Academy of Chiropractic’s Doctors PI Program
From the Desk of :
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
“Obnoxious, Pompous, Arrogant”
Sometimes Often = Referrals
I am a nice guy. I have been raised in a respectful home and taught to respect others. I am never direct and have been raised on innuendos so that feelings aren’t hurt, but the message is clear. I often speak in muted tones and work hard NOT to make the other person uncomfortable.
Scenario #1: I am with an orthopedic surgeon who I have referred dozens of cases to. He agrees to lunch and he is wonderful, he pays for lunch and says really nice things about me. I let him know that I am about “really caring for my patients and have taken lots of courses and have seen miraculous results over the years." I am SURE he gets my message, so I shake his hand and thank him for picking up the bill. Over the next 3 months, I continue to send dozens of patients to him and I have never received one in return.
Scenario #2: I meet with the Physician’s Assistant for a very busy walk-in clinic. I have referred dozens of patients to the clinic. The director, an emergency room physician was to meet me, but instead sends his PA begging forgiveness that he couldn’t make it. Lunch was great, in fact it was very expensive and the PA picked up the tab with the doctor’s credit card. During the meeting, the PA acknowledged that he had treated dozens of my patients over the last few months, mostly pain management cases and they appreciate the referrals. Realizing that the PA has nothing to do with policy of referring back to me, I ask him questions about the care my patients are getting and let him know the various techniques we perform in the office and how chiropractic works. Afterwards, we part amicably and 1 month later, I still have not received one referral in return.
Scenario #3: The orthopedic spine surgeon I have known for years, invites my wife and myself for dinner. We split the bill, but have a wonderful evening. We then agree to walk our dogs at sunrise on the beach 3 days a week and do so for a year. Over that year, we chat about spine care, surgery, chiropractic and drugless treatment.
After 6 months, I start referring to his office on an average of 25 cases per month. After 6 months, there has been zero referrals back to me. When I confront the surgeon, he says that his staff just needs to get to know us better and suggests that we send in lunch to the staff because they direct the referrals, not him to remove his bias. I send in lunch, which costs $650 as he has a large staff and I want to impress them. The orthopedist is very pleased and takes my wife and myself to a very expensive dinner and this time he pays. 2 months later, still no referrals. By now, he has operated on over 40 of my patients and has profited $100,000’s on just my referrals over the last year. When I confront the surgeon about the lack of referrals back to me, he then says his nurse practitioner doesn’t like how we do rehab (I have a PT in the office). I then direct the PT to take any case and work them like mad and then present the chart to the nurse practitioner to show her our outstanding work. She is impressed, but says nothing.
A few weeks afterwards, still without 1 referral to our office, one of our patients that was referred, died during spine surgery as “threw a clot” and the surgeon called to inform me. At that time, I realized that perhaps this surgeon wasn’t as good as I thought because death is a rare side effect of spine surgery. What I realized is WHAT A SCHMUCK I WAS and I was “played like a fiddle” to get my continued referrals.
A year later, after I sent my referrals to 10 different surgeons and not locked into one, one of the surgeon asked me how my relationship was with the original spine surgeon. I said we had a great relationship, but he never referred (neither did any of the 10 different ones I sent to) to me. The surgeon replied “I am surprised he even spent time with you. In surgical meetings he constantly lobbied against any chiropractic referrals or any type of professional elationship.”
This past scenario was ME.... and it verifies that I was “more clueless than all of you combined!!!”
Today, I have learned my lessons well and I realize THOSE WHO CONTROL THE REFERRALS CONTROL THE GAME. Never forget that… EVAH!!!!
When I have a surgeon I am considering working with I am not overly polite. I am borderline pompous, arrogant and VERY DIRECT. That southern, midwestern, west coast lay back stereotypical communication of innuendo is purefailure technology. In fact, the east coast technique of innuendo and sucking up failed too (just ask me). Therefore, no matter where you live, it doesn’t work.
When I am with a potential referring surgeon, I recall my research. A neurosurgeon’s malpractice is over $300,000 annually an orthopedic surgeon is over $200,000. Mine… $2,500 and the rest of the profession is around there. Therefore, who needs whose referrals more to cover overhead? I certainly would LIKE to get the medical specialist’s referrals, but they NEED my referrals to survive!!! NEVER forget that FACT, and it is a HARD FACT verified by surgeons I work with in 32 states that without YOUR referrals they suffer financially. Now… most surgeons have alternative referral sources as we all do, but there need is more direct.
Here is the conversation between the surgeon and myself. First, to get the meeting, I say to the secretary “I am a trauma trained chiropractor and am building my trauma patient population and need to have a sit-down with the surgeon to discuss me referring surgical cases to him/her for care.” That will usually get you a sit down in his office or coffee or a meal (and they always pay… but who cares!).
At the meeting, here is what I say:
I have trained on MRI and Spinal Biomechanical Engineering through the State University of New York at Stony Brook, School of Medicine and am focusing my practice on trauma care. I plan on referring many surgical cases to you and I will screen most to see if the cord or root is either significantly abutted or impinged so as not to waste your time. However, while referring, I expect to have a cross-referral relationship. Not 1 for 1, but if I send you 4-5 cases, I expect at least one back so that I know there is mutual respect. I look forward to a very long relationship and if you would like my credentials to learn more about me, or have a discussion on how I manage my cases and the imaging protocols I use, I would be happy to at any time. For now, I am ready to start referring to you providing we have an understanding and it is first my responsibility to get you the cases I promised.”
That is rather direct and will save you the anguish and embarrassment I experienced for far too long. Please do not share with me the “biggest schmuck prize!”
NOTE: Now you can directly see why your credtnial smatter and why I have gone to such great lengths to ensure you get trained through a medical school. It resonantes well with all referring MD's by removing much of the bias.