One of the really dumb ideas that has been foisted upon the chiropractic profession in general and straight chiropractors in particular is that a high patient visit average (PVA) is indicative of a successful practice and is something to be desired. Now, I realize that just about anything can be construed as success in this profession, including how many patients one refers to a medical doctor in a year. Further, chiropractors can seek just about anything to prove to themselves (and others) that they are successful, but in my estimation, a high PVA is just about the worst goal to set. At one time I fell for the concept and laborously figured my daily, weekly, monthly and yearly PVAs (for the uninitiated, you divide the number of patient visits by the number of new patients). I would hear stories, usually from practice management consultants, how their client’s PVA’s were 2 and 3 times the national average and, of course, I wanted to be in the same league as those heavy hitters.
Then I began to give the whole idea a little more thought (I must admit, it was partially prompted by my young associate who said she thought figuring PVAs was a worthless endeavor, totally unrelated to what we are doing. I just hate it when the student has to teach the teacher!) It should have been clear right away by the term “average” that it is worthless to us chiropractors. We do not strive for average but for normal, and normal is different for different people and is different for the same person at different times.
Let’s look at different practices. What about the new practitioner? Seeing 100 patients in a week in the first few months of practice is pretty good. But if 20 of them are new patients, a PVA of 5 is bad. What about the HIO practitioner who sees 1,000 new patients in a year? I think that is great, but if he or she adjusts people only 3 or 4 times a year, he or she could have a PVA of less than 10, not even half the national average. I think HIO upper cervical is a great way to practice and I resent anyone suggesting that an HIO practitioner who sees the above numbers is not successful and not doing a good job. What about the 30-year practitioner who has a patient list of thousands of patients? He sees 100 patients a week and only accepts 1 new patient. He has a PVA of 100, pretty darn good. While his PVA may be more than five times the national average, his figures are anything but impressive. It seems that your PVA will go up just by virtue of hanging around a long time. I could accept one new patient a week, never promote chiropractic, never educate another patient, never do anything to get the message across and probably still see 500 to 600 patients a week or more, simply because I have so many patients and have been around so long. While that PVA may be great, I would be doing nothing to further the principle or turn my community on to chiropractic. Of course, if I did not accept even one new patient in a week, my PVA would drop from 500 or 600 to 0 (500 divided by 0 equals 0). Beginning to see how dumb it is? If PVA is not a good indicator for new practitioners who are building practices because they are seeing a high percentage of new patients and it is not an indicator for long-standing practitioners who choose to see few new patients and live on a large patient base, who is it good for? I guess it is good for the practice management consultant who is trying to convince some chiropractor that his or her practice is missing something.
Not only is PVA not a worthwhile criteria for different chiropractors (our philosophy teaches that our needs and situations are different), it is also not a good indicator for the same chiropractor at different times. In our practice last summer, in two consecutive months we had a PVA of 36 and 57. It would seem that the second month was much better. Yet, in the lower PVA month we saw almost 400 more patient visits than in the higher. I would venture to say most chiropractors would be willing to have a drop of 21 in their PVA in exchange for an additional 100 patient visits a week. The problem was, while our number of visits was 10% greater, we made the stupid mistake of seeing 37% more new patients, thus destroying any chance of a record-breaking PVA. Of course, I am being facetious, but it does bring out the real danger of this whole PVA thing and the caveat for chiropractors getting hooked up with a practice management consultant who stresses increasing your PVA or even beginning to focus on it in your practice. New patients become a drag and we subconsciously reject them.
This negative will certainly keep new patients out of the office, and we may not even recognize it because our PVA is way up there. For example, if you worry about PVA and a family of five walks in the office as new patients, instead of saying “wow, a family of five is now under care,” you may say “what is this going to do to my PVA?” The difference between the whole family under care and only the father is the difference in a hundred-patient-day of a PVA of 100, which is considered outstanding, and a PVA of 20, barely the national average.
I believe if your PVA begins creeping upward, you had better check your slipping. You are subconsciously or consciously turning off new patients. You may be too selective in who you accept as a patient. What right do we have to judge a person as to whether they are going to be a lifetime patient and do wonders for our PVA, or come once or twice and drag it down? New patients are work, they interrupt the rhythm of the office and you know that a good percentage of them are not going to get the big idea. But that is not an excuse not to see them. We need to expose more and more people to the philosophy of chiropractic if we expect to get society to have an accurate perception of chiropractic. If we do that, our PVA will rise naturally, as it should, because society will see the value of regular care, not because we have reduced our new patient intake. If we are doing our job (educating), our patients will be referring like crazy, good patients, bad patients, those that will increase our PVA and those that will decrease it. If we are not getting the message out, I guess that having a high PVA is as good a way to assuage our guilt as any. It is just as we tell our patients, do what you should be doing and let the body establish its own norms. Concern for averages, whether it be blood pressure or patient visit, is not conducive to a healthy body or a healthy practice and is definitely not chiropractic.v12n2