Fixing Our State Associations
by William D. Esteb
While never a member of a state association myself, I have addressed the membership of countless associations and state societies, and stood for hours among the other vendors whose booth fees paid the hotel costs for hosting the weekend meetings. During the last two decades, I’ve noticed that the turnout at these affairs has slowly eroded to levels that could be more accurately described as a “club,” not an association. While some of the problems plaguing chiropractic organizations have been brought on by themselves, other challenges are merely the symptoms of a shift in the profession and society at large. Fixing this problem will not be easy.
In the 1970s and early 1980s, association attendances were at record high levels. While they were male dominated, a reflection of the complexion of the profession at the time, these “good ol’ boys’ clubs” were opportunities for telling war stories, and a chance to circle the wagons in order to support each other in the battle to survive in the shadow cast by medicine. Tom Brokaw, in his book, The Greatest Generation, documented the characteristics of this generation, who, in their lifetime, saw the Great Depression, Hitler, Pearl Harbor, the atomic bomb, the iron curtain, the Berlin Wall and the world convulsing in massive change. The “enemy” was clearly identifiable and commonly acknowledged. There was little ambiguity in knowing who the “bad guys” were.
In many ways, this is a generational issue. The Baby Boom generation is coming of age and replacing the leadership, not only in our nation’s capitol, but also in chiropractic state associations. With this changing of the guard, a fragmentation is resulting because of the imposition of new values and attitudes. The “question-authority, if-it-feels-good-do-it, do-your-own-thing” generation chafes at the lock-step regimentation that is the basis of many organizations, whether they are civic groups, volunteer organizations, churches, or chiropractic associations. Many are experiencing declining memberships.
Many Baby Boomers and Gen Xers do not find relevancy in these groups. And, while the what have you done for me lately” perception could be turned around with improved communications, that’s not the problem. If state associations are going to be more than relicensure seminar sponsors (hardly a unique position these days) or organizers of phone trees to hound legislators, they must acknowledge something most have been afraid to face.
We Have Met the Enemy
What is the purpose of a state association? Like a practice that has become bland and without a point of view, the result of an attempt to be all things to all people, most associations have lost their power base, hamstrung by an effort to garner a consensus in a profession that is bifurcating before our eyes. Thus, the struggles that associations are facing are merely the corporate manifestations of the one playing out in the profession itself: Is chiropractic a separate profession, or is it to be integrated into the medical model?
States already dealing with this dilemma find themselves fragmented among two or three different organizations, reflecting the answer to this important question. Besides reflecting the views of their membership, they duplicate overhead, thin the leadership ranks and confuse legislators. Today, the enemy is no longer a zealous AMA Committee on Quackery, but those among our own ranks who want to see chiropractic take a different path than the one we see! Increasingly, the reason for an association’s existence is either to secure greater reimbursement from insurance companies, to be recognized as “real” doctors, or to battle their chiropractic brethren who are trying to medicalize chiropractic and dilute its “separate and distinct” DNA. Meanwhile, the majority of the profession sits on the sidelines, ignoring the irrelevant “wienie wagging,” as they focus on keeping their practices solvent.
Ironically, both factions claim that if they’re the ones who prevail, practices will flourish. But the rank and file chiropractor isn’t buying it. Oh, a threatened workers’ comp law or PIP change can produce a temporary spurt of attention and loosened purse strings, but today’s chiropractor, who takes licensure and even the right to practice for granted, finds that getting new patients, paying the bills and keeping the doors open are of higher concern.
Those who see the value of a unified chiropractic front and look for a return to the “good old days” will be disappointed. Because the problem playing out in chiropractic organizations will be with us for years to come unless one of three things happens: the chiropractic colleges become more consistent in what they teach (unlikely), chiropractic encounters another Goliath that would rally the troops (unfortunately, more likely) or a third possibility described below.
The Breeding Ground for Disharmony
The diversity in the profession that is tearing state associations apart is being bred at the chiropractic college level. And, while overall enrollment declines (is chiropractic no longer an attractive career path?), those who graduate do so with unclear or conflicting identities, depending upon which institution they attended.
This has produced an epidemic of what Dr. Larry Markson calls “prefixed chiropractors.” Here are a few you may recognize: straight, principled, objective, wellness, pain relief, multi-disciplinary, and so on. Not to mention: confused, ambivalent, and those who use the name of their adjusting techniques as a means to distinguish themselves. Ironically, back when state association memberships flourished, simply being a chiropractor was enough to satisfy the need to be different and unique!
David Meets Goliath
Unfortunately, it is more likely that the unification that those in state leadership positions yearn for will occur when an enemy great enough to stir up every chiropractor shows up . . . something more threatening than caps on personal injury awards, HIPAA compliance or even the capricious polices of Trigon and Blue Cross.
Which begs the question: Has the state association model run it course? Is it an unnecessary vestigial artifact from a different era? Is there another model more appropriate for our time?
As union membership plummets to an all-time low, and most of us don’t even know the names of our neighbors across the street, is there a more appropriate way to connect the profession and exert influence in our culture? Have “acceptance” and “validation” not only tamed the profession, but made state conventions merely social occasions to commiserate about declining incomes, irresponsible associates, and raise enough money to fund the salaries for the staff in the capitol? If so, most chiropractors would rather use their monthly dues to belong to a practice-building group or join a country club. And, by the looks of the attendance figures of many association meetings, apparently many have done just that.
A New Pride and Purpose
Yes, there’s still the political sausage making that needs to be done at the statehouse. But, if I were asked (I haven’t been) by state association members to help them turn the corner and become a vital force for chiropractic in their states, here are a few suggestions I would make:
Champion success. As you make the state association a more relevant and entrepreneurial effort, you look for problems, and solve them. The biggest problem, one that prevents PAC donations and building the war chest necessary to do big things, is that most practices are struggling to survive. The solution is to turn state associations into a vehicle for making successful chiropractors. Because both associations and the chiropractic colleges have abdicated this role, a battalion of practice coaches, consultants and management firms are thriving. Scratch the itch that field doctors have and you become a magnet for dues-paying members.
Nurture a virtual community. At a time when more and more patients are showing up in chiropractic offices, waving pages downloaded from websites, many state organizations lack even the most rudimentary Internet presence. As online communities grow (by being personal and relevant), many state associations appear more interested in raising money than raising consciousness. Where are the discussion boards, best practices tips, staff training resources and support that can be delivered instantaneously and at virtually no cost? A few have the vision and have done this and more. But most have their attentions elsewhere, yearning for the past while rearranging the deck chairs on the Titanic.
Pool resources. If state organizations adopted the mission of making and nurturing successful chiropractors (which is much more than fighting the latest legislation at the statehouse!), they wouldn’t squander vital resources duplicating what the other 49 states have done. Sharing information about how to hold successful conventions, conducting effective public relations programs and being relevant and accountable to the membership is essential. Instead, many state organizations waste valuable resources training a local public relations firm about chiropractic, or paying for duplicative studies about the public perception of chiropractic!
Become an advocate for chiropractic. It is said that a rising tide lifts all boats. There is little else that would engender loyalty, support and membership from chiropractors in the state, than if their associations became a source for new patients. “We’d love to do that, but it takes money!” Correct. So make it your mission to create happy, healthy and successful chiropractic practices. Paying membership dues is a luxury if you’re worried about paying the rent. Apparently, the association’s executive director hasn’t taken a cut in pay like most chiropractors have. Send patients to chiropractors and the whole equation changes.
Are course corrections difficult to make? Absolutely. Impossible? I don’t think so. But we’re running out of time. Reminds me of the time, shortly after the 1967 Six Day War between Israel and Egypt, when General Moshe Dayan was asked why Israel had so successfully prevailed. “The Egyptian soldiers were fighting for an idea,” he replied. “We were fighting for our lives.”
While the leadership of every state organization would love to see the ranks of their membership swell, and see chiropractors working together to advance the profession, it’s a lofty idea few chiropractors can afford while they are fighting for their lives.
Excerpted from
Connecting the Dots
Published in 2005
240 Pages
US $24.95
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