Okay, here’s a test whether you think outside-in or not. Some time back an editorial in a chiropractic publication described the actions of a managed care organization that was paying chiropractors less than medical doctors for services involving the same CPT codes. The editorial was encouraging chiropractors to send money to a Legal Action Fund to help support an ACA lawsuit against Trigon Healthcare. Here is the question: Should we or should we not be supporting an effort to force third-party payers to give chiropractors equal pay? If you said yes we should, you are an outside-in thinker or at best your thinking on this issue is inconsistent with your world and life viewpoint and is probably clouded by your emotions (treating chiropractors different than medical doctors). We are different and difference in a free society necessitates different treatment. We are all equal under the law (“Lady Justice” with the blindfold) so the law should treat us equally. However, when the law (the courts) imposes equality on free enterprise something is wrong. Forcing free enterprise to treat everyone equally destroys free enterprise. Can you imagine people who buy bleacher seat tickets having access to box seats and box seat tickets holders being forced to sit in the bleachers? No one would buy box seats and the baseball world would lose revenue. Marxism is living proof that making everyone equal does not work. Here are some other aspects of the ADIO viewpoint that impacts this issue.
1. People, or in this situation organizations, must change from the inside-out, if the change is going to manifest itself in permanent good. The title of the editorial is “Conspiracy Gone, but Mindset Lingers.” The idea is that despite the suit against the AMA 25 years ago that forced medical people and medical-thinking people to stop conspiring against chiropractors, we are still viewed us as less than their peers. Outside-in thinking says, “Let’s sue them again, we are doing what they are doing. We will coerce them into accepting us by the power of the courts.” If our chiropractic pioneers adhered to the idea that we were the same as medicine, we would not have a profession today. They were dragged into court, not in civil suits but on criminal charges. They testified that they were not practicing medicine. Now we are saying what we are practicing is medicine or enough like medicine that we deserve the same pay. Why do we not spend the time and the effort in educating people about what it is we do as chiropractors? That is the only way to achieve the results we seek. As the headline unknowingly reminds us, you do not change people’s thinking by force, by suing them in court. The prosecution of so-called “hate crimes” will not wipe out hatred, that is outside-in, it just treats the effects. Hatred comes from the heart, from the thinking process of man. Similarly, thinking that chiropractors do not deserve the same fees as medical doctors for their services (if they really do) comes from the thinking of Trigon Healthcare. We may win a wrongful lawsuit but we will not succeed ultimately unless we change their thinking.
2. The lawsuit defies logic, it is divorced from reality, a very common characteristic of outside-in thinking. Basically, the contention of the chiropractors in this case is, “We are not as well trained as you, either by education or by internship training, yet we believe that we can do the same thing you are doing. We believe that our procedures are as effective as yours despite our limitations of scope of practice and education. Isn’t it interesting that we are suing to keep physical therapists from doing what we do because they are not doctors, their training is not as extensive as ours. Yet we turn around and want to be paid the same as medical doctors whose training exceeds ours. We are saying to the medical doctors: “we want to replace you, to supplant you, to perform procedures that you are capable of doing, and have been doing since Hippocrates, thus take income from you and we want to be paid what you are paid for those procedures.”
3. The lawsuit violates the ADIO principle of freedom. This is a free country. Managed care people should have the right to pay who they want and in the amount that they want. If we do not like it, we should start our own managed care system or just not participate in theirs. What is the difference between the courts telling a private company what they have to pay in fees and telling you as a private practitioner what you can charge in fees? If I want a box on the wall, I should be free to do that. If you want to charge $50 a visit that should be your right also. Should the insurance companies not have the same rights? Whatever the reasons Trigon Healthcare gives for their policy, the bottom line is that from a profit standpoint they believe it is in the best interest of their company, to have the system the way it is. Whether they are right or wrong in their policy is not the issue. That is what free enterprise is, having the right to succeed or fail on your own merits. It is not about having government force you into failure (or subsidize you in order to prevent you from failing).
This issue is one example of how outside-in thinking touches upon every aspect of our professional lives and ultimately our personal ones as well. It touches upon ADIO thinking from a political, legal, economic and a professional standpoint. If you support this suit or the thinking behind it, you may be an outside-in thinker or you may not be thinking consistent with what you claim is your world and life viewpoint.
Here is a news item that shows just what percentage of our profession thinks outside-in. A Dynamic Chiropractic survey found that 45.5% of the chiropractic profession surveyed would like to see some regulation of the number of graduates from chiropractic college. Almost half our profession feels that there are too many chiropractors or that the problems in the profession (and their practices, I guess) could be alleviated if we kept more people out of the profession. Depriving people of the freedom to enter a profession is outside-in. Free enterprise is an ADIO concept. It is frightening to realize that almost 50% of our profession has such thinking. V18n4