#1 Program and Office Infrastructure

MD Relationship Program


 From the Desk of:

William J Owens Jr DC, DAAMLP

#17 “Are You a Leader?”

I talk to many chiropractors across the country on a weekly basis and I would have to truthfully say, EVERY single one of them considers him/herself an “expert” in conservative spine care.   That is great and chiropractic has done very well at creating that feeling within the “chiropractic circle.”  What is interesting is that it doesn’t matter what WE THINK; what matters is how EVERYONE ELSE PERCEIVES US!  That is a major issue when I am consulting with chiropractors and helping them to build MD referral practices.  What you think doesn’t matter and as they say, the “proof is in the pudding…”

Dr. Studin uses the phrase, “March without appearing to march,” and that is a key thing in building a solid clinical reputation in your community.  Maybe a better way to think about the MD Program is REPUTATION MANAGEMENT.  There are two critical areas that need consistent attention when building your relationships. The first is how you are perceived clinically by the medical community. (Are you REALLY an expert?) Regardless of what MDs think about chiropractic, you are your own person and your reputation really does “precede you,” good or bad.  Most DCs never get noticed. Others are put on the “don’t go to them” list. Still others enjoy constant referrals on a weekly basis from numerous MD offices.  What is the difference?  It is PERCEPTION.  Here are some of the key factors that will positively affect perception in the community and a few questions to help you to understand these concepts.

Do you have training in advanced imaging?
What are the MINIMUM slice thicknesses for the cervical and lumbar spine as determined by the American College of Radiology?
Is a 3.0 T MRI useful for imaging the spine?
When is contrast required?

What is a neuroradiologist and how does he/she differ from a general radiologist?
How long can you do a bone scan after a fracture?

Do you have a current CV that shows your expertise?
What does “CV” stand for?

What is the difference between a CV and a resume?
Where is the majority of your CE budget spent?  (If you want to see trauma patients, do not have a CV full of wellness or nutritional classes; focus on your education.)

Are you an educator?
Have you ever written a professional article?
Do you read the latest research and then reach out to medical professionals?
Do you “teach” through reporting?

If you are having trouble with these basic concepts, call me and I can help you.  It is easy, but you need to know these things.  How can a doctor call him/herself an “expert” on the spine when he/she doesn’t understand radiology guidelines? 

The second perception has to do with the business perception.  This is an advanced concept that comes a bit later in your relationship with the MD.  This perception has to do with your ability to LEAD and help the MD get what he/she wants.  Someone that is both a provider and a resource is critical to long term growth.  MDs have to run businesses and, therefore, MUST see patients.  If you become a resource of patients, your value goes up.  In order to be a resource for new patients to the MD, the following points are crucial to understand.


Do you know what the MD does and when the procedure is indicated?
You need to be the person in charge and the leader.  You MUST understand when an epidural is the best choice for your patient.  Just because you cannot perform the procedure does not mean you’re allowed to be a dummy!  When you send a patient to vestibular rehabilitation, what are you expecting to happen to him/her?  What about EMG/NCV, V-ENG, SSEP or BAER? Did you know that you MUST have an order written?

Do you know how to properly order tests?
What is the minimum requirement for your files when ordering MRI, CT, interventional pain management, x-rays [even in your own clinic] or sending out for surgical consultations?
When is CT indicated over MRI? 
If a patient has a hip replacement, can he/she have an MRI?

Do you know how to examine and triage a patient with multiple complaints?
How are you at really “examining” a patient?  There are many DCs out there that glance over multiple complaints stating, “If I adjust them, they will get better.”  That is true and I see it every day in my clinic, but treatment MUST be directed by clinical evaluation.  A detailed history and examination is the first step in being able to “triage” a patient with a cervical spine injury, right shoulder injury and elbow pain.  The doctors that understand how to clinically evaluate the whole person are best at triage.  The patient wins because he/she gets the best care.  You win because you are being the doctor you should be and have a patient to refer.  The MD wins because he/she is getting the referral.  You win again because you are a resource for the MD.

Do you have the relationships to refer?Do you have a neurosurgeon to work with?   What about pain management; a neuropsychologist, a rheumatologist, a neurologist, neuroradiologist, an extremity orthopedic surgeon or an anesthesiologist?  Do you know if these doctors have a good relationship in the community?  Do they also have a referral base that you can benefit from?

Do you have your “expectations” in order?
This is super important.  You are NOT a schmuck or a second class clinician that hopes to get the scraps of busy offices.  Your expectations are for the MDs you are working with to refer to you and to report on what they are doing to “your patient.”  You also expect that your patients do not wait 4 weeks for an appointment and that they are treated with dignity and respect. 

There is a WHOLE lot in this consultation to think about.  Building relationships in the MD community is as rewarding as it gets and is critical to the long term security of the chiropractic profession.  We need to be who we are and stay true to our philosophy, but we need to teach MDs what we do and how to refer.  Call me and we can talk.{jcomments on}

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