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Recently I was engaged in conversation with the Administrative Assistant to the Executive Director of a very populated Chiropractic State Association. In this conversation, I was told that numerous D.C.'s were leaving practice in that State due to the political climate that they felt they were no longer able to earn a living. To say I was shocked would be a gross understatement as we are not discussing a State with an ailing economy, in fact the State I refer to is perhaps one of the more financially secure ones. I literally could not get this off of my mind until two weeks later when I happened to be discussing the situation with the Executive Director of another State which is in another part of the country from the first one. Suddenly I found myself being shocked to my senses with the realization that this individual was telling me the same thing the first one did and that is, numerous D.C.'s are leaving the profession because they feel they cannot earn a living.

This was very hard for me to understand but as I began to inquire of the multitude of people I converse with weekly from around the country, I was being told the same story. I learned of at least two State Associations and I am sure there are plenty more, whose membership is suffering dramatically due to what has been described as the doctors inability to afford membership dues as a result of "the political situation".

What politics am I referring to? None other than "managed care". Now please understand, I am not by any means an authority on managed care. I freely admit I do not know what they are or how they operate. I do not know the names of any of them. Nor do I wish to. I admit I am completely oblivious and 100% ignorant of HMO'S, PPO"S or any other organization which comes under the definition of managed care. Therefore I also freely admit, that I am without question the last person who is qualified to write about managed care, however, according to some of the articles I have read in the past, I see very few people who are more qualified than I am.

In the early days of managed care, I read scores of conflicting reports, articles, etc. to the point I became so turned off, I just said "I PREFER NOT TO PARTICIPATE"!!!!!!!!!!!!!! The articles however, just keep churning out, confusing everyone who reads them and obviously creating such havoc on the professionals life, that just like the person who in desperation and no where to turn, decides the best way to get away from this evil and torment is just to end it all. And, thus, they leave practice to become involved in another endeavor in an attempt to establish some type of continuity and financial stability in their life.

The most interesting thing about this entire scenario is I cannot tell you the number of D.C.'s I am personally acquainted with who have said "To Hell" with managed care, began practicing good old fashioned "get them in and get them out" style of practice. Have incorporated the things that people are asking for with the new found interest in "alternative medicine" such as acupuncture, herbology, etc. Charge a legitimate fee for a legitimate service. Do not become mired in the muck of insurance, managed care etc. but simply charge a fee for service and as a result of a changed focus and new goals, their practices are at an all time high. One of my very dear friends in South Carolina after moving there from a northern state met his two year goals in six months and within two years, his practice is as big now if not bigger than his previous established practice. He will unhesitatingly tell you the reason for his success is exactly what is found in this paragraph.

I have always found it so interesting that most D.C.'s think that if a patients insurance company does not pay for their care, than that person will no longer continue to see the doctor. They will simply go to a doctor where the insurance will pay for it. What a pathologically involved "head trip" that is. Obviously the self worth of the doctor has been compromised some where along their developmental path and the confidence level of the doctors abilities have been challenged, if in in fact they ever had them in the first place.

The vast majority of professionals and most of our patients have a dentist, attorney and accountant none of which are paid for by managed care or third party, yet we have them. We purchased a new washing machine, microwave oven, cellular phone, VCR, large screen TV, camcorder and a host of items too numerous too mention, to include a trip to Las Vegas or Atlantic City etc. etc. etc. all of which were not paid for by managed care and the average person didn't bat an eye. It was all justified by the fact that "they needed it". Well guess what folk, they need health care also. They just don't need it rammed down their throat.

The fact of the matter is, people need what we do and they are more than willing to pay for it as long as they can justify the need. Far too often the need cannot be justified by the patient because the doctor cannot justify it themselves except for how it is going to benefit them. Their goals and objectives are in the wrong place. Many times the doctor's focus is on their lifestyle, their income, their wants, needs and desires as opposed to the patients.

I read an article the other day from one of our major national organizations to the effect that "Managed Care is Here to Stay", it is not going to go away. But, to quote Rhett Butler "frankly Charlotte, I don't give a damn". Today with a cash practice, I am as busy as I can possibly be. I find it difficult to impossible to see more patients in a day than I currently see. I average 5 new patients daily. However, keep in mind, I also release that many to maintain my status quo. I truly believe the reason I am so busy in my clinical practice, is that when people come to us with major disabling conditions, we are able to help them quickly with a combination of therapies to include chiropractic, acupuncture and herbology and as a result of them being helped quickly, the over all cost is negligible and something the average person can afford especially when they know the treatment is not going to last forever. People will always afford what they want or need. Why should a patient come to us and pay us directly when they can go to another doctor and have it paid for by managed care? Let people come to "you" because of who "you" are not just a chiropractor. Learn about acupuncture and herbology and assist patients over their problems in combination with chiropractic care. If the only patients you ever see in your practice from this day forth are only those individuals who have not received help elsewhere, you can have a waiting list practice for weeks or months to come. Remember, there is no shortage of people who need us!!!!!!!!!!!!!!!!1

To really put the whole thing into perspective, copy this quote from B.J. Palmer place it in a prominent place that "you" will see daily. Remember this is your head trip not the patients.

John A. Amaro D.C., FIACA, Dipl.Ac.
Carefree, Arizona, USA