Recently, we sat down with Mark Studin, DC, FASBE(C), DAAPM, DAAMLP, to discuss the state of chiropractic and why primary spine care may hold the key to chiropractic's future. Read what he had to share in this exclusive interview.
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Dr. Studin, you recently shared your vision for the future of chiropractic and what is currently happening around the country, but were reluctant to do so publicly until now. Please tell us why.
Although I was happy to share this with you in private, I was initially concerned that those in chiropractic politics, splinter groups or those who work with insurance companies would take what we have created and attempt to turn this into a "windfall" exclusively for those related to the political hierarchy or who have strong financial ties to insurance carriers. My overwhelming concern is to prevent this from being "business as usual" in our profession, where the few in control profit from the many in the field.
In your mind, what is the most appropriate definition of primary spine care?
Primary spine care simply means you are the first referral option for any spine issue, inclusive of medical primary care providers, medical specialists, lawyers, urgent care centers and emergency rooms.
Is earning a doctorate in chiropractic enough to be considered a primary spine care provider?
Years ago, I thought that was the case; however, the contemporary marketplace dictates otherwise. In today's marketplace, to be considered the first referral option for both the medical and legal communities, the doctor of chiropractic must be considered a peer by medical specialists and expert by the courts to be able to admit testimony with ever-narrowing legal rulings.
To do that, the chiropractor must have graduate-level (postdoctoral) training in topics such as MRI spine interpretation, spinal biomechanical engineering, triaging trauma care, stroke evaluation, accident engineering, head trauma, brain injuries and a few other areas that are not central to our core education.
Isn't it the responsibility of our chiropractic academic institutions to teach this in our doctoral studies?
No. Our professional academic institutions serve a very specific purpose, which is to allow us to gain licensure in our desired state, and they do an outstanding job in preparing future doctors of chiropractic for licensure. After graduation, it is up to the DC to determine their desired professional path and get the postdoctoral training required to accomplish that goal.
Before we get into specifics, what is the "end result" of your vision? What are you seeing right now?
First, let us focus on what is happening in today's chiropractic marketplace. In Provo, Utah, five private-hospital emergency rooms are already funneling many of their 962 spine cases a month into a spine center and the gatekeeper is a trauma-trained chiropractor who is then triaging to the spine surgeons. The only limitation is how many patients the doctor can physically treat (and he is currently adding a lot more doctors of chiropractic to his staff to service all 962).
In Memphis, Tennessee, a seven-orthopedic-surgery group is funneling all of its spine cases first through trauma-trained DCs and they average 600 patients per month. In St. Louis, Missouri, a neurosurgeon has turned away 10-12 new personal-injury cases per day because he doesn't want to "deal with" accident cases and is having a trauma-trained doctor of chiropractic triage the cases for surgery. Like those cases above, the DC keeps the nonsurgical cases to be managed in his individual practice.
In upstate Connecticut, a DC has been referred 23 new cases in the past eight days directly from the emergency room; and in Buffalo, New York, a DC has been receiving an average of 29 cases per week from the emergency room for over a year ... and the only reason that number hasn't doubled is because he doesn't have the manpower or space to see more – despite doubling his space and associates.
Please note that these aren't the exceptions, as this is happening nationally and expanding rapidly. In every case above and the others nationally, the doctor of chiropractic is seeking additional qualified DCs to support the demand for chiropractic. We have gotten the referral sources to "run after chiropractic" and that is the end game.
In your opinion, are the majority of DCs underqualified to work with most medical doctors, hospitals and lawyers in the relationships you've cited above?
Yes. The current and future trend is advanced training in spine care and the course topics I listed previously are examples of the direction the doctor of chiropractic should consider pursuing to keep up with the demands of today's marketplace.
How much of an issue is diagnosis? Do DCs differentially diagnose as rigorously as they need to in order for medical doctors to feel confident in referring to them?
It's not a question of diagnosing differently than MDs, it's a matter of case management, and a complete and accurate diagnosis is a large part of the confidence that the medical and legal communities have in a qualified primary spine care provider to call them a "peer" or "expert."
What is your overall goal for the chiropractic profession?
The goal for the chiropractic profession is to have a significant increase in utilization, as that will serve society best. The goal for each individual chiropractor: If you work hard and want to commit to be the "best-of-the-best through clinical excellence," you can thrive. This is where "any willing provider" can participate, devoid of politics or insurance-company relationships.
For decades, our profession has been plagued with too much of the above. The time has come for it to end. Well-trained doctors of chiropractic are in high demand. Every day, more and more medical doctors, lawyers and hospitals understand the value of chiropractic and are trying to find the right (formally credentialed) DCs to work with.
Dr. Mark E. Studin has been a DC since 1981 and currently is adjunct assistant professor of chiropractic at the University of Bridgeport, College of Chiropractic; adjunct professor at Cleveland University – Kansas City, Chiropractic and Health Sciences; and adjunct professor of clinical sciences at Texas Chiropractic College. He is also a graduate CME educator through the State University of New York at Buffalo, Jacobs School of Medicine and Biomedical Sciences, in conjunction with the Accreditation Council for Continuing Medical Education. Through Bridgeport, he coordinates chiropractic clinical rotations at the State University of New York at Stony Brook, School of Medicine, Department of Radiology. Additionally, he consults DCs, MDs, health care academic institutions and the legal community worldwide and has been published extensively. He can be reached at
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