Practice (5.4 percent)– Practicing with at least two other non-chiropractic professionals (not including massage therapists); providers work as a team to address the needs of almost all patients and some expenses are shared.
On the surface, we see 70 percent of chiropractors still practice a more traditional form of chiropractic (either solo or with other DCs) with at least 80 percent of their revenue derived from adjustments, rehab, PT, etc. Of the remaining 30 percent, approximately half rely on other services and products for at least 30 percent of their revenue. The final 15 percent (approximately 10,000 doctors of chiropractic) have adopted a different style of practice that involves working with non-chiropractic providers (just over 9 percent) or offering other services and products that drive more than half their revenue.
Practitioner Experience and Practice Type / Style
As you might expect, there is a difference between the type of practice chosen by a doctor in their first five years of practice versus a doctor who has been practicing for 25 years or more:
- Doctors in practice for less than five years and those in practice for 5-9 years are much more likely to participate in an integrated interdisciplinary practice (14 percent and 18 percent, respectively).
- Doctors in practice for 5-9 years also are much more likely to practice in interdisciplinary practices (9 percent) or specialized practices (9 percent).
- Doctors in practice 10-14 years are much more likely to be practicing in some form of multiple-DC practice (38 percent) and more likely to have a traditional single- or multiple-DC practice (48 percent and 38 percent, respectively).
- Doctors in practice for 25 years or more are the least likely to have a traditional multiple- or single-DC practice (66 percent), adopting other forms of revenue.
What Percentage of Revenue Is Derived From Third-Party Payers?
The other survey question we found interesting in understanding how DCs have adapted to the changing health care environment had to do with reliance on third-party payers:
- 9.7 percent of DCs said almost all of their revenue comes from third-party payers.
- 22.4 percent of DCs said about 75 percent of their revenue comes from third-party payers.
- 34.4 percent of DCs said about half of their revenue comes from third-party payers.
- 8.5 percent of DCs said about 25 percent of their revenue comes from third-party payers.
- 25.1 percent of DCs said less than 10 percent of their revenue comes from third-party payers.
As you can see, only about a third of the profession relies on third-party payers for most of their revenue. A quarter of DCs are essentially cash practitioners. As is the case with the correlation between practice experience and practice type, revenue source is related to the number of years in practice:
Practice Experience and Reliance on Third-Party Payers
- Doctors in practice for less than five years and those in practice for 5-9 years are much more likely to receive “almost all” of their revenue from third-party payers (43 percent and 45 percent, respectively).
- Doctors in practice for less than five years and those in practice for 5-9 years also are among those most likely to have cash practices, receiving less than 10 percent of their revenue from third-party payers (29 percent and 27 percent, respectively).
- Doctors in practice for 15-19 years are the least likely to depend on third-party payments, with more than three-quarters (76 percent) receiving half or less of their income from them.
Data Analysis: What's Trending
In looking at the data, a number of trends become clear. Almost three-quarters of chiropractors who have been practicing for less than 10 years participate in either third-party-payer-dependent practices or cash practices, with few in between. But after 15 years in practice, the percentage of doctors relying solely on third-party payers drops to less than 10 percent and is consistent from then on. Likewise, after 15 years in practice, the percentage of DCs with traditional practices drops from 86 percent (for those in practice for 10-14 years) to 66 percent (for those in practice for 25 years or more).
Doctors just starting out in practice have more choices than ever. Many are choosing integrated, interdisciplinary or specialized practices as a way to better provide their services. While many new DCs are beginning as cash practitioners, a larger number are almost entirely dependent on third-party payers. But the longer a doctor of chiropractic is in practice, the less they depend on third-party payers, and the more they seek to earn additional revenue from other services and products.
These trends are not altogether surprising, as they reflect the efforts of DCs across the country to adapt to the changing health care environment. Adaptation and innovation will likely continue to be important for success in the near future.
Click here for more information about Donald M. Petersen Jr., BS, HCD(hc), FICC(h), Publisher.