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The Collapse of the Railroads

Posted 10/8/2013

The Collapse of the Railroads (What business are we really in?)

At one time the railroads were the most powerful companies in the United States, they controlled vast tracks of land, money, politicians, and much of the transportation in our country.   Over that last century these mega companies have recessed to struggling relics, shells of their past might.  They have lost their prestige and now struggle to maintain relevance.  What happened to the railroad companies? 

The railroad companies did not realize that they were in the transportation business, not the railroad business[1].  When other forms of transportation evolved, instead of embracing these trends and growing with them, the railroads resisted.  Had the railroad companies realized that they were actually in the transportation business, they could have integrated highways, trucks, autos and fueling stations into their already powerful business.  What caused the demise of the once powerful railroads?  They were product orientated, not customer orientated.  They wanted to dictate what the customer needed, not listen to what the customer wanted.

What business are we really in?

Some would say that chiropractors are in the subluxation business or the adjustment business.  This is not true; we are in the healthcare business.   Providing adjustments is a product-oriented business rather than a customer-oriented business.  Patients are motivated to come to providers to enhance their health and to avoid pain or discomfort.  The adjustment may be the means to that end, but it is not what is sought by patients.  Pain relief and wellness are their goals.  

A while ago I spent a couple days observing a chiropractor friend.  He has a very conservative subluxation-oriented practice replete with all of the associated patient education material.  As I watched him interact with his patients, he continually reinforced his beliefs on the philosophy of chiropractic and wellness to his patients.  But as I observed these interactions I was surprised to discover that not one patient entered that practice simply for wellness.   They all had musculoskeletal complaints.    No one was listening to his philosophy, they were still seeking relief.  There was a communication disconnect in this practice:  he provided a product orientated service, while his patients continued to use him to meet their customer centered needs in spite of his intent.

Society for the most part does not know the differences between subluxation from subjugation.   But they do know what they want: mobility, relief of pain, increased athletic performance, and a hope for a more fulfilling and healthy life.  Judging by the conditions treated by chiropractors, a decided majority of chiropractic patients are being treated for musculoskeletal complaints.[2],[3], [4], [5]  Our patients have decided that we are primarily in the pain relief business not the wellness business.  Only 5-10% of our patients are being treated for non-musculoskeletal complaints or wellness.   Our society has spoken; to them we principally treat musculoskeletal conditions.  Are we listening? These patients will seek out the caregivers who will meet their needs.   Will chiropractors be the providers they seek? The increased chiropractic interest in rehabilitation, orthopedics, and myofascial techniques such as Graston and ART points to a shift in meeting the wants of society.

True wellness care is not limited to the chiropractic adjustment, but in combining chiropractic with an active lifestyle, weight control, exercise, prudence, temperance, smoking cessation, proper nutrition and hydration, proper sleep habits, stress management and routine wellness examinations.  Our patients would like for their providers to work together with the mutual goal of wellness.  Comprehensive wellness and integrated care is not the enemy, it is the future.  If we wish to remain relevant, we need to value what the population desires, rather than what we want to sell them.    If we continue pushing the product rather than listening to the customer, we will duplicate the business model of the railroad companies.

[1] Theodore Levitt, "Marketing Myopia", Harvard Business Review 38 (July-August 1960), 45-57

[2] Coulter ID, Hurwitz EL, Adams A H. et al. 

 Using Chiropractors in North America: Who Are They, and Why Are They in Chiropractic Care? Spine. 27(3):291-297, February 1, 2002


[3] Hawk C, Long CR, Boulangerc KT. Prevalence of Non-musculoskeletal Complaints in Chiropractic Practice: Report from a Practice based Research Program


Journal of Manipulative and Physiological Therapeutics. Volume 24, Number 3, March/April 2001


[4] Cherkin DC, Deyo RA, Sherman KJ, et al. Characteristics of Visits to Licensed Acupuncturists, Chiropractors, Massage Therapists, and Naturopathic Physicians.  

JABFP November–December 2002 Vol. 15 No. 6


[5] The Future of Chiropractic Revisited: 2005 to 2015.

January, 2005

Institute for Alternative Futures.