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What would you be willing to pay for your own services?
What would you be willing to pay for your services if given to your family? When you see your patient in this light you are on the way to a successful practice…of all the principles of good practice none is more important than this one.I hear chiropractic physicians express concern over the loss of patients to the managed care systems. Patients, it seems, are not willing to pay for services they can receive (or believe they can receive) “free.” This is a very real dilemma for the doctor as well as for the patient even though many patients don’t know it yet. The system is not one that can continue indefinitely, but for the foreseeable future, we are all saddled with it so we must seek solutions for ourselves and our patients in the interim. I propose that we address the issue from a simple and basic premise:
What are the best things I can do for my patients in the circumstances in which we find ourselves?
This kind of thinking is probably different and, on the surface, more risky than what we have done in the past even though it is fundamentally what we are all about. The pragmatic issues typically revolve around the fact that the overhead must be met, and by this I mean not only the overhead expenses of the offices but also the family. Then there are the issues of “wants and desires.” They are all part of the picture and none can be ignored. I believe they can all be answered if we pay attention to the basic premise of our practice as enunciated above so let’s look at specifics.
Principle #1. Increase my professional knowledge.
If I am able, I should enroll in an educational program on nutrition, or acupuncture, or orthopedics, or rehabilitation or whatever will improve my ability to care for my patients. Perhaps, I need to subscribe to new journals such as Chiropractic Technique or the Journal of Manipulative and Physiologic Therapeutics to continue the process of renewing my knowledge. The more I know about health and healing, the more I will have to offer my patients. People are always asking for opinions about their health concerns or those of others. When you have answers, you are a source for solutions.
Principle #2. Increase the hours of patient access.
This is so simple and so obvious that I probably shouldn’t even mention it, however, those of us who have been out there for a time begin to think that we deserve to work less and have probably cut our time down. I have to admit that it was somewhat of a shock to come from my four-day practice eleven years ago to my current work week, which is often just a string of days that goes on for weeks at a time. This is no complaint, it is simply a reality that if I want to do the job I have chosen, I must work harder than I did. The same is true in today’s health care market. If you want to keep your patients, you must be available when others are not.
Principle #3. Reconsider my fees.
It is easy for me, sitting here with a salary, to say you should lower your fees, and as professionals, we should not underestimate our value. How much value do our services have, however, if there is no one there to use them? Whether we like it or not, cost containment has been thrust upon us and we must remember that too many patients are thinking “something for nothing” is better than their need to pay. In some respects, people today are correct. They look at the cost of health care and they are simply overwhelmed. Let’s consider, for example, the use of the MRI. When I left practice it had just come into being. Now, it is considered an essential element of far too many diagnoses. Unlike the lumbar series of the past, however, which cost forty-five dollars, the MRI costs a thousand dollars. How about you–do you want to pay that for your spouse, child, or your own needs? The average couple who works in the service industry making twenty-five thousand each or less, with all the costs of living, has very little discretionary income. When an HMO comes along and says, “here is something for nothing,” they believe it, and, to some degree, they receive value but they frequently do not get the kind of personal value that you can provide in your office. Still, you must get them there, or keep them there, so, again, I say, reconsider your fees.
Principle #4. Lower my overhead.
In my own practice, at various times, I employed several assistants. A good friend had once told me that if you have an assistant who is at the point of maximum accomplishment and you employ a second person to assist, you simply divide the job and pay twice as much to get it done. I think my friend was more accurate than we might want to admit. Today, with all of the third party paperwork, I am confident that we need more office help than we did ten years ago, but look at the issue very carefully. I did, and finally limited my employees to one person who worked very hard and was paid well. When this person was not available to answer the phone, I did. When ultrasound was necessary and my assistant was taking radiographs, I did the ultrasound, or collected the fees or made appointments or whatever was necessary. In this way, we were able to see between thirty and fifty patients in a day, and that is a good practice. Some will say that this is a waste of the doctor’s time, but if there are no patients, then whose time is wasted?
What about practice location? You might not be able to change it, but if you can, consider the home office. I had three locations, a home office, a main street professional building rental space and a jointly owned medical arts building. The last one was very professional, and I spent my last seven years there with excellent results, but if I were to do it today, I would try to find a home office combination. You simply can’t beat the overhead values of this arrangement. Some will say that patients will bother you all the time. They will? Well isn’t that great!
Principle #5. Educate my patients about chiropractic practice.
Every single patient whom you see, from the very first one on, must be educated about what you as a practicing chiropractic physician do. This is not just about the subluxation and its effect upon human health, it is about the entire practice of chiropractic; it’s about your ability to diagnose, to manage and when appropriate, to refer. It is about the value of conservative care rather than more invasive care. It is about using your senses as a physician to determine what is wrong with the patient and what is the best therapeutic approach without getting into unnecessary and costly testing procedures.
It is under this principle that we also need to instruct our patients about the rewards of staying healthy rather than trying to regain health. This process is much more than simply convincing them of the value or appropriately timed chiropractic adjustments. We must counsel them regarding health habits, hygiene, appropriate water quality and food quality, and many other related subjects.
Principle #6. Always give more than is expected.
People appreciate a good value and suspect any gimmicks. We have grown so accustomed to the “come on” or the “bait and switch” that it might take a while for patients to realize that you truly are giving them an “added value” which is more than just words. If, for example, you need an extra view in the radiographic series, take it, gratis. It costs you relatively little and can mean a great deal to the patient. It results in patient gratitude rightfully earned and leads to patient loyalty.
Make it possible for patients who have limited resources to make payments to you without interest. I know, the temptation is to think that this is “your money,” and you have every right to have it in hand. This is true, but we are talking about building your long-term strength and practice integrity. It is all of these little things that add up in the long run and cause patients to be loyal to you.
Principle # 7. Offer services that no one else offers.
Today, the greatest interest is in the arena of “wellness,” a word that has been overused but is still popular. One of the greatest concerns in the wellness issue is the problem of being overweight. With your training, you can develop appropriate mechanisms for weight management and can provide a service that few others offer. I am not referring to the typical “pyramid scheme” food supplement programs that are offered through many offices today. I am talking about you sitting down and using your knowledge of nutrition to develop appropriate diets and exercise plans for your patients. These need to be individualized; they take time, but they offer the rewards of patients who come to you because there is no one else. I am not referring either to expensive laboratory testing that costs you fifty dollars and for which you charge two hundred. Do the necessary laboratory tests for a reasonable margin over your costs, and you will develop greater patient loyalty.
Principle # 8. Discharge my patients when they are well.
Our greatest image problem is the one that “chiropractors keep you coming back for life.” It might be a good thing, but it is bad practice for a significant portion of the population. We need to empower the patient who wants autonomy. We give it to them when we say, “You have reached maximum improvement. I am discharging you from active care. We offer many other services that we have discussed while you were being treated, but it is your choice to use them as you see fit.” The great majority of times, the patient will choose to come back to you on some kind of regular “preventive” basis, but it was their decision, and that is important.
Principle #9. Take care of my patients as if they were my family.
This speaks for itself. You know what your intrinsic value is by the way you apply your knowledge and ability to your own father, mother, spouse or child. What would you be willing to pay for your own services. What would you be willing to pay for your services if given to your family? To what ends would you go to take care of your family? When you see your patient in this light, you are on the way to a successful practice regardless of any of the outside influences that affect your practice. If you cannot see a patient in this way, it is best for him or her and for you if you refer the patient to someone else. Of all the principles of good practice, none is more important than this one.
Principle #10. Make an irrevocable commitment to personal integrity.
Being a doctor brings with it special responsibilities that go beyond those of many other professionals. While some professionals can do, “whatever is legal,” it is up to me as a doctor to do what is morally and ethically right. Integrity is more than honesty, it is the process of asking oneself the hard questions about what is best for the patient first–before me–and then answering from a sense of emotional responsibility to the patient. Will some patients take advantage of you? Perhaps, but the majority will honor and appreciate you. Remember, this is a matter of the heart!
These are my suggestions for a successful practice which keeps a strong patient base. Following this system for success will not bring some of the personally desired luxuries at the outset, however, I see this issue from the longer perspective, and when seen that way, there is little for which you will want. When the monetary benefits are properly invested and debts properly paid, you will find that you can be successful at a level that exceeds the vast majority of people in our country. This success, however, will come to you for the right reasons, and you will sleep better and be healthier because you know that what you are doing in your practice is the right thing to do. Best wishes!” “James F. Winterstein, D.C., D.A.C.B.R., F.I.C.C., has served as President of The National College of Chiropractic in Lombard, Illinois since 1986. His career includes service as a Radiologic Technolo-gist in the military and he received Diplomate status as a Chiropractic Radiologist in 1970. Dr. Winterstein graduated cum laude from National College of Chiropractic and was in private practice from 1968 to 1985. He has held positions including member of the Governor’s Advisory Panel on Coal Worker’s Pneumoconiosis and Chiropractic for the State of Pennsylvania, President of the American Chiropractic College of Radiology, and a governor’s appointment as a member of the Advisory Council on Radiation Protection of the Department of Health and Rehabilitative Services of the State of Florida. Dr. Winterstein, who holds an Acupuncture Certificate has served as President of the Council on Chiropractic Education, and has received numerous honors and awards.