DIS-EASE in Chiropractic

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Because of managed care, chiropractic practices are down 20% in the U.S. and down 50% in the state of New York, according to a spokesman for the ACA.  It is such a frightening trend that the organization is considering bringing an anti-trust suit against managed health care program’s carriers.  It is interesting that when some of the profession sees difficulty arising they immediately want to put the blame on someone or something else.  First it was medicine, so in 1976 they sued the medical profession. Somehow they won.  It’s good I was not called as a witness. My practice saw its greatest rate of growth during the period when the medical profession was supposedly waging its anti-trust war on chiropractic.  The bigger issue however, is whether outside factors are the cause of our profession’s problems, or if they are caused by internal factors.  Is it the lack of inclusion in managed care?  Some of the periods of history when chiropractic saw its greatest success were before insurance inclusion, when there were only cash practices.  Is it the economy?  We cannot blame it on the economy (an outside factor) if some chiropractors are doing well in spite of it.  Besides, we had more chiropractors in the Depression than in the prosperity of the 50’s and 60’s. What third party care has been is a temporary treatment for a profession in a state of DIS-EASE.  That DIS-EASE almost led to our demise in the late 60’s (some estimate our numbers were as low as 11,000).  A few philosophically-based chiropractors recognized the problem as having a cause within and sought to adjust the cause with a return to philosophy and service, de-emphasizing our role as “doctors.”  The D.E. movement and Sherman College were two outgrowths of that effort.

Unfortunately, the majority of the profession, thinking outside-in, ignored the cause and began to treat the symptoms.  The most effective treatment, of course, was third party pay dollars.  Like all treatments, it was addictive, it did nothing for the “health” of the profession and as we are now seeing, it was only “temporary relief.” Now that third party pay is drying up, the profession is suffering from withdrawal, plus the effects of the original cause.  The cause is that the profession is not functioning properly, it has no identity, and has no role in the health care system.  Some want us as back pain treaters.  Some want us as PHC providers, some want us as something else.  The incoordination in the profession has led to all kinds of problems which inevitably will result in lowered income and more failing practices, and ultimately less men and women entering the profession.  I predict this effect will be seen in the near future.  We overcame the effects of a profession in a state of DIS-EASE by effectively treating the symptoms with insurance dollars.  As soon as the insurance dollars stop coming, the symptoms will manifest themselves again.     

Some in the profession are saying the same thing that was said in the late 60’s.  (To a great degree it’s the same people saying it).  They are telling us once again to get back to our philosophy, get back to serving people, stop focusing on the material aspects of success, that chiropractic was not intended to make chiropractors rich.  On the other hand, some are saying if we can just get into managed health care we can treat our problems.  As if suing these programs is going to get them to like us and ask us to join them.  Suing medicine did not get the medical profession to like us, it just forced them to find other ways to fight us.  The outside-inners in our profession are still saying there is nothing wrong with us that a few insurance dollars won’t fix.  How can a profession supposedly focused on correcting cause be so interested in treating the symptoms with dollars. The best thing that could happen to this profession would be to go “cold turkey,” quit the third party pay scene and focus on what we do best.  Of course, a few of our profession would have difficulty making a living.     

The IME’s would lose their source of income and be forced to practice chiropractic (if they remember how).  The PMC’s would have to teach chiropractors how to do something other than get big bucks from insurance companies.  Most important, the JERKS in our profession would have to get their act together or find another line of work.  They could no longer bleed insurance companies while embarrassing the profession. It may thin our ranks but I am not sure that all the growth in our profession in the last 10 years has been of a healthy nature.  Our profession could stand to be pruned back.  Those anchored in philosophically- based chiropractic will survive and perhaps our entire profession will be much better off. v11n2

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