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There is a mistaken impression that a holistically, medically integrated practice requires a large staff and high salaries. Such is not the case. Like any practice, the larger the patient base, the larger the personnel requirement to manage the services delivered. Staff requirements are contingent upon two factors:
- The variety and quantity of services offered.
- The number of patients being treated daily.
Please keep in mind that salary ranges may vary greatly, depending upon:
- Practitioner’s years of clinical experience.
- Practitioner’s education.
- Practitioner’s post graduate certification.
- Practice’s geographic location.
Following is a list of personnel who are important in a holistic multi-disciplinary practice. Staffing requirements will vary depending upon the services offered by the practice.
1. Medical or Osteopathic Physician.
This person is the clinical medical director. He or she performs the initial physical exam on all new patients and all follow ups (re-exams) as clinically indicated. This physician should ideally be employed full time or at a minimum of three days per week. Remember, each new patient needs to be examined by this physician, so all new patients should be scheduled during hours when this physician is present.
2. Physician Extender.
Examples of the physician extender are a nurse practitioner or physician assistant. These practitioners can perform certain medical services when the MD/DO is not present.
3. Physical Therapist.
Employed by some holistic physical medicine offices, physical therapists (PTs) are utilized for purposes of rehabilitation and physical therapy of various types. PTs can perform some testing as well; this will be dictated by your specific state’s scope of practice law governing physical therapy. PTs should be employed for your busiest daystypically Monday, Wednesday and Friday or on a full-time basis.
4. Doctor of Chiropractic.
Chiropractors have varying ranges of licensure because each state dictates what services a DC can and cannot perform. The scope of practice for a chiropractor varies more than for most other practitioners and that, of course, will influence what chiropractic services are offered by your particular facility. Adjustments, however, should always be offered. Chiropractors who perform vertebral adjusting or other techniques should be employed full time. He or she will also be the office administrator; coordinating the activities of the various practitioners and front office support personnel.
Please remember that the chiropractor cannot make medical decisions. The clinic’s medical director is responsible for the overall case management of each patient, taking into account the respective findings of the other practitioners. Many chiropractors find it helpful to hire DC associates to assist with adjusting, doing structural exams, taking x-rays and performing other ancillary services.
Interviewing the Physician
The MD’s primary purpose is to serve as medical director of the clinic. He or she will examine all new and existing patients and perform the appropriate medical intake. In addition to examining all new patients as they present to the clinic, the MD will be responsible for re-evaluating the status of each case as needed and approving orders for care and testing.
Your concern when interviewing a medical doctor is that he understand that a level of cooperation and mutuality exist between you as you will both be working closely together. The medical doctor needs to understand that the primary focus of the clinic is holistic.
Regardless of whether you are interviewing the MD over the telephone or in person, the following seven questions should be asked:
- How do you feel about working in a multi-disciplinary arrangement with a chiropractor, physical therapist, acupuncturist, massage therapist and other allied types of practitioners?
- What are your long term professional goals and objectives?
- Where do you see yourself in five years?
- Why do you want to work here? (You want to make sure that the answers delivered by the medical doctor are not rehearsed. Make sure that they are indeed the beliefs of the candidate and not merely rote answers because this person needs a job.)
- What experience have you had with holistic and/or physical medicine? (It is okay to hire a doctor who does not have much experience because it is extremely difficult to find someone who is well qualified in both physical and holistic medicine. Generally, the doctor will have a background in either physical or holistic medicine. In some cases the MD will not have experience in either field, but will be interested in developing such expertise. Such expertise may be obtained by having the physician attend various seminars and programs.)
- How do you feel about taking ongoing continuing medical education courses and seminars for the purpose of developing a greater level of expertise? (Consider for example, the field of vitamin therapy; such as intravenous nutrition, vitamin injections, IV pushes, oral vitamin therapy, chelation therapy, nutritional therapies, homeopathy, herbal therapy and dark field microscopy.)
- How comfortable do you feel about lecturing or conducting community educational workshops for the purpose of developing and expanding patient consciousness?
Bear in mind that this doctor, as medical director, will need to have a working knowledge of both physical medicine and holistic medicine because this person is responsible for everything that goes on in the office. Everyone on the staff will be working under medical supervision and the physician is the ultimate authority from both the medical and legal standpoint. Therefore, he needs to be competent in the fields of both holistic and physical medicine so that he can write orders for procedures being performed within the clinic.
Assuming the answers to these seven interview questions are satisfactory, you will then proceed to ask more specific business-related questions. For example, what are the doctor’s hours of availability? What are his or her salary requirements? One caveat: Never “offer” a salary to a doctor. Instead, ask the doctor how much he wants. Frequently, the doctor will ask for less salary than you would have offered.
However, if the doctor’s salary requirements are far in excess of the amount you are prepared to pay, go elsewhere. Always bear in mind that the facility must make a profit, so overhead should be kept as low as possible, particularly during the first six months. Another caveat: You should have an MD in the office a minimum of three days per week. For example, Monday, Wednesday and Friday. Ideally, you do not want more than one day to elapse between medical coverage. The larger your practice is now, the more hours you can use the medical doctor to perform intake and examinations on those patients that are converting from chiropractic patients to medical patients. If you are starting a multi-discipline practice from scratch, you are not going to have the patient volume to warrant much more than 18 hours of medical coverage per week.
Remember, when you are interviewing the doctor, you need to stay in charge and direct the conversation and interview. It is always a good idea to have the doctor’s CV in hand prior to your conversation with him. I recommend that you have the doctors fax their CVs to your office first. This will allow you ample time to peruse their backgrounds prior to conversation and/or interview.