Certainly any informed doctor of chiropractic is aware of the serious threat that is facing the chiropractic profession today. Without question, some of the major problems include the following:
Certainly, if you do care about the growth of your profession and its exposure to the public (new patients); saving lives; improving the quality of the lives of the people you serve; and establishing a secure foundation for your profession within the insurance and managed care arena, then, unequivocally, the eight problems above are acutely critical to you.
Indubitably, for some of us our individual occupational survival will not be threatened, but our professional freedoms as we know them today may drastically change; we will become an impotent player in the health care industry if this professional dilemma is not solved. Granted the causes are complex, but they can be eliminated and the problems can be solved -- hopefully within this decade.
We seem to be a profession without identity. Look at the Yellow Page advertisements offered by chiropractors. Many of these are not only a "joke," but are disgusting. Often the message appears to demonstrate to the observer that chiropractic or the chiropractor is a "financial counselor" and says nothing about the services they provide. If these ads are demonstrating what chiropractors think chiropractic is, then surely this is the communication the public will believe chiropractic is.
We must keep in mind that as long as the majority of the profession holds to the treatment of functional, self-limiting sprains and strains focused solely on caring for non-life threatening conditions, our discipline will be observed by both private and governmental health agencies, and the scientific community as merely a non-essential "step child to medicine." Can you imagine the difficulty in attempting to convince the officers of a health maintenance organization, or the people directing the Department of Health and Human Services in Washington, D.C., that our profession is capable of primary care, that we are responsible physicians, and that we can diagnose serious disease when, in fact, the evidence does not support the claim. The evidence being, those several thousand chiropractic claim forms submitted weekly that show less than 10 percent of the total services billed are diagnostic, with less than two percent exhibiting blood tests of any type. Admittedly, because the chiropractic adjustment is the fundamental mode of service, it inherently becomes a treatment-oriented discipline. For this reason, often 90 percent of the total revenues earned by the chiropractor is for therapeutic service alone.
Of course, there are several components that are necessary for survival in the "third-party" system. Some include: improved diagnostic skills; better communication with the insurance carriers; sensitive and caring attitudes; empathy; disease prevention focus (especially with cardiovascular disease); generation of a lifetime patient base; patient education; better industrial relations; demonstration of accountability to patients; to the public; and to the insurance and governmental agencies. Many of the solutions to difficult and tough third-party issues reside in clinical skills, diagnosis, clinical documentation, and professional accountability.
Why does our profession see such a small population of people? I believe the answer is that the general public, in most instances, does not equate our services with full-body diagnosis, and for that reason they are very selective and hesitant to seek early chiropractic care. The potential patient is fearful that we may overlook a serious health problem since our emphasis appears to be solely on the back and not the whole body. Many people who have received chiropractic care and benefited, often again return to medical therapy when another similar problem returns, rather than returning to the chiropractic physician that helped them in the past.
Not infrequently, practice management consultants state that the "life blood" of a chiropractic practice is new patients. I would agree if it is the doctor's first year in practice, however, this should not be true in a practice that has been established over four or five years.
Many businesses and large corporations like IBM and AT&T claim that the established client or customer is three to five times as valuable as a new customer. The reason many doctors must constantly "hustle" new patients is that they simply can't keep the patients they already have. Its tragic indeed, but most DCs fail to keep a solid active patient base. If you don't believe this is true go back three years to your patient record list. Count the number of individual patients you treated at least one visit during a one-year period, three years ago. Now, review your patient treatment list over the past six months. See how many of these people that you treated three years ago you have seen at least one time during the past six months.
If you are not maintaining a minimum patient return of at least 50 percent, then you definitely are not building a practice. The ideal return is over 70 percent. Hopefully, you are one of the minority that is retaining over 50 percent of new patient production. Some doctors that have been in business 15 years have never learned to build a functional viable patient base and are merely repeating their first year in practice 15 times, i.e., they are depending essentially on new patients year after year for their livelihood.
Though our percentage is small, many in our profession believe that chiropractic will never be competent to significantly compete as a primary care health profession until we can diagnose to the degree that we can determine the potential state and seriousness of the patient's overall health problem. Continuing to merely limit chiropractic diagnosis to differentiating musculoskeletal symptoms may be very detrimental to our profession's future. So damaging, in fact, that it may result in the requirement that a person with an insurance plan must first be examined by a medical doctor (the gatekeeper) before they are allowed to seek the services of a chiropractor. This could happen!
R. Michael Cessna, D.C., D.A.B.C.I.
Tuscon, Arizona
When sports chiropractors first appeared at the Olympic Games in the 1980s, it was alongside individual athletes who had experienced the benefits of chiropractic care in their training and recovery processes at home. Fast forward to Paris 2024, where chiropractic care was available in the polyclinic for all athletes, and the attitude has now evolved to recognize that “every athlete deserves access to sports chiropractic."
It is estimated that 61% of patients with CTS avoid taking surgical options due to postoperative complications and costly surgical procedures. Chiropractic care offers a comprehensive and effective treatment for carpal tunnel syndrome, addressing the condition from multiple angles. Recent studies also have unveiled a game-changing adjunct to chiropractic treatments for CTS: nerve flossing.
Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
