ChiroACCESS Article



Practice Economics: How Much Do Chiropractors Make?



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ChiroACCESS Editorial Staff

  

ChiroACCESS



Published on

November 11, 2009

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The average income of chiropractors is difficult to identify preciselyThe average income of chiropractors is difficult to identify precisely but several sources give at least a ballpark estimation.  One important factor to keep in mind with most of these surveys is that they do not take into account the fact that many doctors do not work full time.  This is especially true of doctors in their later years of practice.  The primary sources of information about income, like the U.S. Department of Labor, don’t take these part time numbers into consideration. This could have the effect of underestimating the earning potential of those in full time practice.  Other surveys rely upon convenience sampling methods that do not guarantee the findings are representative.  Despite these potential biases, the collective results of multiple diverse sources help give us an educated guess of chiropractic practice earnings.

Updated on 11/12/2009

The following are a few sources:

Some web sites have posted statements contending that the Department of Labor does not conduct an actual survey but rather obtains income information from chiropractic organizations.  The implication is that exaggerated income information is knowingly perpetuated.  This contention is not true.  The Department of Labor conducts its own direct surveys.  These surveys vary in number from year to year in part based upon budget issues.  It is important to note, as stated below, self-employed workers are not included in the estimates. 


For the May 2008 estimates, the Occupational Employment Statistics(OES) program sampled 3,520 establishments in the Offices of Chiropractors industry (NAICS 62131).

 

Also, note that the OES program does not include self-employed workers in its estimates.  According to the Occupational Outlook Handbook, approximately 50% of chiropractors are self-employed.


Michael Soloy

Occupational Employment Statistics - Department of Labor

The chiropractic profession is not alone in feeling the economic crunch of recent years.  The trend is that real income is declining.  As the Chiropractic Economics survey noted a 15% drop but taking inflation into account, the drop in real income is more than that.  The chart below, although a few years old, reflects the drop in real income, adjusted for inflation of medical physicians.


LINK

Several recent medical economic studies reflect continual concern by the medical community over decreased reimbursement and income.  We do not know at this time what impact health care reform will have but it is likely to be profound.  Below are a couple of examples in the peer reviewed literature related to medical economics.

Reimbursement trends for outpatient interventional radiology procedures: comparison of hospital and freestanding physician office sites of service.

J Am Coll Radiol. 2009 Jun;6(6):417-27.

Talenfeld AD, Soni SJ, Moser JW, Kassing PJ.
Section of Vascular and Interventional Radiology, Mount Sinai Medical Center, New York, NY, USA.

Comment in: J Am Coll Radiol. 2009 Jun;6(6):389.
 
PURPOSE: The aim of this study was to compare trends in reimbursement rates between hospital outpatient departments and freestanding physician offices for commonly performed interventional radiology procedures from 2006 through 2010.

METHODS: Using final rules data from the 2006 and 2008 Hospital Outpatient Prospective Payment System for Medicare and Medicare Physician Fee Schedule, reimbursement rates were calculated for a sample of procedures commonly performed by interventional radiologists in the outpatient setting. Hospital and freestanding reimbursement rates for 2006, 2008, and 2010 (projected) were adjusted for inflation to 2008 dollars and weighted by relative procedure frequency using Medicare Part B claims data. Reimbursements for the entire sample of procedures were compared year to year, by site of service, and by payment system. Individual procedure reimbursements were also trended.

RESULTS: In 2006, reimbursements for the entire procedure sample were 6% less in hospital outpatient departments than in freestanding offices. In 2008 and 2010, they are projected to be 3% and 23% greater, respectively, in hospital outpatient departments than in freestanding offices. Over the 4-year interval, reimbursements are projected to fall by 36% in freestanding offices and by 16% in hospital outpatient departments. Reimbursements to hospitals for facility costs are projected to decrease by 14%. Reimbursements to physicians for work done in hospital outpatient departments are projected to decrease by 23%.

CONCLUSIONS: Substantial reductions in calculated outpatient interventional radiology practice expenses being phased in between 2006 and 2010 under the Medicare Physician Fee Schedule seem to be dramatically reducing reimbursements for interventional procedures performed on outpatients, especially in freestanding offices. The impact of these practice expense reductions on interventional radiology seems to far outweigh that of the Deficit Reduction Act and other recent Medicare reimbursement changes.

Physician payment 2008 for interventionalists: current state of health care policy.

Pain Physician. 2007 Sep;10(5):607-26.

Manchikanti L, Giordano J.
Pain Management Center of Paducah, KY 42003, USA. drm@asipp.org

Physicians in the United States have been affected by significant changes in the pattern(s) of medical practice evolving over the last several decades. These changes include new measures to 1) curb increasing costs, 2) increase access to patient care, 3) improve quality of healthcare, and 4) pay for prescription drugs. Escalating healthcare costs have focused concerns about the financial solvency of Medicare and this in turn has fostered a renewed interest in the economic basis of interventional pain management practices. The provision and systemization of healthcare in North America and several European countries are difficult enterprises to manage irrespective of whether these provisions and systems are privatized (as in the United States) or nationalized or seminationalized (as in Great Britain, Canada, Australia and France). Consequently, while many management options have been put forth, none seem to be optimally geared toward affording healthcare as a maximized individual and social good, and none have been completely enacted. The current physician fee schedule (released on July 12, 2007) includes a 9.9% cut in payment rate. Since the Medicare program was created in 1965, several methods have been used to determine physicians' rate(s) for each covered service. The sustained growth rate (SGR) system, established in 1998, has evoked negative consequences on physician payment(s). Based on the current Medicare expenditure index, practice expenses are projected to increase by 34.5% from 2002 to 2016, whereas, if actual practice inflation is considered, this increase will be 90%. This is in contrast to projected physician payment cuts that are depicted to be 51%. No doubt, this scenario will be devastating to many practices and the US medical community at large. Resolutions to this problem have been offered by MedPAC, the Government Accountability Office, physician organizations, economists, and various other interested groups. In the past, temporary measures have been proposed (and sometimes implemented) to eliminate physician payment cuts. At present, the US Senate and House of Representatives are separately working on 2 different mechanisms to address and rectify these cost-payment discrepancies. The effects of both the problem and the potential solutions on interventional pain management may be somewhat greater than those on other specialties. Physician payments in interventional pain management may evidence cuts of 10% to 15%, whereas if procedures are performed in an office setting, such cuts may range from 29% to 39% over the period of the next 3 years if the proposed 9.9% cut is not reversed. Medicare cuts also impact other insurance payments, incurring a "ripple effect" such that many insurers will seek to pay at or around the Medicare rate. In this manuscript, we discuss universal healthcare systems, the CMS proposed ruling and its attendant ripple effect(s), historical aspects of the Medicare payment system, the Sustained Growth Rate system, and the potential consequences incurred by both proposed cuts and potential solutions to the discrepant cost-payment issue(s). As well, ethical issues of policy development upon the infrastructure and practice of interventional pain management are addressed.
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