Developing a specialty or multidisciplinary practice can present a series of obstacles, but the benefits are well worth considering. Understand the ins and outs of widening your practice offerings before taking this major step.

By Amy Wimmer Schwarb * Photos by Ranard Brown

Jennifer Lidstrom, DC, has never known life without chiropractic. When she was born, her mother endured a difficult childbirth, and visited a chiropractor just two weeks afterward.

The chiropractor suggested treatment for the baby, too: “This poor child went through a difficult delivery as well,” the chiropractor told Lidstrom’s mother.

After that initial appointment, her family selected chiropractic care as a regular part of their lives. When Lidstrom suffered an injury as a young athlete, she headed to a chiropractor. And when she found herself considering a career in the medical profession, she realized what a large part of her life chiropractic had been.

“I always knew I wanted to go into the medical world, but I wasn’t sure which direction,” Lidstrom says. “And then I thought, ‘You know what? My whole life, when something’s off and doesn’t feel right, I don’t give it medicine — I just fix it.’ I realized chiropractic was just right for me.

“My father is a mechanic. Being a chiropractor is kind of like being a mechanic for the body,” she says.

In the same way that a chiropractic career came naturally to Lidstrom, so did her decision to diversify her practice, Lakeside Sports Chiropractic Center and Motorsports Rehab, with several other disciplines. Located in Cornelius, N.C., at the epicenter of the NASCAR industry, her office includes a massage therapist, an athletic trainer, a nutritionist, and two chiropractors — including Lidstrom — who also perform acupuncture.

The multidisciplinary aspect of her practice, Lidstrom believes, has made both her patients and her community more aware of the type of help she provides. “I’m able to offer more services and attract more of the population than if I were only a chiropractor,” she says.

“When people introduce me, they say, ‘This is Dr. Jen, and she’s not just a chiropractor — she does everything.’ Patients aren’t just coming in for rehab and nutrition. We’re able to offer more and reach out to more people.”

Shared values add value

Chiropractors are no strangers to holistic healthcare — the notion of treating the body as a whole. But the many forms a multidisciplinary practice can take — and the intricacies of expanding a traditional chiropractic office into a cross-discipline office, with all the legal and ethical concerns that accompany· such a change — can be overwhelming.

Consider, then, the perspectives of several industry professionals and chiropractors who have already gone through the process of broadening the scope of their services. They offer advice on how to transform your office into a multidisciplinary practice, and how to avoid the pitfalls that can make the prospect an intimidating one.

To begin with, just defining a multidisciplinary practice can be tricky, because it can take a number of different forms. Lidstrom’s office, for instance, offers an array of non-medical professionals who traditionally share the same values of healing the body from within, as opposed· to through the use of prescription drugs.

Other multidisciplinary practices can take an even simpler approach, with only a chiropractor and an acupuncturist, or a chiropractor combined with a nutritionist.

Others set themselves apart by combining these specialties with a staff medical doctor, and these practices also can take a variety of forms. A traditional chiropractic office might bring on a medical doctor whose specialty meshes well with chiropractic, such as osteopathy or internal medicine.

Conversely, a large medical practice might partner with a chiropractor to diversify its offerings. In Santa Monica, Calif., for instance, Raymond Hall, DC, is part of the Santa Monica Orthopaedic and Sports Medicine Group, which offers 12 orthopaedic surgeons, one podiatrist and Hall, a chiropractor.

“Patients are so enthusiastic about the concept of an orthopedic group integrating a chiropractor for their benefit,” Hall says. “It puts the patient first and says, ‘If they don’t need surgery, we’re going to try a completely conservative chiropractic approach first.’ So many people are wanting to be holistic and deal with their body through holistic mechanisms.”

Is your practice ready?

For chiropractors who are convinced that a multidisciplinary practice is the right direction for their growth, Mark Sanna, DC, CEO of Breakthrough Coaching, says the first step is evaluating your existing business model.

“In order to become a multidisci- plinary practice,” Sanna says, “you first must know how to run a traditional chiropractic office. Before you can do that, I wouldn’t even think about getting into multidisciplinary practice.”

As a benchmark, Sanna suggests that only chiropractic practices that generate 90 to 100 office visits each week that qualify for health-plan reimbursements should consider expanding into offering other disciplines.

For those chiropractic practices that do have a healthy existing business, the broadened scope of a multidisciplinary practice can help the business grow exponentially.

“Less than 10 percent of the general population accesses chiropractic care,” Sanna says. “Close to 90 percent accesses medical care. By becoming multidisciplinary, you’re now able to market to 90 percent of people who require healthcare.”

Knowing the ground rules

Following close behind, the second step (and the one most frought with pitfalls) is to understand how state and federal laws apply to multidisciplinary practice in your area. Laws vary widely from state to state: In New York, for instance, when a medical doctor and a chiropractor work under one roof, the medical doctor must own 100 percent of the practice. In Florida, on the other hand, a chiropractor can own 100

percent.

Daniel Dahan, DC, president of the Southern California–based management and consulting service, Practice Perfect, says setting up the legal infrastructure is the first thing he advises new clients to do. “Typically, it’s done by a healthcare attorney who is well-qualified and knowledgeable,” Dahan· says. “The corporate practice of medicine varies from state to state. It’s amazing how much each state is quite different from another.”

Philosophical considerations

Sometimes, however, the biggest obstacle to incorporating a medical doctor into a chiropractic office isn’t a business or legal concern, but a question of shared values. Finding a medical doctor who shares a chiropractor’s outlook on healthcare can be difficult — especially when the two are considering a business partnership.

“You want an MD who is prevention- and wellness-oriented,” Sanna says. “You must share a similar vision for your practice. If you don’t, you’re going to find it very challenging. You’d be amazed at how many medical doctors, once they get to know who we are as chiropractors and what we do, say how much they love our model and chiropractic care.”

Michael Hartpence, DC, of Southern Crescent Medical Clinic in Jonesboro, Ga., says the MD in his practice used to commonly refer him patients — a good indication that he was open to chiropractic care.

“It’s a good marriage for us to have a medical doctor who is holistically minded and tries his best not to prescribe medications,” Hartpence says. “It’s a team approach to treating patients. We have team conferences on a weekly basis to discuss all our patients and what their treatment should be, and we try and reach the optimal treatment program for the patient.”

And Hartpence’s advice for those who want to pursue a multidisciplinary practice was echoed by other chiropractors who partner with MDs, as well as the consulting firms who try to help those partnerships happen.

Chiropractors wanting to build relationships with the medical community need to communicate with medical doctors in the same ways that those doctors communicate with each other.

“I’ve consulted with a lot of folks over the years on how to start one of these facilities. And the biggest block is finding a physician who wants to work with a chiropractor,” Hartpence says. “I always advise to communicate with the medical doctors they share patients with. Send them a letter, tell them you’re treating their patients. That just fortifies your credibility in the medical community. They need to see that you’re credible and get good results.”

Your signature style

Just as there are many types of multidisciplinary models that can be made to work, bear in mind that this kind of practice growth can be an ongoing process. You might bring one healthcare professional onboard to join you and evaluate the effect on your practice before considering adding another.

Lidstrom has no immediate plans to seek out an MD for her practice. Instead, she has allowed her practice to grow organically through contacts she makes along the way.

Her next step, in fact, might be to add a sports psychiatrist, because the specialty ties in nicely with the services the practice already offers, and because she has a good relationship with a specialist in that area. “We’ve been talking about how we might add that dimension, because of the body-mind- spirit connection,” Lidstrom says.

For now, Lidstrom is pleased that the many offerings of her practice allow her to expose more potential patients to chiropractic. “Maybe a referring orthopedist isn’t open to chiropractic, but is open to acupuncture,” Lidstrom says. “We’ll get referrals through all different avenues, and then once they’re here, they’ll ask, ‘How does chiropractic work?’

“It allows a person to walk in the door, which is probably the hardest part of the whole process,” Lidstrom says. “And they say, ‘Hey, everybody is getting better here, and it’s a nice, happy environment, so let me ask some questions.’”

Amy Wimmer Schwarb is a writer and editor based in St. Augustine, Fla. She spent 10 years as a writer and editor at the St. Petersburg Times in Florida and was most recently executive editor at Indianapolis Monthly. Among other feature-writing honors, her work was recognized in the anthology Best American Sports Writing 2010. She can be reached at wimmerschwarb@gmail.com.

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Sidebar: Meet the experts

Daniel Dahan, DC, is president of Practice Perfect, a management and consulting service based in Southern California. Dahan formerly owned and operated a successful multidisciplinary health center, where he hired neurologists, orthopedic surgeons, internists, and physical therapists to round out his practice.

Raymond Hall, DC, practices with the Santa Monica Orthopaedic and Sports Medicine group, which also includes 10 orthopaedic surgeons and a podiatrist. His clinical expertise is in treating sports-related injuries, and he has treated several professional athletes.

Michael Hartpence, DC, practices at Southern Crescent Clinic in Fayetteville, Ga. He is a graduate of Life Chiropractic College and is also certified in impairment ratings and physiotherapy. He has been practicing in the Atlanta suburbs for more than 25 years.

Jennifer Lidstrom, DC, has been practicing since 2002. Much of her practice at Lakeside Sports Chiropractic Center and Motorsports Rehab focuses on the golfers and racecar drivers that make their home in the Charlotte, N.C., area. She is also a certified golf injury physician and certified in clinical acupuncture.

Mark Sanna, DC, is the chief executive officer of Breakthrough Coaching, an international practice management consulting and coaching firm, which trains chiropractors in how to manage their practices and build their business. He is a fellow of the International College of Chiropractors.