The Chiropractic School Recruitment Requirement Problem 

From what I’ve heard, most chiropractic schools, if not all of them, have some sort of requirement regarding the recruitment of new patients to the school.  This factoid is conveniently kept under wraps until you actually start school.  I have not yet found any disclosure of, nor information about, this requirement on any chiropractic school websites.

However, the requirement is real.  Very real.  Your graduation depends on it.  Indeed, you could be a straight-A student, you could rock internship clinic, and you could fulfill all of your other requirements, but if you fail to recruit enough new patients to the school’s clinic, you will likely be denied the eligibility to graduate.

Just what constitutes “enough” new patients?  Well, it varies by the school, I think, and since so many schools keep their lips zipped about this tidbit altogether, and I have formed bonds with a mere handful of DCs, I’m only aware of the number of “new recruits” my own school required: 10.

Ten new patients, over the course of 3-4 years.

Now, ten new recruits in 3-4 years may not sound like much.  In fact, it may sound like a walk in the park.  After all, the wisdom goes, you’re going to have to recruit a lot more new patients to your own clinic, and a lot more often (or if you take a position in an already-existing clinic, you’re probably going to be expected to “pull your weight”).

But the school requirement is actually a bit tougher, in many instances.  For us, this is largely due to our school’s strict procedures.

First, they cut us off at the knees when it came to acquiring those patients.  They had very strict specifications under which you had to market yourself.  In short: you really weren’t allowed to.

It goes like this…

Chiropractic Student (CS): Hmmm, I have to recruit new patients.  But I don’t exactly see people lining up at the door to get in, and nobody’s on TV urging people to ask themselves (or their medical doctor) if chiropractic care is right for them, so I guess I need to get out there and pound the pavement and convince people to come see me at the clinic.

OK, great.  That has now been established.

CS: How would I convince them to come see me?  I can walk up to someone and introduce myself and ask them if they need chiropractic care, but they’re probably not interested.

(There’s a pesky statistic making the rounds that states that although 19% of the US population has sought chiropractic care at one time, only about 6%–and I’ve heard as low as 2-3%–actually receive care on a regular basis.  How’s that for optimism?)

CS: I mean, so many people are either against us and the idea of chiropractic altogether, or they’ve been to one, but had a bad experience.  Or maybe they had a good experience but they’re not in pain anymore, so they don’t see why they should come see me.

OK, damn.  Now what?  Wait a minute!–I’ve learned some really cool AK (Applied Kinesiology).  I’m currently taking post-doctoral classes for neurology.  (Or internal medicine.  Or what-have-you.). Maybe I could work that angle and expand my potential pool and attractiveness.  Yeah!  That’s pretty solid!  Let’s do that.

School: Not so fast, little dockling. That’s not consistent with the protocols we’ve specified.  We follow the insurance model, remember?  We only provide what is covered by insurance companies.  And they won’t cover anything but back pain, neck pain, and headaches.

CS: Awww man.  That sucks.  Well hell, I now have one arm tied behind my back.

And so it goes.  Now let’s say that you actually stumbled across a willing participant.  Maybe your former-coworker-now-friend suffers migraines on a regular basis or something.  And now she’s interested in coming to see you.

Awesome!  You’ve printed up business/contact cards of your own that have your name, your cell number, and as luck would have it, you’ve listed “migraines” as one of your specialties, because after all, you’ve always had a knack for solving that problem.  It might have even been your original motivation for entering the chiropractic profession (!).

School (finger-wagging): I don’t think so.  Just when did you print up those contact cards, young man/lady?  You know you’re required to use the school’s pre-printed, pre-condoned cards right?

CS: You mean the ones with my staff doc’s name on them?  The ones with the school’s general clinic line listed, so that I can’t even set my own schedule?  The ones with otherwise zero memorable information?

School: Yep, those.

CS (exasperated): OK, fine.  You win.

School (nods in begrudging approval)

Alright, so migraines it is.  You call your friend.

And then you’re met with the second obstacle in which the school’s procedure stands in your way: the new patient intake procedure itself.  In our school, it was an extremely cumbersome process.  Patients had to:

1 – Show up for their appointment, which could be difficult, due to the fact that most of the people who will afford this type of care and entrust a student to provide it (since they may be under the impression that they might need to see a regular licensed DC to straighten them back out after a student mangles them) tend not to live anywhere near areas in which our chiropractic school was located, if you know what I mean,

2 – Sit through a New Patient Orientation (AKA the “health talk”, a pointless and cheesy 30-minute Power Point presentation that spewed some dogma, interspersed with some general health information that was nothing people didn’t already know),

3 – Schedule–and show up for–a new patient exam, during which you had to find something wrong with their spine, and the more congruent it was with their chief concern (“complaint”), the better,

4 – Schedule–and show up for–their X-rays,

5 – Have everything checked over by the staff doc,

6 – (This one is on you – to write up all the documentation supporting the need to treat them, based on their intake questionnaires but more so the physical exam and X-rays, and write up a report of findings and initial treatment plan)

7 – Schedule–and show up for–their report of findings, during which there’s a steep incentive–and tendency–to scare the patient into agreeing to a course of care, and

8 – Schedule–and show up for–their first follow-up, which is finally their first treatment.

Yep, 8 steps.  And the behind-the-scenes parts can take hours, depending on several factors.

If you were lucky and your staff doc bends the rules a little, you can sometimes combine steps 7 and 8–the report of findings and the initial treatment.  But only after Step 8 is complete, and they’ve received their first treatment, do they count as a new recruit.  And if you made a mistake on any part of that, the school will gleefully yank away the credit for that recruit, even if they continue to let you treat them.

That’s what they make you do 10 times….

…during the course of a year or less.

…while you’re still studying for classes (!) (that’s the way it was when I was in school; they have since changed that, but with those changes came higher and stricter requirements)

…in an area that’s probably already saturated with DCs, all racing each other to the bottom of the price floor, and offering exams and X-ray packages for free or otherwise obscenely low prices.

…in competition with 100-300 other students.

…without any way to set yourself apart from anyone else. No hook, no handle, no incentive for the potential new patient to choose you over anyone else.

…with the school’s crappy business cards as your only marketing option.

…and no other advertising/marketing efforts from the school, which would at least let the public know that the school even exists.

The interesting part about this whole thing is, the schools don’t suffer when there’s low patient volume.  They make very little money off of patients, compared to the students.  If the schools were hurting for money and needed the patient volume, I’d be inclined to support the idea of having to recruit your own–that is, as long as the schools were also taking some advertising/marketing initiative, too.  If we’re all in this together, then we’re all in this together.  Fair is fair, after all.

But we can put that thought out of our heads, because when the president of our school brings down an annual salary of $850k and decides he’s bored with his shiny red recent-model Mercedes and so he trades it in for a Bentley instead, it’s a little hard to cry any tears of sympathy.  The school isn’t in any kind of financial trouble.

So it’s not for financial reasons that the schools institute this patient recruitment requirement (and so strongly so that they tether it to your ability to graduate).

…or is it due to financial reasons–other financial reasons?

(Enter my inner conspiracy theorist into the equation.)

After all, a chiropractic student coughed up about $9,500 every 3-4 months, an amount that only went up.  To give you an idea of how quickly it went up, tuition was $7,200 for the same length of time when we had first started school three years prior.  And it wasn’t long after we graduated–in fact, I think it was within the next couple of terms–that the price tag hit the $10k mark.

And not only was tuition on the rise every single term, but so was the rate at which it increased.  Rumors were alive and well during our last term there that our school was going to start increasing tuition by $500 every single term.  Seven years later, I have to wonder what it’s at now.

(There’s the proof that the school doesn’t actually need any patients; compare $9,500 per term, per student, times about 900-to-1000 students, with the $25 patients were paying for an adjustment at that time.  And although they saw a lot of patients, it wasn’t a huge, high-volume machine; each patient treatment took roughly an hour, unless you were also going to do a re-exam, or X-rays, or a physical therapy modality, or anything else in addition to a regular treatment.)

There’s not much of an incentive to obtain and maintain a high number of patients, but there sure is one for holding a student back from graduating for an extra term.

Because no, our school somehow gets by with not having to prorate tuition.  They charge a single flat amount for the term, and you square up this transaction during a very automated process at the very beginning of the term.  It doesn’t matter if you have three more treatment credits to get, or one more recruit to log; if you’re not done by the due date, you’re stuck paying another $9,500, finishing up your work in the first couple weeks of that next term, and then sitting on your thumbs for the rest of the 3+ months, because they’re only going to issue your diplomas/degrees at the end of the term, and until you have them in hand, you can’t take any steps forward to get your license and start practicing.

You practically have to commit fraud in order to graduate on time.  I’m not saying I did, but I will say that I saw it happen, and it was unspokenly condoned–and even hintingly suggested–by sympathetic staff doctors.  I won’t name names, so please don’t ask.

But anyway…

How’s that for a bloody racket?  It’s damn near a scam.  Especially when they make it a point not to breathe a word about having to recruit anyone until after you’ve started classes.

They’re sure interested in getting you in, convincing you to choose chiropractic as your new profession, and choosing their school as your own (and practically their entire marketing machine is geared toward those efforts).  They’re not, however, nearly as interested in helping (letting) you graduate.

Now let’s compare that scenario with that of allopathic (conventional) medical school.

Allopathic medical students don’t have to recruit anybody.  Enough said.  It’s that simple.

By the time they reach internship, they’re done with classes, there are no recruiting efforts to be made; they just show up at the school’s hospital and focus on treating patients.  Their goal, as I understand it, is to gain as much experience as they can while they’re there, and fulfill their own requirements.  Nobody has to play hardball just to make it through school on time.  They have challenges of their own, and I’m not saying it’s not tough.  It is.  It’s rigorous and burnout rates are high, probably due to the equally-humongous and insane hours they put in.  But they don’t have a stupid recruit requirement hanging over their heads, and even if they did, they’d meet it on the first day, or if they were particularly passive and introverted, maybe within the first week.

But they don’t need that, because their schools are usually part of larger four-year universities, typically also with their own research arms, from which they make far more money, through grants and tuition from a larger student body.  Not to mention that their clinics and hospitals are teeming with patients, because the resident populations of these places are well aware that the schools exist in the first place and every American is encouraged to “see their doctor” for every little sniffle.

So there’s a good ol’ compare-and-contrast, in case you were ever wondering what the hell was going on.  My theory might smack of conspiracy, but I think that conspiracy theory sometimes gets a bad rap.  Sometimes (like when you’re a chiropractic student), somebody really is plotting against you.

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