The Chiropractic Files

Women Leaping to the Forefront

Article posted on acatoday.org  article suggested

by Michelle Logan Chiropractic Student check out her myspace page  http://www.myspace.com/mishllynne 

As Their Numbers and Opportunities Increase, Female DCs Search for Ways to Balance Family, Practice and More Participation in Chiropractic Leadership

By Angela Kargus, Communications and Public Relations Manager

The chiropractic profession has long been noted for the number of women in its ranks, including both doctors of chiropractic and chiropractic assistants.  From pioneers in chiropractic science such as Mabel Heath Palmer, DC, to modern-day educators and researchers, women have played some of the most influential roles throughout the history and development of the profession.

While recent surveys indicate that the number of female chiropractors hovers around 18 percent—a 5-percent increase from just 10 years earlier—chiropractic colleges report rising numbers of female students entering the classroom, with some schools touting female enrollment percentages as high as 49 percent.

If the trend continues, women chiropractors may have an even greater impact on the future of the profession. Still, striking a balance between career and family remains a challenge for most women—chiropractors or not—as they strive to make their mark.

Female Leaders  

As women already in the field attest, there’s no doubt that opportunities for achievement in the profession are greater than ever before for female chiropractors. And while some in the profession may question whether or not chiropractic leadership represents the diversity that exists in the field, when it comes to women, statistics say the chiropractic profession is par for the course.

According to a review conducted by ACA staff of several national chiropractic organizations—including ACA, FCER, FCLB, CCE and COCSA—approximately 17 percent of all board members combined are women—a higher percentage than most Fortune 500 companies.  According to a 2005 report by Catalyst, an advisory organization working to advance women in business, only 14.7 percent of Fortune 500 board seats are held by women.

“Historically, chiropractic has been a male-dominated profession in terms of leadership roles,” says Kate Rufolo, DC, a board member of the Congress of Chiropractic State Associations (COCSA) and the first woman president of the Pennsylvania Chiropractic Association (PCA).  “However, we’re starting to see a change in the trend, with more women holding leadership positions on boards and committees.”

Alana K. Callender, director of the Palmer Foundation for Chiropractic History and an author on chiropractic history, shares similar sentiments, “In the past, women may not have been on as many boards, held as many offices, or been given due recognition by their fellow doctors, but chiropractic…has never closed the door on women.”

While both women are happy to see the increased involvement of women in local, state and national leadership positions, they agree that an even greater increase in participation by women could only benefit the profession.

“You need the female perspective,” Dr. Rufolo says.  “There’s a different breadth of perspective and expertise—just by being female—that one brings to a board of directors or other leadership position.”

Canadian research shows that boards of directors work differently when diverse perspectives are brought to the boardroom table.  In particular, researchers found a distinct difference in governance patterns, especially in setting an organization’s mission and vision, and in planning and policy-making.  Having more women and people from diverse backgrounds means that companies represent—and better understand—the customers they want to attract, leading to improved competitiveness and productivity.

Another recent American study shows that companies with the highest representation of women on their top management teams performed much better financially than those without—a 35 percent higher return on equity and a 34 percent higher total return to shareholders.

Dr. Rufolo admits that in the beginning her position as the first woman president of PCA was daunting.  “I set the bar higher and looked at myself with more scrutiny than any of my male peers.  From my experience, the good ol’ boys club that everyone throws around isn’t actually there. If anything, from years of hearing about it we simply think it exists,” she says.

Other women agree, including Cynthia Vaughn, DC, from

Austin

,

Texas

, an ACA delegate. “There are ample opportunities for women, and the seemingly large number of men involved in the profession shouldn’t be a deterrent.  With the large number of female students entering the profession, it’s only a matter of time before women gain critical mass.”

Work, Family Balance

Undoubtedly, women today have more opportunities than ever before. Whether as entrepreneurs in their own practices or managers in large corporations, female business leaders are succeeding at an unprecedented pace. The percentage of women-owned businesses is increasing at rates exceeding the national average as more and more women entrepreneurs find access to capital and markets for their goods and ideas.

But with this success comes the challenge of striking a balance between professional aspirations and personal responsibilities.  Women tend to play tug-of-war between business needs and spending time with their family, according to a survey conducted by CareerBuilder.com. Although the majority of working mothers say they spend three or more hours with their children after work, 44 percent admit they become preoccupied with work while at home. One-in-four say they bring home work at least one day a week.

“The No. 1 issue for women in practice is balance. How do I have both a great practice and a strong family?” says Janice Hughes, DC, a consultant with The Masters Circle.  In 2003, Dr. Hughes collaborated with fellow

Masters Circle

consultant Elisa Zinberg, DC, to present a custom-designed program to address the unique challenges and opportunities for the female chiropractor.

“The most important thing—for anyone, including moms—is finding what motivates them.  You need to understand your goals, needs and expectations, both at home and at the office,” says Dr. Hughes, explaining that women face intense pressure when trying to balance a high-powered career, marriage and children. “While some women would love more involvement in chiropractic beyond their office, they may realize that taking on an additional professional role isn't a major priority for them at this point in their life."

To achieve a workable balance, many women are blending work and raising kids.  Dr. Vaughn recalls the days when her 8-month-old daughter accompanied her to the office and soon became the clinic mascot. “The key to making home and work balance is different for every family, but it’s not impossible. One of the greatest advantages to owning your own practice is the flexibility,” she says.

Finding Support

For some women, the way to achieve a sense of balance is through membership in a women-specific business networking group, because often the camaraderie goes beyond discussing workplace issues. Women say the appeal to women-only groups is the ability to ask colleagues questions without feeling embarrassed or stupid, and to learn how other women handled difficult situations. Networking also tends to be easier, as women often have things in common already, such as balancing work and family responsibilities.

Sharon Harady, executive director of the Center for Women’s Business Research, a nonprofit group based in

Washington

,

D.C.

, said that successful women network in groups for different reasons. Some look for business leads and help finding employees. Groups specific to women provide those benefits, but also one other benefit that’s hard to find elsewhere: support.

“They are looking for other women with whom they can share experiences and what they’ve learned in a low-risk environment,” Harady said. “That’s the main thing these organizations do. They give you a chance to be with women who have gone through experiences and can help you deal with them, learn from each other and provide connections.”

Aspiring Leaders

For women—or men—who aspire to be leaders in the chiropractic profession, the Women’s Equality Unit, which works to support economic opportunities for women, offers the following suggestions:

·       Seize every opportunity to network. Join professional chiropractic organizations such as the ACA or your respective state association. Attend trade shows and professional conferences. These are excellent learning tools and have the added bonus of enabling you to meet new people.

·       Have the right skills.  Make sure you have as many of the core competencies that boards look for as possible: financial literacy, communications skills, strategic planning, and experience in the decision-making process.

·       Talk about your career aspirations. Let people know what positions or assignments would be of interest to you and why you would be a good match for them.

·       Raise your profile.  Write articles in industry publications, participate in corporate activities and, where possible, attend industry functions.

·       Take on leadership positions.  You know the saying: “Even a journey of a thousand miles begins with a single step.”  If the chance arises, volunteer to sit on a task force or other industry-related board. You gain useful experience as well as the reputation of someone who gets things done. Don’t be afraid to step outside your comfort zone.

·       Identify opportunities. Find out which boards are already looking for women to join them; that way you’ll be pushing at an open door when you put in your application.

·       Believe in yourself. If you can see it, you can have it. Picture yourself in the role to which you aspire.  You must have confidence to get to where you want to go.

·       Persevere.  We are likely to stumble at first. It’s part of the learning process. You may not achieve what you want immediately, but don’t give up. Keep acquiring the skills that will one day take you into that leadership role where you know you belong.

Readers, send us your comments about this article or suggestions for future articles. E-mail the ACA News editor at acanews@acatoday.org. 

My Chiropractor is a god

I must say that this is a very interesting site.  I’m not a doctor and I’ve read some of the articles in there.  I’m actually a patient.  About 2 years ago, I had severe migraine headaches and they did all the test for me.  The MRI, Cat Scan and a lot of other tests that I could not even name.

I can’t even begin to mention all the medications that I was on.  If you can name a pill, I took it.  I had a friend that had similar symptoms but was not as severe as my symptoms.  She recommended that I see a chiropractor, but like many of us, I dismissed it.

What made it worse is that I approached my primary care doctor about the idea of seeing a chiropractor and he told me that they were simply witch doctors and that there is no evidence for what they practice.  In one or two words, he told me don’t waste my time and money at the chiropractors.  So a few weeks went by and the migraines were simply unbearable.  So, this was it folks, I was at the end of the road.

I decided that I had nothing to lose, so what the hell, I was already in pain and I didn’t think that anybody can make it any worst.  All the other doctors were thinking that it was all in my head because their fancy tests could not tell them what was wrong with me.

So, I went to this chiropractor and let me say that from the beginning it was the best experience that I had a doctor’s office.  That was the first doctor that I went to, that did not brush me off, and he actually acted as if he cared.  He made me sign a medical release and he got all of my test results from the hospitals, doctors etc……

I was placed on a 40 visit plan, and he told me that I can stop at any point but he did not recommend it.  I read a lot of negative stuff about chiropractors on the internet but I was desperate and I gave it a try.

LET ME TELL YOU, after the 3^rd week of chiropractic adjustment my headaches were better I would say by 70 %,  when I told my primary about it, he told me that it was something called a placebo and that it will come back.  He told me that strokes have been associated with the neck adjustments.  To be honest with you at that point I was feeling so good that I was willing to take a chance.  When I approach my chiropractor about the stroke thing, he told me that I had a better chance of winning the lottery or a better chance of being dead by an aspirin overdose than to stroke out from a neck adjustment.  My chiropractor showed me the research and I read it for myself.

I am now on my 30^th visit and my headaches are about 90% better.  I get some headaches here and there but I mean it’s a HUGE difference.  I would recommend chiropractic care to everybody.  Since then, I put all my trust in my chiropractor.  I see him first before I see my primary.  Some people may think that it’s a stupid choice but this guy is more knowledgeable than all the doctors combined.  All the stupid tests, pain pills for years and only my chiropractor was able to give me relief.

Yup, I read all the nasty articles about chiropractors and it’s a damn shame.  Chiropractors are great.  I guess they have their limitations, but they can really help.  I read all the articles on this site and for those people that’s criticizing chiropractors, I don’t know what to say but not to “ knock it till you try it”.  All I know is that I went through a lot of pain and suffering before I can get relief.  I know what I went through and for somebody to sit there and tell me that chiropractors are quacks, is simply not true.  Well put it this way, if they are quacks then that’s one quackery that I will like to take part in, because they were the only doctors that was able to treat my problem.

I will like to end this by saying.  Thank you doctors of chiropractic.

Sandy Bonase

NSAIDs and COX-2 inhibitors

Andre Broussard, D.C.

NSAIDs and COX-2 inhibitors impede tendon, bone and cartilage repair

NSAIDs are not appropriate for neurogenic pain with no
prostaglandin-mediated inflammation.

/By //Matt Hasson/
ORTHOPAEDICS TODAY INTERNATIONAL 2006; 9:12

*September 2006*

INNSBRUCK, Austria -- Recent biochemical research suggests that NSAIDs
are appropriate for prostaglandin- mediated inflammation, not
"neurogenic inflammation" associated with tendinopathy.

The upshot: COX-2 inhibitors impair tendon and bone healing, two leading
experts said.

Physicians have typically treated patients with tendinopathy but no
inflammation with NSAIDs. However, there are certain chemical and
genetic factors that discourage NSAID use in some patients, said Hakan
Alfredson, MD, of the University of Umea, Sweden.

"In earlier days, the only information we had to rely on was the
information from biopsies," Alfredson said at the 12th ESSKA Congress,
here. "And those biopsies showed us irregular fiber structure, high
concentrations of matrix, vascular ingrowth but no inflammatory cell
traits. But, despite that, we gave these patients tons of NSAIDs. ... We
wanted to use a new method to try to evaluate whether there was any
inflammation in these tendons."

In vivo microdialysis

"If you use NSAIDs together with proteins, certain NSAIDs virtually
block the protein synthesis in the muscle."
-- Hakan Alfredson, MD

Using in vivo microdialysis to study the biochemical properties of
affected tendons, Alfredson and his colleagues tested 20 patients with
tendinopathy and painful knee function. The control group included 12
patients with normal tendons and no pain. Another arm of the study
focused on six patients with jumper's knee. The control group had six
patients with normal tendons, Alfredson said.

The specialists also assessed patients for prostaglandin E2, which is
"essential for a so-called chemical inflammation," Alfredson said. They
found that prostaglandin E2 levels did not differ between the chronic
painful tendons and the normal, pain-free tendons.

"So, the conclusion from those studies was that there is no
prostaglandin-mediated inflammation inside those tendons," he said.

Studying 1,178 knees, Alfredson's group found that several
pro-inflammatory cell proteins were not regulated in the tissue, again
suggesting no prostaglandin-mediated inflammation in the tendons,
Alfredson said.

"It cannot be justified to treat your patients with NSAIDs with this
background," Alfredson said. "It's also important to remember that
certain NSAIDs have negative effects on muscle protein metabolism. So,
if you use NSAIDs together with proteins, certain NSAIDs virtually block
the protein synthesis in the muscle, so that's another negative factor."

NSAIDs also inhibit tenocytes and, during exercise, decrease blood flow,
Alfredson said. Other factors include heavy vascularity and "neurogenic
inflammation," as opposed to prostaglandin-mediated inflammation.

The benefits of prostaglandins

Norwegian specialist Sigbjørn Dimmen, MD, also noted the value of
prostaglandins, which are "responsible for ensuring balance between bone
resorption and bone formation." Decreased prostaglandin may impair bone
healing, and the COX-2 enzyme is critical for fracture healing, he said.

Dimmen and his group tested how short-term doses of parecoxib, a COX-2
inhibitor, and indomethacin, a COX-1 inhibitor, affect long-bone
fracture healing. The parecoxib and indomethacin groups had lower bone
mineral density than the control group.

Also, mechanical testing showed the parecoxib group and control group
demonstrated significant differences in all properties, Dimmen said.
However, parecoxib proved more detrimental.

"So, our findings with parecoxib had the higher delay in the fracture
healing than indomethacin, with the assumption that the COX-2 enzyme is
responsible for impaired fracture healing," he said.

"Never give NSAIDs for stress fractures or for cartilage damage. NSAIDs
hate chondrocytes."
-- Sigbjørn Dimmen, MD

No prospective, randomized clinical trials or evidence-based
measurements have addressed the effects of NSAIDs and COX-2 inhibitors
on long-bone fractures, Dimmen said. Some data show NSAIDs and COX-2
inhibitors cause no nonunions in acetabular fractures, which "might
indicate that you can't see any negative effects from NSAIDs or COX-2
inhibitors in fractures which normally heal well," Dimmen said.

However, he advised colleagues to avoid NSAIDs or COX-2 inhibitors when
treating stress fractures or even when repairing cartilage.

"We know that prostaglandins are necessary for fracture healing," Dimmen
said. "We know that COX-2 is critically involved in fracture healing in
the first 3 weeks after a fracture. And NSAIDs and COX-2 inhibitors both
impair fracture healing.

"I think one should probably avoid NSAIDs and COX-2 inhibitors in all
shock fractures and also other fractures requiring unimpaired fracture
healing," he added. "Never give NSAIDs for stress fractures or for
cartilage damage. NSAIDs hate chondrocytes."

*For more information: *

* Alfredson H, Dimmen S. Non-steriodal anti-inflammatory drugs
and tissue healing. Mini symposium. Presented at the 12th
ESSKA Congress and 5th World Congress on Sports Trauma. May
24-27, 2006. Innsbruck, Austria.

Article suggested by Dr. Jen MC, DC

In response to the Pediatrician Bartram

It's unfortunate that we have to call this a "battle" between DCs and MDs. It's also unfortunate that people like Clark Bartram do not embrace our chiropractic profession, but that is his opinion and he doesn't represent the whole medical community.

I belong to a family of medical doctors, nurses, and podiatrists and we always engage in wonderful conversations about science and health. My father, who is a general practitioner, now refers many of his patients who have suffered from years of migraines to chiropractors. His patients come back to him thanking him, for had he not referred them to a chiropractor, they might never have gotten better. My father now thanks me for educating him on what chiropractors do.

The point here is that MANY medical doctors really have no idea what we treat and think all we treat is acute low back pain. That is not their fault. In fact we need people like Dr. Bartram to ask these important questions so that we can educate the public.

What is also wonderful is that many other medical doctors, in addition to my father, DO ACCEPT chiropractic. Just yesterday I had a patient with sciatica down her right leg who was told by her medical doctor to see a chiropractor for her sciatica. I feel a great sense of joy every time I see evidence of the medical and chiropractic profession getting along.

As long as the these two professions together with other health care professions get along can we really reach our common goal, which is to HELP OUR PATIENTS. Folks, this shouldn't be a battle between us, it should be a battle to HELP PEOPLE GET BETTER.

Thank you to Dr. Vanden Hoek for educating those who don't understand chiropractic.

Thank you to Dr. Bartram for asking about our profession. Without questions nothing will ever be answered.

Anna Marie

___________________________________________________________________________________

Dr. Bartram,

How could you possibly say the chiropractor made a fool of himself by giving scientifically-referenced (and in many cases, medical journal references) responses to your emotionally-driven questions? Do you have an equally intelligent rebuttal, or must you resort to name-calling in lieu of a real argument?
Incidentally, my 7-year-old was never vaccinated (I don't tell my patients not to do this either, but I will give them the other side of the story, as will our pediatrician, who supports us not vaccinating), has had one round of antibiotics in his life (the infection came back after the meds, and was then successfully and completely resolved with homeopathy), and has only once been sick for more than 24 hours (the chicken pox--no scratching, thanks to homeopathics and adjustments). I have adjusted him since he was 3 hours old.

I would add that my malpractice is so much lower because the "side effects" of my treatments are improved immunity (as reported to me by my patients, who are thrilled to not have so many colds), better digestion and elimination, and improvement in conditions such as asthma (I don't claim to cure it, but know from clinical and personal experience that regular adjustments drastically reduce the need for rescue inhalers--I've thrown away 2 of my own half-full inhalers because they expired.)

How is it that the chiropractor lost? I think it is your patients who are losing because of your unwillingness to learn.

Tina Warren DC

Part IV boards: Is it that bad?

Hey guys, my name is Jason and I wanted to write my experiences with part IV.  This is not one of those scholarly articles, but just some advice on part IV.  I definitely think that you should prepare for part IV.  You should study as hard as you can and personally, I did my review with NBS and my scores were excellent.  I did better than I expected.

Guys trust me you really have to try to fail this test, not to make it sound easy but if you did some studying, you should be fine.  I have to say thanks to Dr. Clerge for letting me participate in this blog. 

Ok, so when I enter the room, I was nervous, nervous, nervous.  The first room was adjusting and I did very well with that, and once again if you study with NBS you should be fine in that section.  Remember do not thrust, DO NOT THRUST, that’s an automatic failure.   I remember a couple of my friends were freaking out because they heard a cavitation upon positioning the patient, even they did well.

The second room was diagnosis, where they presented you with a case and a booklet and you had to choose some diagnosis that went with the case.  I did very well in that also.  By the 4^th or 5^th room, I was calm and I knew that this would be a breeze.  There are several rooms in part IV.  Some rooms deal with adjusting and others may deal with things like Phys Dx, Performing orthopedic tests, Case history etc……with NBS, you will be ok for that section. Some of the instructors or graders are very nice and some of them will talk to you and make you feel at ease.  On the other hand, there are some jerks that will say absolutely nothing and will do nothing but write.  If you see a lot of writing then that’s not good.

The X-ray portion of part IV is impossible.  Most of the students think that they knew maybe 2 or 3 of the X-rays.  If you fail this test, it’s probably because of the X-ray section.  When I left the X-ray room, I was discouraged because some of these X-rays looked normal and I had to choose a diagnosis.   Personally, I don’t think that there is a way to study for the X-ray section, but study your ass off!!!! You will need it.

Ok, so this is what part IV is all about.  They want to be sure that you can diagnose and that you will not be killing anybody when you get out there.  You should study as hard as you can.  Once again put some effort into it and you will be fine.

If you have any questions, I will try my best to answer it.  I do think that students should start using this site more often, because we can learn valuable information from other students and the successful doctors in this site.

Good Luck Guys,

Jason

A C A - Vice Admiral Donald Arthur, MD

 

 

 

 

Vice Admiral Donald Arthur, MD, surgeon general of the U.S Navy, talks about his respect for chiropractic and its contributions to the care of severely injured soldiers returning from Iraq and Afghanistan. Well, as you can see not all MDs are against chiropractors.  I believe as long as we all know our limitations, we can co-exist.  There are conditions that should be treated by the chiropractic doctors  and on the other hand some conditions are not biomechanic in nature and should be treated by the Medical doctors. It aches me when ignorant, misinformed health care providers make negative comments about chiropractors.  Unfortunately, my belief is that people reserve the right to express their opinions.  As much as I want to delete some of the recent comments on this site, I will not. Anyway, enjoy the site and let others know.  I hve some great ideas for the future.  Stick around and you will see. Dr. Clerge, DC

What's in a Flu Shot?

Hello All,

I would like to welcome the new doctor to chirofiles.com Below is his information Dr. Dan DeReuter practicing in Dalton, GA., feel free to check out his blog.

Dr. DeReuter will be posting some articles and you may also check out his blog directly. Below is a clip that the doc brought to my attention.

Before you get your next (bird) flu shot, watch this short vid and make sure it's something you really think you need.

A little Chiro Humor!!

Hello once again docs,

Check out this simpsons episode on chiropractic.  It's funny, funny.  We all work hard throughout the day and I want chirofiles to be a place where all chiropractors can come and relax.  While learning from others, we can also use some laughter.  While relaxing we can check out the humor section and lighten our day a little.

Also check out little taylor the future chiropractor

Enjoy the Clip,

Dr. Clerge, DC

Can Medical Doctors do What we do?

Hello all docs,

First let me say thank you to all the doctors that are contributing to chirofiles.com, Once again there may be positive articles while some may be more on the controversial side.  Hey!! this is America, we all have the right to voice our opinion.  Your articles are really appreciated.  Let your colleagues know that this site is in existence.  We have an obligation to inform the new docs, students, the public and other chiropractors.

Check out this clip

Can medical doctors do what chiropractors do?  Hell no, you wouldn't go to the dentist for a knee problem, so why go to a medical doctor for a chiropractic problem.  Below, a few clips for your enjoyment.

Dr Clerge, DC

And you ask yourself is chiropractic safe. Well check it out!!!!!!

They Don't Care About You

I’m writing this article for the benefits of the new docs and students that is not aware of the real world. I know that some chiropractors will probably read these articles and decide not to post. Listen up and listen good, read and learn from the doctors in this site. They have been through it all and they know what they are talking about.

Ok, I will lay it out once and for all.

I’ve been practicing for 20 years and the first 5 years I worked as an associate. The bottom line is that they don’t care about you. Who is they? Well, the chiropractors that you are working for, the insurance companies etc……

The first couple of years of practice the chiropractors that worked for the insurance board reviews were declining my claims. This is when I realize that this is a dog eat dog kind of world. Most chiropractors could care less about their associates. The reason why the majority of chiropractors hire an associate is to make more money. Trust me, you were not hired so that they can lose an extra $50 to $60,000/year.

Let me tell you the problems with the associate position:

1. You will learn absolutely nothing but learning how to adjust. When it comes to the business aspect of it, FORGET ABOUT IT!!! Most chiropractors will not teach you billing, coding ect…..It’s not that they don’t have the time, it’s just that they don’t want to. If you were making a million a year, would you show somebody else how to make a million so that you can have competition.

2. Work, Work and Work. In a busy practice, you will probably be adjusting 3 to 400 patients a week, will probably be screening, will probably be in charge of all ROFs, Exams, X-rays etc……

3. Commission, most of the compensation or commissions plans are crap. For every dollar you will probably get a nickel. Most associates are afraid of opening a practice and you should. Keep in mind that you are swimming with sharks. Managing and running a practice is not an easy task.

Usually in the interview, everything sound nice and they promise you the world. It’s a trap. Make sure that you read, read, READ your contracts. Your employer is not your friend, they are your employer. You need to lay out all the cards on the table from the start. You should agree on what you will and will not do. This is very important, since new tasks are always assigned during the course of your contract.

For those of you currently in an associate position, GOOD LUCK!!! This is not only for chiropractors!!!! I know optometrist, dentist, podiatrist that went through the same thing.

I know most of you are probably saying!!! Well, his on the other side now, why is he writing this? Like I said before, my first 5 years were spent as an associate. Guess What? I was screwed for 5 years. I’ve been in practice for 20 years and I made a promise to myself not to screw any new docs or associates.

Financially, I’m OK and all my associates are OK. I do not hide anything from my associates, I lay it all on the table. I tell them what I’m making and what they will be making. I tell them from the start that they are not hired because I wanted to lose money, so yes they will be working. I teach them how to bill, code and they have an option to leave and start their own practice if they so wish. The funny thing is that most of them don’t want to after learning all the stress of running a practice. I treat all of them as if they were partners and they are compensated well, well, well. For Example my first year associate is making $78,000/year plus commission. His first year straight out of school, he earned $102,000/year. This is more than any new MD, Dentist, Optometrist etc….. How many associates can you honestly say that’s making that kind of money. Don’t let it fool you Dr. Chuck work his ass off also.

Out of all the associates that I’ve had, only one ended up leaving for family issues. I have 4 associates working for me and they are all happy.

My advice is to be careful, it’s not a kind world out there.

I will be glad to answer any question. Feel free to post any questions, I will be happy to answer them.

Dr. Simmins

Pay-For-Performance

Ever heard of "Pay-For-Performance" healthcare?

It sounds like a great idea at first. The idea is that a doctor or hospital would get reimbursed for following a set of guidelines that could ensure statistically the best care for the given condition. Who is doing it? Mostly HMO plans. And here is the kicker, more than 50% of HMOs are doing it. To be honest, I am not sure if I like it or not. My frustration is that I feel the few will be ignored for the many. That some will suffer because they don't respond to treatments that others respond to. Most of you know I root for the underdog. I constantly treat the person who falls through the cracks of standard care. I treat those that are the few who don't respond the way everyone else thinks they should. As such I am mad that more and more people will fall into this category as they are shoved through a flow chart of protocols rather than the doctor being required to investigate. I am also glad because this means more people for me to treat. But this isn't really what I want.

A recent article noted:

"More than half of the nation's HMOs used pay-for-performance programs in their contracts with doctors and hospitals in 2005, according to a new study supported by HHS' Agency for Healthcare Research and Quality. More specifically, the study, which was published in the November 2 issue of the New England Journal of Medicine, found that nearly 90 percent of those included these arrangements as part of their physician compensation and more than one-third of HMOs with these programs included them in their hospital contracts. "
http://www.medicalnewstoday.com/medicalnews.php?newsid=55682&nfid=nl


What does this Mean for you?
This means that when your doctor sees you, they will get paid more if they follow a flow chart of what most people respond well to. This is good in that is helps motivate your doctor to give you the care most people respond best with, but on the flip side, it also means your doctor is getting trained consciously and subconsciously to think about your care in terms of the dollar. Now don't get me wrong, your doctor won't give you care just because of the dollar value associated, but what it does is create a pattern in your doctors behavior. It trains the doctor to always follow a certain pattern of diagnosis and treatment. When you're doctor gets in this groove, it is hard to get out of the groove. Doctors tend to create habits and follow them, they have to, they don't have a lot of time to spend with you. For the average patient, this is a blessing. But what if you aren't average. This can often result in a delay in the correct diagnosis or treatment. The problem isn't the idea, but the possible result.


As a society we are moving into a grey zone. I remember having the conversation as a youngster that went like this. "If you could save one thousand people, but had to kill one to do it, would you?" Twenty years ago most people would say "No way!". Nowadays most the people I ask say "It depends?" What? But more and more we know the true answer. We practice it and make it law. We say that destroying embryos for research to help bring cures to people is worth it. We say that sending troops to Iraq to prevent an attack on America is worth it. I am not bringing judgment on either of these statements. We all know that freedom isn't free. We all know that sacrifice is required in life. But where do we draw the line, is the line getting thicker or thinner.

What does this last comment have in regards to pay-for-performance?
This is the connection. When we look at people and health care through a statistic, we stop seeing them as individuals with unique needs. We de-humanize people and put them into categories. When this happens, the role of a doctor from being a teacher, investigator, and mediator will be changed to that of a technician. The doctor of today is slowly pushed into treating patients based on their insurance and statistical relevance. Doctors are scared, frustrated, and not sure what to do. They have seen this happen with the drug companies telling people what they want, and as a result M.D.s and D.O.s have become the mediator of therapies based on symptoms. Soon they will be more restricted into the mediator for the insurance company and the drug company.

Will more people get better d/t standards of care. Yes. Will everyone, no. What I predict is that we will just shift who isn't getting better.

Solution: Make your doctors work for you, not the insurance company. HOW? Get yourself a healthcare savings plan. This way you are covered for serious injuries and illnesses, but you pay for the care you get with your own pretaxed dollar. This puts health and healthcare back into your hands. Now your doctor is only responsible to you - not the insurance company. In addition to getting better care, you will save money, and build up savings in your healthcare account.

Live long if you're healthy! Live well, if you aren't! ~sv

Opening A Practice Part B

Remain Driven In All That You Do!!!!!!

This next section will deal with more information geared towards getting your ducks in a row.  This is intended to be a guide.  So please you this information accordingly.

8.  Your Build Out (continued).   The build out of your office is vital to all "First Impressions."  When patients, or more importantly, potential patients step into your office, their first impression will be based on the look and feel of your office.  Wall colors, carpet colors, Front desk color schemes mean so much....With that said, you are going to need Signage.  This can be very tricky, you must first see if the Landlord will include this in your build-out.  Some will, others won't.  If not, then you need to call around and find the best price.  Also, read through your lease agreement and make sure you are staying in accordance with what you signed in your lease.  Landlords that care about their shopping centers would want all Tenant signs to be congruent with one another.  Meaning: Same size, same shape, not necessarily same color..but you get the idea Ex.  Lets say the name of your clinic is Smith Family Chiropractic.  The person creating the sign can use "channel-individual- letters for Smith Family" and use a "modular capsule-all-in-one for Chiropractic"..The sign outside my clinic: 18 inch High Channel Letters mounted on raceway with a 10'x16'' modular unit, internally illuminated with neon..total width is about 25 feet across).  Cost: $3850.  THE SIGN I HAVE JUST DETAILED IS NOT NECESSARY IN ALL CASES, PLEASE KEEP THAT IN MIND. This includes permits and sales tax..  I repeat, this includes permits!!!!  You will need permits to complete your build-out.  Your landlord and his/her contractor must handle this for you.  They are responsible for this...NOT YOU!  I've spent some time on the build out...because it is very important that this goes smoothly.  If not, it can delay your opening!  How long should it take?  Not sure...depends on how much you are having done.  But if contractors work quickly, a mid-size office can be complete in 30 days.  Which brings me to another point.  PLAY HARDBALL!!!  You don't want to pay rent while the build out is taking place.  Timing is everything....

9.  X-Ray Unit Installation:  What should I do?

For those of you looking to take x-rays in your office.  And it is nothing like taking x-rays in school...Much, much, much easier...I can do a cervical and lumber series in less than 5 minutes...Your landlord should have prior knowledge of your intent to have an x-ray unit installed in your office.  State laws vary..so call your chiropractic board for that state. They may tell you that you need a physicist report taken for your space to determine where you need "lead-lined drywall".  This is so easy to do...whoever you are purchasing the x-ray unit from should give you a heads up on this.  If you need this "type" of drywall installed...it SHOULD NOT COST more than $1000 to do. Lead-Lined drywall is just that, drywall that has a thin lead sheet glued to it.  It will come with special nails and nail caps to make sure it's done right.  Especially if you are just going to do a single wall in the x-ray suite.  and for the record: an x-ray unit from www.scrip-inc.com, will run you about 16k which will include the developer as well...  how sweet is that!

10.  MARKETING ONE-O-ONE!

Your clinic is starting to come together..Walls are going up..phone lines are being installed...call your local phone company by the way...a business line is what you need....you're going to need a Main line, a roll over number, and a dedicated fax line.... and high speed Internet...there are packages out there for you..roughly : $290 a month for that type of deal. Please don't have business cards made until you have secured that business phone number!  You must have two things in line when marketing your clinic from the start...(1) Open Date is Concrete.  (2) You have business cards to hand out when talking with potential contacts.  You must join at least two civic groups....Chamber of Commerce and maybe a BNI group..(Business Network International).  Civic groups will put you in front of multiple people all at once.  You must become a walking billboard.  Meet and greet as many people as possible before you open...Talk to the people that do business next to you....Talk to the people that do business around the corner from you.  Create a list of contacts, and invite them to your open house...Create a buzz about your new chiropractic office.  Most Chambers of Commerce will have Ribbon Cutting Ceremonies..which will include the local paper putting your ribbon cutting in the local paper for FREE.  HELLO, I said FREE.  Open up the business section and there you are....Smith Family Chiropractic Now Open..123 Will Hollow Drive, Anywhere, NY 11570.

This should be enough to get you thinking about how you want to practice, and also what steps you need to take to keep things moving smoothly if you have already decided.  Part C will be coming soon.  I hope this last section, has shed light on the build out...Part C will include more marketing and some special attention to building up your business credit.  Once again, if you have any specific questions, please feel free to voice them here in the public domain..or more discretely at : nosurgery@yahoo.com

Dr. Mark

Chiropractic Vs MD: The battle

Hello Doctors.  Below is a perfect example of some of the minds in our profession.  This is debate between a medical doctor and a chiropractic doctor.  I found it on the net and posted it here.  I will email the chiropractor today for permission of this post. The chiropractor's name is Dr. Steven L. Vanden Hoek, D.C. OK READ ON One question I like to ask chiropractors, and one I have never received an answer to, is how organs systems continue to function after transection of the spinal cord due to trauma. They don't seem to understand that many functions of our body do not need the spinal cord intact. Quadraplegics still filter blood with their kidneys. There hearts continue to beat. A chiropractor recently came to Vanderbilt to speak to the 4th year medical students and put up a slide showing how specific subluxations effect specific organs. When will they learn. Clark Bartram | Homepage | 04.09.06 - 3:47 pm | #

Great question - by the way, I am a Doctor of Chiropractic. I appreciate the confusion about my profession, and many claims some of the Doctors make. In response to your question about people with damage to the spinal cord. When a spinal injury occurs, this affects the motor nerves /sensory nerves that allow a person to move muscles and feel sensations. This happens because the damage occurs within the spinal column and signals from the spinal nerves are not properly transmited to and from the brain via the spinal column. Your body has a variety of other pathways for neurologic communication. Your ability to digest food, have bowel movements, breath, or even a heart beat is controlled by the autonomic nervous system - a little diffent than the voluntary motor system. What is also amazing is that both the heart, and the intestines, have additional self stimulating systems. The heart can beat even outside the body, and the intestines can self regulate. Every organ does have a spinal nerve that goes to it, but it isn't the only nerve. The amount of damage you recieve depends on the level of spinal damage, and if any nerves are directly damaged. This is why some people have to use breathing tubes following spinal injury and others don't. The most common sign for emergency surgury associated with a disc bulge is the loss of bladder and bowel function. Yes, you pinch a nerve hard enough and your "organs" don't work properly. But lets get real, very few people actually have a pinched nerve. Most people have over fascilitated (irritated) nerves. And not the big spinal nerves you think about, but the microscopic nerve endings found in the surrounding tissue and facet joints. Ever bump you head? You rub it to calm down the pain. This is because mechanoreceptors (nerve endings) will calm down the pain receptors (nerve endings). Guess what? A manipulation of the spinal joints is done to fire those mechanoreceptors to help modulate pain. More importantly, if you can keep the joints moving, ie. exercise - the pain will continue to decrease. Same reason your stiff in the morning - lack of joint motion!! In comment to the stroke issue - the stats show about 1 in 2 million have a cerebrovascular event following manipulation of the neck. You have a greater chance of a stroke from turning your head to quickly while trying to look out your car window then from receiving a manipulation of the spine. More people have serious complications from taking asprin than from getting an adjustment. Insurance companies understand this - and this is why my malpractice insurance cost are about 1/5 that of a medical doctor. Transplanted organs - give me a break. You don't think nerve supply is required? You don't have to like chiroprators, lawyers, or mechanics. The truth is that every profession has idiots and liars. That doesn't discredit the whole profession. I spent four years postgraduate, taking the same classes as a medical doctor, reading the same text books, cutting up the same dead bodies in gross anatomy. Give me a little credit. Most chiropractors are to lazy to try to educate their patients - and that is why stupid comments, like the chiropractor you reference, are made. Read my blog if you want a better understanding. http://advancedehealth.blogspot.com Steve Vanden Hoek , D.C. Steven L. Vanden Hoek, D.C. | Homepage | 04.10.06 - 3:23 am | #

"Most people have over fascilitated (irritated) nerves. And not the big spinal nerves you think about, but the microscopic nerve endings found in the surrounding tissue and facet joints." Really? How is this measured? What studies support this? "A manipulation of the spinal joints is done to fire those mechanoreceptors to help modulate pain." This has as much scientific support as saying that manipulation allows for better flow of life energy from god. "In comment to the stroke issue - the stats show about 1 in 2 million have a cerebrovascular event following manipulation of the neck. You have a greater chance of a stroke from turning your head to quickly while trying to look out your car window then from receiving a manipulation of the spine." Where did you get these numbers from. I've heard higher rates. "More people have serious complications from taking asprin than from getting an adjustment. Insurance companies understand this - and this is why my malpractice insurance cost are about 1/5 that of a medical doctor." Aspirin has a proven mechanism of action whereas chiropractic has theory and conjecture. Your simplistic analogy fails to take into account the potential indirect damage of chiropractic such as delayed medical care for problems that a chiropractor is not trained to detect and may not even think about. This is particularly an issue when chiropractors attempt to treat children. The chiropractic community is very secretive about just how much malpractic goes on. Your cost is lower because people don't sue alternative practitioners like they do MD's. That speaks volumes about the ability of alternative practitioners to connect with their patients, something MD's can stand to learn from. It does not speak to the legitimacy of your profession which is suspect except in the realm of acute lower back pain. Clark Bartram | Homepage | 04.10.06 - 11:51 pm | #

Do you really want a pissing match? I game! Steven L. Vanden Hoek, D.C. | Homepage | 04.12.06 - 1:55 am | #

Alright Doc - Call me on this if I'm wrong. That is the point of having an open discusion. Please do not be "irritated" by my answers - as I want anyone, not just a doctor to understand what we are talking about. As much as I hate to admit it – most of the support for chiropractic manipulations comes from the medical community and not chiropractic. Unfortunately they are doing most of the research that show the neurological connection between joint manipulation and the benefits the patient experiences. I will kindly address each issue you raise in response to my reply. 1.) "Most people have over fascilitated (irritated) nerves. And not the big spinal nerves you think about, but the microscopic nerve endings found in the surrounding tissue and facet joints." Q: Really? How is this measured? What studies support this? A: The microscopic nerve endings I speak of are nociceptive and mechanoreceptors nerve endings. When a joint has altered kinematics – effusion or swelling (inflammation) is initiated in the area of altered biomechanics. This (inflammation) is a natural response to any proposed injury. Inflammation causes a whole host of reactions. These include increased fluid build up, increased chemicals to the regions, increased blood, etc. This is why when you cut yourself you it swells, gets red and hot, and is more tender. As you know spinal nerves exit the spinal column via the foramen formed by the joints of the spine. If anything – be it a spur, degenerative disc disease, or inflammation and swelling, or a disc herniation encroaches on the nerve directly or indirectly – the nerve will fire. i.e. increased pain, or motor or sensory loss. Basic neurology shows that pressure, even very slight pressure – will cause inflammation of the nerve and increase the firing rate and frequency. You can pump the body with an anti-inflammatory to help the reaction – or you can help improve motion to get rid of the fluid and swelling. Now as you can tell – this doesn’t work when spinal stenosis is present, nor is it as effective with severe disc degeneration or a disc herniation. My study is every neurology, physiology, pathology, and anatomy text book. Look it up – its basic science. Nerve facilitation - I assume you understand the concept of pain and that you understand that inflammation causes pain? This knowledge is the basis for why docs give “anti-inflammatory” medication to patients in pain. That’s why you take ibuprofen. Stop the inflammation, and you decrease the pain. Do I really need a journal article to demonstrate this concept – or will millions of Rx’s for anti-inflammatory meds due the trick. Ever heard of joint effusion – or capsular swelling? Swelling, huh, could this be swelling as in one of the cardinal signs of inflammation – rubor, calor, etc. 2.) "A manipulation of the spinal joints is done to fire those mechanoreceptors to help modulate pain." Q: This has as much scientific support as saying that manipulation allows for better flow of life energy from god. A: Mechanoreceptors modulating pain – scientific proof? You will need three things any 1st year med student will have. 1.) anatomy book 2.) neurology book 3.) physiology book. READ THEM. This isn’t even up for debate. Even the M.D.’s know this - Dr. Mark Sontag – a physiatrist noted “neurological studies show motion tends to block pain impulses to the brain….the more action, the less pain is likely to be felt…” “The perception of pain is dependent upon the balance of activity in large (mechanoreceptor) and small (nociceptive) afferents. John Nolte, The Human Brain, Mosby Year Book, 1993, p. 139. “If large my myelinated fibers (mechanoreceptors) were selectively stimulated, then normal “balance” of activity between large (mechanoreceptors) and small (nociceptive) fibers would be restored and the pain would be relieved.” John Nolte, The Human Brain, Mosby Year Book, 1993, p. 203 It has been shown that in the neck – much neck pain comes from the zygapophysial joints – the very joints chiropractors manipulate. http://www.ncbi.nlm.nih.gov/ entr...l=pubmed_docsum Mechanoreceptor Endings are in human cervical facet joints as per: SPINE volume 19, number 5, pp. 495-501 (March 1, 1994) SPINE 1998;23:168-173 And we also see that these mechanoreceptors provide “afferent input to the central nervous system (CNS); because the endings identified were primarily mechanoreceptive, it follows that the mechanical status … is being monitored at the CNS level.” http:// www.askewchiropractic.com..._adjustment.htm “The transmission of pain signals up the spinal cord can be increased by lack of proprioceptive signals (sensory information to the spinal cord on the movements and positions of muscles); or reduced by greater proprioceptive input. This is Melzack and Wall's "gate" mechanism - the gate is opened to pain (nociceptive signals) by reduced other sensory input.” Bottom line – 1.) mechanoreceptors exist within the joints of the spine. 2.) mechanoreceptors affect the CNS 3.) damaged/injured z-joints cause pain 4.) properly functioning z-joints don’t cause pain 5.) get the z-joint moving, and you help control pain 6.) chiropractors restore normal motion to the z-joints thus helping increase joint motion and pain modulation. 3.) "In comment to the stroke issue - the stats show about 1 in 2 million have a cerebrovascular event following manipulation of the neck. You have a greater chance of a stroke from turning your head to quickly while trying to look out your car window then from receiving a manipulation of the spine." Q: Where did you get these numbers from. I've heard higher rates. A: Lets start with this one: (covers the stroke and NSAID issue) http://stroke.ahajournals.org/cg.../full/32/9/ 2207 As shown in their Table 1, the entire argument as to whether spinal manipulation is a significant risk factor appears to hinge on a total of 5 cases over 5 years, or 1 case per year. To put this matter in the proper perspective, one should be forever cognizant of the fact that death rates following cervical manipulation calculate to be anywhere between 1/100 to 1/400 the rates seen in the use of NSAIDs for similar conditions.11,12 Death rates from lumbar spine operations have been reported to be 300 times higher than those produced by cerebrovascular accidents in spinal manipulation.13,14 For cervical surgeries, recent death rates have been estimated to be 700-fold greater.14 As Rome7 has pointed out, risks for "virtually all" medical procedures ranging from the taking of blood samples15 or use of vitamins or drugs16 are routinely accepted by the public as a matter of course. Then this one: (stroke again) http://www.webmd.com/content/art.../ 1728_80109.htm “As pointed out in Rothwell's study, says Rondberg, the rate of stroke is estimated at 1.3 incidents per one million adjustments given. "Other studies, including one covering a 28-year period reviewing 110 million chiropractic visits, showed conclusively that the risk of stroke from chiropractic adjustments is so small that it's statistically insignificant," he says.” Oh wait, I forgot about this one: (even better – stroke again) http://www.chiroweb.com/archives...s/19/23/ 04.html A paper1 published in the October 2 issue of the Canadian Medical Association Journal (CMAJ) by Scott Haldeman,DC, MD,PhD, Paul Carey, et al. ("Arterial Dissections following Cervical Manipulation: the Chiropractic Experience") reports that the chances of arterial dissection after cervical manipulation is approximately 1 in 5.85 million manipulations. 4.) "More people have serious complications from taking aspirin than from getting an adjustment. Insurance companies understand this - and this is why my malpractice insurance cost are about 1/5 that of a medical doctor." Q: Aspirin has a proven mechanism of action whereas chiropractic has theory and conjecture. Your simplistic analogy fails to take into account the potential indirect damage of chiropractic such as delayed medical care for problems that a chiropractor is not trained to detect and may not even think about. This is particularly an issue when chiropractors attempt to treat children. The chiropractic community is very secretive about just how much malpractic goes on. Your cost is lower because people don't sue alternative practitioners like they do MD's. That speaks volumes about the ability of alternative practitioners to connect with their patients, something MD's can stand to learn from. It does not speak to the legitimacy of your profession which is suspect except in the realm of acute lower back pain. A: Again lets start with this one: (covers the stroke and NSAID issue) http://stroke.ahajournals.org/cg.../full/32/9/ 2207 To put this matter in the proper perspective, one should be forever cognizant of the fact that death rates following cervical manipulation calculate to be anywhere between 1/100 to 1/400 the rates seen in the use of NSAIDs for similar conditions. Then this one: http://www.medpagetoday.com/tbin...x.cfm? tbid=1612 “…the researchers calculated that the national death rate from aspirin or other NSAID-related GI events was approximately 15.3 deaths per 100,000 NSAID and aspirin users. NSAIDs included over-the-counter and prescription drugs. Low-dose aspirin alone accounted for between 8.2% and 12.2% of all GI complications and deaths, the research team reported in the August issue of the American Journal of Gastroenterology. “ Lets look at this one: (malpractice cost) http://tampatrib.com/Business/ MG...GA2EYCO2HD.html “Baycare estimates its average premium for a doctor is $20,000 a year; UCH estimates its average at $20,000 to $25,0 Steven L. Vanden Hoek, D.C. | Homepage | 04.12.06 - 5:03 am | #

(CONTINUED) ---- $25,000. But each insures a large number of physicians in what are considered low-risk specialties, which lowers the average. The cost of the policies generally range from $10,000 to $60,000 - though a few physicians have been given quotes of more than $100,000, Archbell said. “ I paid $1,200 last year for my malpractic – for the whole year – and that was for 1mill/3mill coverage. Sorry I was wrong – it isn’t 1/5th but 1/10th to 1/100th the cost. And bull to not getting sued as much. People can sue for any reason, any time – in fact most the time they know it won’t go to court, but the doc will settle just so his name doesn’t get smeared. Cost are based on pay out – and the more damage you cause – the bigger the pay out. We can’t cause that much damage since we don’t cut on the patient, or rot their liver with powerful drugs. The most we can do is crack a rib, sprain a joint, or exacerbate a current condition. Training: Not trained to detect potential problems? Do you have any idea what are training involves? Per not being trained to detect more complicated problems – is that why I am considered a primary physician – is that why the description of what I can treat and how sasys the following: “…a chiropractic physician(is)licensed to treat human ailments without the use of drugs and without operative surgery.” http://ilga.gov/legislation/ilcs...+Act+of+1987% 2E Now from what I read, this means any – yes any – human ailment. I’m sure you understand that you aren’t legally allowed to treat something you can’t first diagnose. And you can’t diagnose something you haven’t been trained to diagnose. And the training had to come from an approved school – regulated by the government. Look if the government says I can do it – I can. Even if you don’t like it. Even if some of my colleagues choose not to diagnose or treat anything other than a subluxation – which has an ICD-9 code associated with it. Oh that ICD-9 means it is a recognized problem/disease. I guess a subluxation is a disease – at least as much as acid reflux is a disease. Or are only things that can be treated with a drug or knife a true disease? And per future adverse events as the result of a manipulation – give me a break medical mistakes at hospitals cause more serious complications and deaths than all the chiropractic manipulations will ever cause. And if this is such a problem, why are the Physical therapist lobbying congress for the right to give manipulations? Why are Medical doctors taking continuing ed classes to learn how to provide manipulations? Come one – every one wants a piece of our action – b/c it works. I appreciate your willingness to stand up for what you believe is right and wrong. I even agree with your comment that chiropactors haven't proven a great need for children - and the scoliosis screening thing is a scam, a marketing tactic - about the same as those hearing test they give your kids? Honesty - I do appreciate your comments and even your own blog - not bad. Do I treat my own kids – sure. I have three kids – ages 7, 5,4. Guess what – between all three we have had to use one round of antibiotics. I haven’t had one of them sick for more than 24 hours. I feed them good, adjust them, give them food supplements. My son has been in the hospital once – after a bad reaction to a vaccine – guess what, I don’t tell patients not to get vaccinated – that would be practicing medicine. Just like you telling a patient not to get an adjustment is practicing chiropractic. Every profession has to prove itself. Medicine use to use leaches to get the evil spirits out, chiropractors thought they could cure cancer with a spinal manipulation. M.D.’s thought nerves carried air, D.O.’s thought they carried blood, and D.C.’s thought they carried electricity. Guess we got one correct. D.C.’s were doing physical therapy on patients before physical therapist were around. Yeh – we got a lot of quacks out their, but hey, so do you. Feel free to chop up the chiro’s doing crazy stuff , but not the profession – just the person – some of us have our head on straight, and would love to work with you, not against you. Steven L. Vanden Hoek, D.C. Steven L. Vanden Hoek, D.C. | 04.12.06 - 5:28 am | #  Posted by Dr. Clerge

Who's the Doctor?

Once in a while you will meet a “know it all patient”. It’s usually an educated individual with a science background. I’ve discussed this story with many of the doctors that I know and all of them have experienced a similar situation.

Approximately 2 months ago patient X walked into my office with chief complaint of mid-back pain. Patient X is employed in a health related environment and has some knowledge in human anatomy. The necessary imaging and protocols were followed and the conclusion was sprain/strain to the thoracic region. The diagnosis made sense, since the pain was felt upon lifting a heavy object.

The patient was prescribed the proper stretches/exercises and modalities coupled with the proper adjustment. It all started when patient X noted that the Heat from the heat/stim caused stiffness in the midback. I explained to patient X that heat has more of a sedation/relaxation effect. My first mistake was deciding to stop using heat since it caused patient X some discomfort.

The very next week, X stated that it felt better when she was adjusted P-A instead of A-P and that he/she did not want to be adjusted in the A-P position no longer. Once again I explained the purpose and the specificity of the adjustments; however, I decided that I will only adjust he/she in the P-A position.

The following week X recommended some exercises that must be integrated with her treatment. Now, the confrontation started. I explained to him/her that his/her current exercise is designed for his/her specific condition and that he/she could no longer dictate his/her care. It was a very heated conversation, considering that patient X has an authoritative personality. Unfortunately, patient X is no longer my patient.

This is a very short article. The purpose of this article is to prevent the same situation from happening to you. Do not let your patients dictate their care. We all need to let our patients know that we are the doctor and we should never compromise our decision. My mistake was agreeing with patient X when she initially made the suggestion. Stand firm on your decision. It is best to stop this behavior before it escalates into something that we are not able to handle. 

Dr. Paul

"WHY"

Hello to all doctors on this blog,

A friend told me about this site and I decided to check it out.   I must say that I like it. I can see myself coming to this site after a long day of hard chiropractic work. Well, let me introduce myself, I’m Dr. Jay Phinigan and I graduated 3 years ago. I worked as an associate for 1 year and now I have my own practice.

The funny thing is that, I can definitely relate to some of the Drs in this blog. It’s a necessary evil and most of us go through the same thing. I always had an exploding personality throughout school and what I wanted to do is write “WHY” It’s like but not exactly a poem.

Oh, and I have a suggestion. We should have a chat day. For e.g. every Friday at 9pm, a couple of chiropractors should meet in the chat room and talk about nothing. Actually you should feature a chiropractor. One week should be the guy that’s making $3 million/year, and another week should be the guy that’s making $50/year. That will be the guy to show us “What not to do”. LOL…….

Ok, on to “WHY!! THE TOP 10”

1. Why      did we learn the purpose of the spinothalamic tract and that the dorsal      horn branch into ascending and descending collaterals, forming the dorsolateral      tract of Lissauer. No, I mean really why…..Are we, did we,      or will we ever use this in practice…….Uhhhh…………………………NO………….Hell NO!!!!

2. Why do normal X-rays sometimes seem      abnormal? LOL….and why do the abnormal X-rays seem normal…….Should have      invested a little more time in Radiology.

3. Why do patients that’s not doing so well      during their treatment open their mouth and tell you that in front of the      guy that’s doing well. Talk about      an uncomfortable situation. Do they      purposely try to make you lose a patient?

4. Why did we learn, L4 spinous Right,      Contact point = TP!!!! When in      reality (practice that is) it’s more like contact point= mid-back. I mean it’s really not that specific.

5. Why do students in school always know a      guy that’s offering them an associate position for $ 80K/year after they      graduate!!! I mean Cmon buddy.

6. WHY IS LIFE SO UNFAIR !!!!!!!!

7. Why other chiropractors always do well,      when you ask them how’s business?

8. Why was independent contracting      invented? How many chiropractors do      you know that’s doing well as an Independent contractor? Oh, ok!! You know      1, but Can you name 3????????

9. Why is Dr. Frankhart so angry (that’s an      inside chirofile joke) ?? No, I’m just joking. Dr. Frankhart is a good guy his telling      the truth.

10. Why do you get the Oh remark when you      tell people that you are a chiropractor.

A = What do you do for a living?

B = Well, I’m a doctor!!!

A = Really, what kind of doctor are you?

B = I’m a chiropractor

A = Oh!!!!

Oh!!!  I mean what the hell is that all about. People are giving physical therapists more respect than chiropractors. Do they know what our education is like? Do they know how much money we spend on boards? Boards? Boards? LOL….get it…That’s for the guys who took it 3 times.

Thank you for coming up with a site like this. Life is too short, enjoy it, and put some humor into your life. I will certainly tell my buddies (Ooops I meant to say colleagues LOL) about this.

Actually, a question!! How do I get these nice pictures in my article? I want some pictures too.
Well, I got it.  All I need to do is copy & paste a picture from the internet.

Thanks guys!!!

I wish much success to everybody in this blog

Jay Phinigan, DC

Chiropractic Commercial on NBC: We are Mainstream

Hey Guys,

Let me say thank you for posting your articles.  The responses from the articles so far are excellent.  I spoke with a few of my colleagues and they are loving this site.  Remember the purpose of the site is to educate, inform and inspire.   We accept all articles and we do not edit any of them.  Just follow the rules and "you can speak your mind", we actually encourage it.  Once signed up as a Guest Author, you may write all day long. 

With that said, if you know chiropractors, new graduates and students that can benefit from some of these articles, please let them know about chirofiles.com

Ok,  A new series of chiropractic commercials are scheduled for the year 2007 for a whole year.  This is an  excellent idea for going mainstream. Check out the links to the commercials

the website is  www.chiroontv.com  go check it out.......

Below is the information from the website

1. 3 TV COMMERCIALS. Mpower Media has produced 3 television spots in 35 mm. film, the same level of production of Hollywood and Madison Avenue studios. Every commercial was created with the goal of reaching the specific audience of the Chiropractic market.

2. NBC BROADCAST. Mpower Media has secured airtime nationally with NBC, one of the major TV stations in the country. Mpower will air a minimum of 31 spots a month. The start date of the National Chiropractic Campaign has been set for March 2006, to continue for a whole year until March 2007. One year of getting the chiropractic message across to the American public can get you direct business in your practice.

3. CHIROPRACTORS PARTICIPATION. Thousands of chiropractors nationwide will contribute $300 a month to be a part of this national program. More than 650 chiropractors across the nation are already using these television commercials. Everybody counts. We need your support to make this campaign a national success.

4. THE OBJECTIVE. Mpower Media wants to help the Chiropractic world to bring awareness, credibility and visibility to the Chiropractic profession. The Chiropractic message will be seen in highly watched and credible programs that most Americans watch on regular basis, like NBC News.      

5. THE MARKETING STRATEGY. Each television commercial will be aired nationally for a period of 4 months. Your potential clients will see 3 different spots with the same message, and they’ll remember to call you! Each one of the commercials ends with “Call 1-877-CHIRO-06 to be connected to a chiropractor near you”.

6. YOU GET THE PHONE CALLS. Our state of the art phone routing system connects the calls directly to your office. If more than one chiropractor from one area is involved in the program, the phone calls will be distributed in a round-robin system, so everybody gets the same amount of phone calls.

      7. THE MARKETING STRATEGY. Mpower Media gives an entire print campaign that match the television commercials to every chiropractor involved on the program. Your potential patients watch the characters and the slogans of the commercials and then they get print pieces that reinforce the same message and help them make the connection with the TV campaign.      

8. HOW THE AIRTIME SCHEDULE WORKS The National Chiropractic TV Campaign has started and with 540 million people watching NBC every day, we are reaching 90 million with our television commercials. This historic event has begun. The program starts with the broadcasting of the spots in late night programs, like the re-broadcast of JAY LENO (Monday through Friday) and the Sunday late night re-broadcast of DATELINE NBC. There is a minimum of 31 spots to be aired every month, and that number increases once Mpower Media evaluates the response that the American public has to each time slot. That response determines how many commercials should be aired more during certain times or certain programs. The "Doctor's Only" web site will have every month the changes that are being made to the schedule. At our current pace, you'll be able to see more daytime airings in place of the night time ones. The first spot to be added into the daytime schedule will be in the TODAY SHOW, spots that airs around 9am in most markets, or in the PASSIONS soap opera.

Dr. Nesly Clerge, DC

Opening A Practice..Part A

Opening a Practice Part A:

This is going to seem so simple, but there will be times you feel overwhelmed.  If you find yourself at the end of your rope, tie a knot and hold on.  Here we go:

1.  Start a Corporation..probably a P.C....ex ABC Chiropractic, P.C  (or a L.L.C.)

How it's done:  You can have this service done through "The Company Corporation" via the internet www.corporate.com or give them a call 800-877-4224 The process is so simple, but it will run anywhere from $300-$750, depending on what state you are opening your corporation.  The reason why a P.C. (Professional Corpoartion) is used in some states, is because we are licensed doctors and that would require a P.C. established entity. 

2.  Obtain a Federal Tax-Id number.

How it's done:  If you went through www.corporate.com or something similar, they would have done this for you.  Or you can contact the IRS.gov website and apply for one.  There is no cost to do it yourself.  But you need more than that to get your practice rolling.  So, with that in mind, let professional handle that for you.  Some people hire an attorney to do all this for them.  You can go that route, but I'm not sure what the going rate would be.  But typically, if you cut the middle man out, you usually get the same thing..but for less.

3.  Get in Network with one or two insurance companies...My suggestion: BCBS, Cigna, Healthlink, Medicare* and Never ever use United Healthcare unless you want the frustration.  Some parts of the country will determine which ones would best fit you.  Talk to some local docs and find out from them which ones they use.  If you decide to go cash only....you have some hard work ahead of you....so stop reading this blog..and GO SCREEN PATIENTS, Not NOW...but Right NOW!!!

4.  Oh, before I forget...Before you apply with insurance companies...You are going to need some malpractice insurance.... NCMIC, Chirosecure, etc...whoever...should not cost you more than $1,000 the first year... You'll need a copy of your degree, license, malpractice, and fill out a W-9 form, which you can print off the www.irs.gov sight.. W-9 form: what's on it: Name of Corporation, address, Tax-Id number and a signature from you and date...That's It!  You need this stuff to become a Provider.

5.  $$$$$$..You need some money to get going.  SBA loan, Mom and Dad, Uncle Bob over in Brooklyn..you need some money.  How much?  Well, that's up to you.  How do you plan to practice?  Are you doing a Two Day ROF.  Are you taking X-Rays?  Are you doing PT?  Are you using Medisoft, Ez-Biz, Just for Chiropractors, do you have staff other than yourself, etc.....

6.  Practice Space...How much room do you need?  My suggestion is to go around 1000 sq/ft office.  If you are practicing solo.  Maybe bigger...not sure what you have in mind.  How much should you pay?  Not sure...depends on your area.  You start looking around and you find a space for rent...Sign says: 1000 sq/ft office space for lease.. $10 a sq/ft... What does that mean?  You take 1000 sq/ft times $10...then divide that by 12 months= $833.33 per month for rent.  Then you have to include the triple net charges...This can range anywhere from $1.50-$3.75 a sq/ft extra. Triple net?  What the heck is that? : All taxes, insurance, and maintenance expenses that arise from the use of the property. So after it's all said and done, you're looking at $1,041 a month in rent if your triple net was $2.50.

7.  Build-Out Expense..  Now you found your space...This is where your gonads have to show up..Ladies, this is for you too.  You are about to sign a lease on a space and open up a wonderful chiropractic clinic.  Your landlord understands that chiropractic is great, and that you are going to bring foot traffic into their shopping center.  He or she sees $$$$.  The space you found has nothing in it.  It's a shell...no carpet, no paint on the walls or anything...open floor plan, and some bathrooms.  Your landlord will build whatever you want in that shell, provided you take some of the burden off of them.  PLAY HARDBALL...YOU WANT IT ALL FOR AS LITTLE AS POSSIBLE.  You need walls put up...you need doors put up...The build out should not be $50,000....lol... An average build out for a standard chiro clinic should not cost more than $10,000...if you have a small space..(You don't need a waterfall in your lobby area)  Your landlord should put up some of the money to have this done...You have to come up with the rest. 

Part B coming soon...This should be enough to get you started...

Dr. Mark

Any questions: nosurgery@yahoo.com

I'm Tired of this

 

First of all, let me think the owner of the site for starting something like this. I think all doctors and students should come here to learn a thing or two.

I agree with many of the writers in this blog. Chiropractic is great and 90% of my patients get well with chiropractic treatment.

I guess I may sound angry after writing this. I am really sick and tired of ending up on Quackwatch when I type in chiropractic on a search engine. These no life having SOBs do nothing but bash chiropractic. I will get back to my statement later.

Dr. Delvaro, I am very happy that life was easy for you. While I wouldn’t advise these new doctors to treat their patients for free, but it’s true that we need to care about our patients. The only thing is that some patients will take advantage of your kindness. Some of us don’t have mom and dad to finance our practices, so life can be hard when starting into a practice.

Just responding to some of the writers in this site like Dr. Hewitt; I actually agree with the guy. There are management groups that are out there just to get your hard earn money. 90% of the crap that are being taught can simply be learned by talking to a successful chiropractor. Lord knows that they took me for a run for about 2 years. The problem is that these people are so smooth that they prey on new docs and new graduates. I wish somebody had sat me down and say, hey look out for this, that and this. That’s what I plan to do here. I hope students can access this site, because the schools will not teach you what you are learning here. This is real life my friend.

Watch out for these contracts. They all look good in the beginning, especially when your job search is not as successful. Some of these doctors will trap you, take advantage of you, make you work and work while they earn all the money. Working as an associate is safe but not the smartest move. Should you have the available funds, start your own practice, but make sure your work with a doctor for a year or two in order to learn the ropes.  There are some good associate positions out there, but be careful when selecting a position. They will always tell you of the advantages and not the disadvantages. 

The Irony is that some of the same doctors that had bad contracts as associates, turn around and do the same thing to new docs. I never understood that.

Ok, back to the Quackwatch site. All these people are concern about is chiropractors committing fraud. Yes, some chiropractors commit fraud, but what they don’t understand is that MDs, Lawyers, Dentists etc…. commit fraud too. There are rotten apples in every profession. I don’t see a QuackMD site for those MDs that are handing out lipitors as if it was some type of government cheese. I remember a few years ago, this MD got arrested for prescribing and selling medications to a known drug addict. Yes, it was on the news and Yes!! He go arrested. Since they are backed up by the pharmaceutical companies and the media, nobody is writing about that.

I am against fraudulent chiropractors but don’t categorize the profession as if we are all crooks. The majority of chiropractors are very honest and intelligent. Hell, some of them are more educated than these so call MDs.

I can go on & on but to these QuackWatch writers, get a life.

L. Frankhart, DC

Who Knows

By,

B. Velarski, MD

Fortunately I landed on this site via google. I am very delighted that Dr. Clerge decided to invite me to write these short statements after I emailed him. I am a family practitioner and I recently had an encounter with a chiropractic doctor. Let me share a story.

My son is a chiropractor, and myself I never did believe in the practice until recently. For some reason or another, my son swears by it. He is a very intelligent and well educated individual. He averaged a 3.9 GPA throughout high school and throughout his undergraduate education. It was a complete shock when he announced to the family that he was attending chiropractic school instead of Medical school.

Several weeks ago I made a search on google for chiropractic and landed on the site for Quackwatch. This site has a primary focus on fraudulent practices of chiropractors.  Fortunately, I had my encounter before discovering this website; otherwise, I would have been even more biased on my views about chiropractors.

4 months ago, I started experiencing some back pain. Considering that I am a practitioner, I explored all of my options and was not able to reach a diagnosis.  All imaging studies were inconclusive and medication seemed to provide temporary relief of my symptoms. My son is currently practicing out of the US.

and he advised me on a chiropractic consult. Initially, I laughed at the recommendation. My colleagues also ridicule the fact that I was entertaining a chiropractic treatment. To be honest, I went because I wanted to know why Charles decided on a chiropractic education instead of a medical one.

On my initial visit, the chiropractor took some x-rays, did a complete neurological and orthopedic examination. I did not disclose that I was a physician, and she did not know that I was a health care practitioner until the second week of my treatment. Let me tell you that I was very impress. This lady explained the orthopedic examinations, neurological findings, and the possible diagnoses for my condition. To throw her off and test her knowledge, I questioned her on some of her methods using medical terms that I knew would confuse her. Amazingly she answered appropriately, and her knowledge of anatomy, neurological and physical conditions were astonishing. At that point she probably knew that I was somehow involved in a health care environment.

On the second week of my treatment, I told her that I was a physician and we now have mind-boggling conversation about the ignorance of health care providers about chiropractors. I was astounded to learn that the courses in chiropractic school were similar to that of a medical education. My views from that point on were altered and I now refer patients to her on a weekly basis.

I’ve engaged in some research about the profession and this is my take. I don’t discount sites like QuackWatch; obviously, there are chiropractors that only view their patients as dollar signs. We must also consider and respect the chiropractors that are: knowledgeable, intelligent, caring and “know their stuff”. There are rotten apples in every profession and we should not judge the profession based on the actions of a few.

I’m in my second month of treatment. I still think that there may be a placebo type affect related to the adjustments because I’m addicted to them. All, I can say is that my doctor knows what she is talking about and I am feeling much better.

I emailed her today and told her that I was going to write this. I did not disclose her name since I did not have her permission to mention her name but “Who Knows: maybe there is something to this chiropractic thing after all”.

B. Velarski,  MD

chiropractic is Great: Let's not lose focus

While I understand the purpose of this site, and everyone has the right to their own opinion; we must be careful not to defeat the purpose of this site. Let’s not turn it into a chiropractic bashing site. I don’t believe that this was the intention of the owner of the site. I think the purpose is to inform other doctors, students and also the public. We should be careful about the statements that we make!!!

As far as my experience is concern, Chiropractic is a great field and we can help many and many patients. We must understand that starting into practice is hard for all health care providers. Whether it’s a dentist, medical doctor, podiatrist or chiropractor, there will be some financial hardships in the beginning. Eventually, it will be financially rewarding but you may not get to that point if all you focus on is the reward.

Remember back in school many years ago, when we were excited about treating patients and the difference that we were able to make in another’s life. I see this on a daily basis. It feels good when a patient can look at you in the eye and say “thanks doc, my headaches are not as bad anymore!! I really appreciate your help”. Chiropractic has been proven to be effective in chronic low back pain, neck pain, sciatica and many more musculoskeletal type presentations. Let’s concentrate more on the clinical, and more on helping our patients.

I hope that I am not misunderstood. I am not downplaying the difficulties of the new doctor in a practice or the new graduate. Of course, there are and will be financial difficulties but it is a situation that will get better with time. It’s not just chiropractors that go through hard time in the beginning all other health care providers experience the same problem. With knowledge of billing, marketing, etc….Life gets better.

When I started my practice, I was struggling financially like any new doctors out there. My focus however, was always on helping patients, treating the spine and improving health. As a result of my caring personality and concern for people, I was able to obtain many and many referrals.

I use to treat patients free of charge in order to make a difference. Chiropractic is great!!!Learn all you can and help your patients.

Dr. Delvaro, DC