Dangerous Opportunity
by William D. Esteb
Fueled by blind ambition, a desire to change the world, or misled by thinking success could be measured statistically, doctors in the 1980s squandered a valuable opportunity to dramatically change the perception and utilization of chiropractic. Prevalent insurance, combined with low deductibles, made chiropractic accessible to millions of people who might not have otherwise considered it. Instead of using this great influx as an opportunity to inspire and educate patients, it became expensive houses, polyester leisure suits, Rolex watches, and leveraged lifestyles.
Why waste valuable clinical time educating patients that chiropractic is bigger than mere pain relief? Why invest energy in patient education when there were countless other $100 deductibles just waiting in the wings if they could be enticed into the office?
Too many doctors ate their "seed corn" of the future.
Those days are gone. Today at seminars, state conventions, and other gatherings of chiropractors where there is talk of the future, it's done in hushed tones, punctuated by loud "everything's-okay-at-our-house" affirmations.
"How's it going Dr. Bob?" he asks slapping an old friend on the back with a forced grin.
"A little down, John. You?" goes the reply, mustering his most confident posture.
You can almost hear the shallow breathing and feel the sweaty palms over the phone. "Bill, what's going on out there? You've got your ear to the ground, what's the future looking like?"
Where do you start? Do you remind them of the calls I get from doctors congratulating themselves on their best year ever? Or should I join them for a few tears in their beer? There is change in the air. And it's making many doctors nervous. You can smell it.
The word "change" in Japanese comes from joining two ideograms together, much like a contraction or compound word. Combine the ideograms meaning "dangerous" and "opportunity" and you have the Japanese word for change. Change can be dangerous, but it can also be an exciting opportunity. Since the only tangible thing remaining from the change afforded by easy access to chiropractic care in the 1980s is countless files with brightly colored labels on them, how are you preparing for the inevitable and next dangerous opportunity: the disappearance of insurance cases.
While no one can predict the future, here are a couple of different scenarios postulated by doctors and influencers I encounter in the profession.
The Denial Scenario. If Alfred E. Newman was a chiropractor, this would be his outlook. The "What Me Worry?" approach combines a sense of naivete' with the classic frog in the beaker metaphor. Remember? Put a frog in a beaker of water and slowly heat the water and the frog will adapt to the increasingly warmer water until it boils to death. But drop the frog into the warm water and he quickly jumps out.
In chiropractic the warm water started out by first taking insurance assignment, hiring staff to handle the insurance "department", then computers, increasingly more complex software to shake the checks loose, seminars, fax machines, electronic filing; by now the water's beyond tepid. Worse, care recommendations are increasingly dictated by state legislatures that cap visit amounts or unsuccessful chiropractors selling out to insurance companies by passing judgment on the care rendered by their chiropractic brethren!
When a profession starts "eating" its own, you know there's something terribly wrong.
Those who deny there is a problem, figure that someone else will solve it, remain on the course they've set for themselves, and wait for the crowd to indicate which path to take.
The Hard Worker Scenario. This is a less naive version of the Denial outlook. Here, the doctor recognizes there is a problem, probably a serious one, but the strategy for dealing with it isn't ignorance, it's simply working harder.
Sadly, many practice management organizations are still beating this dying horse, continuing to counsel their clients to simply do more of what used to work. With every delaying strategy and claim-cutting tactic the insurance companies employ, they respond with thicker narratives, new CPT codes, and other gamesmanship. Alternative sources of income are seriously explored as areas of the office start looking like a retail store or a gymnasium!
Whether they recognize it or not, the conclusion the Hard Worker reaches is that you can't make a living in chiropractic. Self doubt, burn out, and a self-fulfilling prophesy lurk around the corner. Suddenly they discover it isn't the A.M.A. that will destroy chiropractic, it's the insurance industry.
The Waiting For Santa Claus Scenario. This is a popular outlook among doctors who have never actually talked with their Canadian peers to the north and think some form of nationalized health care will solve all their problems. Administered by the federal government and funded by some phantom source of tax dollars, proponents of this approach reveal their blind trust in the same folks who hatched Medicare!
In light of the recent abuse it has received at the hands of legislatures in an increasing number states, it's hard to know for sure how chiropractic will fare. But it's not likely to be the dreamy vision of sugar plum fairies that dance in the minds of children waiting for Santa's arrival.
Regardless of what happens, just remember they'll call it health care, but what they will really be talking about is sickness care. Even in a best case scenario, chiropractic will probably be limited to 12 visits for the "natural" relief of low back pain much like that sanctioned by the RAND study. Then the next logical step after that is to get it eliminated all together or teach "real" doctors to do it at weekend seminars!
The Opportunity Scenario. Many doctors will find this new practice environment a source of excitement and recommitment. It will require self-confidence and a willingness to make mistakes. There are no history books to consult when predicting what will happen as the insurance industry reorganizes and we see more and more patients without insurance and $1000 or higher deductibles the rule rather than the exception.
If all insurance disappeared tomorrow what would be the cost of an adjustment? Certainly not in the 90th percentile as currently surveyed by Fee Facts! How would that affect your income? Your lifestyle? Your overhead? Your focus?
Get accustomed to something called "downward mobility." Instead of striving for more, we will find a new sense of purpose and fulfillment from simplicity. The debt-laden lifestyles of the past will remain in the past. People are paying off their credit cards and avoiding incurring more debt--even with low Roosevelt-era interest rates. Patients will likely wait longer and be worse off when initially consulting your office. It will require better patient education than ever before.
There will be plenty of offices that will survive and thrive in this new world. Just as there were hugely successful practices before insurance, there will be hugely successful practices when it is gone. Will yours be one of them?
Which scenario or combination do you think will happen? Better yet, what are you doing today to lay the groundwork for successfully bridging this dangerous opportunity? Because change happens. For some it means going kicking and screaming, holding onto the past. For others, with a strong chiropractic philosophy, excellent patient education efforts, low overhead, and a technique that allows them to easily and effectively serve their patients, the future is already in place. What's your plan?
Buy the book
My Report of Findings
Originally published in 1993
240 Pages
US $24.95
Not a reader? Bill reads his favorite chapters from all 10 books on Bill's Best. |
