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He Who Hesitates is Lost

by | Jan 23, 2019 | 0 comments

When almost fifty percent of United States citizens have a problem, they visit their primary care physician, but somewhat unjustly family practice, pediatrics, and internal medicine are among the lowest paid salaries for physicians. This situation has forced a number of physicians to seek out new and novel ways to bridge the revenue gap to their higher paid peers.

The options for boosting revenue streams are wide-ranging, and it can seem daunting to evaluate every opportunity on the market. Cold laser therapy, weight loss, supplements, stem cell are just a few examples. There are advantages and disadvantages to each but client expectations can be high and if a prescribed unsubstantiated product or service fails to meet these lofty expectations fully; it is the physician they will blame.

Indeed, now, more than ever retention is critical. Therefore, meeting client expectations is increasingly challenging. If a client, who has been placed on the latest weight loss supplement in conjunction with stem cell treatment, experiences little or no improvement there is only one person who takes the bulk of the blame, and that is their primary care doctor. And, where Mr. Johnson might have been a regular service user for decades the push to a new experimental treatment could have placed doubt in his mind about the quality of advice he has received.

As doctors struggle with a high volume and turnover of patients, there are no resources to experiment with new treatments. Physicians are more stressed than ever as alarmingly, America is running short on the valued profession. According to the Association of American Medical Colleges, America will have a shortage of 100,000 doctors by 2030, triggered by the increasing population, the extended life expectancy, and the retirement of doctors in practice.2 Most family doctors are busier than ever, and have little or no time to decide what treatments to introduce that can provide a business edge.

However, there is a consensus building among pioneering physicians that there is a treatment that has a scientifically proven track record for reducing pain and the ramifications are that clients are rewarding their primary care physician with loyalty and repeat business.3 As clients experience the power of cold laser therapy, they become evangelic (they tell their friends). Patients are getting out of pain in a cost-effective way, so referrals are becoming the primary source of client acquisition—therefore marketing spend is reduced. However, there is a catch; most insurance policies do not cover cold laser therapy. This creates an opportunity, as some physicians shy away from non-insurance backed treatments, others are embracing the nomenclature of ‘pioneer in practice.’

As traditionalist doctors scramble for the latest insurance allowed treatment, the Frank Sinatra “I did it my way” primary care physicians such as chiropractors are leading the pack when it comes to treating pain in a way that works. It’s a classic case of first mover advantage. And, according to Simon Medcalfe, associate finance professor at Augusta University’s Hull College of Business, first mover advantage is just as relevant in healthcare as it is in retail.4 Which poses the question, given the benefits to patients why are the major insurance companies not onboard? Low-level laser therapy (LLLT) has been put forward as a panacea for a wide variety of illnesses including wound healing, tuberculosis and musculoskeletal conditions such as osteoarthritis, rheumatoid arthritis, fibromyalgia and carpal tunnel syndrome.5 Little or no efficacy has been proven for the majority of these bold claims apart from pain relief and sports injuries.6 There is not enough evidence in peer-reviewed literature to conclude that LLLT works for the conditions mentioned above calling for large, well-designed clinical trials to demonstrate the effectiveness of LLLT for a wider range of conditions.

As you read this, manufacturers are setting up well-designed, double-blind clinical trials to pave the wave for LLLT to be a must-have pain relief treatment, not just a new toy for primary care physicians. In the present day of evidence-based care, it not enough to rely on what was done in the past. It is paramount that top physicians pave the way ahead and not only believe in what needs to be done but can back that up in a clinical setting.7 Of course, this can be expensive, but if manufacturers expect LLLT operators to incur tens of thousands of dollars to purchase this innovative technology, getting no reimbursement is not a viable option at least in the long term. The good news is that the service is gaining in popularity, and industry trend-setters are starting to get behind the game-changing technology. You can expect more controlled studies in the future, but they need to focus on trials that use the right dosimetric parameters which are patient specific. If the wavelength, irradiance (power density), pulse structure, coherence, polarization, energy, fluence, irradiation time, contact versus non-contact application, and repetition regimen are sub-optimal, this can result in reduced effectiveness or even tissue damage.

In essence, as it stands, the first mover advantage lies to physicians who realize that he who hesitates is lost. But, as with all early adopters, it is best to tread carefully. Therefore, using the right software in adjunct with the new LLLT machine is the only way forward. Utilising the recognized software will ensure you use the optimal settings for each new patient. It will track and record progress, and allow you to predict recovery time—to temper patient expectations. In a healthcare world where clients want more and more, there may just be a way—through carefully executed cold laser therapy—to provide affordable, effective, and efficient pain treatment that adds a sustainable revenue stream to your clinic.


1.     Number of active physicians in the U.S. in 2017, by specialty area. Statistica. 2017.

2.     Sarah Mann. New Research Shows Shortage of More than 100,000 Doctors by 2030. Association of American Medical Colleges. March 14 2017.

3.     Cotler, et al. The Use of Low Level Laser Therapy (LLLT) for Musculoskeletal Pain. US National Library of Medicine. MOJ Orthop Rheumatol. 2015; 2(5): 00068.

4.     Simon Medcalfe. First-mover advantage’ applies to retailers – and hospitals. The Augusta Chronicle. March 4 2017.

5.     Elwakil TF et al. Treatment of carpal tunnel syndrome by low-level laser versus open carpal tunnel release. NCBI. March 3 2007.

6.     Morimoto, et al. Low level laser therapy for sports injuries. US National Library of Medicine. 2013;22(1):17-20.

7.     Hoon Chung et al. The Nuts and Bolts of Low-level Laser (Light) Therapy. NCBI. Feb 1 2013.