I get lots of mail and try to respond to every letter. Many letters seek information and concepts about what is happening and how the profession is doing.
The doctor was articulate, the letter was well-crafted and his comments struck a sensitive nerve. His uneasiness is real and widespread, and his concerns about what is happening to the chiropractic professional should not be underestimated.
This doctor wrote about the proliferation of free x-rays, dinners or whatever. He laments the lack of professionalism by DCs who use any and every hook to get people to "sign up" at the mall, at the office, or at the used car lot where the "Saturday special" is now on sale. He also expressed sorrow about the recent national television program showed a DC exploiting the Medicaid system. (Editor's note: See "'20/20' Pounces on Federal Investigation in Indiana," DC, Dec. 1, 1998.)
There were conciliatory comments of the assistant attorney general who acknowledged that only a small percentage of chiropractors are engaged in this activity, but the underlying message was greater than fraud, because it had to do with children. The movement will be to protect society and unsuspecting parents by denying chiropractors the ability to treat children. Is it logical? No. Is it possible? Yes. Are there discussions underway now in some states to limit chiropractic care for children? Yes. The lack of professionalism and the irresponsibility of individual chiropractors is having an impact upon the entire profession.
What a tragedy it would be if there were limitations imposed upon chiropractors to treat children. Children represent not only a wonderful opportunity to demonstrate the value of chiropractic to parents, but also to engage the next generation of adults into a model of health care which includes chiropractic as an initial and primary contact rather than as an afterthought.
The doctor went on to discuss his local television station where one of the local DCs was shown being carted off to prison for "drug peddling" and another local DC for fraud, all in the same program. What kind of image is being generated in the minds of millions who do not go to chiropractors?
The doctor asks, and rightfully so, "How do they get people to sign up? I have been around for 30 years and these new people generate such visibility with the TV coverage and 'free' whatever that their names are known -- good or bad -- better than mine."
Additionally, this responsible DC discussed the problems he is having with the local medical, allied professionals and hospital because of the "image" generated by local DCs who care not about building the profession, but only about immediately trying to build their practices by whatever means.
My advice to this doctor was to remain professional and build relationships the old-fashioned way: one at a time and personally, based upon integrity and solid professional conduct. I asked him to do a short survey in his office to seek the names of those medical physicians, funeral directors, attorneys, etc., that his patients would or would not use. I asked him to find the common denominator that people use to determine "why" they would or would not engage the services of these professionals. I told him he would find that trust, professionalism, image and honest service would be the underlying reasons for seeking and, conversely, not seeking their services.
On the heels of that letter, I got a call from "ABC News." They asked if I would participate in a one-hour, online chat session on their web page, which I did on Monday, January 11th from 3:00 to 4:00 p.m. It was interesting to see the types of questions that were asked:
"Do I have to go forever? The treatment never seems to end.""Can it hurt me?"
"Why do you think there is a bias against chiropractors?"
"Can repeated chiropractic adjustments to the same area cause scar tissue?"
"I have a concern that chiropractic treatments could make the ease of disalignment greater each time. Is there any truth to that?"
"I feel lightheaded each time I get adjusted. Is this normal or a natural high?"
"Adjustments scare me when my neck is twisted. What words of comfort can you give me?"
"My pregnant daughter is being encouraged by a local chiropractor to get treatments. She is having no pain. Is that safe if nothing is bothering her?"
"How can your permit, allow or endorse the use of manipulation to treat medical illnesses?"
I visit a chiropractor and tell my friends, but if I miss a week, I feel like I am falling apart. Why is this?"
"Can you give some tips on finding a good chiropractor?"
The hour flew by quickly, but the impact of the questions remained. It was clear that many people wanted to visit a doctor of chiropractic, but had to overcome serious issues of trust and sought a rational understanding of the profession.
What created this lack of general positive feelings about chiropractic? Could it be that the doctor who wrote to me about what is happening in his area is also happening around the country? Could it be that some chiropractic doctors have stooped to a level of professionalism which is only a step above the proverbial image generated by car salesmen? And by the way, didn't the used car salesman create that image themselves? Notice how the auto maker Saturn is trying to break that stereotype. But that's a discussion for another time.
Could it be that the image of chiropractic ingrained in the public mind is a result of a lack of overall professionalism? We will debate these issues in future articles, but coupled with the concept of the "blue light special chiropractor" is the mindset emerging in the profession concerning how low a discounted fee will ultimately be enough.
The president of the Georgia Chiropractic Association wrote a very gutsy article, "Fungus among Us," which dealt with discounted chiropractic services. His pointed editorial was on target! How low will DCs go with their services before they cry uncle? The proliferation of the $10 visit will certainly not generate any support from those discounted networks or those who want to purchase the lowest cost services. If the DC is willing to work for $10, why should anyone pay more?
Greed is a powerful motivator. Those who form discounted networks with the singular purpose of ratcheting down the fees of their colleagues will continue to survive as long as there are DCs who will succumb to the lure of "more patients," or the fear that they cannot survive unless they provide the "bottom feeders" with the fees they demand.
Many professionals do not know what it costs to operate a practice. The adage, "If you don't know where you are going, any road will do," applies here. If you don't know what it costs to operate your business, any amount will do. There are "fixed costs" in every office. Everyone is entitled to a profit, but many times the fees allotted are insufficient to meet the needs for basic survival.
What is a fair fee is subject to variation, but certainly those, as I call them "bottom feeding" networks, currently limiting care to three visits, or lifetime expenditures to $200, or placing economic barriers for people seeking chiropractic services, need to be seen for exactly what they are -- Discount Centers Using Doctors of Chiropractic to Derive Cash for the Dastardly Charlatans who have Devalued Care to a Deserving Community. Shouldn't DC stand for more than that?
Until and unless the chiropractic community comes to some decision about how it will function in the framework of the health care delivery system, there can never be an adequate resolution to the "worth" and "value" of our services.
No one is suggesting that the fee for doctors of chiropractic be evaluated to such an absurd level where only those with six figure incomes can afford our services. Nor should the cost of chiropractic care be so low as to pose a problem of basic economic survival for the provider. Many an old-time practitioner has said, "If you were paying for your services like your patients are, could you afford to go to someone who charges as much as you do?" That might just be an excellent guide for what a chiropractor should charge. Many DCs forget that there are millions of people who are scarcely making more than minimum wage who desperately need our services. Yet the cost of chiropractic care must be such that practitioners can earn a respectable living, pay their debts, and have money to provide security for the future.
The cost of our services, the image of the profession, and the value perceived by the consumer are inextricably entwined. DCs who charge too much and destroy the image of the profession by hucksterism are contributing to the proliferation of an image the public perceives as untrustworthy. Remember, perception is reality!
The next few years will bring many changes and challenges to the chiropractic profession. How to generate the image of trust will be the greatest challenge facing the profession. Instantaneous broadcasting by the media of an event in some remote part of the country becomes "national headlines" on every news station across America. Such broadcasts will become even more commonplace as competition in the media for sensationalism and market share grow. What one DC does affects every other DC in the community. The responsibility of the image and public's perception is on the shoulders of each and every doctor of chiropractic.
Perhaps DC should stand for Desirous Conduct by Dedicated Chiropractors Delivering Care to Deserving Consumers at Defensible Costs with Dedicated Commitment. Perhaps this column will generate some discussion about the price we collectively pay for the inappropriate conduct of our colleagues. Will we become the "profession of tomorrow?" If "blue light special chiropractic" continues to become the standard marketing ploy by those who fail to see the destruction to the collective profession by their singular action, the answer is no.
My hope is that more and more DCs will come to the realization that rust can only occur the old-fashioned way ... it must be earned.
Click here for previous articles by Louis Sportelli, DC.