E very financial manager will tell you that in order to hedge inflation, a volatile stock market and to meet expectations without jeopardizing your principle capital, diversify. Some recommend more stocks, while others more bonds, yet others urge you to invest in government notes. These are all wise strategies in order to stand the test of time in your long-term strategy-based investment goals.
In practice, the strategy is no different. In the 1980's, I had 50% of my practice covered by the Empire Statewide Plan and I was making a great living. Unfortunately, overnight, without prior warning, every policyholder got a notice that said chiropractic services were available for only "in-network" providers and I wasn't one of them. It turned out that the president of the state organization became the consultant for the insurer and only a few of his handpicked "cronies" were added to the panel, leaving the rest of us "schlubs" to fend for ourselves!
It was a vital lesson in practice and although it was an expensive lesson, it was one that has served me well over the remainder of my career. I learned that you cannot rely on one carrier or financial class for survival in practice. You need to have a mix of patients in your practice. This means you need patients from every arena, managed care, Medicare, workers compensation, personal injury and fee for service (cash) .
With that being said, you have to closely examine the level of reimbursement for each financial class. In today's economy, managed care and Medicare are low payors. Workers compensation, depending upon your state, fluctuates greatly and can fall anywhere in the spectrum. Cash patients are great, but you are at the whim of the economy and then there is personal injury.
Personal injury is by far the last place for a doctor of chiropractic to earn a very good living. If you refer back top to this publication's February, 2011 issue, I chronicle by state the best and worst reimbursement states for personal injury in combination with cost of living factored into the equation. There is one caveat; you have to be the best-of-the-best at what you do in order to survive in each class.
 If you want to thrive in sports chiropractic, then you will have a predominantly managed care practice and you need to excel in treating those types of injuries. The same with Medicare; you need to be expert in geriatric chiropractic as that has its own set of nuances. This also holds true with personal injury and Medicare. You need to be expert in trauma and have the requisite credentials behind you with an admissible "formal" curriculum vitae. The legal community will not take you seriously otherwise. Yes, they will take your referrals and yes, they will accept your invitations to dinner, drinks and ballgames. However, unless you are the "real deal" on paper and in practice through clinical excellence, they will never refer to you even if you refer to them. Why would they want to work with you if you are a liability to their cases? Things are tough for lawyers also, economically.
Deciding on the best way to spend your time, energy, and money is to determine your ideal practice mix and create the perfect scenario for success in that financial class. It is my experience and recommendation that there be a minimum of 60% personal injury with 15% cash and for the rest, be prepared to work a whole lot for a whole little. Many DC's nationally have gone from 10% personal injury to 40 % personal injury and have tripled their incomes, reducing the financial stress in their practices. All of these doctors have one thing in common, they all became expert in trauma care and working in the medical-legal arena. You cannot just decide to get more personal injury cases without the requisite training. Lawyers aren't ignorant. You will get 1 or 2 of tier clients to work on and if you don't have the required training, as soon as they talk to you or see your documentation, you should be prepared to be a 1 and done. They will work with you once and never work with you again.
It is sometimes better not to take a personal injury case if that will create a bad reputation. A good reputation is easy to create if you have none; it is quite difficult to overturn a bad one. The solution is to become expert in all things "personal injury" and that has nothing to do with treating your patients. It is about becoming a good diagnostician and expert at triaging cases. This has nothing to do with your practice philosophy because it has little or nothing to do with the care of your patients. The hard truth is that lawyers do not value a case based on your care. They put less value on technique and more on documentation. They live in the world of "what's wrong " and the documentation of that in an admissible format. That is what you need to become expert in order to succeed in the medical-legal environment in today's economy.
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