Cooks and Chiropractors

I always enjoy speaking to chiropractic students. Since I authored a textbook, The Path to Mastery in Chiropractic, many have come by my office to visit, others send me e-mail or faxes and, on a few occasions, I've had the opportunity to speak at seminars and colleges. Their eager faces and youthful enthusiasm makes me believe our profession is in good hands. More bright students today are enrolled in chiropractic colleges than ever before. For the most part, standards are improving and the quality of young novices is at an all-time high.

It's a new world we're facing in chiropractic and these young DCs face more challenges than ever before in the century of our profession. Changing technology, more clinical studies, better clinical techniques and managed care rule the day. The monsters of MCOs, HMOs, PPOs and other beasts of Wall St. await their new prey graduating from health professional schools. While students are leaving their collegiate nests well stocked in their educated minds, their business minds are still elementary at best. I recall my disastrous first year in practice when I grossed $10,500 and netted a minus $52 even though I had graduated with honors. Quite a predicament for an overachiever like myself, and one that still faces every graduate.

So when I speak to these new graduates, my message is clear: It's time for the cooks to learn how to operate their restaurants. For four long years, these students have learned the many facets of the human body and have been taught the numerous methods of spinal adjustments. To me, it's equivalent to cooking school where their students have learned the many ways of food preparation and recipes.

Unfortunately, whenever I speak to students or when they stop by, the first question most ask is simply: "What technique do you use?" It's to be expected since their professional education and technique seminars place so much emphasis on spinal analysis and adjusting methods. But their long-term success will have less to do with their adjusting methods as much as it will do to their business acumen, a subject that is, at best, poorly taught at most chiropractic colleges. Indeed, while these student "cooks" may have plenty of "recipes," few know how to operate their "restaurants."

Recently I was asked by the career development program instructor, Mr. Fred Zuccala, at the beautiful New York Chiropractic College in upstate New York, to speak to their graduating seniors. It was a great opportunity to discuss with these eager students the challenges that await them all as professionals. My first question to them was: "How many of you are planning on opening up your own office?" Of the approximately 100 students, perhaps 90% raised their hand. My second question was: "How many of you have $50,000 cash or collateral to open your office?" One hand was raised (probably the child of a DC). My third question was: "How many of you know what 'cash flow' means?" Two hands went up.

"So," I told them, "here's your average situation: You're $80,000 to $100,000 in student loan debt, you still have your personal overhead costs of one to two thousand dollars each month, you don't have any money or collateral to finance your own office, you don't know what a simple business term like 'cash flow' means, and yet you think you're going to open your own office? Good luck!"

Needless to say, I got a lot of sour looks from the audience of students. My intent was not to rain on their dreams, but I'm certain that may have happened. My goal was to illustrate to them the dire situation they all face entering the health care marketplace without proper preparation.

To me, it's equivalent to a bunch of cooks who are clueless as to how to operate a restaurant. While they all may be excellent cooks with great recipes, few had any idea how to operate their business. Even associating with field doctors, for the most part, is simply a matter of the blind leading the blind. It's a sad situation when students may graduate with honors only to fail in business because no one taught them how to run a professional office.

McDonald's restaurants have proven that you can be the worst cook in the nation and still sell a lot of hamburgers if you have an effective operating system. While their food may be the most fattening, gut-wrenching products ever sold, their skill at management and marketing has proven the value of an effective, turn-key business operating system. No one questions McDonald's success at running a business despite their poor quality food. Just think what impact McDonald's could have had if they had decided initially to cook good food rather than junk food. Instead of a nation of obesity, America might have been a much healthier country.

Whether or not you're cooking American junk food, Chinese, Italian or Mexican, the ultimate key is not in the recipes as much as it rests with your business operating system. The real challenge every DC faces has less to do with their technique as much as it does with how well they operate their offices, and this is where our profession is terribly lacking. Few students and field doctors are astute about running their restaurants as much as they are still mistakenly focused on their recipes.

And this lack of business acumen has opened the door to many unpleasant situations such as the proliferation of quick-fix schemes: "free spinal exams," "free chicken dinners," and the influx of cultism into our profession. The "Let's Make a Deal" mentality permeates our profession with discount prices, NOOPE, and free services that are only found in the chiropractic profession. Dr. Richard Tyler, better known by his pen name "RHT" as former associate editor of Dynamic Chiropractic, told me of the time a new patient phoned his office seeking free care, "What do you give away?" When he told her nothing was free in his office, she couldn't believe it because she had already gotten over a year's worth of free care going from one DC to the next DC in the same area.

When was the last time you've seen an orthopedist giving free spinal exams? When have you seen a dentist giving free chicken dinners? Why is it some chiropractors give away their services, degrading the entire profession and demeaning their own image and, when confronted by those DCs who refuse to give away their services, they become quite defensive when questioned about their unethical actions? Only in chiropractic do we have this charade. And we wonder why the public and medical profession holds us in such low esteem? Go figure.

Only in our profession do we not only tolerate such questionable tactics, but many fight hard and long to protect their right to embarrass our profession. Some stand behind the guise of "serving for the sake of serving," while they give their services away, telling the rest of us that their mission is to make chiropractic "amendable to the masses." Some who subscribe to the "greed is good" mentality simply laugh at any altruistic motive while they sing the money hum all the way to the bank. Many DCs simply don't know how to build a practice with sound management and smart marketing, and thus fall prey to the unscrupulous practice management firms that teach the short-cuts to financial success, all the while degrading our profession's image in their quest for excess.

Even the most well-prepared students and experienced DCs have now encountered another stress that is taxing their business acumen unlike ever before: managed care. Limitations on length of care, exclusions, IMEs, lowered revenues for services and the increased competition from some chiropractic diploma mills who are flooding the marketplace with graduates looking more for excess than excellence. Some experts speaking at the centennial celebration believe 25% of all DCs will be unemployed by the turn of the century. Indeed, the future for chiropractic seems like risky business for most and, certainly for the novice "cooks" who are clueless about running the "restaurants," their professional dream may end up a nightmare.

Even legitimate groups within our profession who seek solutions to this downward trend in the chiropractic business have stooped to promoting marketing "gurus" to teach DCs how to operate their offices. Whether it's Jay Abraham, Tony Robbins, or Zig Ziglar, I doubt they will help the majority of DCs who are looking more for an effective operating system than the "magic bullet" in advertising or the "stay happy" philosophy. I believe the answer to chiropractic's business is not teaching more "recipes," but it rests with teaching better business methods that are fundamental to every business, and those that are unique to our profession. Can you imagine having such notables as Tom Peters, Stephen Covey, Michael Gerber and Michael Vance teaching DCs the ropes of excellent corporations? Can you imagine inviting successful ethical DCs to teach their brand of mastery rather than listening to the "high-volume" rhetoric of those who have built practices on the smoke and mirrors methods.

Although the state associations historically have had an antipathy toward practice management seminars, and for good reasons, I might add, I believe the time has come for every state to sponsor a week-long "boot camp" for new professionals. Teach them the particular laws in each state; invite successful practitioners to speak; give new DCs a skeletal operating system; familiarize them with MCOs and insurance laws; supply them with an effective marketing campaign so they won't have to resort to gimmicks; and most of all, give them the leadership they will need to make a success in our field. Rather than turning our graduates out cold from their colleges only to fall prey to the innatists, the cultists and the free chicken dinner advocates, let's give them a legitimate and effective business plan that will help them survive in these trying times. Let's teach the cooks how to run the restaurants.

J.C. Smith, DC