Eugene Charles, DC, is celebrating success after going to an all-cash practice 10 years ago

The turning point is still vivid in the recollection of Eugene Charles, DC. A patient he had been treating for a herniated disk said he would have to stop his treatment because his insurance would stop paying for it. “The treatment was very successful. I was able to get him moving again and keep him from having surgery,” says Charles, who currently practices in New York City.

Charles offered to make other arrangements with the patient, but the patient refused. Once the patient left, Charles vowed never to allow insurance companies to come between him and his patients again. “Health insurance is an oxymoron,” he says. The next day, Charles—who was practicing in Norwalk, Calif, at the time—sent a letter to all of his patients informing them that he would no longer accept capricious insurance guidelines as parameters for treatment.

The result was not surprising. In a month, Charles’ patient volume plummeted; half of his patients abandoned him. But the surprising thing was that he began making more money. That was 10 years ago.

Today, Charles has a practice on Park Avenue in New York City, is still only accepting cash, and is operating a practice that is completely centered on patient care instead of volume—a quality-over-quantity mind-set.

Eugene Charles, DC, discusses office policies with his office manager and mother, Antoinette Charles.

Finding the Model
As a chiropractor, Charles might be unique, but his cash-only approach is not. He adopted a psychologist model, charging by the hour for his undivided attention. His fee scale reflects his assessment of his worth as a clinician. He charges $500 for the first hour and $300 per hour subsequently. He sees 17 patients per day, and works only 20 hours per week in the office. Charles’ practice earns revenues of between $19,000 and $25,000 per month.

Charles’ office staff consists of an office manager. He has only one treatment room, and he does no billing. (Patients pay up front and submit the bill to their insurance company themselves.) But his simple office has attracted a diverse range of patients, from millionaires to New York City Transit Authority employees. “One of my most diligent patients makes $28,000 a year and comes in to see me twice a month religiously, and has done so for the past 5 years,” Charles says.

Charles’ no-frills approach is much different than his days in California. There he had a large office that, consequently, had high overhead. That changed when he stopped dealing with insurance and redirected his approach. “I’m focusing on health care, not playing games with the insurance bureaucracy, so I keep the overhead low,” he says.

This trade-off has benefits—not only for Charles, with higher earnings and an abbreviated schedule—but for his patients as well, who have particular demands no matter the sizes of their paychecks. “My practice attracts people who want to spend time with their doctor,” he says.

And he means it. When patients enter Charles’ office, they may not see a crystal chandelier hanging in a well-apportioned waiting room, but they will see Charles.

Patient Melanie Matthews presented with neck discomfort. Charles teaches his patients that “every back has a front attached to it.” Here he is testing the muscles in the front of the neck and looking for any weakness that is, in all likelihood, causing her problem.

Face Time
Patients have the option of 30-minute and 1-hour-long appointments, translating to exam/treatment times of 25 minutes and 50 minutes, respectively. The lack of office staff means that patients are not dealing with intermediaries. “I have nobody coming between me and the patient,” Charles says.

Appointment times are strictly honored. “If your appointment is at 2 pm, I see you at 2 pm,” he says.

Treatments go beyond simple adjustments and include nutritional counseling, acupuncture, reflexology, and applied kinesiology. “I tell my patients that I don’t treat the low back; I treat you,” Charles says. “As chiropractors, we have to remember that the patient is hiring us.”

Charles enjoys interacting with patients—he gets to know them, keeping in touch via phone or e-mail and by giving them an inspirational calendar he wrote for them.

Charles says that one of the downsides of the traditional chiropractic model is that the DC rushes too much to get from one patient to the next, so he says he sees fewer patients, thereby focusing on doctoring instead of patient volume. “I would rather sit and break bread with my patients than scurry for crumbs from a faceless insurance company.” All of his patients come to him through word-of-mouth referrals, and he does no advertising—but it means that he must keep on top of advancements in the profession. “If somebody is paying cash up front, you have to bring your ‘A’ game,” he says.

This means that at the end of a busy day of seeing patients, he is exhausted—sometimes his whole body is shaking. “I’m tired, but it’s a good tired,” Charles explains.

To stay on his “A” game, Charles is constantly taking seminars and presenting at professional meetings, earning, he says, as many as 100 continuing chiropractic education credits. He also passes the same test MDs take yearly and earns an additional 100 continuing medical education credits per year. By keeping up with the latest techniques and honing his abilities, Charles is adding to the future of his bottom line. He says that because of the increased skills that he has gained in the last 10 years, he is in the process of recalculating his practice’s worth and is planning to raise his rates to correspond to this new figure.

Part of being in top form is incorporating new methods that may not be part of the traditional chiropractic menu.

Menu of Services
Charles relies on the system of applied kinesiology to evaluate his patients and get to the root of their discomfort. The premise of the system, he says, is the application of “quantum physics to healing.”

The technique is integrative, employing numerous health systems, including chiropractic, cranial sacral therapy, clinical nutrition, acupuncture, and myofascial therapies.

It involves watching people move and identifying trouble areas and organs that correspond to those muscle groups. Once he has identified an area that could have problems, he then follows up with tests such as magnetic resonance imaging and blood tests.

When diagnosing patients, Charles employs the applied kinesiology triad of health. The triad is represented as an equilateral triangle—symbolizing the ideal healthy balance of the body—with structural health (bones and muscles) being its base, and the sides representing chemical (nutrition) and mental (emotional/spiritual) health. According to the principles of applied kinesiology, if a person is experiencing poor health, it is due to an imbalance in one or more of these three factors.

The technique can identify underlying problems, he says. Once he had a young patient with severe stomach problems. But by using applied kinesiology—observing how she was moving—Charles found that the problem was not her stomach, but her spleen. “Sometimes where you think the problem is, it isn’t,” he says.

He recently discovered the benefits of reflexology, the manipulation of pressure points in the foot to address aches and pains, but he has put his own spin on it. “I use a percussor tool in the treatment. That makes it fun and more effective,” he says. With the various techniques he employs in his treatment, it seems as if Charles has forgotten about the basic one—adjustment. But he offers that service as well. “I’m very specific with my adjustments,” he says.

Charles is the first to admit that his approach is eclectic. “I’m still in contact with my first patient [who lives in California, and is being treated by one of my former students], and she told me recently, ‘Every time I came to see you, the treatment was never the same,’ ” he says. He replied, “That’s because you were never the same.”

This is a reflection of his quest to constantly improve and to treat his growth as a process of continuous improvement. “What I do is a healing martial art,” Charles says. “Like a black belt when I received my [chiropractic] degree, it meant I was ready to learn.”

Charles is not only a lifelong student, but a teacher as well. He lectures to chiropractic and nonchiropractic audiences. He has also written several books, including a workbook on adjusting, and a daily inspirational calendar.

Group Practice
Charles owns the four-unit condominium that houses his practice and the practices of three other chiropractors. Like him, they are all solo practitioners, paying rent to Charles and connected only in the fact that they share a common massage therapist and a similar love of healing.

This arrangement makes good sense from a business and professional standpoint. “In seminars to students, I tell them to keep separate practices, even separate phone systems,” he says. “That way, you won’t have problems and you’ll remain friends.” Charles is living proof of this. He has shared quarters with two of the three for 10 years, and even though he is now their landlord, he has a good relationship with all of them. Still, Charles also has challenges to overcome.

You Want How Much?
Not every patient who sees Charles will be able to afford his services or be willing to pay for them. “If people say that my price is too much, I will refer them to someone who accepts insurance or is more in their price range,” he says.

He acknowledges that his prices might be high compared to someone who takes insurance, but recognizes that whether the patients make $10 per hour or are independently wealthy, they feel good enough about themselves to pay out of pocket.

But Charles thinks highly of himself as well. Recognizing that his patients’ time and money are important, if he is late to an appointment, the time comes off his side of the equation. If patients are late, they have to pay for the time they missed, as well as the time for the attenuated appointment. If patients miss an appointment, they have to pay the full amount, and for their next appointment as well. If they refuse to pay, then Charles drops them as a patient. He recommends against sending nonpayers to a collection agency, saying that you can’t force people to respect you. Instead, he just lets patients know, “I am here should you need me in the future.”

Charles makes payment easy for patients. He accepts cash, checks—including postdated ones—and credit cards.

In his lectures, Charles encourages students to start their nascent practices as cash only. “If I had to do one thing over again, I would have started this way,” he says. “It’s purer, and I highly recommend it.”

The first step is simple. Determine your worth, set an uncompromising hourly rate, and keep overhead low. The benefit is more than making a high wage. “You can enjoy being a doctor,” Charles says, “and this is what society so sorely needs now.” CP

C.A. Wolski is a contributing writer for Chiropractic Products.