Being a doctor of chiropractic is a phenomenal and amazing calling – well, you know that already, being a DC yourself. But what makes you different from all the other DCs out there? Each of us, I believe, has a passion (or two, or more) within our passion of being a DC. You should embrace it. Specialize in it.
And, if it’s a specialty you can get a credential in, all the better. That’s what I did, and I’ll tell you why you should, too.
How I got my DABCI and DACBN
When I was in chiropractic school, I wanted to go the sports route, like everybody else in my class at National University of Health Sciences. That all changed after I went to my first OB/GYN class there.
I thought it was the weirdest thing; I wondered why DCs were even learning OB/GYN. It made no sense to me. I didn’t know anything about it, but after a few classes and a lot of conversations, it was pretty interesting to me and I learned that in the state of Illinois, DCs are considered primary care physicians and can practice basically as a general practitioner does, underneath our scope of license. The main restrictions include: no prescription drugs, no surgery, no delivering babies. I got jazzed about the whole internal medicine/general practitioner/primary care approach.
As I was completing chiropractic college, I had a mentor who got me involved and I served on the board of the American Chiropractic Association’s Council on Diagnosis and Internal Disorders. I got to know everybody who was practicing this way and went to symposiums and watched all of these amazing doctors do amazing things I didn’t even know were considered chiropractic.
I took the coursework pretty early on, and my very first chiropractic patient came in with a herniated disk. I ran blood labs on her, looked at her from a nutritional perspective and incorporated that into my practice from the get-go.
After 300 instructional hours, I sat for the written exam and the clinical board in 2002. I earned the Diplomate of the American Board of Chiropractic Internists (DABCI) behind my name. I also learned the Council on Nutrition offered those of us who had our internal medicine diplomate the opportunity to sit for the clinical nutrition board exam without any further education, because nutrition really falls underneath what we do. I passed that board exam, and earned my Diplomate of the American Clinical Board of Nutrition (DACBN). They complement each other very well. That was about seven years ago.
Give your patients options
DCs are craving more knowledge in different specialties because we’re seeing people with issues that cross specialties, and without chiropractic specialists we have to refer them out to a neurologist, endocrinologist, orthopedist or other specialists who aren’t under that chiropractic umbrella.
That person might combat your way of thinking, or, if they’re an MD, they might say, “don’t see that chiropractor.” They might tell the patient chiropractic won’t work or it’s not safe. If you have the education or the board certification and you work with other specialists, you’ll hear that kind of response a lot less. By having more credentials, we have a broader ability to take care of patients, and more control over their care when we do refer out.
When you’re a specialist, and when you need to refer patients out to other DCs who are specialists, you are keeping those patients under the umbrella of chiropractic; your care philosophy is more likely to be in line with that of another DC rather than an MD who might suggest drugs or surgery to your patients. If a patient came to you looking for a natural, holistic approach, you are serving them better by referring them to others who will understand and support that approach from the get-go.
Specializing supports other DCs
You are also supporting those other specialist DCs by helping make their decision to invest in their education a beneficial (and profitable) one. And really, you’re supporting all DCs, the chiropractic lifestyle and the chiropractic industry by keeping patients in chiropractic care. Chiropractic can handle medically complex cases, and you’re only strengthening that concept by increasing your knowledge and networking with other DC specialist colleagues.
Sometimes I will refer a patient out to a DC specialist and we will work the patient up together. Because we’re both DCs, we each support the other’s approach. Because we’re willing to communicate, the patient gets an exponential benefit.
I have found you don’t have to feel intimidated, either, about admitting what you don’t know when you’re talking to another DC about their area of expertise, the way you sometimes are when talking to an MD. When I get on the phone with another DC, there’s zero judgment about the things I don’t know. There’s no demeaning attitude toward me. Many times when an MD finds out I’m a DC, the whole conversation changes, even if I’ve been holding my own in the conversation up until then. With another DC, there’s an ease and camaraderie; I can just say hey, help me understand my patient. It’s ultimately better for the patient if you can understand each other and talk to each other.
I refer a lot of patients out for chiropractic neurology. The other really cool specialist I use often is a chiropractic trained radiologist. When they look at films, they look from a different perspective than an MD radiologist to give you that functional aspect. That’s a great specialist to have a relationship with if you don’t feel totally comfortable reading X-rays, or to get a second opinion when you need it. Some are dedicated 100% to reading films and make their living doing that, so they can really give you good insights.
I get patients referred to me a couple of ways: first, from my local docs. I also see a tremendous amount of patients through telehealth from other places, like Florida, because I teach in Florida a lot and I’m licensed in Florida. It’s beneficial for other doctors who want to get their patients well but don’t feel comfortable with a certain aspect of treatment. I even have some docs who will sit in on the phone call (with the patient’s permission, of course) so they can learn what I know. Since COVID, about 25% of my patients are telehealth patients, the majority of those being out-of-state. I much prefer seeing patients in person, but if they live out of state and can’t afford to travel to see me, I am glad there’s a way for that to happen.
Why every DC can use a nutrition specialty
I’ve learned over time that we can adjust, adjust, adjust and do all our great musculoskeletal work, but metabolic health will always have an effect, so you have to address it no matter what you’re treating a patient for.
We all have that patient who just doesn’t get better, right? No matter what we do. Then we have the patient who gets better, but it’s short-lived. Then we have the patients who do really well but still could do better. And when I look at all of them, if we go back down to basic science on a cellular level, we dig back down to what all those millions of cells need on a micronutrient level: the vitamins and minerals, the fatty acids, the cofactors, the antioxidants, the amino acids to perform well and replenish those we improve. We heal better when the body has all of those tools. I’ve seen all three of those types of patients truly improve and get better when they’re supported on a cellular level.
If we give our cells what they need and not only nourish them, but also lower our inflammatory load, getting rid of foods or habits that cause inflammation, we heal better. Whether it’s maintenance or an injury, if we’re working on a patient, we have to make sure all of their cells have what they need. For example, if muscles aren’t getting appropriate magnesium, we might have more muscle soreness. I can work on you for an hour and a half, but will that soreness go away if you’re in dire need of magnesium?
Patients need to know how their food intake can affect them. Some do know and still make poor food choices, while others truly don’t realize how they are hurting themselves via their diet. There’s a disconnect between what people perceive as healthy and what actually is, and marketing hugely distorts those perceptions.
Specialty training in nutrition will give your work a new dimension and help patients’ musculoskeletal conditions more than you realize. Everybody in every branch of medicine, in my opinion, should have some level of nutrition training because food affects every condition in some way.
Go specialize!
If you’ve thought about specializing, get started. That’s my first piece of advice. Here are some more:
Find a mentor. When I went into full-blown panic over a patient situation I didn’t know what to do with, I had mentors I could call to say, “please help me, I don’t know what to do,” who would say, “take a deep breath. Here’s what you’re going to do. And if that doesn’t work, call us back.” As I’ve gotten older, I’ve become that mentor for other people.
Find somebody in your new specialty who will take your calls, return your texts and help guide you so you feel more confident. Find more than one person; build a team.
Go to your specialty’s annual symposium. That’s where you’ll learn a lot of new, innovative things and build camaraderie.
Create your network of specialists to refer out to. A chiropractic neurologist, internist, nutritionist, radiologist and orthopedist are a good start. Include some people like yourself who you can bounce ideas off of.
If you’re hesitant to start, start small. Take weekend courses in something you’re truly interested in. For example, if you like GI work, go take the GI weekends; start somewhere. You don’t have to take the entire three years or get your letters to start running tests and helping patients get better.
Just do it. When we were new DCs, on day one, we didn’t know what we were doing then either, but we did it. You learned then that the only way to get to know what you’re doing is to do it. Screw it up. Learn from that. Then do it better.
CINDY M. HOWARD, DC, DABCI, DACBN, FIAMA, FICC, is a board certified chiropractic internist and nutritionist specializing in finding the root cause of symptoms and disease. She earned her doctorate in chiropractic from National University of Health Sciences and is in private practice in Orland Park, Ill., where she focuses on individualized care. For more information, visit innovativehwc.com.
