The Free Adjustment

by William D. Esteb

I'm always in awe when I am on the campus of a chiropractic college. I've had the pleasure of visiting and speaking to students at about half of the colleges in North America and Australia. As a campus visitor, I'm often impressed by the sense of purpose and determination I see in the eyes of the profession's next crop of doctors. Yes, I sometimes see the jocularity and scruffy student personas, but I also see a group of committed individuals who are participating in a process that will have a profound impact, eventually influencing the lives of entire communities. Yet, if the insulated environment of chiropractic college doesn't distort each student's sense of reality, then the bonding process that occurs in the hallways, dissection labs, and late night philosophy debates pervert each doctor's perception of the world. Worse than the dogma that so many student doctors absorb from their experience in chiropractic college, is the resulting lifetime of free chiropractic adjustments that they will receive.

Often referred to as a "professional courtesy," free chiropractic care from your chiropractic colleagues seems to come with the accomplishment of having earned a diploma. I doubt medical doctors receive free prescriptions and triple bypass operations from their fellow doctors, or that dentists willingly install gold crowns at no cost for their dental brethren! As commonplace within chiropractic circles as it seems, there is little evidence that other health care disciplines freely exchange services amongst each other at no cost. At virtually every state association meeting or large gathering of chiropractors, doctors can be seen during the breaks offering detailed explanations of their particular spinal problem to accomplices willing to temporarily change the doctor's spinal biomechanics without an examination, X-rays, or financial exchange.

No wonder chiropractors have such a misguided notion about how much their patients value chiropractic care!

Many doctors who attend my seminars reveal their frustration with what patients seem willing to pay for their chiropractic care. It seems that when patients start feeling better they no longer see a favorable cost/benefit ratio to prompt continued care. Apparently, when patients are in obvious pain, they are willing to surrender the cost of a nice dinner for two, in exchange for some relief. Their willingness to so quickly part with their hard earned cash seems to change once they start feeling better.

So, at my seminars, I'll stop the proceedings and ask for a show of hands of those in the room who actually have to reach into their purses or wallets to pay for chiropractic care. Usually, I'm the only one in the room that has to prioritize my monthly financial obligations in such a way as to pay for chiropractic care.

"I pay for my care," boasts a doctor indignant by the point I'm making. "I paid thousands of dollars for the adjustments I get. In fact, I'm still paying for it!" he says obviously referring to having endured three winters in Davenport or Minneapolis and the pressures of paying back the related school loans. While comments like these often produce some hearty "harumphs" from other doctors who don't get my point, the fact remains that they enjoy virtually unlimited supplies of chiropractic care without having to part with any of their hard-earned income.

It's amazing that doctors who have never had to pay for chiropractic care think that they can create a relevant financial policy!

While it may be the chiropractically correct thing to do, adjusting your fellow chiropractor at no cost produces some serious side-effects.

The first and most obvious challenge is that free adjustments distort the doctors ability to appreciate the financial challenges faced by their patients.

During the years that chiropractic offices were awash with easy insurance money, many doctors got into the habit of not being directly involved with patient finances, unless there was a problem of some kind. Typically, financial matters were delegated to staff members. These individuals were often hired and trained to play hardball with insurance companies and patients who forgot to bring their checkbooks. Whether discussing financial matters was too confrontational or too self-esteem defining, many chiropractors quickly learned to pawn off these matters to assertive staff members. "Now, Barbara will discuss the financial issues involved here so you and I can concentrate on getting you better."

So, while the doctor was able to keep the care, and its associated costs separate, patients have never had that luxury (except in the earliest days of insurance coverage). The danger of this convenient oversight didn't rear its ugly little head until insurance coverage evaporated. Today, many doctors are stunned that patients don't opt to drive a cheaper automobile or give up their annual Bermuda vacations so their entire family can enjoy better spinal biomechanics and unleash the full potential of their innate intelligence.

Would you pay for the care you're asking your patients to pay for?

Patients who don't pay for their care are some of the very worse patients. They don't respect chiropractic. They don't value chiropractic. They often miss their appointments. In short, they don't take chiropractic seriously. Worse, they often refer others with a similar lack of respect.

Why is an adjustment worth $35 for one patient, but is free for another patient (who happens to be a D.C.)? And if that is perfectly acceptable, then why not a special fee for senior citizens, children, automobile accident victims, worker compensation cases, members of HMOs that you don't belong to, those who are left-handed, and patients who drive American-built automobiles? While you're at it, how about special arrangements for patients who whine about your high fees or patients you think would discontinue care unless you lower the price?

The only conclusion I can reach, is that a fellow chiropractor who asks for an adjustment, isn't a patient. In fact, if you look at the casual way in which care is rendered and the typical lack of examinations and the sloppy or nonexistent record keeping, it's pretty clear that what we're talking about isn't a doctor/patient relationship. It's more like the relationship we have with our hair stylist, plumber, or car mechanic. No wonder we're so quick to denigrate other chiropractors who use a technique you don't understand or who went to the "wrong" chiropractic college--you don't see them as a chiropractor!

Start charging your colleagues when they swing by for an adjustment and watch their eyebrows arch!

If that's too scary of an idea, at least when you go get adjusted, take the amount you'd charge your patients for the exact same service, out of your wallet, and deposit it in a container reserved for just such a purpose. Take the money out of circulation. Get an appreciation for the decisions your patients face as they try to place chiropractic care within the context of other demands on their time and money. If it doesn't cause you to rethink your fee structure, it might prompt you to enrich those moments you spend with patients by improving your "tableside" manners and better anticipating the emotional and spiritual needs of your patients. And, if that seems like too much work or appears outside the self-imposed scope of your practice, then you realize why it is often said that doctors make the worst patients.

Excerpted from
Striking a Nerve
Originally published in 1997
240 Pages
US $24.95

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