Is It Time for a Popeye Moment?
Dear Editor:
I think it's time for a Popeye moment in chiropractic: "That's all me can stands; I can't stands no more!" We chiropractors are being held to a higher standard for medical necessity than all other health care providers. We have to demonstrate and document functional improvements on an ongoing basis for the care we provide to patients. Without it, that care is typically rendered medical unnecessary or labeled maintenance care; the insurance payments stop or worse, audits begin.
One of my patients was diagnosed with lupus 10 years ago. She has received countless medical visits, ongoing diagnostic testing, many different "meds" – all resulting in tens of thousands of dollars in medical care. During this treatment period, there has been no functional improvement. In fact, her condition has continued to worsen. Yet the insurance company did not deem this care medically unnecessary, nor did audits begin on the treating doctor. Was this care necessary, even though no functional improvement was demonstrated or documented? Yes.
There is nothing wrong with trying to slow down the progression of a condition or providing palliative care to help the patient, even when their condition worsens over time. Chiropractic care can often slow the progression of a condition, even when that condition will never improve or is classified as having reached maximum medical improvement (MMI). But when a patient can no longer demonstrate forward progress, does this mean health care has to stop? Using that logic, this would be the case for many of our seniors. They are going to continue to decline and may never show functional improvement as they get older.
Chiropractic care can often slow the rate of decline and give temporary relief in helping manage a condition. This is not maintenance care; as opposed to someone receiving care after they have recovered from a condition, but wants to remain healthy and prevent recurrence.
Maintenance care should actually be the gold standard of health care. It could reduce health care costs and improve the overall health of society, which should always be our collective goal. Thus, people who choose maintenance care should not be punished by stopping their health insurance benefits. Instead, the doctor providing the care should be paid, and the patient should receive a bonus for being smart and preventing disease, rather than waiting until the disease has taken hold – and then undergoing diagnostic testing and treatment(s).
Who is setting these standards for health care and chiropractic care? Why do we cower under them as if they were real, genuine or in our patients' best interest? Why do chiropractors have a higher standard of medical necessity, one that demands ongoing documentation of functional improvement, when other health care providers don't? Let's do something about it. It's time for a Popeye moment.
Dan Niequist, DC
Algonquin, Ill.
The Flaw in Recommending Chiropractic as a Career
Dear Editor:
I just finished reading Don Petersen's column about securing our future by encouraging new chiropractic students [Oct. 15 issue]. I am in my 33rd year of practice and am anxious to retire – as are many of my contemporaries, as his column suggests. I have tried to encourage some of my younger patients to pursue a chiropractic career, but will not do so again.
One such young lady had intended to get her PT degree and work as a PT to help pay the exorbitant costs of chiropractic college. When she discussed this with the college, they discouraged her, stating that the "course of study was too rigorous to allow outside work" and suggesting she just borrow all the money she would need for school and living expenses.
I recently met with two new graduates who were both at least $200,000 in debt from chiropractic college after graduation, before they even thought about opening an office or saw patient #1. In addition, both were considering associating with veteran doctors who, at best ,were offering starting pay in the $20,000-30,000 range. My CAs earn more than that.
Add to this the record of loan defaults by new graduates, the continued diminishing of reimbursement for what we do and the fact that we have never hit the "tipping point" in the marketplace, and I do not see a bright future for new chiropractors.
I still love what I do, but the business side of becoming and being a chiropractor definitely diminishes the enjoyment of serving the health needs of the public. I wish it were different, and maybe I'm tainted by having practiced during the times when we were paid reasonable fees for what we did, and the regulations and paperwork were not as monumental as they are at present. We often joke about the "golden years," but they were a time when if you committed yourself, worked harder and had the "fire in the belly," you could build a great practice, make a good living, and still have a life and time to enjoy the fruits of your labor.
I don't pretend to have an answer to solve the problems I have noted. In order to secure a better future for chiropractic, however, I suggest making the schools more affordable. I suggest unifying our national associations (as we have done in Virginia with incredible success) and creating a unified brand that will attract people to chiropractic; so we can finally reach that "tipping point" and be so busy that new graduates will be in high demand. I also encourage chiropractors to become involved in their state associations, at the very least, and form IPNs ( as we are doing in Virginia) to have some negotiating power with the payers. Until these important goals are achieved, I will remain hard pressed to encourage new practitioners.
Elliot Eisenberg, DC
Richmond, Va.
