If I Ran the Zoo
by William D. Esteb
Like sharks, which biologists believe have not changed much in the millions of years of their existence, many of the practice management firms that cruise the waters of the profession, have remained unchanged too. All too many are still beating the dead horse of insurance, focusing much of their "management" advice on increasingly clever schemes to extract the ever dwindling amounts of money available from insurance companies.
Better insurance procedures should not be the focus of a practice management firm. Especially when the days of insurance as we've known them are numbered. When the only thing patients can afford is a catastrophic form of insurance with deductibles in the $500 to $1000 range, it's cash practice time! A better narrative report for insurance carriers won't change much.
Like many, I believe this impending "insurance crisis" will ultimately be a positive thing for chiropractic. It will tend to weed out some of those who got involved in the profession for the wrong reason. It will serve to dissuade those from practicing who do not have a strong understanding, trust, and philosophical basis in chiropractic. Watch for lots of used equipment (and practices) for sale in the near future. This is a time to watch your overhead and be smart about not incurring new debt.
The real tragedy will be the students. Rip Van Winkle never had it this bad! After a few short years of schooling, students are entering a much different practice environment than when they began school. What impact will large loan balances have on the fledging new practitioners?
Don't be alarmed or depressed. Or shoot the messenger. It's just change. And after a 100 year track record, chiropractic has proven itself quite adaptive, the ultimate expression of intelligence. It's a leadership question. Who is going to be leading the average practitioner into the future? Do we look to the national political organizations? The state associations and societies? Seminar groups? Practice management organizations? Headrest paper distributors? Where's the vision for the future of "post-insurance" chiropractic going to come from?
If I ran a practice management firm and was sensitive to the pressures and cultural trends chiropractic is facing today, I'd do things a little differently. For current practice management firms that need some fresh ideas, or a new upstart company that wants to command a presence, here are some free ideas:
Creating a nondependency relationship. Like the highest calling of any doctor (to prevent what he or she treats), tomorrow's practice management firms must work hard at keeping the relationship short. If a doctor simply wants to belong to a group, that can be accommodated through some type of mastermind or "alumni" group with a per-attendance fee. The objective should be to help doctors "get it" and not see how many years they can be strung along.
Telling the truth. It seems so basic. Like chiropractic that corrects the cause, chiropractic management should look to correct cause. Almost always the cause is the doctor. There can be a natural reluctance to tell the emperor he or she isn't wearing any clothes. This is actually a form of stealing. Tomorrow's practice management firm will have psychological experts and counseling services to help facilitate breakthrough changes in the doctor. At the root of virtually every practice management problem or should we say, "challenge," is the doctor.
Clearly stated value system. The chameleon-like appearance of most practice management firms makes it difficult to know just what value system will be taught. Like doctors who are afraid to reveal too much of their own identity for fear they may offend someone, today's management firms submerge key values in the hopes of being more attractive to more people. Oh sure, if you dig deep enough you can find the Jewish management firm, the Christian management firm, the nice guy management firm, the just-love-and-serve-them-enough management firm, the positive mental attitude management firm, etc. That's not good enough. Tomorrow's management firm will need a clearly stated mission statement, philosophy statement, and spiritual statement of beliefs so doctors will know exactly what they're buying. And there will be no pulling punches! If you're spiritual life is a mess, your life and your practice are a mess.
Set measurable outcomes. Incredibly, this is a missing element in many management relationships. Often, merely a small rise in statistical amounts of new patients, volume, or profit serves as a goal. Too bad. Like many patients who feel worse before they get better, or need care without obvious symptoms, quantitative statistics aren't sufficient. How do you want it to be after a six month or one year stint with your management company? How long are you willing to withhold judgment before crying foul? How are you going to measure your psychological satisfaction level? What will constitute a "successful" relationship? What are you really buying? The bottom line is accountability. Without some form of mutually agreed-upon outcomes, the relationship can lose focus and result in misunderstanding.
Trusted coach. If all we had to do was read a book or hear a "solution" at a seminar and instantly adopt it, personal and practice development would be a snap. And very inexpensive. The days of "just do this" are gone. The authoritarian and dictatorial days of "I-made-a-million-dollars-just-do-as-I-did" are over. What most of us really need is a coach that will provide physical, mental, and spiritual support as we try out new success habits. This is crucial because many success habits feel uncomfortable at first. It takes a good coach (not just someone who was successful years ago) to inspire, motivate, challenge, cajole, and beg us to adopt an idea or procedure which makes us at first feel insecure and awkward. A coach must allow rejection and failure, yet nurture an environment in which new ideas can be tested in safety. This requires small group settings and the help of talented facilitators--not sitting in a hotel ballroom with hundreds of other participants!
Chiropractic philosophy. Let's not forget why we're here! Without a constant dose of chiropractic philosophy it's too easy to lose sight of the real purpose for being in practice and forget what unites all chiropractic doctors. This philosophy not only should be talked about, but also practiced. Virtually everything from the registration process to the post-seminar mailings should be true to the chiropractic philosophy. No symptom treating! Seminars should start on time. No excuses about outside forces such as geographical location or economic times should be tolerated. No finger pointing. Solutions come from the inside out, not from a Santa Claus.
Tribal connections. Small group mentoring should be encouraged. Simply having a toll-free number to call a consultant isn't enough. Each doctor should have a number of peers out in the trenches whom they can call on a more regular and low-key basis. These small tribal units could be used to help avoid the sense of isolation many doctors feel. Additionally, they provide a ready source of problem-solving brain power. This decentralized approach may sound threatening to the type of control normally exercised by traditional practice management firms today, but this is what it will take to provide the safety net needed for personal and practice growth.
Embrace diversity. Chiropractic is a profession of Lone Rangers; iconoclasts who embraced a profession they were told no one wanted or needed. Individualists who have never received a perfect adjustment because they can't adjust themselves! This diversity should be honored. In the same way immigrants from around the world have improved the United States through cultural diversity, so too is chiropractic enriched. Without this diversity there is danger of in-breeding and losing touch with the world outside the chiropractic subculture. Participant feedback should be invited. No charismatic management group leader has all the answers. There is a wealth of wisdom in the audience. Coaching is a dialogue, not a monologue. Differences of opinion should be nurtured in the Socratic technique of uncovering the truth. Put microphones in the audience. "Slipping and checking" is part of the growth process.
If you've found a practice management firm that has already implemented these suggestions, congratulations. If this mythical management firm I've described is impossible to create, so be it. The real purpose of these observations is to question the status quo. As times change, so too should the management advice rendered this profession. The good old boy, "this-is-the-way-we've-always-done-it" must change. The psychographic of the typical patient has changed, and so too must the rules of practice conduct.
Intelligence is defined as the ability to adapt. Certainly our ability to exist for long periods under the ocean, in the Arctic, or in space are shining examples of our intelligence. To make course corrections on our commute home by hearing traffic reports on the radio is the result of our intelligence. And changing one's expectations from practice management consultants as the world changes is a sign of intelligence, too.
Buy the book
My Report of Findings
Originally published in 1993
240 Pages
US $24.95
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