Managing a practice in troubled times

Journal of the American Chiropractic Association, Nov 2002 by Feise, Ronald J

Doctors find it difficult to navigate through these troubled times, but most still cringe when they see ads about fellow DCs who seem primarily motivated by the pursuit of money. Unethical marketing hurts all doctors, while honest, professional marketing can be used to support the profession's image, reach patients who need chiropractic, and build successful practices.

People will always hurt their necks and backs. Analysts say that the cost in this country for neckand back-related pain goes beyond $100 billion a year1,2,3,4,5,6,7 The public is growing in awareness of chiropractic's value. From 4 percent of the U.S. population that used chiropractic in 1980, we reached an estimated 11 percent five years ago, and are expected to continue to take an increasing portion of the market. Many of our positive strides can be traced to improved chiropractic research and to the fact that so many doctors are looking for effective, but professional, ways to reach the public.

Most patients with spinal problems still visit allopaths8- despite the fact that many of those MDs do not want to deal with such conditions9 and a majority say they would actually like to know more about chiropractic... The only logical solution would seem to be that DCs must educate AIDs as to the efficacy of chiropractic spinal alignment through sharing studies based on solid evidence." But while DCs know how to communicate with DCs, and MDs know how to communicate with MDs, DCs and MDs still aren't talking to each other. 12,13,14

Ongoing communications must be firmly established if we hope, much less expect, to create a functioning twoway referral system that acts as a patient-centered bridge between chiropractic and the allopaths. The foundation for such a system will be scientific literature. These communications should be structured around a professionally planned marketing strategy.

One strategy that is showing itself to be effective is the medical referral program, which depends on strong DC-MD collaborations. Successful collaborations of this type tend to have several recognizable elements, including the following:

1. Comprehensive case histories, together with specific low-tech, high-touch examination techniques

2. Biopsychosocial evaluations (with "yellow-flag" screening)

3. Avoidance of expensive high-tech procedures (too often result in false positives/negatives)

4. Treatment schedules based on reliable/valid outcome measures (such as the Functional Rating Index-)

5. Patient education based on solid lifestyle strategies (include nutrition, exercise, smoking cessation)

A marketing strategy that uses scientific language and protocols -one that is rooted in the language that MDs use -enables doctors of chiropractic to open the doors to the possibility of participating in a strong medical referral program. While this type of strategy can create the opportunity for peer-to-peer communication, its success depends on the doctor of chiropractic's hard work and commitment to science and professionalism. V

References

1. Borchgrevink GE, Lereim I, Royneland L, Bjorndal A, Harald.jeth 0. National health insurance conisumption and chronic symptoms following mild neck sprain injuries in car collisions. Scand J Soc Med 1996;24:264-71.

2. Bovim G, Schrader H, Sand T Neck pain in the general population. Spine 1994;19:1507-9.

3. Chrubasik S, Junck H, Zappe HA, Stuf ke 0. Asurvey on pain complains and health care utilization in a German population sample. Eur J Anasthesiol 1998,15:397-408.

4. Cote P, Cassidy JD, Carroll L. The Saskatchewan Health and Back Pain Survey. The prevalence of neck pain and related disability in Saskatchewan adults. Spine 1998;23:1689-98.

5. Urwin M, Symmons D, Allison T, Brammah T, Busby H, Roxby M, Simmons A, Williams G. Estimating the burden of musculoskeletal disorders in the community: the comparative prevalence of symptoms at different anatomical sites, and the relation to ocial deprivation. Ann Rheum Dis 1998;57 649- 55.

6. Waddell G. Low back pain: A twentieth-century health care enigma. Spine 1996; 21:2820-2825.

7 Frymoyer JW and Durett Ct. The economics of.spinal disorders. In: Frymoyer JW (Ed). The Adult Spine: Principles and

Practice, 2nd ed Philadelphia: Lippincott-Raven 1997:143 - 50.

8. Media General Chiropractic Survey. Richmond,Virginia, February 2002.

9. Scheri H, Wensing M, Huijsmans Z, van Tuider M, Grol R. Implementation Barriers for General Practice Guidelines on Low Back Pain. A Qualitative Study. Spi,. 2001;26.E3-48-55.

10. Brusee WJ, Assen delft WJ, Breen AC. Commun,ton between general practitioners and chiropractors. J Manipulative Physical Ther 2001;24:12-6.

11. Langworthy JM, B,irkelid J General practice ano chiropractic in Norway: How well do they communicate and what do GPs want to know? J Manip,ulative Phsl Ther 2001;24.576-81.

12. Jamison J. Chiropractic's functional integration into conventional health care: some implications. J Manipulative Physiol Ther 1987;10:5-10.

13. Matthews A, Langworthy J Anticipating change: an opinion survey of the membership of the British Chiropractic Assocition in the Year of the Chiropractor Act. Reading, England British Chiropractic Association; 1996.