Enter to Learn How

by William D. Esteb

As each chiropractic college disgorges a new crop of chiropractors prepared to face licensing boards, students suddenly turn their attention from learning how to pass the board, to the acquisition of the skills necessary to run a practice. Many look for shortcuts or a recipe book that can show them how to successfully run a small business. Like searching for "an old test," these new doctors seem more interested in doing things right, than doing the right things. This misplaced allegiance to a protocol, a procedure, a script or a form is understandable, given the dogma and prejudice surrounding the choosing of an adjusting technique.

There is an undeniable smell of fear on the breath of these new graduates. Some, who come to chiropractic as second careers, seem more confident. They appear to be more attuned to the concepts of supply and demand, customer service and that the notion of profit is an essential ingredient to survival. Unfortunately, the fear that many graduates lacking real-world experience frequently encounter is well-founded. Little of the experience gleaned in chiropractic college resembles the reality of private practice enough to produce the confidence necessary to exchange their valuable skills in a profitable manner!

So, while chiropractic colleges continue to churn out diplomaed graduates who are generally successful in passing state boards, they have played a cruel trick. And in the process created a market for entrepreneurial forces and a parasitic "management" industry that preys on those tasked with carrying the chiropractic torch for its second hundred years.

As the division and backbiting plaguing chiropractic continues at perhaps a greater intensity than ever before, this profession loses valuable time and opportunities for advancement. When medical doctors disagree about a procedure or diagnosis they don't denigrate their fellow doctors. But when disagreements arise in chiropractic many of the least secure doctors seem quick to put down or discredit someone with a different viewpoint. Attempting to validate oneself by invalidating others is an old, ineffective remedy.

When the pioneers were attacked while traveling in hostile territory they circled their wagons. They defended themselves by shooting at the marauding Indians or bandits from behind their temporary fortress. When chiropractic is assailed many chiropractors seem inclined to use the occasion to shoot at each other from within the circled wagons! The target in their cross hairs either uses an "experimental" technique, only takes two minutes with a patient, is an insurance "whore" or graduated from the "wrong" chiropractic college. Meanwhile, the enemy sets fire to the wagons and rapes the womenfolk.

Apparently one of the most important objectives for new doctors (second to actually graduating) is choosing the right adjusting technique. As students walk down the halls past the bulletin boards of the "approved" technique clubs there are subtle pressures to attend the next meeting which will feature a presentation from the visiting technique instructor.

As students choose their weapons in the fight against abnormal spinal biomechanics they are quickly labeled, categorized and often the target of disparaging terms of endearment. The seeds of suspicion, bias and even bigotry within the profession get planted here. In increasingly subtle and destructive ways the importance of "why" you adjust is replaced by an inordinate focus on "how" you adjust.

No wonder patients who don't respond to your adjusting style are rarely referred to another chiropractor with an entirely different approach: they're the enemy. In fact, "the profession would be much better off if it just weren't for those chiropractors who do such and such!"

Perhaps worse than the bias against various adjusting techniques or the reputation assigned by attending a particular chiropractic college is the horrendous debt doctors graduate with. This turns graduating doctors into slaves in more direct ways than any managed care scheme!

The Old Testament addresses this issue in the book of Proverbs quite clearly. Besides several admonitions not to co-sign a loan, many proverbs remind us how the borrower becomes beholden to the lender and how the lender controls the borrower. If you need a textbook example of this just look to any chiropractic college.
At a time when more and more doctors are battling managed care (who reimburse ten cents on the dollar), or the realization that most patients with $1000 deductibles can't afford to pay $50 office visits three times a week, many offices are lowering their fees. No one likes to talk about it because it suggests a flawed ability to "confront" or some other shortcoming. Meanwhile, chiropractic colleges continue to escalate the cost of their tuition as if patients with $100 deductibles were still flocking to free spinal exams. The result is frantic doctors with a heavy burden to produce an income at all costs.

New graduates are handicapped in their pursuit of profitably exchanging their services by an incredible lack of patient communication training. Bent on producing graduates able to pass the national board examination, little focus is given to tableside manners, office protocol, report of findings, patient education and the communication skills essential for effective doctor/patient relationships. Even the school clinic sanctions a pain-relief-only perspective, counting patient visits only and giving little credit or incentive to create and nurture a long-term patient relationship! Many emerge from chiropractic college with the technical skills necessary to move bones, but increasingly unable to form coherent sentences, produce persuasive arguments or bond with patients--essential skills for survival in the post-insurance era.

The wisest new doctors recognize the shortcomings of their education and seek assistance from a variety of seminars, management programs and entrepreneurial organizations. The fact that they are even aware of the importance of these skills, suggests that they have a head start on achieving the satisfaction and fulfillment they sought when choosing chiropractic as a career. It is the huge contingent of "technogeeks" who lack chiropractic philosophy (because it's not politically correct to teach it on campus), and who can't communicate with intelligence and passion, who represent the greatest threat to the survival of chiropractic. Stripping away all else to the exclusion of diagnosis and orthopedic functions, creates uncompassionate spine mechanics. Instead, we have the cold, distant analytical clinicians that were previously reserved for the inner workings of a hospital.

The solution?

1. How about some personality testing upon acceptance at chiropractic college? No need to exclude shy, personality-challenged students, but at least give them the lead time and necessary warnings that actual practice will be especially difficult for them.

2. Add public speaking courses to each doctor's course load. If colleges were truly interested in producing successful chiropractors they would insist on graduating individuals who can form complete sentences, one on one or in front of a group.

3. Teach the latest patient education protocols on campus. In most college clinics patient education is relegated to a brief report of findings. If your care is virtually free at the student clinic perhaps that's all it takes. But not in the real world.

4. Reward alumni who are willing to take in new graduates. Create some type of incentive for field doctors who have been out on their own for five years or so to take a graduating student under their wings.

5. Honor graduating students who are able to attain the highest retention levels with patients at the student clinic. Too many colleges honor graduating students for the highest G.P.A., technique awards and other qualifications that do little to assure success in the real world.

6. Instead of the rhythm-breaking and numbing detail required at the college clinic, create an "advanced" clinic program where office visits are more like the time and treatment protocol of private practice.

Just as field doctors must adapt to changes in insurance reimbursement, managed care rears its ugly head and the population increasingly seeks non-drug and non-surgical solutions, so too must chiropractic colleges adapt.

Buy the book
Chiropractic Patientology
Originally published in 1996
240 Pages
US $24.95

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