Who's Minding the Store?

by John H. Gantner, DC

Today’s practicing DC is busier than ever with paperwork and demands for accountability. This arises in large measure from HMO’s and other third party payors, along with a constant effort to overcome one sided paper reviews and IME’s. Keeping up with these non-paying demands on one’s time along with a busy schedule of patients is a daunting task.

Nobody talks about it but all this reporting we offer third parties, taken together, creates a “record” for our profession. Given our many chiropractic techniques and practice philosophies, it is clear to me that we often present our profession as a virtual Tower of Babel to carriers, employers and even the public. This confusion has enormous ramifications, not the least of which is the frustration it generates in claims reviewers. With few exceptions, we accept this and try to move on. But it still divides us as it confuses our professional image.

Is there an answer to this seemingly perpetual dilemma? Of course there is: strong professional organizations that are capable of establishing reasonable standards of practice. They do this by gathering, debating and developing important data regarding chiropractic practice and our market. The organization then feeds this back to the schools and licensing boards. This mandates action (read teaching and testing) on these issues in the most appropriate venue, chiropractic academia and its students. After all, isn’t that the source of most of our schisms?

But a recent survey conducted by Dynamic Chiropractic revealed that only 27% of DC’s supported their national associations while 43% supported their state organizations. At the same time, only 9% reported that they supported their schools.

Paint this any way you want, it clearly represents a stunning and deplorable lack of interest by practicing DC’s in becoming involved in their professional organizations. The organizations get along, but they are hobbled by the poor support from the rank and file. Bottom line, little gets done. Good leaders exist but they are often outnumbered by others who simply fail to get their hands dirty. No matter how you defend it, a weak organization is a cry for a greater percentage of good leaders, greater vision and better management.

It is clear to me that in today ‘s chiropractic profession too many DC’s who are capable of becoming future leaders refuse to become involved in “politics” as they see it. They find it far more lucrative to pay attention to their practices — to use their abilities to make money and enjoy more freedom rather than to endure the demands of the rough and tumble of professional politics. One hears many “good” excuses: “I have to spend more time with the family,” “My practice is too busy,” “I don’t understand the issues enough,” or “I refuse to work with so and so.” Bottom line, more than a few doctors simply do not want to become that involved. They sit on the sidelines. Their motto is “let someone else do it.” So who does it? Someone who is more willing to accept the challenge. This willing person may not be the most capable, but s/he is willing. And in many cases, that is enough to assure that s/he will be elected to high office (and make policy).

It is not uncommon to see non-productive, sometimes clearly conflicted chiropractors running unchallenged term after term for various association offices. This is as true in State as well as National organizations. The point we miss when we vote for these representatives is that we are not just electing an office holder — we are electing a manager! And isn’t poor management of our organizations one of our greatest problems?

There is little demand for accountability from existing leaders. Committee chairs and association officers usually write reports, at least semi-annually. Members should see these to determine if these office holders actually have a mandate and if they are actually doing anything. Members should demand the freedom to read the report of every single committee chair and officer on a regular basis. If there is no report, that individual does not deserve the position s/he occupies. S/he needs to be replaced by someone who actually works.

One vital purpose of any organization is to create a climate in which new leaders can be developed. But in order to create such a climate, the organization needs leaders with vision, not those who simply covet power. Personally, I see little effort on the part of existing state and national organizations to bring young people “along” through committee work. In some chiropractic organizations, committees — if they exist at all — are sometimes “stacked” with the “right” people that allow various political hangers on to pursue their private agendas for years on end. In too many of our organizations, most committees exist in name only. The officers (managers) we elect quickly learn that they can control the actions of hired staff personnel far easier than that of a working committee of their peers. The absence of working committees assures that decisions on policy will usually be made by various “old timers” and the executive officers of the organization. Many of these individuals have biases or conflicts in interest that prevent them from fairly representing the practitioners that sent them there. They stand in the way of younger practitioners seeking a chance to build a track record of service to the organization and profession.

We too often re-cycle former officers. In other words, they never go away. This can become the kiss of death. It assures that the animosities and biases of these individuals never leave the organization’s agenda. A vital organization moves “onward and upward.” It cannot stay the same, catering to the wishes of the same select few, year after year. Once an officer’s term is up, s/he deserves recognition for a job well done (if true), a sincere thank you and a goodbye handshake. Time to move on. Likewise for association executive personnel, for attorneys, legislative consultants and administrators. These individuals — who are on our payroll — need to be given a clear agenda seeking reasonable goals along with a reasonable deadline. If they succeed, their contract is renewed. If not, we find a new horse. As it stands today, we often see association attorneys, lobbyists and administrators setting the agenda for the profession. One reason this occurs is the failure (or absence) of honestly working committees to offer constructive recommendations and direction to the hired help. Like it or not, the personal goals of those we hire usually do not match our (chiropractic) goals. That’s like saying our organization exists for them to serve. They’ve got it backwards.

Some employers, HMO’s and carriers seek out elected leaders of chiropractic organizations or committees for service in various capacities. Like it or not, this causes a conflict in interest in that individual. Organization officers are mandated to reveal outside jobs/ income. But in some cases, it is impossible for rank and file members to have access to this list. For any of a number of reasons, those in power sometimes find one reason after another not to (fully) disclose such information. This naturally fuels more than a little skepticism from rank and file practitioners. In my view, it is one strong reason for poor association membership.
It is time that we practitioners come to grips with the fact that our professional organizations represent practitioners. That means that our best representation will come from practitioners serving as officers, delegates and committee chairs/members. It is counter productive to see DC’s in leadership positions who concurrently serve as HMO staff (or owners) or who serve as insurance company employees in various capacities — including those who do IME’s for a living. These individuals, in spite of their abilities or record, are inherently conflicted. It’s that simple. Of course, they will make strong arguments to the contrary. That means nothing. They are not one of “us.” They are conflicted. Whether conflicted by their egos or their sources of income, they are a cancer in our professional body that begs for appropriate treatment.

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