In December 2013, I left a multidisciplinary practice to open what I refer to as the "modern chiropractic office." Patients walk right into a common area for working out, a kitchen area with a round table and chairs, and the reception desk area for staff (checking in/out, payments, etc.). I encourage patients to come in early and enjoy a cup of green tea or coffee.
I practice in West Los Angeles; my office is near the affluent areas of Santa Monica, Brentwood and Beverly Hills. These customers want umami depth in treatment and they want pain relief faster than high-speed WiFi. These same people want to live longer, but not older. Who doesn't want to tack on another 10-15 active years?
I want patients to know I have thoughts and strategies to help them live longer, happier and healthier. I encourage each of us in our profession to live a little better so you can live a little longer. That is always a trend!
Chiropractic has many core truths, a shared culture and extraordinary gifts to share in a time when much is in flux. In this article and the next (yep, a second article became three), I will continue to explore what I think are indicators of what's to come (or already here).
Lifestyle Changes and the Chiropractic Opportunity
The "trending" discussion relates to one of my favorite practice topics: therapeutic lifestyle changes. For example, do you know what all of the following conditions have in common – high blood sugar, type 2 diabetes, muscle pain / damage, kidney and liver damage, memory loss, age-related macular degeneration and cataracts? The answer is statins.
Statins have been known as cholesterol-lowering drugs. Now, we are seeing the pharmaceutical industry repositioning statins as simple "heart health" drugs. It will go something like this in the MD's conversation with the patient: "Do you have high blood pressure? Type 2 diabetes? A family history of heart problems? Are you 45 or older? With any one of those problems, you'd better take a heart drug!" Your patients will be told by their medical doctors that the benefits of taking statins outweigh the risks.
But a large part of the mainstream will want alternatives to statins for these conditions. Chiropractors have been talking about progressive, proactive wellness since the beginning. It's important for you to gain extra knowledge on the benefits of vitamins, minerals, herbs, spices, botanicals and exercise in lieu of pharmaceuticals.
Some chiropractors will continue to seek privileges to allow DCs to prescribe medications. My suggestion is to get really good at sound therapies to help people get off drugs. I don't think chiropractors will be prescribing meds in the near future, but whatever the long-term outcome, we will all need to gain more education, along with practical tools and skills that will enable us to meet the challenges ahead.
The Power of Specialization
On the topic of education and learning, we are seeing more students and practitioners moving ahead with master's degrees in sports medicine (and other related fields), and now some chiropractic colleges have residency programs. These are excellent ways to gain and create more skills, and gain an edge over the competition – just because you took the time to get a deeper understanding of specific topics.
The message and trend is clear: Spend time getting more (higher) education. Master's degrees and the chiropractic diplomate programs are excellent opportunities. If nothing else, use mentorship programs, online courses, internships, or the good-old-fashioned "buddy system" to learn new skills and build rapport with other doctors.
I see so many opportunities to become specialists within the chiropractic arena. For example, I don't know one DC who treats pelvic-floor issues intra-vaginally. Don't laugh; lots of physical therapists are making this a specialty practice. Which female chiropractor will be the one in my area I can refer to? If that's out of your comfort zone, become a spine specialist within a multidisciplinary group practice or a team chiropractor, like my friend Dr. Jim Kurtz.
Earlier this year I met Brandon Beck, co-founder of Riot Games, who co-created the huge hit called "League of Legends." Before I met Brandon, I used to think to myself, What good are these games? Brandon explained that "gamers" make decisions faster than non-gamers. They certainly become quicker thinkers, quicker at movement, and have improved focus. Involvement in games lights up the brain more than just being a spectator. Today's gamers are tomorrow's drone pilots and robotic surgeons. If you can relate to gamers, become a specialist in treating what I call "gamer's posture."
Women typically go to the doctor more often than men, but I've noticed an increase in the number of male patients in my practice over the years. I have an MD friend who has a men-only practice. These days, men actually shop far more than marketers and retailers reflect in their promotions and advertising. As a DC, you can specialize by promoting to more of a male practice.
In my experience, male patients seem more likely than female patients to list one specific complaint they need help with, rather than a list of complaints. I also notice men are more inclined to follow through with home-exercise recommendations and programs. This was not always the case. Does anyone else find this to be true? Seems like another trend.
Buzzwords: Chronic Pain & Disease
In the ACA chiropractic rehab diplomate classes I teach, I emphasize working with chronic pain patients. The prevalence of chronic low back and neck pain, and the number of patients seeking care for those conditions, will continue to increase. The big question I have is, will the consumer seek care from chiropractors, physical therapists, hybrid personal trainers (who provide personal training, soft-tissue work and diet advice) or another category of health care provider?
If chronic pain isn't enough, there is the chronic disease category, which affects an estimated 860 million people worldwide. Maybe this is because we live in a more toxic world. Forty-two billion pounds of chemicals are produced every day. Only about nine chemicals are banned in the personal-products line in the U.S.; in Europe, more than 1,000 are banned.
There are 80,000 toxins in the home-care line. It makes me wonder about the prolific increase in acute lymphocytic leukemia among 0-14-year-olds. There has also been a 74 percent increase in asthma and allergies among children over the past 25 years. And then there is the rise in autism in children. Why? My speculation is it could be because more than 250 synthetic industrial chemicals are in our bodies that were not in our grandparents' bodies.
Getting good at diagnosing autoimmune disease and having the ability to help with immuno-suppression, immune-enhancement, detox diets, and supplements is an important specialty. You can become the alternative doctor who has a direct, dramatic effect on these patients. There will be a niche practice for the doctor who figures out the medication alternative. Sometimes the simple stuff (water, oxygen, sunlight) makes a big difference; your recommendations can have a positive effect. (I may not always figure it out, but I try to motivate patients to move more and eat a little better without any harm done.)
The Evolving Athlete
Sports injuries, particularly in football, lacrosse and cheerleading, have increased public awareness of concussion and traumatic brain injury. The ACA Sports Council, chiropractors like Peter Gorman, researcher Dr. William Brechue, along with the U.S. Army, are among those busy figuring out the best practices. I remind practitioners not to forget to suggest omega-3 and/or krill oils as part of the treatment. Concussion treatment is a specialty and the discussion will continue to trend.
Kids are also becoming increasingly specialized in a single sport (e.g., pitchers in baseball), which means more practitioners need to understand specific sports mechanics / injuries and be able to treat them effectively.
Medication, surgery, massage, traction, ultrasound-guided injections, laser, ergonomics, heat therapy, stretching, strengthening exercises, cryosaunas and cold therapy are also trending, particularly in the athletic realm. But due to the considerable "craziness" within our own profession, there is no clear social media message among chiropractors helping to educate the public about the modern chiropractor. (Physical therapists, on the other hand, have done a great job of doing this.)
Be Ahead of the Trends
Do you remember the words (verse) to the song "American Pie" by Don McLean? Here's a taste:
While the sergeants played a marching tune
We all got up to dance
Oh, but we never got the chance
'Cause the players tried to take the field
The marching band refused to yield
Do you recall what was revealed
The day the music died?
If we (chiropractors) "get up to dance" and take our rightful place in the health care system, will the "marching band" ("Obamacare") give us the chance? Today's players are still the AMA. But bright young guys like Gray Cook, Dr. Lee Burton, Brett Jones, Mike Boyle, and a host of others who are not chiropractors, but are in related fields, are also field leaders.
Something I have always been opposed to, but they teach and have made enormously successful at, is a "step-by-step" approach to treatment. This continues to trend. I would not miss an opportunity to learn from these guys.
Within our own field, look to progressive people like Dr. Dana Mackison. He has silently and graciously done more for rehab in our profession than anyone I know. Go to any event with Dr. Mackison and you will hear more people telling him, "Thank you for your help," than anyone I have ever seen in our profession.
Other chiropractic trend setters to watch include Drs. Kim Christiansen, Tom Hyde, Greg Rose, Jay Greenstein, Jason Lord, Justin Brink, Steve Capobianco, Skip George, Makani Lew, Perry Nickelston and Max Poritsky. These are just some of the chiropractic leaders of our time, helping to set the trends. And what about you? Are you willing to stand up and be ahead of the trends?
Click here for more information about Jeffrey Tucker, DC, DACRB.