| By
Bruce Rappaport, D.C., Ms. Jacquie Bradshaw and Ms.
Carol Faas
1978
—This month’s issue of Chiropractic
Economics features an article that grew out of
a series of discussions between a group of Floridians
about the new directions in the chiropractic profession.
Bruce Rappaport, D.C., a new practitioner Jacquie
Bradshaw, a management consultant, and Carol Bailey
Faas, a technical writer, have pooled their diverse
talents and experience and are initiating a series
of articles on aspects of practice management techniques
for the chiropractic office. Future articles will
deal with employee motivation, patient psychology,
filing and record keeping, telephone techniques, and
billing and collection procedures. C.E. readers are
encouraged to let us know what topics they would like
to see covered in upcoming issues.
While
Dr. Bruce Rappaport was a student at National College
of Chiropractic, he visited dozens of chiropractic
offices. “What was it,” he asked, “that
made me feel welcome and confident in some offices,
while in others I had an immediate sense of uneasiness?”
Dr. Rappaport observed that the differences in offices
began with the impression received upon entering the
reception area. “Chiropractors must realize,”
he said, “that their practices are businesses
and their patients are customers! The patients must
be made to feel that they are special and that the
doctor’s office is there is help them.”
During
the early months of his practice, Dr. Rappaport utilized
the capabilities and expertise of Jacquie Bradshaw
through her consulting service of practical and instructional
office management. He also sent his assistant, Deborah,
to the F.C.A. sponsored program by Jacquie Bradshaw
and Doris Logan. This program, which leads to certification
from Logan Chiropractic College, is designed to upgrade
the ability of the assistant, training her (or him)
in the systems and procedures essential to an efficiently
and professionally run office. The program also emphasizes
the personal characteristics as assistant must develop
to successfully deal with the situations that occur
daily in the chiropractic office.
Traditionally,
chiropractic physicians have hired inexperienced personnel
and have hoped that on-the-job training and experience
would give them the skills needed to perform efficiently.
In fact, until recently, the chiropractor has had
little choice since C.A.s of professional standards
and uniform training have been generally unavailable.
This system has worked to the advantage of the ambitious
and imaginative person seeking a career, but, too
often, although the new assistant may be a capable
person, she or he lacks the specific training that
makes the office dynamic and synergistic. Thus, the
doctor’s time has been spent on training and
supervising office procedures, reducing the time and
energy he has available for the care of his patients.
Since
chiropractic colleges often have not adequately prepared
graduates for the business aspects of a practice,
the doctors themselves have not had the skills necessary
to develop and maintain viable systems of record-keeping
and office procedures, so they and their staff have
either had to muddle through or pay sky-high prices
for some external financial and office management
services. A few chiropractic colleges and some seminars
have offered courses to train chiropractic assistants,
and the need for this is now generally accepted by
most doctors. A professionally trained C.A. will not
only free the doctor from routine tasks, but will
play a positive role in practice building and will
benefit the office in many other ways.
An
efficiently run office is vital, but the professional
C.A., through her understanding of the practice and
philosophy of chiropractic, will also be able to raise
the level of patient satisfaction and communication.
She is the first person a patient sees, and on her
rests much of the responsibility of the doctor’s
image. A happy, healthy, friendly, attractive (which
does not depend on physical beauty) CA establishes
a positive public image for the doctor. By engaging
the patients in conversation, noticing posture, mobility,
mood and attitudes, she can provide the doctor with
valuable information.
Jacquie
feels that the professionally trained assistant is
qualified to take a responsible and vital place in
the chiropractic office. However, the doctor must
become aware of this potential in order for it to
be most fully realized. The Harvard Business Review,
in its classic series on motivating employees, concluded
that the only way to motivate personnel is to give
them responsibility and recognition in their jobs.
The
growing professionalism among chiropractic assistants
could herald a new era in chiropractic. This is in
keeping with a similar trend throughout the health
care professions. For example, when the University
of Florida sponsored a two year survey of the effects
a Physician’s Assistant has on a medical doctor’s
practice, it was found that the inclusion of a P.A.
on the heath care team enabled the patients to receive
more thorough and comprehensive treatment, led to
greater patient satisfaction, and increased the M.D.’s
income $1,000 per month above the P.A.’s salary.
The inclusion of two year programs for Medical and
Dental Assistants in many Junior colleges further
supports this trend, and their employers are certainly
benefiting from have well trained office staffs.
Dr.
Janse, president of National College of Chiropractic,
says he is tired of chiropractors feeling inferior
and seeing themselves as second quality to health
care providers. Chiropractic is an essential and rapidly
growing health care profession and practitioners must
take care to keep up with the current trends in the
health care delivery system of which they are an important
part. Having a qualified and efficient C.A. is definitely
an element of this.
Many
of the doctors whose C.A.s are attending the F.C.A.
program are already noticing improvements in their
offices. One area in which results can be quickly
noticed is in billings and collections. A professionally
trained C.A. is competent in efficiently and thoroughly
processing insurance claims. Many chiropractors feel
insurance companies discriminate against them, but
in most states this is not only untrue, but also illegal.
The problem is one of education; the claims adjusters
are not familiar with chiropractic procedures and
will disallow a charge that they do not understand.
However, if the forms are properly completed and provide
adequate information, this problem can be minimized.
Collecting
money from patients is a problem area which is very
sensitive, and a critical aspect of the C.A.s job.
In her analysis of this area, Jacquie has found that
each time a patient is allowed to defer a payment
the chances of ever collecting the balance decrease.
She says, “The patient who owes money will feel
uncomfortable in his/her relationship with the doctor
and this will affect his response to treatment”,
so everyone loses. Therefore, Jacquie emphasizes that
the C.A. should use a positive and direct approach
to collection, realizing that the doctor has performed
a valuable service to the patient, and that it hinders
the patient’s recovery and good self image if
she does not collect the full fee. Of course, a patient
who has serious and valid financial problems will
find the C.A. understanding, and a solution can usually
be found. On no account, says Jacquie, should the
doctor be too concerned or active in the actual execution
of the collection procedure, since he “treats
people, not pocketbooks.”
The
area of collections is just one in which the skills
and attitudes of the professionally trained C.A. will
benefit her employer. Let us conclude by saying that
the organizational and efficiency techniques, the
personality traits and attitudes and the professional
self image of the trained C.A. made her such an asset
to the doctor that she more than compensates for her
salary, with the most positive boost to the doctor’s
image and patient/public relations. In fact, a qualified
C.A. is the doctor’s most valuable asset.
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