Chiropractic Economics Blog

I subscribe to a number of RSS (really simple syndication) feeds as a way to make sure we publish all the news that may affect you and your practice. It seems that at least once a week for the last couple of months, I’ve been seeing press releases from the notorious anti-chiropractic group that is active on the eastern seaboard.

This group has been active for several years. It has put up billboards, plastered advertising on the sides of buses, and bought television advertising. Worse — it keeps feeding the popular press with sensational press releases. Some newspapers and, more recently, television stations that are notorious for reporting biased “journalism” take delight in “warning” the public about the safety of chiropractic.

I put “journalism” in quotes because I do not consider these biased reports to be journalism. A journalist would make every attempt to provide a balanced story. The articles that have appeared in print and on TV are far from balanced.

When I see the propaganda spread by this anti-chiropractic group, I am reminded of the blackballing efforts made by the American Medical Association in the 1960s — efforts that the courts made illegal with a permanent injunction as the result of the landmark Wilk vs. the AMA case. I grew up in the era when the AMA called chiropractic quakery and forbade its members from associating with DCs. It took the education I have acquired as editor of this magazine to learn the truth about chiropractic. What if I had not become editor of Chiropractic Economics? Would I be harboring prejudices against this noble profession?

I just hired a new assistant editor. As part of his training and education, I gave him a copy of Chester Wilk’s book, Medicine, Monopolies and Malice. If you have not read the book, do it now. If you have not read it for years, it’s time to read it again — to take a refresher course on the hard journey chiropractic has had to take to get to where it is now. (I hope this book is on the required-reading list of all chiropractic students.)

Perhaps Dr. Wilk’s words will inspire you to fight back and support the Foundation for Chiropractic Progress (www.F4CP.com), which is valiantly trying to educate Americans about the value of chiropractic, or get involved in your state and national chiropractic association. Strength is in numbers.

The anti-chiropractic group is hoping its yellow journalism will taint everyone against chiropractic. We can’t let that happen.

Until next time,

As editor of Chiropractic Economics magazine,  I get calls from readers. Many of them are similar to these:

• “I’m getting a divorce. Can you tell me the average income and salary of chiropractors in …?”
• “I’m a new DC and I’m setting up my first practice. I need to tell the bank how much I will be paying myself and my staff. What’s the going salary rate for a new chiropractor?
• “I’m hiring my first associate. How much should I pay her?”
• “My CA wants a raise. How can I tell if I’m paying her the right salary?” 

I’m not in a position to advise anyone about financial issues. However, I can and do refer callers to the latest information we have published in our annual salary and expense survey.

The salary and expense survey Chiropractic Economics conducts each year is not acurately named. It is not so much a salary survey as it is an income and expense survey. Its analysis shows how your income (gross and net) compares to your peers across the country and to members of the opposite sex. It shows differences and similarities between group and solo practices. It compares cash-only and reimbursement-based practices.

In other words, it gives you information you can use to set sail on your future.

You can’t get this information from any other source. No other organization conducts a similar survey — not even the U.S. Dept. of Labor, which uses our data in its biannually published Occupational Outlook Handbook.

I am aware that completing surveys is a time-consuming task. When I was in human-resources management, I used to get periodic requests to complete salary surveys that required salary ranges, descriptions of positions, and averages of more than a dozen benchmarked positions. Completing that type of salary survey was very time-consuming.

Our 11th Annual Salary & Expense Survey is online and waiting for your input. It is not a difficult survey to complete. And it should only take about 15 minutes of your time.

Surveys are only as good as quanity and quality of the data they collect. Whether you are a new practitioner or a seasoned doctor, please take the time and go to www.ChiroEco.com/2008survey now. The survey will be active only through the end of February.

It’s easy to dismiss a request to complete a survey, thinking, “Let the next guy do it!” I hope this time, though, you will think, “I am the next guy.”

And who knows? You may need to know some of the information we collect.

Until next time,

Please don’t underestimate the importance of careful hiring and deliberate training — not only in the “hard” skills of the job, but also in the “soft” skills of dealing with people.

I am inspired to comment on this subject because as I write this blog, I am waiting for a call back from the technical assistant at my ophthamalogist’s office. I placed a call to her this morning, but technically, I have been waiting to hear back from her for more than a week, when I last called her for information.

What makes this “wait” so much more irritating and frustrating is that when I last saw this assistant, I related to her the story about my husband getting fired by our doctor because he wanted good customer service. All he wanted and expected was for the staff in her office to keep him informed. When they didn’t, he complained, and she fired him. (See my blog entry, “Do you fire patients?”)

When I told the technician this story, she was dismayed at the lack of understanding by the doctor. But, I guess the lesson did not hit home, because here I am, waiting for the telephone to ring.

The technician is competent, but she could obviously benefit from some customer-service training. Or, the doctor could benefit from more careful hiring practices, to make sure he hires someone who knows how to balance people skills with productivity skills.

We recently asked readers to tell us about mistakes they have made in running their businesses and what they learned from them. (We’ll be publishing what they told us in an upcoming issue.) One of the recurrent confessions was not taking the time to hire the right person.

 Please take time, and then train them in your expectations for good customer service. I suspect your patients are no different from me. They just want the courtesy of being acknowledged.

Until next time,

In my last entry, I shared with you my husband’s experience with our family doctor and her failure to grasp the concept of good patient relations. I have epilogue to that story: The doctor fired my husband as a patient!

A few days after his conversation with the doctor, he received a certified letter in the mail from her office informing him he would no longer be welcome as a patient in her office.

It’s important for doctors and patients to have a good rapport and respect for one another. Rapport, respect, and trust result in patient compliance and satisfaction. So, if these things are missing, the patient-doctor relationship shouldn’t exist.

However, I also feel that a patient-doctor relationship is somewhat like a marriage: Sometimes the two of you disagree. The important thing is to have good, open, and honest communication. That was the point my husband was trying to make to the doctor when he complained about getting a run-around from her staff concerning a medication that was supposedly on back order.

I fully understand why a doctor would fire a patient for noncompliance in a medical situation. I can understand why a doctor would fire a patient who consistently missed appointments or was late or didn’t pay his bills. But firing a patient for expecting good customer service? Somehow I think that was a drastic move.

What are your thoughts? Have you fired patients for pointing out a problem in your office? When would you fire a patient? I’m curious. I hope you’ll let us know.

Late last summer, on her 95th birthday, my mother-in-law came down with a severe case of shingles. Because of her advanced age and lowered immune system, medications that otherwise would alleviate symptoms and pain in younger individuals did nothing for her except give her pronounced and undesireable side effects.

Six months later, she is just now recovering from this painful malady.

When my husband initially took her to the doctor for medical treatment, our family physician told him about a new medication that could prevent the outbreak of shingles in individuals who have had chicken pox and who may be susceptible to it. He asked her to order the medication for both him and me.

Months later, we are still waiting for it. We called the doctor’s office several times to inquire about the medication.  Each time we were told it was “on back-order.” The first time we were told that, we believed it. After several months, we found it hard to believel

Finally, my husband called the pharmaceutical company to find out if the medication was, indeed, in such great demand that it was on back-order for such a long time. The company told him “no.” It had no back-orders of the product.

He then called the doctor’s office and asked to speak with the doctor herself, rather than her assistant.

The doctor finally called him back (three days after his call).  Her explanation for the delay was a misunderstanding about billing between her office and the pharmaceutical company and her staff had not been at liberty to discuss this with us.

We didn’t really care anything about the doctor’s billing problems. All we cared about, as he explained to her, was that we should have been kept informed — and not lied to.

The doctor didn’t seem to grasp the concept of customer service. She kept saying that we should keep calling her office for updates … that “her staff was so busy” it couldn’t call us.

This incident has caused us to rethink who we want to be our primary-care physician. Do we really want someone who does not understand that the success of her practice depends upon good patient relations?

To me, honesty is the single most contributing factor in keeping patients happy — whether it is honesty in admitting limitations of skill and knowledge or honesty in telling a patient the status of a promised remedy.

Unfortunately, my experiences with my medical doctor(s) seem to provide lessons that all healthcare professionals (including chiropractors) can benefit from and that I have shared in editorials and now this blog.

If truth be known, I’d rather not have the opportunity to share those lessons. I’d rather be treated as a valued patient.

Until next time,

When did you write your first term paper? I wrote mine when I was a senior in high school. One of the things I remember my teacher, Miss Lauterbur, emphasizing was that to defend the thesis of the paper, the writer must use strong, credible references.

As an editor and writer I take Miss Lauterbur’s teachings with me to work every day. And, I confess, when I read any work that presents an argument and relies of references, I scrutinize the author’s sources for credibility. If the sources aren’t credible, how convincing can the author’s argument be?

With that in mind, I’d like to refer to you Aetna’s Clinical Policy Bulletin on Complementary and Alternative Medicine (#0388), www.aetna.com/cpb/medical/data/300_399/0388.html. This bulletin is written to defend Aetna’s position on a number of CAM therapies it considers experimental. The list is lengthy, but the first item on it is Active Release Therapy. The list also includes other therapies chiropractors may use, such as acupressure and applied kinesiology.

Aetna cites 126 sources of information as the basis for this bulletin. Look through them carefully: You will find Stephen Barrett’s name, along with his Quackwatcher’s Web site (www.quackwatch.org) or similar sites he owns, listed several times.

Mr. Barrett has long criticized chiropractic and alternative medicine. In June 2007, he lost an appeal to Tedd Koren, DC, in which he said Dr. Koren had libeled him.

Aetna may have legitimate reasons for calling some of the therapies it refuses to pay “experimental.” But, it really should look more carefully at its defense sources in its written opinions. In my book, a Quackwatcher references doesn’t carry much credibility.

Until next time,

All businesses have behind-the-scenes people who are indispensable to their operations. The public never sees these individuals, but without them, companies would fail to function. Our business is no different. One of our key “hidden” staff members is our controller and office manager, Ginny.

Today we say good-bye to her. This morning Ginny lost a three-year battle to cancer.

Ginny was the pulse of the office. It wasn’t unusual for her to order a surprise breakfast to pick up our spirits if she sensed morale was low. Or to put surprises gifts — a patriotic lei for Fourth of July or sparkling bunny pencil for Easter — on each of our desks, just to put a smile on our faces.

Ginny was everyone’s mother-sister-aunt-friend. I don’t think there was a person in the office who didn’t occasionally sit down across her desk, close the door, and talk when they were feeling down. She listened and cared, even when her troubles were literally killing her.

You may have met Ginny at a Las Vegas Parker Seminars or a Florida Chiropractic Association National Convention. She was the bubbly woman who greeted you when you stopped by to say hello, made sure our booth had an adequate supply of magazines, and answered your questions about subscriptions.

“They” say no one is indispensable. I suppose that is true, in one sense. We will hire another person to do the work Ginny did, so accounts will be billed, and payroll will be processed. But the office where that work is done will always be Ginny’s office.

Good-bye, good friend. We miss you.

Until next time,

Sometimes I am ashamed of my fellow journalists. Case in point: A cover headline in the November issue of The Reader’s Digest that reads, “The Vitamin Hoax: 10 Not to Take.”

Scare tactics. The article is written to sell magazines, not to inform the public about vitamins.

The Readers Digest is the most widely read publication in the United States. Most assuredly, a good number of your patients will have read that article — and some of them might ask you about it.

I can “hear” some of their questions based on this single article:

“Doctor, is it true that antioxidants such as vitamins A, beta carotene, E, and C can increase the risk of dying? Should I not take them?”

“Should I take a multivitamin, or am I throwing my money away? Will it increase my chance of getting prostate cancer?”

“Does vitamin C help ward off colds? The Readers Digest article said it offered little protection.”

“How much is too much? What happens if I take more than the RDA of some vitamins? Can too many vitamins hurt me?”

“How can I be sure that the vitamins I am taking have pure ingredients?”

“Which vitamins should I take? Are there some I should stay away from?”

A few years ago, I sat in on a teleconference on understanding research studies, conducted by Anthony Rosner, PhD, who was then director of research and education with the Foundation for Chiropractic Education and Research (FCER). I no longer have the notes I took, but I remember Dr. Rosner cautioning participants to not accept all research findings blindly, but to look at how the research was done. Some research, unfortunately, is biased, just as some writers (and their writing) are biased.

In the case of this article, I would recommend you read it yourself to decide if it is biased against vitamins. Then, I would suggest you brush up on the facts about supplements, including reviewing the latest research (including the studies cited by the Readers Digest). Keep in mind, though, Dr. Rosner’s advice on looking at the construction of the research studies.

It is unfortunate that the Readers Digest would revert to scare tactics to draw readers in. On the other hand, perhaps this is an opportunity to turn a “sow’s ear into a silk purse,” as the saying goes. Arm yourself with the facts and be prepared to answer questions — or even to bring up the subject of the Readers Digest article yourself, especially if you carry nutritional products and recommend them to your patients.

Until next time.

Blogging is not an activity that comes naturally to me. In fact, a year ago, I only had a faint idea of what blogging was. Today, however, I see blogging as a way to share with you some thoughts and observations that I would not be able to share in the magazine.

I love magazine publishing. There is something very satisfying about working with contributors, helping them polish their ideas so that readers can quickly grasp new ideas and information, and then finally seeing the finished product printed on paper. Every time an issue is published I get the same rush I did when I published my first article almost 30 years ago.

Although I get the opportunity to write for the magazine — including an editorial message in each issue — I find that the magazine can sometimes be limiting. There just aren’t enough pages to say what needs to be said.

That’s why this blog is important. I hope to share with you ideas and observations about chiropractic, business, or just life, regularly. Sometimes what I write might border on profound or at least serious; other times, it will be light.

A blog is similar to a column in a magazine, but it has one huge difference: The format and delivery of the magazine does not allow for instant feedback and interaction from readers. A blog does. If you want to reply to something I have written, or to an issue, you can do so, instantaneously. No waiting.

I hope you will comment — frequently. I am always interested in knowing what is on your mind.

Until next time,