Additional education is a direct route to practice specialization.
You can do a number of things to increase your competitiveness in a crowded market. Adding new equipment, profit centers, and additional modalities are common strategies many find effective.
These approaches aim at increasing the size of your patient base. Another approach is to narrow your focus to target a specific population.
Although reducing the scope of your ideal patient demographic may seem counterintuitive, it not only can set your practice apart but also allow you to sharpen your marketing and attract a highly motivated clientele who seek specialized treatment. To accomplish this, you’ll likely need additional education and certification attesting your ability to provide this type of complex care.
We reached out to a number of specialists who shared their thoughts on this subject and described their routes to success with this model.
Healing the youngest
Amber Brooks, DC, knew from an early age that she wanted to work with children. She had planned a route to studying pediatrics as an MD, but her path instead led to chiropractic school.
Unfortunately, her training there was less than thorough—pediatrics was coupled in the same course as geriatrics. There was no clinical experience “unless we could talk someone into ponying up their child to adjust,” she says.
Because she knew she didn’t want to treat only adults, she spent her week- ends during chiropractic school taking classes through the International Chiropractic Pediatric Association. A mere 30 days after graduation, she sat for an exam and received her certification in chiropractic pediatrics. She went directly into practice and has been treating children for 20 years.
“Specialization allows people to focus in an area and market themselves as a specialist, which is what sets them apart,” Brooks says. “It adds some validity—athletes want to go to someone who is a specialist in sports. From a marketing perspective, it is fantastic.”
In an increasingly competitive and ever-changing field, many chiropractors are looking to higher education to focus and grow their practices. Receiving certifications, diplomates, or master’s degrees allows many chiropractors to concentrate on areas where they are passionate, grow their patient population and, some- times, receive higher reimbursements.
Time and money matters
Advanced degrees are no small undertaking. To achieve a diplomate in one of the 11 areas approved by the American Chiropractic Association (ACA), DCs are typically required to take 300 to 400 hours of classes and undergo rigorous examinations in their area of specialty. Some areas require more coursework or the publication of research and can take three to four years to complete. Though it varies by specialty, the cost of such programs can be upwards of $10,000, plus the cost of travel to seminars.
So why would a chiropractor want to take this on?
Many DCs are lifetime learners and enjoy staying abreast of changes in the industry. Advanced degrees are one way to accommodate both of those desires. Some, like Brooks, really want to focus their practice in a specific area.
Jay S. Greenstein, DC, is a sports chiropractor in the Washington, DC, area. He says advanced degrees or certifications can make a practitioner “sought out as the guy who can solve the problem.”
“There are some doctors who just want to do adjustments,” he says. “And then, on the other side, there are longer treatment sessions where patients get educated and become a partner with the doctor, and it takes that knowledge. Each doctor has to decide where to be on that scale.”
If a diplomate sounds like too great an undertaking, most specialty areas— including pediatrics and sports—offer master’s programs and certification.
These often take only about half of the time and cost commitment as a diplomate. The ACA and other organizations are aware of the challenge of going back to school, so they are continually working to ease the process.
Elise Hewitt, DC, says the ACA Pediatrics Council has an online program in the works for general chiropractors who want a one-year certification in pediatrics. Jeff Tucker, DC, says the ACA is working on allowing previous continuing education credits to be applied toward certification.
Some, like Brooks and Greenstein, received certifications and chose not to continue on to become diplomates.
Greenstein opted to pursue other options like becoming a golf fitness instructor, a functional movement screener, and a Kinesio Taping specialist, all of which are obtainable through short, concise programs.
“But the start of my educational journey was with the Certified Chiropractic Sports Physician program, and it really changed my practice forever,” he says.
Scope and marketing
Chiropractors are bound by their states’ laws regarding their scope of practice. And patients don’t automatically flock to the door of those with advanced degrees. But specializing in particular areas can potentially attract more patients and expand treatment modalities.
Julie Hartman, DC interim secretary for the ACA Council on Chiropractic Pediatrics, says specializing in pediatrics opens doors for referrals from practitioners such as midwives, doulas, and occupational therapists.
Frederick Carrick, DC, PhD, says chiropractors with certification and diplomates are able to act as tertiary specialists for other chiropractors and physicians. This certification enables practitioners to work with patients with movement disorders, neurodegenerative diseases, and head trauma.
“Someone with a movement disorder like dystonia or jerking of arms and limbs may have no drug that can help them,” Carrick says. “These people are at a loss for treatments, but chiropractors can make a great difference.”
Probably the most dramatic change in scope a chiropractor can make is through a program that provides an advanced track to a nurse practitioner degree.
“They can go from serving burgers to serving Mexican and Italian food,” says Jeff Rogers of Mid America Learning.
Rogers’s organization offers an online paramedic program that lays the foundation for a faster and less expensive path to becoming a registered nurse and then a nurse practitioner. The program was set up, Rogers says, to help chiropractors who are five to 10 years out of school, still paying back debt, and unable to get onto insurance panels.
“It expands their scope to be more well-rounded and inclusive healthcare providers,” he says. “They can keep patients in the office instead of making them go elsewhere for treatment.”
Nurse practitioners can perform blood draws, electromyography, and can even prescribe some medications. NPs are also able to bill at a higher code than a chiropractor. The average income for an NP is about $98,000 a year and can be as high as $200,000, Rogers says.
These numbers are high in part because reaching that degree can be challenging, even with an accelerated program. The process at Mid America, which takes a chiropractor from para- medic to registered nurse and then to an NP, takes three to four years to complete. It is also a costly endeavor—$13,500 for the paramedic license, $12,000 to become an RN, and $36,000 for the NP.
Since its inception in 2007, roughly 600 students have gone through Mid America’s program. Most have at least received an RN degree and about half are NPs, according to Rogers.
Neurology: This is the oldest specialty discipline in the profession and it has pioneered many other specialties in the ACA, Carrick says. It was the first specialty to obtain certification through the National Commission for Certifying Agencies.
The specialty tends to attract lifelong learners, which is good, Carrick says, because chiropractic neurologists need to remain current on industry changes. One of the current focuses for this group is on athletes with concussions.
“They have become the go-to people for patients who have these issues like concussions in sports and want nonmedical treatment for it,” he says.
Traumatic brain injury is just one subspecialty people can receive fellowships for in neurology; others include electrical diagnostics and neural pediatrics.
Sports: Greenstein said his eyes were opened dramatically when he took his first course toward certification. His mentor taught about the knee and he learned well beyond what he knew from his general degree.
“I learned a lot about knee pathology—plica syndrome, appropriate exams, and rehabilitation techniques,” he says. “It was focused on multifaceted pain and pathology.”
His motivation to continue learning stemmed from his frustration of being unable to help some of his patients. “State board requirements were almost secondary to what I wanted to learn,” he says. “I wanted to see whose problems I wasn’t solving and learn how to change that dynamic.”
Rehab: Tucker says an advanced degree in rehab offers practitioners the ability to teach patients how to use exercise as medicine. The degree taught him how to work with patients to put a full plan together to improve their health.
He has been trained to teach patients how to use foam rollers for soft tissue work, self-stretching, isolation, and whole-body exercises. All the while they discuss lifestyle changes that help increase lung capacity, rid excess weight, and work on balance and speed. His practice has evolved around treating people with chronic pain who have been unable to get relief from other doctors and practitioners.
Pediatrics: These specialists spend an entire year learning about normal and abnormal pediatric development. The program also teaches practitioners how to tend to the needs of a pregnant mother and how what is happening in her body will affect the developing baby.
When she was going through her diplomate courses, Hartman was treating a teenager she had inherited from another chiropractor in her practice. After returning from a class, she asked the mother if the baby had had a particular type of birth that may have caused the problem. He had, and Hartman was then able to change his treatment protocol and reduce symptoms.
Nurse Practitioner: Rogers says creating an accelerated path from DC to NP took some time. His organization worked with paramedic programs to give chiropractors credit for the didactic courses, enabling them to cut the path toward the paramedic degree in half. This program is online, self-paced, and the degree allows chiropractors to work on weekends at a hospital to earn extra money.
The next portion, an RN degree, is also given online and allows chiropractors to work at their own pace. The program is unique in that chiropractors have three different points at which they can stop if they decide they like one area and want to stay there.
“As a paramedic and a registered nurse, there is no hospital in the U.S. they can’t walk into and get a job,” Rogers says.
The NP program is more traditional and structured. It allows chiropractors to use all of their traditional modalities and, in some states, also work as quasi- family practitioners.
The ACA recognizes numerous other specialties beyond those listed above. Training and internship requirements are generally similar among all of them, and the rewards tend to follow similar trajectories. You can certainly make a living as a general field practitioner, but if you’re looking for something more, consider adding to the education you already possess. Many of your colleagues have found tremendous success this way.
Tammy Worth, a freelance writer based in Kansas City, Missouri, specializes in business and healthcare subjects. She can be contacted at firstname.lastname@example.org.