Society of Chiropractic Management Consultants

Nearly every chiropractic, medical, dental, podiatric, and other health care publication has been active in the debate to define what is ethical in practice marketing. As a practice management consultant to chiropractors for 10 years, I have gained a vantage point in having relationship with more than 500 practices, which has helped in understanding and defining this issue.

Ethical concerns for every doctor regarding marketing for new patients are completely honorable and understandable. Until 1977, all doctors and many other licensed professionals such as attorneys, were restricted from advertising. Then a revolutionary decision by the United States Supreme Court (Bates) regarding advertising by attorneys marked the entry of all professions into consumer advertising.

The restrictions on physician advertising were breached three years later in 1980, not by the Supreme Court, but by the federal agency responsible for regulating trade and preventing antitrust and monopolistic practices in our economy, the Federal Trade Commission (FTC).

In a complaint against the American Medical Association, and a state and local medical association, the FTC found that the prohibitions upon physician advertising restrained trade and ordered them discontinued. Restrictions on physician advertising were ruled anticompetitive, depriving consumers of the right to choose their doctors in the same manner they choose other services, using the guidelines of quality, price, availability, and value.

Professional associations, however, continued to frown upon professionals attempting to disseminate advertising to the public to influence their choices.

Many of those brave physicians who attempted to advertise shortly after the FTC's decision found themselves before a hearing board defending their licenses and professional credentials on charges of unethical and unprofessional conduct. They found there were substantial intangible and internal professional obstacles to advertising. Regulatory boards publicly questioned the competence of physicians who advertised. It wasn't all that long ago that the yellow pages contained only listings of professionals -- seeing a photograph of your doctor was unconscionable!

But eventually, the FTC decision did take root. It soon began to change the way we thought about our professions, our professional associations, and fortunately or not, it changed the way many patients came to choose their health care providers.

Since the FTC's decision, economists and researchers in the field have indicated that physician advertising is providing many of the benefits that the FTC sought to introduce. In short, patients can now make an educated choice based on their perspectives which are influenced by the marketing that doctors undertake for their services.

For example, P. Feldstein, in his classic text on health care economics, theorized that physician advertising could actually lower the overall cost of health care (Health Care Economics, 3rd ed., New York, John Wiley and Sons, 1988).

The British government has already accepted this premise and is exploring ways to encourage physicians and hospitals to advertise so that the public can be more aware of and more educated about the services and specialties (H Johns, H Moser. An empirical analysis of consumer attitudes toward physician advertising, International Journal of Advertising, 1989, p.39).

As part of this study, 50 percent of the respondents expressed disagreement with a statement that physician advertising would be more deceptive than other forms of advertising. Fifty-three percent said they would not be suspicious of physicians who advertise, and 58 percent disagreed with a statement that advertising by physicians would only benefit the incompetents. "Consumers desire more information about the services of professionals and they feel that advertising by physicians could help them to learn about services and specialties of particular physicians," concluded the authors of the study.

Patients want chiropractors to educate them. This is seen again with similar results reported in another important study by S. Gould. His original purpose was to compare attitudes toward physician advertising with attitudes toward information by one's own physician. He was surprised when he found patients actually like both. (Physician professional opinion leadership and physician advertising: A consumer view, Journal of Health Marketing, 8(2):57, June 1988).

Gould noted: "Physicians who generally have been negative toward physician advertising should recognize that consumers tend to have more positive attitudes toward such advertising and express even more favorable attitudes toward physicians' personally provided information."

As a practice management consultant, I have personally found that the combined skills of effective advertising/marketing, and ongoing patient education, hold tremendous practice building power. This can clearly be seen by the growth in chiropractic, which in spite of its historic exclusion from the powerful medical establishment, has served more than 10 million Americans, according to the January 28, 1993 issue of the New England Journal of Medicine.

Another study, this time comparing both patients and nonpatients of specifically chiropractic services, was done in 1991 by F. Hekmat and K. Heischmidt. In their study, "A survey of customers and non-customers of chiropractic services," they found that chiropractic patients and nonchiropractic patients alike both welcomed DC advertising (Health Marketing Quarterly, 8(3):4, 1991).

Both groups indicated by strong margins that it was appropriate for chiropractors to advertise their services, and said their image of them would be improved as a result. Both patients and nonpatients liked seeing advertisements that provided office location, office hours and telephone numbers. The study also noted that nonpatients sought out information about acceptable methods of payment and the number of years the chiropractor had been in practice.

What's more, chiropractic marketing and ongoing patient education, combined with real, ongoing, and tangible evidence of chiropractic efficacy, has even enabled chiropractic to make significant inroads into areas traditionally considered to be the provinces of the general practitioner.

According to a 1991 study by N. Hanna, A. Kizilbash, and J. Wagle, "The chiropractic market segment: A viable opportunity for MDs?" (Health Marketing Quarterly, 9(1):2, 1991), a large group of patients said they would first see a chiropractor for back problems and muscular spasms. And a sizable number said they would see a chiropractor for other so-called medical problems, including circulatory problems, headaches, dizziness, and glandular and digestive problems -- all of which are traditionally the primary domain of MDs.

Have a look at the statistics from this study:

Patients were asked:

Yet with all these facts and figures, many chiropractors remain fearful that the use of advertising runs a large risk of impairing their reputations. Pressured between more and more chiropractors opening up nearby, and mountains of debt, many chiropractors have been forced into the position of learning how to more skillfully market themselves or vanish.

The fact remains that chiropractic produces results, often safer and more effectively than the alternatives. Effective advertising and marketing helps to attract more patients in less time. This in turn helps you to build your practice faster and help more people with the gift of knowledge and skill you have been blessed with.

With the future of the entire health care industry in question, effective marketing and advertising can help you to survive the coming "squeeze play" of the competing health care plans and physicians through "differentiation." This is what has a prospective patient know why your practice is unique -- unique enough to go outside a present or future managed care network and pay out of pocket for your services.

It is time to gain the skills necessary to educate your patients better and more thoroughly than ever before. And it is time to invest in the business skills you will need to manage and market yourself effectively and securely as the future unfolds. A good practice management consultant should possess the skills necessary to help you in this endeavor.

I believe marketing can be done tastefully, inexpensively, and provide a powerful impact for your practice. The key is to have the skills and experience to know what will work tastefully and ethically, even when all else has failed.

Brian Koslow
President, Koslow Practice Management, Inc.