Dynamic Chiropractic – September 28, 2006, Vol. 24, Issue 20

Building Bridges Across a Great Divide

By Donald M. Petersen Jr., BS, HCD(hc), FICC(h), Publisher

A recent study makes some interesting observations regarding the growing relationship between medical doctors and doctors of chiropractic.1 The study, results of which are based on a survey of MDs and DOs in Iowa, examined the referral patterns and general attitudes of medical providers toward doctors of chiropractic.

Not surprisingly, the investigators found that 98 percent of medical primary care providers (PCPs) "preferred to initiate formal referral to other PCPs rather than have the patient make the initial contact with the (medical) doctor." When it came to accepting referrals, 79 percent of DOs and 82 percent of MDs "always accepted" referrals from their peers.

The situation with doctors of chiropractic was markedly different. Medical providers seem to know their patients are interested in chiropractic: 81% of DOs and 87% of MDs reported that their patients have asked about chiropractic, and almost 75% of those PCPs have patients who have actually "requested a referral to a chiropractor." But sadly, although "(a)pproximately 65% of DOs and MDs had recommended that their patients consult a chiropractor," according to the study, "only 24% of DOs and 29% of MDs had themselves formally referred a patient to a chiropractor." To make matters worse, "99% of the PCPs responded that they would initiate a patient referral to other PCPs, whereas only 12% said that they would initiate a referral to a chiropractor (p < 0.001)." And while 81% of PCPs had accepted referrals from other PCPs, "only 61% of PCPs had accepted a referral from a chiropractor (p < 0.001)."

The good news is that, for whatever reason, 65% of MDs and DOs "recommend" that some of their patients see a doctor of chiropractic. While this seems somewhat positive, consider that more than 81% have patients who ask about chiropractic and almost 75% have patients who request a referral to a doctor of chiropractic.

It appears there is still some kind of "don't refer" policy in the practice of medicine. Whether this is by design or just a reflection of the lack of relationships is certainly up for debate.

But how do we bridge this gap between "recommendation" and referral? And how do we get more than 12% of MDs and DOs to initiate a referral to a DC? If we borrow a page out of the drug company playbook, we see two strategies that work hand in hand to impact the medical profession: build relationships and engage in direct-to-consumer advertising.

While chiropractic is just beginning to sustain its own direct-to-consumer advertising campaign,2,3 more than 80% of the public is asking PCPs about chiropractic. The message is getting to the consumer, even though we haven't done a very good job of telling our own story.

Where we've failed is in building relationships with the medical community. How is that done by the drug companies? Mostly with food. When a friend of mine began working in a medical doctor's office, he was absolutely amazed at how often the drug company reps would come in with breakfasts, lunches, snacks, etc., for everyone in the office. They weren't really selling anything; they were there to build relationships and give away free samples.

So, what would happen if the chiropractic profession did the same thing? There are more than 60,000 DCs and close to 700,000 MDs and DOs. That's about 11 MDs and DOs for every DC. What could happen if every DC endeavored to ask each of those 11 MDs to lunch and began to explain chiropractic? And what could happen if every DC endeavored to provide some care or collaborate on a back pain case? (Yes, chiropractic is much more than back pain, but we have to start at a place they can understand and where we have solid research.)

It wouldn't take much more then a year to reach out to every MD and DO in the United States. And while we wouldn't win them all over, we would greatly impact the percentage of physicians who referred for chiropractic care.

Sadly, there is still a chasm between MDs/DOs and DCs. We didn't dig that chasm, but it is there, none the less. If we ever hope to reach those doctors, we're the ones who will have to build the bridge.

Think about it.


  1. Greene BR, Smith M, Veerasathpurush A, Haas M. Refferal patterns and attitudes of primary care physicians towards chiropractors. BMC Complementary and Alternative Medicine 2006;6:5. www.biomedcentral.com/1472-6882/6/5.
  2. "Foundation Begins Advertising Campaign." Dynamic Chiropractic, July 16, 2006. www.chiroweb.com/archives/24/15/05.html.
  3. "Foundation Advertising Campaign Continues." Dynamic Chiropractic, Aug. 15, 2006. www.chiroweb.com/archives/24/17/10.html.


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