David Singer, D.C., rose to fame in the early 1970s as a featured speaker at Parker Seminars. He became the youngest chiropractor ever to be voted "Chiropractor of the Year" by the Parker Foundation, as a tribute to his willingness to travel all over the United States and Canada to help fellow chiropractors do better in practice.

Early on, he realized that to get new patients, he had to overcome the medical and pharmaceutical propaganda that made people fear chiropractic and believe that only drugs could help them get well. He applied this knowledge in his own practice and would sign up 50-100 new patients per week. In just nine months, his practice was logging more than 1,000 patient visits each week. It wasn't long before he had built the largest new patient practice in the world.

Yet, while Dr. Singer had found the secret to success, he wasn't willing to let it remain a secret. He wanted to bring it to all D.C.s, so, in 1981, he founded his consulting company. Since that time, David Singer Enterprises has been twice named to the prestigious Inc. magazine's "Top 100 Fastest Growing Companies" list.

Currently on the advisory board of In Practice magazine and The American Chiropractor, Singer has been in the forefront of the battle to fight anti-chiropractic prejudice in the medical and insurance industries. He was one of the largest contributors to the original anti-trust suit against the American Medical Association and most recently, he and his clients have made the largest contribution of any consulting group, toward the new "Save Our Subluxation" campaign.

In 1999, subscribers of Chiropractic Economics voted Singer the person who most helped the economics of the chiropractic profession. In that year alone, his marketing methods brought in over 380,000 new patients to chiropractors worldwide. His clients have included past and present presidents of the ICA, ACA, numerous state associations and chiropractic board members.

The Chiropractic Journal caught up with Singer between trips to explore the issues facing chiropractic today.

I was doing a lot of lectures, going out and meeting people to get them to be patients but I was becoming completely frustrated in my inability to get across to the average person what we do and the value of it so they would, in turn, choose to be a patient.

I was naive enough to think that when you talk to people all you have to do is make logical sense and that should be enough to make them want to come and get our care. I was unaware of the fixed, limited, biased perspective that people have about chiropractic and how strong their medical drug-oriented viewpoint was.

I couldn't crack through their preconceived notions, until I one day I figured out there had to be something wrong with what I was doing. I'm not a bad communicator, so I must have been picking the wrong things to talk about, or saying them incorrectly or ineffectively to bring about a shift in how people think.

What I did was analyze the new patients that were coming into my office and discovered they had four things in common.

One, they actually believed there was something wrong with them. That step is crucial because many times, chiropractors will speak to someone who has headaches or back pain and immediately try to explain why they should come in and get chiropractic. The problem is, the doctors haven't first found out if the person actually considers what's going on with his or her body a problem.

Believe it or not, 85% of the population experiences symptoms every four days, according to Omni magazine. People go around experiencing headaches, aches and pains, sinus trouble, digestive disturbances, but they just cope with these problems rather than recognize them as truly something that can and should be handled.

The point I'm making is that before you can get a new patient, you must make them shift their perspective and recognize that having symptoms is not the norm. Unless you can make them undergo that shift, and get them to admit these symptoms are having a damaging affect on their life (which takes challenging them in a non-obnoxious way) you'll probably never get as many new patients as you should.

Second, my new patients all believed chiropractic could help them with their problem. Chiropractors are notorious for explaining chiropractic in a way no one can understand unless they've gone to chiropractic school or been a chiropractic patient for 20 yrs. Telling someone with headaches that you're going to help them by finding and correcting their subluxations would make no sense to the average American who has no idea what a subluxation is or even how the nervous system works to control the body.

We need to be willing to spend up to 10 minutes explaining how chiropractic works, in simple analogies, so when we're done talking to them they understand how their problem is related to their nervous system. It has to be done in a logical, understandable way so the consumer now feels that going to a doctor of chiropractic makes sense.

Explaining how chiropractic helps sinus trouble, digestive problems, hormone problems, or fatigue requires being able to explain the relationship between the nervous system and stress, and how stress affects the body and can directly cause those problems and how removing stress on the nervous system can actually bring about a change in health.

Third, they weren't afraid of chiropractic. To get someone to become a new patient, you need to overcome their fear that you can possibly hurt them.

For example, many people are terrified that chiropractic can cause a stroke. The risk of stroke from chiropractic is so minor, so remote that it isn't even worth mentioning it, but the medical profession has made it seem that there's a 50/50 chance of being harmed if you go to a chiropractor.

The way to deal with the stroke issue is to say, "In chiropractic, there are 100 techniques ... one of them may hurt people, but we don't use that technique in our office." That's the end of the story. It's a lot better than arguing with them that there is no risk with chiropractic.

The dangerous technique is extension of the cervical spine with rotation. You can also tell the patient, "There are many techniques in chiropractic; some are very gentle and some are very strong. We can always use the gentle one if you feel more comfortable with that." You have to address people's fears and eliminate them or no matter what you do they'll never become a new patient.

Finally, my new patients all made the decision to do something about their problems, not continue to just live with them. Too often, you hear people say they feel they have to learn to live with their symptoms. For example, I had a patient with terrible sinus condition who had gone to four medical doctors and been told her problem was caused by a deviated septum, and she'd have to live with frequent sinus headaches.

I asked her how long she'd had the sinus headaches and she said about seven years. Then, I asked her how long she'd had the deviated septum and she said 20 years. I explained that if the deviated septum was causing the headaches, she would have been having them for 20 years. She started to think maybe there as something to what I was saying.

Finally, I asked her how often she had the headaches and she said two or three times a week. When I asked how many days each week her septum was deviated, she said, of course, it was deviated every day. I pointed out that the headaches, then, couldn't be coming from the deviated septum. Something else must be going on. Her deviated septum might be making her more pre-disposed to sinus headaches, but something else is going on as well, I explained.

It's knowing how to skillfully, artfully -- and nicely -- educate people that allows you to change their viewpoint.

The good news is that there is only a little bit you need to know to effectively communicate in order to get new patient. A doctor who is not a good communicator can become a good communicator by practicing and rehearsing the dialogue that is essential for the future of their career.

New patients are vital to the actual survival of a practice. Without them, you can't make it in practice. Doctors who make the decision to be better communicators only have to simply sit down and rehearse my procedures with someone they know until they become comfortable and effective in what they are saying. I can take anyone and, if they were willing to put in the time and effort, in a matter of hours they'd be effective in getting new patients. Most important is that they don't have to become me to do it ... they can be themselves. They can be more effective in a way that's natural and real to them.

The basic anatomy of the new patient is the same all over the world. No matter where they're from or who they are, if they don't think there is something wrong with them, they're not going to seek out help. If they don't think what you do can help them, they won't go to you. This dialogue spans all socio-economic, national and gender lines.

Of course, to be successful in practice, there is more than one piece to the pie. The first is to get new patients. We teach our clients dozens of easy and effective, ethical ways to get new patients.

But once they're in the door, you need a way to effectively communicate the value of what you do so they're willing to spend time and money to receive your care. They need to be educated about the value of chiropractic and why it takes time to get results so they will make the commitment to stay with you. If you simply get new patients but failed to educate them as to the value of what you do, you'd just have a revolving door practice.

Yes. We created a revolutionary system to get C.A.s to do the patient education and report of findings. If you are going to have a large number of patients, you have to have a system that can be done by the staff rather than by the doctor.

To be effective, we divide our patient education program over four visits, rather than overwhelm new patients with too much material at one time. We give them information in 15-minute sessions rather than try to force it down their throat quickly and expect them to decide right away about whether they want chiropractic.

We believe they first should be educated and understand the value of chiropractic and the role of the spine and the nervous system before being asked to make a decision. Chiropractors usually ask people to decide on the care they should receive before they have enough information to make the correct decision. Unless they're fully educated, patients will say yes to the doctor's recommendation just to be polite, but then drop out.

The way we do it, we educate the patients first, then ask them what they'd like to do. Do they want mere symptom relief or do they want us to correct the problem that's causing the symptoms in the first place? When they understand chiropractic and make their own decision, they will stay as patients.

The biggest issue facing chiropractic today -- that most D.C.s are not aware of -- is the strategic plan of the insurance industry to restrict reimbursement for chiropractic services. What they're doing is slowly, over time, slashing chiropractic payments. They look at chiropractic as little more than fraud. The AMA founded the Council on Quackery and Health Care Fraud purely to eliminate chiropractic, attack the use of any alternative cancer therapy, and eliminate vitamins from the market place.

What people are not aware of is that although the AMA lost in the courts and had to recognize that chiropractic was part of the marketplace, there remains an enormous prejudice against chiropractic, based on the false belief that chiropractic is nothing more than health care fraud.

One reason for this is that, in medicine, the majority of health care costs go for diagnosis rather than treatment. An M.D. will charge a patient thousands of dollars for all sorts of medical tests and they'll walk out the door with a single prescription. In chiropractic, patients spend a small amount for the diagnosis, but a much higher amount for the actual course of adjustments. In the eyes of the insurance company, that's fraud. That bias is nothing more than a holdover from the antiquated prejudice and narrow thinking of the medically dominating insurance industry that has its roots in the pre-Wilk era.

Right now, in many states, lawsuits are being filed to get insurance companies to recognize that chiropractic is a legitimate profession and that our bills should be paid in the same way as medical bills. Chiropractic is definitely going to win. It's only a question of whether it's going to be one, two, or three years. Once we win against Blue Cross/Blue Shield and the courts force them to reimburse us on parity with any other health care professional for the same type of service, the whole industry will change.

These lawsuits are being filed with the help of the World Chiropractic Alliance, the International Chiropractors Association and the American Chiropractic Association, all working together to protect the right of chiropractors to adjust subluxations and be paid the same way anyone else is being paid for the services we provide.

They can definitely support the "Save our Subluxation" campaign being promoted throughout the U.S., by donating as much as they can to have it written into law that doctors of chiropractic are the only health care professionals trained and capable of correcting subluxation.

Currently, all HMOs are supposed to provide services for the detection and correction of subluxation. They have been avoiding chiropractors by saying they provide chiropractic-like services performed by other professionals. We know that only chiropractors are trained to correct subluxations and all chiropractic groups are working to bring about the inclusion of chiropractic in all federal programs, and make HMOs open up to chiropractic.

The environment today has made it more difficult than ever to succeed in chiropractic. Years ago, people got better reimbursement for chiropractic and there was less competition in the health care field. Basically, consumers had a choice between medicine and chiropractic. Now, we have holistic medical doctors, physical therapists who are pushing legislation to allow patients to go directly to them without referrals, natural health practitioners, and of course a greater number of D.C.s.

These factors make it more essential than ever for doctors to know how to communicate with people. In the 1970s, doctors could be lousy communicators and still do okay. In the '80s, they'd have gotten by. In the '90s, they'd have been hurting. In this era, they may actually go out of business.

We see more and more chiropractors leaving the profession today simply because no one ever taught them how to be effective communicators, how to get out there and educate people. The mistake doctors make is to think that, because they went through school, they know everything they need to know in order to succeed.

The fact is, in order to comply with federal regulations, schools devote almost all their efforts to scientific and clinical subjects. They don't have the time to train students to be successful in practice. That's why consultants like me have actually saved the careers of thousands of doctors who would never have survived if they hadn't come and learned what they need know to be successful.

Absolutely. Successful doctors know that it's inefficient and uneconomical to re-invent the wheel. If someone else has already figured something out, why spend the time and money to figure it out yourself?

Every month we work on finding new programs doctors can bring to their communities to interact with the population. People have interest in different subjects, so we create programs geared around specific topics. If you can learn to educate patients on how you can help with a specific problem, you can bring more people into your office.

We have workshops, for instance, that explain natural solutions to women's health problems. Others include natural solutions for arthritis pain, how to stretch your way to health, the five secrets to permanent weight loss, and our most popular topic, the alternative solution to fibromyalgia pain. Any of these programs, implemented properly, would greatly expand a doctor's practice.

Our methods work, they've been tested, and are presented like a cookbook. We offer doctors more ways to expand their practices than they could ever implement. This way, they can find just the program they feel comfortable with. They can go home and immediately expand their practice.

One reason is because we give seminars in eight different cities throughout the country, to make them accessible to doctors no matter where they practice. We offer six different weekends in each of these cities that can train them in 107 different ways to get new patients.

But we don't just hold a seminar and then leave the doctor to work it out on his or her own. We offer phone consultations to help them effectively implement the procedures we teach and clients can fax implementation questions to our unlimited fax hotline service and get an answer within 48 hours. We also offer seven implementation programs done over the phone every two weeks to make sure the material we teach gets used.

There are a number of other important benefits as well, including a fax newsletter every four to six weeks, a C.A.program, tapes, manuals, boot camps, advanced skill training sessions, and much more.

I have over 40 people who work with me. We are a team. We are driven by a common purpose. My purpose has always been -- and still is -- the expansion of the chiropractic profession. It is this purpose that has driven me to travel nearly every week for the last 20 years. I've put in more time and traveled greater distances on the public speaking circuit than anyone else in the profession. I do this because it is my belief that chiropractic possesses the only alternative solution to medicine that can allow our society to get well the way God meant us to get well -- without polluting and poisoning our body.

Chiropractic can not only relieve pain and suffering, it can literally transform the lives of the people we see. It's because of the overwhelmingly great results that chiropractic can bring that I have worked my entire life to better enable chiropractors to be more effective in reaching out and changing the lives of people in their communities.