COLUMN BUSINESS TALK Business is life A How money makes your world go round BY ANTHONY LOMBARDI fundamental difficulty chiropractors have is grasp-ing a deep understanding of what business is, and the role it plays in our society. In Canada, chiropractors, dentists, optome-trists, Tim Hortons, FedEx, WestJet, the shoe-maker and everyone else have bills to pay and need to generate revenue to pay those bills and essentially live their lives. Once chiropractic students graduate, it should not come as a surprise to them that they will need to generate revenue, in addition to competent clinical outcomes, so they can pay their bills and live their lives. flavour. Let’s take the 10 chiropractors from the 80/20 rule for example: The two chiropractors earning a total of $800,000 are too busy to take any hands-on courses, while the remaining eight DCs do not have the expendable income to spend on continuing education and so they don’t make the investment. Demise on the rise Saturation The population in Ontario has not grown as fast as the number of chiropractors has. Between 1990 and 2013, the population grew from 10 million to 14 million – an increase of 40 per cent. In the same period, the number of chiropractors in the province grew from 1,600 to 4,300 – 169 per cent increase. Chiropractic utilization rate of 12 to 15 per cent has remained unchanged from 1990 to present. Essentially, there are now more chiropractors competing for the same patient pool, which means we are seeing examples of the 80/20 rule of economics. The 80/20 rule means 80 per cent of your outcomes come from 20 per cent of your inputs. For chiropractic, it means 80 per cent of the revenue is generated by 20 per cent of the DCs. I have practiced in Hamilton for 13 years, and the 80/20 rule has become evident because of the oversaturation of DCs in the area. Let’s take an example of 10 chiropractors earning a com-bined total of $1 million. Following the 80/20 rule, you will find two of the 10 DCs are earning a combined income of $800,000, while the remaining eight earn a combined total of $200,000. This becomes more prevalent in bigger cities with larger popu-lations, ultimately resulting in practice closures. One vital trickle-down effect of poor performing businesses is lack of continuing education on the part of the chiropractor. Health professionals in general are changing how they earn CE credits based on the advancement of technology and financial decision-making. Webinars, podcasts and virtual courses have become more popular to doctors because they save time and money. However, chiropractic is a kinesthetic profession. To truly be effective, in person manual assessment and treatment courses are essential in our continuing education experience. The continuing education dilemma takes on a Catch-22 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. 12 Canadian Chiropractor September 2015 Since I started my practice 13 years ago, I found there has always been reluctance among DCs to demand a fair and reasonable fee for our services. In 2002, I was charging $20 per visit (plus $9.65 from OHIP). In 2015, the Ontario Chiropractic Associa-tion Guidelines recommend a fee of $39 per visit for our services and a minimum of $86 for an initial visit. Often, I have wondered if chiropractors are asking enough to ply their trade on those in need. Take for instance Sault Ste. Marie, Ont. – a town of 75,000 people. They have 10 chiropractors along a two-kilometre stretch of Great Northern Road. Their average patient visit fee (initial included) is just above $25 and almost every chiropractor in that town charges about the same price. Undervaluing ourselves is one of the top reasons chiropractors fail in practice. When eco-nomics change, the demand for our product also changes, which makes us more likely to lower our fees to stimulate more de-mand. This often leads to gimmicks and off-the-wall incentives just to attract patients, which call into question our level of professionalism. Annual chiropractic surveys found in magazines do not tell us that more DCs are leaving chiropractic and changing careers. This is happening more than at any other time in the history of our profession. Attrition is always largely under-reported because people are embarrassed to report they failed, and chiropractic schools don’t mention it because they tend to focus on the pos-itive news to attract new students. Within the last three years, in my surrounding area alone, five DCs have left practice to pursue other careers. Most chiroprac-tors who leave the profession return to school to pursue other degrees, work as a technician in a hospital, sell insurance, and even become professional musicians. An additional point of interest is that the allied health disciplines of dentistry and op-tometry use a similar business model as chiropractic – and yet they do not have doctors leaving their profession at such an alarming rate. Reduce the number of graduates. One suggestion is to stop graduating chiropractors for a brief period. This would help relieve the oversaturation of DCs, which would elevate the earn-ing potential of all current practicing chiropractors. In this www.canadianchiropractor.ca The solution
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