Joined: Mar 2005 Gender: Male Posts: 532 Location: No B.S. Reality
Operation Money Hum–How to make $ in Chiropractic? « Thread Started on Dec 10, 2007, 6:50pm »
Information in this post was provided by Greg Stanley. His articles are called ”The Sustainability of Chiropractic” from Dynamic Chiropractic, a trade journal and ”The Perfect Chiropractic Storm” from his consulting practice. Mr. Stanley has been directly connected with chiropractic for almost 30 years. He has an excellent reputation in a profession filled with unscrupulous charlatans.
Potential chiropractors and current chiropractic students: Let’s look at some of the numbers provided by Mr. Stanley.
”The number of chiropractors in the U.S. grew from 13,000 in 1970 to 40,000 in 1990. That should have been a large enough jump to invite talk of restricted chiropractic college enrollment. However, the jump of more than 50,000 by 1994 should have set off alarm bells.”
Let’s dissect these numbers…s l o w l y.
1895 – 1970 (76 years) = 13,000 chiropractors total for 76 years • 171 graduated per year (average) for the 76 year period
13,000 graduates total in 76 years
*****
1971 – 1990 (20 years) = 40,000 chiropractors total for 96 years • 27,000 new chiropractors in 20 years [40,000 – 13,000 = 27,000] • 1,350 graduates per year (average) for the 20 year period
*****
1991 – 1994 (4 years) = 50,000 chiropractors total for 100 years • 10,000 new chiropractors in 4 years [50,000 – 40,000 = 10,000] • 2,500 graduates per year (average) for the 4 year period
*****
1995 – 2008 (14 years) = 86,000 est. chiropractors total for 114 years • 36,000 new chiropractors in 14 years [86,000 est. – 50,000 = 36,000] • 2,571 graduates per year (average) for the 14 year period
FACT: Since 2002 the enrollment numbers have been declining sharply, I don’t care what the schools “report” to the trade magazines, they are not in the trenches, they are in fantasyland and in the business of selling classes for profit. (Everything here has been averaged for simplicity.)
73,000 fresh graduates in 38 years between 1971 and 2008.
Do you see the difference between 13,000 births in the 76 year period vs. 73,000 births in the 38 year period…Do you? Talk about being ‘upside down!’
One should ponder, “Why did the number of chiropractic graduates explode by 1990?”
Answer: “Next came the rise of indemnity insurance (mid 70’s until the late 80’s). During this phase of chiropractic’s development, a chiropractor would submit a bill for just about any amount they felt like charging and hope to get a check within the next two weeks for most or all of the billed amount. As some of the more assertive and venturesome DCs pushed the limits of what chiropractors could charge for their services and, more importantly, what procedures they could charge for (i.e., exams, X-rays and physical therapy); the money began to pour into the pockets of DCs across the country. In fact, it was not unusual to see a normal patient’s first day visit reach $600 (1980 - adjusted for inflation 2007: $1,440) for routine diagnostic procedures. During this time, I offered a money-management seminar about debt reduction and conservative investing. It seemed most of the attendees were in a state of high anxiety about what to do with the newfound wealth. Back then, many were saving each month what the average DC now grosses before monthly overhead.”
This period of time was coined, “The Mercedes 80’s” and it was glorious$.
The Bottom Line for that period of time: It wasn’t about ‘serving and giving’ It wasn’t about ‘helping people’, It wasn’t about ‘changing healthcare’, It wasn’t about ‘making a difference’, It wasn’t about ‘saving lives’, It was about making MONEY!!
Hmm…13,000 graduates in 76 years…then suddenly 27,000 appear in 20 years then 10,000 in 4 YEARS! What’s going on? Did a ton of people find the ferocious fire to ‘serve for the sake of serving, give for the sake of giving?’ NO!
They found and exploited a way to make incredible amounts of easy money!…bottom line. Most, if not all of you reading this (not a DC) would have done the same if given the opportunity.
BUT….
That all changed for the worst by the early 90’s.
”Then came 1992, and the rest is chiropractic history. During this fateful year, the well-heeled insurance industry, fearing what would amount to nationalization of the industry, made bold moves to reduce health care costs. The Clinton administration had promised national health care within the first 100 days of its term. This prompted insurance companies to do the unthinkable. They introduced insurance plans that denied or noticeably limited a person’s right to be reimbursed for seeing their own physician. Medical doctors had bet that insurance companies would not be able to induce patients to see the “Company Doctor.” In short, they bet wrong.
During 1992 alone, many states saw physician income drop 30 percent. An orthopedic surgeon client of mine saw his personal income drop from $950,000 to $450,000 in just one year. He called me to ask if he, like many of his colleagues, should bail out and cash in his $25,000-per-month personal disability income policy. Two years later his income had fallen below $200,000 per year with longer hours than when he had worked as a resident. He left the profession for good."
These limitations, caps, reimbursements, denials, and most importantly INCOME DROPS have gotten worse every year since 1992 and will continue to get worse.
School Enrollment: In 1996 the pinnacle of chiropractic enrollment had been reached, 7 years after the last day of 1989. After graduation and a couple of years in the ‘real world’ the fresh grads were saying, “Looks like the Mercedes 80’s lottery win won’t work in the 90’s”
By 2002 (1996 plus 7 years) enrollment in chiropractic colleges began to nose-dive. Word got out that the 90’s were difficult times and appeared to be getting worse. Fresh grads, yours truly, were saying, “What was I thinking? I should have read Chirobase more closely.”
Fast forward to 2008 (2002 plus 7 years), Fresh grads will say, “OH SHIT!! Those people on Chirotalk weren’t lying. I’m screwed!”
From my observations it takes about 7 years to see and react to changes in the chiropractic marketplace – my opinion.
What REALLY exacerbates this dilemma?
“Statistics indicate we’ve already hit the displacement point in the profession; that is, we lose a practicing DC for every one we add. Yes, we’re only reaching 7 percent of the health care market, but unfortunately, that’s all our message appeals to as is now presented. And let’s face it, we’ve had plenty of time to see if this percentage would grow – and it hasn’t."
Meaning…the more chiropractors that are birthed into the marketplace the less ‘piece of the pie’ each individual DC has to that fixed, unchangeable 7 percent.
PLEASE don’t say to yourself “I won’t focus on the 7 percent, I’ll focus on the 93 percent.”, which I’ve heard at kooky chiropractic ‘consultant’ rah-rah seminars while simultaneously chanting, “It’s the best time ever, in history, to be a chiropractor.”
Focusing on the 93 percent or agreeing with the ‘consultant’ makes you psychotic, technically. It’s 7 percent – end of story.
”I'm almost finished with chiropractic school. What options do I have against these grizzly statistics?”
Steal patients from your competitors - or make 'arrangments' with your competitors attorney contacts. This is done by offering them substantial illegal, kickback payments – best bet. Or, scroll down the bottom of my other post (CLICK HERE) for 12 real-world, time-tested solutions to have a semi-successful (PI) practice. Have fun.
Stealing patients is the only solution because 7 percent is…well…7 percent. You better move quickly because right behind you is the next fresh crop of graduates, ready for their ‘piece of the pie.’ Don’t forget, these people will be stealing YOUR patients…the one’s YOU just stole. See the cycle? Indirectly it’s called ‘chiropractic inbreeding.’ Directly it’s called the ‘Law of Diminishing Returns.’
Don’t forget - Mr. Stanley said chiropractic will be a “second job for most.” – and that’s how YOU [will] make money in chiropractic: “Want fries with that?” or “Paper or plastic?”
”As a pre-chiropractor student or current chiropractic student ‘What is my absolute best option?’”
Joined: Aug 2006 Gender: Female Posts: 331 Location: Illinois
Re: Operation Money Hum–How to make $ in Chiroprac « Reply #1 on Dec 11, 2007, 1:41pm »
Great entry! The wonderful thing also is that the chiropractic industry is waking up to its own problems as the original article states. I didn't realize there were so few chiros before 1970 as it seemed every small town had a chiro. But now I see only certain states have a high concentration of chiros. The insurance industry not only attracted more chiros; it drove up the prices of all kinds of medical care, where most couldn't afford to pay & looked for loopholes, which further drove up the prices. The whole system is a mess. It would be nice if insurance went back to its original purpose--for catastrophic situations. Then maybe the dr. fees would slowly go down. I'm insured thru my husband's job, but if I were single, I'd find one of those obscure companies with super high deductibles, save the amount of the deductible aside, & pay the lower premium. This isn't an insurance site, but the system is one contributor to the craziness in the chiro industry!!!!
The Myth of the High-Volume Practice By Tom Necela, DC
(snip)
As insurance reimbursement started appearing on the radar, chiropractors began to include other services, such as X-rays or examinations, in the billing scheme. By the 1980s, when chiropractic coverage by insurance reached its peak, DCs could virtually bill for everything and anything under their scope and delight in the fact that they were actually paid (many times without question) for these services. Unfortunately, some chiropractors realized this and quickly began providing multiple services, some valued more for their reimbursement than therapeutic merit. This increased billings and the costs of care skyrocketed.
During the '80s, for the first time in chiropractic history, it was possible to achieve financial success without high volume due to the fact that reimbursements were so plentiful. Docs who had high-volume practices when these "golden days" came around experienced once-in-a-lifetime surges in income.
The Crash of the Third-Party Train
By the time the '90s hit, many chiropractors noticed insurance reimbursements were beginning to "dry up" and increased scrutiny was being placed on claims. HMOs that came on the scene placed great emphasis on limiting reimbursements and even the number of visits that were reimbursable.
As the century turned, many chiropractors who had been spectacularly successful throughout the '80s and to some extent, the '90s, were becoming frustrated with the changes in the marketplace. Some did not (and still do not) know how to cope with the "new style" of practice and reimbursement that has emerged.
Evidence-based care, utilization review, IMEs and other such entities that did not exist years ago are now staples of the 21st century marketplace. Recovery audit contractors and post-payment audits are here now and, because of their massive profitability for third-party payers, are the waves of the future.
The New Reality
Due to these massive changes that have altered the chiropractic scene, the high-volume practice no longer makes sense as the only viable route toward profitability. After all, what good is it to see 500 patients a week if denials, delays or audits reduce payments to the same level as when you saw 100 patients a week?
Unlike the days of the cash practice, when minimal record-keeping sufficed, adequate documentation is now demanded of all services. Those who cannot afford to develop the systems, retain the personnel or purchase the software necessary to run a high-volume practice while maintaining adequate records would do better to slow down and strive for excellence on a smaller scale.
In the '80s, reimbursement may have been available for anything and everything, whereas today's practitioner may be faced with justifying why certain services were performed. Again, sound documentation is necessary to get paid and increased attention may need to be placed on proper billing and coding - especially if an auditor comes knocking.
(snip)
Some in our profession are still "stuck in the '80s" (or perhaps even the '70s), acting as if volume is the solution to all their problems. Again, I remind you that I am not against the concept of a high-volume practice, but I do not believe it is the cure-all for everything that ails chiropractic today.
(snip)
The common consequences of going in the wrong direction are burnout, frustration and lack of profitability. Today's competitive marketplace has also added several new penalties for not playing "the game" correctly: postpayment audits and even criminal investigations. When you stop and think about it, personal dissatisfaction, financial loss and perhaps even legal troubles are high prices to pay for simply driving down the wrong road.
"One who condones evils is just as guiltyas the ones who perpetuate it." Martin Luther King, Jr.
Joined: Feb 2005 Gender: Male Posts: 548
Re: Operation Money Hum–How to make $ in Chiroprac « Reply #3 on Mar 27, 2009, 7:55am »
IP says...When you stop and think about it, personal dissatisfaction, financial loss and perhaps even legal troubles are high prices to pay for simply driving down the wrong road.
IP, they certainly are high prices to pay for "driving down the wrong road"...and I'm sure you are referring to the Chiropractic road as described in your post...so I ask you, "share with us what the right road is?" GV
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