The Chiropractic Files

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

Dealing with Fractures

Depending on the trauma the spine may be fractured. Fractures are usually caused by high impact collision or extreme trauma. Docotors of chiropractic are primary care physicians and are often faced with analysis of fractures. Fractures can be the result of a fall, sports related injuries, car accidents and even domestic violence.

 
Symptoms range from pain that is aggravated by movement, swelling, weakness, numbness and tingling. Keep in mind that a fractures may affect or puncture other vital structures in the body. When faced with a fracture, the patient should be referred to the emergency room immediately.

There are fractures that may not be trauma related. For instance, compression fractures caused by osteoporosis, and fractures caused by tumors due to the weakening of bones.

If you are called on the scene

Should you be the only doctor on the scene, remember never to move a patient that is suspected of suffering from a major trauma or fracture. Moving the patient may cause more damage. Patient should be braced appropriately before any gross movements are applied. The best course of action is to call 911 and verify that the patient is properly immobilized. The patient should be taken to the hospital immediately for the proper imaging.

 Fractured patients in the office

 Some fractures are not as obvious and some patients may tolerate pain better than others. For chiropractic doctors in a PI type setting. Careful examinations should be conducted to rule out any fractures. 

A proper history should be taken. The history should consist of a detailed explanation of the mechanism of injury. For instance, did the airbag deployed? Were the road conditions dry or wet? Were there any impact to the body etc….. In extreme cases the chiropractor should immobilize the body with a spine board in order to complete a comprehensive examination. This may include checking for neurological signs, brusing, swelling, head related injuries, pain with motion, strength testing, rib tenderness, and all necessary orthopedic examinations.

The proper imaging should be ordered. X-rays should be performed on site and depending on the severity, the patient should be referred for CT or MRI depending on the presentation.

Type of fractures

· Axial burst fracture: Lost of height in the anterior and posterior portion of the vertebra. Falling from a high place where the you may land on your feet may cause such a fracture.

· Compression fracture: Breakage and lost of height in the anterior portion of the vertebrae without any lost in the posterior portion. This usually a stable fracture and is common in osteoporotic patients.

· Flexion/distraction (chance) fracture: The vertebra is distracted or pulled apart, this presentation may occur in car accident victims in which the upper body is thrown forward while the pelvis is stabilized by a lap seat belt.

· Transverse process fracture: Usually happen with severe rotation or lateral bending of the spine. This fracture is often stable.

How to treat?

Patients suspected of fractures should be referred to the proper health care provider. Conservative treatments for a simple compression fracture may include the use of a hyperextension brace, stretches and exercise depending on the stage of healing. Transverse process fractures are often rehabbed with a thoracolumbar corset along with a walking or aerobic type regimen.

Dr. Nesly Clerge, DC

From 1 Figure to 7 Figure

Hello all, I'm Dr. Kinland.  This is an absolutely true story that I'm about to tell you. I went from making no money to a 7 figure income in the past few years. This is my story.

After I graduated 12 years ago, I decided to jump straight into a practice.  I wasn't the type to work for somebody else, specially when that somebody can do the same thing that I can, and went through a similar education that I did. 

So, I decided to buy a practice and for obvious reasons I am not able to say the location of those practices.  After graduation my student loans were not as much and I had some extra funds and contributions from family.  I brought a small practice for about $80,000.  I was told that the first few weeks or even months of practice will be slow.  So I expected to be slow for a couple of months.  Keep in mind that I did not know much about billing, insurance, marketing and talking to patients.  I did Ok in school, so I figure my intelligence would pull me through.

Do you know what being in the Reds mean.  Well, let me explain.

When your overall debt (overhead, staff, lease etc…) is $5000/month and you are bringing in $ 2500/month, then that’s red. Obviously, you don’t have to be a math genius to figure out that you will not be able to keep this up without running into the ground.

Needless to say, after 2 years I sold that practice and took a hit. Let me give you an example of why this practice failed.

I was fresh out of school and I did not know how to run a business and my billing person was just as ignorant as I was when it comes to finances. Hiring knowledgeable staff is very important in starting a practice. Ok, I was working with a Work Comp case and it was a good case. We verified the information and the adjuster told me that the bills will be paid. Little did I know that for a Work Comp case, you will need a claim number and an authorization number. In any case, the bill came up to about $9,000 and I really needed that money to pay my overhead, staff etc……A few weeks after bills were sent out, I received a letter stating that the bills were being denied. The reason why!!! I did not have an authorization number and was never authorized to treat. WOW, talk about a stab in the heart. Lesson here: always have authorizations in writing. What is said over the phone means absolutely nothing.

See, the problem is coming out of school, you are not aware of these issues. I was not using a consulting firm and I had similar problems the coming months. A year later, I sold the practice and took a lost. The only good thing that came out of it, is that I know what not to do for the next time around!!!!!!!!

At this time I was broke, but the good thing is that I had good credit and I was fortunate enough to take a loan. This time around, I decided on another approach. I did not concentrate on the PI, Work Comp type practice and this new practice was mostly insurance. Oh, boy let me tell you, it was horrible. Now I know why some doctors will only run a cash practice. My fees were being reduced, paper work is a nightmare, some of the bills were being denied and it took an eternity to be credentialed with some of those insurance companies. This time around, I did not have a patient flow problem but a cash flow problem.

I had more patients than the first practice since I knew a little more about marketing. My money however, was less because of reductions, denials, patient inconsistency etc…..not to mention that the state laws were not chiropractic friendly.

Now, I was faced with a problem, actually a couple of problems.

1. My family was growing and I needed the finances. Talk about stress, now I see why people can go crazy. Running a practice is STRESS, STRESS, STRESS!!!!!!!

2. My first practice failed and now my second one is failing and I have just a little bit of money left from the loan.

3. I consider quitting the profession and simply getting a regular job!!!!!!

4. I was depressed.

5. I did not know what to do!!!!!!

So I did what most people wouldn’t do I moved my family to a new location and started a very small practice while maintaining a part time associate position. I also decided to go with a consulting firm.

This time around I knew the do’s and dont’s and once again I started with a slow start. The only difference is that my new practice was very small and my wife did the billing, my overhead was very low, and I did PI, Work Comp and Insurance.

It started with 3 to 5 patients a week. 1 month later I had 20 patients/Week. 4 months later I was averaging 60 patients/week and was able to quit the part time associate position. Within a year 160 patients/week. Good news, my practice was now too small and I had to expand. As we speak, I’m averaging 350 patients/week and my total net is $1.5 million/year. That’s not what I take home by the way. You must deduct taxes, staff, overhead, marketing budget etc……

I went through a hard time and I know that a lot chiropractors are going through the same. Don’t give up!!! There’s a light at the end of the tunnel. A few tips to consider:

1. For PI practice, build relationships with attorneys. Most attorneys could care less about you, it’s a good idea to make the first gesture. Send them a patient then contact them and schedule a lunch. Keep the relationship going. You send one or two, they send one or two.

2. Make absolutely sure that you have a claim number and an authorization number for Work Comp cases. Verify all billing info and addresses.

3. Always have back ups. When a patient walks in get copies of drivers, license, insurance card, PIP information of that patient & PIP information of the other party.

4. For new doctors wishing to start a practice get credentialed with the insurance companies, medicare etc…. ASAP. On average, it’s a 3 to 5 months process depending on the state.

5. School will not teach you about the real world, it’s a good idea to be involved with a consulting firm if you are clueless. The consulting firms know the laws and the new changes when it comes to insurance etc……

6. Make sure that all Insurance paper work are submitted on time, e.g. ACN, ASHN, PIP etc……Your claims can be denied if the forms are not submitted on a timely manner.

7. Last but certainly not least, MARKETING, MARKETING, MARKETING, MARKETING. Word of mouth and referrals are good, but referrals will take some time. You need patients in order to survive, so once again MARKETING, MARKETING.

Of course I’m being very general, obviously I cannot mention some of the other techniques for legal reason, but follow these advice and you should be OK.

I can go on & on but I just wanted to write my story in order to inspire those that are going through a hard time. Don’t give up!!!!!!! Feel free to comment.

I’m very busy and I may not be able to answer your questions but I will try.

Good LUCK

Dr. Kinland, DC

What the schools didn't prepare you for

What the Schools didn’t prepare you for:

The real world after graduation!!!

We were always taught that if we get good grades that “everything will be alright”. I had an excellent GPA throughout high school, and a good GPA throughout undergrad and Chiropractic school. Well, I figure that after graduation Life will be OK.

There I was a doctor!!! All I had to do was get good grades and I will receive excellent offers after school. If this is your mentality, well!! my friend you need a “WAKE UP CALL”. This is so far from the Truth. 

After graduation, I went to 25 Interviews. My offers ranged from $28,000 to $75,000 with 70% of the offers in the low $40s. Yes, the offers were crappy; then again, if you knew the complexities of running a practice, you will not blame these chiropractors. Among all these interviews, 2 doctors made a great offer. Unfortunately, I was unable to accept the best offer since it was 90 miles away from my place of residence. I am currently running a practice and I am content with my current position. Many students are not aware of the life after graduation, so I decided to write this article in order to shine some light on the real world.

Chiropractic school is great when it comes to the academics. Academics are very important. We need the necessary knowledge to treat our patients, read the necessary X-ray, and the competence to communicate with other health care providers. The profession requires an extensive knowledge of the human body, considering that doctors of chiropractic treat the whole body and not just the spine.

As far as clinical preparation, diagnosis and knowledge, school is excellent; however, the schools did not prepare you for the real world:

- The schools did not tell you that many of the offers out there are mostly crap.

- The schools did not tell you that you may have to defer that $180,000 dollar loans the first few years after graduation. It is an absolute mistake to burden yourself with these loans. “Try and stay away from school loans, or shoot for the minimum amount”. You may not be able to pay your rent, live and pay your monthly loan payment after graduation. If you can, then consider yourself one of the lucky ones.

- The schools did not put emphasis on Marketing. Students have the misconception that patients will magically appear in their office simply by opening the doors.

- The schools did not tell you that the 1 hour patient examination is simply unrealistic.

- The schools did not teach you about the insurance denials.

- The schools did not tell you that the $3000/month rent for your practice is due every month despite the amount of patients or net income for that month. “So, if you make $1900 for that month because you only saw 20 patients, you will still have to pay your rent, overhead and staff”

- The bottom line is this: you will not learn how to run a practice from school. !!!

It is my personal opinion that the schools should focus more on a practice management type curriculum as well as the clinical. After all, how will you apply all that clinical skill if you are not able to maintain your practice.

Here’s a taste of reality!!! 40 to 50 % of new practitioners fail, 20% or so do OK, and the remaining 10 to 30% are successful. Well, why is that?

Certain individuals have the drive, the aggressiveness, no fear, the ability to hustle and hustle. Unfortunately, only a selected few possess these qualities. Others, had their heads buried in the books while they were in school. 

A word of advice, Learn how to hustle, step out of your comfort zone, Learn the Ins & Outs of marketing, get a job with a chiropractor while in school and learn the complexities of billing, and learn how to educate your patients.

Dr. Nesly Clerge, DC

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