I FIND STORIES OF SUCCESSFUL MD/DC INTEGRATION INSPIRING. Networking in today’s healthcare environment is mandatory to understanding treatment options for chronic back pain and doctors of chiropractic who network are increasingly rewarded with a place at the healthcare table.
Today I share my interview with Dr. Vinicius Francio, a doctor of chiropractic, and his medical colleague Dr. Art Conley, to share their experiences and lessons working together. It’s nothing short of impressive that Dr. Francio graduated only one year ago, but that this three month integrated relationship has been so successful that it has become clear that some services are best offered under one roof to truly benefit the patient: A task easily identified, but difficult to do. Hurdles are always present, so this is a story that will continue to unfold, but for now there is much for our profession to be proud of in Drs. Francio’s and Conley’s working relationship.
Dr. Acampora: What is your current working relationship with MDs?
Dr. Francio: Currently I refer collaboratively with a spine surgeon in Oklahoma City as a chiropractor in a multidisciplinary physician group, called The Physician’s Group – Oklahoma Sports Science and Orthopedics, at the Community Hospital Campus with multiple sites. (www.ossonetwork.com) (www.communityhospitalokc.com)
I currently work with an orthopedic spine surgeon and his physician assistant specializing in pain medicine, all under the same roof. I also travel to a different office weekly to shadow the neurosurgeon that will be integrating with our group, and discuss cases. During the patient consult, if I feel the case is appropriate, I’ll do an immediate exam and then provide an outline for care. However, at this time the separation of office space and limited days often keeps me from offering immediate care, but if chiropractic care is appropriate for that patient, the neurosurgeon usually refers the patient to my office location. We feel it is important to provide patient care under one roof, with multiple spinal care specialists and a closer-in location to the hospital.
Dr. A: What benefits have you seen come from your medical relationships?
Dr. F: One of the main reasons to come together as providers is to help manage complex spinal care with multiple perspectives. By working together we each know and understand what everyone is offering. We meet once or twice a month, or more if necessary, to discuss cases and our referrals are coordinated and communicated. Because I am included in the network, we all work from the same EHR and can easily share medical records. We can accomplish more together to better serve our patients.
Dr. A: Do you feel that as a result of your relationship you see more complicated cases?
Dr. F: I do tend to see more complicated cases of chronic spinal pain. I rarely see wellness patients. I may also provide the initial workup acting as a portal-of-entry physician to determine the best course of care within our network.
Dr. A: For DCs without existing medical relationships, what words of wisdom would you offer so they may start acquiring basic knowledge of all the treatments that exist?
Dr. F: Communication. You have to talk with MDs about what they offer and how you can work together. You also need to educate yourself to get a basic understanding. I like and often refer to the Official Disability Guidelines. Also, I like the American Academy of Pain Management guidelines for chronic pain, and the Annals of Internal Medicine Guidelines for musculoskeletal pain. The Oregon state evidence-based clinical guidelines for low back pain are also a useful source. (Links to these references can be found at www.alignedmethods. com/ACAnews).
This also plays into patient care from a psychological perspective, which is a key issue in spinal pain. We need to be able to reassure our patients that they are getting appropriate quality care choices.
Dr. A: For someone so new to practice you have a great foundation and drive for integrative care. Where did this foundation come from?
Dr. F: Well, in addition to my chiropractic doctorate degree, I have a master’s degree from NUHS in advanced clinical sciences, focused on integrative medicine and multidisciplinary musculoskeletal care. Also, I was chosen to attend nine-month VA training in Texas. As a result, I rotated through multiple specialties such as physiatry, neurosurgery, orthopedic surgery and so on. It made an impression on me that this is how it should work. So I knocked on doors and educated myself on MDs’ skills, and them on chiropractic care. I wish that every chiropractor had that same multidisciplinary experience.
Dr. A: What do you feel that other DCs should know about medical outreach?
Dr. F: They should have a good training and research base when communicating. They need to be and act as the specialists in their fields. They should be open to understanding the MDs’ specialized skills and to use familiar terms. It’s not that MDs don’t like us; they just don’t know enough about what we do. Most MDs don’t have enough training or experience with the manual medicine approach. Everything we do is only going to help them; some services will overlap, but it’s like that in every field. The chiropractor has to make an effort and be willing to fight for it, but you also need MDs behind you to support you to take it to the hospital level. It’s difficult to do by yourself.
Dr. A: What is your view on Physical Therapists (PTs)?
Are they competitors?
Dr. F: PTs are not competitors, but some services do overlap. I do limited modalities and I refer to PTs for those services DCs do not utilize. I have good communication with them and I find value in their treatment for intensive patient coaching for active at-home exercise programs. I think most chiropractors have better training on manipulation and as spine-care specialists, and PTs have better training in rehab, not necessarily only for spine, but for other conditions. It is all about communicating well, and understanding each provider and his or her levels of skill and commitment to the best patient care. I don’t think I will ever lose a patient referring for PT or other services; I will only gain the patients’ and the other providers’ respect, because they know I am doing what is best for their care.
Dr. A: What’s next for you and your group?
Dr. F: Right now we are facing hurdles in establishing an integrative spine and pain center, and getting all providers under one roof. There are a lot of logistics involved. In establishing our treatment approach, we are trying to identify good compliance to ethical and legal issues, but this is still new enough that there really isn’t a guideline on how to do this. We’re interested in talking with other MDs and DCs who have overcome similar barriers. We want to provide care that will, number one, help the patient, and do so at a lower cost. Since there are little to no guidelines or studies on developing such integrative programs, we’re interested in creating a model that can be shared and adapted by other facilities, and we plan to have enough research data to publish our model as a source for developments of future integrative centers in America.
Dr. Acampora: What benefits have you observed in working collaboratively with Dr. Francio?
Dr. Conley: I have gained a significant degree of respect for his expertise, training and professionalism in patient care. I’m encouraged by his enthusiasm for integrating care with an MD spine surgeon, and pain medicine in reviewing exam findings, MRI results, and patient treatment plans. I have found that many patients, who are not candidates for surgery and would normally leave our practice, now are able to benefit from chiropractic care and thus can stay in the practice, and have improved coordinated care because of our collaboration.
Dr. A: What are important points for chiropractors to share with MDs who may be new to chiropractic services?
Dr. C: The first point to share is the scope and depth of the chiropractic education and training especially in neuromuscular and spine care, which equals or exceeds the training for an MD or DO degree. A competent well-trained chiropractic physician, like Dr. Francio, is able to recognize contraindications to care, underlying medical or systemic illnesses, and make appropriate referrals, as well as any MD or DO. An open-minded medical doctor can learn quite a bit about manual medicine, spine care, wellness, and holistic care from collaboration with chiropractic trained physicians.
Dr. A: What other comments would you share with ACA News readers?
Dr. C: Just like MDs who specialize across a wide spectrum of patient care with residency training, fellowships, and CME courses; chiropractic physicians are all not created equal so to speak. Defining what aspects of collaboration that you are trying to develop, is critical in choosing the proper chiropractic physician with which to partner. I was seeking collaboration with the focus on manual medicine, spinal care expertise, and innovative care when I associated with Dr. Francio. He has extra training with a master’s degree in advanced clinical sciences, and specialized hospital training in the physical medicine and rehabilitation services, including manual medicine, and integrative care that helped our collaboration be successful. I also have acupuncture-trained chiropractors, and other chiropractic specialties in the community, to which I refer patients as well.
For more on my interview with Dr. Francio and Dr. Conley as well as links to the references cited above, please visit www.alignedmethods.com/ACAnews.
Dr. Vinicius Tieppo Francio
Chiropractic Physician & Researcher
TPG - The Physician’s Group Oklahoma Sports Science & Orthopedics at Community Hospital Campus
Dr. Art Conley
Orthopedic Spine Surgeon Fellowship Trained in Integrative Medicine
TPG - The Physician’s Group Oklahoma Sports Science & Orthopedics at Community Hospital Campus
Dr. Acampora is the author of Marketing Chiropractic to Medical Practices and the founder of Aligned Methods, a company specializing in helping DCs establish informed working relationships with medical physicians.