The Chiropractor as the 1st Referral Option
FEATURE
Is Chiropractic Headed Towards Back Pain Only?
Mark Studin
William J. Owens
TO DIRECTLY ADDRESS THE QUESTION, “Is BEING THE FIRST REFERRAL OPTION FOR SPINE PUSHING THE CHIROPRACTIC PROFESSION TO BEING SOLELY BACK PAIN DOCTORS?”, THE ANSWER IS BOTH A RESOUNDING “YES” AND A “HECK NO.”
IN FEBRUARY AND MARCH 2015, WE AUTHORED ARTICLES TITLED, “CHIROPRACTIC IS THE PRIMARY CARE PROVIDER FOR SPINE” AND “CHIROPRACTIC VS. PRIMARY MEDICAL CARE: WHO IS BEST AND SAFER FOR PRIMARY SPINE CARE?” THIS ARTICLE IS MORE OF A POSITIONING STATEMENT FOR THE PROFESSION TO HELP EACH PRACTITIONER APPLY THOSE CONCEPTS TO HIS OR HER PRACTICE AND TO UNDERSTAND WHAT IS HAPPENING ON A NATIONAL SCALE.
Thirty-four years ago, I was intrigued with the chiropractic wellness paradigm and advertised extensively in my community for “wellness care.” The results were a robust failure from a marketing perspective, and I was relegated to health fairs, spinal screenings, bent pens, chiropractic lectures, and any other venue or gimmick I could come up with because it was all I had. I was also following the action steps that many of my predecessors and mentors had taken and even considered a bluegrass band and spaghetti dinner to attract people to teach them about chiropractic. I did this because I had great respect for my predecessors who started with virtually nothing and gave the chiropractic profession a foundation from which to grow. That created a chiropractic base, which was predominately from the public’s voice, based upon individual successes and testimonials of chiropractic care.
Today, however, the story has changed. The research is becoming more plentiful and starting to verify what chiropractors and their patients have been claiming since 1895. Chiropractic academic institutions and graduate-level education are stalling to position chiropractors at a peer level with many medical specialists. The combination of the above is starting to change
^Chiropractic academic institutions and graduate-level education are starting to position chiropractors at a peer level with many medical specialists.??
■ "This type of chiropractic research is setting the stage for getting an unprecedented amount of chiropractic patient referrals from the medical community. J J
the chiropractic narrative to both the public and medical communities. To start accessing much of the pro-chiropractic research, go to the free portal www.USChiropracticDirectory. com and learn many of the wonders of chiropractic through the eyes of the scientific community. Chiropractors in the field should start this as soon as possible. This type of chiropractic research is setting the stage for getting an unprecedented amount of chiropractic patient referrals from the medical community.
It is this type of research, along with our basic and graduate academic training, that has gotten attention from medicine at both the practice and academic levels. The authors firmly believe this is the solution for the significant underutilization of chiropractic that has plagued the profession since 1895. Medical primary care providers care for 95% of the population.
Therefore, when speaking or communicating with MDs that are either primary care or medical specialists, we must understand that back pain is the number two diagnosis in the United States, according to many sources. As a result, primary care medical doctors who are trained predominantly in the management of systemic disorders have little to no training in mechanical musculoskeletal disorders, especially in the spine. As a result, they reach for either muscle relaxants or opioids, which aren’t effective in resolving the underlying problem. In fact, they have potentially significant adverse side effects with ultimately no effect on the function of the spine and nervous system. The result has become an addicted population that continues to suffer from the original underlying spinal complaint.
Another significant issue is that medical primary care doctors, as a rule, do not want to manage these patients. However, our population has been trained to seek their counsel first. In a typical scenario, those patients who fail with these ineffective medications are referred to medical specialists whose first line of treatment is more of the same drugs. The next line of treatment in the medical model of spine care is usually physical therapy, which has a very poor record in treating mechanical spinal musculoskeletal disorders in comparison to chiropractic. In fact, most medical students and residents are not taught to refer to physical therapy, but many do so because they have received marketing materials from the therapists. Too often, these patients then end up back in their primary care medical doctors’ offices weeks or months later with the same underlying problems. However, they aie now seeking additional medication as a result of long-term use and addiction.
^Primary care medical doctors who are trained predominantly in the management of systemic disorders have little to no training in mechanical musculoskeletal disorders, especially in the spine. ï J
Many medical primary care providers claim to avoid chiropractic because of the lack of scientific evidence validating the efficacy of chiropractic care. That is no longer true, however most chiropractors aren’t even aware of the pro-chiropractic research that has been published in the scientific community. Unfortunately, they are still trying to discuss treatment modalities and/or techniques with the medical community, which has turned a “deaf ear” to those arguments for more than a century. Once the literature is introduced, all that is left is for the doctor of chiropractic to prove that he or she is worthy of “peer status” based upon his or her knowledge base and ability to properly assess and diagnose the spine patient.
This is where the choice of the type of your graduate-level training will serve you in being a true spine specialist. The purpose of your postdoctoral-level training is to give you a firm foundation in “everything spine,” as well as certify that you ai e competent and a benefit to the public. Your doctoral training gives you the basics upon which to grow and build a reputation in your community as a thoroughly educated spine doctor. It is also the wisdom of each state, which mandates graduate-level education or postdoctoral continuing education to maintain your license. It is at this level that each doctor must choose carefully to both further his or her career and the chiropractic profession.
It has been the authors’ extensive experience, through market research, that advanced education on disc pathology (herniation and bulges), MRI interpretation, and spinal pathology has been the foundation of referral-producing conversations with medical primary care doctors and medical specialists. It is through these conversations, which are bolstered with scientific evidence on chiropractic that has been at the center of this huge paradigm shift in the medical community considering chiropractic as the first referral option for primary spine care.
It is always easy to theorize and hypothesize on any idea, no matter how grandiose, or to extrapolate unrealized outcomes. However, in this instance, the authors have spent the
^One chiropractor is getting between 30 and 60 new patients a month referred by 15 primary care doctors and five emergency rooms. ï Ï
last six years planning and putting together working scenarios to make these theories a reality, having used two cities as our test markets. In Buffalo, New York, over the past six months, one chiropractor is getting between 30 and 60 new patients a month referred by 15 primary care doctors and five emergency rooms. This doctor also feels that because of the paralyzing weather in Buffalo this winter, those numbers have been significantly repressed, and he expects at least twice that amount over the next six months. In Detroit, Michigan, over the past three months, one chiropractor has made a relationship with 10 medical primary care doctors and is now getting approximately seven referrals every practice week on a consistent basis.
In both instances, each doctor feels that these numbers aie only the “tip of the iceberg” because as the patient feedback with their medical primary care doctors grows and their education process is in place, those medical doctors will become more confident and refer with zero reservations. The authors have also taken into account that they aie overturning a lifetime of prejudice against the chiropractic profession from medicine, and these are significant gains in a short amount of time, which broadcasts the true effectiveness of the published chiropractic evidence delivered in the proper manner. The authors are also training doctors in more than a dozen cities across the country to create the same paradigm since the previously mentioned scenario is easily reproducible nationally for the betterment of both the profession and the suffering patient population.
To go one step further, the authors have trained an additional few hundred doctors nationally in just the basics. The statistics came back as follows. For those following the program of utilizing research and increasing one’s knowledge base and credentials, 30% of the doctors are getting more referrals from medical specialists; 22% of the doctors are getting more referrals from medical primary care providers; 87% of the doctors are getting more referrals from lawyers; and 52% of the doctors are getting more referrals from their existing patients. If these statistics are verifying that as a profession, chiropractic should embrace this position then utilization will not be a problem. The only problem chiropractors will have then will be a shortage of chiropractors and chiropractic educational institutions because chiropractors currently are not positioned to handle the significant influx of patients based upon current professional demographics.
Currently, medicine is embracing chiropractic for mechanical back pain and that is predominately where chiropractic referrals will be derived. A chiropractor should not care how a patient gets into his or her office. The authors are more than happy to confine our conversations with our referral sources about solely back pain or neck pain. Once a patient has been referred, then you have the opportunity to treat the musculoskeletal issues and educate the patient on any further chiropractic related problem you choose to educate your patient with, provided, of course, that it is within your lawful scope and is clinically indicated for that patient. Will this lead to back care only? That is your choice in your office based upon how you choose to practice. In the end, every choice is right for the chiropractor making it.
JSZ Dr. Mark Studin is an adjunct associate professor of chiropractic at the University of Bridgeport ^ College of Chiropractic and a clinical presenter
/ I for the State of New York at Buffalo, School of W /¿Æ Medicine and Biomedical Sciences for postdoctoral education, teaching MRI spine interpretation and triaging trauma cases. He is also the president of the Academy of Chiropractic teaching doctors of chiropractic how to interface with the legal community (www.DoctorsPIProgram.com). He teaches MRI interpretation and triaging trauma cases to doctors of all disciplines nationally and studies trends in health care on a national scale (www.TeachDoctors.com). He can be reached at [email protected] or at 631-786-4253.
Dr. Bill Owens is presently in private practice in Buffalo and Rochester, New York, and generates the majority of his new patient referrals directly from the primary care medical community. He is an associate adjunct professor at the State University of New York at Buffalo School of Medicine and Biomedical Sciences as well as the University of Bridgeport, College of Chiropractic. He also works directly with doctors of chiropractic to help them build relationships with medical providers in their community. He can be reached at dr owensicf academyof chiropractic, com or 716-228-3847, or by visiting www. mdreferratprogram. com.
