Academy of Chiropractic’s Lawyers PI Program

Lawyers and Medical Specialist Meetings & Communication #23

From the Desk of :
Mark Studin DC, FASBE (C), DAAPM, DAAMLP

“MD Specialists & Primary Care's : What to Bring, What to Say”



The MD Magic Language

THE GOAL: CREATE A PEER-TO-PEER RELATIONSHIP


Unlike meeting with a lawyer, a collaborating or non-collaborating MD does not care about anything other than your ability to be part of the treating team based upon the scientific evidence and your training. Stupidly enough, they will consider those 2 things first prior to your knowledge. However, your formal credentials usually aren’t even part of the discussion although you need to be prepared. In addition, you should be focusing on mechanical spine pain (no fracture, tumor or infection) as this is not the forum to discuss any other facet of chiropractic care. You are at this meeting to resolve problems in their offices, not educate them to the wonders of chiropractic. 

The biggest challenge all MD's have is with mechanical spine pain is to keep them out of their offices and not increase an already opiate addicted society. MD's already know they have poor solutions with PT's as an alternative to opiates and based upon the amount of addicts already created, they know that physical therapy is a failing solution, but do not see any other viable choices. Unfortunately, because too many chiropractors still "manipulate" just like the PT's, then we get lumped into that failing group intuitively. This is one prime reason why the word "adjusting" is critical. It is not a philosophical debate, it is a practical one that helps removes some "road blocks" for referrals. 

ALL MD’s assume that you are good at what you do and really, really do not give a CRAP about what you do to get your patients well. They only want to ensure the patient belongs in your office. Should you go the technique route, you are better off staying at home and doing nothing. Nothing is worse than creating a huge negative, think... when was the last time a surgeon explained their surgical technique? The answer is NEVER and yet we demented chiropractors feel compelled to discuss that we are an CBP practitioner, or ABC, or HIO or IDNGARA... no one cares but you and will minimize any chance of you getting referrals or having a peer to peer relationship, which is the goal. 

What most MD's are concerned with is creating an accurate diagnosis remembering that treatment in the medical world is typically centered on writing a prescription and occasionally surgery. As a result, medicine is testing heavy to ensure an accurate diagnosis and those who treat short of surgery are merely technicians to the MD. In order to create that paradigm shift, you need to have the conversation centered on your ability to diagnose, your relationship at the peer level or above with the proviso that treatment is the easy part (which it is) as that will remove you from the category of technician or therapist.  

The primary areas of course work to have completed prior to a meeting should be: MRI spine interpretation, spinal biomechanical engineering, spinal trauma pathology, orthopedic testing and impairment rating. The reason is that those are the courses cross-credentialed by the State University of New York at Buffalo, School of Medicine and Biomedical Sciences. This is integral to your meeting with the medical specialists and is applicable to medical primary care providers as well. Shortly, I will share with you how to use that as leverage to getting the referral.

If you are focused on getting more Primary care referrals, the Doctors PI Program will help you as our doctors have reported that we are getting 20-30% more referrals form primary care MD’s.  HOWEVER, this doesn’t come close to the MD Referral Program. For primary care referrals, the MD Referral program is mine “on steroids” and has been uber successful in many offices (www.MDReferralProgram.com).


Caveat Emperor: Remember, the MD primary care’s will refer mostly managed care and this is perfectly OK as part of a practice mix as long as you have a healthy amount of PI cases. 


Medical Specialists are a different story. They will refer predominantly trauma cases to you because they see a greater population of those types of cases and it is here that you need the depth of knowledge. 


Most chiropractors cringe at the thought of interfacing with neurosurgeons or orthopedic surgeons and mostly rely on the “old chiropractic one-step, two-step” which I call a high level of pure bullshit and is the root of our negative reputation within the medical community. This is where the chiropractor, who has not had any significant graduate level education (post-doctoral CE) has a conversation with a true spine specialist and starts pontificating on the wonders of his/her care and when discussing the specifics of the lesion or pathology and gets it wrong based on even the most basic of understanding the anatomy of the lesion. It happens so much that medical specialists in many, many states that I have taught shared with me their experience and it is problematic nationally. 

These specialists are very professional and polite. They will usual not challenge the DC, only politely say to themselves “I will never work with this person and all of chiropractic because they all must have the same inferior training.” That is what too many of these polite medical specialists have told me through the years. Medical doctors have the same “basic training” that chiropractors do. The difference, afterwards, they do significant graduate level training.  

Other than the courses I post online, when was the last time you were challenged in your post-doctoral training? And… We are no longer calling it post-doctoral training, it is formally now called graduate training as that is a more accurate description and starts to put you on a peer level in healthcare. Do I want to be a clone of medicine, yes and no… No because what we do is unique and powerful in healing, but yes in the fact that although medicine offers an inferior choice for what we do, they treat 95% of the population and we treat only 7%. So…I will conform in every area except giving up what is unique to chiropractic and our unique identify as an autonomous DRUG FREE profession. 


The Meeting:

What to Wear

Dress one level below a tuxedo. This is where Uncle Marvin's influence and Robert Ponte's training helps. Uncle Marvin taught me that having one high quality suit is more effective and better than 4 inferior quality garments. Robert Ponte in his course I took decades ago called "Dress for Success" taught me to always dress at least 1 level above protocol for the event to gain an edge in a meeting. I have been to over 1000 meetings with medical specialists and primary's and I can tell you that almost 100% of the time, they were dressed impeccably in high end, well-tailored suits. As a result, all of my suits are custom-made Italian hand crated garments and if you spend less than $500 for a suit, then you not getting what will give you a great first impression. A great garment will not be a huge positive, but a cheap suit will be a significant negative. Not to be obnoxious, but to prove a point, my suits are close to $2000 per suit, which in the fashion world is barely acceptable, but in the business world is in the higher end of clothing, which is my goal. 

Hands... this is another area where doing it right will not be a significant positive, but doing it wrong will be a huge negative. If your hands and nails aren't close to perfect, get a manicure. The same holds true for footwear. Be the total package or be prepared to get ZERO referrals.  


What to Bring 

All placed away in a briefcase or a laptop case to be brought out when the time is appropriate. 

1. The Science of Chiropractic: circa 2015 (CLICK HERE) as this is where over 100 referenced, well-written articles are housed in one publication. Although the book is written for the lay-public, each article is referenced with indexed peer-reviewed articles that is integral to most medical practices who treat of come across spine. You should always keep a few books in your office in reserve for an unexpected immediate meeting. Meeting with MD's was one of the primary reasons we wrote the book, to give you the leverage required. In my past meetings with MD's one of the primary road blocks was the evidence, or at least that was the "reason du jour" not to refer. That issue is now and forever formally off the table. 

The following are tools that probably won't be needed unless you feel required, but falls in the category of being prepared.

2. Your CV. I guarantee the MD will not bring theirs and unlike lawyers could care less about what is on your CV although as we will discuss later on, your training is central to creating a peer to peer relationship, which again is the goal. Should this be needed, an inadmissible CV will be a "deal-breaker" for the MD as CV's are a required part of their training and cannot get into residencies or fellowships without properly formatted CV's. This must be printed on quality stock, the cheap stuff from Staples with wood chunks still in it will be another "deal breaker."

3. Research articles. In the book The Science of Chiropractic: circa 2015 there is a section on disc pathology treatment starting on page 73 and there are 7 articles on how chiropractic is both effective and in many instances superior to medical care for treating disc pathology. Read those 7 articles and find the one that resonates best with you, then go and either download for free from Google or purchase from Google Scholar the full articles (not the abstracts) and have the critical issues in each article pre-highlighted. WE choose disc pathology and mechanical spine pain as this is an area that is easily demonstrable and intuitively will be a patient population the MD will equate to chiropractic care. 

4. Appropriateness Criteria from the American College of Radiology. 

Cervical Spine CLICK HERE to download
Lumbar Spine CLICK HERE to download

These will give you the guidelines for the minimum standards and it sets the foundation for you as an expert by sharing (explained in detail shortly) what your slice thickness protocols are that sets you apart from the rest and instantly creates that peer-to-peer relationship. Most neurosurgeons orthopedic spine surgeons will already know this. However all other specialists will not and primary care MD's will be overwhelmed with your knowledge and this will position you as the teacher vs. the beggar for new cases. Typically this step is the fulcrum in creating the paradigm shift in their minds locking you in as the expert in mechanical spine pain.  



What to Say (MD Magic Language)


After the small talk, you open with "Where did you train?" This is like 2 dogs sniffing each other (oy, do I need help) and is how MD's usually introduce themselves to their peers. Their training program is their calling card and all MD's who are specialty trained will talk about their training. Primary care MD's, will downplay it, but will still discuss their training. Should they not ask you where you were trained, you interject AFTER they finish talking about themselves where you were trained.

Do not discuss your basic chiropractic training as they will not care and this exercise is not to tout your doctoral program as in medicine that is like discussing kindergarten, it is about creating a peer-to-peer relationship based upon your specialty training. 

AFTER you have completed strategic graduate level training (post-doctoral education) in MRI Spine Interpretation, Spinal Biomechanical Engineering, Spinal Trauma Pathology, Impairment Rating and Orthopedics that have been approved through the State University of New York at Buffalo, School of Medicine and Biomedical Sciences, you get to say the following: 


"I have received my trauma training through the State University of New York at Buffalo, School of Medicine and Biomedical Sciences specifically in MRI spine, spinal biomechanical engineering, connective tissue pathology, orthopedics and impairment rating...


Note: add the training based upon the courses you have been credentialed for and the language "connective tissue pathology is for the Spinal Trauma Pathology course. 

"... I would like to discuss MRI slice thicknesses with you along with patient triage protocols (depending upon the specialty you are sitting with) so that we can work together at a higher level."


Neurosurgeons/Orthopedic Spine Surgeons

"In addition, I realize that you are often overburdened with screening non-surgical cases and my training has allowed me to do the initial work-up or take the place of  any mid-levels 
(NP's or PA's) freeing you up to examine more surgical candidates. After I get a patient, they will have already been evaluated, had thin-sliced MRI's and when I refer, most will be surgical candidates. All those who simply need conservative care, I will manage inclusive of co-managing with pain management. So that we are clear, I will refer any patient that has any significant radiculopathic or myelopathic findings with concurrent compromise on either the cord or roots. In the absence of that scenario, should the pain persist past 4-6 weeks, which rarely happens, I will then consider referring the patient. 


Neurologists/Physical Medicine Anesthesiologist

"In addition, I realize that you are often overburdened with screening non-procedural cases and my training has allowed me to do the initial work-up or take the place of  any mid-levels (NP's or PA's)freeing you up to examine more serious cases. After I get a patient, they will have already been evaluated, had thin-sliced MRI's and when I refer, most will require procedures. All those who simply need conservative care, I will co-manage with you. So that we are clear, I will refer any patient that has any significant radiculopathic or myelopathic findings with concurrent compromise on either the cord or roots directly for a surgical consult with either a neurosurgeon or ortho-spine surgeon. In the absence of that scenario, should the pain persist past 4-6 weeks, which rarely happens, I will then consult with you for a better solution."

"I also brought you a self-serving present (ha-ha) it's a book on the Science of Chiropractic for you to keep in your library and if you should ever want a reference from any of the articles, just ask as I have access to them all. I took the liberty of including a research article on chiropractic and herniated disc treatment."


That is it... let the conversation go where it takes you, but that is your message and it should be very short. At this point in time, the MD should want to ask you questions to confirm your knowledge base and historically, they go into MRI slice thicknesses. This is where you have to be prepared and have a copy of the American College of Radiology's Appropriateness Criteria in your briefcase to "whip out" as evidence you are the "real deal."


Primary Care MD's

The MD Referral Program is by far the best in the nation. I suggest you go there... with the Caveat that you will get mostly managed care and cash patients and that is perfect as long as you have a healthy mix of PI cases. Short of that program, you can use the following language and exclude any language above:


"I have received my trauma training through the State University of New York at Buffalo, School of Medicine and Biomedical Sciences specifically in MRI spine, spinal biomechanical engineering, connective tissue pathology, orthopedics and impairment rating. Based upon my training, I manage mechanical spine pain patients inclusive of handling their disability issues. This helps you stem the opiate issue and it is my responsibility to manage the patient from beginning to end inclusive of any imaging requirements or specialty referrals." 

"I also brought you a self-serving present (ha-ha) it's a book on the Science of Chiropractic for you to keep in your library and if you should ever want a reference from any of the articles, just ask as I have access to them all. I took the liberty of including a research article on chiropractic and herniated disc treatment."



That is it... let the conversation go where it takes you, but that is your message and it should be very short. 

All of these messages have been market tested with both MD specialists and primary's in multiple states and practice settings. Please do not deviate from the plan... it works!!!!