In Defense of Practice Management
Dear Editor:
I appreciated and agreed with much in Michael Anderson's article which appeared in the June 20 issue of Dynamic Chiropractic, and which was entitled "Are was entitled, "Are Practice Consultants BAD for Chiropractic?." Dynamic Chiropractic continues to provide a useful forum for the exchange of views. I take issue, however, with the letter to the editor from "Name withheld by request" which appeared in the same issue, and which mentioned Sterling Management Systems, in passing. The author seemed to say that management consultants are using canned, old-time methods which have been around chiropractic for years. He refers, also, to carnival activities which are allegedly ruining the professional image of chiropractic and financially ruining chiropractors.
I can't speak for other practice management companies, but Sterling establishes effective marketing techniques by survey, keeping the good ones and discarding the bad. Whether these methods turn out to be old or new is irrelevant -- they are definitely relevant if they work. What's more, Sterling teaches its doctors and their staffs how to do these surveys themselves, so they can direct their own marketing strategy and tactics. After all, they will not always have their consultant around to tell them how to proceed.
What comes out of properly done surveys are effective marketing campaigns geared to each individual practice. Nevertheless, your readers should take note, though, that marketing tactics can not ignore public relations. PR should be taken into account in every marketing campaign so as not to create an unfavorable image for chiropractic or the chiropractor. Any practice management consultant should be very well versed in public relations as an adjunct to marketing. The smart chiropractor should ask searching questions about the practice management consultant's or company's expertise in public relations, as well as surveys and marketing, before signing up in practice management program.
Lawrence Wiley
Glendale, California
Shame on PMA -- Again!Dear Editor:
I've been reading, with great interest, of PMA's questionable policies and the ruthless manner in which fellow doctors have been treated by a leader in our own profession. Certainly, stepping on each other is no way to progress.
It is time for me to tell my story. In late March, the sheriff served a summons at my home to appear in Pinellas County district court. I had signed a Practice Starter contract in March, 1988, to help me open an office in Boston. I spent over $2,000 attending five seminars and decided I couldn't practice the PMA way.
Why did I sign? I was 41-years-old and gave up a successful career before starting over in chiropractic. I graduated from Life College in March, 1987, and went about passing state licensures. I associated with a New York chiropractor for three months and had a terrible experience. I worked at a chiropractor's front desk in Atlanta for the next six months taking state exams and wondering how and where to practice. I was more than $50,000 in debt. I was frightened and desperate at that first PMA seminar. I was easy prey. They promised the inside secrets, a proven formula for success and motivational support. I had to see what was on the other side of the door in those lectures. I couldn't attend unless I signed -- I signed. I made a big mistake. There was nothing new -- nothing in the five seminars that I attended that I hadn't learned at Life College where, as I belatedly recalled, I had been warned not to sign up for emotional reasons. I was hypnotized by the size and smoothness of the group and frightened by my inexperince, lack of contacts, and a big sophisticated city start up.
My five seminars over four months included how to testify in court, how to stretch the first visit into three visits to build income and "patient loyalty", how to bill insurance for maximum payment, how to advertise, how to take the routine initial sreening x-ray, and other practices which I consider unethical and unnecessary. I obtained a lawyer and rescinded my contract in writing and asked for a settlement for the five seminars. I sent back my manuals and notes. I never used PMA personnel in any way. I was told that PMA wouldn't start working on my new practice until I passed the Massachusetts licensure exam; I didn't pass.
In July 1988, I associated with Dr. John Bandy in Blowing Rock, North Carolina, and in June 1989, I bought his practice. I practice now in a manner that I consider ethical, effective, and progressive. I have a cash practice (no insurance), low overhead, no advertising, and I spend 20 minutes with each patient. All this is very different from PMA advice -- just the opposite!
How can PMA ethically claim I owe them anything more than a fee for the five seminars? They want me to pay $2,000 a month for two years or more for contract breech. Do I have to fight with this chiropractic organization for my economic survival? I need your help! If you think there is an injustice here or would like more information on my situation and other doctors facing litigation with PMA, or on PMA practices, please contact my Florida lawyer at the following address:
Jean Simmons
Simons & Seeley
4300 Duhme Road, Suite 302
Madiera Beach, FL 33708
(813) 393-7988
If you are in a similar situation, please consider joining me in this fight against heavy-armed chiro-lawyers preying on our own profession. Contracts should not be allowed to be written on gross income. Students and graduates without state licensure should not be allowed to sign up for Practice Starters. Practice management firms should not be able to sponsor scholarships, research, or otherwise influence funding at the college level. A lengthy recindment period, in sync with services delivered, should be universally adopted, and a responsible fee for services delivered stance should be enforced by the profession.
David B. Dauphine, D.C.
Blowing Rock, North Carolina
L-Tryptophan -- the Debate ContinuesDear Editor:
In the June 20, 1990 edition of Dynamic Chiropractic, a doctor writes about the FDA's recent ban of L-Tryptophan supplements. His letter showed a disregard for the facts, a lack of compassion for esoinophilia myalgia victims, and a paranoia of the FDA.
There have been over 20 deaths, as well as thousands of severely pain-ridden patients as a direct result of consumption of L-Tryptophan supplements. If the FDA had not taken relatively fast action, even more deaths and greater morbidity would have resulted. The FDA took the only rational position given the fast-growing body of statistics.
Yes, it is true that the amino acid itself was not the culprit, but rather a contaminant in the manufacturing process caused the EMS, a completely new blood pathology (as opposed to a "rare" blood disorder). Concerning the adulterated L-Tryptophan product, the letter writer states, "It is puzzling to me that this information never made any of the news reports or summaries that I could find." Apparently, he didn't look too far. This issue was discussed in Morbidity and Mortality Weekly Report, Harvard Medical School Health Letter, Medical World News, P.T. Bulletin, etc.
The FDA is not perfect by any means. However, in this situation, it is hard to imagine that any reasonable person could conclude that there is "some sort of conspiracy by the FDA and the pharmaceutical industry" regarding the recall of L-Tryptophan supplements. Perhaps if one is paranoid, everything looks like a conspiracy. I long for the day that our profession is able to examine issues with an intelligent review of the facts instead of a temper tantrum against some imagined enemy.
Robert J. Bryla, D.C., P.T.
Utica, New York
"Mindless Mysticism?" -- A response.Dear Editor:
In the June 20, 1990 issue of Dynamic Chiropractic, Dr. Ralph Cinque writes that because the division between the different areas of the spine only exist in our mind, different homeopathic remedies should not be necessary to treat these different areas. This is the basis for his argument that homeopathy is "mindless mysticism."
Perhaps what he means is that the theory supporting it is mindless, since the theory is irrational. From the scientist's perspective, since favorable results are sometimes obtained due to the placebo effect, it could only be classified as "mindful mysticism." Since this is the only rational explanation of how homeopathy works, it stands to reason that because we make these spinal divisions in our mind/imagination, that's where the homeopathic remedy must work. For this reason, it is necessary to have different remedies for different areas of the spine, or at least make the patient believe there are.
With all the discussion about practice management companies lately, it should be pointed out that having more remedies to sell the patient, the more money the doctor can make.
Randall B. Lord, D.C.
Shreveport, Louisiana
The Anti-Chiropractic Paper TrailDear Editor:
Three points in regard to the Prevention Magazine article by Dr. John C. Lowe, June 20, 1990 issue of Dynamic Chiropractic:
- Every chiropractic college library and chiropractic office should have access to the book The Social Transformation of American Medicine, by Paul Starr. This was the 1984 Pulitzer Prize winner for general non-fiction. It is a historical account of the shocking rise of American medical doctors to the status of "dieties." The pathogenesis of the relationship between the AMA, their various publications, and the drug manufacturers is described. Since its beginning, the AMA has extracted enormous sums of money for advertising by drug firms, and that money has translated into enormous power.
- The name John Renner, M.D., should set off alarms for every DC in the country. Dr. Renner was the "medical writer" for the Kansas City, (Missouri) Star/Times newspaper. He wrote many anti-chiropractic articles for the Star, which to this day maintains an anti-chiropractic philosophy. Gary Null, author of the series Medical Genocide, The War On Chiropractic, has some less than complimentary information on Dr. Renner. Dr. Renner has one or more skeletons in his medical practice closet -- no pun intended. Dr. Renner is also affiliated with the new National Committee on Quackery. He also has some sort of information-sharing relationship with a Kansas City area DC who dislikes his own profession, is an insurance consultant, and was a chiropractic college faculty member.
- This is my personal theory: The AMA is continuing their efforts to destroy chiropractic. They made mistakes, they are too open in their attacks, and they left a "paper trail" resulting in the Wilks victory. But that was only one battle; they have not lost the war. It is not coincidental that so many anti-chiropractic articles are appearing in so many and such diverse publications, from popular health magazines to company newspapers; and individual state medical boards filing suits and/or promoting anti-chiropractic legislation. Information favorable to chiropractic is suppressed. I have yet to read any stories about the DCs who treated the 49ers during Super Bowl. The current medical writer for the Kansas City Star newspaper just authored his fourth article in nine months on the same story about a Missouri chiropractor who plead nolo contendere to Medicare fraud charges.
We had better start collecting evidence now, in preparation for the next round of courtroom battles. I would suggest a computerized clearing house of media and legislative attacks on chiropractic. As has been said so many times before, chiropractors fighting their colleagues aids only the enemy, not this profession.
Gerald W. Howe, D.C.
Eldon, Missouri
It's Time to Adopt Stronger LawsDear Editor:
In response to Dr. Strasser's interview, July 4, 1990 issue of Dynamic Chiropractic concerning the recent workers' compensation changes in Oregon, I feel it is necessary to comment on several issues.
I disagree with Dr. Strasser's assessment that SAIF won "---because greed and incompetence fed the existing prejudice against chiropractic, and we ran out of friends---" When are we, as a group, going to start taking control of our profession and stop blaming others for what happens? If, as Dr. Strasser states, this had been brewing for 10 to 15 years, what did the Oregon State Board do to curtail these abuses? In Kentucky, we have established uniform fees for all workers' compensation claims with peer review by accredited reviewers to act on alleged fraud cases.
We also must establish a uniform scope of practice that is consistent from state to state. As a chiropractor, I treat vertebral subluxations only; I do not treat strains (not this straight vs. mixer stuff again) as does Dr. Strasser. I also use modalities where indicated. Until we establish a uniform scope, the profession will continually be compared to the medical profession with its short-term (5 to 10 visits?) crisis-oriented approach to health care.
For chiropractors to continue offering true health care through life-long adjustments to the public, we must adopt state laws with teeth to manage unethical practices, and we must become a united force capable of controlling our own destiny.
I agree with your assessment in "Report of My Findings" in the same issue that states "---until we can satisfactorily demonstrate competence in policing ourselves, the abusers creating these problems will continue to 'load the weapons' that kill off the profession. I suggest we include, as loaded weapons, weak state laws and/or board members, short-term pain relief advertising, and a lack of professional unity.
It's time to stop whining and start acting.
Larry R. Smith, D.C.
Lexingtron, Kentucky
Live and Let Die -- Then CryDear Editor:
Why have we waited so long to see the ACA, the ICA, etc., put its dollars to work in an all-out, twenty-four hour a day national education television campaign for chiropractic.
Isn't it about time that we, as an entire profession, treat 100 percent of the population instead of bickering over a mere small 20 percent. The simple truth is that we would rather spend our money in a very self-centered way. We would rather promote ourselves than educate the entire population and promote chiropractic.
Why are we foolishly spending our dollars to make marketing and management firms rich, while all they do is teach us to prostitute ourselves to 90 percent of the population in order to seduce 10 percent of the population? Why should our profession stoop to such tactics as knocking on doors? Does your internist or gynecologist knock on doors? "Excuse me, we are giving a special on Pap smears and breast palpations this week." If you don't respect yourselves or your profession, at least don't make it bad for the rest of us. We are all motivated by fear and desire and we all desire the finer things in life, however, enough is enough.
It is now time to get the ACA and ICA, together or separate, to promote us -- not the management firms.
At the last several state conventions I have attended, there were several practice management firms. Who is promoting them? We need to promote the profession on a much more dynamic scale before we lose our ground and respect through embarrassing tactics.
We must stand firm, become less self-centered, and demand the ACA and ICA to promote chiropractic. You are an important voice, so please be heard. If it costs us all an extra $25 a month, what is that? (It's less than the cost of one x-ray.) Would one new patient a month pay for it? Do not let this thought dies.
Please sign and forward to both associations listed below.
Yes, I am interested in a national television campaign to promote chiropractic.
International Chiropractors' Association
PO Box 10315
Arlington, Texas 22210-1315
American Chiropractic Association
1701 Clarendon Blvd.
Arlington, Virginia 22209
Signature __________________________________
Richard M. Powers, D.C., P.A., D.N.B.C.E.
