A SWOT analysis is a useful tool for auditing organizations and the environment they exist in. It is an important stage in developing a plan for the future and helps the participants focus on key issues. SWOT stands for strengths, weaknesses, opportunities and threats. Strengths and weaknesses are considered factors internal to an organization. Opportunities and threats exist in the external environment.
Last month, I took a look at our strengths and weaknesses. This month, the focus is on the other two parts of the analysis.
Our Opportunities
Chiropractic Delivers What the Baby Boomers Demand
As the first wave of Baby Boomers reaches retirement age, predictions for the nation's health care system have been nothing short of apocalyptic. Many predict the surge in demand for medical care associated with the aging population will so strain our resources that future generations will face permanently higher inflation, higher taxes – or both. While the news that the first wave of Baby Boomers to hit 65 is bad news for the bankrupt medical health care delivery model, it will be a true boom for the chiropractic profession. What's been labeled the "Silver Tsunami" began in 2011, as the first of the 76 million Americans born between 1946 and 1964 celebrated their 65th birthday. The Boomers are motivated to look and feel their best and have the means and willingness to pay for it. Boomers are expected to spend upwards of $110 billion annually on wellness products and services. They are disenchanted with the traditional medical model and seek natural, non-invasive ways to improve the quality of their lives. Chiropractors should stop wondering if they will survive health care reform and realize that they are health care reform.
Chiropractic and Non-Discrimination in Healthcare Law
PPACA Section 2706 is a landmark provision of the health care reform law that effectively mandates that chiropractors can not be discriminated against in the provision of any "essential benefit" that is within their scope of practice. Section 2706 has been a major focus of chiropractic's legislative efforts, as it represents the first time in the history of the profession that assures non-discrimination in terms of participation and coverage. The Congressional Research Service has confirmed the reach of Section 2706 as including chiropractic. The National Association of Chiropractic Attorneys recognized the Section 2706 provision as having "historic and profoundly positive legal ramifications for the chiropractic profession and the patient community it serves." As the case to mandate certain provisions of the health care reform law moves into the venue of the Supreme Court, it is positive to note that, due to our concerted efforts, chiropractic wasn't sidelined before deliberations ever began.
Chiropractic is an Essential Benefit
A key piece of the health reform law – one that will affect millions of consumers – is taking shape. It's known as the "essential benefits" package. This is the bundle of benefits that will have to be offered through insurance exchanges, which must be up and running by 2014. The Institute of Medicine (IOM) is the organization that was charged with making recommendations about what factors the government should consider in drawing up the package. For example, how many visits should a patient receive for a particular disease or injury? According to the recommendations published by the IOM this October, the essential benefits package will be based upon a typical small employer health plan. According to the IOM, 72% of small employers include chiropractic care in the benefits packages. This is a very positive and inclusive clarification for chiropractic.
Chiropractic Has a Role in the Patient-Centered Medical Home
A Patient-Centered Medical Home is a team-based model of care led by a personal physician who provides continuous and coordinated care throughout a patient's lifetime to maximize health outcomes. In October 2011, Health and Human Services (HHS) announced 500 community health centers in 44 States across the country will receive approximately $42 million over three years to improve the coordination and quality of care they deliver to people with Medicare. Under this program, Medicare payment can be used for such things as helping patients manage chronic conditions like diabetes or high blood pressure. In addition, health centers can use this funding to expand their hours, make same day appointments and accommodate patients with urgent care needs. There are many opportunities for doctors of chiropractic to be fundamental figures within the medical home model. By integrating chiropractic care, medical home care teams are better able to effectively care for patients, and therefore meet the criteria and goals of the Patient-Centered Medical Home.
Chiropractic is an Integrated Profession
Integrated care is also known as coordinated care, continuous care and multidisciplinary care. It is a worldwide trend in health care reform and is a response to the fragmented delivery of health care services prevalent today. As chiropractors define and clarify their role in the overall health care delivery system, they work seamlessly with their medical and CAM counterparts. Chiropractors play an important role in each component of integrated care. First, chiropractors provide coordination of information through shared records. Next, chiropractors coordinate continuity across the secondary-primary care interface by providing case management from specialist to generalist care. Finally, chiropractors coordinate provider continuity through the therapeutic, trusting relationships they develop with their patients. The opportunities for integration have never been greater for chiropractic.
[pb]Our Threats
Chiropractic is at War with Predatory Managed Care
The past decade has seen a staggering rise in abusive practices by some chiropractic managed care organizations (MCOs). These MCOs have violated the trust placed in them by patients and the chiropractors that serve them by implementing a series of predatory practices and skewed policies designed to inappropriately limit needed patient care. They financially exploit business relationships established with doctors of chiropractic recruited or forced into joining their networks. Arbitrary caps are routinely placed on numbers of visits based solely upon financial measures regardless of physical findings or medical necessity. Well-intentioned chiropractors are penalized if they provide a full course of treatment and expelled from the network if they complain or fall outside of practice patterns that inappropriately reduce care. In addition, aggressive post-payment audits are employed by MCOs as a means of increasing insurance companies' profits by extracting money previously paid to chiropractors. The National Chiropractic Legal Action Fund (NCLAF) is deeply involved in helping encourage and advance a multi-state investigation by state and federal authorities exploring whether laws were violated by the activities of predatory MCOs.
Chiropractic has a Shrinking Middle Class
As the Great Recession of 2007-09 finally winds down, many chiropractors face diminished lifestyles, with no obvious way to regain the wealth and prospects they enjoyed just a few years ago. The number of top and bottom performing practices has increased while the middle class of chiropractic practices has shrunk. It's natural to hope for a return to the familiar trappings of pre-recession practice and its steady improvement in living standards. Some may still find that. But a growing number of chiropractors find themselves unable to recover, even as the economy returns. Scarce credit, mounting debt, new technological demands, and the increasing cost to run a practice are stunting the growth of some chiropractic practices and inhibiting the "creative" part of the "creative destruction" caused by the recession. Some experts say the profession didn't experience a recession but a "transformation".
Chiropractic College Enrollment is Decreasing
One report suggests that total U.S. chiropractic college enrollment fell from a high of 15,398 in 1996 to just over 10,000. This 5,000-plus drop represents a 35% decrease in student enrollment overall. Many factors may be responsible for the decline including demographic trends, lack of referrals by disenchanted chiropractors and the diminishing financial return on the cost of a chiropractic education. The cost of a chiropractic education is approaching $150,000. This places it beyond the ability of many potential students to manage the debt they must assume. Our institutions of higher learning must focus on how to educate students more economically and better prepare them for the real world of practice that they will confront upon graduation. The American Medical Association Foundation provides approximately $1,000,000 annually in tuition assistance to financially needy medical students. What would it do to enrollment if chiropractic provided a similar incentive?
Chiropractic Lacks Research on Quality of Life Measures
While chiropractic has excellent research supporting the cost-effectiveness and efficacy of care for headaches as well as neck and back pain, the future of our profession both in the realms of legislation and reimbursement hangs on our ability to perform and publish research supporting chiropractic's ability to produce positive health-related quality of life outcomes. Standardized health-related quality of life (HRQOL) measures are critical for a number of purposes, including evaluating the nation's progress in achieving population health goals, assessing health disparities across different segments of the population, and measuring the effectiveness of health care interventions for age-related diseases. As EHR adoption makes available massive quantities of health care data for analysis, the comparative effectiveness of care as it impacts the quality of life will drive both reimbursement and public policy. The outcomes produced by chiropractic care will be compared to those produced by all other disciplines. Our ability to document that chiropractic has a positive impact on the overall quality of life, health and wellness through published, peer-reviewed research is essential to the future of our profession.
Chiropractors Must Take Personal Responsibility
The failure to take personal responsibility for the future of the chiropractic profession is the greatest threat confronting the profession. A key difference between successful individuals and unsuccessful ones is their readiness to take responsibility for the events of their own lives, as well for others in the realm of their influence and authority. Taking personal responsibility, as opposed to placing blame, is the difference between victors and victims. The victors see themselves as a creator of events and circumstances, whether good or bad. Don't sit idly by hoping that someone else will come to the rescue. Embrace change by deciding that you are the one who is going to make a difference.
Applying SWOT
The next step in the SWOT process is called matching and converting. Matching is used to find competitive advantages by matching strengths to opportunities. Converting is to convert weaknesses or threats into strengths or opportunities. I hope that you will take some time to complete this exercise on your own or with your colleagues. I have never been more excited about the possibilities for the future of chiropractic. This is our opportunity to make massive gains in a time of unprecedented change. It is time for our profession to shine!
When I graduated from chiropractic college in 1981 and started practice, I heard it all, and very little was positive. “You are a quack; you do not know what a subluxation is; you couldn’t get into a real health care program, so you chose the one that is slightly above a mail-order degree; you have no proof that chiropractic works; Are you really licensed?”, and so much more.
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A central challenge in creating our identity is that chiropractic is a method of care, not a technique or procedure. This is an important concept for us to promote. Our patients are treated with lifestyle modification, exercise, nutritional supplements, diet and a whole-body approach to accelerate the natural healing process. We are not simply CMT providers.
The results of a global survey released late last year (2023) unveiled some startling findings among medical and nursing students. The “Clinician of the Future: 2023 Education Edition” surveyed 2,212 students, of which 446 were in the United States, from 91 countries.
