#1 Program and Office Infrastructure 

#28 Starting the Relationship – PART 1

I recently put out and email indicating that the next Consultation would be “The Pillars of Success”, which will help you to understand where the program is coming from and how to leverage it to build your practice. The more I thought about it though, the more I realized that I needed to take a step backward and write out the VERY basics. That way when you read the “Pillars”, you will actually be able to do something with it. So here it goes…

There are ways to ensure that you are positioning yourself to take advantage of every possible grain of momentum when building a relationship with the MD community. Although there are many paths to take, it all ends up in the same place. HOW CAN YOU HELP THE MD get that THEY WANT. It may be money or it may be an outlet for chronic patients. You don’t know until you start to build the relationship. The reality is though, every chiropractor they have met in their careers pander for patients and talk me, me, me. That is a huge turn off in our personal lives and is no different in the professional world. It creates a BAD first date and the MD will run from you…With that being said, let’s take a look at the best options to start developing a dialog with the MD, we will look at the Family Doctor (Internist, Family Practice), the Surgeon (Orthopedic spine or Neuro) and the Pain Management Specialist (Physiatrist).

[This Consultation will be for the Family Doctor, additional Consults will follow on the Surgeon and Pain Management MDs]. Each of these specialties sees practice building a little differently and if you get that, the relationship will be MUSC easier to build. Remember, you don’t know what THEY need and therefore can’t assume in which direction you will be going. It has to play out in front of you, that is the SECRET. Each case is different, every MD needs to be treated as an individual.

First let’s look at the family practice MD. This can be an internist or a general practitioner/family practice doctor. These are the practices that see patients on average 2-3 times per year and just so you know, a busy day for a primary care doctor will be 35 or so patients. There are three main categories of patients [outside of healthy patient physicals] in a primary care office and they fall into cardiovascular, diabetes and musculoskeletal [acute and chronic]. The primary care physicians that I know HATE musculoskeletal conditions and feel that those patients tend to have “multiple complains” and eat up a lot of resources in their offices. I should note that NOWHERE IN MEDICAL SCHOOL DO MDs LEARN THAT MUSCULOSKELETAL CONDITIONS ARE TO BE REFERRED TO PHYSICAL THERAPY, if anything it is in residency because the doctors teaching are using old techniques. PT referral is a learned behavior, and is partially based on the distrust of the chiropractic profession on the diagnosis side and lack of understanding current research topics and trends. Most family practice MDs have notread musculoskeletal research in years as most of their time is spent keeping up with chronic disease management. The first family practice resident that I had in my office said on his first day “wow, I didn’t know you guys did such a complete examination”. REALLY? 

When we are looking to build a relationship with the MD in this scenario we are being judged on diagnosis NOT techniques, so we need to start at the most basic level. The #1 and #2 tools that you have available to show clinical skill are your CV and your reports. Your CV is a living document and has to grow as you do. Your reports have to be spot on and sent regularly. That is the minimum requirement to START this process.

So how do we reach out to the primary care community? [Remember that we are looking for the ones that are interested in working with us, the others we could care less about]. There are two types of MDs in your area, ones that you know [a little or a lot] and ones that you do not know.

Aside from whether you know them or not these points are ALWAYS going on with the MD.

You ALWAYS send the initial, re-evaluations and discharge reports via fax. Everything is faxed. Based on current trends is will cost you $5 to mail a single letter! Faxing is essentially FREE and you have proof that it was received. [make sure you have a delivery confirmation page printed at the end of the fax for the patients file]

You call or text the MD when the patient has significant findings that warrant emergency referral or with pathological findings that require follow up at their office. Circumstances vary, so use your brain…

Now, let’s split these into two categories so that it is easier to understand and work out a plan.

MDs you don’t know – these MDs names are familiar to you and maybe you even see their patients although not on direct referral. They don’t really know you and you are not sure if they embrace chiropractic or not. Remember it wasn’t until the mid-1980’s that the AMA lifted it position that it is unethical to work with chiropractors. The MDs that were educated during or prior to that time are generally the most difficult to work with, it is not always the case but it holds true most of the time. Specialists are
different because they have learned that chiropractors have LOTS of patients to refer, I will cover that in more depth in the next Consultation.

This is where the educational binders and the “Cooperative Spine Care Initiative” come into play. If you need a refresher, review Consultation #4 for the phone script.  Inside the binder [pictures and the cover are in the Forms and Communications section of the MD site] you place your updated CV [use the template at www.uschirodirectory.com] and 5-6 of the research reviews. DO NOT fill it with office brochures or cards, that time will come. You are bringing updated and relevant  neuromusculoskeletal research to the medical community. You are an educator and this will allow you to see who is interested in working with you. The research will show WHY they need to refer to you, create a desired action by TEACHING them. They are much more powerful refers when they REALIZE it themselves…

MDs you know – this set of MDs are ones that you have gotten the occasional referral from, but it is not consistent and it really hasn’t take off. The binders are still a good idea, but you can take it all a step further. This has been successful for me in the past in the primary care and medical specialty worlds and is working across the country. I would call the office manager and say:

“I am expanding my neuromusculoskeletal and rehabilitation practice locally and am looking to work with a few primary care doctors in the area to better care for acute and chronic pain patients. I have examined and treated many of Dr ____’s patients with good results and he/she seems like he/she has a genuine concern for their care. I was wondering if Dr._____ would have a small amount of space that I could rent 1-2 mornings per month to consult with neuromusculoskeletal cases. Is there a time that I could stop down and speak with you a bit more about what I am proposing so that you might be able to run it by him?”

There are only 3 possibilities [the more they know you the higher the rate of success] the first is “NO”, the second would be “I think I have all the information I need, I will ask the doctor” and “yes, I think Dr. ____ would be very interested” This is a growing trend in my area and has been slowly percolating over the last 10 years. If it is not happening in your area it will, and you need to be the first to start asking. The next
several consultations will outline what to do at the meeting. For now, if you get here, CALL ME…

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