If you’re hearing “I love your work, I just can’t afford it,” a lot from your patients, it’s time to take a look in the mirror.
I hear doctors admit that they may be attracting people who cannot afford their care. It is worth pondering the thought that not only are we attracting, but also we are causing people who cannot afford our care. I realize that by saying you are causing this to happen is pretty confrontational, and yes that is my intent. We need to recognize that there will always be people who want our work and simply can’t afford it. My experience is their can be a large percent or a small percent of the people who you are causing to come through your doors with this “condition.”
First let’s get our heads clear about finances, money, responsibility and the value of our work.
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Money is an exchange of spiritual energy. You put your time, talents, energy and really give a portion of your life to them; and in exchange they give you a piece of paper that has some inherent value, that they also gave some of their life in exchange for. So really we are just using pieces of paper as a tool to exchange our time, talents, energy and portions of our life.
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You are not only exchanging X number of minutes, you are also exchanging your expertise, the years of study it has taken to master your craft, the years you were not able to generate income while you were in school, the amount of money you spent on school, books, seminars, lodging etc., and of course the benefits that they will receive.
My favorite story to illustrate this point is the story of the Porche mechanic. Imagine that you have a brand new $100,000 Porche and it starts chugging and knocking and is running very poorly. You pull into the nearest gas station and ask the mechanic to take a look. He goes to the front of the car, opens the hood and asks where the engine is. Politely you point him to the back of the vehicle where he finds the engine. He spends three hours messing around with the engine and finally gets your “baby” running fine again.
A few weeks later the same thing happens, but this time you happen to be right next to a Porche specialist. You pull in and this old timer comes out, opens up the correct hood, listens to the engine run for a few minutes, takes a screwdriver and adjusts one screw, and your “baby” is purring just like off the showroom floor.
Now, the first guy took three hours and the second guy took three minutes. Which was of more value to you? Should the first guy charge more because he spent three hours? As far as I’m concerned, I want my “baby” taken care of by an expert, and I am happy to pay to get the job done right the first time, feeling confident that I got the best service possible in the least amount of time.
Be a master. Be an expert. And let your patients know the value of your services.
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Don’t take responsibility for your patient’s finances; you are not their financial planner. They have made millions of decisions in their life to get them in the financial situation they are in right now. It is not your responsibility.
For years whenever I heard someone say that they really wanted to do the work but they could not afford it, what I heard was, “would you please give me a deal or just give it to me for free.” Immediately I’d start playing let’s make a deal with them. I finally came to realize that most of them really were not saying that at all. Most of them were saying that they really wanted to do the work right now but that they didn’t value my work, or themselves enough to do what it takes to make it happen; or they were non-confrontational people and just didn’t want to say that they really didn’t want to work with me. As soon as I realized this, I stopped playing let’s make a deal, and addressed the real issues with them.
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Address the real issues with them… don’t be afraid. Tell them your truth and consequences. No need to scare them into care or try to manipulate them with strong-arm tactics. Simply be real with them speak from your heart, and find out if they really understand the importance of their health, and the value of your care. We all know that if it were a life or death situation most people could come up with the money. So if they don’t think that they can come up with the money, it is either really not that important to them, or we were not able to fully communicate the importance to them. If they really get the importance and want to do the work, coach them. Ask them if there were a catastrophe like their car broke down, what would they do? Would they go to family for money, would they sell any of their other possessions like art, or get a loan? Help them see that money is available if their health is important enough to them and that this is their responsibility. Many doctors feel that this is too confrontational, but my experience is, if they really do want the care, and if you are sincerely coming from a place of trying to help them find a way to get the care that they want and need, and you are not trying to trick them or manipulate them into care, they are appreciative for the help and the ideas.
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Remember just because they want your care and really can’t afford it, doesn’t mean that they are now your responsibility and that you now have to pay for their care. It simply means that they really can’t afford your care.
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If you do choose to work a deal with them and give them care for a lesser fee, get very clear about the agreement with them from the beginning. Put it in writing. Let them know that you are doing something very special for them and that you request three things.
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They don’t tell anyone else that you are giving them this special deal. Let them know that you do notoffer it to every one and that it is a very special offer. Connect with your patient and let them know how they touched your heart for you to offer this rare gift to them.
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As they start to feel better and are able to generate more income, you expect them to pay more until they are paying full price just like everyone else. Have in the written agreement that you or your staff will be “renegotiating” the deal every X months.
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You absolutely expect that they will tell everyone they know about the terrific results they are getting, and they will be referring in all of their friends and family for care. Make sure you get agreement from them. Remember there must be fair exchange; this is an opportunity for them to “give back.”
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It is almost never recommended, but if you do decide that you are going to give someone care and that they are going to pay you later:
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Get a very clear written agreement.
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Understand the imbalance of being in “out-exchange” and communicate it clearly to them. Out-exchange is when one person owes another person time, energy or money. At some time in the game the person who owes begins to feel the pressure of owing, and subconsciously sabotages the relationship, usually by making the other person wrong, so they don’t have to owe any longer.
The way it usually plays out in our profession is the patient begins to rack up a big bill, they begin to feel the pressure, and something happens so they can quit care and not have to pay us what they owe us. Usually we hurt them, or they just aren’t getting the results that we promised them etc. Anyway about it, it is almost always a loose-loose proposition. Lot’s of friendships have been lost in this manner. So don’t get caught in this trap. Be clear with your patients from the beginning, put it in writing and discuss the concept of out-exchange, and that you do not want this to happen to you two.
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For those of us that are high traditionals or high socials, we need to remember that:
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This is a business and we are also here to make money for our family and ourselves.
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Tithe, or promise yourself that you will only give X% of your services away, this way when you are in the office, you can run it like a business and not give all of your services away.
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Honor your patients and yourself by allowing the process of Fair Exchange.
I would be happy to help you get congruent with your value and your fees, and any of the above that felt a bit sticky.
Russ Rosen, D.C. – Jun 25, 2003
