At a recent convocation attended by chiropractic educators, college presidents, international consultants and movers and shakers in the profession, several things became apparent:
- that in the opinion of the majority of those present, chiropractic will continue to work and integrate with the rest of the health care systems. The majority believe that we should and would retain our identity. Only two felt that we should be working towards becoming LIKE medical doctors.
- that some attendees thought times were tough, things were bad, and our slice of the pie was so small that we needed to stop graduating so many chiropractors, because we were flooding the market.
Some would call it apathy and some negativism: the bemoaning of hard times, lower payments, excessive reduction of care parameters, and the exclusion of chiropractic in many of the managed care programs.
One doctor got up and told a story of how his practice was down over 30 percent in the past several years, even though he was using some of the more nationally famous patient brochures and booklets. He said that they don't work and wanted to know what we were going to do. The doctor in question had been in practice for over 30 years. Another doctor bemoaned the fact that if only the two national associations could quit bickering and get together, things would be better. How convenient to blame others for our own failures. The next day, while hashing out "what was wrong with the profession," one or two others commented that what we needed was a national promotion of chiropractic. That this would help bring more patients into the chiropractor's office. Remember, these are the educators and the high rollers. How to pay for this? "Some of the chiropractors in my area are spending too much money on yellow page ads, if they would just stop we could promote and do advertising on a state-wide basis." Other suggestions were that there are too many chiropractors, maybe we should cut down, or restrict the number of students accepted to chiropractic colleges. Once again our slice of the pie is "so small" that we must not continue to increase our numbers or the share will become smaller and smaller.
Throughout the day another thing was heard time and time again: "market share." An internationally known person got up and said, "It doesn't matter how you practice as long as you give the market place what it wants. I don't think you should use drugs because that is not the public's perception of chiropractic, and it goes against the core of chiropractic's belief, but if the public wants drugs maybe we should give drugs." Don't forget that these are people who are all fairly well respected. Throughout the meeting it occurred to me that no one talked about taking care of the patients. No one mentioned expanding your practice by offering affordable fees, that the reason you're a doctor in the first place is to help care for the health needs of the public.
Are we teaching the wrong thing in our colleges? Are some of them teaching only the economics of chiropractic practice?
Once again during this meeting having "passion and enthusiasm" was ridiculed -- passion for the patient and passion for the profession! Can you image? Can you be overly passionate about your profession? Of course, the person who was condemning the passion was the person who was also talking about "too many chiropractors" and that we needed to restrict chiropractic college entrance.
On my flight home I felt that whatever problems chiropractic has are not the result of the two national associations failing to join together. The two national associations realistically only represent, on a full time basis slightly over 20 percent of the doctors of chiropractic in the U.S. That means the apathy among the other 80 percent is real and true. It is about time we stop blaming the two national associations for everything that is wrong and start blaming the 80 percent that belong to nothing! Maybe we should start wearing badges on our sleeves to denote who belongs and supports. Let's show the profession who really means what they say. You know, sometimes it's easy to love despair.
As to criticizing people who advertise in the yellow pages, maybe that person who is advertising needs to think that they are, at least, doing something. They are participating, and taking some kind of action -- isn't that what success is all about? The person criticizing them was not trying to get the other 95 percent of chiropractor who don't do any type of advertising to help foot the bill, but rather to get the ones who are active to change their methods so he wouldn't have to do anything himself. This is typical of many chiropractors in our profession.
Some of the doctors who spoke out against the "dwindling slice of the pie" would have shocked you: their statements agreed with the mainstream. If we only take care of 12 to 15 percent of the population, there is 85 percent left and the only way to reach the other 85 percent is to continue to promote chiropractic on the local level as well as a national level. Go out and tell the chiropractic story, show people that chiropractic works, and provide $25 worth of service for every $20 we charge. Maybe we need to charge the schools with doing a better job not only academically but morally in their responsibility in responsibility towards patients. We already know that our national associations are not doing the job that they could be doing even with the resources that they have (which are meager at best). God only knows what they can do if we had a 90 percent membership rate!
Most of the fears that seem real to most DCs come from the pocketbook and from the inability to get up and take action. Of course managed care plans (HMO, PPO, etc.) are excluding chiropractic -- so what?! Two things need to be done: 1) band together and force them to include chiropractic with a "any willing provider law" in your state. If nothing else it will give you something to fight for and it will be a good battle! 2) Start your own managed care organization. Tell patients that we will work with fees and if they don't have the finances to come in for chiropractic care that we will set fees that they can afford. Tell them about the wonderful things chiropractic can do for them; brag about the recent studies that have come out; support chiropractic research on a national and a college level, but remember research is only one of the tools needed for a successful chiropractic profession.
Don't wait for others to do things for you, don't wait for national associations to act; don't wait for your state association to act; just do it yourself! Don't wait to be "in the mood" to begin, just do it. Start to realize that it is time to stop talking, stop reading all the self-help books, and to start taking action. Research supports the fact that the fastest way to change how you think or feel about something is to take action. Once you do something -- anything about the situation that your are in -- notice that you immediately feel better. Never waste time convincing yourself that whatever you tried to do "should have worked," but it didn't. Remember if it works, keep doing it and if not, change it. If it's not working, do something else.
Keep moving forward: never stop; keep your eye on the goal; whatever the goal is, don't stop once you start. Stopping causes you to concentrate on all the small things that stand in your way; all the little things that keep you from accomplishing your goals. Don't say, "Tomorrow morning I am going to start." Do it now, and expect success. Get rid of the apathy that stops you from doing what you should be doing. Demand better, and call your state or national association and say, "Get on the stick!" Write your colleges, include a check, and tell them there will be more of this, the more that you see them doing what you want them to do.
We won't wind up with too many chiropractors and too few patients if all the chiropractors in the field start doing their jobs, all of us, not just a few. There is no excuse, it doesn't matter who you like and don't like, nor where you graduated from, how old/young you are, what sex you are, what color you are. If you are not getting up in the morning excited, look within yourself to find out why and do something about it! Refuse to blame others; refuse to blame your circumstances. Just do it!
John Hofmann, DC, FICA
Allen Park, Michigan
