Anthony Lombardi 2016-03-19 05:46:46
Where’s the beef?
Digging deeper into business challenges facing chiropractors
In the October 2015 issue, I wrote an article entitled, “Business is Life,” which outlined the over saturation of chiropractors in Ontario and some of the academic business deficiencies new graduates are facing once they leave chiropractic college.
I received over 300 emails from chiropractors and educators – some of whom chastised me, but the vast majority commended my efforts.
Regardless, there is a need for business practice reform in Ontario. And, over the last five months, I have been preparing this article so I can stimulate serious conversations that can lead to tangible business practice solutions.
In short, we have an overabundance of chiropractors, but not enough chiropractic users, and a brand with an identity crisis that lacks proper academic business training.
Ontario chiropractors and students need to understand:
1.Why chiropractic schools finally need to be responsible and reform their academic business programs in the face of overwhelming evidence that they are not doing their part to prepare graduates for financial success;
2.What drives the chiropractic utilization rate – and how to improve it;
3.How we can use what we learn to find long-term solutions that promote growth and development of our practices.
Back to school
In his letter to the editor in October, CMCC president Dr. David Wickes referred to my articles as being riddled with errors and poorly researched material. I respect Dr. Wickes, so I took it upon myself to work harder to find facts that are even more suggestive of the improvements that must occur in business training programs at chiropractic colleges.
I will simply list a series of facts, so that you may draw your own conclusions.
A study published in March 2014 in the Journal of the Canadian Chiropractic Association concluded and reinforced the premise that new graduates are unprepared for practice.
“Chiropractic students enter the profession within a context of a competitive healthcare market, possibly saturated consumer demand for chiropractic services, and tightened salary prospects,” the report said.
In August 2010, Chiropractic & Osteopathy reported that of the California chiropractors who started practicing in the early 1990s, almost 30 per cent of them were leaving the profession due to over saturation in the state with the highest population of chiropractors.
In Ontario, Canada’s province with the highest population of chiropractors, the College of Chiropractors of Ontario (CCO) reported that the number of chiropractors in the province rose dramatically from 3,886 in 2009 to 4,723 in 2015, an increase of 23 per cent.
The utilization rate and population of Ontario did not increase at all during this same period, which is a contributing factor to the over saturation of chiropractors in the province.
This oversupply has been responsible for the many raw and unfair associate opportunities that many new Dcs encounter after graduation.
According to the U.S. Health Resources and Services Administration (HRSA), chiropractors represent 31 per cent of health professionals who have defaulted on student loan grants from 1978-1999. Dentists represent 18 per cent and medical doctors 24 per cent.
In October 1999, May 2010 and January 2012, more than 50 per cent of the individuals on HRSA’s default list had attended chiropractic college. Inversely proportional to this, the average annual income of practicing chiropractors has been dropping steadily:
In the U.S.:
1989 - $101,000 (Source: American Chiropractic Association) 1997- $86,500 (Source: American Chiropractic Association) 2010 - $87,000 (Chiropractic Economics and U.S. Bureau of Labor Statistics)
In Canada:
2001: $144,254.50 (Source: JCCA, 2005, salary data for Ontario) 2015: $70,000(Source: Pay- Scale, salary data for Toronto) 2015: $66,531 (Source: Pay- Scale, salary data for Canada)
These statistics make sense if you consider that the number of chiropractors has been steadily increasing, while utilization rate has generally stayed the same – meaning more chiropractors are fishing from an unchanging patient pool.
New York Chiropractic College conducts ongoing chiropractic college alumni surveys, which include responses from alumni of nine other chiropractic institutions. The 2011 report – covering data from 2004, 2006 and 2008 – revealed that when respondents were asked to rate their preparedness for business and practice management on a five-point scale, with 1 being “not prepared” and 5 being “well prepared,” the overall rating was 2.02.
In 2007, the same survey covering years 2000, 2002 and 2004, saw alumni give a business/practice management rating of 1.95.
What’s concerning is that the survey echoes other surveys demonstrating a drop in net DC income. The chiropractic college survey data of 2004 reported a net income range of US$75,000 to US$89,000. However, the 2008 alumni data reported net incomes in the US$45,000 to US$59,000 range.
Why are loan default rates increasing and net DC incomes decreasing?
To help me answer this question, I attempted to secure interviews with all of the chiropractic college presidents/ executive directors from all of the schools within a 400-kilometre radius of Ontario’s capital city of Toronto. Unfortunately, our leaders did not respond to my requests, except one who requested not to be asked any questions for this column.
Don’t worry though, it seems chiropractic colleges are, in fact, indirectly getting the message.
According to data from the U.S. Integrated Post-Secondary Education Data System (IPEDS), from 1995 to 2013 chiropractic college enrollment peaked at 15,000 students in 1996, and then dropped consistently until 2002 to an average of 9,957 students – a 33 per cent reduction. Enrollment has remained flat since at an average of 9,980 from 2002 to 2013.
Commenting on the issue, Dr. Dan Krueger, a chiropractor from Kelowna, B.C. notes, “I already had an MBA from the University of Calgary before attending chiropractic college. My specialization was in entrepreneurship and venture development. If anyone should feel comfortable with ‘business,’ it should be somebody like myself.
“It is precisely from that perspective that I felt that our ‘business training’ in chiropractic school was minimal at best.”
Despite all these data trends, our profession and your practices are full of undiscovered opportunities. As practitioners, we have the power to change things for the better, and I offer some recommendations on how we can help increase chiropractic utilization rate. I outline them in the online extension of this article.
Visit Canadian Chiropractor’s website, www.canadianchiropractor.ca, for the full version of this article, including my recommendations on how I believe we can help increase chiropractic utilization rate.
Help your practice grow by simply studying the business habits of Walmart, Starbucks and dentists.
There is more to this article. Go online at www.Canadianchiropractor.ca, type “Anthony Lombardi” in the search box to find the article.
DR. ANTHONY LOMBARDI, DC, is consultant to athletes in the NFL, CFL and NHL, and founder of the Hamilton Back Clinic in Hamilton, Ont. He teaches his fundamental EXSTORE Assessment System and conducts practice-building workshops to health professionals. Visit exstore.ca for information.
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