What Are You Worth?

by William D. Esteb

A question I frequently get asked at seminars is “How much should an adjustment cost?” This is related to, “How much should I charge patients?” and “How much will a cash-paying patient pay for chiropractic care?” That these kinds of questions are being asked seems to foreshadow a deregulation of chiropractic. That is, as more and more third parties are reimbursing less and less, chiropractors find themselves exposed to the same market forces that influence the price of laser eye surgery, an acupuncture session or countless other health care services that have long flourished outside the influence of third parties. What are any of these services worth?

In this new deregulated practice environment, some chiropractors will strive to be the least expensive. One or two will attempt to position themselves as the most expensive. And a vast majority will constantly look over their shoulders, put a finger to the wind, and fight to be somewhere unnoticed in the middle. Lukewarm. Neither hot nor cold. Bland. Each pricing strategy has its pros and cons. Yet more revealing, each is almost entirely a reflection of the chiropractor’s self-esteem.

The warrior spirit that helped this profession persevere in the days of tremendous political bias is pretty well tamed now. Only a handful rise to the battle cry to protect subluxation and keep out the forces that want to make chiropractic merely “medicine lite.” And as the philosophy, that is cause for jealousy among the dental and physical therapy professions, is slowly drummed out of chiropractic colleges in favor of a more rational, mechanistic model, resistance to the forces that want to water down chiropractic so it’s more acceptable to the “establishment,” is likely to crumble still further.

Having clamored for “equality,” (How can chiropractic even be equated with medicine? The form, function, intention and outcomes are completely different!) most chiropractors find themselves powerless to combat the dwindling reimbursement happening equally across the board. And what most refuse to see is that as the aging Baby Boom generation brings their unhealthy “biggie-super-size-me” lifestyles and symptom-treating mentality to bear on the medical-industrial complex, chiropractic will continue to be seen as an unnecessary luxury that can easily be cut without much outcry.

Politics and philosophy aside, this is fundamentally a self-esteem issue. Do you look outside for your affirmation or do you look inside? Do you look to the culture to derive your validation or do you look to your conscience? Are you externally motivated or internally motivated?

Chiropractic is bigger than a treatment for headaches and back pain. To limit it in this way, in the face of millions of cases in which people have experienced the improvement of virtually every nonspinal health problem under the sun, is a form of self-deception difficult to fathom. Yet countless chiropractors, some even in leadership positions, deny this aspect of chiropractic so as not to rock the boat or offend the mechanistic notions of those holding the purse strings at the statehouse or in the boardrooms of insurance carriers and HMOs.

“Something’s better than nothing,” they reason.

Oh, really?

Like children entering adolescence, who yearn to leave the “kids table” and eat with the grownups at Thanksgiving, chiropractors seem to overlook the cost of being “accepted.” Just ask a medical doctor or two how reimbursement is working for them. Ask about the assembly line, take-a-number practices they have. Ask about being turned into a “provider” rather than a doctor. And ask about their malpractice insurance premiums. Is that what you want for chiropractic? Is being accepted really that important?

All of us do things in an effort to compensate for thinking we’re “not enough” or that we are flawed or defective in some way. Some shower their neglected spouse or children with expensive gifts. Others walk around feeling guilty or fearful. Some find dozens of ways to sabotage their brilliance. Still others numb themselves with work, sex, alcohol, sugar, television or a hundred other addictive behaviors. We can become incredibly creative with techniques to dim our brilliance, to be seen and not heard, to fit in, stay small and assume our “place.”

Besides endangering the very existence of the profession, this attitude of surrender, eschewed by the first four generations of chiropractors, overlooks the obvious: we’re almost there. If you’ve kept your head down the last five years or so, trying to eke out a living, chances are you don’t see the emerging trend in the “health care” industry. The Boomers are about to bankrupt the system. If you “go along to get along” you’re likely to become a victim of the implosion that’s around the corner. It reminds me of an apt quote from William Jennings Bryan:

“Never be afraid to stand with the minority when the minority is right, for the minority that is right will one day be the majority. Always be afraid to stand with the majority that is wrong, for the majority that is wrong will one day be the minority.”

We’re almost there. The tipping point has almost been reached. This isn’t the time to succumb to what’s expedient, but rather, to stick to what you know is true!

But it’s even more than the disfigurement to the “sacred trust” that’s going on here. When you have to beg for checks from carriers, wait three to six months to get paid, have your claims arbitrarily cut by 40% (or more!), even the most resolved chiropractor can stumble. They start thinking they aren’t worth a full measure. It’s so easy to think that if you’re paid less, you’re worth less.

In addition to the obvious downward spiral resulting from diminishing self-esteem, affecting everything from state and national association membership to chiropractic college enrollment, it can affect the number of new patients you get. But not due to the “You’re not on my list…” problem. No, I’m referring to the “Oh-no, a new patient” problem. Once even a hint of dread begins to be linked to a new patient waving an HMO card in front of your receptionist as if had value, you’re in trouble.

In the same way that 25 years ago it must have felt strange to provide care to a patient and wait for payment from some insurance company, it’ll feel equally strange to eliminate the habit of taking assignment. It’ll require courage and discipline, courage to face reality and discipline to get your own financial house in order. Because if you’re living beyond your means (like most of your patients), you may not be able to weather the transition back to fee-for-service.

So, how much should an adjustment cost? Exactly the amount you think it’s worth. If you think you’re worth $100, charge $100. If on the other hand, you think the adjustments you deliver are worth only $10, charge that amount. (Still not sure? How much would you pay to be adjusted by you?)

These kinds of price discrepancies are not uncommon among restaurants, automobiles, brain surgeons and paintings. This pricing issue exists because of two key factors: the individual supplying the product or service thought it was worth that much, and the person wanting the product or service thought it was worth that much. Simple. It’s based on supply and demand. It solves the question of how much to charge perfectly. But it starts with your answering the question, “What am I worth?”

Excerpted from
Connecting the Dots
Published in 2005
240 Pages
US $24.95

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