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"Credentials and Success…
In Practice & Survival of the Chiropractic Profession"
I consider this to be the most important consultation I have ever written, as it pertains not just to your practice, but to the profession as a whole…and you are a very large part of the solution. I am sending this consultation to both my current and former clients. Please take a few minutes and read this very carefully. You will also be seeing this in many forms in publications nationwide.
Credentials are what is hurting us as a profession and is also limiting us in practice. Although I have been in practice for over 28 years, over the last 14 years, I have run chiropractic, medical, physical therapy and acupuncture practices, having to hire and fire numerous practitioners. As a result, I have read thousands of curricula vitae during the hiring process that gave me an understanding and an appreciation for what is impressive and what is embarrassing. However, it goes well beyond the emotion about how one feels about their credentials. I am going to give you the following scenarios regarding the importance of a credential:
- Laws being passed
- Hospital inclusion
- Courts acceptance of testimony
- Lawyer relationships
- MD referrals
- Patient in-office referrals
After we go through the 6 scenarios, I will present to you a very powerful solution to succeed in your practice and for the profession to succeed.
- Laws Being Passed:
For over 2 decades, I have been involved politically and have spent a lot of time in my state’s capital, fighting for chiropractic. I have also been the past president of my state organization (executive board of director) and have chaired the legislative committee for many years, lobbying for legislation to further chiropractic. Chiropractors were always treated unfairly and a second class citizen would have been many steps in the right direction. As a result of my relationships, I have come to understand a part of why. Without getting into the politics of my state, the best way to explain part of the problem is to share with you what the physical therapists went through. For years, the PT’s had been trying to gain direct access, where they do not need a medical prescription to see a patient. As a note, chiropractors in New York are not allowed to refer to a physical therapist, only medical doctors, dentists and podiatrists. Makes sense…NOT!
The PT direct access bill was defeated year after year until there was a very significant change in the PT academic world. The physical therapists added a doctorate program and some of the PT’s achieved a doctorate status in physical therapy. Having an office that required me to interview numerous physical therapists and reading their curriculum vitas, I spoke to many PT, PhD’s. I even had the privilege of interviewing the professor of the PhD Program, who was a PhD herself. A doctorate in PT does not give the PT additional clinical skills in diagnosing or prognosing, nor any additional skills in interpreting imaging, testing results or physical examination beyond the musculoskeletal system. They learn more about physical therapy and its modalities. The program is excellent, but it does not make them doctors in any sense beyond PT skills, and their program does not attempt to do so. Therefore, for them to achieve direct access puts the public at risk because, as you know, there are many conditions that mask themselves as musculoskeletal in nature and are quite serious if missed.
Each year, I was charged with contacting the legislators responsible for higher education to render both a written and verbal opposition to the PT direct access bill, as I had the relationships and the first-hand knowledge. After many years of being denied, last year the PT direct access bill was passed into law in the state of New York. Why?
I spoke to my contact that was intimate with the process and the answer was a brilliant political maneuver. The physical therapy organization gathered many of the PT, PhD’s, and paraded them around the capital for months prior to the pending vote, presenting their credentials as doctors. They were articulate, knowledgeable and qualified in the eyes of the legislators. Do their credentials represent the majority of the profession? No. However, those few did represent the profession to the legislative body. It started with a few PhD’s, and those credentials gave their profession more than they had gotten in decades; direct access. Why?...Credentials!
- Hospital Inclusion:
Over the last decade, I have been quietly trying to gain access to hospitals in my area as either an attending, or by instituting a chiropractic department in the hospitals, and I have failed miserably due to the prejudice of the hospitals. Last month, I was sitting with a very good friend who informed me that the hospitals had finally “seen the light.” He is on the board of a hospital system that represents over a dozen hospitals in the NY area. Apparently, the hospital system and its board had recognized that chiropractic inclusion would increase revenue to the hospitals, as they were financially troubled. It always comes down to money!
My friend realized that I no longer practiced and assumed I wouldn’t be interested, so he reached out to the chiropractic community. He was wrong and I am working on rectifying that misconception, as I would gladly chair the chiropractic department if I had the opportunity. However, I now have an uphill battle that is as difficult as ever. The Hospital Board reached out to the community through its members to get the most qualified chiropractor in the region and found a candidate. Upon reviewing his credentials, the board was dismayed and the argument from the “old school” was validated, as the doctor’s credentials read like a poor resume and the doctor was poorly qualified in comparison to even the poorest credentialed MD. The assumption that was adopted was that he represented all of chiropractic and the opportunity was lost.
We are compared to the rest of the medical profession, as we live in that world. You do not have to like it, agree with it or acknowledge it. All doctors comprise the healthcare community and are judged by those who make critical decisions to the delivery of healthcare. If that one doctor had appropriate credentials, chiropractic would have had a presence in over a dozen prominent hospitals in the NY Metropolitan area, serving 100,000’s of patients through the emergency rooms, and serving many more by different parts of the hospital system. Credentials!
- Courts Acceptance of Testimony
I have personally been cross-examined many, many times on my credentials, by both opposing counsel and judges. Each time, opposing counsel wanted to have my testimony limited or not allowed and the judge asked me for my credentials regarding the issue. Those issues ranged from MRI, EMG, x-ray, bone scan and SSEP interpretation, to name a few. Each time I said that I had post-doctoral training in those areas, and each time the judge demanded documentation. I produced my curriculum vitae and every time my testimony was allowed. If I did not have a formal entry on my curriculum vitae, I would not have been allowed to testify for that patient on issues I was qualified to testify for. You also have to remember that your curriculum vitae is a legal instrument and it must be factual and legally defensible. There is never a time to expand beyond the hard facts, as it is considered contempt.
As a result of my being able to testify, the lawyer I worked with was equally impressed that I was knowledgeable, but more so because my knowledge was allowed into testimony and he was able to prevail as a result. To this day, so has every lawyer I have testified for. In addition, there are many that respect me as their expert, and constantly call me for my advice and send me their clients now for second opinions, as I no longer have an office to treat in. Over the last 11 weeks, I have gotten 17 new patients; and that is with no office. Why? Credentials!
- Lawyer Relationships
Once you are taken seriously by lawyers, you will be asked for your curriculum vitae on a regular basis. Until then, you will be humored and used tangentially, not once being taken seriously. The last 5,000 lawyers I have lectured to nationwide have all confirmed in a “formal poll” that the doctor’s CV is equally as important as their narrative report. Without the appropriate credentials, the lawyer cannot enter into evidence the doctor’s findings and therefore, will be in jeopardy of losing their case. The above scenario of the courtroom outlines the details of why.
When working with a lawyer, make sure that you always include a copy of your curriculum vitae in all correspondences. However, make sure your CV reflects the clinical excellence that the lawyer expects to see when presenting your credentials to prevail in a case. If your CV does not have the credentials required…get them! Failure to do so goes to the adage…If you fail to plan…you plan to fail…and you will.
Remember, lawyers seek long-term relationships, as they do not want to find a new doctor for each patient. It is too time-consuming. They will work with the doctor who can get them what they need in the end, a successful outcome in their cases. That will only happen if the doctor’s credentials can stand the scrutiny of the courtroom, as that is the leverage the lawyers use when seeking a favorable settlement with the insurance adjustor in negotiation.
Your entire marketing plan for the lawyer needs to be centered around being the best-of-the-best through clinical excellence and that is only reflected through your CV. Lawyers live in the paper world and if it is not in writing and accurate to the standard of the courts, it doesn’t exist. Do you want to have a huge PI practice? Credentials!
- MD Referrals
I am on retainer for an office that has 1200 visits per week and gets between 40-60 new patients per week, every week. I have been working directly with this office for 3 years in order to help them grow. One of my responsibilities was to create a folder for the office to give out to the professional community, including both lawyers and doctors. I did in-depth market research by visiting the top specialists in New York City. I went to the orthopedic surgery, neurosurgery and physical medicine departments at Columbia Presbyterian Hospital, Mount Sinai Hospital and New York University Hospital.
I found that each department had very sophisticated printed marketing materials and each was similar. The entire package was centered on the credentials of every doctor in the department…period. The doctors' credentials spoke volumes about their practices. I did not see listed the 7 danger signs of a “pinched nerve in the neck.” Medical doctors know what services a chiropractor provides. They do not know about the person delivering those services and that is what the curriculum vitae is for. It is often the difference between having a referral relationship or not.
MD’s live in the world of credentials and the more credentials you have, the more qualified you are, because it is always about what is written. The biggest mistake chiropractors make when marketing to MD’s for patients, is that they market their services, usually insulting the intelligence of the MD, and do not market their level of clinical excellence through their credentials. This isn’t to say you should “shove your credentials down their throats,” as much as it is a belief that you should share your level of expertise in chiropractic and spinal care. It puts you on level ground in the medical community and creates the opportunity for the referral. What will get you in the door and create a level playing field with the MD’s? Credentials!
- Patient In-Office Referrals
Have you ever needed a medical specialist for a serious problem? If so, did you say, “I am using that doctor because he gives free cardiac check-ups?” Or because he was offering a free colon screening in his portable colon station? Even better, he hung a sign outside his office that said, “Free pancakes with pancreatic screenings during the month of July?” Of course you didn’t. You chose a doctor because you felt he/she was the best! Why do we in chiropractic feel that we have to act like carnival “hawkers” to succeed in practice? We don’t.
I am the biggest proponent of doing screenings and health fairs and they can be done very professionally. I also know that in my office, I was the best-of-the-best and I made sure my patients knew it. In my reception area, my personal office and lining the hallways, I placed diplomas, awards and membership certificates that were framed for all of my patients to see. I learned that from a cardiology group I visited years ago that had every diploma on the wall…Credentials! If I got an award or a new credential, my staff was instructed to share with the patients (brag) their boss’ (my) accomplishments. The patients were as proud as my parents and told all of their friends about their doctor who was the “best” doctor with the most credentials. I got many referrals, as new patients would tell me their friends shared with them that I was the best chiropractor in the world and they only wanted the best. Why? Credentials!
SOLUTION & CALL TO ACTION
The solution is simple and powerful. You must first ensure that you are credentialed and that your credentials are accurately reflected on your curriculum vitae. Since I began the Lawyers PI Program over 2 years ago nationally, I was asked numerous times to create CE courses to give doctors the information to become the best-of-the-best through knowledge and the credentials that are associated with that knowledge. In response to the request, I spent 6 months creating the PI Bootcamp that offers a total of 9 CE hours in MRI interpretation, CAT scan interpretation, and an understanding of the nuances of admissibility the lawyer needs in much more depth than the Lawyers PI Program can offer due to the nature of the presentation. The PI Bootcamp will give you the credentials to testify on virtually any subject that will arise in a personal injury case and give you the qualifications for any attorney to use your curriculum vitae in negotiations or court to prevail. To learn more, go to www.teachdoctors.com and click on Personal Injury Bootcamp. Yes, this is a self-serving statement, but it will accomplish the goal. The credentials for each module that would be posted on your curriculum vitae are as follows:
Neurodiagnostics, Imaging Protocols and Pathology of the Trauma Patient, An in-depth understanding of the protocols in triaging and reporting the clinical findings of the trauma patient. Maintaining ethical relationships with the medical-legal community. CMCS Post Doctoral Division, New York Chiropractic Council, New York State Department of Education Board for Chiropractic, Long Island, NY, 2008
Diagnostics, Risk Factors, Clinical Presentation and Triaging the Trauma Patient, An extensive understanding of the injured with clinically coordinating the history, physical findings and when to integrate neurodiagnostics. An understanding on how to utilize emergency room records in creating an accurate diagnosis and the significance of “risk factors” in spinal injury. CMCS Post Doctoral Division, New York Chiropractic Council, New York State Education Department Board for Chiropractic, Long Island, NY, 2008
Crash Dynamics and Its Relationship to Causality, An extensive understanding of the physics involved in the transference of energy from the bullet car to the target car. This includes G's of force, newtons, gravity, energy, skid marks, crumple zones, spring factors, event data recorder and the graphing of the movement of the vehicle before, during and after the crash. Determining the clinical correlation of forces and bodily injury. CMCS Post Doctoral Division, New York Chiropractic Council, New York State Education Department Board for Chiropractic, Long Island, NY, 2008
MRI, Bone Scan & X-Ray Protocols, Physiology and Indications for the Trauma Patient, MRI interpretation, physiology, history and clinical indications, bone scan interpretation, physiology and clinical indications, x-ray clinical indications for the trauma patient. CMCS Post Doctoral Division, New York Chiropractic Council, New York State Education Department Board for Chiropractic, Long Island, NY, 2008
Neurodiagnostic Testing Protocols, Physiology and Indications for the Trauma Patient, Electromyography (EMG), Nerve Conduction Velocity (NCV), Somato Sensory Evoked Potential (SSEP), Visual Evoked Potential (VEP), Brain Stem Auditory Evoked Potential (BAER) and Visual-Electronystagmosgarphy (V-ENG) interpretation, protocols and clinical indications for the trauma patient. CMCS Post Doctoral Division, New York Chiropractic Council, New York State Education Department, Board for Chiropractic, Long Island, NY, 2008
Documentation and Reporting for the Trauma Victim, Understanding the necessity for accurate documentation and diagnosis utilizing the ICD-9 and the CPT to accurately describe the injury through diagnosis. Understanding and utilizing state regulations on reimbursement issues pertaining to healthcare. CMCS Post Doctoral Division, New York Chiropractic Council, New York State Education Department, Board for Chiropractic, Long Island, NY, 2008
Documenting Clinically Correlated Bodily Injury to Causality, Understanding the necessity for accurate documentation, diagnosis and clinical correlation to the injury when reporting injuries in the medical-legal community. Documenting the kinesiopatholy, myopatholgy, neuropathology, pathophysiology in both a functional and structural paradigm. CMCS Post Doctoral Division, New York Chiropractic Council, New York State Education Department, Board for Chiropractic, Long Island, NY, 2008
There are other courses that will accomplish the goal similarly; it doesn’t matter whose course you take. You must be credentialed and there is no room for discussion. None!
I have also been instrumental in creating the American Academy of Medical Legal Professionals, a non-profit organization dedicated to servicing the needs of the medical and legal communities that care for and represent the trauma patient through research. This organization offers the opportunity to be conferred as a Diplomate in the specialty of caring to the trauma patient and will render you the letters DAAMLP after your DC (i.e. Mark Studin DC, DAAMLP). This is called a credential and is very powerful in any of the above scenarios to succeed in practice and as a profession. Join by going to www.aamlp.org. This is a multi-discipline, multi-professional organization whose president is a chiropractor and governs a board of medical doctors and lawyers. Why? He is credentialed!
If legislators, hospital administrators or your patients see that you have advanced credentials, it will equate to both a healthier practice and a more prosperous profession. I have critiqued 1000’s of CV’s of doctors nationwide and the results have been less than exemplary, explaining much of why we, as a profession, struggle to succeed legislatively and with the medical community. This is a call to action to tell the world that we are the best-of-the-best at what we do and we are also the best-of-the-best through clinical excellence within our own profession.
CREDENTIALS! If I have not critiqued your curriculum vitae, send it to me. If you are a former client, I am offering this one time, as a gift to the profession of chiropractic to critique your CV. We are all in this together and my success depends upon you and your success depends upon me. Together, through credentials, we can both win.