Introduction to the FTCA Research Committee

Here is a brief introduction of the FTCA Research Committee and an update on some of the projects they are working on for FTCA members!

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Greetings,

The FTCA research committee, Dale Thompson as chair, desires to help bridge gaps between the chiropractor and their patients, the public, healthcare providers, and researchers. We plan to produce monthly “newsletters” for the website which provides a list of the top 10 published research papers in the last 30 days.

We want to organize a student poster presentation for our annual conferences. These may be formal or informal projects. Awards will be given to the best presentations. We plan to produce brochures that members can give to patients on a specific condition. Wall posters that can be used to help educate the patient. Posters that provide more doctor centered information to help the FTCA member understand the condition and help guide their treatments.  A brief summary of pertinent research and educational materials on a topic that can be given to other healthcare providers. Media products that members can use on their web pages or for the purpose of public education.

A few other possible future projects include being an avenue to help connect researchers with the appropriate clinicians when they wish to conduct clinically-based research. Also, a publication of a differential diagnosis for “red flags”. Hopefully these projects will help The FTCA member to better transfer research into everyday clinical use.

Dale Thompson DC,
Research Committee Chair

Introduction to the FTCA Political Action Committee

Please take time to read the following introduction from Jonathan Parham DC, the Chair of the FTCA Political Action Committee.  A lot of people are very excited to see what may come out of this committee.  Myself, as the founder of the FTCA, all I could really hope for was that their actions will encourage someone, anyone to be involved in their professions political activities in any way possible.  Get out there and represent.  I promise you good things will happen.

Bobby Maybee DC

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Hello FTCA! As chair of the FTCA Political Action Committee, it is my honor to help guide us through the political world in regards to chiropractic. My team and I have set some goals as to what we want to provide to you as members, and I want us to be as transparent as possible, so I have shared them below.

Our committee is not in the business of trying to create new legislation, but in supporting the political organizations and their agendas by rallying our troops with calls to action. This may be as simple as donations, or as involved as filling seats on state association or national association executive boards. We know that some states and organizations are less than aligned with our progressive nature, and we will address those issues through specific action steps. This does mean, that we will be calling on you to rise up to the call when needed! Without showing up, we have no voice. We intend to make our voices loud, and our influence far reaching.

More than anything, our goal is to streamline communication to you, our members, about what is actually happening in health care and how you can make an impact!

Below are our goals, they are lofty. But with time, and persistence, I believe they are attainable.

1. 85% of ftca members also be members of their national, and state associations(if applicable).

2. Annual fundraising of $50k for either the ACA or  state association PACs for SPECIFIC events/legislators. Monthly donations do not count.

3. One ftca member on each state association board within 3 years. Election cycles vary, and we will need time to work on this.

4. Broad involvement. Our goal as a team should be to raise awareness through grassroots efforts. I’d like to have every state(and maybe one person assigned to international affairs) assigned to a member of this committee. That person will be responsible for ensuring that our group is aware of the legislative affairs in relation to chiropractic and health care in that state. When needed, we will raise money, and/or, mobilize people in that state to take action.

5. My personal goal is to have every state association, ACA delegate, and any other groups, aware that we exist and will have a voice!


If you have questions, or want to know how to get more involved today, please never hesitate to reach out!

#riseup

Jonathan Parham
Chair- FTCA Political Action Committee

Introduction to the FTCA Business and Marketing Committee

Forward Thinking Chiropractic Alliance website members are going to receive frequent content from a handful of committee's who have volunteered to take on the task of producing valuable pieces of content for said members.  This article introduces us all to the Business and Marketing Committee, and some of the things they would like to accomplish for you.  Exciting!

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Are you stuck in the throes of starting your new practice? Have you joined an existing practice and you’re responsible for bringing in your own patients? Has your business plateaued, and you’re looking to give it a kickstart and make some changes?

This probably describes many or all of the FTCA, so you’re not alone. Welcome to your newest marketing and business resource, brought to you by the FTCA. We intend to provide you with monthly. actionable, content.

We want to be more than a blog that gives ideas with the intent of selling our services. We want to provide step-by-step instruction for tactics and strategies that are already tried and true. Look forward to monthly content for:

● business systems and resources

● content marketing strategies

● before, during, and after- unit marketing strategies

● digital marketing

● networking tactics

● and much more.

If you’re starting from scratch, we’ll have a quick start guide; several strategies designed to give you the biggest bang for your limited buck.

If you’re rebranding and have some resources at your disposal, we’ll provide you with some guidance, or at least some advice so you don’t get fleeced by a designer or agency.

If you’re an associate and you’re limited in what you can say and do, we’ll provide some tactics to work within those constraints. Basically, we all have our own needs or focuses, and we’re going to try to meet all of them, to some extent or another.

What are you doing right now in your marketing that is yielding the best results? How are you encouraging referrals? Besides “delivering great quality care,” what is an action you can take to increase your referrals?

This month and next we’re going to touch on branding, or messaging. We want you to be able to be crystal-clear in the message you deliver to others. We want your prospects to be able to understand what you do, and if they’re the right patient for you.

Most of us would think that any patient is the right patient for us, but the ever-popular Pareto’s Principle would say otherwise. The idea is that 80 percent of the results come from 20 percent of the effort, so the idea is to focus our message and our attention on the 20 percent, so we can maximize the effectiveness of our message.

This 20 percent would be described as our “perfect patient.” This is the person who has been so thrilled with our treatment that they constantly refer. This is the patient we get excited about working with, and we would like to multiply them. They pay without complaint, and reschedule without reminders.

Effective marketing is efficient marketing, so we really want to be able to direct all of our messaging to that 20 percent. To do that we need to truly identify who that is, what they want, and how we can deliver it to them.

There are many ways to do this. You could go through your files, with your staff if you have any (they will inevitably have insight that you don’t in this exercise), and identify patients that energize you, or at the very least don’t drain the life out of you.

Identify obvious common demographic traits. Where do they live? How old are they? Do they have kids? What are their hobbies? Shopping habits? Vacation destinations? Organizations they’re involved in? Employers?

You could identify a few patients that stand out, and offer them a cup of coffee in exchange for a quick conversation. In this conversation you could find out what really drives them, what they really want.

We all talk about getting people out of pain, but there’s a lot more to it than that. We want to find out what’s truly important to them, what they want to keep doing. Chances are, these activities or values are shared with others, and this could be a way to identify what you should be saying.

For example, instead of, “I get rid of back pain.” You could say, “I ensure that you’re able to keep playing in your tennis league,” or “We help you stay strong and healthy so you can keep up with your kids as they’re growing up.”

I’m sure you’ve heard this before, or at least some variation of it, but the importance should not be overlooked. Don’t presume that you know your perfect patient either. Some leg work has to be done, or there will probably be some incongruency, some disconnect that will get in the way of this strategy.

Make sure you have your values clearly laid out, your mission and vision locked in, and you can really hone in on your 20 percent by getting to know what really gets them up in the

morning. Because as much as your practice is all-consuming, it’s all about your patients. Make them the hero of their story (more on that in detail next month), and they will care about what you can do for them.

Exercise: Take action! Go through your patient files and identify some patients that you just seem to click with. In conversation with them, identify what is actually important to them. Find out what their values are. As above, where do they live? How old are they? Do they have kids? What are their hobbies? Shopping habits? Vacation destinations? Organizations they’re involved in? Employers?

Perhaps in your new patient histories you can identify what their pain is preventing them from doing. If you are just starting, maybe just identify who you enjoy working with through their activities (you have to start somewhere).

Again, don’t assume others’ values. Find them out in conversation, so you actually know what they are. You will probably need to step out of your comfort zone, but that’s ok. That will be necessary during many points in your career, and you’ve probably already done so, many times over.

Remember, nothing happens without you taking action. If you don’t take action here, this will be another useless blog article. You can learn all you want about business and marketing systems, but if you don’t implement, you will not see the results.

Next month we’ll be covering the creation of your message, using your perfect patient, in addition to some quick start ideas. If you have any requests, please get in touch with us, as we want to give you what you want and what you need. Remember to take action or nothing happens.

Andy Cook DC, Committee Chair

Introduction to the Critical Thinking Committee​​​​​​​

Prologue:  The FTCA has moved in a new direction recently.  That new direction is the creation of committees who will work for the benefit of the members of the FTCA and the chiropractic profession as a whole.  Each of these committees will be undertaking tasks and producing content that they themselves have felt is important to FTCA members.  They are all volunteer, they are using their own resourcefulness to accomplish these goals.  And they have my utter thanks and gratitude for stepping up.  This letter is an introduction to your CRITICAL THINKING COMMITTEE.  Having a foundation of critical thinking skills is a hallmark necessity for a Forward Thinking chiropractor.

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Introduction to the Critical Thinking Committee

 

Dear FTCA members,

 

This is our first post so we’d like to introduce ourselves and describe what we are about. Our committee members are: Ashley Dent, Garth Aamodt, Iperlitta Lolis, Jessica Eliason, Jillian Mlinarcik, Melissa MacDonald, Michael Lovich, Michael Raucci, Scott Bennington, Sean Gregory, Steve Pratt, Yannick Shultz, Leighia Wells, and myself, Andrew Shepherd as committee leader.

 

One of our main goals is to provide a new approach to engagement with our peers and the wider community through the use of critical thinking. A basic definition of this is described by Paul and Elder (2008):

“Critical thinking is the process of deliberate, systematic and logical thinking on any subject, while considering bias or assumptions that may affect your discussion. Critical thinking can be defined as, “the art of analyzing and evaluating thinking with a view to improving it”

 

This definition will be explored more thoroughly in future posts from us but suffice to say it is our intention to try and put this method of thinking into practice within our Facebook discussions between members to foster a more thoughtful and professional approach to our dialogue.

 

Another, more profound goal of the group is to begin to build a Forward Thinking philosophy. There are so many current explanations of what chiropractic philosophy is but many of these are not based in reality but rather in belief systems.

 

We would like to develop a true chiropractic philosophy, based on wisdom, intellectual culture and a search for knowledge using the method of science, which incorporates rational and critical thinking, healthy skepticism and ethics.

 

We hope that everyone will engage in this process and welcome all discussion on building both our critical thinking skills and a Forward Thinking Chiropractic philosophy.

 

Warm Regards,

The Critical Thinking Committee


References:

 

 

Richard Paul and Linda Elder, The Miniature Guide to Critical Thinking Concepts and Tools, Foundation for Critical Thinking Press, 2008

Injury Prevention Tips for Our Troops - Dino Pappas DC

Dr Pappas was generous enough to share a slideshow he has prepared in regards to our tactical athletes, our troops.  This presentation is not placed behind a membership wall so that as many people can access it as possible.  The FTCA does hold dearly the conviction that our active duty soldiers, and veterans, receive the highest quality care possible.  It is our hope and the hope of Dr. Pappas that this presentation contributes to that conviction.

Reconciling Order and Chaos in the Chiropractic Profession

Reconciling Order and Chaos in the Chiropractic Profession

Last night I attended a lecture from Dr. Jordan Peterson, a PHD and Clinical Psychologist. Some of you are aware of him through numerous avenues and through his recent thrust into politically divided spheres. Not the point right now.  This post is focused on his lectures and his clinical perspective specifically.

He recently wrote a book "12 Rules of Life, and Antidote to Chaos", which yes, '12 rules' is kind of a cliche, however the depth he goes into in "An antidote to chaos" is not. It is a deep book.

At Forward KC I gave a brief lecture styled after that book. I called it "10 Rules to Chiropractic Life" (Because 10 rules are better than 12).  I recommend the Peterson book, I learned a lot about our profession and even ourselves in FTCA through the book, the ideas, and last nights lecture.

Lets combine that with an anonymous survey Kevin Christie and I just recently did. A survey where the NUMBER ONE AND NUMBER TWO RESULTS absolutely shocked me. The question was essentially "What do you fear the most?' 

Number one response to the question was something akin to responses like fearing how "the other side of the profession is ruining it" or "we dont have any respect because of the straights" "MDs not respecting us" "DPTs encroaching on our territory" and a multitude of these types of answers that can be summed up as "other people ruining it all for me"

Well, this completely contradicts the points that Dr. Peterson makes in "12 Rules..." and makes in general in lecture and elsewhere. First and foremost... "Other people" cannot ruin your thing for you. And that same sentiment goes for straights who feel that "mixers" or nontraditional chiropractors mess up their paradigm.  To me so many people were blaming the crux of all the professions problem on the wrong thing.  Outside themselves.  The bigger problems, and the ones you can tangible do something about, rest on the inside and directly around us.  

Dr. Peterson writes about the concepts of Order and Chaos in his book. A lot of times he's referring to the political spectrum, but I saw immediately how this fit into the chiropractic spectrum. Representatives of Chaos within our profession tend to be the "straights". They favor less rule, they favor less organization, they favor less evidence also less science. They favor less answers and more "freedom" to act as they feel fit. They essentially like to act as if they are molding from a lump of clay. They like to take from nothing (Universal intelligence or quantum? Language they use) and make something. 

The irony here is that if chaos is on a far left of a scale, they must always make SOMETHING out of that NOTHING, so they have the proclivity to create order out of their chaos, up to a limit. That limit appears to be within their specific belief system. That is why the 33 principles is so important to them, Before that, any level of chaos is warranted. But it stops once it meets the Hadrians wall of the 33 principles. Then there is a political refusal to cross that line.

Progressive chiropractors (mixers) tend to favor more order, more rules, more legislation, more regulatory intervention, more science. They tend to be agents of order in the profession. The irony here is that as they do that, many within their own ranks destroy that order or hierarchy, and then try to create their own "chaos". Usually in the form of trying to create new seminar series', new explanations or newly wrapped explanations for old concepts. 

However, they only create chaos up to the line they meet with their ethos, which is science. OR at least biological plausibility. Just as straights will create order until they meet the 33 principles, progressives will create chaos up until they violate the lines of science (most of the time).

Take for example, from our progressive end of the scale, "Pain Science". The Biopsychosocial concept of pain has been talked about and researched for decades.  Leonard Faye has been involved with it for 30, 40, 50 years.  Craig Liebenson has written about it in his texts. Waddell wrote about it. We've had it on scientific record for decades. Yet what have we found? New "Pain Science" gurus have sprung up talking about the new concept and idea of pain science. Its not new!

There are multiple examples of this, but it would be difficult to cite them without making reference to specific names of specific people who made this move to create chaos in the orderly side of the profession. Even if for personal gain or notoriety.

However, is creating Order out of chaos bad for straights? Is creating chaos out of order bad for progressives? Not entirely. It is known that too much order can lead to tyranny. It is known that to much chaos can lead to absolute destruction. In our case, the straights are CORRECT to fight against too much order. The progressives are RIGHT to fight against too much disorder in our profession.

On many levels... BOTH SIDES ARE RIGHT!

Now theres another dichotomy working as well in this battle. Straights represent the "old way of doing things", progressives represent "the new way of doing things" Now the roles of order and chaos are flipped. Straights represent the ORDER of doing it as things were designed and not changing the status quo. Progressives represent a new disorder to them of chopping down their old ways and building anew. 

Its really a fascinating mix we have going on here. Both sides essentially play multiple roles in the battle between order and chaos. Most of the players doing it completely subconsciously. Most people dont entirely do this because of money motivations or ethical considerations as we might assume, they actually do it (based on Peterson's interpretation of the data) based in their own personality temperment.

You are on any side of this battle because of who you are. What you believe to a core. I personally believe you can argue anything with anyone in this world. You can debate, you can rationalize, you can appeal to emotion. However, once you begin to discuss core beliefs or ideologies, you can no longer argue, because that is what the person IS, and that will never change and they will defend it to the grave.

Peterson was asked in his lecture, paraphrasing "So how does one side win the battle over the other?"

They dont. THEY DONT. Both sides are essential to one another. To maintain balance. It is an existential tug of war where, if you do it right, everything comes out okay in the wash. That is where we find ourselves. Straights NEED progressives. Progressives NEED straights.

Or as Peterson put it, we all think politically "If we as democrats could just get rid of those republicans, we would have the utopia we've always clamored for", or vice versa. But thats not how it works. Its a checks and balances. The USA has voted 50/50 essentially for these two parties over the last 20 years. It doesn't matter in an overall sense. Politically, if you wish your opponent would "disappear", you're really wishing half the population would disappear? Friends, families, loved ones, colleagues?

The same goes for chiropractic. 

If progressives were successful in removing every single "straight" from the profession, would it make for a better profession? You might think yes, but of course the answer is no. And vice versa. They need each other. Otherwise they teeter towards the tyranny that would choke this profession to non existence with too much order. Or they would evaporate completely with no structure and complete chaos/disorder.

We always say, an entrance exam sure would fix all of our problems. It might or might not. Maybe an entrance exam that focused on personality profiles, sure. Profile types that tend to become straight in thinking, and types that become progressive in thinking (Research project idea for any out there willing to tackle it!). So yes, you could eliminate half the profession based on core values, but would you want to?

Peterson outlines in more ancient marriages the symbolism was meant to show that a man and a woman, when married, entered into a relationship with a third "higher ideal". And depending on your culture that higher ideal could be many things, God, Jesus, Yahweh, Truth, etc. Whatever it was. And then the man and the woman, through marriage worked together to uphold that higher ideal. Thats why people stand under an arch when married, or under a candle, or at an alter. Its a triumvirate. A team of push and pull to work towards an ideal. Checks and balances with an end goal in mind.

Is it the same nowadays? Well thats a different cultural discussion. I'm an online "ordained minister" and Ive married close to a dozen couples. Almost all of them are shocked at the symbolism of the ceremony I expose them too during their marriage. Man would do man stuff, woman would do woman stuff, and for better or worse even that has dissolved from our culture. My point being, not to make cultural commentary, that even us as chiropractors have lost that relationship in our marriage of both sides with a "higher ideal".

The straights do straight things, the mixers do mixer things, and never to they interrelate. And neither of them are focused properly on the higher ideal.

Does that mean we need unity? NO!! The husband and the wife argue. Thats what they do. They constantly battle on how they do things the right way or the wrong way, and they compromise, oriented towards the higher ideals.

What we need are higher ideals!!!

Now, the straights will tell you that we already have higher ideals, the chiropractic principles. Nope sorry, we are telling you, those no longer apply (or maybe never did) as the higher ideals of the profession, as a whole. It is not accepted.

The progressives will tell you the higher ideal is science. Nope, that too is wrong. NOt that science doesn't play an important role in helping us understand the world around us and how we should act within it, it is not a higher ideal for how people should behave. It is merely a powerful tool.

We need, as Peterson stated last night in his lecture, better language towards each other, more specific spelling out of roles. We need to identify the the times and moments we spend the most time TOGETHER, and make those moments as peaceful as possible. While still maintaining our individuality. We dont need "unity" as so many people seem to define it these days, where we all get along and there are no problems. We need better communication and higher ideals to pursue together.

On that note, subluxation. Stay or go? It most certainly is a very POOR way of communicating. To our partners, to the professional public, and on some levels the way it is used, to the general public. Its akin to asking your spouse how they're doing and they say "fine". What the hell does fine mean? WE may have accepted subluxation as lexicon, but it is a BAD lexicon because it has no solid definition. Accepting subluxation as lexicon as we have is akin to just letting your spouses "fine" comment go on. Ignore it, she said she was fine, she must be fine whatever that means, not my issue.

So ive addressed "unity" and ive addressed "subluxation", whats next? How do we make our marriage better?

We sit down together, use better language towards each other. We recognize that we need each other and no one is going anywhere. We demand more from each other. We would want our spouse to be ethical. We would want our spouse to be fair. We would want our spouse to be the best they could be. Because, as Peterson stated, you could win an argument, and your spouse lose, but then youd be married to a loser, and what would that make you?

If we treat our professional relationship as a marriage, and people come to this table honestly, we could win as a whole. If one of the spouses is irreconcilable, then the only logical next thing is divorce. Real talk.

This is not a unity message. I hope people can see the subtle difference between the rainbows and unicorns stylized "unity" that seems to be tossed around these days, and a stable functional marriage or relationship.  Billy Demoss is the equivelent to your spouse chewing with their mouth open at dinner. I dont have to accept that. But me n Billy do have to come to an agreement on a much higher ideal, one that allows me to tell him to quit chewing with his mouth open, or bop him on his bald head and say "knock it off", or one that encourages me to just let it go, so we can get to that higher place together. 

So I apologize if I have very little tolerance for poorly formed "unity" messages. We need better language, we need to do better, together. Neither of us are going anywhere, so don't let that other side own you. Dont be afraid, be involved. And remember as an FTCA member, you ARE an agent of order, but chaos has a place and deserves some respect. Not unity. Just respect.

p.s.  And I know that the relationship between the two sides of this profession is not a marriage.  Its called a metaphor.  Its probably closer linked to a family situation.  We are two brothers or sisters that have to live in the same house together, but really can't stand each other.  That doesn't matter.  The chores still have to get done, we still have to go to all the big celebrations together, we still have to get good grades and take care of each other and our neighborhoods.  Whether we like each other or not, we are bonded, and we might as well suck it up and try to make something good of it.  That takes two to tango however...

Dino Pappas DC - The DC/ATC Relationship

Prologue

I’ve seen some posts and rhetoric recently in chiropractic forums on social media that concern me.  Largely the context of these posts is negative and often misinformed. Typically, the posts ridicule athletic trainers. In some cases, the critique is pointed toward a specific athletic trainer. Fair enough.  

Every profession has the spectrum from superstars to clowns. In other cases, the negative critique is pointed towards the profession at large. These posts are misinformed.  I’d like to point out that a couple bad apples do not make a bunch. Let’s first clean our own mess up as chiropractors before we throw ridicule at another profession. Chiropractors have done more lately to damage the reputation of chiropractic than almost any other entity. Seriously, let’s clean up our mess before we scorn anyone else.

I’m writing this blog because of the unique vantage point as a dual credentialed athletic trainer and chiropractor. I’ve worked both sides of the relationship. I’ve failed, succeeded and learned so much over the past 19 years in health care.

My goal with this blog is to give you a different perspective. Hopefully, that perspective will help in forming outstanding professional relationships with ATCs. At the very least, I hope you’ll consider a different perspective. I hope the tidbits on relationship building benefit your athletes, your community, the ATCs you work with and your practice.

From the Outside Looking In

Things that cross the ATCs mind when a chiropractor shows up to assist their athletes:

1. WTF is this chiropractor doing here?

2. Doesn’t he just crack necks and cash checks?

3. Does he/she know anything about any other body parts besides the spine?

4. Does this clown know anything about sports medicine?

5. No, I don’t want my athletes touched by a chiropractor!

6. Chiropractors are not real doctors.

7. I’ll just send the athlete to physical therapy because it’s quicker and cheaper.

8. The recommendation of 3x/week for 12 weeks followed by 2x/week for 12 weeks and then 1x/week for 12 weeks seems a little absurd.

9. It’s a little ridiculous that the chiropractor thinks he will treat this ankle sprain by treating the spine only!

10. Why is this chiropractor “talking down” to me?

11. I don’t answer to him/her. I’m under medical supervision.

12. I already have a team doctor and I send my kids to the physical therapy clinic that sponsors the school, so why do I need a chiropractor here?

13. What value does this chiropractor provide to me, my athletes and my school?  Student trainers and certified athletic trainers often do not have much exposure to chiropractors. This is a harsh reality! This reality is a BIG obstacle towards building the ATC-DC relationship.  From the start, athletic training curriculum is housed within the university setting.

The university setting I’m referring to are large accredited 4-year institutions with a multitude of degrees, not the small, professionally focused chiropractic college setting with enrollments of 2,000 students or less. These large 4-year institutions often have allied health programs such as physical therapy, occupational therapy and medicine. At the very least, these academic institutions have pre-med, pre-PT, or other programs tailored towards entry into medical or other allied health programs. Relationship building and cross training with future professionals begins early. Chiropractors are on the outside looking in when these relationships begin.

Athletic training curriculum is heavily focused on neuromusculoskeletal, athletic injuries. The profession was built solely around taking care of athletic injuries. Specialization is a blessing and a curse to the athletic trainers. The ATC profession has long promoted the importance of the gate keeper role in the sports medicine realm. Specialization has historically hampered growth into other areas of health care, but works well in the original sports health care setting.

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The ATC is the central point of contact utilizing the sports medicine team is part of standard training within athletic training curriculum. Daily interactions come with athletes and coaches in all settings. Daily contact also occurs with equipment managers and strength coaches in larger settings. Periodic interactions occur with the team physician(s), other medical specialists, physical therapists, nutritionists, dentists, massage therapists, acupuncturists, opthamologists or other specialty personnel depending on the set up.

A Robust Sports Med Team Separated Into 2 Categories: Performance & Injury Management  Larger settings typically have robust sports medicine teams with frequent contact and communication.  Professional teams, Olympic athletes and high-level college sports teams have a more integrated setting exchanging the athlete from one provider to the next in seamless fashion. Settings like high school sports or youth sports almost certainly will feature less contact with members of the sports medicine team. Smaller settings effectively place the athletic trainer on an “island.”

High level athletic training jobs in professional sports, collegiate sports and with our Olympians are in short supply. It is far more common that the athletic trainer works in a smaller set up like youth sports, collegiate sports, club sports or within a clinic setting such as a physical therapy clinic or orthopedist’s office.  This is the ATC to DC perspective. From the outside looking in, many athletic trainers have no idea that a subset of the profession treats sports injuries. ATCs have not worked side by side on the sidelines with DCs. ATCs have not seen you in their training room. ATCs have not taken college coursework or post graduate continuing education courses with DCs.

ATC training from its inception is heavily biased towards allopathic medicine and the allied health model. Remember, training is often housed within the standard 4-year university setting with coursework and experiences geared towards developing relationships with the immediate support staff, team orthopedist and team physician.

DCs have a lot of ground to make up before the ATC will even let them in. Using a sports analogy, you are in the later stages of a baseball game and you are trailing by 3 runs. It may be difficult to get the win, but not impossible.

The difficult part is starting the ATC-DC relationship with obstacles in the way. Some of these obstacles were created long before you the DC, came into the picture. Some of those obstacles are based on historical educational training and the role of the ATC. Some of those obstacles were also created by the transgressions of past generations of chiropractors.

Those stereotypical questions above that began this segment can only be answered and put to bed for good once you’ve established know, like and trust. I would not let a provider near my athletes unless I knew them, like them and trusted them as an ATC. The most cherished thing an ATC can possess is trust.  Violating that trust with a screwball chiropractor isn’t worth the risk. It’s a bit of a harsh reality to some DCs that it will take some work to make this relationship flourish. Caveat Emptor – “Buyer Beware!” Be willing to put the work in!

From the Inside Looking Out

Things that cross a DCs mind when trying to help the ATC and his/her athletes:

1. What’s up with this guy/gal?

2. Why the ego?

3. Doesn’t this guy/gal understand I can really help his/her athletes?

4. WTF! I’m a real doctor that can order imaging, lab work and special testing like any other physician?

5. Doesn’t he/she know I treat more than the spine?

6. I’m not the 36+ visit chiropractor he/she is thinking about!

7. Building a relationship with the ATC and school will be HUGE for my practice!

8. Why is this athletic trainer not referring to me?

9. Why wasn’t I consulted first on the case since I provide conservative care treatments that most injuries respond to?

10. This is difficult to do because there are political, educational, legal and financial obstacles in front of me.

11. Is this worth it?  As a DC looking for forge relationship with ATCs, you’ll ask yourself the above questions. You may even wonder if forging a relationship is worth it? I can’t answer that question for you. I can provide some of the key pieces missing in creating professional understanding.  DCs are unique as professional doctorate level, portal of entry providers in that for many years we were on the outside looking in. We had a poorly acknowledged and defined role within health care.

Lack of mainstream integration and lack of cultural awareness historically has placed many DCs on an island.  This professional isolation includes things like our terminology, philosophy, our traditional and stereotypical business model and our lack of integrated, interdisciplinary training.  This is way it should be on the sports med team! Everyone playing nicely in the sandbox.

ATCs are trained to operate on an island if necessary in a small school setting as well as play nicely in the sandbox as part of the sports medicine team in larger, more integrated settings. Playing nicely in am integrated setting is foreign to many DCs where the DC serves the dual role of physician and small business owner. The DC is typically “king” or “queen” of their 4 walls. ATCs by training and position are the authority figures in their training room, but recognize the training room is a small part of the bigger house. The disconnect in roles can lead to quite a bit of frustration when the DC tries to gain entry to the sports medicine team.

Sometimes DC’s aren’t aware of the roles and politics within the sports med team and “pee in the sandbox”  Many DCs simply aren’t aware that the training room and playing field are typically the ATC’s domain.  They don’t defer appropriately to the ATC’s expertise. The typical response is that the ATC has an ego. It could be the DC’s ego getting in the way with the DC failing to appreciate the ATC in reality. A large part of this is failure to understand, appreciate and communicate roles.

ATCs wear many hats. They are part cheerleader, coach, medical professional, equipment manager, strength coach, rehab specialist, budget director, travel coordinator, intermediary and confidant. ATCs are the intermediate point of contact between athletes and coaches, parents & coaches and between support staff and athletes. Athletes confide some very personal things in ATCs. It takes a special person to balance these roles and wear all these hats.

ATCs do the stereotypical things of assessing injuries, enacting emergency plans, taping athletes, rehabbing athletes, making return to play decisions and more. ATCs deal with mundane things like filling water bottles, prepping ice chests, looking over the practice fields for potholes, filling out budget requests or checking for inclement weather. ATCs also deal with demanding coaches, parents, athletic directors or athletes.

Three Strikes and a Punch Out

Some ATC workweeks depending on the context are 60-80 hours/week in season. They get tired, fatigued and sometimes impatient. When you approach an ATC about helping their athletes and think “why the ego” be aware of the following:

1. Strike one: You could be dealing with a stressed out professional that’s overworked, underpaid and poorly appreciated.

2. Strike two: ATCs may have a preconceived notion of the stereotypical chiropractor based on DC professional isolation, lack of interdisciplinary co-training, lack of communication about roles/responsibilities and competing financial interests.

3. Strike three: The DC comes into the relationship with something to prove. This could be ego. This could also be an attempt by the DC to validate their expertise. Either way, trying to prove something comes across as abrasive to the ATC on their turf. Abrasiveness is the nail in the coffin!

Many DCs don’t even realize the deck is stacked against them. Many DCs don’t realize they could be behind by two strikes. It may seem like a harmless thing to show off your expertise to gain credibility, but that will rub the ATC the wrong way. Strike 3 and game over.

The best way of going after this is SERVICE! The DC needs to build trust. Humble service builds trust better than any other entity. Serve the athletes. Serve the ATCs. Serve the coaches. Serve the staff. Serve the community. Serve the sports medicine team. Listen first, serve, then speak. Your humble service opens the door, not your title, skill set, expertise or even monetary donations. Be a go giver, not a go getter.

Most Type A Motivated People Are Go Getters, But Maybe The Best Way To Get Ahead is Being A Go-Giver. Give First To Receive. The Book The Go Giver Illustrates This Point Well.

Our Story

Illustrating this point was the relationship we developed with District 230 in the south suburbs of Chicago. There are 3 high schools Stagg, Sandburg and Andrew high school. I attended one of the schools (Stagg) graduating in 1997. We had some familiarity with the district along with key personnel.  Former teachers, trainers and coaches were still working in the district. Some of athletic trainers and coaches in the district were classmates of mine at Stagg High School and at the University of Illinois. I also had previously worked for one of the physical therapy clinics prior to and during chiropractic school.

In addition, we had strong contacts within the physical therapy groups that sponsored the other high schools in the district (ATI Physical Therapy, Athletico & Flexeon).  On the surface, it appears that familiarity and relationships were a slam dunk easy way to access the district. We were mistaken. There were obstacles. Perception and politics stood in the way.  

The best way to overcome the perception and politics was to respond directly to the criticism in an open format. We sat down with the athletic trainers and sports medicine staff at one of the local high schools.  We had an honest discussion. We were there to serve the athletes, ATCs, staff and community. We had no expectation of referral of any athlete to our office. In fact, we encouraged referral to the team physician, team orthopedist and to the physical therapy groups that sponsored the schools.

We even utilized some of those sources for our patients that needed primary care, orthopedic and physical therapy services. We wanted to be there and enjoyed being there. We wanted to set up an integratednetwork to assist our patients that needed services that we did not provide. We wanted to use the sports medicine team’s expertise for second opinions on tough cases presenting to our office.

Eventually we earned trust. We noticed conversations were easier to start. Communication flowed more smoothly. We noticed genuine interest in learning about this “new” breed of forward thinking chiropractors that resisted dogma breaking the stereotype. We noticed our role growing from last man on the bench in basketball to 6 th man. We were providing on site second opinions after the ATC performed the initial on field assessment. We assisted with emergency situations including spine boarding athletes with suspected spinal fractures. We were asked to present at the high school’s career day about chiropractic and sports chiropractors. We became guest lecturers in sports medicine classes at 2 of the 3 high schools. Our topics were LE biomechanics, running injuries and orthotic fabrication.

We were asked to present at the district’s sports medicine symposium. The symposium was a regional gathering of south and western suburban high school students and sports medicine personnel. Students were interested in careers within the sports medicine fields. They came to learn about various sports med topics. Sports med personnel had a specific track discussing protocols, cases and pertinent research. Sports med personnel could obtain low cost, quality CEU’s from a multidisciplinary panel. We even took advantage of this opportunity to obtain ATC CEU’s and DC Category 2 CEU’s in Illinois.

It took well over a year to obtain a referral from this relationship. We really didn’t get as many athletes through the door as you’d think over the course of the 6-year relationship. The politics and financial interests of the district were firmly entrenched.; however, we did benefit from the relationship. The trust we earned through humble service eventually led to referrals of teachers, administration, coaches as well as the occasional referral from the team internist, team orthopedist and from the physical therapy group. Sometimes these referrals were athletes, but mainly they weren’t. We leveraged trust and eventually we saw referrals from the other 2 schools in similar fashion. Our patients also had great options for care including orthopedic referrals, primary care referrals, strength and conditioning referrals and for physical therapy services.

Tips To Forge Outstanding DC-ATC Relationships

1. Check Your Ego: Ego is a big turn off. Ego will end a relationship before you can really get it started. Rule #1 if working as part of the sports medicine team and approaching an ATC is check your ego. Serious misconceptions about chiropractors exist. Don’t play into that narrative. Throw ego into the mix and you’ve got no chance.

2. “Know Your Role & Shut Your Mouth”: DC’s are used to serving as the authoritarian figures in their office. They often aren’t challenged in the office setting. They are “king” or “queen” of their own castles. This mindset can lead to confrontation in the athletic training room or on the playing field. The ATC is quarterback. They organize the huddle, call the plays, audible, distribute the ball and orchestrate the offense. The DC’s role in many cases is that of the 3 rd or 4 th receiver.

Picture a slot receiver that’s a key player on 3 rd downs and in the red zone. DC’s are often an invaluable member of the team, but aren’t the star attraction. Get used to it. Know your role.  Thrive in it. Shut your mouth. Serve the team to the best of your abilities.

3. The Magic is the Relationship: Surround yourself with a great professional network and watch the magic happen. Sports med typically attracts a certain niche. The niche is type-A motivated professionals. Professionals that work to be better, wish to serve, want to win and prefer success within a team setting. They want their athletes performing at a peak level just as you do.  You want to work in a dynamic setting like this. Nurturing relationships in this environment benefits all parties involved. It worked for us and it can work for you.

4. Relationships Take Work: Even the best relationships take work. You don’t just do one nice thing a year for your spouse on their birthday or Christmas and stop. You appreciate your spouse in small ways daily. The same sentiment applies to the sports medicine relationships. Periodic interaction in small ways creates top of mind awareness. The intent isn’t a hard sale, but solidifying a relationship. Holding a door open for your wife isn’t a big thing, but it is appreciated and it does get noticed.

a. Lunches & Coffee Drops: We did this once per semester (2x yearly) We would text to confirm a time. We would stop in and drop off coffee for the athletic trainers, athletic director and staff. With minimal investment, this created better top of mind awareness.

b. In-services: Teachers often have in-service days. Utilize this concept and create one in-service day per semester. Create a theme. Have each team member contribute an article, video or lead a practical session during the in service. We led an in service on gait mechanics and orthotics for example. We covered our gait exam, orthotic evaluation and casting procedures.

c. Lecturing: Ask the athletic trainers if they have a sports medicine, anatomy or physiology class. See if you can guest lecture during one of the classes on a topic of interest.

d. Career Day: Ask to be a guest speaker at a career day. This is a great way to get a couple minutes of face time with the athletic trainers. Career day speaking spreads the brand of the clinic in the community as well as helps inspire the next generation of chiropractors.

e. Shadowing: One of the best ways to develop relationships is to shadow sports med team members on site. It’s a slam dunk, cost effective marketing strategy that builds trust. Shadow the orthopedist in their office. Shadow the team physical therapist in their clinic. DCs mostly train in DC sponsored collegiate settings run by chiropractic schools without interdisciplinary exposure. Seeing how an orthopedist, athletic trainer or physical therapist conducts business on their turf is eye opening. It’s great for your growth and their growth. The other team members haven’t not been exposed to an evidence based, forward thinking DC. Shadowing on their turf shows a genuine passion to be a team member.

f. Scheduling: There’s a quote by Woody Allen that says “80% of success is just showing up.” Simply put, show up and maintain a positive attitude. Collaborate with the ATCs to come up with a schedule based on their needs. When is their busy time of year? What tournaments do they need help covering? What other obstacles are present that impact the ability to deliver sports medicine services? Make a schedule and stick to it as best as possible.

g. On Site Injury Checks: I didn’t utilize this tool as much as I could have to be honest, but colleagues such as a team orthopedists and other sports chiropractic colleagues utilized this tool to great success. Set aside some time during the school week and perform free injury checks at the school. This saves the parent and athlete time and money of scheduling an in-office visit. What seemed to be effective without over reaching was 2 days/month for 1 hour near the conclusion of practice.

For example, on site injury checks were performed the 1 st and 3 rd Thursday’s of every month that school was in session. Make sure to coordinate with the ATC to confirm his/her availability along with athlete availability. It’s also a great idea and wise from a medicolegal standpoint to have the parent present to grant consent. You want the parent present so that there is no miscommunication. Some teenagers don’t talk to their parents at all. Other teens will relay inaccurate information.

Having the parent present eliminates the chances for no communication or miscommunication by the athlete. You really do want the parent present to get a better feel for parent-athlete dynamic. That matters in obtaining an outstanding outcome.  Last point, you really want the medical decision maker present.  They are ultimately the one “investing” in treatment.

h. Staff Dinners & Social Outings: This was a fun thing that we started after trust was built.  Typically, we went out for a sports med team social outing to a local gastro pub 2x/yearly. Often, it was after the last home Friday night football game and towards the end of the school year. The end of the fall season and beginning of the winter season was one of the busiest times of the semester as double the volume of athletes were technically “in season.” At the end of the school year, we wanted to celebrate the accomplishments of the year with a bite to eat and a beer. We typically treated to the 1st round and dinner. This was a business write off under marketing expenses.

i. Professional Newsletter & Content: Add the sports med staff to your professional newsletter and create custom content for them. What do they want to know about?  What weaknesses do they have? What strengths can you share with them? What do they need to know about you or your practice to effectively help their athletes or their patients better? We sent over a custom e-newsletter quarterly with relevant content.

j. Donation: Schools, clubs and smaller organizations have limited budgets. Often the athletic trainers are given lemons and need to make lemonade. Sweeten the deal a bit. If there’s a need and you are able, step up and offer some financial assistance. We donated free orthotic foam casts for the sports medicine orthotic casting lab. It wasn’t a big investment, but it was appreciated because the casts were not approved in the sports med budget. It saved the awkward conversation of the athletic trainers asking mom or dad for $30 to purchase a 1- time use foam cast out of the blue for the student’s sports med course requirements.

5. Market Your Outcomes: One of the central themes of sports medicine is rapid, safe return to action. Rapid, safe recovery is incompatible with the stigma of traditional chiropractic care of extended treatment plans for correction of the subluxation complex. Traditional chiropractors don’t have great baselines to gauge progress with failure to perform adequate re-exams, particularly in the context of sports medicine and sports performance. Many ATCs don’t know the subset of evidence based, sports medicine trained, rehab minded DCs exist.

This is where you can change the narrative. Providing athletes with rapid recovery and outstanding outcomes by obtaining functional and measurable baselines will blow the ATC’s mind. Imagine taking an ankle sprain from crutches to return to prior levels of performance within 4-6 visits over a 2-3 week time period. Imagine that athlete demonstrating the ability to descend an 8-inch step down symmetrically R vs. L with good neuromusculoskeletal control.

Imagine that athlete showing the ATC or the ortho that the 6-8 week time frame for recovery was way too conservative. Imagine the athlete actually demonstrating the improved 8” step down test directly in front of the ATC or the ortho. Imagine that you stated this goal from the start and communicated progress with your sent notes. Imagine that you’ve data tracked 50 or 100 ankle sprains in your athletes looking at the outcomes assessments, # of visits, and other return to play criteria.

Imagine you are leveraging that data to guide your opinion on a speedy recovery. Imagine you followed up with a phone call to the ATC and to the ortho after the initial assessment and at discharge. Imagine that you’ve created collateral marketing pieces around that data and your successful outcomes to distribute to the other team members and into the community. You’ve marketed yourself ethically and extremely well in this scenario. You’ve let your outcomes, data and communication do the talking. This sounds like someone that any rational sports med professional would want to do business with.

6. This is a Marathon Not a Sprint: One of the most common faults is that once you groove the relationship that you forget about it. You take the relationship for granted. Sports med professionals are marketed to on a regular basis. Marketing & sales reps from orthopedic groups, PT groups, medical device makers routinely approach ATCs. ATCs see advertisements in professional literature about products or devices. ATCs are often targeted with Google Ads, Facebook Ads and YouTube Ads just the same as the rest of us. The strategy here is to maintain top of mind awareness. Don’t take the relationship for granted. Be present, but not overwhelming. The marketing strategy is play the long game. Recognize this is a marathon not a sprint.

7. Give So That You Can Receive: Nothing greases the wheels of a referral relationship like giving.  By placing your trust in another professional, you’ll earn their trust. This is especially true if the patient you are sending has positive reviews of your care whether you helped them or not. The big point is that you were truthful, trustworthy and able to recognize strengths vs. limitations.

You didn’t waste the patient’s resources of time, money and hope. We utilized this concept with one of the team physicians. We sent a handful or two of cases his way before we received our first referral back. This was after developing a relationship on the sidelines for 2 seasons and setting up an in-office coffee meeting. At the coffee meeting he reported that he still didn’t know what to make of chiropractors or our office, but the patients sent over all had the same reports. They felt welcome. Patients felt they we weren’t trying to sell them anything. Patients reported that they thought they were told the truth.

This grooved the relationship with the team physician and several physicians in his group more than anything we had done to that point. The team physician (physiatry & sports med trained) would typically send over to us spinal cases that failed an initial bout of physical therapy, that had chronic pain, cases seeking to reduce medication use or cases that he felt required biomedical acupuncture. Most of these cases were not athletes. These cases were typically chronic pain cases with yellow flags. Cases like this required a bit more work. They were typically higher dollar cases for our office on the positive side, but the flipside was these cases had a higher risk of failure of our care. Regardless, it was nice that we earned trust to work on these cases. Remember though, this relationship started by giving first.

Summary

This blog turned out rather lengthy. I apologize if I’ve lost you in the middle somewhere. Some people need more and some people need less. The big take home points are that the DC-ATC relationship can be mutually beneficial. It does take some understanding. It does take some work. Don’t let this deter you!

About The Author

Dr. Dino Pappas

Dr. Pappas is a chiropractic physician, certified athletic trainer and certified strength and conditioning specialist. He recently has moved from Tinley Park, IL to Austin, TX. He works for Airrosti Rehab Centers. Airrosti is a health care company focused on rapid resolution of soft tissue and joint injuries delivering exceptional care and cost savings to patients. His goal is to provide the Austin community of NW Hills with the best conservative orthopedic, sports medicine, rehabilitation and soft tissue based care possible.

Dr. Pappas blends the best of physical medicine with the best of integrated medicine to help patients and athletes of all shapes and sizes. He utilizes tools such as chiropractic manipulation, soft tissue mobilization, functional movement based assessment, the McKenzie Method, strength training and conditioning, kinesiology taping, diagnostic imaging and specialty laboratory testing when needed.

Dr. Pappas’ sports medicine interests are endurance athletes, overhead athletes (pitchers, throwers, volleyball players and tennis players), tactical athletes (police, fire department, first responders and military), contact sports athletes (football, rugby, lacrosse, field hockey, soccer and basketball) and Crossfit athletes. He has worked with athletes at all levels from professional to amateur. He has provided sports medicine services to the University of Illinois, Indiana University, the Chicago White Sox, the Joliet Slammers (Jackhammers) minor league baseball team, the Windy City Thunderbolts minor league baseball team, Victor J. Andrew High School and Carl Sandburg High school.

On a personal note, he reads and interprets the medical literature daily to stay abreast of cutting edge advances in his field. The doctor is an avid runner and aspiring triathlete having completed 5 marathons, 5 half marathons and numerous 5 and 10k races. He has goals of qualifying and competing in the Boston and New York Marathons, the Ironman in Kona, Hawaii, and climbing Mt. Kilimanjaro in Kenya, Africa. He recently completed the Pikes Peak Ascent, a half marathon to the 14,115 foot summit of Pikes Peak. He is currently training to complete the Go Ruck Tough Challenge as well as ruck Rim to Rim across the Grand Canyon. One day he hopes to serve his country as a team chiropractor for the United States Olympic teams and serve as a team chiropractor for a high level collegiate or professional sports team.

The doctor practices in the Northwest Hills area of Austin approximately 7 miles from downtown Austin, TX. The office is located within a multidisciplinary surgical hospital. His mantra is “Why Put Off Feeling Good?” He can be reached by email at drdinopappas@gmail.com and drdpappas@airrosti.com. His business cell phone is 210-243-5734. Call 1-800-404-6050 to schedule an appointment with Dr. Pappas. Please make sure to request the Northwest Hills, Austin-TX office when calling to schedule an appointment.***

***Disclaimer:The views and opinions above represent that of the author, Dr. Dino Pappas. They do not reflect they official policy or position of any agency or company that Dr. Dino Pappas may have a relationship or affiliation with, they neither refelect an official policy or position of the FTCA.***

 

 

 

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

_________________________________________________________________________________

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.