#55 - Medical Collaboration for the Private Practice DC with Dr. Alex Frantzis, Part 1

FAKTR, spelled F-A-K-T-R, stands for Functional and Kinetic Treatment with Rehabilitation. Over the past decade, this unique approach to treating pain and dysfunction has been utilized by healthcare providers on 6 continents. Serving as a framework that guides clinical decision-making in patient visits around the globe on a daily basis. With this podcast, our goal is simple: to bring the best and brightest in clinical education to the forefront and empower practitioners with cutting-edge, evidence-based content that improves patient outcomes and inspires healthcare providers to continually evolve their approach to treatment. In each episode, we will feature a training or interview with some of the top minds in healthcare in a short format that is easy to consume. to digest with actionable information that you can implement into practice right away. Let's get started. Hi everyone, welcome to The Factor Podcast. I'm your host, Jessica Riddle. If this is your first time tuning in, welcome and thanks for listening. If you're in private practice, as many of our listeners are, then you've probably struggled at one point or another with self-doubt. Or even been held back by limiting beliefs or maybe even seemingly insurmountable obstacles that keep you from clearly defining your big, hairy, scary, audacious vision for your business. And when you convince yourself that these obstacles are indeed insurmountable, it's easy to give up on your big vision to instead focus on the low-hanging fruit and lower your goalposts a little bit. I've been there, and I've even been talking a lot about this on LinkedIn lately. About how recently I've been smacked in the face with a big, hairy, scary vision for Factor that I now have no choice but to chase down relentlessly until I make it a reality. So at this point, you're probably asking yourself what any of this has to do with medical collaboration. Well, for those of you in the private practice space, expanding your opportunities to collaborate with local medical providers can be a great strategy for expanding your practice and taking your business to the next level. Creating both a referral source for new patients and a network of colleagues that you can trust to provide your patients the best care possible. Thus expanding your influence and the positive impact on your community. And who better to talk about this than Dr. Alex Francis, a board-certified chiropractic orthopedist who owns several integrated health centers throughout Northeast Ohio. A 2008 graduate of Logan University, Dr. Francis began his first multidisciplinary clinic Soon after graduation, growing to 3 locations and employing a team of providers including a board-certified orthopedic surgeon, general practice medical doctor, physician's assistants, physical therapists, and massage therapists. In 2013, he became staff privileged with a local hospital in Cleveland and has operated an established office in the hospital since 2017, working with specialty teams such as primary care, general surgery, vascular surgery, and podiatry. Most recently, Dr. Francis has expanded to integrate with an urgent care facility, offering chiropractic care as part of their model, managing neuromusculoskeletal conditions alongside various other healthcare specialists. In today's episode, we will discuss the medical model and how medical referrals work, discuss best practices in approaching medical providers for opportunities to collaborate and co-manage cases, And the importance of addressing mental health care as a component of chronic pain and pain management. This 2-part training will provide you actionable steps that you can take to begin establishing relationships with medical providers in your area, along with some guidelines and best practices for overcoming misconceptions about what you really do and establishing yourself as a trusted provider on your patient's healthcare team. Let's cue the intro music and get started.

Thank you very much, Jessica. So everybody that's here, thank you. Everybody that's watching the recording when this comes out, I appreciate you guys taking the time to give me an hour of your time to kind of talk about my specialty and what I do very well. So one of the things that I'm, I'm involved in is I'm a DC, went to Logan. I'm a Logan grad. So one of the things that I've managed in private practice, I graduated in 2008, kind of talk a little about My history, I graduated from Logan in 2008. Since that time, I was an associate initially. I moved into private practice kind of on my own with my partner. But since day one, I've always been in an integrated setting. I started off in my private practice with the usual standard massage therapy, physical therapy, all that. That kind of blossomed into a fully integrated practice with an M— we had a— at any given time, we had pain management specialists, an MD, I've had physician's assistants, I've had orthopedic surgeons in my office and built a model based on that. Moving from that in my private practice, I ended up going into a hospital setting. I was asked back in 2013, I think initially, to be staff privileged with a local hospital here in Cleveland, Ohio. And since that time, I have expanded beyond private practice. I do have 3 private practices that I have associates in. I've expanded into a hospital setting. And actually today, last few months, I've been seeing patients in urgent care. I'm actually at the urgent care today. seeing patients, and I've been doing this for a couple months. So I've always been outside of— since graduating, I've always been in some kind of integrated setting. I've always had a network of medical professionals that I've worked with. So I really wanted to take some time to kind of help. Done this talk with students before, so students, sure, but even some of the more seasoned chiros and providers out there on how to collaborate in a medical setting, eventually leading to maybe an integrated practice, private practice. I also run a group on Facebook about hospital-based chiropractic. There's some of us out there, but trying to help build the medical community for patient base and understanding how to work with other providers. So this first slide is about my biography. I'm originally from Toronto, got my bachelor's degree, went to Logan. I do acupuncture, certified NUA, and I'm also what used to be known as an orthopedic diplomat, but now is known as the International Academy of Neuromuscular Medicine. So that's kind of what my background is. Like Jessica says, I Been in an integrated setting since basically day one of private practice. I've always had some kind of other professional either in office or part of my network, and then that grew into the hospital that I'm in now. That grew into the urgent care where we have variety of specialties. So hopefully you guys can get some information here on what I've been able to do successfully, where very few of us have failed or can't figure out how to get our foot in the door. So everything that we're discussing here is stuff I've done in private practice at one time or another. A lot of this stuff is early on what I did in practice that helped build. My network. And so the preface I want to say before we start all this is I understand the reservations. I understand the, some of us went to different chiro schools where we were taught medical model's bad or the big, big bad MD who's going to give drugs and perform surgery unnecessarily. This is why we're different. And unfortunately, what we learned in chiro school is we actually never learned how to play nice with other providers. So I've spent the last 13, 14 years kind of figuring it out. And I found a system that worked for me. It's not hard. It doesn't have to be hard. But building that network really benefits you as a practitioner. But more importantly, it benefits your patient base. It benefits your everyday Miss Smith that comes in with a little back pain that needs something beyond what we can do. And it really helps build a network of patients that are reliant on you, that love you, that see you for everything, but understand that you have their best interests at heart. So today's presentation is What worked for me and stuff I've seen has been the easiest with my personality. I know there's other providers that offer advice on how to integrate. There is no right answer. It's right, what's right for you and your personality. So moving into that, like I said, there's many different approaches to do this. There's no right, there's no right answer. There's no wrong answer. But the important thing is it doesn't have to be hard. It doesn't have to be uncomfortable. It doesn't have to be challenging. Once you understand the providers you're working with, once you understand where they're coming from and their mentality, this is actually a very simple procedure. So, like I said, many different approaches. Each one can be effective getting your foot in the door, but find what works for your personality. Find what works for you. Could be bringing them lunch, could be just stopping by saying hi. And I'll get into a few stories of what's kind of guided me. And it's funny because before this presentation, actually one of my patients here at the urgent care, she's a primary care MD I've known for a couple of years now. She's seeing me for a shoulder issue. And I asked her, I'm like, hey, I'm doing this webinar today as a medical professional. What's the one thing that you want to see when you're working with not just chiros, but other providers? And she mentioned communication. Just talk to me. If I'm sending you a patient, communicate with me. Let me know what's going on. And that's really what I base a lot of my approach to is communication with other providers. Communicating with your patients is obviously important. But communicating with the providers, it can be, it could seem like a daunting task for many, but it's really not. We learn a lot about how to keep people and get our foot in the door. But the bigger thing is, is keeping that referral, the referral network going and keeping those referrals coming. I've heard countless stories from professionals, from chiros that refer to a specific provider. They're doing great for a couple of months and then that turns to, it disappears. So another approach is not just getting your foot in the door and starting the referral process, but building it and building that trust and building that referral network to a longstanding relationship. We, a lot of us fail at that. So understanding that we want to also not just worry about getting patients in the door and getting referrals into our system. We also want to make sure that we keep that and we build that relationship. It's, we got to nurture it. It's like, it's like planting a garden. You want to really build that. So the headaches a lot of people have is we have no idea what to do. In my slides, I make little, I put little things like funny little comments, but Realistically, with our profession, we have such a wide array of how we practice. I like to say, I don't know what the chiro down the street is doing, let alone what an MD is going to think I'm doing, or a nurse practitioner, or whatever the case is. Like, you have to learn how to educate. And unfortunately, there's— people have their set beliefs. People have their, oh, he's a chiro, he's a quack, or he does this, or he does that. There are some hurdles you have to overcome. But you also have to understand where these providers are coming from. And, and what I mean by providers, I mean MDs, DOs, nurse practitioners, PAs, PTs, dentists, podiatry, all that kind of blending together. And people may have their preconceived notions of what you do. You try to educate, you try to teach them what you're doing. And there's, there's different ways of doing it, but you really have to understand where your audience is coming from, where these people are coming from and these providers are coming from. So before you can get into really building your network and understanding where they're coming from, you also have to understand what you want out of this. You know, what kind of network do you want? Do you want a big network or a small network? And I'm a firm believer in, unfortunately, having referred to and worked with a lot of different providers with a lot of different specialties, you have to also understand who you refer to is also a reflection on you as a provider. If I'm sending to Dr. Smith and he's, he's a hotshot orthopedic surgeon who doesn't spend time with his patients, he's kind of arrogant. That does reflect on you. You have to also understand if you're gonna build your network, you wanna make sure it's providers that are similar to you, that you can relate to. And how, again, how big your network wants to be. I have a relatively small network of providers that I've worked with or I rely on on a regular basis. Some people wanna do a large network. That's not necessarily conducive to the way I practice. And for most chiros, it's not. So in my network, I have my set go-to. I have a podiatric surgeon that I work with that works with me. We're trained in feet. I just don't do feet. It's just for personal reasons. I just don't do feet. I also have an orthopedic surgeon who does spine and extremities. He's kind of my go-to ortho guy when what I'm doing is not working and what he's doing is not working. We can kind of bounce patients back and forth. I have a family practice. I have a couple of PAs that I work with that are fantastic, general practice, internal med. I got a couple of MDs that I work with that are internal med that can co-manage some stuff with me. I also have a cardiologist that I work with. Cardiologist I work with is fantastic. He's my heart guy. If there's an issue or there's a cardiac issue that I'm obviously uncomfortable dealing with, I have somebody I can work with. And we'll get into late— in later slides, kind of understanding when to implement different providers and specialties and all that. The one thing I, I always tell everyone who asks me these questions is don't be intimidated. These providers are no better than you are as a chiro. Getting over that hurdle of the big bad MD—they're scary, they're they're intimidating—they're not. There there's a few arrogant ones out there, but for the most part, don't be afraid of these providers. There's no reason to be. I call it inferiority complex. There's no reason to feel inferior. Like I see my physician assistants I work with. I see my orthopedic surgeon. I see the cardiologist. They're all my equals, and having that mindset of equality really does make a difference when you approach these people. Don't be afraid. A lot of the fear though is based on rejection. We get afraid of being rejected or we get— this is a whole— as a person, we don't want to necessarily put ourselves out there to be rejected. You're going to get rejected. You're going to approach providers that don't want to work with you. They're going to have the preconceived chiro's are quacks. I see it every day in the hospital and I move on. Don't dwell on those who reject you. It's not worth the time or the effort. Concentrate on nurturing relationships with other providers that are open to what you do. If you waste your time on, on trying to convince the primary care who thinks you're a quack that you're not a quack, it's gonna just destroy you. It's not worth the effort. It's not worth it. You work with people who want to work with you, are open to you, and understand that those are the people you want to nurture those relationships with. You want to build those relationships. And the people that don't want to work with you, that don't want to— who think whatever they think, it's not worth your time and effort. So you really want to concentrate on that small network. of providers that complement you, who reflect well on you. And you want to do it in a very understanding way. You might get rejected. You might— they might tell you, no, you're a chiro, I have no need for you. Like, all right, cool, move on to the next one. There's thousands of medical providers out there, and you might get rejected by some of them, but there is those few that will work with you and will promote you and will work well with you and give your patients the care that they need that you can't give them because outside your scope, it's outside your specialty. That you can really grow your practice. You can grow your patient care with very few other providers that you don't need. So understand, don't dwell on the rejection. Don't dwell on any of that. So one of the things I tell people is you need to understand what they're thinking. Okay? So you have to understand medical professionals, they have the same concerns we do. They have the same worries we do. When you're in private practice, my concern in private practice was always the same is where am I going to get my patients from? Are my patients going to like me and follow along with treatment plans? Am I going to be able to get them better? And are they going to be those kinds of patients that I can build on? It's not treating patients for years upon years, but patients know if they have— if their low back flares up, they know they can come and see me and they know I'm going to get them better. I'm going to send them on their way, but I know I have that revolving door patient base that are loyal to me that will come back for their aches and their pains. MDs have the same concerns. They worry about their patients. They worry about understanding, keeping their patients coming. They worry about, if I refer a patient to Dr. Smith, a cardiologist, is that patient going to come back to me? Or is he going to steal that, steal my patient? That's a concern that we have as providers. Like, if I send to primary care, is that primary care going to tell them, don't send to the, to the chiro, he's a voodoo doctor?

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They have those same concerns that we do in private practice, especially. We all are trying to do the same thing. We may have different approaches to what we're doing, but they have the same concerns. It's funny because I did a Zoom call a couple of months ago, and some of you may have seen it, some of you may not, with Dr. David Purse. He's a general surgeon. He's been practicing for years upon years, and he's now a friend of mine. We work well together. He used to be the president of the hospital I'm at. He used to be president of a Cleveland Clinic hospital, which is one of the largest healthcare systems in the country and in the world. And Dr. Purse and I went on this webinar and we had this conversation. And he's a general surgeon. And he goes, you know, my biggest concern is if I see Ms. Smith for a colonoscopy or for a GI issue, is she going to come back to me? Later on in life, like the you would think a surgeon who has referrals coming out, they worry about that one patient that they see, they build a relationship with. Are they going to come back to us? So so those concerns go back and forth across all specialties. When you do finally get meeting with these providers and you start getting your foot in the door, you're always going to get the same questions. It might be a different variety of questions asked differently, but you're always going to get these same kind of questions. One of the questions we have, one of those hills we have to kind of battle, is the concern of what you're doing is evidence-based. Okay, so we'll get more into. Evidence-based, and I know looking at the chat previously, I know we have some life people, and I know Sherman and Logan and National, and we all have different kind of same education but different philosophies. So the one thing they want to know is evidence-based. Is what you're doing evidence-based? Is there what some efficacy to what you're doing? Is there some logic or research to what you're doing is actually evidence-based? The other the other factor they really care about is communication, and and I told a story about my primary care, my primary provider that I saw today as a patient for a shoulder issue. When I asked the question, what advice would you give other practitioners? She's like, the 3 C's: communication, communication, communication. If I'm sending you a patient, don't just send me results of a test. I want you to call me or send me a letter and tell me what's going on. I want to be in the loop. I want to know what my patient's doing so when I follow up with them, I can ask them, hey, how's your low back pain? How's your knee or shoulder? Communication is key. And before talking to her, I thought that's what all providers do because that's what I see. And she goes, there's a lot of newer MDs and DOs and all that stuff that they don't They don't communicate. I want to see communication. I want to know what's going on with my patient. If I refer you a patient, I want to know what you're doing, but I want to know what I can do to help you and help facilitate that. And it's wonderful because when I see my patients, like my patients, and I'm co-managing with somebody, it's nice to have the MD, the PA, the nurse practitioner, the whoever be like, hey, have you been following up with your therapy with Dr. Francis? Have you been seeing Dr. Francis like you told? Like he told you? And they'll be like, well, yeah, maybe sometimes I miss a few. They reinforce that. Well, you need to follow that treatment plan. You need to follow what he's doing. If you have any semblance of getting— wanting to get results, you have to follow it. It's nice having another healthcare professional backing you up. One of the frustrating things that bother me in practice is I tell a patient we're going to do this many visits over this amount of time and they disappear, and then they bitch they don't get better. Having that other provider behind you Sitting there and saying, are you following with Dr. Francis? Are you following with Dr. Smith? Are you doing your therapy? Are you doing the exercise you did? Or whatever the case is, it's nice having that reinforced because it helps with your compliance kind of indirectly. And I do the same with them too. If I'm seeing a primary patient, so referral from a primary care doc, I'm doing the same thing. Hey, have you seen Dr. Smith? Have you seen— are you following up like you should be? Well, no. You should really get in for your diabetes or hypertension, whatever the case is. So understanding that. And that goes into the third point of the slide, which is co-management. Are you going to co-manage these conditions with them? And we'll get more into that later. So let's talk about evidence-based. So the one precursor to this is if I see a safety pin from any of you providers, please just stop. Okay? We're not— that's not evidence-based. So we talk about evidence-based. We're not talking about technique necessarily. I'm a firm believer. I don't care what technique you do. I see value in most techniques out there. I'm not an activator guy. I'll do some diversivators, I call it, on some patients that I can't manually adjust. I see value in Gonstead even though I don't do Gonstead, MPI. I'm Logan, so Logan Basic I see some value in, and Diversified is kind of my stick, and I do a little ART and some soft tissue and therapeutic exercise. But it's not a technique thing. Evidence-based is not necessarily a technique thing. Now, there are some weird techniques out there that have no intrinsic value, but we're not talking about technique here. We're talking about, is what you're doing have some kind of evidence to support it? And it doesn't necessarily just have to be like Double-blinded studies, but is there some efficacy to what you're doing? The key I tell people and all chiro's I've ever worked with, students, providers, is the treatment you're doing appropriate and safe. Okay, if you have a hypertensive patient with stenosis of the like like older patient, you shouldn't be cranking on their neck. You should have some other tools to go there. So is what you're doing evident, appropriate, and safe for that patient? Length of the treatment: Will you over treat? That's a huge issue for a lot of people. A lot of chiro stigma. I hear it in the urgent care. Oh, you're going to see him three times a week for fifty two weeks. I'm like no no no. No, no, no. I'm a firm believer in trials of care. Do a trial of care, see how it works. If it benefits the patient, go on. If it doesn't benefit the patient, change something up, get a consult, figure out what's— why it's not working. My mentality is 6 to 8 visits, I should see some kind of functional improvement. And that's what these providers want to do. They want to see that you're not going to do the same thing over and over again and not get any improvement. So they want to know what you're doing is reasonable. And my reason is you can see a patient 25 times, 100%. But at regular intervals, are you monitoring progress and looking for objective improvement? And when I deal with other providers and they're like, well, you're a chiro, you're going to see them 3 times a week for 52 weeks, my response jokingly is like, you know what, I might do that, but at regular intervals, am I going to see improvement? Is it going to change? Are they functionally getting better? And that's what they want to see. Okay. And no, I will not see a patient 3 times a week for 52 weeks. I'm just saying that there is no 6 visits, 8 visits. Everybody is different. But what you want to see is there's some kind of objective improvement. Please, again, no safety pins. Just let's, let's not go there. The one thing I do want to mention, going back to the appropriate and safe, there's also a time when your treatment is not going to be safe for that patient. It's not going to be appropriate. You got to be able to pick up on those flags and be like, well, working with this patient may not be appropriate. And you should express to the primary carers that I want these patient visits. I want to see these patients. I want to get these people better, but I don't think it's safe for me to proceed. I think there's something else going on that might be the problem. And if I don't order imaging or the testing, I'll send it back to the primary to do it. So you want to make sure what you're doing obviously is appropriate and safe for that patient. And I feel like a lot of chiros, a lot of our profession kind of get worried about numbers and maybe dabble in areas they shouldn't be dabbling in. But you want to make sure it's appropriate and safe. Communication. Okay. Communication is key. Communication, communication, communication. Medical providers, what's wonderful about the medical profession is they already have it built in. They have this communication system already ingrained in their psyche from medical school, internship, residency, of communication. This system is already built into how they work. So for you to take a step into the system is ridiculously easy. They understand to communicate. So they have protocols they follow. They have certain expectations when they work with providers about communication. You stepping into this is a simple process, okay? It could be a letter, could be a fax, could be a phone call. It could be a text message if you, if you have a relationship. A lot with the orthopedic surgeon I'm working with, I've been texting him all morning about patients I've been seeing that I've referred to him. He's referred to And we have a HIPAA-compliant text messaging of like, hey, Ms. Smith, or he'll call me. Like, we have that relationship where as soon as he's done seeing one of my patients or patients he's referred to me, he'll give me a call and be like, hey, Alex, this is what I found. This is what's going on. What do you think? And we'll go back and forth. So we're always communicating. After I see one of his patients, I'll at the very least shoot him off an email or a text, or I'll call him if I have time. I'll be like, hey, I saw this patient. This is what I'm thinking. Are you— Good with it? Do you want me to do something else? Are you thinking something else? And we'll try to get on the same page to kind of direct care to what we think is appropriate. The one thing we'll get into is early on in practice, I had these letters that I used. I call it the 3-letter approach. I know other people who promote working with medical professionals want you to send research, send studies, and send JMPT published a study on low back pain or the American Family Physicians, send them these studies. I'm going to tell you right now, nobody in clinical practice gives a crap about those studies. They just don't. And I'm sorry to say that. And I think it's wonderful for the profession to get more research out there promoting what we do. I'm a huge fan of what the American Association of Family Physicians did years ago. I use that every day. I'm a huge proponent of it. But please, for the love of God, do not send these providers journal articles because it's going to sit in somebody's desk until it ends up in the trash and no one's going to read it. You want it, especially providers in busy clinical practice, short and sweet. Okay, avoid chiro talk. Don't start talking about— well, definitely don't talk about subluxations in terms of our subluxation because that has a completely different meaning in the medical profession. But avoid chiro talk. Avoid what we use lingo between us. Don't do it. Okay, they're not trained like we are. They don't understand the language like we do. Family practice, general surgery, they're not Advert— they don't know what we're doing. Okay, so avoid chiro talk, avoid profession-specific language in these letters. Stay away from research. Use these communications as a very short introduction, a short communication of, hey, this is what I found, this is what I'm doing, thanks for the referral. Keep it simple, keep it at under 3 paragraphs. I don't even say keep it even less than that. And my examples are basically 1 long paragraph and a quick thanks for the referral kind of situation. The other thing I want to— I want you to really concentrate on these communications is, A, thank them for the referral because that shows you're professional, you're courteous, you're respectful, but also reassure them that you're going to work with them to get their patient better. Okay? You're not working against them. You're not taking these patients for your own. These aren't your patients. You are treating these patients, but they're Dr. Smith's patients. So when you get a referral in, you want to thank them and you want to make sure they understand that, yeah, Ms. Smith's going to come still see you for follow-ups and her med checks and all that stuff. I still want them to see you on a regular basis. If they have appointments with you, I wanted to make those appointments. Okay, and you're going to work with them to get them better. Okay, you might do most of the heavy lifting, but you're still going to work with them to get them better. Working with them may only be them seeing the patient and being okay, keep seeing Dr. X for your treatment because it's working. But they're still working with them and keeping in the mentality you're co-managing. You're not controlling the narrative. You have a partner in crime that's going to help you. Get that patient better. Okay, in the letter you want to— or your communication— your findings, what your plan is. For me, it's a trial of care, 6 to 8 visits, and my expectations are. And thank you for referral and instructions that I want them to follow up with you. Okay, so we definitely need that. Nobody wants to read a book. Keep it short and sweet. Okay, don't use chiro talk. Nobody cares. Nobody cares about subluxation complex. Nobody cares. What they care about is getting your patient, their patient better and making them look good. Okay? So understand that. Keep them in the loop what's going on. That's really, really what they care about. Okay? So that's the 3 letters that I use, and we'll, we'll go into examples of that here in a second. So the 3-letter approach. Okay? There should be at least 3 letters when you have a patient referred to you. There should be at least 3 letters. Okay? When— and we're going to talk about you using your patient base to refer, and then the 3 letters also work as well. So you want an initial introduction letter. Hey, Dr. Smith, thanks for the referral. I saw Miss Sally. She was great. This is what I found. This is what I'm going to do as my trial of care. I told them to follow up with you if there's any changes, any issues, or follow up with any scheduled care. Simple, to the point, and easy. Okay. At some point, please, for the love of God, you should be doing a reevaluation on your patients. Something. Okay. Measuring functional, doing functional outcome assessments. Doing an exam, doing an eval somewhere after a trial of care to monitor functional improvement. That's a perfect opportunity to send another letter. Hey, Dr. Smith, this is where we're at. These are the functional improvements I have. This is what I'm going to do for the next trial of care. Just want to keep you in the loop. And then a release letter. Okay, the release letter should basically say, hey, Dr. Smith, patient responded great. We still have some residual issues. This is what they are. I told them to follow up with you and they can come see me if they have any other issues. I told them to follow up with you regularly to keep you in the loop. If there's any changes, they should follow up with you. And that's it. Okay. This is simple. This is template letters that you change names, you change conditions. You kind of keep it simple in general. If the provider has any questions, they will call you and they will reach out. The beautiful part about these letters is now you've gotten your name in front of these providers 3 times for 1 patient. So if you get 10 patients from this, this provider every 6 months, They're now seeing your name across their desk 30 times. That's what they want to see. They want communication. And, and from a marketing perspective, the more your name is getting in front of them, the better off it's going to be. Like, it's just name recognition. That's really key. So understanding communication, and, and the wonderful thing is, is that communication is already ingrained into them. They want the communication. That's what they're used to with other specialists. We are musculoskeletal neuromuscular medicine specialists. We do it wonderfully well. So they see us as another specialty, which I take as a compliment. But those are, those are the things they want to see. That's what they're used to. They don't care if you're a chiro, they don't care if you're a cardiologist or orthopedic surgeon, but if you communicate with them, they will flood you with referrals because they see that's what they're used to and that's what they want. Once they see that referral network is there and you're, you're stepping into communication paradigm they know and they respect, It makes the process a lot easier. You're just— you're putting your name into an already well-oiled machine and what's ingrained into them. Okay, so understanding that approach really makes a big difference. And like I said, it's a text message, an email, it's these letters you're going to see here shortly that really don't take a lot of time out of your practice, that really don't take a lot of time to help introduce you and get your name in front of these providers. And it's already a system they're accustomed to. Okay. It's already a system they were trained on. They went through residency seeing, and that's what they do. And that's a system that they know. And these letters work for orthopedic surgeons, cardiologists, because even as specialists, this is what they know. When a cardiologist sees a patient, they get a referral from primary care. They see a patient, they send a communication back saying, hey, Dr. Smith, I saw your Miss Sally for the heart, the AFib. And I'm saying, this is what I'm going to do for treatment. I'm going to monitor her. Appreciate the referral. This is already something that they see every day that specialists do. There's no reason you can't implement this. We're not reinventing the wheel. It's simple communications. It's a text. It's a letter. It's— this is all it is. So understanding that really makes a difference. And it's not discovering fire here. And this is a whole new mentality. This is a system they already have implemented, ingrained in them that you're just stepping into and building off of. So Jessica, if you don't mind sharing, this is the letters that we're talking about. So next 3 slides, we're going to make these letters available in the file section. So this is the first letter. This is the introduction letter. You can definitely use these letters for yourself. Obviously don't use my name and my reputation, but these are the letters I'm talking about. These are letters they want to see. It's short and sweet and to the point. If you start getting involved in pages upon pages upon pages of letters, no one's going to read it. Okay. No one's going to take the time. If you send them research, no one's going to care. So using these letters and these approaches is something simple. It's easy. Provider sees it, it's going to take them 15 seconds to read it. They're going to look at it, read it, and be done with it. And they're going to see your name, they're going to understand where you're coming from. Don't start talking about extension bias and all these— don't. Just keep it simple. Low back pain, shoulder pain, this is what I'm thinking, this is my kind of working diagnosis, and go from there. These letters should be pretty standard. You're doing a trial of care with everybody. You For the most part, the only thing that should change is the patient name, obviously, and your— what you're treating, and your approach should vary a little bit. You don't have to worry about getting into modalities, and I'm going to do therapeutic exercise, neuromuscular reeducation, dry needling. Don't worry about too— about that too much. They don't care. They care about the patient's going to get better, and if it doesn't get— they don't get better, they want to know there's a plan B, and there always should be a plan B. So this is our first letter. This is the initial letter. It's available to download, so definitely download it. And then obviously the reevaluation letter somewhere in the middle of your treatment plan, or there could be multiple reevaluation letters too if you're doing 6-block kind of treatment plans. This is after 6 visits, you do another 6, another after 6 visits, and should be at least 3 letters, but obviously you can kind of use these as more. And this is our finally our release letter. In the release letter, what I'd like to point out is I also told, although they can be referred back to us and see us if there's a flare-up, They can definitely go back to the primary referring source. Hey, go back to your primary, go back to whoever first, they'll send them back to you. And 99% of the time, if they go to the primary first and you did a good job the first time and you did this communication, guess what? They're sending right back to you afterwards.

That's it for today's episode. Be sure to tune in to episode 56 Where we wrap up part 2 of our training and discuss the easiest way to effectively communicate with medical providers and the best tools that you can use to build professional relationships with multiple providers and specialists in your local area. You won't want to miss it. Episode 56 drops in 2 weeks. Earlier in today's episode, I mentioned that I've recently clarified a big, hairy, scary vision for Expanding Factor. And after working with healthcare providers across the globe for the past decade, I feel like I have a pretty good pulse on the biggest needs of our community. But I never want to make assumptions and miss the mark. If you were alive during the era of Clear Pepsi and green ketchup, then you know exactly how bad things can go when companies make assumptions and radical changes that are not exactly what their audience was looking for. So in the spirit of making sure we're heading in the right direction, Can you do me a quick favor? If you could head to the show notes and click the link on the Factor survey. It contains just 5 simple questions to help us zero in on exactly what you need most from our team. It'll take you less than a minute to complete, and I will be ever so grateful to have your feedback and input. And as a thank you gift, I'll send you a cultivated playlist of our best Factor podcast episodes that provide content custom tailored to your submissions. That's all for today. We'll see you next time. Hey guys, if you like what you heard today, I encourage you to visit our website at factor-store.com. That's spelled F-A-K-T-R-store.com to find out more information about all that we have to offer. We have a variety of online offerings as well as our hands-on Factor Rehab System course Scheduled in cities around the globe. Be sure to also check out our event calendar and bookmark any of these upcoming live webinar dates coming up in the near future so you can join us live. And of course, the biggest compliment we can receive is for you to help us spread the word to your friends, colleagues, and classmates. You'll find all the important links as well as info about our sponsors in the show notes, so be sure to check those out.