CAMPUS NEWS
FOR
IMMEDIATE RELEASE
07/23/01
Success in
Chiropractic Practice: A Practitioner-Based
Content Analysis
by Brian J. McAulay, D.C., Ph.D., Sherman
College Executive Assistant to the President;
Daniel Lemberger, D.C., ’98, private practice in
Colorado; and Edward Owens, M.S., D.C., Sherman
College Director of Research
Success in Chiropractic Practice: Outcomes
and Competencies
Although there has been much recent emphasis in
the popular chiropractic press regarding the
ability of recent chiropractic college graduates
to survive and succeed in an increasingly
competitive and regulated health care
environment, there has been little scholarly
analysis of the components of success in
practice. This study is a content analysis of
what alumni of one chiropractic college consider
to be important components of chiropractic
practice success and the competencies necessary
to contribute to achievement of these
components.
In studies of organizational success, positive
outcomes are usually considered to be financial
(i.e. net revenue or profit) or stock price.
Occasionally factors such as environmental
impact or employee satisfaction are examined in
this context. Similarly, success in professional
practice, at least in scholarly treatments, has
tended to focus on practice income (e.g. Gaynor
1989; Lee 1990; Newhouse 1973).
This study questions the assumption that
financial performance is the sole outcome of
success in professional practice. In the absence
of literature to support what other indicators
might be, we elected to use an open-ended survey
with practicing professionals (chiropractors) to
ascertain the nature of those factors. This
necessitates the utilization of content analysis
for cogent interpretation of data (e.g. Hybels
1995).
METHODS
We identified the target sample of respondents
as 600 alumni of an American chiropractic
college. They were randomly selected from a much
larger population of graduates spanning the last
twenty-five years. We supplied them with a
survey and return envelope. In addition, we
supplied surveys to chiropractic faculty at that
same chiropractic college.
As is the case with all primary research data
content analyses, survey design was critical to
obtaining usable data. In particular, we were
careful to avoid bias by providing examples
which would lead respondents in particular
directions. We did provide an example in an
unrelated industry to provide for them an
illustrative example. We asked respondents to
provide what they felt were “characteristics of
success in chiropractic practice”; we asked for
six such indicators of each respondent. In
addition, we asked what competencies (or
attributes) were required to achieve each of
these six indicators; we asked for two such
competencies for each indicator.
Three practicing doctors of chiropractic
completed the pre-test survey, resulting in
minor modifications prior to distribution to the
entire sample.
When the surveys were returned, research
assistants typed responses into a spreadsheet.
Three researchers working concurrently
categorized each response. The research team
collectively evaluated each response three
separate times on three different occasions.
Categories emerged as analysis continued. The
researchers developed “sub-categories” where
appropriate, to enhance understanding of the
essential nature of the characteristics of the
indicator or competency.
Researchers discussed each item as
categorizations were made; any disagreements
were resolved by discussion. No assignments were
made without consensus of the research team. The
excessive consumption of time required by this
technique was felt to be worthwhile, given the
higher reliability and validity resulting of the
resultant data categorization.
RESULTS
We received a total of 114 usable surveys, for a
response rate of 17%. This is low, but not
surprisingly so considering the amount of
thought and time required to complete the
survey. The result was 942 “lines” of data to
analyze, each line consisting of a practice
characteristic and accompanying competency.
Problematic in data interpretation in this study
is the confounding between characteristic of a
successful practice (or identifier) and the
competency thought necessary to achieve a
success factor. For example, some respondents
felt that clinical success was a characteristic
of a successful practice, while others felt that
clinical success would lead to high volume,
which they considered to be the indicator of
successful practice in this case. In this
regard, the line between indicator (or
characteristic) of a successful practice, and
success competencies is difficult to
distinguish.
The content analysis produced twelve primary
categories of characteristics/competencies.
Table 1 lists each, along with the number of
times they were mentioned by survey respondents.
In addition, the researchers made sub-categories
of the three most frequently cited categories.
Analyses of each of these categories follows.
Table 1
Most respondents focused their attention on the
personal characteristics of the chiropractor.
Much as the entrepreneurial literature (e.g.
Amit 1994) has emphasized how important an
organization’s founder is to a fledgling
company, this research supports the notion that
in professional practice, at least in
chiropractic practices, the chiropractor’s
skills, talents and abilities are a major factor
in success. Within this category, by far the
highest factor mentioned were traits associated
with the personality of the doctor - his/her
charisma, personal health, positive attitude,
enthusiasm, honesty, etc. This suggests that for
professional practice, the fate of the practice
is tightly tied to the abilities of the
individual practitioner. In other words, in
chiropractic practice, chiropractors are not
simply interchangeable parts; rather they are
inseparable from the practice itself.
In particular, respondents noted that
interpersonal skills play a major role in
determining practice success. These skills
include the ability to create rapport,
communication skills, listening skills, and
“people skills”. Clearly, the one-on-one service
aspect of chiropractic practice makes these
skills paramount in building successful
practices.
For a surprisingly large number of respondents,
confidence/faith in chiropractic is an important
component in practice success. This includes the
notion of practitioner commitment to
chiropractic philosophy, understanding the
importance of providing chiropractic care,
“staying on purpose”, and being “principled”.
Notions of knowledge and a service ethic came
lower down in the list. Perhaps surprisingly the
happiness of the chiropractor was not frequently
mentioned as a prime characteristic of a
successful practice. Table 2 provides incidence
counts for all eight sub-categories developed in
this study.
Table 2
Not surprisingly, respondents also reported that
various aspects of business skills and knowledge
are important to practice success. Marketing
acumen was the single most cited essential
attribute. This included the ability to evaluate
practice location, advertising and skills in
networking to mine potential referral sources.
Next in frequency mentioned were skills in
managing office staff, including recruiting,
training, and motivating staff. Also reported
were skills in actually running the office
(smooth office procedures and paperwork to
promote efficiency). Table 3 presents these
data.
Table 3
The third major category of skill reported by
respondents was the clinical skills area. We
discovered that these skills broke down into
three sub-categories (Table 4). Some respondents
mentioned specifically the ability to correct
subluxations and some emphasized the analytical
side of the clinical experience (i.e. locating
and analyzing the vertebral subluxation); many
respondents felt that the ability to create
results (presumably symptomatic results) was
paramount in creating a successful practice.
Table 4 lists these results.
Table 4
In addition to these three main categories,
respondents reported, in smaller numbers, having
a high practice volume, having high levels of
patient satisfaction, and income as determinants
of practice success. They reported patient
education as an important causative activity in
creating a successful practice.
DISCUSSION
This evaluates in a systematic, empirical way,
what chiropractic practitioners consider to be
the identifiers of success in practice. In other
words, if researchers were to attempt to
identify successful practices from unsuccessful
ones, what variables should be examined? In
addition, this study takes a first cut at
determining what the essential competencies are
in creating a successful practice. The source of
this data is from practicing chiropractors, in
practice from one to 25 years.
Results of this study will be helpful to
chiropractic college administrators and
chiropractic management consultants, as they
provide programs to assist chiropractic students
and practitioners to succeed in practice. This
data will help them to pinpoint their programs
to the evaluative measures which best measure
success, and to tailor their educational
outcomes to those competencies most likely to
lead to their students/clients’ success in
practice.
This study provides several interesting and
useful findings. First, the success of a
practice is tied directly to the skill, talents,
capabilities and behaviors of the individual
practitioner. These results have implications
for the sale of chiropractic practices. The
importance of personal characteristics on the
success of the practice suggest that the sales
prices of chiropractic practices apportioned to
goodwill should not be particularly high. If the
incoming chiropractor cannot duplicate the
selling chiropractor’s individual
characteristics, the likelihood is that the
success of the practice after the sale is
consummated is unlikely.
These results also point out how important for
chiropractors to develop interpersonal skills in
order to succeed in practice. We infer that
colleges and management consultant services
should provide training in skills such as active
listening, communication, leadership, etc. These
skills, normally taught in the business school
milieu, should be added to chiropractic college
curricula.
This is supported by the emphasis on business
skills in the data. Clearly, it is not enough to
be clinically sound to create practice success.
Business skills are felt to be very important in
developing a viable practice.
It was interesting that the data did not support
the notion that income level is a definitive
determinant of practice success. Certainly
practice volume was felt by more to be
significant. This suggests that there is a
strong service component implicit in
chiropractic practice. It is much more often
felt that taking care of more people is a strong
indicator of success than income generated by
the practice.
Also worthy of note is that the practice is a
local phenomenon. In other words, the emphasis
is clearly on the patients who come to the
practice. Commitment to the larger community was
not frequently stated as an indicator or
determinant of success, nor was service to the
profession.
Finally, the fact that practitioners see faith
and confidence in chiropractic as a key
component of success suggests that development
of this confidence should be an important part
of the education of chiropractors. This supports
the efforts of some colleges and practice
managers in the past to focus attention on
providing confidence-building presentations for
their students. Some of these lectures take the
form of “miracle stories” of practice, and may
serve to provide confidence to the audience
members.
Future research investigation should take
several directions. First, these results need to
be replicated to test the generalizability of
the data from the sample tested. Second, work
should continue on isolating the particular
skills which practitioners feel are most
important. Many respondents noted, for example,
“marketing skills”, without delineating further.
It would be helpful to note specifically what
types of marketing skills are deemed most
necessary.
Finally, the logical next step from this
research is to survey practitioners on their
self-assessment of the competencies and then
correlate these results with outcome variables.
For example, a survey ascertaining respondents’
marketing skills could be correlated with their
practice volume levels. This would create
valuable information on the cause and effect
relationship between the competency and the
outcome.
This study takes a first step in investigating
the nature of practice success in chiropractic.
Much more study needs to be done in order to
allow researchers to begin understanding the
nature of success in private chiropractic
practice.
REFERENCES
Amit, R. (1994)
Contrasting entrepreneurs with
non-entrepreneurs: Attributes and attitudes,
Academy of Management Annual Meeting, Dallas; Tx;
August
Gaynor, M. (1989) Competition within the Firm:
Theory Plus Some Evidence from Medical Group
Practice, Rand Journal of Economics, 20, 59-76.
Hybels, R. C., (1995) On operationalizing the
legitimation construct in organizational theory:
A content analysis of press coverage of the U.S.
Biotechnology field, 1971-1989, Academy of
Management Annual Meeting, Vancouver, BC; August
Lee, R. H. (1990) Monitoring Physicians - A
Bargaining Model of Medical Group Practice,
Journal of Health Economics, 9, 463-481
Newhouse, J. P. (1973) The economics of group
practice, Journal of Human Resources, 8, 37-56.
Archived News Releases
Back to Campus
News
