What Chiropractic Program Would You Refer To?

What Chiropractic Program Would You Refer To? - By Thomas Dube DC

Introduction

A long time ago I posted a question to the FTCA. Some people had been talking about chiropractic schools and what they did and didn’t like and it got me thinking: What schools would evidence based chiropractors recommend? So, I posted the following question:

“What Chiro schools would you refer a student to?”

I’ve been told when it comes to research I’m pretty naïve, and honestly, he’s probably right. I lack experience, and I’m the kind of person that just finds things interesting—regardless of how practical or pragmatic they may be. That said, I think what school you choose to go to matters, and I posted this with the hopes I could gain some insight about what schools members of the FTCA consider good enough to refer someone to. I also left instructions that people should post why they would or wouldn’t refer a student to that school. I thought it could help me gain insight into what other schools are out there and their quality, because frankly I was aware that I am definitely ignorant on the subject. That and at the time I was under the impression that a lot of the people in the group were Cleveland alums and wanted to confirm my thoughts. Boy was I wrong.

Hey! Stop laughing! I educated myself and now know better.

I wanted to take this opportunity to review the findings of the poll and discuss some insights based on a couple conversations I’ve had and some other research. First I’ll cover my ‘methods’:

For the poll I listed up every school I could think of (allowing people to add schools I missed) and gave members unlimited votes for the schools they might recommend. I then compiled the names of every individual that voted and tallied which schools they voted for. Finally, I started asking people in private messages which schools they attended and checked if they voted for their alma mater. This yielded some different information:

First and most obvious was the most highly recommended schools.

Second, how many people voted for multiple schools and which ones.

Third and Fourth were the number of alumni that voted for their own school as well as the number of non-alum docs that could recommend it. I call the first of those the “Alumni Approval Rating” (AA) which is the percentage of Alumni that voted for their school and the second the “Reputation Rating” (RR), which is the percent of non-alum respondents that voted for a school. This data is a little skewed because I couldn’t find out the alma mater of every respondent (more detail on that in a minute). I deemed it “Reputation” because I figure most people would vote for a school based off what they’ve heard, docs they know from that school, etc. rather than actual personal experience.

Part I-Discussing the Poll

So, let’s talk a little about each of those points in detail.

Regarding the first, in combination with the third point: Obviously, given the fact that overall there was an alumni approval rating of 87.03% we must consider population bias in our sample. I graduated from Cleveland University-Kansas City and to be honest, while I know other schools exist, until I did this poll (and ESPECIALLY up until just a few months before I did it) I had always thought of there being a “Big 4” schools: Logan, Palmer, Cleveland, and Life. Again, stop with the laughing; however once you see my results (and hear some of the arguments I have to discuss) some of even you may be surprised. Suffice it to say I realized CUKC is a very small fish in a—still pretty small—pond!

But back to my point: as there seems to be in general a high AA, obviously then if the members voting on my poll were more from one school than another, that would affect results. I had no intent for this to actually be an ideally random sample. In fact, as I mentioned before part of my ulterior motive for the poll was that I specifically wanted to see where members of FTCA attended school, or in other words, what schools had a higher number of evidence-based progeny, and what schools those people think are better/more evidence based. Emphasis on think, which I’ll be discussing later.

I also want to mention that I only have Alum information on 322 (70.46%) respondents, and I never got around to even requesting the information from roughly half of those I don’t have responses for. Sorry but Facebook started temporarily restricting my private messaging privileges and frankly… I got bored of the tedious nature of the task…

While we’re at it, lets note the other population bias: geography and class size. Bobby Maybee, the man behind FTCA, hails from the area of UWS and attended there, too. So of course, a FB group he started is going to be filled with his closest peers! And what of the foreigners? If I remember correctly, Washington state is in the US, so obviously even in an online world reach to other countries is going to be limited. (accept maybe Canada—XOXO)

Additionally, schools that have smaller class sizes are obviously going to have less representation at all even in an evenly distributed group and given what we know that’s only going to skew the results more.


School Number of votes % of total votes # alum responders %alum responders AA RR

UWS 129 13.33% 45 12.16% 91% 21% NWHSU 112 11.57% 32 8.65% 94% 19% NUHS 103 10.64% 54 14.59% 82% 15% NYCC 95 9.81% 39 10.54% 100% 13% Logan 91 9.40% 46 12.43% 93% 12% CMCC 90 9.30% 21 5.68% 100% 16% UBCC 62 6.40% 15 4.05% 93% 11% AECC 41 4.24% 17 4.59% 100% 5% SCUHS 32 3.31% 2 0.54% 100% 7% PCC 27 2.79% 1 0.27% 100% 6% TCC 26 2.69% 12 3.24% 100% 3% PCC-W 23 2.38% 21 5.68% 81% 1.4% USD 20 2.07% 2 0.54% 100% 4% UZ 18 1.86% 0 0.00% 0% 4% CUKC 14 1.45% 16 4.32% 69% 1% WIC 11 1.14% 2 0.54% 100% 2% DYC 10 1.03% 4 1.08% 100% 1% Parker 10 1.03% 5 1.35% 60% 2% Murdoch 9 0.93% 1 0.27% 100% 2% PCC-F 8 0.83% 6 1.62% 33% 1%

(Editorial Note - We stopped publishing at the top 20 institutions, but there were many more on the list)

On the second set of findings: This was an interesting thing to see. Overall, we had 457 people cast 968 votes. That’s almost two per person, but when you look at the data, 64% of voters cast only 1 vote, which means that less than half of the people cast roughly 2/3rds of the votes. In fact, if you take out all the people that voted for 2 schools, you’re left with 22% of voters casting 56.5% of the votes. (Honorable mention to Stephen Perle, who voted for 15 schools, and the 4 others that voted for 14 schools.) Also, AA increased as the number of voted increased, generally.

And as far as the fourth point, RR, it’s maybe a bit more difficult to figure how this may be important, but I think what is important is very important. First, you ought to consider how many people only voted for one school. Essentially over half of us don’t know enough about other schools to recommend many of them, and when you consider the bias going both ways for those attending, it’s hard to say how many chiropractors can actually make a good, informed decisions about what school to refer a prospective student to. Then you consider that for those recommending other schools, how are they basing that decision? This is where the most important question comes into play: what makes a Chiropractic school (or any school, for that matter) worth going to?

The last thing to consider about this is how geographic bias, especially for the [relatively to an individual] foreign schools are obviously going to limit the reputation that a school can have.


Part II-What Makes a School a “Good” School?

So, what makes a school great? Before we consider anything, we must address the most important factor, personal preference. One critique I got from someone about my post was that most people didn’t even have feedback to give that mattered about certain schools. Well, sure while objectively having a nice fitness center at your school isn’t going to affect your success in practice as much as passing boards, it matters to people, and frankly, if you chalk it up to ignorance, well then don’t you know it’s those same ignorant fools looking at your school considering whether to put their loan dollars into your tuition buckets? What are you going to do, educate them about their choice? They’re already putting a bench press over passing Part I, so…

But for all my dogging on the logical conclusion, the logical conclusion is the best one. I don’t deny it. I’m just saying that the sad fact is it doesn’t matter like it should to most, and many doctors are referring students based on faulty reasoning.

Now let’s go through a list of Chiro school characteristics people can look at (maybe not that they should). I’ll start with the smaller stuff. For each of these, it’s also important to assess how one might measure each of these characteristics. For some it is easier to see, such as board scores, but others, like how well your school prepares people for starting a business, are far more difficult.

Amenities: What kinds of extras does your school offer? Does it have a gym? Cafeteria? What about clubs? Sports? Activities? These are the sweets that get the children into your van so you can take from them all that they’re worth.

Cost: This one is easy, so I won’t take more than another sentence to evaluate the concept as it applies to what makes a school great. You just must ask yourself: Am I getting what I pay for or am I getting good value for my future debt amount?

Philosophy: What kind of philosophy does a school tend to indoctrinate their students towards? And yes, I meant to use ‘indoctrinate’ there. Most students, open-minded or not, will be greatly influenced by the principles taught by the professors at the school and by the general views insinuated by the values of the institution as a whole. Some may not think this matters, and you may be largely correct, but ask yourself this: how much do you care if a doctor gets great results from his patients and sees a patient 12 times before releasing them from care vs one that sees them 48 times? How about if they tell their patients to direct immunization questions to their primary care doctor or tell them that vaccines cause autism? Or if they treat using evidence-based guidelines versus tell people they can cure cancer? Does it matter so long as they get great results? The amount that this matters to you is directly proportionate to how important it should then be that you consider the philosophy put forth in a given school.

Business Classes: How well does your school prepare its students for starting their own business? The best way I think to assess this is by seeing how many docs that decided to start a business right out of school feel after doing it for a couple years. This is hard information to get, though.

Retention: Ever since I had a friend transfer schools because he didn’t like Cleveland, this has been something important to consider for me. Of course, I understand that in schools this is reported it represents any number of things: Is the program to hard, or was the student too incapable? Is the student unreasonable, or is the program really that lacking? It’s hard to tell from just a number.

Program Efficiency and Options: How does your program operate? This can range from things such as whether you use a trimester vs semester method to the way your clinic internships are formatted. What requirements are there for students during their internships? What are your class attendance and testing policies? What kinds of classes do you offer, in general? While it is easy for two graduates to compare how many x-rays they needed to graduate, it isn’t so easy to compare the value when one school requires 30 yards of red tape to cut through for them and the other requires you do it on every patient at the beginning and end of treatment. What kinds of outside opportunities do you have to get experience, such as VA rotations?

Faculty and Class Quality: Simply put, how well do teachers teach their students? And does it make someone a bad teacher if they have a monotone voice? Or poorly organized slides? Or difficult tests? Or maybe more important is the relationships those faculty have with the students as mentors? Are your faculty approachable, instructive, insightful? One good way to see this objectively is to look at your class sizes and student: faculty ratios. If they’re high, developing those relationships and overseeing growth will become more difficult.

Board Scores: You can’t be a chiro without passing them, and the ability for a given school to prepare their students to pass boards is paramount to having any hope of practicing at all. Each school is supposed to keep available their pass rates for each part. This is probably the only purely objective information you can get on a school.

Clinical Preparedness: How well are students prepared for the practical application of what they’ve learned? And I’m talking more than just what it takes to pass part 4. The comprehensive nature of what it takes to be a clinician is so much more than what can be evaluated in a test. What kinds of results can new graduates get from their patients? How accurate are their diagnoses? Essentially, when a new doctor from your school walks into a treatment encounter each visit, how confidently and competently can they take care of that person?

And last but the opposite of least, Geography: From what I’ve heard, more and more people are moving farther away from family as they grow up, but nonetheless, the sweet beckoning of a school close to home is more often than not going to be the lure that grabs most students. Add in the perpetuation of graduates camping out close to their alma mater and influencing the local prospective students and you’ve got a recipe for predicting where a given individual will attend school. I didn’t put this last because it should be the most important when considering a school to attend, but because it likely is the most important to those making the decision.

For those that work in school administrations, these things are obviously under consideration when managing a school. In fact, I probably missed some important key points. The fact is, how many of those of the rest of us consider this when recommending a school to attend, or looking for recommendations?


Part III-What Does this Mean for Recommending Schools?

So, what does this mean for the students looking for advice on where to attend and the doctors hoping to help?

When considering the recommendation someone makes for chiropractic school, there are a number of things to consider about the recommendation itself, foremost being what qualifies their recommendation. Did they go to school there? If not, how did they hear about it, and what, and from whom? Perhaps they know a doc that graduated from that school; can you even consider them to be exemplary of what that school has to offer? How long ago did they graduate? If it’s been a while, how do you know the school hasn’t changed—drastically? And if not, many people leave school with extremely polar views that don’t settle until experience, hindsight, and insight level them out. Maybe the cafeteria staff were horrible, or maybe they just loved the club they were a part of. Those are fairly narrow reasons to approve or disapprove of a school for.

In the end, I believe that overall the best people to ask for input from are probably those close to graduating or that have recently done so, with the opinion of those that have attended more than one school being especially valuable. Despite the bias, this population likely has the most current, accurate, and comprehensive answers for you.

Also, teachers at those schools can probably answer your questions, too. While many of those teachers will likely recommend the school and/or are hoping to change the school for the better, their insights on the subjects above are nonetheless invaluable. The only thing you should remember is to compare. Get current information on multiple schools and compare it. Visit the campus and see for yourself. And always, always remember what matters most to you.

Interestingly after we look into all this information, we also should consider for yourself the following: if you know what other schools have to offer, would it change what you think of your school? Perspective is everything, my friend.

I additionally asked people to comment on my poll why they would or wouldn’t recommend a school and I got some meaningful feedback that if you go back and review, provides some—albeit minimal—insight about those individual schools. Just remember to keep it all in context or how qualified those people are and what their input says about how reliable the information is. (i.e. someone merely whining about stuff vs. meaningful commentary about curriculum). You may visit my post here.

Conclusion

So, in conclusion, apart from 8 respondents (honorably mentioned below) who attended two schools, very few that voted on my poll probably knew what they were talking about when they recommended a school. As a result of that and the huge quantity of bias, design flaws, etc. of the poll, the data is pretty much meaningless.


Austin S - NUHS/UWS

Chuck L - Life/UBCC

Cora B - NUHS/Logan

Emily R - TCC/SCC

Justin S - NUHS/UWS

Kyle S - NWHSU/NUHS

Lacey K - NUHS/ACU

Zac Y - NUHS/UWS

SIKE!

Actually, I’m going to make a case that this information IS valuable. The reason is because it has shown us that many of us have a whole lot more to consider before recommending a school to a prospective student. I’ll even go as far as to say that there are schools you can learn about from this poll. I kind of look at this as similar to a ‘specific’ test rather than a ‘sensitive’ one: few false positives, lots of false negatives.

I mean by this that if the school had a lot of votes and a high AA and RR rate, it’s probably safe to say it’s overall a decent college. I mean, come on, let’s consider just how cynical and critical we are as a group. If anyone would find something to nitpick at, it’d be us. Logically then, in addition to the people I mentioned above, I think it would be an awesome idea to ask people why they didn’t recommend their alma mater, and/or voted for another school. See how their reasons stack up to my reasons listed above. Are they being petty and is their information dated? Perhaps they don’t even know what they’re talking about? Or maybe it’s possible they indeed have something meaningful to say.

In the end, I have a feeling someone is going to say that there’s nothing meaningful here. We can’t rely on a bunch of biased input from a biased population. I however, don’t believe that a school’s board scores—probably being simultaneously the only and the most objective indicator of how good a school is—should be the only thing you base your decision off.

If you agree then that board scores aren’t the only thing you should base your decision off, it seems to me the only other option is to additionally talk with people or look at marketing information that is going to be biased in one way or another to find out about the characteristics I mentioned above. And if you won’t do that simply because the information is biased, and you won’t base your choice off board scores and/or geography alone either, how are your chances of choosing or recommending a good school going to be any better than picking a name out of a hat?

Thomas Dube DC


Getting in Front of a Complaint

None of us like getting complaints. Hopefully they’re pretty rare, but they’re inevitable in clinical practice. Whether it’s something whispered to the front desk, an off-hand comment to our face, or - worst of all - a bad online review, negative comments have a way of ruining our day. Nevermind the fact that all the other patients that day were enthusiastic, positive and making great progress, that one complaint is probably all you’ll think about when you get home.

 

Not only that, but you’ll probably have a good case of l’espirit de l’escalier (French for “staircase wit”, or thinking of the perfect reply too late). “I should have said this, that would have shown them!” I’ve been there, it’s not a fun way to spend an evening.

 

Whilst there’s no simple quick fix for ruminating all night over a complaint, a better use of your energy would be to ask yourself “What could I have done to prevent this?” If your immediate reaction is “Nothing, they’re just unreasonable” - which I totally get - you might want to think a bit harder.

 

[Quick side note for the inevitable folks thinking “I don’t get complaints” - have a good chat with your front desk staff. They will be the ones receiving the vast majority, and often they don’t want to upset you by passing them on. Especially if they also feel it was an “unreasonable” complaint. If you haven’t made it very clear to your front desk that you WANT to know whenever someone expresses dissatisfaction, there’s a good chance you’re not being told]

 

Now, I’m not saying the complaint was necessarily justified - we all have patients with unrealistic expectations, and you can’t please everyone all the time. But, if you plan to only cater to “reasonable” people all the time, you’re in for a frustrating career. You are going to have people coming to you with expectations you can’t realistically fulfill. That’s just a fact (sorry!).

 

However, that doesn’t mean you should just accept some people will complain - there’s a way around this. But here’s the tricky bit - you have to plan ahead and address it before the complaint is made. By the time someone is disappointed, it’s an uphill battle to change their mind. Anger, defensiveness and justification are setting in (likely on both sides!), and in their eyes “what’s done is done”.

 

Obviously we’re not mind readers, and you won’t be able to anticipate everything that might lead to dissatisfaction. But I bet that a good 80% of the complaints you’ve had are around the same few topics. If you’re unsure, again ask your staff - are there any recurring themes that come up when people appear unhappy with the practice?

 

If so, great! This means that you have a clear idea of what you need to get ahead of with your new patients. If you address the topic with someone before it comes up, you can address their expectations before they aren’t met, and alter them. That way, you’ve prevented them from ever being dissatisfied in the first place!

 

Here’s an example - early on in practice, I’d occasionally get comments about the duration of a treatment. Sometimes someone would say “Is that all you’re going to do today?” Others were a bit more blunt: “That’s a lot of money for 15 minutes!” I’d explain to them about how the treatment was very specific, or that I’d provide as much treatment as the needed at each visit, etc. (All the while thinking “It took me 5/6 years of hard work to be able to do that in 15 minutes!”).

 

But no matter what I said, by the time they’d said this they’d already made up their mind - I was overcharging, or I was rushing them out to see more patients per day, I cared more about my income than my patients… etc. That was usually their last visit.

 

So here’s what I did instead: I made it a point to address the length and amount of treatment received at each visit with every new patient at their first consultation. I didn’t wait for them to have the experience and try and change their mind when they brought it up. I got in front of it and told every patient what would happen. Even though the majority didn’t need telling, and might not have even noticed if I hadn’t brought it up. At everyone’s first visit, I’d say something like this:

 

“Now for visits going forward, I can tell you that we will be performing some adjustments pretty much every time. Those are the core part of treatment at this stage, and as you will probably notice, they’re very quick to perform - taking only a few seconds. At times we might use massage, stretching, acupuncture or other techniques as well, but these are all supporting the adjustments, and might not be necessary all the time.

 

So some visits may be very quick - you come in, get adjusted, and get on with your day - but others may take longer, and we may be doing more. Just be aware this is normal, and isn’t a reflection on how well you are doing. Count on around 15 minutes for a visit - because it’s very specific we won’t keep you longer than necessary - but that could vary by 5-10 minutes either side.”

 

For all of those patients who found this normal, it didn’t make a difference. But for those who were expecting a half-hour session every time, I addressed and altered their expectation before I even had a chance to “disappoint” them. And it worked - I’ve never had a patient make a comment about the length of time I spend with them since (to me or my staff).

 

Also note what I didn’t do - I didn’t try to explain why, justify or defend myself. I just put it out there - this is what you can expect going forward. I also left enough “wiggle-room” to account for visits that were longer or shorter than usual.

 

This specific example might not be an issue for you, but I’d encourage you to think of where else you could apply it in your practice. Perhaps some patients don’t like the fact that you occasionally run late. Maybe they expect lots of active care at their first visit (or maybe they don’t expect to have to do any at all!). If you have associates, maybe some of them are unhappy that treatment “feels different” from different practitioners. These are all examples that are easy to “get in front of” and address beforehand with patients.

 

And, this can also apply to things that aren’t even a “complaint” - it might be as simple as patients commenting the decor is out of date, or that the room is cold. They’re all opportunities to improve the patient experience in your office. And that’s what ultimately generates referrals, far more than excellent clinical skills or fantastic treatment results.

 

So, the next time you get some negative feedback from a patient, think of it as constructive criticism (regardless of if it was meant that way!). Rather than trying to justify yourself, getting frustrated with patients, or just trying to forget about those “unreasonable people” you have to deal with, try actively seeking out complaints. They’re an opportunity to manage future expectations, and provide an even better service.

 

And ultimately, it’s the patients emotional experience in your office that generates quality referrals - not a discount on their next treatment, not thank you cards, and definitely not the fact that you actually asked them to refer people to you (please don’t do that!).

 

More on this in a future post.

As well as being a full time chiropractor and dad, Chris also coaches other DC's in patient-centred communication and practice through "Patient Centred Coaching" (www.patientcentred.co.uk)

The Nordic Maintenance Care Program, a Long Journey That Is Starting to Bear Fruit! - Andreas Eklund, MSc(Chiro), PhD

The Nordic Maintenance Care Program, a Long Journey That Is Starting to Bear Fruit!

Maintenance Care (MC) has been around for a long time within the chiropractic profession and has become an issue of great debate and conflict. Headed by Professor Charlotte Lebouf-Yde a serious research effort was made to study the procedure. Over the past decade a series of publications under the name the Nordic Maintenance Care Program has been published [1-11].  The purpose of the program has been to identify indications for care, treatment content, frequency of care and to understand the clinical reasoning process among chiropractors in the Scandinavian countries.

The understanding gained from the preliminary studies were used to design a pragmatic clinical trial that mimic current clinical practice. The trial was conducted between 2012 and 2016, and in September 2018 the first in a series of papers investigating the effectiveness, and cost-effectiveness of MC was published in PLOS ONE (open access).

The result show that patients on regular MC for recurrent and persistent low back pain had 13 fewer days of activity limiting pain during 1 year compared to patients who were treated only when they experienced a relapse of pain.

https://journals.plos.org/plosone/article/comments?id=10.1371/journal.pone.0203029

In the short video below the lead author Dr Andreas Eklund summarizes the key findings from the trial.

Upcoming publications will report on effect within subgroups, clinical mechanism and cost-effectiveness. Keep up to date on the WFC reading list for Maintenance Care:

http://www.wfcsuggestedreadinglist.com/maintenance-care.html

Andreas Eklund, MSc(Chiro), PhD

References:

1. Leboeuf-Yde C, Hestbaek L: Maintenance care in chiropractic-what do we know? Chiropr Osteopat 2008, 16:3.

2. Axen I, Rosenbaum A, Eklund A, Halasz L, Jorgensen K, Lovgren PW, Lange F, Leboeuf-Yde C: The Nordic maintenance care program - case management of chiropractic patients with low back pain: a survey of Swedish chiropractors. Chiropr Osteopat 2008, 16:6.

3. Malmqvist S, Leboeuf-Yde C: The Nordic maintenance care program: case management of chiropractic patients with low back pain-defining the patients suitable for various management strategies. Chiropr Osteopat 2009, 17:7.

4. Moller LT, Hansen M, Leboeuf-Yde C: The Nordic Maintenance Care Program-an interview study on the use of maintenance care in a selected group of Danish chiropractors. Chiropr Osteopat 2009, 17:5.

5. Hansen SF, Laursen ALS, Jensen TS, Leboeuf-Yde C, L H: The Nordic maintenance care program: what are the indications for maintenance care in patients with low back pain? A survey of the members of the Danish Chiropractors' Association. Chiropr Osteopat 2010, 18:25.

6. Sandnes KF, Bjørnstad C, Leboeuf-Yde C, Hestbaek L: The Nordic Maintenance Care Program - Time intervals between treatments of patients with low back pain: how close and who decides? Chiropractic & Osteopathy 2010, 18(1):5.

7. Bringsli M, Berntzen A, Olsen DB, Leboeuf-Yde C, Hestbaek L: The Nordic Maintenance Care Program: Maintenance care - what happens during the consultation? Observations and patient questionnaires. Chiropr Man Therap 2012, 20(1):25.

8. Axen I, Bodin L: The Nordic maintenance care program: the clinical use of identified indications for preventive care. Chiropr Man Therap 2013, 21(1):10.

9. Myburgh C, Brandborg-Olsen D, Albert H, Hestbaek L: The Nordic maintenance care program: what is maintenance care? Interview based survey of Danish chiropractors. Chiropr Man Therap 2013, 21(1):27.

10. Eklund A, Axen I, Kongsted A, Lohela-Karlsson M, Leboeuf-Yde C, Jensen I: Prevention of low back pain: effect, cost-effectiveness, and cost-utility of maintenance care - study protocol for a randomized clinical trial. Trials 2014, 15(1):102.

11. Eklund A, Jensen I, Lohela-Karlsson M, Hagberg J, Leboeuf-Yde C, Kongsted A, Bodin L, Axen I: The Nordic Maintenance Care program: Effectiveness of chiropractic maintenance care versus symptom-guided treatment for recurrent and persistent low back pain-A pragmatic randomized controlled trial. PLoS One 2018, 13(9):e0203029.



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!

___________________________________________________________________________

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

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TORs Do (Some) Things Right

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

*Checks watch*

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

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

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

TORs have certainty in the adjustment.

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

TORs aren't afraid to hustle.

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

TORs don't care what other people think.

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

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

TORs have passion.

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

TORs don't think the grass is always greener.

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

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

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

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

Mike Stanley DC