385- The Basics of Medical Integration with Dr. Mike Carberry of AMI

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. On today's episode, we have a special interview if you have been a doc considering, thinking about or have questions about medical integration. I headed across the bay here in Tampa Bay to sit down and chat face to face with Dr. Mike Carberry, founder of AMI. I asked him a variety of questions about medical integration. What does it mean? How can it benefit your practice? Who is it good for? And what chiropractors does it not make sense for? He answered all of them very graciously. His facilities, awesome. And without further ado, here's my interview with Dr. Mike Carberry. Mike, thanks for chatting with me today.

Thanks for having me, Jeff.

It is my pleasure. I want to kick it off with a question that I know has been a point of confusion for me, and I believe it's been a point of confusion for a majority of people listening and watching. And that starts with the basics. What is medical integration?

You know, when I first got into this game, it was called mddc, and I hated that name because it kept them separate. There's like, one's over here, one's over here. The definition of integration is bringing two parts together to make a whole or bringing two things together that were previously segregated. And that is the exact case with chiropractic and medical. So it's actually bringing the best of both worlds together. Sometimes people think that integration, if a chiropractor goes into integration, they're selling out their values or their integrity. And actually it's not true. They're bringing that value and integrity into the medical world and influencing the medical world to do less drugs and less surgery.

I absolutely love that. And that's been an area that I practiced in a couple different orthopedic groups. And I'm gonna say I saw it almost the other way for many years, but I love chiropractic. Leading the charge and being able to do it. What I'm gonna say is the right way. When we talk about integration, what are typically some of. I know it can vary, but what are some of the service offerings that are usually available in an integrated practice?

Well, it's interesting. You know, obviously one of them is chiropractic. I love chiropractic. It saved my life. I was injured when I Was and had a stinger, experienced temporary paralysis, which is a scary thing. And it wasn't. I went the medical route because my wife's family is very medically oriented, and I didn't get any traction. So I ended up going to a chiropractor, and it saved my life. So that is definitely one of the services that are there. But there's other services that I was looking for when I had my practice. And I was just a straight chiropractor. So we were doing 700 visits a week. And I had, you know, we were doing a lot of marketing, a lot of grassroots marketing, going, speaking, meeting people. So what happened was I started to notice that I was doing a lot of new patient treatments, active patients, we'll call them. And then my list of what we call maintenance patients started to grow. And the maintenance patients bugged me because they weren't actually maintenance patients. They weren't people who were healthy, trying to stay healthy. They were people coming to me and saying, hey, listen, doc, you treated me better than any other doctor. That condition that I had in my neck or my back went away better with you than anybody else, but it's coming back and just give me a quick adjustment so I don't have to go through another care plan. And that bothered me. So one of the things I did is I started doing research, and that brought us to another service, and that is rehab. So the research I did brought me to Vladimir Yonda. Upper cross, lower cross syndrome. Now, you know, I'm married to a physical therapist, and I thought, this is perfect. We could do a PTDC program. But what happened was the state of Pennsylvania said to my wife, if you work off a referral from your husband, you kiss your license goodbye. So a physical therapist at that time, and I think still to this day, is not allowed to work off the referral of a chiropractor in the state of Pennsylvania. So somebody said to me, why don't you bring a medical doctor? And I remember the words came out of my mouth over my. But I was wrong. I didn't realize how many medical doctors were fed up with the amount of prescribing that was going on and how many medical doctors were fed up with the amount of surgeries that were going on and how discombobulated the medical world actually is when it comes to treating a condition. They're really good at diagnosing, they're really good at covering up pain, but they're not so good at finding out what caused the problem. And a lot of doctors that Bothers them. And I did not expect that. When we first advertised for a medical doctor, I didn't want to do it. My wife said, let's just see what happens. We had hundreds apply for the job. Hundreds. We were doing group interviews with medical doctors. And I was floored by that because I remember one time I said to the whole group, why do you guys want to work with a chiropractor? And they were all very nervous looking at each other. And finally one of them said, because I'm tired of all the crap. And I'm like, what do you mean? And then another one chimed in and said, we're being rushed through the visit. We don't have time to spend with the patient. And they changed the codes on us to an EM code. So the fastest way out of the room is write a prescription. And I know it's wrong. And I looked at the other guys, and they're all kind of looking down and shaking their head like, yeah, he's right. That's the first I realized there was discontent in the medical world from the medical doctors, and that that was a game changer for me. When I saw that, I'm like, holy crap. This is all smoke and mirrors. And they need a leader to come in and show them this is the way to get somebody well. And that has been my experience for the last 30 some years. Medical doctors observing us getting people well and seeing the light and going like, oh, my gosh, we could actually get patients well. Oh, my gosh, we get to spend three times a week with these patients and get to know them. We're not rushing through the visit. So there was a lot that came out of that that I did not expect.

Yeah, that's powerful. There's something that I talk with docs about, and when they're building referral relationships, maybe if they're not integrated yet, and they're just building those relationships in their community. And I'm always like, medical doctors don't make bad decisions because they don't like their patients. It's because their systems are built up in so many of these ways.

You know, it's funny, when I started realizing this, I started asking doctors, why did you become a doctor? And I started hearing very passionate stories. I grew up with, blah, blah, blah. My sister had this. My cousin had this. I wanted to help people. And I'm like, that's a lot like chiropractors, you know? And so I realized these people are actually. Their intentions originally were good. The system was screwed up. So then I started doing Research into the system. And that's a whole nother controls. The system is not the doctors. They pretend they're the doctors. Like, for example, I'll just bring this out right now. People cringe sometimes when I say this stuff, but the AMA is not medical doctors. The AMA is. I saw a study back 10 years ago that 8% of medical doctors belong. Now I'm hearing 12%. But I also know that students are being given free enrollment, and so are retired doctors. I know that because my nephew just graduated from medical school. So they're trying to pretend they're doctors, but they're not. So if you trace the money back, it comes from the pharmaceutical industry, and they own the billing codes that we all use.

How convenient. That must have been on accident.

We're never going to change that from the outside. The only way we're going to change that is from the inside. Getting people. Well, seeing other people in medical going, this worked and we didn't hurt somebody, and we didn't have to write these prescriptions. We should do more of this. Which is usually the reaction we see, getting that to go, getting patients to go, you really want me to do the chiropractic? And the medical doctor saying, absolutely. Is so much more powerful than a chiropractor saying, oh, we're not going to hurt you. We're really good. We're scientific. And the medical doctor just has to look him in the eye and go, you need to do this. I'm telling you to do it. And they go, okay. Right?

I could not agree more. I love that. And I got a feeling there's a lot of people listening and watching that this is news to them. You know, they may have heard those terms integration in the past. They might have thought these things. I love the conversation for the docs listening and watching. Who is integration for? Like, how does a doc self identify and say, hey, this might be something that I should be taking a really good look into?

Well, originally we thought it was just for chiropractors, but what started happening, especially since COVID we are getting more and more reach from medical doctors fed up changing their career. I actually spoke with two OBGYNs in the last two months that were giving up their career and going into functional medicine because they can't do it anymore. They're tired of hurting people. And the problem they have is the system is set up that as long as they're playing the game inside the medical world, they get tons of new patients coming straight from the hospital. And now they're going, I Don't know how to get new patients. Can you help me with that? So we're helping them with that. I don't know how to sell cash services because everything was covered by insurance. Can you help me with that? So we're helping them with that because that's part of AMI Systems. Yep.

I love that. What are some interesting things that you'd say in your experience? You've worked with many, many practices, helped many, many practices integrate, be more successful, take care more people in their community. That makes a huge impact on pharmaceutical use, you know, advanced intervention. But what are maybe some of those practices that aren't great fits for an integrated model?

There are some of those. We're selective as to who we bring in. So we don't allow everybody to come in because we don't want to put somebody in a position where they're over their head financially. What we want to do, I mean, we need those chiropractors out there that are doing just chiropractic and we don't want to hurt those guys. But the guys who are willing to open their mind and then be willing to put systems in place and not be the main personality in the practice. See, one of the things with chiropractic is we're very personality driven, which means one, we can never go on vacation. Two, we never have an exit strategy because we are the practice. And that was something I struggled with. I had this huge practice. When I walked into the practice, the patients were like, there's the guy. My ego got real big. I had to turn sideways to fit my head through the door. But I had to give that up because I realized if I was going to do more to help their profession and and to help humanity by getting services like chiropractic to more people, it couldn't be based on me. It had to be other people doing it. And I had to come up with systems. So my wife and I, if you've ever heard of E Myth by Michael Gerber. So we did the E Myth Mastery program, which is a two year program. It was based with the University of Phoenix and it was their mba. We didn't do the MBA part. We just did the correspondence course back before Internet marketing. And it was two years of us writing systems for our practices so it could run without us being the person doing it. And the year I finished that, I opened up three practices in the state of Tennessee. All three were successful. I still own one of them. I've never lived in the state of Tennessee. We've helped chiropractors all over the country in 48 states take those systems, put them into their practice and be able to grow beyond their abilities because they have other people helping. So yes, who is this not for? It's the guy who wants to stay small and have that personality that there's nothing wrong with that we need those people. But if you want to grow bigger and help more people and not be buried by all the work, but having other people help do it, that's who this is for.

You mentioned systems and processes. I think this is so important because there are plenty of chiropractors that have. Well, I integrated air quotes here for anybody listening. You know, I had a massage therapist come in one time a week or I moonlighted a nurse practitioner once a month and that didn't quote, unquote, work out.

And.

And in my opinion, there's a big challenge of that probably has to deal with a lack of systems and processes. My understanding is that's one of the core components of what AMI helps with. When a docs work with you. Speak to the importance of. Let's dig a little bit deeper. Speak to the importance of systems and process, especially when growing a practice that maybe is a little bit different than what a chiropractor has been used to in their career.

Right. I guess I had a bit of an advantage because my undergrad degree was in marketing and I got hired right out of undergrad school by a company that was an affiliate of Dun and Bradstreet, very large marketing company. So I got to work in a very large Fortune 500 company and see how they ran. And I kind of always carried that in the back of my head like, well, if I'm going to be successful, eventually I'll have to get to that point. So what we had to do is create systems to do that. You're only limited by your ability to deliver. And some people have tremendous ability to deliver and can do amazing things, but the more they do, the more it kills them. And that's what happened to my father. He had a business like that, not in healthcare, but he was the main guy and he worked himself pretty much to death. So what this is designed to do is to help you get traction so that other people can pick up the ball and help run with it and sometimes run with it themselves for the company. In doing that, it changes the perception of chiropractic. So you gotta realize as a marketer, I would look at things differently and I would survey. When I opened those three clinics, I didn't live in that state. I went and surveyed and I asked questions. I had an outside company come in and survey the public. And I asked, how many do you go to a chiropractor? Nine out of 10 people? Nope. Why don't you go? Number one reason? Because they don't discharge. I was expecting, oh, they hurt you or they're dangerous. No, they don't discharge. Number one reason, every city we asked it in. Then we asked this question, what do you think of a medical doctor or nurse practitioner that works with a chiropractor? And the answer we got from the public was, well, what's wrong with them? Did they lose their license? Were they an alcoholic?

So fascinating.

Then I said to the surveyors, go out and ask this question tomorrow. What do you think of a chiropractor that works with medical practice? And the answer we got was, it must be a really good chiropractor. So I realized the viewpoint that the public would be willing to accept is a medical practice that has a chiropractor and that is much more accepted in my clinics right now. The number one objection to care we get is, well, do I have to do the chiropractic? And the medical people go, yes, you do. That's why we're recommending it. And they go, okay, it's not fair, but that is the condition that it's in. So there's people that argue, well, more than 10% of the population see a chiropractor. Well, I'd say more than 10% went to a chiropractor at least once, but not all of them stayed. And the going rate is 10% or less right now. Less studies I've heard, yeah, I'm 100%.

In the same boat as far as those stats are concerned. On the topic of integration, we bring medical into a practice and have chiropractic as a core component of it. What are some of the top benefits? And I'll split this down for the chiropractic business owner who's looking to become more entrepreneurial, who's looking to build more of a legacy, who's looking to maybe diminish that personality driven component. What are some top benefits for the doc, for the Cairo? And then on the other side of that coin I'll have you dive into. Some of these are going to be obvious on the second half of this, but what are some of the top benefits from a patient perspective?

Okay, so from the chiropractic perspective, I'm going to touch on some of the research I've done. So I looked into different doctors to model this after. And they were medical doctors, most of them. Renee Callier, Vladimir Yonda, Janet Travell. So they're three of the main ones, but Calier was the first one who came up with the idea of forward head carriage. And Yonda followed that up. And he said, when somebody's head goes forward, if you injure your low back, you're going to shift your head forward unconsciously to offload the facet. And people don't even know they do this. And the pain will ease because you do that. So what happens is, over time, you start to develop this pattern of having your head forward. And Yonda said to do that, you have to start using your muscles differently. You have to use muscles of motion to do the job of a muscle of posture. And he called it upper cross and lower cross syndrome. What happens is scar tissue sets in. Now, chiropractors know this when it comes to the disc, but my wife as a physical therapist knows this. For every joint in the body, lack of movement equals scar tissue. Scar tissue equals more lack of movement. Lack of movement means degeneration, dehydration, arthritis. So what happens is they go through this pattern of shifting the head forward, altering the muscles, degenerating silently. And one day they go to tie their shoe and they can't stand up anymore. And most chiropractors say, yeah, that's what I hear all the time. So what we're doing is having different ways to break up scar tissue. The medical world likes to use cortisone to melt scar tissue, but there's a problem with that. Cortisone melts all tissue. So if you look at Janet Travell's work, she is the medical doctor who treated John F. Kennedy and the mother of trigger point injections. She was using very benign substances like saline solution or lidocaine, which is 99% saline solution, to break adhesions mechanically, not chemically, so they weren't doing damage. And it's a very effective, very viable, very pleasant experience for the patient. So when you put that together, you're not only breaking scar tissue in muscles and tendons, you're also breaking it in the capsules of the joints. So the chiropractor can break those with a very gentle adjustment or a series of them. And the same can happen in the other connecting tissue through the injections of trigger points, joint injections, and so forth with very benign substances, things that do not hurt people. Drugs have been on the market for a long time, like Tramiel, which is a homeopathic remedy from Germany that's over 100 years old with virtually no side effects. There's an injectable version of that. Or Serapin, which is an old biological remedy from the pitcher plant with no side effects. Been on the market for decades, like eight decades or nine decades. So when you use these things, I've had medical doctors come to me and say, these are the best things I've ever used, and nobody gets hurt by it. Then you bring in regenerative medicine, and now there's a right way and wrong way to do it, and there's a right way and wrong way to promote it. But if you do it the right way, the effects on the patient are unbelievable. We had an open house in our clinic in Chattanooga last week, and we had invited old patients who hadn't been in a long time to come in and have some food and get a free trigger point massage and a free adjustment. And there was people that came in that told us that they were scheduled for a knee replacement in 2015 and 2016 and went through our program, and here it is, 20, 23, seven years later. They never got the knee replacement, and their knee is better than it's been for the last 25 years.

Love that.

So the benefits to the patient is unbelievable. The benefit to the doctor, one, there's a good portion of it that's cash, probably 40% or more, which means they're not dealing so much with insurance companies, but they're getting more patients. They're getting patients that would not typically go to a chiropractor to get chiropractic. And when they get finished a program, they're actually going, you know, I realized chiropractic was a big part of this. I'm so glad I did this. I'm going to refer all my friends here because they have it all together.

Absolutely love that. On the other side of that coin, as people are listening, I got a feeling there's a lot of people listening and watching and saying, this sounds like it's super interesting and that they'd love to learn more about. So that we're gonna encourage everybody at the end to connect with your team, but so that they're super prepared. What are some of the biggest challenges when somebody goes about the beginning process of integrating a practice? What are some of those common challenges that you see that everybody should be aware of and in tune with?

Well, we're not really taught in school how to be a business person. I even had a business degree, and I wasn't prepared to run a business, although I did Very well. It became a very personality driven business and I had to readjust my thinking to realize one, I have to bring other people into the fold. Two, I have to provide them with the environment and the training to be able to think on their feet, to make decisions for the company. You know, Bill Gates and Jeff Bezos, they could not make every decision for those companies. It would have killed them if they did. They had to be able to set up a hierarchy so that other people could make decisions for those companies to grow. And that's what we need to do. We need to be able to be willing to learn about business concepts and learn about management and about HR and about dealing with people, which is a sticky, hairy subject. Some people say I'd rather not deal with it. A friend of mine had a business in Massachusetts, he was a printer and he said, you know, management would be easy if it wasn't for the people. But that is what we got to deal with. So I mean, instead of shying away from that, there's an opportunity there. If you embrace it and you learn how to do it right and you inspire other people and they benefit from your growth as well. You can't just keep all the money yourself. You have to spread the wealth, which is what we try to do here. And when you do that, you get people that are willing to go so far above and beyond what you ever dreamed of. That's how you're going to grow. That's the biggest challenge.

Yeah, that makes a lot of sense to me. I can say as somebody who's practiced in a few different orthopedic groups, many, you know, in the community here and all the listeners have heard me talk about this before. One of the biggest challenges that I had is they were medical orthopedic groups with medical decision making that I happen to practice in. And I find that there's a lot of young docs who are very interested in being in a multidisciplinary practice, but probably don't have really great knowledge or exposure at what that means. Long winded way of getting towards. I love hearing about the integrative model that has a chiropractor leading the charge because that really makes a big difference in how clinical care gets broken down.

Now you do have to realize that as a chiropractor, our license is not as broad as a medical license that includes mid levels like nurse practitioners and PAs. So we have to be willing to step back clinically and not give up the reins. You know, the way we modeled our company and our clients is like a CEO of a hospital. A good friend of mine, he's the CEO of a hospital chain in Chicago. And basically, he is not allowed to make clinical decisions, but he can set the venue. He can tell those doctors, we're not going to do this procedure in this hospital. That surgery will not be done in this hospital. These are the things we do in the hospital. We are allowed to do that. But when it comes time to diagnose and treat, that's up to the clinicians. So what we do is provide the training for them to understand. Like when I've taught a lot of medical doctors and nurse practitioners how to diagnose upper cross and lower cross syndrome, and I've never had one of them say, this is stupid. Everyone's like, this is brilliant. I've never learned anything like this before. This is awesome. I'm like, well, medical doctor came up with it. So when they understand that, they realize I don't have to rely on the drug. Nine out of 10, well, eight out of 10 of them will go, I'd rather not use the drug. And of the 2 out of 10, we just say to them, you know, this isn't a perfect fit. You should move on. It makes me remind. It reminds me of a story I just encountered. This. We had a guy reach out to us, a medical doctor, a surgeon recently, and wanted to join ami, and he was ready to sign without knowing anything about us. I want to join ami. Why do you want to join ami? Because you guys do those injections to help avoid knee surgery. I'm like, yeah, so I want to join ami. Are you a knee surgeon? That's what I do. So you want to do injections to avoid knee surgery? Oh, no, I just want to advertise it. I'll talk them into surgery. So you guys are hurting my business so much that nobody's coming in for knee surgery. They're going for these injections. I'm like, this isn't going to work. I don't think we should work together. And he said, okay, that's a true story.

That is. That is fair and honest. In his own way. Yeah, Mike, I really. I know we're up against time. I really appreciate you having me. If you are somebody listening, I'm going to encourage you to head over and watch this on YouTube, this interview, because you're so gracious to have me over to your absolutely awesome facility. The other thing, I'm gonna encourage everybody listening and watching. If integration has been something you are interested in, if it's something you want to learn more about or if it is something that you are ready to take that next step on. Right now connect with Ami. They have an awesome team over here. We're gonna drop the links down in the show notes. That's the easiest point to be able to connect with Mike and his team and get a great understanding of what the next steps are for you to be able to ultimately build the practice of your dreams. Mike thanks so much for taking time out of your busy day.

Jeff, anytime you want me back I'd be glad to have you here or go over to your place. No problem. I'd love to do it again and it's good to see you.

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