Man ... if I don't hear that question about 3 times a week!

As one who utilizes the flexion/distraction table, I appreciate the therapeutic benefits of decompression protocols. However, I see giving any recommendations concerning these tables/devices as a possible liability.

I have not spent much time investigating but am unaware of any research concerning the contra-indications and proper protocols for each of the numerous types of tables that are purchased at most sporting good stores and sky-mall magazines. 

Do they work? 

According to the testimonials of my patients who tried them, they helped reduce the pain in their low back. However, I still do not feel comfortable making any recommendations concerning the benefit of any specific table/device without proper literature to review. 

A sales person at Dick's Sporting Goods is not making a recommendation based on his/her education and training as a doctor.

What do or would you say to these patients?

I hope everyone had a good Fourth of July holiday. It is a good time for summer fun with friends and family.  I always use this holiday as my mid-year check point for a few business issues.

Imagine yourself sitting in a lecture hell, I mean hall, with all of your peers going through a spinal anatomy class. 

You look to your left and your right and you see your friend; you also see a colleague, plus the guy that you always compete with in class; that girl who seems more interested in her phone than the class; the weirdo that seems to rock back and forth to some inner beat that clearly fascinates him; and the mentally challenged loud mouth that you wonder who he slept with to make it this far.

What makes you different from them? 

You will all (well hopefully not) be chiropractors.  Identical to the public. 

As a Doctor of Chiropractic you will help them with their neck and back.  Oh yeah, and maybe headaches too.  I don't care what your philosophy is, that is reality.  That is public perception, right or wrong. 

Why should someone come to you, rather than the loud mouth?

I'm sure that your technique and skills are clearly superior to the lady texting on her phone all day, but how does the public know that?  What does it mean to them?  What value do you bring to the table?

This is a difficult concept to tackle.  Unfortunately, as we go through school, we all have fairly similar identities and MO's.  We are students trying to get through school and find a way to be successful. Another challenge in pondering this concept is our general lack of experience as a student or new practitioner. 

There are many things that can be a unique selling point:  your personality, your skills, your practice focus, your location, your services, your staff, etc. 

For me, I started off mainly focusing on my location as being unique:  I was the East Village doc. 

For a long time that functioned well, yet as I progressed in practice, another USP grew on me.  I became the answer guy.  Patients started coming to me for answers, and I listened and started using that concept as my USP. 

It is now the focus of all of my marketing.

Understand that yours will probably change over time. So talk with your friends and confidants.  Identify areas where you as a person and as a doc are particularly strong and start there. 

There is no right answer to your USP, but starting thought on it now can only help you in the future.

It has been just over one-year since my wife, Melissa, and I started practicing.  In that time, Melissa has been associating in a well-established office in the community with two other doctors and I have been in private practice.

While we’ve had some ups and downs like any new practitioner, overall I would consider this year a success. If you would ask us, in the first year, what was the single most important thing we did to help us succeed in practice it would be this: find a mentor.

Melissa and I have been extremely fortunate in this regard as we have been surrounded by experienced and willing mentors. When I purchased my office, the retiring doctor stayed at the office for two months, acquainting me with patients and particular adjustments that he had learned in his many (many, many) years in practice.  He was quick to share the clinical pearls that often only come with experience.

When Melissa started practicing in her office, the advice of the other two doctors and their office staff was invaluable to her, but also for me as I worked to establish my office in a nearby community.

Melissa was able to ask her colleagues about particular issues of patient management. And they offered me a wealth of knowledge from experienced practitioners and staff whenever I had questions about insurance companies, billing issues, and a variety of other things you cannot prepare for until you are in practice.

If you don’t have a mentor in your area, do not be afraid to look elsewhere. 

Recently, Melissa developed an interest in pediatric chiropractic.  However, there are few chiropractors in the area that specialize in this particular population.  Through one of the many professional organizations she was able to contact a female practitioner in Michigan.

Like Melissa, she is married to another chiropractor and just out of school she became an associate while her husband opened an office.  Through email they learned that our situations had much in common and she was able to share the ups and downs of their experiences with us. 

She freely offered suggestions and advice which will be invaluable for us as we continue in practice. As you go into practice, whether as an associate, an independent contractor, or private practitioner, there are many practicing doctors who shared similar experiences as they were starting out. 

It is worthwhile to develop a relationship with a chiropractor either in your area or your particular area of interest as their experience and advice can be invaluable. 

And when you become an experienced practitioner, don’t forget to pay it forward.

If you are having trouble finding a mentor, consider starting here.  Feel free to post a comment or question for any of the bloggers on Starting Into Practice.

Not long ago, I met with what some term an "old time chiropractor." Dr. Steve has practiced for many years and has always had a busy office. During our visit he shared an interesting story.

He reported that he had recently received a call from a patient who he'd not seen in almost 10 years. The patient requested an appointment time which would allow them to chat about a matter which did not require his being treated.

On the day of the consultation, Mr. Jones and Dr. Steve caught up a bit and exchanged pleasantries. Each was a bit grayer and carrying slightly more weight than during their last encounter. Mr. Jones thanked Dr. Steve for seeing him and said... "Doc, I'll get right to the point."

Apparently, he had a younger sister who lived out of state. Four months earlier, she had been diagnosed with an internal medical condition for which she had seen several specialists. Opinions from the doctors regarding subsequent treatment varied and as a result the family was in a quandary on how to proceed.

Dr. Steve as always listened carefully to Mr. Jones and then inquired, " After all these years why have you now come for advise?" Spontaneously Mr. Jones replied, "You're my doctor and have always been. I trust you with my, and my family's health."

I recount this story as it provides a great lesson to each of us.

While many chiropractors feel as if they specialize in certain areas, often our "old time brethren" served as both a doctor and adviser to those they cared for. They spent considerable time getting to know their patients and often managed their general health care needs.

They developed a bond and trust over time which instilled the type of allegiance that Mr.Jones expressed to Dr. Steve.

In this era of specialization, are you establishing a strong rapport with your patients ... and if not, what can you do to build a patient's confidence so that they will always feel that "You're My Doctor." 

Happy Days!

Everyone has a bad day … or two. And then there’s the employee who is permanently unhappy.

Is it because of something in the office? Is there someone they don’t get along with or don’t like? Maybe they don’t like you. What are you going to do?

It may not seem like a big deal – it’s hard to like work, your boss, your co-workers, or even patients every single day. But a disgruntled employee can cause concern in several ways.

• Patients – how are they treating patients? If your employee is unhappy, are they telling patients? Sometimes actions speak louder than words – maybe the way they’re acting says more than what they’re saying.

• Workload – are they getting the work done that you expect them to do? Are they causing you to lose income because of inaccurate insurance filings or slow billing procedures?

• Staff – how do they get along with other staff (including you)? Are they disrespectful? Is their attitude rubbing off on other employees?

Each of these alone can be cause for concern. All of them combined are a sure recipe for an unhappy office atmosphere. It may be time to discuss your expectations and the performance of the employee.

Better yet, sit down to talk with your employee about your policies and procedures in the employee handbook.

You have an employee handbook, right?

This manual should outline performance expectations … and consequences for not meeting those expectations. Document the conversation and be specific about what is happening (or not happening).

And take the necessary steps to get your office running in tip-top shape.

Your collection policies should clearly state that ALL co-pays are due at the time the clinical services are rendered.  The forgiveness of co-pays must be considered a "no-no" and front desk staff must clearly support and carry out the office policy. 

Once any policy is compromised, the practice is on a slippery slope to collection and cash flow problems.

When the patient is first introduced to the practice, it is incumbent on you (or your designated staff person) to ensure the patient has clarity around the subject of payment for service.  To do otherwise is unfair to the patient and the practice.

Make no mistake about it ... although you are in a health care profession, you are also in the business of health care and failure to learn and embrace the principles of business will lead to economic challenges of the highest order.

You are responsible for the establishment of policy.  If you or your staff fail to take full ownership of those policies and are not congruent in that regard, danger is on the horizon.

Take full view of the way you and your staff approach the financial side of the practice and if change is the order of the day DO IT NOW!  You will be happy that you did.

Everyone is up to their eyeballs in work.

Time constraints are everywhere. So much to do and so little time to do it.  

This refrain is a constant in every community in America and it goes to the heart of how to build relationships …especially with local MD’s. 

For new D.C.s, visiting your colleagues is a must - not only because it is the right thing to do, but also because they can help you if you simply ask.  Don’t try to avoid your colleagues when you move into a community - this is simply not the best way to approach relationships. 

Start with the local D.C.s who have been in practice for some time to get some advice and introductions to the M.D.s in your community.  Chances are most have had some relationships with the local orthopod, neurosurgeon, cardiologist, etc and can easily let you know if they are cooperative, friendly, etc. 

Everyone needs referrals, the orthopods et.al. and your colleague might just be the best people to make an introduction.

Depending on how good the relationship is, they can arrange a luncheon where all three of you can meet. They can write a letter on your behalf letting the physician know you will be calling. Or they can simply pick up the phone and call the doctor to announce your arrival in the area. 

Why would this be good?

Because it enhances everyone’s position. The ortho has a new referral source, you have made a new referral contact, and the established doctor has made the connection happen. 

Some of the business books have fancy names for these kinds of individuals.

• in politics they are lobbyists

• in society they are the social butterflies

• in business they are the matchmakers

Regardless of what you call them, do not overlook your colleagues as the first approach to introductions not only in the medical community but also in the advisors they feel comfortable with and trust.

Sometimes the acres of diamonds are in your backyard.

Recently I was told by several doctors that they do not participate with Medicare.  Since they do not participate with Medicare, they charge their normal fee for Medicare spinal manipulation and collect cash.  This is not only illegal, it will probably result in huge fines for these doctors.

Before you see a Medicare patient, you must first enroll with Medicare. 

This is accomplished with the 855i Enrollment application that can be downloaded from the Medicare website.  Upon filling out the form, you must then choose whether you wish to be a participating or a non-participating physician.

Participating Physician means that you bill Medicare for the service and they reimburse the doctor directly.  Medicare also pays you a 5% increase in fees over the non-physician rate.  Medicare will forward the claim to the Medigap insurance for the secondary payment.  As a Participating (PAR) physician, you are also listed in the Medicare Participating Physician Directory, which is provided to each Medicare patient.

A Non-Participating Physician (Non-Par) means that you still must file the claim with Medicare for the patient, who then is reimbursed by Medicare.  In this case, Medicare reimburses the patient directly.  Medicare reimburses at a lower rate than the par rate, but the doctor can charge up to the limiting charge.  If the doctor charges anything over the Limiting charge, you will be fined $10,000 per occurrence (per claim)!

Under NO circumstances can a chiropractor not bill Medicare for spinal manipulation that is medically necessary (i.e. not maintenance care).  IT IS ILLEGAL FOR A CHIROPRACTOR TO OPT OUT OF MEDICARE.  An M.D. or a D.O. can opt out of Medicare, but it is illegal for a D.C. to opt out of Medicare. 

If you do not wish to bill Medicare or in anyway participate with Medicare, then you cannot see a Medicare patient.

The bottom line is this: if you see a Medicare patient, you must file a claim for them.  here is no opting out of Medicare and there is no such thing as a pure "cash" practice when it comes to a Medicare patient.

I remember very clearly looking dumbfounded at a friend of mine as he made a major confession to me.

Was I hearing right?  Had he actually said what I thought he said? 

He is a student at a premier chiropractic college with straight A's and a great personality, and he was going to be an Associate?  He was going to work for someone else?  What isn't working for him, or what went wrong? 

These were the thoughts I had at the time, and to this day, I feel a sense of shame that I felt that way.

Yet, as I travel to different colleges, there still seems to be a timidity toward people who are associating as if it is some sort of failure or poor decision. 

This has to change.

A major failing that our profession has is a lack of support for our new practitioners.  It is getting better, as this blog is a testament to, but there is much work to be done.  Cultivating good associate experiences is a crucial step for us to increase our overall training and success in this ever changing business world.  Plus, I feel it will help more of us stay in practice longer by teaching us the pratfalls of practice.

There seems to be a mentality that you're in a race ... I felt it when I was a student.  Oh wow, such and such is opening their practice within a month of graduating... I need to get a move on!  I felt the push to dive in sooner to make sure I was, well, making it. 

I need to act fast and think later.

NO!!!!  It is not a race! 

There is no prize for being the first to open your practice ... that is unless there is an equivalent prize for being the first to close your practice due to poor decisions.

Take your time.  Go through our survey on starting into practice to help you determine where you are at.  Look at your options and take your time.  Make that good decision, and make it well.

Please visit our resources to learn how to create a good associate experience if you decide that it is a good step for you.