I would love to get your take (a patient's point of view) on a GREAT DEBATE I and some colleagues have been having. One camp feels to charge anything less than $135 for an initial exam/x-ray demeans and decreases the value of what we offer. By charging more than offices around us we set ourselves as more valuable. The other side feels that to gain value one must first produce results and therefore allows for special offers ($25 x-rays) to get people in the door. Much of the population does not value chiropractic until they experience it. Any opinions?

My response:

If one's self-esteem is so wrapped up in what one charges, why stop at $135? How about $500? Or more?

Tragically, due to the influence of third party reimbursement (which is a short-term and quickly depreciating reality in the 108 year history of the profession), chiropractic is starting to assume some of the negative characteristics of medicine. Making the entry fee high is among them.

Somehow, chiropractic greats like Clay Thompson, Clarence Gonstead and countless others saw no reason to charge high entry fees. In fact, those practicing before the Faustian "validation" offered by inclusion in third party schemes looked at fees quite differently than most DCs today. So many chiropractors have a "show me the money" attitude about practice rather than the serving-others-protecting-principle notion that prompted hundreds to go to jail for chiropractic. Know any colleagues who would go to jail to protect chiropractic these days?

If you want to salute the values of third parties (symptom treating, short-term, no kids, etc.) charging as much as you can get away with seems to make sense. Yet on the other hand, if you want cash-paying wellness families, one might think twice about making the entry fee high. What kind of practice do you want? Just what do you think chiropractic is? A natural therapy for back pain? Or a way of life?

So the answer depends upon what vision you have of the future of the profession and how you see chiropractic fitting into (or remaining outside) the medical industrial complex that runs "health" care in our nation.

If I were in practice I'd do everything I could to stay outside the reimbursement model, charging a fee-for-service that families could afford.

If all third party reimbursement vanished tonight, incomes would immediately plummet. Those who are intellectually honest and admit to this marketplace reality use it as proof that reimbursement is a good and necessary thing. Yet, I think it has stolen the very soul of chiropractic.

On our deathbeds, we won't care how much money we made or give much thought to our biggest collection day. No, we'll recount the lives we touched, the relationships we formed and the eternal differences we made. Something difficult to do when you're just the "boy" for an HMO.

Bill