This special report outlines the external forces at work on the chiropractic profession plus, find out where the jobs are ’98, eight tips to master job interviews and three key areas: employment prospects, job outlook and earnings potential.
Students enter professional school with one thing in mind-success! However, the optimism and enthusiasm of newly minted professionals often turns sour as dreams give way to paying the high cost of chiropractic education. Who’s at fault when graduates fail to make good on their student loan payments? Unfortunately, we will find no “smoking gun.” Consistent with chiropractic’s world-view, loan defaults are instead the visible symptom of an array of underlying causes.
Some blame lies with the difficulty graduates encounter when seeking to fund their fledgling chiropractic practices. Thriving practices require equipment and adequate real estate to house them. In addition, they need sufficient cash to survive the lean start-up and marketing period. Financial institutions hesitate to dole-out the substantial outlays required to purchase existing practices. Students knee-deep in school loans and lacking in business experience are fraught with risk..
One of chiropractic’s problems rests in its relatively low visibility. Chiropractic schools produce fewer professionals than do those who teach law, medicine or dentistry. Since lenders are more likely to know a lawyer, physician or a dentist than a chiropractor, chiropractors find start-up loans harder to get. The unfortunate scenario repeats as bankers unfamiliar with chiropractors and their financial needs continue to cite their inexperience in making these types of loans as a reason not to make them. A would-be borrower will visit ten banks before he will find one knowledgeable about chiropractic in those areas where the chiropractic utilization rate is 10%. Nor has the American media been chiropractic’s ally. Legendary charges of quackery and spurned efforts at legitimacy have not gone unnoticed by lenders.
The Effects of Managed Care
As if scarcity of capital weren’t enough, the 1980s and 90s saw a burgeoning managed health care system all but redraw the health care map. Chiropractors unversed in the intricacies of insurance and government agency billing lost substantial business to managed care. In response, a few chiropractic colleges hastened to offer their students instruction in business basics, including the proper methods of billing the health care giants. Nevertheless, things turned grimmer for new graduates as the rapidly multiplying Health Maintenance Organizations (HMOs) demanded that chiropractors who sought membership on their panels demonstrate at least five years prior practice experience.
It looked as if the 1990’s might toll chiropractic’s death knell-as lenders unfamiliar with (if not downright skeptical of) chiropractic denied financially strapped graduates the needed capital to succeed in business. Add to this dilemma an increasingly hostile managed care system that often excluded chiropractors from participation or otherwise handed them an incomprehensible billing system.
Just as things appeared dire for chiropractic’s graduates of the ’90s, promising news began to break. The United States Bureau of Labor Statistics published findings that forecast a healthy chiropractic growth rate at 36% through the year 2005, exceeding national occupational averages. The Trends Research Institute Study published an upbeat 1996 forecast for the profession. The report explained how aging “Baby Boomers” were supplanting “Depression Era Elders” as the largest segment of health care consumers. While the preceding Depression Era Elders were sold on traditional allopathic health care models, the Baby Boomers had proven more receptive to alternatives such as acupuncture, homeopathy, yoga, special diets, vitamins, massage techniques and chiropractic.
Alternative health trade in the mid-nineties grew at an unprecedented 7 to 12% annual rate as Boomers increasingly viewed chiropractors as primary health care physicians. An equally receptive Generation X will follow on the Boomers’ heels mirroring their attitudes and perceptions-all of which translates into a sustained and significant consumer segment of Americans who will consistently seek the benefits of chiropractic. These successive generations together number in excess of 123 million people.
In addition, the American complexion is undergoing radical change as ethnic minorities will advance to outnumber whites by mid-century. Because of their cultural heritage, many of those within the swelling ethnic ranks are comfortable with natural therapies, as opposed to medicine’s traditional drugs and surgery. This group is often more accustomed to hands-on and personal forms of treatment. The Trends report advised that chiropractors seize the opportunity to become the nation’s “wellness” professionals.
Chiropractic Colleges Work to Empower Their Graduates
All professional disciplines have faced their respective challenges and when graduates encountered employment hurdles their response generally included the creation of in-house career centers to help locate professional opportunities and secure sources of capital for their students. Sensing the power of the marketplace, academia redesigned curricula to include courses calculated to boost students’ business acumen and ease “lender-anxiety.” However, not all chiropractic colleges were quick to remedy the dilemma faced by graduates. In fact, a surprising number still do not maintain professional career centers staffed with experienced counselors. A few progressive chiropractic colleges took up the gauntlet and developed career centers designed to transform students into effective job-seekers.
Masters of the Job Interview
The job interview was a universally acknowledged element essential to any hire, as employers do not routinely offer employment to applicants sight-unseen. Career offices labored to add polish to their student interviewers. Nonetheless, harrowing stories persisted about practicing chiropractors who conducted tag-team job interviews, quizzing unsuspecting applicants about esoteric anatomical minutiae. Generally, these accounts were the cruel imaginings of upperclassmen intended to unsettle the new recruits. In fact, “oral exam” interviews are relatively infrequent and ordinarily unnecessary in that students have adequately demonstrated a technical competence through a battery of national boards that follow on the heels of a grueling graduate curriculum.
Employers more commonly engage in “stomach test” interviews-designed to elicit whether the chiropractor and his staff can “stomach” working alongside the applicant on a daily basis. Successful chiropractors want associates who can nurture healthy doctor-patient relationships. Throughout the interview employers scrutinize an applicant’s body language, word selection, enthusiasm and eye contact. They know that job seekers who do not evoke feelings of trust and comfort are unlikely to stimulate business and could unwittingly sink a practice.
It is felt that salary negotiations are best left until after a job offer has been made. Nor should an applicant necessarily hold firm on salary demands and risk “scaring off” an employer. He might better demonstrate value to the practice and renegotiate salary a few months into the job having proven his worth.
Dreaded “crash and burn” type interviews sometimes do occur and often through no fault of the applicant. To qualify what is meant by “through no fault of the applicant,” an astute applicant who detects an interview careening off track will rescue it. Interview savvy can compensate for an employer’s inadequacies and yawning silences can be turned into animated exchanges.
Applicants should beware of pat interview questions such as, “What do you consider to be your weakest trait?” Remember, an interview does not call for self-flagellation. Rather, employers generally like people who are able to turn potential losses into wins (or tough interview questions into rewarding answers). A weak trait many employers find tolerable in an applicant is an obsession for perfection.
Eight Interview Tips
- Applicants preparing for interviews are advised to dress conservatively.
- Men are to wear suits (or jackets with ties), and women are encouraged to wear business suits.
- Clothes should be neat and clean with creases pressed and shoes shined.
- Hair should be neat and businesslike.
- Extremes in makeup and jewelry are a no-no.
- Upon meeting the employer the applicant should smile, make eye contact, and shake hands firmly.
- Since people love to hear their name spokenapplicants are encouraged to speak it often.
- Tardiness dampens the best interview, so allow time for travel mishaps.
New Grads Take Demographic Stock of the Market
Those who are about to enter the job market should have demographic data available to make important career decisions. Chiropractic graduates will more likely succeed where the local population is receptive to chiropractic, can afford it and are underserved by chiropractic professionals. An analysis of a region’s vital and social statistics will disclose whether the area holds promise for budding chiropractors. The graduate should look at a population’s health and consumer habits as well as the area’s economic and educational characteristics.
In an effort to assemble relevant demographic information, some chiropractic colleges have invested in state-of-the-art “Chiromaps,” desig-ned by chiropractor/demographer Dr. John Marty of Minnesota. The large maps, as shown in Item One, are mounted on view boxes that display a brightly lit United States whose counties are color-coded to reveal demographically favorable factors. These favorable factors are based upon an extrapolated model chiropractic patient including her gender, age, median income, education and geography. Yes, these are “her” characteristics-more than half of chiropractic patients are white females. Furthermore, her family income will likely exceed $50,000. (We might even spy a “Gucci” emblem on her handbag because more patient families actually earn $60,000.)
The demographic map identifies underserved areas at a glance; no longer will entire states be dismissed because of chiropractor-to-population ratios that appear unfavorable. Instead, the student will identify individual counties that hold promise.
Chiropractic Broadens Its Horizons
Students are also encouraged to consider global opportunities rather than simply “packing up” and heading home upon graduating. It is suggested students select their courses and seminars with the marketplace in mind-geriatrics seminars for work in expanding retirement communities or pediatrics concentration in bustling young suburbs. Practitioners will continue to extend chiropractic’s scope as they discern instances where chiropractic training dovetails fields such as ergonomics, scientific and academic research, occupational safety, insurance consulting and government service. The American Chiropractic Association helps to foster associations as specialties develop.
Job Lists in the Information Age
Many chiropractic colleges have invested in efficient job posting systems as computer technology turns information management into a 21st Century art form. However, job lists should serve to complement comprehensive career counseling efforts that produce empowered and self-reliant graduates.
Some job databases allow students and alumni to search for jobs by location and by the type of opportunity available. For example, New York Chiropractic College’s database website may be accessed at www.nycc.edu/cdc/. A chiropractor looking to purchase a busier practice might scan “practice for sale” postings that list patient flow. Were he to simply desire a change of scenery he might search for opportunities in selected states or countries. Still another search category allows the alum to locate equipment offered for sale. In addition, the career center contacts regional Chambers of Commerce and requests their latest demographic statistics.
Career Services Go “Holistic”
College placement used to consist solely of disseminating job prospect lists, but thankfully those days are long past. Students are now taught to use a number of career tools to their best advantage in an effort to target and achieve their career goals. A “holistic” career approach is encouraged whereby no one element is emphasized at the exclusion of others.
Cover letters complement resumes and encourage interviews. Interviews take up where cover letters leave off to help show how an applicant “fits.” Resumes provide the substance-the credentials-and the issue of competence goes begging in its absence. And finally, the chiropractic schools stress “hands-on” experience in supervised settings that culminate the educational experience. Student practice within a college’s clinic run by select clinicians or similar external work at private chiropractic offices, ensure some level of “real world” exposure.
A Closing Challenge
Apropos is the saying, “You may lead a horse to water, but you can’t make him drink.” While a career development center may point the way to opportunities, it cannot force students to apply for them. Familiar surroundings and family ties may cause students to locate in home towns, though to do so might be economically disadvantageous. Other students will turn their backs on lucrative metropolitan practices for a hand-to-mouth existence in the wilds of a remote Western region. It is the students’ decision, as it is their “success.”
As for the high cost of chiropractic education, the profession will continue to experience its unique challenges. Once beyond the difficulties associated with office start-ups, economic projections suggest a sustained and comfortable lifestyle for most practitioners. Enlightened chiropractic schools will continue to help students forge prosperous career paths.
Admittedly, professional competition will continue to rage in geographic pockets where populations are over-served and where creative ways to expand utilization have not been fruitful. Chiropractic is subject to the same market forces borne by other businesses. So again, how do students face the increasing costs of a chiropractic education? It has been said, “If you are not part of the solution, you are part of the problem.” We all share responsibility-students, schools, colleagues and associations alike: each of us must take active steps to identify and develop healthy markets within this great profession.