Ethics and Jurisprudence

Finances and the Chiropractic Patient

Here's an article I wrote for a recent issue of Straight from Sherman.

Ethics In Action
By Leslie M. Wise, D.C.

Pod/Vodcast:



In a recent workshop for faculty, Dr. Norman Ouzts, Chairman of the South Carolina Board of Chiropractic Examiners, indicated that complaints filed about D.C.s to the SC Board are heavily weighted in the category of financial misconduct, with sexual misconduct a distant second place. This gives rise to the important consideration of what chiropractors can do to assure that we are absolutely fastidious about the financial conduct of our practices, and avoid public sentiment that we are less than honest.

In our ethics and practice management classes at Sherman, we make the following suggestions regarding finacial interactions with patients:

• Always discuss fees very early in the doctor/ patient relationship, preferably on the first encounter. Be sure to deal with initial visit fees, such as exam and x-rays, as well as the fees for subsequent routine visits. Patients hate surprises. Be willing to state your fees when asked.

• Have a written policy on fees and collections. Include it in your practice brochure, and on your website. Transparency is best when it comes to money. Patients will appreciate your willingness to discuss finances, even when they are hesitant to open the discussion.

• If you use pre-paid plans of care, be especially scrupulous in your explanations of what a patient gets for their pre-paid fee. You must have a refund policy, if a patient decides to drop out. Some states require that you keep all funds collected in a special escrow account until the services are actually delivered. Put it in writing and answer all questions before taking payment.

• If a dispute over money arises, be willing to take the high road. Ask the patient what would make him happy, and do it, even if it involves writing a check for a refund to which you are not legally obligated.

As ethical chiropractors we have a fiduciary responsibility to our patients, which means that we are obligated to look out for their best interests first, and that includes their financial best interests. Absolute financial integrity, with no hint of shady dealings will help assure that our profession gains the esteem we rightfully deserve.

How much do DCs make?

Always an item of interest for chiropractic students, average chiropractic income is talked about a lot, but there's no way to absolutely pin it down. Some students really want to hear that when they graduate they will magically have an $85,000 paycheck waiting for them, but it doesn't work that way. If you see a lot patients five or six days per week, charge a relatively high fee per visit, manage to actually collect those fees, keep your expenses such as office rent and employee salaries at a modest level, then you will make more than the average chiropractor. On the other hand, if you see a few patients on Monday, Wednesday and Friday, charge a lower than average fee, have a poor collection rate, pay high rent on an extravagant office space, and pay a stable of assistants, you're not going to do so well.

In other words, there are lots of variables contributing to average chiropractic incomes, so when someone tosses out a number, don't naively think that getting a license automatically entitles you to  the "average chiropractic income"(which, by the way, falls somewhere in the 60 to 100 thousand dollar range, depending on who's telling the story.) Follow the link above to a rambling discussion of chiropractic incomes. The numbers are interesting.

Ethics In Action - article and podcast

Here's an article I wrote for a recent issue of Straight from Sherman.

Ethics In Action
By Leslie M. Wise, D.C. 

Podcast of this article available here.

In a recent workshop for faculty, Dr. Norman Ouzts, Chairman of the South Carolina Board of Chiropractic Examiners, indicated that complaints filed about D.C.s to the SC Board are heavily weighted in the category of financial misconduct, with sexual misconduct a distant second place. This gives rise to the important consideration of what chiropractors can do to assure that we are absolutely fastidious about the financial conduct of our practices, and avoid public sentiment that we are less than honest.

In our ethics and practice management classes at Sherman, we make the following suggestions regarding finacial interactions with patients:

• Always discuss fees very early in the doctor/ patient relationship, preferably on the first encounter. Be sure to deal with initial visit fees, such as exam and x-rays, as well as the fees for subsequent routine visits. Patients hate surprises. Be willing to state your fees when asked.

• Have a written policy on fees and collections. Include it in your practice brochure, and on your website. Transparency is best when it comes to money. Patients will appreciate your willingness to discuss finances, even when they are hesitant to open the discussion.

• If you use pre-paid plans of care, be especially scrupulous in your explanations of what a patient gets for their pre-paid fee. You must have a refund policy, if a patient decides to drop out. Some states require that you keep all funds collected in a special escrow account until the services are actually delivered. Put it in writing and answer all questions before taking payment.

• If a dispute over money arises, be willing to take the high road. Ask the patient what would make him happy, and do it, even if it involves writing a check for a refund to which you are not legally obligated.

As ethical chiropractors we have a fiduciary responsibility to our patients, which means that we are obligated to look out for their best interests first, and that includes their financial best interests. Absolute financial integrity, with no hint of shady dealings will help assure that our profession gains the esteem we rightfully deserve.