My wife and I have been meeting chiropractors throughout Pennsylvania and have noticed a trend of "Dual doctor" marriages.  I opened the blog for her to address this area, I think you will find it very interesting. 

All the single ladies …
There is a popular song on the radio these days in which the lyrics state, “If you like it then you shoulda put a ring on it…”  In my recollection from chiropractic  college, it was quite common for students to date fellow students. 

I was unable to find statistics for the chiropractic profession, but one study of medical doctors revealed that 22% of male physicians and 44% of female physicians were married to other physicians in what are known as “dual-doctor” marriages. 

Since January of this year, Ryan and I have been in a “dual-DC” marriage.  We have found there are some definite advantages (and yes, some disadvantages) to this arrangement which I will share with you. 

Shared interest/understanding
Have you met that patient, friend, family member that you just can’t convince about the benefits of chiropractic care?  Try marrying someone with that mindset.  One of the greatest benefits to having a DC spouse is knowing that you come from the same philosophy.  It is certainly of benefit in our relationship that we agree on issues of health which translates to what we eat, our shared activities, and eventually how we plan to raise our kids.

Closest colleague
Many conversations at our dinner table will sound like, “I had a patient today and…what do you think?”  (No names used – it’s still a HIPAA violation, even if it’s your spouse!)

We have often conferred on issues of patient management, insurance or billing snafus, or office procedure issues.  It is of great benefit to have an understanding sounding board right at your own kitchen table. 

If you are in a dual-student DC relationship, it is much like having someone to study with or clarify that concept you missed in lecture.

“Free” help
This may or may not work for all couples, but it works for us.  As you know, Ryan has his own office in a nearby community to mine. 

While I do not practice in his office, I can be found behind the front desk one morning and one afternoon a week.  I answer the phone, schedule patients, and do the billing and accounting.  Initially we chose to do this to keep a low overhead as I am not an employee and I do not receive a paycheck. 

However, we have found that this works for both of us in different ways.  For Ryan, he feels comfortable that he can trust me to manage the administrative aspects of the office.  For me, it makes me feel connected to a practice that we are building, even if I don’t practice there.

Double your debt
This is likely the most obvious (and the only) disadvantage I can think of to marrying a fellow chiropractor.  These days, our education does not come cheap as those of you who just had your financial aid exit-interview have learned.  Enjoy that 6-month grace period because when loans come into repayment for a dual-DC couple, monthly payments can total enough for a mortgage on a really, really nice house.

And speaking of mortgages, we are often told in school that “student loan debt is good debt.”  While investing in your education is certainly a wise investment, banks tend not to look favorably on nearly a quarter-million in combined student loans.  (Do the math, some of you dual-DC couples may even top the quarter-million mark!) 

While these financial issues are certainly present in our relationship, they are thankfully not crippling.  We lived like students for many years in school and continue to do so as we save for our first house.  And we’re already planning a party for 2019 … the end of our 10-year loan term! 

So, please comment if you have additional questions about “dual-DC” marriages.  In my mind, there was no better answer when he “put a ring on it” than YES! 
 

I get a lot of questions from recent and soon-to-be graduates.  One common question I've been getting a lot of lately is about Medicare.

Can I opt out of Medicare or can I just not accept Medicare patients?

I am not an expert on Medicare.  Fortunately, though, Dr. Mario Fucinari, one of our bloggers is.

He addressed this issue last summer and I think it is an issue worthy of a revisit.  So check out Dr. Fucinari's blog here and feel free to submit comments with your specific questions.

I recently received an interesting letter from a woman I treated about 10 years ago. I was one of 22 doctors who she saw over many years for several conditions who all received the letter.

She described her current predicament noting a long history of fibromyalgia and her past regimens of care.

Most recently, she'd made an appointment with a specialist in the community, waiting two months for the appointment. On the day of her visit, she entered the doctor's office with preinfiltrated historical information about her prior care, which she'd spent considerable time gathering.

She was ushered into a treatment room where she waited approximately 15 minutes. The doctor then spent about 5 minutes with her and became incensed as she'd forgotten and failed to list a longstanding prior carpal tunnel surgery. She was advised that she was "withholding" information and felt humiliated by the doctor's demeaning comments and attitude.

When the doctor left the room he concluded "you have issues." 

By way of background, this woman is well-educated (a college professor who holds a Ph.D) and her husband is a very prominent judge. She recounted her story in her letter to inform of the rude and unprofessional behavior of a medical colleague believing that physicians would be interested and should know about those that they might refer patients to in the area.

Her story reflects consumer attitudes and the effects that a dissatisfied ... or for that matter a satisfied ... patient may have on your practice.

While seeing patients, each will present with different needs and wants. As we also know, they all react differently, but all deserve thoughtful evaluation, courtesy, and respect.

Happy Days!

Maybe you had a great idea for an ad that you wanted to place in your local newspaper. With a little tweaking – and maybe some input from family and friends – you finished it up. It was creative, clever – and sure to bring in the business.

But along the way, maybe you forgot to ask yourself if it met the standards created by your state board of examiners.

I know – who wants to bother with something as boring as that? But you NEED to understand what you can and can’t do when it comes to your advertising.

Why?

Because misleading or unethical advertising is generally one of the top complaints against D.C.s.

A common mistake made in chiropractic advertising is using the word “cure.”  Others may say that their product or service will “cure” something … but that does not mean it’s OK for you to say that. Doctors of Chiropractic have different rules to follow.

So what can you do?

• get a copy of your state's current advertising regulations and read them thoroughly
• carefully review all your ads and any other promotional and educational material you’ve created
• you may want to contact your state association ... getting their ideas and input is a great way to take advantage of the benefits of membership
• then be very objective … and make sure nothing in your advertising and marketing materials can even remotely be interpreted as breaking any of the rules

For more information, check out the Starting Into Practice website.

What has worked for you in your advertising? Click on the comment button below to share your ideas.

Being from Boston you can't help but be a sports fan...I can't help it...as they say in Boston, "I bleed Celtic green!"

For a long time I have been observing the rituals of the foul line.  Next time you watch a game, zoom in on the process of shooting a foul shot.  Each player, no matter what team, has their own "ritual" for getting "in the zone" on the foul line. 

Paul Pierce takes two deep breaths and blows them out.  He bounces the ball exactly 3 times, without fail, looks up to the rafters (in Boston I am sure he is looking at those championship banners) and shoots. 

Exactly the same procedure, every time! 

Ray Allen, another Celtic player,  immediately makes two "practice shots" with his right arm...setting his subconscious mind into the shot.

Why this basketball trivia? 

Because shooting a foul shot, for every player, means "getting in the zone" and scoring extra points.  Shouldn't everyone in your office, starting with you, "get in the zone" every morning and afternoon to start your work? 

Do you?  Does your staff? 

Setting up to win takes an extra couple minutes of visualization to "zone in" on the work that needs to be done.  Make your office a champion ... dwell on the positive and make it happen!

I frequently attend post-graduate seminars at a nearby chiropractic college and shortly after students find out I'm a "field doc" they start firing questions about contracts, jobs, etc. 

I even met one intelligent young man who had a 10-year plan mapped out to the finest of details like where he'd grocery shop to save money!  I couldn't help but wonder what would happen if his life didn't go 'according to plan'.  What would he do if that particular store chain closed?  Could he adapt to the inevitable changes ahead of him? 

I heard a great piece of advice from a professor once:  "failure to plan is planning to fail" and I couldn't agree more. 

However, failure to be flexible is a recipe for disappointment. 

Sit back and look at what has happened to the economy in the last 24 months.  Do you think anyone, even the nations' top financial advisors saw "it" all coming? 

Doubtful. 

Do you think the 70-year old-man who spent years dumping funds into a 401k thought the bottom would fall out months before he attended his own retirement party? 

Not likely. 

Let me be the first to tell you, and anyone who knows me will agree, this "field doc" never in a hundred years would have believed I'd be practicing how, with who, or where I'm at now.  But guess what, I wouldn't change a thing now, but it took adapting to change to make it possible. 

Embrace change.  It's inevitable.  Life is colorful ... become your own chameleon!

Is the economy really that bad? First of all the answer is “yes.” The economic outlook is very guarded and, more important, there is a “crisis of fear” permeating the nation that is fueled by the media. 

This is affecting everyone’s practice from the hospitals to the private practitioners, from the chiropractors to the cosmetic surgeons; all health care professionals are feeling the crunch.

Employees and employers are sorting out health care benefits. Guarded use of limited resources is preserved for an unexpected emergency and many patients are rationing their own use of care.

During these times, it is more critical than ever to do two things.

1. Watch your own economic debt and remain diligent in any purchase that cannot be justified.  Stay away from large ticket items even if you can obtain funding.  The return on investment is important to analyze. Every new purchase must be one which will:

   • enhance the efficiency of the office
   • improve patient care
   • provide services which are needed, and most of all
   • can be justified with critical analysis.
2. When new patient numbers are down, when practice volume is down and when the economy is in a slump as is currently is, there is opportunity.  Begin with your staff and do not let them have a “negative” attitude.  It may be more important than ever to have weekly staff meetings - not to have pity parties, but to recognize that the patients who are coming in must be treated in a manner to make the office experience memorable.  Staff attitudes are contagious and your staff must know that they are important in formulating the first and last impression of your office.  Patients, regardless of age want to know that someone cares about them and is listening to them.  Take some extra time, and it is amazing what a few extra minutes can do, to talk to your patients about how they are doing.  Finally, be certain that you spend some quality time in your community. Today more than ever, volunteers are needed for a host of projects ...volunteer your time for a worthy cause.  It is always rewarding to give to others and the benefit always comes back to you.

Do not let the global negativity of this moment determine how you will think, act, feel and believe.  These times demand that your attitude will determine your attitude and your attitude will determine your success. 

And this too shall pass, but how you manage in the interim will be remembered by your patients and staff for a long time.

Everyone needs to take some time off to spend with family and recharge their batteries.  It is not recommended to just close the office, unless you are going to give everyone else a vacation.

Pain takes no vacation.  What do you do about your patients?

When you have someone cover for you in the office, in Medicare this is called “locum tenen.” Locum tenens (or substitute physicians) usually assume the practice in the absence of a regular physician for reasons such as illness, pregnancy, vacation, or continuing medical education.

The substitute physicians often have no practice of their own and move from area to area as needed. Medicare rules require that a locum tenens cannot provide services for longer than 60 days. The regular physician generally pays the locum tenens a fixed-rate, per diem amount, with the locum tenens having the status of an independent contractor rather than an employee.

The regular physician may submit the claim using the Q6 modifier (services furnished by a locum tenens physician). Additionally, the regular physician must keep on file a record of each service provided by the locum tenens along with the locum tenens’ National Provider Identifier.

There may be a problem with certain PPO carriers.  For PPO payors, the requirements may vary, making it necessary to determine billing procedures on a payer-by-payer basis.  It is best to call customer service to seek their policy.

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.