Is it me or should we be telling chiropractors to set their standards of care at 40 PVA

I think we are all agreed the marketing is abhorrent and agreed that different folk practice equally ethically but in different ways.
 
I would suggest that perhaps sometime Liam do check a loved one or even your CA/receptionist every two weeks and see if although without sign or symptom is does in fact have a subluxation or restriction?
 
As for the new patients – if it took years to get like that it might be worth suggesting it will take more than a snap pop and crackle in your office to correct it (;

Right I have 3 new patients in a row should I try to sign em up for 3 or 4 dozen visits??

Liam,
 Your comment:”The so called chiropractors running this youtube crap have deleted my first comment so I’ve posted another.”Not sure why my last comment was deleted, so I’ll say it again, and if you delete it again, ill put it on again. This is disgusting, why don’t you try evaluating your patients progress at each visit rather than deciding on how much money you can make. Can you really tell me you can assess a patient and decide they need 40 visits???? Ok you had better give me some lottery numbers then. Try putting the patients needs first rather than how much you can get from them.”Sounds like you are questioning, but again I might be wrong here…S

Oh Stefaan, I have never questioned treatment protocols only had mine questioned. Should I get a patient back every 2 weeks when I know they can return in 6 months and have no problems? At no point have I said anybody is wrong. I am not looking down but I say again, “but if you try and tell me what I do can’t be or is impossible I will tell you you are wrong” and that means 6 monthly check ups for the majority of my patients and they stay problem free. Perceived or not.

Liam, 
You showing me your perceptions through pelvic check procedures (as it would be if I showed you mine) are still opinion, not fact. Whether an adjustment is supplied by a therapist or a robot is irrelevant to the measurability of the outcome and I do consider a person taking a stance looking down (and maybe you didn’t mean to come across as such but you came across that way to me on this particular topic) as trying to establishing a “higher moral ground”. I don’t agree with seeing patients lots, because like you I don’t perceive the need for it, and quite frankly haven’t got time to, but that does not deny that I am willing to examine and appreciate the relevance of those treatment protocols if there were any without me getting uppety about my perceptions and assumptions. Fact is that I care about one thing only and that is : am I giving the best patient care possible? and if these protocols exist I want to know what their value is (if any) to the patient and as I have stated before: until we have a real way of evaluating the value to the patient of differing protocols it is just one perception versus another and there is no moral high ground whatsoever whether in clinic for 5 year or 30 years…

They can be either problem free “without getting adjusted and remain outwardly problem free and in good health ”

or they can’t ” I don’t believe that after 6 months someone is restriction free never”

I don’t see the contradiction?

Missed this bit

 ”it’s quite likely that you are undereducated as to the possible detrimental effects of a subluxation”

Don’t worry guest I’m not offended by it, it just concerns me that unfortunately all you do is offer ammunition to those that wish to shoot us down.

Hi Guest, I had to look that up. It,s not a slur, just that in the US, I beleive, 95% of patients have their treatment paid for by their insurance company,(I may be wrong) so basically it doesn’t really matter how many times you visit it’s included in your monthly payment, whereas in the UK 95% of treatment is paid for by the individual. Out of their own pocket. I think there is a realistic chance that is would be far easier to get a patient with health cover to visit far more regularly than somebody that has to pay for it.

To calculate this number, multiply your average collected office visit fee by your patient visit average (PVA).
For example: If your average collected office fee is $50 and your PVA is 12, your current base patient value is $600. Add in the value of other services, such as x-rays, to get a total current average patient value: $600 + $80 = $680.
Finally, multiply the current average patient value by the number of patients you currently have (in this example, 20) with the insurance company to see their total value: $680 x 20 = $13,600.

???????????????????

PVA I assumed to be the number of visits divided by number of new patients, NOT number of times a patient is seen per year

Liam, I don’t get it. If you didn’t mean it as a measure of your practise, then why only aspire towards 6 months and not 1 visit for a life-time? Or in fact no need for visits at all?  If we’re going to aspire…let’s aspire properly! I am sorry but that is a ridiculous commentary in my opinion

Great to hear it, I don’t have every patient on 6 months but Im aiming for it. Its a goal. But it is dictated by the patient recovery, lifestyle etc,

Hi Stefaan, ehy is this getting narrower? I have said my ultimate goal is a visit every 6 months, but of course we have gone from weekly to 2 weeks to a month etc, with constant monitoring. If at any point problems re emerge then the treatment plan is altered to suit. I do not say to patients “you must not come back for 6 months or else” And I do not say you must come back every month or else. I re assess every time and advise accordingly. If somebody has just been involved in an accident of course you wouldnt leave it. I’m not saying EVERYBODY can go 6 months and be problem free but that is MY goal and it happens with the MAJORITY of people I see. I’ve seen 4 people this morn for 6 months check up. None where in pain or had any symptoms. 

Liam, I would really love to agree with you, and although I oddly seem to place my work somewhere between you and Guest (in terms of frequency of check ups: and yes, it will extend over time, but it will vary between athletes and post-surgical times and it will vary between levels of activity of the patients involved) I can’t agree that there is uniformity in the looking after of such widely varied population groups (the likelihood of you being wrong (conscious or subconsciously) about it being possible (to have  similar results with patients with such widely varied presentations and histories despite using the same after-care protocol) is in my view far greater than the likelihood of being right. But that does base itself on logic and intuition. Both open to fallacy, I accept that. The other thing to bear in mind is that I see a lot of people who were on “twice a year” schedules but weren’t getting good enough results to their liking and came to me on referral. Point is we are all capable of delusion, even the person who thinks they have the moral high ground…in fact I have seen far more patients from ‘twice a year chiros’ and osteos than I have from ’40 a year chiros’. But that MAY be because those have been dissuaded from ever seeing anyone…

Hi stefaan, By OK I meant within limits, no pain, no restrictions. What else do most patients come to see us for? What more can you realistically offer? What else can you prove to be beneficial for the patients health except their perceived lack of pain? When a patient first sees you I bet they want you to help them with their pain Right? Some then sell them the importance of regular visites to maintain health, right? I only sell them the treatment necessary to prevent their pain from returning, which is their only reason for seeing you in the first place.

Liam no stress – its obvious that we practice differently indeed and have differing perspectives on what patients want most probably based on our own care schedules – a comfortable deterioration is not what I would wish for me or mine so I suppose I carry the same standard into practice as per Stefan’s post.
 
How does one know they need an adjustment – if I am pain free and symptom free yet a check determines I need an adjustment I most likely need an adjustment. If I am checked and I don’t need an adjustment – then I don’t. How would a patient know if I don’t?
 
This is how I care for my patients along with advice as stated because personally I believe walking around with a subluxation for four weeks could be more detrimental to health than not drinking enough water during the same period.
 
I would like to see lots of people lots of times and make a difference to a wider circle. You are wrong that we have a role in ‘maintaining well being’ we have a role in creating a better higher more robust level of health (salutogenesis) through chiropractic care.
 
I think what is key to this debate is money – I do not charge patients to check them if they do not require an adjustment.

If someone needs an adjustment correct it. Do we try and see lots of people or the same people  lots of times. Do we need to check someone every two weeks, rather than say every six weeks. Would walking around with a subluxation for four weeks be more detrimental to someones health than not exercising and eating properly. Chiropractors have a role in maintaining people well being, thats all we have, a role and by exaggerated the importance of that role we damage our credibility to all except those who want to bleed people getting them to pay thousands up front. I know when I need an adjustment so do my clients, they are the consumers.  

Let me start out by stating I do not agree with sticking it to the ‘patient’ to get a 40 PVA, nor do I agree with massive forward payments or prostitute my profession, but neither do I feel comfortable selling it short nor providing a comfortable deterioration when I doubt very much this is what any ‘patient’ wants – even yours.
 
If you assess objectively a patient’s condition every fortnight and find they need an adjustment – they most probably need an adjustment. If they don’t – don’t adjust them. However knowing they need an adjustment – most folk would then in all likelihood want and like an adjustment.
 
The problem then I find with alot of chiropractors decrying those providing a regular adjustment is they feel somewhat guilty about earning from this situation of need and they need to force that feeling outward when in fact most when it is reasoned out would not feel it a crime or immoral to earn a living whilst making a difference to people’s lives.

It is not a crime nor is it immoral to adjust someone on a regular basis be it weekly fortnightly or monthly on the basis of their needs and be paid for it.

This is a very interestingly thing to say and it is obvious you feel you are ‘treating’ a condition or symptom. Perhaps with your care plan you are affording the ‘patient’ a ‘comfortable deterioration’ rather than addressing the causes? The most basic causes of which are gravity, mass, movement and aging which would infer never addressing but rather managing.
 
Also such a sentiment would signal some consideration within it that chiropractic adjustments are not good for the ‘patient’ and should be limited. Can you tell me which part of the adjustment you feel introduces something negative into the ‘patient?’
 
How do you assess the need for an adjustment – do you have or use an objective system to do so?
 
Any pro sportsman or woman I have ever adjusted enjoyed the freedom of a wider limit to their performance and as a pro continued to push them so requiring more regular care than every six months.
 

Although I have as much evidence as you do to support any such statement, logic dictates that your comment as I understand it is impossible ie someone with multi-level djd, ddd and/or rod and screw fixations requires as much/little looking after than someone with a normal spine?

PS, I work with every group, acute, chronic, sports, pro and casual and it seems to work for every type. Your welcome to come visit any time :-)

I can’t quite beleive the MCA has thought of adding a “clinic for sale” with their latest newsletter, especially as the clinic is described like this, “With an average of 150 practice visits/week in 24 adjusting hours and a Patient Visit Average (PVA) of 42 over 2011, this policy pays dividends.”
42 visits a year average????  Bad practice IMO.

Check this out a good program on how to improve a business, its a garage but the principle is the same and no need to pay a chiropractor in a shiny suit £500 a month http://www.bbc.co.uk/iplayer/episode/b01cp3y3/hd/Alex_Polizzi_The_Fixer_Guidebridge_MOT/

The bottom line is if you provide excellent service and the customer knows this and tells their friend you will have success.

Hello F Mac, no it definately does not mean he is bad. Of course treatment sessions close together are needed in the early stages, but for the majority of the people I see, I aim for maintanance visits of once or twice a year, its what I expect. Your treatment is keeping you active and off pain meds which is great but I also beleive patients should not become dependant on chiropractic care. Have you tried any other form of treatment? If you have and what you are getting is the only way to stay mobile then you have found the only course of treatment for you. If you havent tried any other treatment then something else may have the same effect but require less visits. This thread is aimed more at the chiropractor who tells you you need to come every 2 weeks for the rest of the year before they even know if they can help.

Hi Liam
If I went to the chiro one or twice a year then I would be back on the daily codeine pain killers and still not exercising. I prefer to go every 2 to 3 weeks (depending on chronic my back is) and be off the pain mess and able to walk my dog 3 times a day.

Does that make my chiro bad that he works with me in this way?? It seems like that is what you a saying.

Fiona – a patient not. Chiro

HI CDC,
I hear you loud and clear, but the nuance I would put into this commentary is that there is nothing absolute about anything (the number of treatment visits, the way to package treatment costs) until you have defined your target group enough. Some people will hate that which another person loves and unless you know who you have in front of you and what kind of thing that kind of person likes. This is why I think the key-word is “choice”.
I don’t like open-plan practice but some people do. And unless I am going to descend into fascism I think that it is their right to like it and it is mine not to.
The biggest problem lies in the way we present choice. Take the consent process for example: I always explain that a clot might dislodge with cervical manipulation causing a stroke and that I might fracture through an osteoblastic spine. Everyone understands that there are risks and despite whatever old Edzard is saying, they are not expecting things to be “risk-free” whether by virtue of being CAM or being practiced in a clinic where crystals dangle from the window (again you are allowed to like that stuff, I don’t) everyone understands that something that potentially carries benefit inherently potentially carries risk. Point is that these stark notions don’t get rejected in my consent process but is that because there is an informed consent going on or because I wear a tie and my office looks like I know what I am doing.
The “choice” in my experience lies with the old adage of “voting with the feet”. Others have seen patients of mine because I wasn’t their cuppa flavour and vice-versa. I have always refrained from saying bad things about others because sometimes I will get it wrong and will have done already no-doubt but some names just keep cropping up with the same complaints, and you know what? they’re not doing that well right now…
This is what I love about this recession: we simply cannot afford to mess people around or have a messy street cred and like many businesses and industries: it is in recessions that reputations are made and businesses are liquidated.
But please forgive that tangent, because what I really want to say is that there are ways of finding the right patient for the right process if only we were willing to open our books for all to see and assess…
Stefaan 

We understand the need for chiro treatment and if you explain the benefits of it then many patients will return for maintanence care, the problem lies, I feel, in the sales techniques used to “sign patients up” for this many visits. If we look at why patients first visit a chiro, when they are in pain, its easy for the skeptics and money minded chiros to use the bait and switch analogy. You should not, in my opinion, be selling 40 PVA to a patient in pain, especially if you cannot guarantee to deal with the pain in the first place. Lets say you have dealt with the patients problem, which is basically why they came to see you in the first place, and then talked about “so many” visits over the next year, surely that would be a better way of doing it, BUT of course far fewer would be likely to sign up for so many visits.

Hi CDC,
I thought you were American, I will e-mail you and you can tell me who you are? I think everbody should have their spine checked every month, they sit at computers etc, I have made this graph which shows the increase in back problems since the mid 80s from Gordon Wadells book “The back Pain Revolution” the increase in problems almost mirrors computer purchases. So I do offer the same care to patients as I do my family, some take it up some dont. In these times less than ever.

Now everybody knows if they go to the gym regularly their health will improve, they dont keep it up. The gyms figured it was best to charge them in advance when they were in the mood for exercise. Like wise people will sign for a lot of chiropractic treatment when they are in pain. If one persons uses these practices unethically it reflects on the entire profession. If chiropractors focused on what we do well rather than our differences the public would understand chiropractic better and I believe would go as they do to dentists. WE are out own worst enemies.

I did not like that Chuck Gibson, he asked me to leave the seminar because I asked him why you had to make this commitment for twelve months. I asked if the programme was as good as he said why would anybody leave?

Hi Stefaan,
I have never been to a masters circle and I am sure they would say its about establishing a relationship with a patient. However the practice building seminar I attended soon after graduating was by a guy called Chuck Gibson he was talking about a “million dollar practice” by having high annual PVA,s, and generating them by x raying every patient and you know the rest.

Now of course chiropractors need business and marketing training, I watched Alex Polizzi “The Fixer” on BBC earlier this evening, the principles of good business practice and marketing are the same, so why would one go to a chiropractor for sales and marketing expertise and then to find much of the advice is scripted into a cook book resipies for a successful practice. Bob Hofman speaks of some guy called Larry who always talked about “two to four dozen visits in the report of findings”. 

We provide a service and its up to patients to decide the kind of chiropractic care they want. I cant imaging a situation where I would set in front of someone and tell them the needed to come in 24 times never mind 48. There are patients I have seen  every moth for years, for them its like going to the gym, if they decided not to come  in I would never chase a patient  up  unless it was in the acute phase and I would never use a script or instruct a member of staff to speak to a patient using one.

I am sure everybody who goes on these course will say its helped them, the question is do these practices help the chiropractic profession when it only needs one person to use them unethically to create a problem for everyone. The fact this clip has generated such interest in the skeptic world, suggests they dont look good.

 Hi Liz
I remember in the 80s I opened one of the first Aerobic centres in Europe and went to US to learn. No prices in reception which i thought was weird, then they took you into a room with on of the “sales team” it was nauseating  and they all worked like this, Its the American way. In Sweat Shop we werer so busy all classes booked up for three weeks, however the  big money is in pre payment memberships, I never went there, so we did not make the big money, but I sleep well at night.

Young kids come out of college, taught by people who were not sucessful themselves in practice . These kids have bills to pay and along comes another chiropractor who probably does not practice, in a thousand dollar suit and colourfull tie telling kids about the millon dollar practice, based not on seening lots of people but seeing the people they have in the practice lots of times.

 It happens in Dentistry, Gyms, Law, Banks and many professions putting people under pressure to purchase things they dont need.  Can someone explain why they are so impressed with people talking about the joy of a succesfull practice when they dont practice themselves and just want you to sign up to their scheme. I love what I do and I love talking about it and I rarely charge money. I have an interesting story about that which I will share next weekend.

  Do the “ends” justified the means. The ends being getting people to have their spines checked regularly. My family and I get checked about every two weeks, thats my choice, I think all patients should have their spine checked at least once a month, but its their choice, and not subject to the colours of a SEMG scan or the chiropractors bank balance. If a chiropractor gave me a year long treatment plan based on having me return 40 times, I would laugh in his face and so would most chiropractors and yet many offer this bullshit to patients daily.

 Its not acceptable to me to set a target for practice growth based on an average number of visits a patient can be convinced to come in, and the convincing is done  when many patients are in pain. This contradicts the whole theory of the “vertebral subluxation” and each individuals innate healing ability and its time subluxation chiropractors stood up and were counted. Some people need one adjustment others need 20, but we cant tell in advance. Some athtlets need to lift a lot of weights others do little. 

If  chiropractors cant convince patients in a honest way of the benefits of regular care, then they should find another career, and let the rest of us get on with providing quality chiropractic care . There was a guy in Sligo in Ireland did a spinal screening on weekend signed up people for around £20,000 and fucked off on Monday, with no regard for the people he had ripped off or the chiropractors left behind. 

 We are approaching a junction, some will go left and buy shiny suits and colourful ties and get into sales. Others will turn right and become pseudo medical doctors, they rest will follow the leader wherever that will go. When I am finished chemo I have decided where I am going and anyone will be welcome to follow.

I can’t stop thinking about this. How does 40 PVA make you a good chiropractor (he salutes them) when the average is 19PVA. If I had to get a plumber out to fix my boiler every month but somebody could look at it a couple of times and sort it, how can the former be regarded as the better plumber?? 40 PVA might mean that you arer a good salesman, it might mean you are good at marketing but if definately does not mean you are a good chiropractor. Infact you are probably the worst kind of chiropractor as you cannot rely on your own skills, you cannot rely on your patients improving so you have to try to lock them in to as many visits as you prossible can, some up to 60 PVA FFS.

I’ve posted on the youtube site, disgusting. AT REPORT OF FINDINGS TALKS ABOUT 2 TO 4 DOZEN !! VISITS. And they wonder why chiros in the USA, or chiros that use such dubious tactics over here, are not trusted.

I
think that we should do what we do best, stand on the shoulders of the
giants that came before us, use our best clinical evidence and research
experience (where it exists) to grow healthy people from the people who
come in to see us> for some that is a
crisis period before maintaining their health through adjustments and
new healthy behaviours, for others, its digging them out of a trench
that 40 people could sit in, the coaxing little by little to take on
things (like eating fresh whole food, managing stress, exercise, sleep)
to take back their health. Chiropractors have always seen people as
INDIVIDUALS. I do think that more regular care keeps people healthy.
Actually i dont just think it , i live it. But i dont go in for the one
size fits all type of thing at all!!!