William E. Morgan, D.C.

It is a noble calling to serve the poor and disadvantaged, one that draws chiropractors attracted to this profession by purer motives. Unfortunately, most chiropractors can only treat a small percentage of underserved disadvantaged patients due to the financial constraints of their benevolence; we can only afford to see a few patients for little or no recompense. My mentor, Dr. Chuck Wynn, taught me that it was the duty of all of the chiropractors in our little town to take care of those of modest means. If we all pitched in and donated some of our clinic time we would be able to share the load and fulfill the needs of others. We lost money by performing this service, but we were amply blessed in other more profound ways.

In certain rural regions there are too many underserved patients for chiropractors to provide care for free or the low rates of Medicaid reimbursement. The U.S. government has long known that rural communities have been underserved by health care. In an attempt to attract more health care providers to serve in rural regions of the country, the U.S. Government has created special programs that provide increased reimbursement to providers working in Rural Health Clinics (RHC). Places like Appalachia and remote Southwest locations have long been the poster children of Rural Health proponents, but surprisingly most of the geography in states like California is also considered "underserved and rural." In fact, most of the land area of the United States is considered rural and underserved.

What is not widely known is that chiropractors working in RHC are eligible for much higher reimbursement for providing care to patients served by Medicaid and other government programs than they may receive in private practice .

For several years I worked part time in an RHC and hospital and enjoyed a higher rate of reimbursement and less administrative hassles than with the major chiropractic managed care organizations . These clinics by nature are multidisciplinary and provide chiropractors a great opportunity to integrate with other health care providers in their community. I found that my time in RHC resulted in more referrals to my private practice and a greater amount of collegiality with the medical doctors of our community.

The federal programs governing these privately or non-profit organization owned clinics required them to be primary care in orientation. Chiropractors may not individually own a rural health center, but may co-own one with an MD.

Most RHC administrators are unaware that chiropractors are eligible for the higher level of reimbursement provided under this government program. Michel Tetrault, DC (a proponent of chiropractic integration into rural health clinics) interviewed 200 rural clinic CEOs and found that only 20 percent realized that chiropractic care was covered as a regular encounter.

Medical clinic administrators usually are resistant to adding a chiropractor to their staff because they are ignorant of the low start-up and running expenses. They are accustomed to working with MDs who require a nurse, special equipment, on going consumption of expensive supplies (syringes, EKG leads, bandages, speculums..). A chiropractor by contrast requires little: a treatment table, a 10' X 12' room and a few low cost clinical items. With these minimal resources the typical chiropractor can see 20-30 patients per day, often exceeding the production of the MDs in a rural clinic. I should note that the reimbursement for each type (MD, DC, PA, NP, and DDS) is the same. Consequently if a neurologist working in a rural health clinic sees eight patients per day and a chiropractor sees 24 patients, the chiropractor will make three times the amount as the neurologist.

Rural Health Centers represent a prime opportunity to serve others and receive a respectable income. These centers are subject to very specific regulations that may be different from state to state. If you are interested in participating in a RHC, I recommend that you seek information from your particular state.

Additional resources regarding RHCs:

U.S. Department of Health and Human Services - Rural Health Clinics
Chiropractic in Rural Health Clinics