1976 SOLE PRACTIONER 2000 SOLE PRACTIONER MORE STRESS ADVERTISING PHYSICAL THERAPISTS MORE HOURS MD/DC ASSOCIATE DRS MORE STAFF MORE SPACE MORE OVERHEAD THE DREAM As 1 sat in my study looking out the window on the first day of the new millennium, I could not help thinking about where our profession is headed. Twenty-five years ago, upon graduating from chiropractic college, I reflected on similar questions; and, as I look back now, what I thought was to be still has not happened. I was taught that chiropractic physicians should be the primary health care doctors; and that we, as doctors, should treat and dictate care to other physicians, when absolutely necessary. That, if we were to make this nation a healthier nation, this would have to be accomplished. At that time, approximately 10 percent of the population went to chiropractors. Twenty-five years later, that percentage has not changed much. So what was "to be" did not happen. Why did such a noble cause lose its momentum? There are many reasons, but all have a common denominator, which I will discuss as this article unfolds. Having twenty-five years of experience, I feel I have, at least, the right to discuss what I saw, what I see, and, as the new millennium unfolds, in which direction we, as a profession, should head. MAY YOU GET WHAT YOU WANT AND WANT WHAT YOU GET. AUTHOR UNKNOWN THE REALITY When graduation rolled around, approximately 25 years ago, I had already decided on how I wanted to practice. My dreams became my reality, as I built a thriving practice, and was finally receiving financial remuneration. Back in the early 1980's, bigger was better; and the more patients you saw, the bigger you became. But, as your income grew, so did your overhead. So, you'd then start looking for other ways to make additional income and, hopefully, at the same time, free up some of your time. Or, so you'd think. Well, 1 had the beautiful health facility, with a staff of 18-20, high-volume, high-fees, associate doctors, a medical doctor, physical therapists, trainers, massage therapists, and physiologists. I had them all. Running a facility like this, though, takes a lot of time, effort, and money. All of a sudden you find yourself in a situation where you are running at $70,000-per-month in overhead expense, with your staff stealing and embezzling money. It's very difficult to sleep, especially when you know that your signature and no one else's, is on every loan, lease, and every other legal document known to mankind. Also, you have staff meetings, manager meetings, doctors' meetings; meetings with advertisers, for radio, TV, billboard, direct mailing, and every other scheme that you can think of, to draw patients to your office. You even have to set up meetings with your wife and family, because, otherwise, you are never going to see them. (When this scenario had become my "reality", I would be in the office at five or six o'clock in the morning, and not get home until eight or nine o'clock in the evening. It wouldn't have been so bad, if my job were just to be the CEO; but this is and was not the case.) Eventually, I had to remind myself, "You're the doctor, understand? You're the doctor. Patients come to see you, not some other doctor or staff member. You must devote all of your time to treating patients. When you lose sight of this, you lose all control of your practice, and you are heading down creek without a paddle." When we lose sight of this as a profession, the same thing happens. Do you know that, although I was making a lot of money and seeing a lot of patients, I was not happy, because I knew that I could not give the quality of care that I knew I could and should give. Some of my highest volume weeks-both in patient visits, and fees collected-were not happy ones. The stress and demands by staff, patients, doctors, family, and finances are not worth it. I've seen the liberal insurance collections of the '80's become worthless in the '90's. I've seen managed health-care cripple the medical establishment. I've seen managed health-care cripple the nation's health. I've seen friends of mine, after 20 years of practice, who are so disillusioned with their practices that they are out on disability, involved in multi-level marketing companies, angry and frustrated about managed care, and a public that does not understand chiropractic. I've seen doctors quit the profession, because they could not make it. I've seen massage therapists, personal trainers, nutritionists, herbologists, acupuncturists, and physical therapists, gain more of a foothold and take a bigger chunk out of our existing patient base, which, by the way, is rapidly dwindling. I've seen, and probably have done, every marketing, public relations, and advertising project that you could possibly think of. They don't work-unless you, the doctor, speak, and lecture to your patients, as well as educate the community. Reflecting on my own professional career, I realize that I have come full circle, and have discovered anew that what I really wanted to be all along is the doctor who gets sick people well. That is why I originally pursued a chiropractic education; that was and still is my purpose. I do not want to be a CEO, always pushing for patients, meeting with doctors, staff, and carrying a large overhead, where I spend more time being concerned with business than with patients. "Been there; done that." Also, in retrospect, I see how, as a profession, we have also lost our focus on what it is that we are supposed to do, and become complacent, while medicine and other alternative approaches have weakened our position in the health field. We have become so concerned with managed health-care, and how to survive, that we have lost track of the only way to survive-and that is by getting the patient well. That's all we have to do. You don't need 45 medical doctors, a staff of 30, a huge facility, and hundreds of thousands of dollars worth of useless equipment and overhead to get patients well. WHY YOU SHOULD EMBRACE MANAGED CARE, BUT NOT BE PART OF IT You do not need HMO's and PPO's to get new patients either. Patients come looking for you, when you get consistent results, even when they have to pay out of their own pockets, because they know that their HMO doctor is not helping. When your patients find a caring physician, who gets results, they tell their friends about you. You know, doctor, that "the more health problems you can treat with consistent results, the more patients you will have". I was very fortunate in constantly trying to improve my treatment results. I've dedicated my life's work to developing a treatment protocol that can improve a myriad of health problems, not to mention enhance the health index of my patients. I have become very comfortable, and confident in treating many types of conditions, which has allowed me to prosper in spite of HMO's/PPO's and managed health-care. (I do not belong to any HMO/PPO organizations). In fact, managed health-care will embrace our very existence. With skyrocketing medical costs compounded by procedures that cause more damage and do more harm than good, an insurance industry that is willing to pay for this nonsense will eventually create its own demise, as is already happening. The system is rotting and eroding and you do not want to be part of it. WHAT WE MUST DO AS A PROFESSION IF WE ARE TO FLOURISH IN THIS NEW MILLENNIUM As I mentioned earlier, over the past twenty-five years, I have come full circle in remembering the basic reason why I became a doctor of chiropractic. As for our profession, I still believe that we should be primary health care physicians and that patients should be offered the natural approach first. I also feel that, in order to do this, you must offer a multi-disciplinary approach, but not the MD-DC relationship. It's obvious that the primary purpose of this kind of relationship is financial, which is why it will fail more often than not. Besides, medicine and chiropractic do not mix. Their views and approaches to treatment are at opposite ends of the spectrum. Because medical doctors still think bacteria and virus cause disease, they must give your patients antibiotics to get them well. They treat diabetes, digestive problems, lung and sinus conditions, ovarian diseases, and endocrine malfunction with harmful drugs and surgery. You and I treat these conditions and health problems with chiro-practic/cranial/viscerosomatic care, nutrition, exercise, success management, and lifestyle changes. How can chiropractic and medicine ever agree on anything? THE SOLUTION TO YOUR WELL BEING, YOUR PATIENTS' AND OUR PROFESSION'S By multi-disciplinary, I mean, you, the doctor, should treat your patient as a patient, and not just as a spine. Who, but a chiropractic physician, is qualified to care for your spine? Who, but a chiropractic physician, is qualified to develop the necessary exercise program to strengthen the sup porting muscles, ligaments, and ten dons, so that the spine can function properly? Who, but a chiropractor, understands structure vs. function the way we do? Who is more qualified to give diet ary and supplemental recommenda tions than a chiropractic physician? Who is more qualified to explain why people get sick and how, through treating the neural endocrine axis, they can be made well again? Who is more qualified than a chiro practic physician to help create life style changes that will improve your patients' health? There is no one, and I repeat, "no one", more qualified than you, as a chiropractic physician, to treat the whole person, and don't you forget it. This is what you were trained for: to treat disease and sickness through chiropractic and its ancillary procedures, exercise, nutrition, success management, and lifestyle changes. You, doctor, should be in charge of your patients' health, and well being, and understand exactly what each patient's wants and needs are, so they can be fulfilled. What good does it do your patient, if he comes to you for low back pain, and goes to his medical doctor when he or she is sick or has a debilitating disease that only you can help, through the education and knowledge that you possess as a chiropractic physician? Why allow your patients to suffer needlessly when, through a multi-disciplinary approach, you could correct the cause of your patient's condition? Continued on page 44... MUL TIDISC1PLINA R Y PR A CTICE ...from page 9 If, as a profession, we decided to dedicate ourselves to, and take responsibility for, being primary health care physicians, we would not be facing the threats we now face both as doctors and as a profession. We will rightfully take our position as primary health care physicians, making our profession the number one choice for health care in the greatest nation that ever was. Let's start by making a valiant effort to treat patients utilizing the Triune of Health. Let's create a paradigm shift in this millennium, so that patients understand what we have to offer the world, which is health and prosperity to all. In a nutshell, what I am saying is that the best way to flourish in the new millennium is to develop a multi-disciplinary approach to the treatment of our patients, using nutrition, rehabilitation, and other ancillary procedures that can treat the myriad of health problems Americans face today. This is what the American public wants, and most are willing to pay for it, regardless of insurance coverage. If we, as physicians, can treat all health conditions that are slowly killing Americans right now-with confidence-then we, as a profession, will rise above every other profession in the healing arts, taking our rightful place in society. Dr. James P. Cima received his Bachelor of Science degree from Cornell University, and his Chiropractic degree from New York Chiropractic College. He has authored 10 hooks on all aspects of health care and treatment, and has, also, just developed a blood chemistry software program, to assess your patient s nutritional requirements. Dr. Cima is in private practice in Palm Beach Gardens, Florida. For seminar information and books written by Dr. Cima, call 1-800- 229-9763; Fax. 561-624-3871; Web site www.unlimitedhealth.net; e-mail [email protected]. ♦♦♦
