To help you enhance your practice and increase your bottom line, we ask practicing doctors of chiropractic like you for ideas and solutions that have been tested in real-world environments.
Based on the responses we received from your peers, all of the above factors – and a few others – play a role. Let's see what your fellow chiropractors have to say about what's preventing patients from visiting chiropractic offices – and what to do about it.
1. Education Void
According to your peers, lack of education / information about chiropractic's value is a major barrier keeping patients away. "I think that the main factor is lack of reliable, accurate information about the benefits of chiropractic care," said Dr. Tony Klatt from Anderson, S.C. "People really do not understand how many differing conditions can be helped by a properly functioning nervous system. It has been my experience that chiropractic care is rarely rejected if you tell people what chiropractic can do, how long they can expect it to take and how much it will cost. I guess you might call that expectation management."
Dr. Lee Dinoff from Griffin, Ga., also emphasized the power of an informed patient: "If [there is] one thing that my 30-plus years in chiropractic has taught me, education, education, and more education of your patients is the key to a busy and stable practice," he said. "An uniformed patient is never going to refer or stay on a care plan. An educated patient will refer and stay on his care plan because he has been taught the importance of chiropractic."
"People really don't understand the value of chiropractic [beyond] 'There's something out of place, maybe a chiropractor could pop it in," commented Camarillo, Calif., DC Dr. Adam Story. "They know their HDL, LDL and total cholesterol numbers by heart, but they couldn't tell you what's inside the spinal bones."
"I find that many patients are just generally unaware of how chiropractic can help them," added Dr. Danielle Finden from Saint Paul, Minn. "The scenario that is most alarming to me is when a patient presents with acute lower back pain that they originally reported to the emergency room several days prior. They were prescribed narcotic pain meds and muscle relaxers and told to "take it easy" and are often unable to work due to pain. Occasionally they have also tried physical therapy and/or epidural steroid injection(s). They wind up in a chiropractor's office out of desperation that nothing else is helping them."
2. Price Points
"The primary factor inhibiting patients from seeking chiropractic care in my area is insurance coverage and cost," said Dr. Michael McIrvin of McPherson, Kan., a point echoed by many of the chiropractors we surveyed.
Dr. Michael Lane of Salt Lake City, Utah, noted: "Chiropractic patients are still discriminated against by their insurance carriers by offering only limited visits (5-10 per year with some companies), while not doing so with other methods of treatment. They pay for endless medication and surgery without question, but hog-tie DCs with these restrictions. High deductibles and copays don't help."
According to Dr. Story, patients say lack of insurance is a barrier "because they do what the insurance says. They look first to their insurance. If you needed knee surgery and the guy on your plan was a $10 [copay], but the guy outside the plan was $15,000, whom would you choose?"
3. Image Issues
Your peers were also quick to reference a long-standing professional issue as a primary barrier to more patients endorsing chiropractic care: poor public image. According to Dr. Joseph Mitchell of Claremore, Okla., "Individual chiropractic doctors try to provide public relations in their local communities through radio, TV and newspaper advertising, and giving talks to small groups; however, these efforts are uncoordinated and usually poorly designed and produced. They are also primarily designed to promote an individual chiropractic doctor in a limited area."
Dr. Mitchell continued: "The medical, dental and optometric professions have hired public relations experts to professionally design and produce radio, TV, newspaper and magazine promotions to promote their professions and, in the case of the medical profession, to defame the chiropractic profession by denying its effectiveness and effectively convincing people that chiropractic adjustments are very dangerous.
"Unfortunately, we see very little effective public relations coming from our national and state associations, likely due to lack of funds as a result of low membership numbers and lack of association leaders who will insist that the associations direct more resources and effort to this necessary function."
Dr. Randolph Harding of Palm Harbor, Fla., agreed that chiropractic's image needs help: "I feel we need to improve our professional image. Many people do not view or are not aware of our scientific training, the length of training and/or our scope of practice. A PR effort over time should help change this perception of the profession. We need to be a part of and have a role on the team of health care providers."
4. Open-Ended Care
Ongoing / maintenance care remains an issue with insurers, patients and the public, according to our respondents. According to Dr. Dean Rutherford of Hailey, Idaho, "Overutilization (prolonged treatment plans that are unnecessary) is a major factor keeping patients away from chiropractic offices. Some of my patients throughout the years have stated that their friend / acquaintance / co-worker won't see a chiropractor because they believe, 'You have to go back forever once you start.'"
"'Why do I have to keep coming back week after week, month after month if I feel good?' is the No. 1 complaint Mandan, N.D. chiropractor Dr. Joel Newgard hears on an ongoing basis. "Some doctors cannot let go of their patients, and see them long after MMI."
Brainstorming Solutions
After laying the challenges on the table, your peers were quick to brainstorm potential solutions, providing insight into how the profession can serve more patients. According to Dr. Lane, the medical profession "needs to be educated as to what modern chiropractic is and the research that backs it up, which should be published for all to see, especially our legislators. ... Better education to patients, MDs and our elected officials is necessary."
For Dr. Story, fixing these problems requires a patient-centric approach: "Provide [patients] with initially what they want and then each visit, constantly educate them so in the future, their thought [will] be, 'I'll always check with a good chiropractor first, no matter what it costs.'"
Dr. Harding emphasized the value of public relations: "A PR effort over time should help change this perception of the profession. We need to be a part of and have a role on the team of health care providers. We need to be a part of 'the system' and not outside the system."
Scope expansion is an important variable according to Dr. Richard Muccillo of Dana Point, Calif.: "Chiros are limited in scope and not a one-man shop. [We] need advanced scope like MDs – and believe it or not, it will happen sooner than you think."
Dr. Finden believes educating the public and other health care providers so chiropractic becomes a first option, not a last resort, is an ideal strategy to pursue. Following up on her earlier comment that patients often "wind up in a chiropractor's office out of desperation that nothing else is helping them," she noted that "these patients often become the best referral sources because they feel like they got lost in the system and want to help spread the word that they needlessly suffered when they would have been back to work and feeling great in no time with the immediate referral to a chiropractor.
These patients often become the best referral sources because they feel like they got lost in the system and want to help spread the word that they needlessly suffered when they would have been back to work and feeling great in no time with the immediate referral to a chiropractor.
She continued: "The only ones to blame in this scenario are ourselves. Emergency room physicians just aren't taught that this would be an ideal, appropriate referral to a chiropractor. The MDs don't want to just push pills and send people aimlessly out the door, they truly do want to help their patients.
"We, as chiropractors, need to help educate the public, including other health care providers, about scenarios like this. And then once you start getting referrals from your local ER or area MD, send a thank-you letter and follow up on how you treated the patient and their progress. This will ensure continued trust and endless referrals!"
What do you think is the biggest challenge to growing your patient base – and what are you doing to address that challenge? Feel free to email your thoughts / comments to
with "Patient Barriers" in the subject line.