Within the neoliberal model, the chiropractor is motivated to practice more like a neoliberal technician than a professional clinician. In this model the chiropractor is a marionette, providing products and services as neoliberal puppeteers (e.g. the fee-for-service health care system, product manufacturers, practice management firms, corporate manual therapy and assessment technique systems) pull the strings. Instead of learning from engagement with patients and implementing this learning to the betterment of other patients, neoliberalism incentivizes prioritizing increased service production, practice management skills, and building a practice through retaining patients who can afford the “chiropractic lifestyle”. This is exemplified by a portion of chiropractors delivering care outside of guideline recommendations including providing excessive services that promote ongoing passive care, offering services without evidence to support their use, and over-utilizing imaging [21].
Certain chiropractic communication and marketing practices may elevate chiropractors’ financial self-interests over best patient care practices. Chiropractic has embraced marketing and entrepreneurialism with financial achievement seen as a gauge of success [12]. Marketing and communication practices that focus on appealing to fear, such as for health risks of “vertebral subluxation” may drive the patient to seek ongoing care. These practices may be unethical, [12] however, and impact an individual’s pain and potential for related disability [20].
Another common practice building tactic is tallying and advertising patient satisfaction metrics and testimonial stories to the public. The consumer may believe these advertisements indicate the chiropractor’s professional expertise, altruism, compassion, and self-sacrifice. Ironically, even a genuinely well-intentioned chiropractor’s decision making, when framed by this neoliberal construct, may be motivated more by accumulating positive patient reviews or likes on their social media feed than by implementing best clinical judgement, especially when such judgment conflicts with patient expectations. This scenario reinforces the neoliberal system by exploiting the patient experience as a means to generating greater profits, potentially at the expense of best clinical decision making and patients’ wellbeing.