By Alex Tauberg, DC
Just over one year removed from graduation, I feel like I am a competent practitioner. But being simply competent isn’t enough--being the best that I can be is my goal. Thinking back, I realize there were a handful of things I could have done in school that would have benefitted me in the working world.
On occasion, when I'm working on a particularly difficult patient, I reflect on my undergraduate and graduate school careers and sometimes think, “If I could redo it, I would.…” I'm sure this is common among professionals. We all have things in our lives we wish we could change; that’s just part of living. What if we didn’t make those mistakes in the first place? We can’t change it, but I realized that others can learn from our mistakes. I am writing this blog post with that in mind. I want to share, as a new doctor, the things that I would do differently and what some of my more experienced peers would do differently. I am hoping students can learn from my mistakes. I asked around and found 10 chiropractors to weigh in on what they would do differently if they could go back to school. It is my hope that this post helps students and future chiropractors take full advantage of their opportunities.
- Take greater advantage of the sports club at school.
This one is my biggest regret. My school had, and still has, a really good sports club. The club is connected to great sports chiropractors in the area and they participate in a wide range of sporting events. While I went to some of these events, I did miss out on most of them. When I went to the events, I usually learned a lot and they were fun--but they were on weekends. To be a sports chiropractor or a chiropractor in general, you must be able to think on your feet. This is not something that I had very much practice with. You aren’t really exposed to fast-paced situations until clinic, and even there it isn’t the same as working in the real world. Looking back, the sporting events that I went to were the closest thing to the real world. You had to be ready to act quickly when it was time. If I could redo my schooling, I would make sure that I hit as many of these events as possible. There is no doubt that I would be a better clinician today if I had gone to more of those events.
- Take more continuing education classes.
“If only I had the money, I would take that class.” Are you familiar with that line? It is one that I heard fairly often in chiropractic school. I get it, you already have loads of debt and don’t know what you are going to do. The thing is, an extra few thousand in loans is not going to be the straw that breaks the camel’s back. When I asked Chris Mulhall, DC, what he would do differently if he could go back to school this was his biggest quip. He said that he should have taken out more loans so he could have taken some courses. Dr. Mulhall noted that courses often have student discounts, so it ends up being less expensive to take those courses as a student than when you are out of school and can’t find the time to take them. Eric Graf, DC, agreed that he should have taken more courses. Specifically, he said he would have “taken a seminar a year in addition to classwork. If you can take three, three-day seminars prior to entering clinic, you will be able to hone skill sets in clinic as opposed to waiting until after clinic to hone those specialty skills.” Dr. Graf is absolutely right. There are a variety of skills you can learn from continuing education classes that you only briefly touch on in school. Actually learning these skills sets you up nicely for clinic and your career beyond. There are some really great classes out there, too. Make sure you do your research though. There are also a lot of “gurus” out there trying to sell their programs or classes. You have to be wary of them. Find reputable courses that interest you and are related to what you think you want to do in practice.
- Master differential diagnoses.
When surveyed on Facebook, Stephen Shinault, DC, said he would have made sure to “get really good at differential diagnosis and know how to recognize what should and shouldn't be in your office.” This is spot on and great advice. When you are in the real world, some really scary stuff will walk into your office. It is not every day, but you must know when you should refer a patient to another type of practitioner. Dr. Shinault was put through the gauntlet and noted, “In my first two years, I've caught MS, GB, two AAA, diagnosed multiple Parkinson's, and caught three or four vascular claudications.” When you step out into the real world, you had better be ready to catch patients who might otherwise fall through the cracks.
- Get EMT certified.
This may not apply to everyone, but it would have been beneficial for me. I'm currently going through the process of earning my CCSP. One of the biggest parts of being an on-field sports chiropractor is emergency care. You need to know what to do in an emergency without hesitation. Emergency procedures are taught in chiropractic school, but the certification helps in the real world. Coming out of school and looking for on-field opportunities was extremely difficult. People think, “What does a chiropractor know about emergency care?” Well, if you have EMT or EMR after your name it is a much easier sell. This can help you whether you become an associate or open your own practice. I know some chiropractic colleges offer an EMT class. While this was not true at my school, we were lucky enough to have an EMT program sharing the same building that the chiropractic program used. I should have taken advantage of this, but did not. If you are lucky enough to have the opportunity to take an EMT course in school, do it. I know it feels like you don’t have enough time, but you can find the time. I know I could have.
- Shadow more doctors and find a mentor.
When asked what he would do differently, Thomas Dube, DC, says he would have “shadowed more docs and tried to find just one or two that could be a mentor.” This advice is solid. I’m unsure how many doctors Dr. Dube shadowed, but I know that I shadowed a grand total of three doctors during my time at school. I was lucky enough that two of the three doctors practiced very similarly to how I wanted to practice; however, I should have gotten more exposure. You really should get out there and shadow all kinds of chiropractors. Shadowing is a useful tool and lets you learn new things that you might like to do in practice. At the same time, it will reveal to you things you thought were good ideas but just don’t work in practice. I know I saw both sides of that dichotomy during my short time shadowing.
- Start a blog.
If you haven’t already done so, start a blog or a vlog now. This applies to graduates and students. If you plan on owning your own practice at some point in the future, you need to start creating content as soon as possible. When you start a website, it takes time for Google and other search engines to deem your website credible enough to put in their search results. If you start a blog now, it can help you in a few ways. It will give your website time to gain credibility in the eyes of Google, and you can start to gain a following if you have good content. From my point of view, if you want to own a successful chiropractic practice in the future then you need to have a good online presence. Starting a blog now will put you ahead of the game. Instead of starting from zero when you open shop, you will already have a head start. Try to decide on a website name that could be affiliated with your future practice and start creating content.
- Learn how to market yourself.
I am sorry to break it to you if you didn’t already know, but if you want to make it in the chiropractic profession chances are you are going to have to do self-promotion. This is something I was blatantly awful at coming out of school. It is something I am still working on almost every day. You need to learn how to be comfortable not only talking with strangers, but promoting yourself to them. According to Michael Kroft, DC (and I agree with him), a great way to learn how to market yourself is to get involved with clubs such as motion palpation, SACA, and the sports clubs and participate in events. Events not only make you think on your feet, they make you get involved in your community. This is something you are likely going to have to do in practice. Another great way to learn how to market yourself is to join your local Toastmasters or a similar organization. Toastmasters and the like are clubs that meet usually on a weekly basis, providing members the opportunity to practice their public speaking skills. You can learn a lot at one of these clubs and become more comfortable talking with strangers. These clubs are also a good place to network.
- Pay more attention to the details.
Quick, what is the origin for iliopsoas? Did you know it or did you have to look it up? I can vividly remember thinking during my first trimester that no one needs to know that, and you probably thought that too. I figured I’d just learn it for the test and then forget it. That was a mistake, and I'm guessing it’s a pretty common one. Believe it or not, little things like origin and insertion are actually pretty useful. As Tyler Reidhead, DC, says “Pay attention to the details. Details matter. Details about normal ranges of motion, innervation, positioning for orthopedic tests, etc. Details matter a lot.” He is absolutely right. If I would have focused more on the details the first time around, I would have saved myself so much time. There have been many times since that initial anatomy class where I have had to look up those small little details that I “already learned.” Sure, to some extent this is part of the learning process, but if I would have paid more attention and really committed the details to memory the first time around, I probably could have learned it the first time. Oh well, at least I know now that the origin of Iliopsoas is T12-L4 transverse processes, vertebral bodies, and the iliac fossa. Maybe part of the issue was rushing through school…
- Slow down the course load.
This one I am still stubborn on; I am glad I finished school as quickly as possible. By graduation, I was pretty exhausted. That said, I certainly could have learned more if I had slowed my course load down. The course load is exhausting and there is just a ton of information coming at you. I think Mehul Parekh, DC, summed it up pretty well when he was asked what he would do differently: “I don’t know if all schools offer the option to slow down the course load from the start. Life did, and I wish I had. Not because the material was overly difficult per se, but there was just so much of it. No time for absorption of material, which is critical during the basic science portion of the curriculum. Use the extra time to not only learn the material better but to pursue any of the aforementioned suggestions (technique seminars, working to make the student loan whammy a little less oppressive, finding a mentor). In my case, it would have meant more time to learn the nuts and bolts of neurology more than the therapies.”
- Learn how to interpret research.
You are going to be a doctor, so you need to learn how to interpret research. Richard Mcilmoyle, DC, said that he would have learned “the critical appraisal tools necessary to appropriately analyze research.” This is touched on in school, but more importance should be placed on it. Learning the levels of research is a great start, but you also should know how to tell when a systematic review isn’t that good, or when an RCT manipulated the outcome. There are a lot of papers that are passed off as being high-quality evidence, especially in our field of study, when they truly are not. You can’t just take all research conclusions at face value. You must be able to tell if their methodology and overall design was solid. You need to know when the conclusion is overreaching. These are important concepts that are touched on, but really you will need to do some extra studying on this topic. Mark Cashley, DC, recommends that you, “Go and get a good independent grounding in stats so that you can interpret the evidence for care competently.” I agree; statistics are a large part of interpreting research. Understanding how statistics work, and how they can be manipulated is vital. In my view, you should strive to keep yourself up to date with the research so that you can provide the best possible care to your patients.
- Go to more motion palpation classes.
Motion Palpation Club is available at almost every school, and it certainly was at the school Adam Groch, DC, and I attended. When I asked Dr. Groch what he would have done differently in school, he said he “would have gone to more adjusting labs.” This is a great point. I know that I did not go nearly enough, and I missed out on a bunch of chances to get my hands on people. I imagine that Dr. Groch feels the same. Motion palpation at our school met during lunch almost every week. I probably only went to 10 to 20 meetings. That is a lot of missed opportunity. I know what it feels like after sitting through classes all morning only to have a test in the afternoon. You want to study during lunch or just take a breather, but seriously, the best thing you could probably do is make sure you get your hands on people.
- If you can get an internship or clerkship with the VA, do it.
When I surveyed Facebook chiropractors on what they would go back and change, Kyle Swanson, DC, said “When I was in school, I did not know there were residency opportunities through the VA. I'm kicking myself for not knowing enough at the time to ask the right questions. I feel a proper residency included in our professional training would really help bridge the gap between us and other health care specialties we need to coordinate care with.” Luckily this is one of the few things on this list that didn’t apply to me, as I took part in a VA clerkship during my 10th trimester and I learned a lot there. It was a great experience that kicked my butt on several occasions, but made me more competent in the long run. If you have the ability at your school, apply to the VA clerkship. Apply regardless of whether you think you will get the clerkship or not. There was no chiropractic student at the VA the trimester after my experience because no one applied, and that’s a shame because it was a great opportunity.
- Take care of your health.
When I asked Ryan Bakosh, DC, what he would have done differently he noted how unhealthy he felt during his time in school, sitting all day and stressed out. Dr. Bakosh wanted to point out that this applies to all graduate schools really. It is just not a particularly easy time to focus on your health, but you certainly should. Try to eat healthfully, try not to get so stressed about exams and try to exercise more. Easy to say, harder to do.
- Bonus for the undergrads out there: major in athletic training.
This one predates chiropractic school. I majored in Psychology in undergrad. I knew I wanted to go to chiropractic school, and all I had to do was take the pre-med courses and I could major in whatever I found interesting. I love psychology, it is super interesting to me, and it has been somewhat useful in practice. With that said, if I could go back to college I would have majored in athletic training or something similar. There are not very many undergraduate degrees that let you get your hands on patients, but athletic training is one of them. One of my buddies in chiropractic school, Dr. Mulhall (who is mentioned above), was smart enough to major in athletic training. It was clear to me in school that he had a heads up on the rest of our class. He had actually dealt with injuries and the rehabilitation environment in real-world situations. I know that things are changing a bit now and ATC is becoming a graduate-level degree, but if you are an undergraduate student who knows they want to be a chiropractor, do yourself a favor and major in athletic training or something similar. Try to find something where you can get your hands on patients, and if that isn’t possible then at least find a major where you learn about rehabilitation principles like exercise science. Trust me, you will be thankful later.
When I started this blog post, I thought there were a few things that I would change about my time in chiropractic school. In reality, as more and more doctors chimed in on what they would change, I realized that I wish I had done those things differently too. I think the things on this list probably apply to most doctors. In my experience, you always look back at what you could have done better, and that’s great. That is how you get better going forward. I learned a lot in chiropractic school, but I also left a lot of opportunities and knowledge on the table. It’s not easy to take advantage of all the opportunities available, but one day you will look back and consider what you could have done differently…so try and keep missed chances to a minimum.
Dr. Tauberg is a 2016 graduate of National University of Health Sciences. He practices at Tauberg Chiropractic and Rehabilitation in Pittsburgh, Pa.