Re: Supply and demand (Letter to the editor)
By Anthony Lombardi
Thank you, thank you, Dr. Wickes, for your response and for taking the time to write a letter to the editor. Students and practicing chiropractors need to hear from our leaders and I’m delighted that we have your attention.
There are a few things I wanted to let you know concerning the evolution of Business Is Life and its upcoming sequel. The article is based on the state of chiropractic business practice in Ontario and the article had an overwhelming response as I received over 30 personal emails and several social media comments from chiropractic several groups.
You had made mention to other provinces in your email and the purpose of the sequel, as the editor and I discussed was to find out the state of chiropractic – and the demand in other provinces. The OCA president along with five other presidents received the same interview questions you did for the sequel and responded without reservation – while four other association presidents and one other chiropractic president did not respond.
What I say in Business Is Life is not without merit. The suggestion to write a follow up article was made by a current elected CCO official who after reading my article sent me the recent numbers from the CCO Annual Meetings regarding saturation rates in Ontario. Further, I have collected nine interviews of chiropractors who graduated three years ago who confirmed and spoke of the concepts I mention in the my article. They all requested to stay anonymous as they were graduates of both Canadian and US schools. I found this unpublished study, handed to me by a chiropractic college president, accurate in explaining why graduates feel the way they do:
“In 2007, the third annual Chiropractic College Alumni Survey asked chiropractors from five different chiropractic schools who graduated in the years 2000, 2002 and 2004 the following question: Were you prepared for business and practice management when you graduated? An average of 90 per cent of the chiropractors reported that they were not.”
Further, in Business Is Life I cited the Moir, Laporte article you mentioned and I even reached out to Moir to make a present day comment on the piece for my article. I tracked him down at his faculty position at CMCC but he did not respond to attempts to be interviewed. My suggestion to slow the graduation rate is based on similar things the Ontario teachers colleges implemented and in fact the CPSO, (College of Physicians and Surgeons of Ontario) will shortly be directing where MDs can and cannot practice in Ontario to prevent oversaturation. This, I secured in an interview with a doctor working for CPSO. I also contacted Dr. O’Byron at the CCE (Council on Chiropractic Education) because he spoke about oversaturation in a 2008 article of American Chiropractor – but he declined to comment. So while my suggestion was merely a suggestion, the concept is not much different than what other professions are proposing and implementing.
The other articles you mention (Longo and Davis) have little bearing on what I’m taking about. The Longo study, which I’m familiar with is a mail questionnaire sent to 200 Toronto DCs and of which only 92 responded who ever used OHIP. The sample is too small to compare the whole province, and OHIP leaving was a good thing anyway. The Davis article features people in the US on Medicare where chiropractic visits in the study are covered by insurance – Ontario for the most part cost people out of their own pocket. How many people would have gone to the chiropractor if they had to pay in the Davis study? It doesn’t reflect Ontario very well.
Lastly, I draw parallels about what I know in Ontario based on my experiences, my interviews and economics. My use of the Pareto Principle is very accurate. I have made inquiries with the Ontario Chiropractic Association and according to them, many of their members believe that, from the practitioners’ perspective, there is an oversupply of chiropractors in the province. So if the utilization stays the same, the province takes on an 80/20 flavour – its simply economics. You could never prove this in a study because you would never get enough subjects to volunteer how little they are making. The attrition rate of chiropractors in Ontario is also very real and must be addressed.
At the end of the day I’m just one person with a passion. I’m thrilled that you responded after I reached out to you. We need to get people talking about this because that’s the only way things change. I look forward to collaborating in the future to better educate the future of chiropractic.