Is an adjustment commodity? That is, is an adjustment delivered by Doctor A the same as an adjustment delivered by Doctor B? You and I know that even if the same technique is employed, they can be two very different adjustments. It’s easy to forget this distinction because of the spell cast by third party reimbursement. Carriers have chosen to look past this difference (even though cash-paying patients don’t). To carriers, the full body diversified adjustment, the one-bone adjustment and the energy focused tonal adjustment are all the same. To a carrier, an adjustment is an adjustment is an adjustment. A commodity. It’s easier that way. This has created a huge problem for chiropractors coming out of the third party trance: “How much should I charge?”
As the influence of third parties wanes, more and more chiropractors are placed in the position of having to do what other small businesses have always had to do: set the price for their goods or services. What is an adjustment worth?
Millions, if it saves a life, avoids irreversible surgery, averts a deadly drug mistake or prevents the need for an organ transplant or a life of dialysis. (Clearly, what an adjustment is worth is quite different from what someone would pay!) Yet, tamed by mechanistic insurance companies, many chiropractors can’t see the greater significance of chiropractic and have reduced themselves to spine therapists—as if improved biomechanics or pain relief was the highest and best use of chiropractic.
It’s not. Never has been. At least not until the generous reimbursement opportunities intoxicated a generation of chiropractors to trade their wholistic-vitalistic-wellness services for the mechanistic-short-term-pain-relief focus of an allopath.
For the longest time coffee was just a commodity. Do you want Folgers, Sanborn, Yuban or Maxwell House? Then along comes Starbucks. They make the distinction between the cheaper, lower quality Robusta beans and the higher quality Arabica beans. They convince millions to enjoy a $3-$5 cup of burnt-tasting-hand-scalding coffee that previously, a buck would buy you a “bottomless cup.” Starbucks turned a commodity into a specialty item.
If you’re relegated to being a commodity (an adjustment is an adjustment is an adjustment) the only thing that distinguishes you are symptomatic results (can you do it in six visits or less?) or price. That’s why some people drive across town to save 20 cents on paper towels or save a nickel a gallon on gasoline. They have little allegiance to the shopkeeper or service station because they’re buying a commodity.
Are patients buying a commodity from you?
Of course not. Virtually every chiropractor thinks they’re special and laments that they can’t get a decent adjustment because they can’t adjust themselves. What are patients buying from you? Better yet, what have third parties been paying for? And perhaps more important, have you been delivering a service that would create even the slightest sense of patient loyalty if their carrier were to suddenly cut them off? Could you afford you? Would you pay for you?
“Of course!” is the natural answer. “I’m worth it.” The problem of course is that we can’t test your assertion. In fact, most chiropractors, after becoming one, have never paid for an adjustment. So, it’s easy to pay lip service to the idea that you’d pay for chiropractic care, but if the truth be known, most chiropractors would go without before paying a colleague for an adjustment.
Could your unwillingness to take money out of your own pocket or purse to pay for chiropractic care be related to your inability to set a fair fee for your services?
Some practitioner somewhere offers the cheapest, least expensive adjustment. And somewhere there’s a chiropractor who is known for delivering the most expensive adjustment. Between these two extremes is a vast wasteland of chiropractors delivering competent, yet unremarkable adjustments. Commodity adjustments. Utilitarian adjustments. Adequate adjustments.
If you suspect you may be in this large undistinguishable middle, here are some ideas to consider if you’re inclined to break away from the pack:
Sell your talent, not your time. Make sure every patient knows that it is your expertise that allows you to size up his or her problem and deliver the most appropriate adjustment in a short amount of time. It’s the unsure beginner that needs the most time, not the experienced veteran! (Would you like a two-hour or a 20-minute root canal?) Patients aren’t living to get adjusted, they get adjusted so they can go live. Remember, stopping by your office, as pleasant as it may be, is an imposition; a distraction from their life.
Increase the intensity of the visit. As you shorten visit time, you’ll want to increase your presence. You’ll want to show up more intuitive. You’ll want to amplify your listening skills. You’ll want to touch the patient and stay connected as you walk around the table and going about your “business.” Intermittent contact produces a “start and stopping” that diminishes the impact of your connection. Remain 100% focused on the patient, their health and their life while you are with them.
Do less. Under the guise of being thorough, many chiropractors brag about their self-imposed mission to add adjust virtually every articulation and extremity. Actually, this “scorched earth” strategy starts to look a lot like manipulation; a nonspecific “atom bomb” to the nervous system. Is this merely a way of justifying a lack of proper analysis or the inability to distinguish the secondary compensatory subluxation from the primary subluxation? Where is the specificity that is the unique territory of the adjustment?
Avoid first-visit adjusting. Nothing destroys the majesty and meaning of an adjustment more than a rushed intervention at the end of an already long first visit. With pressure from the reception room backing up, all the patient gets is an “I’ll-explain-all-of-this-on-your-next-visit” explanation as they try to assimilate the fact that someone has just rearranged an internal structure of their body. Justified as a compassionate gesture to help relieve their suffering, many times this works against any hopes of creating a long-term relationship. If you’ve encountered chiropractic patients who claim that their “last chiropractor only needed one adjustment,” then you’ve already seen what this attempt at pleasing patients can do to their perception of an adjustment.
Granted, I don’t know how to adjust. But in my travels, I have been the delighted recipient of masterfully delivered adjustments from some true chiropractic masters. While the energy they added to my spine was artfully delivered, what made them so significant was their presence. Who they were showing up as; their willingness to drop all pretense, ego and outcome. They got themselves out of the way so they could be merely humble servants and the conduit for divine inspiration. Clearly, not a commodity!