I want to keep everyone updated on what I am currently working on to help support your practice and personal growth as doctors of chiropractic. This is based on teaching 4th year medical students and Family Practice Residents about chiropractic. I see firsthand what the MDs need and how interested they are in chiropractic care, the truth is they don’t trust our profession as being clinically competent, which is a significant barrier to more referrals! Without “trust” there is no relationship, I think that is a truism for most anything…So what do we do to gain trust and build a relationship? At the present time the MD Referral Program focuses on two main components (for most DCs in the field these are areas that they need A LOT of work), communicating research and timely/complete reporting. This program has this handled and many members have come a long way. The interesting part is that while you are fixing documentation/reporting issues and getting to know the chiropractic research better inadvertently your office is running more efficiently, your collections will increase and your new patient referrals will go up. Not a bad tradeoff for focusing a few hours per week on the things that matter.
So, what is the last barrier to building a career long relationship with the medical community? The last part of the puzzle is additional training that is comprehensive and will establish you as a spine care expert in your community. When it comes to post-graduate training there is a risk that there are hundreds of hours of didactic training and zero, nada, zilch clinical training. One of the most commonly asked questions by MDs when I teach them relates to our clinical training. How much do we get? How many patient contact hours are we getting? I personally agree that we do not get enough, but that is a topic for another discussion. Before I actually get to my point, let me tell you how the foundation of medical education works and a brief overview of how post-graduate medical education is processed, this will give you a great foundation to begin to understand how the MDs view other professions.
Medical Education
4 year undergraduate degree
4 years medical school – when they graduate they are licensed MDs but NOT BOARD CERTIFIED YET
Medical Residency – 3 years to 6 years depending on the specialty
– Each specialty has its own governing Board and examination; all require “recertification” on a pre-determined time frame.
– Medical Residents are paid, their hours are capped at 90 per week (each State is different but this is the general idea) and they are managed and overseen by their Attending MD which holds the Board Certification in that particular specialty. For this discussion Family Medicine is 3 years, in New York pay is $55,000 per year.
– Imagine how many patient contact hours you have at the end of even 3 years working 90 hours per week? These hours are split between inpatient (hospital) and outpatient (clinic) work, so the candidate gets exposed to REALLY SICK people…chiropractic currently does not have that, my opinion is that is a HUGE weakness in our educational system. That is the point of the hospital rotations some chiropractic institutions give…to expose the DC to bigger pathologies.
Medical Fellowship – additional 2-4 years of highly specialized training – usually surgical (spine/cardiac/oncology) or radiology.
Medical Post Graduate Education
All CME criteria are provided through the medical schools and are managed at the National Level. So what that means is there is no State BULLCRAP – if you are an MD and you go to a conference your credits are good in EVERY STATE. That is in stark contrast to the chiropractic profession where each State has its own rules. That is ridiculous. That is why the CME program is critical for you to grow your practice and build relationships, it works EVERYWHERE. Now one more item that is important for you to understand. That is HOW a medical specialty board is created, I just learned this a few months ago mostly by asking hundreds of questions and meditating on it. I needed to be able to put it all together so that I can teach it to you and create a system that will build your practice. Here is how it works…
A new medical specialty board will ALWAYS start out as a Certificate Program, which is how it gets created. With the Certificate Program there are set criteria on which present Boards are allowed to participate, it is not open to all. For example, the Addiction Medicine Certificate Program at University of Buffalo School of Medicine and Biomedical Sciences allowed only Board Certified Family Practice Physicians and Board Certified Psychiatrists to participate. The Certification included additional training, but was only a Certificate offering additional focused training. Once the Certificate Program gains some traction and there are enough physicians participating (remember the Certificate gives special treating privileges and will “protect” the physicians ability to provide certain treatments in the long term – chiropractic does not have that) a Board is created. The new Boards responsibilities are to oversee the education, testing and enforcement of the “rules” of the specialty while also producing the RESEARCH to maintain the Board, drive the education and DEFEND what the Board Certified Providers are doing in their clinics. HOW DIFFERENT IN CHIROPRACTIC. It seems to me that all our specialty Boards were created without anyone really understanding how a specialty Board works! How many of our Board publish any REAL RESEARCH? I am not even going to speak about the fact that regardless of your additional Board Certifications your FEE SCHEDULE is the same as a recent graduate. That also is a topic for a future discussion.
Now comes the fun part…in thinking about what I just shared with you and comparing it to our profession, can you see why sometimes the MD has a bias AGAINST chiropractic training? Ok, maybe that is not so much fun…but taking all this in, what the chiropractic profession needs is a way to educate chiropractic on “everything” spine with an emphasis on clinical exposure to SICK patients WHILE building your practice! How do we do that you ask??? J
We do that by creating a Fellowship in Evidenced Based Spine Care that is credentialed by the post graduate division of a CCE accredited Chiropractic School and the post graduate division of a medical school. That is a total game changer for your ability to build relationships with the medical profession in your community. I had briefly spoken about this on a webinar, but the details are pretty simple. This process will ensure that you understand EVERYTHING relating to current evidence based spine care in the United States. That means every profession that will put their hands on a patient’s spine along with the evidence or lack thereof for their interventions. Imagine REALLY knowing what the evidence says for facet ablasion, micro-discectomy, fusion, opioid medication or NSAIDs? You will have so much ammunition in your tool chest including being able to start the patient on the most conservative care path currently available. Everyone wins…Below is the outline of the program and today I am putting more of this together to send to the chiropractic school that we are working with as well as the medical school. I am anticipating a start date of July 1, 2014 for this…the first group to go through will be limited so as not to overwhelm a new system. I am in the process of establishing the enrollment criteria and fees so please stay tuned for that.
This is going to be a MAJOR focus of the MD Program since I personally believe it is critical for your long term success. Along with Bimonthly Flyers and Consultations I will be putting out more information in smaller bites over the next few weeks. See below, your clinical rotations (Grand Rounds) will include outpatient (clinics) and inpatient (hospital) rotations. This program will help you to establish those…it is easy.
Evidence Based Spine Practitioner Mini-Fellowship
Part I – Didactic Lecture – Distance Learning –
A Module I – Anatomy and Physiology of the Spine
B Module II – Spinal Biomechanics
C Module III – Chiropractic Research and Evidence
a. Chiropractic Management of Disability
b. Chiropractic Conditions – specific
c. DME Evidence
d. Additional modalities Evidence
D Module IV – Medical Research and Evidence
E Module V – Opioid Dependence and Addiction
a. Patient identification
b. Co-Management
c. Medication mechanism of action – opioid, opiate and non-narcotic
F Module VI – Cooperative Spine Care
a. Medical Specialist and Chiropractic Referral
b. PCP and Chiropractic Referral
G Module V – Evidence Based Documentation
a. EMR
b. Compliance
c. Macros
d. Billing and Collections
Part 2 – Grand Rounds and Clinical Rotations
A Neurosurgery or orthopedic neurosurgically trained
a. 10 article review with written report
B Interventional Pain Management
a. Epidural injection under Fluro
b. Facet Injection
c. Facet Ablation
d. Trigger point injection
e. 10 article review with written report
C MRI Tech
a. Observation
D Radiologist
a. MRI
b. Other imaging
c. 5 article review with written report (500 words)
E Electrodiagnostic Testing
a. Observation
b. 5 – Article Review
Neurology Rounds
a. CNS
b. Extremity including RSD
c. TBAI/mTBAI
d. 10 article review – 20 hours
G Final Report and Statement on the program
H Testing at each module and each grand rounds
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