The current state of Chiropractic, in my opinion, is on a cusp. This might just be my observation but it’s what I actually see on a daily basis. The profession is ever evolving and appears to be going more to a rehab/functional medicine model. Outside of prescription rights, there are not a lot of limits on the scope of practice within the chiropractic profession. While I don’t want anyone to limit our scope of practice, it is my thought process that some offices take this to a new level. The comingling of providers skews this practice quite a bit because you as the patient may not even know the what type of provider they are seeing, physical therapist, occupational therapist, nurse practitioner or chiropractor….while all in the same office the flow may never been known by the patient but from a billing and licensing prospective, they are all different.

There to be a time and place for multidisciplinary offices, it is of my opinion, that patients do not want to be served a platter of services when presenting to a chiropractic office for pain in the lower back or neck, they want to get better as fast as they can and come back when it happens again.  I’m totally aware of the premise of maintenance care and life long treatment, I just don’t prescribe to it. There is still a vast array of people in this world and community that wants to present to a chiropractic office for a quality adjustment, trusted therapies and not spend an hour in the office. There is a time and place for the extensive rehab, but not everyone needs or is looking for that.

One major crux in healthcare is the insurance industry. It may be the greatest curse and biggest blessing to the profession as a whole. It’s absolutely awesome that chiropractic is included in the vast majority of major health insurance plans; the downside is that insurance is essentially sick care. There is no incentive to get a patient better faster and not see them, the provider that essentially abuses the insurance reimbursement and the “system” will make more money, bill for more services, have more headaches and have very little incentive to get patients out of pain as soon as possible.

Different services are covered by different insurances. Physical therapists are reimbursed at a higher rate for certain services while both professions can provide the same service; I’m not saying this is right or wrong. Medicare doesn’t even reimburse for an initial exam but more private insurances do. If you get an injection from a nurse practitioner that works in a chiropractic office, this may be a cash service or a covered service but offices are normally set up in such a way to maximize reimbursement. Read an EOB some time from your insurance company, it doesn’t usually matter what the provider charges, the insurance dictates what is and isn’t covered. Even in our office, there are certain things that certain insurances don’t cover, it’s not our responsibility to know your insurance coverage, we submit the insurance claim and hope for the best with the information that is provided to us by the patient.

Personal research and development can pay huge dividends for offices, while it’s always a learning experience, it also teaches you what things work and what doesn’t. We have tried traction tables and lasers. I’m a terrible sales person and most patients don’t seem to have interest in these types of therapies. I’ve come to learn that the tried and true techniques and therapies are what the vast majority of my patients want and appreciate. Sure, I fell into the DOT realm and like it as a niche part of my practice and having acupuncture available is beneficial but outside of that we keep things VERY simple in our office and feel that most people appreciate that. I’ve said this before and I will continue to say this: our office is not for everyone but we will give it our all for those individuals that find value in our services.

Slightly different tangent, but students are coming out of school with MASSIVE student loans and the traditional model of chiropractic is not conducive to high profit margins that are needed to pay your bills and live a comfortable life. Insurance dictates a lot of things in the healthcare realm and the only solution for reimbursement is to see more people.  If you are not capable of seeing more people you tend to lean towards providing more cash based services and longer treatment plans in order to maximize the insurance and patient dollars. While we may be old school in our treatment techniques, we have positioned ourselves well for the future by delivering a quality product at an affordable price. Are we the cheapest, I’m not sure and are we the most expensive, not by a long shot. But I do try to live by the motto: I’m able to sleep soundly at night with how the practice is run. The profession and my own practice drive me crazy from time to time but ultimately I’m happy with where things are.

While this may just be my personal opinion and not do anything long term but it’s a reminders that we attempt to provide quality, honest care with good people to help you feel better as fast as we can with no long term time or financial commitment. In ending, what is chiropractic anymore, I know what I would like it to look like but I’m starting to think that my type of practice is a dying breed as they are not huge profits driven. I’ll survive and thrive (hopefully) but the profession is ever evolving and there are a lot of factors at play, but the chiropractic profession will look different in 20 years then it does today, I will promise you that.