Initial clinical consultation fee

Initial clinical consultation fee asks what a DC should charge?

Is your high initial clinical consultation fee the stumbling block to new patients, doctor?

The life blood of any chiropractic clinic is new patients. A high first consultation fee, whilst entirely justifiable, may well be the stumbling block to new patients. A free initial consultation fee, with a free chicken lunch thrown in, perhaps stinks of chicanery; where is the balance?

"A good objective of leadership is to help those who are doing poorly to do well and to help those who are doing well to do even better."

Jim Rohn

At the initial consultation, a Chiropractor would go through a personalised routine, but the intent behind the doctor's consultation is to elicit what the core problem is, eliminate serious disease, and figure out a course of action that will fix the condition.

Alas most chiropractic conditions are chronic, stemming back to an injury many years ago, and hence are not curable in the strict sense of the word.

Maintenance care is the solution to such conditions, just as it is in medicine; no doctor is likely to cure diabetes or hypertension.

1. History
2. Examination
3. Order, or perform other tests (such as X-rays and scans)

History

Can you afford not be thorough, doctor?

1. The history could be straight forward: "I have stabbing right low back pain, it radiates to the back of my thigh and it tingles on the side of my right foot. The pain in my back started three weeks ago after lifting a heavy television, and the tingling in my leg three days ago. The pain gets worse when I bend and sit, and when coughing. It's relieved by lying down, but is much worse in the morning. I had a similar episode seven years ago which responded well to Chiropractic. My doctor's anti inflammatory pills have given me diarrhoea, so I've stopped them. I'm in good health, and have had no significant trauma." Such a routine doctor consultation history might take, say, ten minutes.
2. Or, the history could be very complex: "I've had nagging rib pain on the right side since a mastectomy fifteen years ago. It begins in the midback, between my shoulder blades and radiates under the armpit, and my breastbone is very sore. The radical mastectomy and lymphectomy in my armpit was a nightmare, but it saved my life. But it's left me with a constant dull ache. It disturbs my sleep regularly. Medication makes me nauseous, and only the morphine pills help really, and I refuse to take them. Physiotherapy brings a little temporary relief. It's really only relieved by keeping busy, moving. I've had regular cancer check ups, chest X-rays, scans, and my doctor says I just have to learn to live with the pain. It's the price I must pay for being alive. I also have severe pain in my right midfoot and I can barely walk. It started after I kicked a heavy kist and broke my second toe two months ago. The toe has healed but the pain in the middle of my foot is getting worse..." Such a history could take half an hour to take, taking into account the emotional content of having a cancer patient, and wanting to be thorough, yet treading warily on sensitive feelings.

Examination

Are you conscientious, doctor?

The routine orthopaedic, neurological and chiropractic exam, at the first doctor consultation, once perfected and routine, can often be performed fairly quickly.

One wouldn't do too many tests on the patient in acute pain, but on the look out for a foot drop, or numbness, gentle range of motion tests, a Slump test, sacroiliac tests, and motion palpation. Always a brief examination of the hip.

However, the clinical consultation of the cancer patient would need to be far more thorough, checking the lymphatics, not only in the neck and axilla, but also in the groin... The motion palpation of the ribs posteriorally would not elicit difficulties, but checking for a Tietzes syndrome, and the normal movements at the costo-sternal joints, and along the ribs needs to be done discreetly, and compationately. The pain in the foot...

Add to that the vital signs at the first consultation, and an hour will be nearly up.

Consultation fee

After an hour of the chiropractor's time, s/he is probably in no mood for any talk of a free initial consultation! One is entirely at liberty to say, "I charge $250 per hour", and that's my fee. Whilst hopefully the number one reason to be in the health care business is not simply to make a profit, the Chiropractic Clinic is in fact a business. Secretaries have to be paid, the rent, Uncle Sam, and hopefully a little left over...

Initial clinical consultation fee

Initial clinical consultation fee questions if your high initial fee is the stumbling block to your new patients numbers?

Here is some basic math, and a few assumption concerning the initial clinical consultation fee. These figures were taken from 2010, and are dated, but the principle remains sound.

USA

1. Let's assume you have currently five new patients per week and your first consultation fee is $80. Further, that each new patient comes for another ten regular consultations at $40: 5 new patients X [$80 + (10 X $40)] = 5 X $480 CONSULTATION FEES GENERATED: = $2400
2. Now, if you were to drop that $80 first consultation fee to $60, perhaps it may bring you one extra new patient per week: 6 new patients X [$60 + (10 X $40)] = 6 X $460 CONSULTATION FEES GENERATED: = $2760
3. Perhaps you could drop that $80 first consultation fee to the same as your regular consult. The big assumption, it makes you the cheapest first consultation doctor in town, and you get five extra new patients per week: 10 new patients X [$40 + (10 X $40)] = 10 X $440 CONSULTATION FEES GENERATED: = $4400

UNITED KINGDOM

1. Let's assume you have currently five new patients per week and your first consultation fee is £80. Further, that each new patient comes for another ten regular consultations at £40: 5 new patients X [£80 + (10 X £40)] = 5 X £480 CONSULTATION FEES GENERATED: = £2100
2. Now, if you were to drop that £80 first consultation fee to £60, perhaps it may bring you one extra new patient per week: 6 new patients X [£60 + (10 X £40)] = 6 X £460 CONSULTATION FEES GENERATED: = £2760
3. Perhaps you could drop that £80 first consultation fee to the same as your regular consult. The big assumption, it makes you the cheapest first consultation doctor in town, and you get five extra new patients per week: 10 new patients X [£40 + (10 X £40)] = 10 X £440 CONSULTATION FEES GENERATED: = £4400

1. Let's assume you have currently five new patients per week and your first consultation fee is €60. Further, that each new patient comes for another ten regular consultations at€45: 5 new patients X [€60 + (10 X €45)] = 5 X €510 CONSULTATION FEES GENERATED: = €2550
2. Now, if you were to drop that $60 first consultation fee to €50, perhaps it may bring you one extra new patient per week: 6 new patients X [€50 + (10 X €45)] = 6 X €500 CONSULTATION FEES GENERATED: = €3000
3. Perhaps you could drop that first consultation fee to the same as your regular consult. The big assumption, it makes you the cheapest first consultation doctor in town, and you get five extra new patients per week: 10 new patients X [€45 + (10 X €45)] = 10 X €495 CONSULTATION FEES GENERATED: = €4950

1. Let's assume you have currently five new patients per week and your first consultation fee is R400. Further, that each new patient comes for another ten regular consultations at R200: 5 new patients X [R400 + (10 X R200)] = 5 X R2400 CONSULTATION FEES GENERATED: = R9600
2. Now, if you were to drop that R400 first consultation fee to R300, perhaps it may bring you one extra new patient per week: 6 new patients X [R300 + (10 X R200)] = 6 X R2300 CONSULTATION FEES GENERATED: = R13800
3. Perhaps you could drop that first consultation fee to the same as your regular consult. The big assumption, it makes you the cheapest first consultation doctor in town, and you get five extra new patients per week: 10 new patients X [R200 + (10 X R200)] = 10 X R2200 CONSULTATION FEES GENERATED: = R22000

Traffic builds enthusiasm

There's no question about it, traffic builds enthusiasm. When there's a steady stream of patients, everyone knows they are attending a healthy practice.

$2100 > $2760 > $4400 > $6600

RUNNING LATE ...

Within a month patients arrive to their surprise to a full waiting room. The doctor's running late. They can't always get the appointment they want first thing in the morning, or straight after lunch.

Some, a few, may be irritated and go elsewhere. The rest will start to think, my chiroprator must be the best in town. Just look how busy he is. I must convince Betty and Tom to come to get those headaches fixed... BOOM!

15 new patients X [$40 + (10 X $40)] = 15 X $440

CONSULTATION FEES GENERATED: = $6600

Now you can afford that custom made Fat Boy you've been wanting...!

FEELING NEGATIVE?

Are you feeling negative? "I won't get any new patients. All that will happen is that I still get only five new patients per week, and I'll lose $200. I know my initial clinical consultation fee is worth $80... worse, they'll think I'm a cheap-skate and I'll only get three new patients per week. I'm going to increase my initial clinical consultation fee to $100. That's what I'm worth...

INROADS

The fact of the matter is that despite the number of new chiropractors joining the ranks rising dramatically (some think alarmingly and flooding the market), we have made virtually no inroads into the general populace. Roughly the same percentage of people are consulting chiropractors as twenty years ago. There's no increase in the number of patients benefiting from the enormous progress of what the chiropractic adjustment has to offer.

So, to maintain our income we have to start squeezing a few extra treatments out of our current patients. We start over servicing them, we hear of practice building gurus who are telling their clients that the average chiropractic patient should be having 25 treatments, or 50... Greed sets in. But our patients, most of them anyway, are not fools, and they know when we are milking them.

Rather than squeezing more treatments out of our patients, we need to be setting our goals on making serious inroads on the populace who either know nothing about Chiropractic, or just think they can't afford our services.

Here's a thought for today. Gradually lower your initial clinical consultation fee (and even your regular fee) until you appointment book is near to overflowing every day.

KENNISMAKINGSGESPREK Free Initial Consultation

The Dutch love their long words! There is no literal translation of the word "kennismakingsgesprek", but loosely one might describe it as a "getting to know the doctor (and the patient) consultation". It's usually free, or there may be a small fee.

It's a wonderful concept. Many patients have reservations and concerns. They may have heard the tripe about having a stroke, or perhaps they've been told that they'll end up in a wheel-chair after chiropractic. Perhaps they are in severe pain, and think the treatment will be excruciating...

The kennis-makings-gesprek is a very short, perhaps fifteen minutes, consultation during which a very brief history and examination are performed. No more than ten minutes. Then five minutes is given to an equally brief report of findings, and a few words about the philosophy of Chiropractic. Period.

In my experience eight out of ten of them will then immediately make an appointment for a full examination, at the full normal fee. Your work is already half done, and often no more than half an hour is needed for the next consultation.

Win-win.

I use it frequently when patients have a concern about a child, their mother, a patient's neighbour is in trouble, but dares not to come for treatment. Putting them at their ease during a "kennismakingsgesprek" is rarely difficult, leading to a normal initial clinical consultation fee.

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