Destination: specialization

Sencer9-2013Have you considered creating a fibromyalgia niche practice?

By Marc H. Sencer, MD

Fibromyalgia (FM) and the closely related chronic fatigue syndrome (CSF) are serious medical problems that impact more than 5 million Americans annually. These patients require an inordinate amount of attention and care, and there are few doctors who specialize in treating them.

You can make a difference in their lives and create a profitable niche for your practice at the same time.

FM is thought to be a rheumatologic condition related to autoimmune dysfunction like lupus and rheumatoid arthritis, but the etiology is unknown at this time. It affects women more than men by a factor of seven to one. It is diagnosed most frequently in middle-aged or slightly younger individuals. Often these patients have seen multiple doctors before getting an accurate diagnosis.

FM represents a diagnostic challenge because the symptoms mimic so many other diseases. There are no lab tests that are definitive and the diagnosis is made on clinical grounds. The American College of Rheumatology criteria is used to make the diagnosis and grade the severity of the illness. In the past, it was necessary to palpate 12 tender points at specific locations to make the diagnosis; however, this method has been discarded. Instead, the criteria include pain at various areas. Symptoms must be present for three months at the same level.

Most importantly, the patient cannot have another illness that would explain the symptoms.

In addition to widespread pain, FM patients have sleep disturbances, tingling and numbness, irritable bowel syndrome, headaches, and cognitive problems.

CFS patients share many of these same symptoms, but extreme fatigue — especially after exertion — night sweats, fevers, and swollen lymph nodes predominate more than widespread pain. Many researchers believe that these are both variants of the same disorder.

Many doctors are uncomfortable treating these patients, because these are chronic conditions with no “cure.” And many patients will have a comorbid psychiatric condition like depression, so making the diagnosis is time intensive.

Despite these hardships, there is a great opportunity for you to take on patients that other doctors in your community simply have no time for. Some of these patients will benefit from very gentle adjustments and palliative modalities. The key word is gentle, as these patients often have altered pain perception and very low pain thresholds. In addition, many are highly sensitive to medications and must be titrated up from almost homeopathic doses.

FM and CFS treatment is best undertaken in an integrated practice. Physical therapy is a mainstay of treatment and one of the main profit centers in this type of practice. Occupational therapy also can be helpful. Aerobic exercise has been found to be helpful when started at low levels and increased according to the patient’s tolerance.

FM patients offer an opportunity to provide both services reimbursable by insurance such as physical therapy and trigger point injections, as well as alternative medicine services that are cash based. Because diagnosis is difficult and these patients exhibit multiple comorbid conditions, you also should seek consultations with multiple specialists and family doctors in your community. This will increase referrals and your visibility in the community.

Marketing this niche is easy. Once word gets out that there is a doctor who understands FM and takes the time to listen, patients will seek you out.

Find out if there is an FM or CFS support group in your area and get involved with them. As far as any other external marketing, the Internet takes precedence. These patients are looking for a doctor who can help them, so make sure your website is informative and up to date. Use separate landing pages and be high on Google’s first page for common key word searches such as fibromyalgia doctor or fibromyalgia treatment.

FM patients can be demanding and challenging, but they present the chance to quickly build a niche practice that incorporates multiple cash-based and insurance-based profit centers. In addition, you will be helping an CHEC_09-13_69underserved group of people who truly appreciate the time you spend with them.

MarcSencerMarc H. Sencer, MD, is the president of MDs for DCs, which provides intensive one-on-one training, medical staffing, and ongoing practice management support to chiropractic integrated practices. He can be reached at 800-916-1462 or through