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Deprogramming Chiropractors

deprogramming.jpgEarlier today, I completed a one-hour telephone consultation with a chiropractor. The anger I’m feeling might be similar to what you’d feel when presented with a child suffering from vaccine damage or a patient who was maimed by a medical mistake.

Just what has produced this angst? The suffering inflicted on this coachable chiropractor at the hands of the top practice management organizations in chiropractic. Finally, I’m present to the far-reaching and deleterious effects of these well-intentioned “coaching” programs. I’m fed up with the manipulative techniques taught chiropractors that are justified by a do-gooder mentality.

It would be easy to use this space to take pot shots at this parasitic industry that has sprung up from the confluence of low self-esteem, third-party reimbursement, a lack of business training and old-fashioned greed. Instead, allow me to deprogram some of the more common beliefs that come from brushing up against these chiropractic cults.

Granted, I've never hired a chiropractic consulting company. And I consider the leadership and consulting staff of many of these groups to be personal friends. I've even spoken at many of their seminar gatherings. So, while I'm not sure about the specifics of what they teach, I do see the resulting effects! Here are seven common lies that seem to have been suggested to chiropractors and the truth that could set them free:

“3X for 4 weeks, 2X for 4 weeks, 1X for 4 weeks.” I’ve written about this and other forms of bluffing elsewhere. This is the “Take-two-aspirin-and-call-me-in-the-morning” cookbook approach to chiropractic. Many chiropractors have made this formulaic recommendation so often they think it was handed down from D.D. Palmer himself. Astonishingly, this visit schedule is usually presented at the report of findings before the first adjustment has been delivered! Just how can you predict their recovery 60-90 days out? Give me a break.

“My way or the highway.” Asking patients to mindlessly follow your recommendations or you’ll withdraw your services is such a flawed model of practice I don’t know where to begin. If your self-esteem is especially low, use this prima donna blustering and you can attract patients who have had their critical thinking skills surgically removed. However, it’s been my observation that this form of posturing may give the illusion that you’re in control, but it’s just an illusion. And it rarely produces the abundant referrals and reactivations that are the foundation of a stable, profitable practice.

“We only offer annual care plans.” Sure, having a nervous system free of interference can enhance one’s overall health and well-being. And if that’s what someone wants, an annual care plan makes sense. However, it’s rarely the reason someone consults a chiropractor. It only makes sense if you “get” the lifestyle implications of chiropractic—something most patients lack and rarely embrace on their first encounter, regardless of your “mandatory” class. Ask for their hand in marriage on the first date if you wish, but it’s a bit presumptuous and ignores a patient’s allopathic mindset that became entrenched long before meeting you.

“It’s in the patient’s best interest to… (Fill in the blank).” This parental notion has been taught to justify all types of manipulation. Besides emotionally draining (because it doesn’t work very well) and unsustainable, it exudes a profound mistrust of patients. This is the “end-justifies-the-means” mentality that is used to rationalize scare tactics (“You have diabetes of the spine”), produce guilt (“Are you leaving your kids at home to develop the same problem you have?”) or shame (“Do you want patch care that stupid people choose or fix care that enlightened, attractive people choose?”). All this to get patients to do the “right” thing. Hijacking the patient’s free will in this way may extract a few more visits, but at a profound cost to you, the profession and the patient—who vows never to set foot in chiropractic practice again when they have their subsequent relapse.

“An effective report produces patient commitment.” I’m not sure how reporting your clinical findings morphed into a sales session, but my guess is that it had something to do with fully exploiting the patient’s insurance policy. (For their own good, of course!) If you have any notion of practicing chiropractic, as opposed to chiropractic medicine, the consultation is far more important than the report.

“Don’t let the patient give up on themselves.” When patients make the slightest noise about discontinuing care, chiropractors have been taught that it’s a poor reflection on them. You blew it. It’s your fault. You didn’t say the scripts correctly. If you’ve been saddled by this guilt, I’m sorry. God grants each of us the right to treat our temple; our “soul package,” the way we wish. What you would do if it were you is interesting, but superfluous. When you make it difficult for patients to announce their last visit for fear you’ll melt into a weepy puddle or try to talk them out it, you practically eliminate the possibility of a future reactivation.

“I’m the master, the patient is the servant.” Really? Last time I checked masters hired servants, determined whether the servant did a good job and dispatched them when they were no longer needed. Sounds like what patients do to me. Once you fully acknowledge the real powerlessness you have, the sooner you’ll be able to show up as the attractive, humble servant prepared to guide, suggest, facilitate and inspire. Until then, patients have no other choice but to discipline you for your hubris and arrogance.

Is there a place for practice management firms these days? Yes.


1. If you don’t have a paperwork system or you’ve never worked in a chiropractic practice before, a management consultant can be helpful. Procedures, patient flow and perhaps even some hiring skills could round out your education. Shouldn’t take more than a year or so to acquire. If learning this justifies the $500 or more a month, great.

2. If you don’t have the necessary discipline to do what you already know you need to do, you may want to buy an “accountability partner.” If so, you can probably acquire one locally at a fraction of the cost. (Unless you have to pay a large sum to actually compel yourself into action.) In fact, by not knowing what chiropractic is, you could actually get some advice that could better help you connect with the lay public. Put an end to the genetic mutation from inner breeding! Most of the problems dogging chiropractors are rarely chiropractic problems, anyway.

3. If you don’t have a clue about ways to develop yourself as a leader, you may find that an outsider can point the way out the box you’re in or the scotoma you can’t see. Investing in personal development is among the best investments you can make. I’m assuming there are practice management groups that can help you with that.


Realize that management firms are likely to use the same manipulative techniques on you that they teach you to impose on patients. Whether long-term contracts, calling you on the carpet or shaming you into thinking you can’t make it on your own. Here's an entirely different approach if you're looking for a chiropractic consultant.

Before you post a comment, please read Broad Brush.

Comments (21)

Bill,

We go back a long way and I am very grateful for all you do for chiropractic. I believe you are one of the brightest, if not the brightest mind when it comes to the doctor/patient relationship and how to grow the practice for the inside-out.

Some think this was a tough one for you to write. I don't think it was at all. Given all the extrordinary ideas you come up with and knowing how much time you take to put that info together, your points of view outlined above where just another example of you saying something that most feel, but won't say.

Years ago when presenting seminars to doctors, I would get all caught up into the surveys hoping to read comments on how to improve my presentation. I was usually disappointed.

Someone far brighter than I said surveys are not about evaluating the speaker; but more about evaluating the type of audience you're speaking to...

What I have found is the "type of audience" and typical characteristics of those doctors in attendance are easily recognized depending upon the type of practice management firm we're talking about. I also believe that these firms serve a very small percentage of chiropractors, nationwide.

Which ties into my final point. One would think, given the challenges of every day practice, that a large percentage of DC's would be members fo one practice mgmt firm or another. I have not found that to be the case.

Although anectodal, given the many doctors and companies I interact with daily, I would estimate that of the approx 65,000 practicing DC's, about 5% are involved with different practice mgmt companies, and that the majority stay for 1, may two years.

I know some of the key players out there running companies who are very well intentioned.

Either way, not to oversimplify, I think what most need is just a good helping of common sense and simply believing in the "golden rule". Having said that, firms do serve a great purpose in helping the doctor put together the every day workings of an office.

As you know, I always wish you the very best.

A fan forever,

Sig Miller - Exec Dir
Assoc of NJ Chiropractors

Thanks Bill. If I could have all the money back that I spent on coaching I would be much better off. The cookie cutter approach with 1980's marketing does not work.

Dr. Leo K. Silverstein:

Bill-
Thanks again for your wonderful insight on how most, not all, of these PM groups treat their clients. I too was a member in my earlier years of practice and got duped into believing their thought patterns. It’s a disgrace what they have reaped on this profession. Another interesting insight that no one has touched on is the way the sales reps of some of the companies that sell equipment, etc to this profession also know what buttons to push. Something needs to be done. Everyone old and new in this profession needs to take an active step in the correct direction to stop this nonsense.

Bill, I understand what you are talking about when you refer to manipulative techniques espoused by several management companies. I have been exposed to this and I think this is very wrong. I also think it’s wrong to have a cookie cutter approach to care plans.

That being said, I have personally learned a lot from several practice management groups, and I am a better chiropractor for it. I have learned better ways to communicate the value of our care, higher efficiency & productivity, how to encourage wellness participation and I am reaching more people than ever. I enjoy a wellness based, profitable practice.

When I first started in practice, I thought practice management companies were ridiculous, only for the weak and the stupid. The problem was, my results were dismal. My practice was totally insurance dependant, acute care based and I eventually resented being a chiropractor.

I realized that I was trying to re-invent the wheel, so I finally decided to hire somebody that had a working blueprint. They taught me many useful things, and they taught me many things that I reject.

So yes, there are management groups that teach unethical things and set up warped relationships. But many also teach great chiropractic and business principles.

When I read your comments posted here, there are many useful and valuable ideas, and some that I do not agree with. This doesn't prevent me from continuing to read and participate. In the end, it is up to the individual to decide what to accept and what to reject.

Brandie Nemchenko:

I'm sorry to be different than the above comments, Bill, to be quite honest, I am completely shocked that you wrote this. Even the style in which this is written is completely different - there is a hard edge to it and a blanketing to the entirety of management companies that confuses me.

To me, one company specific company was targeted, that being The Masters Circle with the jab about "Even Tiger Woods has a coach" which is on their website.

I will admit - I have been with 5 different management companies.

Aside from one - that I will not mention which was completely unethical and I fired them when they told me to put the next 5 patients on the same plan of 30 visits. Overall, I have gotten so much from them all. I chose to take the best of what they had to offer and rejected what didn't resonate with me or I wasn't comfortable to do.

You and I have discussed by phone before, that I believe if I educate my patients and give them choices (the basis of almost all that you write about) I will earn their respect. Over the years, I have faithfully read your Monday Morning Motivation and felt like "Yes! There is someone in the world that feels like me!" I firmly believe in patient choice and respect that they are the boss of their body. I refuse to compromise that. When the management companies didn't respect that in me - I let them go.

Last year - I swore off management companies. I didn't need them. I had been in practice 6 years. I could do it myself.

I took business courses (I highly recommend chiros doing this as it is a business after all), leadership retreats, hired life coaches (who charged much more than any management company) and read voraciously. It may be appalling to some that I would actually consider my business a business but it is. Does that mean I don't care as much as the next chiropractor,...no! I just want to be educated enough to have the systems and acumen in place to have an office that can support itself to heal others).

This education was great but I did not get the information and jazz that I got from attending a specific seminar until I went in April to a fellow doc's office where they hosted a Masters Circle event.

I didn't go to sign up for them. I had worked with them years before and had to leave due to finances. When I listened to Bob Hoffman speak, I was hooked. It inspired me, just like listening to somethings you have done, has inspired me. I liked the people that were members because they emulated my best self. How I wanted to be. I wanted someone to hold my hand in the fire and instead of complaining about reimbursement or crying about the state of things, to be a better person, a more effective communicator, to have more impact on my community.

They have gotten even better. They genuinely want to help and are willing to meet me whereever I am and to aid me to get over the blocks in my practice. They always supported that I was an acute pain practice and never told me or forced me to say cheesy things or cookie cutter patients. They helped me improve my thinking and helped me become a better person/doctor and to hold myself to a higher level because that is what my patients and community deserve.

I can ask them questions my life coach or business class couldn't answer. They are helping me ethically build a the wellness practice of my dreams so I can make a bigger impact on my community. Offering services that patients are getting elsewhere anyway.

I understand your frustration with the bad ones. Honestly, Bill, I do. I'm just shocked that you blanketed the whole profession of management companies and lumped them all together.

Just like every patient is different, every chiropractor needs something different. Some need coaching. Some don't.

Greatest practice management guru on the planet is the Innate Intelligence residing in you. If you quiet your mind a few minutes a day, listen to the thought flashes that rise from your subconscious to conscious mind and ACT on them, you'll have the EXACT practice you desire.

Victor Sañudo:

Bill,
One year before I started my practice from scratch, one of my mentors (my uncle) told me that in life everyone is trying to sell you something. And it´s really up to us to accept or not everyone´s ideas. I believe that you can take very positive things from many practice consultants and put them in the service of patients (that would be the right thing to do). I do not despise neither love these guys. It really depends on everyone´s heart. If you are in this profession for the wrong reason, you will become a salesman, and most likely a slave of a consultant group. If you are here to serve, you will gain communication skills, business skills, motivation, etc. from whatever source (including them). It´s all part of the lifelong search.
Thanks a lot
Victor

I am a 10+ year veteran of one of the largest and most ethical personal development management groups in our profession. While I agree with your assessment that a lot of the practice management groups out there are less than honorable, I caution the reader from assuming that they are all the same. The particular group that I've been with stresses that they are there to help raise the self-esteem of their members, raise the awareness of chiropractic in the community and to help set aside the divisions that exist in our profession.

Through them, I've gotten to hear, meet and learn from leading experts such as you, Dr. Gentempo, Dr. Hanson, Dr. Mancini, Dr. Clum, and Dr. Riekeman. I have had the experience of meeting bestselling authors, business leaders and college presidents. I’ve been given the opportunity to discover and experience the various equipment suppliers and vendors who support our profession.

I have also had the opportunity to meet some of professions best practitioners. To learn from them so that I am able to serve the greatest number of people in our community ethically, professionally, and practically.

I have been coached on and encouraged to raise the bar in how I approach my daily interactions with my practice members and the community at large. All of this would not be possible had they not given me this exposure.

Never have I ever heard them offer a "cookie-cutter" approach to patient management, pressure or subversive techniques to persuade someone into a treatment plan they didn’t need, or even "how to close the deal."

The bottom line is this: Not all management groups are the same. They are an invaluable asset to their members. It is said that to learn from ones mistakes is smart, but to learn from someone else’s mistakes is genius.

The group I am with allows me to avoid the pitfalls and mistake already made by countless others.

Dan:

Mr. Esteb, I could not say it better myself. I am one of those Doctors in the process of deprogramming. Everything you touched on in this article is what I experienced in my past year and now I am in a dogfight to get out!

I have recently listened to Greg Stanley's stuff and it is right on with your comments here. Especially the report. The idea that you can change a person's mindset in five minutes with a good report is ridiculous! The idea that taking the hard line with patients as you would your children is ridiculous too. The reason I drew back from the management group is because their procedures required me to essentially treat my patients like children and I knew if I were a patient that was a pretty good way to get me to walk out the door pretty darn quick! I highly recommend against joining a management group. They are just vultures out to suck you dry.

Michael Soucy, DC:

Bill,

The year plan strategies taught by coaching companies are replete with sales and psychosocial techniques for manipulating patients. These manipulative fear based techniques have set chiropractic back decades, regardless of how heavy handed or how subtly they are applied.

Thank you for pointing out the damage they are doing to patients, doctors and chiropractic's image. This type of intellectual use of force must be stopped if chiropractic is to grow and mature. I'm hoping that this represents the beginning of the end for them.

Thank you
Michael Soucy, DC

Bill, thank you for saying what we at Rosen Coaching have been saying for years! Both Dr. Rosen and I completely agree that most practice management companies use the same scare tactics they teach chiropractors to use on patients, to get the doctors to commit to their programs. At Rosen Coaching, we have been publicly promoting the "Scare vs. Care" approach for chiropractic for the past 5-10 years and we appreciate your support and vocalization of the subject!

May I suggest the 4th reason that people get coaching is to look at both procedure and headspace with relation to whatever problem they are having in practice (low new patients, low retention, staff changeover etc.) This is the key distinction between coaches and consultants. Practice consultants tell you 'what to do' and it's 'their way or the highway'.

A coach will help you customize your procedure, help find obstacles and help resolve the headspace and mindset that is so key to running a successful practice. Most chiropractors have incongruencies and headspace issues and have never been taught how to run a successful practice! They don't know how to hire the right staff, have a 'Dream Team', how to ask Socratic questions to help patients see that they do want what the chiropractor is offering OR that they don't! How to do this all without patient SCARE but EMPOWERMENT! That is our job to help them learn and refine these skills!

The 5th reason people get coaching is that they want to grow to the next level and they don't know how to create the space, to fill it and then to reorganize to get to the next level. Most people have no idea how to do this - because if they did, they would have already.

Warmly,
Dr. Angie Meyer
Rosen Coaching

Christopher Sande:

Bill,

You certainly put yourself out on ledge with this one. If the gurus read this, I don't think they will be very happy and you may not be asked to speak at their next SUCK ‘EM IN, BEAT ‘EM DOWN ‘TIL THEY SIGN UP, BRAINWASHING EXTRAVEGANZA that only the best of the best will attend. Oh, and they will have a testimonial or two of the couple of people who were actually successful with their programs. BILL I’M VERY PROUD OF YOU FOR WRITING THIS. THIS POST SAYS ALOT ABOUT YOUR CHARACTER. I am ashamed to admit I've been duped by not one, but two of our profession’s gurus. But no more. They are stain on our profession and may in fact be the undoing of chiropractors across America.

Lowell Keppel:

Yes Bill,
You know, I have been thinking why Chiropractors have such low self esteem; then one day looking in a typical Chiropractic magazine, I realized that our own profession is the reason. Every advertisement is telling us we are too stupid to run a practice and we must join such and such a group to get a leg up on our competition.

I also dislike the way they tell us how hard it is to get patients (clients) and keep them. When the reality is, that it is very easy to get patients (clients). We, the Chiropractors, are buying into the chicken bone curse.

Let's start telling everyone how easy it is to be sucessful and that people would love to come to see us.

The abundance of practice management people out there is a real testament to greed and low self esteem of this wonderful profession. We seem to have lost the art of getting people well (including ourselves).

Chad McKeel:

I see your point on the 3,2,1 approach.
But at the same time it takes 9 mos to have a baby no matter what you do. It takes 6 weeks for a bone to heal, no matter what you do. So there are certain physical laws that can be applied. Not everyone treats the spirit, some do focus more on the physical and a cervical sprain will take 12 weeks to heal whether they get chiro or not. (The goal at that point to be minimize scar tissue). So there are occasions to line up with time frames but not always. I know, I know, we don't treat. But some do.

Great job Bill!

As a veteran of at least 5 practice management groups, I agree with everything you said. The patient must be treated with respect and allowed to make the decision about their care without being manipulated or coerced into care they don't want or need.

You are a great asset to the profession and I look forward to seeing more of your work.

Tom Close:

I was in the same Conversation in 2007 that Dr. Mithra attended and really left that event in a joyful state, empowered to simply be myself with no overlay of templates of "proper" patient management, which I knew in my heart and clinical judgment were more or less coercive. So, ditto to all the comments above.

All the consultant firms I’ve brushed up against have some sincere service consciousness and Chiropractic vision to offer as well as pragmatic systems, but it seems they also have a knack for making what could be a effective and happy DC feel like loser and or a slacker as well as the yucky patient experiences already mentioned. I had a fit of ambition some months ago and started to search for the magic scripts so I could "go to the next level.” After about 3 weeks of struggle and consternation (it didn’t feel right at all, try as I might, and I was enjoying practice less not more) I heard two words from an interview with our Bill Esteb: HUMBLE SERVANT.

Its effect was like an excellent perfectly timed spinal adjustment and my whole approach to practice settled down to its own innate sincerity: no scripts, just sincerely sharing my honest recommendations without attachment to how they're received; back in touch with what a gift were given to significantly help people by liberating their neurology; having joyful encounters with clients without inhibiting my spontaneity (and finding the words coming from my being in the moment that communicate better than any script).

Curiously, perhaps the granddaddy of patient management mentors (J.W. Parker) was congruent with the core of healing and if I really owned what he taught, I'd saved myself a lot of grief over the last 34 years as a DC:

LOVING SERVICE, MY FIRST TECHNIQUE
TAKE NO CREDIT, TAKE NO BLAME
ACT WITH LOVE, REACT WITH FAITH...
SUCCESS AND HEALING ARE MORE OF A SHEDDING PROCESS THAN ADDING ANYTHING

So, that simple shift of basically DOING NOTHING (other than surrendering to my own innate and RELAXING !) .......the practice has gotten not only more fun again but really busy (like Mithra, the reactivations and referrals indeed keep on coming). Practice is more fun when it’s fun.

Wow, both barrels today Bill!
As a chiropractor who was signed up with one of the biggest coaching companies before graduating (it was expected with the associate position I accepted) I agree with you. On the other side of the coin I must say it was a heady experience running a credit card for thousands of dollars before a single adjustment was rendered. Then the other shoe dropped.
Several years ago I was walking around a car lot while getting my oil changed. A nice young man started talking to me. About 45min later I awoke from a sales-pitch induced coma to find I was just about to buy a Suburban I neither needed nor wanted. I gave a few lame excuses and managed to wiggle out of it.
Over the next few weeks I found myself feeling uneasy every time as I drove past the place and haven't been back since. Not only did they not sell me a car, but they lost my repair business as well.
I realized how I felt about this dealership is how some past patients felt about my office. With a sense of dread I realized as a patient, I wouldn't seek care at my own office. Not because of any competence issues but due to the concern of always being "sold" something.
I've since realized the best "closing technique" is to say " I agree with you." when they decide chiropractic is something worth buying, however long that may take.

WBD:

Stright Talk: Again you are right on. Regardless of the business/practice, those who seek only to fill their wallet will always use the same manipulative techniques.

There is always room for a good Chiropractor who speaks straight, to the point and actually wants to help the patient feel better.

Honesty is still the best practice.

Like Bradon Harshe cmts above, "If you give a solid, specific adjustment, a patient might not even need 3 adjustments in that same 90 days. Why don't they teach that?"

Those who really want to be better, will treat others better, more honestly and with a desire to help.

Speaking as a student, I've been to quite a few of these practice management seminars and it's the same. I've even signed up as a student member for one in the past.

All those points you brought up are dead on and just as ridiculous as they sound. It took me forever to get myself out of that 3x a week for 90 days mentality. It's just not ethical.

If you give a solid, specific adjustment, a patient might not even need 3 adjustments in that same 90 days. Why don't they teach that?

Dan Lyons:

Well said Bill.
Everyone entering Chiropractic college and in the profession today needs to read this.

Thank you for all you do.

Dan

Tony Russo:

Woew Bill,
Good one, man. Real good. all the Chiropractors who get into these practice managers, all of them, are the talk of the town. And it's not complementary, at all. Thank you for telling others what I've been thinking for years. Hard pill to swallow for these well intentioned managers indeed. But if their intentions where well wished, would they do it for free? Then their heart is not in the right place. How much to we on the front lines do for free? They always get their 500 lira, though. Good job, Bill. Good job.

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From June 11, 2009 3:40 PM

This page contains a single entry from the blog posted on June 11, 2009 3:40 PM.

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