CF 200: The State Of Chiropractic Via ChiroUp & Chiropractic Economics
Today we’re going to talk about the state of chiropractic and we’re going to use a couple of more recent articles I’ve come across to do it. One from Chiropractic Economics and one from our friends at ChiroUp. It’s a good one today folks! But first, here’s that sweet sweet bumper music
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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around. We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. If you haven’t yet I have a few things you should do.
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You have found yourself smack dab in the middle of Episode #200 Now if you missed last week’s episode, we talked about Fear Avoidance & Opioids and Neuro Changes With Cannabis Use In Adolescence. Make sure you don’t miss that info. Keep up with the class.
On the personal end of things…..
I just returned from Chicago from the American College of chiropractic consultants and the chiropractic forensic sciences conference. It was great I got to hang out with my forward-thinking chiropractic alliance buddy Mr. Dr. Michael Massey. He was probably tired of me by the time we got done hanging out and I had to go home. Honestly, we were there from Wednesday night through Sunday morning. That’s a long time to be hanging out with someone. Hopefully, I didn’t talk his ear off. But I learned a lot about him and his history. He’s gotten to do a lot of cool stuff and I enjoyed learning more about it. Here in Amarillo, you don’t get a lot of really cool opportunities. For example, Dr. Massey has gotten to be on the NASCAR circuit treating the drivers.
He’s been on the Rodeo circuit. He’s a certified coder. Which, let’s be honest, that’s not that cool really but, very impressive. He’s gotten to teach and speak all over and just has a very interesting background. If you don’t know about Dr. Michael Massey from down around the Athens and Chattanooga area of Tennessee and of Practice Mechanics fame, make sure you go check him out. Practice Mechanics is his and Dr. Rob Pape’s mentoring and consulting group. Go look into practice-mechanics.com. As far as the conference itself, it happens the first weekend in October every single year. At the same hotel. The Marriott in Oak Brook Illinois which is basically Chicago.
Just about all of the people there are pretty darn impressive and they’re on both ends of the spectrum from working for the insurance company to working for chiropractors and defendants. They’re expert witnesses. They’re independent medical examiners. And, yes, some even work for the insurance companies. I have to tell you meeting them humanizes them to an extent even if we may not agree with every opinion they may have. Most of the continuing education I get through the years involves a 16-hour weekend. I typically end up with 80 to 100 hours a year. Sometimes more, sometimes a touch less. But it’s usually quite a few hours through my activities with the Texas Chiropractic Association. We have more than one event and I usually go to more than one event every year. At least a couple of the events. Then I have the orthopedic hours. And then I have the other stuff I learn and take here and there. So, I’m usually in the 80-100 hours per year range.
This weekend was 27 hours of continuing education. These folks are serious about getting some CEs in, man. Crazy. Thursday went from 8 am until 9 pm. Friday was 8-6, and Saturday was 8-4. One-hour lunches. Class…..all day….every day. On this deal, what had happened was….as my long-time listeners know, I got Board Certified, which means a Diplomate, also known as a Fellowship…..I got that in the Neuromusculoskeletal Medicine program in 2019. Dr. James Lehman with the University of Bridgeport contacted me last year. He said, “‘Ya know…since you already have the Neuromusculoskeletal Fellowship, you can get your Forensic Fellowship a lot easier since it’s a subspecialty of the Neuromusculoskeletal specialty.” That’s about the time that I responded with, “What’s that?” I had no idea what Chiropractic Forensics was. I thought I might be solving some sort of murder mystery or something. Anyway, Dr. Lehman explained to me that it was to bolster experience and credentials in the medicolegal arena.
The original Fellowship took 300 hours to complete. Since Forensics is a subspecialty of it, this second Fellowship was only 100 extra hours for me to complete. How do you say no? Well, you don’t. I did it. I got through it. And here we are. Two Fellowships within about 3 years. Where the hell did that come from? When it came to classwork, I didn’t thrive in the classroom. I hated the classroom. Sitting there for hours on end day after day…..yeah. I struggled. I was just a B student at chiropractic school. Not an overachiever. Not an underachiever. I swore I’d never take another class. Forever and ever amen. And then, things changed. I got into research and evidence and all that good stuff. Hell, I got into learning again and I enjoyed it. I wanted to raise my game all of the sudden and there it went. And here we are.
Old dogs can indeed learn new tricks, folks. So, keep moving forward. Keep learning. Don’t just knock down the high spots. We’re capable of so much more than that.
This first one is called, “Survey says 1 in 4 Americans would pay up to a $40 co-pay for chiropractic care” by the Chiropractic Economics staff (Staff 2021) and published on their site on October 6 of 2021. Hot tamale, hot tamale….get em while they’re good n hot. It’s an article so let’s summarize and hit the high spots, shall we? They start the article by saying, “A recent survey of more than 2,000 Americans revealed that roughly 1 in 4 (24%) would “be most likely to pay a co-pay of $40 or less without hesitation.”
This survey was done by ATI Physical Therapy which they say is one of the nation’s biggest providers of PT services. I am unfamiliar with the group but their website says they have 900+ convenient locations They say that 33% of Americans think PT is among the outpatient services they would be most likely to pay a co-pay of $40 or less without any reservation or hesitation. Other services they would be most likely to pay $40 or less for would be Urgent Care visits at 55%, regular screening or check-ups at 35%, prescriptions at 33%, and chiropractic at 24%.
I became aware of this one from a post from Dr. Bobby Maybee in his Forward Thinking Chiropractic Alliance group. Also known as FTCA. If you’re not a member and you are evidence-based, patient-centered, I recommend you fix that situation and hop in there. It’s a group you’ll want to just sit and lurk for a little while before you pop in and start spouting off. They, much like myself, have very little patience for the more vitalistic stuff in the profession. Once you get the lay of the land, you’ll find a group of very welcoming, friendly, productive, and very helpful doctors that you’ll be glad you became a part of. Great group. All groups have their issues but I’ve been a part of the FTCA for several years at this point and it’s a great group with great people.
Anyway, As Dr. Maybee pointed out, Chiro Economics is looking at this information as a positive while he, and I by the way, see it as a negative. Patients value us at $40. Those that don’t value us at that price point value us as less than $40. Not a good thing. Especially when you’ve gone to the lengths to specialize and get board certified in one or more diplomates. We’re specialists but still lumped in at $40/visit. And that’s by only 24% of Americans while PTs get 33%. When we know through Palmer/Gallup poll and other research that chiros are more cost-effective, with more patient satisfaction, and with better patient outcomes.
The schiesters in the profession, I’m convinced, are the reason we aren’t further up the chain. And the lack of standardization. You don’t know what the hell you’re getting when going to a new chiropractor. About the time I saw that article, I got a great email from ChiroUp (Bertelsman T 2021) with a summary of the ChiroUp dataset. I’m including the link to this in the show notes at this point in the transcript: https://chiroup.com/COPSsynopsis2021 They shared that the percentages of issues chiropractors see are as follows:
- Lumbosacral at 36% – which makes sense. It’s the leading cause of disability in the world and has only gotten worse over the last 20 years. If you’re not a low-back ninja, that’s your first mission right there.
- Neck pain at about 18%
- Thoracic pain at about 6.5%
- Then shoulder, hip, knee, foot and ankle, elbow, and last but not least the hand and wrist.
All of the extremities added up to about 14% of cases. It seems that having some extremity skills is a good addition to your toolbox but the bread and butter is the spine for chiropractors when you see that spinal issues add up to about 60% or more of the cases we see. They say the most common chiropractic diagnoses are:
- Lumbar intersegmental joint dysfunction – or facet
- Upper cross
- SI Dysfunction
- Cervical intersegmental joint dysfunction
- Lower cross
Those are the top five but I can tell you from the ortho diplomate that 40% of our low back cases are discs, 30% are facets, and 22.5% are SI issues. This information, when combined with ‘give me one finger and point to one spot where all of the pain comes from’….those two bits of information, for the vast majority of cases, will get you most of the way home for a heck of a lot of patients.
With Lumbar facet being the top diagnosis code, it makes me wonder how good others are at diagnosing. Or….how bad I am. Do the extension/rotation test on a low back pain patient. If it doesn’t hurt, it’s about 94% or so that the issue is NOT a facet. That’s if the extension/rotation test is pain-free, it’s almost certainly not a facet issue. And a whole bunch of low back pain patients can extend and rotate without pain. So, I’m skeptical of how accurate these numbers are. Also, a lot of times you see facet pain, it’s secondary to spinal instability. A new research paper recently estimated spinal instability at as much as 60% of low back pain cases.
That’s A LOT!!
You get those vertebrae rattling around a bit, you get sore facets. A clue is asking them if it hurts when they roll over in bed. If it does, why the hell would it hurt to roll over? There’s no weight-bearing on discs or anything like that. Instability may explain. McGill’s Big 3 plus Dead Bug may be your answer rather than continuing to mobilize segments that are already moving more than they should. Maybe it’s weak hip abductors. If you’re not checking hip abductors with one-legged mini-squats looking for a medial deviation of the knee, then start looking. Weak hip abductors can be a missing puzzle piece to long-standing low back pain.
And, in ChiroUp’s top DXs per region, for the hip, the number one issue diagnosed is hip abductors. So some of you are doing a good job there. On their top 3 knee dx’s we see that patellofemoral pain syndrome is #1. However, in our ortho diplomate, we’re taught that the most common knee issue is actually pes anserine. If you’ve never heard of that one, google it up and start putting a thumb on it when you have a knee issue and see what you find. Here’s one I find quite a bit off-kilter. In the headache section, they have cervicogenic headache as the most commonly diagnosed issue. Now, understand, this is not ChiroUp’s fault. They’re simply reporting what people are diagnosing. ChiroUp is a literal game-changer and you should all be a part of it. I just want you all to be diagnosing better. That’s all. The breakdown on headaches is as follows:
- Tension-type headache at about 40% of cases.
- True migraines only make up about 10% of headache cases.
- Cervicogenic headaches are only about 4% of the headaches that come into our offices. Meaning, if accurately diagnosed, the condition could not possibly come out as the number one issue in the headache category. Yet, it does because chiropractors don’t have a good handle on headaches right now. Tension-type and cervicogenics do both commonly start at the base of the noggin and, ultimately, it doesn’t necessarily matter how it’s diagnosed because we’re most likely going to treat it the same. It’s just the knowledge part of it that matters. Being on top of your game. That’s all.
Regardless of the accuracy of diagnoses, ChiroUp reports patient satisfaction at a robust and most wonderful 92.7%. Kaya Pow! Understand that includes satisfaction with chiropractic case management for everything from plantar fasciitis and axillary nerve entrapment to the stuff that is in our wheelhouses like spinal pain and headaches. Then we have that the average chiropractic patient’s likelihood refer others is at a delicious 96.7%. And that’s yummy to my tummy. Lip-smacking fantastic.
They also share that the average improvement 30 days after initiating chiropractic care for all diagnoses is about 80%, Slap yer mama! That’s some good stuff. Here was a particularly telling stat from a trial that suggested the percent of patients that resolved after only having standard medical care was only 17%. That’s in contrast to 73% when chiropractic manipulation was added to standard medical care.
ChiroUp then ventures into costs. They show a claims analysis of BC/BS of Tennessee’s low back pain claims data. It showed that care initiated with a DC saves nearly 40% on healthcare costs compared with care initiated through a medical doctor.
Forty Freaking Percent!! Smack! KaChow! Slap!
They go on to say, “The choice of initial provider is significantly associated with the likelihood of subsequent surgery. A Spine journal study found that approximately 42.7% of injured workers who first saw a surgeon had surgery, in contrast to only 1.5% of those who saw a chiropractor.” Most of us have seen that one. I believe it was done by the state of Washington. All of this while malpractice claims categorized by provider type shows that chiropractors come out on the bottom in a GOOD way.
We are the very least likely profession to have a malpractice claim against at only 0.6% of all claims. And the Medical Associations always say all of their pushes are in the interest of public safety. Are you sure? Incidentally, RNs suffered the most malpractice claims at 25.5% of the claims and physicians came in at about 16.1%. We’re way down there at 0.6%. Get out of here with that ‘public safety’ garbage.
Your comment has been found invalid and mostly stupid.
Their conclusion says, “This 2021 COPS synopsis confirms that chiropractors demonstrate above-average performance for the essential healthcare consumer needs. Evidence-based chiropractors should play a vital role in the future healthcare model because of their ability to safely and cost-effectively deliver excellent musculoskeletal clinical outcomes with high patient satisfaction.” And they’re 100% correct.
They always are by the way. Dr. Tim Bertlesman and Dr. Brandon Steele are two of the brightest chiropractors and human beings you’ll ever meet in your life. The content they put out through ChiroUp is always right, always timely, always good, and always appropriate. So there you have it, the state of chiropractic. We are absolutely amazing with effectiveness, patient satisfaction, outcomes, cost-effectiveness, and safety. Yet, only see a small percentage of the population, and those that we do see only see us as being worth about $40 per visit……or less.
Thank you, vitalists. Really appreciate you guys and girls. Y’all are really special. What a life it is to be a chiropractor.
Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in the leadership of state associations. So quit griping about the profession if you’re doing nothing to better it. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.
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I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!
At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic!
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We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.
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About the Author & Host
Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
- Bertelsman T, S. B. (2021). “2021 Chiropractic Outcomes & Patient Satisfaction Synopsis.”
- Staff, C. E. (2021). “Survey says 1 in 4 Americans would pay up to a $40 co-pay for chiropractic care.” Chiropractic Economics.