Which one are you?

It’s interesting that every couple years, I’ll have the same conversation with a colleague.  We have differing opinions on the topic, “Are you a specialist or a generalist?”  Seems like a simple question, but the ramifications will have drastic impact on your practice.

The ramifications first deal with mindset. How do you view yourself?  What is your identity? What is your image? What is your brand? This one decision then leads you down the rabbit hole to decisions on:

  1. How you structure your business
  2. How you draft your business plan
  3. How you brand your practice
  4. How you select and attract your target market
  5. How you set your fees.

Specialist vs. Generalist

  1. A specialist has a specific, defined area of interest


A generalist does not have a specific defined area of interest


  1. A specialist typically has a patient base that in whole or in part falls within their specific, defined area of interest


A generalist has a patient base with a range of health care problems


  1. A specialist is typically viewed as having the highest level of training and expertise within a given field


A generalist as having the standard education and training as other professionals within their field


  1. A specialist typically receives increased compensation on a per patient and per visit basis for their services


A generalist which typically receives less compensation on a per patient and per visit basis


  1. A specialist typically commands greater yearly total compensation (salary, benefits, retirement, bonuses and perks)


A generalist that typically receives smaller yearly monetary compensation (salary, benefits,    retirement, bonuses and perks)

  1. A specialist’s talents and services applies to a specific, defined segment of the population


A generalist’s talents and services applies to a broader, less well defined segment of the population


  1. A specialist typically advertises and markets their specific credentials, specific skill set and specific expertise to the public in a well-defined and cohesive message


A generalist that typically advertises a broad range of services to a wide market to the public


  1. A specialist may find comfort in knowing that they will see by virtue of training, marketing and advertising a specific subset of problems


A generalist that may have comfort in seeing a very broad array of problems within the office

  1. A specialist does not typically appeal to all


A generalist which may appeal to all


  1. A specialist which is not typically seen as the first provider, portal of entry for many typical medical conditions


A generalist which typically serves as the gatekeeper and portal of entry for many ailments and typical medical services


  1. A specialist typically has a practice built in part or in whole by health care provider referral


A generalist which may have limited practice growth based on health care provider referral

Have You Thought of the Ramifications?

I’m sure there are other things that can be mentioned regarding the differences between specialists and generalists, but you get the point. There are advantages and disadvantages of either position.  What’s relevant to this article and more importantly the reader is the central theme, “Have you thought through the ramifications of this designation to you and your practice?”

In my ongoing conversation with my colleague, he has advocated for reduction of co-payments from $50 (specialist) to $30 (generalist/PCP) in his state. His view is that insurance tactics via a specialist designation create a financial obstacle towards care. Higher co-pays for a chiropractor vs. a PCP/generalist reduce utilization. Reduced co-payments could potentially drive more patients into his office and the offices of chiropractors across the US.  Increased utilization would translate into greater revenues for his office and chiropractors in general; in fact, he was looking forward and professionally advocating towards legislation in his state to change this.  Unfortunately, an unintended consequence of this action could also be lower per visit and case reimbursement as this strategy attracts the generalist designation rather than the specialist designation.

The Cold, Hard Truth About Chiropractic Services

Our running conversation centers on the theme of whether you view yourself as a specialist or generalist.  The harsh reality is that the demographics regarding chiropractic usage haven’t changed much in the past several decades.  National demographics of utilization routinely show that our services are used by a tight demographic that includes:

  1. A range of 6-14% of the population & more realistically 8-12%
  2. Educated patients: College degree (associates degree) or higher (bachelors, masters or doctorate)
  3. Females > Males
  4. Middle Aged (30-55)
  5. Families
  6. Patients with disposable income
  7. Patients that are typically higher income earners for their geographic area
  8. Innovators & Early Adopters: Patients that are relatively early to use complementary and alternative medicine (CAM) services. Usage of CAM services in some areas of the country is still considered faux-pas.
  9. Patients with strong beliefs or fear of more invasive options such as medications, injections or surgical management
  10. Patients looking for more personalized and satisfying medical care
  11. Patients that overwhelmingly seek conservative care options for spinal and neuromusculoskeletal (NMSK) conditions as a front line approach.

The important statistic is the range of 8-12% national usage rates.  Another important fact is that the population largely sees chiropractors for a niche in conservative spinal and conservative NMSK conditions.  The rate of 8-12% hasn’t changed much over several decades despite the profession’s campaigns.

Illinois, my former state, has advertising campaigns of “Natural First” and “18% by 2018.” I fully support those campaigns, yet recognize those numbers locally, regionally and nationally maybe difficult to reach. The identity of the profession and professional image of conservative spinal and NMSK providers hasn’t changed too much in the past several decades.

It’s a worthwhile quest to attempt to spread usage to 14-20%; however, the harsh reality is that it will take several more generations. Our profession will face significant economic and political obstacles to do so. We face a well-organized and funded establishment of medical, medical device, pharmaceutical and insurance industries. These giants have vested interest in their own agendas for NMSK care despite repeated studies that show how affordable and effective our care is for spinal and NMSK conditions.

Innovation Theory, Adoption of the Service, Growth & Branding

These reasons  above are why I respectfully differ with my colleague. I don’t feel that lowering co-payments and moving towards the role of generalist is the best path forward for the immediate future. This strategy can only work when the brand and message appeals to a greater percentage of the population taking it from innovators and early adopters towards the early majority.  This would mean that 16-24% (effectively double the current usage) of the population would already use the service  before value and price point becomes a factor for future growth to the realm of 30-40%.

If the brand, message and service is understood and valued, then lower price point (service fees & case fees) can then attract those that are interested but on the fence. You can’t attract someone to use your service when they can’t or don’t want to hear the message, then listen to the content of the message and lastly aren’t willing to utilize the service because they aren’t past the phase of hearing then listening. When the consumer at large, chooses to listen to the message and is  then seeking a reason to try the service, only then will price point grow the market from that 16-20% to 30-40%.  As a profession, we appear to be still quite a bit away from 16-20% utilization.  That means the 30-40% could be generations in the making if past growth is indicative of future expansion.

At this time, I don’t see that reducing fees will attract newer markets and more patients to our offices.  This strategy of lower price point hasn’t worked in decades for our profession. We have a select and well defined market. This market has consumers that value and are routinely satisfied with our services. These patients are typically ready, willing and able to pay the additional fees for perceived value, restoring quality of life measures and overall satisfaction that we can routinely deliver.

Please don’t misunderstand me. I’m not advocating for gouging patients.  I’m advocating for recognizing the value you deliver patients, the specialty you provide, the cost savings per visit and per case you provide. Take that and then price yourself appropriately to compete in the arena of conservative, NMSK specialist. Inevitably, I’ve seen on several occasions that charging a fair price for your specialty brings greater credibility, greater perceived value and a more defined target market to your office. It will also weed out some of the consumers that don’t truly value your service. You know the ones that routinely show up late, cancel last minute or don’t want to stick to your treatment plans.

I think that embracing the role of the specialist and namely THE SPECIALIST in conservative spinal and NMSK conditions would provide more value to my colleague’s practice, his patients and his bottom line.  I think that this small subtle change in mindset may provide value to many chiropractors and chiropractic offices across the nation. That’s the real point here. A small change in mindset to your practice identity can have drastic impact whether you know it or not.

About The Author

Dr. Dino Pappas

Dr. Pappas is a chiropractic physician, certified athletic trainer and certified strength and conditioning specialist. He recently has moved from Tinley Park, IL to Austin, TX. His goal is to provide the Austin community of NW Hills with the best conservative orthopedic, sports medicine, rehabilitation and soft tissue based care possible.

Dr. Pappas blends the best of physical medicine with the best of integrated medicine to help patients and athletes of all shapes and sizes. He utilizes tools such as chiropractic manipulation, soft tissue mobilization, functional movement based assessment, the McKenzie Method, strength training and conditioning, kinesiology taping, customized nutrition, diagnostic imaging and specialty laboratory testing when needed.

Dr. Pappas’ sports medicine interests are endurance athletes, overhead athletes (pitchers, throwers, volleyball players and tennis players), contact sports athletes (football, rugby, lacrosse, field hockey, soccer and basketball) and Crossfit athletes. He has worked with athletes at all levels from professional to amateur.  He has provided sports medicine services to the University of Illinois, Indiana University, the Chicago White Sox, the Joliet Slammers (Jackhammers) minor league baseball team, the Windy City Thunderbolts minor league baseball team, Victor J. Andrew High School and Carl Sandburg High school.

On a personal note, he reads and interprets the medical literature daily to stay abreast of cutting edge advances in his field. The doctor is an avid runner and aspiring triathlete having completed 5 marathons, 5 half marathons and numerous 5 and 10k races. He has goals of qualifying and competing in the Boston and New York Marathons, the Ironman in Kona, Hawaii, and climbing Mt. Kilimanjaro in Kenya, Africa. He recently completed the Pikes Peak Ascent, a half marathon to the 14,115 foot summit of Pikes Peak. He is currently training to complete the Go Ruck Tough Challenge as well as ruck Rim to Rim across the Grand Canyon. One day he hopes to serve his country as a team chiropractor for the United States Olympic teams and serve as a team chiropractor for a high level collegiate or professional sports team.

The doctor practices in the Northwest Hills area of Austin approximately 7 miles from downtown Austin, TX. The office is located within a multidisciplinary surgical hospital. His mantra is “Why Put Off Feeling Good?” He can be reached by email at drdinopappas@gmail.com or at 210-243-5734 (cell). Call 1-800-404-6050 to schedule an appointment with Dr. Pappas. ***

*** Disclaimer: The views and opinions above represent that of the author, Dr. Dino Pappas. They do not reflect the official policy or position of any agency or company that Dr. Dino Pappas may have a relationship or affiliation with. ***

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