After building a successful practice, Mark N. Charrette, DC, gives back to the profession with his hands-on extremity adjusting seminars

Mark N. Charrette, DC

Starting with exactly zero patients, Mark N. Charrette, DC, built his Las Vegas practice to a caseload of about 300 patients a week—and it took him little more than 60 days to do it. Even more remarkable, he accomplished that feat without benefit of paid advertising or aggressive marketing stratagies.

What attracted patients to Charrette’s practice—and kept them there—was his willingness to provide a thorough explanation of their problems and an equally comprehensive run-down of what they needed to get them better again. There were sincere personal touches as well, such as his habit of calling new patients at home after providing the initial adjustment to see how they were doing and to give them an opportunity to ask questions they might not have thought to raise during the office visit. He also routinely sent handwritten thank-you notes and birthday cards to first-time patients and to those who had referred them.

“People quickly got the message that I cared deeply about them, and they responded to me accordingly—it was as simple as that,” says Charrette. “Word-of-mouth spread like wildfire from there.”

Charrette also developed a 20-minute presentation on the damaging health effects of various types of poor posture that he delivered to members of civic groups, community clubs and other organizations in his market. “I offered simple explanations for these problems and had four charts and diagrams to visually reinforce my message,” he says.

The drawback to explosive practice growth was the long hours Charrette was obliged to work in order to keep pace—more than 70 hours per week.

“It was constantly pedal to the metal,” Charrette says. “A big part of the reason I worked so many hours was that I refused to cram people into the schedule and rush through the appointments. I made sure that each patient received ample time with me. In a way, that worked against me because it ensured patient satisfaction, which then resulted in more referrals.”

Two Roads Diverged
Charrette sold his Las Vegas practice in 1993. It was the second high-volume office he and a partner had operated. The first was in Lafayette, Calif, which he launched in 1981, almost a year after graduating summa cum laude from Palmer College of Chiropractic in Davenport, Iowa (he was class salutatorian). In 1989, Charrette moved to Las Vegas to open his practice.

Charrette demonstrates how to adjust—with a fast thrust, not a forceful thrust—the humero-ulnar joint of the elbow to Carolyn Sue Kelton, DC, Carl Simpson, DC, and (laying down) Michael F. Radice, DC.

Charrette took a hitus from practice after being diagnosed with prostate cancer in 1991. The battle against the disease dragged on for well over 3 years, but Charrette came out on top when it was over and his health has never been better. After he divested himself of the Las Vegas practice, Charrette joined Hagensick Chiropractic Offices in Waukon, Iowa, on a part-time basis. It wasn’t long before he found himself at a career crossroad. The path he chose to take led him into the arena of conducting hands-on, how-to seminars for colleagues.

“My first seminar was held in October 1994 in Oklahoma City,” he recalls. “It was an incredible experience and inspired me to do these kinds of teaching events all over the country.”

It is not an understatement to say that no other chiropractor in America spends as much time touring the nation for purposes of educating fellow doctors and chiropractic students as does Charrette. Currently, he is on the road every nonholiday weekend, traveling to cities across the United States where he presents insights concerning extremity adjusting, biomechanics, and spinal adjusting techniques to colleagues. By Charrette’s count, he has delivered more than 650 such presentations thus far.

But that is not all. During the week, he also visits chiropractic colleges to provide education on a guest instructor basis. He conducts day and evening presentations once a semester at seven chiropractic colleges.

Put it all together and, out of the 30 days that make up a typical month, Charrette is home on no more than four. It has been this way for him since mid-2000 when demand for his appearances shot off the charts. “You really have to like traveling in order to maintain the kind of speaking engagement schedule that I’ve got,” he says. “Otherwise, you’d find it grueling.”

Not to mention inconvenient: in the aftermath of the September 11 terrorist attacks on New York and Washington, intensified airline security has added to the time Charrette is forced to spend at each airport from which he departs. Charrette nevertheless endures it—and with a smile. “There’s such a tremendous need for information on extremity adjusting in the chiropractic profession,” he says. “Seeing how doctors and students respond to that information makes it all worthwhile to me.”

Extremity Value
The seminars Charrette conducts—each runs 12 hours, split over a Saturday and Sunday—are often held at the request of various state chiropractic associations and under the auspices of a chiropractic college. Doctors who attend receive continuing education credits to apply toward satisfying the re-licensure requirements of their state.

“In my seminars, I provide an explanation of the neurology behind extremity pain.” he says. “There are receptors everywhere in the joints and the body known as mechano-receptors. When joint are misaligned, some mechano-receptors begin firing more than they are supposed to. Most of the time they don’t cause pain. But there is a body of research showing that if, for example, you have a subluxation of the wrist, it doesn’t hurt at the wrist, but may cause symptomatology in the shoulder or neck.

“Usually, when chiropractors encounter a patient with extremity pain, they will try to adjust that area where the pain is manifesting, and the patient may not show improvement. So, eventually, the chiropractor refers the patient to a specialist who may or may not be able to help. The message of my seminars is that you don’t need to refer that patient out, that you can solve the problem right in your own office, but first you must understand what is really going on with the patient before you can know what to do.

“Over the years, I’ve developed protocols for adjusting the most common subluxation patterns found in the extremities. It’s not a technique, per se. By reviewing studies of published orthopedic and podiatric research, I attempted to understand where the bone misalignments occur when, for example, you extend the wrist or a foot goes through heel-strike and toe-off motion. I also examined—frame by frame—studies using high-speed photography of joint motion. And I spent 3 months using a motion x-ray system to establish subluxation patterns in the lower extremity function of 246 adults as well as in the upper extremity function of 146 others.”

From the insights gained, Charrette was able to come up with a list of indicators that can help a chiropractor correctly identify the nature of the extremity pain-producing problem. “I’ve been refining the original set of indicator patterns as new and deeper insights arise, although what I have today is not appreciably different from what I started with,” he explains. “The results seem to improve as the protocols are refined.”

Charrette says the procedure for addressing extremity pain is, in essence, “to adjust the spine first, then the feet, knees, hips, wrists, elbows, and shoulders. Most students are taught to adjust the extremity at the source of pain—to first adjust the foot when the foot hurts or the wrist when the wrist hurts, but that is not as effective.”

Pedagogy to an Art Form
The seminars are popular, too, because they include a hands-on workshop in which Charrette first demonstrates how to use the protocols then the attendees work with one another. “I now use a computerized program with a digital projector so it is easy to demonstrate, via a large screen, all of the protocols during the workshop portion of the presentation,” he says.

Charrette lectures on adjusting and stabilizing the most common extremity subluxation patterns in the feet, knees, hips, wrists, elbows, and shoulders at Palmer College of Chiropractic, Davenport, Iowa.

An average of 75 chiropractors show up for each Charrette seminar. Some months afterward, he can always count on receiving at least a handful of effusive testimonials from those attendees. “They’re amazed at how well it’s worked for them,” he says. “I hear over and over how they now have the confidence to examine and deal with these extremity problems themselves. All doctors with confidence in their ability to treat will discover that they possess the key ingredient necessary for building an enormously successful practice.”

Interestingly, the seminars are not huge money-makers for Charrette because the proceeds of the reliscensure seminars are donated to the chiropractic colleges and organizations for which Charrette instructs. “Since I first started conducting seminars, my motivation has never been to make money but simply to make a contribution to the profession of chiropractic,” he says.

To lighten Charrette’s burden, a manufacturer of orthotics has assigned one of its employees to coordinate his seminar and teaching schedule for him. Also, Charrette’s fianceé Sue Kelton, DC, who teaches extremity adjusting and biomechanics at Parker Chiropractic College in Dallas and will become a permanent team-teacher in September 2002, has been accompanying him on the instructional circuit to share some of the teaching load.

Charrette laments that chiropractic colleges have historically taught very little on extremity adjusting. However, thanks to his efforts at popularizing that aspect of care, extremity adjusting is now a greater part of the curriculum at three schools: Parker College of Chiropractic, Palmer College of Chiropractic, and Kansas City, Mo-based Cleveland College of Chiropractic.

A while ago, those colleges named Charrette to their postgraduate faculties. In each instance, it was an honor for him, although Charrette, a native of Mt Clemens, Mich, has considered himself a teacher ever since graduating summa cum laude from Illinois State University in Normal, Ill, with a degree in education. Even in his years at Palmer College, his talent for instructing was evident. “I started giving informal presentations to the other students,” he says. “Basically, I would demonstrate the various techniques I had already learned.”

Charrette’s first real venture into teaching came while operating Lafayette Chiropractic Group. Located a stone’s throw from both Life West College of Chiropractic and Palmer College of Chiropractic West, Charrette invited students from those schools to his office for 12-hour weekend seminars covering a gamut of clinical matters and techniques. He hosted those events twice a month over a span of 9 years, drawing anywhere from 15 to 30 attendees per session.

The Business of Chiropractic Is Chiropractic
Today, one of the main bits of wisdom he imparts to chiropractic students is the recommendation to put the clinical aspects of practice ahead of the business and marketing aspects.

“Know how to examine, how to do a report of findings, how to adjust, and how to put the patient on a treatment schedule—and know how to do each of these well,” he advises them. “If you do this, you’ll see substantially more growth than would be the case if you emphasized marketing and other business-oriented practice-building techniques instead.

“The time to become knowledgeable about clinical aspects is while you’re still in school, not after you’ve opened your office. The opportunities to learn all this in school are plentiful, but, sadly, too few students avail themselves of these opportunities. As a result, many new chiropractors are not anywhere near as good as they could be when they first start out. That’s why their practices struggle for an unacceptably long time. They could be successful almost right out of the box, if they’d only take more time in school to learn those things they really must know in order to be great chiropractors.”

Charrette says he has no regrets about leaving practice, since he has not ever really been far from it. In addition to adjusting his colleagues on most weekends, Charrette also spends 2 weeks per year running the practice of his brother, Dale Charrette, DC, in Visalia, Calif, while the sibling goes off on vacation.

“It’s good to take a break from teaching every once in a while and be able to catch my breath by getting back to a super-busy practice,” he says facetiously. CP

Rich Smith is a contributing writer for Chiropractic Products.