The Three Hats of Chiropractic

by William D. Esteb

At the helm of every small business is an individual struggling for balance--not just the books, but three voices battling for attention. Within chiropractic, these voices are called the Clinician, the Manager, and the Visionary. When these three dimensions are balanced, the business grows and prospers. When one voice dominates, which usually happens in most small businesses, including chiropractic, the business stagnates and flounders against an unseen barrier to practice growth and personal satisfaction.

The Clinician is that part of you with the technical skills to locate and remove the Vertebral Subluxation Complex among your patients. The curriculum at chiropractic colleges focuses on the technical aspect of chiropractic. From the results chiropractic doctors get with their patients, it is fairly safe to say that there is a high level of competency in the technical arena of chiropractic. Of course, there is diversity in technique, but the end result is the same. Why do some doctors possessing superb clinical skills go from one failed practice to another? Because to complement these healing skills and make your exchange with patients win/win you must be a Manager, too.

The Manager sets office policies and implements procedures that are compatible with your clinical perspective and value system. This is the chiropractic businessman, recognizing that fee structures must be set, collection mechanisms established, quantitative statistics kept, and staff management issues faced. Many abdicate their management responsibilities, relying instead on "squeaky-wheel-brush-fire" management. No wonder most doctors have little time or energy to plan the future of their business beyond mere survival.

The Visionary is the entrepreneurial spirit that constantly questions the status quo and reinvents the future. Patient negativity is seen as valuable feedback. Foul-ups are just hidden opportunities. While significantly affecting the lives of their patients, Visionaries don't take themselves too seriously and have a sense of humor about their work that is attractive to staff and patients.

Searching for balance

You'll agree that if each of these personality traits were equally developed and functioning in balance, there would be no stopping your practice.

But how do you achieve a workable truce?

First, look at how most small businesses get into the trap of placing a lopsided emphasis on the technical aspect of their business. While working for someone else, we are given the task of learning and excelling at some narrow range of activity. Let's say you're a travel agent. After a couple of years in the business, you'll have experienced 99% of the kinds of things travel agents experience. You've conquered the computer booking system, arranged tours, handled corporate accounts, and performed a host of other duties. Working at your computer screen, you've mastered the technical aspect of be being a travel agent. After a disagreement with your boss one day, you say to yourself, "Anyone can run a travel agency; look at the jerk I'm working for!"

As you leave with the technical skills of being a travel agent to create your own business, you view the travel agency business as merely a series of technical details. Soon you discover the real truth about running a travel agency!

If you've ever been an unappreciated associate doctor, maybe you experienced a similar scenario. But regardless of whether you started your practice right out of school or worked as an associate first, your technical resources were significantly more developed than the management and entrepreneurial skills needed for a balanced business. And they likely remain that way to this day.

In many chiropractic offices, as much as 70% of the practitioner's energy is devoted to being the Clinician. Reluctantly, managerial responsibilities account for only another 20%, with a meager 10% or less left over to dream in the role of the Visionary. No wonder burnout is rampant among doctors of chiropractic. No wonder the promises of practice management consultants seem so alluring. No wonder so many chiropractic offices look as imaginative as medical doctors' offices.

The challenge is to amplify the Manager and re-introduce the Visionary factor. This needn't lessen your Clinical commitment. Just prevent it from being an easy distraction from facing your underdeveloped managerial skills and the introspection required to identify new dreams for yourself and your practice.

Dangerous inbreeding

If you've worked with practice management consultants, you already know that after the dust settles it's still you who has to assert, confront, collect, educate, organize, direct, and motivate. Yet, many doctors continue to pay exorbitant fees to a parasitic industry that often makes, then feeds off the insecurities (and cash flows) of doctors who no longer see differences in their bottom line or in their sense of satisfaction. Doctors have been convinced to adopt the obscure procedures from corporate giants. Doctors are often exploited even more than they are taught to exploit their patients.

The solution? Admit there isn't a Santa Claus. No one can look after your interests or understand your needs better than you. Look for neutral practice development and business procedures--organizations or consultants not interested in creating a long-term dependency or asking you to change religions. Develop friendships with others who have successful small businesses in your community. Join the American Management Association. Read their books. Attend their seminars. Design your business based on mainstream business thought--not the inbred distortion of someone who was successful (whatever that means!) back in the 1970s and wants to show you how to duplicate it.

When it comes to vision, the last time many doctors utilized their creative skills was when they picked out the carpet color or designed their letterhead. Which probably accounts for why many offices have the same layout, colors, furniture, and chiropractic college graduation photo on the wall as they did when they first opened their doors. But vision is more head space than office space. If you take the time to imagine the office of the future, you can have it today. If you're worried about the future, invent it. Recognize that coasting requires that you go downhill. Without dreaming, planning, and trying new things you assume a passive posture that requires large amounts of energy to react to any changing health care/insurance/cultural/sociological/business shift. If the experts are right, the next five to ten years are going to be very challenging, yet it will be a very exciting time to be in chiropractic. Will you be prepared?

Spend some quiet time each day thinking about the future. Keep a journal to record your ideas and concerns. Read John Naisbitt's book, Reinventing the Corporation or listen to it on audio cassette. Write your statement of purpose. List every job function, activity, and aspect of your practice as it exists today and then imagine how will it be done in the year 2000. Question the status quo. What do you want? How do you want it to be?

Just as chiropractic enables patients to enjoy a better balance in their lives, it should afford doctors and their staffs at least the same. This exciting balance is possible after first recognizing what you're trying to balance and then taking action. You can find comfort in Walt Disney's proven axiom: "If you can dream it, you can achieve it."

Buy the book
A Patient's Point of View
Originally published in 1992
240 Pages
US $19.95

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