…The Tough Get Going!!
We’ve all heard this old phrase (or at least I hope that you have heard it) but what does it really mean?
I can remember distinctly when I was on my very first organized sport team (6th grade football) the coaches shouting this from the top of their lungs while we were lying on our backs with our feet held a mere 6 inches off the ground. Of course, this was core training from years gone by but I digress. I remember asking myself what does he mean? I understood that he wanted us to keep our feet from dropping regardless of the pain that we may experience. Of course, most of my teammates were crying out in pain after a few minutes, some were even crying and I seriously doubt that any of them had the wherewithal in that moment to actually contemplate anything. However, I wasn’t feeling any discomfort and was initially wondering what was the big deal.
You see, my father, wasn’t really excited about my playing football because everyone else had been playing for few years and he thought I would get hurt. So, in an effort to discourage me from the idea he made a deal with me. I had to do weight training 3x/wk and run 5k 3x/wk from June through August. By itself that doesn’t sound too bad but when you consider that my father’s collegiate level sport was boxing – his idea of weight training was quite intense and included doing hyper-extension sit-ups off of a bench with weights behind my head. In the first few weeks of weight training I had a hard time getting out of bed in the morning, straightening my arms, and reaching for just about anything…pain, pain, pain!! Then my body adapted and the pain went away. Of course, my father, saw that happen and would increase the intensity of my workout stating emphatically, “no pain, no gain!”
While I was lying on my back contemplating the meaning of, “When the going gets tough, the tough get going!” I finally realized that what my teammates were experiencing was what I had gone through at the beginning of the summer. They were still sore from yesterday’s workout and trying to deal with that pain while working out today. Most of my teammates were a bit frustrated with me that I didn’t show any signs of discomfort while doing this particular exercise but they also appreciated the break they would get as my coach wouldn’t go on to the next exercise until everyone had dropped their feet. After the first couple days he realized that it was just too easy for me and added assisted leg push downs to my routine where I would bring my feet up to 90 degrees and he would push them back down quickly. I found myself reaching the pain threshold much faster with that routine.
I have dissected that statement hundreds of times throughout my career searching for it’s true meaning and have come up with a few parallelisms.
1. The Going Doesn’t Get Tough When You’re Properly Prepared.
2. When the Going Get’s Tough…Most People Quit Just Before it Get’s Easy!
3. When the Going Get’s Tough…Hang in There; You’ll Adapt.
What I tend to see in my profession, “When the Going Get’s Tough…” is rather disturbing.
More than 50% of my classmates have stopped practicing. Of course, the reason’s for this are quite similar among many health professions today: the downward spiral of reimbursement, escalating costs of treating patients and insurance companies deciding when and how much they will pay them. Strangely enough over the last two decades the primary conversation among the majority has not changed, “How do we change what we are doing so that we can continue billing and get reimbursed?” The ideas which they have come up with are entertaining if nothing else.
About 15 years ago the idea was to create a Medical Chiropractic office where all services would be billed by the medical doctor. Hard to imagine how that was going to go wrong. That’s right many doctors and chiropractors ended up in jail cells for insurance fraud. Rather than realizing that this was a stupid idea to begin with they decided to pour over the laws and ensure that the crossed all their T’s and dotted all their I’s and voila we now have a huge re-emergence of Integrated Offices.
What the majority of them haven’t realized yet is that the fix is on and it is designed to do one thing – put small to medium sized independent practices out of business. Why? Because there is big money in healthcare and the corporate interests want to extract as much of that profit as possible. By changing the laws regularly and making it more and more difficult for the small practices to survive they will force those who survive into working for one of their corporate owned practices on a tiny salary that they will either graciously accept or one of the other thousand applicants will accept.
If you just look at how the corporate world has strategically positioned itself and become multi-national conglomerates with vested interests in everything from insurance to computers to soft drinks to drugs it isn’t a difficult leap to see how they are pushing the healthcare professions out of business. And of course they have the clout in Washington to get things changed at a pace that helps them to take over.
Honestly, the only solution is to stop playing their game and start playing your own!!
I want you to think of this scenario:
You are living in a country with socialized medicine. Anyone can go to see their medical doctor for free. Their medical doctor can send them to a surgeon or physical therapist for free. Chiropractic is not even a licensed healthcare profession but it is legal to practice under their “freedom of healthcare” act which states that anyone who has achieved a higher level degree in the study of a healing art may practice that art.
You walk down the main street of a small town of approximately 10K people in this country and notice that there are literally dozens of medical doctors, surgeons, and physical therapists offices lining either side of the street and all of them appear to be busy with people waiting in their lobbies. You also note that there isn’t a chiropractors office within 20 miles of this town. Does this sound like a good place to setup a practice or is it doomed to failure?
Well that is the exact scenario of my very first practice. It took me a few months to really get things rolling but before I knew it I was so busy that I was scheduling new patients 2-3 weeks out. Trust me when I say that I didn’t make it easy on them either. My practice was 5 miles outside of town in a small bungalow that was difficult to find and I wasn’t allowed any signage. I kept my prices reasonable and every patient paid in cash. I kept my overheads low and I worked hard at doing what I love to do – adjust patients. Eventually, I had to move my practice to another location because the traffic in my driveway was driving my neighbor (the landlord) a bit crazy.
The reality is that in the US you have it easy but you tend to make it hard on yourselves.
Think about it this way (from a business perspective) what does it cost you to make an adjustment? Factor in the cost of everything: rent, labor, utilities, consumables, etc. Then look at the maximum number of adjustments that you can provide in a week using the system you are using (most insurances now expect a certain amount of time to be provided with a service that is billed and in most cases and adjustment is 15 minutes). What percentage of your billables are you actually receiving? What it the maximum that you can bill for those services? What is the average copay that your patients must pay each visit? What is the realistic maximum that you could earn per month and most likely you are actually earning between 70-80% of that amount or less.
Now watch this: If you stopped doing insurance what does it cost you to make an adjustment? If you adjusted your fees to 80% of the average patients copay (now the patient can see you and it costs them less) and modified your adjustment time to 7.5 minutes (you have doubled your capacity to see patients) and then work out the math on the maximum that you can earn in this model in most cases it is equal to or greater than the maximum potential from above. The realistic is that you would earn between 70-80% of that amount which is still significantly greater than the amount from above and most importantly you would be able to eliminate your non-productive hours of doing paperwork for insurance reports in favor of seeing more patients and at the end of the day you get to go home with the real hard cash that you have earned from today’s work. In business there is nothing more satisfying that getting paid at the time of service. It tends to be a serious motivator to keep you working hard.
In healthcare: “When the going gets tough…The Tough Go Cash!!”
For Your Health,
Dr. John MyChiroBlog