Chiropractic Care: A Dying Profession?

Remember the good ol' days? We would see 40 to 50 patients each and every day, workers' compensation cases drove much of our workload, and we were even getting paid a decent amount by the health insurance companies. What a good life!

Well, as the saying goes, we're not in Kansas anymore. The chiropractic profession has changed dramatically over the past 15 years. The days of glory are gone while most of us struggle just to survive. What has caused this demise? It's a combination of things:

• the ACOEM (American College of Occupational and Environmental Medicine) 2004 Guidelines, which basically state that chiropractic care is not a solid avenue to take for rehabilitation;
• health insurance companies cutting benefits and co-pays while simultaneously delaying payments to chiropractors;
• third-party administrators further cutting the "customary and reasonable fees" paid to chiropractors;
• attorneys cutting personal-injury bills by 50 percent;
• tightening of workers' compensation laws; and
• escalating costs of health insurance paid by companies and individuals.

What's particularly disturbing about all this is that we should be experiencing a major "boom" in business, because baby boomers continue to make up a larger part of the population, which means the median age of people in the U.S. is increasing. This aging population should be creating the need for more chiropractic care, not less.

So, should we just pack it in and move to the Bahamas? Absolutely not. There's a better way to run your business and stay true to your profession while also providing better care to your patients. What's the secret? In my opinion, the answer is integrative medicine (IM), better known as anti-aging. IM will not only help you survive, but also will help you revive your practice.

In this series of articles, I will attempt to provide a solution for the typical chiropractor's business in terms of adding services to complement the practice. In this article, I will provide an overview of the services you can add to your practice. Subsequent articles in this series will detail each additional service by providing an in-depth look at the topic along with examples to illustrate the point.

Integrative medicine is a holistic approach to patient care. It recognizes, as described by the American Association of Integrative Medicine, that health is more than just an absence of disease. Integrative medicine combines the discipline of modern science with the wisdom of ancient healing. For people living with chronic or life-threatening illness, it can transform the physical, emotional and spiritual dimensions of their lives. Integrative medicine also might be valuable to those who are not ill, but who wish to increase their self-awareness, enhance overall well-being, and prevent health-related problems.¹

In treating disease, complementary therapies are not substitutes for mainstream medical care. They are used in concert with medical treatment to help alleviate stress, reduce pain and anxiety, manage symptoms and promote a feeling of overall well-being. Integrative medicine has a number of "patient-friendly" solutions, including:

Support

We are not alone. The American Academy of Anti-Aging Medicine (A4M) has been supporting the integrative medicine movement for the past 15 years. The A4M provides excellent educational conferences for chiropractors geared toward the various alternative services available to integrate IM into your practice. In addition, it has a diplomate and a fellowship credential that will further your education in the field of IM. You can contact the A4M via its Web site: www.worldhealth.net.

Education

We need to stay abreast of the latest and greatest in not only our own chiropractic field, but also in the fields of nutrition, exercise and integrative medicine (including anti-aging and hormone therapy). We also need to provide training and education to our patients so they can make more educated decisions about their health and wellness.

Nutritional and Dietary Evaluations

This service simply provides patients with a sound diet and meal plan to follow. If Jenny Craig can do it, why can't we? It's been said that diet accounts for 80 percent of the battle for health and fitness, so providing your patients with a reasonable diet to follow surely will make a difference to their overall health and well-being. Again, when used in conjunction with exercise and supplementation, this service attacks health from the inside.

Supplementation

During this era of processed and microwavable food, the likelihood that your patients are getting sufficient nutrition from their daily intake of food is low. Based upon the laboratory testing and analysis you perform, you can suggest a daily regimen of vitamins and minerals to add to their diet. Studies have shown the positive effect that a multivitamin and a B complex have on total body chemistry.

Exercise Programs

Offering your patients a glimpse into proper exercise, this service simply puts together an exercise plan that consists of both cardio and weight training. The idea here is to give your patients a step-by-step exercise plan that makes going to the gym simple and fun.

Laboratory Testing and Analysis

This process consists of testing blood, urine, and saliva for essential hormones, neurotransmitters, amino acids, toxic metals and other substances. Most medical doctors only test blood and urine for disease and serious medical conditions during routine physical exams. That's what they are taught to do. I don't think my GP has ever suggested a particular diet or exercise program, or tested me for body fat. It's just not what they do. In addition, most chiropractors do not perform any lab testing, yet they are licensed to do so.

Body Composition Testing

Sure, your patients can go to the local gym to get body composition done by a 24-year-old fitness instructor. Why not provide this service by someone better trained, more experienced and better educated. Body composition testing consists of evaluating body fat and lean mass percent.

Example of IM in Practice

Imagine this: A patient named John comes into your office with lower back pain. He's your typical baby boomer - late 40s, poor diet; a couch potato who barely exercises and is 25 pounds overweight. He also has 30 percent body fat. You perform the normal spinal manipulation and muscle stimulation, and John gladly gives you his co-pay amount.

But instead of sending John on his way, you suggest he enroll in your integrative medicine program, whereby you provide him with a diet, a recommendation on supplements that fit with his body chemistry (based upon laboratory testing), an exercise plan, and a detailed evaluation of his overall health. These suggestions will be based upon a detailed review of his history, a physical exam and laboratory testing. The plan consists of a fitness prescription that will lower his body fat percentage to 20 and drop his weight by 15 pounds. Of course, John is happy to continue to come to the office for his chiropractic care, but in addition, he gets weekly coaching to keep him focused. He also is quite happy to pay for the added services because he knows that after some time, he will feel better, look better, and be better. Even if only 10 percent of your patients take you up on these services, the incremental income adds up fast, as these services pay a great deal more than normal chiropractic care. And to boot, most of this stuff doesn't even run through insurance!

Holistically Speaking

When used in concert with traditional chiropractic care, IM will not only increase your patient count and the corresponding money flowing through your business, but also will help your patients live longer, more productive and healthier lives. The question that must be asked here is, what are people willing to pay for their mortality? It's no secret that a good diet, appropriate vitamin/mineral supplementation and a sound exercise program will lead to more youthful and vibrant appearance. IM is the means to this end.

I am encouraged about the prospect of helping our industry get back on track, and I believe that integrative medicine is the way to go. I don't know about you, but I think I'll save the Bahamas for my next vacation.

Reference

1. Sloan-Kettering Web site: www.mskcc.org.