This Philadelphia chiropractor believes in working with medical doctors and attorneys toward one common goal—helping patients

While speaking at a local ski club meeting 2 years ago, Robert Z. Rush, DC, spied a well-known physician who appeared to wince and grimace throughout the presentation on the benefits of chiropractic. The next day, Rush wrote a note to him: "You looked a little perturbed and confused by some of the things I discussed last night. Can we meet for lunch and talk about it, face to face?" A week later, the two were seated across a restaurant table. It was the start of a mutually rewarding relationship.

"At our first encounter, I explained the concepts of innate intelligence, the philosophy of chiropractic, clinical protocols, and the results I was achieving," Rush recalls. "I didn’t fully persuade him with regard to the how and why of chiropractic, but I did gain his respect. Importantly, I stood my ground whenever he disagreed with me. And soon afterward, he began referring patients to me."

This inspired Rush to consider ways of developing similar beneficial dealings with other physicians. "I thought if I could establish a satellite location in the office of one or more primary care physicians, people would have greatly improved care options, MDs would learn firsthand that chiropractors are competent, educated users of highly successful protocols, and I would increase my practice with compliant patients," he says.

Just this past April, Rush convinced a physician to make space for him. Now, one day each week, Rush sets up shop in that MD’s clinic. Thus far, he has seen many patients there and even acquired 25 of them and their families as regulars who now come to see him in his own clinic. "The MD understands that I’m not soliciting his patients, but only educating them about chiropractic and health care options," Rush adds.

Reach Out and Touch Someone
Recently, two more physicians in the Philadelphia region have likewise invited Rush to use their offices. However, Rush is not sure whether this type of relationship is something that can be readily replicated by other chiropractors. "It’s a form of marketing, which has to be seen as a very individualized factor," he explains. "What works for one chiropractor won’t necessarily work for another. I recall a colleague once telling me that the best marketing tool is coupons—he said it was generating four or five new patients a month. So, I tried coupons and didn’t get a single new patient. Then, another colleague told me the best tool is health screenings, and so I tried screenings. My results were poor.

"Then I engaged in some experimentation and discovered that, for me at least, among the best marketing tools is calling directly on physicians."

Rush estimates, though, that he gains the ear of only about 5% of the MDs he phones. "That’s not bad," he assures, adding that remaining undaunted in the face of frequent rejection is crucial to success. "In October, for example, I met with two physicians—partners with a huge local practice and very good reputations—whom I had been trying to get in to meet since July. Initially, they were too busy to meet and asked me to try them again in the fall. I said, ‘OK, I’m putting it down on my calendar to call you on October 15.’ On that day when I called them, they were impressed by my determination and agreed to a meeting as a result. I don’t work in their office, but they sent me a patient last week. Now I’ll follow up with a letter and monthly progress reports. I also made it clear to the patient that his wife and 10-month-old son should be under care. I expect they’ll be starting within a week or two."

The names of physicians Rush contacts are obtained in two ways. One is from his patients—he finds out who their primary care physician is and asks their permission to call for purposes of getting to know their doctor. "I call to introduce myself and tell the physician that I’d like a chance to get to know how he or she practices and explain how I practice to see whether we can work together in ways that will better serve the public while simultaneously enhancing our individual practices," he says.

The other way Rush gathers names is by scanning the phone book for cold calls since he has no patient to reference. "When I call cold or at the suggestion of the mutual patient, I have a game plan in mind," he reveals. "I am working toward achieving a specific result with that call—getting the physician to agree to a meeting. This is key: having a result in mind."

Robert Z. Rush, DC, gives his patient personalized treatment.

This is Personal
Buoyed by the gains he has made through outreach to physicians, Rush recently began attempting to do the same with personal injury attorneys. "I would love to have a 75% cash practice, and I will one day," he says. "But right now, my practice is almost entirely insurance-based. About a year ago, I went through a process of evaluating the various types of insurance and decided that among the most profitable for chiropractors in Pennsylvania is personal injury. I then looked into how I could increase the amount of personal-injury insurance cases I was seeing. The upshot was that I needed to become better acquainted with more personal injury attorneys."

His primary vehicle is a 2-hour seminar conducted in law offices titled, "A Crash Course: How to Win a Personal Injury Case by Using a Chiropractor."Attorneys learn, for instance, why it may be counterproductive to insist on having an MRI performed on the patient (according to Rush, the test often comes back showing nothing that will buttress the case and wastes money).

"I basically tell them, ‘You be the attorney, and let me be the doctor; you want to win the case, and I want to help the patient—your client—[improve],’" he says. "There is usually a right test for a right finding, and I’m in a better position to make that determination than you are.

"I also teach them, among other things, the physics involved in low impact accidents and the mechanisms an automobile accident can cause in lasting or even permanent health problems for the victim. Most importantly, I make sure they understand that there is no better method of care that can be given to people involved in the typical automobile accident than chiropractic. In fact, I point out that, if they don’t receive chiropractic care soon after the accident, they’ll probably never really be fully [recovered] and will likely suffer a lifetime of poor health that can be traced back to that accident."

A side benefit of these seminars is that Rush finds himself increasingly being called by personal injury attorneys to serve as an expert witness. "It can be a grueling job to be an expert witness," Rush confides. "For example, I was recently on the witness stand testifying for 6 hours. I felt like I had been turned into ‘cream-of-chiropractor’ by the end of the day. Nevertheless, the opposing attorneys found it impossible to trip me up because I am the expert in this situation—I know it, and I make them and the jury know it."

Still another benefit to working with attorneys is that it gives Rush an added means of deepening contacts among orthopedists, neurologists, and internists who may also be involved in treating the patient or in substantiating claims presented in court.

By Way of Singing Telegrams
Hailing from a suburb of Philadelphia, Rush became a chiropractor in 1993 after completing studies at Pennsylvania College of Chiropractic (formerly the Pennsylvania College of Straight Chiropractic). He was 41 at the time, "with a wife, two kids, and a mortgage," he notes.

Before entering chiropractic, Rush owned a singing telegram company. He started it in the late 1970s, following his graduation from La Salle College (now La Salle University) with a degree in English. "I was in my early 20s and had just come back from California, where I was performing as a musician," he says. "I halfheartedly decided to try law school. One night, I was watching a TV talk show [about] a guy from San Francisco who had started a singing telegram company. I don’t know why it appealed to me, but it did, and I thought, wow, now that’s something I’d really like to do."

Rush proceeded to get in touch with the owner of the singing telegram company. Three months later, Rush opened an East coast franchise. With the help of talented voices he recruited, he began delivering musical missives not only in Philadelphia, but also in New York City and Washington, DC. But a short time later, Rush parted from the company to start his own singing telegram enterprise. "I built it into a very successful venture that employed 35 people at its peak," he says.

Six months into his career as a singing telegram entrepreneur, Rush herniated his bilateral L5-S1 disc. "The injury left me in constant pain and with intermittent loss of leg strength," he says.

He refused surgery and sought care from a chiropractor instead, who was able to restore Rush to full health. Awed by what chiropractic was capable of achieving, Rush decided to give up the singing telegram business and become a chiropractor himself. "I’ve always been academically inclined and enjoyed working with my hands," he says. "I also love people. As such, getting into chiropractic as a profession made perfect sense to me."

However, upon entering practice, Rush found himself plagued by self-doubt, much of it arising from emotional exhaustion following years of intense study in chiropractic college and the struggle to keep his family intact and financially secure during that time, but also from his sense that chiropractic was less respected than medicine.

"I looked at the medical profession, and projected onto it a great deal of power and confidence, or at least that’s how I perceived the public looked at it," he explains. "Plus, I was hearing a lot of negative comments from my patients—ostensibly made by medical doctors about the profession—such as, ‘If I tell my doctor I’m coming here he’ll stop seeing me,’ or ‘My doctor said too much manipulation isn’t good for me.’

"It caused my faith in myself to drop to an all-time low. But then, the most amazing thing happened. As I developed my skills as a chiropractor and with the guidance of my mentors, Dennis Perman, [DC], and Larry Markson, [DC], confidence in my abilities and in myself increased. Before long, I was no longer feeling intimidated by physicians. I reasoned that if medical doctors were able to carve out for themselves such a niche of influence in the minds of the public, then why not use their momentum to enhance and further our own profession?"

Arch-Allies
That, of course, is what led Rush to attempt working with physicians. "I realized," he says, "that there’s no use fighting an adversary that’s 100 times your size. Why not become allies instead?

"The cool thing about working with physicians is that, even though their patients are reporting back to them how chiropractic is able to deliver remarkable results, they don’t feel threatened by chiropractic. They actually are delighted that their patients are being dramatically helped by someone they like, trust, and respect. The way patients are looking at it, they have the best MD in the world because he knows when to refer them to a specialist like me. In other words, I’m enhancing the patients’ favorable feelings about their physician. That’s good for the patient, good for the physician, good for me, and good for the profession of chiropractic."

Nonetheless, working with physicians can be challenging, Rush indicates. "The hardest part is maintaining your identity as a chiropractor—to know and respect your role in the health care world," he says. "As such, I don’t try to be a medical doctor. I don’t offer medical opinions to patients for the simple reason that I am angered when I hear about physicians offering chiropractic opinions in return."

Rush says he hears concerns from some chiropractic colleagues that physicians, once they truly understand the power of chiropractic, will begin to offer their own forms of adjustment, thereby capturing business that rightly belongs to chiropractors.

"I don’t believe that will happen," Rush proffers. "Physicians come from a totally different paradigm. What we do is almost subclinical to them. They’re not taught our protocols or philosophy. They do what they do, and we do what we do. That’s just the way it should be." CP

About the Author
Rich Smith is a contributing writer for Chiropractic Products.

Robert Z. Rush, DC, can be reached via email: doc@drrobertrush.com.