“Would you like to see a beautiful purse to go with those shoes?”
I was 22 years old, fresh out of college, and a salesman at Leed’s Shoes on Market Street in San Francisco. The manager was an Israeli whom my uncle knew, so that’s how I got the job. My cousin had a job at Burt’s shoes, just up the street, which was run by the same guy. I earned minimum wage—around $2.00 an hour—and I also earned a commission on the shoes and accessories I sold, or so I thought. As the first payday approached I counted my chickens: $2.00 x 40 hours + commissions. Not bad! But when I looked at the meager amount of the paycheck and inquired why it was so much less than I’d expected, I was told that commissions applied to the minimum wage. In other words, for each 40 hours I worked I would earn a minimum of $80, but if I had earned commissions of $80 in that same time, I’d see a check for just $80, minus taxes, social security, etc. So, really, I was working only on commission. If I didn't sell enough to cover my minimum-wage salary I wouldn't be there for very long.
It was a hustle, which was why the young salesmen—we were all young men wearing cheap suits, selling cheap shoes—were eager to push purses, stockings, and other accessories on the customers. And what customers they were! Hispanic girls from the Mission District shopping for prom shoes. Old transvestite men from the Tenderloin with feet swollen and arthritic. Obese black women from the Fillmore who insisted they could squeeze into a size 7. If the shoes were too small we would “put them on the stretching machine,” a broom handle kept in the back of the store for that purpose.
One Saturday a teenager came into the store with her mother. They were shopping for her first prom. They settled on a pair of pumps. I went into the storeroom to search for a pair in her size. I found but one pair. Not exactly in new condition, they had obviously been worn and returned. The insole was partially torn out of one shoe. I knew that the girl’s mother would buy those shoes or nothing else so, desperate for a sale, I quickly smeared some glue into the shoe and smoothed down the damaged inner sole. Then, "Would you like to see a purse to match those shoes?”
I felt miserable when they left with that $15.95 pair of shoes. I had not been honest. Worse, I believed I was taking advantage of these people and many others like them: they wanted to look fashionable but could afford only the cheapest shoes, shoes worth far less than their price, shoes that would wear out or break or tear soon after the receipt was lost, shoes that would end up in the back of the closet, at the Salvation Army, or in the trash.
I had worked at Leed’s for a month, and I’d had enough. I sensed bad vibes. I left in the middle of the day, never to return. About an hour later a prostitute was shot to death by her pimp on the sidewalk in front of the store.
* * *
Too late, I discovered that being a chiropractor was a lot like selling shoes.
Most chiropractors are self-employed. There are more multi-doctor offices and associate positions now than there were when I started practicing in 1981. Nonetheless, most chiropractors still practice in doc-in-the-box offices—single doctor businesses in leased or purchased spaces. As the saying goes, when you're self-employed you only have to work half time—any 12 hours of the day you want. Anyone familiar with running their own business knows that the benefits of being your own boss are at least balanced if not outweighed by extra responsibilities and expenses such as self-employment tax, employee salaries and benefits, withholding taxes, workers' compensation, office liability and malpractice insurance premiums, business and professional license fees, leasing or purchasing equipment, rent, the professional fees of a bookkeeper, an accountant, a lawyer, and many other operating expenses. I once saw a bumper sticker that said, "Become a doctor and support a lawyer."
A business class was taught in the senior year of chiropractic college. The instructor had a successful practice in Portland, and I considered myself privileged to work in his office on Saturday mornings as a receptionist and typist. This chiropractor, let's call him Dr. Jack, “talked to the hands” of his patients, asking in his mind such things as which vertebra needed adjusting, how to adjust it, what nutritional supplements were needed, and what size of heel lift was required, while holding a patient’s arms and looking at the hands for changes in their length. He told our class that he had already leased an office and borrowed money for therapy equipment and furniture before he had passed his licensing exams, even before he had graduated. Dr. Jack had held himself over a barrel intentionally. By putting himself in this position he believed he had created a vacuum that would be filled by successfully entering practice and attracting patients to his clinic. His busy practice spoke to the success of his business sense.
And then there was advertising.
Whatever business methods one chooses to adopt, advertising is as necessary to a chiropractic practice as breast milk to an infant. B.J. Palmer (1) is famous for saying, “Early to bed, early to rise, work like hell and advertise.” The internet has made the Yellow Pages obsolete, but in the early 1980s it was the place to advertise. Medical doctors were prohibited by the AMA from referring to chiropractors, managed care was still ten years away, and although plenty of people sought treatment, chiropractic did not have as rosy a reputation as it enjoys today. The best methods for securing new patients were word of mouth, signage, and Yellow Pages ads.
Most of the chiropractic ads were variations on the same theme: a list of conditions treated such as back pain, neck pain, headaches, shoulder pain, pain in arms or legs; the types of cases accepted like on-the-job injuries, auto accidents, private insurance, Medicare; and a list of warning signs that you need to see a chiropractor, which varied from one chiropractor to another.
Many chiropractic ads featured a quote attributed to Thomas Edison:
The doctor of the future will give no medicine but will interest his patients in the care of the human frame, in diet, and in the cause and prevention of disease.
Allegedly stated by Edison, no one has been able to pin down the exact statement, where he said it or where it was published. The ads seem to imply that Edison was either speaking specifically about chiropractic or prophesying its practice. At any rate, quoting the esteemed inventor imparted an aura of credibility. Snopes.com, (2) the great oracle of internet truths and falsehoods, has determined that Edison probably said something similar in the earlier years of the 20th century:
… we turned up several newspaper articles from late 1902 and early 1903 that reprinted Edison’s predictions for the upcoming year. Those predictions included some comments from him about the future of medicine, a portion of which incorporated the “doctor of the future” statement now attributed to him. …
The Snopes article also puts Edison's words into historical context:
… one should keep in mind the context in which Edison made this statement. He was speaking at a time when very little effective “medicine” existed: the drugs used for alleviating illness in his era consisted primarily of useless (and often harmful) “snake oil” concoctions, toxic bromides, and "patent medicines” based on narcotics such as heroin, opium, morphine, and cocaine. Aspirin, which might be considered the very first safe, effective, non-addictive drug to be widely used, had been introduced only a few years prior to Edison’s remarks, and the development of antibiotics was still several decades away. In retrospect, therefore, it’s hardly surprising that a scientist speaking at the dawn of the 20th century might have declared medicine to be “played out” and instead have advocated a focus on health maintenance [and] disease prevention … over a reliance on crude drugs.
Many chiropractors offered free spinal exams. Chiropractors also gave free exams at county fairs, 5K and 10K runs, RV shows at expo centers, any place they could get some public exposure. I thought of these spinal exams as wallet examinations. There was absolute certainty that the chiropractor would find something wrong with each spine that was examined, some bone-out-of-place or postural misalignment that could be corrected by chiropractic adjustments. The uncertainty lay in the person's ability to pay for treatments. Thus the wallet exam to see if they had insurance that covered chiropractic, or perhaps the potential patient had recently—at least within the past year or two—been injured in an automobile collision or had an on-the-job injury. I confess that I myself am guilty of soliciting patients in this unprofessional manner. Some years later, as a college clinic supervisor, I accompanied my student charges to health fairs and sports events so they too could provide free examinations—and treatments—to the attendees and participants. It was one of my job requirements. (3)
I still don't understand why someone would choose a chiropractor from the Yellow Pages, but the ads apparently worked. Chiropractors with the largest ads seemed to have the biggest practices. (Or maybe the busiest chiropractors could afford those large ads.) But yellow page ads were very expensive, the equivalent of buying real estate. In 1981 I leased a medical office for $1,200 a month, almost $4,000 in today's currency. That was about the same cost as a half-page display ad in the Portland Yellow Pages. With no patients coming in the door I couldn't afford such an ad, but without advertising there would be few patients. Even a smaller advertisement, a quarter or eighth of a page, was beyond my means.
Paying for a larger ad ensured its placement at or near the front of the CHIROPRACTORS section of that thick yellow book. Further back were the in-line ads, but very few potential patients seemed to consult those pages, judging by the low number of patients I saw as a result of my ad. Chiropractors who placed such ads jockeyed for position by naming their clinics alphabetically, e.g., the AAA Aardvark Chiropractic Clinic’s placement came before AA Allied Chiropractic. It was a contest to see which chiropractor could put the most A's in front of their clinic name, which also had to begin with the letter A. The phone company was only too happy to indulge them.
Footnotes
Thomas Edison on the “Doctor of the Future” [Internet]. Snopes.com. [cited 2022 Jul 14]. Available from: https://www.snopes.com/fact-check/the-doctor-of-the-future/ back
Chiropractors might argue that a spinal screening is similar to other medical screening procedures like mammograms and colonoscopies. But what's the use of a screening exam that produces a positive result every time? back
