President's Opinion Poll

While practice management can be a very important factor in the doctor's success, I feel that a student would be much better off if he waited until after the pressures of completing the requirements of obtaining his diploma and passing the state board examinations have been relieved before signing a contract with a practice management consultant.

I feel that a new graduate should then take some practice management seminars and become familiar with a number of practice management consultant programs. The new doctor should discuss the various programs with practicing doctors, not just the super salesman and promotors of these programs. Then, before signing the contract, the new doctor should certainly consult with his financial advisors and with his own attorney to see what he is really getting into.

The new graduate needs to remember that there are ethical patient management consultants and there are unethical ones. It is a "buyer beware" situation.

C.S. Cleveland, Jr., President
Cleveland Chiropractic College
Los Angeles, California

In response to your request for an opinion on students signing contracts with practice management consultants, the following is provided:

Yes, under certain conditions, and with the student positioned to make an informed decision, a practice management relationship may serve as a valuable transition into private practice. Such an agreement should only be considered during the final trimester of chiropractic college and then only after careful evaluation.

This issue is complex and must be viewed in relation to specific internal and external factors impacting chiropractic education and the transition into private practice.

The Issue

Chiropractic college curricula are intense with specific requirements in basic sciences, diagnoses, techniques, radiology, and numerous other clinical subjects as mandated by the CCE and by various state boards. This leaves limited time in a program of four academic years for business and management related coursework to be part of the core curriculum. Students may only occasionally focus toward managing a practice until they realize that they must begin to prepare to become business people.

Graduates may have had no practical experience in interviewing, assessing skills and hiring staff, and limited knowledge of how to supervise or delegate to employees.

A student may intellectualize elements of practice management as they are presented at various points in the curriculum, but may internalize the elements of business only when confronted with the realities of starting a practice and applying management concepts.

The clinical experience in a college teaching clinic is, by its very nature and purpose, significantly different from the business aspects of private practice. For some students, a capable and experienced practice consultant may bridge the transition and prevent pitfalls in beginning a practice.

I. Timing

Most students are not ready for signing a practice management contract until the last term of the chiropractic curriculum and, therefore, should keep options open to allow for other opportunities. Binding agreements for practice consultation should be considered during the final term of chiropractic college at the earliest, and then only after careful analysis and comparison shopping.

II. Research the Options

The student must comparison shop the practice management marketplace. Examples of points to consider:

What is the consultant's overall performance record over time? Consider reputation, his principles of right and good conduct, ethics, and record of success.

Interview present and former clients. Are they satisfied? Would they renew the consulting relationship?

Is the consultant willing to share the risk with the new practitioner; i.e., will the consultant receive payment only out of the practitioner's future generated income?

Is the consultant's philosophy and style of practice compatible with the client's objectives?

Does the consulting agreement allow for application of monthly base expenditures, including office overhead, student loan repayment, and reasonable living allowance, to be subtracted from income prior to calculation of consultant's fee?

What is the nature of the cancellation clause? Is the agreement subject to the graduate's passing state and national boards and getting into practice?

Is arbitration provided for as a way to resolve differences without costly litigation?

Is the consultant's percentage subject to an amount capped annually, thus allowing the practitioner to calculate the maximum annual obligation?

What is the duration of the agreement? The agreement can always be renewed after one year if the consultant/client relationship is mutually beneficial.

Has the practitioner sought legal review of the agreement?

It goes without saying that there is no place in chiropractic for management programs that teach taking advantage of those suffering poor health by promoting unethical or fraudulent procedures.

III. An Informed Decision

Colleges must introduce students to business concepts at strategic points in the curriculum. Ideally, students should be exposed to a variety of practice approaches so that they can intelligently choose the path they will take. Many colleges have incorporated course work and programs into the curriculum to meet these needs.

At Cleveland Chiropractic College of Kansas City, for example, students must take several required courses that cover the doctor/patient relationship, patient management, patient and community education, legal aspects of patient and staff relationships, record keeping, insurance relations, office design and location, sources of business capital, tax management, and insurance and financial planning for sole proprietors, partnerships, and professional corporations. In addition, Visiting Lecture Series are held several times each trimester at which acknowledged practice management experts address students on these issues.

At Cleveland College, there are also elective business programs available, such as association with the members of the Business and Economics Club or the Public Education Organization, seminars offered at a discount to students through the Office of Postgraduate Education, and formal sharing sessions at which students draw on the expertise of successful alumni.

The piece de resistance in any program that prepares its graduates for the "real world" is an "on-the-job" experience such as that offered by the college's preceptorship program. Here, students work side-by-side with field doctors in all phases of successful practice. Students say preceptorships provide the ultimate stepping stone from the college to private practice.

All such offerings by the colleges, combined with the rich experience of working with patients in clinic, provide graduates with a foundation from which to make informed decisions of whether to utilize consulting services, and if so, which consultant service.

There is no doubt that consultants fill a need in certain cases. It is the responsibility of college leadership in this regard to strive to instill in students a commitment to service, based on moral principles of right and good conduct and the skills by which to make informed and intelligent choices.