Now that Northwestern Health Sciences University has appointed a new president, it seems important to reflect on the direction being taken. It’s probably important to look forward by first looking to the past. Rather than being ‘doomed to repeat history’ without examination, perhaps they should be seeking to replicate parts of it.
Northwestern’s proud history is based on the pioneering work of Dr. John B. Wolfe, who established the college in 1941. Northwestern quickly garnered a reputation as a place that did a good job of training doctors of chiropractic in both the science and the art of the profession. While others focused more on philosophy than NW, elements of chiropractic philosophy were clearly discernible in the work of a number of its instructors. It charted a course that may best be described as being based on a rational application of chiropractic precepts.
As the school matured and Dr. Wolfe retired, the Board of Trustees hired someone from outside the profession, imagining that a broadened set of skills would help assure continued growth and maturation of the institution. Don Cassata, PhD. seemed at first to be a good choice for a school and a profession seeking to establish an identity and presence that would have credibility outside the profession, and may have partly succeeded in this, but some of his tactics alienated a number of alumni, and he was let go by the Board. Following his short tenure was Dr. John Allenburg, a practitioner with a long history in leadership, clinical business development for Northwestern, and understated skills in consensus-building. Dr. Allenburg stabilized the college, largely recovered the confidence of alumni, and significantly advanced the position of the profession in the school’s marketplace by adding academic and professional programs and transitioning to becoming Northwestern Health Sciences University. Nationally, he played a significant role in establishing the ACC Paradigm of Chiropractic, no small task in a fractious and contentious profession.
Dr. Allenburg retired and was replaced, after two executive searches, by Dr. Al Traina. Dr. Traina had been an instructor at NW, had worked in the clinic system of another chiropractic school, and was welcomed as an old friend by many. His tenure can perhaps fairly be characterized as inwardly-focused, as he sought to stabilize and improve internal academic and clinical operations. Upon his retirement, late in the subsequent executive search, the chair of the Board of Trustees threw his hat into the ring. Dr. Mark Zeigler was quickly hired and became the school’s fifth president.
Dr. Zeigler sought to expand on the achievements of his predecessors in establishing and broadening Northwestern’s presence in the upper midwest marketplace for recruiting, enrollment, integrative health care, and peer organizational/institutional relationships. While he may have ‘held steady against the tide,’ it can be argued that not much progress was made, and despite some administrative moves made that he would defend based on his experience as an elected official running a city administration in his home town, it’s difficult to discern much strategic vision from his tenure. If that vision indeed existed, it’s hard to argue that it was successfully executed.
Now the school has completed another executive search, and their choice is a professional who has been a senior executive in a number of health systems and institutions. Judging by his published work record, his apparent speciality is in financial management and organizational improvement, especially in systems optimization. These are distinct and important skills, and Northwestern’s Board obviously believes they are needed. Taken with the recent revision of the institution’s mission and vision, the direction that seems to have been clearly established is to move away from being a place that supports the growth and development of health care professionals’ identity and distinctive culture, to being a place where those health professionals support the growth and development of the institution’s identity. That is not a small change. The seminal concept of Northwestern Health Sciences University, its embrace of ‘natural’ health care (a term not of precision, but based on marketplace realities and on the ability of all stakeholders to see the concept as a relevant connection point), and its growth strategy in 2000 as it transitioned to becoming a health sciences university was based on a sense of responsibility for stewardship and growth of non-medical professions. Coupled with an awareness that collaboration was probably critical as a strategy as opposed to marketplace competition, the institution originally saw its strengths based on skills any parent understands when they’re managing strong-headed children who all need to play in the same sandbox. It also saw an opportunity for establishing a distinct identity in integrative health care. For a time, it seemed to work well. But the years since Dr. Allenburg retired have not been characterized by strong strategic vision or competent execution. In that vacuum the energy, focus and opportunity created by the establishment of NWHSU appears to have dissipated.
In an attempt to define the basis for a potentially more market-facing set of skills in its new president, the Board of Trustees recently set a new direction. It has not been well received by many alumni. In the view of many, the school has lost its focus and distinction. While for some the new direction may be clear, it may not be relevant because of how the Board has misread market trends and marketplace interests. It may be fundamentally missing the mark in ways that contribute to the disturbing trend of decisions that place the profession of chiropractic in real jeopardy.
Trends are just that: trends, and while they are developing many things can change. What concerns me about Northwestern’s direction, and the direction of a number of other chiropractic programs and their host institutions, is that in my view there seems to be little connection between what these institutions espouse to become and some very clear and discernible healthcare marketplace trends. If I’m wrong and if the Board does understand what those trends are, it has not hired someone with a track record of strategic ‘reads’ of trends. It’s hired someone who can run a lean operation. That may be a critical organizational need. If so, then Northwestern’s got a winner. But if that’s not what the marketplace wants, or if its operations don’t need optimization as a requirement for its viability, then it’s got problems. I would submit that I think it’s causing more problems than it’s fixing. I see three distinct areas of concern.
Chiropractic cannot survive as physician extenders or assistants. The profession has a unique contribution to make to population health, and we are missing that opportunity. We need to be clear with ourselves: the marketplace does not understand and only appreciates a small portion of the contribution of chiropractic (true as well for Oriental medicine and massage therapy). As health care becomes more “retailized,” consumers will be looking for distinction, not homogenization. If we believe that the chiropractic profession can be sustained by being ‘back and neck doctors in your health care team,’ then there’s no problem. That strategy, though, does not offer any distinction to a consumer looking for services to help them. Worse, it perpetuates the failed symptom-based, disease-management model of the current (collapsing) health care system. By not working to strengthen these professions’ identities based, if nothing else, on the marketplace’s needs for clarity and choice, the school is inadvertently contributing to the failure of these professions to thrive–or even survive. The trend to homogenizing scope and aligning with medicine may appear to help chiropractic ‘grow its business,’ and diversify revenue streams for its entrepreneurial members, but I would argue that it’s far more likely to result in consumer confusion and business erosion. How will consumers choose between PTs that manipulate, PTs with doctorates who end up with prescription privileges, Naturopathic physicians who have prescription privileges, and chiropractors who adjust and have prescriptive privileges? If we cannot define a unique and distinct identity, then we should sit down and figure it out. And if we don’t think that we need to do this, then everything’s great.
It’s not great. We’re in real danger. It’s just a matter of time before some state expands its chiropractic scope law to include prescription privileges, and the dominos will start to fall. Without a thoughtful, articulate, active adverse stance on this trend, NW will contribute to the creation of a two-tiered profession. And if I’m right about this being a problem, NW enrollment will decline, no matter how refined their marketing efforts are or become, because the school will not be prepared to address or correct confusion on the part of consumers–whether they are potential students, patients, or both.
If we don’t understand the need for unique contributions to population health, how can we efficiently train professionals to meet those needs? We have a marketplace that is extremely dynamic and a professional educational process that is stilted, steeped in convention and largely unlinked to market realities. As long as the supply/demand dynamic in health care has been inverted compared to retail (health care supply side has controlled what the demand side could have), health professionals have been able to get away with telling consumers what they thought they ought to know viagra 50 mg precio. Now that the supply-demand dynamic is ‘normalizing’ to retail-like function, health professions who aren’t listening directly to consumers are going to have their heads handed to them. If we think that more advertising, better advertising, or social media campaigns are all that we need to tell our story, we are not paying attention. If we keep turning out graduates who are well-prepared to practice in the 1980’s, there may be a bit of a problem.
If we can’t efficiently train people to effectively meet marketplace needs, how will we sell that education? Why would people take on $100,000, $200,000, or even $300,000 in student loan debt to make $45-60,000 in practice? How will Northwestern be able to sell its own services?
The challenging practice business environment these days has many DCs asserting they won’t even recommend their own children enter the profession. Others in the profession with a passionate love of what they are doing–and a strong connection to the marketplace and a distinct chiropractic identity–are thriving and recruiting like mad. In the upper Midwest, the level of financial desperation many people feel can push them to dress up unwise tactics in the guise of a strategic vision. Doctors of chiropractic certainly can take advantage of the mechanistic medical system’s human resource shortage and be trained to serve as physicians’ assistants. But if we do, we unintentionally will contaminate the marketplace and confuse consumers and professionals alike. And the costs of our education will drive people away to other professions where success is more assured.
It’s always fair to expect that, under new leadership, an organization should be given some time to get things right on its (presumed) new course. But here’s the problem: we don’t have any time. In my view, the school has languished since Dr. Allenburg retired, and because it’s been operating without effective strategic vision in the primary role at the University, I’d further argue that it’s further behind in the marketplace than it was a decade ago. I’m sure some will argue and defend what’s been accomplished at the school in the last decade, but in my view the school can’t point to any meaningful accomplishments in integrative health care in a dozen years. And blueprints were created for moving these affairs forward in 1999.
The marketplace is not waiting around for Northwestern to figure this out. Our profession is in trouble. We’ve dug a hole for ourselves, and the school is still digging, having convinced itself that the tunnels are essential infrastructure. If it hasn’t already, it will soon become irrelevant if it does not come to understand the fundamental problems it’s been creating, and permit itself to be dragged out into the light of reality.
This is not a problem solely at, or for, Northwestern. It’s true for many, if not most, other chiropractic programs and their host institutions. But the upper Midwest is a very mature and cutting-edge healthcare marketplace, and I would submit to you that the stakes are proportionately higher here, because the marketplace is unforgiving. The missed opportunity costs are mounting. I firmly believe the Board has the bests interests of the school at heart. I just think they misunderstand what those interests are. That is of no small consequence.
It is my hope that I am wrong about a good part of this and we’ll see Northwestern succeed and thrive, and the professions it trains along with it. But I remain gravely concerned, and can only hope that the school’s leadership realizes their mistakes and corrects them. If I’m wrong, I only hurt myself. If the Board and the University administration are wrong, they will have inadvertently wounded the profession.