#4 MD Meetings- Primary Care
#21 MD Relationship Agenda – April and Onward
Good morning everyone, thank you for your patience over the last few weeks. I was not as available as I should have been to some of you due to my responsibilities at the medical school. Having MD students attached to your hip all week does not allow too much extra time to be on email or the phone. The experience is a critical part of the MD program and although it is difficult, it is necessary to ensure the information that I am giving you is current and relevant. It is truly amazing to me how quickly you can get to know someone in such a short time when you are in the right environment. My goal for YOU as members is to get as much “inside information” as possible on medical education and most importantly on how the medical schools are positioning new graduates to succeed in our healthcare environment. This will in turn allow you to position yourself to SOLVE their problems and talk their language. There are always a few recurrent themes and I want to outline them below.
Theme #1 – Medicine has its struggles too
– They struggle politically like us BUT they also do it through specialty boards. We know from observation that the specialties within medicine push the profession forward, and in fact are part of the reason that healthcare costs tend to rise. It is about the newest technology and the newest procedures. Medicine is one of the few things in professional life that have a reduction in fees over time, it similar to a reverse inflation. I spoke with a long time radiologist friend of mine about reimbursement for CT scan, he mentioned in 1968 (when he started reading as a radiologist) he was paid $38 for the professional component of the CT read (the technical component is what the tech do and pays for the machine). In 2013 he is paid $8! So the insurers including the Federal Government will pay less for services that have been around in favor of the new technologies.
– When we look at chiropractic care our most common (and important) intervention has been around forever, and regardless of what chiropractic schools teach, what consultants profess and some in our profession tell patients, we do not own it. Although we have special codes for the chiropractic adjustment when we look at the research it is not a separate entity. All spinal manipulation is combined in the research and in fact the most important research on spinal manipulation is coming from Physical Therapist and Osteopathic Physicians.
– My point in all this is simple and straight forward…Medicine is MORE FRAGMENETED than the chiropractic profession and they continue to gain influence and win. Chiropractic falls farther and farther behind because we are not united. The only way to win is to fight for the rights of chiropractors to manage patients, our primary focus is on the spine. That is what we are trained to do and that is our professional focus. We, like medicine, will always struggle that is the nature of healthcare, however we are positioned to win if our voice is united and focused on caring for the spine.
Theme #2 – They PROVE that their education is continually relevant and updated
– Medicine is divided into general medical education which occurs for four years following and undergraduate degree. Once the four years is done a medical student becomes a medical physician however they are required to specialize in a particular division of medicine and are not licensed to treat without a supervising physician until they are board certified. There are many different boards, but as an example the Family Practice Board requires an additional 3 years of training, the Anesthesiology Board requires an additional 4 years of training and as an extreme example the Neurosurgery Board requires up to 8 years of additional training with an additional 2-4 years of Fellowship Training. Each Board then requires testing to ensure each medical physician is up to date and working at current standards. Remember though that all Residency Programs leading to Board Certification are paid positions. The Board that you are working towards certification dictates the maximum hours that you can work and the annual salary of the position. They vary but the reality is that they are paid. Truth be told if it were not for 90 hour Resident work weeks, most hospitals would be financially insolvent. (yes the cap on hours worked is 90 hours per week)
– Chiropractic on the other hand requires 4 years of training in chiropractic school which includes an internship with a requirement of 300 patient encounters before we graduate. There are additional Board Certifications that we can apply for such as Radiology, Orthopedics or Internal Disorders which all vary based on the school and State that you are working in. These Board Certifications can also be met by working as a clinician and studying outside of an official Residency Program. Testing for Board Certification is the same regardless if you pursue it through a formal Residency Program or a Diplomate Program. In either case, there is no re-certification required.
– Can you start to see the “perceived barrier” when talking to the MD and why Post-Graduate Certification and a proper CV is critical
Theme #3 – They no ZERO, ZILTH, NADA about the chiropractic management of spine conditions
– The amount of musculoskeletal education in medical school is significantly deficient and it’s not necessarily medicine’s position to change that since there are many other conditions that they have to treat and manage. It is interesting that they overlook one of the most common sources of disability. What I often see is that the lack of knowledge in spinal biomechanics in particular translates in to the attitude that “spine care is full of abuse” and that most patients are “malingering”. They are trained to objectively identify the issue (usually through blood work etc.) then prescribe a medicine to change the physiology surrounding that condition. Once the objective test returns to “normal” the condition is managed. The little education that they received on spine care is directed toward a muscular problem, hence their propensity to refer for physical therapy intervention. If the muscle is the issue then balancing the muscle through supervised exercise is the solution. If the patient does not get better then they are referred to manage the source of pain through injection or pills. Can you see now how this has created an epidemic of pain medication addiction?
– I will tell you that talking biomechanics and spinal compensation makes a lot of sense to them. Simple things like leg length changes pre and post adjustment are very well received and for me, are an entry point for educating the medical profession on chiropractic care. YOU CAN NOT USE OUTDATED VOCABULARY TO TEACH THE MD. It is disrespectful to chiropractic and what chiropractic can do for patients and minimizes our ability to treat more patients. So my final words on this topic is don’t do it…J
Lastly, I would also like to tell you that I was notified that the next round of 4th year students are not scheduled until September! The last 4 students that I had at the office over the last 8 weeks are currently accepted to Residency Programs in Anesthesiology (2), Orthopedics and Neurology. More on those discussions and their feelings on Chiropractic in additional consultations. So, from April onward I am freed up because I don’t have 4th year medical students attached to my hip asking questions and looking confused. I can answer my phone throughout the day and talk frankly about practice issues and money. I am looking forward to my new found FREEDOM!
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