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The Selling of the Spine

Stephen Barrett, M.D.

The American Chiropractic Association's 1997 survey—in which respondents were asked to report 1996 figures—found an average (mean) gross income of $228,236, with a net of $86,519 [1]. However, this figure does not indicate how the numbers were distributed. Chiropractors who practice part-time would be likely to drag the average down, whereas some who really sell themselves would tend to raise it. Top chiropractic salespeople can earn a fortune.

Intensive selling of the spine begins in chiropractic school as instructors convey the scope and philosophy of chiropractic to their students. After graduation, chiropractors can get help from many practice-building consultants who offer seminars and ongoing management advice. This article describes observations I have made over a 30-year period in which I collected practice-building manuals and many other relevant documents.

When confronted with my writings on this subject, most chiropractors respond that my information is outdated and that the unethical practices I have described are not widespread. They also claim that many chiropractors who take practice-building courses don't use the unethical techniques to which they are exposed. I have received many reports from consumers who have encountered inappropriate salesmanship in chiropractic offices. Undercover investigations have also found evidence of their use, but, as far as I know, no professionwide survey has been conducted.

How to Sell Services

During the 1970s, flamboyant ads from practice-builders were much more common than they are today. The Drennan Seminar, for example, offered to "double your income and patient volume in 90 days" and said that one out of every ten registrants would receive a free Cadillac. The Stoner Chiropractic Research Foundation offered to "show you how to make $350,000 as easily as $50,000"; promised "no more end-of-the-month jitters"; and one of its ads depicted a chiropractor pushing a wheelbarrow full of money toward the First National Bank. Dr. Robert A. Jarmain invited chiropractors to a three-day seminar to "build the $1,000,000 practice." The Yennie Chiropractic Success Seminar offered to "put you on the road to total success" and to "upgrade your practice into the $100,000-$200,000-$300,000 service levels." In 1978, Clinic Masters advertised that three thousand chiropractors had enrolled in its program and increased their incomes, on average, more than $50,000 a year. Its fee for a program of seminars and ongoing consultation was $20,000-$100 initially and the rest payable as income rose. Its seminars included "How To Increase Insurance Business $100,000 Or More A Year" and "How To Achieve The 'Optimum Gettable' With Every Patient." Santavicca and Associates charged $30,000 for its advice-$100 for an initial three-day seminar and the rest payable as income rose. Recent ads for Nikitow Training Seminars promise that they will reveal how "only 200 NP's [new patients] in one year yield you ONE MILLION DOLLARS - CASH COLLECTIONS."

The largest practice-building firm is the Parker Chiropractic Research Foundation, founded by the late James W. Parker, D.C. A 1987 brochure for its Parker School of Professional Success Seminar claimed that "over 125,000 Doctors of Chiropractic, spouses and staff assistants worldwide-over two thirds of all practicing chiropractors-have attended nearly 300 Seminars more than 400,000 times. . . . Resulting in millions and millions of additional patients being served. . . . And surely resulting in at least a billion dollars of EXTRA CHIROPRACTIC EARNINGS!" Attendees receive a diploma for completing "the prescribed course of study at the Parker Chiropractic Research Seminar." In 1989, the fee for first-time chiropractors was $389 for the four-day course plus a gold-lettered plaque indicating membership in Parker Chiropractic Research Foundation.

Parker's basic course was built around a 335-page Textbook of Office Procedure and Practice Building for the Chiropractic Profession. Parker appears to believe that the scope of chiropractic is unlimited. The Textbook suggests that patients be offered a "free consultation" but led into an "examination" that costs them money. It suggests that "One adjustment for each year of age is a rough thumbnail guide of what people will willingly accept and pay for," but "If in doubt about the payment or the return of the patient, take only the smaller x-rays on the first visit but ostensibly x-ray fully."

Writing in a Parker publication, L. Ted Frigard, D.C., a prominent California chiropractor, has asserted: "A patient is much more satisfied if you give him an adjustment every time he comes into the office. If you do not . . . you will have to spend a lot of time explaining why you didn't." [2]

Share International, Parker's sales organization, sells hundreds of educational items and other practice-building aids. One is a chart alleging connections between points on the spine and organ disfunctions. Another is a "report of findings" on which chiropractors note "subluxations" and the (large) number of visits needed to correct them. A set of cassette tapes I acquired in the late 1970s included "Sentences that Sell," in which Parker described how chiropractors associated with him tested ideas scientifically and reported back to him how they worked. The set also included "Ways to Stimulate Referrals," in which he told how to steer conversations to sick people. "In a casual, natural way," patients should be asked about the health of their families, friends, and neighbors. Should any be ailing, patients should be urged to be "Good Samaritans" by telling them about "all the wonderful things" that chiropractic might do for them.

During the 1970s, for about $20, chiropractors could get copies of 107 advertisements to "guide" preparation of their own ads. Most of the ads were case histories. The instructions that accompanied them suggested: "Re-type each ad on your own stationery for presentation to the editor. This would indicate that they are your own creations, and that the cases mentioned . . . are from your own files." Sale of this advertising kit was discontinued after its instructions were exposed in Jack Anderson's syndicated newspaper column.

Despite the questionable methods Parker espoused, he was a highly respected and integral part of the chiropractic world. He was president of the Parker College of Chiropractic in Dallas, Texas, which he founded, from 1978 until about two years before his death in 1998. He lectured at many other chiropractic schools, and school officials often attended ceremonies at his seminars. The Parker School for Professional Success is now owned and operated by Parker College. Parker's son H. Karl Parker, D.C., now operates "Karl Parker Seminars," which he calls "The Official Seminars of the Parker Family."

Sid Williams, D.C., another leading promoter, has been president of the International Chiropractors Association. He founded and served until 2002 as president of Life Chiropractic College in Marietta, Georgia, where his salary and benefits rose to over $900,000 a year [3]. His other enterprises have included Today's Chiropractic (a journal), Health for Life (a testimonial newspaper), the Life Foundation (for public education), the Dynamic Essentials (DE) Seminars (at which Williams expounds on chiropractic's "Dynamic Essentials"), and Dynamic Essentials (a chiropractic supply house originally called Si-Nel). Williams appears to believe that virtually all health problems are caused by nerve interference and should be treated by chiropractic methods. In 1979, he appeared on CBS's "60 Minutes," adjusting the neck of an infant girl. When asked why, her mother said the adjustments (begun on the child's third day of life) were "preventative measures—to keep her healthy."

The DE meetings are intended to inspire chiropractors to greater income as well as greater self-confidence. During the late 1970s, the fee was $325 for a three-day program during which "the DE Team speakers will show you how to increase your practice with the secrets that have enabled them to build their practices into the $300,000-$500,000 range." Other ads for the seminars boasted that their top instructors saw 200 to 400 patients per day.

During the 1970s, Williams distributed two volumes entitled Dynamic Essentials of the Chiropractic Principle, Practice and Procedure. One volume, also called the "Doctors Red Senior Textbook," outlines his views on the importance of chiropractic. It states: "Life Foundation and the Life Principle offer the world its one hope for freedom from disease, self-annihilation and eventual oblivion." The volume also affirms that God told Williams "in very clear language on three different occasions during a five-month period" to commence the DE meetings.

The practice-building aspects of the DE meetings were centered around the other volume, which resembles Parker's textbook but is far more detailed in its instructions. The initial phase of patient contact is said to have three parts: the consultation, the examination (including an x-ray of every patient), and the report of findings. Page 129 states:

Every step of your procedure should be thorough enough to convince the patient that you are not overlooking anything. The sophisticated age in which we live prevents the simplicity of chiropractic from being understood by the average person. . . .

The examination procedures are not diagnostic, they are to emphasize to the patient that a weakness exists in his body and that they have been caused by spinal fixations. By fortifying the patient's knowledge of the 'spinal cause' by the use of test instruments and graphs, the patient is able to see beyond any doubt that he is actually physically sick; that a spinal condition caused it, and that something needs to be done chiropractically to correct it.

Much of this volume is composed of statements for selling patients on chiropractic care. On pages 98-100, for example, Williams recommends that the doctor feel the spine for tender spots, "predict the conditions that might occur underneath," and ask whether various symptoms have yet occurred. If the patient answers no to any of them, say: "Well, Mrs. Jones, it certainly is a wonder. I must say you have a strong constitution in order to stand up under the many problems that you have. You have trouble in many areas, but you don't have many symptoms as of yet. But I would make the prediction that if you hadn't turned to chiropractic, you'd be a very sick girl shortly." Page 148 suggests telling patients: "Medicine is very effective in its place; however, it is a simple fact that it is becoming obsolete. The theory of medicine is false."

Williams's suggested goal was to convince patients to continue "preventive maintenance" once a month for life. (Page 75 notes that "once the patient has experienced relief through chiropractic adjustments, he will accept almost any reasonable recommendation.") If the patient asks, "But will I have to continue with chiropractic care as long as I live?" the recommended reply (page 175) is:

(Chuckling) No ma'am, you won't have to continue it as long as you live. Only as long as you want to stay healthy. Every spine needs some maintenance, Mrs. Jones. My family and I are checked regularly on a monthly basis, and more often when we think that it is necessary. Yes, if you want to stay healthy, you will have to continue some chiropractic care.

Page 216 describes a technique called "sealing the patient in." First the patient is asked if various positive responses have occurred yet. If any have, he is told he even looks better. Then he is instructed to rest quietly in the chiropractor's office so he can get "filled up with the thought that he is better, looks better, and he will be able to tell all his friends how much better he is." But page 218 cautions: "Keep in mind that we don't want to feature 'Well' or 'Cure' too soon or too strongly because the patient won't show up for the next visit since he thinks 'I'm ready to quit; I am well.' He is never well-just better. Don't emphasize improvement too fast. Instead we say, 'We want to get you over on the good side of the ledger and keep you there.'"

Recently, I was informed that a newly formatted version called Dynamic Essentials Seminars Procedures Manual is still distributed at DE Seminars and that passages from it are used as classroom materials at Life University.

During the late 1970s, I acquired a set of tape-recorded lectures from the April 1978 DE meeting. In "The Patient Report That Eliminates Premature Dropouts," Williams advised using a magnifying glass to point out to patients the "fixations" on their x-rays. "If you'll remember the first time someone showed you an atlas and the condyles of an A-to-P cervical view, it looked like so much nothing. But you can get the magnifying glass out and . . . you'll say 'Here . . . here,' and they'll say 'Um hm . . . Um hm.' And they'll go home and they'll say, 'I saw it. He showed it to me!'" But if patients don't look convinced while listening to the report, Williams suggests in the tape called "Office Procedures of the Big Men,""Tell 'em they ain't ready—you gotta re-x-ray 'em."

Ronald L. Halstead,, D.C., who operates Practice Systems, in Scottsdale, Arizona, is one of several practice-builders who provide suggested scripts to help retain patients. In an script called "Overcoming Patient Objections," he advises telling patients who are feeling better that they might relapse if they stop too soon and telling patients who feel worse that additional discomfort :indicates progress is being made." [4]

David Singer Enterprises, a practice-management firm in Clearwater, Florida, published additional insights in its bimonthly Purpose Newsletter. A 1991 issue, for example, stated:

Patient retention comes as a result of education. . . . There is usually only one reason why your patients don't continue to receive the chiropractic care they need: They don't understand what a subluxation is and its effects. . . .

We must educate patients so that they understand that chiropractic care is a part of life; once subluxations are corrected, the body will innately heal itself. . . .

Only the consumer who understands nerve interference will pay cash after his symptoms are gone [5].

Curiously, Sid Williams has expressed concern about overutilization. In the January/February 1992 issue of Today's Chiropractic, he said:

Unfortunately, some members of the chiropractic profession have been engaging in what amounts to "crime and wicked conduct" in their practices by jumping on the bandwagon of getting all they can from the insurance industry while the "getting" is good. They have been playing a numbers game of getting as many patient visits and as many dollars per visit by whatever means they (and often their practice consultants) can devise. . . . Some members of our profession have been engaging in outright fraud with too many examinations and inflated office fees-which include inappropriate and worthless therapies and x-ray procedures-that sometimes amount to $1,000 for the first visit before they've done anything at all for the patient!

How to Attract Patients

Practice Management Associates (PMA), a Florida-based firm run by Peter Fernandez, D.C., advertised that chiropractors who followed its guidelines would gross an average of $240,000 in their first year of practice and that the average for all of their clients was about $350,000 [6]. The firm touted itself as "the world's largest full-service chiropractic management firm." An ad for one of its 1991 seminars stated: "We use an 'idea' factory approach which teaches a chiropractor every conceivable way that exists to attract new patients, from the most subtle to the most aggressive."

Fernandez has marketed a cassette tape series called "How to Keep Your Patients Coming Back," which included this inspirational message:

Constantly educate your patients as to the value of chiropractic. . . . Get out there and beat the bushes, advertise, word-of-mouth, either way. But let's let the people in our country know what we can do. We only take care of four percent of the people. Guess what, gang? One hundred percent of the people out there have spines, 100 percent have subluxations. They all need adjustments. We have 95 or 96 percent of the people still to reach.

Fernandez has also produced a five-volume series called Secrets of a Practice Consultant. The first (1981) edition of Volume I, 1001 Ways to Attract Patients, included the following suggestions on how to build one's reputation when beginning chiropractic practice:

The fifth volume in the series, published in 1990, is called How to Become a Million Dollar a Year Practitioner.

For several years, Fernandez published Chiropractic Achievers, a bimonthly magazine distributed free of charge to chiropractors throughout the United States. One thing it reported was the record set by clients during their first thirty business days-the highest of which was $91,000 in services to 177 new patients. A 1987 ad for Fernandez's school of patient longevity stated, "Once you've acquired a patient, keep him coming back because he wants to, because he believes in chiropractic and in you."

During the early 1990s, Fernandez and PMA became embroiled in a large number of lawsuits with clients who said they were dissatisfied. Another company purchased the right to service PMA's clients and Fernandez dropped from the limelight. He now operates as Fernandez Consulting, but I have no idea what he is teaching.

References

  1. Goertz C. Summary of the 1997 ACA annual statistical survey on chiropractic practice. Journal of the American Chiropractic Association 35(11):30-34, 1998.
  2. Frigard LT. If I were graudating today. In 477 Practice Building & Office Procedure Ideas. Fort Worth, TX: Parker Chiropractic Research Foundation, 1977.
  3. Dr. Sid is targeted for the exorbitant administrative pay schedules at Life College. The American Chiropractor 22(1):55, 2000.
  4. Halstead RL. Overcoming patient objections. Undated, circa 1981, marketed through the mid-1990s.
  5. Lund S. The most effective way to increase patient retention. Pupose Newsletter. Issue 3, pp 5-6, 1991.
  6. Ads in Practice Management Association's Chiropractic Achievers magazine, Sept/Oct 1989.

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This article was revised on February 16, 2003.