Fireside Chat 4/30/18

This fireside chat is hopefully one of many.  These videos are for members, by members.  FTCA Members hang out and shoot the breeze.  We never know what might happen!  There is no agenda.  There is no script.  The format that worked today was that a post is made in the facebook group, and whoever shows up, shows up!  As you can see, some people roll in and some people roll out.

In this episode I am joined by Gregg Friedman DC, and then Blake Kalkstein DC takes us for a ride.  Then at the end Kurt Kippenberger DC jumps on the call to chill.

Now our first fireside chat should be available to all...

https://youtu.be/sA2u8LHWsw0

Moving Forward by Christina Aiello

Here is a blog entry from a chiropractic student, Christina Aiello.  Christina loves to mix her two passions, chiropractic and dance, which should serve her well in the future as she carves out a niche in her career.  You can find more of her blog at https://www.adjustingdance.com.

____________________________________________________________________________

As a follow up to my NCLC blog, I had been struggling. It was difficult for me to decide what direction to take or where to start this discussion.

I knew nothing about the divide in the chiropractic profession prior to entering school. Straight versus mixer, or science versus philosophy. I only knew from my past experience, which if I had to put them into a category I would say they are more “mixers”. They just listened to me and helped me recover from my injuries and get back into dancing at my fullest potential. That is what was most important to me and that is what I want to give to my future patients.

Now this post may turn away some of my classmates, but I needed to share my voice and my opinion based off an experience from when I first entered the DC program. I started school in May 2017, almost on a whim, but a well educated whim nonetheless. As I stated before, I did not know any of this divide in chiropractic but I knew what I had experienced before and I knew who I wanted to be. My confidence entering school was brought down all to quick when the harsh reality of the divide set it.

Let’s be honest, you can easily get me to free meetings and conferences with free food, so the promise of free pizza on a Friday night for only a few hours of my time seemed like a no brainer. The meeting was put on by a practice management group (nothing against practice management groups) and it had a bunch of their top “successful docs” in their group talking about their experience. Yes, getting out of debt and making money may be successful to some people, but it was not success for me and it was very intimidating.

Success to them meant numbers.

Don’t get me wrong, being able to see as many people and help as many people as you can is a great goal. But I knew I did not want to sacrifice quality for quantity, but this event made that seem like an impossible goal. Walking out I was confused and just feeling as though I was going to fail before I even started. That my dream practice was just that, a dream. I honestly thought I might drop out of the program and go back to the orthopedic/sports medicine M.D. route I had considered doing before. I was told how many chiropractors fail and how I had a chance to fail if I did not run my practice this way. I thought I knew what I wanted, but I lost my confidence in chiropractic and myself.

I am not bashing this group, nor any practice management group, club or an group of chiropractors. What you believe and what you are passionate about should be your guiding force throughout life. I am in no position to tell anyone that their opinions are wrong or they should think the same way I do. I am just a student eager to be out in the profession and make a difference in people’s lives. I just wish I had gone into that meeting more confident in myself and my capabilities because I left scared. Scared to be successful and even scared to be a chiropractor.

Is this what we are getting chiropractic students into? Scaring them into buying into management groups? Telling them they will fail even before they graduate? Having them doubt why they chose to get into chiropractic?

So how do we move FORWARD?

I just want current and future chiropractic students to know they are not alone, and that it is perfectly ok to have your own opinions and to question others. Stay firm in your beliefs and don’t let others tell you that you will fail if you do not believe the same things that they do. Be yourself and good things will come. You will find where you belong. I rediscovered my love and passion for what I am doing at NCLC this year, and I am forever thankful for the experience.

My classmates suggested I look into the Forward Thinking Chiropractic Alliance. A group of evidence-based doctors and students… and I am so thankful I did! The FTCA group and the FORWARD KC conference coming up in Kansas City has inspired me to write this post and speak up about how I am going to move forward, and how I can be that voice to help move my profession FORWARD.

More soon!

-Christina

Rebuttal to Dr. Beau Pierce's Article "Getting Adjusted Can Make You Smarter"

Rebuttal to Dr. Beau Pierce's Article "Getting Adjusted Can Make You Smarter"

(In this guest blog post, Dr.'s Lovich and Parekh politely dismantle the false claims put forth in Dr. Beau Pierce's article linked below.  We in the FTCA find that there is a serious disconnect in some corners of our profession between what evidence says, and what some colleagues say it says.  The root of that problem - whether it be a poor scientific foundation, inability to properly read a scientific paper, or just plain personal motive and unethical disregard - the root of that problem only fuels the divide between some elements of the chiropractic profession and the rest of the evidence based world.  

While some "straight" chiros will say that is fine, and even attack the merits and importance of evidence, they will also parade any poor evidence around as codified fact if it even hints slightly towards their preconceived beliefs.  My contention is that you can't have your cake and eat it too.  If you are "anti-evidence", and by that I mean not only ignorant of what the evidence is and how to interpret it, but also unable to accept it when it doesn't support your beliefs, then you can't use evidence in your favor at all.  And if you do wish to utilize evidence to support your practice (as we all should), then you better take the professional responsibility to understand how to interpret it properly, utilize it correctly in a clinical setting, and properly disseminate it to the general public without spreading nonsense. - Bobby Maybee DC)

  • Michael Lovich DC MS DACNB CCSP & Mehul Parekh DC DACNB

http://doctorbeau.com/new-chiropractic-research-shows-that-getting-adjusted-can-make-you-smarter/

Dr. Beau wrote an article seemingly digesting and explaining the application of the results of “Manipulation of Dysfunctional Spinal Joints Affects Sensorimotor Integration in the Prefrontal Cortex: a Brain Source Localization Study,” published in the journal, Neural Plasticity, in January 2016. Unfortunately, this piece is closer to Sponsored Content or an Op-Ed piece, because Dr. Beau’s conclusions are not supported by the paper itself.

The study (Lelic et al., 2016.) was published in a highly reputable, multi-disciplinary journal. In response to this study being published, Heidi Haavik stated, “We do know that spinal function does affect brain function. There’s now solid evidence that adjusting the spine changes brain function. This is the fourth time that the effect of adjusting the spine has on the brain has been studied. This last time it was studied and confirmed by an independent medical researcher.”

The study investigated changes in the N30 Somatosensory Evoked Potential amplitudes following spinal manipulation. The N30 peak is shown to have multiple neural generators, including the primary sensory cortex, basal ganglia, thalamus, premotor areas, and primary motor cortex, and is thought to reflect early Sensorimotor Integration.

They hypothesized that spinal manipulation would reduce the N30 amplitude, and this is attributed to a decrease in strength of the underlying brain sources. The post-intervention N30 amplitude analysis supported this hypothesis, and showed a decrease in N30 amplitude compared to control groups, specifically in Prefrontal Cortex activity by 20.2 ± 12.2%. What makes this change all the more significant is the association between decreased N30 amplitude and the presence of Parkinson’s Disease. This correlation was proposed in several research studies, including one cited by Dr. Haavik herself.

From here, connections can be drawn to, “position sense error, reaction time, cortical processing, cortical sensorimotor integration, reflex excitability, motor control, and lower limb muscle strength.” In reality, this paper has shown that peripheral input can have central effects. While it does not show that adjustments make you smarter, it does show that adjustments have a neuromodulatory effect on the brain. This can be positive or negative, and it depends on the neurophysiological stability of the brain. Another shortcoming of the study, noted by Dr. Haavik, was that the changes were only tracked for a period of 30 minutes post-manipulation. From this, we cannot infer any long term changes as a result of manipulation, beyond somatosensory activation in the associated areas.

Ultimately, the claim in the title of Dr. Beau’s article, that chiropractic adjustments can make you smarter, is an inappropriate extrapolation, just like his claim that “every time we’re adjusting someone, we’re having a big, positive effect on the brain.” Lelic et al., 2016 has only shown a decrease in activity by ~20% in the pre-frontal cortex. It is unfortunate that unsubstantiated extrapolations are commonplace in certain camps in this profession, but there is a growing movement to ensure quality and an evidence based mindset for the good of the patient.

Members Only Podcast - New Doc "Quickstart"

Join me and Dr. Brandon Langerude as we discuss some specific tactics to get a young doc started off quick in the realm of getting new patients into their fledgeling practice.  We discuss issues related to prospecting and relationship style marketing, which sometimes is the more applicable (and more affordable) approach for a new doc who hits the ground running.

FORWARD KC - Let's Start With "Why?"

FORWARD KC - Let's Start With "Why?"

The first annual convention of the Forward Thinking Chiropractic Alliance is taking place at Cleveland University Chiropractic College June 1-3, 2018. For those who don't know what the FTCA "is" or why it should even have an event, I have prepared a primer. After all, we must have, and start with a "why" if we are to go anywhere. So let us proceed.

Why is there a Forward Thinking Chiropractic Alliance?

For years there has been a heavy demand for a group or organization that was aimed towards and focused on the evidence based DC and student. Everywhere you turned, our leaders were often bogged down by slow changing politics and the need to make compromises. There has simply been too much political and financial pressure to stand up and proclaim that anything less than unethical, patient centered, and evidence informed chiropractic would be accepted.

Seeing this demand, the FTCA was formed as an exclusive group. Simply speaking, if you were an evidence based chiropractor, and questioned the status quo of doctor centered care that permeates the profession (especially on social media), you were often shouted down, ridiculed, threatened, immediately removed and blocked from social media groups. Your voice was silenced in social media spheres, with no place to rationally discuss progressive chiropractic. So the FTCA was formed.

Why FORWARD KC?

After a few years of the FTCA forming a direction and a head of steam, eventually members wanted to do SOMETHING. Is the FTCA a political group? Should we form a PAC? No, we didn't feel that was our mission. But we feel that mission is very important and look to support it fully, and support the major players in the political arena who support evidence based practice.

Is it a watchdog group, designed to take down quacks and fraudsters? Not entirely, particularly because that undertaking has very specific challenges that are hard to overcome in order to make it a successful endeavor. We do feel it is important, through public education and even ridicule, to point out the less desirable members of our profession, for the sake and safety of of the public, and of students who are often prey to their products.

As we have gone back and forth over the years, deciding what FTCA is and isn't, certain people have emerged from the fold to show themselves as leaders. FTCA isn't particularly any one "thing", it is an idea. And the idea is that each individual doctor, and the profession as a whole, should look towards the future, and not to the past, if they are to make chiropractic the profession the world truly needs.

So my idea was to promote that through education, and fellowship. To have us all meet in one spot, and to listen to the leaders of this movement who are paving the way for a bright chiropractic future. We're doing this to start the conversation. To place our stake in the sand and say here we are, and this is what we stand for. We want to carve out our niche in the chiropractic marketplace, and let the vendors, the money, know where when and what we are willing to spend our money on. This is the first step in letting the world know that a clearly defined group of evidence based chiropractors exists, and here we are.

Then we'll see what happens after that.

Why Cleveland Chiropractic College?

Admittedly, not a bastion of evidence based chiropractic. There is a simple answer: There is a hungry student base there, and they MADE it happen. The campus has been exceedingly supportive of the idea. And tremendously supportive of their students and the energy the students have put into the event. It is a great facility, a great town, and its in the middle of the USA, easy for travel.

Why these speakers?

Why Leonard Faye DC?

Dr. Faye is beloved across the profession. He is a legend. He was chosen because he has an understanding of the adjustment and its effects that few readily grasp. He also brings us back to a root idea that many young chiropractors seem to be losing generation by generation: the adjustment is a valuable tool, and being a good adjuster matters. It matters a lot. Dr. Faye WANTS to provide a presentation that reverberates throughout the profession, a magnum opus. We are providing the stage.

Why Jeffrey Langmaid DC? Has there been any doctor of recent memory that could communicate the importance, and more importantly the how to of marketing medical professionals better? One thing I wanted to be evident with our event, even though it is "evidence based" I wanted to be clear in saying that marketing, ethical marketing is an essential part of our practice. And being able to speak in a powerful manner with medical professionals is essential for bridging that gap.

Why Brandie Nemchenko DC? Brandie brings an idea to the seminar that needs to be exemplified... Hard freaking work. She is a successful chiropractor who has put in the work to do so. I wanted someone here to tell people that it isn't always easy, it isn't always glamorous, but even though it can be hard, it can also be the most rewarding life possible. Also, as Brandie and I have talked about quite often, there is a lack of female leadership in a profession that would thrive with a strong female presence. Honestly, there are MANY great evidence based female DCs out there, but she is the only one who stepped up and volunteered to speak right out of the gates. We need her to show young female DCs and students what is possible with the right focus and grit.

Why Gregg Friedman DC? Look, no one can do documentation better. Thats it. Gregg brings the knowledge and the party. We are honored to have him in our program. We are lucky.

Why Josh Satterlee DC? I don't know. He slipped in somehow. JUST KIDDING!! Josh has been teaching assessment and rehabilitation his whole career. Josh is proving himself as the expert in bridging the gap from rehab to fitness, on a business level. H's on a mission to make the profession a better place, and to help DCs make more money (they go hand in hand). He's a force to be reckoned with.

Why Jason Hulme DC? Because he is brilliant. Because in the future, if you can't assess, you can't success. And few can do it better. He's professional, and sharp, and will give you what you need, I have no doubts.

Why Cliff Tao DC DACBR? There simply isn't a DACBR in the game teaching field docs better than Cliff Tao. He's even brave enough to go into the strongholds of principled chiropractic to hopefully even teach them the proper ways to utilize and read radiographs. He's the best. Once again, we are honored to have him at our event.

Why Michael Massey DC? Michael knows Medicare inside and out. Nothing scares or confuses DCs more than medicare. Nothing in our practices needs to be improved more than our approach to medicare. An essential patient population that NEEDS our services, we need to do it the right way... walk our walk and talk our talk, and Dr. Massey is going to show us how.

Why Howard Fidler DC? Howie brings passion and experience to the game. Howie has been to the mountain top and has seen success with many great athletes. He's going to share his knowledge involving care of the extremities. Howie is everything, I have a feeling many of you will just want to be around him, something will rub off if you do!

Why Blake E. Kalkstein DC? Because Blake is, as I've named him, a fire breathing dragon. He's unlocked the code of social media marketing, and he wants to show you how too. He gets it. He wins if we all win. We lift each other up in this game. And Blake is a lifter.

Why Kevin Christie DC? Kevin Christie OWNS ethical chiropractic marketing. Owns it. And even he will admit that is essential to have great clinical skills as a DC, they get you nothing if no one knows that you exist or they don't know how to find you.

Why Benjamin Fergus DC? Dr. Fergus has been teaching assessment and rehabilitation across the globe. Making abstract approaches accessible and usable for DCs. He is bright, approachable, intelligent, and will give Drs the tools to succeed.

Why Brandon Steele DC? Brandon doesn't just know research, he knows how to apply it in practice. What good is evidence if it can't be used to help our patients? Dr. Steele is bridging the gaps in big ways, and he's here to help you build those bridges as well. He's also funny. That helps at a seminar.

Why Todd Riddle DC? Todd is a paragon of the rehab arts in the chiropractic profession. Todd also helps DCs bridge the gap, between soft tissue work and motion by way of FAKTR. He also serves as our appointed BBQ expert as we visit Kansas City proper.

Why David Wedemeyer DC? No one, and I mean NO ONE in our profession is as skilled as David in understanding foot biomechanics and orthotic application. David is at the event to show you the value, the application, and the assessment and outcome tools of orthotic implementation in your practice.

Why Greg Rose DC? Whether you know it or not, Dr. Rose is the most transformative figure in evidence based chiropractic. Whether he admits it or not. His understanding of biomechanics and the data sets he has acquired are unparalleled. The scope and meaning of his work span almost all sport. He's a fascinating presenter. He's a stud. He's an enigma. He will blow your mind.

I brought together speakers that i knew would give you CONTENT. Fresh and current content. And not be sales oriented or hold back on you. I didn't choose the same circuit speakers. I chose doers and doctors who are in the trenches. I chose winners.

Why the EXPO TED Talk?

You really have to ask why for a reason to party? The progressive practice expo was created by me as a way to demonstrate and expose the crowd to the many different facets of progressive practice that could not be covered in the original program. Its going to be like a cocktail party, with speakers giving short presentations about the angle of practice or discovery they've made on their own. I wanted this to be a vehicle for anyone, ANYONE to be able to step up to the mic and share something they find important to chiropractic. All attendees are eligible to present. There is an application from available and our final lineup will be announced at the end of March.

Members only party?

Yes, saturday evening there will be an FTCA Website members only party/gala. If you are a member of the FTCA website, you will get an invite. At that event we will make a big announcement about what is next for the FTCA!

Sponsors?

Yes, we will have sponsors and vendors. Many of them know nothing about you evidence based chiros, or that you even exist. They don't know your tastes or preferences. And as such, they dont know sometimes how to make products you LOVE. Imagine telling an EHR software developer what you NEED face to face, vs, hoping someday they'll get it right.

So to answer the question, "why?"... How about this...

Why Not?

Why not come out and join us? This is going to be epic, but its only epic if you're there with us.

http://forwardthinkingchiro.com

Mechanical Assessment Pyramid - Dr. Dino Pappas

In musculoskeletal medicine, lack of standardization is rampant. Ask several different professionals and they'll have different diagnoses, different treatment plans and different techniques/methods to treat patients. This begs the question of do you have ways and what are those ways of processing the exam data to obtain clinical success with patients and outstanding, rapidly-reproducible outcomes?

The following video covers the approach that I like to use. It isn't the only and maybe not the best way, but it's a systematized way to help me sift through the data to help generate outstanding, rapid and reproducible outcomes. What is your approach?

Dr. Dino Pappas

 

TORs Do (Some) Things Right - Mike Stanley DC

Forward from Dr. Maybee:

FTCA Blog features guest articles from FTCA members.  They of course are not completely the sanctioned opinions of the FTCA, but are editorial in nature.  And hopefully educational, or thought inspiring, and fresh, and and and...  A new perspective as we catapult this profession into a future leaning trajectory.  

With that in mind, it is however important to reflect upon the past.  It would be wasteful to take what has worked well in the past, and toss it merely because it is attached to "old thinking".  We don't want to throw the baby out with the bath water so to speak.  And we don't, if we are to be critical of the "straight" or "vitalistic" part of the profession, want to dismiss everything they have done as worthless or unimportant.  In fact, there are many things we can learn from that corner of the profession that could make our practices better.  There are things they do really, REALLY well.  

It would be advantageous for us, as progressive chiropractors, to recognize those things and re-engineer them into our evidence based practices.  As we move forward, it is important to define who and what we are as the chiropractors of the future, and dwell on or center our language on what we are NOT.  Dr. Mike Stanley understands this, and he expands upon it in the following blog entry.

Bobby Maybee DC

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TORs Do (Some) Things Right

Ah, the TORs. If you've been a member of the FTCA for more than...

*Checks watch*

24 hours...you have seen the disdain that we progressive chiropractors have for "The TORs." It's all too common to see Billy D freaking out about planes flying over California or yet another person that we've seen conned into a 3-year treatment plan, paid up front, for the bargain deal of $8,000. All you must do is attend 10 mandatory workshops, bring all your friends, shave your heads, drink this, put on these Nikes, and don't ask any questions.

There are plenty of TORs out there who are taking advantage of people for their own personal benefit out of nothing more than greed. Of course, there also are some TORs out there who have bought in and they think that they are doing a disservice to their patients by NOT signing them up for years of care because "If I don't check them for silent killers then WHO THE HELL WILL?!?!"

The TORs and the Progressives will likely never see eye to eye on chiropractic philosophy. The philosophical gap between the two is too great, and odds are that you have either bought in or you have not. However, I do believe that there are many things that we progressives can learn from the TORs when you look at the attitude they bring to practice and how they engage their patients and potential patients. They do a lot of things well, and I think that it is worth our time to recognize what those things are and apply them in our own lives and practice. Now before, you pluck the chickens and warm up the tar, hear me out.

TORs have certainty in the adjustment.

Certainty is a buzzword in chiropractic. It has gained a bad connotation due to its vague usage, but it is something that even we progressives should have when it comes to our best form of treatment, the chiropractic adjustment. I see too many progressives doubting their own training and treatment, and often over-complicating the issue. Let's be real, if you're not being dumb, you're not going to hurt anyone with an adjustment. In the absence of red flags, move the damn bone. The adjustment, a spinal manipulation, or whatever the hell you want to call it, is a powerful treatment. Don't be afraid to use it.

TORs aren't afraid to hustle.

Spinal screenings, health fairs, bridal shows, the mall. Many of us laugh when we see these poor saps wasting their weekends out there. We would never be caught dead doing such a thing! We chuckle that someone would stoop to that level, and then we sit back in our office and wonder where our patients are. Meanwhile, the doc you were just laughing at will see 15 new patients in the next week. Now, I'm not saying that we all need to do screenings at the mall, and God knows you shouldn’t lure people in with a bait and switch, but we also need to not be ashamed to get out and do some legwork. You may be a great doctor, but if no one knows who you are, they're going to go to the doc they know. And guess what? The general public doesn't care what the specific details of a chiropractor’s treatment philosophy are if they get results, and we all know you will get results in most cases by adjusting alone.

TORs don't care what other people think.

To be a TOR, you have to be someone who is comfortable challenging the status quo. TORs do not fall in line. They do not fit the mold. They do what they want when they want, and most don't care that we are hiding in our groups and laughing at them. They have defined their purpose, regardless of how much we

may disagree with it, and they are not afraid to go for it. We need more of this in the progressive world. Too often it seems like we are looking out the window and laughing at the TOR across the street when we don't even have our own office in order. Find how you want to treat and what chiropractic means to you and go for it. Stop worrying about what anyone else thinks. They aren't treating your patients and they aren't paying your bills.

TORs have passion.

Spend some time with some TORs. Their passion is infectious. They really do have a passion for helping people and they believe that chiropractic is the best way to do that. They get that twinkle in their eye when they talk about it. They get pumped up about chiropractic, and you cannot help but do the same when you are around them. Passion is what attracts people to anyone. Period. A person who is passionately speaking on a subject (even if it isn't one we agree with) will draw the crowd from the person who is robotically reading off today's newest research every time. Why? Because passion engages people on an emotional level. We need more passion in the progressive realm of chiropractic, and I'm not talking about passionately hating on the TORs. You'll win more people over when you passionately promote something rather than being critical regardless of how right you may be.

TORs don't think the grass is always greener.

Every now and then, the topic of bailing out of the profession comes up in the FTCA. I understand that for some people, this profession is not the right fit. If you got into chiropractic and you don't enjoy it or if you feel like you are being led elsewhere, best of luck to you and best wishes. However, if you want to make a good living in chiropractic, you must decide whether you're going to go all-in or whether you're going to fold. The chiropractic profession is not a profession that you can half-ass. No one, and I mean no one, does well in this profession by accident. You cannot succeed in chiropractic if you have one foot out of the door. The grass always looks greener, but every profession has the drama that the chiropractic profession has, it just is not at the forefront of your consciousness.

Being a successful chiropractor is hard. It's damn hard. However, this profession can provide you a great income and a great quality of life if you prove yourself worthy. It also cannot be denied that we have some hurdles to jump that no other profession has. Philosophically, the two camps in chiropractic could not be more divided, however, I do believe that we all have the same goal: to help as many people as we can live better lives through chiropractic care. While the two sides will likely never agree philosophically, I do believe that there are things that we can learn from one another to be successful and to help move the profession forward.

Be certain in your training and treatment, and if there's no reason not to, don't be afraid to adjust someone. Sometimes it can make the difference. Don't be afraid to get out and put in the legwork to build your practice. Stop caring what people think about you or how you treat your patients, and in that same vein, we could stand to stop picking apart everyone who doesn't practice identically to us on social media. One of the great things about chiropractic is you can practice how you want. As long as people are being ethical and getting results, give them a break. Finally, identify your passion within this profession and go all-in on it. This profession is not one for the lukewarm. The lukewarm will be chewed up and spit out.

The tides are turning in chiropractic. We are slowly seeing this ship turning around and that is due in large part to progressive chiropractors regaining public trust and integrating with other healthcare professionals in a patient-centered approach, but we still have to reach more people. While we may only see 10% of the population currently, the optimist in me means that we have a 90% untapped market. I think that if we take a step back we can learn to apply some techniques from our more vitalistic colleagues to reach the 90%, educate them on how we can help, and help the world to see how we are the answer when it comes to evaluating and treating the cause of pain without the use of drugs or surgery. 

Mike Stanley DC

A Marketing and Media Crash Course with Dr. Kevin Christie

This informative webinar was produced by Kevin Christie DC of Health-Fit Chiropractic & Sports Medicine.  Dr. Christie also administrates the Modern Chiropractic Marketing Facebook Group, which I highly recommend.

Check this video out and use it as a great launching pad for your content creation ideas and marketing strategy.  Don't just use your website as a digital business card...  CONTENT IS KING!!

Our Hybrid Model of Healthcare

Guest post by Dr. Josh Satterlee

I am a chiropractor, and I own my own clinic.

I am a strength coach, and I own my own gym.

I am a business owner, and I recognize the limits of each of those practices. And, in all three of those capacities, I am a witness to the changing landscape in healthcare, which is being reshaped due to changes in law, repayments and consumer desires.

But out of this chaos I think I’ve come up with a hybrid healthcare idea that makes perfect sense for me and my clients, and I think it can make sense for you, too.

Origin of the Idea

Quick history: I graduated from chiropractic college in 2006 and then opened a small office in Henderson, Nevada, with a partner. I was “Full-Body” certified in ART, and we worked the local race circuit to build up our clientele. So we had a pretty active client base. I fell in love with the SFMA, FMS and TPI in 2011. In 2012, we started seeing a significant decline in repayments from insurance. At the same time, I had been going to a CrossFit gym for about four years and treated many of my fellow box-goers. And then we got inspired to more fully combine our work with our passion—our sweat with our smarts—and we opened a hybrid facility in February 2013.

The idea basically came from two core convictions.

The first was teaching patients to move better. This is THE most important aspect of healthcare. See, doctors know that people need to exercise to keep their hearts healthy, keep the weight off, and keep their joints moving. However, if it hurts to move, most people will NOT move enough. So moving pain-free is a “first-principle” matter in healthcare. The idea also stemmed from an inherent limit within the current style of chiropractic: The better you are, the fewer visits you’ll see from each patient. It always bothered me that to make a decent, TESLA-driving living within chiropractic, I felt that you had to
sell your soul to the devil and push six-month care plans. We kept stats on every patient, and I was only averaging 4.7 visits per injury with my patients—and that included teaching home therapy as well. So the “customer value” was less than $1,000. And that was at a cash price of $85 per follow-up. In fact, I was seeing five to 14 new patients per week, and my schedule still had room. I ran that by my “straight chiro” friend, and he said that was a big number.

I also was seeing the huge influx of boutique gyms popping up—CrossFit boxes, Orange Theory, small yoga/pilates places. Although their average sale was small, it was recurring monthly revenue.

So we threw our hat in the ring.

Current Business Model

We ended up moving into a 5,000-square-foot office—more than triple the size of our old place. Along one side is our clinic with three large treatment rooms, and the doors of the treatment rooms open out to the gym. We want to empower our clients to get right back to training. The gym is an open-concept training space like a CrossFit gym, with a large, multipurpose rack as the centerpiece. We keep the place very clean and everything (save for the rack) is on wheels and can be moved. We change the floor plan every six weeks to keep it interesting and let our clients know we care.

We still have clients who are “treatment only” and have never used the gym other than for rehab. We also have a few gym members who have never been patients. And we have a large portion of people who get treatments and use the gym.

Most clients are looking for recommendations for what to do post-injury. And if you are trained in the FMS/SFMA model, you are probably performing a lot of rehab that looks similar to exercise. We use kettlebells extensively in rehab, and most of our lowback patients will work in some deadlifting before they leave. So, our thinking goes, why not keep them around by extending the exercise piece to them? That way, with our highly trained coaches, we can closely monitor their progress and correct their mistakes as they work their way back to good, functional health.

This develops the sweet spot for the business: gym memberships. It cures that part I don’t like about treating people as a chiropractor—when it goes on forever—and yet also encourages the doctor-client relationship to last as long as possible. As a business owner, it’s also reassuring to know that you have recurring monthly cashflow. Done correctly, this can become greater than 60 percent of your monthly revenue.

In our model, we try to perform a “discharge” FMS/YBT on each patient. This is included in their care plan, and it’s actually run by one of our trainers. It empowers the coaches and sets up a great conversation about the next step. Clients are invited to work out in the gym, and based on their FMS, we recommend Group, Small Group (4:1 ratio) or Individual (1:1) training. If they are a perfect fit, this sale is easy. One caveat, though, is a lot of patients were referred to us by another gym or another trainer. We work hard to send these people back to their gym with our training recommendations. As much as we’d love to have them join our gym, it would be bad karma and bad business to try and “poach” these people.

They often note our advantages over their old gyms, though. A big one is the quality, caring and attentiveness offered by our coaching staff.

In our model, the “traditional” CA role is boring and out of date. Our trainers function as CA’s. We find motivated, smart, hungry personal trainers and train them in the FMS and SFMA. They understand the system and know where they can help, but they don’t ever perform something beyond their scope. Instead of applying hot packs and EStim for the 18th time in a day, they are an active part of the patient’s case. They help reapply tape, teach home exercises, and offer some soft-tissue solutions. Thee trainers love it, the patients love the trainers, and this frees up the doctor to do what only he can do: diagnose and adjust.

One more bit of advice: Get every member of your team operating at the highest possible legal level of their training. Empower, don’t stifle. It has worked great for me.

For example, our head coach is Brian Chandler. He’s a licensed massage therapist and spent years in a big-box gym as a personal trainer. He is now trained in the SFMA, and he is able to help a lot of our clients through the transition from treatment to rehab to training. While doing this, he absolutely loves the challenge of getting our clients moving better. They perceive him as an expert, he works his butt off, and when the client needs to be manipulated, he refers them to me. This helps build the relationship AND it positions our facility as something special. Who else offers that? Chandler is also used to spending one hour with clients, which is perfect in his model. No one expects that a personal trainer will bill their insurance, either.

So the trainers in our clinic are treated as high-level players. The patients and clients positively respond to that “air of excellence,” and we can all help bounce ideas, exercises, and outcomes off each other because we are all using the same operating system. It’s the Functional Movement System, and it works great.

Recommendations

Looking back, we had a bumpy start to our gym. The main bump turned out to be time. You are only one person, and you may be asked to coach, treat, bill and manage. For a while, my Monday-Wednesday-Friday involved coaching classes at 5:30 a.m. and 5:30 p.m., then treating patients all day between. Most lunches were meetings to grow the business. I also cold-called 18 doctor’s offices to pitch my concept. On many Saturdays I would do presentation at local gyms or travel to teach with SFMA. It was crazy, but somehow I made it through. Here are some of the lessons I learned along the way: First, develop a system to “selling” at your clinic. I don’t mean a hard-style close in the ROF, but a systematic approach to how each patient gets processed and goes through care. You should work to make this so smooth that it runs even when you’re not there. This way your clinic revenue won’t take a dip while you get distracted by this new venture (ask me how I know). Second, develop early traction in the world of exercise. Host workshops for patients about mobility or shoulder care that are focused on a very active population. They have to perceive you (or your head trainer) as an expert in the field. And see if you can start your gym in someone else’s. We started an early class in a local CrossFit gym that let us use its space for free. Actually, we traded care (and the owner went to the finals at the 2012 CrossFit Games), so it was just a time investment.

Recap

I believe this is the model of the future. With the changes in healthcare and repayments declining, it becomes battle of value versus time. By leveraging our knowledge of movement, we can better help our clients. When your trainers can help with rehab, it establishes them as experts in the eyes of your patients. Then the lead in to the gym is easier. Plus, if you are able to capture just 10 percent of your chiropractic clients into a recurring revenue membership, you will have a highly successful gym. And you’d probably worry less about repayments and be more present with your patients. It works out for everyone.
By the way, we are looking to add a couple more clinicians to our team in the next year. If you are interested in joining us, please contact me. And if you have any questions about this model or need some help, I’m happy to share with you what I’ve learned. If nothing else, I can point you to someone who can help.

Resources

Here are some resources that have been helpful to us:
Gym Business Consultant: Thom Plummer. (http://www.thenfba.com/)
I met Thom through TPI, and he was incredibly instrumental in getting our systems up and running. Plus, he is quite inspirational and an all-around good guy.

Injury Risk Measurement: Move 2 Perform (www.move2perform.com)
The Move 2 Perform software prints out a report for each client, categorizing them into a risk bracket. This is the single best tool for client retention. Once you run the client through the test and print a report, the client essentially sells themselves on training with you. I can say that this tool also single handedly helped us land a 12-week,$14,000 contract to train the local fire department.

Equipment: Perform Better (www.performbetter.com)
The crew at Perform Better will hook you up with the right equipment. Plus, I would HIGHLY recommend their 3-Day Training Summits. It’s the best three days you can spend, and I would HIGHLY encourage you to take your trainers.

Functional Movement Systems (www.functionalmovement.com)
The FMS and SFMA are the single greatest tool in our arsenal. It’s not just the diagnostics (which are fantastic); it’s that the clinicians and the trainers are all communicating the same way. A DN for Hip IR, moving to a 2:3 makes sense to our crew, and the patients feel confident.

Dr. Jason Hulme, DC, Active Spine and Joint Center (http://www.activesjc.com/)
I met Jason at the Functional Movement Summit at Duke University a few years back. More than anyone else I know, he has developed an incredible system to implement the Functional Movement Systems into clinical practice. His consultation fee is money well spent to systematize and communicate your office systems.

NPE/Net Profit Explosion (www.netprofitexplosion.com)
I took NPE’s online-training course and it helped us get over the hurdle of not having great sales systems in our gym. Once we started running their systems, our gym revenues quickly beat our clinic revenues, which was awesome. Looking back, I wished we would have found them sooner. I can’t recommend them enough! I would talk to Ric Isaac there, and he can get you set up.

Custom Foot Orthoses

Chiropractic doctors see a variety of patients and complaints in daily practice and we offer highly beneficial treatment and care to the patients who seek our services. The majority of that care is focused on the spine, although we encounter a good deal of extremity complaints as well. The foot and ankle are an often overlooked etiology of many common complaints and training in this area and especially custom foot orthoses, is entirely lacking.

Corporate Spotlight: David Wedemeyer and Solelutions Orthotic Lab

Corporate Spotlight: David Wedemeyer and Solelutions Orthotic Lab

We are extremely excited about this post because it's our first ever Corporate Spotlight!

Dr. David Wedemeyer of Wedemeyer Chiropractic and Orthotics AND Solelutions Orthotic Lab has become the first corporate sponsor of the Forward Thinking Chiropractic Alliance.  Dr. Wedemeyer is located in Costa Mesa, California and is a Cleveland Chiropractic College - Los Angeles graduate.  To learn more about his view, experience, and sponsorship, keep reading!

Ego - A Rant

We have members who have been “in the field” for decades.  We have researchers who have worked on the newest and best methods known to chiropractic practice.  We have business owners who operate million dollar clinics.  We have students who have learned the best methods, as refined over years of practice.  We have new doctors who are learning new methods as you read this.