Lawyers PI Program
 
 #19

 From the Desk of:

 Mark Studin DC, FASBE (C), DAAPM, DAAMLP


Why Lawyers Prefer MD’s

The Truth & The Myth

 

Do lawyers prefer MD’s over chiropractors for their trauma patients? The answer was not surprising, only the reason was.  I have polled 1000’s of lawyers in the following cities over the last few years and the results are as follows:

 

  1. Manhattan, NYYes
  2. Ft. Lauderdale, FLYes
  3. Louisville, KYYes
  4. Naples, FLYes
  5. Buffalo, NYYes
  6. Hartford, CTYes
  7. Raleigh, NCYes
  8. Orlando, FLYes
  9. Queens, NYYes
  10. Long Island, NYYes
  11. Stamford, CTYes
  12. Baltimore, MDYes
  13. Seattle, WAYes

 

I think you get the picture; lawyers do prefer MD’s over DC’s. This is the same story I heard through the first 20 years of my career in chiropractic, from every local lawyer in New York. You see, New York is a very difficult state to practice personal injury. In fact, it is perhaps the most difficult in the nation. What makes a state easy or difficult to practice personal injury are the courts and the ability to get new patients and eventually get paid.

 

In New York, particularly in the New York City-Long Island region, there is a strong defense court, as it takes a lawyer many hurdles to get a case to trial and most cases get dismissed prior to trial, unlike in many other states. It has gotten so difficult that many lawyers have abandoned personal injury entirely. I am talking about seasoned attorneys who have spent their careers in personal injury. As a result, there are fewer lawyers, less cases and less of a desire to work with doctors because the money is no longer there for them. The insurance industry is making it more difficult for the lawyers than doctors in many instances, and we know how difficult it can be for us.

 

Secondly, the most expensive zip code in the entire planet is Times Square, Manhattan, where a 600’ office can cost $7,000 per month, just in rent. The maximum a chiropractor can get reimbursed for a PI case is $33.70 per visit, and the number of visits allowed are limited. As a result, New York is a very difficult place for the chiropractor and lawyer in personal injury. Therefore, when a lawyer says they prefer MD’s over DC’s, it is out of necessity for the court’s requirements to prevail in their cases…or so I thought!

 

I practiced in very close proximity to New York City. Therefore, there were some of the best medical facilities in the world with many of the best credentialed doctors for the lawyers to choose from. In fact, most of the lawyers I knew worked with many of those credentialed MD’s for their cases. Therefore, practice life went on with Mark referring lots of cases to lawyers throughout his career, accepting the crumbs from the lawyers. Meaning…they sent their crappy cases to me, so they could keep me happy and ensure my referrals kept coming.

 

I lived this miserable personal injury existence for many years. This wasn’t just the lawyers; it was the MD’s as well. I was everyone’s cash cow and the biggest schmuck in my region, perhaps the state, maybe the world! Everyone was my friend and they willingly allowed me to take them to breakfast, lunch, dinner, ballgames, theatre, beach parties, fishing trips and holiday parties. I was the life of the party and I also picked up the tab for the privilege of accepting their crumbs in return!

 

When I say I was a schmuck, you must understand that I don’t like to do anything small…I once paid $1200 to take a neurosurgeon and a lawyer, with his college-aged son, to a NY Knicks Basketball game, a steakhouse and cigar bar. New York City is very expensive, but I was going to wine and dine them and get them to remember me in their referrals afterwards. I was right; the lawyer sent me 1 and then he was done…I was the proverbial “1 & done” with the crappy case he sent me. The good news was the lawyer got to know the neurosurgeon better and he got numerous referrals from the lawyer after that evening, so my $1200 did good…for someone else! The truth is, as a rule, lawyers do prefer to work with MD’s. Let’s get to the reason why.

 

Over the last year, I have polled over 200 DC’s nationwide and asked 1 simple question, “Do you know the difference between herniated and bulging discs?” The cross section was a national survey of doctors in practice from 1 to 30 years and is an accurate sampling to create statistical certainty. The results, most were clueless, some were close…1 completely accurate answer and 2 almost correct. Scorecard: 1 correct answer and 199 incorrect answers. Many of you reading this have participated in my poll and, rest assured, it is purely statistical with no record keeping. My point is to underscore the reason why lawyers prefer MD’s.

 

I blame chiropractic colleges nationwide. Every state licensure board holds each and every doctor of chiropractic to an advanced imaging standard for spinal cord and spinal nerve root pathology, yet do not teach our doctoral candidates the basics of understanding, nor interpreting, that to which we are held. A mouthful, yes, but I have lived through the inquisition of a state board holding me responsible for technology that didn’t exist when I was in school, nor when I was treating my patients. Your state board will not care either. You must be an expert on the spine.

 

Herein lies the issue with lawyers and it’s no different than the state boards. Chiropractors are considered spine specialists in a drugless discipline. That is what we tell the world; drugless first, drugs second and surgery last, and chiropractic is the largest drugless healing profession in the world. Does that mean we are exonerated from being able to diagnose serious pathology? Do we not need to know anything beyond subluxation, nutrition, wellness, exercise, genie rubs and chiro-cleanse? The answer is “no,” and also the answer to why lawyers prefer MD’s. If we are expert at spine and want to be considered specialists, then we need to be just that, expert.

 

I spoke to a lawyer many years ago who informed me that he preferred chiropractors over MD’s because we have our hands on our patients on a continual basis versus the MD who sees the patients two or three times. It makes it much easier in court to get a jury to understand the continuum of care and the functional losses. His challenge was to get a chiropractor who was good at documenting that care and also understood the diagnostic responsibilities in caring for the injured. He prevailed at a much higher level with the diagnostic documentation than with care. As a result, he chose the MD over the DC because he made more money…until he met a chiropractor who understood what a spine specialist should. It wasn’t me. At that stage of my career, I was about explaining healthcare issues to lawyers with ½ of the story accurate and the other ½ a bunch of crap. Mind you, it sounded really good to me and I was convinced I had my story down really well. Remember the “1 and done?” This was me and the reason why!

 

If you recall from a previous consultation, I have talked about that neurosurgeon I took to the basketball game often, as he clearly defined my practice path as soon as I met him. He let me know there is no room for bullcrap in healthcare and everyone can spot someone who is full of it in a nanosecond. It was at that moment that I made my decision to be the “best of the best through clinical excellence.” I traveled the country to get the education needed to become a real “specialist.” I have never and will never have a desire to be a medical specialist, as there are many of them and they are very good at what they do. I do have a desire to be a chiropractor and a specialist in spine; everything about spine and spinal trauma as it relates to the population of patients I treat and other specialists I interface with, regarding the care of those patients.

 

If you ask any orthopedist, neurosurgeon, neurologist or physiatrist the difference between herniated and bulging discs, 99% will give you the correct answer. On trial, if a lawyer needs an expert to give testimony, who do they want? Someone with a line of bullcrap and ½ the story, or someone who gets it right 99% of the time? Lawyers have a tool called “cross-examination” and it is a very good tool. It ferrets out fact from nonsense and the doctor who doesn’t get it will cost the lawyer their case. The lawyers pick a doctor to work with, keeping the “end-game” very much in sight. They have to start a relationship based upon the doctor’s ability to function in court. Most of the time they do not get to court, but why start a relationship that cannot be finished successfully? Why would a lawyer want to work with you if they know you cannot stand the scrutiny of cross-examination?

 

Lawyers are looking for a few things:

 

  1. Admissible paperwork
  2. An understanding of the clinical issues
  3. Identification of treatment issues
  4. An understanding of diagnostic modalities
  5. Identification of disability impairment/functional loss
  6. Articulateness
  7. Credentials

 

If you demonstrate that you meet the above criteria you will break through the myth of the lawyer only wanting the MD. They will want to work with you and have you care for their clients. Does this mean the lawyer will want you in every case? No, but they will also not want the MD in every case. It depends upon clinical issues and I am the one usually making that decision for the lawyers I work with. It will give you the control you need over your practice and referral sources. It will take work on your part and it will take time, but it’s the direction that’s needed. Does it mean you need to be an expert on everything? No. You need to be the expert on certain things and very knowledgeable on others. When you become the resource, the lawyers will reach out to you continually...if not for the direct information, then for the direction they should take. They have no one to guide them, as a rule, and will value your relationship. Henceforth, you get to choose the patients you get to take. You will have earned it.

 

Here is the list of clinical issues you need to learn to become both expert and “the source” for the lawyer:

 

  1. MRI, CT Scan, Bone Scan, X-Ray
  2. Disc
  3. Spinal Cord-Nerve Root
  4. Electrodiagnostics
  5. EMG/NCV
  6. SSEP
  7. V-ENG
  8. BAER
  9. VEP
  10. Crash Dynamics
  11. Impairment/Disability

 

As you all know, these are the subjects taught in the PI Bootcamp and other courses offered on the Web site, but there are many other resources to get the information. I hope it now has become abundantly clear as to why I created the PI Bootcamp, as it is the only place in the country to get everything you need at your fingertips without having to get on a plane and travel the country. Others, who are very good at what they do, also teach these subjects. Use every resource and become the best of the best to have the ability to break the myth. Will the knowledge alone ensure success? NO! You must have a plan to ensure the medical-legal community knows you have that knowledge and then take action to make the plan work.

 

I welcome your calls to help you create a plan that works for you. Be as bashful as I am…That is a challenge!!!!