Does Better Revenue Really Mean Better Patient Outcomes?
- Dr. Lucas Marchand
- Jan 21
- 6 min read
Lucas Marchand, DC 1/21/26
A Chiropractor’s Honest Look at a Popular Business Argument
Every few months, a familiar idea makes the rounds in chiropractic circles: if a practice is financially healthy, patient outcomes will follow. It usually shows up in the form of a clean infographic, a conference slide, or a social media post framed as reassurance—proof that talking about revenue isn’t a betrayal of our clinical values. Recently, one such graphic circulated online arguing that “better revenue and profits equal better patient outcomes,” laying out a sequence that links financial success to better teams, better equipment, better education, and ultimately, helping more people.
At first glance, the argument feels not only reasonable but comforting. Many chiropractors—especially early in practice—carry a quiet guilt around money. We want to help people, not “sell care.” We’re told to focus on outcomes, not income, yet we live in a system where burnout, debt, and thin margins are common. So when someone says, actually, doing well financially helps you take better care of patients, it resonates.
But resonance is not the same as accuracy.
This isn’t a takedown of that argument. There is truth in it. Real truth. But there is also oversimplification, and in a profession that already struggles with credibility—both internally and externally—oversimplification is risky. If we’re going to make claims about outcomes, ethics, and the role of money in care, we owe it to ourselves to be precise.
So let’s take the idea seriously. Let’s look at what holds up, where it breaks down, and what a more honest version of this argument might look like.
The Strongest Part of the Case: Financial Stability and Clinical Presence
The most defensible claim in the “revenue equals outcomes” argument has nothing to do with equipment, square footage, or scaling. It has to do with the clinician.
A chiropractor who is under constant financial stress does not practice the same way as one who is stable. That’s not a moral judgment—it’s human physiology and psychology. Financial insecurity increases cognitive load. It narrows attention. It accelerates decision-making under pressure. Across healthcare disciplines, clinician burnout has been linked to worse communication, lower empathy, and increased errors.
When a doctor is worried about making payroll, paying off student loans, or whether the practice will survive the next six months, that stress doesn’t stay neatly compartmentalized. It shows up in rushed visits, shorter explanations, and a subtle but real shift from curiosity to urgency. In contrast, a financially stable chiropractor has more mental bandwidth. They can listen longer. They can think more clearly. They can tolerate uncertainty without panicking.
In that sense, money doesn’t heal—but the absence of financial distress can absolutely create the conditions for better care. This is not controversial outside of chiropractic, and it shouldn’t be controversial within it.
Profit as an Enabler, Not a Treatment
Another valid element of the argument is the idea that revenue can improve outcomes indirectly by improving the systems around care. Profits can fund staff who handle scheduling, billing, and patient communication more efficiently. They can support continuing education that keeps a clinician current. They can buy time—time to review cases, to reassess plans, to actually discharge patients when appropriate instead of keeping them out of fear.
When framed this way, profit is not positioned as the driver of outcomes, but as the infrastructure that supports good clinical decision-making. That distinction matters. No serious clinician believes money itself produces healing. But many would agree that poorly designed systems, constant chaos, and operational friction can absolutely interfere with it.
This framing also challenges a long-standing and unhealthy narrative in chiropractic: that struggling financially is a badge of honor. The idea that good doctors should be broke, or that business success somehow cheapens clinical integrity, has done real damage to the profession. Reframing financial competence as ethically neutral—or even ethically supportive—is a step in the right direction.
Where the Argument Starts to Slip: Correlation Masquerading as Causation
The trouble begins when revenue is presented not as a supporting factor, but as a reliable predictor of patient outcomes.
“Better revenue and profits equal better outcomes” is a clean slogan, but it collapses under scrutiny. High-revenue practices do not consistently produce better results. Some do. Others do not. There are practices with impressive top-line numbers that rely on high volume, minimal visit time, aggressive care plans, or weak outcome tracking. There are also small, low-overhead practices that quietly deliver excellent results through strong clinical reasoning, patient education, and appropriate dosing of care.
Revenue is neither necessary nor sufficient for good outcomes. It can coexist with excellence, mediocrity, or outright poor care. Presenting it as a near-causal force oversimplifies a system that is far more complex.
If we’re being honest, the real drivers of outcomes are boring and hard to package: clinical judgment, patient buy-in, natural history, adherence, and reassessment. Money can support those things, but it cannot replace them.
The Equipment Problem: When Tools Become Proxies for Care
Perhaps the most vulnerable part of the infographic’s logic is the suggestion that better equipment leads to better outcomes. This is where the argument drifts closest to marketing.
Many popular modalities—lasers, shockwave, decompression, high-end rehab setups—have mixed or condition-specific evidence. Some can be useful in certain contexts. Many show modest effect sizes at best. Very few outperform fundamentals like education, movement, load management, and time. Yet they are often framed as outcome-enhancing breakthroughs rather than adjuncts.
In practice, new equipment frequently improves perceived value and differentiation more than it improves clinical results. It can attract patients. It can justify higher fees. But none of that guarantees better outcomes.
When we equate technological investment with clinical effectiveness, we risk reinforcing the idea that outcomes are purchased rather than earned. That mindset doesn’t just weaken our scientific credibility—it subtly shifts responsibility away from clinical reasoning and onto tools.
More Patients vs. Better Outcomes
Another quiet assumption embedded in the argument is that helping more people is synonymous with helping people better. It isn’t.
Scaling a practice can improve access and sustainability, both of which matter. But as volume increases, so do the risks: shorter visits, standardized care pathways, less individualization. None of these are inherently bad, but they are not automatically good either. Outcomes per patient do not necessarily improve as patient count rises, and in some cases, they worsen.
Helping more people is a business metric. Helping people better is a clinical one. The two can overlap, but they are not interchangeable.
The Missing Piece: Ethical Tension
What’s striking about the “profit equals outcomes” narrative is not what it includes, but what it omits. There is no acknowledgment of ethical risk.
Every financial incentive structure carries the potential to distort judgment. In chiropractic, that distortion can show up as over-treatment, prolonged care plans without reassessment, or the routine sale of low-value adjuncts. These behaviors are not caused by profit itself, but by unexamined incentives and poorly defined outcome goals.
Ignoring this reality doesn’t protect the profession—it weakens it. A more credible argument would openly acknowledge that while financial health can support good care, it can also undermine it if left unchecked.
Outcomes, Defined—or Not at All
Finally, there’s the question that the infographic never asks: what do we mean by outcomes?
Pain reduction? Functional improvement? Patient satisfaction? Return to work? Long-term disability reduction? Each tells a different story, and each responds differently to variables like visit frequency, modality use, and patient education.
Without defining outcomes, claims about improving them become unfalsifiable. They sound good, but they don’t mean much.
A More Honest Conclusion
The problem with the claim that better revenue leads to better patient outcomes is not that it’s wrong—it’s that it’s incomplete.
Financial stability can support better outcomes by reducing clinician stress, improving systems, and allowing for ethical, evidence-based care. It can also, if poorly aligned, incentivize behaviors that undermine those same outcomes. Profit is a tool, not a proxy for quality.
If chiropractic wants to mature as a profession—clinically, scientifically, and culturally—we need to get comfortable holding both sides of that truth at once. Business competence is not the enemy of good care. But neither is it a guarantee of it.
The real work lives in the nuance, and that’s where the conversation needs to stay.
Have a wonderful week,
Lucas
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