Thanks to ACA News for permission to reproduce this article!
By Christina Acampora, DC
Chiropractic marketing to medical physicians has traditionally focused on campaigns dedicated to letters of introduction. These campaigns have had consistently lackluster results for most chiropractors. It’s understandable that some doctors of chiropractic feel certain trepidation when considering personally approaching a medical physician, but they shouldn’t. Surveys illustrate that medical physicians want to learn more about chiropractic care and that they prefer personalized presentations focused on scientific literature. 
Successful marketing requires knowing your target audience, but it also relies on creating a need for your service and uncovering objections to it. This article will help you understand how to listen to and respond personally to the medical community.
Overcoming Objections to Chiropractic Care
Some DCs have begun to personally reach out to MDs and are often confused by meetings that seem to go well, but fail to generate referrals. Typically, it is owing to an unspoken objection health care providers have to any new treatment options. These objections vary by doctor and can range from a belief that certain services are not covered by insurance to more serious misperceptions.
A meeting with a physician should begin with an understanding of the physician’s belief system about chiropractic care. A simple statement to begin with is: “Doctor, could you share with me what your experience with chiropractors or understanding of chiropractic care is?” This begins a conversational exchange allowing opportunities to uncover objections and a basic understanding of what data you should use when you start your presentation.
Many times a doctor will say he or she doesn’t know what chiropractors do. In this case, start with a scientific paper that explains the mechanism of action of manipulation.  Often, as you are illustrating how manipulation works, a doctor has the opportunity to voice an objection as a question, such as “Why do patients have to keep coming back?” or “What type of safety data are there for manipulation?”
Common Objections and Sample Responses
In my experience, the most commonly reported objections and their solutions are:
Prolonged patient care
This objection can be overcome by chiropractors who practice a treat-and-release philosophy through a conversational exchange that discusses your practice philosophy, as well as by emphasizing the number of treatments patients had, while presenting research to achieve the reported efficacy. (Look for more information in upcoming issues of ACA News).
It is important to understand that it is confusing to physicians if a chiropractor utilizes research to document the overall efficacy of manipulation with modest treatment plans and to then advocate lifetime care without scientific support. Because wellness care is not yet supported by research, it will be difficult to convince a physician otherwise.
Safety of cervical manipulation, particularly the cervical spine
This objection can be overcome through research. Two scientific papers that can be utilized include:
"Cervical Safety: Risk of Vertebrobasilar Stroke and Chiropractic Care” 
“Lumbar Safety: Safety of Spinal Manipulation in the Treatment of Lumbar Disk Herniations: A Systematic Review and Risk Assessment” 
Treating patients outside our scope of practice
If this objection were to come up, it can be covered through a conversational discussion emphasizing your focus on musculoskeletal conditions and concentrating on research that illustrates these conditions. Bringing your examination forms can help you illustrate the orthopedic and neurological approach you take to assessing back pain.
Identifying Clinical Needs
Once objections are clarified and addressed, you’ll want to uncover the physician’s clinical needs. Like DCs, medical physicians have a treatment algorithm based on clinical experience and research that dictates their treatment strategy. No singular treatment works on every patient every time. Asking questions to help uncover what motivates a physician to choose one treatment over another will help you determine what needs the physician has that chiropractic care can help meet. Here are some sample questions:
“Doctor, for your patients with acute lower-back pain, what is your immediate treatment objective?”
“Doctor, you mention you refer for physical therapy. What types of patient symptoms perpetuate a referral?”
“How do you choose between medication and PT referral for your back-pain patients?”
Uncovering these needs will help you understand where there may be opportunities for collaborating with the doctor on treating certain populations or conditions. For example, if the objective is pain relief, demonstrating your patient outcomes in this area—such as VAS scores—can help present chiropractic as a viable option. Knowing which symptoms or patients the physician refers to other providers can help you pull together research on the effectiveness of chiropractic in treating these areas. And knowing what medications the physician prescribes for back pain can help you discuss the pros and cons of different treatment alternatives.
Consider the following example. You ask a physician what her starting approach is for treating back pain. She indicates that she tends to use a wait-and-see approach for back pain but may include a prescription for NSAIDs, depending on the severity of symptoms. She refers to a physical therapist if the patient returns for care. If physical therapy fails, she initiates a referral to an orthopedic surgeon. She likes prescribing medication because it is readily available and it usually relieves the pain, but indicates that GI upset is an issue for some patients.
One approach to use with this physician includes targeting the patients she has identified as being problematic. Share a head-to-head study comparing manipulation with NSAIDs.  This study can help you illustrate statistically significant findings in every outcome measurement for the manipulation group only, and just like her patients, a percentage of patients in this study who were prescribed NSAIDs experienced side effects, which can compromise care. (Editor’s note: For a one-page summary of the study, turn to page 28.) A study like this one supports your conversation and illustrates that manipulation not only worked better than NSAIDs for these patients, but also didn’t cause the GI upset, which solves one of the doctor’s treatment problems.
In summary, a personal approach to physicians will open up the lines of communication to help you understand and overcome MDs’ objections to chiropractic care. When you understand physicians’ needs and help solve their problems, you begin to build common ground to provide optimal patient care.
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2. Maigne JY, Vautravers P. Mechanism of Action of Spinal Manipulative Therapy. Joint Bone Spine 2003;70:336–341
3. Cassidy JD, Boyle E, Cote P, DC. Risk Of Vertebrobasilar Stroke And Chiropractic Care. J Manipulative Physiol Ther 2009;32(2 Suppl):S201-8
4. Oliphant D. Safety of Spinal Manipulation in the Treatment of Lumbar Disk Herniations: A Systematic Review and Risk Assessment
J Manipulative Physiol Ther 2004 (Mar); 27 (3): 197–210
5. Muller R, Giles L. Long-term Follow-up of a Randomized Clinical Trial Assessing the Efficacy of Medication, Acupuncture, and Spinal Manipulation for Chronic Mechanical Spinal Pain Syndromes
J Manipulative Physiol Ther 2005 (Jan); 28 (1): 3–11
Christina Acampora is the author of Marketing Chiropractic to Medical Practices and founder of Aligned Methods, a company specializing in providing chiropractors with the tools and materials needed to establish informed working relationships with medical physicians. To contact Dr. Acampora or to learn more, visit www.alignedmethods.com.