When I was at New York Chiropractic College in the 1970s, I learned anatomy from textbooks and a rhesus monkey. I learned physiology from textbooks and professors who taught students in local colleges how to adjust on a ripped adjusting table with duct tape holding it together in an abandoned elementary school’s auditorium. I learned about chiropractic in philosophy classes, which included textbooks that reflected the philosophy taught in class. The closest I came to research was reading B.J. Palmer’s Green Books, and I read most of them from cover to cover. That foundation sufficiently allowed me to have a very successful chiropractic career and enabled me to wake up every day privileged to go to work and serve. I can report 40 years later that I made the best career choice possible.
However, upon graduating from chiropractic college, I sat during commencement and had so many questions but absolutely no answers. I wanted to know why people got well, how chiropractic work could cure diseases (as so many claimed), and what else a chiropractic adjustment could do to help the sick. There were so many unanswered questions, and I vowed that before I died, I would have those answers and be part of the solution.
Growing up, I remember watching Neil Armstrong take the first step on the moon on July 20, 1969, and the comments were, “I never thought we could do that, but we did.” During my graduation, I recall telling myself that if we could put a man on the moon, I could help answer those questions about what I know to be true about chiropractic and helping the sick beyond pain relief and joint rehabilitation. That “yet unanswered” truth is based upon the tens of thousands of patients I have since witnessed get well—watching the sick get better.
In the span of my “short” 40-year career, through the evidence, we have come to understand that D.D. and B.J. Palmer were correct—almost. There are bones on nerves, just not nerve roots; how they came so close without the advances of imaging or neurodiagnostic testing is nothing short of “Herculean” in conclusion. We now understand how the chiropractic adjustment works, including why there is pain modulation, encompassing both central sensitizations and local effects. We understand so much, and it is all evidence-based. Collectively, we owe so much to researchers worldwide who have published many of those answers. This outpouring of information has occurred predominantly over the past 20 years.
Today I want to report that we are close to answering many of the questions I had while sitting on that graduation stage. We now have the tools in place to render evidence in literature about the effects of chiropractic care on systemic diseases. We already know the mechanisms, and all that is left is “connecting the dots.” For those “steeped in philosophy,” let me remind you what Dr. Frank Zolli, the founder of the University of Bridgeport, College of Chiropractic, and my former clinic director in the 1970s, taught me. He taught that philosophy is the study of truth versus dogma that will erode the fabric of our profession. For those who believe that chiropractic is only good for pain management and joint rehabilitation, I also implore you to read the previous statement.
I calculate that I am halfway through my career, and for the first time, I have more answers than questions. However, the balance of those questions centers on spinal biomechanics and the neurological sequelae to patho-neuro-biomechanic lesions or vertebral subluxations, as historically labeled. With the tools in place and collaboration from computer science, medicine, and engineering, the correlation of systemic diseases and chiropractic care is within our grasp. This does not negate the volume of literature on pain management, scoliosis, degenerative changes, and a host of other issues related to chiropractic because they are all critical to our future. The conglomeration of research gives us choices for how we choose to practice chiropractic with a more “evidence-based” approach. The stronger the evidence, the more stable the profession. However, this still leaves room for practicing with what we know works, just not yet why or published.
State of the Practice of Chiropractic
The chiropractic profession is doing extremely well. As previously described, research is being published that validates what we have been saying for years, and patients consistently rate chiropractic very high in patient satisfaction. The practice of chiropractic is also doing very well for many, while others struggle. In part, the current “uptick” in practice is due to COVID and the changes that many offices made. However, others have experienced a downturn in their practice for the same reasons. The dichotomy of utilization is typically reflected in the incidence of infection in a doctor’s community and the doctor’s understanding of what needs to be done to overcome the fears of current and potential patients.
COVID has changed the marketplace of chiropractic, and, from a strategic business strategy, you can position your reputation in your community and increase market share significantly to endure well past the COVID pandemic. Think of the adage, “As you get older, you become more of who you are.” COVID has caused us to “get older” much quicker, and to compete, we must accelerate those action steps that typically take years to both develop and accomplish. I will focus on the previously used words that are the keys to success, no matter the environment— 1) strategy, 2) reputation, 3) endure, and 4) accomplish.
Strategy
The strategy is to expand your marketplace to ensure that you create multiple access points or referral streams into your practice. It is no great secret that the lifeblood of any business or practice is new business or, in our case, new patients. Advertising, standing in malls with crooked spines, and breakfast, lunches, and dinners have yielded costly and modest but unsustainable results. Being involved in chiropractic politics through nepotism has delivered referrals in the past, but those “underhanded” actions are directed to only a few in power (typically at the state level) and are rapidly disappearing.
The only strategy is to expand your referral sources and then get them to run after you. What that looks like is your phone ringing consistently with lawyers, medical primary care providers, medical specialists, emergency rooms, urgent care centers, and large corporations seeking your advice, sending patients for your care, or requesting second opinions. It then expands to asking you to teach them, get research on various topics, and bringing you into their organizations to present because they see you as a solution to their problems. What I have described is called primary spine care (PSC), and it is the verified solution to chiropractic utilization locally, nationally, and globally. I can say that with 100% certainty because this strategy has already gotten 1,158,506 new patients into chiropractor’s offices since 2012.
Graphically, here is what the PSC strategy looks like:
To implement your strategy, you must vigorously study the most successful businesses in our sector, the insurance carriers. The carriers realized a long time ago that playing the long game was the only solution to becoming one of the most powerful financial sectors in society. However, they needed a “rock-solid” infrastructure and very smart people to get there. You need the same.
Reputation
Your reputation is the tool that puts your strategy into motion and will secure its success. Your reputation is comprised of three components—1) formal credentials, 2) the knowledge behind those credentials, and 3) putting that knowledge into action by managing and treating patients to successful outcomes. Never lose sight that your doctoral degree in chiropractic, although critical to “be in the game,” is where you start but not where you end. That is your essential yet basic credential.
Credentials are not just the letters after your DC; they are equally the citations in your curriculum vitae (CV) that reflect formal coursework. Our profession is mandated to have graduate (postdoctoral) chiropractic education because those wiser than us recognize that advances and areas need to continually evolve to better serve our patients. Since your reputation evolves with your credentials, choose your coursework wisely. You should also limit your coursework to instructors who have impeccable credentials and the reputation of delivering excellence in content and presentation. In many medical and legal forums, you could be challenged with, “Where did you learn that?” or, “Who trained you?” I get feedback from many doctors nationally who shared that the person who trained them became a “bridge-builder” and, in most circumstances, led to referrals. For example, when a neurosurgeon asked who trained me, my answer was Robert Peyster, MD, neuroradiologist trained at Harvard’s Massachusetts General Hospital and now the chief of neuroradiology at the State University of New York at Stony Brook, School of Medicine. The entire relationship changed then. Before that statement, I was considered a therapist—no different from a physical therapist, but now I am considered a highly trained peer. However, they will “test you” on your knowledge to become that peer, and with the proper credentials and training, that is the easy part.
In building your strategy with your reputation, you can become qualified in many disciplines. You can earn formal credentials as trauma qualified, MRI qualified, hospital qualified, primary spine care qualified, evaluation and management qualified, expert witness, and documentation qualified, as well as complete a mini-fellowship in both MRI spine and MRI extremities. Each of these qualifications reflects a significant amount of coursework, where most are credentialed through both chiropractic and medical academia, and most are recognized through formal academia.
The highest level of credential in our profession, from my perspective, is to become a fellow in spinal biomechanics and trauma. All the above are the tools required to compete in the marketplace to make your competition irrelevant.
Enduring
Marketing, advertising, fancy meals, ball games, and standing in a field are all great for that moment in time. You spent a considerable amount of money, often prostituted yourself, and performed many acts of “veiled begging” for referrals. And then, it’s over. Other than your reputation of being a beggar, what's left? A few referrals? A tattered reputation and a screenshot of your ad? As a strategic business strategist in the healthcare sector, I can say with 100% certainty that unless you have a program that will endure the balance of your career, your practice will be a perpetual rollercoaster. Your income will fluctuate, and you will be forever frustrated. There are exceptions, but they are few.
When you have earned a qualification or become a fellow, that endures the balance of your career. The knowledge you acquire and your CV become your tools to open the referral doors. All that is left is to have a strategy to take your reputation with the tools you earned that will endure the balance of your career. Unless you are building an enduring strategy, plan on struggling in perpetuity. There is a caveat, though. Once all the pieces are in place, that’s when you add marketing, advertising, and fancy dinners, albeit on a very limited and “strategic” basis.
Accomplish
The last step is to accomplish the previous steps and get your referral sources to know that you are the solution to their practice and business challenges. Your strategy starts with a reputation as being clinically excellent (which has nothing to do with your ability to help people get well) that will endure throughout your career because once you have attained a credential, it can never be taken away. All that remains is a plan to accomplish your goal of a constant stream of new patients.
The plan is to strategically position yourself so that your referral sources see you as their clinical and business solutions. If you follow the two pyramids in the graphic, you can see it starts with an infrastructure that does not have any “one” solution. The solution is comprised of all the little things required of successful professional documentation, communication, triage, being an expert in all the modalities used for diagnosis (X-ray, MRI, CT Scan, EMG-NCV, etc.), and understanding the needs of both medical and legal experts.
Too many doctors are still looking for that “magic report,” or the one advertisement, website, newsletter, or research article that will open the “floodgates” of referrals. Here is the hard truth; it doesn’t exist because you would have already seen it if it did. The overwhelming majority of doctors with whom I work are typically experienced practitioners. Younger doctors too often look for that “get-rich-quick” scheme, where more experienced doctors have already tried and failed. I can say again with 100% certainty that it doesn’t exist. However, the “superstar” doctors are usually the younger doctors who have embraced the concept of clinical excellence as the foundation for enduring success.
Conclusion
The published evidence in the past 20 years has given chiropractic a strong foothold in the healthcare community that has allowed us to provide answers beyond philosophy. The evidence has answered so many questions about why chiropractic adjustment works and how the brain is affected by our care. This answers questions about pain, with answers about systemic diseases and chiropractic care within our grasp.
The evidence has also expanded our ability to be PSC providers and be considered the first option for referrals on spinal-related conditions. To achieve this goal, a strategic business strategy needs to be put in place requiring four components — 1) strategy, 2) reputation, 3) endure, and 4) accomplish. These are not “sound-bite” solutions because they require formal credentials through postdoctoral, graduate chiropractic study, and then a strategic plan to get your referral sources to run after you. All the tools are now available to get there.
Dr. Mark Studin is an Adjunct Associate Professor of Chiropractic at the University of Bridgeport, School of Chiropractic [UBSC]. He teaches MRI spine interpretation, documentation, and Triaging the injured. He also coordinates a chiropractic clinical rotation for UBSC on Neuroradiology at the State University of New York at Stony Brook, School of Medicine, Department of Radiology. He is also an Adjunct Professor of Clinical Sciences at Cleveland University Kansas City, and Texas Chiropractic College teaching and coordinating Post-Doctoral Education. Dr. Studin is a Graduate Medical Educational Provider at the State University of New York at Buffalo, Jacobs School of Medicine and Biomedical Sciences teaching an array of courses from documentation to basic and advanced imaging. This outpouring of information has occurred predominantly over the last 20 years (if you want to read concise synopsis of much of the research, please go to www.USChiropracticDirectory.co... and click the research tab, the cost 0.)
