In the first article in this series, I reviewed some of the many advantages that can be realized by having a multidisciplinary practice. I also discussed some of the changes in the health care industry that have made it advantageous for chiropractors to broaden the type of services that they offer in their practices. In this installment, I am going to highlight how important it is to create your multidisciplinary practice correctly, and teach you some of the basics that you must know in order to do it the right way. I can't tell you how many times I've heard unsuspecting chiropractors say that they don't think they need any help get- ting started. "It's going to be easy", they say. "I'll just hire an M.D. and we'll be multi-disciplinary in no time!" After many years of working in multi-disciplinary practices as a physician, and also advising and staffing them, I know that, when I hear these words, I am hearing a doctor who is setting him- or herself up for tremendous problems down the road. The truth is that setting up a multidisciplinary practice is a complex undertaking. It must be done with great care or the entire endeavor will be for naught. Simply having an MD on your staff is not going to help you, if you haven't addressed all of the issues that must be considered. What are some of the other things you will need to consider in order to do multidisciplinary practice "the right way"? First of all, you need to find an MD, right? Wrong. First you must have the proper consultants and legal advisors in place to assist you in setting up the correct corporate structure for your new venture. You must learn new office proce- dures and the correct way to bill for all of the new services you will provide. Searching for an MD without having this infrastructure in place is like attempting to erect a building without first laying a strong foundation. Don't Be Afraid to Ask! We have made it a policy of our medical staffing com- pany to recommend that our clients utilize the consulting services of a nationally recognized DCMD consulting company that we trust, because we know that they have the expertise necessary to create the right infrastructure. In addition, we employ the services of one of the larg- est healthcare law firms in the country, with local attorneys in each state, to be sure that the negotiations that take place with your MD are done in a timely and correct manner. Once your legal and operational infrastructure is in place, you are ready to think about finding the right medical doctor. You will want to give some thought to whether or not you want to use a professional staffing company or search on your own. Many doctors mistakenly assume that they will save money by not using the services of a staffing company. This is a very shortsighted view. You must constantly keep in mind the fact that you are making a tremendous investment in time, money, and in your future success, when you create your multidisciplinary practice. Next to you, your MD is the most important person in your practice, and finding the right medical doctor may be the most important hiring decision you will ever make in your professional career. Do you really want to cut corners here? I think not. Working on your own, it can be challenging to find MD's who understand and respect the chiropractic profession and their role in your practice. Frankly, most of my energy is spent not in searching for the right MD for a practice, but in resolving the miscommunications that commonly occur between MD's and DCs. Make no mistake about it, these mis-communications can be fatal to your relationship with the medical doctor and to your practice. You will not save money in the long run by hiring an MD at the lowest salary you can, and expecting to relate to him or her the same way you do your other employees. If you do, the medical doctor will never be truly involved in your practice, and when he or she leaves, your practice will be seriously disrupted. A Background Check is Paramount Recently there has been a spate of legal activity surrounding the employment of medical doctors by several unscrupulous practices and practice management consultants as "ghost" or "on-paper-only" multidisciplinary practice owners. In several cases, it was discovered that the medical doctor involved in several multidisciplinary practices had never even met the chiropractor, and had never even visited the practice location! Your medical doctor must have a bonajkle role in the day-to-day operations of your multidisciplinary practice. For this reason, the wise decision is to let experienced professionals find the right MD for you. The right medical doctor is one who will take an active role in the sue- cess of your practice, and one who will remain with you in that capacity for years to come. It's also very important to thoroughly check the background of the MD you choose. A National Data Bank check, available to the general public, is not sufficient. We employ databases that are not available to the general public that enable us to search for hidden problems in a doctor's background in every state. If this initial probe reveals a problem, we request a detailed report from the State Medical Board, including the actual transcripts of any legal proceedings conducted by that Board. A problem that might slip through the cracks of a more superficial background check will show up in living color with this more sophisticated and intense scrutiny. In addition to finding the right MD, you must also find a physical therapist that understands his or her role in the team approach to care of the multidisciplinary practice. Typically patients are scheduled for physical therapy 3-5 times per week. Therefore, your PT will spend more time in direct contact with your patients than any other professional on the multidisciplinary team. In addition to providing one-on-one active rehabilitation services and passive modalities, your physical therapist will perform diagnostic evaluations and re-evaluations, range of motion and manual muscle testing, and functional capacity evaluations. As with your medical staff, you shouldn't take shortcuts when you look for the right physical therapist. These professionals must also have their background and credentials checked thoroughly. Finally, once you have assembled the right professional staff, you must be sure that your multidisciplinary practice follows the standard of care for the medical community, which is very different from the chiropractic standard of care. If you do not follow the appropriate standard of care in your practice, your medical staff will not be comfortable, and you will leave yourself open to considerable liability. For example, it is important that your radiographic studies be over-read by a medical radiologist. It is the standard of care for X-ray films taken in a medical practice to be over-read by a medical radiologist, and so you must adopt this standard for your practice as well. The right practice management consultant can be a valuable resource with many of these standard of care issues. This is another good reason to have the support of excellent consultants and staffing professionals to guide you when you set up your practice. Multidisciplinary practice can be a wonderful experience for you, your patients, and your staff, if done correctly. Please, don't look for shortcuts in creating and staffing your new venture. Do it the right way! Marc H. Sencer, MD, FA CIP has spent years working as an ardent supporter of the chiropractic profession. He has served as the medical director in five multidisciplinary practices. Dr. Sencer is the Vice President of MD Solutions, a medical staffing company specializing in the needs of chiropractic practices. Through MD Solutions, Dr. Sencer has placed MD s and physical therapists in chiropractic practices across the country. He can be contacted at 1-800-665-0106, or on the internet at wMu.mvmedicalsolution.com.
