Business Talk: Reviewing our ethical business practices

When I was in chiropractic school, I had one of my professors tell me that in real-world practice there would be the opportunity to make a lot of money, but the path we chose would determine our happiness.

He said that his benchmark was gauging how well he slept at night. He insisted that if we put the needs of the patients ahead of our own needs, then we would all sleep like babies. With that being said, there are two concepts that in my opinion, push the ethical envelope.

Multi-level marketing (MLM)
For me, these companies are huge red flags whether they are legitimate or not. In many cases you have unlicensed, regular everyday people with minimal medical or nutritional training who are dispensing advice and selling health care products to the general public. These companies target chiropractors because we have years of education and training that gives us credibility to push the company’s product. There are many DCs involved in MLM companies, and although they are not all are controversial, they traditionally come with a caveat.

In general, MLM companies are focused on building a team rather than selling their product. Traditional MLM companies reflect pyramid schemes, where the company is driven in a bottom-up direction. The company recruits people to buy and sell their product, but they highlight the incentive that if they recruit more people, then they earn dividends from the investment those people made into the MLM company. Then, they also earn dividends from the people they recruited (and so on and so forth). As this chain extends the goal becomes more of recruiting people and less about selling the product.

Often MLM products are significantly overpriced. For instance, about 65 per cent of people will spend $10-$15 on glucosamine at big box stores. Others will buy a better product at specialty health food stores for $20-$30, but some MLM companies will sell their glucosamine product with unsubstantiated or little research behind their claims for over $40 per bottle. According to the journal Clinical Nutrition ESPEN (2018), good MLM products are competitive with the common spending tendencies of the consumer landscape. This means that a product priced between $15-$20 would be acceptable to the consumer while conversely a product price over $40 would raise red flags.

Ideally, solid MLM businesses should drive value in a top-down direction. A quality product is produced and the end consumer reaps the maximum value from the transaction. A good example of this in a non-MLM company is Costco or Sam’s Club. Here consumers obtain a quality product at very competitive prices.

The secondary ethical issue with MLM companies and chiropractors is that it can interfere with our ability to objectively take care of patients. Is it possible that the mission to sell products or recruit more people to your sales team can interfere with your capacity to take care of your patients? It’s a good question to reflect upon before engaging in an endeavour like this one. This article is worth writing because the biggest targets are newly graduated DCs who aren’t making much money to begin with. Generating some additional income is enticing, especially if your practice is slow. My advice would be to steer clear of MLM companies and focus on your strengths and the values that made you decide to join the profession.

Unnecessary patient treatment
I have been in practice for 16 years. In that time I have seen the de-listing of chiropractic from the Ontario Health Insurance Plan, massive changes in auto injury guidelines, and adjustments in various governing college rules. However, the biggest change has been the mainstream use of the Internet and the technology explosion that has given people greater access to information.

Back in the day, there were motor vehicle accident clinics that would seemingly prey on patient misfortunes. Patient A would go to a “multidisciplinary clinic” to be assessed for injuries suffered in a motor vehicle accident. Then, the patient would see the chiropractor for a while before being referred to physiotherapy while at the same time having massage therapy treatment. Acupuncture would be added to the mix and concurrently they would be referred to see the clinic psychologist. In a couple of months they would see the resident occupational therapist for a trial of care. This would be prescribed to every motor vehicle accident patient.

I’m completely serious. How did clinic owners sleep at night? Taking advantage of patients’ circumstances is unacceptable. I am pleased that over the years the auto insurance legislation has been re-tooled so that some of these opportunist clinics have met extinction as a result of the changes.

Ask yourself: Am I benefiting the patient as much as they are benefiting me? Do you find that you are unnecessarily asking the patient to come in more than they need to? It’s a deep and poignant question. For instance, in this information age, how do we (DCs, our patients, and the general public) make sense of every patient entering John/Jane Doe chiropractic practice who are prescribed the exact same treatment? Does every patient that enters said clinic need to come in three times per week for one year? There comes a point where the ethics of the situation are called into question in the absence of supporting clinical relevance within the scope of the best available research.

Translation: If you are doing this, knock it off because it gives chiropractors a bad name.

In business and in life, the temptation to skirt around the rules to benefit oneself will be ever-present. We must keep in mind the oath we took to take care of our patients and protect them from exploitation.

ANTHONY  LOMBARDI, DC, is  a  private  consultant  to  athletes  in  the  NFL,  CFL  and  NHL,  and  founder of the Hamilton Back Clinic, a multidisciplinary clinic. He teaches his fundamental EXSTORE Assessment System and practice building workshops to various health professionals. For more information, visit exstore.ca.