Over the years I've not only been in private practice but have worked with other DCs as an associate in their practice. In other words, I've had the opportunity to observe first-hand some of the good, the bad, and the ugly in our profession. Fortunately, I believe that the majority are honest and sincere in their desire to help their patients with a reasonable remuneration schedule.
It's the bad and the ugly we have to worry about and unfortunately the public and insurers tend to judge the whole by the lowest common denominator.
Recently I went to a license renewal seminar and found it to be interesting in more ways than one. During a break I overheard a conversation that was at once reassuring and disturbing. This one doctor was talking about financial success with someone and described a few DCs that he knew who were very productive.
The one thing he found that was common to all who attained great financial success was their total lack of social or personal commitment to anyone. All either weren't married or had relationships that were quite tenuous in character. In other words, they were "married" to their practices and seduced by promise of great masses of money. One practice management firm even encourages contests to see who can make the most money in their first month of practice. To achieve this lofty goal they are required to virtually sleep at the office. The whole day (seven of them each week) is spent using every gimmick possible to get people through the door and then getting them to come back until the insurance policy is beaten dry of money.
But the pendulum swings and now the insurance companies, who aren't paragons of virtue themselves, are beginning to form their defense networks of PPOs, HMOs, and EPAs (exclusive provider arrangements). It's estimated that by the year 1995, managed health care will dominate the health fields. In other words, you won't be king of your castle -- rather, the managed servant of the money merchants. All because of the get rich quick schemes that have permeated the profession since the insurance gates were opened.
Some within the profession have reacted with righteous concern. In fact some have overreacted with righteous concern and now are going in the opposite direction.
The instructor of a recent seminar seemed to shiver as he told of x-ray abuses. In some respects I had to agree with him, remembering when one DC had the gall to take something like 17 views of the cervical spine in one visit. The instructor, however, advised that x-rays should be avoided in almost all circumstances -- even accidents.
Say it isn't so. While the chiropractic abuses of insurance have sometimes been excessive, we shouldn't literally throw out the baby with the bath water. It's difficult to conceive how any responsible teacher could counsel other chiropractic physicians that x-rays should be avoided even in the case of accidents.
This is insane. Imagine, when under litigation, the judge asks where the doctor's x-rays are. "Sorry your honor, I don't like to abuse the use of x-rays." X-rays are needed to protect not only the doctor against malpractice but, more importantly, the welfare of the patient.
While still in clinic, one of the senior externs told me of how a patient didn't want x-rays because he had only been in a "minor accident." The extern agonized over what he should do and finally decided to stick strictly to the clinical protocol of the school. The x-rays showed a recent dangerous fracture in the cervical spine. This dramatically changed the therapeutic approach and possible serious consequences.
The point of all this is that while we must alter some of the obvious abuses we've allowed to transpire, we mustn't do so at the expense of therapeutic quality. The anger must be directed at those who take too many unnecessary x-rays, charge too much, use too many modalities or have the patient come back too often -- not at the honest, cautious physician sincerely working for the welfare of his patient. So let's see changes made based on what is right -- not changes based solely on fear.
In the last analysis then, we are beginning the harvest of the seeds of greed we have sown for so long. We must, therefore, clean the crumbs off our own table or the insurance companies will bleach all the guts out of our professional tablecloth.
RHT