Medical referrals have long been recognized as an enviable and secure source of new patients. In fact, for other health disciplines such as physical therapists, it’s often their only source of new patients; and enough to sustain a business with multiple competitors. But it’s unusual for a chiropractic practice to enjoy such a stable source of referrals.
How can this be when back pain costs more than $30 billion in ambulatory care each year in the U.S.?1 Especially when we know that medical doctors don’t want to manage back pain? How can this be when spinal manipulation plays a starring role as a recognized therapeutic intervention in the guidelines for both acute and chronic back pain and where chiropractors have the reputation of being holistic care providers for back pain?2 How can this continue in a time of crisis over opioid addiction and black-box warnings on NSAIDs?
A brightening picture
Increasingly, you’re seeing improvements in MD-DC relationships, such as chiropractors working in the VA hospitals or alongside medical residents and in integrated care settings. Nevertheless, the average independent chiropractor still struggles to gain medical referrals despite the economic burden, scrutiny over pain medications and guidelines to support such referrals.
With stronger competition from those disciplines already welcomed by the medical community and who are now offering spinal manipulation, it’s important for DCs to work harder to build their medical relationships if they hope to engage and improve access to their services. The obvious motivation being a stronger and more stable source of referrals that works within a circle of care rather than outside of one.
Continued exclusion of chiropractic results in a fracture in care and provider communication that can cause duplication of services, delays, and nonsensical progression in care—in addition to extreme frustration for the patient who is bounced from one provider to another (or worse, left alone to navigate their pain). It’s quite a disservice to patient care to allow this separation and lack of communication to continue.
Fortunately, the scrutiny over spinal manipulation is one for the history books, with the safety and efficacy of spinal manipulation now secured in the literature. But the scrutiny and discrimination over chiropractors is still a daily problem.
The good news is that you have the power to correct it and in so doing can help continue to propel the profession forward, expanding access and treatment choices for patients who might not otherwise consider your care. Imagine the type of demand that would create.
While many DCs have the desire for medical referrals, their knowledge of how to go about building key relationships is often nonexistent. So where does one start? By finding physicians in your area to begin the communication process.
Here are some tips to help identify physicians in your area who will be most receptive to your outreach:
Existing patients: Nothing speaks higher of your skills than success with a patient who has been struggling with back pain and is finally having some success in pain reduction. Make it a routine to ask patients if you can share their results with the physicians they have sought care from for that particular condition and provide these physicians with a written discharge report. It doesn’t need to be a full narrative; a short one-page summary of care is enough.
Do a Google search: Google is a rich source of insight into physicians in your area. Start geographically and explore their websites and social media to prequalify them as a potential source of referrals. Look also at patient reviews, which yield a lot of information into what the MDs treat and how they approach patient care (and occasionally who and where they refer to).
Networking: If you already have a physician you work with, ask them who else you should consider reaching out to. For instance, if you have built rapport with an internal medicine doctor who appreciates your approach, ask them what orthopedic physicians they think you should speak with. Don’t forget to ask if you could mention that they suggested you make this outreach, which can make it more likely that the physician will meet with you.
Solo practitioners: Consider working with smaller offices. They are often easier to get time with, more open-minded, and unencumbered by bureaucratic protocols.
New and younger physicians: In general, newer (which usually means younger) doctors are more likely to be open to complementary and alternative medicine (CAM) services because they have had more exposure in their education to the benefits of such care.
Specialists: Pain management doctors and orthopedic surgeons are likely to be open to your care and recognize the value of your services. In fact, one study that surveyed attitudes of surgeons toward chiropractors found they felt spinal manipulation was effective, and those who had an existing relationship with a chiropractor were more likely to make referrals specifically to that particular chiropractor.3 (I’ve also found specialists are easier to get time with, such as a lunch or late afternoon meeting.)
Once you have identified a list of 10 physicians, start prioritizing. Which ones do you share patients with? Is there one who really stands out as being open to CAM providers? This will be a working list, meaning some won’t work out and new ones will be identified through new patients or by expanding your network.
For those who want the stability and relationships a medical referral practice will offer, the doors are open to conversations. Research and guidelines, problems with prescriptions, and the economic burden of medical costs will support you in changing the referral dynamic and enhancing patient access to your care!
Christina Acampora, DC, founded Aligned Methods, a free online medical marketing resource for chiropractors. She also teaches the Introduction to Business Principles and the Principles of Marketing and Communication courses at National University of Health Sciences in Lombard, Illinois. She can be reached through alignedmethods.com.
1 Smith, Monica et al. Aging Baby Boomers and the Rising Cost of Chronic Back Pain: Secular Trend Analysis of Longitudinal Medical Expenditures Panel Survey Data for Years 2000 to 2007.” Journal of manipulative and physiological therapeutics. 2013;36(1):2-11.
2 Chou R, Huffman LH, American Pain Society, American College of Physicians. Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med. 2007;147(7):492-504. Review. Erratum in: Ann Intern Med. 2008;148(3):247-8.
3 Busse JW, Jacobs C, Ngo T, et al. Attitudes toward chiropractic: a survey of North American orthopedic surgeons. Spine. 2009;34(25):2818-25.