302- What Primary Care Docs Think About Chiropractic

Welcome to the Evidence Based Chiropractor where each week we deliver the latest chiropractic research and marketing strategies all in the time it takes to get to your office. Now here's your host, Dr. Jeff Langmaid.

Hello and welcome to the Evidence Based Chiropractor. I am your host, Dr. Jeff Langmaid. And on today's episode we're back at it with the research. A brand new study from BMC Family Practice and this is a good one. They did an update on the cross sectional survey of family physicians attitudes towards chiropractic. So if you have been interested in building relationships, referral relationships with other healthcare providers in your community or if you're just interested, hey, what's kind of the pulse check of what primary care physicians think about chiropractic? This is an episode you're going to want to pay attention to. A ton of great stats and a bunch of actionable information for sure. Before we get started, I want to say a few words about novopulse. It is where recovery meets performance. You can learn more about this tech that reduces pain and inflammation while improving function that helps get your patients back to the activities they enjoy@novo-pulse.com again, that's novo-pulse.com I will drop that link down in the show. Notes. This is a really cool piece of tech. There is nothing else like it on the market. I'm going to encourage you to, to head on over, check it out. But as I said at the top of today's episode, we're talking all about the research and this is attitudes towards chiropractic. A repeated cross sectional survey of Canadian family physicians. And this just came out. 2021 BMC Family Practice. Let's dive in. If you are new in the profession or maybe you're a younger doc out there, you might not be aware of really the challenges that the Canadian Medical association and the American Medical association have faced placed within the path of chiropractic over the years. For instance, in 1972 the Canadian Medical association reaffirmed its policy that physicians may not make referrals to chiropractors or acquire X rays on the behalf of Chiropractors. In 1983, it was only, it was just in 1983 that the American Medical association held that it was unethical for medical doctors to associate with chiropractors. So this is not stuff that was in the 1920s. I mean this is, you know, during my lifetime that this has been a real issue and the downstream effects of that continue to play out and Although we know family physicians are much more accepting of chiropractic, the relationships still remain suboptimal, Right? They are not perfect. And this is something I'm gonna say a couple times on today's episode. But when we look at the stats involved in this study and understanding the marketplace, we see guidelines that recommend chiropractic. We see the fact that, you know, so many people are in chronic pain, have back pain, have headaches, have nec. I'm taking even out the performance aspects of things and we're so underutilized. It's super clear that the relationships still aren't there. Obviously that's part of what we do at the evidence based chiropractor is give you the tools and resources. That's what our membership's all about, give you the exact tools and playbook to build those relationships. But it doesn't happen automatically. You need the tools, you need the process. Right? So they had, in this study, they basically had four hypotheses. You know, one was that older physicians would hold more negative attitudes. Two is that more positive attitudes would be with the doctors that saw more musculoskeletal complaints in practice. Three was that physicians endorsing patient feedback, a relationship with a specific chiropractor, personal experience, would trend to have favorable relationships. And also that physicians endorsing the scientific literature would hold potentially more negative attitudes, which is really interesting and dichotomous in many ways, but we'll dive into that in a moment. So the mean age of the respondents here was about 50 years old and it was 56% male. So they sent out all these surveys to primary care physicians, family physicians, and they said, what's going on? And they had a whole bunch of questions. So most physicians, you know, attended to patient populations of which more than 30% presented with musculoskeletal complaints. This is something we've talked about previously with the evidence based chiropractor. And I think many times, you know, we under appreciate the fact that over 30% of most primary care internal medicine, family physician, daily visits, weekly visits, monthly visits are musculoskeletally related. That's a lot of people that they're seeing. This is when we talk about who has your patients in their practice, primary care physicians seeing 30, 40 patients a day. They are seeing, you know, eight to 10 to 15 to maybe even 20 musculoskeletal cases each day. You think they could be referred in your practice? I think so. So with this study they found that 40% had sought chiropractic care for themselves. That's high. And that's interesting certainly to me. In most 51% described themselves as a little knowledgeable, which is an interesting way to put it. So over half of them were like, I don't know much about chiropractic. And that's an important takeaway. Over half of them self admittedly said I don't know that much about chiropractic. It's probably more than that because you know and I know that probably they didn't want to people that thought, you know, overestimating how much they kn. I don't want to say I don't know anything about that. I'll put I know some. Right. So that's probably even more than 51%. 15% of physicians felt that chiropractic care should be available in a multidisciplinary setting. And 25% felt that chiropractic should be available in hospitals. So you could look at that two ways and say, oh wow, 15% thought this should be available in a multidisciplinary setting, 25% in hospitals. That's good. I'm gonna say that's pathetic. When we look at the research, when you see that chiropractic has been around 100 years, when we know that the guidelines support what we do for the fact that only 15% even think it should be available in a multidisciplinary setting and 25 in a hospital, wow, that tells all there needs to be said. In terms of their guideline discordant. They have no idea what's going on and quite frankly their tools stink. I bet you if you ask them should primary care be available, the answer would be yes. 81% wanted consultation notes from chiropractors. So this is an important part. When we talk about the three pillars of relationship building within the evidence based chiropractor, we talk about case notes, research and meetings. So overwhelming majority wanted those case notes. Getting them out, simply getting there easily and having the right thing on them is what we dive into with evidence based chiropractor. We'll talk about that on a different day. But bottom line is get out those case notes. 48% of families positions endorsed a positive impression, 27% were unsure and a quarter 25% held negative views. So less than half, 48% had a positive impression. More than half either were unsure or had a negative viewpoint. Think there's an opportunity to teach and invite there. I certainly think so many here's this is wild to me. 47% felt that chiropractic Manipulation of the neck was unsafe. This coming from, you know, individuals. And I'm not trying to pile on family physicians or make this negative. I'm trying to actually just look at the stats and data with a rudimentary understanding. When we look at the fact that they're writing scripts, and we've talked about this on previous episodes for opioids, a third of the time somebody comes in with a musculoskeletal complaint, when we see the fact that they are referring to specialists too quickly. Quite often for advanced interventions, you want to talk about unsafe, it is wild and crazy. However, this is impactful information. When you're going in and building those relationships, you need to understand where the other party is at, regardless of whether we agree or disagree. You know, the good news about this is, wow, talk about an opportunity to get in there and build relationships. It's not like they're saying 99% love chiropractic. 99% refer to chiropractic. As I've said in the past, at that point, you need to either be way better than your neighbor or way cheaper. If they were already sending a ton of people and referring a ton of people and loved it, right. You need to be better or cheaper. Right now, thankfully, you don't have to be 10 times better than the chiropractor down the street. And you also don't need to be cheaper. You can be a good chiropractor and have fair rates when you get out there and educate. Because clearly they dramatically have a misunderstanding of who we are and what we do. And not surprisingly, they have an incredible bias towards what they do. You know, the fact that almost half believe adjusting the neck is unsafe when with what they do every day themselves is laughable in many ways. But it's important to understand. So they did find that negative attitudes towards chiropractic care were associated with an older age. The belief that adverse events are common obviously participated in a negative attitude in a reported use of the research literature as a source of knowledge on chiropractic paradoxically resulted in a more negative view. And this is a quote from the study. Paradoxically, support from the scientific literature was a common reason given for referring patients for chiropractic care, while reliance on research literature for information on chiropractic care was associated with more negative attitudes. This is like that gif of the mind being blown right now. The research and literature overwhelmingly supports what we do. And we've seen previous studies with chiropractic care for neck and low back pain outperforming NSAIDs, beating placebo being equivalent long term to the results given through microdiscectomies, et cetera, for sciatica and for aminal compression resulting in foraminal stenosis and sciatica complaints. This is wild and crazy. So at the same time they're saying support from the literature. They're saying on one hand, hey, I'm seeing positive literature about this. That's why I make referrals. That's what some of the respondents were saying. While the other side are saying, well, the reason I don't refer is because of what I've read in the literature is wild and crazy. Again, I don't say this to dog and pile onto the family physicians. I say this from an understanding of this sort of research is super important. Understanding the current attitudes of primary care physicians and urgent care physicians give you an opportunity to make informed, relationship building decisions. You get to go in there and have positive communication because now you can take away from this and say, okay, I know that they think adjusting the neck, many of them believe adjusting the neck is unsafe. Okay, so how do I proactively address that in my conversations? I know that if they're not currently referring, they might think the literature doesn't support what we do. If they've referred in the past, they think the literature does support what we do. So let me get a feel for if and how they've worked with a chiropractor in the past because now I'm able to position things appropriately. This is all very, very important. It's built into what we do at again at the evidence based chiropractor. But it's important if you're going to get out there and do this yourself, which you can do, you know, to understand where these individuals are coming from. And to me, one of the most important things is that over 30%, you know, of their case volumes are musculoskeletal related. So as we talk about, there's only three things that a primary care physician is doing. They're either prescribing, you know, writing a script, they are referring to a, you know, orthopedist or neurologist, et cetera, you know, or they're referring to pt. So understanding if they're, what are they currently doing? Are they scripting and starting with medications as a first line, are they referring to PT as a first line or are they upstreaming to an orthopedist or neurologist as a first line? Asking those questions and understanding that can really help you expedite the process of Building a relationship. Because now you get to position yourself as a value add based upon what they're doing. Not just a let me tell you everything you never wanted to know about chiropractic. And understanding that is so, so critically important. And that's why in my opinion, I also understanding the research is so important. Additionally, when we see so few of these individuals, these primary care physicians, you know, thinking or believing that chiropractic has a place in multidisciplinary settings or in hospital settings, that might be, I don't think this is a lead story, but I believe that as you're building that relationship, letting them know how many chiropractors are in those settings or how many chiropractors, you know, really, you know how many healthcare institutions have adopted chiropractic within their conservative care landscape, it's quite clear that they really don't know what's going on. And informing them, educating them in a positive way, of course you want to go about this. You're trying to build the relationship, not deteriorate a non existing relationship. So doing it in the proper way in really ensuring that you get the case notes out as well to keep them informed. I view case notes by the way as B2B testimonials. Business to business testimonials. So many docs out there, Google reviews, they want all these things. Hey, I hear you. Getting out there and showcasing the result of what you do is a great thing to do, but man, that's only half the coin. If you're doing based on Google reviews, Facebook reviews, Those are all B2C right? You're hoping other future potential patients see those reviews. Great idea. But don't Forget about the doctors. 90%, 80%, 99%. Some overwhelming percentage of the individuals that you've taken care of in your practice have a primary care physician. So being able to showcase the good results that you get with them, that you're actively co managing, whether that patient was referred to you by them or not is gonna open highs over time. It's like the faucet, drip, drip, drip. You have to get out there and do that. Which is why it's one of the three pillars, right? Case notes, research and meetings, they all have their place, they all do something different in the relationship building process and they're all equally important to helping you get across the finish line. Before you have a hundred referrals, you gotta get that first referral. So I'm going to say that this paper is while at times can be cringe worthy, a lot of the stats we reviewed, it's like, you know, smack my head. However, it's also a great opportunity to say, man, if I get out there, do a little bit of work, I'm going to really start to see some results in my practice. I got an email from a doc earlier this week who is new at the Evidence based Chiropractor who said, I haven't been implementing things of what you've given me very well, but I've already had a few phone calls and a couple referrals come in. And I can tell you the ROI on that is wild because once you build a relationship, relationships last a lifetime. It's not like an advertisement that goes away as soon as you stop paying. Once you build a relationship, those sort of things can last a career. It can last a lifetime. It can be super, super positive for your practice and the people in your community. One other thing I'll say about this is I said, you know, hey, 80, 90% of your patients probably have primary care physicians. You might think to yourself, hey, I know some of my people that they don't see anybody consistently. That's okay. Talk about a great opportunity to send them to somebody. You'd go to yourself, don't let them. These are your patients that know trust and like you. Don't let them go out there and visit one of these, you know, bobos that, you know, just don't understand who we are, what we do. And all of a sudden the patient doesn't come back in to see you because they saw somebody else one time who says, don't go back and see that chiropractor so you can play a little bit of offense and defense. As you understand the landscape of what's going on out there, it's important to stay in tune with this. The first study of this, I think was done 10 years ago. This is an UPD fantastic study. Hopefully you got some takeaways. Thank you so much for tuning in. If you haven't left us a rating or review on itunes, please scroll on down and do so. That helps more and more people find out about this podcast and additionally, I'm going to encourage you to check out Echiro EHR I've talked about a few times on the podcast here. It is built on documentation and compliance. So every EHR you know, sells features, but few have Echiro's expertise. They can help you create a better lifestyle and improve your practice health. That's easier. Echiro ehr e chiro ehr. I'll drop that link down below, but Scott Munsterman over there has done a fantastic job building a super super compliant and documentation based ehr. So if those words pique your interest, I'm going to encourage you to head on over and check it out. Otherwise, have a fantastic week in practice and I will talk to you soon.

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