Please tell about your background.
I’ve been practicing as a DC for 18 and a half years. I have had five practices and presently practice in New York City and am a partner in two other multidisciplinary centers. I was assistant professor at New York Chiropractic College from 1989 to 1993 and have been a practice management consultant to the chiropractic profession for ten years. This past year I co-founded a company called DC-MD Consultants and we create multidisciplinary health centers for chiropractors.
What does DC-MD Consultants do?
We teach chiropractors how to get different doctors in practice together primarily in medicine, chiropractic, physical therapy, podiatry, nutrition and acupuncture. It’s kind of a complicated relationship, but it can be done. I believe there are approximately 800 multidisciplinary offices around the country; so it’s growing fiercely.
Are those mostly in metropolitan areas?
Not necessarily. This model of practice seems to be catching on in suburban areas, as well as metropolitan areas. It’s not restricted to any one geographic area. We’ve had inquiries from almost every state.
In what situations do you feel multidisciplinary clinics work best?
I think the multidisciplinary clinics work well anywhere. I think the era of the individual practitioner is passe. I don’t think it behooves a chiropractor, as well as any other types of physician, including MD’s, to practice autonomously for many reasons.
It never makes sense to me to go down a street and see 10 or 20 chiropractors within a three to five-mile radius. A group of them together makes a lot more sense where they can do a shared-cost operation much as they do in medicine and in the large legal groups. For example, if you’re going to have five chiropractors within five blocks, why not have them operate in one big facility? It looks more substantial, it has more ambiance, and more clout in the community. You can use one x-ray machine instead of five.
You can have expanded coverage, and better clinical ability because you have other people to rebound from; for example, one of the chiropractors may be strong in radiology, one in physical diagnosis, one in technique, and perhaps one who’s the administrative or marketing manager, who can really go out there and bring in the business. In law they have somebody they call the ‘rainmaker’ and that’s the way it should be in chiropractic, but unfortunately it hasn’t been that way.
What do you feel is the biggest obstacle or resistance to group practice?
Insecurity on the part of the chiropractors. Unfortunately I find chiropractors to be very insecure. They’re always afraid to do this because they think somebody will steal their patients or something’s going to happen to upset this arrangement. However, it doesn’t make any sense.
What about when you add the other disciplines to the group?
If you take the added dimension of medicine or podiatry it’s a wonderful thing because you have one-stop shopping, so to speak. Oftentimes somebody won’t come to a chiropractor’s office because a chiropractor’s scope of practice is so much more restrictive than a medical license. People will go to a medical doctor or, oftentimes there will be a personal injury case where a chiropractor is forced to send his patient to a neurologist or an orthopedic surgeon for an independent review. If you have various practitioners working together you can keep everybody in-house. You don’t have to refer these people off and everybody wins. People can have the best of medical attention with the best of chiropractic, podiatric, physical therapy and everything else. It’s like having one-stop shopping at a big supermarket versus a little grocery store.
If you look around, you’ll see the trend in business in general has been mega stores. Big operations like Sam’s Club, K-Mart and Wal-Mart are taking over. How many local grocery stores do you see, notwithstanding 7-11 stores, which are for convenience shopping? The public is shopping in supermarkets and it’s the same thing in medicine. People want to go to one place and don’t want to be sent to three or four locations.
Where do you see the chiropractic profession heading?
I recently read an article that by the year 2,000, only four years away, 40% of the chiropractors who practice in the U.S. will be either out of business or working for a managed care company. Forty percent! That’s two out of five! That’s not the only place I’ve seen that statistic, by the way. I’ve seen some statistics even higher. Certainly 40% can be extremely realistic.
What about new practitioners?
When I was teaching up until a few years ago, I remember many of the students in their senior year of school had no idea of what they were going to do. I recently ran into about a half dozen of my students from ’91 and ’92 and several of them still are either not working or working as an associate for a meager salary, not even enough to exist on. That’s pathetic. To become a doctor and come out of school oftentimes $100,000 in debt. Some have families to support. How are you supposed to live on only $30,000 or $40,000 a year? The neighborhood chiropractic practice is done. It’s antiquated and it no longer makes sense.
Why is this?
I would not recommend to any chiropractor just to go some place and open up an office because the chances are better than not that they will go out of business within the first three years. More than 90% of all start-up businesses fail and they fail because they are under-capitalized, which many chiropractors are. You get a kid out of school, for example, and let’s say he’s $100,000 in debt, which is not uncommon anymore. If, for example, he wants to open up a little neighborhood office in his hometown he borrows $60,000 or $70,000. Now he’s $160,000 or $170,000 in debt and he wonders how he can make enough money to pay back his loans. He’s not going to have any substantial income for six months. And even in six months, the money is just going to start trickling in. So what even if he’s luckier than most or more dynamic than most? Fine. So what do you do with all of your loans? And then you have to keep up with not only your business expenses, but your personal expenses, plus you may have a family. It’s a really tough deal.
It’s not easy to have a profitable office in the beginning because you don’t have insurance the private indemnity insurance paying the bills of a lot of these patients like they did.
Where do you see the future of chiropractic heading?
I believe that by the year 2,000, 90% of the people in this country will be covered by a managed care contract and it’s up to almost 60% now. Chiropractors are at the most precarious crossroads of their lives. I don’t think there’s ever been a time in history since we’ve been around, except for perhaps the 1970’s and early 1980’s after we started getting included in Medicare and some of the private insurance companies, that chiropractic’s been in a more precarious situation. And it’s not going to get any better in the foreseeable future. It’s only going to get worse. The only way out of it, is if we join forces. Medicine is going to dictate what happens in health care. It always has and will continue to do. We have to find a way to work with medicine. We cannot look at them as antagonists.
What chiropractors fail to realize, first and foremost, which medicine already does, is that chiropractic is a business, and you will not be able to survive in chiropractic and do what you want to dowhich is deliver chiropractic adjustments to the people of this country unless you can first find a way to make it profitable. It has to be a profitable business in order to succeed. You can have all the philosophy you want, above-down and inside out, but if you don’t make a living at it, you won’t be around long enough to reap the rewards of practice. You have to make it profitable first.