Lawyers PI Program
From the Desk of:
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
Continuing Education and Picking the Right Courses
I speak to doctors and lawyers on a daily basis at the national level. Many of my calls are from doctors who are not yet in the program and the balance is from you. When I speak to a new doctor, or one recently admitted into the Lawyers PI Program, I go to great lengths to explain that advertising and marketing will not build the PI practice that anyone wants. Driving a new patient into your office via advertising will require an expensive ad campaign and will only be effective for as long as you advertise. The other problem is when you look at the net profit from the ads, the margin is exceptionally low after expenses. Therefore, unless you are willing to make a substantial commitment in advertising and render a lower profit margin, advertising is a poor choice because it will also yield a one-and-done result. There are no residual referrals from the person driven in by the advertisement. We have chronicled “ad nauseum” the failures of a wining and dining program to “woo” lawyers into sending you patients unless your infrastructure is solid.
This consultation is about just that; your infrastructure. The easiest component of your infrastructure is your paperwork. The communication system between your office and the lawyers, creating a “calendar system” for timely information sent…easy. Your narrative; send a copy and I will critique it. You will get pissed off at me and call me names. Then you’ll fix it or buy a template…easy. Creating an admissible curriculum vitae involves the same process. We go back and forth and it gets into an admissible format…easy.
Now, here is the hard part for many; becoming expert at spine and disc pathology. Not so easy. It requires a significant commitment of time on your part. You have to go back to school and learn to “walk the talk.” This is where rhetoric (bullcrap) stops and the “real deal” prevails. This is the single reason for success or the opposite in our profession.
Here is the other side of the coin. I have a few clients that I would love to name, but won’t, who are so smart. In fact, they humble me in their knowledge, but can’t get the program off the ground. The reason, when they read about the steps required to ensure success, they pick and choose what they want to adapt because they are smarter and have better solution based upon their knowledge.
By the way, I am not one of “the smart people.” I am dumb enough to know that if someone else figured out how to do what I want, I am not deviating from their plan and will not re-invent the wheel. I will do better than they ever could, because I will win by outworking them, but will not deviate from the plan. I find those who do not deviate from the program win at a higher level in the Lawyers PI Program because they do not stray from the success formula. They just follow the steps outlined in excruciating detail.
Therefore, to all of you smart people, you know who you are, you never had to study really hard for an exam because you remembered everything more easily and got all A’s while the rest of us “common folk” were slaving for B’s. Follow the program. It works. I know because I have made every mistake that is possible, including the famous $1600 dinner and basketball game, for a kiss on the cheek (I am such a loser)!
Regarding that single reason for success; your knowledge base and the requirements. If you go to the Web site, click on "Continuing Education" and look at the courses offered, you will find the topics you need to become expert on. The curriculum offered was created specifically for the doctor desiring to work with the trauma patient. The PI Bootcamp covers advanced imaging, electrodiagnostics, crash dynamics, triaging and documentation of the injured, and an advanced plan to get the lawyers to call you. This course was created to go in depth on each subject. It’s not meant to make you a neurologist, neurosurgeon or a neuroradiologist, but to make you understand when to order an MRI vs. bone scan or an EMG vs. an SSEP, and how to interpret the results. It is also designed to help you communicate to medical specialists and understand the diagnostic technology that is utilized and its results. This course gives you more than the base basics. It allows you to see your patient in a different light when determining the extent of pathology secondary to injury.
Note: Although I offer these courses, there are other courses in the chiropractic community where you can get similar information. It doesn’t matter where you get the information and the credentials. Just get it.
I practiced in a state that doesn’t require impairment rating, either whole body or individual regions injured. Yet, every year I was asked by various attorneys, on the average of once monthly, to comment on whole body impairments. If my knowledge base didn’t include an understanding of whole body impairments, I would have lost credibility with those lawyers and it would have tarnished my reputation and lessened my prospect of referrals. In fact, the credential of Impairment Rating on my CV was cited numerous times in court while testifying for patients, thereby allowing my opinion regarding the disability status of those patients. You must be versed in the language and parameters of impairment and offer lawyers the choice of including whole body impairments, even if not required. It makes you a better candidate for the medical-legal community to work with.
The final course currently on the Web site is Head Trauma, Brain Injury and Concussion. Although as chiropractors we do not handle a bulk of head trauma cases, we are primary health care providers and often are the first doctors to see trauma patients after accidents. Many of these patients have head injuries and a delay in care can be fatal, at worst, or require a referral to an ancillary health care provider for additional care. Your knowledge becomes critical at this juncture.
Lawyers consider head trauma cases the pinnacle of the trauma victim, as the monetary awards are considerable in comparison to the soft tissue spine cases. First and foremost, you have to be able to triage the head trauma victim in a timely fashion in order to care for your patient clinically. Not secondarily, but the last reason to have this knowledge is lawyers. Over time, they will need to discuss head trauma with you and if you want to maintain that relationship, you had best know more than the lawyer.
In creating this course, I consulted Jean-Robert Desrouleaux MD, Neurologist, and Magdy Shady MD, Neurosurgeon, to ensure that no significant issue was overlooked or misstated. The good news is that as chiropractors, we are well-versed in head trauma issues, or at least I was, and didn’t feel like an idiot, unlike my next experience that I will discuss that occurred when reviewing the new MRI Certification Course being created. Back to head trauma…
Three weeks ago my $1600 dinner lawyer, who eventually referred over 60 cases a year to me (well chronicled), requested that I meet him in his office to discuss a head trauma case. He needed help in understanding the findings and where to send him next. My knowledge was all he needed and I was his first phone call.
A few months ago, I was summoned by the same lawyer to his office to find one of his clients waiting for me. He wanted me to do a detailed history on this patient, so I could determine if his ongoing symptoms were from head trauma or spinal injury. He knew that the chiropractor the patient was being treated by was deficient in his clinical knowledge (or “dumb as dirt” according to the lawyer). After a 1 hour evaluation (I used the spine of a thin book for a reflex hammer), it was determined that his problem was spinal related and his cognitive issues were either mild traumatic brain injury or post traumatic stress disorder (PTSD).
I referred the patient back to his treating chiropractor for care and called the doctor. I informed him that he needed to order a head MRI to rule out any pathology that might be present, although there were no other clinical signs of traumatic brain injury. (You must know the difference between traumatic brain injury and mild traumatic brain injury.) In addition, I suggested that if any positive finding was found on the MRI, a referral to a neurosurgeon should be made. I also suggested to the chiropractor that a referral be made to a neuropsychologist for his PTSD. The result of that encounter, the lawyer will never refer a patient to that chiropractor…ever. However, my phone will keep ringing, even without having had an office for 4 years and counting.
The next course being developed is a certification course in MRI interpretation, and I believe the only one offered in the profession. As a result of the feedback from the profession and the courts nationwide, this course is being co-taught by Robert Peyster MD, Neuroradiologist. Dr. Peyster is a graduate from Columbia and Harvard. He has been published on MRI and spine over 60 times and has practiced for close to 40 years. His credentials are impressive. The reason for including Dr. Peyster is twofold; knowledge and credentials.
The courts have ruled in some cases regarding admissibility of a chiropractor’s opinion of MRI, deciding that if the course work utilized to obtain the credential was not given by a medical radiologist, that the opinion would be disallowed or inadmissible. I have never personally had that experience, but I have now heard that a few times, and I am concerned it will become the standard. It is here we go back to the 6 P’s (Proper Planning Prevents Piss Poor Performance). In keeping one step ahead of the pack to ensure success for the future, it is these types of actions and credentials that will secure your success for the lifetime of your career.
The second reason for Dr. Peyster is his knowledge base. I have to admit that I am a moron. I would like to say that with a certain degree of humility and my ego partially intact. However, after spending numerous hours locked in a room with Dr. Peyster creating this course, he has snickered, chuckled, guffawed and rolled his eyes at me on a repetitive basis and there is no hope of my maintaining any type of “warm fuzzies.” I still have over 50 hours of work to complete this course, many with Dr. Peyster, so when you speak to me, please be gentle! This course will be the best program in the profession. In fact, Dr. Peyster will be using this course as part of the training of the neuroradiology residents in the fellowship program he teaches in the State University of New York. As you can see, the courses developed are done in concert with the brightest minds in the field because we should only learn from the masters in the field.
Dr. Jason Davis, a chiropractor in The Villages, Florida, shared with me his plan for directing his career and it is simple yet powerful. He decides where he wants his career to go during the upcoming year and he maps out what CE courses are offered and where, then attends them either in person or online. By the year’s end, he has accomplished his goals and can now guide his practice, staying 1 step ahead of last year. A simple and powerfully organized plan, as he has charted his own success.
As I stated above in RED, whether you take the courses through our program or with someone else, it doesn’t matter. You must be complete in your knowledge base, as infrastructure is critical to your success.